Noah Levine

The evidence of humans replacing damaged and missing teeth goes back centuries. Based on the archeological and anthropological records, it appears these restorations were undertaken for both functional and esthetic reasons. Although dentistry was likely quite painful for patients back then, especially in the earliest days before the dawn of the concept of anesthesia, some of these ancient techniques and the materials used can be easily connected to modern dental restorations. Gold, for example, is among the earliest materials used to fix and replace damaged teeth.

Although the use of gold is less common than it was in the mid-20th century, gold is still a part of the dental industry today. However, other materials have been left to the pages of history books, and this was a smart move, as some of these indirect dental restoration choices sound far less than optimal. Here’s a look at a quintet of abandoned restorative materials from throughout history.

Animals come in a variety of shapes and sizes, and so do their teeth. Animal teeth were used in many ways for dental restorations. Some evidence shows that animal teeth were used as direct replacements for missing teeth in humans. More commonly, the large teeth of animals, such as the hippopotamus, were carved to create sets of dentures that were likely not very comfortable but durable enough for long-term use.


Wood is plentiful. It’s durable, and it’s fairly easy to shape. For this reason, it shouldn’t be too surprising that wood, specifically bamboo, has been used for dental purposes dating as far back as 4000 years ago. Human remains were found with carved bamboo pegs pounded into the jaw, creating an effective but likely extremely painful replacement for a missing tooth.

Used both for decorative and potentially functional purposes, stones as dental restorations date back more than a millennium, with evidence that the Mayan civilization would drill holes in teeth and fill them with precious stones. But stones have also been used to replace missing teeth, with some archeological evidence showing that rocks had been specifically carved to fit in place of a missing dentition.

Although the esthetics and functionality of seashells as dental restorations remain something of a mystery, the archeological record does demonstrate this material might have been one of the more successful attempts at replacing a missing tooth. Once again, the Mayans are behind this dental innovation. In 1931, investigators discovered remains dating back to the seventh century, when seashells had replaced several missing teeth. Most significantly, evidence of bone growth around the shells indicates these restorations were placed while the patient was alive. This is ome of the earliest known evidence of osseointegration.

Much like with animal teeth, this option seems pretty straightforward. Someone is missing a tooth, and the dead person isn’t using it anymore. However, implanting a cadaver tooth in place of a missing tooth can lead to infection, rejection, and a range of other complications, and this doesn’t even account for the fact that many of the teeth sold to dentists were sourced from unwitting donors by grave robbers. As gruesome as the practice of using cadaver teeth must have been, it still doesn’t compare with the brutal practice of slave owners replacing their teeth with dentition taken from living slaves.

Articles

A look at some materials used to replace missing teeth from the times before organized dentistry.

5 Historical Indirect Restorative Materials Unlikely to Be Used Again

Any dental lab with a 3D scanner or the ability to accept digital impression scans from practices.

Whenever a case comes into the lab, because DentalCAD 3.0 Galway features powerful tools for designing fixed and removable restorations.

This single software platform is designed to make restoration design simple and features enhancements, including instant anatomic morphing where proposed tooth anatomy automatically adjusts when the crown proposal is moved on screen. A new interface makes the software easier to use and more intuitive and tool updates make it easier to plan restoration insertion angles and bridge connectors. Updates to the implant module allow easier implant connection switches as well as easier implant positioning adjustments.

 Automation allowing this software platform to accomplish more in less time is a focus of the enhancements in this latest version of DentalCAD. Beyond the automated anatomical morphing, the latest update also adds artificial intelligence–driven smile design that can aid in both treatment planning and patient communication. The model creator module is designed for efficiency and can be used with any 3D printer. For removables, the software includes preset tooth setups and the ability to save custom setups from completed cases.

With more than 90 new features and an updated user interface, this impressive CAD application is even more powerful than previous generations of exocad’s flagship software.

5Ws* DentalCAD 3.0 Galway

Implant cases with screw retained restorations where either or both esthetics and access are priorities.

During case design and at delivery of the case so the implant screw channel can be hidden or positioned for easier access during placement of the abutment and final restoration.

