WedgeGuard – your new best friend

WedgeGuard – your new best friend

How can such a simple little thing save you time and get you out of a whole lot of tight spots? Read on…

Class IIs and IIIs

WedgeGuard prevents iatrogenic damage to the adjacent tooth, a consequence in the majority of Class II cavity preps¹. Without having to worry about the adjacent tooth, you can concentrate fully on preparing the cavity – and there’s no need to slow down when breaking the contact point.

It also prevents unnecessary trauma to the papilla, thus helping keep the cavity dry and clear of blood.

Detach the guard after prep and continue to use the wedge. You can slide a matrix down beside the wedge to continue with the restoration. Keeping the wedge in place prevents reactive hyperemia, further reducing bleeding.

Crowns, onlays and veneers

Use WedgeGuard during prep for crowns and onlays. It’s also useful for protecting the adjacent tooth when using air abrasion to clean a tooth before etching and bonding.

Before bonding the restoration, detach the guard and leave the wedge behind to fill the negative spaces in the embrasure during cementation. This makes interdental clean-up much quicker.

References:
1.  Lussi A and Gygax M (1998). Iatrogenic damage to adjacent teeth during classical approximal box preparation, Journal of Dentistry 26:435-441.

Helpful hints

Get WedgeGuard through a tight contact

Push firmly, wriggling the WedgeGuard at the same time. In almost all cases it will pass through the contact. If it still won’t go through, there are three options:

• Drill through the occlusal enamel into the carious lesion to weaken the marginal ridge then fracture off the ridge.
• Use a diamond strip to shave a little off the contact point.
• Place a V3 Ring on the teeth for half a minute or so to create sufficient separation.

Maintain good occlusal view and access

Sometimes when doing an MO, the view of the occlusion may be slightly obstructed by the guard. If this happens, use a bur to trim the top of the guard.

Bend guard for easy detachment

To make it easier to detach the metal guard, try bending the pinhole end of the guard 90 degrees towards you before placement. That way it's easier to grab the hole with the tweezers after prep, when you’re ready to detach the guard.

Easy guard removal

Use a finger or an instrument to press down on the head of the wedge while detaching the guard. This ensures the wedge will not pop out of the embrasure.

Place a matrix beside the wedge

With the guard detached, the remaining wedge is effectively a Wave-Wedge, retaining all of that wedge’s award-winning abilities to seal the matrix at the gingival margin. Because of the wedge’s smooth surface, in most cases it is possible to slide a matrix between the wedge and the margin without removing the wedge first. If the matrix will not slide past the wedge, withdraw the wedge slightly to allow the matrix to slide into place, then push the wedge back in while pressing down on the matrix tab.

Triodent wins Townie Choice 2011 Award!

V3 does it again

August 2011

We’re pleased to announce that Triodent has just won five-star Reality awards for its V3 and Wave-Wedge products.  This latest five-star award means the V3 has now won the title for three years in a row.  When you add this to the numerous other awards that V3 has accumulated since its launch, it is clear that the V3 is by far the most highly regarded sectional matrix system in the world today.

Triodent has also recently won a DPS*- recommended 2011 award for WedgeGuard, the two-in-one interproximal shield.  WedgeGuard takes much of the risk and challenge out of cavity preparation, leading to better outcomes for the patient.

 (*Dental Product Shopper)

Preventing bite registration distortion

Clinical tips by Graeme Milicich, BDS

A simple tip for dentists doing direct CAD/CAM dentistry with the E4D and Cerec systems. When the bite registration is created using something like Tooth Mousse, there is a risk of the material being displaced in patients who have large tongues, or those who cannot control the movement of their tongue. This leads to the unset material being displaced by the tongue, creating a discrepancy in the accuracy of the occlusal record. This creates a potential for the occlusal surface of the CAD restoration to be designed to an incorrect opposing occlusal contour that was partially created by the tongue, leading to a distorted occlusal morphology in the crown. There is a very simple trick to prevent the tongue from distorting the bite record while it sets. Slide a small Dry Tip between the lower teeth and the tongue, inject the bite registration paste and get the patient to close into centric. The Dry Tip will slide up the palate and create a barrier between the tongue and the teeth, preventing the displacement of bite paste. Holding the gingival flap If you want to hold a surgical gingival flap and don't have a pair of rat-tooth forceps handy, use Triodent Pin-Tweezers – they'll work just as well.

