Nina McCollum

	If you aren’t utilizing in-house 3D radiography in your dental practice, you’re missing out. Where traditional 2D X-rays are found to be lacking, dental cone beam computed tomography (CBCT) excels.

	It’s widely accepted that with CBCT imaging, clinicians have access to greater detail and more information. Historically, this had come at a price. 3D images required higher doses of radiation than their 2D counterparts. However, Planmeca customers using Planmeca Ultra Low Dose™ technology can get this information at doses equivalent, or even less in some instances, than 2D radiography.

	Dr. Victor Rodriguez, who practices in Doral, Fla., recently upgraded to the Planmeca ProMax

 3D Classic system and indicates the results have been excellent. The system produces high-quality 3D images of the mandible and maxilla for about the equivalent dose of a single intraoral periapical image using Planmeca Ultra Low Dose.

 Dr. Rodriguez describes it as a “panoramic technology, but in 3D,” and he says the CBCT images help him to create the right treatment plans with better patient outcomes.

	“More information is always better,” Dr. Rodriguez says. “I don’t like surprises. I want to be able to plan everything before I even begin the procedure. Previously, you might not know exactly what you’re going to find when you begin working. Now, I know what to expect. It’s a finer image, and it can find defects more effectively.”

Read more: How to use a 3D digital workflow for ortho treatment

	Dr. Rodriguez uses the Planmeca ProMax 3D Classic system throughout his general dentistry practice in everything from root canals to periodontal surgery to wisdom teeth extractions. In addition to utilizing Planmeca Ultra Low Dose technology, Dr. Rodriguez has access to Planmeca CALM™, an exclusive feature that corrects for patient movement during imaging. Planmeca also offers options such as cephalometric imaging for orthodontics and other advanced modalities that are only available with its equipment.

	“I know exactly how many canals and the exact length of each of them when I’m performing a root canal” Dr. Rodriguez says. “That’s particularly helpful to reduce costs and chair time.”

For dental implants, a clinician might opt to choose one of four resolution settings to capture the detail required to perform minimally invasive surgeries and have ideal patient outcomes. Again, with Planmeca systems, the low dose technology can be used on any resolution setting producing and image with no statistical reduction in image quality.

	Some dental professionals refer patients to specialists or imaging centers for 3D imaging, but this can be problematic. Patients have to find time to go to a separate location, prolonging the time until they receive treatment and causing additional inconvenience. Some patients will simply skip this step and go elsewhere. With the ProMax 3D Classic system in-house, you can get the images right away and relay the information to the patient immediately, which increases case acceptance and conversion rates.

	“It’s very simple to use, particularly the Planmeca Romexis software,” Dr. Rodriguez says. He went on to praise Planmeca’s customer service. “Their team easily walked me through the new equipment when I upgraded to the 3D system. Part of why I selected a Planmeca ProMax when I started my practice is the ease of upgrading the equipment. It allowed me to grow when I was ready and it protected my initial investment.” 

	1. Data on file.
	2. “Dosimetry of Orthodontic Diagnostic FOVs Using Low Dose CBCT Protocol” by JB Ludlow and J Koivisto.

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How the Planmeca ProMax 3D Classic system helps one clinician to better plan procedures. 

Practice better dentistry with 3D imaging

	After amalgam, the standard for replacing missing tooth structure became inert, tooth-colored dental composites made from ceramic particles and a resin base. These restorations offer a more esthetic look but require multiple steps and exacting precision. Even when well-crafted, research indicates traditional composite fillings last an average of five to seven years.

	“Long before composite resins, we had the original bioactive material: glass ionomer,” says Susan McMahon, an accredited cosmetic dentist in Pittsburgh, Pennsylvania. “They leach fluoride, are cariostatic and form a chemical link to the tooth. They are far less technique-sensitive, but glass ionomers are not as esthetic as composite and do not wear as well.”

	Pulpdent worked to improve the bioactivity property in fillings, designing a product to better protect pulp while delivering a stronger, more active filling through the bond it created with teeth. The result was 

Related reading: How bioactive materials are changing restorative dentistry

	ACTIVA BioACTIVE-RESTORATIVE is a dental resin that elicits a chemical reaction from the tooth, releasing more calcium, phosphate and fluoride directly into the tooth structure to help it to actually repair itself. Whether the lesion is from decay, fracture or trauma, the interface between the material and the tooth is said to result in less vulnerability to decay over time.

