Crown preps (and the unexpected challenges they can present) are among my favorite procedures. I love the test of turning my focus to a single tooth for an hour or 2. In our office, we commonly talk about striving to make each one the “best crown ever”—prep design, hemostasis, impressions, temporaries, crown fit, occlusion, and cement all play a role in trying to achieve this.

Thermo Clone Clear Bite products from Ultradent are among those advancements that improve my provisional crowns. Thermo Clone Clear Bite is a vinyl polysiloxane impression (VPS) material that sets fast (60 seconds), which is quicker than most conventional VPS materials. Its flexibility simplifies removing and reinserting into the mouth. It is far more accurate than alginate and can be reused should the patient lose their temporary a few days later. It also has the unique property of being a clear material that aids in seating the material back over the prepared teeth.

Ultradent Case Study

The patient shown in this case is a man aged 92 years who had an onlay I did for him 15 years ago on tooth #31 (

). It had been serviceable for many years until it fractured along the distal marginal ridge. No caries and no pain were reported. We discussed options and decided that we would replace the restoration with a zirconium-based crown.

I placed J-Temp (Ultradent) into the missing distal area (

. J-temp is a radiopaque, light-cured, flowable, methacrylate-based temporary resin that has a self-leveling quality. Its purple color makes it easy to distinguish from tooth and crown materials.

I placed the Thermo Clone Clear Bite into a quadrant tray and placed this over the lower right quadrant (

). Note that the use of an impression tray is optional with Clear Bite. I have found a tray helpful when working on most distal teeth, but Clear Bite also can be extruded directly over the teeth to be impressed without the need for a tray (

After removal of the old ceramic onlay and completion of the crown prep (

), I proceeded with tissue hemostasis—this is an especially important and often overlooked step. It is important to control any hemorrhage prior to cord packing and retraction. I placed Astringedent X (Ultradent) in a syringe with the yellow Metal Dento-Infusor tip (

The way you use the chemistry is just as important as the type of chemistry you use. Use of a firm scrubbing motion with the Dento-Infusor tip is critical. You do not want to lightly apply it to the tissue as this tends to run and can be messy. Application must be done with a firm scrubbing or rubbing motion, working the solution into the tissue, which is far more effective in controlling bleeding. If you were not taught the benefits of ferric sulfates in dental school, do not fear the brown color; it goes away quickly and it is more important that you have control of the area for a quality impression.

For cord packing, I used ViscoStat (Ultradent) and did a double cord packing technique. I soak the cord for a few minutes (

) and then just lightly blot the cord to remove excess hemostatic material. The viscous material helps the cord slide into the sulcus better for me. In this case, I used an Ultrapak cord #00 (yellow) as a first layer (

), then placed a larger #1 cord (blue) over this for greater retraction (

). I find that I can pack larger diameter cords than I used to because the cord compresses much more than I originally realized. It is still very gentle and I get better retraction. I am not in a hurry to pack the cord; my goal is to be gentle and achieve retraction without injury to the tissue. I want the top cord to be visible (

) and I leave this in place for 5 minutes. When I remove the cord (

), I am careful to tease the moistened top cord out and check for bleeding, then I rinse and dry. This technique is called “car wash” because I spray heavy with a combination of water and air. If I can do this and not have any bleeding, then I am ready for the impression (

). If I have bleeding, then I just pick up hemostatic solution in a syringe and scrub the area again before retesting the area with the car wash spray until I am confident that I have a clean and dry area to impress. Do not rush this step. Using the hemostatic solutions prior to cord packing, soaking the cord in the solution, and gently teasing out the moistened cord all help to not create bleeding.

I am impressing with a dual arch tray and Thermo Clone heavy and light body VPS impression material (

To create the provisional restoration, I placed ExperTemp material (Ultradent) into the #31 site of the Clear Bite matrix we had previously created (

). ExperTemp is a bis-acryl material with a working time of 40 seconds. I remove it from the mouth between 1½ and 2½ minutes (I tend to go much faster if the tooth has a great deal of retention or if I am concerned about locking the material into proximal undercuts; if we have a second molar like this, I can wait the full 2½ minutes if my patient will allow it). (

Upon removal you will see flash around the margins and the proximal areas (

). You can trim the flash with a diamond in a handpiece and polish in your lab or use composite polishers such as the Jiffy Natural Composite Polisher (Ultradent) pictured (

). ExperTemp material, like other bis-acryl materials, needs to have the oxygen inhibition layer removed with alcohol. You can add to any deficiencies with more ExperTemp or a flow resin. You can bond to it or apply a glaze such as PermaSeal (Ultradent) if you want a shiny temporary crown.

I have found that the fit of the temporary crowns made with the help of the Clear Bite have been exceptional. Do temporaries come off? Yes, but not as often. If I have a good crown prep with adequate retention and a nice provisional crown with closed margins, I am confident that it will be a durable and protective crown that will be there until the final crown is ready. If a temporary crown comes off or is lost, I can remake the temporary crown in minutes with the saved Clear Bite impression—I save and label them in a clear plastic bag until the final crown is seated.

There are many temporary cements we can choose from to select the ideal retention for the case on which we are working. My go-to is the new UltraTemp REZ II (

). This is a recently reformulated cement that has great seal, low irritation, and seems easy to clean up. One of my favorite features is that when I remove it, the cement tends to stay in the temporary crown and not as much on the tooth. If I am worried about too much retention with the temporary cement, then I have our UltraTemp cement, which is a great cement with low irritation and less retention.

We owe it to our patients to offer the best skills and materials available.

Articles

We take a deep dive on this impression material to unwrap just what makes it such a boon for restorative treatments.  

Can Ultradent’s Thermo Clone Clear Bite Material Improve Your Life? 

