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Modern alternatives to traditional

treatment modalities

Dr. Todd Snyder, DDS, AAACD

Todd C. Snyder, DDS, AAACD

Private Practice in Laguna Niguel, California

Accredited, American Academy of Cosmetic Dentistry

Former Faculty, UCLA Center For Esthetic Dentistry

Faculty, Esthetic Professionals

Member of Catapult Elite

F.A.C.E. Graduate

CEO, Miles To Smiles®

CBDO, ContentActivator.com

CEO, DENToolz

Owner, Katalyst Motorsports, LLC

The goal of minimally invasive dentistry, or

microdentistry, is to conserve healthy tooth

structure. It focuses on prevention,

remineralization, and minimal dentist

intervention. Using scientific advances,

minimally invasive dentistry allows dentists to

perform the least amount of dentistry

needed while never removing more of the

tooth structure than is required to restore

teeth to their normal condition.

Minimally Invasive Dentistry? Diagnostic Tools

Equipment

Materials

Techniques

Business

Marketing/Advertising

Communication

Value

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Corporate dentistry is growing 15%

annually

Online reviews are ever increasing

Dental insurance companies are

systematically decreasing

reimbursements

Discretionary income has shrunk for

every segment of American society

except the top 10%.

• What does the patient see?

• Insurance dentist?

• Family dentist?

• Discount dentist?

• Who are you?

One can place a number of restorations

or fillings and yet not treat the underlying

disease

The bacteria remain in the plaque on

the teeth, capable of creating new

areas of tooth decay

We need to shift from a surgical

approach to disease management and

prevention

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Designed for dentistry › 8 shooting modes

› Dental cropping range and cropping grid lines

› Water and chemical proof – Essential for infection control

› Durable rugged Exterior

Special Benefits › Compatible with the Eye-Fi X2

card – Immediately upload images onto PC, iPad, Tablet or Smartphone

› SureFile Photo management software – Keeps record of patient information

High quality images › 12 Megapixels

› Built in dual flash (inside & outside flash)

› Large LCD touchscreen

› Excellent depth of field range

› Infrared, UV and anti-reflection filters

User Friendly › Fast autofocusing & anti-shake

capabilities

› Easy to use – no photography skills required

› Light weight/can be held with one hand – weighs only 1lb

Chose the magnification ratio/range by rotating the dial key

Icons to help you determine and select the range properly

Edit functions are ideal for patient education

Under the Menu key you can: › Draw on images to

show areas of focus

› Rotate the image

› Protect the image against being deleted

Similar to “Low-glare” mode but with lower light intensity

Ideal distance 5.5 in

Patient will be sitting in chair with cheek retractors – want to be able to capture before and after's of all teeth whitened

Reduces glare and emphasizes the surface texture and shade

Upper arch

whitened

Lower arch not

whitened

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Gingival shades removed › Improves visual

acuity

› Excellent case selling tool

› Ideal distance 5.5 in

› Patient may have cheek retractors in place – could be used on a model at the bench in a laboratory

Oral Cancer Detection Systems: Helps potentially

save the lives of patients by locating oral cancer in

its earliest stages allowing for early treatment.

Head & Neck Exam

Conduct a proper extra-

oral and intra-oral head &

neck exam before doing

your VELscope

examination.

Only 14% of patients in the United States over age 40

claim to have

Ever Been Screened for Oral Cancer

Horowitz AM, Drury TF, Goodman HS, Yellowitz JA

Oral Pharyngeal Cancer Prevention and Early Detection Dentists' Opinions and Practices

J Am Dent Assoc (JADA) April 2000;131(4):453-62

New Cases of Cervical

Cancer Diagnosed in 2008 in the United States

New Cases of Oral Cancer

Diagnosed each year in the United States

Deaths each year from Oral Cancer

Deaths every hour from

Oral Cancer

American Cancer Society. Cancer Facts and Figure 2008. Atlanta: American Cancer Society, 2008

11,150

36,540

7,880

1

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When discovered in the late stages

The five year survival rate is only 30%

When discovered in the early stages

The five year survival rate is 80-90%

Late Diagnosis Leads to High Death Rate

American Cancer Society. Cancer Facts and Figure 2008. Atlanta: American Cancer Society, 2008 44

Lichen Planus

Lichenoid mucositis

Squamous Papillomas

Candidiasis

Viral and bacterial infections

Inflammation from a variety of causes

Salivary gland tumors

Early

Dysplasia

Moderate

Dysplasia

Severe

Dysplasia

Carcinoma-In-Situ

(CIS)

