First Impressions: April 2009

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

Syrijet Mark II
Mizzy (a division of Keystone Industries)

One of the 2 overriding reasons patients avoid or delay routine dental care is fear of the needle (or injection). The prospect of “no-needle anesthesia” provides a welcome alternative for existing patients while attracting many new patients to the practice. Occasionally, a well-established product deserves a first re-impression. These “oldies but goodies” that have been a part of everyday clinical practice for so long often blend into the background among the regularly used clinical tools. Syrijet Mark II by Mizzy (a division of Keystone Industries) is a needleless injector designed for reliable routine use in the dental practice. There is no needle, of course, just a pressurized infiltration of the anesthetic directly into the target tissue, a welcome change for the apprehensive patient. The patient should be warned of a little bump that they may feel or a sound they may hear; beyond that there is no discomfort. It eliminates needle apprehension and reduces patient anxiety, increasing practice efficiency. Syrijet Mark II uses any standard 1.8-cc anesthetic cartridge (dosage adjustable up to 0.2 cc per application). It is indicated for upper and lower anterior infiltration and topical anesthesia prior to posterior superior and inferior alveolar nerve blocks. Syrijet Mark II offers unbroken cartridge-to-orifice sterility; the unit is autoclavable. Interchangeable rubber caps fit on the tip easily. The injector is a precision instrument that offers many years of clinical use with routine care. Aside from a routine flushing out with water, no maintenance is required. I have personally used the Syrijet for more than 20 years with apprehensive patients. The needleless anesthetic option has certainly been a topic of interest for many patients, and has resulted in numerous referrals over the years. For more information, call (800) 333-3131 or visit the Web site at


The triple tray is a boon for the dental practitioner. Used properly, it is a massive time saver, cutting 15 chairside minutes or more from the typical crown-and-bridge procedure. Limited to single- (or at most, 2-single unit) tooth preparations, it provides the final impression of the prepared abutment, the opposing arch, and the occlusal relationship in one single procedure. Past problems included the lack of tray body rigidity and sidewalls that did not adequately contain the impression material. TrioDent, the innovative New Zealand developer of clinical solutions, has just introduced the Triotray, a new direction in sectional impression taking. A sturdy metal frame construction with rolled edges maximizes tray stability, eliminating distortion and allowing accurate impressions. The metal in the retromolar area is very thin, permitting the patient to close completely during the impression, establishing the ideal interocclusal relationship for a well-fitting and occluding crown. Bendable metal tabs (that look like a dinosaur’s spine projections) keep the impression material in the tray and the tongue and cheeks out. To customize the Triotray, simply preinsert the tray over the arch and use finger pressure to model the tabs to an ideal position. The Triotray’s 3-D anatomy makes tray adhesives totally unnecessary, eliminating their obnoxious odor as well as the time spent in application and drying. Triotrays provide impressions that present all the information necessary to the lab technician, including a rigid framework that results in both an accurate fit and an excellent occlusion. This, in turn, allows the dentist to seat and cement the crown quickly and efficiently with minimal occlusal adjustment. For more information, call (800) 811-3949 or visit the Web site at







Not all seventh-generation adhesives are created equal. Their major advantage is that this generation of bonding agents is all-inclusive, one-step, self-etch adhesives that can be used for a wide variety of clinical situations in direct restorative dentistry. Since this class of adhesives is characterized by one single component and one single application step, there is little likelihood of clinical confusion or sequential error. Thus, the technique sensitivity and clinical failures of seventh-generation adhesives are very limited. In fact, there is an excellent chance of adhesive success in just about every instance. A long-time international leader in dental bonding agents, SHOFU has recently introduced BeautiBond, an innovative dual-adhesive monomer that has been designed to maximize adhesion to both enamel and dentin, with a separate chemistry for each. The 2 monomers, phosphonic acid for enamel and carboxylic acid for dentin, deliver equal bond strength to enamel and dentin and include a new polymerization catalyst. BeautiBond’s phosphonic acid monomer is a more stable than phosphoric acid and enhances enamel bonding. The adhesive is HEMA-free, eliminating gingival blanching, and irritation. The low film thickness of approximately 5 µm ensures better adaptation of the composite resin restoration to the remaining tooth structure. Worldwide clinical trials have demonstrated the efficacy and the bond strength of BeautiBond and have shown it to be comparable to or better than most multicomponent self-etching adhesives. The stable design of the unit-dose capsule prevents it from tipping over and spilling the adhesive. The unit dose also prevents cross-contamination. BeautiBond is the single step to better adhesion for both enamel and dentin. For more information, call (800) 827-4638 or visit the Web site at

