Noah Levine

As a dentist in her hometown of Columbus, Ohio, for more than three decades, Susan K. Wilson, DDS, is always looking for new ways to help care for her patients. She currently practices with her daughter, Maurina L. Brooks, DDS, at Hot Smile Dental and Heavenly Sleep Center as the first black mother-daughter dental practice in the Ohio capital.

A general dentist who also spent 10 years as a clinical instructor at her alma mater The Ohio State University College of Dentistry, Wilson says she began offering sleep services around 5 years ago to help her aging patients manage some of the co-morbidities they were developing.

“I began to search out more answers as to why this was occurring and how I could better serve them,” she says. “I decided to take new sleep courses that were being offered at conventions.”

After taking several courses and feeling ready to provide sleep services to her patients, Wilson said she was all set to partner with one sleep company, but she changed her mind at the last minute and instead decided to work with SleepArchiTx as her preferred sleep partner because she liked the company’s philosophies and treatment methods.

“I have not regretted that decision. Their knowledge and dedication is unparalleled in the field of sleep medicine,” she adds.

Designed to be a turnkey solution to help dental practices provide sleep medicine to patients, this 360° solution includes a sleep medicine education curriculum, diagnosis through board-certified sleep doctors, treatment planning, a wide selection of sleep appliance design and fabrication, medical billing assistance, and individualized support. The system is designed to get any practice up to speed with sleep medicine.

SleepArchiTx provides dental practices with a turnkey system for providing sleep solutions to patients. The solution includes access to board-certified sleep physicians who work on the diagnostics, while also providing access to a portfolio of sleep appliances to meet different clinical needs, as well as billing assistance to make sure dental practices are compensated properly for their work. Sleep medicine education, training, and support are also parts of the turnkey solution.

After educating herself on dental sleep diagnostics and treatment, and selecting SleepArchiTx as her partner, integrating sleep services into her practice was relatively simple. Wilson says having medical research and billing integrated into the SleepArchiTx program is a huge advantage, she liked the remote, video conference training for her and her staff, and has continuously been impressed by the way the SleepArchiTx staff is available to answer her questions.

Today, with so many patients of all ages exhibiting some symptoms of a sleep disorder, her practice conducts sleep screenings during routine dental examinations. When a patient’s sleep score is high enough to warrant follow-up, they recommend a sleep study, which is usually conducted at the patient’s home.

These studies are organized through SleepArchiTx and the results are interpreted by their board-certified sleep physicians. Wilson and SleepArchiTx then prepare the case presentation with her recommendation of the ideal treatment option for that patient. Once the patient accepts the treatment plan, SleepArchiTx fabricates and delivers the appliance to her practice so she can provide it to the patient.

By partnering with SleepArchiTx, Wilson says she’s been able to enhance the care she provides to patients, and to treat more than just their dental health issues. Wilson says she enjoys having options for her patients, and she likes being able to provide appliances to help patients who have been unable to manage their sleep issues with other medical devices, such as a CPAP machine.

“We can give the patient more options to decide on how best to treat their particular sleep disorder,” she says.

Saying she’s been completely satisfied working with SleepArchiTx, Wilson says her patients generally feel the same way about their oral sleep appliances. Getting an improved night’s sleep can help people in a number of ways with one patient who couldn’t tolerate a CPAP describing her new sleep appliance as “convenient” and “the best thing ever!”

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Partnering with SleepArchiTx and the company’s turnkey sleep solutions helps Columbus dentist Susan K. Wilson, DDS, help her patients with more than just their dental health issues.

Closer Look: An ideal partner to help patients improve their sleep

Bone graft materials can be difficult to manipulate and place

When placing a bone graft, minimally invasive approaches can be challenging because the graft material can be hard to deliver to difficult to access defects.

The material features a bimodal particle distribution of Calcium Phosphosilicate with Polyethylene Glycol to create a putty that does not set like cement, but can adapt to the defect shape

Available in a variety of delivery systems, including shells, syringes, and uni-dose cartridges which dispense the material through a 2.8 mm cannula, allowing easier placement

A bioactive regenerative material, the putty acts as an osteoconductive scaffold while also providing active osteostimulation to encourage differentiation of new bone cells at the site for faster bone regeneration and increased rate of resorption

Radio-dense, the material appears as a mass on radiographs that can be differentiated from surrounding bone by the lack of trabecular pattern

The putty has a 4-year shelf life and does not require refrigeration

With NovaBone Dental Putty and its uni-dose cartridge delivery, clinicians can take a minimally invasive approach when bone augmentation is necessary.

Solve My Problem: Easier delivery for more consistent bone graft placement

	Many of the advances in restorative dentistry are driven by advances in materials. Every generation of new composites, adhesives, and every other dental material category aims to achieve an end result closer to natural dentition in looks, function, and durability. They also aim to be easier to use and more convenient for clinicians and patients alike.

	This consistent development of new material choices means dental professionals are constantly challenged to stay informed of all of the options that could bring benefits to their practices and their patients. But adopting new materials can be more complex than opening a package with different branding on the outside. New materials often mean new clinical workflows, sometimes new operatory equipment, and even new training. This means changing what’s used in a practice is a choice rarely made on a whim.

