Noah Levine

new products debuted in the previous 12 issues of 

of dental practices say the prevalence of bruxism among patients has increased since before the COVID-19 pandemic. Other stress-related conditions such as chipped and cracked teeth (increased at 63% of practices) and TMD symptoms (increased at 60% of practices) are also up compared with prepandemic norms.1

toothbrushes were used to create Fastminar, a 45-foot-tall statue of a tooth at Terna Dental College in Navi Mumbai, India, which received a 

 title as the largest toothbrush sculpture of a body part (supported). The toothbrushes used in the statue were donated by 8890 dentists throughout India. Source: 

 of dental practices were more interested in aerosol mitigation solutions because of the impact of the COVID-19 pandemic. Source: 

 predoctoral students were enrolled in US dental schools for the 2020-2021 school year, the largest number during any single school year. 2

 of enrollees (16.6 million individuals) in Medicare Advantage individual plans chose a plan with at least some dental coverage. However, this number reflects only Medicare beneficiaries who have chosen to enroll in voluntary Medicare Advantage plans. Forty-seven percent of Medicare beneficiaries do not have any dental coverage.3

 new practices joined the largest dental support organization (DSO) in the US, Heartland Dental, in 2021. With this expansion, the DSO is now affiliated with more than 2300 doctors at more than 1400 practices in 38 states. Source: Heartland Dental

 of dental practices reduced their materials purchases because of the COVID-19 pandemic, and 34% of practices expressed increased interest in products offering simplified workflows because of the impact of the pandemic. Source:

Health Policy Institute, “COVID-19: Economic Impact on Dental Practices, Week of October 11 QOW Results” 

https://surveys.ada.org/reports/RC/public/YWRhc3VydmV5cy02MTY4OGNkZjRkMGNmZTAwMTc0Y2MzOTQtVVJfM3BaeGhzWm12TnNMdjB4

Health Policy Institute “2020-2021 Survey of Dental Education” 

https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/SDE1_2020-21_final.xlsx

Freed M, et al. “Medicare and Dental Coverage: A Closer Look” KFF. 

https://www.kff.org/medicare/issue-brief/medicare-and-dental-coverage-a-closer-look/

Articles

A look at some significant and interesting numbers and statistics from around the dental industry in 2021.

2021 The Year in Numbers

Brett S. Silverman, DDS, MAGD, LLSR, founded Advanced Cosmetic & Family Dentistry in Alpharetta, Georgia (

) where he and two other doctors run the 100% fee-for-service operation. The practice generates a steady stream of new patients through both the internet and a strong network of referrals from other clinicians with challenging cases.

“It's all about the patient. It's not about us,” Dr Silverman says.

The practice was previously using the DEXIS Imaging Suite to manage its clinical image files. Dr Silverman says the DEXIS software is a “very, very good product” but it was not always easy to integrate images from imaging technology made by different companies.

With the practice using several x-ray sensors, different intraoral scanners, a cone beam, and intraoral cameras, there was a definite need to find a centralized software solution that works well with input from a range of sources.

“When you have different software, and different companies, everybody plays well on their home turf, but when you mix and match, and pick the best for you, they don't always like to behave,” he says.

Linked with the most popular and used practice management systems, DTX Studio Clinic is the ultimate dental imaging software that keeps all of your 2D and 3D imaging data together. DTX Studio Clinic puts clinicians and patients first, simplifying the interaction with scans and images and making each appointment more focused and valuable for everyone.

Dr Silverman believes his practice found that solution in DTX Studio Clinic.Setting up the software and connecting the practice’s imaging systems was straightforward, and now he and his colleagues don’t need to shuffle between a dedicated cone beam computer, an x-ray computer, and other computers to view different types of images.

“We can have all our sources of information together,” Dr Silverman says. “You click here and it's 2D, it’s 3D, if you want to see a specific tooth, you can review and look at all the images of that one tooth. It just makes everything uniform in one place, which is awesome. Any imagery we want is in there. We can plan it, do it, have it which makes our communication with the patient seamless.”

A surprising benefit with the DTX Studio Clinic software has been the quality of the image display, and the way the software remembers his preferences for settings such as contrast.

Dr Silverman says he’s thrilled with the cohesion DTX Studio Clinic brings to his practice and how it supports his vision of finding and adopting the technology he believes offers the most to his patients. If he could have an extra feature in the software, he says he’d love to have the software automatically highlight or note areas of interest on the images so he can do an even better job of identifying decay or bone loss. The way the DTX software is already benefiting his practice and his patients, Dr Silverman says he feels like he’s already a few steps ahead of where dentistry has been.

