Southern Utah Dental Review
Anesthetics
Carbide Burs
¼, ½, 2, 4, 6, 8
330 (Pear)
34
169
245
556/557
702/703
1557
Diamond Burs
Rounded or Flat
Tapered or Straight
379
801
Can also do a One-Time Use Diamond from Midwest Buy 4
(25-packs) at $39.29 each and get 1 free
Standard Burs can average $26.99 per 5-pack
Cements and Liners
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Dycal (Dentsply)
Fuji Liner (GC America)
Vitrebond Plus (3M ESPE)
Do I Cement or Bond and With What?
Bonding to Ceramic
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Macromechanical- no sharp edges or surfaces (promotes
cracks). Create retentive preparations rather than alter the
inside of the restoration.
Micromechanical- acid etching and sand blasting. Acid
etching with HydroFluoric acid works well for silica based
materials because it will etch glass. Phosphoric acid does
nothing to any surfaces except enamel and dentin.
However, acid etching won’t touch alumina oxide and
zirconia cores and may cause cracking. Sandblasting works
best for both.
Chemical- only with silane and only if silica is present. Use
HF to etch silica-based ceramics.
Cement Types
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Luting cements- cements that achieve retention by
filling in the gaps between the tooth and the restoration.
Adhesion is at best a surface phenomenon of wetting
and micro-mechanical interlocking.
Bonding cements- stronger than luting cements so “gap
filling” offers greater retention. Bonding to tooth
structure through the smear layer or into dentinal
tubules is more than just a surface phenomenon.
Bonding to restorations can be achieved through the use
of primers which allow for the chemical adhesion to
inorganic fillers, or metal oxides.
Luting Cements
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Used almost exclusively with metal based restorations.
Self curing, with generally two components (liquid/powder
or paste/paste) for mixing.
Four classes: zinc phosphate; polycarboxylate; conventional glass
ionomer; resin-modified glass ionomer (marginal Fl release).
Of these classes, only conventional glass ionomer and RMGI
cements have true indications in modern dentistry. Their
indications are limited to metal; metal-based; or core
strengthened, glass-free ceramic restorations with retentive
preparations. Examples: FujiCem, RelyX Luting, Ketac Cem
Luting Cements
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Paste/paste system
Easy mixing, radiopaque, 3min. working time
Low film thickness (10 microns ).
Do not use a dentin conditioner (removes smear layer).
Fluoride release, low solubility
Bonding Cement
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Composite resin cements: are modified
composite resin materials with high adhesion,
low solubility, and good esthetics.
Like any direct composite materials, this class of
cements must be used with a bonding system.
There are Three subtypes: total-etch system, selfetching system, self-adhesive systems.
Composite Resin Cements
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Total-etch system- most systems are dual cured or light cured.
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The steps are as similar and diverse as that for direct
composite restorations. Examples: Variolink II, Calibra,
Duolink, RelyX Veneer cement. In general, any of these systems
are moisture intolerant.
Self-etching systems- Typically a dual cured, two part system
where the acid etching and bonding steps are replaced with a
self-etching primer mixed and activated with a bonding
agent. The manufacturer’s instructions usually require PhD
in interpretive science to decipher. Examples: Panavia F
Composite Resin Cements
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Self-adhesive cements- 3M-RelyX UniCem is
the #1 selling cement in the US market. It is a
capsule dispensed dual cured cement that
eliminates separate etching and bonding
steps. It is uniquely moisture tolerant, and has
a low risk of post- operative sensitivity. It has a
broad range of applications and a simplified
technique. Kerr MaxCem.
Resin Cements – RelyX Unicem 2 and RelyX
Choosing The Right Cement
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The determination of the cement type begins with the clinical
situation not vice versa. This is determined in the treatment
planning stage.
The key factors that determine restoration and cement type are:
esthetic demands, ability to maintain a dry field, occlusal forces,
remaining tooth structure, prep design (retentive or nonretentive), and margin location.
In general, weak restorations must be adhesively bonded with
strong cements.
Ceramic restorations require either micro-etching or acid-etching
of the undersurface and silane coating to achieve bonding with
resin cements; this is not achievable with luting cements.
