Last month in Part 1 of this article, we looked at a variety of dental material types including traditional light-cured bulk fill flowable composite, incremental fill of packable composite, and resin-modified glass ionomer. Here, in Part 2, we’ll get into the benefits of self-cure bulk fill flowable composite.

Until recently, I didn’t know that a self-cure bulk-fill flowable existed. SDI Limited, an Australian-based dental product manufacturer, has been providing innovative solutions for more than 50 years.

Most dentists have already tried or regularly use its composites, cements, silver diamine fluoride, and whitening products available through brands like Luna, Riva, and Pola. One solution that I have had the opportunity to try was the Stela Self-Cure Bulk Fill Flowable Restorative. What makes this product unique is that it self-cures at the point of contact with its proprietary primer/adhesive.

The composite itself is a combination of a bisphenol A (BPA)–free resin monomer along with a bioactive ion glass filler. It is delivered via an auto-mix syringe and comes out in a consistency similar to flowable composite (Figure 4). This results in an overall bulk fill with very high compressive and flexural strength to rival any modern composite, zero voids, and a gap-free interface between the material 

and tooth surface. The fact that the material is BPA free, free of tertiary amine, and bioactive is icing on the cake for an already excellent option.

Let’s take a closerlook at the Stela Bulk Fill Flowable Self Cure Restorative via a clinical case (

Dentistry is, and probably always will be, difficult at times. But materials like Stela, a monolithic solution that is a self-cure, bulk-fill composite that does not require separate etching or light curing steps, can make things easier for clinicians. Thanks to SDI and its Stela solution, I can confidently deliver bulk-fill restorations with a lot less indigestion, nausea, and upset stomach!

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[Sponsored] In part 2 of this article, one clinician explains the benefits of self-cure bulk fill flowable composite.

Part 2: SDI’s Stela Self-Cure Bulk Fill Flowable Self Cure Restorative Delivers Stress-Free Bulk-Fill Restorations

While a provisional restoration is intended to be temporary, the waiting period can feel much longer and more uncomfortable than anticipated for patients undergoing extensive restorative procedures. The appearance, fit, and durability of temporaries play a significant role in a patient’s comfort and confidence during this time.

Fortunately, advancements in dental technology, particularly with the rise of 3D printing, have streamlined the production of temporaries. Companies such as VOCO America are at the forefront of this innovation, offering new materials designed not only for strength and durability but also for enhanced esthetics. These temporary materials, such as V-Print c&b temp, allow patients to maintain the smile and function they desire while they wait for their permanent restoration.

Pittsburgh-based clinician and cosmetic dentistry expert Susan McMahon, DMD, AAACD, FAGD, says that V-Print c&b temp from VOCO has set the trend for new and innovative restorative materials, particularly as her office has moved from analog to digital.

“I used to wax up all my cases in my back room by pouring up models,” Dr McMahon says. “Now we work a lot in the digital realm, and V-Print crown and bridge temporary materials made a huge difference in my practice.”

Long-Term Solutions for Short-Term Restorations


V-Print c&b temp harnesses a light-curing resin formulation that touts qualities such as its high abrasion resistance, low water absorption, natural fluorescence, and resistance to discoloration. These features, combined with it being sedimentation-free, makes V-Print c&b temp applicable in a variety of cases such as crowns, bridges, and mock-ups.

Dr McMahon cited its advantages over the old analog ways. “Within a very short period of time, we are able to print a temporary right out of my 3D printer that is already very close to where I want it to be, and it’s going to have absolutely precise margins,” she says. “I know that the embrasures will be open the way I want, so there’s almost zero finishing and polishing when it comes out of the printer.”

Another notable advantage of the V-Print c&b temp material is the way patients have adopted it, especially as more of them are seeking cosmetic dental work, according to Dr McMahon.

“One of the things that I find time and time again is when people are having cosmetic work done, and loads of people are asking for it these days, people want cosmetic work done on their teeth, but they hesitate. They’ll say 2 things—‘last time I had this done, the temporaries were so horrible I hated it. They looked horrendous, and they tasted awful.’

“What printing temporaries with a material like this crown and bridge temp from VOCO can do is you can confidently say to [patients], ‘You are going to have beautiful provisionals,’” she continues. “They’re going to look great. They’re not going to look like anything you had before, and it doesn’t [require] the skill [of] somebody who has been doing dentistry for 30 years because we have this digital help. We have the collective intelligence of the dental community that works with us now.”

One of the key advantages of digital dentistry is that it gives clinicians the confidence to print restorations effectively and efficiently, thanks to faster print times. According to Dr McMahon, the entire process of designing and printing a provisional restoration can take as little as 45 minutes, depending on the complexity of the design and the amount of components that need to be printed. By moving from analog to digital methods, clinicians can avoid the mess and inconvenience of pouring models and save valuable time in the process.

With the fit, durability, and efficiency of using V-Print c&b temp, VOCO has developed a temporary material that crafts provisionals that both patients and clinicians desire, with features such as its color stability, optimal margins, and more.

“I never, ever want to make provisionals the other way anymore. Once you make them like this, you just don’t ever want to go back because of all those benefits that we talked about,” Dr McMahon adds.

A dentist, author, lecturer, and instructor, Susan McMahon, DMD, AAACD, FAGD, is an expert in the fields of cosmetic dentistry, dental care, dental services, and teeth whitening. Dr McMahon is a past clinical instructor in prosthodontics and operative dentistry at her alma mater, the University of Pittsburgh School of Dental Medicine. She lectures around the world on cosmetic dentistry, minimal prep dentistry, dental technology, dental service, and teeth whitening.