Patient just opening after the Tooth Mousse has set. Note how the Dry Tip has prevented any displacement of the lingual portion of the bit registration paste.

Dentistry still plays most vital role in victim identification

Dr David Antunovic examines the lower jaw of a Phuket tsunami victim.	Morgue workers take a body from a refrigerated container at one of the makeshift morgues.

The total death toll from the tsunami was nearly 290,000, with more than 230,000 of those in Indonesia. Mainly because of the large number of Western tourists affected in Phuket, Thailand, the main international focus for victim identification was there, where the death toll was about 5400. In the largest humanitarian effort since World War II, 34 countries sent personnel.

There were stark similarities between the situation in Phuket and what unfolded in Haiti, among them:

• Thousands of bodies;
• Traumatized population;
• Sunshine, heat and humidity;
• Insects;
• Poverty and lack of equipment, especially refrigeration;
• Few hospitals;
• Lack of or destroyed infrastructure.

Within hours of the disaster in Phuket, makeshift outdoor morgues were set up in nearby temples. But in the hot and humid conditions, the bodies, many of them badly mutilated, quickly started to decompose. Dry ice was brought in to arrest decomposition but generally there was serious deterioration before many of the bodies could be transferred to refrigerated containers rushed to the island. Advanced decomposition was the single greatest problem the victim identification teams faced.

Basic post mortems were usually able to determine cause of death and the sex of the victim, as well as record secondary identifying details like tattoos, pacemakers, breast implants, surgical scars and missing digits. Much rested, however, on primary identifiers based on known ante mortem data: Dental records, DNA and fingerprints. Of the victims identified in Phuket, nearly 75% were traced through dental records, about 15% through fingerprints and 10% through a combination of the two. Just a fraction was identified through DNA.

Despite its reliability, DNA identification is still flawed in a large-scale disaster situation because of the time it takes to process samples and the cost of that process. On average it took 156 days to process DNA from Phuket victims, though it was much quicker, down to as little as two days, when an ante mortem specimen was immediately available. DNA identification was also hampered by the high cost – between $1500 and $4500 per victim.

Fewer than 1000 bodies in Phuket were never identified. Many of them were believed to be illegal immigrants from Myanmar, for whom there were no records.

Dr David Antunovic, secretary of the New Zealand Society of Forensic Dentistry, says that as the 21st century progresses, DNA is likely to come more to the fore as processes improve and perhaps also as fewer people need dental surgery, but in the meantime he cannot emphasise enough how valuable dental records, and particularly X-rays, are for victim identification. Dr Antunovic was in one of seven New Zealand Disaster Victim Identification (DVI) teams sent to work with the international effort in Phuket, which was managed by the Thai government and Interpol. Each New Zealand team of approximately 22 personnel included 18 forensic police officers, one a specialist photographer, as well as a pathologist and two or three dentists.

Dr Antunovic meets ex-President Bill Clinton in Phuket.

They processed between 10 and 12 bodies a day, taking one to two hours per body in a makeshift morgue with no air-conditioning.

"The number of victims took some getting used to - it was jaw-dropping," Dr Antunovic said of his first impressions in Phuket.

Distinguishing individual dentition features make for compelling evidence of identity but the process in Phuket left nothing to chance. Data collected was taken to the International Repatriation Center, where it was entered into the Plassdata DVI database. Dental records of potential victims were also entered into the system. Plassdata and software systems like it have considerably sped up the identification process in these sorts of crises. The ID program would run through the night and potential matches, or "hits", would be checked against any fingerprint or DNA evidence in the morning. Once a match was confirmed, it had to be verified by an identification committee. A death certificate was then printed and the body was able to be sent home.

Dr Antunovic's month-long mission allowed him to work alongside some of the world's leading forensic dentists, so it was also an invaluable educational experience, and the satisfaction of playing a significant part in returning victims to their loved ones was huge for everyone involved.

Anyone who has worked on victim identification knows the value of good training and preparedness for the situation in order not to be overwhelmed. This can even include humor at the right times, but there is one time when all jokes stop – the arrival of a child victim. "The whole place goes quiet," Dr Antunovic said. While he experienced no emotional after-effects from his mission, despite an at times "horrific" task, he said all of the New Zealanders who went were well supported by clinical psychologists on their return home.

