Dr. Lou Graham

What is a “must have” or a “go to” product today in our offices? We all have our ‘go to” products and that is exactly what

Traxodent can be used by itself, in conjunction with retraction cord, or with the retraction caps for when additional hemostasis or retraction is desired. The system is easy to adopt into our practices and, equally important, is cost-effective. Two months ago the Catapult Group evaluated 

 and overwhelmingly, the hemostatic paste was given a 100% rating by everyone who reviewed the product.

Yes, I said 100% and as you will see, the Traxodent system is multifunctional and deals with two main problems we face every day: bleeding and tissue retraction.

Bleeding is a daily issue for numerous procedures for every one of us. How do you stop bleeding effectively in your office? As answered in our own survey to the group, common products or techniques include: 1:50,000 Lidocaine and epinephrine, an 810 laser, small amounts of super-oxyl, Viscostat in either the Ferric Sulfate and or Aluminum Chloride, Astringodent, Hemostasyl, and other products.

No question many of us use a combination of these but let me introduce you to Traxodent Paste, which like Viscostat Clear (which I do use in between my 2-cord technique) is a 15% Aluminum Chloride a paste (rather than a liquid) that comes in pre-loaded syringes and can be used with cord.

I haven’t counted how many uses per syringe, but there are plenty and the beauty is that this system placed onto bleeding tissue will stop routine bleeders in 2 minutes.

The first case presented involved an 84-year-old patient, with a long history of high levels of plaque and recurrent decay.

Once the decay was removed on the distal buccal surface of No. 11 with 

, the preparation was coronally beveled and ready for the final restorative. With the restoration being extremely subgingival, the question was how do we stop the bleeding 

The answer, in this case, involved first packing a 000 cord from the mesial buccal line angle to the disto buccal line angle. Once placed, a small amount of Traxodent paste 

was delivered to the bleeding area (the retraction cap was not required) for 2 minutes.

After the 2 minutes, the Traxodent paste was easily rinsed away (85% of the Catapult Group reviewers noted the ease of rinse removal). As seen in 

, the bleeding was gone and the tooth was then selectively etched, followed by 

 as the initial layer over the dentin and gingival margin followed by 

The second case involved deep interproximal decay on tooth No. 3 

with supra-eruption, along with periodontal issues that were to be addressed (patient declined an implant). At the same visit, implant No. 30 was impressed and a decision to wait on caries treatment on the mesial and buccal of No. 2 until after periodontal surgery was completed. After the decay was removed, the area required both a cessation of the bleeding along with retraction of the tissue such that a glass ionomer could be placed and then the crown fully prepared.

After the decay was removed, the Traxodent paste 

was placed both mesially and distally and a large cap was inserted 

. The cap was removed after 2 minutes and again, the paste was easily rinsed away revealing non-bleeding gingival tissue.

The tooth was then mildly etched with Riva Conditioner for 15 seconds, rinsed and Riva Silver was injected into the areas requiring this build up material. After 20-30 seconds, the material moved into a more semi-solid state, allowing the practitioner to pack the Riva Silver into the preparation 

After waiting 4 minutes for the material to set, the tooth was prepared and the paste and 

for 2 minutes and finally, the temporary was started 

Retraction caps a valuable option when needed

The Traxodent system has equally important functions in maximizing successful impressions for our crown and bridge procedures. With all the advances made in taking both traditional and digital impressions, retraction and control of hemorrhage are two key issues that have to be handled correctly or else failure will result.

First, let me clearly state, Traxodent paste doesn’t act exactly like 

. Traxodent paste in my hands doesn’t expand tissue as much as Expasyl, however the group found that Traxodent used in conjunction with a retraction cap provides superior retraction. Therefore, my uses in impression procedures primarily fall into two recommendations.

