First Impressions: July 2007

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

VELscope Mucosal Examination System
LED Dental


Images courtesy of the British Columbia Oral Cancer Prevention Program.

Risk factors for oral cancer include tobacco use, frequent alcohol consumption, and compromised immune systems (among many others). However, approximately 25% of newly diagnosed cases do not fit this high-risk profile. Since the dentist and the dental team are the front line for protecting the population against oral cancer, professionals must use every reasonable means to identify these lesions as early as possible. Early-stage oral cancers are typically painless and asymptomatic; thus, all adult patients should be screened annually. Ideally, oral cancer screening must accurately classify subepithelial cellular changes at the basal membrane. The process must be simple enough to incorporate into routine preventive hygiene appointments. Recently, the FDA has approved a breakthrough technology that (combined with traditional white-light examination) is the new standard for oral mucosal screening. LED Dental’s VELscope Mucosal Examination System has been de-signed to assist dentists in detecting cancerous growths that may be missed with traditional examinations. VELscope’s strength is that it helps to identify precancerous epithelial lesions below the tissue surface at the basal membrane (which remain essentially invisible in white light until they grow to the surface). Natural fluorescence visualization helps to identify clinically invisible oral abnormalities. Fluorescence works by exciting tissue with light at a specific wavelength, causing it to emit its own light (natural fluorescence). Natural fluorescence is very dim and is not visible. In order to visualize natural fluorescence, all the reflected original light must be filtered out to allow only the natural fluorescence to reach the eye. Early discovery and intervention at the premalignant stages, before the disease has reached the surface and become invasive, is essential. Annual oral cancer screening with fluorescence visualization of the soft tissues should be as routine a dental procedure as bite-wings.
For more information, call (888) 541-4614 or visit velscope.com.


Breeze Self-Adhesive Resin Cement
Pentron Clinical Technologies


The clinical images courtesy of Michael Maroon, DMD.

The major clinical liabilities of most adhesive resin cements include (1) the number of separate steps involved in the procedure and (2) the complication that many of these steps have to be carried out concurrently, making resin cementation a cumbersome procedure ideally requiring 6 to 8 hands rather than the 2- or 4-handed setup that is typical of most dental offices. Recent advances in chemical technology have made possible the manufacture of more effective and more efficient adhesive resin cements. Pentron Clinical Technologies has recently introduced Breeze Self-Adhesive Resin Cement, a universal automix material that offers clinical convenience and excellent properties. Its primary advantage is that no etching, no priming, and no separate bonding procedures are required. The Breeze approach is a single-step cementation easily accomplished by a 4-handed team, yet practical even for the solo dentist. Breeze has excellent bond strength and is dual-cured, allowing the margins to be light-cured immediately, sealing the tooth-restorative interface and preventing contamination throughout the self-cure stage while the light-inaccessible resin polymerizes. It is provided in a convenient automix delivery system for guaranteed perfect chemistry every time. Breeze releases fluoride and is offered in a selection of 3 shades, including the all-important translucent. The technique is very simple. Dispense the automixed Breeze directly into the crown, seat the crown on the prepared abutment, check the seating of the crown at the margins, then light-cure, self-cure, or dual-cure. This self-adhesive cement is formulated to facilitate virtually all cementation procedures, including metals (precious and semiprecious), composite and cementable ceramics. No etching, no priming, no bonding; cementation is simply a breeze.
For more information, call (800) 551-0283 or visit pentron.com.


COLORISE
Zhermack


Neither the patient nor the dentist wants to keep the impression tray in the mouth any longer than is absolutely necessary. For the patient, the tray is large, uncomfortable, and causes drooling. For the dentist, it’s a waste of valuable chairside time. Therefore, given that an impression must be accurate, the faster that it is accomplished, the better for all concerned. Zhermack has recently introduced COLORISE, the thermochromic VPS impression material with Zhermack’s Chromatime technology that clearly indicates the stages of the working time and the setting time. This innovation in vinyl polysiloxane technology utilizes a color change to signal the endpoint of the impression procedure. There is no need to watch the clock or guess when the impression is done. The color of the impression material changes to clearly signal the first moment that it can be safely and accurately removed from the mouth by the dentist or auxiliary.

For the COLORISE light body, the color changes from green to yellow to indicate the end of the polymerization phase.

For the COLORISE heavy and the monophase viscosities, the color changes from light blue to white to indicate the end of the polymerization phase.

The COLORISE light body changes from green to yellow to indicate the end of the polymerization phase. For the heavy and the monophase viscosities, the color changes from light blue to white. While any metal or plastic tray can be utilized with the COLORISE family of impression materials, there is a product-specific line of clear impression trays that have been designed to facilitate the viewing of the chromatic changes of the impression material. COLORISE is very hydrophilic (due to enzymatic hydrophilia), offering a reliable and precise reproduction of both preparation and tissue details in the moist environment of the mouth.

The final detail result of an impression taken with COLORISE.

A light vanilla flavor also makes the impression procedure a more enjoyable experience for the patient. COLORISE impression material is available in 9 different viscosities. COLORISE always times your impressions perfectly.
For more information, call (877) 819-6206 or visit zhermack.com.