Sometimes in what I like to call the great invention curve, there is a calm before the announcement storm. We saw it with artificial intelligence (AI). As I wrote in February 2024, AI was making quiet inroads into society at large and then moved into the dental profession before anyone was really aware of it. As we all know, AI seemed to explode across the profession in 2023; however, it had been flying under the radar for almost a decade. We are now about to see some similar amazing things that are in development in the areas of magnification.

First things first, though. I refer to loupes as surgical telescopes or scopes because that is what they are. Personally, I feel the word loupes lessens how important these things are.

I find it amazing how far the profession and our industry have come in this field. When I look back over the years of my career, I can say that I have seen the full spectrum of this. When I was being trained, no one used magnification. To many of you reading this, that probably seems hard to fathom, and I’ll admit that it is for me as well. I do remember one particular doctor in my clinical team who kept a very low-magnification pair of glasses in his pocket. Occasionally when he was looking at a crown on a model, he would pull out those antiquated glasses and look at a margin. I don’t ever recall him actually looking in a patient’s mouth while wearing them, though. Rumors were that he had been incredibly successful and was teaching just to give back, but I never made the connection that perhaps that incredible success could be, in part, due to magnification helping him achieve his clinical excellence.

The first 7 years I spent in private practice, I did so with just my naked eyes. One day a good friend from Phoenix called me to excitedly tell me about his new 2.5x glasses. By this point you could see booths at trade shows selling these “glasses,” but the crowds looking at them were sparse. My friend kept pushing me to make a purchase, but I was stubborn. I had been blessed with 20/15 vision, while my friend needed prescription eyewear to read the newspaper. I thought, “Of course you need that. You can’t see things right in front of you without help.” Ah, youth.

However, he kept after me and I am so grateful that he did. About 6 months later, I finally succumbed to his persuasion and bought a pair identical to his. They were 2.5x “flip-ups,” and they rocked my world. By this time he had purchased a light system, and he told me I needed to purchase the light system too. This time, I was all in. By this point I’d have bought clown shoes if he told me they would help me see better.

Back then the lighting systems were big boxes that had a high-intensity halogen bulb. The light traveled to the glasses via a fiber-optic cord that you plugged into the light box. The boxes were big and heavy, so you had to have one in every operatory, and the $125 halogen bulbs burned out every 3 months. The setup was expensive but so worth it. I quit using the track lights in the operatories, and I was amazed how much easier it was to work when I wasn’t reaching up to constantly reangle the track light every time a patient moved or I needed to change my angle of access. Everywhere I looked, the light followed. It was phenomenal.

Once I got used to working with 2.5x, I wanted to see even better. Before long I had reinvested by upgrading to 4.8x, and my world changed again. My posture got better, I was more efficient, and best of all, my dentistry got better.

The next big jump was to LED lights. I was no longer tethered to “the box,” and I no longer had to buy all those expensive halogen replacement bulbs every 90 days. I was much more mobile while still having all the advantages of the light on my scopes. When I built my new office, I helped buy scopes for the hygiene team because I wanted them to see what I was seeing. That also meant that I didn’t need to purchase track lights for 7 new operatories either. And for those of you who are wondering, there are several very low-cost options for assistants that can attach to regular safety glasses, so your auxiliaries don’t need you there to provide illumination when they are fabricating temporaries, etc.

Of course, the only constant is change, which I love. The bright people doing research and development kept working at making vision better and better. One of those earlier changes was to prismatic lenses. These high-quality lenses gave doctors a more generous field of view with amazing definition and edge-to-edge clarity. Prismatic lenses allowed me to see even better while allowing me to see even more.

This is also a good point to mention: the improvements to LED lights and why lighting is so important. Many current LED systems are incredibly bright, but they are also very much needed. One of the laws of light physics is that when you increase the magnification, you also need to increase the length of the telescopes. The longer the scope becomes, the less light actually enters it. The result is that a bright illumination of the field is not only nice but also required. I honestly don’t even want to think about practicing without the light.

Further improvements came along in the form of telescopes that have variable magnification. These scopes allow me to work at 3.0x-4.0x-5.0x, depending on my needs. The level is adjusted by rotating the telescopes until they click into the next level up. I find that for my needs, I like to do hygiene exams at the lower magnification of 3.0x, which allows me to see about a single quadrant at a time. This gives me a better field of view to help visualize and get a big picture of what is going on. During the exam, if I see an area that perhaps needs a closer look, I can easily move to a higher magnification level by just rotating the barrels on the scopes to the right. For those of you thinking about infection control in this scenario, wiping the barrels (and anything else you’ve touched with gloves) can be accomplished with a CaviWipe or similar surface disinfectant.

The only drawback to variable magnification is that if you prefer to do most of your dentistry at 3.0x and use higher magnification only in certain situations, you have the weight of all 3 levels on your nose all the time. For those who would like to have higher magnification on less frequent occasions, I’ve got your answer. For that doctor, I’d recommend a frame that allows you to swap in and out individual telescopes to change your levels. The OmniOptic frame (Orascoptic) has a single frame that has interchangeable telescopes that snap into place and are held there with powerful magnets. The telescopes come in levels 2.5x, 3.5x, 4.5x, and 5.5x. The nice thing about these is that you can have all those levels of magnification but have the weight of only what you are currently using. You can also pick and choose which telescopes to purchase and buy only the ones you prefer. Of course, if you then decide to have 

level, you simply purchase the level you’d like. All the personal correction (if you need an optometric prescription for your vision) is built into the lenses mounted into frame. This means you don’t need to buy anything else with the correction. The telescopes are off the shelf and readily available when you order.

The great news here is that progress continues. Recently we’ve seen the launch by several manufacturers of deflection or declination telescopes. These telescopes exit the lens of the glasses and have a bend or angle built into them. The idea behind this is to allow the operator to sit in more upright posture. As someone who has been using straight telescopes since the late 1990s, there was a bit of a learning curve as I used them, but that learning curve was short. If a doctor bought some as a first-ever step into magnification, I would anticipate that learning curve to be less. At this point, I can swap between standard and deflection systems without even thinking much about the change.

