Jul 152014

adhese-universalThe recent launch of Ivoclar’s Adhese Universal adds to the growing category of materials known as “Universal Adhesives”.  In general when I hear the word universal I assume it is a product that can be used for all possible applications and with a single set of instructions. I have learned over the years not to assume in dentistry what the word universal applies and make sure I understand the specifics. This new group of materials is no different. There are multiple manufacturers with “Universal Adhesives” on the market, and each one has a different set of procedures it includes with different recommended directions. So with that what are the advantages of using a “Universal Adhesive”?

  • Streamlined purchasing & inventory control with fewer products
  • Predictable procedure set-up with one product

With this in mind there are several pieces of information you need to have about your particular “Universal Adhesive” to use it optimally.

  • Are there different directions for Total Etch, Self Etch & Selective Etch
  • Is it Compatible with dual cure products if light cured first?
  • Can you add a dual cure catalyst to convert it to dual cure?
  • What are the manufacturer handling recommendation? refrigeration, shaking?
  • Is an additional primer recommended when bonding to restorative material?

These new category of materials is showing great results in testing, and does streamline part but not all of the process when doing adhesive dentistry. We have several years of good data behind these products and my guess is we will see additional companies come out with “Universal Adhesives”.


Jul 092014

Cartridge CouplerWasted material is wasted money. Over the years I have tried to analyze the remaining impression material or bite registration in cartridges and make the decision whether there is enough remaining material to accomplish our goals. If not time to use a whole new cartridge. We have also loaded two separate guns and used the remaining material, switched guns to finish loading the impression tray or taking the bite. This approach uses two tips, another way to increase costs.

Recently we became acquainted with a product called Lock-n-Reload. The blue plastic connectors fit on to the end of the cartridge of material, and allow you to attach a second cartridge of material. Using the gun you move the remaining material from cartridge one into the second combining the contents. The now empty cartridge and connector are thrown away and you can get full use out of the material. The connectors are manufactured by a company called IndiGreen Innovations at www.IndiGreen.com and is available from most of the major dental distributors.

Jul 012014

Teflon Tape Block Out WebVinyl Polysiloxane and Polyether impression materials are stiff enough that material that locks under a bridge pontic or through a large gingival embrasure can make removal of the impression from the mouth difficult to near impossible. On the other hand Alginate used int he same situations can tear easily or be dislodged from the tray causing distortion that renders the resulting model inaccurate. Continue reading »

May 272014

Woman's Eye and World GlobesBy Mary Osborne

For more years than I care to admit I told patients they should brush their teeth; they should floss their teeth; they should come in for regular exams and cleanings. I did that kindly, gently, with compassion and with the best of intentions. Still, I had patients who were not effective at removing deposits and who did not keep their scheduled appointments. I wondered why they didn’t listen to me.
I have come to understand that personal hygiene is, well, personal. Most adults believe they have good enough hygiene. They feel judged and insulted when they are told their hygiene is not good enough. When people feel insulted their defenses go up.  When they feel a need to defend their actions they are likely to get attached to those actions; to justify them; to resist any change. Continue reading »

May 122014

Imacon Color ScannerLast week we had a team meeting on Wednesday. This is something we do about every 4-6 weeks. We block out the entire afternoon, order in lunch for everyone and plan some valuable time together. It is amazing to me how often these meetings turn into logistics discussion about the radio station, uniforms or how we are handling sterilization. I am even willing to admit sometimes they degrade into “gripe” sessions. When this happens I wonder why we continue to schedule these as they seem more stressful than helpful.

One of our goals is to have these meetings be positive and  beneficial. There are many levels of benefit we can get, from clinical or technical development, resolving systems based issues, resolving conflict and becoming a more cohesive team. Last week at our meeting one of our team members requested that everyone bring in photos of themselves over a span of years. The suggestion was met with mixed reviews. The day before the meeting at the morning huddle she reminded everyone to bring their photos and some groans were heard. Continue reading »

Apr 302014

Image converted using ifftoanyI think all of us have patients in our offices who chronically complain of a bad taste or bad smell in their mouths. Some of these patients perceive this themselves, and others have feedback from others. I’m discussing the patients who have excellent oral hygiene, have tried brushing or scraping their tongues, do not need scaling & root planing and still the problem persists. I can only imagine that this is distressing whether it is a continual bad taste or smell for the people who experience it. Recently I have come across a fabulous solution I can offer these patients. Continue reading »

Apr 152014

Full Coverage ApplianceMany times I get asked if there is a connection between the vertical dimension of an occlusal appliance and it’s effectiveness. The answer is “yes” and “no”. There is scientific evidence that supports that the activity of the elevator muscles decreases as we open the vertical dimension of occlusion. The next questions to ask, are how the amount of vertical change affects the amount of muscle activity reduction and the duration of this affect. One of our goals in appliance therapy is to reduce the activity of the elevator muscles. This reduction directly affects the signs and symptoms associated with muscles, like headache as well as having a positive impact in reducing joint loading which is a percentage of the total force applied. With this in mind the fact that the muscle activity of the elevator muscles decreases as we open vertical dimension is most likely one of the reasons appliance therapy works in helping our patients feel better.  It may also contribute to why during appliance therapy of short duration we see less evidence of attrition. It may not be that the person has stopped or reduced the amount of parafunction occurring, but that they are applying less force and therefore not notching the appliance significantly. Continue reading »

Mar 312014

RingInPlace_03.RGB_color.0620_0We are all on the search for the perfect matrix system. Our hope would be to find one system that works every time. Working would be defined as sealing the margins of the prep so we have minimal to no excess to finish off, replicating the original shape of the tooth, and creating tight interproximal contacts.  My experience is that there isn’t any one system that works in every clinical situation. Exceptional results are dependent on having multiple matrix systems and choosing the appropriate one based on the tooth preparation. Continue reading »

Mar 182014

http://www.dreamstime.com/royalty-free-stock-photos-dental-mirror-patient-mouth-teeth-reflection-image26818748This quarter’s e-newsletter looked at the concept of completing comprehensive exams for new patients and fitting this in to your practice philosophy and current circumstances.



Sometime in the past I think I heard that all “good” dentists completed a comprehensive exam on every new patient at the first appointment. In truth a rigid interpretation of this idea in a private practice setting can be overwhelming and a barrier to changing and improving your new patient experience.

Right after dental school in the 80’s I believed I gave a comprehensive exam to all of my patients, and it included dentition charting, necessary x-rays, and periodontal screening. As I went through more advanced continuing education, my comprehensive exam grew to include a comprehensive periodontal exam, joint & muscle exam and digital photography. Continue reading »

Mar 042014

Shrink Wrap Provisionals WebFabricating provisionals for anterior veneers can be one of the most challenging of our clinical procedures. For some it is such a challenge that they hesitate to offer veneers to their patients. There are three methods of fabrication: indirect, direct and shrink-wrap. The indirect approach requires fabrication of a model of the preps on which the provisionals are made. The model does, however, allow the bisacryl to be trimmed on the model without the challenge of holding the fragile provisionals. Direct fabrication, forms the bisacryl on the preps in the mouth. This technique has both the challenge of timing the removal of the bisacryl and then trimming in your hands without breaking. Shrink wrap provisionals are formed directly on the teeth and then trimmed and polished int he mouth. The technique challenge is int he handling of the matrix and flash of bisacryl without damaging tissue or preparations. Continue reading »