Post on 15-Jun-2020
5/11/2019
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TODD SNYDER, DDS, FAACD, FIADFE, ASDA
Accredited Fellow, American Academy of Cosmetic Dentistry
Fellow, International Academy for Dental Facial Esthetics
Member of The American Society For Dental Aesthetics
Former Faculty, UCLA Center For Esthetic Dentistry
Speaker, Catapult Education
LEGIONpride.com, Online Training Challenge for Dentists
Todd Snyder, DDS, FAACD, FIADFE, ASDALaguna Niguel, CA
Aesthetic Dental Designs®
doc@tcsdental.com
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Are you still diagnosing with this??
50%accurate
Adrian Lussi - 1994 paper in Caries Research demonstrated that an explorer only detected caries in 14% of teeth that actually had decay histologically (Low sensitivity)
How do you diagnose decay??
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
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Thru intraoral photographic interpretation?
How do you diagnose decay??
Pathology Driven Diagnostics
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1896
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Fiber Optic TransilluminationMicroLux Kavo DiaLux 2300L
Fiber Optic Transillumination
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Fiber Optic Transillumination
CariVu Fiber Optic Transillumination
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Routine Bite Wings
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Clear View
Contrast
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Intra Oral ImageWhat do you see #20D
No question D1 caries on CariVu
Bitewings versus CariVu
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From 2014…faint sign on 20 distal, nothing really in 2015…but now we have CariVu
2014 2015
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Huge Marketing Opportunity• Non Ionizing Diagnostic Tools
• Minimally Invasive Dentistry
• Longer Lasting Restorations
• Community Educational Programs
• Internet and Local Media Advertising
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Everyday Go To Minimally Invasive Burs
0512C1300F0710C 0116C
How will you diagnose?
How will you treat?
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◼ Access, viscosity, small areas
◼ Deep, narrow, preparations
◼ Lots of enamel
Flowables
Flowable
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Crystal Structure DiagnosticsThe 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, 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
The Science Behind The Canary System
• 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 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.
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Delegated Scanning & Whitening Assistant
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
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Canary is Superior to X-Rays for Proximal Caries DetectionJan 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
Interproximal Caries Detection
Bitewing radiograph did not detect caries.
Caries located on buccal aspect of the contact area
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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 37Caries into dentin
Post-sealant
Pre-sealant
Cross-section
Sealant
Detection of Caries Beneath Sealants
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After all the cleaning and diagnostic technology being used, what if you find something?
Topical Therapies• More caries resistant• Remineralization• Desensitization
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Minimally Invasive Treatment
• Apply MIPaste Plus for 3 minutes
• Patient applies at home 2x/day
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MI VARNISH™ WITH RECALDENT™ (CPP-ACP)Bioavailable calcium, phosphate & fluoridefor an enhanced varnish treatment
Bacteria
Produce Acid
Attack Enamel
Demineralization
DECAY
Xylitol & ProBiotics
MI Paste, Enamelon
Remineralize
Other Systems
Radiograph
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How will you diagnose this?
How will you prepare
and treat this?
Total-Etching
Bonding to Enamel/Dentin
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Dentin
OdontoblastDentinal tubule
Smear layer
Adhesion process – Total Etching
Dentin fluid
Dentin
OdontoblastDentinal tubule
Smear layer37 % Phosphoric acid
Adhesion process – Total Etching
Dentin fluid
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Adhesion process – Total-Etching
Adhesive
Etched dentin
Post- Operative Sensitivity
Adhesion process – Total-Etching
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Mpa MAX (Clinician’s Choice)
▪ MPa MAX 5th Generation
Total-Etch Adhesive produced
the highest bond strength to
dentin, enamel, zirconia and
lithium disilicate.
▪ MPa MAX is one of the
few adhesives that contains
0.2% CHX to help prevent
adhesive bond degradation
caused by MMPs
▪ G5, a gluteraldehyde-based desensitizer that prevents post-operative sensitivity.
▪ G5 is placed after etching and before MPa MAX adhesive placement.
▪ G5 works by coagulating the intratubular fluid, helping to seal the dentin and prevent stimulation of the odontoblast processes.
