John Flucke, DDS, is in private practice in Lee’s Summit, Mo. He also serves as chief clinical editor and technology editor for 

® and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.

John Flucke, DDS

has a section devoted to coverage of the 2024 Cellerant Best of Class Technology Awards. You’ll find a full listing of the winners along with descriptions of the products as well as some reasons from the panelists on why they voted as they did.

However, you may be asking yourself, “Why does one more dental award matter?” and I’d like to take some time this month to explain just that. After all, there are several awards given out in the profession each year, so why are the Cellerant Best of Class Technology Awards special? Allow me to explain.

The program began back in 2009 when Cellerant Consulting Group founder and CEO Lou Shuman, DMD, CAGS, had a vision for an award to provide recognition to companies that were developing leading-edge products for the profession. Originally it was called the Cellerant Best of Class Technology Award, and the focus was tech centric. However, shortly after the award’s inception, the group quickly realized that there were many other companies and products that deserved recognition for cutting-edge materials and devices that fell outside of the technology category. This gave birth to the current wide scope of product considerations.

The panel is composed of prominent technology leaders in dentistry. They are Dr Shuman, Paul Feuerstein, DMD (editor in chief of 

), Pamela Maragliano-Muniz, DMD (chief editor of 

), Marty Jablow, DMD (“America’s Dental Technology Coach”), Chris Salierno, DDS (chief dental officer of Tend), and myself.

As both technophiles and doctors, the panel members approach the voting process by considering what we would purchase for our practices to help give our patients the best care and best results possible. By putting ourselves in the shoes of the doctors who benefit from our selection, we hope to help the profession and the patients we serve.

The awards require a rigorous nonprofit, impartial process and that is exactly the way it happens.Every year the panel meets to talk about products that have impressed them. There are no guaranteed categories, ensuring the panelists are free to bring up any product they feel has made or is poised to make a significant impact on the profession. Each product is discussed and debated. Not all nominees win, even if they are the only product considered for a category they cover.

Occasionally a product from the previous year continues to impress and again is recognized with an award. This lets the industry know that the product has still met expectations and has a track record of success.

Throughout the year, the panelists scour the dental landscape to find products to discuss.Some of them are from companies with a major industry footprint, while others are from small start-ups that are just beginning to find their way into the dental landscape.

Occasionally a panel member has some type of relationship with a company that might cause a bias. These relationships are disclosed to the panel and that person removes themselves from the discussion. This process helps ensure that the winners are not determined by any type of financial consideration.

We hope to increase awareness of products and devices that can make an impact for dental practitioners. Doctors need to make the best decisions possible to ensure they provide the best possible treatment and do so in a way that helps ensure their profitability. To do that, doctors need a trusted and unbiased source of information that can aid in their purchasing decisions. “Expert opinions” always appear high on lists of how doctors make their buying decisions, and the goal of the awards is to offer information that doctors can depend on to help them in that process. Marketing is a part of life, but it shouldn’t be the sole determining factor for a purchase. Doctors need input from other professionals to help them make decisions that are right for both their practice and their clinical needs.

, please take some time to review the winners of this year’s Cellerant Best of Class Technology Awards. You can do so with the confidence that these products are truly reliable while providing the best outcomes currently possible. I can assure you that the panel takes our selection process very seriously so that you can take them seriously as well.

You may just find a product or device that can change your office for the better. We sure hope so. That’s always our intent as we put the list of winners together.

Articles

Chief dental and technology editor John Flucke, DDS, gives an in-depth look at the annual Cellerant Best of Class Awards, from their history to the decision-making process.

Why the Cellerant Best of Class Technology Awards Matter

To kick things off, I have some questions for those of you who have been in practice 10 to 15 years or longer. Do you miss the darkroom? Do you miss having to dispose of all the chemicals properly and paying for a hazardous materials disposal company to remove them from the office? Do you miss waiting 5 minutes for a film to spit out of the processor while running 30 minutes behind on a complex endodontic case? How about films getting stuck in that processor and disappearing until the next time someone cleaned the unit? Yup, I don’t miss that either. I started using digital radiography in the early 2000s, and when I built my new office in 2007, the architectural plans didn’t even include a darkroom. I don’t pine for those days, and I’m sure you don’t either.

The other thing I did when designing the new office was to make the lab area considerably smaller. I gladly admit that I gambled a bit by doing that. However, I did it with a little perspective on the future. I had been using in-office CAD/CAM for a few years but had stepped away by 2005. At that time, I wasn’t getting the fit and feel I got from lab-fabricated restorations. Yet even though I was back to taking analog impressions, I was pretty sure I knew where the industry was headed. Fortunately, my gamble paid off. One year after moving into the new office, I brought in the original Cadent iTero system, and we were going to digital impressions rather quickly.

I bring up all these old stories because I want you to know we are on the brink of another wholesale change in the dental industry. 3D printing is about to do the same to dentistry as digital radiography did. In the not too distant future, we will experience another digital workflow that will change dentistry for the better––much better. For most of 2024, I have been immersed in the world of 3D printing, and I think it’s time you learned more about it.

Some of you are saying, “Flucke, 3D printing has been around for 5 or more years and hasn’t caught on. What’s the big deal now?” My answer is that a lot has changed since we first saw 3D printing in dentistry. The best example I can give is to look at artificial intelligence (AI).

I don’t think many will argue with me that 2023 was the Year of AI in Dentistry. AI seemed to come out of nowhere. Several companies had released dental products in 2022, but in February of 2023, ChatGPT was suddenly a huge news story. The press coverage of AI was immense, and suddenly AI was of interest to everyone. However, the tech had been in development for years. While it seemed to emerge out of nowhere, in reality it had been building slowly under the radar for over a decade.

 The Carbon Gen2 aligner solution was launched last year. | Image Credit: © Carbon, Inc

We are seeing a very similar situation with 3D printing. It has been around in dentistry for 5 to 10 years but has had limited scope. But trust me when I say that the next 12 to 18 months will see a major shift in our workflows as this tech goes more mainstream.