First, as a two-cord user, you can place Traxodent in between your two cords, similar to 

 from Ultradent has worked so well for me in this manner for years. The ideal time to use this system is after the second cord. If bleeding is still pronounced, add the Traxodent paste followed by the appropriate cap 

If bleeding is under control, then simply bypass the paste and place the Cap. After waiting 2 minutes, you will find the tissue further retracted than just with 2 cords. Without question, this enables the practitioner to take superior impressions 

The last procedure demonstrated in this article deals with hemorrhage present at the time of cementation. Regardless of the cement, contamination with blood creates immediate micro-leakage at the marginal interface. So, you removed the not-so-perfect temporary or the patient had poor home care, or you flossed too heavily during the initial try-in.

Each of these can be a reason bleeding is present at the time of cementation. With the Traxodent system, minor bleeding can be easily overcome by applying the paste, waiting 2 minutes and rinsing the area. If pressure is needed, the caps can be applied 

Two of the most common issues we face in dentistry are bleeding and retraction. 100% again found it very effective in reducing bleeding and 85% of the group found the rinsing away of Traxodent is far easier than Expasyl.

Rinsing is important as per Reality, if paste systems are not completely rinsed away and are found to be present after rinsing, it can affect bond strengths which can affect final adhesive cementation or affect the way impression materials set or don’t set.

Those in the group who use Expasyl for retraction didn’t find the paste equal in retraction.

For those like myself, I prefer to place the 2nd retraction cord in lieu of Expasyl and found superb retraction when coupling the caps with my 2nd cord technique. This id visible in 14c.

In summary, Premier has provided dentists a valuable one-two punch for many of the clinical situations we are presented with daily.

As a group, the hemostatic properties of the paste were overwhelmingly received and the majority of the group agrees that the retraction caps aided the impression procedures after proper cord replacement.

Traxodent Hemodent Paste Retraction System

Traxodent Hemodent Paste Retraction System is designed to serve as a retraction and hemostatic system for use prior to taking crown and bridge impressions or wherever hemostasis and retraction is required. Traxodent comes in pre-packaged syringes that contain 15% aluminum chloride, dispensing tips, and three sizes of the optional retraction caps for use when added hemostasis and/or retraction is desired.

Find out why Premier’s Traxodent system recieved a 100% Catapult rating

			The Catapult Group reviews this hemodent paste retraction system.			Written by: Dr. Lou Graham			Premier’s Traxodent system			Date published: 07/30/2013			5 / 5 stars

Articles

What is a “must have” or a “go to” product today in our offices? We all have our ‘go to” products and that is exactly what Premier’s Traxodent system is.

Review: Find out why Premier’s Traxodent system recieved a 100% Catapult rating

Bisco’s DUO-LINK composite luting cement is a dual-cured, highly filled cement and competes in a very crowded and often confusing product niche in restorative dentistry.

DUO-LINK is not a newly-introduced product, but one that has had a long history of producing excellent clinical results. So why is this product of such great interest today? Selecting the ideal cement from the pure resin, self-adhesive resin, glass ionomer categories with all-ceramic, metal ceramic and post cementation procedures is a challenge and most clinicians use multiple materials in their day-to-day treatment.

DUO-LINK shines as a versatile cement for numerous clinical indications when the doctor demands a dual-cured chemistry for the clinical procedure. It is suited for adhesive cementation of metal supported porcelain-fused-to-metal crowns and bridges, crowns, inlays and onlays fabricated from metal, composite resin or ceramics, and metal and fiber-reinforced endodontic posts.

In looking at what makes DUO-LINK stand out as a luting material, it is important to understand that many cements do not cure equally as well in the purely light-cured mode compared to the self-cured mode. For many clinical situations it is not possible to get light penetration through the restoration to the deepest part of the cement layer. The integrity of the cement (and the restoration itself) then is dependent on the chemical curing components to achieve a high degree of conversion (cure) without light exposure. DUO-LINK achieves a very high degree of conversion in both the self- and light-cure modes, independent of each other. The physical properties of DUO-LINK also are excellent and balance a high filler content for marginal wear resistance with a low film thickness and flow to ensure ease of cementation.

