First Impressions: February 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.

Acrytemp
Zhermack


1. Detail of an alginate impression (Phase Plus LL, Zhermack). 2. Acrytemp application including tips in the impression.
3. Acrytemp impression taking. 4. Temporary extraction during the elastic phase.
5. Finishing 6. Finished temporary implant.

Fabrication of the provisional is often the curse of the indirect restorative procedure. Historically, the acrylic materials that were used were difficult to mix, manipulate, and control chairside, often requiring so many relines and adjustments that the temporary took longer to fabricate then all of the preparation and impression steps combined. These earlier provisionals used methyl-methacrylate monomers, materials that smelled bad, tasted bad, and made the fabrication process very technique-sensitive, unpleasant, and possibly (due to a significantly exothermic polymerization reaction) dangerous to the tooth stump. Zhermack, a company well-known internationally for its impression materials, has recently introduced the Acrytemp provisional crown and bridge material. Acrytemp, provided in self-mixing cartridges that guarantee an ideal mix each and every time, simplifies the provisional procedure. The material becomes elastic within 60 seconds and can be removed from the mouth, stress and pain free, to allow for bench setting. Acrytemp does not incorporate any residual methyl-methacrylate (the inconvenient monomer of the older provisionals), improving its comfort and handling characteristics significantly. Acrytemp exhibits a very low temperature change during the polymerization process. Thus, the patient feels no discomfort, even when the prepared teeth are vital. Acrytemp is biocompatible; it is well tolerated by the oral tissues and in particular the gingival areas, and it poses no threat to stump vitality. Once cemented, Acrytemp is resistant to occlusal forces, protecting both the prepared abutments and the vertical opening during the provisionalization phase. Acrytemp can be easily relined with conventional composites, easily characterized or reshaded, and easily repaired with flowable resins. Acrytemp is easy, fast, and aesthetic–the excellent provisional.
For more information, call (877) 819-6206 or visit zhermack.com.


GC Fuji IX GP Extra
GC America


Glass ionomers have had a complicated track record in North America. The problems with the earlier ionomers included poor aesthetics, inconvenient polishing regimens, and a radiolucency that made it difficult to distinguish decay from restorations. With extensive research over the past 20 years, the positive dental properties of glass ionomers have been steadily expanded. As their dental uses have developed, their utility in the dental practice has increased tremendously. Today, the recommended indications for glass ionomer re-storatives include deciduous tooth restorations—both class I and class II lesions, nonload-bearing class I and class II restorations, and intermediate bases for heavy stress situations in the sandwich laminate technique. Other indications include class V and root surface restorations as well as core buildups. GC America’s new GC Fuji IX GP Extra is the latest addition to the glass ionomer armamentarium. It is a radiopaque posterior glass ionomer that is provided in conveniently mixed capsules. Some of the major advances incorporated into GC Fuji IX GP Extra are excellent shade- matching capability, extra translucency, increased fluoride release (6 times higher than the current GC Fuji IX GP Fast), good handling, improved physical properties, and a fast setting time where finishing can be started after approximately 2.5 minutes from mixing. It also offers excellent viscosity and packability and improved polishability and wear resistance. GC Fuji IX GP Extra utilizes a newer, innovative generation of fluoroaluminosilicate glass particles to provide fast-setting, enhanced aesthetics, and an easily placed restoration that does not sacrifice strength or other physical properties. GC Fuji IX GP Extra’s major contribution to clinical dentistry is that it is a glass ionomer that is designed to be aesthetic.
For more information, call (800) 323-7063 or visit gcamerica.com.


Embrace WetBond Esthetic Opaquer Kit
Pulpdent


In aesthetic dentistry, practitioners are often trying to improve tooth coloration. Often, the best method for a severely discolored tooth (or area of ceramic fracture- exposed metal) is to simply block out the offending discoloration. This neutral-shaded base can then be covered with appropriately shaded composite resins to achieve the required aesthetics. The trick is to use opaquers. Previous opaquers have not bonded well either to discolored substrates (metal, tooth, or ceramic) or to the overlying composites. Thus, they have been the weak link in the aesthetic restoration of severe discoloration. The Embrace WetBond Esthetic Opaquer Kit solves many of these concerns. Embrace Opaquers incorporate the innovative Embrace Resin Acid-Integrating Network (RAIN) Technology. They bond chemically (and very strongly) to metal and ceramic as well as tooth surfaces. Embrace Opaquers apply easily with a brush and work well in the moist environment of the human mouth. They cure effectively with all dental lights. The Embrace WetBond Esthetic Opaquer Kit offers 5 shades that fit just about every aesthetic niche, including Bleach White, Off White, Yellow, Pink, and Brown. With these colors, stains can be cancelled out (using the color wheel principle), and an aesthetic whiteness can be developed as a foundation under restorative materials. Tooth surfaces should be slightly moist prior to application (etching dentin or hard enamel is not necessary). Metal, ceramics, and amalgams should be micro-abraded (and ceramic can be etched with Pulpdent Porcelain Etch Gel). Embrace Opaquer is painted onto the etched or abraded surfaces and light-cured. (After the opaquer is applied, a routine bonding agent is optional.) The restoration can then proceed aesthetically. The Embrace WetBond Esthetic Opaquer Kit eliminates the fear of severe discolorations.
For more information, call (800) 343-4342 or visit pulpdent.com.


