Cosmetic Tribune U.S. No. 2, 2011
28 earn AACD accreditation: largest class in history / Caries removal and esthetic direct composite restorations / New option for missing teeth
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Cosmetic TRIBUNE
The World’s Cosmetic Dentistry Newspaper · U.S. Edition
February 2011
www.dental-tribune.com
Vol. 4, No. 2
Caries removal and esthetic
direct composite restorations
By Ian Shuman, DDS, MAGD
When treating a carious lesion,
it is critical to identify and remove
only infected tooth structure,
avoiding the needless removal of
healthy tissue.
Past techniques were unreliable
for the sole removal of diseased
tissue; however, current advances
have improved both the recognition of what is considered active
caries and those methods for its
elimination.
Research conducted at Temple
University has verified that a new
instrument made from a unique
polymer resin technology is able
to remove decay, and unlike carbides and other burs, is the only
rotary cutting instrument that is
incapable of cutting healthy tissue.
The Smartburs II works because
it is harder than decay, but not as
hard as healthy dentin.
BEFORE
Mode of operation
The Smartburs II uses an extraordinary concept in blade configuration and material structure, allowing it to remove carious dentin
only, and rendering it incapable
of cutting healthy dentinal tissue.
By eliminating contact with the
dentinal tubules, pain is virtually
eliminated.
During the removal process,
patients have reported only a feeling of pressure, thereby eliminating the need for anesthesia.
This improvement in clinical
efficiency translates into savings of
both time and cost and an increase
in patient referrals.
In cases where the lesion is deep
and anesthesia is required, pulp
exposure can be greatly reduced,
providing safer, more comfortable
and effective treatment; making
Fig. 1a:
Patient
reported with
the chief complaint of having cavities
in his upper
front teeth.
AFTER
Fig. 1b: Tissue appearance after one
week.
g CT page 2C
28 earn AACD accreditation:
largest class in history
The American Academy of Cosmetic Dentistry (AACD) announced
that 28 dental professionals have
recently been awarded accreditation status — the largest group to be
awarded the coveted AACD credential to date.
There are only 331 dental professionals worldwide who have
achieved this prestigious honor,
having reached this achievement
after completing a rigorous credentialing process including a written
examination, oral examination and
the submission of clinical cases for
peer-reviewed evaluation.
These professionals practice
internationally and in the United
States. The newly accredited AACD
members are shown in the box at
right.
The accreditation process, which
was developed by the AACD and
is the world’s most recognized
advanced credentialing program,
encourages further education, inter-
action with like-minded colleagues
and the opportunity for professional
growth. Accreditation requires dedication to continuing education and
responsible patient care.
“We are honored to welcome
these professionals to the ranks of
AACD accredited members,” said
Dr. Nils Olson, chairperson for
AACD Accreditation.
“Accredited dentists and laboratory technicians are the most passionate and committed dental professionals. Those who have achieved
accreditation have improved their
skills, acquired new techniques and
can provide their patients with better care and services.
“They understand that a smile
is more than just an anatomical
part, it’s an expression of who their
patients are,” Olson added.
The 28 newly accredited dental professionals will receive their
recognition and award at a special
ceremony during the 27th Annual
AACD Scientific Session, to be held
May 18–21 in Boston.
For more information about AACD
accreditation, visit www.AACD.com/
accreditation.
About the AACD
The AACD is the world’s largest
non-profit member organization
dedicated to advancing excellence
in comprehensive oral care that
combines art and science to optimally improve dental health, esthetics and function.
Composed of more than 6,300
cosmetic dental professionals in 70
countries worldwide, the AACD fulfills its mission by offering superior
educational opportunities, promoting and supporting a respected
accreditation credential, serving as
a user-friendly and inviting forum
for the creative exchange of knowledge and ideas, and providing accurate and useful information to the
public and the profession. CT
Newly awarded
AACD accreditation
R. Steven Ballback, DDS
Angela Britt, DMD
Randall S. Burba, DMD
Stephen D. Doan, DMD
Juan M. Escobar, CDT
Henry F. Evans, DMD
Craig P. Goldin, DDS
Prashant A. Hatkar, BDS, MDS
Ross S. Headley, DDS
James C. Hodge, Jr., DDS
Gary R. Hubbard, DDS
Donald M. Jayne, DDS
Michael J. Koczarski, DDS
Ryan Langer
Gerard J. Lemongello, Jr., DMD
Dianna Lenick, DDS
Elizabeth L. Lowery, DDS
Adamo E. Notarantonio, DDS
Jason S. Olitsky, DMD
Nicholas J. Pournaras, DMD
Denise L. Quitter
James D. Salazar, DDS
Naoki Ned Shimizu, DDS
Robert E. Stafford, DDS
Shoji Suruga, CDT
Nathalie Vachon, DMD
Mark B. Whaley, DDS
Barbara Warner Wojdan, CDT
[2] =>
2C Clinical
Cosmetic Tribune | February 2011
COSMETIC TRIBUNE
The World’s Dental Newspaper · US Edition
Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Fig 2: The tissue was retracted and all ragged and
sharp enamel edges were removed.