The proliferation of intraoral scanners is one big reason. At least 30% of offices now have a scanner, and surveys indicate that for those who don’t, purchasing one is high on their list of must-haves. We have 2 scanners in our office, both used multiple times a day. Not only the doctors but also the hygiene team use them.

Many offices now include a full mouth scan in their new patient intake process. That means a large percentage of offices are moving in that direction. Yet even with scanners becoming increasingly intrinsic to what we do, many offices still take physical impressions for various services other than fixed prosthetics. If a patient comes into the office and has a full mouth scan but also wants to undergo at-home whitening, many offices pull out alginate, pour the impressions, and then create the trays with a vacuum-forming device. In the sense of a totally digital workflow, that is like confirming an appointment by fax. Once the scanner digitally captures the patient data, having a digital solution just makes sense.

However, that digital solution must be simple, which brings us to the other part of why 3D printing is poised to change dentistry significantly. Until recently, designing anything produced by a 3D printer was cumbersome and complicated to learn. The companies that make these amazing pieces of hardware quickly realized that a busy office has trouble integrating any technology with a significant and challenging learning curve. No one wants to have to open Adobe Photoshop and spend 30 minutes editing just to post a photo on Instagram. The 3D printing companies quickly came to the same conclusion and set about creating design software to allow quick, easy, and reliable processes to generate the majority of projects a dental office might require.

These software solutions are available now and have essentially solved that problem. Many are cloud based, which simplifies things even more. Cloud-based systems update independently with no user intervention required and back up projects every step of the way. All the office needs to do is upload the STL files from the scanner and select the project required. The system then walks the user through the process.

Let’s use a bleaching tray as an example. The upper and lower arches are uploaded, the “bleaching tray” option is selected, and the user creates the reservoir area by drawing the proper shape on each tooth. The system then proposes a margin for the tray that the user can edit by simply clicking on it and dragging it to the desired area. When the design is completed, the finished project appears on the screen so the user can be sure it is exactly what they want. Many of these design programs integrate AI into the design, so the design process is often a matter of just clicking “next” and moving to the next step. I am really excited about this, and you can expect these systems only to get smarter as they continue to get feedback from users and the software engineers improve these already intelligent platforms.

The finished project is then downloaded and loaded into the printer’s “slicing/nesting” software. This software shows the user the appliance’s position on the printer bed. Once confirmed, the software converts the STL file into a language the printer understands, and the project is printed.

This cloud-based software makes it easy to integrate dental 3D printing into day-to-day work at your dental clinic or laboratory. | Image Credit: © DMG America

The design project I just described takes only a few minutes. The advantages are quite clear when you think about the analog process (and mess) of making an impression, pouring, trimming the model, blocking out for the whitening agent, heating and vacuuming, and trimming the tray. Of course, one of the other great advantages of having a digital design is that if the patient loses their trays or their pet destroys them, making a new one is as easy as pushing a button. (By the way, are you as amazed as I am at how often pets chew up dental devices?)

The project is printed using a liquid resin––and hundreds of resins are on the market. Thus, no matter what type of project you need, chances are there is a resin that will meet your needs. You can create bleaching trays, soft and hard occlusal guards, orthodontic retainers, surgical guides, models, dentures, and more.

The other thing the slicing/nesting software does is add supports to the project. These are necessary to help build the project. The resins are liquid and, like composites, are light cured. The printer builds the projects in layers, again similar to composites. Because the printer cures the projects in layers, supports are needed to ensure printer accuracy. The supports are tiny cured bars that stabilize the resin. When the project is completed, it is removed from the printer with the supports attached to it.

The project is then placed in a wash station that circulates isopropyl alcohol, removing any remaining liquid resin. Once the wash is completed, the project is put into a curing station, essentially a box with high-intensity LEDs on all sides. The project then goes through a set “postcure” time to ensure a total and complete cure. Once the postcure stage is complete, the supports are removed, and the project is polished.

3D printers are incredibly precise, with many having an accuracy of 50 µm. That means pairing an intraoral scanner with a 3D printer gives results that meet our profession’s extremely high demands. When I first began using the iTero back in 2008, I immediately noticed how much faster our crown seat appointments were. The tech was precise even nearly 2 decades ago, but I hadn’t expected that much precision. Of course, the current generation of scanners has only got better. (Since 2008, Align Technology’s iTero systems have made even greater strides, and other manufacturers have developed high-quality scanners that give clinicians numerous choices to find the solution that best fits their practice.) The combination of scanner and 3D printer offers serious advantages over analog systems. Your in-office lab will soon be used for fewer and fewer things.

Many of you will have noticed that I haven’t mentioned permanent crowns in my discussion and may be wondering why. I want to state my feelings on the subject for the record. My opinion is based on a couple of factors. The first is that I have an in-office mill. In April 2022 we installed a DGSHAPE DWX-42W mill, producing fantastic results. The main materials we use are presintered zirconia and prefired lithium disilicate. These materials eliminate the need for an oven and are ready to cement after being polished. Both materials have a long track record of clinical success, and I am incredibly confident in their long-term viability.

is a light-cured resin for 3D printing of highly esthetic long-term temporaries. | Image Credit: © VOCO America, Inc

The second factor is that resins for 3D-printed crowns don’t have that same track record, which is why I am still not printing permanent crowns personally at this point. I realize some people are, and I have no problem with that. As I already have an in-office solution that works well for me, I am still watching and evaluating this permanent crown aspect. I have no doubt that someday soon, this will become a viable option for all of us. I have been practicing for a while, and over those years I have occasionally pushed the envelope with materials. Some of those decisions have been ones I regret. I have redone cases because a new material has fractured or not held up, and I admit those experiences have affected how I view crown materials. We all have our biases, and I want to be sure you understand mine. If you are currently printing crowns and having success, I would love to hear more about your experiences.

Other than anything permanent, I am all in on 3D printing. I am a big fan of how the manufacturers approach this. There are so many everyday applications for this tech, and I appreciate that those companies have noticed this. There is no need for a patient to wait 2 weeks or more for a slam dunk occlusal guard or anything else that can be easily created in a day in the office. I can envision a patient being diagnosed as a candidate for implants and having the guided surgery performed the very next day. The process is now that simple.