	ACTIVA consists of a bioactive ionic resin matrix-a rubberized resin component to act as a shock absorber-and a reactive ionomer glass filler. It’s designed to elicit a response that stimulates apatite formation and the natural remineralization process that unites the restoration and tooth together, while also sealing margins against microleakage, secondary caries and failure.

	“I like it because it not only makes beautiful durable restorations, but it is a great choice for minimally invasive fillings. It’s more like natural tooth structure,” Dr. McMahon says.

	Since the bioactive composite releases ions directly into the teeth, Dr. McMahon chooses ACTIVA for areas that are prone to recurrent decay, such as interproximal boxes of Class II restorations and root surface fillings.

	“ACTIVA polishes well. This material is getting closer and closer to the natural properties of the tooth,” Dr. McMahon says.

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ACTIVA is formulated to offer the advantages of glass ionomers in a stronger, resilient matrix. It not only chemically bonds to the tooth and releases calcium, phosphate and fluoride, but it also offers better bioactive properties than regular glass ionomers.

	Dr. McMahon has been using this product for about four years, and she says she believes in Pulpent’s research and dedication to delivering an improved composite product that will result in longer-lasting, better seated restorations.

	“I choose it because I have confidence in their research and their company. It works well and makes beautiful, conservative restorations,” she says.

	Dr. McMahon says she uses the product in a variety of restorative applications, including pit and fissure caries. She says it allows her to remove the smallest amount of tooth, retaining the healthy tooth structure and restoring it with a material that supports the natural remineralization process. According to Dr. McMahon, her patients are actually happy and excited about the prospect of fillings that include a material that will end up being helpful to the affected tooth, which makes using ACTIVA a positive experience for both the dentist and the patient.

	Bioactive materials that behave well in a moist environment, help to neutralize the conditions that cause dental caries and maximize potential remineralization may become the new standard, according to Dr. McMahon.

How ACTIVA™ BioACTIVE-RESTORATIVE™ leads to longer-lasting restorations.  

The benefits of bioactive restorative materials

	Vinyl polysiloxane impression material (VPS) is the top choice for the best, most precise crowns, bridges and other dental prostheses. Since their introduction many years ago, VPS impression materials continue to improve, producing even more accurate and more comfortable impressions. Now, Clinician’s Choice has introduced the PowerMix™ Automatic VPS Dispenser to prep heavy body material faster and more easily while delivering perfectly mixed, void-free impressions in a jiffy.

	“In my opinion, you want a heavy body that’s not going to drift,” says Robert A. Lowe, DDS, who practices in Charlotte, North Carolina.

	But timing and handling issues are persistent challenges in creating perfect, bubble-free impressions with no voids or distortion. To date, extrusion of putty-like heavy body VPS materials has been tough to control from tabletop mixers, which are typically shaped like an injector gun or machine. As heavy body must be mixed just prior to use, timing and placement of machines have presented further challenges, limiting impression treatments to specific rooms where the mixer is located or investing in multiple machines in order to have one for every treatment room.

	Clinician’s Choice has solved these issues with its lightweight (two pounds) volume mixer, which is designed to perfectly mix the heavy body impression materials instantaneously and easily, on the spot. Without hand pumping, heavy body material is loaded into the tray in as little as 15 seconds.

Related reading: The top 3 mistakes dental professionals make when taking traditional impressions

 is completely portable, easy to use by anyone in the office and is much more cost-effective because you only need one mixer for the whole office,” Dr. Lowe says. “I’ve always been a fan of volume mixers, but the majority of volume mixers are designed to sit up on a counter. They’re pretty big, and I needed one in every room, whereas the PowerMix dispenser is portable, easy to use and much more cost-effective.”

He notes that the size and cordless functionality are also key benefits.

	“My assistant operates ours, as it’s smaller than traditional power mixers and operable by holding it in one hand,” Dr. Lowe says. “By simply holding down the button on the dispenser, the heavy body material is prepared consistently with the exact right mix and is done so in an instant. I really like that it gives a predictable result time and time again.It also saves time, as I can work on injecting the light body material while my assistant prepares the heavy body material at the same time, in advance of both materials mixing to form the dental impression.”

