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ut to try and buy time with less-invasive procedures — giving the pulp chamber a chance to become smaller, giving the dentinal tubules a chance to become smaller, and saving that more invasive procedure for their later years. When you do so, you minimize the number of root canal treatments that are required later, you minimize the amount of replacements that have to occur with crowns and the like. We will always, within my lifetime, I believe, have the need for full-coverage crowns. I’ve got one that my daughter put in my mouth just four years ago. It was an upper second molar that was a virgin tooth, but it succumbed finally to the “dental student syndrome.” Namely, when I was a junior, a senior student had to take out impacted wisdom teeth in order to graduate, and I became the volunteer. The student wasn’t the sharpest knife in the drawer and took out some of the buccal plate over my second molar, and I’m sure he leaned that elevator on that root. Later, bacteria got in that crack and it was discovered, much later, probably about eight years ago, when the tooth abscessed and became a sinus infection and all the rest. If you’ve got a tooth like that, or you’ve got a molar that’s taking a heavy load, or a tooth that’s had root canal treatment — you’ve got to put crowns on those kinds of things. MD: Of course! And I know you don’t hate crowns. I know that what you don’t like is the overuse of full crowns as the easy way out, or kowtowing to what the patient’s insurance might pay. Did you go with cast gold on that crown? DF: It’s solid cast gold on this upper second molar. MD: Good choice! We like to see that. That’s becoming an endangered species in the laboratory today. I guess part of that is gold hitting $1,700 an ounce. It’s also patients giving some pushback about having gold in their mouth — even on a second molar — which is kind of crazy, especially after we tell them it’s the best material we’ve ever had in dentistry. DF: Well, when you said, “Good choice, that’s what we like to see,” the truth is at the end of the day, you can’t even see it, Mike! (I’m teasing you a little based on the meaning here.) But, yes, it’s true: if nobody is going to see it, you can’t beat it. That being said, I am impressed with how zirconia continues to improve. In fact, boy, with the cost of metals and the like, thank goodness we’ve got materials like zirconia that are evolving to where they are. MD: Right. Let me share some numbers with you. In 2007, 66 percent of the crowns that we fabricated here were PFM crowns and 23 percent were all-ceramic crowns. If you look at 2011 and the first half of 2012, and PFMs have gone from 66 percent to 20 percent, and all-ceramics have risen from 22 percent to 68 percent of the restorations, and it’s because of zirconia and lithium disilicate. It’s shocking to me, and even to us as a laboratory, to see how quickly dentists have changed their allegiance and have been willing to kind of drop the PFM. It has been an amazing transformation largely pushed on by zirconia and dentists being somewhat satisfied with the material because they continue to order it. Let me ask you about one other thing I find fascinating about you: your drive to find a cure for dental caries. I don’t think there could be a higher mission on the planet, and least in the dental world, than to tackle something like this, and I don’t hear anybody else really talking about this. In fact, I saw in a recent article that the city of Phoenix is thinking about not fluoridating their public water supply. Can you tell me how your drive to find a cure for dental caries is going? DF: The progress has been slow. Not because of the technology, but because of regulatory constraints that we’re up against with the FDA. We have a technology that we feel can go a significant distance on this. We’re being very active on it, and we feel like we’re making some good inroads relative to explaining the technology to the FDA. It’s a little device that in the first human studies — four kids in a lower social economic group for which oral hygiene is pretty low — was shown to decrease caries 76 percent. If we can reduce caries 76 percent, we can reduce the incidence of the abscessed tooth 95 percent, which is exciting to me. But, yes, we’re still battling that. That being said, and I don’t know if I told you this last time or not, Mike, but if we could bring about a cure to caries today, we’d still need more dentists. I mean, when you consider that in our country before the recession, onethird of our fellow Americans couldn’t afford to go to the dentist except for emergency treatment. When you consider that teeth are like tires — they’re good for so many miles, and then the treads wear out, the sidewalls give out. When you consider the jobs of the Western world, there’s hardly 42 www.chairsidemagazine.com
