First Impressions: January 2008

In First Impressions, George Freedman, DDS, gives readers a brief summary of products that have been introduced to dentistry, based on his clinical experience.

Opalesence BOOST
Ultradent Products


The demand for whiter teeth has grown tremendously. With direct-to-patient and over-the-counter bleaching products, public awareness of and its demand for tooth bleaching are universal. Numerous at-home and in-office products and techniques are available, and generally their combined use yields the fastest results. In-office bleaching is a particularly contentious field; some techniques involve the use of bleaching lights while others do not. It is important to determine, a priori,  whether the bleach can potentially harm soft tissues. (Tissue protection, such as Ultradent's OpalDam, can be placed.) Ultradent's Opalescence BOOST is a 38% hydrogen peroxide power-bleach designed specifically for in-office use. Packaged in 2 separate syringes, it is mixed immediately prior to use for maximum freshness and effectiveness. One barrel contains concentrated hydrogen peroxide; the other barrel a unique chemical activator of 1.1% fluoride and 3% potassium nitrateóproducts that lower bleaching sensitivity and increase enamel microhardness. The 2 component syringes are locked into each other, and the material is mixed from one syringe into the other  (minimum 20 times). Opalescence BOOST is then applied to the isolated teeth (up to one mm thick). The bleach should be reactivated every few minutes for maximum effectiveness. Each Opalesence BOOST application lasts 10 to 20 minutes, and the process can be repeated a number of times (patient's request and dentist's prerogative). The unused material may be refrigerated and stored for up to 10 days. Upon completion of treatment, the gel is thoroughly vacuumed, and the teeth are wiped and then rinsed. Opalescence BOOST has a neutral pH of 7.5 to minimize postbleaching sensitivity. It can be used in conjunction with at-home 10% to 35% carbamide peroxide products for maximum bleaching effectiveness.
For more information, call (800) 552-5512 or visit ultradent.com.


CLEARFIL MAJESTY Esthetic
Kuraray


The keys to successful composite restorations are ease of use and the appearance of the finished restoration. Dental composite materials have been evolving steadily for more than half a century. Today, practitioners are fortunate to have a number of products that serve both the patient and the dental professional very well. Recently introduced  by Kuraray, CLEARFIL MAJESTY Esthetic is a highly refractive composite that exhibits light diffusion properties that are similar to natural tooth structure. CLEARFIL MAJESTY Posterior is a nano-superfilled light-cure radiopaque restorative composite resin. It uses a proprietary surface coating technology that can incorporate a larger quantity of nanofiller within a resin matrix; this very high (92% by weight) filler loading results in very low polymerization shrinkage, high durability, and a reliable natural appearing posterior restoration. CLEARFIL MAJESTY Flow, the flowable companion, is a superfilled radiopaque restorative material. Its 81%-by-weight filler loading offers excellent strength and consistency. The flowable is delivered through a smooth, bubble-free syringe. CLEARFIL MAJESTY Estheticís proprietary composite filler has a very highly refractive matrix. This uniquely refractive matrix develops translucency by a selective transmission of light that is similar to that of natural teeth. The composite is very easy to place. CLEARFIL MAJESTY Esthetic is nonslumping. Its consistency makes it easy to shape and sculpt. It is not sticky and can be used with the time-saving monolayer technique. This technique delivers, with a single application layer, those natural aesthetics that are typically only possible with multilayers of other composites, achieving a high polish and extended durability. CLEARFIL MAJESTY Esthetic composite represents the fusion of aesthetics, technology, and ease of use.
For more information, call (800) 879-1676 or visit the Web site kuraraydental.com.


G-Cem
GC America


A SEM cross section showing how G-Cem effectively penetrates the dentin tubials.

Deliver G-Cem directly to the crown.

Seat crown and light cure.

Easily remove excess material.