“It's one of those things where I've seen the future and it's incredible because our history in dentistry is patchwork all the way around,” he says. “This works. They’ve listened to our pains and have a fully integrated application.”

A look at the benefits Advanced Cosmetic & Family Dentistry in Alpharetta, Georgia experienced with the upgrade to DTX Studio Clinic.

Up Next — DTX Studio Clinic

This issue’s cover story looks at the subject of growth as it applies to practicing dentistry and being a dental professional, but the term can also be applied in several clinical ways. Not every growth is a good thing, just as not every unusual growth is a bad thing. Encountering any of these situations may be extremely rare, but it’s never a bad idea to know about some of these unique and unusual dental situations.

This condition is when extra or supernumerary teeth grow in a person’s mouth. Although this is most common among children with extra primary teeth, hyperdontia can occur with adult teeth as well. The condition is diagnosed via visual examination if the supernumerary teeth have erupted, or via radiograph if they remain below the gingiva. Treatment involves extracting the extraneous dentition. This condition occurs in just 1% to 4% of the population.

This condition occurs when 2 teeth grow from the same root. In these cases, each tooth has its own crown and pulp chamber, but they both originate from a single root. Geminated teeth are diagnosed via radiography or visual examination. Although these teeth can sometimes remain untreated, a geminated tooth can cause alignment problems with adjacent teeth and sometimes requires extraction or restorative treatment. This condition occurs in less than 0.5% of teeth, so it is rarely seen.

This condition occurs when gingival tissue growth occurs beyond normal and can cover more of a patient’s teeth or prevent tooth eruption. Although rare, it is most commonly linked to hereditary factors and is diagnosed based on visual examination. Treatment of this condition involves surgical removal of extra gingival tissue using either a scalpel or a laser.

These benign tumors are comprised of dental tissue that grows irregularly, often without erupting. Although they are generally benign and eventually stop growing, odontomas can cause more serious health issues on occasion. These growths are most commonly identified via radiography, and surgical removal is the usual course of treatment.

As the name would suggest, these growths occur on the mandible, and in this case, they are bony growths on the inner side of the mandible that occur in approximately 6% of the population. These growths can go unnoticed by patients and at times do not interfere with dentition, mastication, or speech. Diagnosis can be done via visual examination or radiography, and treatment via surgical removal is only necessary when the growth is causing the patient pain or discomfort.

A look at some uncommon ways growths can develop in a patient's mouth.

5 Types of Uncommon Dental Growths

Implant-supported overdentures are a life-changing option for many fully or partially edentulous patients. Attaching dentures to an osseointegrated dental implant enhances stability for the restoration, which allows for better function and increased confidence that the dentures will stay where they’re supposed to whether the wearer is talking, chewing, or doing anything else.

When it comes to affixing the dentures to implants, there are numerous approaches to choose from. The clinical situation and the patient’s anatomy inform the choice, but an in-depth knowledge of attachments allows the technician to select the best option for the case at hand and design the restoration to meet the case’s functional and esthetic requirements.

With this in mind, here are some pros and cons for 5 different styles of attachment.

The “most-fixed” type of fixed removable, this involves designing a restoration that will be attached directly to implant abutments with screws.

Creates a secure connection and provides optimal restoration stability

Can be used without a bar or metal substructure

Restoration cannot be removed by the patient

Screw access channels can create esthetic or structural challenges

These attachments are versatile and feature a male ball usually attached to an implant bar or directly to implant abutments. The restoration locks onto the balls with integrated o-ring female attachments.

Numerous design options exist for the location and orientation of the attachments

Easy for patients to remove and replace the appliance

Requires enough space for the ball to be fully above the gingiva

Retention o-rings or other devices wear out over time and must be replaced

Similar to a ball attachment, these features a low-profile, cylindrical male component and a cap style female that clips the restoration to the attachments.

Easy for patients to insert and remove restorations

Attachments can support angulated connections from nonparallel implants

Low profile makes it easier to use when vertical space is limited

As they allow some movement, they cannot be used when a rigid restoration is required

Connectors wear out over time and must be replaced

This attachment style features an implant bar that is affixed to the implants with screws, and then the dentures contain a channel that fits around the bar with plastic or metal clips in the channel to provide retention

Bar does not need to be integrated into the dentures themselves, making replacement easier

Bar must be designed to accommodate clips

Requires more precision in design and fabrication

These attachments feature magnets that are attached to the implant abutment or screw-retained bar, as well as corresponding magnets that are attached to the denture.

Low profile for when vertical space is limited

Retention is often weaker than other attachments

Magnets can corrode or lose strength over time.