Invasive

Squamous Cell

Carcinoma

(OSCC)

Potentially Malignant Disease Stages

Oral Cancer … o Is the only cancer that the mortality rate has increased over the last 30 years

o Accounts for 2-4% of all cancers and only 50% of patients are still alive 5 years after diagnosis

o Has demonstrated a 60% increase in adults under 40; 25% do not fit the high profile risk (Women that do not drink or smoke)

EARLY DETECTION IS THE KEY VELscope will assist with

discovering mucosal changes

down to the basement membrane

Before they are visible.

67% of all oral cancer is currently

discovered beyond this stage.

(Stage II)

Left palate : low-grade

mucoepidermoid carcinoma

{Dad’s} Moderate Dysplasia

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SCC

New York University, Dept of Oral Medicine Images courtesy of the British Columbia Oral Cancer Prevention Program

Dysplasia & Oral Cancer

51 Copyright ® 2002-2007 by Oral Health Study, Oral Oncology/Dentistry, BCCA

Clinical Appearance (Visible White Light)

Loss of Fluorescence

Carcinoma-In-Situ

(CIS)

Patient visualization

Documentation

Email specialist

Discussion

Surgical

assistance

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Adjunctive Mucosal Screening

An adjunctive pre-diagnostic test that aids in

detection of mucosal abnormalities including

pre-malignant and malignant lesions

Not to include cytology or biopsy.

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Offers a different type of service and

care

› Preventive Model

› Revenue Creator

› Business Differentiator

› Marketing Platform

Adjunct Products SALIVA-CHECK MUTANS, from GC America, tests for a very specific bacteria known as streptococcus mutans.

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SALIVA-CHECK BUFFER, from GC America, tests for salivary flow and buffering capacity Ivoclar CRT

Ivoclar Vivadent’s CRT

• Tests for S. mutans and Lactobacilli

• Caries Risk Test seeks to quantify the levels of bacteria as well as the buffer and demineralization strength of saliva, in order to give an assessment of risk of susceptibility to caries.

• Lactobacilli are fluoride resistant

Custom Brochures For Practice

PROPHYflex 3®

Clean the teeth prior to diagnosis

• DENTSPLY – Prophy-Jet

– Cavitron® Jet Plus™

• Emery Dental – STAINBUSTER®Inc

• KaVo – PROPHYflex 3

• Parkell – The Prophy Pencil

• Others???

• Abrasive

– sodium bicarbonate

– aluminum trihydroxide

– glycine

Air Slurry Polishers

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Air-Flow (EMS) Biofilm Removal

Satelec/ACTEON:

Biofilm Removal

Satelec/ACTEON: Biofilm Removal

Satelec/ACTEON: Create Healthy Biofilms

Included procedure or additional fee? No CDT code.

EvoraPro

• Streptococcus oralis (S.oralis KJ3), Streptococcus uberis (S. uberis KJ2), and Streptococcus rattus (S. rattus JH145) are naturally-occurring oral bacteria that can act as antagonists to reduce or replace harmful oral bacteria.

• S. rattus JH145 specifically targets the reduction of acidogenic S. mutans in the oral cavity.

Other Brands Available

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Shade Evaluation

Immediate Call to Action Motivator Reduced Fee When Done Same Day

Zoom! QuickPro

• Research shows that 8 out of 10 Americans are concerned about yellowing teeth, but only 2 of 10 are using a professional whitening product, the company said in a presentation.

• 20% Hydrogen peroxide

• 4 shades, 5 minutes, wipe at 30

• Low to no sensitivity

• Cost $45. ($100-$125/pt)

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Laser and Non-Invasive Decay Detection: Reliable and enhanced early

detection of cavitations and decay to allow for early restoration and tooth

preservation. Magnification: Allows for earlier detection of symptoms, less invasive

treatment and, preservation of dental hard and soft tissues.

Digital Radiography: Instant and enhanced images to aid in diagnosis,

while exposing patients to less radiation, without harmful chemicals.

Are you still diagnosing with this??

25%-50%

accuracy

Radiographic diagnostics?

Is it thru conventional radiographic analysis? Approximately 25% demineralization must occur to see a cavity on a

conventional radiograph. Equates to 40-60% demineralization on the

tooth surface. Radiographs miss 70-80% of occlusal cavities. Digital radiographs provide the ability to manipulate image size and

appearance.