	To find out what goes into those decisions and what types of material choices dental professionals are making of late, Dental Products Report conducted our 2020 Materials Survey. We asked you, our audience, about your materials decisions and the reasoning behind your choices. Read on to see how your material preferences fit with those of your peers, as well as for material advice from Editorial Advisory Board Member Dr. Sarah Jebreil.

Continue to page 2 for Dr. Jebreil's take…

		Advice on materials and the choices clinicians make about the brands and materials they use.

				If it ain’t broke don’t fix it…

				This old adage is the tune many of us run our practices to, but why? Why are we so hesitant to try new things? Is it the research we need to see, or the live demonstration, or the approval of like-minded colleagues, or our patients’ asking for it to get us to try something new?

				I would say it is different for all of us, as some of us are more risk-adverse and others like to stay in their comfort zone, but how do we know if by staying in our comfort zone we are hurting our quality of dentistry or if by being more risk-adverse we are missing chances to improve our standard of care? Of course, it’s not a one-size-fits-all situation, as the quality of care your practice gives is unique to the mission of your practice and therefore assessing a new material is truly a personal decision.

				The perfect bonding agent has been an area of debate forever. There are so many bonding agents it hard to know which one really is the best. Bonding is case sensitive and technique sensitive. So, do you choose one go-to agent for everything, or do you choose a plethora for each situation? Do you choose according to colleagues and articles’ approval, or what has been tried and true in your hands? Also, how expensive is the risk if this product fails in your hands or fails to deliver as promised?

				I don’t know about you, but the health of my practice relies on the strength and predictability of my bonding agent because I use it for almost every procedure. Because it is such an essential part of my practice, I can’t afford to just try something new. When I started practicing, I used the bonding agent that was given to me at the practice I was associating. After a time, I started to realize I was having a lot of failures with de-bonding and patient sensitivity. I immediately ordered my tried and true bonding agent that I was familiar with since dental school, and everything improved.

				Since then I have been very hesitant to change, but a few years ago I learned of another agent while taking a course and I was amazed at its reviews and ease of use. I decided to give it a try, and since then I have been hooked. So, it is understandable that materials that make up an integral part of your practice must be chosen with a great deal of precaution.

				Other materials, such as liners and matrix systems, are easier to change as they are not as impactful. It is noted that many clinicians debate for some time before buying a new piece of equipment because the price tag is much higher and oftentimes the learning curve can be cumbersome. Clinicians and dental teams often become stuck in their routines and it can be challenging to bring a new piece of equipment in to disrupt the usual flow. If the equipment is guaranteed to save time and money but the price tag is high, it is often the thought of training our staff something new that drives our decision whether the investment is right for our practice.

				I personally debated a while before buying an intraoral scanner, and then after buying it I had buyer’s remorse because initially impressions were so much quicker than scanning. As we became more adept with the scanner, I cannot imagine not having it in my practice. I believe it is good for our teams to constantly change and evolve-it keeps us our brains working and alert rather than on autopilot.

				Lastly, the other big driver in what determines our material choice is our patients. Do they like our rubber dams, or do they complain too much? Do we try a different isolation system to wow our patients, or will they complain about that too? Oftentimes, it’s consumer behavior, meaning it’s the way we present our materials and methods to our patients.

				Having conversations with our patients on what materials we are using and how great it is for them and their overall health usually wins their satisfaction. But what about when it comes to appearance of our restorations? There’s not much sweet talking we can do if our restorations stick out like a sore thumb. In those instances, patients definitely drive the clinician’s material choice. We are all so eager to “wow” our patients we will often try anything that sounds promising in hopes of gaining our patients’ approval.

				As you can see, there are three big factors that motivate clinicians’ material choices: Cost of failure, barrier to entry (cost vs. changing the team’s routine), and patient approval. Each material choice is unique to each practice. Oftentimes, if we work for a DSO or large group, we choose from a curated formulary or simply use what we are given. If you do have the ability to pick and choose what materials your practice utilizes you should consider that a gift with which you chose carefully.

Continue to page 3 for the survey results…

				The properties of dental materials, such as shade and shelf life, play a big role in the way those materials are stocked at dental practices. Having the material you need on hand when you need it is key. Our survey shows dental composites are the material where the largest variety is kept on hand. 44% of respondents stock six or more, and another 37% stock four or five. The choices simplified for other types of materials, with fewer than 10% of respondents keeping more than 3 resin cements or adhesives on hand.

Continue to next page for more survey results…

				When conducting these surveys, we always ask how you describe yourself and your material decision-making process. The two most common categories were the researcher and the patient purchaser, both relying on a published track record before adopting a new material. The least popular description in this survey-chosen by just 4% of respondents-was of someone uninterested in trying new things. With so many material options available all the time, there is no shortage of options for curious clinicians to try.

The 2020 DPR Materials Survey continues on the next page…

				It’s no big surprise that different types of materials are the go-to choices for different types of restorations. However, universal composites are the go-to for most direct restorations. For direct posteriors, 51% of you grab the universal, while 32% prefer a bulk fill option. However, in the anterior, 82% of you say a universal composite is your first choice.When it comes to indirect crowns, zirconia is the choice for 58% of you, while glass ceramics such as lithium disilicates were the preference for 18%, and porcelain-fused-to-metal crowns are still the go-to for another 18% of you.

