	Every practice has those patients who need a little extra prodding to schedule visits on a regular basis.

Even when patients do come in faithfully every six months, there are still times when an additional service or follow-up may slip their mind, or they simply might not know about all of the services the practice offers. With both types of patients, it makes sense to keep in touch regularly and promote the practice in a way that is both unobtrusive and helps them learn about what your practice has to offer. But for office staff, these tasks can be time-consuming and easier said than done.

For just over a year, our practice has been using

, a practice marketing and patient communications suite. This service automates a long list of tasks for staff members, while at the same time helps to increase revenue and gives patients tools to easily get in touch with the office using the methods they prefer.

RevenueWell lets patients tell you how they like to be contacted-email, text message, phone or regular mail. With that information, the service can automatically send appointment reminders to patients to give them a little extra help remembering their appointment. For patients who have enabled text messaging, the service can even send them a final reminder one or two hours prior to their appointment. We’ve had many patients tell us that the text message made the difference in helping them remember their appointment on a busy day.

The service comes with a library of professionally written email and direct mail campaigns. Practices can also create their own campaigns to promote specific services. Our practice has seen great success with promotions for 

, and we’ve also done campaigns promoting Botox, which is a service that many patients didn’t realize we offered.

For added convenience, campaigns can be planned and prescheduled months in advance. This lets the practice manager easily organize, for example, a quarter’s worth of promotions, set them up quickly in the system, and then not worry about it for the rest of the quarter.

Click here to learn how RevenueWell makes follow-ups a snap. 

It’s easy for patients to forget about a treatment plan, but it can be obtrusive for the office to contact the patient to find out their status. RevenueWell automatically monitors our practice management software and sends patients a reminder about their treatment plan if it has been presented but not scheduled.

This approach allows us to stay in contact with patients and gently help them remember their dental needs. The revenue generated by this feature alone has added up to more than $18,000 over the past year in our practice.

In our experience with RevenueWell, we’ve seen that pretty much any marketing campaign or communication we send helps remind patients to get back in touch with us. They may not even be calling about the specific promotion we’ve sent, but just seeing our email in their inbox triggers the thought, “Oh, I’m probably due for an appointment.”

It also helps position our practice as tech-savvy and convenient for patients, since we can communicate with them in the method they prefer most. The fact that all of these features are largely automated and require little time from the office staff is extra icing on the cake, and further reinforces that using this service has been a great decision for our practice.

This article originally appeared in the April 2014 issue of Dental Products Report. For more great articles about products in action, 

click here to subscribe to DPR: http://bit.ly/17ocF5z

Articles

 Every practice has those patients who need a little extra prodding to schedule visits on a regular basis.

3 tips to get patients back in the office

When placing partial coverage restorations, marginal integrity and esthetics are logical concerns.

Dentists with in-office milling systems may have a heightened awareness of these issues, as they can see the impacts of the edge quality of their materials at each step of the way. While some chairside blocks can be brittle, resulting in minute chipping at the margins of a restoration, a non-brittle material makes the process much smoother, with a restoration that almost disappears into the margins.

 in my office, I have recently come across a combination of materials that is now my first choice for partial coverage restorations: 

3M™ ESPE™ Lava™ Ultimate Restorative

3M™ ESPE™ Scotchbond™ Universal Adhesive

3M™ ESPE™ RelyX™ Ultimate Adhesive Resin Cement

, not only gives CAD/CAM dentists a strong, easy-to-mill chairside block, but also tools for adhesion and cementation that contribute greatly to the efficiency of a procedure.

Block, Adhesive and Cement Working Together

Lava Ultimate restorative is a unique block material that is categorized as a “resin nano ceramic.” This material is both strong and resilient, and it is designed for fast, easy milling and easy adjustments. It can even be repaired with composite, making it very versatile for teeth that might need additional work in the future.

