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Endo TribunE pages 15-16page 12-14 Richard Mounce looks at twisted files Diana Dumiriu discovers there’s more to teeth than you think Michael Sultan discusses ways to battle bacteria Doing the twist Under the enamel Beat the Bugs pages 21-22 Endo TribuneEndo Tribune Endo Tribune New developments in esthetic dentistry Dr Michael B Miller reveals some secrets you may not know about the new developments in esthetic dentistry E sthetic dentistry, which really encompasses a major part of many dental practices, contin- ues to become more sophisticated in this digital era. Unfortunately, with this sophistication also comes com- plication. Everything we as clinicians do today requires more thought, more training, and more attention to detail for success to follow. After reviewing products and techniques for more than 23 years for the Reality Research Laboratory, I am always amazed how little is known about new products when they finally hit the market. Constant pressure Manufacturers are under constant pressure to introduce products be- fore they are really ready for use on patients. One problem that continues unabated is the almost universal is- sue of poor directions for use (DFU). If a manufacturer cannot tell a clini- cian exactly and explicitly how to use its product, then failures are bound to occur. Let’s take bonding agents as an example. Most of these products per- form optimally when the surface of the preparation is left in a specific moisture status. This means that if you need to leave the preparation glis- teningly wet, then you should be in- structed by the manufacturer exactly how to achieve that status. But too of- ten, DFUs use ambiguous terms such as “slightly moist” or “lightly dry”. In the Reality Research Lab, we created three, very specific protocols for test- ing bonding agents. These protocols are dry, moist, and wet, with each protocol accompanied by clinically relevant methods of achieving them. If we can provide this information, why is it that manufacturers continue to keep us in the dark? Curing light Another minefield is the trend to cure composites in only five to 10 sec- onds. One new curing light is even making the claim that it will cure to a five mm depth in only three sec- onds! While it may be possible to cure a shallow Class V restoration in 10 seconds using a light with ad- equate power placed virtually in con- tact with the restorative material that is also sufficiently translucent, it is dramatically different when curing a material at the bottom of a Class II proximal box. In the latter situation, our tests are very definitive – extended curing times of usually 40 seconds are still necessary to achieve a proper cure. I feel that it is irresponsible for manu- facturers not to give clinicians this information, but it’s even worse when the manufacturers don’t even test this scenario before making the claim. The three-second cure claim is even more absurd! On the other hand, there is also a trend to simplify procedures. Prod- uct categories that typify this trend include self-adhesive, resin cements, one-component, self-etching bonding agents, and self-adhesive restorative materials. While it is laudatory for manufacturers to try to give us prod- ucts that are easier to use, our tests show you usually don’t get optimal performance out of these “advanc- es”. In my way of thinking, a simple procedure is only better than a more complicated one if the results are at least on par. Why would you deliber- ately perform a procedure knowing you are going to get worse results? Too good to be true? What all this means for clinicians is that the old cliché still applies – if it sounds too good to be true, it probably is. Remember that no manufacturer is going to show up at your office, com- pensate you for having to replace a failed restoration, and tell the patient that it wasn’t your fault. That’s nirva- na, not reality! DT EverClear™ a triumph in clarity For details of Carl Zeiss and our wide range of other dental products contact: See what you are missing... Carl Zeiss EyeMag Smart 2.5x loupes Carl Zeiss GTX Carl Zeiss EyeMag Pro prismatic loupes Carl Zeiss OPMI® Pico Nuview Ltd, Vine House, Selsley Road, North Woodchester, Gloucestershire GL5 5NN Tel: 01453 872266 Fax: 01453 872288 E-mail: info@nuview-ltd.com Web: www.voroscopes.co.uk •Floorstand, ceiling or wall mounted •Photoport for digital camera •Five step magnification •Superlux 180 Xenon daylight illumination V2 LED Illumination About the author Dr Miller is a Fel- low of the Academy of General Dentistry, a Founding and Ac- credited Member, and Fellow of the American Academy of Cosmetic Dentistry, and has memberships in the International Associa- tion of Dental Research, Academy of Dental Materials, and Academy of Operative Dentist- ry. He is also a founding board member of the National Children’s Oral Health Foundation, which is dedicated to fostering the develop- ment of local dental heath and education fa- cilities for underserved children. In addition, Dr Miller is the co-founder, President, and Editor-in-Chief of Reality and maintains a dental practice in Houston, Texas.