67% accuracy

Thru intraoral photographic interpretation?

How do you diagnose decay?? KAVO DIAGNOdent

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Spectra – Air Techniques

CarieScan Pro Dexis CariVu or KAVO Dia Lux 2300L Dexis CariVu

Can’t track or measure cavity growth

20th Century Tooth Decay Diagnostics

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X-Rays & Visual Exam - Tools from the Last Century

Visual exam only sees the tooth surface not what is happening beneath it:

– Tooth decay begins below the enamel surface and only appears as a white spot

– As the decay grows one only sees a white or brown spot until a hole develops

Explorers or probes are not recommended for examining grooves & pits

– They can break the fragile enamel crystal structure

– They can introduce and drive bacteria deeper into the tooth

– A sticky groove does not indicate tooth decay

X-Rays have significant limitations;

– Can only find decay on the sides of teeth once the lesion has grown to involve ½ the

thickness of the enamel shell

– Can’t find decay on the biting surface until the cavity is very large

– Designed for an era when decay was more aggressive and Dentistry was advocating

a more aggressive treatment approach – “extension for prevention”. Larger fillings

prevented decay from occurring again on that surface.

X-Rays provide an average two dimensional view of a three dimensional

hole so they cannot measure lesion size or depth

Crystal Structure Diagnostics

The Canary System Detects Cracks & Cavities not Visible on X-rays

+ Around & beneath intact margins of fillings & crowns

+ Under sealants (including opaque sealants)

+ On proximal surfaces

+ On smooth surfaces, pits & grooves

+ Around orthodontic brackets

Measures tooth structure breakdown and allows for early treatment

+ Restore conservatively

+ Remineralize back to health

+ Seal with confidence

Research claims validated by 60+ papers

15+ case reports & 2 FDA CFR 21 clinical trials

Canary Solves Current Limitations

Accurate, repeatable, and reliable supported with multiple

sensitivity and specificity studies

Detection of decay on ALL tooth surfaces including

– Occlusal pits and fissures

– Interproximal regions

– Root surfaces

– Caries around and the margins of restorations

– Caries beneath intact margins of amalgam and composite fillings

– Caries under opaque dental sealants

– Caries up to 5 mm below the surface & lesions as small as 50

microns

No significant tooth prep required

Over 60 peer reviewed articles & 2 clinical trials

The Science Behind The Canary System

• Originally created for erosion and remin/demin but adapted to caries in 2008 to appeal to market.

• Pulses (2 Hz) of laser light hit the tooth surface.

• Tooth glows (Luminescence, LUM) and releases heat (Photo-Thermal Radiometry, PTR).

• Defective tooth crystal structure (enamel) affects the retained heat and luminescence signatures.

Energy Conversion Technology Temperature

increase < 1oC

not harmful

• Detected signals reflect the tooth’s condition.

• Detects 50 micron lesion up to 5 mm below the surface.

The Canary algorithm is the core function that takes PTR-LUM

amplitudes and phases and converts to a numerical scale:

• The strength of the converted heat

signal (PTR Amplitude)

• Time delay of the converted heat

to reach the surface (PTR Phase)

• The strength of the emitted

luminescence (LUM Amplitude)

• Time delay of the emitted

luminescence (LUM Phase)

Canary

Number

The Canary Number

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Canary Number Mapping

Canary Number

Camera

Image

with Grid

Nine Section Grid

•Allows easy identification

of the scanning area.

•Canary Number for each

section is stored in

computer memory.

•Squares are colour-

coded for status of decay.

Canary Patient Report

Customized patient report

on dental practice letterhead

Available on Canary Cloud

Clear simple indication of

problem areas

Patients can track their

progress

Engages patients in their

oral health care

Medical model for treatment

of tooth decay

Sensitivity & Specificity Study:

University of Texas October 2012

Study Design

20 tooth surfaces selected with range of clinical conditions from healthy to early caries

Visual ranking by 2 dentists

Canary Scan

DIAGNODent

Polarized Light Microscopy used as the gold standard to confirm presence of lesion & depth in that section

Caries Detection Method Canary System DIAGNODent

Sensitivity 100% 18%

Specificity 100% 100%

Spearman Correlation with Lesion Depth

.84 .21

Canary is Superior to X-Rays for Proximal Caries Detection

Jan J et al. Caries Res 2014;48:384–450 DOI: 10.1159/000360836

Objective:

To compare the accuracy of The Canary System, ICDAS-II and bitewing radiographs in detecting proximal caries

in vitro.