He and his Kiwi colleagues were not been called upon for the Haiti disaster and so far have not been required for Japan, but he says that despite the difficult conditions these disasters inevitably involve, he wouldn't hesitate to go in a similar crisis, if asked to by his government.

"It is a great honor to represent your country in any capacity and I was enormously proud to wear our nation's silver fern while helping in Phuket," he said. "There was also a fantastic camaraderie among our team."

Ironically, Dr Antunovic's forensic skills were needed much closer to home when he was summoned to identify victims of the Christchurch earthquake in New Zealand's South Island in February this year.

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Mind the gap

June 2011 Simon McDonald, BDS

It is possible for a sectional matrix ring to "pinch" the matrix band during placement, thus opening a gap at the gingival margin. However, in the case of the V3 System, with careful placement and holding the matrix tab down with your finger, this is not usually a problem.  

Simon McDonald, BDS, is the founder and CEO of Triodent.

Read more about V3 Ring maintence tips here

Other blog entries:
http://www.triodent.com/getting-a-handle-on-indirect-restorations.html
http://www.triodent.com/pre-wedging-the-triodent-way.html
http://www.triodent.com/inventiveness-is-in-all-of-us.html

Triotray Pro makes a splash

May 2011

Triotray Pro, Triodent's latest innovation, was recently on show at CDA in Anaheim.

Here's Rudy Van Het Wout, General Manager Lab Division at Triodent, providing more information about the benefits of the new Triotray Pro – a dual-arch stainless steel tray designed with single-use mesh inserts.

Tricks of the trade

Dr Milicich came up with this cool trick using a Wave-Wedge and paper point. If the enthusiastic reaction to it on Dentaltown is anything to go by this little technique is well worth sharing. Where a rubber dam is not being used, a paper point placed on the underside of the wedge goes a long way to helping control crevicular exudate.  Made for each other! And what about this case below from Munich dentist Andreas Hugenberg - an example of "if at first you don't succeed, try Triodent again"?

The patient was suffering from horizontal bone loss. Because of the low gingiva height in relation to the cavity, Dr Hugenberg had to be imaginative when it came to the marginal seal. This is where Triodent wedges, with their hollow underside, were his salvation. First he placed a large (blue) V-Wedge then stacked, on the same side, two large (purple) Wave-Wedges. This gave him the tight seal he was looking for on the matrix with the wedges locked in place. The V3 Ring did the rest, as usual.

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The smile that sells

When dental industry marketers go looking for generic pictures of healthy teeth and captivating smiles, great minds often think alike and we all end up with the same image in our promotional material. One such image in the past couple of years has been that of a young woman with a radiant smile and a healthy set of gnashers. For a time she has been the face beaming from Triodent trade show banners. But we aren't alone; this lovely lady has smiled at us from other booths from Cologne to London, Dubai to LA. She catches our eye in brochures and magazines, catalogues and websites. Who is this woman? Does she know how marketable her face has been? Such is the world of stock photography these days, very few of us would have a clue who she is or where she's from. And she may have no idea of her anonymous "fame". Triodent is using her less, having moved on to other marketing ideas and images, but we thank you, ubiquitous but mysterious pretty woman.

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Cosmetic Dentistry with Direct Composites

Xcel Seminars & Triodent Present:

Be nice to the neighbors

April 2011 Simon McDonald, BDS

Restorative Dentistry with Dr Alan Atlas

There are key fundamental concepts that will determine the long term favorable outcome of esthetic restorations.  This course will demonstrate step by step concise restorative treatment planning guidelines that fulfill today's esthetic demands and integrates current restorative materials and protocols. Procedures and techniques for esthetic and functional success with adhesives, composites and ceramic materials will be reviewed based on the most current scientific evidence. Mastering Adhesion Dentistry and the Direct Posterior Esthetic Restoration Clinical prerequisites and the influence of material, clinician experience and the patient on long-term outcomes. Describe how the tooth location and preparation configuration determines the adhesive system, composite materials and placement technique utilized. Describe what factors most affect successful or failed results Describe the survival of restorations. Utilize CaMBRA and other preventive measures. Review the scientific analysis of adhesive systems. Describe treatment planning selection of adhesive systems and material choice for Class I,II and V restorations. Utilize research based application techniques for improving long term durability. Describe precise and consistent contacts utilizing optimum matrix systems. Review finishing and polishing materials and techniques. Review light curing options and protocols. Describe the controlled placement and delayed polymerization technique. Mastering the Indirect Anterior and Posterior Esthetic Restoration Utilize proper treatment planning concepts for anterior and posterior esthetic ceramic restorations. Describe scientific based indications and treatment planning strategies for selection and placement of post systems, luting cements and core materials. Preparation techniques for all ceramic crowns, inlays and onlays. Describe specific diamonds and rationale for perfect finish lines. Utilize predictable impression techniques. Describe simplified provisionalization for indirect restorations. Describe and compare conventional all-ceramic and CAD­CAM technologies. Describe differences between Lithium Disilicate and Zirconium systems (monolithic vs. layered ceramic) with specific indications for each. Laboratory considerations for all ceramic inlay, onlay and crowns. How to direct your dental laboratory to produce indirect restorations with better fitting margins. Describe cementation criteria. Utilize simple and predictable smile design methods. Dates: Wednesday, May 4, 2011 Time: 9 a.m to 5 p.m Location: The Atrium in West Orange, NJ (New Location) Tuition: $225 for Dentists, $135 for Auxiliaries/Residents Credits: 7 credit hours Course Code: 11D0222 Click here to book now!  http://bit.ly/fLcqIR Top of Page

New V3 Ring maintenance tips

April 2011 Simon McDonald

If you're already a V3 Ring user, you will be interested to know that we've updated our advice regarding ring maintenance.

The advice was quite conservative, suggesting dentists avoid ultrasonic cleaning on the grounds that some ultrasonic cleaners could cause discoloration of the ring tines. It turns out this was like using a sledge hammer to crack a nut: to avoid the mere possibility of what was only a cosmetic consequence anyway, general cleaning of the ring was made more difficult.

So, after giving this some thought we have decided to reinstate ultrasonic cleaning as a recommended method. This does mean that there is a risk of tine discoloration with some cleaning solutions but we believe that risk is small. Have a look at the image here of two V3 Rings. The ring on the left is new. The one on the right is approximately two years old and, despite very regular use, is still in very good condition. The ring has been given no special treatment. It is put in an ultrasonic cleaner with other materials and instruments, in the cleaning solution Cavicide.

If you're still concerned, there is another "solution": put the ring in a beaker of water/detergent and place that in the ultrasonic cleaner so that the ring does not come in contact with any chemicals.  

Here is the complete guide to ring maintenance:

Preventing contamination: 
A light smear of petroleum jelly on the V3 Ring tines will help prevent bonding agents sticking.

Removing bonding agents:
It is easier to scrape off bonding agents if the ring is soaked in alcohol for a few minutes first.

Pre-sterilization:
Rinse rings before ultrasonic cleaning. Most ultrasonic cleaning solutions will not affect the V3 Ring, although chemicals in some cleaners may cause tine discoloration. The discoloration is only cosmetic, but if that is a concern put the rings in a beaker with a water/detergent solution and place that in the ultrasonic cleaner to keep the rings away from the chemicals.

Sterilization:
Only steam-autoclave V3 Rings. Avoid leaving the rings in an autoclave overnight or for long periods, as this may cause staining from the autoclave itself. Do not use chemical sterilization techniques. Chemi-claving chemicals such as amines attack plastics. 

Retensioning:
Triodent forceps have built-in grooves for resetting V3 Rings. To help ensure you get the longest possible use from your rings:

• Avoid over-stretching. Open the ring only as far as needed to place it over the tooth.
• Try not to leave the ring open in the forceps for a long period of time.

To download the V3 Ring Instruction Guide, click here.

 
Simon McDonald, BDS, is the founder and CEO of Triodent.