Mpa MAX (Clinician’s Choice)
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Composite resin
Post- Operative Sensitivity
Adhesion process – Total-Etching
Problem with Total Etch Bonding(Over drying phenomenon)
Dentin
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Problem with Total Etch Bonding(Over drying phenomenon)
Dentin
Phosphoric acid
Problem with Total Etch Bonding(Over drying phenomenon)
Water
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Problem with Total Etch Bonding(Over drying phenomenon)
Dentin
No filtration into the collagen fiber Excess drying
Dentin
Shrinkage of collagen fiber
Problem with Total Etch Bonding(Over drying phenomenon)
No filtration into the collagen fiber Excess drying
Adhesive
Dentin
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Problem with Total Etch Bonding(Over wetting phenomenon)
Adhesive
Water
Insufficient drying
Dentin
SciCan
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Handpiece Lubricants
Disposable Single Use Diamonds
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Everyday Go To Minimally Invasive Burs
0512C1300F0710C 0116C
Long term failure occurs at gingival margins and adhesive interfaces.
Yiu CK, Hiraishi N, King NM, Tay FR. Effect of dentinal surface preparation on bond strength of self-etching adhesives. J Adhes Dent. 2008 Jun;10(3):173-82.
Higher bond strengths when using tungsten carbide burs with SE adhesives
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Dentin
OdontoblastDentinal tubule
Smear layer
Adhesion process - Self-Etching
Dentin fluid
Use Carbide Burs Large layers inhibit acidic monomers
Duration of exposure& acidity
Dentin
OdontoblastDentinal tubule
Smear layer
Adhesion process - Self-Etching
Dentin fluid
Self-etching adhesive
Use Carbide Burs Large layers inhibit acidic monomers
Duration of exposure& acidity
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Dentin
OdontoblastDentinal tubule
Smear layer
Adhesion process - Self-Etching
Dentin fluid
Self-etching adhesive
Use Carbide Burs Large layers inhibit acidic monomers
Duration of exposure& acidity
Adhesion process - Self-Etching
No Post- Operative Sensitivity
Excellent sealing and desensitizing
Fixing
Odontoblast
Sealing
the Dentin
Hybrid layer
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Composite
Adhesion process - Self-Etching
Bonding
No Post- Operative Sensitivity
Excellent sealing and desensitizing
Fixing
Odontoblast
Sealing
the Dentin
Hybrid layer
Bond Degredation
▪ Pashley DH, Tay FR, Imazato S. How to
increase the durability of resin-dentin bonds.
Compend Contin Educ Dent. 2011
Sep;32(7):60-4, 66.
Resin-dentin bonds are not as durable as was previously
thought. Microtensile bond strengths often fall 30% to 40%
in 6 to 12 months.
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Factors that compromise bond durability in restorative dentistry
“The major shortcoming of contemporaryadhesive restoratives is their limited durability in vivo.”
alarming
words …
but
the
reality
we
face
should
trigger
alarm
Hydrophilic dentin bonding (1956 - )
Factors that compromise bond durability in restorative dentistry
alarming
words …
but
the
reality
we
face
should
trigger
alarm
Hydrophilic dentin bonding (1956 - )
(RFA-DE-10-004) “Tooth-colored resin restorations have an average replacement time of 5.7
years due to secondary caries precipitated by bond failure.”
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Factors that compromise bond durability in restorative dentistry
Hydrophilic dentin bonding (1956 - )
We challenged that current dentin adhesive designs that incorporate increasing concentrations of hydrophilic monomers are going in the wrong
direction
Water sorptionPolymer swelling
Decline in mechanical propertiesLeaching of hydrolyzed resin components
Factors that compromise bond durability in restorative dentistry
Hydrophilic dentin bonding (1956 - )
Intact hybrid layers created by a simplified etch-and-rinse adhesive in caries-affected primary dentin partially disappeared after 6 months of
intraoral function
Instability of hybrid layers- problem may be more severe than we realize
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Factors that compromise bond durability
Hydrophilic dentin bonding (1956 - )
MMP-8MMP-2MMP-9
Demineralizing dentin is like openingthe Pandora’s box, releasing
endogenous enzymes (Matrix Metalloproteinases - MMPs)
that were trapped withinthe mineralized dentin matrix.