Fig 3: A #6 Smartburs II instrument was used to begin
gross caries removal.
Editor in Chief Cosmetic Tribune
Dr. Lorin Berland
d.berland@dental-tribune.com
Managing Editor/Designer
Implant, Endo & Lab Tribunes
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Fig 4: The preparation with the bulk of carious dentin
now removed.
Fig 5: Complete removal of remaining infected tooth
material was accomplished with a #4 Smartburs II
instrument.
Account Manager
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia E. Wehkamp
j.wehkamp@dental-tribune.com
C.E. International Sales Manager
Christiane Ferret
c.ferret@dtstudyclub.com
Fig 6: The completed preparation.
f CT page 1C
patient outcome — especially in
deep preparations — more predictable.
Removing decayed dentin with
Smartburs II
Step 1: In order to use the
Smartburs II properly, an operating range of 5,000–10,000 rpm in
a standard slow speed is ideal and
increases the longevity of the bur.
In addition, a light brushstroke is
used during operation, essentially
teasing out the carious tissue.
This is a significant departure
from previous techniques using
traditional carbide and diamond
burs.
Step 2: When treating a carious
lesion, it is critical that sharp and
ragged enamel edges be removed
with an appropriate high-speed
bur before introducing the Smartburs II to avoid dulling the instrument.
The Smartburs II is then introduced into the center of the lesion.
Fig 7: The completed Class V direct resin restoration.
This helps to avoid unnecessary
initial contact with healthy enamel
and dentin that could prematurely
dull the bur.
Step 3: Starting in the center of
the lesion, the most superficial,
softest decay is removed using the
largest size Smartburs II. The next
smaller size Smartburs II is then
worked laterally, removing layer
by layer throughout the lesion,
finally cleaning the entire cavity
floor.
The removal of caries to the
cavity floor in one area only will
prematurely dull the instrument
and make caries removal in adjacent areas more difficult.
It is important to emphasize
that contact of Smartburs II with
hard enamel, healthy dentin or
restorative materials will result in
dulling and premature failure of
Smartburs II.
Step 4: The last action with the
Smartburs II is to clean the cavity
floor with more forceful strokes.
Here you will have increased
tactile sense when encountering
decay versus using standard car-
bide burs.
This enables the conservation
of healthy tissue when the selflimiting action of the Smartburs II
instrument is experienced. After
using the Smartburs II instrument,
a careful examination of the area
is required to confirm complete
decay removal.
Case report
A patient reported with the chief
complaint of having cavities in
his upper front teeth (Fig. 1a). He
reported no discomfort, but was
self-conscious about his appearance.
Upon examination, the maxillary anterior teeth were diagnosed
with both Class V and Class III
carious lesions.
A treatment plan was formed
that would include the restoration
of these teeth using a direct composite resin technique with the
possibility of root canal therapy
where required.
Following the administration of
local anesthesia, the cavity preparation for the maxillary right cen-
Dental Tribune America, LLC
116 West 23rd Street, Suite 500
New York, NY 10011
Tel.: (212) 244-7181
Fax: (212) 244-7185
Published by Dental Tribune America
© 2011 Dental Tribune America, LLC
All rights reserved.
Cosmetic Tribune strives to maintain
utmost accuracy in its news and clinical reports. If you find a factual error or
content that requires clarification, please
contact Group Editor Robin Goodman at
r.goodman@dental-tribune.com.
Cosmetic Tribune cannot assume responsibility for the validity of product claims
or for typographical errors. The publisher also does not assume responsibility
for product names or statements made
by advertisers. Opinions expressed by
authors are their own and may not reflect
those of Dental Tribune America.
Tell us what
you think!
Do you have general comments or criticism you would like to share? Is there
a particular topic you would like to see
articles about in Cosmetic Tribune?
Let us know by e-mailing feedback@
dental-tribune.com. We look forward to
hearing from you!
[3] =>
Clinical
Cosmetic Tribune | February 2011
Fig 9: The finished direct resin restorations.
Fig 8: The remaining carious lesions were accessed,
cleaned and prepared.
Fig 10: Tissue appearance after one week.
tral incisor was initiated. Retraction cord was used to expose subgingival caries.
Ragged and sharp enamel edges
were removed and the enamel
opening was expanded using a
330-carbide bur (Fig. 2).
A #6 Smartburs II instrument
(SS White) was used at 15,000 rpm
to begin gross caries removal (Fig.
3). This instrument was used until
the size of the bur head could no
longer access smaller areas for
effective caries removal (Fig. 4).
This was followed by complete
removal of the remaining infected
tooth material with a #4 Smartburs
II instrument (Fig. 5).
