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ChairSide Essentials                For more than 100 years, your most                                               Profi...
trusted source for dental supplies and equipment.                                                                         ...
ChairSide Essentials                            For more than 100 years, your most                    Profitable Dental Im...
trusted source for dental supplies and equipment.                                                                         ...
ChairSide Essentials                         For more than 100 years, your most                    L a se r Tissu e M anag...
trusted source for dental supplies and equipment.                                                 Spring 2009 EditionTr ou...
ChairSide Essentials                       For more than 100 years, your most                    H em ostati c Age nts    ...
trusted source for dental supplies and equipment.                                                                         ...
ChairSide Essentials                                                                For more than 100 years, your most    ...
ChairSide Essentials                        For more than 100 years, your most                     Dental Impression      ...
trusted source for dental supplies and equipment.     Spring 2009 Edition                                                 ...
ChairSide Essentials                                       For more than 100 years, your most                     Impressi...
trusted source for dental supplies and equipment.                                             Spring 2009 EditionDigital D...
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Profitable dental (impressions)

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Transcript of "Profitable dental (impressions)"

  1. 1. ChairSide Essentials For more than 100 years, your most Profitable Dental Impressions:TISSUE MANAGEMENT You intend for impressions to make you money, but often times they can cut into your profits. New technologies for “impressions” continue to hit the market making this necessary task easier and more predictable. Regardless of the tech- nology used to obtain the impression, one factor remains critical to get- ting a good impression: Tissue management, the ability to effectively create and maintain a dry field with adequate retraction. * This article discusses techniques to help achieve this task so that whether you take a traditional or digital impression, you’re more likely to get the results you desire. I deally, a first impression on a prepped tooth will be all that is need- ed to create a well fitting restoration. In many offices, this is fre- quently not the case. Many times, multiple impressions are taken to ren- der one the lab can work with. Or worse, problems arise when a techni- cian has to call requesting additional definition of the margin. Even worse, the lab attempts to create a restoration from the questionable impression. Then upon attempting to seat the restoration, it does not fit requiring additional remakes, patient appointments, and lab involve- ment. This problem is not only frustrating and often times embarrassing, but it is the cause of lost revenue to the practice. www.nashvilledental.com 16 615-860-7100
  2. 2. trusted source for dental supplies and equipment. Spring 2009 Edition A large number of offices complain of retakes and remakes. In discussing this issue with a number of labs, a common issue is poor tissue management. While there are a number of things that can contribute to problems with an impression, this article will deal with tissue man- agement and the tools available to provide the best pos- sible field for recreating the margin with dental impres- sions. When creating a cast or ceramic restoration, the ability to record the prepared margin is a critical factor in fabri- Poor Retraction and Syringing Technique cating a well fitting result. Soft tissue management for a final impression is dependent on the ability to create suf- ficient space to visualize the prepared margins while maintaining a dry field. This is true for traditional OFFICE MANAGEMENT impression materials as well as for the newer digital TISSUE MAINTENANCE impression systems. Even with CAD/CAM systems, the operating field must be well isolated during the imaging process to record an accurate image of the margin. Tissue Management consists of two key elements: Poor Retraction - Insufficient Tear Resistance hemostasis and retraction. These can be achieved in a number of ways. It is best to keep a few different tools at Ferric Sulfate is a very popular fast acting agent giving your disposal depending on the situation. Common rapid coagulation. In some patients, ferric sulfate has tools include: been known to blacken the tissue, leading to the need to A. Hemostatic Liquids/Gels clean the area prior to taking the impression. In many B. Retraction Cords cases, this can often cause hemorrhaging to recur. What causes Ferric Sulfate to stain the soft tissues? C. Retraction Pastes The so-called “staining” is