Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

What you never knew about tooth sensitivity…and how to effectively treat it!

Categories:

Author(s):

Course Type: elearning

Target Audience: Dental Assistants, Dental Students, Dentists

  

View Video

Educational Objectives

After completing this webinar, participants will understand:

» The two causes of / how to treat / and how to prevent / dentinal hypersensitivity found with:
o General sensitivity
o Exposed root sensitivity
o Post restorative (including crowns) sensitivity
o Hygiene and post periodontal surgery
o Teeth whitening

» Why some teeth end up requiring endodontic therapy at some point after new crowns and other restorations – and how to prevent that from ever happening again.

» How various desensitizers work, and what to look for in the ideal desensitizer.

» Why some patients are more or less susceptible to sensitivity.

» Why teeth whitening sensitivity occurs, and how to prevent it.

» What causes whitening zingers and how to prevent them.

Abstract

If you’re a practicing dentist, sensitivity is a thorn in your side…period. We’re all frustrated with sensitivity. I’m talking about chronic sensitivity (and unhappy patients), sometimes ending up in endodontic therapy, after new crowns are placed. And sensitivity after direct restorations. Sensitivity during and after hygiene procedures – and acute sensitivity after periodontal treatment, including surgery.

What about patients with super-sensitive exposed roots due to gingival recession? And of course there are simply those patients who constantly complain that their teeth are sensitive in general. Oh… and let’s not forget about the complaints of sensitivity during and after whitening procedures.

But did you know that if you really understood everything there is to know about sensitivity, all the various reasons it happens, how various desensitizers work, when and how to treat all of these types of sensitivity… and especially how to prevent it, you (and your patients) could breathe a huge sigh of relief?

Well, take heart. This webinar will teach you things you never knew before. And following the suggestions in the webinar will promptly lead to that needed sigh of relief!

COMMERCIAL SUPPORTER: This course has been made possible through an unrestricted educational grant from Kor Whitening.

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 117 of 123

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Managing Restorative Emergencies Part 2: Sensitivity, Fractured Teeth, and Restorations

Categories:

Author(s):

Course Type: elearning

Target Audience: Dental Assistants, Dentists

  

Download this course

Educational Objectives

On completion of this article, the reader will be able to:

1.  Delineate a method for triaging restorative emergencies;

2.  List and describe treatment choices for patients with dentinal hypersensitivity;

3.  Review the management of a fractured tooth or restoration; and

4.  Describe the management of a fractured full or partial denture.

Abstract

Esthetic restorative emergencies in the anterior esthetic zone can involve a fractured tooth, fracture of metal or ceramic material from fixed indirect restorations, or the avulsion or loss of a periodontally involved incisor. While these are not acute emergencies from the perspective of pain or discomfort, they are emergencies from the patient’s perspective due to the loss of esthetics. Triaging patients prior to their appointments is helpful in planning and optimizing treatment. A number of treatment options are available to provide these patients with single-visit solutions to these esthetic restorative emergencies.
 

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 36 of 123

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Managing Restorative Emergencies Part 1: Esthetic Emergencies - Fractures and Tooth Loss

Categories:

Author(s):

Course Type: elearning

Target Audience: Dental Assistants, Dentists

  

Download this course

Educational Objectives

The overall goal of this course is to provide the reader with information on the management of esthetic restorative emergencies. On completion of this article, the reader will be able to:

1. Describe and evaluate esthetic restorative emergencies;

2. Review the steps involved in the evaluation of an esthetic restorative emergency;

3. List and describe the protocols and options available for the treatment of a fractured incisor without pulpal involvement;

4. Review the materials and protocols available for the treatment of patients presenting with fractured porcelain on all-porcelain or porcelain-fused-to-metal restorations; and

5. Provide an overview of the methodology involved in the treatment that can be provided to restore esthetics for a patient presenting with an avulsed periodontally-involved anterior incisor.

