First Impressions: June 2007

Dentistry Today


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

Nobel Biocare

People today generally demand more from their lives. These people are also our patients, and they demand more from their dentition. Whereas the appearance of “natural aging” was once the technologically limited norm, current dental science and art are able to offer an uncompromising, functionally aesthetic restoration of many, if not most, dental problems. As ceramics take on an ever-greater role in restorative dentistry, there is a need to integrate the various feldspathic, alumina, and zirconia formats to optimize the convergence of strength and aesthetics. From both the dentist’s and the technician’s perspectives, the manufacture of the materials must incorporate innovations that make both of these properties relatively easy to achieve and clinically predictable. Nobel Biocare, the manufacturer of Procera, has now introduced NobelRondo to round out the total solution to ceramic concerns in dentistry. Procera, a ceramic that unlike metals allows some translucence, is used for the substructures, while NobelRondo offers the ceramic color harmony system for developing extremely strong (120 MPa) and very aesthetic restorations. An innovative layering technique and ergonomic kit design simplifies fabrication at the lab. NobelRondo Press is an easy-to-use, versatile, and predictable pressable ceramic for alumina and zirconia that is suitable for onlays, inlays, overlays, and veneers. Anatomical details and function can be precisely modeled and verified with the wax-up technique. NobelRondo Gingiva Zirconia offers an aesthetic, soft-tissue-pink solution (6 shades available) for receded gingival tissue and ridges, particularly useful with implant bridges. Metal copings obstruct all light totally; Procera ceramic substructures allow some light (semitranslucency) with both alumina and zirconia. Where the opacity is still problematic, Nobel-Rondo Zirconia Intensive Liners reduce the whiteness to provide proven ceramic aesthetics.

For more information, call (800) 993-8100 or visit the Web site located at

Palfique Estelite LV
Tokuyama America

The ongoing improvements in the chemistry of flowable composite materials have led to a greatly increased spectrum of intraoral utilization for this class of resins. As the profession has expanded the use of flowable composite, in more and diverse situations the need for innovative properties has grown dramatically. Flowables are now used for small occlusals and to repair restorations, class Vs, small class IIIs, a variety of patching functions, and numerous other treatment opportunities as they arise. The recently introduced Palfique Estelite LV from Tokuyama America is a flowable composite that is supplied in 3 distinct viscosities as well as in a variety of shades. The high flow adapts readily to any surface upon which it is placed. The medium flow can be positioned in the cavity and then moved as required. The low flow is rather viscous and tends to stay where it is put. One component of Palfique Estelite LV is a unique spherical submicron filler particle that supplies the shade-friendly chameleon effect of these restorations. Developed to balance the translucency and opacity parameters that dental restorative materials require, this filler tends to refract the underlying tooth shade through the restorative material. The Palfique Estelite LV opaque can be used in very thin layers as an effective block-out for offensive underlying colors. For the best adaptation to the tooth surface, incremental drops of the high flow, successively cured after each application, will develop excellent marginal and anatomical contours. The clear flow coats the tooth surface (or a provisional restoration) without altering the shade. The Palfique Estelite LV is easy to dispense, easy to place, and easy to trim—an excellent choice for flowable resins. For more information, call (877) 378-3548 or visit

V Ring System

Getting tight interproximal contacts used to be fairly easy with amalgams. Contacts are somewhat more difficult with composite resin restorations. There have been many attempts to make the contact easier to form and more predictable in adhesive dentistry. TrioDent has now introduced 2 products that, particularly when used together, facilitate class II composite restorations and develop those elusive contacts at the first try. The Tab Matrices are sectional matrices that are easy to hold and place; grip holes and a grabbable tab handle facilitate manipulation with a gloved finger. Pin tweezers offer secure placement and removal of these matrices. The Tab Matrices have a unique anatomical form and are designed specifically for use with the V Ring. The Wave Wedge is a wave-shaped wedge that conforms to the contours of the gingival margins. Its flexible tip directs the wedge supragingivally (of particular importance when the patient is not anesthetized). The Wave Wedge stays down apically, allowing the interproximal contact point to be formed in its correct anatomical position, not too close to the marginal ridge. The wave shape of the wedge conforms the matrix tightly to the gingival margins of the preparation on both the buccal and the lingual. The ring handle, easily gripped with pin tweezers, secures the wedge. The V Ring retainer is smaller than most other retainer rings. Its nickel-titanium elasticity offers excellent tooth separation and interproximal retention, while its anatomy does not permit the V Ring to collapse into wide cavities and works well in most clinical situations. TrioDent’s Wave Wedge matrix and V Ring System truly makes the class II composite restoration easier and more predictable.

For more information, call (800) 811-3949 or visit

FormCore DC
J. Morita USA

Tooth No. 30 is in need of core build-up treatment.

Matrix band placed; bonding agent applied.