Methods:

ICDAS-II (Direct Visual Examination): Blinded examiners ranked 100 proximal surfaces using ICDAS-II by

direct visual examination of the surfaces

Manikin mouth models: The teeth were then set in manikin mouth models, creating contacting proximal

surfaces that very closely resemble in vivo situation.

Histological validation: All surfaces were examined by polarizing-light microscopy to confirm the presence

and depth of the caries lesions.

Conclusion: • BW radiographs could only identify 26.7% of the lesions which questions its ability to be the

gold standard

• The Canary System is the only method examined with both high sensitivity and high specificity.

• The Canary System is more sensitive than bitewing radiographs in detecting interproximal

caries

What fluoresces in fluorescent-based technologies?

Bacterial porphyrins (bacterial breakdown product),

Stain,

Tartar,

Food debris

All fluoresce under the wavelengths used in most caries detection devices, whether or not caries is present.

Lussi A , Imwinkelried S, Pitts N, Longbottom C, Reich E. Performance and reproducibility of a laser fluorescence system for

detection of occlusal caries in vitro. Caries Res 1999;33(4),261–266.

Lussi A, Hibst R, Paulus R . DIAGNOdent: an optical method for caries detection. J Dent Res 2004;83C, C80–83.

Verdonschot E H, van der Veen M H. Lasers in dentistry 2. Diagnosis of dental caries with lasers. Ned Tijdschr Tandheelkd

2002;109(4), 122–126.

Konig K, Flemming G, Hibst R. Laser-induced autofluorescence spectroscopy of dental caries. Cell Mol Biol (Noisy-le-grand)

1998;44(8), 1293–1300.

Alwas-Danowska HM, Plasschaert AJ, Suliborski S, Verdonschot EH. Reliability and validity issues of laser fluorescence

measurements in occlusal caries diagnosis. J Dent 2002;30(4):129-34.

Rechmann P, Rechmann BM, Featherstone JD. Caries detection using light-based diagnostic tools. Compend Contin Educ Dent.

2012;33(8):582-4, 586, 588-93; quiz 594, 596.

Fluorescent Technologies

Do Patients Understand and

Believe Your Diagnosis?

The Canary System Provides the Solution

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Case Study 2: Pain Mandibular Right Posterior Quadrant

No pathology on x-ray. Canary Scan

Revealed Pathology on Mesial & Distal

Marginal Ridge and Caries around the

Lingual Margin of the Amalgam

97 58 36

Case 2: Removal of Amalgam Confirms Caries

97

58 36 Crack on mesial and distal

marginal ridges with caries.

Caries around the lingual

margin

Case 3: Crack on Mesial Marginal Ridge

Pain on Mesial aspect of bicuspid. No crack

visible. Canary Scan of 88 indicates crack is

present

Case 4: Interproximal Caries Detection

Bitewing radiograph did not detect caries.

Caries located on buccal aspect of the contact area

Demineralized enamel

Caries Detection Method

The Canary System

DIAGNOdent

Sensitivity 83% 64%

Specificity 79% 46%

• Canary Numbers >20 when scanning sealants (3M™ ESPE™ Clinpro™ Sealant) placed over pit & fissure caries.

• The caries detection ability of the Canary System was not affected by sealant & was more accurate than DIAGNOdent.

Sensitivities and specificities for pit & fissure caries detection after sealant placement.

Canary Number 66

Canary Number 37 Caries into dentin

Post-sealant

Pre-sealant

Cross-section

Sealant

Detection of Caries Beneath Sealants

1. Canary is linked with crystal structure

of the tooth, not bacteria

2. The Canary software designed to

monitor and track patient data.

3. The System also generates reports for

the dentist & patient

4. Cloud based technology

5. The Canary System is integrated

with an intraoral camera.

6. Teeth do not need to be dried or

polished

7. All claims are based upon strong

solid scientific evidence – 60+ peer

reviewed publications

Canary Competitive Advantages

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The Canary System Has the Most Critical Features

PRODUCT Canary System DIAGNOdent Spectra SoproLife CariVu

MANUFACTURER

Detects caries and cracks on all tooth surfaces

Detects caries under sealants

Detects sub-surface caries

Detects and measures tooth structure beneath white spots

Detects caries around margins of restorations (amalgam and composite)

Detects caries around crown margins

Quantifies changes in lesion size

Monitors effectiveness of remineralization agents

*Comparison information is based on published studies and QDT data

Building a Remineralization /

Prevention Program

The Canary System Allows You to Monitor Changes in

Lesions as they Respond to Remineralization

129

Is this Lesion Growing or Re-Crystalizing?

