In this new column focused on the team approach to infection control, we’ll look at the benefits of microbiology, and why it may offer a better alternative than using chemicals to kill unwanted bacteria in your practice.

Change is one of life’s few certainties. As I pen this article, reflecting on my recent Thanksgiving excesses, I am intensely aware that Christmas, New Year’s Eve and most of our New Year’s resolutions will be history by the time you read this.

I do hope that its relevance will not also have flown away?

There are 46,000 dental products (excluding any special order items) according to the Henry Schein product catalog, and they seem to change even faster than our “vaporous” efforts each January. So it is easy to understand why a dental practice might give serious attention to the purchase of a new imaging system, yet have little time to evaluate the plethora of sundry products offered for “cleaning” each day.

Science can be a catalyst for change. I hope this new column, centered around a team approach to infection control in the dental practice, will introduce and stimulate a healthy discussion on the opportunity microbiology (good bugs) introduces as an alternative to chemicals for killing unwanted bacteria.

In our own bathrooms, where any “lesser cleaning” approach (slow drains or dirty surfaces) is more likely to be annoying than harmful, we get to decide on our level of cleaning slippage. But, this is not acceptable in a dental office where cleaning and hygiene are the only antidote to patient infection.

It may be OK for us to avoid a particular chemical, or save time and cost by “skipping” a particular cleaning protocol, but we are responsible for how this decision might affect our patients’ well-being. The choice of an apparently trivial product or protocol could have life determining implications for everyone concerned.

 often hear worrying comments like, “We do not clean the evacuation system daily,” or “We clean the lines with warm water each week,” or “We know we have poor suction.”

I certainly like to be 100% certain of strong suction, clean lines and that nothing might flow “at” me should I close my mouth on the saliva ejector. Compared to Europe, we have remarkably little legislation regarding back flow protection.

For the past 30 years, chemicals, and more chemicals, and then more and stronger/enzymatically boosted chemicals have been the de-facto solution for surface, water line, and evacuation system cleaning.

[ Read: How Bio-Pure, a simple system cleaner, can save your practice money ]

Speaking to two of the thought leaders in dental hygiene, Noel Kelsch and Nancy Andrews, at a recent meeting of dental hygienists, I was most impressed by their new thinking on “good” bacteria. Healthy biofilm requires bacteria, while trying to kill all bacteria is proving responsible for the mutation of the new “super bugs” we hear about.

All of this is of importance to the dental industry, particularly as we learn more about the mouth and its role as the “architect” of the body’s immune system.

As long as humans can’t live without carbon, nitrogen, protection from disease and the ability to fully digest their food, they can’t live without bacteria, said Anne Maczulak, a microbiologist and author of the book “Allies and Enemies: How the World Depends on Bacteria” (FT Press, 2010).

On our skin surface, a forest of bacteria (almost 200 separate species on a normal person, according to researchers at New York University) dominate the skin and its resources, keeping other bacteria from being able to establish a foothold, according to Maczulak’s book.

Many areas of health have recognized that “bad” bacteria can be controlled by the targeted use of “good” bacteria. This is an area known as probiotics when applied to digestion, and developing “healthy” biofilms when used by dental hygienists.

This is not the forum for a detailed scientific explanation of microbiology. What we can know for certain is that “bug wars,” the science of using healthy bacteria to combat disease, is emerging as an attractive alternative to chemicals or sterilization, the science of killing all bacteria, for effective infection control.

Over the next 12 months, we will examine three areas of microbial cleaning in this column.

First, the microbial cleaning of systems that lead away from the patient (e.g. evacuation); Second, the microbial cleaning of systems that indirectly contact the patient (e.g. surfaces); Third, the microbial cleaning of things (e.g. instruments) that directly contact the patient.

New products based on microbial science are going to require significantly more stringent testing and legislative approval. Particularly, should they address cleaning equipment that comes into direct contact with a patient? It is one thing to have “good bugs” reduce the probability of e-coli or some other nasty in the drain. It is quite another to depend on microbiology to ensure bacteria-free water is delivered from a water line into a patient’s mouth.

