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OPT-In Clinical Updates for September, 2013
• Subtle
VPS Impression Differences Make the Difference
• New
Dental Laboratory Specialties
• A New
Category of Permanent Cement Changes Everything
• OPT-In
Laboratory Members Near You
by
Dean Mersky, DDS
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Creating Excellence, Partnering in Growth
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Who are We and Why are You Receiving This?
In October, 2012, Dr. Dean Mersky formed
A national cooperative of small dental laboratory
owners
Dedicated to the growth and viability of Private
Practice Dental Offices.
A part of our support is providing doctors with
evidence-based
information about materials and techniques key to
patient care.
Look for the Logo in Choosing your Laboratory Partner
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How We Decide Which Materials and Manufacturer to
Feature
The
products and services we feature must have benefits supported by
independent research and be offered by companies dedicated to
education in best practices patient care, or, provide services that
support patient care at the highest levels. We understand the lines
between advertisements and useful clinical information can be blurry.
We make sure that is not the case. For example, we will not
substantiate 24 hour bond strength reporting as useful.
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Consistency in VPS Impressions
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Little Known Facts about VPS Impressions
That can Increase Consistency
Profitability, and Productivity
Background
In our last
edition of Clinical Updates, we mentioned that for the best, most
predictable results with the dual-arch impression technique, we need
to match dual-arch trays and impression materials. We also noted that
Clinician’s Choice extra rigid Affinity 3rd Generation InFlex
hydroactive impression material was designed specifically for
dual-arch impression trays, such as their Quad-Tray Xtreme.
VPS chemistry
determines how each material will respond to less than ideal clinical
situations and various impressioning techniques. Many VPS impression
materials add surfactants to help minimize the hydrophobic nature of
the material. Affinity (Clinician’s Choice) utilizes a grafted
surfactant with distinct advantages for working in moist
environments, such as subgingival areas. Additionally, an evenly
distributed hydrophile assures a complete cure, producing a higher
degree of accuracy, less re-impressioning, and a more accurate fit.
Also
chemistry-related is tear strength, especially important in tight
subgingival areas. The Affinity product line utilizes a unique,
3-dimensional branched resin chemistry which produces tear strengths
more than 50% higher than Imprint Low Viscosity and Impregum Penta
Soft Light Body (both 3M Espe). Fig 1
Clinical Guidelines
The dual-arch
impression has become the standard for many clinicians. Lane, in
2003, discussed their advantages in detail stating, “Within the limitations
of this study, double-arch impressions were found to take less time,
to use less material, and to be preferred by patients. Under the
conditions of this study, the resulting restorations were no less
accurate than those made from complete-arch impressions.” (J Prosthet
Dent 2003;89:141-5.) http://www.sciencedirect.com/science/article/pii/S0022391302527347
Clinical
conditions often require the placement of subgingival margins and
utilization of medicaments to control bleeding. Certain medications
used for this purpose can negatively affect VPS materials. According
to Vaishnav et al, VPS is not affected by epinephrine, but clinicians
should avoid the use of aluminum chloride and ferric sulfate when
taking VPS impressions. http://www.scopemed.org/?jft=18&ft=18-1351279244.
Other compounds to avoid are related to the sulphur in surgical
gloves that can adversely affect complete cure of VPS. The handling
of VPS (mixing putty), retraction cords, or implant abutments with
typical latex surgical gloves should be avoided. Instead, use vinyl
or nitrile gloves
Clinical Tip
Clinical
situations often dictate the need for a resin core build-up to
support a crown or bridge abutment. Dual-cure resins of any kind that
are allowed to auto-cure need to be prepped or vigorously cleaned
with alcohol or a cleansing solution, such as Detail
Pre-impression Cleansing Gel (Clinicians Choice), to eliminate
the oxygen inhibited layer. If not removed, the inhibited layer will
adversely affect the VPS impression material.
The photo
shows a polyether interproximal margin adversely affected by
epinepherine. In contrast, VPS is not affected by ephinepherine.
The new generation of cleansing materials will correct
many problems that can go easily undetected:
- Hemostatic agents
impeding the flow and setting of PVS materials
- Residual hemostatic
agent on the tooth reducing final bond strength
- Residucal hemostatic
agent on the tooth increasing margin leakage
- Residual hemostatic
agent on the tooth causing inflammation and/or discoloration
- Residual sulphur
compounds from latex gloves impeding VPS fully-cured accuracy
Summary
Johnson reported in 2010, that dual-arch impressions were about 20% more successful with VPS than with polyether. http://www.sciencedirect.com/science/article/pii/S0022391309602080
One way to
ensure a high level of success is to make certain working times and
setting times, two of our most misunderstood measurements, are
properly managed. Affinity has an extended working time of 1:45,
matched to a 3:00 minute (100% cured) intra oral setting time. If
only a single crown is being impressed , a fast-setting formula
reduces working time to 1:10 with a 1:45 intra oral setting time.
