Dr. Jason H. Goodchild

	After two decades in clinical practice, technological innovation has made my job easier, improved my patients’ experiences and, in many cases, resulted in better patient outcomes. Technology has invaded all facets of my practice, but the areas of diagnostics and imaging have been the most impacted. 

	Every day, oral healthcare providers must synthesize patient data such as intra- and extraoral exams, radiographs, clinical images and oral histories to develop treatment options. From there, a shared decision-making process between provider and patient serves to define the treatment plan, but the quality of the data and our ability to communicate and educate helps to inform patients’ decisions and shape the treatment path. In my practice, the process of collecting patient data, documenting the clinical situation and planning treatment has been impacted by several key technologies.

Trending article: 6 emerging technologies that will change dentistry forever

	Like any dentist who has decided to eliminate paper charts and adopt electronic records, it is no secret this process is difficult and time-consuming. The benefits, however, are worth the growing pains! Utilizing electronic patient notes and charting, images, radiographs, billing, claims, etc. creates efficiencies and better workflows for the entire team. No longer are my dental assistants scrambling to find paper records when a patient walks in with an emergency, and now my practice administrator can more easily collate information for referrals and insurance claims.  

I have been wearing loupes for years, but the addition of the LED headlamp has changed my world. The expression, “I just didn’t realize how much I couldn’t see before” as it pertains to a dental practice with an operatory light is not hyperbole. I am now able to see magnified areas that are better illuminated, which has definitely improved my clinical dentistry. The batteries for the LED headlamp have gotten smaller and are more able to provide a full day’s charge. For most patients, I do not even reach for the overhead light anymore!

	Capturing excellent digital images should be a part of every patient’s initial exam, in addition to before/after treatment. To fully document the patient’s clinical situation is vital, but clinical images are an ideal way to also educate and inform patients about problems they sometimes cannot see or feel. Integrating digital clinical images into electronic patient records makes communicating between providers easier and more effective. The intraoral cameras available are now easy to use and capable of capturing high-quality images. Digital cameras have always been capable of creating outstanding images but were not always easy to use; however, set-ups are getting smaller and lighter as highlighted by adaptors for smartphones that can make intraoral capture possible.

Trending article: The top 10 developments in dental technology

	Digital capture of intraoral radiographs is simple, predictable and, just like loupes, has changed my world. From the elimination of chemicals to the instant gratification of digital sensors and the ability optimize views on a large viewing monitor, digital radiography allows me to better diagnose potential problems. It is almost hard to believe that we were capable of appreciating early carious lesions on the small film we used to use!  

	The most recent technology adopted in my office is digital scanning. When combined with the electronic record, digital images and digital radiography, I can now not only educate patients about what their current situation is, but also show how we can address their complaints and even plan/predict the final outcome. For orthodontic, crown and bridge, and implant cases, we utilize digital scanning not only to plan treatment but also for communication between providers and laboratory technicians.

Articles

The times are changing, and dental practices are as well.

The top 5 ways technology has changed dental practices

Whether practitioners record a fixed prosthodontic impression using conventional means or via digital capture, appropriate tissue management is vital.

In some cases, precise preparation of the tooth without iatrogenic damage to surrounding tissue is sufficient, while in other cases both hemostasis and gingival retraction are needed. Ideally, marginal gingiva should be healthy at the time of crown and bridge procedures.

 When factors such as esthetics, existing restorations or fracture dictate that finish lines of the prepared tooth are placed equi-gingival or subgingival, some form of tissue management is necessary. According to a 2015 Clinicians Report survey, 64 percent of dentists utilized gingival retraction cord and 48 percent used retraction pastes.

There are several means of tissue retraction commonly used by dentists to create sufficient depth and width of material for crown and bridge impressions: mechanical, chemical and surgical. 

 Often, a combination of techniques is used.

The most common form of mechanical tissue displacement to record a conventional fixed prosthodontic impression involves the use of a gingival retraction cord. Several studies have examined the use of gingival retraction techniques by dentists, and mechanical or mechanico-chemical were most commonly utilized.

 Mechanical retraction using gingival retraction cord is simply the use of a string, usually made of cotton, silk or yarn wool. Products can be fabricated into configurations of knitted, braided or twisted cord of varying diameters, giving the practitioner many choices for easier placement, manipulation, absorbency and tissue retraction (e.g., Knit-Pak™ [Premier], GingiBRAID+™ [Kerr] and Z-Twist

The use of chemical agents such as epinephrine, aluminum chloride and ferric sulfate - used alone or in combination with cords - is typical in clinical practice for fixed prosthodontics impressions. The agents can be supplied in the form of gingival retraction fluids, gels and pastes, or as a part of local anesthetic solution (e.g., epinephrine).