December 2012 January 2014

• Stained hardened buccal surface of a mandibular bicuspid

• No radiographic or visual evidence of change

• Is remineralization working?

• Is the lesion stable?

• What do we tell our patients? 130

Is this Lesion Growing or Re-Crystalizing?

December 2012 January 2014

• Canary Scan measures the changes in crystal structure

• Remineralization is working with the existing home regime

132

Tracking Caries Clinical Case:

Female Age 36

Grew up in a fluoridated community

Diet

– 2 or more between meal snacks per day

– 1 can of pop or sport drink per day

Good Oral Hygiene

Lesions on buccal surfaces of molars developed post-ortho.

DMFT 35% 4 filled teeth 4 teeth with ICDAS 1 -3 lesions

DMFS 12.5% 5 filled surfaces

Operative Interventions in the last 6 years

– 5 composite restorations placed in 2008

– Replaced one restoration in 2014

Risk of developing caries?

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Remineralization of a Brown Spot Lesion

3M ESPE Vanish Fluoride Varnish & Clinpro 5000 Tooth Paste

Initial

0

20

40

60

80

1 3 7 9 12 17 20 30 34 36 41 42

Canary Number

Canary

Number

Month

42 Months

Integration Remineralization Therapy into

Clinical Practice

Recall or Specific Exam •Identify White Spots •Measure with Canary •Risk Assessment •Apply Remin Therapy •Oral Hygiene Instruction •Provide Home Therapy

Reassess 6 Months •Assess lesion •Measure with Canary •Apply Remin therapy •Dispense Home therapy

Reassess 9 Months •Assess Lesion •Measure with Canary •Apply Remin Therapy •Dispense Home Therapy

Reassess 3 Months

• Assess Lesions

• Measure with Canary

• Apply Remin Therapy

• Dispense Home Therapy

Canary Patient Report – Medical Model for

Management of Caries

Engages patients in their oral

health care

Patients can track their

progress

Numbers & Colours highlight

areas of concern

Available on The Canary

Cloud

ROI for the Dental Practice

Strong ROI with Five Separate Revenue Streams

5 Revenue Streams for Dental Practices

• $96,000/yr.

• Detecting Restorations not found Visually, with X-Rays or other systems. Revenue from detection of just 2 lesions per day

Restorative

• $28,800/yr.

• Increased sealant placement on 80 teeth (20 patients) / month Sealant Program

• $28,800/yr.

• Marketing Canary to attract at least 4 new patients /month New Patients

• $42,000/yr.

• From ½ hour scan exams on < 40% of patients in the office & then moving 25% of these patients into a preventive program

Build a Prevention Program

• Depending upon the jurisdiction, home & office preventive products can be sold at a profit. (no estimated dollar value)

Remineralization Program

Canary System can be paid for in one month based on $14,995 price. Based upon retail price of $14,995.00

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ROI: Dr. Nagelberg Philadelphia Pennsylvania

“The Canary will pay for itself in approx. 8-9

months…improves our ability to identify & treat

previously undetectable lesions.”

Additional revenue: $4,160 in 8 days

15 patients were scanned

– 40 lesions were identified that were not seen visually

or with x-rays

Dr. Nagelberg • Family dentist in Philadelphia • International lecturer • Dental Economics & RDH magazines

ROI: Dr. John Leitner Grand Haven Michigan

“In this office, The Canary can be fully paid

off in 10 months, after which it will generate

approximately $50,000 in new revenue

annually.”

42 patients were scanned during their

hygiene / recare appointments

Scanning time per patient was < 5 minutes

26 lesions were identified among 22 patients

that were not seen visually or with x-rays

Dr. Leitner • Family dentist in Grand Haven • Clinical Consultant with Dental Advisor

ROI: Dr. Bruce Silver Burlington New Jersey

With conservative treatment, The Canary System could

be paid-off within ~7 months if purchased ($15,995).