I am also excited about 3D printing to help with full arch or full mouth reconstruction. One of the most difficult things we do is correctly open a collapsed bite. With the right design software, those cases can be created digitally, and the temporaries fabricated on a 3D printer. If you place the 

3D Print Resins and Technology Are Always Evolving

Dental manufacturers appear to be launching new 3D printer technologies and advances in materials every week. The capabilities of 3D printing resins are constantly expanding, and companies are regularly introducing digital workflows with a focus on quick, efficient 3D printing solutions.

To stay on stop of this evolving field, visit 

temporaries and the next week determine that the vertical needs to be changed, you simply correct it in the software and print new temporaries to the corrected vertical. If a fractured temporary occurs, reprinting a new one is a simple process. The same can be said of dentures. If a patient drops one and it fractures, printing a new one is straightforward. I’ve even heard of doctors providing 2 dentures at delivery so the patient always has an identical backup if disaster strikes.

Get ready. 3D printing is going to change our profession, and I believe the change will happen quickly. After my deep dive into 3D design and printing this year, I am confident we will see some profound changes in the near future. If you have invested in companies that make plaster and stone, now might be a good time to put that money to work for you elsewhere. If you are thinking of building a new office or new office space, I would think about where you can better use the space you might have been considering for your large in-office lab. Square footage is expensive, and you might not need as much room for that lab as you thought.

I sometimes think about the days when I would watch a talented dental assistant squeeze equal lengths of an impression material out of 2 tubes and mix it to a perfect consistency with a spatula before loading my syringe and then loading the tray. I don’t sigh longingly and think, “Ah, the good old days.” Instead I think, “I can’t believe we ever did it that way!” Soon we will feel the same way about mixing stone, pouring impressions, and trimming models. Imagine the possibilities.

3D printing technology is the next big thing, and we are going to experience another digital workflow that will change dentistry for the better sooner than you think.

3D Printing: Bigger & Better

Video Test Drive: KaVo DIAGNOcam Vision Full HD from KaVo

Videos

Dental Products Report Chief Clinical Editor and Technology Editor John Flucke, DDS, gives a hands-on explanation of why the KaVo DIAGNOcam Vision Full HD imaging solution works efficiently and effectively. [6 minutes]

Over the past 20 to 30 years we have seen tremendous improvements and advantages in increasing our ability to visually educate our patients. Intraoral cameras meant that for the first time, patients could see their oral health conditions and better understand our explanations of our diagnoses as well as the solutions we offered.

Better information leads to better decisions and better outcomes in dentistry. It’s important that doctors gather and maintain as much information as possible.

That’s why I’m so excited to be able to tell you about a new device from KaVo that not only increases our visual communication, but also provides critical diagnostic information that previously has been difficult to share with patients. The device is called the KaVo DIAGNOcam™ Vision Full HD, and it is impressive.

The KaVo DIAGNOcam Vision Full HD allows the dental team to capture intraoral photos, transillumination photos, and caries fluorescence photos all with a single device. Up to this point, these images were challenging to acquire. It required different devices with separate computer inputs capturing each image separately. Acquiring all of those images required a serious amount of time, if the office even had all 3 imaging capabilities in the first place.

Into this realm comes the KaVo DIAGNOcam Vision Full HD, which can acquire 3 diagnostic images with 1 device. You can place the device over a tooth and, with the push of a single button, acquire an intraoral photo, a transillumination photo, and a caries fluorescence photo within a second or 2. The entire mouth can be captured and recorded in 2 to 3 minutes by an experienced user.

We all know the value of a good, clear intraoral photo for communication with patients as well as for diagnosis and recordkeeping. Most offices use an intraoral camera multiple times a day.

Despite their usefulness, intraoral cameras can suffer from some problems and limitations. Most have a set focal length, which means it might be easy to capture a single tooth, but images from farther away or outside the mouth are blurry or have a fisheye effect that distorts the images.

KaVo built in a constant autofocus that instantly brings things into focus and renders them without distortion. You can easily take a photo of a second molar and then take a full-face extraoral photo a moment later, and both images are rendered perfectly with no distortion. Simply point the camera at the target, and it is instantly in focus and ready to capture. Whether it’s a single tooth, a quadrant, a smile, or full face, this device does it all.

The KaVo DIAGNOcam Vision Full HD captures precise and clear high definition images. These crisp images allow both the professional and the patient to see amazing amounts of detail.

Most offices using transillumination are doing so with small bright lights utilizing visible white light. They are like tiny flashlights that can be placed to illuminate the interproximal area. The problem with this approach is that because they are bright by design, the light pollution often makes things hard for the doctor to visualize clearly.

The second problem is simply sharing what the doctor sees. Because a flashlight doesn’t take pictures, the doctor has to share their findings verbally, and that brings us back to the fact that only 10% of our perception comes through the ears.

The DIAGNOcam Vision Full HD uses near-infrared (NIR) illumination instead of white light for this process. In the product photos, you can see what appears to be 2 small arms on the device. These arms go over the tooth to embrace it from the buccal and lingual aspects, and they contain fiberoptics that deliver this NIR from both sides of the target tooth. NIR harmlessly penetrates the tooth more effectively than white light and with no light pollution. These images are just as clear as the intraoral ones, and they can be shared with the patient to explain the findings.

Transillumination is a great tool for finding lesions too small to be found on x-rays. It’s a tremendous tool for early diagnosis, pediatrics, and pregnant patients. It is also a tremendous tool for monitoring remineralization therapy.

Transillumination is also a useful tool for locating cracks in teeth and decay under sealants and restorations. Conservative doctors will find this device a wonderful adjunct for their patients.

The third function the device delivers is fluorescence imaging. The bacteria that cause decay create a metabolic byproduct that glows (fluoresces) under certain wavelengths of light. The DIAGNOcam Vision Full HD has LEDs that emit these wavelengths.

The image created by this wavelength causes healthy enamel to have a light-green color, similar to the skin of a green apple. Areas of active caries glow with a red color, allowing for quick identification of their presence.