 Cords may be pre-impregnated (i.e., the chemical agent is incorporated by the manufacturer) or the chemical agent may be applied to cord by the clinician prior to placement. If chemical retraction is applied to the cord at chairside, it should be allowed to soak for approximately 20 minutes to achieve proper saturation.

Authors have described the most desirable chemical agents to be used in gingival retraction procedures as meeting three criteria: the drug must be effective, it should not cause significant and irreversible tissue damage, and it should not produce potentially harmful systemic effects.

 With respect to the pharmacological effects of the active substance, the hemostatic agent aluminum chloride is most desirable because it has minimal systemic effects due to poor cell permeability, is effective for constricting blood vessels and drying tissue, will not discolor tooth structure and is the least irritating of the hemostatic agents.

 Although it can interact with the setting reaction of polyvinyl siloxane impression materials, this inhibitory effect is neutralized after thoroughly rinsing the area with water.


To overcome the challenges of traditional mechanical retraction - the need for anesthesia, risk of damage to gingival and epithelial attachment, possible gingival recession, gingival inflammation and post-operative discomfort - a new class of cordless gingival retraction materials (gingival retraction pastes) has been introduced.

Generally - when clay-based to absorb moisture and coupled with an astringent - retraction pastes are designed to be placed into and around the gingival sulcus and within several minutes produce hemostasis and drying. When used with a compression cap (a cylindrical, dense cotton pellet) and direct pressure, retraction paste can also provide excellent tissue retraction. Traxodent

 Paste Retraction System that features a functionalized proprietary clay. Compared to other kaolin-based clay systems, Traxodent’s clay delivers improved ion exchange of the astringent and, due to its surface area, provides “swelling” capacity for fluid control and drying.

Traxodent contains 15 percent aluminum chloride and comes in either pre-packaged syringes utilizing bendable metal tips or unit doses with a slender plastic tip that fit into an autoclavable dispenser. Information from the manufacturer indicates that “Traxodent can be used in virtually any clinical situation in which control of bleeding is required.”

 There is essentially no learning curve to using Traxodent; the material is simply dispensed into the area around the prepared tooth (with or without retraction cord) followed by having the patient bite on a Retraction Cap (Premier).

 After two minutes, the paste is removed by thoroughly rinsing the area with water. After gentle drying, the tissue should appear free of moisture and blood and ideally prepared for the final impression.


A 62-year-old male patient presented for a full-coverage restoration on tooth No. 12. The tooth had a large existing MODB amalgam build-up following successful root canal therapy. The treatment plan included a full-contour, monolithic zirconia restoration (Fig. 1).

 (Premier) Single Patient-Use diamond burs, tooth No. 12 was prepared for a zirconia restoration. At least 1 mm of occlusal and axial reduction was prepared, with a smooth 90-degree shoulder finish line ending equi-gingivally. Knit-Pak size 000 gingival retraction cord was placed atraumatically using a flat ended instrument (Figs. 2-4).

Because of persistent oozing of blood and fluid around tooth No. 12, Traxodent retraction paste using a unit-dose capsule was used. After removing the individual capsule from the foil package and inserting it into the dispenser, the material was placed around the prepared tooth (Figs. 5-7).

After placing the Traxodent retraction paste, a Retraction Cap was positioned so the patient could bite down and provide direct pressure to the area (Fig. 8). After approximately two minutes, the Retraction Cap was removed and the area was thoroughly rinsed with water. Hemostasis was achieved and the margins of tooth No. 12 were clearly visible (Fig. 9).

The selected impression tray, in this case a T-LOC™ Triple Tray

 Adhesive-Free Dual Arch Impression Tray (Premier), was tried in to verify full seating without interferences (Fig. 10). An extra-light body PVS impression material was syringed around the tooth while heavy-body PVS material was placed into the impression tray, and within the manufacturer’s intraoral working time the tray was seated (Aquasil

 Impression Material, XLV and Heavy [Dentsply Sirona]) (Figs. 11-12).