In the presence of water (such as thatderived from water sorption or from
adhesives, MMPs (2,8 & 9) can breakdowncollagen fibrils that are not protected
by intrafibrillar minerals
Sukala et al. (2007)Mazzoni et al. (2007)
Franklin Tay & Dave Pashley Med College of Georgia
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More useful for etch-&-rinse adhesives as CHX can be applied to acid-etched dentin
Potential ways to extend bond longevity
-MMP inhibition with chlorhexidine
Potential ways to extend bond longevity
Without
chlorhexidine
With
chlorhexidine
as a MMP
inhibitor
Chlorhexidine prevented degradation of hybrid layers created by
Prime&Bond NT after 12 months of intraoral function
Brackett et al. Chlorhexidine preserves hybrid layers
but not nanofillers in vivo. Oper Dent (2009)
MMP inhibition with chlorhexidine
Potential ways to extend bond longevity
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4th6th5th
7th
▪Courtesy Pacific University (Dr Marc
Guisberger)
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•Courtesy Pacific University (Dr Marc Guisberger)
InstroN
▪ Ultra Tester (Ultradent)
▪ Ultra Jig (Ultadent)
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Average Shear Bond Strength to Dentin: 24.2 MPa
Courtesy Pacific University (Dr Marc Guisberger)
Shear Bond Test Results - 2012
Maximum/Minimum Shear Bond Strength per Bonding Material
Courtesy Pacific University (Dr Marc Guisberger)
Shear Bond Test Results - 2012
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Drawbacks of Any Composite Resin
▪ Material placement techniques
▪ Variable substrate
▪ Polymerization stress & shrinkage
▪ Water absorption
▪ Hydrophobic bonding agents
▪ Decreased adhesive bond strength over time
▪ MMPs and Cathepsins
▪ Microleakage
Decreased Bond Strengths due to
▪ Substrate
▪ Preparation technique
▪ Bur selection
▪ Hand piece oils
▪ Bonding technique
▪ Curing device and position
▪ Material selection
▪ Layering technique
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What substrate are we treating?
Class I or II
:Composite Preparation
3x Tubule Density Equals Higher Fluid &
Increased Difficulty for Bonding
%30 Degrease in Bond Strengths with most
bonding systems.
“Adhesive dentistry could be expressed as a
simple relationship between bonds and
stress. If the bonds can withstand the
stress, the restorative technique will be
successful.”
Unterbrink and Liebenberg (1999)
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“C-Factor” Definition
Configuration Factor:
“The ratio of bonded to un-bonded (free) surfaces”
Feilzer, DeGee, Davidson (1987), Universtiy of Amsterdam, ACTA
Lowest Stress
Low Stress
Medium Stress
High Stress
Highest Stress
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Excellent Flow & Handling Base/ Lining
“C-Factor”
Dentin Replacement with Composite Cap?
◼ Dentin substitute
◼ Flowable Resins
-3%-6% vol. shrinkage
-1.6-3mpa shrinkage stress
-What bonding agent?
◼ Glass Ionomers
◼ Enamel Replacement
◼ Modern Composite
ADA reports flowable resins
are used by 82% of dentists
as bases or liners.
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Tokyo Medical & Dental University, 2010 J. Tagami et al
Flowable Composite Shrinkage(2mm Bulk Fill w/ 71%/wtFlowableON DENTIN ONLY)
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Resin to Dentin Hybrid Zone
Preparations > 2mm
▪ Traditionally, numerous increments have to
be placed to diminish polymerization
shrinkage as well as stress on tooth structure
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Technique
0.5mm Flowable & Bonding Agent?
Composite
Normally….