Read other blog entries here:
http://www.triodent.com/getting-a-handle-on-indirect-restorations.html
http://www.triodent.com/pre-wedging-the-triodent-way.html
http://www.triodent.com/inventiveness-is-in-all-of-us.html

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Top 50 biggest game changers in dentistry

An imperfect paradise

April 2011

Many of us dream of going to a remote tropical island. New Zealand dentist Adam Doudney did that recently, though he didn't have a lot of time for sight-seeing. Instead he was on an aid mission, ministering to the acute dental needs of people on the island of Vava'u, in the South Pacific. This is his story:

The tiny though widespread Kingdom of Tonga is in the South Pacific, about 500 miles (approximately 800km) east of Fiji. Vava'u, the main island in a group of about 40, is a one-hour flight north of the Tongan capital, Nuku'alofa. Few people have heard of this beautiful island, and those who do tend to go there for the boating, scuba diving and deep sea fishing.

Despite its beauty, Vava'u has very Third World living conditions outside of a few tourist accommodations. It's because of those living conditions that I was there. I was part of a group of 25 volunteers from my church in Auckland, New Zealand.

Our mission was mainly to construct a building and paint much of the very run-down hospital in the main town of Neiafu. Meanwhile, a medical doctor, a midwife and I got straight to work treating the local people and helping train staff. We had also brought medical and dental supplies to boost stocks at the hospital.

The Vava'u people are lovely - Tonga isn't called the Friendly Isles for nothing - but their teeth are in a bad state. I haven't treated so many children for many years. I had some four-year-olds who needed most of their teeth removed. It seems to be a case of too much sugar in their diet - a Western influence - and a lack of oral health education and dental hygiene as a lifestyle priority.

The only dental facilities on Vava'u are in the hospital, with one local dentist and a therapist holding the fort for a total island population of about 15,500. They had two boxes of local anesthetic left, so I was just in time with the year's supply I had brought with me.

I asked what they did when they ran out: "We use topical cream and tell them it will hurt a bit!"

We treated one little four-year-old with Ketamine to put her to sleep. Not only did seven teeth need to come out, but I noticed above her upper front tooth what looked like a bit of bone poking through the gum. In fact it was the root tip; the crown was completely broken off and rotten. I was able to grip the root to wriggle the tooth loose. When I asked the caregiver later what might have happened, she seemed to remember the girl hitting the tooth "a long time ago". With this and other interesting cases, working on Vava'u was a matter of getting used to what equipment and materials were available and doing the best job possible.

The island pace is easy-going and it can take a while to get used to what that can sometimes mean. The hospital was only about 20 years old but it was basic and uncared for, and had lots of mangy dogs and cats running round. When some of the girls on the mission went to paint the hospital they wanted gloves because they didn't want to touch the walls with their bare hands. The local people didn't seem to mind and were very thankful for all the help we gave.

There was time for some highlights outside of the hospital experiences, like swimming with whales (this was better than I expected); feasts put on by the local church with lots of whole pigs on the table; and the fantastic people, of course.

Vava'u does have its problems but the people and its beauty make for a wonderful experience. Next time I would like us to take more health professionals and I would also take my family, to let them enjoy helping in such a needy place.

It’s All in a Days Work at Kid’s Dental - 14 CE Credits

March 2011

Triodent presents Dr Carla Cohn "It's All in a Days Work at Kid's Dental". This full day hands-on course will take you through a typical day at the office. Everyday scenarios will be explored from our unique risk assessment program and preventative program, restorative options for children, space maintenance, and of course behaviour management. Dr. Cohn will provide instruction and hands on opportunities in this session. Many of the "common" questions posed by parents will be addressed. Attendees will learn to: provide a thorough infant, toddler and child examination; use a variety of restorative techniques; fabricate a chair side space maintainer; manage behaviour effectively; answer parents’ concerns with confidence; incorporate a preventative program into their practice. For more information and to register contact: This e-mail address is being protected from spambots. You need JavaScript enabled to view it     Date:     April 1st Time: 8 A.M – 4 P.M Location: Embassy Suites Minneapolis Airport, 7901 34th Avenue South, Bloomington, MN   CE Credits:  14 Dr. Cohn graduated from the Faculty of Dentistry at the University of Manitoba in 1991.  Dr. Cohn has lectured nationally and internationally on risk assessment, prevention, behavior management and restorative treatment options. She speaks as a clinician who has observed first hand and dealt directly with everything presented in her courses. Dr. Cohn’s goals for the future are to help educate the community, dental professionals and medical professionals on prevention of tooth decay. Her hope is to help to create a new generation of cavity free children, one in which a child has never experienced an injection of local anesthetic or the dental drill. Dr. Cohn holds an appointments at the University of Manitoba, Faculty of Dentistry, and the Dean’s Advisory Board at the University of Manitoba. She has surgical privileges as a shareholder at Western Surgery Centre - a private surgical clinic. Dr. Cohn is a member of the following organizations: Canadian Dental Association, Manitoba Dental Association, Manitoba Dental Alumni Association, Winnipeg Dental Society, Women’s Dental Group, American Academy of Paediatric Dentistry and the Canadian Dental Institute. Top of Page