After the mouth removal time had elapsed, the impression of tooth No. 12 was removed and inspected (Fig. 13). Complete capture of the preparation details was verified, a provisional was fabricated using Luxatemp

 Automix Plus (DMG America) and cemented using NexTemp

 Temporary Cement (Premier), and the patient was released. He was re-appointed in three weeks for definitive cementation of the final restoration. 


To adequately capture the details of crown and bridge impressions, the area needs to be free of blood and moisture. Typically, mechanico-chemical retraction is utilized, and when coupled with materials and techniques to consistently create astringency, better outcomes can be achieved. Traxodent retraction paste, used alone or in combination with cord and/or compression caps, provides the practitioner an armamentarium to achieve reliable tissue management.

1. Christensen GJ. Have fixed prosthodontic impressions become easier? J Am Dent Assoc 2003;134:1121-3.

2. Christensen GJ. The state of fixed prosthodontic impressions – room for improvement. J Am Dent Assoc 2005;136:343-6.

3. Christensen GJ. Foolproof Techniques for Optimum Impressions. Clinicians Report 2015;8(3):1-4.

4. Donovan TE, Gandara BK, Nemetz H. Review and survey of medicaments used with gingival retraction cords. J Prosthet Dent 1985;53(4):525-31.

5. Moldi A, Gala V, Puranik S, et al. Survey of impression materials and techniques in fixed partial dentures among the practitioners of India. ISRN Dentistry 2013. Available at: https://www.hindawi.com/journals/isrn/2013/430214/. Accessed November 8, 2017.

6. Azza AA, Bennani V, Chandler NP, et al. New Zealand dentists’ use of gingival retraction techniques for fixed prosthodontics and implants. N Z Dent J 2010;106(3):92-6.

7. Hansen PA, Tira DE, Barlow J. Current methods of finish-line exposure by practicing prosthodontists. J Prosthodont 1999;8(3):163-70.

8. Strassler HE, Boksman L. Tissue management, gingival retraction and hemostasis. Oral Health Journal 2011;7:35-42.

9. Nowakowska D, Panek, H. Classification of retraction materials in the aspect of biocompatibility with gingival sulcus environment. Pol J Environ Stud 2007;16:204-8.

10. Gupta G, Kumar SMV, Rao H, et al. Astringents in Dentistry: a review. Asian J Pharm Health Sci 2012;2(3):428-32.

11. Csempesz F, Vag J, Fazekas A. In vitro kinetic study of absorbency of retraction cords. J Prosthet Dent 2003;89:45-9.

12. Schillingburg HT, Hobo S, Whitsett LD, et al. Fundamentals of Fixed Prosthodontics. 3rd Ed. Carol Stream, IL: Quintessence Publishing Co. 1997. p261-7.

13. Kumbuloglu O, User A, Toksavul S, et al. Clinical evaluation of different gingival retraction cords. Quintessence Int 2007;38(2):e92-98.

14. Nowakowska D. Classification of chemical retraction agents. Protet Stomatol 2008;58:202-8.

15. Goodchild JH, Donaldson M. Local and systemic effects of mechanic-chemical retraction. Compend Contin Educ Dent 2013;34(Spec No 6):1-7.

16. Boghosian AA. Clinical and material factors in achieving the ideal impression. Available at: https://www.dentalacademyofce.com/courses/1424/pdf/clinicalandmaterialfactors.pdf. Accessed November 8, 2017.

17. Conrad HJ, Halten JR. Internalized discoloration of dentin under porcelain crowns: a clinical report. J Prosthet Dent 2009;101:153-7.

18. Tarighi P, Khoroushi M. A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014;11(4):423-8.

19. Traxodent–Hemodent Paste Retraction System. Premier Dental Products Company. Available at: http://www.premusa.com/wp-content/uploads/2015/09/Traxodent-Brochure.pdf. Accessed November 8, 2017.

20. Using Traxodent in Clinical Practice. Inside Dentistry 2011;7(2). Available at: https://www.dentalaegis.com/id/2011/02/using-traxodent-in-clinical-practice-premier-dental. Accessed November 8, 2017.

How retraction pastes can be used to great effect in restorations.

How to perform tissue management for accurate crown and bridge impressions

 dental composites were introduced in the 1970s, significant advancements have been realized in resin and filler technology, and today more than 70 different brands of composite exist on the market. Today’s clinicians can be easily confused about the subtle differences between the many available 

 materials and may find it more difficult to make the correct decision about which material is best for each clinical situation.