However, the next step in this product category is coming soon, and it is going to be game changing

 That’s because this product space is soon going to be digital! When you think of how much the camera in your smartphone has improved over the last 3 to 5 years, imagine that being built into your surgical telescopes! That’s right. Digital magnification is about to hit it big in dentistry.

Few things in recent history have gotten me this fired up. We are talking about a head-mounted system that puts high-definition stereoscopic screens right in front of your eyes. This is going to be paired with either a single or a pair of high-resolution camera(s) and bright, true-color, adjustable lighting. These systems will offer a large viewing field that will enable the operator to zoom in to levels of magnification that will up to this point have been available only with a surgical microscope.

Some of the systems will be WiFi enabled, which will allow the operator to take still photos or full-motion video and save them on the office network. You will also be able to stream this video for live demonstrations or for those curious patients who have always wanted to see what’s going on. If your WiFi signal is weak, the system should also have a memory card slot so that the images and video can be stored for downloading later.

There may be foot pedal controls or even voice activation to simplify usage and decrease infection control concerns.

Of course, there are going to be bumps in the road as we, the end users and our patients, adapt to this. How will patients react to these systems? No matter how stylish manufacturers design these, they are going to look different. Some systems may prevent the patient from actually seeing our eyes. Will patients trust that we are seeing better than ever before?

There is also the issue of what is referred to as lag time. The digital processors are going to need to be superfast so that there is no time difference between what the camera sees and the moment it is rendered on the screens. We cannot have a system where something moves and there is even a fraction of a second before the doctor sees it.

Weight is a concern. How heavy will these be and how comfortable will they be to wear? Doctors suffer enough from neck and back issues. The weight of these must be kept to a minimum. Some systems will be worn with a head loop, while others will look more traditional, with the system secured with the snugging neck strap we are used to.

And of course there is the simple subject of need. I know that some doctors are going to say that we are seeing well enough already. Do we need to see any better? How high in magnification can we go before small head movements appear to be drastic? One other factor to consider is the resolution. How high can the magnification go before we see pixelation on our screens? These questions and others are all things that both manufacturers and the end user need to consider.

As regular readers know, I am always enthusiastic about progress in our profession, but I try to remain realistic in my expectations. “Underpromise and overdeliver” is normally my mantra. However, I feel in my gut that this is going to be a quantum leap forward over today’s systems. For years I’ve been saying that, at least for me, the more and better I see, the more and better I want to see

As you read this, I will be knee-deep in a clinical evaluation of one of these systems that is being created by a major manufacturer. I am going to be bench testing the device and then after the learning curve, I’ll be going live with use during actual clinical procedures. As soon as I am able, you can expect a follow-up column on my experiences. I can’t wait to tell you more!

John Flucke, DDS, is in private practice in Lee’s Summit, Mo. He also serves as chief clinical editor and technology editor for 

 ® and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.

Loupes and magnification enable clinicians to be more accurate and efficient. Dive into this month’s Technology Evangelist to learn more about just how far loupes have come. 

This Is Where Things Get Interesting…

As a clinician in a surgical general practice, my top priority has always been the search for reliable dental instruments that optimize my efficiency. I believe you’ll agree—there’s nothing more frustrating than dealing with handpieces that lack the necessary power and torque to cleanly section through a tooth. Stalling burs and chattering handpieces are enough for us all to pull our hair out.

Having dependable dental equipment is not just a matter of speed and convenience; it is a necessity that directly impacts my patient care. With this in mind, I would like to highlight 3 essential tools that have formed the cornerstone of my practice.

First, the W&H Implantmed Plus Motor System. 

To call the Implantmed Plus unit just a surgical motor is an understatement: I like to think of it as more of a surgical ecosystem. I use the W&H Implantmed Plus system (

) for all my everyday oral surgery procedures—from dental implant placement to impacted third molar removal.

The added flexibility of connection to the new Piezomed Plus module from W&H allows the use of surgical piezo procedures to perform sinus lifts, ridge splits, and atraumatic extractions. The Implantmed Plus motor combines incredible power with a simple, intuitive, and user-friendly interface that I can depend on for efficiency in my surgical procedures.

Further, after dental implant surgeries are completed, we can wirelessly connect the Osstell Beacon tool to the Implantmed Plus to assess the implant stability quotient post surgery and then again prior to delivering the final restoration. Through the modular components of the W&H system, we minimize the overall counter space necessary to perform many procedures in an already crowded surgical operatory. Short of physically extracting a tooth, there isn’t much that the Implantmed Plus can’t do for me.

Second, the W&H WS-91 surgical handpiece. 

) with a 45-degree head connects to the W&H Implantmed Plus motor and supports you with precise and smooth sectioning of all teeth. When I say smooth, I mean no chatter, no stalling bur—just crisp, clean sections. This handpiece is my go-to, everyday extraction hero.

With a gear ratio of 1:2.7, I set the Implantmed motor to 40,000 rpm, which allows for up to 108,000 rpm at the bur. I prefer the WS-91 over other handpieces due to its smaller head, bright LED system, and precise sterile saline spray to keep the site cool and my bur clean. I highly recommend this handpiece to dentists who do any level of surgical extractions.

Lastly, the tool I can’t live without, the W&H S-16 surgical handpiece. 

 Third Molar Handpiece. In my opinion, this is a must-have handpiece for any dentist who tackles wisdom tooth extractions.

As you know, when you approach deeper impactions or horizontally positioned third molars, you always wish your bur was just a little longer. This is where the S-16 handpiece (

) truly shines. With the perfect 20-degree angle for tackling impacted third molars, a 1:2 gear ratio that allows you to section teeth at up to 80,000 rpm, and incredible torque at full speed, I feel confident sectioning furcations and removing bone around wisdom teeth.