It is indicated for crowns, inlays, onlays and veneers, and as noted, I particularly prefer it for partial coverage restorations. When used for inlays, onlays or three-quarter crowns, the material’s ability to mill with no chipping helps it blend seamlessly into margins.

Additionally, no firing is required for this material and it takes only a few minutes to polish, adding to the efficiency of a chairside milling system.

Efficiency is also a key feature of Scotchbond Universal adhesive. This adhesive bonds methacrylate-based restoratives, cement and sealant materials to dentin, enamel and glass ionomer, as well as indirect restorative substrates like metals, glass ceramics, alumina and zirconia, without an extra primer step. It can be used in total-etch, self-etch or selective-etch modes, providing reliable strength and virtually no postoperative sensitivity.

The simple technique of Scotchbond Universal adhesive is made even better by combining it with RelyX Ultimate cement. The cement is made with an integrated dark cure activator for Scotchbond Universal adhesive, so when the two products are used together there is no need for a separate activator.

This can give dentists extra peace of mind in cases where a restoration is hard to reach with a curing light or they are worried about the depth of cure. The cement also cleans up easily, whether it is still in its liquid form or after tack curing. I personally prefer to clean away excess cement right away without tack curing, and have found this gives me great margins and adaptation.

With RelyX Ultimate cement, I can do this easily and achieve a great bond. The cement is ideal for CAD/CAM and glass ceramic restorations, making it an easy choice to use in combination with Lava Ultimate restorative.

The case shown here will illustrate the use of these products to create a seamless onlay.

A patient in her 50s presented complaining of sensitivity on a 20+-year-old amalgam restoration on tooth No. 20. Examination revealed a crack through the enamel on the lingual cusp of the tooth.

The patient consented to removal of the amalgam and treatment with a Lava Ultimate restorative onlay, which would cover the lingual cusp and reduce the sensitivity.

The old amalgam was removed and the tooth was prepared for an onlay. The CEREC Omnicam was used to capture a digital scan of the tooth, and the onlay was milled with a Lava Ultimate restorative block.

The sprue was removed from the block and it was tried in the mouth to confirm a good fit. Following this, a Danville MicroEtcher was used to sandblast the inside of the onlay, after which it was rinsed and dried.

Scotchbond Universal adhesive was scrubbed for 20 seconds into the bonding surface of the restoration and then air thinned until the solvent was evaporated and the adhesive no longer moved.

The adhesive was also applied to the prepared tooth and scrubbed in for 20 seconds. The material on the tooth was also air-blown until it no longer moved and then light cured for 10 seconds.

RelyX Ultimate cement was applied to the preparation, and the onlay was then seated in place. Excess cement was immediately cleaned away and the restoration was light cured for 20 seconds.

A fluted finishing bur was then used to clean residual cement away from the edges. Polishing was performed with a Brasseler point, progressing to a final polish with Diamond Twist SCO polishing paste and a micro-cloth disc. The case was completed in approximately one hour, and the final result was a much more esthetic restoration with indetectable margins.

The combination of the esthetic block material, adhesive and cement used here helped create a restoration that is nearly invisible at the margins, with a strong bond that will keep it in service for the long term. With a system of products that is designed to work together, dentists can enjoy a process with fewer steps while still feeling assured they are delivering great care.

How to complete partial coverage restorations with the 3M™ ESPE™ Trifecta System [VIDEO]

Caries Management by Risk Assessment (CAMBRA) has been something of interest to me for a few years. Last February, I decided to take the leap and give it a try in my office.

Professionally, my motivation stemmed from the desire to speak and to work more systematically in regards to patient care. Personally, and maybe more importantly, I could no longer overlook the thought that 

 was simply the right thing to do. As a result of the decision to implement this protocol, I have experienced a better bottom line for my business than I could have ever imagined.