Simply put, if there are no metabolic byproducts, there are no active cariogenic bacteria. This also allows doctors to find and treat caries at their earliest stages as well as allowing for active monitoring for doctors using remineralization therapy. Comparing images taken over time can give a much better indication if lesions are progressing or shrinking.

If lesions are found when small, restorations can be small and potentially done with no anesthetic while preserving tooth structure. Being able to find active caries early also helps prevent the placing of a sealant over an area of active caries.

The device can also be used during restorative procedures to ensure all active caries are removed before placing the final restoration.

The KaVo DIAGNOcam Vision Full HD is an amazing device. Not only does it provide high-quality images in all modalities, but it also streamlines treatment. The efficiency of gaining all this information in a short amount of time means that offices can obtain more diagnostic information than ever before and still maintain the efficiency of a digital workflow.

I’ve found it to be a valuable addition to my office, and I highly recommend giving it a look. For offices looking to improve their diagnostic accuracy while maintaining efficiency, this is a device that should be considered. KaVo has a long history of delivering high-quality equipment and devices for the profession, and the DIAGNOcam Vision Full HD is a great addition to their product line. I’m confident you’ll be as impressed with it as I am.

This three-in-one intraoral imaging solution is designed for efficient diagnostics and documentation.

See It All With the New KaVo DIAGNOcam Vision Full HD								

The Dangers of the Status Quo | Image Credit: © Michael Brown - stock.adobe.com

I’ve seen a lot in my years in this profession. I was lucky to have entered dentistry at the time I did. I love change, and I have been fortunate enough to see a lot of them in my career. There are always better ways to do things. Those processes are out there just waiting to be discovered or uncovered. Like valuable minerals trapped inside a mountain, they just take a spark of motivation and a lot of digging to get to the gold.

Younger doctors will probably laugh when they read this, but in my first couple of years in practice, I charted with a red and blue pencil on a paper chart. We used film and a chemical processor to take radiographs, and when they were dry, we would put them in a small coin envelope and write the date on the outside of it. My procedural chart notes were written by hand, and I was sure to use ink so there was no way they could be edited. I had to print when I wrote up notes, because my cursive is so abysmal that sometimes even I can’t read it. I didn’t have time to write up those notes during the day, so at the end of the workday, I would spend approximately 30 minutes at my desk doing my notes.

Those days were long, and looking back, they seem so tedious. Of course, at the time, they didn’t seem that way. Simply put, I didn’t know any better. That’s just the way it was, and I slogged along blissfully unaware of how great the future would be. So this month, because the focus of this issue of 

 is our Tech Census, let’s take a look at 4 things you should be using at this point along the dental timeline.

The things I’m mentioning here are what I think you should be using at minimum. I understand that acquiring and integrating technology requires an investment in capital and time, so my recommendations here are for things that have been available for a while, are easy to use, and won’t put a huge dent in your operating revenues while enhancing productivity and giving you better clinical outcomes.

I’m sensing some eye rolls here, so please bear with me. I was peer review chair for the state of Missouri for approximately 25 years, and I also do expert witness work in the malpractice space. Because of my work in these areas, I’ve seen a lot of dental records in my career. I was constantly amazed by how many doctors were still using paper in their recordkeeping. Something to keep in mind if you ever end up in litigation: Perception by a jury is tremendously important. If your records look sloppy and unorganized, people may be inclined to assume the doctor is sloppy and unorganized, whether that’s true or not. I’ve also read records where the handwriting was worse than mine, and that is saying something. If your records cannot be understood, are sloppy, or are minimal, they could come back to haunt you.

Keeping all your clinical notes and charts digital is a tremendous time saver. Nothing is illegible, it’s hard to lose things, everything is in sequential order, and clicking a mouse is inordinately easier than coloring with that red and blue pencil. Knowing that charting, periodontal probing, and notes are instantly available and easy to use makes your day easier and less stressful.

American Dental Association statistics state that 90% of doctors are currently using digital radiography. That’s great news to me. My question is, why are there around 10% who are still holding out?

For those doctors, I have one thing to say. The 1990s just called, and they want their film back.

In all seriousness, in all my years talking with my peers, I’ve never had one person tell me that they got rid of their sensors and went back to film. Once you go digital, you’ll wonder why you waited so long.

Add to that the explosion the industry has seen with artificial intelligence (AI) in radiographic analysis. The number of users increases every month, and the more radiographs these systems see, the smarter and better they become. Of course, digital radiographs are necessary to use AI, so that’s one more reason to make the change from film. For those of you who are already on board with digital, you should be considering which AI system you want to implement.

For those of you who read this column regularly, you know how passionate I am about communicating visually with patients. It’s much easier for patients to comprehend their problems and understand treatment recommendations if they can see what those problems are.

The great news in this area is that the prices of intraoral cameras have fallen significantly in the past 5 to10 years. This allows the office looking to provide an image to use as a focus of communication with patients to purchase a camera for a few hundred dollars.

Two examples of very affordable intraoral cameras are the MouthWatch and the Shofu EyeCam. Both connect to a computer via a standard USB cord and are incredibly portable. However, the prices of these devices are low enough that buying a camera for every operatory can be accomplished without breaking the budget. The last time I checked, these 2 cameras were both under $300.

For offices that perform a lot of cosmetic or full-mouth reconstruction treatment, there are several cameras that provide stunning images in the higher price range. Every doctor has different wants or needs. The takeaway is that you should have an intraoral camera and use it regularly.

This is another product category that has seen amazing progress coupled with astounding price drops since the product first came to market. It’s incredible to me that when I was a kid, lasers were things only superheroes used, and now I pick one up every day. When I bought my first laser, it cost approximately $35,000 and was approximately the size of a 2-drawer filing cabinet. Today, a laser with similar power and settings can be purchased in the same form factor as a powered toothbrush for less than $5000.

Lasers can make everyday operative and surgical tasks easier and faster. One of the best things about them is that laser wounds heal incredibly fast and with minimal, if any, postoperative pain. They also rarely require sutures, even for large areas. A diode laser has an affinity for hemoglobin, which creates immediate hemostasis. This allows the doctor to work in a practically bloodless field. Being able to see the field while reducing the need for chemical hemostatic agents and sutures means more clinical efficiency, fewer postoperative visits, and fewer postoperative calls from patients.

