Dr Ian Shuman maintains a general, reconstructive, and aesthetic dental practice in Pasadena, Md. He is a Master in the AGD, a past associate Fellow of the American Academy of Implant Dentistry, and a Fellow of the Pierre Fauchard Academy. He is the Editorial Director of Continuing Education for PennWell Publishing and an advisory board member for Dentistry Today. ​

Since 1993, Dr Shuman has personally authored a vast array of peer-reviewed published articles. As a lecturer and author, he has developed and taught his advanced, minimally invasive techniques to dentists worldwide. His mission is to teach dental professionals the most current methods for creating beautiful, long-lasting restorations that preserve maximum tooth structure.

Ian Shuman, DDS, MAGD

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Help patients get a better image of the procedure by showing them intraoral scans. 

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Safe and effective cleaning agents should be used prior to cementation to best results. 

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Technique Touch-Ups 2022

Tokuyama made a big splash in our industry a few years ago with the introduction of OMNICHROMA. It was a unique product in an otherwise well established, and somewhat boring, space. The company itself has been around for a while and this by far is not its first innovation. When I first used their hard REBASE material for denture relining, it was as good as anything I got back from the lab. Accurate, chairside, no lab fee. It was a push against the norm with a simple but elegant solution. For me, OMNICHROMA was equally innovative, as well as impressive.

The whole idea of “one shade for every tooth” was obviously a compelling story. I am always looking for a way to simplify our armamentarium and streamline our product supply. OMNICHROMA’s success stems from a basic optical property of the composite. Most composites are shaded by having a particular color of the filler. A1 shaded composite has particles that are A1, for example. A light source hits the surface of the composite and reflects light to your eye for your brain to perceive color. In the case of OMNICHROMA products, the filler actually regenerates light from the surrounding tooth against the filler particles. This essentially creates the illusion that the composite itself is the same color as the structure around it. If you could isolate that composite, you would see it hasn’t actually changed color at all.

One technicality of using the product is that you do need actual structure to reflect that color. If you have an incisal extension that extends out, it would have less to reflect back and potentially look a bit too translucent or gray. In this case, Tokuyama recommends using their OMNICHROMA BLOCKER or OMNICHROMA BLOCKER Flow. It has similar regenerative properties but also creates a base layer of color to avoid that grayed-out look. Because of its ability to block color, it is only recommended to use a 0.5 mm layer of OMNICHROMA BLOCKER Flow. I find this is also useful when I have a darker base shade, such as a tooth with amalgam staining or a dark root surface. The opaque layer nicely blocks out the undesirable shades for a more esthetic color match in the final result.

The introduction of OMNICHROMA Flow BULK further redefines this category with simplicity and greater efficiency. Like other bulk composites, you don’t have to place the material in small incremental layers. The reason we used to place composites small layer by small layer is because large layers would exhibit greater shrinkage affecting marginal integrity and deeper layers could remain uncured if light could not get to the material in the deepest parts of the prep for proper curing. In the case of OMNICHROMA Flow BULK, this is no longer an issue. Its flowability and self-leveling help to not only layer evenly but the supra-nano fillers allow reflection of red to yellow structural color. It also enables the material to have a high level of polishability. Considering extensive studies that show great compressive strength, flexural strength, and lack of polymerization shrinkage, the company has definitely backed their claims with good science. 

When I first got a chance to use OMNICHROMA Flow BULK, I was most surprised by the simplicity of the packaging. A syringe and some tips were all that was in there, again reinforcing the value of OMNICHROMA products when it comes to helping declutter our storage. According to their recommendations, I can use the material on any posterior or anterior application. The instruction card had just a few steps that basically consisted of apply your bond of choice, fill it up, cure, and polish. The viscosity of the material is noticeable and flowed well into crevices, especially the floor of a Class II prep. I used the OMNICHROMA BLOCKER Flow in all cases of amalgam stain and it definitely helps keep the restoration at the brighter shade of the surrounding teeth. I did not have a single case that developed that “little white line” from poor bonding. If anything, it feathered well across any bevel.