The 2020 DPR Materials Survey concludes on the following page…

				Modern dental materials offer a wide array of features. Knowing which factors are most important to you is key. Our survey looked at which of these factors matter the most. Enhanced durability stood out as the most important factor, as 79% of you say it’s a very important consideration, and an additional 18% listed it as important. The other considerations rated very important by more than 50% of the survey respondents were enhanced esthetics, simplified technique, and bioactivity. While almost every aspect of a new material was considered important enough to be taken into account, one product enhancement-a reduced number of shades-did not receive 50% of the respondents listing it as very important or important. When it comes to fewer shades, 27% of respondents said it was not important or slightly unimportant, while an additional 29% of respondents said it was neither important nor not important.

The Dental Products Report 2020 Materials Survey looks at the types of materials you prefer in different situations, how you manage materials inventory, and how you evaluate and adopt new material options.

Material Thoughts: The 2020 Dental Products Report Materials Survey

	Dentistry in one form or another dates back thousands of years, as humans have long sought ways to reduce or eliminate oral pain, replace missing teeth, and even enhance cosmetics. But while the goals of dentistry remain similar, the paths toward achieving these goals continue to evolve and improve.

	Changing dental products often drive these enhancements in both clinical and operational approaches. Sometimes they even impact the physical space of a dental practice, such as switching to digital X-rays and eliminating the need for a room for processing the images. Of course the past isn’t static, as some practices today are completely digital in both practice management and patient care, and others still operate with films and paper forms. In fact, to a practice that has rarely invested in new equipment, today’s state of the art dental technologies might seem plucked right out of science fiction, but the truth is, lasers, 3D imaging, digital treatment planning, and even robotic systems are not the future, but are all parts of dentistry’s present.

	What do all these advancements mean for the industry’s future? No one really knows exactly what’s going to revolutionize the industry and set a new standard of care, but, whether it’s technologies from other industries or based on research underway right now, there are plenty of hints to where we’re headed. Read on for visions of the Past, the Present, and the Future of dental practices and dental products.

See the Past, Present, and Future of Practice Operations on the next page…

	If there was one word to describe the hub of dental practice front offices of the past it would be “paper” because paper was used for everything from patient records, to patient forms, to practice marketing, and patient communications. Practices advertised for new patients in local newspapers and The Yellow Pages, mailed postcards to patients’ homes, and managed the practice’s operations with literal paper trails for every appointment. The telephone was also a key tool for connecting patients with the practice. Billing and insurance was handled with the telephone, letters, and eventually the fax machine. Needless to say, this was a slower, less efficient situation for practices where losing information was as simple as a page of paper falling out of a folder unnoticed.

	Today practices can leave the paper behind and manage their practice digitally. This means keeping practice schedules, patient records, and more in a digital database that can even be stored in the cloud and accessed from anywhere. Patient communication is managed via text messaging and emails more often than phone calls, and video calls and even remote, teledental appointments are growing more common, partially due to the COVID-19 pandemic. In the up-to-date practice, new patients are found with varying digital marketing campaigns with the ability to focus efforts on specific types of prospective patients. Many of these digital tasks can be automated with software and artificial intelligence constantly reviewing efforts and adjusting in real time for optimal impact.

	"Although software that is professionally managed in the cloud is widely adopted in most industries today, it is just now catching fire in the dental community.” – Mark Blount, Vice President, Curve Dental

	“In the wake of the COVID-19 quarantine and subsequent shutdown, dentists across the country are implementing innovative strategies to allow continuity of care for their patients. Through the use of teledentistry and various models of mobile care delivery, practice owners are creating non-traditional patient touch points outside of their brick and mortar practice.” – Melissa Turner, BASDH, RDHEP, EFDA, Chief Hygiene Officer, Cellerant Consulting

	“Artificial Intelligence and Machine Learning hyper-efficiently analyzing, automating, completing, or delegating tasks is the cutting edge of front office management. What could more helpful than an AI Virtual Office Manager pre-educated with the best practices, KPIs, successes, and failures of some of the nation’s top practices?” – Paul Intlekofer, CEO MMG Fusion

	“Incorporating secure, touchless workflows in the front office are not only easy to do, but add massive efficiency and convenience for patients and teams.” – Dr. Bryan Laskin, Founder OperaDDS

	“Advertising automation is becoming a popular marketing trend that leverages machine learning technology to improve the placement of ads in real-time – saving dental practice owners time and money by stretching their advertising budgets farther than ever before.” – Daylen Farkas, VP of Search Advertising Product, Scorpion

		The future of practice operations is likely to include even more automation and deeper AI integration into all parts of the practice workflow, including patient communications. While teledentistry is taking off now during the COVID-19 pandemic, this is a technology likely to play a larger role in the future, as more diagnostic and screening services will be able to be provided remotely via secure platforms and enhanced commercial imaging capabilities. Practices will also involve less physical contact as voice operated systems from patient forms to charting to scheduling are handled without the need to physically interact with an input device. The technologies ready to hit dentistry will make managing a practice more streamlined, more reliable, and even safer for staff and patients.

See the State of the Art in Practice Operations on the next page…

		The State of the Art in Practice Operations

See the Past, Present, and Future of Equipment & Technology on the next page…

	This is an area of dental practices that is advancing at an incredible pace. But in the past, the technology in a dental practice was likely to be mechanical rather than digital. Sure patient chairs tipped back and handpieces were driven by air turbines (after belt drives went out of fashion), but things needed to be moved and adjusted manually. X-rays were captured on film, and those exposed films had to be properly processed before the clinician knew if the image was usable or not. Impressions were captured using physical materials, and those impressions-or models poured from them-had to be shipped to a lab for dental restoration fabrication. The past of dental technology was noisier, clunkier, and often bulkier and heavier.