		95% of the Catapult evaluators would use Bisco DUO-LINK cement for at least some clinical indications in their practices. In situations where adhesive cementation is required, such as with single all-ceramic restorations made from a feldspathic or leucite ceramic (i.e. Empress I) or when there is a compromised retention form, this material (in conjunction with a compatible adhesive system) would be a material of choice.

		81% of the evaluators rated the flow characteristics of the cement as “just right” with less than 5% feeling the working time was too short. This characteristic is critical to ensure full and complete seating of the restoration to achieve the best marginal adaptation. The film thickness of the cement was rated either very good or excellent by more than 75% of the evaluators.

		The majority of evaluators rated the automix delivery system as close to ideal in terms of extrusion force and the quantity of material in the delivery system. The delivery system was especially noted for creating a minimal amount of wasted material.

		62% of the evaluators found the cement working time to be “just right” with fewer than 5% who felt the working time was too short. Favoring a slightly longer working time is better in most clinical situations to eliminate the chance for incompletely seating a restoration.

		Clean-up of the excess cement also was rated very highly by the Catapult evaluators. On a 1-7 scale where 1 represented ‘easy’ and 7 ‘very difficult,’ clean-up in the self-cure mode was rated 2.8 and in the light- cure mode 2.9-both excellent scores. As with all resin based cements, the timing of cement removal in the light-cured mode is dependent on the power of the light used. A bench trial of the cement and the light to be used clinically can help the clinician gauge the appropriate clean-up timing.

DUO-LINK is available in a translucent shade and as such would not provide significant color modification to the final restoration. While certainly this cement can be used for cementing veneers, for achieving significant color stability a light-cure only cement such as CHOICE 2 would be preferred.

The very high percentage (95%) of evaluators that would incorporate this cement into their practices is impressive and reflects the very good physical properties and the well accepted handling characteristics of this cement. While certainly it would not be the definitive choice for cementing all indirect restorations, it represents a terrific option when an adhesive cementation technique is indicated.

DUO-LINK is designed for use with universal adhesive systems such as ALL-BOND 2, ALL-BOND 3, ONE-STEP PLUS or ALL-BOND SE. Some incompatibilities may occur with dual-cured resin cement systems and some adheesive systems, especially adhesives that are low in pH, such as most self-etching systems. Prior to using DUO-LINK with other adhesives, check with the manufacturer to be sure there are not unexpected interactions that could inhibit chemical curing of the cement.

At room temperature the working time for DUO-LINK is 2 minutes and the setting time is 5 minutes 30 seconds for dual-syringe mixed material. Both working and setting times will be accelerated by mouth temperature, and by coming into contact with some adhesive system primers, depending on the adhesive system used. When used for the first time, careful attention to the intraoral setting behavior is important to prevent the cement from setting to a point that makes removal of the excess difficult.

Promotion of adhesion of DUO-LINK to the restoration surface can be accomplished by the appropriate preparation of the metal, ceramic or composite surface and the use of a suitable bonding primer for the specific material being cemented.

This review represents a summary of the findings amongst the Catapult evaluators, who used this product to cement a wide variety of restorations. While a small minority would have preferred the cement to have a slightly shorter work/set time, the survey results show that overall there was wide acceptance of this cement, especially for adhesive cementation of ceramic restorations.

Key tips and feedback on Bisco’s DUO-LINK™ Composite Luting Cement

 and the question was: Is this cement different?

For half the group the answer was overwhelmingly “yes.” The remainder of the group truly appreciated how easy the cement was to use and its physical properties but had issues with the delivery system because it requires a triturator.


	With today’s easy-to-use delivery systems that include clicker systems, paste packs and dual barrel syringes, the question becomes why would you need a triturator?