To simplify decision-making and to offer a composite that can insure excellent performance in all clinical situations, 

. This new composite is based on the resin technology of TPH3 and contains nanohybrid- and micro-filler components. The result is a composite that has the potential to perform well in either the anterior or posterior, and should have tooth-like translucency, improved polishability and color stability, and good wear resistance.2-4  TPH Spectra also comes in two handling choices: A creamy light-viscosity formulation, and a packable high-viscosity formulation. For both viscosities, the physical properties are similar. Because handling preference is subjective and highly individualized, practitioners are now able to select the right viscosity for all clinical situations. 

Trending Article: Discussing current hot topics in dental infection control

Restorative outcomes can be influenced by simplified 

 options when the restorative material selected has excellent blending capability. Often called the “chameleon effect,” composite blending with adjacent tooth structure is dependent on material translucency and shade, and is most pronounced in small- to moderate-sized 

. Building and improving from the previous TPH3 composite formulation, TPH Spectra has a refractive index that falls directly between enamel (1.63) and dentin (1.54).5-6 Put simply, this means that when light hits TPH Spectra it appears indistinguishable from natural tooth structure.
	In order to make shade selection simpler, it is available in the seven most popular shades: B1, A1, A2, A3, A3.5, A4, and C2.

Recent Article: ADA 2014: Big launches and must-see products at the annual session


	Intraoral exam reveals a lesion on the disto-occlusal surface of tooth No. 29 (Fig. 1). After verifying the medical history and reviewing the radiographs, a direct composite resin restoration of the disto-occlusal of No. 29 was treatment planned.  
	Anesthesia was achieved with one carpule of 4% 

) via buccal infiltration. Caries excavation was completed using a 330 carbide bur on a high-speed handpiece and a #4 round bur on a low-speed handpiece. The preparation was verified caries-free with Snoop caries detector (

). A rubber dam was placed after preparation was completed.

Related Article: Double Take: DENTSPLY Articadent

Because of the amount of remaining enamel, a 

 (DENTSPLY Caulk) was used. This technique was chosen to maximize enamel bonding while minimizing the potential for postoperative sensitivity.7-8 The enamel was etched with 34% phosphoric acid for 15 seconds and then rinsed.  
	

Paoldent Plus Sectional Matrix System (DENTSPLY Caulk)

 was utilized to isolate the restoration. An 

was placed followed by seating of the nickel-titanium ring. Lastly, the appropriately sized plastic wedge was inserted through the tines of the ring (Fig. 2).

Click here to see the results of this restoration. 

 was scrubbed into the preparation for 20 seconds followed by a 5-second air drying to remove the solvent. The adhesive was light cured for 20 seconds.

E-book: Dental Trends: The latest in universal adhesives

was used as the initial restorative layer. As a low-viscosity flowable it is capable of adapting to the prep geometry and can be placed in up to 4mm increments. After dispensing Surefil SDR flow into the preparation for tooth No. 29, it was light cured for 20 seconds.

On-Demand Webinar: Navigating digital impressions and CAD/CAM in the real world

 was dispensed into the preparation and contoured with composite instruments (Fig. 3-4). After gross reduction with fluted composite burs and checking occlusion, 

 were used for final contouring and finishing of the completed restoration (Figs. 5-6).

, dentists now have one material that can be used for all situations. As a result, practitioners no longer need to struggle with decisions of shading or selecting the material with the most appropriate physical properties. TPH Spectra’s characteristics and excellent chameleon effect will provide the dentist and patient with predictable results not only during placement at 

 but for years to come. •
	
	References available at 

This article originally appeared in the September 2014 issue of Dental Products Report. For articles on upcoming products, 

click here to subscribe to DPR's newsletter.

 Since the first resin-based light-cured dental composites were introduced in the 1970s, significant advancements have been realized in resin and filler technology, and today more than 70 different brands of composite exist on the market. Today’s clinicians can be easily confused about the subtle differences between the many available composite materials and may find it more difficult to make the correct decision about which material is best for each clinical situation.1  

Fewer shades but still covered

Despite advancements in almost every facet of impression-making, from materials to hemostatic agents to cords and retraction paste, achieving accurate impressions of crown and bridge preparations can be frustrating for practicing dentists.