Combined with my favorite bur, the 1703 HP bur (45 mm), the S-16 allows me to provide my patients with efficient extractions of impacted third molars. One of the biggest advantages of the W&H S-16 and WS-91 is that they are fully dismantlable into several individual parts for proper cleaning and then sterilization of the handpiece. This feature increases the life span of the handpiece while also ensuring complete removal of any bio burden within it.

In conclusion, the W&H Implantmed Plus and WS-91 and S-16 handpieces provide me with the confidence to continually redefine and elevate the standard of care in surgical dentistry, ultimately benefiting both clinicians and patients alike.

One clinician explains how 3 products from W&H enable him to confidently redefine and elevate the standard of care in surgical dentistry, which in turn benefits both clinicians and patients.

Essential Tools That Redefine and Elevate the Standard of Care in Surgical Dentistry

This profession is full of gray areas. In the mouth, and (literally) in the radiographs, we are asked to make a distinction between perfectly healthy, fully mineralized, intact enamel and cavitated enamel requiring restorative intervention.

While there are times where these distinctions are easy, we all must admit that there are several clinical occasions that we encounter daily where the surface of a tooth lies somewhere in the middle. Let’s take, for example, the following:

A patient with a high-acid oral environment

Stained margins around an old composite or crown

Radiographic decayed enamel that doesn’t extend to the dentin

While there are several practical clinical strategies to handle situations like the ones above, perhaps none is more accepted and well researched than regular topical application of a fluoride varnish. Several randomized controlled trials have supported and maintained the idea that regular application of fluoride varnish is an incredibly cost-effective and successful strategy to prevent the incidence or progression of decay, especially in high-risk populations.

As a result, the vast majority of practicing clinical dentists and hygienists have made it a part of their regular clinical routine to at least offer fluoride varnish for all interested patients after their routine recall prophylaxis and maintenance appointments.

Profisil

Twenty years ago, the fluoride application that was most common consisted of foam trays with a fluoride gel, intended to bathe the teeth in fluoride for approximately 5 minutes. Patients were told not to eat for several hours after the appointment due to the toxicity of fluoride when consumed. Most patients and practitioners found this to be a cumbersome and messy treatment modality.

It was replaced in the past decade with the use of fluoride varnish, painted onto the teeth. This painted-on substance forms a sticky covering of the teeth and quickly hardens when exposed to saliva, which effectively delivers fluoride onto the enamel. Patients are allowed to eat immediately afterward, but in order to maintain effectiveness, it is required that they not brush off the material for several hours. This was thought to be a superior alternative for most practitioners. The biggest drawback was the sticky, waxy feeling that sadly made the teeth feel less “clean” even though they just had a professional cleaning completed.

Kettenbach, a leader in the dental industry in providing high-performing materials in the fields of impression taking, cementation, and temporization, has recently introduced a new product, Profisil, a 5% sodium fluoride delivered in a mucosa-friendly, pleasantly flavored dimethicone gel. In contrast to other topical fluoride options, this particular product is free of colophony (rosin). As a result, this varnish is said to eliminate that uncomfortable, sticky feeling on the teeth post cleaning.

Profisil was given to 15 members of the Catapult Education product review team, who were asked to use this new fluoride varnish in typical clinical scenarios and compare the patient experience with that of their original fluoride varnish. The results are below.

Almost all the Catapult reviewers used this product on 10 or more patients. Several indicated that they used the product on themselves and on their dental teams. As a result, many had the opportunity to test the product in a variety of clinical scenarios and oral environments.

Areas of evaluation and results are as follows:

Overall handling: 73% reported excellent, 13% very good.

Viscosity: 60% reported excellent, 20% very good.

Ease of application: 80% reported excellent, 6% very good.

Ability to apply to dry teeth: 73% reported excellent, 6% very good.

Ability to apply to moist teeth: 73% reported excellent, 6% very good.

Volume of material in the pack: 73% reported excellent, 13% very good.

The patient reaction to the varnish was 64% excellent and 21% very good, with 1 evaluator commenting, “perfect balance of taste and stickiness. Very well received by all.” Another commented, “Berry flavor is wonderful!”

None of the survey respondents reported adverse effects of the topical application.

When asked to compare the Profisil product with what these clinicians were already using, almost every evaluator reported that this material was either similar or superior, with most remarking that the material is simply more comfortable, is less sticky, and tastes better.

Of the survey respondents, 85% would recommend Profisil to a colleague and 70% intend to immediately incorporate this product into their practice.

I had the opportunity to try this product myself, using it on my team, my patients, my children, and myself. The positive response was consistent and overwhelming. The berry flavor truly was delightful, and there was a very noticeable decrease in the sticky feeling. I must agree with the majority of Catapult reviewers and am happy to see this product achieving the Catapult Vote of Confidence™.

This fluoride varnish from Kettenbach USA aims to eliminate the discomforts that sometimes come with other fluoride varnishes all while maintaining the efficacy that clinicians desire. 

A Comfortable, Patient-Friendly Way to Deal With the Gray Areas

For the longest time, we’ve known that using loupes is critical when it comes to seeing inside the mouths of patients. Magnification is essential, and using loupes—and even surgical microscopes—has allowed dentists and hygienists to deliver better care. After all, it’s hard to fix what you can’t see.

Dental loupes and magnification have changed for the better over the years, with lighter, more comfortable designs and a variety of magnifications designed to aid clinicians. Much has been written about the importance of ergonomics in the dental operatory, with seating, lighting, and cabinet and delivery system locations all revamped over the years to help staff with everyday work that can be physically and mentally stressful.