Technique
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Bond Strengths Related To Tooth Structure
0
5
10
15
20
25
30
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DEJ Superficial(Sound)Dentin
BeveledEnamel
DeepDentin
AffectedCariousDentin
InfectedCariousDentin
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30 30 30
10
Irie m, suzuki k, watts dc, 2004, marginal gap formation of light activated restorative materials, affects of immediate setting shrinkage and bond strength. Dent Mat 18, 2002; 203-210
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Caries Detector
Caries Detector by Kuraray
Dental is the original caries
detecting stain material. It was
developed by Dr. Fusayama &
Kuraray Dental at the Tokyo
Medical & Dental School in 1978.
Caries Indicator Dyes
▪ Roydent-To Dye For
▪ Kuraray-Caries Detector
▪ Ultradent-Seek/Sable Seek
▪ ProOptions-Caries Indicator
▪ Danville-Caries Finder
▪ Pulpdent-Snoop
▪ Vista-Caries Indicator
▪ Ronvig-See It
▪ Patterson-
▪ Henry Schein-
▪ Pearson-
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Caries Detector 86% Accuracy:
▪ As noted by Southern Illinois Dental School in-vitro research,
“Caries Detector Solution Identified 86% of Subsequently Confirmed Caries Lesions
After Sectioning”.
▪ Reference: Caries Detection Accuracy by Multiple Clinicians & Techniques, Thomas, Land, Wilson & Gregory Stewart DDS, Southern Illinois University School of Dental Medicine, IADR Abstract 3127, 1998.
Caries Removal Burs
▪ SS White
Single use
Polymer
Hardness
5000-10,000 rpms
▪ Komet
Multi use
Ceramic
Hardness
1000-1500 rpms
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Size 4,6,8
Round Burs (#6) Carbide CeraBur SmartBurs II
(SS White) (Komet) (SS White)
1,000-1,500rpm 5-10,000rpm
J Adhes Dent 2011 Feb;13(1):7-22. doi: 10.3290/j.jad.a18443.
Current concepts & techniques for caries excavation & adhesion to residual dentin.
de Almeida Neves A, Coutinho E, Cardoso MV, Lambrechts P, Van Meerbeek B.
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Round Burs (#6) Carbide CeraBur SmartBurs II
(SS White) (Komet) (SS White)
1,000-1,500rpm 5-10,000rpm
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▪ Indications
Anterior & Posterior Simple or Complex Bonding
Excellent Handling
Easy to Polish
Refractive Color Index Similar to Tooth
EVANESCE means to disappear gradually; vanish; fade away
Excellent Handling / Incredible Colors
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The Dental Advisor
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How Do We Restore?
• Composite, Veneer or Crown?
• Patient Input?
• Color?
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Initial Mockup
• Select Shade(s)
• Quick Initial Mockup (<3minutes)
– Free Hand
– No adjustments
– Prove Color(s)
– Prove Translucency
– Thickness Role
• Template
– Capture Lingual and Incisal
– Check Template
– Remove Excess
– Remove Composite
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Air Abrasion, Total Etch, Mylar
MPA Max, Template, Evanesce Enamel
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Evanesce Dentin
Sculpt Dentin, Cure, Add Enamel
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Discs to Contour
Discs to remove fine scratches
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Polishers for surface and interproximal areas
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Bulkfill Options
▪ Light Cured (C-factor issues and adhesion)
▪ Self Cured (More reliable)
▪ BulkEZ (Danville)
▪ HyperFil (Parkell)
▪ Activa (Pulpdent)
▪ Fill Up! (Coltene)
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Internal (Polymerization) Stresses of Composites
“A Simple Pain-Free Adhesive Restorative System by Minimal
Reduction & Total-Etching (1993)
Takao Fusayma DDS,
Tokyo Medical & Dental University
Test your light output and practice with your materials
Curing bulk fills remains a question
CRA questions the ability for most practitioners to place bulkfill materials
properly in addition to getting adequate curing.
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Lots of optionsWhat works best for your practice and skills?
How much time do you have?Bond Strengths?
Risks and Longevity?