the ferric ion combined with the D. Electrosurge coagulum plugging the once bleeding blood vessels. Because of this, in thin tissue patients or areas with an excessive num- E. Lasers ber of open vessels, the coagulum plugs may be more visible and discoloration of the affected tissues would be noticeable. Hemostatic Liquids/Gels - come in different chemical This will clear in the normal 24 to 48 hours. compositions that react differently with tissue. Sometimes when ferric sulfate is used for fluid control, a stain is left around the gingival margins and has been know to last Buffered aluminum chloride has been a traditional 20 days or more in some cases. The "staining" that the den- chemical that gives adequate hemostasis in most sit- tists are seeing may be the coagulum plugs in the cut capillar- uations. A well known product containing this ies. Like any cut tissue injury, it will take time for the tissue to chemical is Hemodent by Premier Dental. heal and the coagulum to dissipate, at which time the tissues should return to their original state. It is important for the Epinephrine is a well known hemostatic agent due dentist to rinse really well with a firm air/water spray after to it’s ability to constrict the vessels. It is limited to placing the ferric sulfate and cord as well as when the cord is removed. This will wash any residual chemical off the tissues. use on patients with no known heart conditions. Note: If ferric sulfate is used with epinephrine there is a reac- Gingi-pak makes Orostat, an epinephrine solution tion that can cause the gingival tissue to temporarily turn a that pellets, cords and other cotton products may be dark blue or black color. It is best to use ferric sulfate with dipped in. Many retraction cords come impregnated plain, non-impregnated cords. It is also important to thor- with epinephrine. oughly rinse any residual chemical from the site prior to bonding. (A hibiclens or CHG wash can further assure a clean site for bonding.)* This article assumes that the practitioner is attaining adequate axial and occlusal reduction and is maintaining adequate biologic width. It also assumes that the correctinstrumentation is being used to create the appropriate margin for the restoration type selected. These things being true, tissue management continues to be critical in finalimpression accuracy. 1-800-861-6105 17 www.nashvilledental.com
  3. 3. ChairSide Essentials For more than 100 years, your most Profitable Dental Impressions ...continued from page 17 ...continued Aluminum Sulfate is a fast act- Twisted Cord - tration by even the smallest of pack- ing chemical that contains no Gingi-pak’s ing instruments. Because of the epinephrine and is safe on heart Original 2-Ply and unique weave characteristics, the patients. While hemostasis is Crown-Pak® 4-Ply retraction cords braided cords create a more visible slightly slower than the ferric were the first impregnated dry pack retracted tissue than knitted cords sulfate products, aluminum sul- cords produced for the dental pro- because they do not collapse under fate achieves excellent hemosta- fession. Introduced in 1955, they pressure. sis and tends to leave a cleaner remain the product of choice for field with less need for clean up those dentists who want the ability STEP 1 Regardless of which before impressions are taken. to adjust the physical quantities of cord is chosen, the the cord to match clinical situa- most recommended technique for Hemostatic gels have become very tions. The soft 2-ply and 4-ply achieving and maintaining a dryTISSUE MANAGEMENT popular because of their ease of cords are loosely wound and the blood free field for impression placement and ability to control strands are easily separated, twisted material is the double cord tech- and lubricate the cord for easier or combined to make it readily nique where the first cord is left in packing. A clear version is available adaptable for use in the gingival sul- place for the impression. This cre- from Pascal that aids in visibility cus, regardless of the sulcus size and ates a “V” shaped sulcus which aids when packing the cord. is suitable for all techniques, includ- in the impression material captur- ing the 2-cord technique. Several ing the margin much better. companies now offer a twisted Syringe a hemostat- cord. STEP 2 ic gel around the sulcus. This not only begins the Knitted cord con- hemostatic reaction but it also lubes sists of 100% cot- the cord and helps to facilitate pack- ton cord knitted ing and retention of the cord. (Note: into interlocking chains to facili- When using a hemostatic gel, or wetting a tate easy packing of the cord into cord with a hemostatic solution, different the sulcus. This minimizes chemicals should not be mixed. This unraveling and fraying during could cause temporary and even perma- nent discoloration of the tissue. Be sure to packing. During crown prepara- use like solutions if wetting impregnated tion knitted cord will not entan- cords.) gle diamond burs. Cord can be soaked in a hemostatic solution Choose two sizes of STEP 3 cords. The first is a of choice. Knitted loops absorb