The answer truly is contained in the capsule and its unique calcium based reaction that requires both an activation of 2-3 seconds along with a subsequent 10-second trituration. Is this a deal breaker? If you don’t have a triturator, you may miss out on a game changing product that fulfills the above list of properties for an ideal cement. The vast majority of dentists own triturators and this simply gives us another indication for use.


	Once you get past the fact that you need a triturator, the question is, can a new chemistry in dentistry revolutionize the cement market? The answer is maybe yes! Doxa has now published 2-year data and has 3-year data confirming there is no loss of retention, no secondary caries, no marginal discolorations and no subjective sensitivity.

The material itself hardens through a mechanism of dissolution and re-precipitation, where nano-crystals are built and are bonded to each other. This hardening process allows the material to seal at the tooth’s interface and further build hydroxyapatite in proximity of the dentin interface. This inherently makes this material bioactive.

The process involves the dissolution of water after the activation of the capsule and trituration, causing a reprecipitation where particles in nanometer sizes are built and bond upon each other and create a basic pH. As the material dissolves it wets the tooth and then as the nano-crystals begin to form they precipitate on the tooth surface and upon other crystals. Within minutes the hardening mechanism begins creating a dual functional result: sealing the interface and creating the conditions necessary at the interface of building hydroxyapatite. In essence, its adhesion to the tooth takes the same form as its infrastructure. Another important feature of this cement is that when the powder is dissolved, hydroxide ions are released, creating a basic pH. This higher pH is critical on many fronts because it not only creates an environment conducive to growing hydroxyapatite but it also stabilizes the hydroxyapatite (hydroxyapatite breaks down with acid). Long term, this means it’s caries resistant.


	Ceramir Crown and Bridge is a bioceramic dental cement for permanent cementation of conventional prosthetics, including all-ceramic constructions with frames of aluminum oxide or zirconium dioxide (alumina and zirconia). This cement is easy to use, provides stable sealing of the prepared tooth, good retention and is tissue and environmentally friendly.
	

You’ve prepared your crown, you’ve removed your temporary, adjusted any minor occlusal and contact issues and now you are ready to cement your restoration. So the key question is, what are you looking for in your cement? The answer is universal and covers the following:

		Long-term permanent seal, i.e. long-term stability and minimal degradation

		Biocompatible both internally and externally

		Strong physical properties such as flexural and compressive strengths

		Universal usage for all ceramic and metal crowns

		Good working and setting times both for single and multiple units

		36% of reviewers said thixotropic working property is one of the most important cement characteristics, while 21%  listed working time as most important

		Setting time was most important to 27% of reviewers

		80% of reviewers said easy excess cement removal and cleanup are important, while 60% believe film thickness is one of the most important characteristics

		86% listed marginal integrity as one of the most important characteristics, while 47% are most concerned with physical properties

		Only 7% listed odor as one of the most important characteristics, while 36% listed the delivery system


	With all this said, let’s bring this down to earth and truly explain how this may be a game changer in the cement category. Once the internal surfaces of all zirconia crowns, zirconia to porcelain, gold, porcelain fused to metal and lithium disilicate (prepared via the guidelines of e.max) crowns are all cleaned in the proper way, this cement can be used for all of the above.

Yes, this makes it a universal posterior cement with the exception of ceramic inlays and onlays. I also have used this material for anterior restorations fabricated out of zirconia to porcelain, e.max and porcelain to metal restorations. The exceptions in the anterior category are veneers, Empress and feldspathic crowns that require adhesion support.

After placing this cement into the mouth and waiting 3 minutes, cleanup is as easy as any resin-ionmer cement. Seating multiple crowns (all at once) is equally easy and the capsules come in single dose and multiple dose (up to 3 crowns). It’s also very thin, 15 microns, and makes for a wonderful implant cement because it is tissue biocompatible, which becomes very important because peri-implantitis is often the result of excess cement that is NOT biocompatible.