Heine HR Series Binocular
Heine USA


Magnification is a standard parameter of modern dentistry. Without visual enhancement, accurate diagnostics, accurate preparations, and accurate marginal polishing are very difficult for the practitioner and become more so as the dentist ages and both the light gathering and the visual acuity components of vision weaken. The magnification system must be as adaptable as possible to the entire practice day and all clinical procedures. The Heine HR (High Resolution) series Binocular Loupes are Heine USA’s most recent and advanced products. The HR Loupe glass blanks are from SCHOTT AG, a renowned glass company in Germany. Six different lenses are used to make a single pair of HR Loupes. Heine grinds the optical blanks to an accuracy within 0.0001 mm. The resulting optics are superwide, distortion-free, and offer an increased depth of field. The HR Loupes use a doublet lens to correct achromatic aberration (combining 2 lenses with different refractive dispersions corrects the color wavelength distortions), resulting in a very clear, crisp image that is free of annoying color fringes. Unique coating technologies limit light diffraction to 0.03%, and 99.7% of the light entering the HR Loupes makes it through to the practitioner’s eyes. This en-sures an exceptionally bright image. At just 1.5 oz, the HR Loupes are designed to be comfortable. The frame weight is reduced with materials such as carbon, kynetium, titanium, magnesium, and silicone. The completely adjustable S-Frame weighs in at only 2.5 oz, allowing the loupes to be worn over extended periods while reducing operator discomfort and fatigue and thereby increasing productivity. An Rx lens insert allows dentists with prescription glasses to build this into their HR Loupes. The Heine HR series Binocular Loupes are light, comfortable, and accurate.
For more information, call (800) 367-4872, or visit heine.com.


Protemp Crown Temporization Material
3M ESPE


Figure 1. Trimming Protemp Crown Temporization Material to correct height.

Figure 3. Finishing with a carbide bur.

Figure 2. Refined marginal adaptation made with a composite instrument.

Figure 4. Final buccal view of Protemp Crown seated and cemented with 3M ESPE RelyX Temp NE Temporary Cement.

Clinical case images by Dr. Scott Arne, Deerfield, Ill.

It is frustrating to spend a lot of expensive chairtime on a provisional crown knowing that it will only be in place, in most cases, for 1 to 2 weeks. It is even more frustrating to the practitioner if the provisional crown fails or breaks, and additional chairtime is required to remake, replace, repair, and/or to recement it. Historically, the temporary technique involved the empirical mixing of a powder-and-liquid acrylic material into an ill-fitting, bad-tasting, stain-attracting provisional. More recently, automixed composites combining 2 fluid pastes have been used to fabricate better fitting and far more comfortable temporary crowns. The latest concept in provisionalization is the preformed malleable crown, the Pro-temp Crown Temporization Material introduced by 3M ESPE. For the clinical practitioner, this innovation is a revolutionary time saving approach. No pre-prep impression or matrix is required. No gun or mixing tips are needed. There is no mixing of components. The Protemp Crown is supplied in one universal shade and a variety of preformed sizes. Fabrication is easy: select the appropriate size, adapt the crown right on the tooth (trim following the gingival contour), light-cure, polish, and cement with a standard temporary cement. Fabri-cation time is reduced by 50% for single-unit provisionals (typically 4 minutes or less). The Protemp Crown has no unpleasant odor and produces little polymerization heat; it is very easy to repair (anatomy) or add to (margins) with flowable composite. The Protemp Crown is a strong material whose preformed anatomic shape provides relatively rapid aesthetics. Simple, fast, and innovative, the Pro-temp Crown Temporization Material makes the temporization process as fast as you would like it to be.
For more information, call (800) 634-2249 or visit the Web site located at 3mespe.com/innovation.


Multilink Sprint
Ivoclar Vivadent

Wanted for cementation: a material that is as strong or stronger than conventional cements and has all the advantages of resin chemistry as well as ease of mixing and placement. Nonresin cements do not adhere to the enamel, dentin, metals, or the ceramics that are the 4 most common substrates in indirect dentistry. Resin cements do adhere to these substrates with varying efficacy but have been burdened in the past with cumbersome and complicated chairside techniques. Ivoclar Vivadent’s new Multilink Sprint is self-adhesive “conventional” resin cement for the rapid and easy cementation of indirect restorations. Indicated for metal, metal-ceramic, and high-strength all-ceramic (lithium disilicate, zirconium oxide, aluminum oxide) restorations as well as fiber-reinforced composite posts, Multilink Sprint bonds better than conventional cements. However, it is not recommended for glass ceramics or veneers due to the low flexural strength of glass ceramics. Multilink Sprint is extruded from a single-action, double-push automix syringe directly through the mixing tip and into the restoration. Dual-cure initiators provide maximum clinical flexibility, ensuring that Multilink Sprint can be used as a light-cure, self-cure, or dual-cure cement. The relatively translucent cement is advantageous in creating an aesthetic marginal color gradient. Multilink Sprint is available in translucent, yellow, and opaque shades. Multilink Sprint’s acidic adhesion promoter provides true self-adhesion on enamel, dentin, and most restorative surfaces, eliminating the need for separate etching, priming, or bonding agents. High shear bond and flexural strengths, lowered water solubility, and a very convenient diagnostic radiopacity round out the technical advantages of this cement. Multilink Sprint–cement with speed, simplicity, and confidence.
For more information, call (800) 533-6825 in the United States, (800) 263-8182 in Canada, or visit the ivoclarvivadent.com Web site.


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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