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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

 

 

 

 

Creating Excellence, Partnering in Growth

 

 

 

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

 

 

 

 

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.

 

 

 

 

Consistency in VPS Impressions

 

 

 

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/

 

 

 

 

 

Announcing New Laboratory Category:

OPT-In Insurance

 

 

It Should be Easier to Find the Right Dental Laboratory

 

 

 

 

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

  • Provide reduced fee dental practices with competitively priced cost effective products, with a relationship that only a small dental laboratory owner can provide


OPT-In Esthetics

  • Specialty in multi zone layering and internal staining with attention to the details of vital blending, contours, anatomy and texture for the most demanding 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

  • Dedicated to the daily needs of general practice and the wide variety of everyday requirements dentists face, for an equally wide variety of clinical criteria and budgets


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

  • Provides all aspects of orthodontic laboratory services from the simplest to the most complex

 

Learn More about OPT-In Laboratory Specialty & Expertise

 

BEGO Certified

 

Visit

 

http://www.optindentallab.com/dentists/services/choose-a-laboratory-specialities/

 

 

 

 

BEGO Advanced Technology 2.0

 

Wironium RPD Frames

 

 

 

 

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/

 

 

 

 

A New Category of Permanent Cement

 

All the benefits of others, None of the drawbacks

 

 

 

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

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.

 

 

 

 

 

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.

 

 

 

 

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

CA Marc Gerstel
Seabridge Dental Lab
805-985-3189

CA Steve Killian, CDT
Killian Dental Ceramics, Inc.
949-733-3111

CO Pedro Vargas, CDT
Logic Dental Solutions

303-933-9263 

FL Rick Sonntag RDT, AACD
4Points Dental Designs, Inc.
(727) 329-8981

IL Jeff Null, CDT
Rock Creek Dental Ceramics
618-632-2237

KY Marvin Janes, CDT
Janes Denture Services
270-932-3810

MD Adam Ben-Zev
Triple Crown Dental, Inc.
410-371-3885

MN Tom Dippel
Mississippi/Minnesota Dental Lab
917-747-7519

NY David Birnbaum
MobilTeK Labs, LLC
651-457-5380

NY Boris Lezaja, MDT
Boris Dental Lab, Inc.
516-864-2515

OR Mark Hidde, CDT
Rogue Valley Dental Arts, Inc.
541-779-6503

PA Jim Spangler, CDT
Select Dental Studio
717-578-6320

PA Rick Knect
RGK Dental Lab, Inc
814-445-7561

PA Michael Young, MDT,Joe Young
Young Dental Lab, Inc., CDL
215-334-8888

PA Mark Walter, II, MDT
Smile Renovation Studio
570-687-0049

PA Jim Bostelle
Paramount Prosthetics
610-565-5868

TN Dennis King
King Dental Arts Studio, Inc
423-573-9200

VA Larry & Hal Clukey
ServeDent Ceramics
757-422-8670

VA Aubrey Williams
Quality Dental Lab, Inc.

757-497-8211

UT Marva, CDT, & Michele Lotsher
Colourtec, Inc.
801-966 8260

VT Bryan Booth
Booth Dental Lab, Inc.
802-234-4087

WA Mike Dominguez, CDT/TB
Kymata Dental Studio Arts, Inc
206-683-9484

WA Tim Trosvig
Trosvig Dental
425-257-1176

 

GA Douglas Dental Lab
In Dental Office
Private

                     

                                                                              

 

 

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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