Although retraction cord is still an option, I rarely use it anymore. I can create clear, clean views of my margins in approximately 1 minute using a diode laser and sometimes by adding VOCO Retraction Paste into the mix.

Diode lasers are a critical part of my clinical armamentarium. A day rarely goes by when I don’t pick one up for a procedure. When you consider the tremendous benefits, ease of use, and low price tag for many of these units, it’s hard to find a reason not to own one.

Let’s take a quick look at some technologies with either less time on the market or a higher price tag. If you already have the 4 things I discussed previously, this is where I’d direct your interest.

I won’t cover this in-depth because I’ve written on this subject recently. Let me just state that this is a technology that is now ready for prime time. Users are finding AI critical to help increase diagnostic accuracy and productivity. Having an objective “second opinion” always available to point out areas of interest is a game changer for the profession. As more features are added by the vendors and the products mature, they will continue to be game changers for doctors who embrace them.

This is another product category that has seen amazing progress in both features and lower prices. At this point, there is a scanner for every budget. Many offices, mine included, cannot imagine being without it.

Add to this the fact that an intraoral scanner is the entryway to a truly digital workflow. If you have not yet purchased a scanner and are looking to improve both your workflows and your clinical outcomes, this should be on your short list of technologies to invest in.

The devices can be used for fixed and removable prosthetics, orthodontics, diagnosis, and even hygiene, making them universal must-haves for practices. This is a technology that has a model with the right features for any office, no matter the budget. They save time and improve clinical results, and patients are fascinated by the technology.

Whether you are interested in same-day dentistry, improving results, or controlling costs, in-office milling has something to offer you. Today’s mills can create results previously thought to only come from a skilled laboratory technician with years of experience. We installed the DGSHAPE DWX-42W in our office more than 2 years ago, and I am still amazed at the results it creates.

When you combine the results with the lineup of materials you can select for your patients, in-office milling has tons to offer. The materials have a proven track record of success. That means that things you mill today have the longevity you expect from something created in a laboratory. There is also the fact that many laboratories are now milling most of their restorations. That translates to having the quality of materials you can purchase for your office match that of the same materials being used by dental laboratories around the world.

Milling in our office has improved efficiency, which our patients love, and given us the results we demand as clinicians.

Behold the next wave in the world of dental technology. The next 18 months are going to see in-office 3D printing take the industry by storm. For the past 3 to 4 months, I’ve been up to my elbows in the world of 3D printing, and I can tell you that from what I’ve seen behind the curtains, you are going to be thrilled.

Workflows are going to be changed for the better as we eliminate steps in our processes that are rapidly becoming unnecessary or redundant. Cloud-based design systems that use AI to help create all kinds of dental devices are on the horizon. Imagine diagnosing the need for an implant on Monday morning and performing the placement on Tuesday morning with precision and confidence and with a guide printed to your specifications right in your office. Then imagine placing a transitional removable partial with the pontic custom-designed to create the tissue contours exactly as you, the doctor, want them—also printed in your office.

Plaster and stone will rapidly become “remember when” materials as we move to virtual design using models that exist only in the design software. Occlusal guards, bleaching trays, interim partials, full dentures, and more will be delivered, sometimes within hours, to happy patients.

Our profession has become a moving sidewalk of progress. It seems that the only way to make sure you stay current is by constantly moving forward. Of course, I appreciate the fact that offices are always walking the tightrope of investment in technology vs maintaining profitability. However, in my career, I’ve seen doctors wait too long to pull the trigger. By not embracing the future, doctors are often overwhelmed by how much it will cost to invest in several new things at once. The best way to avoid this is to implement a policy of a technology budget. This allows you to set aside a specific amount of money every month knowing that at some point, those savings will be used to bring in new technology or to replace legacy systems.

The good news is that technology can decrease stress, streamline workflows, and give you amazing clinical outcomes. If you have not yet implemented the 4 must-haves I listed here, I highly advise you to do so. Then implement a technology budget and begin the process of saving to invest in even more cutting-edge products.

I’ve been lucky enough to have lived through this tremendous time of advancements in dentistry, and my perspective tells me that things are only going to get better. Even though I’m closer to the end of my career than I am to the beginning, I believe I was born right on time. See you next month.

Doing the same thing the same way will never move your dental practice forward.

The Dangers of Status Quo

With new and innovative approaches to dental treatment and practice management being introduced all the time, dental professionals face a challenge when it comes to trying everything and staying up to date. Fortunately, no dental professional faces this challenge on their own. Learn and stay on top of the latest in dentistry with this annual collection of advice from across the industry.

Smooth Transitions

A New Twist on an Established Material

Use Tints to Elevate Single-Shade Composites to High Esthetics

No more “Watch & Wait” with Silver Diamine Fluoride

How best to advance care for treatment of dental hypersensitivity and promote dental health

A New Adjunct Treatment for Periodontal Infections

Achieving Optimal Marginal Integrity With a New Lithium Disilicate Block

Increase Clinical Efficiency With Two Instruments in One Hand

Point-of-Care Testing for Personalized Patient Care

What I Wish Every Dental Professional Knew About Whitening

Unlock Workflow Efficiency by Optimizing Suction Line Health

Making X-ray Aiming Easy

Enhance Your Oral Health Assessments With Fluorescence Technology

Esthetic Enameloplasty With Clear Aligner Treatment

Streamlining Care Through Wireless Innovation

Revolutionizing Case Acceptance and Financial Management in Dental Practices

Instrumental Precision Redefined

Invest in Cutting-Edge Dental Management Software to Transform Your Dental Practice

Increasing Restoration Accuracy With Chairside Milling

Automate Your Front Desk Workflows and Improve Efficiency

Finding the Perfect Mix to Help Perio Patients at Home

Technique Touch-Ups 2024

Dental professionals throughout the industry share their favorite new workflows, technologies, materials, and more.