A recent study found that 89% of impressions taken had one or more observable errors; the most common error was voids or tears at the finish line (likely because of difficulty obtaining intimate contact of material around the tooth and gingiva, faulty manipulation of the materials while placing it around the tooth, or premature removal from the mouth).1

Three major challenges facing dentists when recording conventional crown and bridge impressions are: correctly managing the soft tissue, placing material precisely around the properly prepared tooth, and dispensing both injection and tray materials into the mouth within allowable intraoral working times.

Prior to capturing a final impression, practitioners have historically used mechanical retraction through the placement of cord, alone or in combination with a chemical agent to promote hemostasis, drying, and retraction of tissue (e.g., aluminum chloride, ferric sulfate, racemic epinephrine). In one study of North American dentists, it was found that 95% of respondents routinely used gingival retraction cord during crown and bridge impressions.2

To allow enough material to create an undistorted impression, a 0.2 mm space must be created between tooth and gingiva. This minimum space requirement is intended to allow the impression material to flow into the sulcus and not exceed its tear-strength capability, preventing the chance for remnants to be left behind that could cause gingival irritation and inflammation.3-6

Recently, product manufacturers have introduced retraction paste as a less traumatic means of achieving hemostasis and local retraction (e.g., 

Even though retraction paste has been shown to create temporary gingival inflammation, it is considered less traumatic when compared to placing retraction cord and is as effective in promoting hemostasis.8,9

There are several ways that conventional crown and bridge impressions are taken: the single-step technique using only one material (e.g., monophase technique), the single-step technique involving impression materials of two viscosities (e.g., light body and heavy body), and the double-step technique which also includes two materials with different viscosities, however, one is allowed to set followed by placement of the second material as a second step.

All of the options for placement of impression material around the prepared tooth require the dentist to perform two tasks simultaneously: expressing the material by pushing down on the plunger or squeezing the impression gun and, placing the material around the tooth.

DENTSPLY Caulk has developed Aquasil Ultra Cordless Tissue Managing Impression Material and digit power™ Dispenser

 as a means for dentists to precisely place material for improved crown and bridge impressions without the need for retraction cord or retraction paste in most cases.

The digit power™ Dispenser is a pneumatic impression device that is compatible with most dental units. It connects to an air line at the dental chair via commonly available connectors and uses digit power™ unit-dose impression cartridges. Instead of loading a backfill syringe or squeezing the 50 mL impression gun, dentists are now able to simply step on the rheostat to express material while holding the impression device in a pen-grip.

The small diameter intraoral tip on the impression cartridge allows placement directly into the sulcus or around a dental implant. Different sized impression cartridges are available for either single- or multiple-unit cases.

Aquasil Ultra Cordless Tissue Managing Impression Material is designed for use with a single-step dual-viscosity impression technique.

[RELATED: A behind the scenes look at DENTSPLY Caulk's new Aquasil Ultra Cordless Tissue Managing Impression System]

Both the tray material and the wash material for this system have been formulated to provide several advantages compared to Aquasil Ultra. First, because the wash material is intended to be placed around the prepared tooth without the use of cord or retraction paste, it is designed for flow into sulcus widths of less than 0.2 mm without distortion or tearing.

Compared to Aquasil Ultra the tear strength of Aquasil Ultra Cordless impression material has been improved to prevent rips or tears at the impression margin.

Additionally, to meet the needs of dentists adopting newer technologies, the materials have been optimized for digital scanners. 

show the digit power™ Dispenser device being used to capture a final impression for tooth No. 19.

An important feature of the Aquasil Ultra Cordless impression material is the minimizing of errors due to working time/setting time violations. Exceeding the working time and/or setting time of an impression material can result in many different errors. Some examples include: incomplete or inaccurate marginal reproduction, tearing, pulls/drags, lack of coadaptation, and others.10

The digit power™ cartridges are designed so the entire impression cartridge can be expressed within the material’s intraoral working time and practitioners still have enough time to seat the tray properly. The intraoral working time of the single-unit cartridge is 35 seconds while the intraoral working time for the multi-unit cartridge is one minute; the working time of the tray material is approximately one minute and 15 seconds.

Mouth removal times for the single- and multiunit cartridges are three minutes and four minutes and 30 seconds from the start of mixing, respectively.11

Clinical Case at a Glance with Corresponding Technique Video

Aquasil Ultra Cordless digit power™ Dispenser, with installed intraoral tip, is shown in the blue plastic adaptor. To its right is the regulator attached to the dental air line. Note at the top of the regulator is a silver knob with settings for flow rate of the impression material.