Truthfully speaking, the financial aspect of CAMBRA was always a worry for me. I questioned whether or not I was in the process of employing a philosophy that would gradually put me out of business. Although privy to adverse rumors-excess time consumption, complications, and possible patient noncompliance-I decided to look further into it before passing my own judgment. Perhaps I am naive or the emergence of my inner rebel briefly dominated. Either way, my team went ahead and launched the CAMBRA program developed by 

As we are now a more experienced office, I would like to voice the truth of CAMBRA and put some of those played-out rumors to rest. My office has been positively impacted, and seen significant ROI in three areas because of CAMBRA. 

First, my team is now more experienced and knowledgeable about managing dental caries than ever before. In fact, my staff members, as attendees of the Florida National Dental Meeting, were the only professionals in their session that had any hands-on experience with an in-office CAMBRA protocol.

They fielded more questions from their colleagues than the instructor. That kind of experience gets people excited about their work and that energy is evident in our office daily.

Second, I have seen first-hand the tremendous power that stopping this disease can have on the life of a patient. One patient in particular, had been hearing the same bad news his whole life. Every six months, he needed a filling, a bridge, or a crown due to his recurrent decay.

He remained unhappy with his dental care and when asked why, his response was, “They never told me why I keep getting cavities.” This demonstrates a glaring lack of CAMBRA use. Honestly, I wasn’t sure I would have the answers he needed but, after telling him about our new program, we were both willing to give it a shot. He just came in for a 6-month exam and, for the first time in recent memory, he is cavity-free! I have never before seen a patient so excited. He expressed that it was a major benchmark in his life. 

The third way my business has been impacted and the largest surprise of all is that I am actually making money. I knew that I wouldn’t be making much on product sales, and fewer cavities meant fewer restorations. While I was happy with the intangible ROI-professional satisfaction, personal satisfaction and patient trust-I just couldn’t measure those things in dollars and cents.

That is, until recently when a referral from the aforementioned patient came to see me. He came solely due to his friend’s experience with us. This patient wanted a doctor that could help him control his disease long-term and he knew I was the guy to do it. He wanted to keep his teeth, and was very motivated to do so. He just accepted an extensive treatment plan, one that I know I never would have had before CAMBRA. His plan amounts to 10 times the total investment in my CAMBRA system. Not only that, I have since had countless new patients referred to my office because of our program. 

The intangible ROI, I have learned, is in no way independent of the monetary ROI. It is, instead, an imperative step in the process to a profitable practice. CAMBRA, as it turns out, has been the perfect vehicle to get me there.

The advice I would give to someone looking at starting a CAMBRA program is to just do it. Start small then build your program. Personally, I think it is the right thing to do, as you will too. More than that, it will pay dividends as far as ROI is concerned. But don’t take my word for it. Do your research and find a system that works for you.  

Dr. Michael McClure attended the University of California and graduated with a bachelor’s degree in physiology in 1988. After entering the United States Navy where he served seven years as a Naval Aviator, he attended dental school at the University of Florida where he graduated Summa Cum Laude in 2000. Following graduation, he served five years as a Navy Dental Officer making deployments twice to the desert and once to Djibouti, Africa. After leaving the Navy in 2005, he has been practicing dentistry in Orange Park, Fla. In 2007, he was awarded a prestigious Fellowship in the Academy of General Dentistry. In 2012, he was awarded a Mastership in the Academy of General Dentistry. In 2013, he earned Board Certification by the American Board of General Dentistry. Dr. McClure continues to stay on the cutting edge of new techniques and technologies through hundreds of hours of continuing education annually.

Dr. Michael McClure: Where I've seen the unexpected ROI of CAMBRA

	Since the first resin-based light-cured composites were introduced many decades ago, there have been significant advancements realized in resin and filler technology. 

Practitioners are faced with ever-increasing composite choices that are designed to give better results during placement and over the lifespan of the restoration. Ironically, the introduction of sophisticated materials designed to improve restorative procedures can have the opposite effect. Today’s clinicians can be easily confused about the subtle differences between the many available composite materials and may find it more difficult to make the correct decision about which material is best for each clinical situation. 