A look at the benefits and drawbacks of different approaches to implant attachments.

The Pros and Cons of 5 Implant Attachment Styles

On any ceramic restoration in need of enhanced esthetics

The stains can be applied after the ceramic restoration has been surface treated.

Designed to be a universal coloration solution, Biomic Stain/Glaze is compatible with all ceramic dental materials including zirconia, glass ceramics, and porcelain. The colors are simple to apply and can be custom mixed to achieve desired viscosities and shades. The materials are available in 3 kits, the Basic set contains the most used stain colors, while the Aesthetic set includes an even wider range of shades. Additionally, the Biomic Gum set includes shades for creating lifelike gingival shading and effects.

The Biomic system is capable of adding efficiency to all-ceramic CAD/CAM workflows by eliminating the need to cut back restorations after milling to allow a technician to add 3D effects via ceramic layering. Instead the system features a set of 2D shades designed for mimicking the colors of natural teeth, as well as additional 3D pastes that contain porcelain powder and are designed for adding esthetic effects and adjusting tooth surface morphology. The materials can add a natural-looking fluorescence to zirconia crowns, and the sintering temperature can be adjusted to achieve different surface brightness effects.

A coloration system designed to add esthetic details to all-ceramic restorations.

5Ws* Biomic Stain/Glaze

Whenever implant screws need to be adjusted.

With many implant manufacturers using multiple prosthetic connection types with their implants, making sure the correct drivers are always on hand and ready to go can be challenging. Implant Buddy is a kit of color-coded long and short implant drivers that are compatible with 99% of dental implants, such as those from Straumann, Nobel Biocare, Lifecore, BioHorizons, Astra, Zimmer-Biomet, Megagen, Hiossen, Friadent, Ankylos, and more.

Stored in a magnetic base that makes keeping all the kit components together easy, the system features tapered driver tips designed to provide an optimal connection between the screw and driver to reduce the risk of dropping the implant screw. The entire Implant Buddy kit can be sterilized, and the included thumb knob fits directly into torque drivers.

A nearly universal set of implant drivers to simplify working on implant cases.

5Ws* Implant Buddy Driver Set

Replacing missing teeth has long been a priority for civilizations around the globe long before the advent of science-based oral care. Whether accomplished with dentures, bridges, or various objects wedged into the space created by a lost tooth, implant-supported replacements have always sought a balance between esthetics and functionality. The advent of the modern dental implant best realized this ideal. Here is a timeline noting 14 steps along the way to developing implants as we know them today.

The oldest evidence of dental implants comes from China, where bamboo pegs were once used as replacements for missing teeth.

The oldest records of dental implants integrated into the jawbone are osseointegrated seashell implants found at a Mayan archeological site.

Numerous implant materials including human teeth, precious metals, and porcelain were used but often failed to osseointegrate.

With a hollow, cylindrical “cage” of iridio-platinum topped with soldered gold crown, Dr EJ Greenfield pioneers one of the first successful implant designs.


Brothers Drs Alvin and Moses Strock developed the first metal “screw” style of implant that proved to be biocompatible using a chromium-cobalt alloy.


Dr PB Adams patented an implant design featuring internal and external threading as well as a smooth gingival collar and healing cap.


Researchers M. Formiggini and F. Zepponi pioneer a spiral post–style implant made from stainless steel. During this period, Dr Gustav Dahl develops the subperiosteal implant that sits on top of the bone rather than osseointegrating.


Per-Ingvar Brånemark discovers and coins the term 

 while working with titanium implants placed in rabbit femurs.


Dr Leonard Linkow develops a blade-style implant featuring a flat metal plate that is implanted in the jaw rather than a screw.


Brånemark places 4 modern-style titanium dental implants in Gösta Larsson, a patient with jaw and chin deformities.


Brånemark officially debuts the 2-stage threaded titanium implants used with Larsson and other patients while testing his concepts.


Dr Paulo Maló pioneers the All-on-4 technique allowing faster delivery of full-arch, implant-supported restorations.


Nobel Biocare launches NobelGuide, the first 3D treatment planning and guided implant surgery platform.


Neocis obtains FDA approval for Yomi, the first robotic guidance system for dental implants.

A look at the development—from ancient times to today's cutting edge—of dental implant designs and the technologies used for dental implant placement. 

14 Milestones in Dental Implant History

Nothing lasts forever. Although the purpose of a product, device, or system may never change, it is very likely that its design features will evolve over time.

With that in mind, there are numerous types of products that will always be a part of the practice of dentistry. Although these types of products have and will be enhanced with new features and innovative designs, their core functions remain essential to the practice of dentistry, and they are highly unlikely to be completely replaced by a new technology.

