First Impressions: June 2008

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.




Troll Foil
Troll Dental

Maintaining the appropriate (and comfortable) occlusal interrelationship between the maxillary and mandibular arches is a large part of the dental practitioner’s responsibility. Developing the proper occlusal interrelationship between the maxillary and mandibular arches is an integral part of the restorative process, both indirect and direct. Current tooth replacement materials are very hard and durable, unlike the materials of yesteryear, which tended to slowly wear away when they were in superocclusion. Today’s materials are more likely to abrade and damage the opposing natural tooth structure. Thus, the dentist must develop an accurate and harmonious interocclusal relationship for every restoration. This avoids costly, embarrassing, and unnecessary occlusal adjustment visits by the patient. The dentist’s time spent in adjusting a restoration during a subsequent visit often costs the dentist more chair time than the charge for the original restoration. Troll Dental’s Troll Foil is a unique articulating material that is packaged in its own individual intraoral plastic application frame. This delivery mode eliminates the use of articulating forceps as well as the potential risk of cross-contaminating the articulating foil roll or packet during dispensing. It is only 8 µm thick, and the surface is filled with color on both sides. Thus, even a light contact readily releases the color on both arches. The markings are very distinct and specific. It clearly indicates the high spots and takes the guesswork out of occlusal adjustment, saving considerable chairside time for the practitioner. It marks well on dry, wet, or damp surfaces, and it can be clearly seen on highly polished surfaces of composite, ceramic, and gold. Troll Foil takes the stress out of the articulating process.For more information, call (800) 537-8765, or visit

Adper Scotchbond SE

Increasingly, dentists are selecting self-etch dental adhesives as the foundation of their dental restorations. Two major reasons for this are the clinical predictability (lack of technique sensitivity) and the virtually total absence of postoperative sensitivity. Dentists have the option of multiple-component or single-bottle self-etch adhesives; the choice is a personal one. Self-etch adhesives are indicated for (1) bonding between tooth surfaces and composite materials, (2) bonding between tooth surfaces and compomers, (3) the intraoral repair of porcelain and metal, and (4) the desensitization of hypersensitive areas. 3M ESPE’s Adper Scotch- bond SE is a self-etch adhesive that delivers total-etch performance with a significantly reduced occurrence of postoperative sensitivity. The unique color change indicator verifies total surface coverage and adhesive activation. Adper Scotchbond SE is radiopaque to eliminate the risk of misdiagnosing an adhesive layer as decay post-treatment. The bonded nanofiller optimizes bond strength. It is moisture-tolerant and thus can be applied to both moist and dry enamel and dentin. It has excellent shelf life and does not require refrigeration or shaking prior to use. The technique is straightforward. The primer applies pink, guiding full coverage of the bonding surface. As the bottle B adhesive is applied, the pink color disappears, clearly indicating where the adhesive has been applied. The color change is also indicative of the activation of the acid and the beginning of the etching process. After 20 seconds of agitation, air-dry for 10 seconds. Then the hydrophobic overcoat is applied and air-thinned. A 10-second light-cure readies the preparation for composite placement. For more information, call (800) 634-2249 or visit

Ceram•X Mono and Duo

Fortunately for the dental practitioner, research and development in dental materials is fast and furious. This leads to constantly improving restorative materials that are easier to place, function more effectively, look better intraorally, and are generally less technique-sensitive in terms of shading and polishing. DENTSPLY Caulk’s Ceram•X nano-ceramic restorative provides a simplified restorative solution for composite procedures. For Ceram•X, a new proprietary particle technology has been developed that contains smaller nanoceramic materials (2 to 3 nm) in addition to the more typical nanofiller particles (~10 nm). The varying sizes of the nanofilling ma-terial allow the composite restorative to be more highly filled and to include a lower percentage of the weaker resin component. Ceram•X contains 76% fillers and conventional nanofillers, 12% nanoceramic fillers, and 12% conventional resins. This higher fill ratio provides increased fracture toughness and less volume loss during localized wear. The innovative shade concept was developed referencing the simple and efficient VITA reference shade system. Two separate concepts are accommodated within the restorative system: intermediate translucency and enamel translucency. The Ceram•X Mono intermediate trans-lucency products cover the entire VITA range with 7 shades determined by the overall shade of the central part of the tooth. The Ceram•X Duo offers 5 dentin and 3 enamel shades for advanced aesthetics closely matching the cervical and incisal regions respectively. The Ceram•X system offers a simplified natural coloration with fewer shades that are easily layered. Generally, the Ceram•X Mono 7 shades are more suitable for posterior teeth, while the Ceram•X Duo composites are indicated for the more aesthetically sensitive anterior teeth. An original material Ceram•X shade guide is also available. For more information, call 800-LD CAULK (532-2855) or visit

Before-and-after clinical photos courtesy of Dr. Didier Dietschi.

