Dr Daniel H Ward is in private practice in Columbus, Ohio. He served as assistant clinical professor at Ohio State University College of Dentistry for 13 years. He is a fellow in the American and International College of Dentists, a fellow in the Academy of General Dentistry, and a fellow of the American Society for Dental Aesthetics. He is an associate member of the Academy of Esthetic Dentistry. Dr Ward is a member of Catapult Education, a leader in Dental Continuing Education.


Daniel H. Ward, DDS

Dentists want to simplify treatments in their offices and reduce costs by downsizing inventory. Universal composites are effective in many types of restorations, and their qualities only improve as they continue developing. In recent years, the trend has moved toward formulating composites in which fewer shades are necessary to satisfy the esthetic demands of patients.

One of the most challenging aspects of reducing the number of shades is developing composites that have the proper balance of translucency and opacity. Translucency allows the underlying tooth structure to influence the final shade of the composite. Popular single-shade composites are more translucent and can be effective in smaller restorations. Opacity helps to block light transmission through the restoration when there is not underlying tooth structure to avoid a gray cast. Composites with optimized opacity can be used in restorations large and small and are more universal in their applications.

GC America has introduced a composite that addresses these challenges: G-ænial™ A’CHORD. This universal composite features a good balance of simplicity, excellent color-blending capability, and physical properties for use in most situations, including Class I, II, III, IV, and V restorations. It offers a versatile universal solution for anterior and posterior restorations, and its simplified shade system achieves the esthetics of all 16 Classic Vita® shades with just 5 core shades. It achieves invisible restorations with a reduced inventory and quick polishing, which makes it not only efficient but also cost effective.

Fifteen Catapult evaluators were invited to use G-ænial A’CHORD in their practices. They were asked to compare the handling and esthetic characteristics of the new composite with the composites they were currently using. Among the handling properties surveyed were viscosity, adaptation, packability, sculptability, polishability, and overall handling. In the esthetic evaluation, shade difference before and after light curing, chameleon effect, match with shade tabs, gloss retention, and overall esthetics were evaluated. Most evaluators found their experience with the material to be very good and liked its ability to match several different shades with 1 material. They found the translucency to be just right, and the majority rated its polishability as excellent. 

Comments included, “It fits in areas where I need more chroma,” and, “It was easy to use and condensed nicely in Class I and II preps.” Several evaluators preferred that the material be warmed, as they do with other composites they use, to give their accustomed handling characteristics. Although not required, this is a procedure that I always incorporate. Because of the overwhelming positive reviews of the material, G-ænial A’CHORD received the Catapult Vote of Confidence, and most evaluators said they will add this material to their repertoire.

Case Presentation

Articles

A new universal composite works well in any size anterior and posterior situation and uses just 5 core shades.

Simplified Esthetics With Fewer Shades

Calcium-releasing bases and liners protect the integrity of the tooth and its restoration. They help to maintain pulp vitality and reduce postoperative sensitivity.1 They also provide insulation from the restorative materials placed on the surface of the tooth and the temperature and stress variations placed upon the tooth.

TheraBase is a dual-cure, calcium and fluoride-releasing, self-adhesive base and liner that will polymerize in deep restorations where light cannot reach. Using THERA technology, it chemically bonds to tooth structure and releases and recharges calcium and fluoride ions.2 This is designed to generate an alkaline pH,* which promotes pulp vitality.1 Said to be stronger and more durable than other materials,* it is also radiopaque.

BISCO Dental’s TheraBase is a new dual-cured, calcium- and fluoride-releasing self-adhesive liner and base. It is hydrophilic and reacts with the tooth by releasing and recharging calcium and fluoride ions.2 It also helps to promote a basic pH* 

. The self-etching, self-adhesive base simplifies the process by eliminating a separate etching and rinsing step, thus reducing the risk of postoperative sensitivity. Heat produced from the curing light is easily transmitted through clear bonding agents into deeper areas of the tooth, possibly raising pulpal temperatures and increasing the chance of negative pulpal effects.3 TheraBase’s self-adhesive property eliminates the need for a separate bonding agent in the deepest areas and covers deep dentin with an opaque protective material. Its physical advantages include good compressive strength and bond strength because it contains 10-methacryloyloxydecyl dihydrogen phosphate (MDP), which is known to provide reliable and optimal bonding to dentin. The base is radiopaque and easily viewable on radiographs.

Twenty members of Catapult Education participated in the review. They were asked about their use, desired characteristics, and preferred materials for liners and bases. Almost all the evaluators utilize liners or bases. A vast majority of respondents use them any time a restoration depth extends well into dentin or when there is concerned risk of postoperative sensitivity. And 95% reported using a base when the final preparation is within 1 mm of the pulp, when affected dentin remains, or when questionable dentin is left in order to avoid pulpal exposure.