and transport significantly small size cord packed to help with greater quantities of hemostatic hemostasis and to open the tissue solution or gel providing more up. The second cord is a larger cord effective hemostasis. that achieves the primary objective of retraction. Leave the cords in Retraction Cords come in a wide Braided cord has a place for 3-5 minutes. selection of sizes and composition. unique braided con- Each type has its benefits. The figuration giving the Slowly remove the top cord. Rinse most common types of cords are 100% cotton cord clean and dry the area leaving the twisted, braided & knitted. A com- excellent handling characteristics first cord in place. Take the impres- plete listing of cords can be found that packs easily and remains in sion before removing the second on page 23. place. The tight weave resists pene- cord. www.nashvilledental.com 18 615-860-7100
  4. 4. trusted source for dental supplies and equipment. Spring 2009 Edition ExpasylE very so often, a product is introduced that has a composed of significant impact on the way we practice den- kaolin (a clay sub- tistry. When that product provides quick, pre- stance) and alu-dictable soft-tissue management for crown and bridge minium chlorideprocedures, its a certain success. Expasyl has proven to (an astringentbe a valuable adjunct for taking accurate impressions. that controls gin-One significant advantage of Expasyl versus convention- gival bleeding).al retraction methods is its time savings. Also, the controlof soft-tissue deflection combined with hemostasis It is dispensedmeans the quality of final impressions and the fit of labo- into the sulcusratory restorations are significantly improved. Expasyl with a special TISSUE MANAGEMENTalso creates the ideal environment for bonding of final delivery gun. It is thick and firm allowing the material torestorations. gently displace the gingival tissue. The hemostasis is achieved with the presence of the aluminium chloride. ItExpasyl is a paste-like material that is used for gingival creates a beautifully dry and clean sulcus that is ready forretraction and hemostasis leaving the prepared field an impression or restorative procedure in a much short-clean, retracted and dry, ready for impressions or for er time than conventional techniques and is gentler toother restorative procedures. This product is primarily the soft tissues.Images courtesy of Kerr Dental and Dr. Christopher CK Ho, BDS HONS (SYD), GRAD DIP CLIN DENT (ORAL IMPLANTS), Sydney Austrailia Alternative Retraction Materials & PastesExpasyl™ Gingival Magic FoamCord -Retraction System - Coltene WhaledentKerr The first expanding VPSA fast, safe and painless alter- material designed for easynative to packing retraction and fast retraction of the sul-cords. Expasyl is a paste for cus without pressure or pack-gingival retraction that not only ing.opens the sulcus but alsoleaves the field dry, ready for Intro Kitthe impression taking or Contains: 2 - 50 ml cartridges, 30 mixing tips yellow (C6550) and 30cementation. oral mixing tips (C6555), 10 each Comprecap Anatomic #1, #3 and #5.Starter Kit C6735 . . . . . . . . . . . . . . . . . . . . . . . 139.99Contains: 6 Capsules Retraction Paste (1g each-6g total) 12 ApplicatorTips, Applicator Gun Refill32379 . . . . . . . . . . . . . . . . . . . . . . . 345.59 Contains: 2 - 50ml cartridgesCapsules (20/pk) C6737 . . . . . . . . . . . . . . . . . . . . . . . . 112.9931172 . . . . . . . . . . . . . . . . . . . . . . . 304.99Applicator Tips (40/pk)31173 . . . . . . . . . . . . . . . . . . . . . . . . 85.39Applicator Tips (100/pk)32264 . . . . . . . . . . . . . . . . . . . . . . . 159.69Applicator Gun33167 . . . . . . . . . . . . . . . . . . . . . . . 337.59 1-800-861-6105 19 www.nashvilledental.com
  5. 5. ChairSide Essentials For more than 100 years, your most L a se r Tissu e M anageme nt The lower price of diode lasers has put them in the forefront as a viable instrument of choice for this procedure. While this option does not offer speed, with practice, it can become as quick as cord assisted management with more predictable hemostasis. With careful control of the power settings and fiber tip movement, the diode laser offers excellent tissue management and hemostasis with little risk of recession after healing.TISSUE MANAGEMENT www.nashvilledental.com 20 615-860-7100
  6. 6. trusted source for dental supplies and equipment. Spring 2009 EditionTr oughin g with an E lec tr osu r geThe use of electrosurgery to excise gingival tissues has been a common choice for clinicians for some time. The elec-trosurge will cut and simultaneously create effective hemostasis. One key cosmetic concern with electrosurgery isthe heat generation due to misuse that can lead to irreversible damage to the alveolar crest. This effect can lead torecession having a negative effect on the gingival margin. The PerFect® TCSII by Coltene Whaledent claims a choice OFFICE MAINTENANCE - EQUIPMENT ROOMof settings that fine tune the instrument for this sensitive procedure. When used as recommended, the PerFect®TCSII has been successfully used in this procedure with uneventful healing. TISSUE MANAGEMENT Receive Free 8 pack of electrodes when you buy a complete unit. PerFect TCS II S8115 - ® $1,289.00 Includes: 115 Volt Unit, Cord Assembly, handpiece • • holder, 3 sheaths: coag ball, 45 straight knife, 45 straight loop, user guide/technique video 1-800-861-6105 21 www.nashvilledental.com