The SMARTbase abutments are designed to improve both esthetics and accessibility with a screw access channel that can be redirected from 0º to 25º, allowing for easier hiding of the screw channel in anterior restorations and easier access to the screw channel in posterior restorations. The abutments are designed with dual hue anodization to seamlessly blend with surrounding dentition to provide a natural look. The versatile abutment solution is compatible with both screw-retained and cement restorations. With a variety of cuff heights and widths available, the abutments can be used with a range of situations.

 The off-axis screw channel allows cases to be designed with lingual screw access as well as other configurations for enhanced access. Specialized off-axis implant drivers are used to attach the screw, and the abutments are designed with grooves that are said to enhance cement retention when the abutments are used with cement-retained restorations. The dual-hued abutments feature gold color at the top to naturally blend with the restoration, and a pink hue in the lower section to better match the gingival tissue. Additionally, the abutments are designed with a concave profile that is said to enable subcrestal placement without the need for major tissue manipulation.

With its angulated screw access channel, this implant abutment system from Implant Direct aims to make implant cases simpler and more esthetic.

5Ws* SMARTbase from Implant Direct

The US dental industry is far more diverse today than it was just a decade or 2 ago, but it still has a long way to go to be an accurate reflection of the US population. The industry was once almost exclusively White and male for many years, but that has been changing—with the pace of change increasing.

This shift is important because minority populations exhibit poorer oral health outcomes due to a range of socio-economic factors. A more diverse dental industry will be better equipped to meet the needs of an increasingly diverse population. Each step toward greater diversity requires a “first” along the way. What follows are 9 such milestones in dental diversity.

Lucy Beaman Hobbs Taylor graduates from the Ohio College of Dentistry to become the first woman to graduate with a doctorate in dentistry.

Robert Tanner Freeman and George Franklin Grant graduate from Harvard University’s School of Dentistry, becoming the first professionally trained African American dentists in the US. Dr Freeman goes into private practice, and Dr Grant stays on at Harvard to become the first African American faculty member at the university.

Ida Gray Nelson Rollins graduates from the University of Michigan School of Dentistry, becoming the first professionally trained female African American dentist.

Faith Sai So Leong, DDS, becomes the first female Chinese American dentist after graduating from College of Physicians and Surgeons, now known as University of the Pacific Arthur A. Dugoni School of Dentistry.

Jeanne Sinkford, DDS, PhD, DSc, FACD, FICD, is named dean of Howard University College of Dentistry to become the first female dean at a US dental school.

Geraldine Morrow, DMD, becomes the first female president of the American Dental Association.

Rear Admiral Carol Turner is named the first female chief of the US Navy Dental Corps.

Raymond Gist, DDS, becomes the first African American to serve as president of the American Dental Association.

More than half of US dental school graduates are female for the first time.

A look at some of the pioneers and key moments in the diversification of the dental industry.

9 Diversity Milestones in Dentistry

Chemistry remains a vital part of dentistry, and like most technologies, the chemistry of dental materials continues to evolve and improve. New materials often bring enhanced physical and esthetic properties, new ways to use them, and the latest approaches to familiar situations. The 

 2021 Materials Survey looked at what enhancements mean the most to readers like you and how you can evaluate new material options for your patients.

The 2021 Materials Survey asked many of the same questions as the 

® 2020 Materials Survey, and many of the results were similar. But preferences do change over time, and there were some interesting shifts in the data from one year to the next. Read on to see what type of materials the 

 audience prefers and what capabilities or improvements are most likely to get the industry interested in new material innovation.

Material preferences remained fairly stable year over year. The most popular choice for crowns and composites in both the posterior and anterior remained the same this year, but there were a few notable shifts. Universal composites continue to earn their title, but flowable composites grew more popular in both areas of the mouth, with twice as many survey respondents in 2021 saying they prefer a flowable in the anterior compared with 2020. When it comes to crowns, zirconia remains the top choice of more than half the respondents.

Even when a material is new, dentists still prefer something with a track record. This is demonstrated by the fact that half of the 2021 Material Survey respondents said they want to see published research on new materials before bringing them into the operatory. This was up from the 37% who said the same thing last year. The second most popular choice was a tie between the early adopters and the wait-and-see crowd.