	I have cemented more than 250 units with this material and the Catapult reviewers have cemented more than 1,000 units in the past 8 months. I personally have had one recementation on a minimally retentive prep with an all zirconia crown. Beyond that, patients report minimal to no sensitivity upon placement. The Catapult Group, beyond the need for a triturator, was very excited about the technology in Doxa’s Ceramir cement.

Catapult was asked to review Doxa’s new cement, Ceramir, and the question was: Is this cement different? For half the group the answer was overwhelmingly “yes.” The remainder of the group truly appreciated how easy the cement was to use and its physical properties but had issues with the delivery system because it requires a triturator.

REVIEW: This is what makes Doxa's Ceramir® Crown and Bridge different

Crown and bridge procedures are often complex, labor intensive and detail oriented endeavors incorporating a number of different dental materials for success from start to finish. 

Clinician’s Choice has two stand-out products 

that offer the possibility of easing the dentist’s burden in managing two elements of crown and bridge: fabrication of the provisional and cementation of the provisional.


	Template™ is a silicon based matrix material that is rigid enough for minimizing flash and producing accurate temporaries. The material is also fast, creating a provisional template after only 30 seconds of curing.

Cling2™ is a zinc-oxide non-eugenol, automix temporary cement with a unique polycarboxylate resin in a paste-paste format. The addition of polycarboxylate optimizes adhesion and provides an excellent seal, while allowing the material to be easily removed from the tooth preparations when desired.

A recent Catapult evaluation of these materials showed excellent acceptance of both as adjunctive to prosthodontic procedures.

		89% of the evaluators rated viscosity, working time, setting time, ease of mouth removal and overall use to be “very good” or “excellent.”

		The majority of the evaluators felt the use of Template reduced the marginal trimming needed during the creation of a provisional restoration.

		82% of the evaluators would consider switching to Template.

		91% would recommend Template to a colleague.

		82% of the evaluators considered Cling2’s handling “just right” for flow and viscosity during placement.

		88% of the users felt removal of excess cement after placement was equal to or better than the leading provisional cements, while 54% felt Cling2 was “better” or “much better.”

		More than 90% felt removal of the cement from both the preparation and the provisional (after removal) was equal to or better than their current material.

		82% of the evaluation team would consider using Cling2 routinely in their offices.


	While other kinds of materials garner more attention in crown and bridge, Template and Cling2 represent two materials to consider to help minimize problems associated with the provisionalization part of these prosthodontic procedures. Their excellent handling attributes make them worthy of a closer look.


	Described as versatile and easy to use, Cling2 resin optimized temporary cement features a quick 90-second set time and easily peels off the prep site for fast cleanup. The non-eugenol temporary cement, available in 5- and 10-ml syringes, is dispensed in an automix delivery system. It is a zinc oxide/carboxylate hybrid that includes a small amount of polycarboxylate material for easy removal from the tooth preparation site. The cement is said to be well suited for cementing provisional crowns, bridges, inlays and onlays.


	Template Ultra Quick Matrix Material provides an accurate and detailed matrix that reportedly eliminates the need for adjustment to temporary crowns, bridges or veneers. Its fluid viscosity captures dentition detail, with a cure time of 30 seconds. It is designed to minimize the chair time associated with fabricating temporaries.

Crown and bridge procedures are often complex, labor intensive and detail oriented endeavors incorporating a number of different dental materials for success from start to finish. Clinician’s Choice has two stand-out products that offer the possibility of easing the dentist’s burden in managing two elements of crown and bridge: fabrication of the provisional and cementation of the provisional.

Why you should try Clinician's Choice Cling2 and Template

Many clinical situations demand a provisional restoration that must serve in function for extended time. Large fixed prosthodontic cases and implant treatment are examples of situations where an easy to handle but retentive and durable temporary cement is required.  

GC America has introduced Fuji TEMP LT provisional cement.