  7. 7. ChairSide Essentials For more than 100 years, your most H em ostati c Age nts Gel Cord Blue - 25% Aluminum Sulfate Hemodettes 30g Jar (bulk jar for dispensing into a dappen dish and (Unit-Dose) dipping the cord into or applying with a microbrush 20% buffered alu- applicator.) 15-510 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22.69 minum chloride lubricating hemostatic gel with saturated cotton pellets Pro Pack 12 Syringe packaged in unique plastic cups with attached finger ring. Contains : 12 - 1gm syringes and 14 tips Unit-Dose packaging eliminates cross-contamination. 15-540 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.99 Light blue color indicates area of placement. The gel vis- cosity enhances placement and eliminates migration Pro Pack 40 Syringe from the site. Cranberry flavor. Contains : 40 - 1gm syringes and 50 tips 15-545 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111.79 13150 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22.49 Gel Cord Clear - 25% Aluminum Sulfate Styptin - DUX 30g Jar (bulk jar for dispensing into a dappen dish and 20% buffered aluminum dipping the cord into or applying with a microbrush chloride applicator.) A fast-acting, hemostatic solution in 15-810 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19.99 a lubricating base. The blue color shows the operator Pro Pack 12 Syringe where the solution is placed. The increased viscosity pre-TISSUE MANAGEMENT Contains : 12 - 1gm syringes and 14 tips vents the solution from migrating from the site. Squeeze bottle allows easy dispensing and minimizes the possibil- 15-840 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.99 ity of cross-contamination. Cranberry flavor. 15ml Squeeze bottle Stat Gel FS - 15.5% Ferric Sulfate 13157 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.49 30g Jar (bulk jar for dispensing into a dappen dish and dipping the cord into or applying with a microbrush applicator.) Hemogin-L - DUX 15-710 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19.99 25% aluminum chloride Pro Pack 12 Syringe A lubricating glycerin base. An eye dropper is provided to eliminate cross contamina- Contains : 12 - 1gm syringes and 14 tips tion. Applied with cotton pellets to the gin- 15-740 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.99 gival tissue, or pre-saturate retraction cord. Pro Pack 40 Syringe 10cc dropper bottle Contains : 40 - 1gm syringes and 50 tips 13057 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.99 15-745 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111.79 40cc bottle 13052 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.99 Quick Stat FS Gel - 15.5% Ferric Sulfate - Stat-Flo Hemostatic Delivery Tips - Vista Dental Vista Dental Value Pack (40 prefilled syringes with stat-flo delivery tips) 502800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76.39 19ga Prebent (Yellow) Single Use - Disposable Tip Curved cannula for optimal entry. The soft bristle end Stasis® - Gingi-Pak allows for non-evasive brushing of solutions. Has a uni- versal luer lock style hub to be used with any luer lock syringe. Polyester bristle allows for spreading of viscous A 21% liquid ferric sulfate hemostyptic solutions while stiff enough to avoid metal canula contact formulation offering unsurpassed hem- with soft tissue. orrhage control, when measured against any non-epinephrine solution. 40ml 20pk refill 312102 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.99 13115 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34.69 100pk refill 312100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.49 FS Hemostatic Solution - Premier A 15.5% ferric sulfate liquid solution. Epinephrine Free. 1oz Dropper Bottle 9007057 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.19 2oz Refill Bottle 9007058 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.29 www.nashvilledental.com 22 615-860-7100
  8. 8. trusted source for dental supplies and equipment. Spring 2009 Edition Retrac ti on Cords Original Cord - Z-Twist Cord - Gingi-Pak Gingi-Pak Braided Retraction Cord Twisted Retraction Epinephrine - Green Cord 108” Length . . . . . . . . . . . . . . . . 11.49 10170M . . . . . . . . . . . . . .#00, Very Thin 10171M . . . . . . . . . . . . . . . . . . . .#1, Thin 10172M . . . . . . . . . . . . . . . . .#2, Medium OFFICE MAINTENANCE - EQUIPMENT ROOM Epinephrine 72” Length . . . . . .1 - 9.29 . . .3 - 8.89 108” Length . . . . . . . . . . . . . . . . 11.49 10173 . . . . . . . . . . . . . . . . . . . . . .#3, Thick 10120M . . . . . . . . . . . . . . . . . . . . . . .2-Ply Non-Impregnated - Purple 72” Length . . . . . . . . . . . . . . . . . 14.69 108” Length . . . . . . . . . . . . . . . . 11.49 10130 . . . . . . . . . . . . . .4-Ply, Crown-Pak 1117TM . . . . . . .