Compressive strength was selected by half of the evaluators as the No. 1 desirable characteristic. Other top choices included ease of use, fluoride release, the ability to dual cure the material, and calcium release.

There was a difference of opinion regarding the preferred materials for liners and bases. Flowable composite resins were used by two-thirds of those surveyed, whereas resin-modified glass ionomer and glass ionomers were used by 35% and 25%, respectively, showing that some utilized multiple materials in their practices. Within that group is a smaller group of practitioners who use glass ionomer or resin-modified glass ionomer liners and bases for a majority of their restorations. Fluoride release, consistent (but lower) bond strengths, and reduced postoperative sensitivity are often cited as their motivations. However, because of their decreased strengths, resin-based alternatives are preferred by many. The properties of TheraBase allow most of these concerns to be met with a stronger material.

BISCO TheraBase

How did TheraBase rate according to the above preferences? The ease of use was rated excellent by a majority of evaluators. The working and setting time was rated as excellent or good by 90%. Ability to light cure, ease of dispensing, and placement were benefits highlighted by the group. Ultimately, 100% of the reviewers said that TheraBase would be incorporated into their practices. Positive comments included: “This is my new go-to material,” “Slick delivery tips,” “Stays where you put it,” and “I love it because it has every characteristic I need.”

TheraBase comes in an automix dual syringe with small disposable cannula tips that allow easy placement. The tooth should be excavated, and decay removed. The tooth structure should be irrigated with chlorhexidine and then excess moisture removed. If the preparation is within 1 mm of the pulp, TheraCal LC should be placed as a separate step 

. TheraCal LC provides significant calcium release,4** stimulates hydroxyapatite and secondary bridge formation,5,6 and promotes healing.1,5 TheraBase is expressed onto the dentin and allowed to self-cure or light-cured for 20 seconds 

. Excess material can easily be removed prior to placement of phosphoric acid and bonding. The definitive composite restoration is placed over the base, shaped, and polished 

A patient presented to the office and interproximal decay was detected in the radiographs. An initial preparation through the enamel was performed to confirm the presence of decay on his lower first molar 

. The tooth was excavated and decay was removed 

. There was significant deep decay. The preparation was irrigated with chlorhexidine and excess moisture was removed. A thin layer of TheraCal LC was placed and light cured

. A sectional matrix (Garrison Dental Composi-tight) was placed 

. A bulk-fill composite (SonicFill 3, Kerr) was placed, cured, shaped, and polished 

TheraBase is a welcome addition to our choices of bases and liners. It is effective and easy to use. Catapult Education is pleased to offer a resounding vote of confidence to TheraBase, and it is highly recommended for use in your clinical practice.

Okabe T, Sakamoto M, Takeuchi H, Matsushima K. Effects of pH on mineralization ability of human dental pulp cells. 

 2006;32(3):198-201. doi:10.1016/j.joen.2005.10.041

Gleave CM, Chen L, Suh BI. Calcium & fluoride recharge of resin cements. 

 2016;32:e26. doi:10.1016/j.dental.2016.08.051

Vinagre A, Ramos JC, Rebelo C, et al. Pulp temperature rise induced by light-emitting diode light-curing units using an ex vivo model. 

Gandolfi MG, Siboni F, Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. 

 2012;45(6):571-579. doi:10.1111/j.1365-2591.2012.02013.x

The American Dental Association. Glossary of dental and clinical administrative terms. Accessed July 1, 2021. https://www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-terms

Gandolfi MG, Siboni F, Taddei P, Pradi C. Apatite-forming ability of TheraCal pulp-capping material. Paper presented at: IADR General Session 2011; March 18, 2011; San Diego, CA.

**BISCO has the calcium release data for TheraCal LC on file.

This dual-cured, self-adhesive liner and base impresses, thanks to its easy dispensing and placement.

Reviewers Give High Marks to BISCO’s New Base

The dental industry constantly moves toward higher standards of care via decreasingly invasive treatments and workflows. Updated materials, instruments, and technologies improve the outcomes clinicians can achieve for their patients. Although the benefits of these advancements are easily recognized, the many steps to get there are not always seen.

Still, every innovation that helps drive dentistry forward is worth noting and even celebrating. One way to put these innovations in the spotlight is to take a look at what they replaced. It’s easy to get used to a comfortable and effective daily workflow, and sometimes it may even seem there’s no need for change. But once something new is brought in to save time, enhance results, or otherwise make things better, it’s easy to move forward from the way things were.