Simplicity Goes Even Deeper with OMNICHROMA Flow BULK case images by Jeff Rohde, DDS

The only tricky part for me was for Class V applications. Due to the viscosity of the material, if I overfilled the preparation at all it would pool across onto the gingiva and make finishing a little more laborious. In this case, I found that it was best to initially wet the preparation right up to the margins, but not totally filled. After an initial cure, I would then layer the regular OMNICHROMA material over that due to its thicker handling. Sandwiching like this gave a great optical result, I still got a good seal, and simplified finishing. If this were a Class IV fracture, I would only use the original OMNICHROMA to ensure you can build out that body of the material to the intended incisal edge. One nice thing about OMNICHROMA Flow BULK is you don’t have to have that topper layer to protect it. In the Class V case switching materials to cap the restoration with the original OMNICHROMA viscosity was to be able to shape and sculpt the material.

Because of the viscosity of OMNICHROMA Flow BULK, I would recommend confirming you have nice four wall preparation to get the best results with the material. This would include a Class I, a Class II with a matrix band, a Class III with a matrix band, etc. You can also very easily adapt this for use with the Bioclear technique, especially in the posterior.

In a Class II situation, the material flowed nicely in the bevel areas of the buccal and lingual walls. Once placed in those areas, I filled the bulk of the rest with no issues. I still did another round of curing after I removed the matrix band but that was more out of habit than necessity. For anterior restorations with Bioclear matrix bands, I would place OMNICHROMA BLOCKER Flow into the deeper areas of the black triangle to block off the dark background and then fill with the regular OMNICHROMA Flow BULK material over the top of that.

OMNICHROMA Flow BULK definitely delivers on the simplicity of the system, as well as its broad range of use. It’s an excellent addition to Tokuyama’s line-up and continues to push the boundaries of what can be accomplished when solid science and research are applied to developing innovative and effective dental materials.

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Dental Products Report's Technique Touch-Ups 2022

	Dentistry’s approach to diagnosis and management of dental caries has undergone a marked evolution over the last few decades.

	Thanks to advancements in instrumentation, techniques and restorative materials, as well as scientific developments in cariology and diagnostic systems minimally invasive dentistry (MID) is now the standard of care in the modern restorative practice.

	Defined as a conservative approach to saving tooth structure, MID requires a change in traditional cavity preparation design. While traditional preparations follow a lesion-centered method as described by G.V. Black’s “extension for prevention” fundamentals of dentistry,1, 2 MID designs require a much more conservative approach. Based on advances in science that have furthered our understanding of the caries process and remineralization, this method relies on dental science to detect, diagnose, intercept and treat dental caries at an early stage, thus impeding disease progress.2

	To approach dental treatment from the proper perspective, it’s imperative to understand that caries is a bacterial disease that must be eliminated. Modern materials enable us to remineralize and heal demineralized tooth surfaces, thereby reducing future incidence of caries and minimizing tooth-structure removal during preparation.3 To successfully practice MID, carious lesions must be detected as early as possible so caries progress can be halted with preventive remineralization therapy.1 Due to the restorative cycle of placement and replacement, which necessitates progressive loss of tooth structure, the goal for any restoration is to maintain as much natural tooth structure as possible. Likewise, durable, long-lasting restorations must be appropriately placed to further diminish the cycle.1,2

	As the disease process begins, bacterial pathogens cause reversible demineralization of hard tooth structure. At this stage of the disease, a lesion is termed “subclinical” because it isn’t detectable via visual, tactile or radiographic means. Simply put, the tooth structure in question looks and feels like a normal healthy tooth.4 Presenting a unique diagnostic challenge, such noncavitated carious lesions may indicate high caries activity and caries risk.1 It’s well established that mineral loss associated with caries can be arrested and even reversed at an early stage, before cavitation occurs;2 however, if the needed remineralization isn’t initiated, the disease will progress to an irreversible stage leading to tissue morbidity. It’s therefore incumbent upon dentists to treat caries in the subclinical (i.e., noncavitated) stage.4


	In addition to proper restorative materials, the appropriate instruments must be used to operate within minimally invasive restorative principles. KOMET USA’s CeraBur® system is an advanced bur system created to preserve the maximum amount of tooth structure while addressing the removal of caries only. CeraBur® Kit 4547 features a range of K1SM ceramic instruments that are highly efficient for minimally invasive excavation on soft, carious dentin with minimized reduction of sound tooth structure. Offering superior tactile capacity, the burs essentially tell the operator when it’s safe to stop drilling. The burs are made of high-quality ceramic, and they effectively reduce the need for explorers and spoons in evaluating decay removal. Because of their ceramic composition, the long-lasting, smooth-running burs resist corrosion and are unharmed by disinfection and cleaning processes.

