Breaking Material Boundaries
The rapid innovation of dental materials creates new possibilities for treatment, results in easier workflows for clinicians, and improves outcomes for patients. But just how far have things progressed, and what new materials are making an impact on dental practices?
The practice of clinical dentistry employs a wide array of materials. Just about every procedure requires at least one specialized formulation, and while one product might be accomplishing the task at hand, this doesn’t mean something more effective isn’t in development or already available.
Even as innovative technologies create new ways of diagnosing and treating patients, this often simply means switching from using one type of dental material to another. So while practices using intraoral scanners are likely capturing fewer impressions with physical materials, the act of restoring a tooth will require some material to be affixed in the mouth.
Dental material innovations take many forms, but the end goal is to create something that looks and functions as much like the material it is replacing as possible, and every generation of dental materials gets closer to that objective. Today many material options are designed to both mimic natural esthetics and to provide patients with added protection from recurrent decay. To showcase these innovations, we spoke with a number of clinicians, who shared their thoughts on the types of products making a huge impact in their practices and for their patients.
Direct Restoratives
“I started using Tokuyama’s OMNICHROMA years ago. It works very well, and the truth is most clinicians are using a single shade or universal shades of composites for their restorations. OMNICHROMA’s spherical particle technology works in most cases, and it worked well in my hands. These chameleonlike materials simplify the life of most clinicians without sacrificing the quality of the restorations we are providing our patients.”
—MICHAEL MIYASAKI, DDS
“I believe that resin technologies are getting pretty much to the pinnacle. Where can we go with resin technology, because we’re pretty much as good as it can be?”
—JASON GOODCHILD, DMD, vice president of clinical affairs at
Premier Dental Products
“Self-cure composites are a great way to efficiently fill large restorations and may have advantages for shrinkage stress because of the slower polymerization of a self-cure material. Some clinical tips include: Fill from the bottom of the preparation first to allow polymerization and shrinkage to be directed toward the bottom of the prep; for dual-cure materials, allow time for chemical curing prior to light curing in order to allow the slower polymerization to occur; and make sure there is compatibility between any self-etch bonding agents and the chemical cure composite because acidity of adhesives can inhibit amine-based, self-cure mechanisms of self- and dual-cure materials.”
—NATHANIEL LAWSON, DMD, PhD, associate professor and director of the Division of Biomaterials at the University of Alabama at Birmingham School of Dentistry
“My philosophy on direct restoratives is a get-back-to-basics approach. What I see in the industry both as a clinician and on the other manufacturing side is a move toward robustness—universal materials that can be used under many different clinical situations and in many different environments.”
—JASON GOODCHILD, DMD
Preventive Materials
“Scolding a patient and telling them to brush, floss, and eat better, and if they don’t, they’ll see a drill—that’s old school. It’s time to learn a bit more about preventative options.”
—ANKUR GUPTA, DDS
“Silver diamine fluoride has completely transformed the way we noninvasively manage the development and propagation of oral disease. It has offered pediatrics to geriatrics the opportunity to safely control decay, an overt and prevalent epidemic we continue to see in escalating proportions across the United States. What’s more: The companies formulating these products have taken a deep and vested interest in prevention, transforming the tools in our tool belt to better meet the growing demands for targeted therapies in caries management, such as the integration of nano-hydroxyapatite and povidone-iodine, for example. With the integration and acceptance of modalities such as silver diamine fluoride into community and mobile programs, the educational setting, and now private practices, the conversation around caries management becomes more patient-centric, more noninvasive, and certainly more evidence-based. What an exciting time to practice dentistry.”
—KATRINA SANDERS, RDH
Bioactive Materials
“Bioactivity is fantastic, but it’s not tangible. I can’t see it. I can’t feel it. I don’t know if it’s there. I just have to believe that it’s there. It’s not like I see something different in the restorative material. It still, as a restorative, has to function. It has to work like a composite, handle like a composite, cure like a composite, and be finished and polished like a composite, but there’s other stuff that’s in there. I just hope that it works. If I can do it the right way, [how we are] taught to do it, and it has the fluoride and it has the remineralization and everything else, well, then that’s just the icing. A little bonus.”