#000, Extremely Thin Non-Impregnated 108” Length . . . . . . . . . . . . . . . . 11.29 108” Length . . . . . . . . . . . . . . . . 10.89 11170M . . . . . . . . . . . . . .#00, Very Thin 11120M . . . . . . . . . . . . . . . . . . . . . . .2-Ply 11171M . . . . . . . . . . . . . . . . . . . .#1, Thin 11172M . . . . . . . . . . . . . . . . .#2, Medium Soft-Twist Cord - Gingi-Pak 72” Length . . . . . .1 - 8.49 . . .3 - 7.99 Epinephrine 11173 . . . . . . . . . . . . . . . . . . . . . .#3, Thick 108” Length . . . . . . . . . . . . . . . . 11.49 10105M . . . . . . . . . . . . . . . . . . . .#1, Thin Hemodent 10110M . . . . . . . . . . . . . . . . .#2, Medium Cord - Premier 10115M . . . . . . . . . . . . . . . . . . .#3, Thick TISSUE MANAGEMENT Braided Retraction Non-Impregnated Cord 108” Length . . . . . . . . . . . . . . . . 10.89 Epinephrine free 11105M . . . . . . . . . . . . . . . . . . . .#1, Thin hemodent cords are 11110M . . . . . . . . . . . . . . . . .#2, Medium already impregnated with hemodent 11115M . . . . . . . . . . . . . . . . . . .#3, Thick liquid. Hemodent Cord is easily packed subgingivally without fraying or disinte- grating. Cord remains placid when Z-Twist Cord - Gingi-Pak placed due to its hollow braiding. Braided Retraction Cord Packaged with self-cutting dispenser Aluminum Chloride - Teal container. 108” Length . . . . . . . . . . . . . . . . 11.49 Each . . . . . . . . . . . . . . . . . . . . . . . 14.79 12170M . . . . . . . . . . . . . .#00, Very Thin 9007077 . . . . . . . . . .Regular Twisted #3 12171M . . . . . . . . . . . . . . . . . . . .#1, Thin 9007078 . . . . . . . . . .Regular Twisted #9 12172M . . . . . . . . . . . . . . . . .#2, Medium 9007065 . . . . . . . . . . . . . . .Braided, Thin 72” Length . . . . .1 - 9.29 . . .3 - 8.89 9007067 . . . . . . . . .Braided, Med/Thin 12173 . . . . . . . . . . . . . . . . . . . . . .#3, Thick GingiKNIT+ (Knitted Retraction Yarn) Constructed of many tiny, absorbent loops knit- UniBRAID - ted in long, interlocking chains, GingiKnit+ Pre-cut sterile places easily without fraying or memory, and the unidose pkg. cotton fiber wont "pop-out" of the sulcus. Great for tub set-GingiBRAID+ Braided Retraction Cord - ups. GingiKnit+ conforms to sulcular anatomy withSpecially treated braid for faster absorption allowing Epinephrine/Alum 87 - Each . . . . . . . . . . . . . . . . . . 14.79 gentle, outward force and cuts clean if touched byimmediate use and effectiveness. Braided retraction 13370 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0e fine, blue a high-speed cutting instrument (unique constructionmaterials are made of cotton fiber that will not split or 13371 . . . . . . . . . . . . . . . . . . . .#1e small, blue w/purple strand eliminates inadvertent removal if used as a finish guide-collapse in the sulcus. The retraction braids have a 13372 . . . . . . . . . . . . . . . . . . .#2e medium, blue w/green strand line). Available in 6 diameters. 6 feet (72 inches/183background color (for medicament identification) with Aluminum Potassium Sulfate - A 10% solution; impregnated cm) of knit per bottlea second color to identify diameter. 6 feet (72 inch- and dried. Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.79 13360 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0a fine, yellow Aluminum Potassium Sulfatees/183 cm) of braid per bottle. GingiBraid also comes 10% solution; impregnated and dried. 13361 . . . . . . . . . . . . . . . . . . .#1a small, yellow w/purple strandunit dose as UniBraid. 13362 . . . . . . . . . . . . . . . . .#2a medium, yellow w/green strand Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.39 13509 . . . . . . . . . . . . . . . . . . . . . . .#00 fine, yellow w/blk strandEpinephrine/Alum 87 - A solution of approximately 8% GingiGEL (Gel-Coated Braided 13510 . . . . . . . . . . . . . . . . . . . . . .#0 small, yellow w/orng strandRacemic Epinephrine (a vasoconstrictor) and 7% Aluminum 13511 . . . . . . . . . . . . . . . . . . .#1 med, yellow w/orng-blk strand Retraction Cord) 13512 . . . . . . . . . . . . . . . . . . . . . . .#2 large, yellow w/red strandPotassium Sulfate (an astringent); impregnated and dried.Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.89 This braid is made of synthetic fiber and packaged in a hemostatic gel containing Non-Impregnated13170 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0 fine, blue 20% buffered aluminum chloride. The Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.8913171 . . . . . . . . . . . . . . . . . . . . . .#1 small, blue w/purple strand 13499 . . . . . . . . . . . . . . . . . . . . . . . .#00 fine, white w/blk strand13172 . . . . . . . . . . . . . . . . . . . .#2 medium, blue w/green strand braid is completely saturated and has an 13500 . . . . . . . . . . . . . . . . . . . . . .#0 small, white w/orng strand13173 . . . . . . . . . . . . . . . . . . . . . . . .#3 large, blue w/pink strand extra layer of medicament coating. This 13501 . . . . . . . . . . . . . . . . . . . .#1 med, white w/orng-blk strandAluminum Potassium Sulfate - A 10% solution; impregnated thorough saturation allows easy place- 13502 . . . . . . . . . . . . . . . . . . . . . . . .