This article (and its online components at dentalproductsreport.com) puts some of those former favorites front and center a final time, as dental professionals share stories of things they once used day in and day out but no longer need due to innovations that make practicing dentistry better for everyone.

How Ameet R. Sachania, DDS found a better material for posterior composites when he tried VOCO's VisCalor Bulk.

Warming to a New Bulk Fill Composite

A simple design feature makes these posts suitable for almost any situation where a post is indicated.

Adaptable Post Becomes Core Part of Armamentarium

Using Simplifeye makes running the practice easier for patients and clinicians.

Simplify the Payment Process

How the Clio Prime intraoral sensor from SOTA Imaging solved one practice's imaging challenges.

The Perfect Digital Development

Adopting Stellalife's natural rinses impacts a practice and its patients.

Natural Rinse for Better Postop Care

Finding the best mill for his practice set this clinician on a new path.

Milling Made Easy

Necessity leads one clinician to find a faceshield that delivers on both comfort and convenience. 

Pandemic Leads to Face Shield Find

Sometimes the innovation doesn't seem that large, but the effects can still change a practice.

Chemical Bonding Means Better Endo Temps

With the right tools, creating restorations with lifelike anatomy can be simplified.

A Better Shape for Shaping Anatomy

A new material selection helps eliminate postop sensitivity.

Eliminate Sensitivity and Toxicity

Using VoIP phones can change the way a dental practice and its patients connect and interact.

Move Beyond the Phone to Connect With Patients

A new option for sealing root canals helps this clinician perform at his best.

Enhanced Endodontic Chemistry Means Better Seals

3D printing leaps forward with printed, long-term crowns.

Permanent Crown Resin Replaces Conventional Restorations

Shifting from a scalpal to a laser makes treatment easier on patients and for clinicians.

Why I Tabled My Scalpel for a Dental Laser

Find out why the author believes every practice should be using an electric handpiece.

It’s Time to Upgrade to Electric Handpieces

Why Gary Radz, DDS, believes he's found an "easy button" for creating temporary crown matrices. 

Pressing the Button on a Better Temporary Crown Matrix

The dental mirror will always be essential, but it doesn't need to be limited by the past.

Reflections on the Dental Mirror

A pre-exam rinse is a good prophylactic step for many practices, and finding the best rinse is a key to success.

Replacement Rinse Leads to Better Results

Oral probiotics show favorable results for enhancing oral health in both lab testing and clinical use.

Out With Bad Bacteria, In With the Good

Why a new technology, and its fresh approach to treating xerostomia, might be the best approach for some dry mouth patients.

A New Technology to Manage Xerostomia

The Vivos sleep system aims to treat patients with sleep apnea rather than help them manage their condition.

Treating Sleep Issues at the Root Cause

Finding a system for automatic shade matching can save a practice time, improve relationships between clinics and labs, and enhance restorative outcomes.

Shade System Reduces Miscommunication

Using tooth morphology as a guide, one clinician designed an instrument set to make it easier to mimic the details of a natural tooth.

Let the Tooth Design the Instrument

One clinician is excited about the possibilities of moving his clinical imaging to the cloud.

Add Security and Convenience With Cloud Imaging

The Dental Products We’ve Left Behind (and What’s Replaced Them)

Dental professionals share stories of dental products they’ve stopped using and innovations that are their new favorites.

	Nothing is more frustrating than completing a beautiful restoration and having a call back from a patient saying the tooth was sensitive. All that artistry for naught! If we’re going to pour our creative talents into esthetic procedures, we must make sure the patient is comfortable. After all, a sensitive yet beautiful restoration is a failure in our patients’ eyes.

Fifteen reviewers from Catapult Education were asked to test Hemaseal & Cide (

) in their offices to see if the product fulfilled these four stated benefits:

		Elimination of post-operative sensitivity

		Enhancement and prolongation of bond strengths

	Studies have shown these benefits to be accurate, but only the post-operative sensitivity could be effectively evaluated in our initial clinical evaluations. The reported results were unanimous; the group voted with 100 percent acceptance, a rare event.

	More than 150 restorations were placed using this product and none reported post-operative sensitivity from patients. The majority have worked with other formulations that reduce sensitivity, including those containing glutaraldehyde, chlorhexidine, benzalkonium chloride and potassium oxalates.

	There are several reasons for post-operative sensitivity, but the primary cause is opened, unsealed dentinal tubules created during the bonding process (

). This allows fluid flow within the tubules, which causes pain.  HEMA, which is present in Hemaseal & Cide, increases the ability of primers to infiltrate the dentinal tubules, allowing better sealing of the tubules. This occurs while increasing bond strengths.