		The cutting edge of dentistry these days might seem like science fiction to some. A practice up to date on its clinical technology is likely using lasers in place of handpieces, providing same-day crowns via CAD/CAM, 3D printing anything they can produce on their printer, and using 3D imaging to diagnose and plan treatments. Today’s clinical technologies make diagnostics faster and safer, while also allowing clinicians to do more for patients in fewer appointments with less pain and discomfort than was possible with previously available technologies.

 all-tissue laser and doing virtually all of my fillings needle-free and drill-free has dramatically increased new patient flow. It has also made me more efficient and enabled me to perform surgical procedures I couldn’t do before."  - Dr. Yooson Kim

		“Oftentimes with 2D imaging a patient’s anatomy obscures what you are trying to detect, but with the Planmeca Ultra-Low Dose 3D CBCTs, they have proven to be 100% diagnostically accurate and lower radiation exposure, so it’s beneficial all around for the patient and my practice.” – Dr. Michael Young

		“This has not only yielded efficiencies within the practice, but patients have been very pleased with the convenience of not having to make multiple appointments for one treatment.” – Dr. Laura Justice speaking about same-day CAD/CAM dentistry

		The motto for the future of dental technology could easily be, “Better, faster, stronger” as each new generation of imaging system, laser or CAD/CAM solution gets easier to use to produce better results in less time. The next wave of new technologies is likely to include radiation-free imaging solutions that provide safer ways to capture diagnostic quality images. A laser solution designed to treat healthy teeth to provide protection from dental caries is in development now as well. Other improvements that could be the future of dentistry include automated clinical assistance (i.e. robots to help clinicians), as well as integrated, intelligent diagnostic platforms that produce a potential diagnosis based on the imaging input provided. Virtual and augmented reality solutions will also be likely to be integrated into loupes and microscopes to allow visual prep guides and other information overlays during treatment.

Get Up to Speed with Dental Equipment & Technology on the next page…

			Get Up to Speed with Dental Equipment & Technology

See the Past, Present, and Future of Dental Materials on the next page…

		Restorative dental materials date back as far as dentistry. When all or part of a tooth is missing, replacing it with something is important to helping that patient regain full function, not to mention esthetics. In the distant past these materials were found in nature, but synthetic dental materials have been around for a long time as well. The dental materials of the past were rarely tooth colored, so dental restorations stood out in a patient’s mouth regrardless of the clinician’s skill. These materials could also be touchy to work with, as they offered less than optimal working and set times. Still it wasn’t all bad, especially for patients, as materials from the past often provided durability and functionality, which is likely one reason some older materials, such as gold-as well as the related clinical techniques-are still in use today.

			The dental materials available today are generally simpler to use, while producing highly functional, and highly esthetic outcomes. The word universal is now a common descriptor, as tooth-shaded composites are the norm, and incredibly strong adhesives that work with a wide range of materials are growing increasingly common. But the real push for cutting edge materials today are ones that do more than fill a hole, but add in beneficial bioactive properties or even anti-microbial properties to provide lasting protection and benefits. Modern dental materials are easier to use, and provide better results for patients.

			“I believe restorative materials will see an increase of products that focus on the streamlining of the restorative process. Technological and scientific advances allow manufacturers to develop composites and bonding agents that reduce the guesswork in bonding protocols, depth of cure and shade matching.” – Masa Ogata, CEO Tokuyama Dental America

			“In today’s new normal this type of material offers a unique solution of versatility and increased utilization while also minimizing cross contamination.” –  Russ Perlman Executive Director of Marketing, VOCO America

			“Dentistry is swiftly moving towards composites with a new mindset. Injecting rather than packing. Monolithic restorations rather than using multiple resins and a variety of opacities for esthetics.” – Dr. David Clark

			“Unlike traditional restorative materials, which are passive and meant to fill an empty space, bioactive materials actively release and recharge essential mineral ions that help stimulate apatite formation and seal restorations at the margin.” – Dr. Robert Lowe

				The trajectory for dental materials is ever and ever closer to something that looks, feels, and functions like the tooth it’s replacing. In the near future products such as GreenMark Biomedical’s LumiCare™ Caries Detection Rinse and CrystLCare™ Caries Prevention Gel will hit the market to offer new approaches
				for early, incipient lesion detection and treatment. Eventually, regenerative technologies will likely make many materials obsolete, as a combination of better decay detection and prevention and the ability to spur a patient to regrow missing tooth structure is likely to take over. The good news is more patients are likely to keep their teeth throughout their lifetime, even if they have to regrow one or two along the way.

Continue to the next page to see some materials at the cutting edge today…

A look at how far the dental industry has come from the analog products of the past, to today’s cutting edge technologies and materials, to visions of what dental products and practices might look like in the future.

Past, Present, Future - The Evolution of Dental Products

	Busy is the normal state of being for most dental practices, labs, and manufacturers because everyone is  a potential patient, and oral health care is a constant need.

	So, what happens when a global pandemic largely idles the industry? It certainly doesn’t sit still or stay on the sidelines. Dental professionals are in the business of helping, so during this pandemic, many dentists, hygienists, lab technicians, dental product manufacturers, and other dental professionals are finding ways to put their skills and equipment to use.