#2 large, white w/red strandand dried. ment and immediate hemostatic results. The gel keepsEach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.89 the braid soft and pliable to prevent “pop-out” of the13210 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0 fine, yellow sulcus. 6 feet (72 inches/183 cm) of braid per bottle.13211 . . . . . . . . . . . . . . . . . . . .#1 small, yellow w/purple strand Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.99 RETRAX CORD CUTTER - PASCAL13212 . . . . . . . . . . . . . . . . . .#2 medium, yellow w/green strand 13165 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#1 small Stainless steel scissors designed for precision cutting of gingi-13213 . . . . . . . . . . . . . . . . . . . . . .#3 large, yellow w/pink strand 13166 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#2 medium val retraction cord intra-orally or extra-orally. 13167 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#3 large 26-440 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.89Non-ImpregnatedEach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.8913217 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0 fine, white13214 . . . . . . . . . . . . . . . . . . . . .#1 small, white w/purple strand13215 . . . . . . . . . . . . . . . . . . .#2 medium, white w/green strand13216 . . . . . . . . . . . . . . . . . . . . . . .#3 large, white w/pink strand 1-800-861-6105 23 www.nashvilledental.com
  9. 9. ChairSide Essentials For more than 100 years, your most Soft Tissue Lasers *6 req mo f me uires inanc n in an ts be that p g app p a rov osted y- e car d cre to d. dit 6m 6m 6m ZER os ZER os ZER os O% O% O% only on p $ urch a * only on p * only on p urch * 5K-$ se urch $ a 15K s of $ 5K-$ sea 5K-$ se 15K s of 15K s of Hoya - The DioDent Micro 980™ Ivoclar - Odyssey Navigator Kavo - GENTLEray 980 Classic Represents the next generation of diode soft-tissue The Odyssey Navigator features technology that The GENTLEray 980 soft tissue diode laser, used dental lasers from HOYA ConBio™. It is ideal for provides more convenience, easier operation, for oral soft tissue procedures, is the easiest to dental professionals who would like an affordable more flexibility and unmatched portability: integrate into your practice.DIODE SOFT TISSUE LASERS way to enter the world of laser dentistry. The versatil- ity, efficiency, and cost-effectiveness of the DioDent * Touch screen monitor * Intuitive design and navigation ability make The GENTLEray 980 diode laser delivers excel- Micro 980™ allow for a rapid return on investment program simple and easy. lent clinical results and outstanding ease of use and increased growth potential for dental practices. * Inverted screen capability with the handpiece design you know and trust The DioDent Micro 980™ is used for aesthetic smile * Allow for incredible flexibility by keeping the screen from KaVo. The 980nm wavelength provides the designs, periodontal therapies, fibroma recoveries, readable in any orientation. best combination of clean cutting and excellent gingivectomies, implant recovery, tooth exposures, * Uni-dose fiber tips hemostasis in a wide range of soft tissue indica- gingival troughing, and frenectomies. Its light weight * No cleaving, no stripping of fiber just snap on and tions. and portability make the DioDent Micro 980™ ideal for you’re ready to lase. dental professionals with multiple operatories. * Ergonomic hand piece design * Arc design fits comfortably in your hand The well-balanced, patented KaVo handpiece Why Choose the DioDent Micro 980™? * Lithium Polymer battery 45 minutes of portable provides individual adjustment of the fiber length * Next-generation diode laser — built on years of lasing in combination with superior touch and feel. The experience • Portability direct fiber running through the handpiece * Single Strip laser fiber (The jacket may be C-Flex or ensures maximum transmission of laser energy The Odyssey Navigator is the first truly portable Silicon tubing) reaches the treatment point. diode laser. The unique design features a docking * Autoclavable laser fiber storage spool www.kavousa.com cradle that secures the Odyssey Navigator on a * Intuitive touch screen controls countertop and provides a charging base for the * Pre-programmed & customized presents rechargeable battery. Incorporating a state-of-the-art * Grab-and-go handle lithium polymer battery allows you complete freedom * Dimensions: 9”W X 2”H X 7”D to use the Odyssey Navigator in any operatory in * Low entry price, rapid return on investment your office. 658-0500 . . . . . . . . . . . . . . . . . . . . . . . .$8,249.00 603302 . . . . . . . . . . . . . . . . . . . . . . . .$11,749.00 1005.2900 . . . . . . . . . . . . . . . . . . . . . .