Dental Restoration with Dr Alan Atlas

March 2011

Join Dr Alan M. Altas for a CE Event on enhancing the esthetics and function of composite and ceramic restorations: treatment planning, the materials, techniques and procedures for optimal clinical success. This is a Triodent co-sponsored event with Allegany/Garrett Dental Society, Western Maryland AHEC and Allegany College of Maryland Center for Continuing Education. There are key fundamental concepts that will determine the long term favorable outcome of esthetic restorations. This course will demonstrate step-by-step concise restorative treatment planning guidelines that fulfill today's esthetic demands and integrates current restorative materials and protocols. Procedures and techniques for esthetic and functional success with adhesives, composites and ceramic materials will be reviewed based on the most current scientific evidence. Dental hygienists and assistants encouraged to attend, as adhesive application is within their scope of practice.  Date:     Friday, April 1st Time: 8 A.M – 12 NOON: MASTERING ADHESION DENTISTRY AND THE DIRECT POSTERIOR ESTHETIC RESTORATION LUNCH 12 NOON – 1 P.M. PROVIDED 1 – 4 PM: MASTERING THE INDIRECT ANTERIOR AND POSTERIOR ESTHETIC RESTORATION Location: Continuing Education Building 12-13-14, Allegany College of Maryland, Center for Continuing Education, 12401 Willowbrook Road, SE, Cumberland, MD 21502 Tuition: Allegany/Garrett Dental Society Members: $69 Member dental hygienists & assistants: $44 Non-member dentists: $119 Non-member dental hygienists & assistants: $59 Includes morning refreshments, lunch, contact hours and educational materials. Click here for your booking form. CONTINUING EDUCATION UNITS: The Western MD Area Health Education Center is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 4/1/2009 to 3/31/2012. This program qualifies for 6.5 contact hours of Academy of General Dentistry Continuing Education credit. Top of Page

Electric vs air-turbine dental handpieces

March 2011

Comparison of cutting efficiencies between electric and air-turbine dental handpieces

Reporting in the Journal of Prosthetic Dentistry (2010;103:101-107), authors Charlson Choi DDS, Carl F. Driscoll DMD and Elaine Romberg PhD said they tested one product of each style of handpiece on seven different dental materials. Their conclusion, within the limitations of the study, was that the electric handpiece was clearly more efficient. They observed that electric handpiece enthusiasts say their constant torque and lack of "stalling" are major benefits.

To read the full article, click here.

Predictable and Profitable Anterior and Posterior Esthetic Restorations

Whether you're in practice a long time or starting out, this course will give you take-home knowledge to use in your office on a daily basis. With the many changes in concepts and materials for restorative and esthetic procedures, it can sometimes feel overwhelming. Simplifying these concepts, demystifying the newer materials, and seeing how to ensure excellent predictable results will help make your practice easier, more profitable, and more enjoyable. Marketing concepts and materials to motivate patients to a higher level of care will also be discussed.   Upon course completion, you will:  Make restorative dentistry easier and more predictable. Have better case presentation skills leading to higher patient acceptance. Be able to utilize the concepts needed to create lifelike smiles. Understand how to solve esthetic challenges. Have had a GREAT day! Date:  Friday, April 8th Time: 9.00am to 4.00pm Location: Renaissance Hotel (Near Philadelphia Airport), 500 Stevens Drive Philadelphia, PA 19113  Tuition: Dentist $350, AM/PM Session – 6 Credits (L/P)                      Dental Team $95, AM Session Only - 3 Credits (L);                       Lunch not included Click here for your booking form. Temple University Kornberg School of Dentistry is an ADA CERP Recognized Provider   Top of Page