In order to achieve a harmonious, seamless and esthetic transi-
tion at the marginal interface, a
beveled chamfer was created using
an 868-024 flame-shaped coarse
diamond (SS White) (Fig. 6).
In class V composite cavity preparations, bevels have been shown
to enhance retention, decrease
micro-leakage and improve esthetics. To maximize the amount of
light diffraction and the final
esthetic outcome, a wavy striation
pattern was created.
Following total acid etching and
the application of a primer/bonding agent (Optibond, Kerr), composite resin was applied. A thin
layer of flowable composite resin
in shade A3.5 was placed along the
cervical margin and light cured.
It has been reported that the
application of a thin layer of flowable composite at the cervical margin enhances the marginal adaptation of the restoration.
An initial base layer of mediumflow shade A3.5 composite resin
was then placed along the pulpal
floor as a complete dentin substitute and light cured.
The restoration was completed
with a micro-hybrid enamel shade
3C
composite (shade A2) and white
tint to mimic calcification patterns
(Fig. 7). Studies have shown that
the use of micro-particle size composites demonstrates lower polymerization contraction stresses and
a decrease in marginal leakage
when compared to hybrid composites.
The remaining Class V and Class
III carious lesions were prepared
(Fig. 8) and restored (Fig. 9).
At the next appointment one
week later, the patient was seen
for continued treatment.
The gingival margins demonstrated significant improvement
owing to the corrected emergence
profiles (Fig. 10). CT
About the author
Dr. Ian Shuman maintains a fulltime general, reconstructive and
esthetic dental practice in Pasadena,
Md.
Shuman is a master in the Academy of General Dentistry, a fellow of
the Pierre Fauchard Academy and a
member of the ADA and the AAID.
Since 2005, he has been voted
one of the Top 100 Clinicians in
Continuing Dental Education in
North America by Dentistry Today
and was voted Baltimore’s Top Doc
by Baltimore Magazine in 2008 and
2009.
He is also the official dentist and
a regular guest on Baltimore’s No. 1
morning radio show, “98 Rock.”
Contact Shuman at ian@ian
shuman.com.
New option for missing teeth
industry news
For many years, people with
chronic dental problems or missing
teeth had limited options.
They could continue with the endless cycle and expense of root canals,
crowns and other restorations; live
with the chewing, speaking and
comfort problems often associated
with dentures; or pay the extremely
high costs of dental implants.
Now Drs. Andrew Spector and
Michael Migdal, practitioners in
Haworth, N.J., who have long been
at the forefront of dental implant
technology, are one of a relative
handful of dentists throughout the
country (and the only ones in the
New York metropolitan area) to offer
patients the benefits of “permanent
teeth” at about half to one-third the
cost of implants, and in a fraction of
the time.
Hybridge™ — a hybrid bridge system — is a mix between a conventional fixed bridge and a denture.
Unlike a conventional bridge made
of metal and porcelain, the system
uses a resin and titanium bridge restoration that replaces up to 12 teeth
and is supported on five or six dental
implants. It is not intended for people requiring single tooth implants,
but rather sectional or complete
mouth restoration.
The teeth look, feel and function
just like healthy, natural teeth and
last a lifetime.
As with conventional implants and
unlike dentures, they sit on implants
rather than the gum line for greater
comfort, allow people to eat and
chew as they would with their own
teeth, and stimulate the jawbone
(thereby preventing the “caved in”
look found in people with years of
denture wearing).
While a fixed bridge or removable dentures works for cosmetic
reasons, and allows the individual to
eat and speak clearly, they also pose
restrictions — fixed bridges require
the filing down of healthy teeth, can
weaken adjacent teeth and inhibit
maintenance (e.g., you can’t floss
between them).
Dr. Andrew Spector
Dr. Michael Migdal
Meanwhile, removable dentures
can slip, cause embarrassing clicking sounds and lead to bone loss
around teeth they are hooked onto.
“The efficiency and precision of
the fabrication with the Hybridge
system allows us to keep the fee
far lower than traditional implant
treatment for those patients who
need to replace an entire upper or
lower archway,” said Spector, who
has been at the forefront of dental
implants for many years and taught
implantology at NYU Dental School.
“While dental implants remain the
‘gold standard’ for patients replacing
single teeth, the cost makes them
prohibitive for many who require
full mouth or arch restoration, as
many older people do.”
Patients for the Hybridge system
tend to be older, according to the
American Association of Oral and
Maxillofacial Surgeons, and by age
74 more than one in four American
adults have lost all their permanent
teeth.
Yet, Spector said that he has also
recommended Hybridge for patients
who have lost their teeth as a result
of early periodontal disease, traumatic injuries and eating disorders,
such as bulimia, which cause tooth
decay. CT
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[toc_titles] => 28 earn AACD accreditation: largest class in history
/ Caries removal and esthetic direct composite restorations
/ New option for missing teeth
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