	It’s much easier to operate than older forced extrusion setups and offers versatility because you can use the dispenser with one hand to load the material into the tray with the other, or you can place it on a small tabletop stand for additional stability and precision while filling the tray, he adds.

	“The versatility makes it different than every other model I’ve seen,” Dr. Lowe says.

	The PowerMix Automatic VPS Dispenser is specifically designed to have a long battery life and a large capacity so it can be used repeatedly throughout the day. When fully charged (solid green light), it has the ability to dispense eight full 120 mL cartridges - up to 24 full-arch impressions - before needing to be recharged, and it requires no servicing or maintenance by the user.

	Each 120 mL PowerMix cartridge holds enough impression material to fill three full-arch trays or six to 10 quadrant impression trays. PowerMix cartridges are designed to reduce plastic waste and minimize impression material being left in the cartridge.

How the PowerMix™ Automatic VPS Dispenser enables perfectly mixed impression material with the press of a button. 

Heavy body impression material mixing made easy

	Communication with your patients is one of the most important parts of presenting treatment options. You know an optimal path forward, and you can visualize the successful end result, but sometimes convincing a patient to proceed with verbal description alone can be a real challenge. 3Shape TRIOS

 MOVE is a big step forward in patient communication and can help to increase case acceptance rates.

	3Shape TRIOS is a high-tech intraoral scanner that transmits images to a nearby computer to allow for quick viewing and sharing of scans and images with patients. The old saying, “seeing is believing,” is even more relevant here, as patients can really see what’s going on inside their own mouths instead of relying on a verbal description or hard-to-read X-rays.

	The new TRIOS MOVE takes sharing to the next level, with the computer and scanner positioned on a wheeled module that can easily travel to different exam rooms as needed. This apparatus has a flexible arm that allows the viewing screen to be brought down to each patient’s level and positioned at any angle to enable him or her to see what the dentist sees while suggested procedures are explained. Procedures play out on screen in front of patients via the TRIOS MOVE treatment simulator, showing patients the end result using their actual teeth and gums.

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	New York-based Dr. Dean Vafiadis, founder of the New York Smile Institute, has been using 3Shape TRIOS for years with great success. As a result, his practice is always one of the first to upgrade to newer and better options. What he likes best about the latest scanner is the wireless capabilities, which have been networked to allow images to be shared throughout all of the office’s computers. But there are many other improvements to the overall system in the new TRIOS MOVE model, and he and the others in his practice have noticed the changes.

	“It’s faster and easier, and the menus are more intuitive,” Dr. Vafiadis says. “We can train a new person on this system in just a few hours.”

	The system comes with a responsive touch screen, a swivel arm for custom positioning and long-lasting, rechargeable batteries for the scanner.

	When patients can see the final results ahead of time, they’re more likely to accept a suggested treatment plan. Whether you focus your practice on orthodontics, cosmetic dentistry, or, like Dr. Vafiadis, use it for implants, temporaries and night guards for sleep apnea, the results are positive.

“We can scan a patient and send to the lab electronically,” Dr. Vafiadis says. “They’ll make a smile trial overlay on top of the patient’s teeth, and they can see it in 30 minutes. The patient might have come in just for a hygiene visit, but when we can show them the overlay, they’re convinced to go ahead with a whole smile makeover.”

	It’s not just for cosmetic use though. Dr. Vafiadis goes on to describe how he uses the scanner for pre-planning for implant latents. Using the 3Shape TRIOS intraoral scanner and a CT scan, he and his team can merge the files in just a few minutes and plan the surgery right in front of the patient so that he or she knows what to expect.

Read more: 3Shape launches new clear aligner workflow

	“The technology is super-fast in terms of patient experience,” Dr. Vafiadis says.

	What makes the 3Shape TRIOS MOVE system unique is not just the flexibility and movement afforded by the swivel arm and rolling unit but also the particular scanner used in the system. Dr. Vafiadis describes it as “the ideal tip size” for speed and accuracy of scanning over any other scanner he has seen. It’s also one-handed and can be operated by a single operator, instead of needing an assistant for retraction and multiple hands to handle the scanner and software.

	“One-handed scanning is one of our favorite features of this system,” Dr. Vafiadis says.
	Incorporating the cutting-edge 3Shape TRIOS MOVE into your practice can have a positive impact on patient communication and help to advance case acceptance rates.

How this new system can be used to include patients in the treatment planning process.

Author | Nina McCollum

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