AdDent’s Compex HD features a warming unit built into the barrel that heats the composite compule in the gun. | Image Credit: © AdDent 

In my years of being Technology Evangelist, I have gotten to work with some amazing products and collaborate with some amazing people. As an industry, we are lucky to have these individuals in the world of research and development. We count on them to deliver us state-of-the-art tools, supplies, and materials that allow us to do better in helping patients.

Dentistry is a huge industry. Because of that, we benefit immensely from all types of companies that support us. Large multinational companies, medium-sized operations, and smaller companies provide us with things we use every day that improve the lives of our patients. As a tech lover, I see and use the benefits of all types of their hard work. This month, I would like to highlight one of those smaller companies that gives us big benefits. That company is AdDent in Danbury, Connecticut.

The company was founded by Josh Friedman, DDS. He is one of those individuals who quietly work behind the scenes, but we all benefit from what he has created. I do not remember the first time I met him, but what I do remember was realizing he is an “outside the box” thinker.

One of his great advantages is that he is a dentist. That allows him to understand the unique things we face clinically every day. However, he is not just a dentist. This bright individual is also an electrical engineer with a bachelor’s in electrical engineering that he earned at City College of New York in 1959. After earning his degree, he embarked on a career that spanned working on intercontinental ballistic missile (ICBM) guidance systems, being a research scientist at the New York University College of Dentistry, and founding 3 companies: Demetron Research Corp, the first company to introduce an efficient handheld curing light; Electro-Lite Corp, a manufacturer of powerful UV lighting systems for industrial use; and his current company, AdDent.

Those of you practicing in the late 1990s probably remember the Demetron curing lights that were incredibly popular then. After selling Demetron to a large dental manufacturing company in the early 2000s, Dr Friedman’s next dental manufacturing company was AdDent, which he continues to run today.

I mentioned that he is an “outside the box” thinker and that is borne out by the fact that he hasover 30 patents with more pending. He has also been given the moniker “the da Vinci of dentistry” due to his creative problem-solving. He has a real knack for developing “better mousetraps” for the profession.

I recently asked him about his time working on missiles, and this is what he had to say: “My first job out of engineering school was with a company that made the guidance system for the Atlas ICBM…precursor to the Minuteman missile. These missiles are in silos throughout the West and Midwest. I was then faced with an urgent and unusual challenge—to find out why the guidance memory was defective. In the event of a launch, the ICBMs could go anywhere. It turned out that the epoxy coating on the memory boards was shrinking during polymerization and causing critical components to crack. As I reflect on that experience, I think of how directly it relates to dentistry in the way we formulate and manage composite filling materials to reduce shrinkage.”

After solving the problem with polymerization shrinkage on missile guidance systems, he applied those lessons learned and his problem-solving skills toward the issues with composite shrinkage in dentistry. That led him to become a leading advocate of warming composite before placement and curing to help reduce polymerization shrinkage. When the curing light is applied, composite has a natural tendency to shrink, which can lead to cracks in the healthy tooth structure as well as gaps in the restorative margin. This leads to recurrent caries. Studies have shownwarm composite has fewer voids and less marginal gap formation.

Under his guidance, AdDent developed the Calset Composite Warmer. This is a device that uses alternating current power to warm the material before placement. It consists of a base that creates heat as well as a variety of trays that can be placed on top of the base to warm things such as composite compules, composite syringes, operative instruments, anesthetic cartridges, and even veneers and crowns (to warm them before final cementation).

Not resting on the laurels of Calset, AdDent decided to take composite warming to the next level and recently created the Compex HD, a composite-dispensing gun. Most companies sell composite-dispensing guns, but they are usually throw-in products made of inexpensive plastic that do not work very well.

AdDent’s Compex HD has a warming unit built into the barrel that heats the composite compule in the gun. You place the compule in the gun, push the “on” button, and in 30 seconds the compule is heated to 155 °F. The heating element is under the compule and well insulated so that any part that touches the patient stays cool. Once activated, the device continues to warm the composite for 10 minutes before automatically shutting off. It has a rechargeable battery that allows use with 100 compules before needing a recharge.

I use total etch as my go-to technique, so in my workflow, we activate the Compex HD as I begin to place the etchant. By the time I get ready to deliver the restorative, the material is warmed and ready. In addition to less shrinkage, warm composite is easier to place, condense, and sculpt. This device is intrinsic to how I work and is now something I cannot do without.

The latest creation from the mind of Dr Friedman is another interesting and “better mousetrap” problem-solver. In clinical dentistry we are often faced with handling and manipulating small objects that require a sturdy grip as we place them. Veneers and crowns can be small and delicate. When you factor in the luting materials, these can be difficult to hold and place.

In the past I would tell patients, “If, God forbid, I drop this in your mouth, don’t be polite. Spit this out and don’t worry about my reaction. Even if it hits the floor, we can clean it, but if you swallow it, we aren’t going to go looking for it.” That usually elicits a chuckle, so I explain, “The glue we use works incredibly well, but it has the viscosity of maple syrup and the coefficient of friction of baby oil. If I happen to get some on my glove, these things get really slippery, and it may slip out of my fingers.” Although it is a decent way of letting patients know not to swallow anything, it is also a conversation I would rather not have.

To the rescue comes the Vac-Tak. It is a small handle with a suction cup that attaches to it. The suction cup is moistened and used to pick up the prosthesis. Once attached, the luting material is placed, then the Vac-Tak is used to deliver the prosthesis onto the tooth. Once the prosthesis is seated, it is tack-cured and the Vac-Tak removed.

The process is quick, simple, and efficient. The device has 2 sizes of silicone suction cups and I have not come across a crown or veneer that I cannot attach. Both the handle and the suction cups are autoclavable.

Placing a crown on a maxillary second molar is one of the trickiest things I must do. Despite my best efforts, I often get a tiny bit of the luting material on a finger and suddenly the crown is sliding around in my grip like a wet marble. The Vac-Tak has solved that problem as well as the stress that comes with it.

AdDent makes much more than the products I have mentioned here. The company sells a variety of products, including a very good oral cancer screening light called the Bio/Screen. To see all their products, visit www.addent.com.