Choosing which composite material to purchase can be a difficult decision. Ideally, practitioners should rely on published reports and a careful review of a product’s physical properties when selecting a material. However, this level of review is generally not realistic for everyday providers.

Dentists’ purchasing decisions may be based on cost, brand preference, and the “works best in my hands” argument, rather than a strict review of each product’s fracture toughness, volumetric shrinkage, or other properties. Clinicians become more confident in their procedures and materials through repetition of use and clinical observations. This is especially true when considering material choices: exacting use of poorly selected materials will not offer better clinical results than use of ideally chosen materials.

To simplify decision-making and to offer a composite that can ensure excellent performance in all clinical situations, 

. It is based on the resin technology of 

 and contains nanohybrid- and micro-filler components. The result is a composite that has the potential to perform well in either the anterior or posterior, and should have tooth-like translucency, improved polishability and color stability, and good wear resistance. TPH Spectra also comes in two handling choices: a creamy light-viscosity formulation and a packable high-viscosity formulation. 

For both viscosities, the physical properties are similar. Because handling preference is subjective and highly individualized, practitioners are now able to select the right viscosity for all clinical situations.  

In order to make shade selection simpler, the material is available in the seven most popular shades. According to DENTSPLY’S internal data, the seven shades of TPH Spectra represent more than 80 percent of total sales from the previous TPH3 formulation.

The TPH Spectra shade guide was condensed for several reasons. First, some practitioners may be overwhelmed with the number of current shades; the Vita Classic (Vident) shade guide has 16 shades, and the TPH3 shade guide has 26. Because only seven of the current 26 TPH3 shades are regularly purchased, the color difference (i.e., Delta-E value) between shades was calculated to determine if a top-seven shade could be used in place of another shade not offered.

Available data shows that it will be possible to “cover” all the Vita shades with the existing TPH Spectra offerings by keeping the Delta-E less than four (if the two shades, tooth-composite or composite-composite, have a Delta-E difference of less than four, the difference is difficult to distinguish for the human eye).  

TPH Spectra also offers optimal color blending between restorative materials and natural tooth, often called, “the chameleon effect.” 

How to simplify composite selection, procedures

Step 1: An intraoral exam revealed a fractured composite resin restoration on tooth No. 29. The patient’s chief complaint involved food impaction in the area leading to discomfort after meals (

).  After verifying the medical history and reviewing the radiographs, a direct composite resin restoration of the disto-occlusal surfaces was treatment planned.  

Step 2: Anesthesia was achieved with one carpule of 4% Articadentwith 1:100,000 epinephrine (DENTSPLY Pharmaceutical) via buccal infiltration. Caries excavation was completed using a 330 carbide bur on a high-speed handpiece and a #4 round bur on a low-speed handpiece. The preparation was verified caries-free with Snoop caries detector from 

Step 3: A rubber dam was placed and isolation of the preparation was accomplished with 

 Because of the depth and size of the final preparation, a selective etch technique with 

 (DENTSPLY Caulk) was used. This technique was chosen to maximize enamel bonding while minimizing the potential for post-operative sensitivity. The enamel was etched with 34 percent phosphoric acid for 15 seconds and then rinsed. Prime&Bond Elect was scrubbed into the preparation for 20 seconds followed by a five-second air drying to remove the solvent. The adhesive was light cured for 10 seconds (

Step 4: The first restorative layer was placed using a 

 (DENTSPLY Caulk), a low stress bulk fill material with excellent cavity adaptation (

). TPH Spectra Low-Viscosity shade A2 was selected for the final occlusal layer because of its creamy handling and placed in 2mm increments (

). Each composite increment was light cured for 20 seconds. After the last layer of composite was cured, the Palodent Plus ring and sectional matrix were removed (

