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.
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ClearShield 5% Sodium Fluoride Varnish |
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The dental profession has long accepted the efficacy of fluoride varnishes. According to ADA studies, fluoride varnishes are effective in preventing dental caries in the permanent and primary dentition of children and adolescents (American Dental Association Council on Scientific Affairs. Professionally applied topical fluoride. Evidence-based clinical recommendations. J Am Dent Assoc. 2007;137:1151-1159). Fluoride varnishes relieve hypersensitivity and deliver fluoride ions to the tooth structure. This helps strengthen dentin and enamel, making them more resistant to acid dissolution and decay. Both patients and dentists have concerns with the traditional fluoride varnishes. From the patient’s perspective, the older varnishes are quite yellow, a color that can be embarrassing on the anterior teeth. The earlier varnishes tended to clump on the teeth irregularly and created a gritty taste and feeling. From the dentist’s point of view, their limited flow consistency made these materials difficult to apply. Zenith Dental’s ClearShield 5% Sodium Fluoride Varnish applies clear, with no yellow stain and no patient dissatisfaction. It is sweetened with xylitol and sucralose, helping to further inhibit bacterial growth in the acidic oral environment. ClearShield is free of gluten, saccharin, and aspartame, covering a variety of potential allergic reactions. Its flow consistency allows it to be positioned on the teeth accurately, without clumping. Overall, ClearShield significantly improves the patient’s intraoral comfort. Sealed, single-dose packaging includes easy-to-use disposable applicators and mixing wells. The maximum fluoride formula ensures that an optimal amount of fluoride ions is available to the nearby tooth structures at all times. ClearShield’s watermelon flavor was developed by gourmet industry professionals to make it more attractive to both children and adults. Significantly, fluoride varnish has also had its own code (D1206) since January 2007.|
3M ESPE Filtek LS Low Shrink Posterior Restorative System |
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Polymerization shrinkage has been a problem for adhesive dentistry since the earliest days of light curing. The methacrylate-based resins polymerize through a radical addition reaction of their double bonds that brings molecules closer together—hence shrinkage. Polymerization shrinkage can lead to marginal microleakage and failure of the restoration. It has also been implicated in tooth deformation, enamel cracks, and stress-induced postoperative sensitivity. While polymerization shrinkage can largely be overcome by layering composite (up to 2 mm per layer), and then completely curing each layer, clinical practice is not always conducive to the precise depth measurement of restorative materials within preparations. Thus, composite researchers and manufacturers have endeavored to develop lower shrinkage composite materials that are less technique-sensitive. In 3M ESPE’s Filtek LS Low Shrink Posterior Restorative System, the microhybrid composite is based on the new silorane (not methacrylate) resin chemistry. Silorane polymerization begins with the cleavage and opening of the ring systems. The process initially gains space, counteracting the loss of volume that occurs later, when chemical bonds form, yielding a lower volumetric shrinkage for the overall polymerization process. Filtek LS’s cationic ring-opening reaction results in lower polymerization contraction during the curing process, with a polymerization shrinkage of approximately 1%. Filtek LS is indicated for posterior class I and class II restorations and is available in 4 radiopaque shades with one opacity. It is important to cure Filtek LS (with halogen and LED light sources) for the full minimum time of 20 seconds. Higher light intensities cannot compensate for shorter curing times. Plasma arc and laser curing devices do not allow adequately long curing times (possibly overheating tooth structures) and thus are contraindicated for the Filtek LS Low Shrink Posterior Restorative System.|
Speedy Gloss |
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Polishing composites is not an overwhelmingly difficult task. Given enough time, most composites can be polished to a high gloss. Time, however, is the major problem. In most cases, the process is technically complex. A series of different instruments and/or grits is required. Each instrument, of course, takes time to insert into the handpiece and then to polish the restoration. A lengthy sequence of instruments can add significantly to the chairside operative time required for the polishing process. This is an important issue when one considers that at a production rate of $350/hour (low-average for North American dentists), each chairside minute costs approximately $6. Thus, a 5-minute chairside polishing sequence costs the dentist approximately $30. Ideally, limiting the number of polishing instruments in the sequence, while at the same time achieving an excellent, high-quality polish, tends to make the practice more efficient and productive. Microdont’s Speedy Gloss instruments are designed for efficient composite finishing and polishing. Their main advantage is that they are single-step silicone polishing instruments that quickly and efficiently develop an excellent glossy finish. The snap-on Speedy Gloss silicone polishers produce a satin surface in one single step with one single silicone polisher. The dentist or auxiliary’s tactile pressure on the handpiece determines Speedy Gloss’s effect on the composite. Greater pressure removes more composite. A feather touch delivers a satin-like surface gloss. Speedy Gloss is available in 3 anatomically driven shapes: disk, point, and cup. They all snap on easily and securely to the same sterilizable metal mandrel. Typically, Speedy Gloss used with various pressure levels achieves a high-gloss polish in less than one minute.|
Crest Pro-Health Night Toothpaste |
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Together, the dental profession and the dentifrice industry have been very effective in public education regarding the benefits of regular toothpaste use. Brushing twice daily is now considered a routine and required daily task for most people. While toothbrush bristles mechanically dislodge bacteria and disturb caries development both on smooth dental surfaces and interproximally, dentifrices contain materials that make brushing more effective, preventing dental caries and gingival problems. Dentists are constantly seeking to solve dental problems and to alleviate patient concerns. A common problem is the grungy-mouth feeling that people have on waking (the result of bacteria and acids affecting both the teeth and the gingiva overnight). Some products attempt to eliminate “morning breath” after the fact. What about tackling this issue at night, immediately before bedtime? Procter & Gamble’s innovative Crest Pro-Health Night dentifrice significantly reduces plaque formation between brushings, decreasing bad breath. It provides protection against gingivitis, sensitivity, caries, plaque, calculus buildup, and extrinsic stain. Crest Pro-Health’s polyfluorite system offers a stabilized stannous fluoride that significantly reduces gingival bleeding and dental sensitivity and promotes caries protection. The advantage of stabilized stannous fluoride is that unlike earlier varieties of this material, it does not stain the teeth. Pro-Health Night’s sodium hexmetaphosphate inhibits calculus formation and resists the deposition of stains on dental surfaces while it whitens teeth by removing extrinsic stains. The Pro-Health system has been designed to provide specific day and night dentifrices that, combined with routine home care and regular dental maintenance visits, help the patient to achieve comprehensive oral healthcare. Now when a patient complains of “morning breath,” we can offer a solution. Crest Pro-Health Night toothpaste works all night to make the morning more pleasant.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 epdot@rogers.com.