After decades of clinicians working through back and neck pain caused by the often awkward movements and difficult posture positions required to examine a patient’s mouth, a much-needed focus was given in recent years to protecting dentists and hygienists, who are more susceptible to musculoskeletal injuries and disorders. Dental professionals frequently suffer from back and neck pain caused by the awkward, forward-hunching posture that is necessary to examine a patient’s mouth.

“Magnification provides an ergonomic solution that can reduce musculoskeletal discomfort and improve patient outcomes,” says Erica Born, marketing manager, consumer strategy, at Orascoptic. “Loupes can help dentists and hygienists reduce back and neck discomfort, see the mouth with more clarity, and improve efficiency.”

Katrina Klein, RDH, CEAS, CPT, is a certified ergonomics assessment specialist and a certified personal trainer in addition to a hygienist, and she’s well aware of the importance of using proper magnification to reduce pain while improving your work.

“Studies have shown that magnification is the number one impactful piece of equipment for reducing workplace injury. Stated more simply, they significantly help reduce our pain from practicing,” says Klein. “Wearing loupes benefits clinicians by promoting a neutral body posture. Magnification keeps the upper body at a safe working distance.”

While manufacturers have been providing magnification solutions for dental practitioners for decades, a newer trend has brought about a newer category of loupes—ergo loupes. While earlier versions were indeed designed to combat back and neck pain and eyestrain, today’s loupes help clinicians improve their posture and mitigate neck discomfort.

 in April 2023, Orascoptic’s High Definition Ergo loupes tout a 3.5x magnification that allows users to reduce neck tilt while maintaining a clear view of the treatment area. The loupes are mounted through the lens with a field width of 8.5 cm and a field depth of 8 cm.

“Ergo loupes are a great new option in clinicians’ ergonomic toolbox. Using ergo loupes allows the user to sit up straight, further reducing back and neck discomfort,” adds Born, who also notes the importance of choosing the best loupes for each individual team member. “Loupes are an important tool for clinicians as they function as an extension of themselves—having loupes that are custom-made to each user is essential for proper function, which in turn improves patient outcomes.”

The InfinityVUE Loupes from Designs for Vision, Inc, are designed to provide a straightforward approach to ergonomics and are available in 3.0x, 3.5x, and 4.5x magnification. Infinity VUE Loupes with Vision Up Ergonomics are said to keep a practitioner’s chin up, neck straight, and eyes forward while viewing the oral cavity. By changing the positioning of the internal prisms, these loupes allow you to see intraorally without having to bend your neck.

Irene Iancu, BSc, RRDH, CTDP, OM, gave a presentation on the Infinity VUE Loupes at the Greater New York Dental Meeting last fall and explained that if you wear standard telescopes, you know that although your magnification is great and your posture may be great, you may also still be suffering from head and neck pain because of the angle of declination and from bringing your chin down and forward.

What these new ergonomic loupes do is bring your chin up and your posture back because you are looking straight down at the patient, instead of having to bring your chin down in the line of vision as you do with traditional loupes. “It’s kind of like using a microscope, but the microscope is attached to your loupes,” says Iancu, a restorative dental hygienist from Toronto, Canada.

Mounted on a Steam frame and with the side shields attached, the VUE Loupes weigh 3.2 oz. They arrive in a plastic case with a secure fastener that keeps the loupes protected.

Enova Illumination provides loupes and surgical microscopes to the dental industry. The Minneapolis, Minnesota, company’s Vizix® Ergo Elite Loupes are the company’s latest product with a big emphasis on protecting the health of oral caregivers.

Available in 3.5x, 4.5x, and 5.5x magnifications, they are described as a lightweight, ergonomic, angled prismatic loupes that provide unparalleled visibility through the lens. They are designed to support natural posture and therefore help prevent pain caused by the awkward, unnatural movements often associated with using traditional loupes. The Vizix Ergo Elite Loupes can be paired with any frame in the company’s Airon™ series.

“When using prismatic [ergo] loupes, the spine, head, and neck are in neutral,” adds Klein, who uses the 3.0 ErgoPrism Airs by LumaDent. “The majority of our pain comes from putting our heads down into flexion so to reduce or eliminate the primary cause for pain is a huge benefit.”

Scott Green, executive vice president for Enova Illumination, is proud that his company has played a role in improving the way clinicians see and practice dentistry and in how improved magnification helps clinicians stay healthy and extend their careers.

“When my dad started practicing over 50 years ago, dentistry was done without any magnification, including loupes and microscopes,” Green says. “It was not uncommon for a dentist to work as close as 6 to 8 inches from the patient’s face. You could always tell a dentist because their shoulders were rounded. With that being said, the biggest advantage that we’ve seen is the ergonomic body positioning that has improved over the years. We’ve gone from traditional loupes to ergo deflection loupes to now microscopes.”

Loupes and microscopes have enabled dentists and hygienists to visualize the oral cavity in much greater detail at a much farther distance. This allows them to identify pathology, decay, and anatomy that would otherwise be very difficult to see with the naked eye, Green explains. Using these tools leads to more accurate diagnoses and improved treatment precision and success rates, all while clinicians are in a more upright position that protects them from back and neck fatigue and pain.

“Using dental loupes enhances ergonomic positioning and postural alignment, minimizing back and neck strain and discomfort. Loupes help magnify tiny details, revealing hidden cavities and cracks and pathology for improved accuracy. Also, loupes can help the user become more precise, resulting in better proficiency and happier/satisfied patients,” Green adds.

It is quite common for specialists to use a surgical microscope for endodontics and other surgeries, but general practitioners should also consider using the technology for many—if not all—of their restorative cases.

Glenn DeWeirdt, DDS, has been using microscopes for 2 decades, and he uses them on a regular basis.