VOCO’s V-Print c&b temporary material prioritizes both flexural strength and esthetics to ensure patients receive a strong provisional that they can be pleased with.

Strength and Esthetics Take Center Stage With This 3D Printing Temporary Material

Whether planning for significant milestones or simply trying to go about one’s day, the possibility of a sudden chipped tooth or a cumbersome toothache isn’t something that’s anticipated. Unexpected, and sometimes time- sensitive, dental issues can bring pain and discomfort, as well as the looming stress of unplanned costs to consider. In fact, many patients may not be prepared to address the costs associated with unforeseen dental needs that go beyond routine dentistry.

More can be done to help patients financially prepare for dental services, and providers need to equip them with proactive financial education and tools to access timely, quality care without any financial stress. Partnering with a third-party financing company helps dental teams have proactive financial conversations with patients and ease their cost-related anxiety about unexpected dental care. Financial hurdles can be a significant barrier to patients seeking necessary oral care. According to Synchrony’s 2023 “Dental Lifetime of Care” study, 83% of people would consider delaying unanticipated dental care due to its cost.

 Further, 17% of survey respondents reported ignoring professionally recommended procedures, nearly half of whom experienced additional oral health issues. When patients postpone necessary treatment due to financial concerns, there is a chance existing conditions may worsen, or new ones may arise.

With oral health and oral germs being directly associated with overall health, it’s no surprise that it they can be linked to severe conditions such as cardiovascular diseases, pneumonia, and pregnancy complications when left untreated. For example, periodontal diseases have been proven to have a strong association with strokes, related to atherosclerosis, while untreated dental abscesses have the potential to spread to other parts of the body.

Untreated dental issues may also have financial ramifications. What can initially be a simple procedural fix can cause additional issues and expenses that may impact patients long term. The financial pressure, coupled with the dental pain and discomfort, may create stress and anxiety for patients, which can lead to them feeling overwhelmed and contribute to the avoidance of needed care.

Based on insights from the Synchrony and Commonwealth Health Advisors’ “Patient Pay” survey conducted in 2020,

 patients are looking for payment products and plan options from their providers before receiving any care at all, suggesting that patients are willing to invest in the quality care they need, if the options are extended to them. Providers can help patients manage care costs and financially prepare for nonroutine dental care by expanding consumer payment offerings and working with a third-party financing partner. When considering the right financing partner, there are important aspects for dental practices to consider, including the following:

A seamless and accessible prequalification process:

 Prequalification helps providers and patients understand what resources are available to help patients manage costs. Solutions such as Synchrony’s CareCredit credit card allow patients to see in real-time if they prequalify for a financing solution they can use to pay for their treatments. If approved, patients can use their credit card immediately to receive timely care. Further, patients can use CareCredit to purchase daily dental care tools, from Waterpiks to floss and routine dental services.

Digital financing tools can help patients assess their financial resources anytime and anywhere,giving them a sense of control in the process. CareCredit offers digital solutions to help patients learn more about the credit card and apply from the privacy and security of their own device. This fosters consumer-driven financing, where patients are in control of their payments.

Integrated practice management software (PMS):

 Providers would benefit from an alternative financing solution that can be integrated across the revenue cycle into their PMS, alleviating the burden for care teams by creating an enhanced and simplified administrative workflow. CareCredit offers an integration in PMS that streamlines the process and makes it easier to process transactions, saves time, and reduces the number of manual errors.

Equipping patients with information about financing options prior to facing unexpected dental treatments and care helps providers and patients act quickly when necessary and to move forward with timely care, avoiding the risk of more costly and invasive procedures in the future, which can lead to better oral health outcomes.

1. SynchronyDental Lifetime of Care Study. October 2023. CareCredit is a Synchrony solution.

2. PatientPay. CareCredit and CWH Advisors. October 2020.

Practices must equip patients with treatment information and discuss potential financing options before unexpected dental treatments become too big of an obstacle and to help them avoid the risk of more costly and invasive procedures in the future.

How Dentists Can Help Patients Navigate Unforeseen Dental Care

Fones School of Dental Hygiene, the world’s first dental hygiene school, holds the unique distinction of being the originator of dental public health. This heritage drives the school’s commitment to remain at the forefront of dental education and public service.

Embracing new technologies has always been integral to our mission of simultaneously and effectively educating our students and serving the public. Achieving this dual mission is made possible by Fones continuously incorporating new technology into its curriculum.

Since 2021, Fones School has integrated MouthWatch intraoral cameras and its TeleDent teledentistry platform into its hygiene education program. This was made possible by a grant aimed at addressing post-COVID-19 access to dental care.

Although intraoral cameras were already in use, the grant provided the impetus for the school to expand into teledentistry, thus allowing hygienists to work within the top of their scope of practice, while also improving patients’ access to care.

The Fones School teledentistry program began almost by accident. A grant needing fulfillment led to an unexpected but welcome opportunity to use newer technologies offered by MouthWatch, such as intraoral cameras and its cloud-based teledentistry platform called TeleDent.

This unforeseen opportunity significantly broadened the school’s horizons in hygiene education, but also in community outreach. During and post-COVID-19, access to care dramatically decreased, but this technology has enabled us to have our doctor on campus while Fones’ faculty and students provide virtual dental exams and consultations at off-site locations across Bridgeport, Connecticut.