The ever-increasing use of progressively more toxic chemicals for effective infection control is not sustainable. Even if we ignore the cost savings microbial solutions typically offer, and we ignore the potential of creating chemically induced super bugs, and we ignore the increased efficacy these new products bring to patient infection control, maybe we will start by paying attention to ourselves.

We are at risk of systematically poisoning our environment as we pour these chemicals down the drains. And I fear for the lungs of the junior team members, who are the ones most often tasked with end of day cleaning. Please do not be deceived! If it smells nice, it does not mean that it is nice!

The MSDS sheets for all cleaning products are easily accessible online. I know they are hardly the most exciting reading, but protecting yourself from the chemicals they disclose makes them a “hot read” in my book!

Alexander (Alex) Bischoff is Executive VP of Sales and Marketing at Bio-Pure. Bischoff’s responsibilities as EVP of Sales and Marketing include product sales, training the dealer network, and educating the dental industry about the potential of microbial cleaning. 

Articles

Are you using too many chemicals in your dental practice?

Despite advancements in almost every facet of impression-making, from materials to hemostatic agents to cords and retraction paste, achieving accurate impressions of crown and bridge preparations can be frustrating for practicing dentists.

A recent study found that 89% of impressions taken had one or more observable errors; the most common error was voids or tears at the finish line (likely because of difficulty obtaining intimate contact of material around the tooth and gingiva, faulty manipulation of the materials while placing it around the tooth, or premature removal from the mouth).1

Three major challenges facing dentists when recording conventional crown and bridge impressions are: correctly managing the soft tissue, placing material precisely around the properly prepared tooth, and dispensing both injection and tray materials into the mouth within allowable intraoral working times.

Prior to capturing a final impression, practitioners have historically used mechanical retraction through the placement of cord, alone or in combination with a chemical agent to promote hemostasis, drying, and retraction of tissue (e.g., aluminum chloride, ferric sulfate, racemic epinephrine). In one study of North American dentists, it was found that 95% of respondents routinely used gingival retraction cord during crown and bridge impressions.2

To allow enough material to create an undistorted impression, a 0.2 mm space must be created between tooth and gingiva. This minimum space requirement is intended to allow the impression material to flow into the sulcus and not exceed its tear-strength capability, preventing the chance for remnants to be left behind that could cause gingival irritation and inflammation.3-6

Recently, product manufacturers have introduced retraction paste as a less traumatic means of achieving hemostasis and local retraction (e.g., 

Even though retraction paste has been shown to create temporary gingival inflammation, it is considered less traumatic when compared to placing retraction cord and is as effective in promoting hemostasis.8,9

There are several ways that conventional crown and bridge impressions are taken: the single-step technique using only one material (e.g., monophase technique), the single-step technique involving impression materials of two viscosities (e.g., light body and heavy body), and the double-step technique which also includes two materials with different viscosities, however, one is allowed to set followed by placement of the second material as a second step.

All of the options for placement of impression material around the prepared tooth require the dentist to perform two tasks simultaneously: expressing the material by pushing down on the plunger or squeezing the impression gun and, placing the material around the tooth.

DENTSPLY Caulk has developed Aquasil Ultra Cordless Tissue Managing Impression Material and digit power™ Dispenser

 as a means for dentists to precisely place material for improved crown and bridge impressions without the need for retraction cord or retraction paste in most cases.

The digit power™ Dispenser is a pneumatic impression device that is compatible with most dental units. It connects to an air line at the dental chair via commonly available connectors and uses digit power™ unit-dose impression cartridges. Instead of loading a backfill syringe or squeezing the 50 mL impression gun, dentists are now able to simply step on the rheostat to express material while holding the impression device in a pen-grip.

The small diameter intraoral tip on the impression cartridge allows placement directly into the sulcus or around a dental implant. Different sized impression cartridges are available for either single- or multiple-unit cases.

Aquasil Ultra Cordless Tissue Managing Impression Material is designed for use with a single-step dual-viscosity impression technique.

[RELATED: A behind the scenes look at DENTSPLY Caulk's new Aquasil Ultra Cordless Tissue Managing Impression System]

Both the tray material and the wash material for this system have been formulated to provide several advantages compared to Aquasil Ultra. First, because the wash material is intended to be placed around the prepared tooth without the use of cord or retraction paste, it is designed for flow into sulcus widths of less than 0.2 mm without distortion or tearing.