40 patients were scanned during their hygiene /

recare appointment

Scanning time per patient was < 5 minutes

48 procedures were billed for lesions that were not

identified visually or with x-rays

Additional gross revenue generated $11,331

or $283 per treated patient or $539 per working day

Dr. Bruce Silver Dr. Silver is a family dentist with advanced education In many aspects of dentistry including laser periodontal therapy, surgicall and restorative implant dentistry.

143

Return on Investment: Restorative Dentistry

Code Description

D1351 Sealant – per tooth

D2140 One surface amalgam

D2150 Two surface amalgam

D2160 Three surface amalgam

D2330 One surface, anterior

D2331 Two surface anterior composite

D2391 One surface, posterior

D2392 Two surface, posterior

D2393 Three surfaces, posterior

D2394 Four or more surfaces, posterior

D2950 Core buildup, including any pins

D2740 Porcelain Crown

The Canary System found caries

which other systems could not -

including radiographs.

Over the study period, each practice

generated, on average an additional

$7,400 in gross revenue.

Each practice generated an additional

$288 per treated patient.

On average, 60% (77/131) of patients

scanned with The Canary System

required restorative treatment.

If leased (~$295/month), payments

would be covered by finding just 2

lesions on posterior teeth requiring

multi-surface restorations.

Restorative Procedures

Integration into Clinical Practice

Recall Examination Remineralization Program Canary Examination

Part of Recall / Recare Appointment

Specific Appointment 15 minutes

Specific Examination Book 45 min – 1 Hour

Scan a few suspect surfaces using Quick Scan Record findings in chart

Use Detailed Scan Scan Surfaces for monitoring Generate Report Apply Fluoride Varnish

Scan all suspect areas Pits, Fissures Around restoration margins White Spots Brown Spots

Included in Recall Exam Use Remin or CAMBRA code Specific Exam Code

Provided by Hygiene Team Hygienist or Dental Assistant Hygienist or Dental Assistant

Patient Message: New System for Accurately Detecting Tooth Decay

Patient Message: Monitoring Remineralization & preventing placement of fillings

Patient Message: Number of areas of concern that we need to examine that can’t be seen on x-ray

Billing Codes US

Billing Code Descriptors ADA Billing Code

Limited Examination D0120

Specific Examination D0140

Application of Fluoride Varnish D1206

Oral Hygiene Instruction D1330

CAMBRA D0601, D0602, D0603

Intra-Oral Photographs D0350

Nutritional Counseling D1310

Treatment of Dentin Hypersensitivity D9910

Application of desensitizing resin for cervical and/or root surface, per tooth.

D9911

Unspecified Procedure by Report. Not covered unless report documentation support needs & there is no other acceptable code

D1999

Office Visit for Observation (during regularly scheduled hours) – no other services performed

D9430

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Testimonials

Dr. Bruce Silver (Burlington, New Jersey) “The Canary System has been another great technology added to my practice! The ability to track decay along the margins of old restorations that can't be detected by radiographs has been a boon to my production, both in re-mineralization products and replacement of restorations. It is

most remarkable to track the decay, then open the tooth and notice the decay patterns matching the Canary scores! I'm amazed every time I see this!”

Dr. Sarah Poteet (Dallas, Texas)

“We have been using the Canary for several months and I love the ease of use and accuracy

of the system. The Canary allows us to identify early structural changes in teeth. My hygienist is comfortable using it and explaining to patients the findings before I come into the room. My patients are impressed with our new technology and appreciate the extra attention to their care.”

The Solution

“While there have been numerous advances in the dental

industry over the years, I have not found anything in the

area of diagnostic devices that is as revolutionary as The

Canary System.

This highly effective diagnostic tool allows you to find

pathology sooner so that it might be reversed or treated

earlier by less invasive forms of dentistry.

Patient engagement and involvement within my practice is

at an all-time high.”

Dr. Todd Snyder Dentalcompare April 2014

TOPICAL THERAPIES

More caries resistant Remineralization Desensitization

You cannot treat what you cannot measure.

Apply twice a day, AM & PM

After brushing and flossing

Pea size amount on finger and rub it on the teeth › You can floss it between them as well

Rub the material around all the teeth with tongue

Leave on the teeth for approximately 3 minutes

Spit out excess but do not rinse or drink for 30 minutes.