The Real-World Impact of Teledentistry on Access to Care


Teledentistry has enabled Fones School to extend care far beyond the clinic. Students now provide dental services at a homeless shelter, a Head Start program, and a community center in East Bridgeport, serving patients from newborns to older adults.

This expanded outreach allows hygiene students to act as the primary information gatherers; they use intraoral cameras to capture detailed images and videos of patients’ oral cavities. These are immediately uploaded to the TeleDent platform, where our on-campus dentist can review them in real-time or asynchronously. The dentist can then use the video conferencing feature to discuss findings with the hygienist and patient, annotate images to highlight areas of concern, and develop treatment plans collaboratively.

The program’s success has led to additional funding, enabling us not only to continue providing free oral care but to serve a larger population.

Another significant achievement is the high rate of patient referrals for further care, demonstrating the effectiveness of our outreach with intraoral cameras and teledentistry.

The introduction of the teledentistry program brought exciting opportunities for growth and learning. While the school initially encountered some technical considerations regarding software and hardware compatibility, data security, and system integration, these were promptly addressed by MouthWatch’s dedicated client success team.

Although adapting to new systems required some adjustment for staff members, they quickly recognized how teledentistry simplified remote supervision procedures. This ultimately led to a more streamlined and efficient process, enhancing the overall experience for patients and practitioners alike.

Dental hygiene students at Fones School are now trained in using intraoral cameras and teledentistry during their first year. They gain practical experience in the classroom and clinic before participating in external rotations in the community.

This training is essential as intraoral cameras are the primary tool for virtual examinations, enabling students to gather accurate data for remote assessments.

Our students quickly adapt to this technology—appreciating the practical application of their classroom skills in real-world settings. The technology’s user-friendly nature facilitated a smooth transition from clinic to community-based care, enhancing the students’ educational experience and their contributions to public health dentistry.

Intraoral Cameras, Teledentistry, and Their Positive Impact on Patient Care


The use of intraoral cameras has greatly enhanced patient education. Showing patients what we see in their mouths has always been beneficial, and the new MouthWatch cameras have made it even easier. They are lightweight, easy to use, and help capture clear images, which aid in accurate diagnosis and referral.

What’s more, patients have responded positively to teledentistry. The technology facilitates thorough and engaging consultations, enhancing the patient-provider relationship.

The convenience and accessibility of care in their communities, coupled with the removal of financial barriers, have significantly improved patient satisfaction and follow-up rates.


The success of the Fones’ School program can be seen in the number of patients treated and their continuous return for care. Initially anticipating treating around 150 patients a year, Fones School ended up treating closer to 350.

The ease of use of the technology, once implemented, played a significant role in this success. More than 300 patients of all ages have benefited from the program. It has also identified patients eligible for free restorative care, creating a comprehensive care loop.

In addition, the ability to see patients return to the clinic for routine care is a significant achievement, addressing a common challenge in outreach programs. Perhaps most importantly, the trust built through these services ensures patients receive continuous and comprehensive care.

Fones School of Dental Hygiene’s integration of teledentistry and intraoral cameras has significantly advanced its mission of providing advanced hygiene education for its students and delivering accessible, high-quality dental care through its clinic.

The program’s success serves as a model for incorporating innovative technologies in dental education and public health. Through community rotations, mobile equipment, and supportive technology, Fones School of Dental Hygiene has not only expanded its reach but also ensured that dental care is accessible to those who need it most.

Here’s a look at the history of technology adoption and the benefits gained by the first dental hygiene school, its students, and dental patients.

Intraoral Cameras, Teledentistry  Enabling Fones School to Advance Hygiene Education and Access to Care

Most dental practices perform extractions, so these elevators should be available in every operatory to assist in ensuring more efficient and less stressful procedures. This instrument will improve your confidence and decrease the need for referring out extractions.


These atraumatic elevators can be used in any situation and are designed to help avoid the dreaded deep broken root tip mishaps that can occur during extractions. The Xpanders’ power comes from its double-action prongs.

With these elevators, users achieve both buccolingual and mesiodistal movement. The more movement you can get prior to the use of forceps, the less likely root tips will break off. Xpanders prongs allow for a stable 2-point contact between the crest of bone and the neck of the tooth. Clinicians can elevate their surgical setup with an Xpanders kit.

With simple twisting, one point locks onto the bone, while the other point pushes the tooth laterally, causing buccolingual socket expansion and superior pre-forceps loosening. These powerful intraligamental elevators are designed to make extractions less stressful, and much faster. Just a small amount of penetration into the periodontal ligament space is all that is needed for maximum lateral tooth movement.

[Sponsored] Invented by a dentist, Xpanders atraumatic elevators are designed to enable clinicians to avoid breaking root tips in their practice.

5Ws: Xpanders

There is no shortage of classes on digital photography, and most dentists have taken more of those courses than they can count. Each time I think that this is it. It’s the time when I will finally memorize what shutter, aperture, and ISO mean, the time when I will sit down with my camera and really figure it out. I have committed to this more times than I can remember. It just seems so appealing to be able to document dental scenarios and to use beautiful, high-quality photos to further develop conversations with patients regarding their long-term dental goals.

For years, I wanted consistent photos of my patients but could never establish the process and systems to accomplish this goal. I would head back to the office, usually after making a purchase of some sort, and then progress would halt as I tried to figure out how to train each assistant, transfer the photos onto our imaging software, and properly disinfect the camera after use. I had the courses, the camera, and the need for photos, but I never had the right systems. This was the case for so many years.

