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Dr. Michael DiTolla: I’ve always admired Ultradent and what you guys have done because you’ve brought a lot of common sense to dentistry. You’ve taken some product categories and dispensing systems that needed cleaning up and really made things easier for those of us out there practicing. One of your newer products that came across my desk the other day is UltraCem (Ultradent; South Jordan, Utah), your resinreinforced glass ionomer (RRGI) cement. I’ve always felt like this was a product category that could use another product or two in it. It’s far from the sexiest product in dentistry, but it seemed like there were only two companies dominating the market. So not only did you come out with a traditional crown & bridge cement, but you put it into a dispensing system that is so novel, it could only be from Ultradent. Can you share a little bit about the development process? Dr. Dan Fischer: Sure. Most of the credit on that syringe mixing device for the liquid and powder goes to our young team in R&D that picked up on the passion of the ease of use of a syringe. If you think about it, a syringe is one of the simplest hydraulic devices on the planet. But to be able to mix a liquid and a powder brings so much to the equation, on the logic that no paste-paste resin-modified glass ionomer (RMGI)* can be as strong as a pure liquidpowder — you just can’t get enough of the glass ionomer powder into a resin-based system. MD: So when you guys started development of UltraCem, you already realized that, in order to have the best physical properties for this cement, you were essentially going to have to take *RRGI and RMGI are used interchangeably in this interview. Ketac-Cem - 3M ESPE RelyX Luting Plus - 3M ESPE RelyX Luting - 3M ESPE GC FujiCEM - GC America GC Fuji PLUS - GC America UltraCem - Ultradent Bond Strengths of Popular Luting Cements 3.65 MPa 4.36 MPa 5.25 MPa 5.12 MPa 4.76 MPa 1 2 3 4 5 6 7 8 9 10 11 Metal Button Shear to Dentin a step back to a powder-liquid and move away from the pastebased systems? DF: Yep. In fact, if you look at what was the strongest RMGI out there prior to UltraCem, it was GC’s FujiCEM , and that is a liquid-powder mix in a capsule. And it’s the same with 3M ESPE RelyX Luting Cement; their strongest RMGI is still a liquid-powder mix in a capsule. As soon as you have to go to paste-paste, you lose the opportunity to get the amount of the glass ionomer silica in there that you’d like to have for creating a very strong cement. There was something else we realized, which we feel puts this product into its own distinctive category, Mike, and that is: RMGI is so fabulous for bonding to metal, and it is wonderful for bonding to zirconia, especially with the zirconia primer. But to really bond well to dentin and enamel, you need to have a minimal dwell time of the polyacrylic against the dentin to be able to etch it. That’s why UltraCem comes only in a regular set. If we were to bring it out in a fast set, it wouldn’t have that dwell time. But by having that dwell time, you have the first self-etching, resin-modified glass ionomer, which gives us a bond strength that more than doubles GC Fuji’s, which was the strongest heretofore. MD: You said a couple things there that I want to touch on. So the paste-paste delivery system, which has kind of become the norm — I think it’s probably the biggest seller in the category — it sounds like that was designed more for the dentist’s convenience than for the quality of the cement that comes from that mix. Is that right? 10.89 MPa Courtesy of Ultradent Products Inc. DF: Absolutely. It’s been the same name of the game for 90 percent of the bonding agents out there: they have been designed more for the dentist’s convenience. Tragically, in that process, we’ve had some great fourth- and fifth-generation bonding agents that have kind of been pushed aside, with the dentist running to the single bottles and the like, many of which, Mike, give one-fourth to one-half the bond strength of what a non-compromising adhesive can provide. So you take something like Clearfil SE (Kuraray America Inc.; New York, N.Y.) or OptiBond ® (Kerr Corporation; Orange, Calif.) or our Peak ® (Ultradent) — these are a handful of what I call “non-compromising adhesives” — and these can give an adhesion to dentin at around 65 to 75 percent of the actual strength of the dentin. Yet so many adhesives designed in the sense of speed can 38 www.chairsidemagazine.com
give you one-fourth to one-half that, and it’s really a lost opportunity. It prevents the dentist from being able to place larger, direct-bonded restorations. For the RMGI, it’s succumbed to the same gig: put it in a double-barrel type device and run it through a static mixer. When you’re doing that, you’re leaning more toward a resin cement with a minimal amount of resin-modified glass ionomer. Doing this was kind of a stepping stone to our resin cement. The best resin cement today can’t perform as well as UltraCem RRGI. Additionally, they don’t get the fluoride release like a RMGI can get. So, all in all, to push the level of the RMGI to a higher level, you’re getting a great, strong cement to metal with the self-etching feature, over twice the bond strength to dentin as what you’d get with the best out there heretofore, and you’re getting the