Abstract

Esthetic restorative emergencies in the anterior esthetic zone can involve a fractured tooth, fracture of metal or ceramic material from fixed indirect restorations, or the avulsion or loss of a periodontally-involved incisor. While these are not acute emergencies from the perspective of pain or discomfort, from the patient’s perspective these are emergencies due to the loss of esthetics. Triaging patients prior to the appointment is helpful in planning and optimizing treatment. A number of treatment options are available to provide these patients with single-visit solutions to these esthetic restorative emergencies.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 37 of 123

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Early Diagnosis and Treatment of An Anterior Crossbite

Categories:

Author(s):

Course Type: elearning

Target Audience: Dental Assistants, Dentists

  

Download this course

Educational Objectives

The overall objective of this article is to provide the participant with information on the treatment of anterior crossbites. Upon completing this course, the participant will be able to:

1. Determine the circumstances under which early orthodontic intervention is appropriate;

2. Identify a case in which early orthodontic intervention was used successfully to treat an anterior crossbite; and

3. Identify the outcomes of orthodontic treatment, including those that affect the patient’s quality of life.

Abstract

Early orthodontic intervention can have numerous benefits for patients. Treating an anterior crossbite with early intervention can improve function, appearance and self-esteem. In the case report included in this article, an 8-year-old girl was treated successfully for an anterior crossbite. In this instance, an acrylic bite jumper may have saved the patient from future surgery while improving her occlusal function and social interactions.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 38 of 123

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Restorability and Treatment with the Single-Unit Crown

Categories:

Author(s):

Course Type: elearning

Target Audience: Dental Assistants, Dentists

  

Download this course

Educational Objectives

The overall goal of this course is to provide the reader with information on the considerations and procedural steps involved in treatment with a single crown. After completing this article, the reader will be able to do the following:

1. Review the criteria for restorability with a single full-coverage crown.

2. Describe the concept of biologic width, its importance and considerations with respect to crown design.

3. List and describe the steps involved in treatment for a single crown, including the preparation design with respect to general parameters and the restorative material selected.

4. Delineate the main types of impression materials used during treatment for a crown, and describe the impressiontaking techniques that may be used for these materials.

5. Review the steps involved in placement of a temporary restoration and in the luting of a permanent crown.

Abstract

Treatment with a single-unit crown is one of the more common indirect restorative procedures. Once the restorability of the tooth has been confirmed, and patient acceptance of the proposed treatment plan obtained, a series of proscribed procedures are performed prior to and after fabrication of the crown. Periodontal, anatomical, functional and esthetic factors are all considerations both during treatment planning and during the treatment phase.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 22 of 123

People Who Took This Course Also Took


Cost: $
ADA Credits:
AGD Credits:


Cost: $
ADA Credits:
AGD Credits:

Artifacts / , / Read Article

Proper Clean-up: Removing Excess/Residual Resin-based Dental Cement

Categories: ,

Author(s):

Date: 08-03-2017 03:39:33 am

The primary functions of dental cements are to enhance resistance to displacement and to seal the interface of the restoration to the remaining tooth structure. Available options include but are not limited to composite resin cements and resin modified glass ionomers. Proper selection of dental cements is a key factor that increases the success of restorations. Several factors determine which type of dental cement, restorative material, and restoration a clinician chooses, including the ability to maintain a dry field, esthetic demands, tooth structure, the location of margins and chewing forces.

Resin cements were introduced in the 1970s as an alternative to acid-based reaction cements such as zinc phosphate. These cements vary in their setting mechanisms, which consists of polymerization either by chemical curing, dual curing, or light curing. Resin cements offer good adhesion (and therefore retention) as well as low solubility once set and good compressive strength. They are, however, technique-sensitive, require careful clean-up, and excess cement is generally difficult to remove once set.

Resin-modified glass ionomer cements contain resin filler particles consisting of polymerized functional methacrylate monomers. These monomers modify glass ionomer cements which consist of powder containing fluoroaluminosilicate with a liquid that is composed of polyacrylic acid and tartaric acid. When mixed, the polyacrylic acid reacts with particles and releases aluminum, calcium, and fluoride ions. Resin modified glass ionomers offer improved adhesion, strength, and low solubility. In addition, they are easier to manipulate than glass ionomer cement. The working time is affected by temperature: high temperatures shorten the working time while low temperatures prolong it.