	Dental practices have been shut down to all but emergencies in most states as a part of stay-at-home orders attempting to slow the spread of the coronavirus. This has left most practices with around 10 percent of usual revenues coming in and a lot of free time on their hands. The drop in practice production is felt similarly by dental labs and product manufacturers.

	But as oral health care providers are shutting down, the hospitals managing patients with COVID-19 are facing supply shortages, especially when it comes to personal protective equipment (PPE) and supplies for administering COVID-19 tests. These are some of the gaps the dental industry is finding ways to fill.

	Dental businesses are donating excess PPE supplies to local hospitals and other essential services, while those with the right equipment are now producing PPE and testing supplies, often using 3D printers. These efforts are being driven on local, and individual levels, but no one has been left to help alone. Shared information and digital resources are easily accessible for anyone who wants to help.

	“We’re all in this together, and I think the strength of strategic alliances are very, very important in this time and it’s proved out to be a tremendous advantage,” says Brian Ganey, vice president of oral health at Carbon.

	“It’s amazing to see how people are helping each other develop products, and how everyone is opening up and sharing ideas,” adds Maggie Dempsey, vice president of information systems & corporate development at Dental Arts Laboratories, Inc., of Peoria, Ill.

	A lot of this online sharing has been centered around 3D printers. Some of the larger 3D printer manufacturers are taking on lead roles to vet and distribute printable files for face mask headbands, testing swabs, a wide range of face mask designs, and more.

At 3D Systems, the company focused on keeping operations going in a safe manner. At the same time, they turned attention outward to interact with customers to assure them of ongoing support and to engage them in helping where they can, says Menno Ellis, senior vice president and general manager for Plastics at 3D Systems.

	He sees his company’s technology as being absolutely critical during this pandemic because it can be implemented quickly, plans can be shared digitally, and the versatility of the technology can allow it to fill gaps when traditional supply chains break down. 3D printers are the perfect technology to keep hospitals focused on providing care instead of on finding supplies.

	“3D printing allows you to address disruptions in a relatively fast manner,” he says. “This is a scenario where you can be the solution for that one broken weakest link in the chain, and by fixing that you can have a massive impact on what somebody else can do as part of their response effort.”

	That impact is on full display right now, but it’s always been the potential of the technology, says Ben Johnson, director of healthcare product development at 3D Systems. Companies like his moved quickly to fill supply vacuums in the medical space, and the technology’s ability to support innovative approaches to product design and production creates new ways to integrate 3D printing into medical supply chains now and in the future.

	“It’s been really amazing to see 3D printing can be used to rapidly iterate, develop, and provide the critical tools and products needed to respond to an unknown or unforeseen crisis like this,” Johnson says. “I think moving forward, 3D printing will be seen as a strategic resource to respond to unforeseen types of catastrophes.”

	The story at Carbon has been similar. As the gravity of the pandemic set in, the company focused its efforts on helping increase COVID-19 testing capacity and helping meet the shortages in PPE face shields. The company found it was creating a lot of workable designs for these problem areas, and in order to engage with their customers, they made their design files for PPE face shields open source and available on their website so anyone with a printer could get started producing masks, says Carbon Chief Marketing Officer Dara Treseder.

	Carbon has been engaging with customers via the company website, as well as via webinars. Smaller labs are printing materials and supplies for local distribution while larger customers, such as clear aligner maker Candid, have turned their printers to producing these supplies on a large scale.

	“It’s been amazing to see our customers and partners really step up and start producing,” says Treseder.

	A web page featuring sharable print files has also been a key part of how 3D Systems has coordinated with customers. The page includes print files along with detailed instructions on how to get the best results. The 3D Systems page also includes ways for people who have specific needs to solicit requests or people with printing capacity to find places that need the things they can produce, Ellis says.

The 3D Systems page includes details about the company’s materials to help explain which materials can be used for which types of projects. Having materials with FDA clearance for intraoral use speeds up the process of safely designing components for medical uses. At 3D Systems, they’re working to leverage their materials data and processing data to create the most efficient and safest designs.

	The ability to 3D print at scale is still a challenge for many, but when it exists, it can be a literal lifesaver. Treseder says an example of this is the partnership between Carbon and Resolution Medical. Both companies worked together, and Resolution is now printing more than a million of the new Resolution Medical Lattice Swab, Crafted with Carbon™ Technology each week. These conformal nasopharyngeal lattice swabs are in demand for COVID-19 screening tests and they are being printed using Keystone Industries’ KeySplint Soft Clear material which is most commonly used for printing dental splints.

	At the individual dental lab level, the desire exists to jump into helpful projects, but while their efforts have been rewarding, labs are facing different challenges when working to help meet the shortages in supplies.

	At Bismarck Mandan Dental Lab, a third-generation business in North Dakota, Ken Kincaid said his business is down to less than 10 percent of normal volumes, but they’re trying to stay open so they’re available to help doctors treating emergency patients. But as that is not enough work to fill the day, Kincaid jumped at designing and 3D printing face masks. After optimizating designs he found online, he began printing masks. However, Kincaid said he’s still trying to find out the best place for those masks, which are likely not approved for use in hospitals. Now they’re turning attention to other printing projects. 