One day, I discovered Shofu’s EyeSpecial camera. I was in a sleep apnea course with our entire team, and we were working through the steps on how to gather all the information for patients with sleep apnea. Photos are an essential part of the sleep apnea workup, and in all the instructor’s examples, team members were taking the photos. It was seamless. Photos were being taken at an extremely consistent rate, and they were being taken without any of the roadblocks I was used to seeing. My big question was “How did they do this?” The instructor mentioned the EyeSpecial camera and that it was the most user-friendly camera in the industry, able to take quality images and every single team member could use it. I couldn’t wait to try it!

During the breakout session, we were given a quick rundown of all the features, and in a few minutes, each of us was able to take quality photos that we were proud of. The camera is user-friendly and easy to navigate. The photo quality was superb, even when my least tech-savvy assistant had the camera in her hands. It was so simple, we decided to give it a try at the office.

Taking photos of our patients in the dental office is helpful for a variety of reasons. The most obvious is having “before” and “after” images. However, as the digital age has expanded, the need for photos has increased. When we have photos on the screen in an operatory, we give the patient a glimpse of what we see in the mouth. The patient can see why treatment is needed. And in some cases, the photos help them articulate their wants/needs.

As more offices embrace technological advances, it is becoming a standard of care in high-level practices to include extraoral photographs as an adjunct to standard radiographic exams and intraoral photography. These extraoral photos, at a simple level, include a basic smile, retracted front facial with the teeth in occlusion, retracted front facial with the lower incisors showing, retracted upper occlusal, retracted lower occlusal, and specific lower lingual anterior. 

Showing these photos to patients very conveniently opens the door to discussions about their long-term oral health goals. Rather than lecturing a list of problems, dentists can discover various dental needs along with the patient.

This only works if the camera used is simple. It needs to consistently produce high-quality images, be easy to focus, be easy to disinfect, and seamlessly integrate with the multitude of imaging software available.

Catapult Education consists of several general dentists and specialists, representing a variety of clinical backgrounds, all of whom are charged with objectively evaluating various dental supplies, software, equipment, and technology. For the most recent product evaluation, members were asked to rate the EyeSpecial camera based on the following characteristics: chairside workflow, learning curve with the camera, shooting modes, and prevention of cross-contamination (infection control).

When respondents were asked about the use of camera and chairside workflow, the answers were as follows:

“ [The] workflow is so smooth since anyone in the practice can take photos.”

“So easy to use—just point and shoot.”

“[It’s] user-friendly for the entire team.”

It often can take a long time for team members to become proficient with a new technology in the practice. Respondents were asked about the learning curve for the EyeSpecial camera. Here are their responses:

“It’s very easy to use with little or no prior experience.”

“[It took] 1 session with the Shofu representative.”

When respondents were asked about greater office efficiency and better patient outcomes, all responses were overwhelmingly positive:

“It’s so much easier to see what is going on when the image is taken quickly and can be displayed on a TV.”

All respondents reported that the camera was easy to disinfect because normal disinfecting wipes can be used on it.

There are 2 tips that I would like to share with readers. The first is to consider purchasing Wi-Fi memory SD cards. Prior to learning about these, our office team had to take photos with the camera, then remove the SD card, plug it into the desktop workstation, and upload those photos to our imaging software. Having a Wi-Fi SD card has allowed us to directly send images to our software under the patient’s name the moment the photo was taken. This has been an incredible time saver.

The second is to consider purchasing antifog, LED-illuminated mirrors. One issue that most dental photographers run into is fog from the patient’s breathing during occlusal photos. This technology connects to an occlusal mirror, providing additional light, and a constant stream of air, which prevents the mirror from fogging. Both of the items can be purchased online.

Every survey respondent said they would highly recommend the EyeSpecial camera to their colleagues, which is a rare response. It is clear that they had a great experience with the EyeSpecial camera. For this reason, it is without hesitation that we would like to bestow the Catapult Vote of Confidence™ on Shofu’s EyeSpecial camera. Congratulations!

Catapult is a premier dental education company with over 21 years of experience in providing world-class CE, product reviews, and now savings opportunities through our buying group, Catapult Grow. Our esteemed Speaker Bureau and evaluator team lead all product and service reviews, with companies paying a fee with the understanding that the Vote of Confidence™ award is not guaranteed. We deliver honest and unbiased feedback through thorough evaluations and surveys, often aiding companies in improving their offering prior to market release. Our commitment to dental excellence allows us to work with a diverse range of clients, ensuring impartiality—no favoritism, just constructive feedback. Visit 

With 9 modes and extremely accurate images, the EyeSpecial extraoral camera from Shofu is easy for any dental professional to use.

User-Friendliness Is a Hallmark of This Extraoral Dental Camera

Passwords can be the first line of defense against unauthorized access to business data and systems. Cyber threats are constantly changing, so it’s crucial for all dental practices to prioritize password security. Weak passwords can be easily exploited by malicious actors, possibly resulting in severe consequences. 

This month, we’ll take a close look at passwords, with a focus on problems that may occur when you have weak passwords and what you can do to fend off some all-too-prevalent cyber security issues.

Password security is a basic yet crucial way to protect ourselves online. It means creating strong and complicated passwords to keep our private information safe from people who shouldn’t have access to it.

Consequences of Data Breaches
Data breaches

: Recent studies, including one from Verizon's Data Breach Investigations Report, show that 80% of data breaches are caused by compromised passwords. 

: The average cost of a breach in the US in 2020 is $8.64 million, according to Digital Guardian. 

: A company may experience a long-term loss in its market value and decreased customer trust from a data breach.