Proper use and clean-up of dental cement

Proper use and clean-up of dental cements ensures the success of restorations and aids in preventing postoperative complications associated with residual cement. Effective removal of excess cement is important in the prevention of gingival bleeding, soft-tissue inflammation, crestal bone loss, and peri-implant disease. The presence of dental cement is a direct result of poor clean-up and use, as well as lack of assessment of residue after cementation. Residual cement can be extremely difficult to remove from subgingival areas, making proper handling at the time of cementation crucial. To reduce the possibility of problems caused by the use of dental cements, several aspects need to be considered.

Appropriate amount of cement and placement

Proper preparation and resistance form help avoid overuse of cement. A thin layer of cement, which for crowns amounts to about 3% of the volume of the crown, should be all that is required (Fig. 1). Application of the cement near but not on restoration margins helps prevent excess cement from building up. When the crown is seated, the cement will flow toward the occlusal table of the preparation and then move to the preparation margins where the excess cement is then readily extruded. Another approach is the placement of a cement vent that helps to minimize hydraulic pressure that could otherwise push the cement subgingivally. Retraction cord also can aid in easy clean-up of excess cement.

1

Using silicone as a “cementation device” also has been described in the literature. Silicone is first injected into the crown to create an analog. Cement is then placed in the restoration, first seated over the analog to displace most of the excess, and then removed and seated over the preparation. Care must be taken if using this technique to work quickly to avoid the onset of initial setting before the restoration is fully seated over the preparation.

Working and setting times

Working times and setting (or curing) times are important to understand when handling a cement:

  • The working time is the time available for the manipulation of unset cement
  • The setting time refers to the time that is required for the cement to set or harden from its plastic or fluid stage to a rigid one.

The working and setting times are different for each cement manufacturer, it critical to read the instructions. Long-term success is heavily dependent not only on appropriate selection but also on proper handling and use of dental cements. It is extremely important that all excess cement be removed. This requires a careful technique and an understanding of when during the setting reaction excess cement may be initially removed. Various approaches can be taken to remove excess cement and minimize the risk of residual cement.

Excess cement removal at the restorative margins

Clean-up of resin-modified glass ionomer and glass ionomer cements is easy, as the excess cement can be removed with a plastic instrument or scaler while in the waxy stage. With a dual cure composite resin–based cement, in the case of ceramic restorations that transmit light, using a curing light for 1 to 2 seconds tack cures the cement, making it possible to peel away the excess with an anterior or posterior scaler while the cement is still waxy/ rubber (Fig. 2), and then following this up by using an explorer.

2

For cementation of opaque metal and zirconia based restorations, however, there is a risk with removing excess dual-cured cement using the tack curing method as the excess cement at the margin will be cured, but not the cement under the restoration since light cannot penetrate through the opaque restoration. Mechanical forces involved during cleanup can weaken or cause failure of the bond if the cement is not sufficiently cured. Therefore, it is recommended for these restorations that the cement be self-cured to reach the gel phase at which point excess can then be conveniently and safely removed.

Timing is important - if cleanup begins before cement reaches a gel state then premature failure of the restoration can occur, and conversely if cleanup is late the cement will already have set making removal of excess cement difficult without rotary instrumentation. For optimal cleanup results, it is important to check the excess cement closely to determine when it reaches the gel phase during which excess cement can be safely and efficiently removed. It is also important to follow the directions for use which should indicate when the gel phase will commence.

Floss also can be used at this stage to remove excess cement, as well as afterwards to remove loose excess in the gingival sulcus, help remove adhered excess, and to check that no residual cement remains. Methods for removing residual cement, beyond the use of floss and scalers for hard set cement, include cleaning with a water and pumice paste and prophylaxis cup, and using an intraoral sand blaster. Of all three, the sand blaster has been the most effective and manual removal the least effective. All surfaces of the tooth should be cleaned, especially the margins.