 The digit power™ adaptor sits in the tool holder and permits the air switch on the dental unit to be activated.

 Comparison of conventional plastic intraoral mixing tip (back, right), and digit power™ Aquasil Ultra Cordless plastic intraoral mixing tip, (front, left) with depth markers of 3 mm and 5 mm.

 digit power™ Dispenser and Aquasil Ultra Cordless single-unit wash material being used to capture a final impression for tooth No. 19. Buccal retracted view.

 Final impression captured with the Aquasil Ultra Cordless system.

Pre-op view of patient. Buccal retracted view.

 Finished preparations on patient for full-coverage lithium disilicate restorations on tooth Nos. 8 and 9. Buccal retracted view.

 Final impression of tooth Nos. 8 and 9 on 25-year-old male patient. Note the extension of the material on the mesial aspect of tooth No. 8. No cord was used.

After final cementation of lithium disilicate crowns on tooth Nos. 8 and 9.

The Aquasil Ultra Cordless Tissue Managing Impression System is intended to make conventional crown and bridge impression-making easier and more predictable.

The factors that make the Aquasil Ultra Cordless system unique are:

1) Precision placement through a fine cannula allows for delivery of impression material directly into the sulcus.

2) Aquasil Ultra Cordless impression material has been optimized for placement without cord or retraction paste to capture a thin, readable sulcus and prep margins. Increased tear strength minimizes the chance of tearing.

3) The working time of Aquasil Ultra Cordless Tissue Managing Impression Material is designed to coordinate with the amount of material in the unit-dose cartridge for single or multiple preps to eliminate impression errors because of violation of working time and setting time. Dentists can now concentrate on one thing-precisely placing the material-rather than squeezing the gun or depressing the impression syringe during the placement step.

4) The ergonomically designed digit power™ Dispenser uses the pen-grip (the same grip dentists use when using handpiece).

Read the references on the next page ... 

1.Samet N, Shohat M, Livny A, et al. A clinical evaluation of fixed partial denture impressions. J Prosthet Dent 2005;94:112-7.

2.Donovan TE, Gandara BK, Nemetz H. Review and survey of medicaments used with gingival retraction cords. J Prosthet Dent 1985;53(4):525-31.

3.Laufer BZ, Baharav H, Yehuda G, et al. The effect of marginal thickness on the distortion of different impression materials. J Prosthet Dent 1996;76:466-71.

4.Laufer BZ, Baharav H, Cardash HS. The linear accuracy of impressions and stone dies as affected by the thickness of the impression margin. Int J Prosthodont 1994;7:247-52.

5.Shah MJ, Mathur S, Shah A, et al. Gingival retraction methods in fixed prosthodontics: A systematic review. J Dent Sci 2008;3(1):4-10.

6.Shiozawa M, Takahashi H, Finger WJ, et al. Effects of the space for wash materials on sulcus depth reproduction with addition-curing silicone using two-step putty-wash technique. Dent Mater J 2013;32(1):150-5.

7.Feng J, Aboyoussef H, Weiner S, et al. The effect of gingival retraction procedures on periodontal indices and crevicular fluid cytokine levels: a pilot study. J Prosthodont 2006;15(2):108-12.

8.Kazemi M, Memarian MA, Loran V. Comparing the effectiveness of two gingival retraction procedures on gingival recession and tissue displacement: a clinical study. Res J Biol Sci 2009;4(3):335-9.

9.Smeltzer M. An alternative way to use gingival retraction paste. JADA 2003;134(11):1485.

10.Impression-taking Guide. DENTSPLY Caulk. Available at: http://www.caulk.com/assets/pdfs/Techguide.pdf. Accessed June 17, 2013.

11.Aquasil Ultra Cordless Directions for Use. DENTSPLY Caulk.

How to create accurate crown and bridge impressions with Aquasil Ultra [VIDEO]

	Since the first resin-based light-cured composites were introduced many decades ago, there have been significant advancements realized in resin and filler technology. 

Practitioners are faced with ever-increasing composite choices that are designed to give better results during placement and over the lifespan of the restoration. Ironically, the introduction of sophisticated materials designed to improve restorative procedures can have the opposite effect. Today’s clinicians can be easily confused about the subtle differences between the many available composite materials and may find it more difficult to make the correct decision about which material is best for each clinical situation. 

Choosing which composite material to purchase can be a difficult decision. Ideally, practitioners should rely on published reports and a careful review of a product’s physical properties when selecting a material. However, this level of review is generally not realistic for everyday providers.