Zir-Cut
AXIS Dental


Ceramics are wonderful restorative materials. They are aesthetic, they are strong, and they provide the profession with a rapidly expanding scope of clinical applications. The zirconia ceramics are even stronger and harder than traditional ceramic systems. As our restorative materials improve their physical characteristics and endurance, it becomes more difficult to cut, reshape, and specifically, to polish them. This is particularly of concern with the zirconia class of ceramics. Cutting any material that is as hard as zirconia carries certain risks; the material absorbs heat, possibly damaging the structural integrity or strength of the restoration or ultimately fracturing it. Historically, the supercoarse diamonds offered the best option for lab and clinical adjustments on ceramic and in particular, zirconia products. The introduction of Zir-Cut by AXIS Dental decreases the stress of cutting or shaping zirconia ceramic products. AXIS’s use of the exclusive Z-Grit diamond and bonding technology prevents microfractures while assisting the technician and dentist in working more effectively and efficiently with the latest advanced ceramic and zirconia restorative materials. More than a dozen friction grip and slow-speed bur shapes have been designed with specific attention to concentricity; this minimizes operational vibration for smooth cutting and finishing. Zir-Cut instruments are used with very slight or no pressure to recontour crowns, bridge frameworks, and to thin out marginal ceramics. The Supermax tools included with the kits permit the reduction of thickness on the incisal edge of the ceramic with minimal heat, reducing the risk of fracture (slow speed). Zir-Cut diamonds are designed for accuracy and ergonomic comfort. Position the Zir-Cut diamond, apply minimal pressure, and let it work for you.
For more information, call (800) 355-5063 or visit the axisdental.com Web site.


Bond Boost SE
Premier Dental


Step1. Clean and dry freshly cut tooth structure. Step 2. Brush on Bond Boost SE three times wait 20 seconds, blow dry.
Step 3. Apply your bonding agent ad directed, light-cure.

Dentin adhesion is likely the single most common procedure for clinical dentists today. Just about every procedure in the oral cavity involves bonding or adhering to enamel and dentin. Some adhesives are better and some are less useful; some techniques are practical clinically while others are too complicated and technique-sensitive to master effectively. Generally, the more steps that are involved in any technique, the more technique-sensitive the procedure will be and the more likely that the final result will be compromised by at least one missed or mismanaged step. Thus, every step that can be reasonably eliminated without compromising the final adhesive strength and marginal integrity is likely to improve the overall success of the restoration. Premier’s new Bond Boost SE (self-etching bond enhancer) not only eliminates many steps in various established adhesive techniques, but also improves the bond strengths for dual- and chemical-cure. It eliminates the acid-etch step that is believed to contribute to much of the postoperative sensitivity seen with composite dentistry. Bond Boost SE dissolves the smear layer as its hydrophilic component penetrates deeply into dentin. Then, it interacts with the adhesive agent, optimizing the hybrid zone to provide a chemically compatible bonding interface. Bond Boost SE is easy to use: apply three times to freshly dried prepared tooth surfaces, wait 20 seconds, and air-dry; follow with the selected bonding agent (as directed), and light-cure. The steps of etching, rinsing, drying, activating, and priming are all reduced or eliminated from their respective fourth-, fifth-, and sixth-generation bonding protocols. Adhesive bonding is simplified, and bond strength is improved. Bond Boost SE, a win-win enhancer for dental adhesion.
For more information, call (888) 670-6100 or visit premusa.com.


Imprint 3 Penta Putty Impression Material
3M ESPE


Impression techniques are highly specific to every individual dentist. Most practitioners are able to develop relatively accurate impressions on a daily basis using a variety of materials and a host of techniques, all accomplished under typically less than ideal conditions. Many dentists learned the putty impression system in dental school and have continued to use it in practice. The mixing of putty, however, is a technique-sensitive procedure. One of the major clinical pitfalls of manual mixing is the presence of sulfur on the mixer’s gloves or hands (even if the gloves are removed and hands are washed, residual sulfur remains) that can compromise the polymerization of the impression material. An automated, nonmanual mixing of the putty material would be ideal if only this was possible given the high viscosity of most putty materials. 3M ESPE’s new Imprint 3 Penta Putty Impression Material is a high-viscosity tray material that has the clinical benefits of automix delivery.
Designed for use with the automated Pentamix 2 mixing unit, the technique eliminates manual contact, allowing the dentist to obtain reliable mixing and reproducible setting times for highly accurate impressions. The Pentamix 2 dispensing system is convenient and fast, guaranteeing homogenous, void-free putty that is consistent and reliable each and every mix. The recognized features of hand-mixed putties, excellent flow, structural viscosity, and precision, are maintained. Additionally, Imprint 3 Penta Putty technology accelerates the wash material’s set without reducing working time; the putty material is dispensed at approximately body temperature and thus is already warm during seating, heating the wash material and thereby accelerating its setting time. Imprint 3 Penta Putty eliminates the inaccuracy of manual mixing and the dangers of sulfur contamination.
For more information, call (800) 634-2249 or visit the Web site at 3mespe.com/imprint3.


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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