This past year was especially hard on dental practices, and COVID-19’s impact affected the ways materials were purchased and managed. Many practices were conservative and reduced purchasing and inventory, but a fifth of respondents said they increased inventory, possibly to ward off the impact of supply chain issues.

Factoring the Optimal Material Properties

Close to 80% of respondents said enhanced durability is an important factor they look for when considering a new dental material, and this number is almost identical to the result of last year’s Materials Survey. However, it seems that esthetics grew in importance over the past year, as almost 10% more respondents said improving a material’s esthetics is very important. Another key factor that can make adopting a new material worth it is ease of use, which 97% of respondents ranked as important or very important.

Increased durability and enhanced esthetics are the top factors when it comes to choosing a new material. Find out what material preferences matter most with the Dental Products Report® 2021 Materials Survey.

2021 Materials Survey: Stronger & Better Looking

 15 Steps in the Evolution of Endodontics

With May being Save Your Tooth Month, we take a look back at significant developments in the history of endodontics and root canal therapy.

15 Steps in the Evolution of Endodontics

Dental ceramics have been the focus for Rafael Santrich, CDT, throughout his career, which stretches back to the 1990s. Santrich has used numerous ceramic systems and materials and developed esthetic techniques and workflows such as the Scoop Technique. In the early 2000s, he founded VM Lab Technologies in Aventura, Florida, which now has 9 employees as well as a small teaching center.

“I’ve been doing esthetics, always, always,” he says. “This is my main focus esthetic cases, custom cases, and we do a lot of hybrids.”

A technician who is comfortable pioneering new workflows and employing new technologies such as photogrammetry imaging of implant cases, Santrich says he was skeptical about 3D printers when they began to be employed in dental laboratories. He only started using the technology at his laboratory 2 or 3 years ago.

“At the beginning, I didn’t believe in 3D printing technology because I always heard the materials are not stable. So I never got involved 100% with it,” he says.

The first printer he purchased for his lab didn’t always meet his expectations. Santrich says solid models were fine, but when it came to printing models for implant cases requiring as much precision as possible, he’d find the analogs would not seat completely. He would have to adjust the printed models, which made work more complex and time-consuming. Santrich eventually found better results outsourcing model printing to a larger lab with a large-scale printer. He was happy with the results of the handful of models he’d outsource each month, but he still preferred analog impressions and models.

Designed to provide a start-to-finish 3D printing solution, the PrograPrint system from Ivoclar Vivadent includes the PrograPrint PR5 3D Printer, PrograPrint Clean, PrograPrint Cure, and ProArt™ line of print materials. The PrograPrint PR5 is a self-calibrating DLP printer featuring a 4-million-pixel resolution, 49-µm pixel size, and 50- to 100-µm layer thickness. The system produces models, splints, surgical guides, as well as wax for pressing or casting. Self-contained material cartridges increase efficiency and reduce waste.

Earlier this year, he added Ivoclar Vivadent’s PrograPrint 3D printer to his lab. Santrich says he is trying a variety of applications for the printer, and it is producing results he’s happy to use. Models produced with his previous printer didn’t meet expectations, but the PrograPrint models provide a good fit for implant analogues and deliver when it comes to resolution.

“The quality is really nice, allowing me to see very good details,” he says. “There is no need to make adjustments and accuracy of fit is right on.”

Santrich also is using the PrograPrint to produce wax-ups for pressing IPS e.max restorations. He likes having the freedom to allow the software to attach the sprues or to choose the contact points himself. Although the printed wax material does shrink a bit, the workflow for printing, cleaning, and then pressing with the wax parts helps eliminate any negative impact. Santrich likes that the wax remains stable until it is cleaned and cured, and as long as it is pressed within the next 2 hours he’s able to get the printed accuracy in the pressed ceramic.

“Once we press, it’s really good,” he said. “It prints thin margins, which is really important today with noninvasive dentistry, and that is something that some mills can’t produce, so that level of precision is really important.”

The print-and-press workflow Santrich is employing with the PrograPrint is a growing part of his workload. The self-described “really, really picky” technician says the PrograPrint’s production quality is meeting his expectations. Santrich says the printer adds efficiencies to his lab, but no matter how good the technology gets, an experienced technician is always the most important part in meeting each case’s unique challenges.