	It’s been a similar story at Dental Arts Laboratories, Inc., where Dempsey says that while they remain fully operational and open for business, they too have experienced a sharp decline in cases coming in to the lab. With this extra time, they are also producing masks along with two different faceshields which they hope can be used in dental practices.

	“Our idea is to provide something to our customers, our dentists, our practices, when they start opening their doors again,” Dempsey adds.

	But making the masks has turned out to be the easier part of the process. Eric Kukucka, DD, president at The Denture Center in Canada, is also doing everything he can to stay busy while fewer cases come in. He’s focused on improving his business systems during the downtime, but he and his team also jumped at the opportunity to help and began working with online files to put their 3D printer to work producing face masks. 

	“It was extremely exciting, and it actually gave you a good feeling that maybe you could make a difference, or you could help make a change,” he says. “We got really excited at the opportunity, and we hit the ground running and threw ourselves into it 100 percent. Then you hit a roadblock and you look around and think, is this all for nothing?”

	The hitch in the excitement at Kukucka’s lab is due to running up against the immovable obstacles of safety regulations, and other labs are experiencing this as well. While the masks look great, they have not been evaluated for effectiveness and many designs have not been approved for use by medical professionals.

	“The biggest challenge is navigating the regulatory waters,” adds Dempsey.

	That’s been the case for Kincaid as well. He said he’s slowed down producing masks after attending a National Association of Dental Laboratories webinar where the regulatory questions surrounding these printed masks was discussed. He plans to try to get clarification from the FDA about where and how these masks can be used prior to distributing them to health care workers.

	“For now, I’m going to get more information and still plan on producing masks and handing them out to family, friends, and then basically, if anybody wants one, they can call and say, ‘I would like one of these,’ and they’re going to have to understand this is not an FDA-approved product, but it’s also going to be better than a T-shirt,” Kincaid says.

Regulatory concerns are a part of the equation putting Kukucka on hold with mask production, but he’s also concerned about whether or not producing them at a small scale in his lab will make more of an impact than if they turn their printers toward producing less regulated devices such as face shield holders or mask holders.

	“That’s where we’re stuck in the middle of all this, and it’s a really unfortunate,” he says.

	While lots of questions remain, Ellis says he appreciates the way most dental labs are approaching these projects with pragmatism and an understanding and appreciation for safety standards, regulations, and best practices. Even if labs are not producing final pieces that will be used by someone in a hospital, by working to enhance and improve these crowd-sourced designs, those labs are helping with the overall effort to overcome the pandemic.

	So even as every good intention doesn’t lead to the desired outcomes and impacts, the collective efforts are not only creating parts and goods that help meet acute needs, they’re also validating, in real time, the true potential of 3D printing as a technology in the medical industries.

	Because of the widespread nature of these efforts being taken on by people and businesses in different locations, local news coverage of these efforts has been widespread and, in some cases, people not familiar with the technology are learning about real world applications for 3D printing.

	“3D printing, the promise of it, has always been for local production, and you’re starting to see that when supply chains are disrupted, 3D printing technologies are able to really step in and actually meet the production needs of their local areas,” Treseder notes. “I think one of the things that we’re going to continue to see, even after we as a society overcome COVID-19, is I think you’re going to continue to see just an interest and a desire to have digital manufacturing being mission critical. It’s been really amazing to see again, the power of the ecosystem, the power of the community, and how we’re able to step up.”

	The dental industry might not be helping the same number of patients meet their oral health challenges as usual, but it’s definitely not sitting on the sidelines during the pandemic. Some efforts are making huge impacts, others are being felt just locally, and even some projects that looked promising have been abandoned, but in every instance the heart of the dental industry has been fully on display during this crisis.

	“At the end of the day, it’s not for nothing: What we’ve witnessed in the last month is what a powerful force the dental industry is collectively, and how it’s coming together in innovations and ideas of these people integrating their knowledge,” Kukucka says. “People will remember what we did and what others have done during COVID-19 pandemic, and that’s what’s going to determine who you are-in terms of social responsibility-for years to come.”

In ways large and small, international and local, the dental industry is stepping up to help with the response to the COVID-19 pandemic.

Largely shut down, the dental industry steps up

	The COVID-19 pandemic took the dental industry by surprise, and as the quickly imposed shelter-at-home and business shutdown orders rolled across the United States in March and early April, most dental practices, labs, and product manufacturers saw their workloads almost completely disappear.

	This created challenging situations for every dental operation, but even as the industry went into semi-hibernation, the medical community actively treating patients with COVID-19 was facing crucial shortages of personal protective equipment (PPE) and some critical medical devices including ventilators. While there was less opportunity to care for patients’ oral health, the dental industry jumped at opportunities to keep busy while helping overcome these supply issues.

	Whether it was the team at A-dec quickly adapting to meet a local need, or BIOLASE leveraging an employee’s connections to partner with a ventilator manufacturer, or the HuFriedyGroup running its production facilities non-stop to keep up with demand, everyone felt a drive to be helpful, and is gratified to have done a little something to help the United States overcome the pandemic.

	3D printing is an exciting technology, but it’s not the only way to produce things that are in demand, and a number of dental product manufacturers are turning their production capacity away from their traditional products to build items and technologies that are in short supply right now. At A-dec, a conversation with a friend of an employee who works as a nurse got the company to start producing face shields that are needed at her hospital. Meanwhile at BIOLASE, the company leveraged connections with a Korean ventilator manufacturer to start producing those in-demand medical devices.