Dentists’ purchasing decisions may be based on cost, brand preference, and the “works best in my hands” argument, rather than a strict review of each product’s fracture toughness, volumetric shrinkage, or other properties. Clinicians become more confident in their procedures and materials through repetition of use and clinical observations. This is especially true when considering material choices: exacting use of poorly selected materials will not offer better clinical results than use of ideally chosen materials.

To simplify decision-making and to offer a composite that can ensure excellent performance in all clinical situations, 

. It is based on the resin technology of 

 and contains nanohybrid- and micro-filler components. The result is a composite that has the potential to perform well in either the anterior or posterior, and should have tooth-like translucency, improved polishability and color stability, and good wear resistance. TPH Spectra also comes in two handling choices: a creamy light-viscosity formulation and a packable high-viscosity formulation. 

For both viscosities, the physical properties are similar. Because handling preference is subjective and highly individualized, practitioners are now able to select the right viscosity for all clinical situations.  

In order to make shade selection simpler, the material is available in the seven most popular shades. According to DENTSPLY’S internal data, the seven shades of TPH Spectra represent more than 80 percent of total sales from the previous TPH3 formulation.

The TPH Spectra shade guide was condensed for several reasons. First, some practitioners may be overwhelmed with the number of current shades; the Vita Classic (Vident) shade guide has 16 shades, and the TPH3 shade guide has 26. Because only seven of the current 26 TPH3 shades are regularly purchased, the color difference (i.e., Delta-E value) between shades was calculated to determine if a top-seven shade could be used in place of another shade not offered.

Available data shows that it will be possible to “cover” all the Vita shades with the existing TPH Spectra offerings by keeping the Delta-E less than four (if the two shades, tooth-composite or composite-composite, have a Delta-E difference of less than four, the difference is difficult to distinguish for the human eye).  

TPH Spectra also offers optimal color blending between restorative materials and natural tooth, often called, “the chameleon effect.” 

How to simplify composite selection, procedures

Step 1: An intraoral exam revealed a fractured composite resin restoration on tooth No. 29. The patient’s chief complaint involved food impaction in the area leading to discomfort after meals (

).  After verifying the medical history and reviewing the radiographs, a direct composite resin restoration of the disto-occlusal surfaces was treatment planned.  

Step 2: Anesthesia was achieved with one carpule of 4% Articadentwith 1:100,000 epinephrine (DENTSPLY Pharmaceutical) via buccal infiltration. Caries excavation was completed using a 330 carbide bur on a high-speed handpiece and a #4 round bur on a low-speed handpiece. The preparation was verified caries-free with Snoop caries detector from 

Step 3: A rubber dam was placed and isolation of the preparation was accomplished with 

 Because of the depth and size of the final preparation, a selective etch technique with 

 (DENTSPLY Caulk) was used. This technique was chosen to maximize enamel bonding while minimizing the potential for post-operative sensitivity. The enamel was etched with 34 percent phosphoric acid for 15 seconds and then rinsed. Prime&Bond Elect was scrubbed into the preparation for 20 seconds followed by a five-second air drying to remove the solvent. The adhesive was light cured for 10 seconds (

Step 4: The first restorative layer was placed using a 

 (DENTSPLY Caulk), a low stress bulk fill material with excellent cavity adaptation (

). TPH Spectra Low-Viscosity shade A2 was selected for the final occlusal layer because of its creamy handling and placed in 2mm increments (

). Each composite increment was light cured for 20 seconds. After the last layer of composite was cured, the Palodent Plus ring and sectional matrix were removed (

Step 5: The final restoration was finished with fluted composite finishing burs and white stones to achieve proper shape and contour. After occlusal adjustment, the composite was polished with DENTSPLY Caulk’s Enhance Finishing System points and cups (

Step 1: During a periodic exam, caries was noted on the mesial and distal of tooth No. 30  (

). After local anesthesia with one carpule of 4% 

 (DENTSPLY Caulk) were inserted mesially and distally to prevent iatrogenic damage to adjacent teeth during preparation (

Step 2: Because of the large amount of dentin present in the preparation, a selective-etch technique was chosen. The exposed enamel surfaces were etched with 34 percent phosphoric acid for 20 seconds and then thoroughly rinsed with water (

). Isolation of the preparation was achieved using 

Prime&Bond Elect was scrubbed into the preparation for 20 seconds followed by a five-second air drying to remove the solvent. The bonding agent was light cured for 10 seconds. An initial layer of Surefil SDR flow was placed into the preparation, followed by a 20-second light cure. 