“I think it’s a device that helps us to be more predictable and faster, but [the technology won’t] replace us,” he says.

With the PrograPrint in his lab, he is able to speed up veneer and similar cases by digitally designing and printing the wax-ups and then having his waxing department check for quality and invest the ring, which saves a significant amount of time. His workflow takes into account the 2-hour window of time post curing, so they print the cases overnight in order to clean, cure, and press the next morning.

For Santrich, the PrograPrint is a printer with the accuracy he demands. He’s continuing to develop and refine his workflows and finding ways to use the printer instead of his mills.

“I was skeptical about having a big machine [such as] that in the lab, but now it’s worth it,” he says. “We are experiencing the advantages. Right now we’re super busy.”

How the PrograPrint 3D Printer from Ivoclar Vivadent is meeting the requirements to work in Rafael Santrich’s lab.

A 3D Printer Providing the Precision Labs Require

Today’s dental practice very likely looks different from how it did a year ago. In response to the coronavirus disease 2019 (COVID-19) pandemic, dental practices changed schedules, modified clinical and operational workflows, and adopted new strategies and products to prevent infection.

These steps clearly made a difference: Although dental professionals work in one of the riskiest environments for the spread of infectious diseases, COVID-19 was not widely transmitted in dental settings. With multiple approved vaccines, the pandemic might be a less pressing concern later this year, but some of the changes in dental practices likely will be permanent industry shifts.

With this in mind, here’s a look back at 6 ways dentistry changed in the wake of the AIDS pandemic in the 1980s and ’90s.


This is one of the most noticeable changes that arose in the 1980s. Due to the risks of transmission of HIV and hepatitis B, dentists were encouraged and then required to wear gloves, masks, and other PPE. Today, the idea of working in a patient’s mouth barehanded seems outrageous.


Prior to the AIDS pandemic, dental handpieces were generally cleaned after use but rarely sterilized. This was due to both design and a lack of sterilization requirement. When the requirement changed, handpiece design followed; today, like all other nondisposable instruments in the practice, these vital pieces of operatory equipment get sterilized.


The processing of instruments also changed as hand cleaning and cold sterilization were determined to be less effective than heat sterilization at preventing the spread of disease. An increased awareness of how to prevent the spread of blood-borne pathogens led to a decline in hand washing of instruments, especially those with sharp points and edges. This made way for ultrasonic cleaners and instrument washers to enter the industry to improve the safety and efficacy of instrument processing.


With the risks of the spread of deadly diseases such as HIV more widely understood, dental practices began implementing more stringent processes for cleaning waterlines, wiping down surfaces between appointments, and using protective barriers on surfaces and instruments that cannot be sterilized or sanitized.


In 1986, the Centers for Disease Control and Prevention issued formal infection control guidelines for health care settings, standardizing how dental practices are expected to operate regarding sterilization, sanitization, staff training, and general protocols for keeping patients and practitioners safe.

Dental professionals have long known about the risks of transmitting disease in health care settings, but with the spread of both HIV and hepatitis B in the 1980s, the risks from viruses that are transmitted by blood and other body fluids became far more present, and training in how to mitigate those risks became standard.

These are some of the most noticeable ways the dental industry adapted to meet the challenges of the AIDS pandemic in the 1980s and early ’90s. Not every change adopted during the COVID-19 pandemic will stick around, but some will. For example, the industry’s new focus on aerosol risks and mitigation strategies is likely here to stay. Although change can be difficult, clinicians and patients are better off with every step practices take to make things safer.

The full impact of the current pandemic might not come into focus for several years, but here's a look at some of the key changes to the industry following the AIDS pandemic of the 1908s and 1990s.

6 Ways the Previous Pandemic Changed Dentistry

It’s safe to say that over the course of the past decade 3D printing has advanced to the point where the technology is not only a vital part of many modern dental laboratories but a foundation for the future of the industry.

Perhaps the ideal technology for meeting the needs of dental labs, 3D printers allow for rapid production of small, customized parts with a high degree of detail and accuracy. With different printing systems capable of printing in wax, polymers, ceramics, and metals, the technology is already able to meet most of the needs of dental labs when it comes to the production of dental prosthetics and the various parts and pieces needed to fabricate them.