Related article: Largely shut down, the dental industry steps up

	For A-dec it took the company less than two weeks from learning about the need for these shields to turn a new facility that was not yet online into a face shield production center, according to A-dec COO Marv Nelson. The company actually had more volunteers for the project than they could realistically have involved in the planning, and they not only began producing the shields quickly, but after taking in feedback from the nurses who use the shields they were able to make design improvements and are now producing approximately 9,500 shields each week.

	“We're in production and we're really proud of the fact that we're involved in the fight against COVID, and we've got people that we can keep employed and at the same time do good,” Nelson says. “The thing about A-dec is that everybody here really cares about each other, cares about the community, cares about doing the right thing, and cares about taking care of our customers.”

	Of course, the actual logistics of producing these masks and the normal A-dec product lines remains a challenge amidst social distancing orders. A-dec Production Supervisor Jered Billings said adjustments have included spacing out employees, setting up designated walkways, and in some cases installing barriers to keep employees safe while working.

	The challenges for A-dec are not only about staff safety. Billings says supply chains for the raw materials they need to make the new face shields have been as erratic as everything else during the pandemic, and he’s learned to acquire resources when they’re available, because they might not be there later.

	“It's been a roller coaster actually,” he notes. “As far as the plastics, the plastic supply chain has been eroding by the minute. I think I think the biggest learning is if you can get the material, don't hesitate. Get it while you can. I think the other lesson for me is how supportive the executive team has been in empowering us to help the community.”

	At BIOLASE, a partnership with Korean medical device company MEKICS, came about through the experience of BIOLASE team members who previously worked in the medical ventilator industry, and this drive to help during a crisis, says BIOLASE CEO Todd Norbe. The company was able to move quickly because of experience manufacturing in the highly regulated medical device space. The ventilators they make will help patients, and the process of making them is letting the company keep more staff on the payroll during the pandemic.

	“Our focus has always been on patients and caring for them in the best possible way with the right technology and felt it was a great opportunity to get our facility and people back to work,” Norbe says. “In this time of global crisis, it is important for everyone to do what they can to support our citizens in the U.S. impacted by the pandemic, and we saw this as an opportunity to do our part.”

	The impact of the pandemic on companies that were already in the business of making PPE and infection control products has been just as dramatic, and they’ve been just as eager to be helpful resources during this time. The pandemic really hit the United States while HuFriedyGroup was undergoing an integration following a merger with Crosstex, and unsurprisingly, they’ve experienced a jump in demand for many products. The company obtained special permission from the state of New York to put their New York production facilities on seven-day-a-week production schedules in order to maximize the number of products they can produce, says HuFriedyGroup Chief Marketing Officer Patrick Bernardi. 

	“This is something that we are very, very proud of,” he says. “We’ve moved to 24/7 manufacturing of our masks and our shields to try and get as much out to the frontlines as we possibly can.”

	The company is also busy making sure it is providing the best information they can on infection control regulations and best practices via its online GreenLight Dental Compliance Center™, as well as via online articles, live webinars, and on-demand sessions, says HuFriedyGroup Chief Commercial Officer Jennifer Naylor. The company has also been in touch with the EPA to verify claims about their surface disinfectant products when it comes to COVID-19. Staying up to date with all the changing information, and making sure dental and medical professionals get accurate, up to date information from HuFriedyGroup has been keeping them busy.

	“Information is coming fast and furious,” she adds. “One of the things that we kind of have been laughing about here is that CDC guidelines typically change every eight to 10 years, and now we could be getting updates because more and more information is coming in multiple times in a week.”

	This is certainly not the spring anyone planned for, and getting dental practices and laboratories back on their feet is going to be a new challenge for the industry, but finding ways to help care for the sick and protect those caregivers has been a worthwhile effort. Now it seems like the industry is ready to tackle that challenge of getting back to the work of providing oral health care.

	“Were very much in the beginning, how much information can we get out to the dental practitioners in the field to help them you know, wade through the mountains of information coming out, and how can we chunk it out in easy ways,” Naylor says. “Now we're really focusing on the second part of this, of getting both staff, dental practitioners as well as patients back comfortable getting in the chair.”

With the dental industry at a standstill, companies such as A-dec, BIOLASE and HuFriedyGroup are finding ways to help overcome shortages of medical equipment and supplies.

In novel and familiar ways, dental companies help respond to COVID-19

Keeping the practice schedule full is always a challenge

	Even when the schedule fills up, lining up the right appointments at the right time of day remains difficult.

				Monitors available appointment times and analyzes patient data to identify and connect with patients who best match your custom parameters including procedure types, profit margins, and more

				Leverages machine learning capabilities to automate unique communications with every potential patient

				Uses targeted and custom messaging based on age, gender, and type of service in order to increase the probability of scheduling as patients see images and copy relevant to themselves

				Customized messaging also includes the way the message is delivered, which is automatically selected based on patient preference or other identifying data

				Designed to increase the number of patients and practice revenues while also reducing front desk workload

ChairFill from MMG Fusion automates practice scheduling and proactively communicates with patients.

Solve My Problem: Intelligence to find and book the right patient for the right time

	Each year in late february the dental industry descends upon Chicago for a multitude of events that bring clinicians, technicians, hygienists, assistants, managers, manufacturers, and others together. Amidst the educational courses, the entertainment, the social functions-not to mention the food and tourist activities to be found in The Windy City-a massive number of new products for dental practices and labs make their industry debuts.