—JASON GOODCHILD, DMD
“I think the problem is defining what we mean by ‘bioactive.’ If we say it is when our materials have the ability to exchange ions with the oral environment, that technology has been around for quite a long time, and we know that we often sacrifice esthetics, wearability, strength, and bond when using these materials. If we call bioactive the use of materials that will help the tooth heal, remineralize, and create an alkaline environment, then we are at a different level. Today, we are applying bioactive materials to the tooth in ways that will help the tooth repair itself, form hydroxyapatite, and resist future decay without adding additional steps to the placement protocol. Maybe this is the best we can do now. Eventually, product workflows will become shorter as technology is developed to help us do so.”
—MICHAEL MIYASAKI, DDS
“We are no longer just filling a hole, but helping the tooth heal from the disease. I am pleased to report that since we started using bioactive restorative adhesives, composites, and EndoSealer, we are seeing better patient outcomes measured as less postoperative discomfort, due to the alkalinity, and less recurrent marginal decay.
—MICHAEL MIYASAKI, DDS
“I think my colleagues can benefit from knowing how to pretreat their zirconia restorations before the final cement is used to minimize the need to recement the restoration down the line. I favor the cements with true bioactivity. Our indirect restorative materials can last a long time, as long as we can protect those margins.”
—MICHAEL MIYASAKI, DDS
Image Credit: © SDI
Stela
A single-shade, self-cure composite said to be well suited for Class I, II, III, and V restorations, Stela is designed for efficient, reliable placement. The composite works in conjunction with Stela Primer, which provides the catalyst to initiate polymerization, allowing the material to cure starting with the restoration interface, rather than the exterior surface. This is said to help prevent marginal gaps, eliminate postoperative sensitivity, and reduce restoration failure. Available in a single shade in either syringe or capsule delivery, the material can reportedly be placed in as little as 15 seconds. Its two-step workflow is said to eliminate the need for the traditional etch, prime, bond, and light cure composite workflow.
Image Credit: © Tokuyama Dental America Inc
OMNICHROMA Flow BULK
omnichromaflowbulk.com
Image Credit: © Young Innovations
Curodont Repair Fluoride Plus
Curodont Repair Fluoride Plus is a noninvasive preventive therapy that treats early caries and remineralizes white spots from the inside out. Clinicians can easily apply this therapy to remineralize white spots around brackets on patients who wear braces or to remineralize incipient caries. Curodont Repair Fluoride Plus is applied directly onto the cleaned surface of the tooth and allowed to dry for 5 minutes. After as little as 1 application, Curodont Repair Fluoride Plus acts where it is needed. Initial results are visible in about 90 days, according to the manufacturer.
info.youngspecialties.com/curodont
Image Credit: © Vista Apex
RE-GEN
RE-GEN is a line of bioactive materials composed of a flowable composite, bulk fill and resin cement, pit, and fissure sealant, and what is reportedly the world’s first bioactive universal and self-etch adhesives. It is said to be the first line of bioactive products to employ Bioglass as an active ingredient. The blend of ingredients in RE-GEN products is said to provide a restoration that is osteogenic, antimicrobial, biocompatible, and BPA-free.
Image Credit: © Parkell, Inc
Predicta Bioactive Cement
Predicta® Bioactive Cement is designed to fill and seal microgaps with hydroxyapatite formation at the margin. This is said to prevent microleakage, which is otherwise associated with recurrent decay. It is a self-adhesive, self-etching, dual-cure resin cement indicated for luting crowns, bridges, inlays, onlays, and posts (prefabricated metal/nonmetal/fiber posts). By combining all the properties and performance benefits of premium universal resin cements with bioactivity, Predicta Bioactive is said to offer a cement that gives crown margins protection against secondary caries. It also contains 10-methacryloyloxydecyl dihydrogen phosphate (MDP) for strong bonds to zirconia. Predicta Bioactive Cement is formulated to provide optimal viscosity and consistency for easy handling and easy cleanup. It is highly radiopaque and has a low film thickness for complete seating of restorations.
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