Compared to Aquasil Ultra the tear strength of Aquasil Ultra Cordless impression material has been improved to prevent rips or tears at the impression margin.

Additionally, to meet the needs of dentists adopting newer technologies, the materials have been optimized for digital scanners. 

show the digit power™ Dispenser device being used to capture a final impression for tooth No. 19.

An important feature of the Aquasil Ultra Cordless impression material is the minimizing of errors due to working time/setting time violations. Exceeding the working time and/or setting time of an impression material can result in many different errors. Some examples include: incomplete or inaccurate marginal reproduction, tearing, pulls/drags, lack of coadaptation, and others.10

The digit power™ cartridges are designed so the entire impression cartridge can be expressed within the material’s intraoral working time and practitioners still have enough time to seat the tray properly. The intraoral working time of the single-unit cartridge is 35 seconds while the intraoral working time for the multi-unit cartridge is one minute; the working time of the tray material is approximately one minute and 15 seconds.

Mouth removal times for the single- and multiunit cartridges are three minutes and four minutes and 30 seconds from the start of mixing, respectively.11

Clinical Case at a Glance with Corresponding Technique Video

Aquasil Ultra Cordless digit power™ Dispenser, with installed intraoral tip, is shown in the blue plastic adaptor. To its right is the regulator attached to the dental air line. Note at the top of the regulator is a silver knob with settings for flow rate of the impression material.

 The digit power™ adaptor sits in the tool holder and permits the air switch on the dental unit to be activated.

 Comparison of conventional plastic intraoral mixing tip (back, right), and digit power™ Aquasil Ultra Cordless plastic intraoral mixing tip, (front, left) with depth markers of 3 mm and 5 mm.

 digit power™ Dispenser and Aquasil Ultra Cordless single-unit wash material being used to capture a final impression for tooth No. 19. Buccal retracted view.

 Final impression captured with the Aquasil Ultra Cordless system.

Pre-op view of patient. Buccal retracted view.

 Finished preparations on patient for full-coverage lithium disilicate restorations on tooth Nos. 8 and 9. Buccal retracted view.

 Final impression of tooth Nos. 8 and 9 on 25-year-old male patient. Note the extension of the material on the mesial aspect of tooth No. 8. No cord was used.

After final cementation of lithium disilicate crowns on tooth Nos. 8 and 9.

The Aquasil Ultra Cordless Tissue Managing Impression System is intended to make conventional crown and bridge impression-making easier and more predictable.

The factors that make the Aquasil Ultra Cordless system unique are:

1) Precision placement through a fine cannula allows for delivery of impression material directly into the sulcus.

2) Aquasil Ultra Cordless impression material has been optimized for placement without cord or retraction paste to capture a thin, readable sulcus and prep margins. Increased tear strength minimizes the chance of tearing.

3) The working time of Aquasil Ultra Cordless Tissue Managing Impression Material is designed to coordinate with the amount of material in the unit-dose cartridge for single or multiple preps to eliminate impression errors because of violation of working time and setting time. Dentists can now concentrate on one thing-precisely placing the material-rather than squeezing the gun or depressing the impression syringe during the placement step.

4) The ergonomically designed digit power™ Dispenser uses the pen-grip (the same grip dentists use when using handpiece).

Read the references on the next page ... 

1.Samet N, Shohat M, Livny A, et al. A clinical evaluation of fixed partial denture impressions. J Prosthet Dent 2005;94:112-7.

2.Donovan TE, Gandara BK, Nemetz H. Review and survey of medicaments used with gingival retraction cords. J Prosthet Dent 1985;53(4):525-31.

3.Laufer BZ, Baharav H, Yehuda G, et al. The effect of marginal thickness on the distortion of different impression materials. J Prosthet Dent 1996;76:466-71.

4.Laufer BZ, Baharav H, Cardash HS. The linear accuracy of impressions and stone dies as affected by the thickness of the impression margin. Int J Prosthodont 1994;7:247-52.