?How are you restoring
these different preparations
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ORAL BACTERIA DEGRADATION OF RESIN RESTORATIONS
MORE RESEARCH
American Journal of Dentistry Oct 2017
• https://www.researchgate.net/publication/321184952_The_role_of_adhesive_mat
• erials_and_oral_biofilm_in_the_failure_of_adhesive_resin_restorations
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• Bioactive material
• affinity to tooth structure. when placing a glass ionomer a weak acid or conditioner is used to aid in releasing calcium and phosphate ions from the tooth structure. These calcium and phosphate ions combine into the surface layer of the glass ionomer and form an intermediate layer called the interdiffusion zone. This bond layer can be very strong and significantly reduce the microleakage that would occur at the margins of the restoration.
• Very good fluoride and ion release helps remineralize tooth structure in the remineralization–demineralization process that naturally occurs in the oral cavity.
• They bond to enamel, dentin, and metals.
Why Glass Ionomers?
• They produce good marginal integrity.
• They shrink only one ninth the amount of composite material.
• They are fluoride-rechargeable.
• There are no free monomers in the material.
• The cavity preparation can be bulk-filled, making the materials easy to place.
• They exhibit excellent biocompatibility.
Why Glass Ionomers?
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148178/
(RFA-DE-10-004) “Tooth-colored resin restorations have an
average replacement time of 5.7 years due to secondary caries precipitated by bond failure.”
Fig. 15 – Graph representing the mean annual failure rates
per adhesive class, determined according to a systematic
review of Class-V clinical trials of adhesives during theperiod 1998–2004 [2].
Van Meerbeek B, et al. Relationship between bond-strength tests and clinical
outcomes. Dent Mater (2009), doi:10.1016/j.dental.2009.11.148
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Deep Preparations◼ Bonding Agent & Flowable composite
◼ Conventional Glass Ionomer or GI then Composite◼ Fluoride Release
◼ High compressive strength
◼ Hydrophillic
◼ Insoluble
◼ True chemical adhesion
◼ Minimizes microleakage
◼ No sensitivity
◼ Acid Base Resistant Zone
◼ Decreased gap formation & C Factor
◼ Coefficient thermal expansion similar to
dentin
LARGE SIZED LESIONS (>2MM)• Mostly dentin
• Dentin has more moisture and less substance
• Open and Closed defects
• Complications & Risks are higher
• Porous, Wet, Dentin Available
• Interproximal concerns
• Increased Occlusal Loading
• Remaining Tooth StructurePulpal
Proximity
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Seals & Protects the Pulp:• For Direct & Indirect Pulp Capping
• Light-curable, Radiopaque Liner
• Significant Calcium Release:
• Stimulates Hydroxy Apatite & Dentin Bridge Formation.
Resin-Modified Calcium Silicate Pulp Protectant/Liner
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THERACAL LC (BISCO)CONVENTIONAL GLASS IONOMER
GLASS IONOMER SANDWICH
•Class I, II, III & V posterior
restorations
•Open & Closed Sandwich
techniques
•Composite replacement
•Amalgam replacement
•High caries risk patients
•Pediatric patients
•Geriatric patients
•Special needs patients
•Long term resistance to
microleakage
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GLASS IONOMER MATERIALS• Dentsply-ChemFil Rock Restorative
• SDI-Riva LC, light cure HV, Riva SC, self cure HV
• G.C. America-Fuji II LC, Equia Fil (Fuji IX)
• VOCO-Ionolux, Ionofil Molar AC
• 3M/ESPE-Ketac Nano, Photac Fil Quick, Vitremer, Ketac Molar Quick, Ketac Fil Plus
• Shofu- FX II
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• GC EquiaFil Compressive Strength 255mpa
• Equia Forte 280mpa
• Riva SC compressive strength 271mpa
• Chemfil Rock Compressive 200mpa
• Voco Ionolux had higher compressive strength than Equia Fil or ChemfilRock
• Surefil SDR compressive strength 220mpa
• Dentin 280mpa-297mpa
• Enamel 384mpa
• Grandio SO HF has compressive 417mpa
• Fuji II LC 170mpa (RMGI) Compressive strength
COMPRESSIVE STRENGTHS
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GC AMERICA
MINIMALLY INVASIVE PREPARATIONS
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Komet & Kavo
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Komet SF1LM
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GLASS IONOMER INTERFACE
Inte
rfac
e A
na
lysis (TE
M)
CARDOSO et al. J Dent 2010