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Can be done once every 4 weeks

Minimally Invasive Cosmetic Treatment

Etch for 1-2 minutes

Apply MIPaste Plus for 10 minutes

Patient applies at home 2x/day

Minimally Invasive Cosmetic Treatment

Etch for 1-2 minutes

Apply MIPaste Plus for 10 minutes

Patient applies at home 2x/day

EnamelonNow with Stannous Fluoride

Optimized with ACP Technology

Premier’s New Enamelon®

Enamelon® • Stabilized SnF2 Formula

• ACP Technology

• Single tube - Anhydrous

• Substantivity Ingredients – Ultramulsion®

– Gantrez

• Refreshing Taste

OLD Enamelon • NaF Formula

• ACP Technology

• Dual tube - Aqueous

• Refreshing Taste

Premier Dental Presents:

Stabilized SnF2 (970 ppm) Preventive Treatment Gel

designed to deliver ACP

1. Helps Prevent Caries

2. Helps Prevent Gingivitis

3. Treats Sensitivity

1. Independent Testing Data: Therametric Technologies, Inc. 2014

2. Negative Control (Water) recorded an uptake of 8 ppm

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1. Independent Testing Data: Therametric Technologies, Inc. 2014

2. Negative Control (Water) recorded an increase in solubility (-5.45%)

Enamelon® Toothpaste

• 1150 ppm SnF2 Toothpaste

delivering ACP

• Low abrasive (RDA 39)

• Saliva-stimulating

• No SLS

• No gluten, dyes or dairy-based

ingredients

• Refreshing clean mint flavor

Reduced Orifice for Easy Dose Control

• Saves waste

• Saves money

• Controlled dose delivery

• After whitening in tray

MI VARNISH™ WITH RECALDENT™ (CPP-ACP)

Bioavailable calcium, phosphate and fluoride

for an enhanced varnish treatment

MI Varnish 5% Sodium Fluoride (22,600 ppm) ・ 2% RECALDENT™ (CPP-ACP)

Remains on the tooth surface longer than conventional fluoride varnishes.

Enhances acid resistance of enamel and promotes calcium and phosphate enriched

saliva.

Flows easily into interproximal areas, due to its viscosity.

Non-clumping white natural translucent shade.

Excellent retention – stays on longer than the leading varnishes.

Unique unit dose, easier to open, easy to access varnish, generous volume per unit

dose, enough for a full adult dentition.

Does not immediately clump upon exposure to

saliva allowing ease of use and longer working time.

Greater fluoride contact time and increased

calcium and phosphate bioavailability than gels,

foams and varnishes.

Stands out on tray, easy to identify - brightly colored

.50ml uni-dose

Why Choose MI Varnish?

MI Varnish with RECALDENT™

(CPP-ACP) reduces sensitivity

by penetrating into the dentin to seal the dentinal tubules

and effectively block out

external stimuli that can cause

sensitivity.

MI Varnish enables the repair and strengthening of enamel.

The result is a strong but safe

fluoride varnish that can be

used anywhere in the mouth,

including the marginal areas of crowns and veneers

SEM OBSERVATION

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3M Clinpro 5000 with TCP

Premier Enamel Pro with fluoride and ACP

Remin Pro (Voco)

Sensodyne ProNamel

Arm & Hammer’s Enamel Care

Arm & Hammer Complete Care w/ Enamel Strengthening

Colgate Sensitive pro relief

Fluoride Varnishes

Glass Ionomers

Acidulated phosphate fluoride (ApF)

Non-acidic sodium fluoride (pHn)

• No tooth reduction.

• Adhesive and mechanical retention

• Radiolucent

Resin Infusion-ICON Resin Infusion-ICON

How will you diagnose this?

How will you treat this?

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• Traditional handpiece

-Diamond vs. Carbide?

• Fissurotomy burs • Slow speed burs

-Ceramic vs. Polymer? • Air/Helium abrasion • Water abrasion • Lasers • Sonic Preparation

Air Abrasion: Allows for better detection of carious lesions, improved

bonding of sealants and restorations, and tooth structure preservation

with decreased need for chemical anesthesia.

Treat upon diagnosis

Treat without anesthesia Treat multiple quadrants in one visit

Remove tough stains Diagnose lesions in darkened grooves-enhance

DIAGNOdent’s accuracy

Decrease microfracturing of enamel seen with a bur Prepping for pit & fissure restoration Prepping incipient lesions and minor Class I-IV

Find root canal openings Debriding bur preps for best esthetics & bonds

Enhance bond to dentin & enamel Repair intraoral porcelain fractures Etches all metals, composites, amalgam, orthodontic

brackets & bands for maximum bond strength

CRYSTALMARK Dental Systems

Air abrasion using Helium -cuts faster -utilizes less powder

-less mess -deeper preparations

-less discomfort -less air pressure

Millions of treatments have been

performed over years with out injection.