fluoride release. You also get a great film thickness that’s around 25 microns. So we’re kind of passionate about that. Furthermore, to eliminate the need for that plier that’s required to break the capsule before you can put it into the Wig-L-Bug ® (Dentsply Rinn; Elgin, Ill.) to mix it, and to eliminate the Wig-L-Bug mixing and then to eliminate the little mix device, it brings about a lot of simplicity in our own office. Our guys have fallen in love with it because it’s so simplistic. Schools love it, too. You can probably remember when you had one Wig-L-Bug mixer between maybe 20 to 40 students, and you had to leave the patient and travel some distance to get your little capsule mixed, and then you headed back hoping you would be able to get everything in place before it set. MD: Not only that, but I remember mixing about 10 crowns’ worth of cement for every actual dose of cement that I needed to cement one crown. So, I’m sure that for the schools it’s also going to eliminate a lot of waste, in addition to streamlining the cementation appointment. That really is amazing that you’ve been able 25 to have UltraCem be self-etching and take advantage of those higher bond strengths, yet still have the fluoride release and not have to kowtow to going 20 down the paste-paste route. Now you mentioned the bonding agents. I think dentists are probably a little confused. I think sometimes they see products that appear too good to be true. One company releases a product like this and then the bigger companies, like the 3Ms, figure it’s selling so well that they need to release their own one-bottle system or their own paste-paste cement to keep up with the Joneses. I guess when the reputable companies release a product, the dentist tends to think: this product must be OK. PPM 15 10 5 DF: Yeah, it’s frustrating. And with your dentist hat on, it’s doubly frustrating because it’s the patient that loses in the process. The patient is totally ignorant as to what’s going on. When you consider that there is somewhere around 100 brands of bonding agents out there now, and you’ve only got a small handful that are really non-compromising ones, that’s disconcerting. Every time I’ve lectured over the last year, I share with dentists that there are two products that have a greater influence on the quality of your resin restorations than any other two products, simply based on what you choose to purchase. One of those is your bonding agent, and the second is your curing light. There are a number of quality composites out there, and there are a number of different matrix systems and the like, but, everything else being equal, the two factors that have the greatest impact on the quality of your restorations is the quality of your adhesive and the quality of your curing light. For posterior composites, you’ve got to have a curing light that will deliver around 15 to 16 joules entirely into the floor of your Class II box. You get on a first or second molar with one of these light guides that has the bend it in, and you just can’t direct that light directly down into those Class II boxes. So when I’m lecturing to dentists, I share with them that if you are using a compromising adhesive down on the gingival floor of that Class II box, or if you are using a light that just can’t illuminate the gingival floor of a Class II box then, yes, there is a much higher potential for recurrent decay in the next two to three years under that area. It’s sad to say that our patients, when we notify them of such, just look up at us and say, “Well, doc, don’t worry, I just have soft teeth.” It Fluoride Release — One Week Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 • UltraCem - (Ultradent) • Fuji PLUS - (GC America) Courtesy of Ultradent Products Inc. Interview with Dr. Dan Fischer39
Page 1: Chairside® A Publication of Glidew
Page 4 and 5: Contents 49 Case Report: The Creati
Page 6 and 7: Letters to the Editor Dear Dr. DiTo
Page 8 and 9: Contributors Michael C. DiTolla, DD
Page 10 and 11: Numbers by the 2 26% Percentage of
Page 12 and 13: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 14: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 17 and 18: Photo Essay The Pursuit of BruxZir
Page 19 and 20: Figure 5: This is the shade taken f
Page 21 and 22: Figure 11: Because of the pressure
Page 23 and 24: Figure 17: On the lingual, I cut th
Page 25 and 26: Figure 23: I make my next depth cut
Page 27 and 28: Figure 29: Toward the end of the pr
Page 29 and 30: Figure 35: The next step of the Rev
Page 31 and 32: Figure 41: The bottom cord provides
Page 33 and 34: Figure 47: The BruxZir crowns fit w
Page 35: Figure 53: I fill the BruxZir crown
Page 39: Interview with Dr. Dan Fischer - IN
Page 43 and 44: ourselves darn hard, it’s still n
Page 45: one job I can think of in Western c
Page 48 and 49: In late 2010, Straumann introduced
Page 50 and 51: Our last step was to select Glidewe
Page 52 and 53: Strassler has written extensively o
Page 54: Dr. Len Boksman formerly was direct
Page 57 and 58: SPEED DENTISTRY Fast Is Better —
Page 59 and 60: apidly would lead to more mistakes
Page 61 and 62: 7. Move faster and have your staff
Page 63: There is no one method for speed de
Page 66 and 67: centrals at the current length or s
Page 68: Retraction cord was used to gently

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