One-step, self-adhesive resin cements were introduced about 5 years ago. Since then, they have had a major impact on the dental profession as well as the everyday dental practice. They are generally easy to use with most dental restorations, both metal and ceramic. Furthermore, they are far less technique- sensitive than both their nonresin and early resin cement predecessors. To a great extent, resin cements have replaced zinc phosphate and polycarboxylate in the dental ar-mamentarium. GC Americaís recently introduced G-Cem combines 2 great technologies: the proven science of seventh-generation resin adhesives with the well-established properties of biocompatible, hydro-philic, resin-modified glass ionomer cements. The cementís chemistry is based on functional monomers and water (rather than polyalkenoate acid). G-Cem's hydrophilicity provides effective penetration into the dentinal tubules. There the cement cures and thereafter becomes hydrophobic. Thus, G-Cem forms a strong chemical bond, sealing and protecting the tooth from external stimuli while at the same time eliminating postoperative sensitivity. This occurs whether the crown or cavity preparation surface is moist or dry at the initial application of the cement, doing away with much of the technique sensitivity associated with resin cements. G-Cem also provides a higher fluoride release when compared to other self-adhesive resin cements. It is an easy-to-use, single-step cement that is specifically designed for 4- or 2-handed practices. The cement is easy to clean up, particularly during the setting phase. It provides high bond strength to both enamel and dentin surfaces and achieves this within a reliably fast setting time. G-Cemís clinically focused chemistry offers excellent color stability and resistance to external stains. One-step cements are here to stay.

For more information, call (800) 323-7063 or visit gcamerica.com.

AMARIS
VOCO


Figure 1. Selection of translucent shade.

Figure 2. Brushing of translucent shade.

Figure 3. Translucent neutral was applied to complete the incisal area in the palatal region.

Figure 4. Shade O1 was applied in a second step reproducing the dentin.

Figure 5. To create the mamelons, an AMARIS special shade, high translucent, was applied to a previously prepared area (see in Figure 4 the spaces left free of resin).

Figure 6. Final result without any shine-through effect.

Today's dental consumer expects aesthetic restorations, and the dentist who cannot deliver these results loses patients to colleagues who can. Aesthetics can be developed with a variety of products; many techniques require multiple steps, multiple decision-making levels, and a degree of shade-matching that metamerism, ambient, and operatory lights complicate in the typical practice. AMARIS from VOCO simplifies aesthetics to an intuitive 2-step process, with 8 shades that make color selection and application fast and easy (eliminating the expense of buying and stocking more than 30 shades). The restorationís appearance is actually developed right on the tooth! Five opaque shades cover the entire dentin shade range (plus an O-shade for very bright bleached teeth). The selected opaque material, essentially replacing missing dentin, is placed and cured. Step 2 consists of fine-tuning the opaque dentinal shade on site. Only 3 enamel shades are required (translucent dark darkens the base; translucent light lightens the base; and translucent neutral lets the base shine through). It all depends on how closely the base opaque dentin shade matches the tooth. The AMARIS technique allows the dentist to simplify shade selection and to match shades intraorally, right on the tooth. The scientifically developed AMARIS shade system is based on the equal distribution of the opaque shade hues, chromas and values; equal gaps between each shade can be closed with the translucent modifier shades. It is recommended that the translucent layer be 0.5 mm, but varying the thickness of the translucent layer offers more spectral latitude. Additional flowable shades can mask discolorations (high opaque) and develop visual depth (high translucent). Nanofillers and prepolymerized isofillers provide strength and a high luster finish that rounds out AMARISís highly aesthetic properties.

For information call, (888) 658-2584 or visit vocoamerica.com.