5.Shah MJ, Mathur S, Shah A, et al. Gingival retraction methods in fixed prosthodontics: A systematic review. J Dent Sci 2008;3(1):4-10.

6.Shiozawa M, Takahashi H, Finger WJ, et al. Effects of the space for wash materials on sulcus depth reproduction with addition-curing silicone using two-step putty-wash technique. Dent Mater J 2013;32(1):150-5.

7.Feng J, Aboyoussef H, Weiner S, et al. The effect of gingival retraction procedures on periodontal indices and crevicular fluid cytokine levels: a pilot study. J Prosthodont 2006;15(2):108-12.

8.Kazemi M, Memarian MA, Loran V. Comparing the effectiveness of two gingival retraction procedures on gingival recession and tissue displacement: a clinical study. Res J Biol Sci 2009;4(3):335-9.

9.Smeltzer M. An alternative way to use gingival retraction paste. JADA 2003;134(11):1485.

10.Impression-taking Guide. DENTSPLY Caulk. Available at: http://www.caulk.com/assets/pdfs/Techguide.pdf. Accessed June 17, 2013.

11.Aquasil Ultra Cordless Directions for Use. DENTSPLY Caulk.

How to create accurate crown and bridge impressions with Aquasil Ultra [VIDEO]

As modern-day dentists, we are faced with a complex set of treatment decisions, compelling us to continually weigh the available therapeutic choices as we push toward optimal patient care combined with efficient and profitable clinical practices. 

Endodontic treatment is one area of dentistry in which the options are plentiful and varied, often leading us to ponder how best to provide conservative, predictable root canal treatment that offers long-term solutions.

To achieve this goal, we must begin with confidence in our instrument system and technique. The right mix yields a therapy based on the ideal combination of safety, simplicity and sophistication.

In selecting a treatment system, most clinicians aim to find reliable instruments that offer comfortable handling, perform appropriately, and, ideally, expedite treatment. The following three cases demonstrate the treatment of common endodontic problems using 

Komet USA’s new, two-file F360™ NiTi endodontic file system

The instruments in the system feature a thin-core, .04 taper, S-curve design that provides outstanding cutting efficiency while respecting natural root canal morphology. Although most cases can be completed using the .04- taper, sizes 25 and 35 files, the system also accommodates larger canals by offering additional .04-taper files in sizes 45 and 55.


	The patient presented with acute pain and reported a feeling of swelling in his face. Tooth No. 6 was sensitive to percussion, but it did not demonstrate sensitivity to air, sweets or temperature stimuli.

Following a discussion of the treatment options, the choice was made to perform endodontic therapy on the tooth to eliminate the pain. The prescription for definitive treatment was a post and core with a full-coverage IPS e.max® (Ivoclar Vivadent) CEREC® crown.


	The patient presented with temperature sensitivity and pain during mastication. The treatment plan consisted of endodontic therapy on tooth No. 13 to be followed up with post and core treatment and an IPS e.max® CEREC® crown.


	Having received treatment two weeks earlier for caries control and replacement of defective amalgam restorations, the patient presented with an inability to tolerate hot or cold temperatures. In addition, he was unable to chew any type of food. Following consultation, the patient accepted the treatment plan of endodontic therapy to be followed up with post and core and IPS e.max® CEREC® fullcrown coverage.
	 


	Typical of the types of endodontic cases seen in most dental offices, these cases each presented differently, yet they successfully responded to standard 

The two-file technique that follows access opening and coronal enlargement can be used for up to 80 percent of the root canal therapies most dentists prescribe, thus making standard endodontic treatment predictable, efficient and straightforward.

This translates into significant time savings, which in turn leads to increased profitability in the dental practice.

How to make endodontic treatment more predictable with Komet USA’s F360™ NiTi endodontic file system

Marketing not a priority in your practice? Here are five ways a dental marketing consultant can help change that.

1. Marketing efforts are disjointed, half-hearted and sporadic

 should work with you to create an overarching strategy behind all marketing efforts so they work in concert with each other-and to focus on creating momentum behind a few key tactics that can 

create results and achieve your marketing goals

2. Marketing always ends up on the back burner

The right consultant will hold you accountable and ensure the plan you create together actually gets implemented over time rather than getting shelved whenever something more urgent comes up. Consistency matters!

A good consultant will not only be your coach but also your quarterback, recommending the best vendors so that not every item on your to-do list becomes another skill you have to master.

Remember, your time is best spent doing dentistry, not building 

4. You’re spending marketing money with no discernible ROI

A capable marketing consultant will help you be more results focused and can help identify marketing activities that should be eliminated in favor of more trackable, proven tactics.

A marketing consultant with experience in dental practice branding and online marketing can help attract new patients by 

bringing your practice marketing up to date

 and into the era of websites and social media-even if you don’t know your https from your htmls.

Top 5 signs you need a marketing consultant

 different enough in the adhesive cement market to convert them to users? The overwhelming response was yes and the key was the handling.

Final cementation of a single or group of indirect restorations is the culmination of hard work in tooth preparation, accurate impression making, provisionalization with tissue management, technical lab work and artistry, and proximal and occlusal contact adjustments.

The grand finale is proper cementation of your adhesive or cohesive restoration(s). 

Graham (2012) listed several contemporary considerations:

		Long-term permanent seal, i.e. long-term stability and minimal degradation

		Biocompatible, both internally and externally

		Strong physical properties such as flexural and compressive strengths

		Universal usage for all ceramic and metal crowns

		Good working and setting times for single and multiple units

Given the crowded market of cement choices and the multitude of restorative options (metal; porcelain fused to metal; all-ceramic zirconia or lithium disilicate), the Catapult Group was asked to review 

, which is its newer and improved version of a composite resin cement that the manufacturer reports offers improved radiopacity; improved film thickness and setting time; and a higher degree of conversion (cure) after 15 minutes of seating and much easier clean-up of excess cement. 

The question posed to the Catapult Group is: Is DUO-LINK different enough in the adhesive cement market to convert them to users? The overwhelming response was yes and the key was the handling.

More than 90% of the evaluators would incorporate this DUO-LINK into their practices. This, without question, is an outstanding response to this cement product.

		By far, the most important area to assess for resin cements was the ability to remove excess cement.

		This was closely followed by characteristics such as: physical properties, flowability, working time, seating time, film thickness, and delivery system. All were indicative that usability and predictability were highly important to the clinicians.

		Choices in shades were also of importance to the evaluators.

		Bonds to all substrates with extremely high bond strengths

		Indications include: crowns, bridges (fixed prostheses), onlays, inlays, and posts/dowels, fabricated from metal, composite, porcelain, ceramic, zirconia, alumina, 

		Extremely easy clean-up because it is precisely formulated to allow for quick and easy removal of excess cement

		It’s highly radiopaque and can be easily identified on radiograph for quick and effective diagnosis

		Easy to use automix, dual-syringe provides a consistent mix for immediate delivery

		Universal (A2) shade can be used with most restorations and has some translucency at low film thickness

		Milky White shade is more opaque and can be used to mask darker tooth preps

1. Removal of excess cement was deemed good to easy by 55% of the evaluators. Using a tacking tip or the flash cure technique (2 seconds from 3 inches) aids in easy removal. Evaluators found this extended gel phase to be better than the previous version of DUO-LINK.

2. Film thickness was seen by 95% of the evaluators as close to ideal. Sounds simple, but all too often easy seating can be prevented by a cement that is too thick and if it’s too thin, then it’s an issue of being too runny and difficult to clean.

3. Flowability impacts the placement of cement into the crowns. More than 86% of the clinicians found this product was “just right.”

4. The working and setting time are also critical issues and these were favorably evaluated with the vast majority of the group, who said it offered plenty of time for up to a few crowns. More than 81% felt the working time was just right for single crowns and 61% for bridges. With almost 70% giving a good to excellent rating for the setting time, positive feedback on these issues make bonding or two to three units at a time much more predictable and stress-free.

5. Finally, the appearance of the shades was again positively seen with both the Milky White and Universal with good to excellent responses for 66% and 86% respectively.

Given the statistics, more than 90% of the evaluators would incorporate this DUO-LINK into their practices. Clearly the focused development and hard work put into this product by Bisco’s developers has resulted in an outstanding product. Two key tips from the manufacturer:

		To avoid incompatibility, it is recommended to avoid using different bonding systems with different resin cements. Therefore, using All Bond Universal (with a film thickness < 10μm) is suggested to optimize results, however DUO-LINK Universal is compatible with most adhesives.

		Bisco research shows that a separate pure silane primer (such as Porcelain Primer or Bis Silane) for porcelain/lithium disilicate and separate metal oxide primer for zirconia (such as Z-Prime) results in better long-term durability of the bond.

		Lastly, based on clinical experience with other products by many Catapult members, careful isolation technique and temperature/moisture control will result in better handling properties and clinical results.

Is DUO-LINK different enough in the adhesive cement market to convert them to users? The overwhelming response was yes and the key was the handling.

Review: Why Catapult Group evaluators would convert to Bisco's DUO-LINK

 helps this patient better understand what’s happening in her mouth, making her more comfortable while at the dentist.

Sue Wallitner describes herself as a nervous patient.

She doesn’t want to be in the chair any longer than she has to, and she certainly doesn’t want to think about any pain associated with treatment she might need. That’s why she loves going to Dr. Gerald Bittner, Jr.’s practice in San Jose, Calif.

From digital x-rays to lasers, his office is equipped with the latest technology, something Sue has appreciated over the last 10 years she’s been a patient.

About 9 months ago, Dr. Bittner introduced Sue to 

 and was designed to provide a visual experience that takes patient education to a new level-all on an iPad.

“I like to be able to see things. I like to have all the information,” Sue said. “If I need something done I want to know exactly what’s going on. I like looking at the x-rays and photos and the details. I like to know so I can prepare myself for what needs to be done.”

Sue bought an iPad for personal use about a year ago, so when Dr. Bittner first introduced her to DEXIS go she was comfortable right away.

She was also impressed with the technology and loved the fact she was able to hold the iPad and really see the images and radiographs up close. She’s easily able to look at the images and ask her doctor any questions she has. Having everything right there really does make it easier for Dr. Bittner to explain what he sees in the photos and radiographs, and for her to understand her treatment options.

“He used to have a TV in the operatory, but I think it’s easier to have an iPad right in your hand,” Sue said. “I think having something people can hold onto makes a huge difference. I know I can see my x-rays and photos. It’s nice to have it right there as the doctor explains what’s going on.”

Sue hasn’t needed much dental work, but she does have an area of recession that her dentist wants to monitor, she said. She isn’t ready to go forward with treatment just yet, but said she is considering doing something to cover it up at some point down the road.

With DEXIS go, she’ll be able to look at photos that show the recession’s progression at each visit, and that will help her decide if and when she wants to go forward with treatment.

To Sue, it’s important that her dentist has the most up-to-date technology. She wants to know exactly what’s going on in her mouth and what her options are to fix any issues that might come up. She may not like going to the dentist, but she’s a lot more comfortable when she knows exactly what to expect and can understand the importance of any recommended treatment.

 offers that, and is just another reason for her to stay with Dr. Bittner.

Find out how DEXIS go helps this patient better understand what’s happening in her mouth, making her more comfortable while at the dentist.

How DEXIS go® helps this patient feel more comfortable at the dentist

I flat out cannot believe that another year has melted away that quickly. It feels like when I woke up this morning, it was Memorial Day!


	However the best way for me to keep track of the passage of time each year is to think about all the amazing devices, procedures, tools, and programs that I get to test and evaluate every year here at DPR.

This year, I had some really good products to choose from and, quite honestly, this was one of those years where having a Top 10 Test Drives would’ve made my job a whole lot easier.

However, it also can be a nice thing for you, the reader, because you can rest assured that this year’s Top 5 faced stiff competition and still came out on top. The products listed here are not in any particular order. They are all equally deserving.

So without further ado, I present this year’s Top 5 Test Drives.

More than 50% of U.S. dentists wear some type of magnification, and with many schools encouraging students to do so, those numbers will only continue to climb. This really warms my dental heart as I am a huge proponent of magnification for many reasons.

Magnification is no longer a “want” but truly a “need” for ideal treatment, yet it’s not just a matter of seeing things “bigger.” There’s also auxiliary lighting. Having a surgical telescope setup that not only magnifies, but completely illuminates the field, is a game changer of epic proportions.