To significantly reduce the risk of a data breach, implement strong password policies, such as the following:

Require the use of unique passwords for different accounts. 

Educate employees on the importance of password complexity.

Regularly update and review password practices.

 are inherently more secure due to their complexity. Thus, they are more resistant to common attack methods such as dictionary attacks and brute force attempts. 

Practices often falter when creating passwords by:

Using easily guessable information (eg, birthdates, simple sequences).

Reusing passwords across multiple accounts, which increases vulnerability if just one account is compromised.

Ignoring the importance of updating passwords regularly for each service. 

Adopting these password security tips can mitigate risks and fortify your organization’s defenses against cyber threats.

Real-World Examples of Data Breaches:
Yahoo (2013-2014)

: One of the most infamous cases involved Yahoo, where weak password practices led to the exposure of 3 billion user accounts. This breach not only resulted in a substantial financial loss but also severely damaged Yahoo’s reputation.

: Marriott experienced a breach affecting approximately 500 million guests’ information due to inadequate password protections. The fallout included hefty fines and a significant blow to consumer trust. 

: The credit reporting giant suffered a breach impacting 147 million customers. Poor password management was pinpointed as one of the contributing factors, causing extensive financial damage and eroding public confidence.

Best Practices for Creating Secure Passwords


Creating robust passwords is essential for safeguarding data. Here are some best practices to ensure your passwords are secure:

: Use a combination of uppercase and lowercase letters, numbers, and special characters. This complexity makes it significantly harder for attackers to guess or crack the password.

: Aim for passwords that are at least 12 characters long. Longer passwords provide enhanced security by increasing the difficulty and time required to crack them.

Traditional complex passwords can be difficult to remember. Passphrases offer an effective solution by combining multiple random words into a single, memorable string. For instance:

This method maintains high levels of security while being easier for users to recall when the passphrase has meaning to them.

Incorporating these strategies will significantly bolster your password security, making it much more challenging for unauthorized individuals to gain access to sensitive business information.

Strong passwords can bolster the security of your data and make you less likely to be the victim of a data breach.

Don’t Get Burned by Having Weak Passwords

For dental professionals, addressing noncarious cervical lesions (NCCLs) effectively can be both easy and rewarding. Early intervention is crucial, offering numerous benefits such as cost efficiency, minimal discomfort, and improved restoration longevity. Our patients are living longer, and with this increased longevity comes a greater likelihood of experiencing dental issues such as caries, xerostomia, gingival recession, periodontal disease, and, of course, tooth wear. Class V lesions, in particular, are prevalent among older adults and present unique challenges in treatment.

Tooth wear is a general term used to describe surface loss of dental hard tissue from causes other than caries, trauma, or developmental disorders. Tooth wear is a multifactorial process that results from 3 main interacting mechanisms, each of which is age/time related, progressive, and omni-directional. The types of tooth wear are attrition, erosion, and abrasion. Though not technically tooth wear, abfraction is a common condition seen in aging patients. Abfraction is the loss of hard tissue due to eccentric occlusal loads leading to compressive and tensile stresses at the cervical fulcrum area of the tooth. It usually manifests with the classic wedge-shaped defects with sharp rims at the cementoenamel junction.

Patients are living longer, so the dental profession must help them manage their dental health, which affects overall health through the oral-systemic connection. The number of Class V lesions in older adults is increasing, and this may be attributed to the growing population of older adults and a lower rate of tooth loss. It may also be due to the increase in some etiologic factors such as inadequate brushing techniques in gingival recession cases, corrosive food and drink consumption, and occlusal stress concentrating factors (eg, occlusal interferences, premature contacts, habits of bruxism, and clenching). Treating NCCLs can be problematic. They can result in lack of retention, secondary decay, and improper placement of materials resulting in open margins, contouring, finishing and polishing.

Patients don’t know what to do about it.

Patients rely on their dentist’s knowledge of how and when to treat it.

They don’t want healthy tooth structure removed.

Patients don’t like needles (eg, for local anesthesia).

Patients want convenient, affordable treatment options.

Many dentists take a wait-and-see approach to treating NCCLs. Treating cases of Class V NCCLs can be easy and profitable. Early intervention can take very little time and materials to arrest damage caused by years or even decades of this condition. The wait-and-see approach can lead to severe tooth wear and may evolve into complex Class V restorations. The costly options that a patient may be less likely to want or be able to afford include restorations, bite modifications, implants, tooth alignment, and/or nightguards.

What Are the Benefits of Early Intervention and Treatment of Lesions?

Greater case acceptance by and lower cost for the patient and more profit for the dentist. With a thorough explanation of the causes and effects of tooth wear and the necessary treatment—along with the use of intraoral photography—patients will find it difficult to refuse treatment.

Less technical procedures for the dentist. Most cases of NCCLs are quite simple to restore when treated in the early stages because the patient’s bite has not yet been altered. Use composite to restore the teeth to their original size and shape to restore normal function. A nightguard is often recommended to protect certain restorations and prolong the need for additional treatment.

Less drilling, anesthesia, and sensitivity, which result in less anxiety. Most cases of tooth wear treatment are quite comfortable for the patient when caught early. Since these restorations are primarily in the enamel, often they can be accomplished with minimal drilling, anesthesia, and sensitivity.

Improved prognosis of the restoration and preservation of enamel. When caught early, most tooth wear restorations are primarily in the enamel, and bonding to enamel allows for high bond strength and more reliable long-term predictability.