G-CEM Automix Self-Adhesive Luting Cement
GC America

While resin cements are far superior to zinc phosphate and polycarboxylate, the earlier versions of these materials required numerous steps of etching, priming, bonding, drying, ceramic activation, etc. The typical resin cementation procedure called for a 6-handed operatory, not the customary dentist-assistant scenario. The introduction of self-adhesive luting cements has done much to popularize the utilization of this category. GC America’s new G-CEM Automix self-adhesive luting cement is indicated for the permanent cementation of all-ceramic, PFM, and prefabricated restorations (crowns, bridges, inlays, onlays, and posts). The self-adhesive cement is moisture-tolerant, and is offered both in triturable capsules and automix syringes. For post cementation, elongation delivery tips are available to introduce the cement into the deepest portions of the post space. G-CEM self-adhesive luting cement eliminates the effort, technique-sensitivity, and chairside time of etching, priming, bonding, etc. Furthermore, its chemistry minimizes the risk of postoperative sensitivity, largely by eliminating the etching step. Dentinal tubules not exposed to acid etching are far less likely to be sensitive after treatment. The G-CEM capsules have approximately 70% more cement than competitors. The cement is easily cleaned after a 1- to 4-second tack cure; simply peel it from the buccal, lingual, and interproximal areas. Thus, by the time that the self-cure is completed, the margins of the restorations are generally clean and require only minor tidying. G-CEM Automix self-adhesive luting cement has excellent adhesive strength and demonstrates improved bond strength to dentin, enamel, and zirconia after repeated thermocycling. It is available in shades A2 and the popular translucent, both with excellent aesthetics and color stability. For more information, call (800) 323-7063 or visit

Kobo Chair Version 1
DK&E Technology

Typically, dentists spend far more time and money selecting their “television” chairs than their dental stools. Paradoxically, the recliner or massage chair (costing $1,000 to $5,000) will be occupied for no more than 2 to 3 hours daily, whereas the dental stool used for 8 to 10 hours (day-in, day-out) receives far less attention. DK&E Technology has introduced the Kobo Chair Version 1 to alleviate the back and shoulder strain that commonly develops from unergonomic “lean-forward” work habits. The Kobo Chair Version 1 looks like a conventional operator’s stool. Counterintuitively, however, the dentist sits facing the vertical support rather than facing away from it. The vertical panel provides firm support for a forward leaning body, decreasing or eliminating back and shoulder strain. The unlocked vertical chest cushion allows forward body movement while a locked cushion prevents movement entirely. Innovative removable arm supports provide relief from prolonged forearm extension and suspension that cause upper arm, shoulder, and neck pain. The arm supports provide stability during longer procedures and delicate operations requiring steady hands. The armrests swing freely in order to follow the operator’s natural arm movements and give maximum latitude for any position comfortable for the clinician. They can be positioned close to or far from the stool and are easily adjusted to any desired vertical position for practitioner comfort. The seat cushion has variable front to back settings for optimized dentist positioning. Both the seat and chest cushion heights are fully adjustable to accommodative a variety of body contours and heights. The 5 casters of the Kobo Chair Version 1 offer increased stability during easy movement, also making it very compact and suited to minimalist office de-signs. The Kobo Chair Version 1 dental stool can be counted on to support you. For more information, call (888) 466-5033 or visit the Web site at

Xyli-Tots Tooth Gel and Xyli-Tots Oral Wipes

Despite the best efforts of the dental profession, dental caries is still the No. 1 childhood disease, far more prevalent than any other, affecting up to 30% of children up to 6 years of age. Since this age group is likely to have minimal direct input from the dental team, it is important that their parents who do visit the dentist regularly receive the education and the tools to actively prevent childhood dental decay. CariFree has introduced 2 child-friendly products, Xyli-Tots Tooth Gel and Xyli-Tots Oral Wipes, that are designed to not only combat dental caries in young children but to also promote good oral health as a fun and desirable activity. Xyli-Tots Tooth Gel is a grape-flavored, fluoride-free gel that combines the well-established benefits of xylitol with CariFree’s innovative pH+ technology and is safe for the child to swallow. Used twice daily, it is spread evenly on the teeth. For children where the gel may be difficult to apply to the oral structures, Xyli-Tots Oral Wipes keep the teeth and the gums healthy as well as clean from the earliest of ages. The Oral Wipes are also used to clean a child’s teeth “on the go,” creating a healthy oral environment by elevating the acidic pH of the mouth to a noncaries promoting level with its pH+ technology. It is available in 2 flavors, Grape Giggles and Watermelon Wiggles. Pro-fessionals and parents can work together to begin the elimination of dental decay at the very earliest ages by reducing caries-producing bacteria in the child’s mouth and replacing fermentable sugars with the bacterially indigestible xylitol. For more information, call (866) 928-4445 or visit the Web site at

Dr. Freedman is past president of the American Academy of Cosmetic Dentistry, is the Materials & Technology Editor for Oral Health, and is the Materials Editor and author of the monthly section “First Impressions” for Dentistry Today. He is the author or co-author of 11 textbooks, more than 400 dental articles, and numerous CDs, video and audiotapes, and is a Team Member of REALITY. Dr Freedman is a co-founder of the Canadian Academy for Esthetic Dentistry and a Diplomat of the American Board of Aesthetic Dentistry. He lectures internationally on dental aesthetics, dental technology, and photography. A graduate of McGill University in Montreal, Dr. Freedman maintains a private practice limited to Esthetic Dentistry in Toronto, Canada. He can be reached at (905) 513-9191 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .