Clinicians desire solutions that are not only effective but also save time in everyday practice. The processing, firing, characterizing, and cooling of restorations can eat up a lot of time, particularly in high-volume practices that serve large patient populations.

Consider a material that eliminates the need for the firing process without sacrificing esthetics or durability. The GC Initial LiSi Block from GC America, crafted from lithium disilicate glass ceramic, does just that, according to Jacob Dent, DDS, who has been using these blocks in his practice since 2023.

“The biggest thing for me is the time savings,” Dr Dent says. “It’s the time, a factor which also plays a big role in the financial aspect of a dental practice. If I can get a chair back open in an hour versus 2, I can see a whole new patient.”

LiSi Blocks are formulated using GC’s proprietary high-density micronization (HDM) technology, which is identified by its densely packed microcrystals. These microcrystals offer a variety of benefits, says Gaurav Joshi, PhD, BDS, FICD, senior product marketing manager of GC America.

“Small crystals also cause less wear. Wear is a complex phenomenon where size and shape of crystals can affect the wear behavior. Large crystals typically cause more wear and more rough surface that will also abrade the opposing tooth,” Dr Joshi says. “With the LiSi Block, because the crystals are so small, there is less wear on the restoration itself as well as the opposing tooth.”

With its fully crystallizated nature, clinicians can skip the firing step, which saves them time.

Another feature that Dr Dent finds appealing for his practice is the optimized margins, with an edge stability that makes LiSi-crafted restorations not only durable but also eliminates repeat visits. Its optimized margins along with time savings work so well for Dr Dent, he can create multiple anterior restorations for same-day dentistry, as evidenced by an anecdote about a specific case.

“Yesterday I had a patient come in at 1 pm. At 1:45 we had signed him off for 5 anterior crowns and we close at 4 pm, so there is no way with the traditional firing block that we were going to be able to get out of there on time,” he says. “But with the LiSi Blocks, we did an amazing anterior case for him, prepped all 5, and milled and delivered the restorations within 2 hours. That is one of the biggest benefits to me.”

In modern dentistry, precision is key, particularly when it comes to procedures that involve creating and placing restorations such as onlays and inlays. These restorations are often designed using CAD/CAM, which allows for highly accurate digital designs. However, even with advanced technology, the accuracy of the margin—the edge where the restoration meets the tooth—can significantly impact the success of the procedure.

Dr Joshi emphasizes the importance of marginal accuracy and adaptability in achieving a good fit for restorations. Margins that are not precise can lead to fit issues, which means the restoration may not sit properly on the tooth. This can cause a range of problems, from discomfort for the patient to potential failure of the restoration.

However, the GC Initial LiSi Block offers a solution to these challenges.

“But here, since there is no shrinkage involved, you get better fit of the restorations, allowing clinicians to practice minimally invasive dentistry,”
Dr Joshi says.

Minimally invasive dentistry focuses on preserving as much of the natural tooth structure as possible, which is crucial for maintaining the long-term health of the teeth. When margins are accurate and the restoration fits perfectly, it reduces the need for extensive adjustments or removal of additional tooth structure. This approach not only improves patient outcomes but also supports the overall goal of conservative treatment.

Finally, LiSi Blocks are designed to closely mimic the translucency and color of natural teeth, with 4 shades and 2 translucencies available. According to Dr Joshi, this allows the restorations to blend with the patient’s existing dentition. The high-density microcrystals in LiSi Blocks contribute to their exceptional polishability and smooth surface, which reportedly enhances the visual appeal.

“Because these are already fully crystallized, there is no change in color. You get what you see,” Dr Joshi says. “This means that clinicians are able to determine the shades more accurately.”

These features combine to create a restorative material that aims to save time while maintaining high standards. It is a particularly helpful material for Dr Dent, who serves many neurodiverse and neurosensitive patients at his practice, Baton Rouge Modern Dentistry in Louisiana.

“For me specifically, my specialty is working with patients with neurodiversity, neurosensitivities, or special needs, so time is not necessarily the thing that they give me a lot of,” he says. “The patients’ chair time is limited. So if I do have to do a crown, it is much easier to do a same-day crown in 45 minutes than it is to do it in an hour and a half.”

“A lot of times we’ll get patients who come in and say, ‘I just want whatever my insurance covers. Give me that base benefit crown,’ and that’s traditionally a nonfired crown,” he says. “So we can give them a LiSi Block because it is going to be less expensive for the patient. But it also takes away the time spent in the chair.”

Articles

GC Initial® LiSi Block from GC America can be used to mill durable, esthetic restorations without the need for firing, harnessing the power of micronization and densely packed microcrystals.

Saving Time and Money Using Nonfiring Lithium Disilicate Materials 

Dental treatment challenges are commonplace in an active pediatric dental practice, especially with children in the precooperative stage. This clinical case presents a quick, noninvasive caries intervention using SilverSense SDF™ (Centrix, Inc) to address early-stage caries in an uncooperative child due to dental phobia. It also demonstrates a far-reaching benefit for adults to prevent caries from progressing until the patient returns for restorative treatment.

Noninvasive Caries Intervention

All clinical images provided by Dr Simchi.

During an initial exam of a 6-year-old boy, visual inspection revealed poor oral hygiene and gingivitis surrounding most teeth. Tactile exploration uncovered incipient decay on 2 partially erupted permanent first molars, teeth #3 and #14 (

). Given the poor state of oral hygiene, this patient presented with a high risk for progressive caries.

The treatment plan presented to the child’s parent emphasized the benefits of using a safe, noninvasive product, SilverSense SDF, to apply to the teeth and halt further growth of early tooth decay. As described to the parent, this procedure is a medicinal option for treating early decay compared with the more invasive treatment of drilling to remove decay in a newly erupted tooth.

The primary treatment advantages of silver diamine fluoride (SDF) are the silver’s antibacterial effect, which halts decay progression, and the remineralization benefit of fluoride, which strengthens the tooth. The discussion also included photos of completed cases with SDF to show examples of the localized dark stain along a site-specific application area and offer reassurance that the color of the rest of the tooth remains unchanged. The parent was also told that local anesthetic injections were unnecessary, another key advantage to the proposed treatment. As standard operating procedure, the child’s parent completed a consent form to initiate treatment.

SilverSense SDF, which is 38% SDF, dispenses as a liquid with a blue tint to guide more precise application and avoid staining unintended surfaces. The 5-mL dropper bottle dispenses 30 µL one measured drop at a time. When preparing for treatment, a drop or 2 of SilverSense SDF is dispensed into a dappen dish, and a microfine applicator is made ready to dip and absorb the product. The SilverSense SDF Standard Kit includes a supply of 20 Benda® Micro Fine Applicators (Centrix, Inc).

The clinical application of SilverSense SDF is simple, quick, and easy. There is no need for drilling or abrasive tooth preparation. However, if the patient cooperates, we may clean the occlusal grooves with pumice. Each tooth receiving treatment must be dabbed dry with a cotton roll before applying the SilverSense SDF with the Benda Micro Fine Applicator. It is important to keep the carious area dry while the product is applied directly to that site alone. As the SDF infiltrates the incipient decay, the wait time is preferably 1 minute and largely depends on the patient’s cooperative behavior. SilverSense SDF is absorbed quickly, and the site-specific application is reactionary and visible. It gradually changes to a darker color over time or immediately, as in this case (

Following the application of SilverSense SDF, a flavored fluoride varnish was applied to the treatment area, serving 2 purposes. First, the varnish does not wipe away quickly and provides an added protective layer of fluoride on top of the SilverSense SDF–treated site. Second, and importantly for the patient, the flavored fluoride varnish introduces a needed pleasant taste. If patients cannot tolerate the immediate use of a fluoride varnish, they enjoy a flavored xylitol lollipop to offset the metallic taste of SDF.

 A characteristic of SDF is that it will stain clothes, surfaces, or skin. Use gloves, face masks, plastic-lined tray covers, patient bibs, patient protective eyewear, and barrier protection on dental equipment that may come into contact with SDF. Applying petroleum jelly to the patient’s lips and the skin surrounding the mouth protects the skin from stain due to inadvertent contact with SDF. It is helpful to avoid oversoaking the Benda Micro Fine Applicator with the product to prevent dripping before reaching the working area.

SDF is a remarkable product with far-reaching advantages. However, flavor is not one of them. SDF has a metallic taste. As standard operating procedure, when introducing new dental materials into our patient care procedures, our doctors and staff try out the products to experience what the patient will experience. This assessment includes trying an SDF treatment and evaluating flavored fluoride varnishes and xylitol lollipops to discern the best flavors to override an SDF aftertaste and recommend to patients.

Our standard SDF treatment protocol is a follow-up appointment within 4 to 6 weeks to assess if an additional application is needed. Visual and tactile inspection of the SilverSense SDF treatment site revealed it to be intact after 6 weeks. A glass ionomer cement was placed over the treated area on both partially erupted first molars, protecting the occlusal grooves from further decay and infusing the occlusal surfaces with the fluoride inherent in the glass ionomer cement (

Treatment decisions at these follow-up visits are made on a case-by-case basis. At times, SDF treatment may need to be applied a second or third time. Definitive treatment decisions depend on the tactile quality of the tooth surface. Despite precooperative challenges, the 6-year-old patient managed very well with this noninvasive treatment protocol to halt decay. These newly erupted permanent first molars were spared a drill-and-fill procedure, and the incipient decay was stabilized. Treatment is complete, and the patient will return for a regular checkup in 6 months.

A pediatric dentist shares his experience using SilverSense SDF from Centrix as a noninvasive caries intervention tool for a patient with dental phobia.

Noninvasive Caries Intervention Using Silver Diamine Fluoride

As dental professionals, we are constantly investigating ways to make our practices run smoother, especially concerning something as critical as infection control. Given our fast-paced environment, selecting products with broad-spectrum effectiveness and seamless integration into existing workflow is paramount.

Catapult Education convened a panel of expert evaluators, including dentists, hygienists, and dental assistants, as part of our ongoing commitment to enhance dental practice operations through superior products. Below is a detailed report on our collective findings on the efficacy and usability of 6 PDI products in a clinical setting. PDI has been a leader in innovation for infection prevention, providing cutting-edge infection control products for over 40 years.

Twenty-two Catapult dental professionals were involved in the evaluation process. They tested the following PDI products: Sani-Cloth® AF3 Germicidal Disposable Wipes, Super Sani-Cloth® Germicidal Disposable Wipes, Sani-Cloth® Plus Germicidal Disposable Cloth, See Clear® Lens Cleaning Wipes, Easy Screen® Cleaning Wipes, and Sani-Hands® Instant Hand Sanitizing Wipes.

Let’s look at each wipe and its criteria separately:

These intermediate-level disinfectant wipes are effective against 45 microorganisms. They are bactericidal, tuberculocidal, and virucidal, with a kill time of 3 minutes.

Our evaluators highlighted these wipes for their broad-spectrum efficacy and the fact that they are alcohol free and fragrance free. They are ideal to use around patients and staff, especially those with respiratory sensitivity.

These intermediate-level disinfectant wipes are effective against 32 microorganisms. They are considered bactericidal, tuberculocidal, virucidal, and fungicidal.

The panelists appreciated the wipes for their quick microbial kill time of 2 minutes, making them highly suitable for high-turnover environments.

These are US Environmental Protection Agency (EPA)–registered, low-level disinfectant wipes. The bactericidal and virucidal cloths are effective against 18 microorganisms, with a kill time of 3 minutes.

These individually wrapped wipes are compatible with glass and polycarbonate lenses, making them safe to use on antireflective, UV, and glare-free coated lenses. They are ideal for disinfecting protective eyewear, reading glasses, and loupes. The dental hygienists in the group praised them highly. The wipes––a particular favorite among some of our evaluators––provide streak-free clarity for optical devices, which is crucial for precision in dental care. Here are some comments from the evaluators: “See Clear wipes are excellent”; “Love these. Patients like them too. RDH and other docs in the practice tried these with the samples sent and now they’re using them regularly”; “Easy to implement into clinical [practice]. [The] packaging allows for easy storage and use.”

These wipes are made with 70% isopropyl alcohol to remove dirt, grime, fingerprints, and smudges. Our evaluators were enthusiastic about their effectiveness on digital displays. They noted their residue-free finish ensures clean and clear views on the screens that are essential for modern dental diagnostics, making these wipes a huge boon in the age of digital dentistry. Many of us use tablets for patients to update their medical history and sign forms electronically; these wipes are perfect for disinfecting those digital devices around the office. Easy Screen Cleaning Wipes are available in canisters or packets.

Comments from our evaluators included the following: “In the age of digital dentistry, everything comes with a screen, and it is important to be able to disinfect all surfaces. [The] packaging makes it easy and efficient to turn over rooms”; “Exactly what I would hope for in a screen wipe”; “The screen cleaners are amazing. I have been using them for my computers and then for my iPad and phone as well.”

These wipes are ideal for hand hygiene both in and outside the office environment. Formulated with 70% ethyl alcohol, they offer fast and effective disinfection. Testers commended the smooth, residue-free feeling they provide after use. They also appreciated the mechanical removal of debris and the sanitizing component. These wipes come in canisters, portable packages, and single packets, making them ideal to use in public settings to prevent the spread of infection.

PDI wipes offer numerous benefits. They come premoistened and ready to use, which helps minimize waste and streamline processes, saving time. These wipes are EPA registered, ensuring compliance with guidelines from the Occupational Safety and Health Administration and the Centers for Disease Control and Prevention. They are color coded for simple staff identification and boast large compliance icons for easy recognition. Many have a dual-access lid with a large access design for the fast dispensing of single and multiple wipes. Overall, they are practical and seamlessly fit into workflows.

We asked evaluators how well PDI disinfecting wipes (Sani-Cloth AF3 Germicidal Disposable Wipes, Super Sani-Cloth Germicidal Disposable Wipes, and Sani-Cloth Plus Germicidal Disposable Cloth) met specific needs and challenges within their health care environment. These were some of their responses:

“They’re effective, efficient, and don’t smell as bad as [those of] other competitors.”

“Our practice moves at a quick pace. We need to be able to turn rooms over quickly, and disinfection is a big part of that. We especially like the Super Sani-Cloth due to its effectiveness across many bacteria and the 2-minute disinfection time.”

“The wipes were great—they did not leave streaks like the ones we use now.”

Following the evaluation of PDI disinfecting products, 100% of the survey respondents expressed their intention to integrate PDI wipes into their routine infection protocol and recommend them to a colleague. Among the wipes, Super Sani-Cloth Germicidal Disposable Wipes, See Clear Lens Cleaning Wipes, and Easy Screen Cleaning Wipes received the highest acclaim.

This review isn’t solely about acquiring new tools; it is also about elevating patient care. PDI wipes offer a unique advantage in the realm of infection control with their high-grade antimicrobial properties specifically tailored for different equipment and surfaces. Although the market offers a variety of infection control products, a noticeable gap exists regarding ones that effectively disinfect specific equipment such as screens and loupes. PDI fills this void with well-researched products designed to tackle these areas effectively. What sets the company apart is its versatility. They offer a range of options that cater to different needs and scenarios, making disinfection routines more convenient and efficient. PDI products have become indispensable in our practice, significantly boosting efficiency and patient safety.

After thoroughly evaluating PDI’s range of products, we see clearly that they have made a real difference in our daily routines. My colleagues and I have noticed how using these wipes streamlines our workflow, making the necessary but often tedious task of disinfection quicker and more manageable. I am glad to see these products gain our Catapult Vote of Confidence™.

These wipes provide various disinfection and cleaning options for any dental practice’s infection control and cleaning needs.

Surface Disinfection and Cleaning Wipes Designed for Everyday Dental Practice Needs

As our patients’ expectations continue to rise, it becomes profoundly important to use tried and tested protocols and techniques that deliver beautiful and predictable results. This article details the clinical and technical aspects of transforming severe dark brown–stained teeth to a natural, gorgeous smile.

This case had 2 main objectives. The first was to take away the tetracycline stains, and the second was to pull back the splaying of the upper anterior teeth. Additionally, we wanted to brighten, refine, and harmonize the patient’s smile.

Our patient presented with prenatal exposure to the antibiotic tetracycline. Her dentition had severe dark brown staining (

). This appearance is a result of tetracycline binding to calcium ions in teeth during mineralization, or calcification. The phenotypic result can vary between gray, brown, or greenish hues and varying degrees of each.

In our patient’s case, it was a deep, dark brown color on the severe end of tetracycline staining. She stated she hated to smile, and when she did smile, she tried to show as little of her teeth as possible. She desired a change and was seeking more information about treatment options.

Although the patient was fixated on the darkness of the staining, the length/protrusion of her upper anterior teeth were not obvious to her because they were overshadowed by the dark colors. The patient expressed several reservations as the discussion progressed. First, due to her family culture, her parents did not approve changing her smile. Thus, her parents were not going to 

be involved in the decision-making. Second, cost was a factor. Lastly, she wanted the case to have minimal preparation, as she was not comfortable with too much tooth reduction. We discussed all her concerns and addressed them to her satisfaction. Once she decided to move forward, we involved the ceramist.

Brad Jones, FAACD, fellowed master ceramist with the American Academy of Cosmetic Dentistry, created a diagnostic wax-up and clear matrix along with a reduction stent. This diagnostic wax-up is essentially the blueprint of the proposed final shape/form. The patient was able to visualize our mutual goals, and as a result, the patient felt at ease to move forward.

As the appointment arrived, our patient was a bit nervous, but she did well overall. The internal dark brown tetracycline stains turned darker as the preparation enters the dentin layer. After we finished the preparations, I made a set of provisionals using the clear matrix to check for thickness. They were too thin, and had show-through of the dark brown stains on the facials of teeth #6 to #11.

Because we wanted to be mindful of the patient’s wishes and prepare conservatively, we went back in our toolbox, and after preparing only on the facials of the prominent dark areas, we bonded Cosmedent Pink Opaque and then Cosmedent Renamel Microhybrid Composite shade A1 to mask (Cosmedent, Inc).

Pink is the opposite of gray, so this application helped us arrive at the desired stump shade, which allowed us to achieve our desired final shade. When we made her temporaries a second time, there was much less show-through, which indicated that the preparation was sufficient, especially knowing that Brad [Jones], the ceramist, applies an opaque internal filter to the IPS e.max (Ivoclar) restorations in these types of cases.

Shade selection was straightforward. Because the patient was having all upper 10 teeth restored, we did not have to match to her other teeth. We simply chose which shade was the best fit for her. Our patient is young, and she desired a lighter/brighter shade but authentic-looking restorations, so we mutually chose Vita B1. Also, our shade selection factored in that someday this patient would have her lower 10 teeth restored with porcelain veneers as well. Satisfied with our preparations and shade selection,we sent all the necessary materials to Brad Jones for the fabrication of the final porcelain restorations.

In order to predictably exceed patient’s expectations in today’s world, it is necessary to follow the smile design protocol. This starts out with preoperative records in the way of photography and full-arch impressions. Once the patient has been prepared, master impressions have been made, and the provisional has been placed and idealized, it is most important to record them with a full-face photo (patient must be standing for this photo) and an impression of the provisional.

This middle step, of providing a diagnostic wax-up and matrix to be used in the way of provisionals, is the first chance to get it right. Through the cast of the provisionals and a full-face photograph of the patient smiling in their provisional, we were able to assess and make any necessary corrections to the cast of the provisional. Tripod bites are used to record the patient’s preparation to opposing dentition so that the technician can replicate the actual bite relationship.

The core restorative units can be acquired in several different ways. I use a Pro-Craft wax injector from Grobet USA (

), with beige wax (Yeti Dental) being injected through a clear matrix over the lubricated master dies (

). This clear matrix is formed over the corrected cast of the provisional, giving us an exact copy, in wax, of the corrected cast of the provisional.

Through the process of the lost wax technique, we press IPS e.max lithium disilicate (Ivoclar)—in this case, MTB1. The MT signifies medium translucency, which is necessary for this case because of the underlying tooth discoloration.

This extreme case of tetracycline staining was controlled by a 3-prong technique. First, the clinician blocked out the facials for tooth #s 6 to 11 (

) with pink opaque composite. Second, by evaluating the 1:2 photos of the provisional (

), a medium translucent IPS e.max ingot (Ivoclar) was chosen for the restorative material. Last, it was evaluated and found necessary to place an internal opaque composite filter inside the veneers (

When this internal opaque filter technique is used, the ceramist is responsible for the composite interface with the veneer and they need to follow the manufacturer’s guidelines in its application. It is also necessary to inform the clinician not to etch the areas inside the veneers where this opaque filter is placed because it will etch away. I let the clinician know these restorations are ready for the luting dual-cure (DC) cement. In this case, all the restorations were cemented with light cure cement with the exception of teeth # 7 to #10.

In order to mimic the illuminating beauty of a natural anterior tooth, it is necessary to cut back and layer at least the restorations on teeth # 7 to #10 (

). A natural tooth not only reflects light but also absorbs light, especially in between the internal lobes and under the halo found on a natural anterior tooth’s incisal edge. The facial enamel in nature is approximately 0.5 mm in thickness and filters these internal effects, which lie underneath (

Because the IPS e.max MT ingot has built-in vitality, it is not always necessary to fully cut back and layer the entire facial of the incisors. In this case, we cut back and layered about two-thirds of the facials. A guaranteed halo effect was created by undercutting and embossing an extremely thin incisal edge, and then high- and low-value stain was applied and fired in between where the mamelons will be placed (

Opal Effect 1 (OE1) powder (Ivoclar) was color-tagged blue and added into the mesial and distal trough cutback (

). A 50-50 mixture of Mamelon Material (MM) light and Dentin A1 powder was color-tagged orange and placed in for the mesial and distal mamelons (

The middle mamelon was made up from MM salmon, color-tagged in pink, and a sliver of MM light powder, which shows up as white color. Then, Opal Effect 4 powder (Ivoclar) was applied as a high-filter band found in nature, which shows up in the midsection as white in color (

Lastly, the internal powder effects were finished off with an extremely thin line across the incisal edge, which shows up white in color and will strengthen the halo effect in mimicking the incisal edge of a natural incisor. The precise addition of the complete internal IPS e.max powder effects are shown in 

. The fired internal effects are shown in 

.Note the mamelons, halo, and high-value filter band found in a natural incisor tooth.

The mesial and distal cut and stained low-value troughs were again filled in to full contour with OE1 powder (

). The Transpa Incisal for B1 shade (TI1) powder, color-tagged fluorescent yellow, was filled in to full contour.

Final shapes and contours with surface morphology and perikymata were added to the restorations using diamond rotary instruments with an electric handpiece. The entire surface, both facial and lingual, was softened using a carborundum-impregnated knife-edge rubber wheel, then cleaned with soap and water and steam cleaned.

IPS e.MAX Non-Fluorescent Glaze paste (Ivoclar) was thinned out with glaze liquid and carefully applied to the restoration’s entire surface. After drying this applied glaze surface in front of the porcelain furnace’s muffle, the restorations were fired at 720 °C at the rate of 70° per minute.

Continuing to mimic a natural tooth, the artificial glazed surface was knocked down using the same carborundum-impregnated knife-edge rubber wheel. We then highlighted the polish in some areas using a felt wheel and diamond paste (

Even after having more than 25 years of clinical experience and working with a world class ceramist for the same period, we are always learning, Dr Krishnaiah states. This case had its challenges, but with an armamentarium of dental knowledge, tools, and techniques at hand, we overcame these challenges and delivered an outstanding end result. Our patient was extremely thrilled with the results. She could not stop smiling. The completed case is shown in 

, and the happy patient’s smile is shown in 

The authors used a variety of products from several manufacturers to complete this case. Dr Krishnaiah wanted it noted that she used milky color Variolink Light (Ivoclar) during the cementation process. Afterward, she handed the patient the mirror and noted her reaction. 

shows the prepared 1:2 photo of retracted view.

In this case presentation, IPS e.max and other Ivoclar products are used to remove tetracycline stains, pull back the splaying of the upper anterior teeth, and deliver a great new smile to the patient.  

Restoring Severe Tetracycline-Stained Teeth and Correcting Protruding Anterior Teeth

Not to oversimplify matters, but DentiMax Implementation Manager Micah Huish credits much of the company’s success to following some basic principles: produce quality products that are easy to implement in any practice; back them up with support; and get the products into the hands of as many clinicians as possible.

The Arizona-based company that offers digital x-ray sensors and dental practice management software has built a reputation for delivering x-ray sensors that feature incredible detail and capabilities without the high cost of some of the larger companies.

“The proof is…in the pudding. When you see our product and actually get to use it in-house, you’ll find that what we’re stating, what we’re advertising, is true,” Huish explains.

DentiMax’s Dream Sensor has garnered awards and high ratings from the likes of Clinician’s Report and DENTAL ADVISOR, and the company’s newer sensor—the Open Sensor—provides a lower-cost option with great images and the same functionality.

Several practices are using both sensors. Not only is the Open Sensor ideal for hygienists, but the images are of such high quality that most staff members are hard-pressed to notice any differences from the Dream Sensor’s diagnostics, the company says.

“Actually, we do have a lot of practices that use both our sensors,” says Huish, who has worked with DentiMax for 6 years. “The Dream Sensor is a little [more of a] higher-resolution sensor, and because of that, it does produce a little bit higher image [resolution]. [But] the functionality between the sensors we have developed is pretty much the same. So it wouldn’t really matter in most cases. If practices had both [sensors, they would find] they’re interchangeable.”

DentiMax’s digital sensors are designed to deliver extraordinary anatomical details with reduced noise and improved tissue contrast for accurate diagnoses. The sensors have an active imaging area of around 900 mm2, allowing clinicians to capture more teeth in the x-ray. Additionally, the software enables you to tailor the x-ray to be sharper, smoother, lighter, or darker, ensuring you get the perfect image.

Kent Stapley, DMD, receives x-rays from other offices, and in many cases, the imaging is not as good as what his practice gets with its DentiMax sensors. A dentist who practices in the same building uses a competitor’s sensors, and, according to Dr Stapley, the results cannot be compared.

Huish works with new customers regularly, talking to practices looking to learn about DentiMax products, setting up and training offices that have purchased sensors and software, and demonstrating the benefits and explaining the free trial programs.

“I do most of the trainings and the demos, and introducing DentiMax to the world is what I do,” Huish explains.

The openness of a sensor is what allows the sensor to function in more software programs, and a lot of software on the market is closed, he says.

“Because our sensor is so open, it pretty much works with any of the mainstream software on the market,” Huish says. “You have Eaglesoft, Schick products, DEXIS products, and Carestream, all the bigger named companies.

“Because our sensors are open, [they’re] going to function as close to how their current sensors work, so there’s very little learning curve. In many cases there is little to no training needed. Offices get compatibility and functionality in one seamless integration.”

The x-ray sensors have won awards for producing high-resolution images and excellent diagnostics, and the DentiMax support team ensures clinicians get the best results possible.

“What I think is amazing about these sensors, and what we have been told by many doctors, is we have a very high-resolution sensor that can compete with the most expensive sensors…. It’s a very high-quality product,” he adds.

Throw in a strong support team knowledgeable about all the DentiMax products and all the software systems it integrates with, and you get practices that are happy with their everyday results.

“We have a huge team that is very knowledgeable about our products and how everything integrates,” Huish says. “Because our sensors are such open products, our support team is very knowledgeable about many different software [programs], many different products, and how our solutions integrate and function with them.”

DentiMax handles the office set-up process remotely, which allows them to offer quality products at a lower cost than many of their competitors.

“We do everything remotely. That’s part of what allows us to keep the costs as low as possible,” he says. “When we do our installs, we schedule a time to [connect] to their computers, and then we follow instructions from either the practice’s IT [department] or…the office, and we do all the work.”

Huish says practices get set up, installed, and fully functioning, and then the office gets more involved. DentiMax shows them how it works; makes sure they are familiar, comfortable, and happy with how everything is working; and then at that point “they’re off and running and doing their thing.”

“Our products are set up to function like their existing sensors, so there is very little training needed, which is another big selling point of our sensor,” he adds. “It’s really like you’re using your current sensor. You plug it in, and if ours is plugged in, it’s going to work pretty much the same way as if you had the sensor you’ve been using for years plugged in. The trainingis very simple, andthe installation isquick.”

The images can be filtered and adjusted to provide the diagnostics quality each clinician is seeking. Much of what Huish and his team do each day is adjust the image quality to help doctors get the x-ray to look more like how they want it.

Huish adds that the company’s free trial program is so successful because DentiMax products don’t make claims they can’t deliver on.

“If doctors give us a [chance] and try it, a lot of offices end up purchasing our product because we do stand behind [it]. We have an amazing product with an amazing image,” he concludes. “That’s why our trial program has been so successful for us.”

[Sponsored] The company’s Dream Sensor and Open Sensor, as well as its strong support and software, allow clinicians to get the best diagnostic results.

DentiMax Sensors Provide High-Quality Images and Support Without the High Costs

Although many of my articles focus on cybersecurity and Health Insurance Portability and Accountability Act compliance, I am asked to assist offices with many other things. Having spent 10 years as a periodontist, I am uniquely positioned to work with practices in areas in which other information technology companies have little experience. I recently visited an office in Pennsylvania to help diagnose less-than-satisfactory digital x-rays, and I thought how I handled the troubleshooting would make a good article.

One of the main challenges in digital radiography is that many variables exist between the taking of the image and what appears on the screen. In no specific order, these include the x-ray head, the sensor, the patient, the USB cables, the monitor, the video card…the list goes on and on. When the practice first contacted me, the initial thought was that the images were diagnostic but that there were just some people in the practice who could not differentiate between a good film image and a good digital image (digital x-rays tend to be a bit softer or fuzzier).

When I arrived onsite, I realized a few things:

The images were indeed not diagnostic. There was considerable graininess in the images, which is almost always due to underexposure.

As I evaluated the setup in more detail, I saw that every image had a sharpening filter applied, which tends to accentuate the graininess. When I removed the filter, the raw image was completely undiagnostic; it was not capturing enough information.

When I visited a second location for this group practice that used the same software and settings but different sensors and x-ray heads, the images were far more diagnostic.

So, what conclusions could I draw, and how would I test them?

The primary way to troubleshoot is to do a differential diagnosis. I had to determine the most likely diagnosis and work from there.

The most common culprits are the x-ray heads and sensors.

Software and computer infrastructure can also cause similar issues, but because both locations had the same computers and monitors, I ruled those out as the leading causes.

One thing I suggested, and we tested, was bumping up the exposure times. Back in the day, digital x-rays required less radiation than film, so many people still have this too low. The practice used 0.16 seconds, but when I tested at
0.20 and 0.25 seconds, there was no evidence of overexposure. I suggested they keep going higher until it was clear that the exposure was too high, then step back 1 setting from there.

I suggested that they take the x-ray head from the office with good x-rays and test it at the office with bad images; it is easy to do because they have a portable NOMAD handheld system (DEXIS).

I also suggested they take a sensor from the good office and test it at the office that needed to be getting better images.

Anytime you deal with systems with multiple steps in their processes, it can be challenging to isolate the one variable causing the issues. Approaching it just like we approach patients with nonspecific pain is often the best course of action to determine the problem and how to fix it.

Various digital radiography challenges due to factors like x-ray heads, sensors, and exposure times can affect practice performance. By applying a differential diagnosis approach, practices can find the solution and improve their image quality without breaking the bank.

Digital Radiography Troubleshooting

To kick things off, I have some questions for those of you who have been in practice 10 to 15 years or longer. Do you miss the darkroom? Do you miss having to dispose of all the chemicals properly and paying for a hazardous materials disposal company to remove them from the office? Do you miss waiting 5 minutes for a film to spit out of the processor while running 30 minutes behind on a complex endodontic case? How about films getting stuck in that processor and disappearing until the next time someone cleaned the unit? Yup, I don’t miss that either. I started using digital radiography in the early 2000s, and when I built my new office in 2007, the architectural plans didn’t even include a darkroom. I don’t pine for those days, and I’m sure you don’t either.

The other thing I did when designing the new office was to make the lab area considerably smaller. I gladly admit that I gambled a bit by doing that. However, I did it with a little perspective on the future. I had been using in-office CAD/CAM for a few years but had stepped away by 2005. At that time, I wasn’t getting the fit and feel I got from lab-fabricated restorations. Yet even though I was back to taking analog impressions, I was pretty sure I knew where the industry was headed. Fortunately, my gamble paid off. One year after moving into the new office, I brought in the original Cadent iTero system, and we were going to digital impressions rather quickly.

I bring up all these old stories because I want you to know we are on the brink of another wholesale change in the dental industry. 3D printing is about to do the same to dentistry as digital radiography did. In the not too distant future, we will experience another digital workflow that will change dentistry for the better––much better. For most of 2024, I have been immersed in the world of 3D printing, and I think it’s time you learned more about it.

Some of you are saying, “Flucke, 3D printing has been around for 5 or more years and hasn’t caught on. What’s the big deal now?” My answer is that a lot has changed since we first saw 3D printing in dentistry. The best example I can give is to look at artificial intelligence (AI).

I don’t think many will argue with me that 2023 was the Year of AI in Dentistry. AI seemed to come out of nowhere. Several companies had released dental products in 2022, but in February of 2023, ChatGPT was suddenly a huge news story. The press coverage of AI was immense, and suddenly AI was of interest to everyone. However, the tech had been in development for years. While it seemed to emerge out of nowhere, in reality it had been building slowly under the radar for over a decade.

We are seeing a very similar situation with 3D printing. It has been around in dentistry for 5 to 10 years but has had limited scope. But trust me when I say that the next 12 to 18 months will see a major shift in our workflows as this tech goes more mainstream.

The proliferation of intraoral scanners is one big reason. At least 30% of offices now have a scanner, and surveys indicate that for those who don’t, purchasing one is high on their list of must-haves. We have 2 scanners in our office, both used multiple times a day. Not only the doctors but also the hygiene team use them.

Many offices now include a full mouth scan in their new patient intake process. That means a large percentage of offices are moving in that direction. Yet even with scanners becoming increasingly intrinsic to what we do, many offices still take physical impressions for various services other than fixed prosthetics. If a patient comes into the office and has a full mouth scan but also wants to undergo at-home whitening, many offices pull out alginate, pour the impressions, and then create the trays with a vacuum-forming device. In the sense of a totally digital workflow, that is like confirming an appointment by fax. Once the scanner digitally captures the patient data, having a digital solution just makes sense.

However, that digital solution must be simple, which brings us to the other part of why 3D printing is poised to change dentistry significantly. Until recently, designing anything produced by a 3D printer was cumbersome and complicated to learn. The companies that make these amazing pieces of hardware quickly realized that a busy office has trouble integrating any technology with a significant and challenging learning curve. No one wants to have to open Adobe Photoshop and spend 30 minutes editing just to post a photo on Instagram. The 3D printing companies quickly came to the same conclusion and set about creating design software to allow quick, easy, and reliable processes to generate the majority of projects a dental office might require.

These software solutions are available now and have essentially solved that problem. Many are cloud based, which simplifies things even more. Cloud-based systems update independently with no user intervention required and back up projects every step of the way. All the office needs to do is upload the STL files from the scanner and select the project required. The system then walks the user through the process.

Let’s use a bleaching tray as an example. The upper and lower arches are uploaded, the “bleaching tray” option is selected, and the user creates the reservoir area by drawing the proper shape on each tooth. The system then proposes a margin for the tray that the user can edit by simply clicking on it and dragging it to the desired area. When the design is completed, the finished project appears on the screen so the user can be sure it is exactly what they want. Many of these design programs integrate AI into the design, so the design process is often a matter of just clicking “next” and moving to the next step. I am really excited about this, and you can expect these systems only to get smarter as they continue to get feedback from users and the software engineers improve these already intelligent platforms.