Until recently, when dentists purchased surgical telescopes they first had to purchase the glasses setup. Once brand, magnification level, and style were locked in, the user then looked at what lighting options were available. This means you’re using two separate components to create one piece of “dental gear” you’ll use for every procedure. Auxiliary lights are tethered to battery packs, batteries can be heavy, cords can break or snag on things. Many of us have been dreaming of a better solution.

The Orascoptic XV1 is the first all-in-one surgical telescope

 and headlight. The LED light components are built into the frame. An auxiliary lighting system is basically three pieces--the battery, the wiring and the LED.

The batteries are placed in two “tubes” that attach to the end of the arms of the frame. Wires are hidden inside the frame and run to the LED, which is also part of the frame. The result is a clean stylish look that does away with wires and a battery pack.

The system also features Capacitive Touch Controls. There is a logo on the temple area of the glasses (both Left and Right). By lightly touching this area with the forearm or another uncontaminated area, the XV1 can cycle through High/Low brightness and Off/On.

The LED “Low” setting provides light intensity of 2500 foot-candles and 10 hours of battery life while “High” provides light intensity of 4000 foot-candles and 6 hours of battery life. The system also comes with a charger and a spare set of batteries that will charge in less than 2 hours.

The frames can accommodate telescopes from 2.5X to 4.8X, and I have been impressed with this setup from the day I put them on. 

I experimented with the idea of using electric handpieces a few years ago. The concept was a good one, but I found drawbacks in thick bulky cords, overly large handpieces that were noticeably heavy, and less than optimal uptime. Those problems were enough to keep the idea of electric handpieces off my radar for quite some time.

Fast forward to 2013 when the folks at Bien-Air introduced me to the 

This system took the problems I had experienced with previous electrics and not only beat them … it blew them out of the water. The system comes with two contra-angles. One is a 1:5 gear ratio and the other is a 1:1 gear ratio. These two contra-angles allow the user to operate them in speeds from 100 rpm to 200,000 rpm. To clarify that point, the 1:1 contra-angle can deliver 100-40,000 rpm while the 1:5 contra-angle can deliver 500-200,000 rpm.

[ Read real product reviews from real dentists on Dental Products & Reviews ]

For those of you who are students of rpm in dentistry, you may notice the 1:5 contra-angle does not rotate as fast as an air-driven turbine. This is because electrics like the MX2 provide significantly more torque than their air-driven counterparts. Air turbines spin faster to compensate for a lower amount of torque.

When an air turbine makes contact with tooth structure, it actually drops in rpm down to about that of an electric. Because electric handpieces use gears and electric motors with significantly higher torque, their rpm does not drop when in contact with tooth structure. This allows the user to operate the device at lower rpms and accomplish significant reduction; they have more control and zero chance of stalling.

The MX2 is 30% shorter and 23% lighter than previous models. Pair that with the fact the cord is also much lighter and more flexible than in years past. These features combine to give the operator a much better view of the field and much less hand and wrist fatigue.
	My maintenance issues from previous electrics were laid to rest when I discovered the Bien-Air MX2 has ball bearings that are “lubricated for life.”

The MX2 is completely autoclavable and yet requires minimal maintenance. In fact, in my time testing and using the MX2 system I have been impressed with just how reliable the system is.

Then comes that part that makes a diehard geek like yours truly so glad to have a career in dentistry. The system also has the 

 In a nutshell, the Optima is a “brain” that provides intelligence to the power of the handpiece. The Optima MX2 controller has an LCD touchscreen that allows the user complete control over the handpiece.

Simply select something like “crown preparation” and preset parameters are applied such as maximum speed allowed, torque allowed, etc. This allows the operator to truly have the ability to control the procedure from start to finish.

This system has completely changed to way I look at electric handpieces. If you are in the market for a new handpiece, you really should have this design on your short list to evaluate.

As a techie, I don’t usually get all worked up over a new cement, but every once in a while something comes along that could change the landscape of dentistry. 