one job I can think of in Western countries that makes it easy for a patient with a missing central or dark, disfigured teeth to get a job. It’s a different world than it used to be. If we can bring about a cure for caries today, we’d still need more dentists. The most exciting news to me would be the amount of suffering we could stop for those who can’t afford Western dentists. Whereas one-third of our fellow Americans can’t afford treatment, two-thirds of the world doesn’t even have access to dentists. You’ve got humans who would jump off a cliff to escape the pain of an abscessed tooth. You’ve got humans who are known to pick up a boulder and mash it into the side of their head trying to escape the pain of an abscessed tooth. In so many parts of the world, including America, there are 12-, 13-, 14-year-old kids who are totally edentulous! The magnitude of this infectious disease is so devastating, when humans don’t have access to or can’t afford access to our Western-trained dentists. I believe it’s something we have to be serious about, just out of humanitarian reasons beyond mastication, chewing and the like. MD: I thought it was kind of self-evident that we’d still need dentists, even if we found a cure for caries. Can you clarify what you mean by that? DF: What I meant to say is, for sure we’ll need dentists. But I believe, even if we bring about a cure for caries, we’ll need more dentists. MD: Right. But are you saying there’s some pushback from the dental industry when you talk about curing dental caries? DF: I say that, quite frankly, just to let the dental industry know it shouldn’t be afraid of any source that is going to bring about a cure to caries because, whether it be us, whether it be NIH, whether it be JNJ, whether it be any company that comes out with a cure for caries, we’ll still need more dentists. So in a proactive way I’m saying: dentists shouldn’t be afraid of that, dental companies shouldn’t be afraid of that. Teeth being like tires, look at the challenges to the dentition with people living longer and keeping their teeth longer. We’d have a shifting demographic. We’d have less need to be addressing severe, early childhood caries. We would be working more on older people. But that would be a good problem, Mike. MD: I actually think that sounds like a great practice! In fact, most of the dentists I know who work on adult populations refer the kids out anyway. They don’t enjoy treating childhood caries. They prefer doing restorative dentistry on older patients. For dentists who say they want to do more esthetic dentistry, if you get rid of caries, a large part of it will be esthetic dentistry. So that sounds like a very modern, desirable way to practice. I like your vision of the future. DF: And if more families, even in lower socioeconomic groups, didn’t have to spend as much money addressing caries, they could potentially have more there, including the insurance companies they align with to help them get orthodontics for their kids. So you’d have more pediatric dentists doing more orthodontics, taking more ortho courses. There’s always going to be the need for it all, we just will be shifting to somewhat different demographics. But we’ll still need more dentists, Mike. MD: I think that’s such a noble effort that you’re putting forth toward doing that, especially for somebody from a restorative company — although, as you point out, it’s really not going to put anybody in dentistry out of business. Business will boom. It will just be a slightly different treatment modality than we practice today. It’s been fascinating hearing about UltraCem, especially because when I first looked at the product, honestly, without a bunch of the literature, I just thought that you had reinvented the dispensing system. But I really appreciate you informing me on the difference between the powder-liquid and the pastepaste cement. It’s nice to hear that you guys decided to go with the product that was the best clinical product available and not just chase the easier money and high convenience. You chose something that’s going to stand the test of time and ultimately benefit the patient. DF: That’s right. I think it’s important that the dentist sees it’s not just a fancy, fun mixer, but that it’s actually a superior cement. One other quick note on this: You know how frustrating it is if, say, there’s not adequate retention on a preparation and the crown comes off, but I’m sure you also know the most challenging of all cases when that occurs is when you have compromised retention on one abutment and good retention on the other and one side of the bridge comes loose. For dentists who are cementing crowns in which they have less-than-ideal vertical wall retention capabilities or any concern over one side of a bridge coming off, they can take that bond strength — which is a little more than double GC Fuji’s — and double it again simply by putting a little of our Peak on the preparation before they cement. MD: Interesting. That’s certainly an easy way to double the bond strength. And with the UltraCem, they get all the fluoride release as well, so they don’t have to make that compromise. DF: Yes, you are still getting the fluoride release, and you go from twice the bond strength of a GC Fuji to four times the bond strength. And the GC Fuji and UltraCem are higher in bond strength than the self-etching resin cements that are out there today. CM For more information on Ultradent, visit www.ultradent.com or call 888-230-1420. Interview with Dr. Dan Fischer43
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 and 40: Interview with Dr. Dan Fischer - IN
Page 41 and 42: give you one-fourth to one-half tha
Page 43: ourselves darn hard, it’s still n
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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