Radii Plus
SDI (North America)


The curing light is an integral part of the modern dental practice. Throughout the last 3 decades, dentists have worked with a variety of curing lights: ultraviolet, halogen, xenon plasma arc, high-power halogen, and light-emitting diode (LED). In the past 5 years, LED technology has made major strides in becoming the most popular and the most useful curing modality available. As the various LED manufacturers compete, they tend to continually offer the dental profession ever-increasing capabilities and widening treatment and diagnostic options in curing lights. SDI has introduced Radii Plus, a modular LED light-curing instrument and so much more. It offers tremendous latitude to the practitioner that was previously not available in a single in-strument. First and foremost, the Radii Plus is a curing light: high intensity (1,500 m W/cm2) with a 360˚ swivel (providing easy access to any area of the mouth), and lightweight for ergonomic efficiency and clinician comfort. The diagnostic tip sheds new light on interproximal decay and cracks, fractures, calculus, and recurrent carries, offering a visual adjunct to radiographic and tactile examination. The orthodontic tip is designed for rapid and predictable resin cement curing during the bonding of brackets; the components exchange easily and intuitively. It eliminates the problems associated with frequent recharging; efficient energy use maximizes the utility range of each cycle. The emission spectrum ranges from 420 to 520 nm, with the highest output at 465 nm (the maximum absorption wavelength of camphoroquinone, the most common light-cure initiator). The Radii Plus is a LED curing light for the present and the future.

For more information, call (800) 228-5166 or visit the Web site sdi.com.au.

Pencure
J. Morita USA


Combining a mirror and an aspheric lens, the unique head design creates a well-defined parallel light beam.

With its parallel beams of light, Pencure maintains a consistently high level of power and achieves excellent penetration for uniform polymerization. At a distance of 5 mm, the power level is still 79%.

With Pencure, molar regions that are difficult to reach (ie, distal side of tooth No. 7) are very easily irradiated.

Just think how many times a day you pick up your curing light. If you place only 10 aesthetic restorations per day—and many practitioners place far more than that—it is likely that you are using your curing light 60 to 100 times (or more) per day. The total chairside time spent daily with the curing unit represents a significant part of the clinical day; this means that an effective, dentist-friendly, ergonomic, and predictable curing light is a mainstay of the successful dental practice. J. Morita's new Pencure curing light looks very much like its name. It feels and looks like a slightly large pen and is just as comfortable, even through extended use. The Pencure has a powerful light-emitting diode (LED) beam that is paralleled to concentrate its curing power directly on the composite, where it is most needed. Parallelism provides for less light dissipation and thus less curing power loss as the distance between the composite increases somewhat. Equal power distribution means that there is plenty of effective curing power, even at the edges of the beam. It delivers a very bright LED light that is powered by high-performance lithium ion batteries. The strong, 1,000 mW/cm2 light intensity offers consistent and rapid polymerization of all composites in the optimal wavelength range of 420 to 480 nm. Its integrated time display offers 10-, 20-, and 40-second curing settings at the touch of a button. The instrument is very light and comfortable, enabling precise positioning and handling as well as comfortable extended use. The compact Pencure has a swivel head providing maximum utility in the narrow confines of the mouth.

For more information, call (888) 566-7482 or visit jmoritausa.com.


Dr. Freedman is past president of the American Academy of Cosmetic Dentistry and a founder of the Canadian Academy for Esthetic Dentistry. He is the Chairman of the Clinical Innovations Conference (London, United Kingdom) as well as the Dental Innovations Forum (Singapore). Dr. Freedman is the author or co-author of 9 textbooks, more than 220 dental articles, and numerous CDs, video and audiotapes, and is a Team Member of REALITY. He is a past director of CE programs in aesthetic dentistry at the Universities of California at San Francisco, Florida, UMKC, Minnesota, Baylor College, and Case Western Reserve, and was the founding Associate Director of the Esthetic Dentistry Education Center at the State University of New York at Buffalo. Dr Freedman is a Diplomate of the American Board of Aesthetic Dentistry and lectures internationally on dental aesthetics, dental technology, and photography. A graduate of McGill University in Montreal, Dr. Freedman maintains a private practice limited to aesthetic dentistry in Toronto, Canada, and can be reached at (905) 513-9191 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it


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