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I 35 opinion _ dental materials I cosmeticdentistry 2_2010 The problem, of course, is that most LEDs still won’t cure some materials that utilize photoinitia- tors, which are activated at wavelengths lower than the usual coverage of LEDs. Therefore, even with the market domination of LEDs, the halogen light re- mainsthegoldstandard.Thisisevidencedbythefact thatahalogenlightremainsREALITY’shighest-rated curing light. _Radiography Thedigitalrevolutionhasdefinitelychangedradi- ography, leaving film in its wake. Digital radiographic images can be organized, stored, and recalled elec- tronically for instant retrieval and presentation with specialsoftware.Thissoftwareallowsforawidearray of patient-pleasing devices (such as zoom, image re- versal, image coloration, annotations, and so forth), which also are very valuable when sending prede- terminations. This software also provides dentists with the capability to e-mail images to colleagues or insurance companies. Patients also respond very favorably to digital images,becausetheimageismuchlargeronthecom- puter screen and they can see what you are talking aboutmoreclearlywhenyoupointtoashadowyarea of a radiograph. Viewing an image on a computer monitor is also much more comfortable for patients, since they are more used to viewing images this way than viewing a film-based image on a viewbox, with its glare and unfamiliar feel. Options such as color- ation, image enhancement, and image reversal allow for better contrast and improved views of carious lesions, open margins, bone loss, and furcations. While some clinicians still believe that film-based radiography is more diagnostic, this is one category where the gold standard has surely shifted to digital. _Cements Materials designed for luting restorations have undergone such significant changes over the years thatdesignatinganygoldstandardwouldbedifficult, if not impossible, in part because no single type of cement can be used across the board. Therefore, to establish any sanity in this area, you have to iden- tify a type of restoration and then establish a gold standard for it. For example, cements for metal-based crowns and bridges have morphed from zinc phosphate to zinc polycarboxylate to glass ionomer to resin ionomer to resin. There are several permutations in the resin category alone, ranging from the early self-curedmaterialspairedwithself-etchingprimers to the current crop of dual-cured, self-adhesive versions.Whilemostoftherecentbuzzinthemarket has surrounded the self-adhesive resin products, resin ionomer still has to be the gold standard in this arena; two such products achieved a rating of five stars in REALITY. On the other hand, no self-adhesive resin cements even came close to this lofty status. Tolutemetal-freerestorations,thechoicesareeven moreconvolutedandbeyondthescopeofthiscolumn. Suffice it to say that you need to identify your needs carefullyandmatchthemtoaspecifictypeofcement. Gold standard status remains a useful parameter to judge new entries in specific product categories. However, with the rapidly changing marketplace, the gold standards of yesterday may not be applica- ble today or tomorrow._ Editorial note: This article originally appeared in the November/December 2009 issue of General Dentistry. It is published with permission by the Academy of General Dentistry. © 2009 by the Academy of General Dentistry. Allrightsreserved. _References 1. Christensen G. Longevity versus esthetics: The great restorative debate. J Am Dent Assoc 2007;138(7): 1013–1015. 2. Q&A: Dr. Byoung Suh. Dental Products Report 2009; July: 8. DrMichaelB.MillerisaFellowoftheAcademyof GeneralDentistry,aFoundingandAccreditedMember andFellowoftheAmericanAcademyofCosmetic DentistryandhasmembershipsintheInternational AssociationofDentalResearch,AcademyofDental MaterialsandAcademyofOperativeDentistry.Heis alsoafoundingboardmemberoftheNationalChildren’s OralHealthFoundation,whichisdedicatedtofostering thedevelopmentoflocaldentalheathandeducation facilitiesforunderservedchildren.Inaddition,DrMilleris theCo-Founder,PresidentandEditor-in-ChiefofREALITY andmaintainsadentalpracticeinHouston,Texas. RealityPublishingCompany 11757KatyFrwy,Suite210 Houston,TX77079 USA Tel.:+18005444999 | +12815589101 E-mail:mm@realityesthetics.com Website:www.realityesthetics.com cosmeticdentistry _about the author

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