In a letter to scientist Robert Hooke in 1675, Sir Isaac Newton wrote: “If I have seen further, it is by standing on the shoulders of giants.” As a profession, we in dentistry stand on the shoulders of many giants. We are lucky to have “outside the box” thinkers in our industry.

In my time as Technology Evangelist, I have been lucky enough to meet many of them. As clinicians in the trenches every day, we often do not realize the contributions that many of our own have given us. We truly see farther because of them. I am excited to see what Dr Friedman comes up with next.

The industry is fortunate to have many great minds developing products and techniques that help clinicians perform better dentistry.

AdDent Keeps Delivering “Better Mousetraps”

I hope the title of this article got your attention because that was my intent. We all expect a title like that to use the high price of something, but that is not always the case. Especially when you are thinking about your office information technology (IT) security.

A couple of decades ago I had just finished giving a lecture on taking your office totally digital. As the audience was packing up and leaving the room, a well-dressed and obviously successful doctor walked up to me. At the time, practice operating systems were undergoing many frequent changes. Digital charts were a new thing, and most of the larger software companies were working on ways to integrate digital radiographs directly into their platform.

“How easy is that to do?” the doctor asked. I told him it wasn’t really that difficult but that it depended on the software. I asked him what practice management software he was using. “Heck, I don’t know,” he replied. “That’s the gal at the front desk’s department.” I was a little taken aback by the answer, but honestly also a little irritated by the way he said it.

My response? “You know that beige box with the keyboard and the mouse that sit on your front desk? That’s where all of your money is,” I said. All these years later, that statement is thousands of orders of magnitude greater.

I mentioned this in my April 2024 column. Dentists, as business owners, are always walking a tightrope between money coming in and money going out. Profitability is how we continue to pay our bills. Also, if you cannot stay in business, you can’t help those who depend on you. Patients, as well as our teams, count on us to be there for them.

Every month, doctors are looking at their costs and trying to figure out a way to minimize them while still delivering the best care and best wages possible. Lowering costs and not overpaying are things we look at all the time…and you should.

However, I think that sometimes when we don’t really understand the importance of something, we tend to not understand why it’s valuable. It’s similar to a patient who asks, “Can’t you just do a filing?” when presented with the need for a crown. As doctors, we understand why a filling is not the right choice, but often as business owners, we hesitate to spend money on something when we don’t comprehend its value. IT security in the dental office isn’t a “want” or a “nice to have” item. It is now, more than ever, a 

There are a couple of points I want to make. The first is that security is absolutely critical. I once had a friend ask me, why would anyone want to know that “Mrs Brown had a crown done last March on tooth #30” and why it was critical? I agree that probably no criminals would want to know that. However, what they would like to know are things like Mrs Brown’s date of birth, her address, and her Social Security number…among lots of other demographic information. Once they have all of that, they can very easily perform identity theft and convert that stolen data into ill-gotten gains.

The second point is that your server has become that “box where all of your money is.” If your computer is hacked and your data encrypted, you are now completely dependent on restoring your system from backups. Good backups are critical to success, but even if you have pristine backups, your practice is going to be down until your systems are restored. That is going to mean closing the office for business until your network is back up and running.

That is why I’m such a big fan of DDS Rescue (ddsrescue.com)—they help you continue to operate with all your data accessible remotely and keep the doors open if a problem occurs. Yet, even if you have DDS Rescue service, you are still going to be out the money it will cost to restore your local system, and that can be expensive. And even if you are using a cloud-based system, odds are that you have lots of data that need to be protected on your local network.

Ransomware attacks are common. Tech security company NinjaOne estimates that ransomware attacks occur 19 times per second.¹ Plus, health care ransomware attacks have increased significantly in the past few years. You may have recently seen news of the Change Healthcare attack. That company (which is owned by UnitedHealth Group) paid a $22 million ransom to get their systems back up and running. We also saw a huge data breach at the American Dental Association in 2022, and in September 2023 supply company Henry Schein suffered a massive breach of their system.

I’m sure many of you are thinking that you are just a small fish in a big pond. Why would anyone want to bother with you when there are much bigger fish to go after? The answer to that is part of why I’m writing this column. Cybercriminals know that small health care offices are underprotected and easy targets. It’s much easier to break into systems that don’t have large IT departments tasked with protecting the network. If you are just buying some equipment from Amazon and hooking your office up to the internet, it’s akin to going on vacation, posting it on Facebook, and then leaving your doors unlocked.

If it is easier to get $100,000 from 10 offices than it is to get $1 million from a large company, odds are that the criminals will look for the low-hanging fruit.

If you are still having doubts, let’s talk about getting the US Department of Health and Human Services (HHS) involved. You are required by federal law to protect your patient data. If you have a data breach, you are required to notify the authorities. The HHS Office of Civil Rights is the enforcement arm of the Health Insurance Portability and Accountability Act (HIPAA), and its fines are severe. To ensure that health information is truly protected, severe fines are meted out when breaches happen. In addition to lost income and the expense of restoring your system, you then have to factor in a very large fine.

The next step is to notify your patients, which is also required by HIPAA. At that point, the loss of goodwill and trust of your patients must be factored into this equation. You will also, of course, have to pay for the notification letters and postage, but that is a drop in the bucket compared with all the other problems and expenses you will face.

I feel the best way to look at IT security is through the lens of an insurance policy. We all have malpractice insurance. No practitioner should think, “I’m just a small office and a good doctor; no one will ever sue me.” You also don’t think, “I’m a good driver. I’ll never have an accident.” We have these insurance policies in place because we want to be protected if something bad happens. Of course, we’d save a lot of money if we didn’t pay for those policies, yet we all still have them.

So look at security as a business expense. Put it into your budget. Similar to a percentage of production being spent on wages, supplies, etc, your accounting firm can help you determine what percentage of production should be spent on IT security. Once you know that, you can then get bids and determine the best solution for your individual situation.

There are even health care–specific security companies such as Black Talon Security (blacktalonsecurity.com) that have solutions for dental offices.

This is a difficult subject, but theft and extortion have been around almost since Adam and Eve were kicked out of the Garden of Eden. There will always be a small percentage of the population that thrive on crime. Unfortunately, it’s a reality.