FormCore DC placed directly into restoration.

Light-cure for 40 seconds.

Material set; matrix band removed.

Final build-up preparation complete.

The core is, quite simply, the foundation of the entire crown restoration. As the replacement for the lost tooth structure, it must fulfill many clinical and technical criteria. It should flow well and adapt into the remaining tooth structure, dual-cure effectively and quickly, create an aesthetic dentinal replacement under PFM and ceramic crowns, and be easy to prep. Ideally, it should be equally useful with both vital and nonvital teeth. In the past, many materials were used for this procedure: amalgam, cast gold, acrylics, composites, and even glass ionomers and cermets. Over the past 2 decades, it has become evident that that the composite-based core is the most practical clinically and the most predictable in the long term. J. Morita’s FormCore DC is a composite-based, flowable core build-up material that is indicated for both vital and nonvital (endodontically treated) teeth. Form-Core DC is supplied in a convenient automix syringe. Auto-mixing ensures repeatable chairside precision integration of the separate components into a highly consistent mix. The angulated dispenser tip allows the core material to be applied directly into or onto the tooth in a single-step insertion. FormCore DC is a dual-cure resin material that typically achieves a complete self-cure within approximately 3 minutes (without the need for curing lights). On the other hand, if FormCore DC is light-cured for 40 seconds, complete polymerization will occur without any significant heat generation, eliminating the possibility of thermal irritation of the pulp. Following polymerization, FormCore DC is radiopaque, simplifying postoperative diagnostic procedures. FormCore DC’s A3 shade is similar to natural dentin and is therefore suitable for the replacement of dentinal tissues.

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

Oral-B Triumph Toothbrush
P&G Professional Oral Health

Power toothbrushes are far better than manual toothbrushes. Just ask anyone who has used one. Of course, the science and literature are replete with the advantages of power versus manual tooth brushing, and it is incumbent upon the dental profession to make the community at large, its patients, aware of this. Patients who use power toothbrushes brush better and thus have better oral and gingival health than those who are relegated to brushing manually. P&G Professional Oral Health’s Oral-B Triumph Toothbrush is the latest addition to the dentist-patient joint armamentarium. The Triumph is the first power toothbrush with an onboard computer that provides real-time feedback, motivating patients by offering brushing guidance that tracks brushing time and mode. The Triumph’s motivational timer shows a real-time readout of the time the patient has spent brushing and subliminally encourages the patient to continue until the ideal 2-minute time. This positive feedback keeps the patient excited and actively involved in his or her oral health. There is a choice of 4 brushing modes that provide a totally customized brushing experience to every user according to his or her own oral needs and preferences. The brushing modes include, polish, clean, massage, and soft. The brush movement modality is a clinically established oscillat-ing/rotating technology. The Triumph’s built-in tracking determines the battery status of the toothbrush and the wear of individual brush heads even when there are multiple users on a single handle. The proof is in the dramatic results of patients’ teeth and gingiva looking better on their return to the dental office. The Oral-B Triumph Toothbrush encourages patients to take their home care to the next level.

For more information, call (800) 543-2577 or visit the Web site


Electronic claims are the preferred format for obtaining insurance company payment. (Electronic claims are faster and less expensive, and they eliminate the lag time associated with manual paper claim processing and the cost of mailing individual forms.) A major obstacle to electronic claims is the software’s cost. For the dentist opening up a new practice, the management system is one of the larger expenditures, often undertaken for very simple tasks such as online claims submission. For those of you who believe there is no such thing as a free lunch…ADSTRA SYSTEMS’ ADSTRA CLAIMS PLUS offers free dental claims software using Emdeon (formerly WebMD) to process claims electronically. (ADSTRA, a dental practice management and image management provider since 1993, has an excellent track record of reliability and technical support.) ADSTRA CLAIMS PLUS contains all the essentials of ADSTRA’s entire full-featured Practice Made Perfect management software. The free software provides easy and efficient tools for patient registration, treatment charges, electronic claim submission through Emdeon, payment tracking, complete ledger cards, treatment logs, treatment planning, predeterminations, clinical notes, and prescriptions. And best of all, electronic claims submission and rapid payment. What’s the catch? There is actually no catch. ADSTRA is introducing dentists to its easy-to-use system. As additional, more advanced features are required, the company assumes that your positive experiences will encourage you to give its unique system a try. ADSTRA’S dentist-friendly business model means that full-system purchase is not necessary. Segment shop: use what you need, when you need it, as you need it. Purchase only those software segments that you need and use them for as long as you need on a monthly basis. Once you no longer need the software, simply cancel your subscription and stop the payments. Or purchase the full software. ADSTRA’S renowned online service is second to none. ADSTRA CLAIMS PLUS software system is geared to the practitioner, not the software company.

For more information, call (800) 450-0220 or visit

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