Some patients report no discomfort at all

Most report some discomfort, but less

than the injection.

< 5% will request an injection.

Why doesn't it hurt?

No one knows for sure but it is believed to be due to the lack of vibration & heat that is imparted by a bur. Tubules are also closed by AA.

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Best choice for Pit & Fissure or treating “watches”

0.015” tip prep is about ½ the diameter of the smallest bur or “fissure burs”. The volume of tooth reduced is dramatically less! Conservatively treated “watches” often disclose decay along the DEJ not seen on radiographs.

Carious material in Pits & Fissures, is fully removed in seconds. Bond for sealants is enhanced.

188

Masoumeh Moslemi, DDS,MSc Leila Erfanparast, DDS. MSc; Reza Fekrazad,DDS, MSc; Nike

Tadayon, DDS,MSc; Hamed Dadjo,DDS; Mohammad Mostafa; Zahra Khalili The effect of

Er,Cr:YSGG laser and air abrasion on shear bond strength of a fissure sealant to enamel. JADA,

Vol141 February 2010 (157-161)

Unmatched in its ability to increase surface area on a variety of materials

Increase surface area up to 400%

Improves bond strengths by 400%

Typical Etching: Diamond bur abrasion on alloy

MicroEtcher abrasion on alloy

45o 80o 90o

120o

• Adjustable pressure and

powder flow

• Uses 0.015 and 0.019 tips

• Uses 27 micron Aluminum Oxide

• Tips are autoclavable

Limited Pit & fissure prep

Etching restorations for bonding

Intraoral porcelain repair

Removing cement for

recementing

Limited stain removal

Medical grade

alpha alumina

Precisely sized and

dessicated

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Fissurotomy Burs (SS White)

Micro Prep diamonds (Komet) Sonicys (Kavo) & Sonic Prep (Komet)

Air Abrasion or Helium Abrasion (Crystal Mark)

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This along with air abrasion offer some

of the most ideal surfaces to bond to

Starts off by marking occlusion & selecting color

Anesthetize Preparation Caries indicator Materials Mark occlusion again

at end with different color

What Is Your First Step??

Parkell Accufilm II is 21µm

for dentistry

Great Lakes articulating

ribbon 12µm

8µm Almore Shimstock foil

8µm articulating paper??

What do you use…..

.…and why?

8µm articulating paper

Available in blue

and red also

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• Small load bearing

• Deep, narrow preps

• Voids & air inclusion concerns

• Increased longevity due to high filler content

• Lining proximal boxes

• Low or high viscosity

• Fluoride releasing

• Radiopacity

• Highly polishable

Flowables Access, viscosity, small areas

Deep, narrow preps

Lots of enamel

Flowables

• Voco (Grandio SO HF, Xtra Base)

• Kerr (Revolution, Premise, Vertise)

• Ivoclar (Tetric Flow)

• Heraeus (Venus Diamond Flow, Bulk Fill)

• SDI (Wave MV, HV)

• Shofu (Beautiful Flow Plus-Zero & Low Flow)

• G.C. America (G-aenial Universal Flo)

• Dentsply (SureFil SDR, EsthetX Flow)

• Kuraray (Clearfil Majesty ES Flow)

• Tokuyama (Estelite Flow Quick)

• 3M (Filtek Supreme Flow Plus)

Flowables

• Operates like a low-flow flowable, and performs like a

restorative

• New polymer chemistry formulated with DuPont • Innovative delivery system

• Easy access, handling and placement

• Highly thixotropic, with an excellent flow

• Recommended for Class I, II, III, IV and V Restorations

• Higher strength than the leading flowables and conventional composites

• Higher wear resistance than the leading flowables and

conventional composites

• Higher gloss retention than the leading flowables and

conventional composites • Contains 15 shades in three opacities

• bis-GMA free

• G.C. America (G-aenial Universal Flo)

• High compressive & flexural strengths

• Good modulus of elasiticity

• Low Shrinkage

• Universal Restorative Material

• Amazing viscosities

• High Strength, Wear resistance

& polish/gloss

• Surface Pre-Reacted Glass (S-

PRG) ionomer technology

proven by independent clinical

trials as published in JADA*

SHOFU

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Flowable Medium Size Defects