However, planning for the future and the long-term viability of your practice now requires vigilance in the IT security space. You don’t need to be an expert to deal with this. Instead, what you need to do is find the experts and let them do what they do best. In a similar way that patients don’t understand and perform their own dental procedures, you don’t need to understand and implement your own security profile. However, that doesn’t mean you don’t need it. Part of my job as “Technology Evangelist” is to give you the straight scoop on how tech impacts dentistry, and security is having a major impact.

Implement what your experts recommend. You’ll be better off in the long run, trust me. See you next month!

1. Crowe J. Must-know ransomware statistics, trends and facts. NinjaOne. Published March 18, 2024. Accessed April 8, 2024. https://www.ninjaone.com/blog/must-know-ransomware-statistics/

With cybercrime flourishing, you need to protect your network and data. Try viewing it as a business expense.

The Low Price of  Office Data Security

Oh, the things I’ve gotten to do in my life!Some have been a result of dumb luck, being in the right place at the right time—like catching that foul ball at a Royals game about 10 years ago. Yet some of the best things that have happened in my life were simply being faced with an opportunity and thinking: “What the heck? Take some chances.”

In the fall of 2017, long before we even thought a pandemic could happen, I was browsing my Twitter (now called X) feed and being a geek, I follow a lot of National Aeronautics and Space Administration (NASA) feeds. On that fateful day I saw a post stating that they were looking for people with a love of NASA and a social media following/presence. The offer was to apply for a special program that would allow those lucky enough to be chosen to come to Kennedy Space Center in Florida and witness a rocket launch while continually posting to their social media channels about the experience.

Now, I’m no social media guru. I don’t have tons of followers. However, I immediately thought: “What the heck? The worst that can happen is that they say no and I get to tell people NASA turned me down.” I mean, in my geeky mind, even a rejection from NASA was something to crow about.

Six months later, on April 2, 2018, I was getting a full-blown tour of the Kennedy Space Center and all the tech glory it contained. Then I stood in the press section and watched SpaceX launch a Falcon rocket to the International Space Station. I was as close to that launch as NASA deemed safe, and let me tell you, the shock wave that came off that thing hit me in the chest like a full-volume Led Zeppelin concert. It was magnificent and awe inspiring.

So what does this have to do with dentistry? Simply put, many of us in the profession are sticklers.We find something that works and we tend to stick with it—sometimes way longer than we should.In the days before digital impressions, I used to tell salespeople the hardest thing to do was to get a doctor to change their impression material—and that was so true.

However, change is good. Bluntly put, change works. Dentistry is a high-burnout profession. Not many people hang it up early, but a lot of us struggle mightily in clinical practice. Like baseball, we go through slumps and streaks. Sometimes you get a phase where it seems you can do no wrong.Patients get numb in seconds, crowns fit like they were sent straight from heaven to your office, and that class IV composite on No. 9 looks like the tooth never fractured. Other times you send folks home because anesthesia didn’t take, endo files fracture, and your “simple” crown fits like the proverbial “socks on a rooster.” The good news is that tough times don’t last but tough people do.

So this month let’s consider some things that, from a restorative standpoint, will make your life easier and your clinical results exactly what you expect of yourself.

So much of what we do today depends on chemistry, and yet not many of us have degrees in the field. That can make bonded procedures stressful and sometimes confusing.Lots of bottles, lots of syringes, and lots of confusion are frequently the norm for us.What works with what?If I bond a post with this material, will it stay or is the patient going to come back in 3 months with a crown in their hand that contains all the buildup and the post?

I love chemistry, but I am by far not an expert in the subject and that is why I love to keep it simple.One of my favorite bonding agents is Futurabond U from VOCO. There are 2 genius parts of this product. The first is that it works with everything. When the smart people at VOCO say “universal,” they mean universal. The material is both light cure and dual cure. That means even in bonded posts, the material will set in areas that the curing light will never reach adequately. Plus, it works with every bonded material out there. Futurabond U is material agnostic, which means that composites, buildup materials, and bonded cements work equally well with impressive bond strengths.

The second impressive thing about Futurabond U is the packaging/dispensing system. It comes in a blister pack that holds the 2 components of the system in separate wells. Simply push on the bubble in the package and those 2 components flow together. You then break the foil on the package and stir the contents. The genius of this is that every mix is a fresh mix. You never have to worry about solvent evaporation or the material losing potency sitting in a bottle or syringe.

Another terrific bonding agent is from Vista Apex and is called RE-GEN Universal Adhesive, which works with every material. The product is the first universal bonding agent that employs bioglass as an active ingredient. In keeping with the idea of simplicity and predictability, bioglass has more than 50 years of medical use. It was originally developed for use in orthopedic surgeries to stimulate bone growth in difficult cases. What is amazing about bioglass in our profession is that it forms a hydroxyapatite-like surface where it touches tooth structure, which means it promotes the regeneration of healthy tooth structure (hence the name RE-GEN).

Bioglass also has the amazing property of broad antimicrobial effects, which means that it helps promote healing and prevention of recurrent caries at the margin of restorations. Considering how recurrent caries is the main problem in adhesive dentistry, being able to kill bacteria at the marginal interface is a huge plus. Studies show that the average life span of a multiple surface composite restoration is around 5 years. I feel we can do better than that and I firmly believe RE-GEN products can help with that.

One line that I feel the profession needs to know more about is the Giomer-containing products by Shofu. Giomer is a proprietary filler particle that Shofu created and engineered. The products that contain Giomer release and recharge 6 ions: fluoride, strontium, sodium, aluminum, silicate, and borate. When these ions are combined, they inhibit plaque while neutralizing the acids that plaque-containing microbes create.

It’s a bit amazing to me that Giomer was created well over 20 years ago and yet many practitioners are not aware of it. As I noted above, the average life span of a multisurface composite is around 5 years. The margin is where the battle of restorative longevity is won and lost. Sending in as many reinforcements as we can to the margin can truly help make a big difference in our clinical outcomes.

Sometimes improving your dental practice is all about stepping outside your comfort zone. Here are a few techniques and products that may enable that.