	Disinfection is important prior to the placement of a bonded restoration. Bacterial invasion can cause post-operative sensitivity, decreased bond strengths and secondary caries. Chlorhexidine is an effective broad spectrum antiseptic. Recent studies have demonstrated a wide inhibition zone around Hemaseal & Cide placed on agar plates inoculated with Porphyromonas gingivalis and Streptococcus mutans  (

). This was shown to be superior to several well-known glutaraldehyde containing desensitizers. 

	Fig. 2                                                                                                                 Fig. 3

	Long-term stability of dentin bonding agents has been a concern due to a number of factors. Matrix Metallo-proteases (MMPs) and Cathepsins (cysteine proteases), which are present within dentin, become activated when exposed to acids. They subsequently attack and dissolve collagen, which is the dentin component of the hybrid layer, resulting in diminished bond strengths. Studies have shown a loss of up to 30 percent within the first year. Chlorhexidine, which is present in Hemaseal & Cide, has been shown to be effective in initially preventing dentin bond degradation due to protease activation.

	Microleakage affects the longevity of composite restorations. Recurrent decay is the primary cause for their failure, often resulting in replacement sooner than other traditional metallic direct restorations. Studies have shown that HEMA results in lower leakage scores because it helps to rehydrate collapsed collagen fibers that may have been overdried during the dentin bonding process (

). HEMA aids in better infiltration of the opened dentinal tubules with the bonding agent and a stronger hybrid zone (

	Fig. 4                                                                                                                   Fig. 5

	Hemaseal & Cide can be used in a number of clinical situations to seal the dentinal tubules, wet the dentin surface and desensitize the tooth. It’s indicated for use under direct restorative materials such as composites, glass ionomers and amalgams. It can be used on crown preparations after shaping or before seating. It’s effective in reducing cervical sensitivity.

	Hemaseal & Cide is simple to use. Place several drops into a dappen dish and apply to the dentin using a brush. Agitate into the surface for 10 to 15 seconds. Suction away excess with high-volume evacuation or wick away with a brush leaving the surface slightly wet. Care should be taken to avoid splashing excess liquid onto the gingiva, as reddening may occur. Also, be aware there have been reported allergies in a few individuals.

	When using under composites with the total-etch technique, the dentin should be etched, rinsed and then the Hemaseal & Cide applied (

). This is followed by placement of the dentin bonding agent and the composite (

. With the self-etch technique, the desensitizer is placed prior to dentin bonding agent placement. 

	Fig. 6                                                                                                               Fig. 7

	With glass ionomers, the Hemaseal & Cide is placed after the dentin conditioner has been applied and washed. If no conditioner is used, place immediately prior to glass ionomer placement. Under amalgam restorations, Hemaseal & Cide is placed following tooth preparation immediately prior to amalgam placement. Suction or wick away excess, but leave the surface slightly moist. 

	Following crown preparation and/or prior to crown placement, Hemaseal & Cide is placed following tooth rinsing and excess moisture removal. If placed at the crown preparation appointment prior to seating the provisional, you’ll notice a significant reduction of sensitivity at the crown seating appointment, and you’ll often be able to seat the crown without anesthetic (

). This is especially useful on lower molars since an inferior alveolar nerve block can often be avoided. 

	Fig. 8                                                                                                                     Fig. 9

	To use Hemaseal & Cide as a desensitizer, first treat the area with EDTA for 15 seconds and blot away the excess. Apply desensitizer for 15 to 20 seconds. For best long-term results, apply a dentin bonding agent and light cure (

	In summary, evaluators give Hemaseal & Cide the Catapult Vote of Confidence. It’s a simple, effective way to reduce sensitivity and enhance the lifetime of restorations, and it costs significantly less than other popular desensitizers. We recommend you try it to keep patients comfortably smiling and recommending you to friends. 

Why reviewers gave Hemaseal & Cide Desensitizer a 100 percent acceptance rating.

A simple and effective way to reduce sensitivity

Today’s shift toward all-ceramic crowns requires a more accurate impression material. Not only is it important to accurately portray the marginal area, but the tooth’s entire surface must be captured.

An even thickness of cement between the crown and the tooth along with even ceramic thickness reduces internal stresses that might lead to premature fractures.

Beveled or light chamfered margins are easier to accurately impress because moisture at and slightly above the marginal area is more easily displaced along a smooth margin by the impression material. Shoulders, which are often required for all-ceramic crowns, are more difficult to impress because the fluids are not as easily carried past the abrupt joint created at the margin.

In an ideal world blood and saliva would not be a problem, gingival health would always be present, and preparations would not encroach upon biologic width.