$9,995.00 *Six payments of $1,374.83 plus tax *Six payments of $1,958.17 plus tax *Six payments of $1,665.83 plus tax 6m 6m ZER os ZER os O% O% only on p urch * only on p $ urch a * $ 5K-$ sea 5K-$ se 15K s of 15K s of 6m ZER os O% only on p $ urch a * 5K-$ se 15K s of Ivoclar - Odyssey 3W Ivoclar - Odyssey 2.4G Kavo - GENTLEray 980 Premium The Odyssey 3Watt Diode Laser is a high per- The Odyssey 2.4G Diode Laser is a high perform- All the benefits of the GENTLEray 980 Classic formance soft tissue laser that combines 810 nm ance soft tissue laser that combines 810 nm laser plus: laser wavelength with excellent design, innovative wavelength with excellent design, innovative and and user friendly features and consistency and user friendly features and consistency and safety • Includes water cooling accessories safety for clinicians and patients. for clinicians and patients. • Frequency 20,000 Hz, burst mode • 2 standard laser fiber handpieces The Odyssey 2.4G Diode Laser has several The Odyssey 3Watt Diode Laser has several • 2 water cooling handpiece kits unique features all of them providing operators unique features all of them providing operators • 2 Laser Fiber Diameter, 200ìm / 300ìm efficiency, convenience and performance. For full efficiency, convenience and performance. For full details, click on the featured items to the right. details, click on the featured items to the right. Water Cooling provides fast healing and • Features Laser wavelength of 810+/-20nm that has the more comfort for your patient highest affinity hemoglobin and melanin making the laser • Reduction of heat effects results in lower pain • Features laser wavelength of 810+/-20nm that has the a precise, least invasive and least traumatic tool to perform highest affinity hemoglobin and melanin making the laser sensation for the patient before and after treat- soft tissue procedures. a precise, least invasive and least traumatic tool to per- • Aiming beam to assist with the location and placement of ment form soft tissue procedures. the laser. 630 nm laser pointer that serves as a guide • Reduction of charring and coagulation zones • Aiming Beam Control – provides 5 Levels of illumination • Blood is removed from dental pockets after scal- • Aiming beam to assist with the location and placement in 20% increments. It is elective, does not need to be on ing and root planing, so that sulcular debridement of the laser. 630 nm laser pointer that serves as a guide for the Odyssey 2.4G to be effective can be performed more efficiently • Aiming Beam Control – provides 5 Levels of illumination • Three user defined programs, each determines power, • Increased efficiency and fast cutting results in in 20% increments. mode of operation and aiming beam intensity of illumina- less treatment time for doctor and patient tion. www.kavousa.com • Offers two modes of operation – Continuous Wave • Wireless Pedal – the first dental laser featuring wireless and Pulsed Mode technology for portability, flexibility and ease of use. 603286 . . . . . . . . . . . . . . . . . . . . . . . . .$8,499.00 595126 . . . . . . . . . . . . . . . . . . . . . . . . .$9,915.00 1005.2899 . . . . . . . . . . . . . . . . . . . . .$13,295.00 *Six payments of $1,416.15 plus tax *Six payments of $1,652.50 plus tax *Six payments of $2,215.83 plus tax www.nashvilledental.com 24 615-860-7100
  10. 10. ChairSide Essentials For more than 100 years, your most Dental Impression Technology Advances Dental Impressions have long been a critical step in the crown and bridge procedure. Getting a good dental impression is still one of the most important aspects of producing a well fitting restoration that requires little adjustment. In order to achieve this, the dental profession as well as materials manufac- turers have developed hundreds of techniques and materials. All these materials claim to be a key fac- tor in reducing or eliminating retakes and remakes. In spite of these innovations and product enhance- ments, in the December 2005 issue of Dentistry Today, it was estimated that among US dentists, remakes cost the dental profession a combined total of $3.2 billion dollars in dental revenues. This wasDENTAL IMPRESSIONS directly linked to quality of dental impressions. This article will look at the newest technologies avail- able for getting a good impression and will compare traditional impression systems to the new digital impression technology. ...continued on page 28 www.nashvilledental.com 26 615-860-7100
  11. 11. trusted source for dental supplies and equipment. Spring 2009 Edition DENTAL IMPRESSIONS 1-800-861-6105 27 www.nashvilledental.com
  12. 12. ChairSide Essentials For more than 100 years, your most Impression Systems: Traditional Dental Impressions: R egardless of technique, some steps are always required in order to get optimum results. Adequate axial and occlusal reduction, parallel sides, good tissue management, and adequate mainte- nance of 3-4 mm of biologic width are some of the non- negotiable criteria that must be performed well to get the desired results. Beyond this, there are critical issues specific to tradi-DENTAL IMPRESSIONS tional impression taking in order to get optimum results. Factors that play into poor performance of a good material can include technique of the operator Caulk), and Imprint 3 (3M/ESPE). Due to the and the patient’s ability to comply during the critical extremely hydrophyllic properties of these materials, intraoral set time of the material. A good impression they have captured the largest share of the impression requires the following: material market. 