What is the criteria for material selection when treating Class V restorations? Universal single-shade paste and flowable composites offer an efficient and effective solution for today’s dentists. The omni-shade restoratives—which include OMNICHROMA from Tokuyama Dental America—combine the light transmission and diffusion properties of enamel and dentin, which negates the need for a multiopacity layering technique that is required by many brands. These universal restorative materials offer high strength that can be used for all restorative classes. They are durable and wear-resistant for load-bearing applications.

By leveraging advanced restorative materials and adopting a proactive treatment strategy, dentists can provide patients with comfortable, durable, and esthetically pleasing outcomes. Prioritizing early treatment enhances the longevity and health of restorations and aligns with the growing need for cost-effective solutions in today’s dental practice. Embracing new restorative solutions will ultimately lead to better patient care and more successful management of tooth wear.

The clinical photos highlight the preparation steps and the benefits of OMNICHROMA. 

are preoperative photos of the typodont. 

illustrate the preparation and the placement of the restorative. The final polish with the OptraGloss universal polisher (Ivoclar) and the completed restoration are shown in 

Clinicians should embrace new restorative solutions, including Tokuyama Dental America’s OMNICHROMA, to provide better patient care and more successful management of tooth wear. 

Conservative Treatment of Noncarious Class V Lesions

I’m back and ready to wrap up 2024 with this year-end issue of 

. We focus this month on minimally invasive dentistry (MID), a topic the profession has been interested in for some time. We have probably been focused on being minimally invasive for as long as modern dentistry has been around—and by that, I mean for the last 150 years or so.

Some incredible advances in this concept have been made over the course of my career. During my days in dental school, the focus was on really well-done amalgams. Of course, amalgams were anything but minimally invasive, unless we are talking about a buccal pit. Amalgams needed a minimal width and a minimal depth to resist fracture. That meant we often sacrificed unaffected tooth structure just to get the prep to an adequate depth and width, frequently a very conservative 2-surface restoration fractured at the isthmus because the operator was trying to conserve tooth structure and there was insufficient bulk to resist the occlusal forces.

Amalgam doesn’t bond to dentin or enamel, which means it also requires mechanical retention. Doctors were forced to create undercuts on the occlusal and interproximal surfaces to create a retention form that essentially locked
 the restoration.

I was also trained in the philosophy of “extension for prevention.” The basic idea was that if you were going to put bur to tooth, you might as well go into all the pits and fissures to include them in the prep. The thought was that as amalgam did not decay and teeth did, you might as well include areas of potential breakdown to the restoration to help prevent breakdown in the future.

Back when restorative dentistry began, MID had a different definition, probably because anesthesia did not exist yet. When you were excavating decay, you wanted to stay as far away from the pulp as possible simply because it hurt. A revolution occurred in the 1870s when actual dental-
specific handpieces were invented. However, there was still no local anesthesia. I feel this was when the extension-for-prevention idea became a real thing. If you had a chance to prevent further decay by being able to run out grooves, why not? In those days, people only sought treatment when in pain. If a patient was having a restoration done anyway, why not decrease the chance of future problems?

In 1884, the brilliant surgeon Dr William Stewart Halsted (chief of surgeons at Johns Hopkins University School of Medicine) read about the topical anesthetic properties of cocaine. This led him to conduct some experiments where he prepared a solution of cocaine powder and water that was placed in a syringe and used in various areas of the arms and legs to cause anesthesia. He then delivered it to a medical student volunteer. The result was the first successful anesthesia of the inferior alveolar nerve. This changed everything.

However, the profession was still far from having safe and predictable local anesthetics. Injecting cocaine into patients had many drawbacks. Of course, when it was first discovered, it was considered a wonder drug. The year 1904 saw the discovery of procaine (Novocaine), which worked without the problems of cocaine but was quickly metabolized, which meant a short duration of action. The real revolution in dental local anesthesia came in 1946 with the discovery of lidocaine. At long last, patients could be reliably anesthetized for an entire procedure.

Then along came composite, and the world was rocked again. At long last, dentistry had a material that did not require mechanical retention. It flexed similarly to tooth structure, so bulk was not always needed for strength. Plus, it was beautiful.

Composite allowed doctors to be much more conservative than ever before. Dentistry went from extension for prevention to constriction with conviction, where the focus became on removing only diseased or weakened tooth structure. Gone were the days of 2-surface restorations dovetailing into the occlusal surface, replaced by the current philosophy of “slot preps,” where only the marginal ridge and interproximal caries are removed and replaced.

Our decision-making process has also undergone major shifts. Bringing digital tools into the treatment sphere has allowed us to see things better than ever before. Almost everyone has readily available intraoral cameras, but other tools exist. Transillumination and fluorescence are also great ways to find caries at the earliest stages.

The Microlux DWfrom AdDent is a great, affordable device for transillumination and fluorescence detection. The device is a small handheld unit with a small tip (3-mm diameter) that can be easily used in both the interproximal and occlusal areas. It has 2 settings: 1 for white visible light for transillumination and 1 for purple (405 nm) that can be used to look for caries fluorescence.

KaVo also has a recently released device called the DIAGNOcam Vision Full HD—a sleek device that looks like an intraoral camera. However, it does much more. The device takes high-definition intraoral photos, transillumination (using infrared) photos, and fluorescence caries detection photos. The best part? You can take all
3 image types with the push of 1 button.

Advanced devices such as these can help us find problems when they are tiny and allow us to perform equally tiny restorations.