This is a glass ionomer based material formulated to have excellent handling characteristics and a very low film thickness. It has numerous beneficial properties that would be expected from a glass ionomer including fluoride recharging, excellent hard and soft tissue compatibility and very high mechanical strength properties.

Because of its tooth like coefficient of thermal expansion and ionic bonding to metals and tooth structure, the maintenance of a marginal seal around the provisional is enhanced. The material also is radiopaque, making detection of interproximal and gingival sulcus excess easy.

Results from a recent Catapult evaluation revealed that Fuji TEMP LT was well received and 83% of the evaluators would adopt this cement as a material of choice in their practice. Other findings from the survey included:

		The flow and film thickness at initial seating was rated as good as or better than the users’ existing cement by 100% of the evaluators; 82% rated the flow “just right.”

		The ease of clean-up at initial seating was rated as good as or better than the users’ existing cement by 88% of the evaluators.

		Retention was excellent and rated as good as or better than the cement currently used by 88% of the evaluators.

		Removal of remaining cement for the abutment or preparation was rated slightly less favorably and was as good as or better in 66% of the cases.

		83% gave the cement an overall rating of “Good” or “Excellent.”

As might be expected with a cement designed for long-term function, there was a 31% rating of nearly difficult or difficult for removal of cement from the abutment. However, this is likely a small trade off in having a highly retentive and long lasting provisional cement and may be a perfectly acceptable characteristic for a truly longer term provisional.

Fuji TEMP LT represents an important material for practitioners looking for a solution to an often difficult problem, retention of a provisional restoration for an extended period of time. This material should be considered by anyone looking for a long-term provisional cement solution.

		For single units of crowns and onlays with low retention, this cement can help reduce the hassles of lost temporaries and/or the same old, “my temporary came off” the next day.

		An added benefit of Fuji TEMP LT is that it is eugenol free, which is a consideration for many dentists when doing a final cementation.

		For high caries risk patients, if long-term use helps reduce potential caries issues or helps remineralize the tooth, that much the better to implement into your practice.

		For those patients with lower vital molars that you don’t want to numb due to sensitivity in removing the cement, (we all know the hassle of lower molars) this may not be your best option.

Suggestions to the next generation of the product

		Dual Cure, which ultimately leads to faster clean-up

		Clear color added to the options for anterior provisionalization

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

Many clinical situations demand a provisional restoration that must serve in function for extended time. Large fixed prosthodontic cases and implant treatment are examples of situations where an easy to handle but retentive and durable temporary cement is required.  GC America has introduced Fuji TEMP LT provisional cement.

REVIEW: GC America’s Fuji TEMP LT™ has excellent handling, low film thickness

	You don’t come to your choice of dental materials lightly. Creating restorations that you can be proud of and that your patients will love are a priority. With all the research that goes into choosing the materials we use, how often do we share that information with patients? They may not care about all the science, but translating that data so that we demonstrate this value to patients is a vital part of gaining case acceptance.

	In my case, I know the value of offering 3M™ ESPE™ Lava™ Crowns and Bridges to patients. These strong, esthetic restorations offer a number of characteristics patients can appreciate. I’ll use Lava as an example throughout this article, but you can use similar concepts to promote your material of choice.

	Patients’ foremost concern with crowns and bridges is often esthetics. How does your material perform when it comes to translucency or shade matching? Is there clinical evidence to support those claims?

	In this area, the natural look offered by Lava Zirconia easily tops PFM alternatives, so that is a major selling point to share. After explaining to patients that metal frameworks block light from passing through the restoration, the dental team can then demonstrate how zirconia provides natural translucency, offering a much more lifelike appearance. Evidence shows Lava Zirconia is one of the most translucent materials compared with other zirconia restorations of the same thickness.

	Additionally, because Lava restorations only require a wall thickness of 0.3 mm in the anterior, their translucency is significantly increased when wall thickness is reduced from 0.5 to 0.3 mm.