1. Uniform, homogeneous mix of material (no air bubbles, no glove residue or hemostatic chemical inhibi- Because this is such an important component in the tion.) crown & bridge procedure, attempting to cut costs on 2. Tray is sufficiently filled with impression material impression material is rarely a profitable decision. With 3. Thoroughly applied tray adhesive chair time ranging from $300 - $600 per hour, one 4. Rigid, sturdy impression tray remake a month could cost an office from $3,600 - 5. No voids or pulls on margin detail (tissue mgmt is $7,200 per year. If purchasing an economy impression critical as well as material strength and elastic properties) material saved the office even $1,000 a year, the net 6. Detailed margins with no tears or rough surfaces cost of this decision to the office would be a minimum 7. No tray show-through of the impression material of $2,200. So when choosing an impression material, (adequate syringe mtrl around prepped area is critical) make sure to invest in high quality materials. 8. Good blend between heavy body and light body materials While the properties of the material are not always the 9. Strong bond between impression material and tray cause of a poor impression, quite often, a high quality 10. No tooth contact with the tray (controlled, careful seat- material can help to minimize the effects of inadequate ing of the tray and patient ability to comply during set) tissue management. It is very difficult to find an office 11. Complete information about the impression mate- that is impression perfect one hundred percent of the rial used provided to the dental laboratory (good time. There are numerous parameters that can affect communication with the lab and ability to adjust technique as the final results of this process. However utilizing good needed) material and techniques can help to reduce the failures. When using traditional techniques, the choice of a high quality material is critical. While many different mate- Nashville Dental stocks a majority of the best perform- rials are available: hydrocolloid, rubber base, alginate, ing impression materials sold. In addition, we stock addition silicone, polyether, and vinyl polysiloxane everything needed to choose your armamentarium for (VPS), the most prevalent are polyether (Impregum), tissue management. If your impressions are not achiev- and VPS materials. According to SDM, a company ing the optimum results, ask your representative to dis- dedicated to market research of the dental materials cuss the various options that are available and allow us market, the top products sold in 2008 in the US market to find the right product for your technique. were Impregum(3M/ESPE), Aquasil Ultra(Dentsply www.nashvilledental.com 28 615-860-7100
  13. 13. trusted source for dental supplies and equipment. Spring 2009 EditionDigital Dental Impressions:S ome of the common problems with traditional occlusion. From there, the impressions include: patients with a strong gag Lava C.O.S. continues to maxi- reflex, selection of appropriate material, avoiding mize productivity by elimi-residual sulfur or chemicals on the prepped area that can nating steps at both theinhibit set, impression distortion, drags and pulls, mate- dental office and the lab.rial tears at the margin, retakes, and material waste.With new technology, the ability to eliminate these Steps Eliminated at the Dentist Officeproblems is quickly becoming a reality for the everyday » Tray Selectiondental practice. » Material Dispensing DENTAL IMPRESSIONS » Material SettingThe in-office CAD/CAM systems have been well » Disinfectionreceived in many offices; however, not all offices want to » Packagingadjust their scheduling to accomodate the time required » Shipping Impressionto deliver the restoration the same day, nor do theirbudgets allow for the up front costs of a milling station. Steps Eliminated at the LabFor those offices that prefer to utilize their chair time » Plaster Pouringwith traditional scheduling, the digital impression sys- » Base & Pintems are ideal. » Die Cutting » TrimmingThe Digital Workflow, beginning with a digital dental » Articulationimpression, is a highly efficient, indirect restorative » Scanningprocess used by dentists and labs to deliver a comfort-able patient experience and a high-quality, precise-fit- Whether you decide to use a traditional process, liketing restoration. PFM, or sophisticated CAD/CAM processes, including Lava™ Restorations, the Lava C.O.S. initiates the digitalThe efficiency begins with the very first step: capturing a workflow by providing a highly accurate digital impres-digital impression with the Lava™ Chairside Oral sion resulting in an extremely precise model for creatingScanner C.O.S. As long as tissue management is good, the restoration desired.this new system will allow you to quickly take digitalimpressions of the prepped arch, opposing arch and 1-800-861-6105 29 www.nashvilledental.com

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