 Unfortunately, this is not always possible. Making accurate impressions is a challenge. Dentists always are looking for a more forgiving material to help compensate for less than ideal intraoral conditions.

Flexibility is important when selecting an impression material. It is amazing how many different techniques dentists use to obtain their ideal impression. There is the no-cord, single cord, and the double cord technique with or without a number of astringents and medicaments. Some use a laser or electrosurgery to expose sub-gingival margins while others prepare supra-gingival or gingival margins eliminating the need for cord. Different viscosities are used from the all-in-one monophase to combine materials such as putty and extra-light. It is important to realize dentists like to do a procedure their way.

Panasil impression material is available in many viscosities, hardnesses, speeds and delivery systems. For example, in the heavy bodied tray material viscosities, there are traditional putty, a machine mixed putty viscosity, fast set heavy bodied, soft heavy bodied, and soft heavy fast-set materials. The syringable viscosity materials are available in regular viscosity, light viscosity, extra-light viscosity, and extra-light fast set viscosity. The available formulations should meet the needs of nearly every technique and preference.

Addition reaction poly-vinyl siloxane impression materials are the most popular impression materials for fabricating fixed removable prostheses in North America.

 They achieve the best dimensional accuracy and stability of all available dental impression materials and exhibit an extremely low polymerization shrinkage of 0.04% at 24 hours.

The ability of the unpolymerized, unset material to wet intraoral tissues has led manufacturers to add surfactants to increase their hydrophillicity.

 Not only is it important for an impression material to wet the surface of a tooth, it also must displace water away from the preparation and marginal areas. This is a physical property in which Panasil excels.

When members of the Catapult Group were asked to evaluate Panasil, they were most concerned about reducing the need for impression remakes because of missed margins, and bubbles and voids on the impression’s surface. They felt the material would need to exhibit better detail along the margins, especially sub-gingivally, and have fewer voids or bubbles before they would consider changing from their present-day impression material.

Eighty-eight percent of respondents rated Panasil as equal to or better than their current material, and 57% rated it better than their present in-office impression material. In particular, they rated the superior sub-gingival margins very high. Eighty-six percent said they would consider using the material in their offices. These are unusually high marks for a group that tests many available products and can make personal decisions for their offices from a high level of experience.

A patient presented with a discolored maxillary left central incisor that had undergone endodontic root canal therapy 

. Another dentist had performed composite bonding on several occasions, and the patient was looking for a more long term solution.

Treatment options including bonding, veneering and an all-porcelain crown were presented. The patient elected to have an all-ceramic crown placed. The tooth was prepared and impressions made 

. A custom shade guide along with photographs were sent to the laboratory (Fig. 4). The patient returned 2 weeks later and the crown was tried in, adjusted and bonded into place 

Poor preparation and impression taking technique cannot be fully compensated with improved materials. However, with newer all-ceramic materials requiring precise impressions in difficult situations, anything that can improve the likelihood of success should be explored. Panasil offers a wide variety of products that should satisfy most dentists’ personal preferences. The group finds that the Panasil impression materials should be considered if you are thinking about using a new impression material.
	
	

Acknowledgement: Thanks to Jenny Wohlberg at Valley Dental Arts for the fabrication of this natural-looking crown.

1. Reitmeier B, Hänsel K, Walter MH, Kastner C, Toutenburg H. Effect of posterior crown margin placement on gingival health. J Prosthodont Dent 2002;87(2):167-172.
	2. Padbury Jr A, Eber R, Wang HL. Interactions between the gingiva and the margin of restorations. J Clin Periodontol 2003;30(5):379-385.
	3. Donovan TE, Chee WW. A review of contemporary impressions and techniques. Dent Clin North Am 2004;48:(2) 445-470.
	4. Darvell BW. Materials Science for Dentistry, ed 9. Cambridge, UK:2009;180-196.
	5. Petrie CS, Walker MP, O’mahony AM, Spencer P. Dimensional accuracy and surface detail reproduction of two hydrophilic vinyl polysiloxane impression materials tested under dry, moist, and wet conditions. J Prosthet Dent. 2003;90:365-72.

	Catapult is an organization that consists of more than 50 clinicians spread throughout Canada and the United States. As a company, manufacturers pay a fee for their product to be evaluated and what we deliver are truthful, independent answers from surveys that we develop with them. We have had many products that have either had to be altered before hitting the market or simply never arrived because of our openly honest evaluations. In this way, Catapult assists the manufacturer to avoid potentially releasing a faulty product, or simply a product that needs refinement. Lastly our clients are omnipresent in the industry, small to large, no favoritism, simply reviewing the latest products in our practices.