 Patients also can appreciate that the thinner design of a Lava coping, in comparison with other zirconia and all-ceramic restorations, allows the dentist to save more tooth structure when preparing the teeth.

	Finally, while metal frameworks can leave a dark ridge over time where gums recede, Lava restorations can be precisely matched to patients’ teeth for a most natural look that lasts for many years.

	Long-term clinical data demonstrating the strength of a material is important in the dentist’s decision making process, and should be part of how you talk about materials with patients. I want my patients to feel confident knowing millions of Lava restorations have been placedthroughout the past eight years with outstanding clinical performance.

	In fact, a study of five-year clinical results for Lava crowns and bridges found no failures among bridges that could be recalled after five years. Additionally, the largest dental laboratory in the United States recently released data showing clinical success rates of Lava zirconia restorations at 98.4%2 over thousands of restorations, similar to the success rates of porcelain-fused-to-metal restorations. If you don’t know these kinds of facts about your material, don’t be shy. Contact the company and see what clinical data they can share.

	In my personal experience in placing more than 600 Lava zirconia restorations during the last six years, I’ve only seen three situations in which the veneered porcelain has chipped or fractured.

	While marginal fit may be a more difficult concept to explain to patients, they should know it is an important characteristic that can contribute to a restoration’s clinical performance. To ensure the best fit, a precise CAD/CAM process must be used in conjunction with high quality, homogenous zirconia.
	Multiple studies have found restorations designed with the Lava system demonstrated the lowest marginal gap among systems tested, highlighting the accuracy of the Lava CAD/CAM system in combination with Lava zirconia.

	Who are your sources? Is it just the manufacturer telling you its product is great? Independent confirmation of the values I’ve discussed is critical to patient trust.

	In my office, patients can be assured that the evidence in favor of Lava restorations does not come from 3M ESPE alone. Study results recently published in The Dental Advisor examined the six-year clinical performance of Lava zirconia and found, “3M ESPE Lava Crowns and Bridges performed exceptionally well over the six-year evaluation period in their resistance to fracture and marginal staining and exhibited minimal wear.”

	Not every patient is going to care about the R&D behind his or her crown, but your ability to demonstrate the value of that crown can go a long way in helping increase treatment acceptance and overall trust with your patients.

Dr. Lou Graham is an internationally recognized lecturer extensively involved in continuing education, and the founder of Dental Team Concepts.

	1. Translucency of different zirconia materials, Prof. R. Scotti, Prof. P. Baldissara, Dr. A. Llukacej, Dr. L. F. Valandro and Prof. M. A. Bottino, Academy of Dental Materials Conference, 2006. [Abstract 103].
	2. Glidewell Laboratories, restorations fabricated between 7/1/08 and 9/30/08, 3MESPE.com/Lava.
	3. A. Piwowarczyk, H.-C. Lauer (2006), Determining the marginal fit of CAD/CAM bridge frameworks, Pan European Federation Conference (PEF; CED) #0254
	4. F. Beuer, T. Fischer, K.-J. Erdelt, H.-U. Aggstaller, K. Spiegl, W. Gernet; (2005) IADR #1336 and In vitro Study Marginal fit of Lava restorations; F. Beuer, T. Fischer, K.-J. Erdelt, H.-U. Aggstaller, K. Spiegl, W. Gernet, industrial report (2006)
	5. A.J.T. Shannon, F. Qian, P. Tan, D. Gratton (2007) In-Vitro Vertical Marginal Gap Comparison of CAD/CAM Zirconium Copings, IADR #0828
	6. 3M ESPE Lava Crowns and Bridges 6-Year Clinical Performance. The Dental Advisor. August, 2009.

 You don’t come to your choice of dental materials lightly. Creating restorations that you can be proud of and that your patients will love are a priority. With all the research that goes into choosing the materials we use, how often do we share that information with patients? They may not care about all the science, but translating that data so that we demonstrate this value to patients is a vital part of gaining case acceptance.