Step 5: The final restoration was finished with fluted composite finishing burs and white stones to achieve proper shape and contour. After occlusal adjustment, the composite was polished with DENTSPLY Caulk’s Enhance Finishing System points and cups (

Step 1: During a periodic exam, caries was noted on the mesial and distal of tooth No. 30  (

). After local anesthesia with one carpule of 4% 

 (DENTSPLY Caulk) were inserted mesially and distally to prevent iatrogenic damage to adjacent teeth during preparation (

Step 2: Because of the large amount of dentin present in the preparation, a selective-etch technique was chosen. The exposed enamel surfaces were etched with 34 percent phosphoric acid for 20 seconds and then thoroughly rinsed with water (

). Isolation of the preparation was achieved using 

Prime&Bond Elect was scrubbed into the preparation for 20 seconds followed by a five-second air drying to remove the solvent. The bonding agent was light cured for 10 seconds. An initial layer of Surefil SDR flow was placed into the preparation, followed by a 20-second light cure. 

Step 3: TPH Spectra High-Viscosity shade A2 was packed into the preparation and cured in 2mm increments. The final restoration was finished with fluted composite burs and polished with

 Enhance Finishing System and PoGo Micro Polishers (DENTSPLY Caulk) 

With the introduction of TPH Spectra Universal Composite by DENTSPLY Caulk, dentists now have one material that can be used for all situations. As a result, no longer do practitioners need to struggle with decisions of shading or selecting the material with the most appropriate physical properties. 

TPH Spectra’s characteristics and excellent chameleon effect will provide the dentist and patient with predictable results not only during placement at chairside but for years to come. 

 Since the first resin-based light-cured composites were introduced many decades ago, there have been significant advancements realized in resin and filler technology. 

	The old saying that “no chain is stronger than its weakest link” is certainly true in dentistry. When working with crown and bridge, one of the primary complaints from dentists to dental technicians is that “the occlusion was high and it took a long time to adjust it clinically.”

 The restorative process for an indirect restoration includes many steps that, when not carefully executed, can contribute to this problem. 

One of the most important steps is the provisional restoration, and it plays a crucial role in avoiding sensitivity, infection, and maintaining a stable position of the tooth by maintaining opposing and adjacent contacts, and thereby avoiding tooth movement. At this temporization stage, an adverse outcome could mean an emergency visit to your office, or a problematic appointment during the placement of the final prosthesis

 as mentioned by Loos, Boyarsky and Quiring (2001).

Currently amongst the provisional materials categories, bis-acrylic provisional material is the product of choice due to its low shrinkage, easy handling and esthetic properties. This year, 

, which demonstrates a dramatic improvement in its mechanical and esthetic properties.

This material has an excellent flexural strength (105 MPa) and impact strength (76 MPa). These properties combined with its diametral tensile strength (62 MPa) which is similar to restorative composites, imparts to this material the ability to withstand the challenges that the oral environment imposes on our temporary restorations. Such strong provisionals will reduce the risk of breakage, especially at the margins, where most provisionals fail if the amount of reduction it is not adequate.

Clinicians should keep in mind that wear of the proximal contacts of the provisional restoration is the main reason why the final restoration does not seat properly on the prepared tooth. Every dentist knows how frustrating it is when you have to adjust the proximal contacts of your crown and the final result is a mesial or distal open contact. Also, occlusal wear of the provisional, with resultant tooth movement, is main reason for “high” contacts. Preventing this from occurring is why 

You should also keep in mind that, at the provisional stage, not only does the temporary restoration play an important role, but the selection of the temporary cement is also crucial. An ideal temporary cement should present the following characteristics: easy removal of excess cement from around the margins; good marginal seal to help minimize sensitivity; good retention but easy removal of the temporary prosthesis; low solubility in oral fluids; and compatibility with provisional resin restorations, resin core materials, bonding agents and permanent cements. Polycarboxylate cements are the easiest to clean, and Santos & Santos (2012)

 also reported that polycarboxylate temporary luting cements present low post-operative sensitivity, adequate retention, and easy clean-up and they mentioned 

In the following clinical case, we will explore a predictable technique for preparing a strong and reliable temporary restoration where we combined these two products (

 Patient presented to the office with a lower first molar which was endodontically treated and restored with a 

Zircules Zirconium Nano-Filled Core Material (

]. Before preparation for an all-ceramic crown, a disposable and customizable metallic tray (

Clinician’s Choice) was loaded with a PVS matrix material (T

). Template is a PVS matrix material designed specifically for this step; it sets in only 30 seconds, saving time for the clinician when compared to traditional “putty” matrixes, which can take up to 6 minutes to set. Template also flows into the embrasure areas well, and will release maintaining its form as shown in 

. Due to its mechanical properties, the tray and matrix can be easily reinserted without distortions, thereby producing a provisional with virtually no flash. 

 shows the molar prepared for a full coverage ceramic restoration and, since the preparation margins were quite sub-gingival, a double cord technique was used with a #000 and #00 

Re-Cord (Clinician’s Choice) retraction cord. 

After the final impression was taken, a provisional restoration was fabricated using 

The Template matrix was reseated onto the preparation (

) and a provisional with no voids and minimal flash was produced (

). INSPIRE is easy to remove from the impression and requires little or no polishing due to its minimal surface oxygen inhibition layer. It produces a smooth, high luster, nonporous surface that will resist biofilm and plaque build-up. For this case, the clinician decided to polish the provisional and apply a final layer of a light-cured glazing material (

The temporary restoration was cemented with 

 polycarboxylate temporary luting cement and the excess was easily removed (

), due to the cement’s mechanical properties and due to the smoothness of the final surface obtained by the use of 

At the final appointment, the provisional was easily removed followed by manual clean up of the preparation. The combination of the smooth surface of temporary material and the bacteriostatic properties of the temporary cement results in a healthy gingival tissue as can be seen in 

The significant amount of frustration and wasted time that is experienced by the clinician when a final restoration needs significant adjustment can be avoided by the use of a provisional restorative material that not only resists premature fracture, but also resists wear which results in tooth movement. The above combination of 

1. Loos LG, Boyarsky HP,Quiring DJ. Procedure for occlusal refinement of mounted definitive cast to reduce clinical time required for adjustment of occlusion. J Prosthet Dent 2001;81:246-51.

2. Ramp MH, Dixon DL, Ramp LC, Breeding LC, Barber LL. Tensile bond strengths of provisional luting agents used with an implant system. J Prosthet Dent 1999;81:510-4.

3. Lind SD. INSPIRE. Strong, fracture-resistant material for temporaries. Dental Product Shopper. Nov 2013;128.

4. Santos MJMC, Santos Jr GC . Selecting a Temporary Cement: A Case report. Dentistry Today: 31(3): 96-99, Mar 2012.

 The old saying that “no chain is stronger than its weakest link” is certainly true in dentistry. When working with crown and bridge, one of the primary complaints from dentists to dental technicians is that “the occlusion was high and it took a long time to adjust it clinically.”1 The restorative process for an indirect restoration includes many steps that, when not carefully executed, can contribute to this problem. 

How to prepare a strong, reliable temporary

	It's a sad fact, but nobody reads anymore. Using video can be a terrific way for your practice to communicate with patients. Here are the top five reasons why switching to video can benefit your practice. 

Videos receive a big slice of the limelight when it comes to search results, and are often listed in results all their own. Through separate video listings, your site gains additional access points, making it easier for patients to find you. With proper tagging, videos can also bolster your authority levels.

It’s a sad fact – many people don’t enjoy reading. Video-enhanced patient education clears that hurdle by catering to both visual and aural learners at the same time. Appeal to more learning styles, and more patients are likely to use your materials.

Video posts are a perfect way to break the monotony of an otherwise plain news feed. In fact, visual posts like photos and videos consistently get more interaction than their text-driven cousins. Your Web Presence, especially your social media, should include every type of media you have access to.  

Videos provide an unparalleled opportunity to make your Web Presence truly your own. Before your patients even step through your door, videos can provide them with an inside look at your practice and an opportunity to meet you and your staff. What better way to make them feel welcome?

We live in an age where people not only enjoy technology, they expect it. Including video in your communications demonstrates that your practice is keeping up with the times. Modernity helps credibility, and so video can obliquely make your practice appear more authoritative.

 It's a sad fact, but nobody reads anymore. Using video can be a terrific way for your practice to communicate with patients. Here are the top five reasons why switching to video can benefit your practice. 

Top 5 reasons your practice should communicate with video

 with Sirona Dental, gives you his top three tips to get the most out of your intraoral camera.

Using your camera often can help inform and educate patients. Tour the mouth and show patients two to three teeth that could benefit from treatment, i.e. Amalgam vs. Composite fillings.

Email pictures to patients so they have them on file to consider and discuss with a spouse/significant other.

Call attention to potential problem areas sooner

Patients need to be aware of potential problems and treatment options. A camera can help identify problem areas so you can alert patients to a tooth that may break off, or cause pain or sensitivity in the future.

A chipped tooth may not hurt, but dentin can be penetrated more easily by bacteria and decay if the enamel is gone. A fractured tooth is painless until it breaks off.

Documentation protects the doctor and patient from emergency problems and strengthens insurance cases. Many insurance companies request a photo for approval of fillings that need to be replaced, and a crown will likely have better coverage with a photo.

Keep image records of specific cases discussed with your patients.

Want more in intraoral cameras? Check out these related articles ...

How to get the most out of your intraoral camera [VIDEO]

Product Review: How to use your intraoral camera to increase case acceptance in your practice

Intraoral cameras offer more than just meets the eye

Tom Erickson, territory manager for Schick Intraoral Imaging with Sirona Dental, gives you his top three tips to get the most out of your intraoral camera.

Top 3 ways to maximize your intraoral camera

Practicing general dentistry at a consistently high level of quality is perhaps the hardest “specialty” in our profession.

Today, many general dentists who are able to successfully perform root canal procedures find it challenging to do so efficiently enough to justify the routine in their practices.

If the procedure could be streamlined without compromising the clinical result, many more endodontic procedures would be performed within general dental practices.

In dental school, rotary instrumentation of the root canal was contraindicated because rotary instruments often ledged the canal system, created “false canals” due to a lack of flexibility and caused separation of instruments in the root canal.

With the ability to flex and follow complex canal systems, nickel-titanium (Ni-Ti) files revolutionized this process. They are easier to use and much more efficient than previous generations of hand instruments and, when properly paired with a handpiece that offers controlled rotation and torque and stops or reverses if the instrument binds in the root canal, they significantly simplify the cleaning and shaping of root canals.

 aims to further streamline endodontic procedures by combining an easy working sequence with a technique suited to both specialists and general dentists.

Most root canals can be prepared with a simplified sequence requiring just two files. Highly flexible to minimize canal transportation, the .04- taper files feature a unique S-curve design and a thin instrument core to deliver outstanding cutting efficiency while respecting natural root-canal morphology.

Curved root canals can be easily negotiated without “ledging” or “zipping,” and the presterilized, single-use files significantly reduce or eliminate the risk of file separation due to instrument fatigue.

Used with a torque-limited motor (250-300 rpm), the files are ISO color coded to match all standard endodontic file systems. The files effectively debride the root canal space while maintaining a high degree of flexibility to negotiate the “elbows” of root-canal systems.

The following is a case report on root canal therapy using Komet USA’s new F360™ file system with

Case report: a mandibular central incisor

The patient presented previously with a fractured mandibular central-incisor porcelain restoration that had been repaired with a temporary composite restoration. A periapical radiograph showed the presence of a defined periapical radiolucency necessitating root canal therapy prior to remaking the ceramic restoration.

Note: With an efficient way to perform this service, it is now possible to complete the root canal therapy, place a fiber post, prepare the tooth and take a master impression for the replacement restoration-all in one visit.

This is a major time-saver for the patient and an efficient revenue producer for the practice.

Read the detailed technique case on the next page ... 

 A lingual access cavity is made using a round diamond bur from the 

. Note: The access cavity should provide a near straight-line access to the apex of the mandibular central incisor.

 A rubber dam is placed, and cleaning and shaping of the root canal system begins.

 A number 10 endo file is used to establish the working length of the root canal.

 If a number 10 file cannot reach the apex or if additional flare to the canal is desired, the Komet Pathfinder instrument (PF03L25) is used to establish a mechanical glide path to the apex.

 The root canal is irrigated with sodium hypochlorite or other appropriate antiseptic solution to remove any remaining infected canal debris.

 The size 25 F360™ file is used with the NSK Endo Mate handpiece at 300 rpm in a slow, up-and-down motion; it is employed to the working length until the file is loose. Note: The double-S cross section of the file has very sharp cutting angles for efficiency and a large chip space for removal of infected canal debris during cleaning and shaping.

The root canal is copiously irrigated shows a periapical radiograph following completion of cleaning and shaping with the first F360™ file.

 The size 35 file is used to the full working length of the root canal. Note: If the file binds prematurely, go back to the 25 and work it around the diameter of the canal to slightly enlarge it, enabling the 35 to extend to the working length. Once the size 35 instrument is non-binding in the root canal at the working length, the cleaning and shaping is complete.

The orifice opener (AK10L19) is used to further taper the coronal third of the root canal to facilitate obturation. Note: If needed, this instrument can also be used prior to the glide-path instrument to open a restricted canal orifice.

 The obturation procedure is initiated with try-in of the 35 master gutta-percha cone. A radiograph is used to verify that the cone goes to the working length.

 Root canal sealer is mixed, and the master gutta-percha cone is covered with sealer and then placed to the working length of the root canal. A size-25 finger spreader is pushed into the orifice next to the master cone as far apically as it will go, laterally condensing the gutta-percha in the root canal.

 After the finger spreader is withdrawn, a size-25 accessory gutta-percha point is placed into the void left by the spreader. This procedure is repeated with more accessory points until the coronal third of the root canal is adequately obturated.

 A plugging instrument is heated in a flame and used to remove the excess gutta-percha in the canal access cavity. With the root canal obturated, the next clinical step is to establish post room and place a prefabricated fiber post into the coronal two thirds of the root canal space. Note: Komet’s DentinPost® system is used for this case.

Composed primarily of special glass fibers to ensure high stability while offering exceptional esthetics and radiopacity, DentinPost® prefabricated, tapered-root posts are available in four different sizes with matching instrumentation.

For this case, a DentinPost size 050 is selected.

 A Gates Glidden drill is measured 5 mm short of the radiographic apex of the root canal and used to remove the gutta-percha from that portion. The DentinPost® yellow preparation drill is measured, again 5 mm short of the working length of the root canal, to prepare the internal shape of the canal to accept the yellow fiber post.

 Once the post room is achieved, the fiber post is cemented using 

. Note: A bit of sealer has passed into the periapical area, indicative of a good periapical seal of the root canal apex.

 After the post is trimmed and the crown preparation is refined, a master impression can be made, followed by a provisional crown.

In this case, a simple, effective way of performing root-canal therapy has been demonstrated using Komet USA’s new F360™ rotary file system.

This system can add a whole new dimension to the practice by enabling doctors to combine clinical procedures and shorten treatment time for the patient. In turn, practitioners who may or may not be experienced at performing root-canal therapy can now confidently incorporate endodontics into their routine.

 is a “must have” in any general dental practice.

Dental Products Report-2014-04-01