Other Types of Cements
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PolyCarboxylate –
•Durelon (3M ESPE)
Glass Ionomer •Ketac Cem (3M ESPE)
•Fuji I (GC America)
RMGI •RelyX Luting and Luting Plus (3M ESPE)
•Fuji Cem and Fuji Cem 2 (GC America)
Other Types of Cements
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Bonded Resin Cement • RelyX Unicem Aplicap *
•Dual Cure and Self-Adhesive – NOT for Veneers
• RelyX Unicem 2 Self-Adhesive (3M ESPE) *
•Claims no need for etching, priming or bonding of tooth
• RelyX Veneer (3M ESPE)
•Light Cure only – all types of colors to choose from
• Variolink Veneer (Ivoclar) *
•For Veneers, Inlays and Onlays
• NX3 (Kerr)
•Light-cure and Dual-cure available in 5 shades
• MaxCem Elite (Kerr)
•Single Step for all restorations
• MultiLink (Ivoclar)
• Calibra (Dentsply)
Cement Recommendations
Composite
Crowns, Inlays,
Onlays
Strengthened core
Crowns, bridges
Alumina/Zirconia
Cement
PFM/Metal
Inlays/Onlays
Glass
Ionomer
X
X
RMGI
X
X
Bonded
Composite
Resin
X
X
X
Feldspath or
Pressed ceramic
Crowns, Anterior
Veneers
E-Max - Lithium
Discilicate
X
X
X
Temporary Cement
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Premier Implant Cement (Premier)
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Integrity TempGrip (Dentsply)
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TempBond (Kerr)
•Resin based design for security and able to retrieve
•Zinc Oxide, Non-Eugenol
•Clear version claims to have Triclosan (anti-
bacterial to prevent gingivitis but may inhibit
muscle contraction – FDA is checking on it)
Desensitizers
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Gluma (Heraeus)
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MicroPrime (Danville)
•Comes in Liquid Bottle, Single Use and Gel
•Has the old B version and now G version that is
comparable to Gluma at a much lower price
•Prestige Dental has it for $50.95 / Gluma is $135.99 in
the Benco Catalog
Differences Between Self and Total Etch
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Enamel acid-etching involves demineralizing portions of hydroxyapatite crystals to
develop a porous surface for micro-mechanical bonding. Today, acid-etching is
performed on dentin, and with a total-etch (TE) or self-etch (SE) technique.
Total Etch - In the TE technique, the outer layer of dentin is decalcified, removing
the smear layer and opening the underlying dentin tubules. This exposes collagen
fibers that are then infiltrated with a primer, followed by the application of a resin
adhesive. Primer and adhesive are applied simultaneously in many systems. In this
procedure, it is critical that you completely seal dentin tubules to avoid bacterial
invasion and/or sensitivity. Generally this technique is used for larger direct
restorations and indirect restorations.
Self Etch - Rather than removing the smear layer, the SE approach involves the
application of an acidic primer that will promote micro-mechanical bonding of the
adhesive to the smear layer and the underlying dentin. This technique minimizes
the potential for postoperative sensitivity by preventing the collapse of the collagen
fibers that can occur after conditioning and drying in the TE process. The SE
technique has less clinical history, but appears to be best in less invasive procedures
such as shallow Class I or Class II restorations.
Primers and Bonding
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OptiBond (Kerr) – Total-etch
XP Bond (Dentsply) – Universal Total-etch “(1 bottle/1 coat)”
ScotchBond Universal (3M ESPE) – Total or Self-etch
• Claims to bond to metal and Zirconia surfaces
Adper Single Bond Plus (3M ESPE) – Total Etch
iBond (Heraeus) – Has both Total and Self-etch products
• Claims to Desensitize as well with the Self-Etch
Peak Universal (Ultradent) – Works with both Self and Total-etch
techniques,
• Also contains Chlorhexidine for added bond longevity and strength
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BondForce (Tokuyama) – Self-etching, Fluoride releasing
Clearfil SE (Kurary) * - Self-etching primer and bonding agent
Clearfil S3 (Kurary) – Self-etch, one-step, fluoride releasing
All-Bond ACE SE – Self Etch
Brush N’ Bond (Parkell) – Self-etching but seems to be more of a sealer
Universal Composite
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Estelite Omega (Tokuyama) – Spherically filled supra-nano (82% filler)
Estelite Sigma Quick (Tokuyama) –“Radical Amplified Photopolymerization
Technology”
Filtek Supreme Ultra (3M ESPE) * - Nanotech provides retention of a microfill
and the strength of a modern hybrid
GrandioSO (Voco)
Vit-L-Escence (Ultradent)
Tetric Evoceram (Ivoclar)
Heliomolar (Ivoclar)
Venus Diamond (Heraeus)
Esthet-X HD (Dentsply)
N’Durance (Septodont)
Premise (Kerr)
Herculite Ultra (Kerr)
SonicFill (Kerr) – $818.91 on average for handpiece / Up to 5 mm then cure
Flowable Composite
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Filtek Supreme (3M ESPE)
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Starflow (Danville) – Claims to have highest
compressive strength
Surefill SDR (Dentsply) * - Up to 4 mm, 15 of .25 g.
for $70-80 (3.75 g.)
Venus Bulk (Heraeus)- Up to 4 mm
HyperFIL (Parkell) – 22 g. for $65.25, Doesn’t work
well with self-etch. Claim to need Brush N’ Bond.