Now dentistry has moved into the realm of truly bioactive materials that can help the tooth rebuild itself. We all know that the area most susceptible to recurrent caries is at the restorative margin. I like to say that the margin is the trench warfare of dentistry. Because of that, I am excited to see manufacturers creating restorative materials that not only seal the margin but contain components that can fight recurrent decay and even remineralize weakened structure. Another great thing about these products is that although some are fairly recent additions, they contain components with a long track record.

As an example, I will use the RE-GEN™ product line from Vista Apex. This product line contains Bioglass, which was discovered in the late 1960s and has been used in orthopedic surgery for decades. Without going into excessive detail, Bioglass helps create hydroxyapatite where it contacts the tooth. That means it helps seal margins and helps the tooth repair itself under restorations. It also creates an alkaline environment along the margins, which has bactericidal effects.

Bioglass is currently available in the RE-GEN product line, which includes a bonding agent, a pit and fissure sealant, a flowable composite, a bulk fill composite, and an endodontic sealer.

Then there is GIOMER technology from Shofu Dental. GIOMER has a history dating back about 20 years and is present in many Shofu products. It is a bioactive surface prereacted glass that releases fluoride and 5 other beneficial ions, and one nice feature is that it also recharges them. That means that there is an active effect. GIOMER is a part of many of Shofu’s products, including universal composites (Beautifil II and Beautifil II LS), specialty composites (Beautifil II Gingiva and Beautifil II Enamel), flowable composite (Beautifil Flow), and more.

Another product line with bioactivity is ACTIVA™ BioACTIVE from Pulpdent. These products contain a product called Embrace Resin Cement. The unique aspect is that Embrace resin contains a small amount of water as well as phosphate acid groups. In the oral environment, this material loses hydrogen ions, which are replaced by calcium ions from the tooth; this forms a resin-hydroxyapatite complex and helps seal the restoration to prevent microleakage. It also absorbs ions from the saliva to help recharge its bioactive properties.

Bioactivity also can promote healing and aid reparative dentin in areas where caries approach the pulp. Usually we think of minimally invasive as being tiny preparations with tiny restorations, but we can apply bioactive materials in areas of near pulpal exposures for large restorations, even full coverage.

When deep decay approaches the pulp, reparative dentin formation can help prevent sensitivity and help the tooth recover from the mechanical insult of caries removal. In these situations, the go-to has always been calcium hydroxide. However, new materials have put a new spin on this.

BISCO’s TheraCal® LC is a resin-modified calcium silicate material. It is designed to be used in direct and indirect pulp capping procedures and as a general protective liner. Additionally, it releases calcium and helps create an alkaline environment to promote healing. The material assists with hydroxyapatite crystal formation. Plus it is light cured, which ensures the set and reduces the amount of time required for the procedure.

There is also Ultra-Blend™ plus from Ultradent. This material contains calcium hydroxide in a urethane dimethacrylate base. It is light activated, and the resin is highly filled, which means it experiences minimal shrinkage as it polymerizes.

The profession has seen some amazing advances in materials in the past decade. During the early explosion of bonded restorations, doctors’ greatest concerns were polymerization shrinkage and occlusal wear. The material scientists who make our jobs easier have more or less solved those problems. We are now moving into materials that continue to work long after the patient leaves our office.

Study data show that many composites fail within 5 years, and that failure has been mainly due to the problem of recurrent decay at the margin. However, we are now seeing materials that can better seal the margins, help regenerate the needed mineral matrix, and even kill bacteria at the tooth or restoration interface. Beauty is a terrific quality, but beauty anddurability in the challenging world of the oral environment are what we all strive for daily. We are now seeing materials that are helping make that goal a reality. What a great time to be in dentistry.

The way we practice minimally invasive dentistry and how we define it have changed greatly over dentistry’s history.

The Maximum Advantages of Being Minimally Invasive

Dental Innovation Alliance (DIA) is a unique investment firm built by more than 40 individuals and organizations dedicated to ushering in the next generation of dental innovation. Working to create positive change through technology, DIA has connected innovators and investors across the industry to improve practice performance and patient outcomes through competitive research and innovation. I spoke with cofounders and managing partners Doug Brown and Thomas Sharpe to explore the goals of this dynamic group and learn about its impact to date.

Can you share some of your backgrounds in dentistry?

I started my career in finance. After that, I led and grew 2 national dental support organizations for more than 20 years, most recently as CEO and vice chairman of Affordable Care, d/b/a Affordable Dentures & Implants. In the late ’90s, I brought together several prominent dental industry leaders into a small study group, which over time grew and eventually led to the formation of the Association of Dental Support Organizations (ADSO). I have been both president and chairman of the Government Affairs Committee of ADSO, and currently serve on ADSO’s Executive Committee.

I met Thomas when we were chosen as co–vice chairmen for Affordable Care. We both saw a huge opportunity to invest in early-stage dental technology companies and began to lead the process to invest alongside several of our trusted industry colleagues. We then decided to take it to the next level by launching DIA in October of 2022, so that we could bring more investors in to scale this important work. We now have 11 professionals on the DIA team, and 34 industry investors, who collectively bring their diverse expertise and backgrounds to make DIA so successful.

Separate from DIA, in 2021, Thomas and I launched a successful nonprofit clinic and learning center, Local Start Dental, in Durham, North Carolina, which works closely with faculty and students from the nearby UNC Adams School of Dentistry, where I’m on the Dean’s Advisory Board. It serves underserved populations but is also a hands-on learning center for GPs [general practitioners] who wish to advance their clinical skillset into implants, surgery, digital workflows, and advanced prosthodontics. Local Start often has the first look at new concepts brought to DIA, which provides us with real-world feedback in the early stages of a company going to market.