Removal of residual dental cement around implants

Floss is also used around implant restorations to detect and help remove residual cement. After inserting the floss on both sides of the implant, it is wrapped in a circle and crisscrossed and then moved in a shoeshine motion in the peri-implant crevice. Great care should be taken during removal of residual cement to minimize trauma to the peri-implant tissues, and to avoid roughening the neck of the implant (if exposed) and implant complex– restorative interface (Figs. 3, 4). Titanium implant scalers can be used to debride the area and dislodge excess cement. These are preferred over graphite and plastic scalers that may leave traces of graphite or plastic embedded in the rough surfaces of implants, which may increase the risk of peri-implantitis. Titanium implant scalers are strong enough to remove hard cements, yet have a low Rockwell hardness to avoid scratching implant surfaces.

34

Clinical and radiographic visualization

Good visualization and moisture control is essential when placing indirect restorations. Good visualization also aids with removal of excess cement. Proper visualization can only be achieved through the use of magnification. Loupes are invaluable in providing this for dentists, dental hygienists, and assistants. Using a dental mirror defogging solution also helps, and systems such as the Isolite system allow for improved visualization with an intraoral light incorporated into the device, in addition to providing for isolation.

There are various method for identifying excess cement. A common method is to use dental tape floss; if the floss is roughened or frayed after being used around the indirect restoration, this can be indicative of residual cement. (Note, however, that adjacent overhangs and calculus also can result in frayed or roughened floss.) It is important to use a radiograph to check for residual cement. It is therefore important to select a cement with radiopaque properties so that it can be detected radiographically. In some cases, the removal of excess cement may require use of a local or topical anesthetic so that the cement can be effectively removed.

Surgical removal of old residual cement is only recommended if nonsurgical removal is unsuccessful. This involves flap surgery to help identify, access and remove residual cement that is located 3 mm to 5 mm subgingivally. While it may be successful, it is invasive and traumatic and represents a failure at the time of treatment planning and restoration.

Conclusion

The risk of residual cement can be avoided and minimized by understanding the properties of different cements, through proper selection and handling. Practitioners should be aware of the point at which excess cement may easily be removed for a given cement, and a thorough check should be made to identify any residual cement and remove it before the patient leaves the office. By using modern technology and tools available in dentistry, it is possible to eliminate the threat posed by residual cement.

References

Bonsor SJ, Pearson GJ. A clinical guide to applied dental materials. 2013. Amsterdam: Elsevier/Churchill Livingstone.

Carson J. The pros and cons of bonding or cement restoration. Available at: http://www.speareducation.com/ spear-review/tag/cementation/ Accessed 15 October, 2014.

Chun Z, White S. Mechanical properties of dental luting cements. Journal of Prosthetic Dentistry. 1999;81(5): 597–609.

Farah J Powers J. Resin Cements. The Dental Advisor. 2003.

Leevailoj C, Platt JA, Cochran MA, Moore BK. In vitro study of fracture incidence and compressive fracture load of all-ceramic crowns cemented with resin-modified glass ionomer and other luting agents. Journal of Prosthetic Dentistry. 1998;80(6):699-707.

Lohbauer U. Dental Glass Ionomer Cements as Permanent Filling Materials: Properties, Limitations and Future Trends. Materials. 2012;3:76-96.

Lowe R.A. Dental cements: an Overview. International Dentistry. 2011;2(2):6-17.

Pameijer CH. A Review of Luting Agents. International Journal of Dentistry. 2012;10:1-7.

Ramaraju SD, Krishna SA, Ramaraju VA, Raju M. A Review of Conventional and Contemporary Luting Agents Used in Dentistry. American Journal of Materials Science and Engineering. 2014; 2(3):28-35.

Wingrove S. Peri-implant therapy for the dental hygienist: Clinical guide to maintenance and disease complications. 2013. Ames, Iowa: Wiley-Blackwell.

Yu H, Zheng M, Cheng H. Proper selection of contemporary dental cements. Oral Health Dental Management. 2014;13(1):54-49. 

Article 2 of 4