Tetric EvoCeram Bulk Fill (Ivoclar)
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•Also Filtek Bulk Fill – Cure up to 4 mm
•Contains Ivocerin – Patented light activator to help full light
curing
Core Build-Up Materials
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Clearfil Photocore (Kuraray) – light-cure
CorePaste (DenMat) - self-cure
Build-It FR (Pentron Clinical) – dual-cure
Luxacore Dual (DMG America) – dual-cure
FluoroCore 2+ (Dentsply) – dual-cure
Crown and Bridge Temp Materials
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Integrity (Dentsply) *
ProTemp Plus (3M ESPE)
Structur 2 (Voco) * - Appears to be best price
Luxatemp (DMG America) – Star, Plus and Solar
PerfecTemp II (DenMat)
ExactaTemp (Exacta)
MaxiTemp (Henry Schein)
Are you Impressed?
Alginate
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Identic (Dux) –
•Kromaphase Dust free or Regular Powder (Color change
from purple to mix, pink to load and white to seat then 30
sec.)
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Jeltrate (Dentsply)
Chromaclone (Ultradent) * – Walterberry and
Bubble gum Flavors, Same color changes as
Kromaphase
COEflex (GC America)
Bite Registration
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Blu-Bite HP or Clear (Henry Schein)
Blu-Mousse (Parkell) *
•30 sec. working and 30 sec. set time
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SuperDent (Darby Dental)
Genie (Sultan)
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MegaBite (DenMat)
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Vanilla Bite and Chocolate Bite (DenMat – just
bought from Philips Discus)
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•Superfast has 60 sec. setting time in Mint flavor
•Spearmint flavor – 55 sec. set time
•What else to say, its chocolate flavored!!!
Claims 45 set time.
Vinyl Polysiloxane
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Aquasil Ultra (Dentsply) *
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Exafast NDS (GC America) *
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Genie (Sultan) *
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Imprint II Garant (3M ESPE)
Precision Plus (Burkhart)
FlexiTime (Heraeus)
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• Has XLV, LV, Monophase, Heavy and Rigid Options
• Regular, Monophase and Heavy Options
• 90 sec. set even in a wet enviornment
• Berry flavored with Extra Light, Light, Regular and Heavy Body
• Has an Advanced ThermaSense (ATS) which allows fast setting
material with flexible working times.
PolyEther
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Impregum F (3M ESPE)
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Impregum Soft
•Base/Catalyst Mix
•Cartridge mix from tip, Easier removal
Bleaching
Take Home Bleaching
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Venus White Pro (Heraeus)
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Opalescence PF (Ultradent) – Melon, Mint, Regular
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Opalescence Oh! (Ultradent)
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Zoom NightWhite and Day White (Philips)
• 16% - Daytime of 4-6 hours, Nightime 8-10 hours
• 22% - Daytime of 60 minutes 1-2 times a day
• 10% - 8-10 hours or overnight
• 15% - 4-6 hours
• 20% - 2-4 hours
• 35% - 30 minutes
• Same as PF but in individual doses
• NightWhite 10%, 16% and 22% are Hydrogen Peroxide 4%, 6%, 8% respectively
• DayWhite is 9.5% and 14% (The 14% was named 38% but they changed the name to not
have people thinking it was a full 38% HP. It is a mix of HP and Carbamide)
In-Office Bleaching
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Opalescence Boost 40% (Ultradent)
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Venus White Max 38% (Heraeus)
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Pola Office 37.5% (SDI North America)
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LumaWhite Plus 35% (Luma-lite)
• 2 – 20 minute applications
• Claims to strengthen enamel, decrease sensitivity and prevent caries
• Patient kit - $51.99
• 3-4 – 15 minute applications
• Contains potassium nitrate to decrease sensitivity
• Patient kit - $55.99
• 3 – 8 minute applications
• No mixing materials, Contains potassium nitrate, with or without light
• Patient kit - $75.99
• 3 – 8 minute applications
• Includes “Stay Bright” professional take-home maintenance kit/enhancer
• Patient kit - $68.99
In-Office Bleaching
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Zoom WhiteSpeed
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BriteSmile
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Dash
• Clinicals show proven 8 shades brighter in 45 minutes
• Uses LED light to accelerate the bleaching gel
• Similar to WhiteSpeed
• In concentrations of 15 or 25% Hydrogen Peroxide
• 30% hydrogen peroxide whitening gel. No syringe-to-syringe mixing
• Sensitivity management. Includes a syringe of Relief ACP, that combines
chemical sensitivity relief (potassium nitrate) and long-term relief with
ACP (Amorphous Calcium Phosphate) and fluoride.
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These are all Philips brands. They also have a Zoom Whitening Pen
for maintenance with 5.25% Hydrogen Peroxide.
Final Wrap-Up
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Sample Requests
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Treatment Videos
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Discounts/Rebates
•How to for Cutting/Temping/Bonding Veneers
•Possibility of Starting CE Library