I have a business background and an MBA from Vanderbilt University and a law degree from the University of Oklahoma. I currently serve on the Innovation Investment Committee at Vanderbilt, which helps augment my work at DIA. After graduating from law school, I helped form a DSO [dental service organization] concept called DDS, which we successfully grew from eastern Oklahoma to 10 states in width and 52 units in size. We subsequently joined forces with Affordable Care, where Doug and I met. When the company was sold to a private equity firm in August 2021, we turned our knowledge, wisdom, connections, and financial resources to DIA.

Doug and I come from decades of operational roles and have an investor’s passion but with the scar tissue of veteran operators. We know the pain points and dynamics of dental offices and what it takes to operate complex companies, both DSOs and product and service companies that support them.

 DIA is a uniquely designed venture capital firm made up of a diverse group of investors—industry veterans, business leaders, dental clinicians, some of the largest global dental OEMs and distributors, a large DSO, and even the Florida Dental Association. This sets us apart from other venture funds that don’t have the scope of industry knowledge and connections that we do,and increases the chances of success for new ventures.

 I like to describe DIA as a rising tide that lifts all stakeholder boats. These stakeholders include the following: innovators, investors, end users of the innovation, patients who benefit from the innovation, and the dental industry overall. Through its network, DIA is leveraging its collective power to benefit all of them. Our pipeline is robust, with more than 1000 companies in our database, which is growing at between 30 to 45 new companies per month. This tells us it’s a good time for dental technology growth. It’s exciting!

LS: What does this mean for dentists? What’s in it for them?

 For dentists, it’s very difficult to keep up with all the innovations that are developing so quickly and so broadly. Dentists are—and should be—focused on patient care. It can be overwhelming for even larger DSOs with internal business teams to keep up with technology development at the current rate of new concepts coming to market. So, we view DIA as being a hub for information of all things relating to innovation. We have divided the dental technology industry into 40 vectors, and we have a mix of current and pending portfolio companies that fit into those vectors. We also conduct deep analysis into how potential competitors overlap and differentiate themselves. As we make investment decisions, we compare the advantages of certain companies over others, analyze which are competitively best positioned to succeed, and which have the best technology and approach to going to market. When provided to forward-thinking dentists, this research can help guide them and their teams to the services and products that can best improve practice efficiencies and patient outcomes. Many dental practices and group practices are highly leveraged. So, if we can help provide the information and guide dentists and group practices in making smart decisions about their technology choices, then we feel like we’ve elevated the profession.

LS: How are you different from other venture capital firms?

 DIA is pursuing a business model of venture capital [VC] reimagined. We are more deliberate in our investments than many other VC firms; specifically, we invest in a relatively small number of companies so we can use our resources to support each one more deeply.

 Simply stated, our strategy of being narrow and deep with our investments means fewer investments, more support, and larger checks. We also reserve significant investment dollars for critical second and third rounds of capital for our growing companies as they scale.

 The world is taking notice of artificial intelligence [AI], and Pearl was DIA’s first AI investment. We’re happy to report that Pearl recently had a tremendous round—$58 million raised at a $400 million premoney valuation in a Series B funding in July 2024. The company noted that this funding marks the largest investment ever in dental AI. We’re very excited about its future.

 Another company that we are engaged with, Perceptive, has developed 2 ground-breaking technologies: 1. a new scanner and imaging system that uses optical coherence tomography [OCT], giving it the ability to capture 3D volumes of data — including below the gum line, through fluids, and under the tooth surface without exposing patients to ionizing radiation; 2. coupled with the OCT imaging, the company also has developed a robot that can complete crown and filling preps fast (targeting 5 minutes), safely and accurately. We are eager to see how this combination of advanced imaging, AI, and robotics evolves over time.

 Also important are developments in revenue cycle management [RCM] products, software that manages items from payment options and processing to dental plans to insurance verification and processing. Beyond the ever-present staffing concerns, one of the biggest pain points reported by dentists includes RCM.

RCM technology is currently very siloed, and many dental practices are paying multiple subscription fees to several platforms, which involves considerable effort by staff members to learn and operate through this complexity and clunkiness. We see DIA constructing a conduit to ideally combine these technologies so they can work together as one de facto system, one integrated product, one subscription fee that ties into the practice management software systems. This will take some time, but with our knowledge and access to most of the SaaS dental products, we are in a unique position to help make this happen.

We want large group practices and individual dentists alike to view us as the world’s most innovative investment firm for supporting early-stage dental and health technology companies. We want to be at the center of the ecosystem for improving practice efficiencies, expanding care, and achieving better clinical results in dentistry.

 We are now developing DIA’s InnoCircle, a virtual community where members of the dental industry can share best practices and knowledge of the top emerging technologies. The InnoCircle will provide unmatched research on the most important innovative tech trends impacting the future of dentistry and be the connective tissue for dental professionals. This initiative is a key part of DIA’s strategy to position itself as a hub for innovation, fostering collaboration, and driving the future of the industry.

What is the best way for practitioners and companies to get more information?

 Contact Tori Cockman at tori@dialliance.com to get in touch with us about DIA and how you can plug in. You can also follow DIA on LinkedIn, sign up for our monthly Dental Innovation Insights newsletter, and listen to our Bright iDIAs podcast.

This alliance is built by dental experts for dental experts.

Dental Products Report November/December 2024