But a 3D printer is one of the most versatile technologies in the dental laboratory industry. These systems are limited only by their build volumes and material options, and even with those limitations, there are numerous other applications for 3D printers that might be of interest to dental lab professionals. Here are 5 other things you can print on your lab’s 3D printer.

5 Other Things to Produce With Your Dental 3D Printer

A 3D printer is one of the most versatile technologies around, and these systems can do a lot more than produce dental models and restorations.

Through his work at his Boston dental practice, his role as a dental educator at a local university, and his extensive experience testing new dental materials, Gerard Kugel, DMD, PhD, MS, feels confident he knows what to look for in a composite system.

Throughout his more than 3 decades of clinical experience, Dr Kugel has worked with and tested many generations of direct restoratives. He believes clinicians today have more great material options to choose from than ever, and is excited by some of the newest dental composites that take shade matching to a new level with the ability to match almost any tooth shade with a single composite shade.

“It’s the translucency and refractive index,” he says. “It picks up the color of the [surrounding] teeth, almost mirroring the color.”

Among the materials he’s used, Dr Kugel sees Ivoclar Vivadent’s Tetric Prime as a standout. He first encountered the material while conducting research with composites offering a single-shade chameleon effect.

“Other conventional composites didn’t work as well,” Dr Kugel says. “We were impressed with Tetric Prime. I’ve used it in practice as well. It has a very streamlined shading system in general. They have universal enamel shades, which are great, but you could theoretically complete a lot of restorations with just the translucent shade.”

Tetric Prime is a universal composite system featuring prime handling and a simplified shade system. Tetric Prime is said to provide the creamy handling necessary to use in the anterior and the adaptability and nonslumping characteristics needed for posterior efficiency. Tetric Prime’s T shade is 15% translucent and contains refractive index technology to match the optics of natural teeth, offering a single shade option for Class I and II restorations.

The material’s composition includes a monomer matrix and filler materials with a matching refractive index to allow light to transmit through the composite in order to produce natural-looking shade blending.

Dr Kugel says the T shade can get the job done on its own for many Class I and II and some Class V restorations, but Tetric Prime offers 11 additional shades with differing levels of translucency to allow more conventional shade matching and customization.

This versatility sets Tetric Prime apart from other composite materials, according to Dr Kugel. He says the translucent shade allows clinicians to work with Tetric Prime the same way they would with other single-shade composites. This means a simplified clinical protocol and less material in inventory. But with Tetric Prime, clinicians gain the benefits of a more traditional composite system as well.

“Ivoclar knows they’ve got a product that’s good for a lot of restorations with the translucent shade, but they’re still giving you the option, which is probably smart,” Dr Kugel says.

The 2 dentin shades are useful for cases in which opacity is critical, he adds, noting that Tetric Prime can be a go-to option for many practices. Still, Tetric Prime brings more than simplified shade matching, Dr Kugel says.

“Most of the new composites that come out are pretty decent,” he adds. “What really makes a difference for dentists with new composites is handling. [Tetric Prime is] creamy, I can sculpt it well and it’s got great handling characteristics. The other thing I found in my study is that it polishes really well.”

As impressed as he is with the material, Dr Kugel says there are still capabilities he hopes to see in restorative materials of the future. While Tetric Prime checks the boxes forsimplified shade matching, reduced inventory, and smooth handling, Dr Kugel says he’d love to have a material that adds self-adhesive to that list of capabilities.

“To me in a perfect world, the ideal composite would be a universal shaded, self-adhesive, bulk fill material that handles well and polishes well,” he says. “We’ve come very far, but we still could make it even better.”

Dr Kugel says there are numerous high-quality restorative materials available today that make it simpler for clinicians to get the results they and their patients expect. Tetric Prime is among the new materials to impress Dr Kugel, and he thinks it makes a great single-shade solution while maintaining the flexibility for use in complex situations.

“Having a product that can answer your questions, meet your needs, and not take up 800 shelves in your storage room is a good thing,” he says.

Gerard Kugel, DMD, PhD, MS, shares his experiences working with and testing Tetric Prime, a versatile universal composite from Ivoclar Vivadent.