	Another indispensable component of the dental armamentarium is the KOMET family of Micropreparation instruments. Engineered with smaller-than-standard working parts and thin necks, these diamonds are specially suitable for minimally invasive preparations in microdentistry. Together, the CeraBur® system and the Micropreparation diamonds create the ideal toolbox for minimally invasive tooth preparation.

	The following case demonstrates  minimally invasive restoration of a noncavitated carious lesion, with a focus on vital preparation steps.  
	MID on a noncavitated carious lesion

	Recognition and treatment of noncavitated carious lesions are vital to the MID process. Treatment at this early stage is aimed at preserving integrity of the tooth and averting additional, more aggressive therapy later.  

	A 26-year-old female patient presented for a routine examination, during which a noncavitated carious lesion was discovered on the maxillary left first molar, tooth No. 14 (Fig. 1). After discussing a treatment plan designed to arrest caries progress, the patient elected the recommendation to undergo treatment for noncavitated lesion with a minimally invasive tooth restoration using a flowable composite resin.   

	Following local anesthesia, initial cavity access was achieved with the KOMET 889M.FG.007 tapered diamond Micropreparation bur (Fig. 2).

	With the same bur, the cavity preparation was then widened for visual and instrument access (Fig. 3).

	Once access was achieved, a CeraBur® K1SM round ceramic bur was used at 1,500 rpm for slow-speed excavation of caries (Fig. 4). With exceptionally smooth operation and optimal cutting efficiency, the bur achieved complete caries removal. With its superior tactile feel, the CeraBur essentially signaled when it was safe to stop drilling. The maximum amount of tooth structure was preserved with the removal of caries only. The completed preparation shows the integrity of the tooth has been maintained thanks to the minimally invasive technique made possible by using the appropriate instruments (Fig. 5).

	The cavity preparation was restored using the dual-etch technique; a resin-reinforced, glass-ionomer base for remineralization of affected dentin; bonding agent; and a microhybrid composite resin.

	Following composite placement, the restoration was given a final polish with the KOMET 9686.RA.040 silicone brush (Fig. 6). The restoration is completed (Fig. 7).


	Although small to the naked eye, this MID restoration represents decades of scientific research and engineering. After receiving a very small composite filling, this patient walked out of the office caries-free, armed with the knowledge she needed to maintain good dental health for a lifetime.
	By conserving dentition and supporting structures, minimally invasive dentistry is gratifying to both doctor and patient.5 The current generation of composite restorative materials facilitates minimal intervention without sacrificing strength or beauty.3 To successfully perform MID, however, it is imperative to have the appropriate tools at hand. KOMET USA’s CeraBur® instruments are ideal for a multitude of techniques, and they are especially suited to MID procedures.  

References
	1. Strassler, HE. Minimally invasive dentistry: today’s restorative materials meet the challenges. Kerr University Online Learning Center, dentalaegis.com.
	2. Murdoch-Kinch CA, Mclean ME. Minimally invasive dentistry. J Am Dent Assoc.. 2003;134(1):87-95.
	3. Okuda WH. Minimally invasive dentistry: a natural evolution in cosmetic restorative dentistry. Inside Dentistry. January 2011;7(1):54-62.
	4. Conners D., Curtis A., Cziok A., Donnelly R., Duchsherer C., Dunlavey R., Elmelakh M., Elmaijri A., Fiedler J., Fordahl B., Zidan O. Dental caries: the non-cavitated carious lesion. Course lecture, University of Minnesota. 2004.
	5. Christensen G. The advantages of minimally invasive dentistry. JADA. 2005;136:1563-1565.


	Dr. Ian Shuman maintains a full-time general, reconstructive, and esthetic dental practice in Pasadena, Md. Dr. Shuman has lectured and published on advanced, minimally invasive

 Dentistry’s approach to diagnosis and management of dental caries has undergone a marked evolution over the last few decades.  Thanks to advancements in instrumentation, techniques and restorative materials, as well as scientific developments in cariology and diagnostic systems minimally invasive dentistry (MID) is now the standard of care in the modern restorative practice.