“I’ve been using dental operating microscopes in my practice since the early 2000s, which makes me one of [their] very early adopters,” says Dr DeWeirdt, a dentist in Woodridge, Illinois. “I use my microscopes for everything from oral surgery and endodontics, of course, which is [their] primary use. We’ve been using surgical microscopes since they first came into widespread mainstream use in the dental profession. I use them to perform all my crown and bridge [work]. I literally do every procedure using the dental operating microscope.”

Because the microscopes allow him to see such detail, the technology enables Dr DeWeirdt to perform better treatments for
his patients.

“Absolutely. There’s no question about it,” he says. “What general dentists in particular don’t really realize is that when they embrace high magnification using the dental operating microscope, not only does it improve your quality of care, but it makes you more efficient as well. Because with the ergonomic benefits, the fact [is] that your posture is much better…. I often tell people, I’m 66 years old and I don’t have neck problems, back problems, or eyestrain problems. That [pain] causes many dentists to retire before they’d like to. Sure, a lot of that is just good genes, of course, but much of it is having used dental operating microscopes in my practice for well over 20 years.”

Dr DeWeirdt, an active lecturer on the topic of magnification and a frequent speaker at the Chicago Dental Society Midwinter Meeting and at dental study clubs in the area, uses surgical microscopes and loupes from ZEISS and is a consultant for the international leader in advanced optics. There are 5 ZEISS microscopes in his Hobson Dental Associates practice in Woodridge, a western suburb of Chicago.

While many clinicians currently use microscopes for endodontic procedures, he stresses how beneficial they are for him when performing all dental treatments. Loupes, such as the EyeMag® medical loupes from ZEISS, offer premium optical performance for users in dentistry, neurosurgery, spine surgery, and more. Typical dental loupes range from 2.5x to 5.0x magnification, while surgical microscopes are in a whole different range.

“I guess I could distill that down into what one of my clinical instructors told me, which was, ‘What you don’t see, you’ll never know,’”
Dr DeWeirdt says. “With typical loupes, for example, high-power loupes, you’re usually talking around 2.5x or 5x. I’m doing many of my dental procedures, operative endodontics, and even oral surgery at 18x to 22x power magnification.

“So, you’re seeing everything. There are no secrets.”

While Dr DeWeirdt’s practice uses traditional loupes, not the ergo loupes that have gained in popularity, he knows many clinicians who like the newer versions because of the reduction in pain. But he also believes there is a trade-off in terms of visibility when comparing ergo loupes with the traditional models.

“I teach, and many of the students have the ergo loupes, and they’re great,” he explains. “In my personal opinion, from what I’ve observed and what I’ve experienced, the ergo loupes tend to solve a significant ergonometric problem at the expense of a visibility problem.”

With ergo loupes, the field of view tends to be a little smaller. Also, the focal length of those loupes must be very accurately measured, and this can be difficult because of all the variations including the different heights of the clinicians.

“So, I would say that ergo loupes are a wonderful, wonderful tool when they are set up properly. But my focus is on microscopes, where you don’t have any of those issues. Once a clinician can move past the small initial adaptation issues, they can go to town and be more accurate, more efficient,” he says. “To me it’s a no-brainer, so I can do an incredibly accurate crown preparation in 10 minutes. And patients appreciate it because they’re not [lying] back for 30 to 45 minutes. It’s absolutely a tool that I have embraced. And in my practice, and for me, it is an essential tool.”

Enova’s Green agrees, stating that microscopes aid in a number of number procedures.

“Dental microscopes are critical for procedures like root canals (endodontics), examining cracks and tooth trauma, placing posts, implants, intricate preparations for crowns/bridges/inlays, identifying/refining margins for impression taking, and periodontal surgery,” Green says. “They provide high magnification and coaxial illumination for very minute and delicate dental procedures. Also, they are fantastic at educating patients and documenting procedures when they have an integrated digital camera.”

Some companies have developed 3D vision goggles, and there are products currently in development designed to allow clinicians to wear a headset while delivering a 3D view and magnification that assists with treatments.

Dr DeWeirdt says some of these concepts have been around for years, and he sees promise in 3D microscopes in the future.

“It’s not a new concept, actually,” he says. “Back about 10 to 12 years ago we had a headset type of thing. Now, I think what may be in the works is something where it’s combined with a virtual reality or 3D type of system. And the 3D microscope systems are, I believe, very promising.”

Dr DeWeirdt had the opportunity to preview a 3D microscope system in his practice about 5 years ago. While it didn’t work well for him in part due to some minor vertigo issues, he realizes that it may be a good option for some clinicians, especially new users not trained on traditional microscopes and loupes for many years.

“From my point of view, I want to communicate to my fellow dentists that high magnification has just incredible value in terms of patient care,” he says. “How that magnification is utilized, whether it’s 3D, whether it’s video, virtual reality, or traditional microscope, really doesn’t matter that much. Having said that, the traditional microscope, binocular microscope, is really, in the end, the easiest and the cheapest way to achieve high magnification.”

The bottom line, as clinicians have come to know, is that you can do more for your patients when you can see more.

Breaking down all the latest trends and technologies in dental loupes and magnification. 

See More Do More 

I love efficiency. But actually, I love technology more, because with the use of technology, efficiency follows. For many years we have been experiencing technology-related efficiency gains through the data aspects of our treatments. By that I mean digital charting (including periodontal charting), digital radiography, digital photos (intraoral and extraoral), and more.

Now we are seeing more of this efficiency extend to aspects of our practices that impact things outside the arena of data gathering and hands-on treatment. Sure, we all want to make appointments shorter for our patients while delivering outstanding care. However, how about making orthodontics more effective and easier by applying technology to help with that? And even better, what if that technology went with the patient everywhere, including when they are not in your office?

Did that get your attention? Good, because when I learned about this, it grabbed mine too.