The finished project is then downloaded and loaded into the printer’s “slicing/nesting” software. This software shows the user the appliance’s position on the printer bed. Once confirmed, the software converts the STL file into a language the printer understands, and the project is printed.

The design project I just described takes only a few minutes. The advantages are quite clear when you think about the analog process (and mess) of making an impression, pouring, trimming the model, blocking out for the whitening agent, heating and vacuuming, and trimming the tray. Of course, one of the other great advantages of having a digital design is that if the patient loses their trays or their pet destroys them, making a new one is as easy as pushing a button. (By the way, are you as amazed as I am at how often pets chew up dental devices?)

The project is printed using a liquid resin––and hundreds of resins are on the market. Thus, no matter what type of project you need, chances are there is a resin that will meet your needs. You can create bleaching trays, soft and hard occlusal guards, orthodontic retainers, surgical guides, models, dentures, and more.

The other thing the slicing/nesting software does is add supports to the project. These are necessary to help build the project. The resins are liquid and, like composites, are light cured. The printer builds the projects in layers, again similar to composites. Because the printer cures the projects in layers, supports are needed to ensure printer accuracy. The supports are tiny cured bars that stabilize the resin. When the project is completed, it is removed from the printer with the supports attached to it.

The project is then placed in a wash station that circulates isopropyl alcohol, removing any remaining liquid resin. Once the wash is completed, the project is put into a curing station, essentially a box with high-intensity LEDs on all sides. The project then goes through a set “postcure” time to ensure a total and complete cure. Once the postcure stage is complete, the supports are removed, and the project is polished.

3D printers are incredibly precise, with many having an accuracy of 50 µm. That means pairing an intraoral scanner with a 3D printer gives results that meet our profession’s extremely high demands. When I first began using the iTero back in 2008, I immediately noticed how much faster our crown seat appointments were. The tech was precise even nearly 2 decades ago, but I hadn’t expected that much precision. Of course, the current generation of scanners has only got better. (Since 2008, Align Technology’s iTero systems have made even greater strides, and other manufacturers have developed high-quality scanners that give clinicians numerous choices to find the solution that best fits their practice.) The combination of scanner and 3D printer offers serious advantages over analog systems. Your in-office lab will soon be used for fewer and fewer things.

Many of you will have noticed that I haven’t mentioned permanent crowns in my discussion and may be wondering why. I want to state my feelings on the subject for the record. My opinion is based on a couple of factors. The first is that I have an in-office mill. In April 2022 we installed a DGSHAPE DWX-42W mill, producing fantastic results. The main materials we use are presintered zirconia and prefired lithium disilicate. These materials eliminate the need for an oven and are ready to cement after being polished. Both materials have a long track record of clinical success, and I am incredibly confident in their long-term viability.

The second factor is that resins for 3D-printed crowns don’t have that same track record, which is why I am still not printing permanent crowns personally at this point. I realize some people are, and I have no problem with that. As I already have an in-office solution that works well for me, I am still watching and evaluating this permanent crown aspect. I have no doubt that someday soon, this will become a viable option for all of us. I have been practicing for a while, and over those years I have occasionally pushed the envelope with materials. Some of those decisions have been ones I regret. I have redone cases because a new material has fractured or not held up, and I admit those experiences have affected how I view crown materials. We all have our biases, and I want to be sure you understand mine. If you are currently printing crowns and having success, I would love to hear more about your experiences.

Other than anything permanent, I am all in on 3D printing. I am a big fan of how the manufacturers approach this. There are so many everyday applications for this tech, and I appreciate that those companies have noticed this. There is no need for a patient to wait 2 weeks or more for a slam dunk occlusal guard or anything else that can be easily created in a day in the office. I can envision a patient being diagnosed as a candidate for implants and having the guided surgery performed the very next day. The process is now that simple.

I am also excited about 3D printing to help with full arch or full mouth reconstruction. One of the most difficult things we do is correctly open a collapsed bite. With the right design software, those cases can be created digitally, and the temporaries fabricated on a 3D printer. If you place the 

temporaries and the next week determine that the vertical needs to be changed, you simply correct it in the software and print new temporaries to the corrected vertical. If a fractured temporary occurs, reprinting a new one is a simple process. The same can be said of dentures. If a patient drops one and it fractures, printing a new one is straightforward. I’ve even heard of doctors providing 2 dentures at delivery so the patient always has an identical backup if disaster strikes.

Get ready. 3D printing is going to change our profession, and I believe the change will happen quickly. After my deep dive into 3D design and printing this year, I am confident we will see some profound changes in the near future. If you have invested in companies that make plaster and stone, now might be a good time to put that money to work for you elsewhere. If you are thinking of building a new office or new office space, I would think about where you can better use the space you might have been considering for your large in-office lab. Square footage is expensive, and you might not need as much room for that lab as you thought.

I sometimes think about the days when I would watch a talented dental assistant squeeze equal lengths of an impression material out of 2 tubes and mix it to a perfect consistency with a spatula before loading my syringe and then loading the tray. I don’t sigh longingly and think, “Ah, the good old days.” Instead I think, “I can’t believe we ever did it that way!” Soon we will feel the same way about mixing stone, pouring impressions, and trimming models. Imagine the possibilities.

3D printing technology is the next big thing, and we are going to experience another digital workflow that will change dentistry for the better sooner than you think.