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RESIN TO DENTIN HYBRID ZONE
A3.5 A3 A2
Glass Ionomer Bulk Fill
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EQUIA FORTEEQUIA™ FORTE is a complete system that is an ideal solution for posterior restorations:
•Class I, II, III and V posterior restorations •Composite replacement •Amalgam replacement •High caries risk patients •Pediatric patients •Geriatric patients •Special needs patients •Buildups•Long term provisionals
EQUIA FORTECaries control/quadrant dentistry
(Class II, III, V & core buildup)
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WHAT DOES EQUIA COAT DO?Fill porosities to increase physical properties of the restoration and offers a much smoother surface…
(SEM
im
ag
es
x1000)
100um 100um
Some voids are observed A smooth surface is obtained
EQUIA FilPolished by using silicon
carbide paper (#600)
EQUIA FilAfter coating
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SDI
VOCO
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ENDODONTIC SANDWICH TECHNIQUE
ENDODONTIC SANDWICH TECHNIQUE
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ENDODONTIC SANDWICH TECHNIQUE
ENDODONTIC SANDWICH TECHNIQUE
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ENDODONTIC SANDWICH TECHNIQUE
ENDODONTIC SANDWICH TECHNIQUE
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ENDODONTIC SANDWICH TECHNIQUE
ENDODONTIC SANDWICH TECHNIQUE
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ENDODONTIC SANDWICH TECHNIQUE
Open Sandwich with glass ionomer & nanohybrid composite
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Glass Ionomer vs. Open Sandwich
• 7 years later.
Glass Ionomer vs. Open Sandwich
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HOW DO WE CREATE THEM?
Interproximal Contacts
Problem & Solution
Tofflemire vs. Sectional Matrices
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PROBLEM & SOLUTIONTOFFLEMIRE
Universal V3 Ring Narrow V3 Ring
TrioDent has developed Narrow V3 Ring in addition to the
Universal V3 Ring to ensure ideal separation on smaller teeth.
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Note how the anatomical shape of the V3 Ring matches the
lingual contour of the molar while engaging the gingival undercut
Wave Wedge
Hole to fit with positive
grip Pin-Tweezers Inter-proximal contour for
a better gingival seal and
V-shaped concavity to
protect the papillae
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4.5mm
5.5mm
6.5mm
Tab can be bent 90˚ for
contra-angle placement
Holes designed to fit with
positive grip Pin-Tweezers
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by TrioDent
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3.5mm 4.5mm 5.5mm 6.5mm 7.5mm
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▪ A.S.A.P. Pre-Polisher (purple) (44 micron
diamond particles) reduces small surface
defects, without affecting anatomy, and
prepares the surface for a final high gloss
polish
▪ A.S.A.P. Final High Shine Polisher (orange)
(3-6 micron diamond particles) to provide a
life-like polish in as little as 20 seconds
▪ Both are autoclavable
ASAP Polishers (Clinician’s Choice)
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Access to the curing site = Energy to the resin
VALO’s footprintEVEN POWER AND WAVELENGTH DISTRIBUTION
COMPLETE COVERAGE
Images provided by Dr. Richard Price, Dalhousie University, 2014, Halifax Canada
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Machined from Aerospace Aluminum
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$200 $205
$321
$73
$175 $175
$11
$0
$50
$100
$150
$200
$250
$300
$350
Demi Demi Plus Elipar S10 SmartLite Max Bluephase Style Bluephase G2, 16-20i VALO
Curing Light Replacement Battery Cost
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Garrison Dental 3D Ring
System
Garrison Dental
XR = Extra Retention
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Fender Wedges & Slick Bands
Clinician’s Choice
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Composite Ninja
Composite Ninja
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Composite Ninja
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Lecture Handout
www.DENTOOLZ.comDigital Handouts, Products I Use & Special Offers
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Free Marketing Information & Handout
www.DENTOOLZ.com
TODD SNYDER(949) 643-6733
doc@tcsdental.com
www.aestheticdentaldesigns.com
www.drtoddsnyder.com
www.toddsnyderracing.com
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