Ultreo, The Ultrasound Toothbrush

Slowly but surely the general public is realizing the value of power tooth brushing. While manual brushing with a dentifrice is well-accepted as a very important component for developing and maintaining oral health, it is scientifically proven that power tooth brushing with the same dentifrice makes a significant, positive difference. Patients are faced with a dilemma: the choice between very inexpensive, limited-power brushing products and more sophisticated and well-researched high-end power brushes. The former typically match their lower cost with lower quality. The latter brush better, brush more effectively, and last far longer than their less sophisticated counterparts. The Ultreo is the first power toothbrush that combines ultrasound wavelength technology with sonic bristle action. The bristles develop microbubbles at the hard- and soft-tissue surfaces that are, in turn, activated by the ultrasonic energy channeled through the ultrasound waveguide, resulting in a gentle brushing experience for the patient while providing a long-lasting “clean” feeling. It should be used with a tiny amount of dentifrice and applied to the dentition with a gentle touch. The bristles should be kept in contact with the teeth and the gingival margins during the entire brushing process. This power brush removes plaque quickly and effectively, even in hard-to-reach areas, and leaves teeth whiter by removing surface stains. Thirty-second signals help the user to monitor the pro-gress of the cleaning, and the shut-off timer automatically ceases operation after the recommended 2 minutes of utilization. The Ultreo base has a built-in battery charge level meter and a brush head replacement indicator.For more information, call (877) 4-ULTREO (485-8736) or visit

Walser Matrices

The dental profession’s matrix systems were designed during the days of amalgam, and they were extremely useful for that material. The packing of amalgam created good interproximal contacts, while the tightness of the matrix against the tooth gingivally maintained the marginal integrity of the restorative material. Unfortunately, conventional amalgam matrices are not quite as suitable for composite restorations. Vident’s Walser Matrices are stainless steel matrix bands that are positioned on the teeth with matrix forceps and are held comfortably and snugly in place by the spring action of the mechanism’s wires. Unlike conventional matrices, the Walser bands accommodate MODs, kissing class IIs, anterior restorations, and even large molars. In fact, 2 adjoining teeth can be banded and restored simultaneously. Walser Matrices are easily placed and removed; either process takes just seconds. They can fit over some rubber dam clamps, and barring other impediments, patients can actually close their mouths to test their bite with the matrix still in place. Twenty-five different sizes are available, making the system applicable for virtually every maxillary and mandibular need. The thin band material ensures tight contacts. The band’s low profile permits placing the curing light in close proximity to the composite restorative. The spring tension inherent to the Walser Matrix apparatus adapts the material gingivally, creating a good marginal seal while allowing the band to flare somewhat occlusally in order to accommodate the emergence profile towards the contact point. Since the Walser Matrix does not require tightening around the tooth that is being restored, it is far easier to establish appropriate proximal contact points with the ad-jacent teeth.For more information, call (800) 828-3839 or visit

X-Pur Revitalizing Paste
Oral Science

The good thing is that most of our patients are brushing their teeth relatively regularly and with some proficiency and effectiveness. The bad thing is that we don’t necessarily know with which toothpaste formulation they are brushing their teeth. Many dentifrices are on the market. Unfortunately, many of them provide little more than physical consistency and flavor. Oral Science’s X-Pur Revitalizing Paste contains NovaMin, which is a well-researched material that is essentially calcium sodium phosphosilicate. Thus, it is composed of elements that all occur naturally within the body (and the tooth): calcium, sodium, phosphorus, and silica. NovaMin technology has been developed from the science that has been used for surgical bone regeneration (used successfully in more than a million surgical procedures). As the Nova-Min contacts water or saliva during brushing, it releases fully active calcium and phosphorus ions. These ions are identical to those that are present in normal saliva, but the release provides much higher concentrations. After the brushing process, microscopic NovaMin particles adhere to the teeth and continue to release ions, sometimes for hours afterward. These ions ensure that the natural self-repair process of tooth surfaces in the charged saliva is accelerated. X-Pur provides relatively rapid as well as ongoing relief from dental sensitivity. It repairs painful exposed dentin and lays down a new protective layer. NovaMin creates a biomimetic hydroxyapatite that can be beneficial to early surface lesions by producing a high ion concentration at the level of the enamel. X-Pur has been shown to be a powerful plaque inhibitor, protecting the soft tissues and combating gingivitis.For more information, call (888) 442-7070 or visit

Dr. Freedman is past president of the American Academy of Cosmetic Dentistry and is the Materials Editor for Dentistry Today. He is the Chairman of the Clinical Innovations Conference (London, UK) as well as the Dental Innovations Forum (Singapore). 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. 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. He 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, 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 .