	The Chicago Dental Society Midwinter Meeting and Lab Day are always premier launching pads for innovative ideas and enhancements to established brands. With other meetings orbiting this pair of major events, it’s no surprise companies of all sizes treat late February in Chicago as the industry’s Cape Canaveral.

	Keeping track of all of these new items can be a challenge for anyone. Those who visited the Chicago events likely made some time to check out the exhibit halls and to find some new solutions for their practices and labs, but even spending three straight days walking the show floors isn’t likely to allow a single person enough time to see everything new. Those who weren’t able to attend possibly only saw some of the new products via online coverage, if they saw them at all. 

	That’s where this month’s Roundup article comes in. It’s not a completely comprehensive accounting, but we’ve collected quick snapshots of some of the recently launched products being highlighted at the Chicago shows to help those who attended-and those who did not-keep track of all the innovations.

	Read on for an overview of some of the products that debuted or were highlighted during the Chicago events:

		With 39 watts of power, it is designed to provide the cutting power of an electric handpiece with the lightweight feel of an air-driven handpiece

		Patent-pending RFID technology makes the handpiece interactive and intelligent in order to automatically track use and sterilization processes

		Designed for in-office turbine replacement and features LubeFree technology for easier maintenance

		Optimal head size for patient comfort and intraoral access is combined with cool-spectrum LED light technology

			More durable than previous generations of sensors, KaVo IXS features KaVoTough™ engineering in both the sensor and the cable

			The sensors are designed to be open architecture and can integrate with a range of leading imaging and practice management applications

			Features direct-download calibration files inside the sensor and automatic software updates along with proactive sensor health monitoring

			Capable of capturing high quality images, it is available in sensor sizes 1 and 2

			An aqueous oral rinse featuring proprietary nanoparticles that reportedly illuminate early carious lesions in teeth using a curing light

			The rinse is designed to enable early detection and treatment of dental caries

			The material can be used via a simple protocol and images of detected carious lesions are easy for patients to understand

			The product is still waiting FDA 510(k) clearance for sales in the U.S.

				Designed to provide secure retention, the cement is said to enable easy, non-destructive crown retrieval when necessary

				The elastomeric cement flexes under force to absorb shock and maintain a tight marginal seal

				It is easily applied without the need for etch, primer, or bonding agent and achieves gel stage in two minutes for easy excess cement clean up

				Available in both white and pink shades, it provides a high level of radiopacity

				Designed to make denture fabrication as simple as boiling water, Easy Denture can be fit to a patient after boiling it in water for one minute and cooling it for another minute

				While not intended as a replacement for lab-fabricated dentures, Easy Denture dentures aim to provide an immediate solution when needed

				The dentures also are viewed as a solution for patients who cannot afford traditional removable solutions

				The latest updates to this intraoral scanning software are designed to offer benefits to clinicians and patients

				Manual Bite Alignment allows users to ensure ideal alignment in scans, while the software now also allows users to open digital jaws for enhanced visual scan inspection

				New colored distance maps help clinicians plan restorations for ideal function

				Along with the scan software, a new HeronCloud solution provides improved information exchange between practices and labs

More new dental products on the next page.

				A kit of hand instruments designed to enhance the effectiveness of ultrasonic solutions by allowing clinicians to detect and remove residual calculus from hard to reach areas following ultrasonic and air power scaling

				The instruments feature blades that are 10 percent thinner than standard but still feature EVEREDGE 2.0 technology

				The kit features seven scalers and an explorer housed in an Infinity Series

				There are 11 different Empowerment Scalers to choose from

A collection of some of the brand new and recently launched dental products featured at the Chicago Dental Society Midwinter Meeting and LMT Lab Day.

Roundup: Midwinter Dental Product Lift-Offs

	Using a Ziploc bag in an ultrasonic cleaner to clean dentures or retainers doesn’t clean well and OSHA calls it a risky practice

	The soft plastic bag material blocks ultrasound and is prone to puncture. Cross contamination is also a concern, but using two bags or a bag inside a beaker creates a double-barrier, reducing cleaning effectiveness.

iSonic DS310 miniaturized commercial ultrasonic cleaner with a disposable PET cup

		The world’s smallest commercial ultrasonic cleaner-less than 9 by 6 by 6 inches-features a powerful stack transducer and power intensity 2 to 3 times or higher than a larger instrument cleaner

		Using a standard 9 oz. PET water cup-a hard plastic that transmits ultrasound -provides a leak-free, disposable and lowcost way to clean appliances and it doesn’t interfere with regular instrument cleaning

		Used in conjunction with iSonic White denture/retainer cleaning crystal it is proven to be effective

		A disposable PET cup can also be used for chair-side operations such as removing debris from a rotary tool with saline water

		The system includes an integrated stainless steel beaker with a cover for cleaning burs and files, and the main stainless steel tank can also be used to clean instruments as well

Solve My Problem: iSonic DS310 – Simplify and accelerate denture and retainer cleaning

Information provided by Ultradent Products.

	Prophy paste can splatter when being applied, creating a mess and wasting material

	This splatter not only causes clinicians to use extra prophy paste during each appointment, but it can also obscure the working area, reducing a clinician’s efficiency.