Step 3: TPH Spectra High-Viscosity shade A2 was packed into the preparation and cured in 2mm increments. The final restoration was finished with fluted composite burs and polished with

 Enhance Finishing System and PoGo Micro Polishers (DENTSPLY Caulk) 

With the introduction of TPH Spectra Universal Composite by DENTSPLY Caulk, dentists now have one material that can be used for all situations. As a result, no longer do practitioners need to struggle with decisions of shading or selecting the material with the most appropriate physical properties. 

TPH Spectra’s characteristics and excellent chameleon effect will provide the dentist and patient with predictable results not only during placement at chairside but for years to come. 

 Since the first resin-based light-cured composites were introduced many decades ago, there have been significant advancements realized in resin and filler technology. 

The first resin-based light cured dental composites were introduced in the 1970s. Since that time significant advancements have been realized in resin and filler technology, and today more than 70 different brands of composite exist on the market. 

Practitioners are faced with ever-increasing composite choices that are designed to give better results during placement and over the lifespan of the restoration.

Today’s clinicians may be easily confused about the subtle differences between the many available composite materials and some find it more difficult to make the correct decision about which material is best for each clinical situation.

Choosing which composite material to purchase can be a difficult decision.  Ideally, practitioners should rely on published reports and a careful review of a product’s physical properties when selecting a material, however, this level of review is generally not realistic for everyday providers.

Dentists’ purchasing decisions may be based on cost, brand preference, and the “works best in my hands” argument, rather than a strict review of each product’s fracture toughness, volumetric shrinkage, or other properties.

Clinicians become more confident in their procedures and materials through repetition of use and clinical observations. This is especially true when considering material choices:  exacting use of poorly selected materials will not offer better clinical results than use of ideally chosen materials.

To simplify decision-making and to offer a composite that can ensure excellent performance in all clinical situations, DENTSPLY Caulk has introduced TPH Spectra Universal Composite.

This new composite is based on the resin technology of TPH3 and contains nanohybrid- and micro-filler components. The result is a composite that has the potential to perform well in either the anterior or posterior, and should have tooth-like translucency, improved polishability and color stability, and good wear resistance.

TPH Spectra also comes in two handling choices:  a creamy light-viscosity formulation, and a packable high-viscosity formulation. For both viscosities the physical properties are similar. Because handling preference is subjective and highly individualized, practitioners are now able to select the right viscosity for all clinical situations.  

To make shade selection simpler, TPH Spectra is available in the seven most popular shades:  B1, A1, A2, A3, A3.5, A4, and C2. According to DENTSPLY’s internal data, the seven shades of TPH Spectra represent more than 80% of total sales from the previous TPH3 formulation.

The TPH Spectra shade guide was condensed for several reasons. First, some practitioners may be overwhelmed with the number of current shades; the Vita Classic (Vident) shade guide has 16 shades, and the TPH3 shade guide has 26. Because only seven of the current TPH3 shades are regularly purchased, the color difference (i.e., Delta-E value) between shades was calculated to determine if a top-seven shade could be used in place of another shade not offered.

TPH Spectra also offers excellent color blending between restorative materials and natural tooth, often called “the chameleon effect.” Again, building and improving from the previous TPH3 composite formulation,

TPH Spectra has a refractive index that falls directly between enamel (1.63) and dentin (1.54).

 Because of TPH Spectra’s excellent translucent properties and an appropriate refractive index similar to natural tooth structure, it will have an excellent chameleon effect and create undetectable restorations.

Intraoral exam reveals a cavitated lesion on the disto-facial surface of tooth No. 8 

. The patient was experiencing no pain but was displeased with the esthetics of the tooth. After verifying the medical history and reviewing the radiographs, a direct composite resin restoration of the disto-lingual-facial surfaces was treatment planned.  

Anesthesia was achieved with one carpule of 2% Xylocaine

 with 1:100,000 epinephrine via buccal infiltration. Caries excavation was completed using a 330 carbide bur on a highspeed handpiece and a #4 round bur on a lowspeed handpiece. 

The preparation was verified caries-free with Snoop caries detector (Pulpdent Corp.)

.  A facial bevel was placed with a football shaped diamond bur to increase retention and facilitate shade matching and blending.