Ceramir offers “Nano-structurally Integrating Bioceramics,” or NIB. This is a product that takes conventional glass ionomer technology and interlaces it in a specific mix with Ceramir technology.

When I first spoke with the folks at Doxa about Ceramir, I was concerned that the material comes in capsules that are required to be “activated” and then triturated. I felt this was a serious drawback. Triturator manufacture, purchase, and usage has been in decline for several years, tied directly to the decrease in amalgam use. The brain trust at Doxa explained to me the reasoning behind the need for precise measuring, which can only be accomplished through the capsule interface. Once I understood that, my opinion was completely reversed.

In several microscopic studies, Ceramir C&B clearly shows the material building hydroxyapatite. The material is truly “bioactive.” Over time, the cement’s chemistry evolves and forms a layer of hydroxyapatite between the tooth and the restoration. This helps decrease sensitivity and the potential for staining at the margin.

As all-porcelain crowns have become stronger and more esthetic, margins don’t need to be placed subgingivally. Many doctors leave their margins supragingival or directly at the height of the gingival crest. While this is better for overall periodontal health, you risk staining. Ceramir is less likely to stain because of the formation of the hydroxyapatite crystals, which also increases retention.

Doxa has created a new category of dental cements that may very well usher in a game-changing, outside the box approach to a variety of restorative procedures. 

Every once in a while, a product comes along that surprises me with both its versatility and simplicity. That’s exactly the way I feel about 

 The device is a piezoelectric scaler and so much more.

When one thinks of the term “piezo scaler,” it conjures the image of a high-end device used in the hygiene department for cases requiring extra energy to help remove tenacious subgingival deposits. In the case of the P5 Newtron XS LED, you’d be correct, but you’d be missing out on lots of other uses.

The device has a 100,000 lux LED light (9290 foot candles) and an ultrasonic frequency of 28 kHz to 36 kHz. It has a nice kit of tips for perio procedures that allow easy access to any area of the mouth, as well as a self-contained irrigation system.

The perio uses alone justify having this device in your office, but we’re just getting started. Those of us doing endo are well aware of the great benefits of proper irrigation. Now we can create agitation of irrigants without damaging the canal wall by using Irrisafe instruments in the Newtron handpiece.

There are also tips specifically designed for endo. My favorite are very small diamond coated tips that remove small amounts of tooth structure while locating canals that are sclerotic or difficult to find. The Excavus tips used for operative/restorative dentistry are valuable when performing minimally invasive restorative procedures, and the Perfect Margin tips for fixed prosthetics allow you to create a rounded or shoulder margin that is free of unsupported enamel rods.

These end cutting tips are the final step in my fixed prosthetic procedures before retraction. My office has found the Perfect Margin tips are a big plus for digital and traditional impressions, which then leads to better fit for the final restorations. 

I made the decision to go digital in the late 1990s and never, ever looked back. Since then I have seen the quality of digital images skyrocket and costs plummet. And it hasn’t just been the costs of the images. Hard drives and other hardware have continued to drop in cost as well.

Now, while this column is called “Top 5 Test Drives,” this particular situation wasn’t really a “test.” We were in need of a new panoramic x-ray and we have had good experiences with Gendex radiographic equipment going back to our 

, which we were thrilled with from the day we bought it.

The practice had owned a Gendex Orthoralix 9200 digital panoramic and cephalometric system since 2002 and we had been very happy with it as well, so when we decided to upgrade to a new unit with even better resolution, Gendex was at the top of our list. We knew that we not only needed the image quality Gendex provided, we wanted to have the mobility of the data. Nothing can beat being able to see radiographs anywhere in your office or anywhere on the planet.

But there are a few other important reasons we went with the 

. The first was image quality. The radiographic images that come from the device are very crisp and clear.  We were impressed when we saw the images taken during demos, but there is something about seeing images taken in your own office that just adds a certain amount of “gee-whiz” factor, which gets you excited about it in your work environment.

The other really critical piece of the radiographic puzzle for us was cone beam computed tomography (CBCT). We have been using 3D imaging in the practice for a few years now, and we simply cannot practice without it. It’s truly become one of our “must have” devices for a lot of what we do.  We felt having a second system in our three-doctor practice would actually help improve our workflow.