In my practice,
I preferred to use products designed for the specific technique at
hand. Affinity InFlex (Clinician’s Choice) has a high rigidity
designed specifically to help eliminate distortion in dual-arch
impression techniques. Stiff, but less rigid, Affinity Heavy Body is
recommended for all other techniques [except monophase or
putty/wash]. Light Body HF (High Flow), will flow around the tooth
and into the sulcus, while Light Body RF (Regular Flow) is designed
for the “air syringe” technique. Both are fully miscible into
Affinity InFlex and Heavy Body, reducing the chances of irregular
layering, pulls, and missed impressions.
For more information on the Affinity product line
visit www.clinicianschoice.com
You can also view a VPS comparison chart for their uses
at:
https://www.clinicianschoice.com/marketing/affinity.product.sheet.pdf
Please submit questions or find the right laboratory for
your practice
by contacting us at:
info@optindentallab.com
855-321-OPTN (6786)
or visit our website at:
http://www.optindentallab.com/
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Announcing New Laboratory Category:
OPT-In Insurance
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It Should be Easier to Find the Right Dental
Laboratory
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OPT-In Dental
Laboratory Specialties
OPT-In Laboratories
are grouped by their specific expertise
To simplify finding
The right laboratory for your needs, with owners eager
to help
OPT-In Insurance
OPT-In Esthetics
OPT-In Implants
-
Experience in complex
implant cases, including fixed-removable, full-mouth fixed and
removable implant restorative, milled bars, and various
attachments and complex designs
OPT-In General
Practice
OPT-In Prosthetics and Full Mouth Reconstruction
-
Expertise in
removable prosthetics, including simple and precision partial
denture designs, and standard to complex over-dentures. This
group is also familiar with a variety of occlusal approaches and
articulators used in reconstruction
OPT-In Orthodontics
Learn More about OPT-In Laboratory
Specialty & Expertise
BEGO Certified
Visit
http://www.optindentallab.com/dentists/services/choose-a-laboratory-specialities/
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BEGO Advanced Technology 2.0
Wironium RPD Frames
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BEGO USA's 2.0 Technology Center
BEGO, the leader in SLM crown & bridge production, a
process it developed over 12 years ago, is also the inventor of
Wironium, a speacialized alloy for cast partial dentures and implant
frames. Wironium alloy has advantages over traditional cast materials
that make partial denture frames stronger and longer lasting.
Wironium alloy has higher MOE and elongation limits. For
clinicians and patients, this will mean fewer clasp adjustments and
less breakage. Also, when combined with vacuum casting, BEGO Wironium
alloy frames are lighter, denser, and can be polished to a smoother
surface that is easier for patients to clean, as seen in the below
photo.
Next month, we will spend time reviewing various aspects
of
Wironium alloy supporting indepedent research.
BEGO Wironium alloy cast frames are only available
from BEGO Certified Wironiaum trained dental laboratories.
Contact us for more Information about BEGO 2.0
Digitally Designed SLM Copings, All-Ceramics,
& Wironium
Visit
http://www.begousa.com/
800.342.2346
To learn about special OPT-In member pricing from BEGO
info@optindentallab.com
http://www.optindentallab.com/
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A New Category of Permanent Cement
All the benefits of others, None of the drawbacks
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It has been
quite awhile since clinical dentistry has been offered a product
that is not only new, but also defines an entirely new category. Ceramir Crown &
Bridge (Doxa) is a new category of permanent
cement, complete with evidence-based information clinicians should
be aware of.
What is
Ceramir?
Most cements
have both strengths and weaknesses. RMGI is easy to use and less
soluble than traditional cements, but more soluble and weaker than
resin based cements. Resin based cements have greater holding
power and compressive strengths than RMGI, but suffer from
shrinkage and are more technique sensitive. According to research,
Ceramir C&B, a new “bioactive,” permanent cement, combines RMGI
ease of use without the expansion and solubility, with the strength
and holding power of self-etching resins without the shrinkage.
Above, the enamel on the left side of the photo is
fully integrated with Ceramir C&B on the right side.
Ceramir
C&B relies on the bioactivity of its key components, CaO and
AlO, to form ionic bonds with both hydroxyapetite of the tooth, and
the oxides of restorative materials. That means, etching enamel or
dentin and using a bonding agent aren't needed. Moreover, its
hydrophilic nature is impervious to oral fluids, while its
alkalinity is anti bacterial and prevents sensitivity.