Technology is helping make dentistry more predictable every year. With today’s modern materials, equipment, and techniques, we can forecast with great accuracy the amount of time needed for most of our procedures. This is key to operating an efficient dental practice and delivering a “wow” patient experience. Efficiency in treatment means your “reception area” is exactly that—a place where the patients are greeted, then escorted to the treatment area—not a “waiting room” where they sit for 30 to 45 minutes because the office is running behind schedule every day. Those are things that, with careful planning, we can control.

However, delivering clear aligner orthodontic treatment efficiently presents a few unique challenges that even the most experienced clinicians cannot control, namely adherence, complexity, and biology.

Orthodontic treatment involves the gradual movement of teeth into a more healthy, stable, and esthetic position. Simply put, this takes time. With clear aligners being a removable appliance, it is hard to gauge in advance whether a patient will adhere to your daily aligner wear instructions. This is especially true when weeks or even months pass before you see them again. Scheduling “aligner check” visits every 12, 8, or even every 4 aligners can still allow for tracking issues to manifest, or relapse to occur, which often results in refinement.

All of us who provide clear aligner therapy have struggled with patients, normally younger ones, who feel that aligners are like homework—something to be done “if Mom is watching.” The patient comes in for a check and things have barely moved, if they have moved at all, or they are tracking in a way that will require corrective action.

Another variable that is hard to control for is complexity. Although a case may appear rather straightforward, and even on the lower end of the complexity spectrum, there are still some movements that are going to be more challenging to achieve with clear aligners. We know tipping is rather predictable, but even a small rotation planned and staged to occur between aligners 9 through 12 of a 22-aligner case adds complexity. Some manufacturers suggest that doctors should instruct patients to wear their aligners longer during these specific stages. From an execution standpoint this is nearly impossible to achieve with consistency. There must be a better way to control for complexity that meets adherence in the middle.

In recent years, research has shown that patients struggle with correct interval dosing on prescription medications, and some experts have even suggested moving to larger doses with twice-daily administration. If patients struggle to remember to take medications on a fixed interval, how successful will we be in expecting them to remember a variable schedule to wear aligners 9 to 12 for 2 weeks instead of 1? Not very successful, I would guess.

Then comes the most elusive element of all: biology. It is completely invisible and can change during treatment based on medications, hormones, and other factors.

 Every patient is unique, and their teeth can only move at the rate the bone remodels. We also know that nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen (Advil) and naproxen (Aleve) significantly slow the rate of bone remodeling and are readily available over the counter.

 Controlling for consumption of this variable is nearly impossible, as pain is a powerful motivator. These 3 variables are the cause of countless tracking issues, resulting in refinements, inefficient workflows, and a diminished patient experience.

As I have said in my columns many times, no one wants dentistry to take longer. There needs to be a way, a system that can provide a beautiful and esthetic result helping to minimize treatment time and discomfort. Anything that can decrease that treatment time will be welcomed by patients with open arms…and open mouths.

Fortunately, and finally, the clear aligner industry has caught up with clinician needs and assembled a solution. CandidPro clear aligners incorporated remote monitoring technology into the aligner system to address all these pitfalls without sacrificing the results that doctors and patients expect. It is called CandidMonitoring and it is included with every case, at no additional charge (

Artificial intelligence (AI) is making tremendous advances in dentistry, and now it is helping to make orthodontics easier. CandidMonitoring’s roots are deeply embedded in Dental Monitoring API, the French company that is home to the dental industry’s largest image database. It utilizes advanced remote monitoring technology powered by AI. Although it is an incredibly complex system on the back end in the cloud, it is easy to use and to explain to the patient. CandidMonitoring AI employs a multilayered neural network trained by real doctors to analyze specific pathologies with consistent digital precision. This allows for more frequent and accurate supervision of clear aligner cases, effortlessly advancing your clinical oversight to the next level from wherever the patient happens to be. I will go into more detail about the process, but for now imagine your patient using their phone camera and an app to let you see exactly where they are in the treatment process.

A decent analogy (and I love a good analogy) may be to relate it to flying one of today’s advanced commercial aircraft. The pilot’s main job is getting the aircraft in the air and ensuring a comfortable and timely landing. Most of the flight is on autopilot with smart systems monitoring known and unknown variables and adjusting to them along the way to stay on course. Of course, the pilot is always truly in control and can at any time intervene and alter course. The pilot is the ultimate decision maker.

This is, in many ways, akin to how CandidMonitoring works. Once the doctor has approved the patient’s treatment plan, much of the work is already done. This plan includes the doctor’s prescribed protocol from takeoff to landing. In the event of a tracking issue, patients do not continue to blindly advance aligners, straying further off course. The system monitors the patient’s movements and alerts the patient and the doctor if the case is not tracking as anticipated.

Typically, the doctor has prescribed for the patient to remain in a holding pattern for 1 extra week. Patients must then check back for clearance to proceed to the next aligner by submitting a new scan to see whether they are back on course. If not, the cycle repeats again for 1 week. If the patient is still not on track, the doctor is notified, takes the controls, and manually instructs the patient on what to do next. In most instances this is a hands-on office visit to allow the doctor to fully assess the situation and prescribe the necessary corrections to get back on track (

Doctors can simply log into their CandidMonitoring portal and access their patients’ complete monitoring histories. These detailed records include high-resolution images and video showing tissues, teeth, and tracking at every aligner stage, with aligners inserted and out.

Fully informed with current clinical context, most often the patient is still instructed to continue to hold in their current aligner by their doctor and encouraged to be more adherent to aligner wear or counseled on other potential variables such as NSAID use. Thankfully, the patient has not continued to advance aligners through this challenging movement, as that can make it impossible to recover tracking without committing to a refinement. Even better, none of this required scheduling an appointment, appointment confirmation, room turnover, or a minute of chair time unless the doctor desires that.