Dentistry is almost always practiced with the patient and the clinician seated, and thus some form of seating is likely to stay. Patient chairs have gone through multiple rounds of innovation. New features are designed to enhance patient comfort, and some chairs are smart systems with internet connectivity and integration with other practice systems. Still, they are chairs at their core. The same is true for clinician seating. Options and styles continue to change, and ergonomic advancements are helping clinicians avoid injury, but they’re still seats. Unless chairs are replaced by some sort of antigravity technology, dental patient and clinician seating is here to stay.

There’s an adage that states, “You can’t treat what you can’t see.” But the inside of a patient’s mouth is a dark place. Lighting is a key part of dentistry because it makes the oral cavity visible for both diagnostics and treatment. The style and placement of dental lighting continue to change as many practices forgo overhead lights in favor of loupe-mounted illumination. Still, the concept remains unchanged, and dental lighting always will be needed.

Imaging technologies have revolutionized dentistry when it comes to diagnostics, treatment planning, case documentation, and patient education. Capturing images of the exterior and interior structures of a patient’s dentition is critical to practicing dentistry. So as the styles of cameras continue to advance, radiation use will continue to be minimized and new technologies will likely make imaging more detailed as well as safer for patients and clinicians. Capturing photos, scans, and radiographs will remain a part of practicing dentistry.

This category has seen an innovation boom in the past year due to the COVID-19 pandemic. PPE will always be a part of dental practice because the mouth remains a major waypoint for pathogens. Looking into and working in a patient’s mouth comes with the risk of pathogen exposure, not to mention the added risk of contact with blood and other fluids from dental instruments kicking up a splatter of these potentially harmful materials. Dental professionals will always need masks, gloves, gowns, and other types of PPE to keep themselves safe and reduce the risks of cross-contamination.

It may seem simple, but in one form or another, the toothbrush has been around for more than a millennium; the modern toothbrush,—for more than 150 years. Over time, the design has been refined in a multitude of ways, and powered versions continue to push the limits of what a toothbrush can do and how effectively it can clean teeth. It’s possible that toothbrushing might be replaced by an antimicrobial solution that eliminates harmful bacteria without the use of a brush, but it’s likely that the concept of rubbing a bristled device across the teeth will be a standard way of caring for oral health for many years to come.

A look at categories of dental products that will always be a part of providing dental care, even as technologies, form factors, and other aspects of these tools and instruments continue to change.

5 Dental Products That Will Never Be Replaced

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

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

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

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

Warming to a New Bulk Fill Composite

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

Adaptable Post Becomes Core Part of Armamentarium

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

Simplify the Payment Process

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

The Perfect Digital Development

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

Natural Rinse for Better Postop Care

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

Milling Made Easy

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

Pandemic Leads to Face Shield Find

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

Chemical Bonding Means Better Endo Temps

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

A Better Shape for Shaping Anatomy

A new material selection helps eliminate postop sensitivity.

Eliminate Sensitivity and Toxicity

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

Move Beyond the Phone to Connect With Patients

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

Enhanced Endodontic Chemistry Means Better Seals

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

Permanent Crown Resin Replaces Conventional Restorations

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

Why I Tabled My Scalpel for a Dental Laser

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

It’s Time to Upgrade to Electric Handpieces

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

Pressing the Button on a Better Temporary Crown Matrix

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

Reflections on the Dental Mirror

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

Replacement Rinse Leads to Better Results

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

Out With Bad Bacteria, In With the Good

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

A New Technology to Manage Xerostomia

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

Treating Sleep Issues at the Root Cause

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

Shade System Reduces Miscommunication

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

Let the Tooth Design the Instrument

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

Add Security and Convenience With Cloud Imaging

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

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

Online and everywhere patients happen to be.

At the right time for patients to be contacted.

Dental practices are busy places, and calling patients to remind them of upcoming appointments or unscheduled treatments is time-consuming for staff. Curve GRO is designed to reduce no-shows and cancellations, freeing up staff time previously dedicated to patient communication.

Curve GRO uses “if-then” logic to automate communication with patients based on customizable settings that can be tailored to each practice. By combining patient communications with the patient records database, Curve GRO automates email and text appointment and scheduling reminders without the need to sync data between platforms. The system is fully HIPAA-compliant and supports 2-way text messaging, allowing patients to schedule appointments and communicate with practice staff in a convenient manner using the device of their choice. The system also includes a payment portal for patients and the full Curve Dental library of patient education videos.

A software solution that takes the guesswork out of when to engage and communicate with patients.