Clinicians
seeking more information about this new category of bioactive
cement should visit:
http://www.CeramirUS.com or www.ceramir.se
855-DOXA-USA
or
847-281-7622
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Ceramir C&B used Clinically
RMGI is known
for ease of use, resins for insolubility and holding power. Testing
shows Ceramir C&B tolerates wet environments, eliminates
cementation sensitivity, and, according to Jefferies, et al, has
retention strengths exceeding RMGI and equal to or greater than
self-etching resin, even after water storage.
Below, dentin on the right side of the photo has fully
integrated with Ceramir C&B on the left side.
Ceramir C&B Bioactivity
Attesting to
the holding strength and insolubility of its CaO-AlO matrix, Loof,
et al, showed in 2008 that hydroxyapatite crystals (10-30 nm)
formed a surface layer at 4 weeks in the presence of Ceramir C&B
materials. He went on to state that the bioactive nature of Ceramir
C&B could be responsible for generating a new protective layer
of hydroxyapatite. And, Unosson, et al, reported in 2012 that the
streptococcus mutans count suffered a “significant reduction” in
the presence of Ceramir’s alkalinity.
When considering cementation, keep in mind the unique
properties of Ceramir C&B:
- Eliminates
sensitivity
- Ease of use similar
to RMGI
- Holding power and
insolubility of resin
- Highly retentive of
zirconia (due to nano particles).
We will more fully examine the science of Ceramir
C&B next month.
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This Clinical Update is Presented by Your
OPT-In Dental Laboratory Cooperative Partner
http://www.optindentallab.com/dentists/
Experience the Difference an OPT-In Laboratory
Owner can Make
To Find the Right Dental Laboratory Partner for Your
Practice
Contact Us
info@optindentallab.com
855-321-OPTN (6786)
Next month we will discuss restorative materials &
more.
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Proud OPT-In Members
Creating Excellence, Partnering in Growth
OPT-In Dental
Laboratories...Always Aware of the
Clinical Challenges You Face
Call Today and Experience the Difference
Ask for the OPT-In Laboratory
Specialty You Need Most
All OPT-In Members own small Dental Laboratories
Dedicated to the successes of the dentists they serve,
The unique needs of each practice, and
Tailored to the individual needs of each patient.
AZ Steve Dearien
Sundance Dental Laboratory
877-429-3543
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CA Marc Gerstel
Seabridge Dental Lab
805-985-3189
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CA Steve Killian, CDT
Killian Dental Ceramics, Inc.
949-733-3111
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CO Pedro Vargas, CDT
Logic Dental Solutions
303-933-9263
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FL Rick Sonntag RDT, AACD
4Points Dental Designs, Inc.
(727) 329-8981
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IL Jeff Null, CDT
Rock Creek Dental Ceramics
618-632-2237
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KY Marvin Janes, CDT
Janes Denture Services
270-932-3810
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MD Adam Ben-Zev
Triple Crown Dental, Inc.
410-371-3885
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MN Tom Dippel
Mississippi/Minnesota Dental Lab
917-747-7519
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NY David Birnbaum
MobilTeK Labs, LLC
651-457-5380
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NY Boris Lezaja, MDT
Boris Dental Lab, Inc.
516-864-2515
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OR Mark Hidde, CDT
Rogue Valley Dental Arts, Inc.
541-779-6503
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PA Jim Spangler, CDT
Select Dental Studio
717-578-6320
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PA Rick Knect
RGK Dental Lab, Inc
814-445-7561
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PA Michael Young, MDT,Joe Young
Young Dental Lab, Inc., CDL
215-334-8888
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PA Mark Walter, II, MDT
Smile Renovation Studio
570-687-0049
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PA Jim Bostelle
Paramount Prosthetics
610-565-5868
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TN Dennis King
King Dental Arts Studio, Inc
423-573-9200
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VA Larry & Hal Clukey
ServeDent Ceramics
757-422-8670
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VA Aubrey Williams
Quality Dental Lab, Inc.
757-497-8211
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UT Marva, CDT, & Michele Lotsher
Colourtec, Inc.
801-966 8260
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VT Bryan Booth
Booth Dental Lab, Inc.
802-234-4087
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WA Mike Dominguez, CDT/TB
Kymata Dental Studio Arts, Inc
206-683-9484
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WA Tim Trosvig
Trosvig Dental
425-257-1176
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GA Douglas Dental Lab
In Dental Office
Private
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About the
Author
Dr. Dean
Mersky practiced general dentistry 26 years in Manhattan Beach, CA
before spending 7 years as
director of clinical communication for the Captek Company. Dr
Mersky has been a dental lab implant
coordinator, a national speaker, authored over a dozen published
articles, is a regular on DentalTown.com. He
launched OPT-In Management, LLC, in 2012, to help owners of small dental laboratories better
understand dentists and the many clinical and business pressures
facing today's private practice clinicians.
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