For patients, things could not get much more intuitive. Every patient has become fluent with downloading an app, so installing CandidMonitoring takes just a couple of clicks. Today’s mobile phones use cameras with multiple lenses, incredible depth of field, stabilization technologies, and image postprocessing that allows them to upload intraoral images that are crisp, clear, and diagnostically accurate (

All patients are provided a compact and durable ScanBox pro device with their aligner kit at no cost. If they lose it, the company will send a replacement at no cost to the patient or practice. After completing 2 weeks in their current aligner, patients will be prompted on their phone to take and submit a scan that includes data on adherence, tracking, hygiene, and much more. This all takes just a few minutes with nothing more than their phone and the ScanBox pro attachment. It can be done from anywhere they are and will go directly to your portal, which you can access and respond to from anywhere you are. CandidMonitoring AI evaluates every image at every aligner stage for tracking and pathology. Based on your preferences, your patients will receive a notification to stay in their current aligner or advance to the next, based on how well their teeth are tracking to your prescribed treatment plan.

Utilizing a system like this makes sense. Instead of expecting each unique patient to adapt to a one-size-fits-all system, let the system dynamically adapt to each patient. That is exactly how our other clinical treatments and processes work.

We have seen some incredible advances in orthodontics in the past 2 decades. We have progressed from circumferential bands and ligature wires to bonded brackets and elastics to clear aligners that move the teeth gently and predictably. Now we are using the incredible advancements in AI to make another quantum leap forward. Considering so many practices offering clear aligner therapy struggle with efficiently completing cases, it may be one of your smartest decisions to evaluate this intelligent solution to see how it can benefit your practice. It has certainly made a positive impact on mine.

Bartzela T, Türp JC, Motschall E, Maltha JC. Medication effects on the rate of orthodontic tooth movement: a systematic literature review. Am J Orthod Dentofacial Orthop. 2009;135(1):16-26. doi:10.1016/j.ajodo.2008.08.016

Ong CK, Joseph BK, Waters MJ, Symons AL. Growth hormone receptor and IGF-I receptor immunoreactivity during orthodontic tooth movement in the prednisolone-treated rat. Angle Orthod. 2001;71(6):486-493. doi:10.1043/0003-3219(2001)071<0486:GHRAII<2.0.CO;2

Krishnan V, Zahrowski J, Davidovitch Z. The effect of drugs, hormones, and diet on orthodontic tooth movement. In: Krishnan V, Kuijpers-Jagtman A, Davidovitch Z, eds. Biological Mechanisms of Tooth Movement (Third Edition). Wiley; 2021:199-215.

Karthi M, Anbuslevan GJ, Senthilkumar KP, Tamizharsi S, Raja S, Prabhakar K. NSAIDs in orthodontic tooth movement. J Pharm Bioallied Sci. 2012;4(suppl 2):S304-S306. doi:10.4103/0975-7406.100280

CandidMonitoring solves the biggest clear aligner challenges for practices and patients.

A System to Keep Practices and Clear Aligner Patients Connected

As any dental office owner knows, there’s a lot more to running a practice than just honing your clinical skills. Keeping up with the latest procedures and getting your continuing education credits is important, but there are so many other facets to a practice. Offices must deal with daily staffing issues, insurance, billing, scheduling, supplies—the list goes on and on. One area that is specifically very important to me is making sure you do everything you can to secure and protect your most valuable asset: your patient data.

With all the focus in recent years on cybersecurity, such as dealing with ransomware attacks, many practices may have forgotten that there is still a set of rules and laws, called the Health Insurance Portability and Accountability Act (HIPAA), that offices must follow to avoid significant fines and penalties. While it doesn’t seem to get talked about as much, there are still a number of reasons why I feel that dental practices can and should be current on staying HIPAA compliant.

The biggest reason I advocate for HIPAA compliance is that there’s a huge crossover between HIPAA regulations and cybersecurity best practices. The entire reason that the Health Information Technology for Economic and Clinical Health Act of 2009 was enacted was to provide guidelines for following the Security Rule of HIPAA, which deals exclusively with electronic data. It became obvious as we entered the 2000s that as more and more practices were moving toward a chartless or paperless environment, and by definition more and more patient information became electronic, it was critical that health care providers develop systems to meet the expectations of patients, that their critical and private data was being protected and secured as best as possible. Many of the best ways to accomplish this, such as encryption, firewalls, data backup, patching, and managing access, have been part of the HIPAA regulations for close to 15 years now. In other words, you’re killing 2 birds with 1 stone when you implement systems to secure the data: You’re protecting the information and meeting HIPAA guidelines at the same time.

HIPAA still has a lot of teeth when it comes to enforcement. There are currently 4 levels of violations, and the 1 you really want to avoid, willful neglect, can destroy a practice. Willful neglect occurs when there is evidence that the practice knew it was in violation of HIPAA laws but still elected not to rectify those violations. How would they know? Easy. If you are following HIPAA rules, then you know that you must do a risk assessment on a regular basis and develop a plan, called a HIPAA Management Plan, to address those issues. If you do your risk assessment (which I highly recommend doing annually) and don’t ever lift a finger to remedy those concerns, then by definition, that’s willful neglect. The fines start at $50,000 per violation and can go up to $1.5 million in a year…ouch!

Finally, of all the HIPAA violations out there, suffering a breach would, in my opinion, be the most damaging to an office. Forget the fines and penalties: If you suffer any type of data breach, the Breach Notification Rule says you must not only notify the local media but, worse, notify every single patient in writing about the breach. The question at that point wouldn’t be whether you are going to lose patients, it’s how many you will lose.

While HIPAA doesn’t get as much press as the latest ransomware news that seems to flood in daily, it is indeed something to worry about still, and I suggest that every practice do a reevaluation of its HIPAA preparedness.

While HIPAA may not get the attention it deserves, it’s still something to worry about, and every practice should do a reevaluation of its HIPAA preparedness.