Climb For a Cause is proud to announce the formation of the Jeff Baumrucker Memorial Scholarship. Beginning in 2013 the scholarship will be awarded to a deserving third or fourth year dental student, allowing them the opportunity to gain real world dental experience during a SmileTree™/Climb For A Cause™ sponsored oral health education and treatment project.

“One of the personal benefits of this organization is the pleasure and privilege of meeting like-minded people. Many times these relationships develop into friendships – that certainly was the case with my good friend Jeff Baumrucker. We are honored to continue his legacy in a way that we feel is true to his spirit of giving and support of his chosen profession.” Says Climb For a Cause Executive Director, Daniel Bobrow.

We invite all interested applicants to visit http://climbforacause.org/jeff-baumrucker-scholarship to download the 2013 application. Applications will be accepted no later than June 30, 2013 for the 2014 opportunity.

The Jeff Baumrucker Memorial Scholarship honors the memory of a loving father, devoted husband and generous dentist. Dr. Baumrucker was dedicated to helping people achieve their best smile possible – many patients loved coming to visit his practice. His adventurous and giving spirit lead him to support the efforts of Climb For a Cause and through that support many young children received desperately needed dental care. Jeff Baumrucker was a friend to many and an inspiration to all – those who knew him will miss him always.
 
A big thank you goes to our sponsor, Quality Dental Plan, without whose generosity this scholarship opportunity would not be possible.
 
 

“As a frequent Climb For a Cause Participant and a previous dentist volunteer, I know first-hand of the benefit of this exciting opportunity,” says Dr. Dan Marut, Founder and President of Quality Dental Plan. “As dentists we have the ability to bring relief and help those in parts of the world where dental care is virtually non-existent. As a company, Quality Dental Plan is dedicated to improving access to care in communities across the USA while maintaining the Dentist-Patient relationship without third party hassles.  Our support of the Jeff Baumrucker Memorial Scholarship furthers our belief that by giving our time and skill in the service of others, we can grow as individuals beyond our traditional educational experiences. A little adventure never hurts either!” explains Dr. Marut.
 
Recipients of the Jeff Baumrucker Memorial Scholarship will join Global Dental Relief on one of the oral health education and treatment projects held annually in Guatemala. Applicants must possess a valid Passport prior to date of departure, and be available for the full term of the SmileTree™ sponsored health project. Applicants must also provide verification of GPA and two letters of recommendation from college professors. Please return completed applications no later than 6-30-13 to:

SmileTree & Climb For A Cause
Attn: Daniel Bobrow
747 Brighton Circle
Port Barrington, IL 60010

or Director@ClimbForaCause.org Please use “Scholarship Application” as your subject line.

Climb For a Cause™ is a non-profit Foundation that combines the breathtaking beauty of the mountains with the desire to make a positive difference in peoples’ lives. Since 1998, we have been making meaningful differences in the lives of needy children by ensuring the delivery of much needed dental education and care. Those interested in learning more about this opportunity may visit ClimbForaCause.org or call (312) 455-9498

In the last issue of The New Dentist, I wrote about flowable composites and their use in restorative dentistry. Since the publication of the article, my flowable usage has decreased significantly. Many clinicians use flowable composite to line the floor and line angles of class II composites. In addition, I use flowable for ultra-conservative preparations that are too small to consistently pack regular composite into. Recently, I have begun modifying regular composite to allow for this ultra-conservative use. By heating regular composite to 130 degrees Fahrenheit, the viscosity of the composite is increased greatly. This causes the regular composite to flow much more like flowable composite and conform to the small preparation better.

I am now using heated composite for almost all posterior resin restorations. The composite can be heated in a couple of different ways. A messy but cheap way is to let the composite compules soak in a hot water bath for about 15 minutes prior to placement. This way works, but is not as nearly slick as the CalSet Compule Heater. This handy piece of equipment can be purchased through almost any dental supply house and costs around $300. It keeps 4 compules of composite at the prerequisite 130 degrees and can maintain that safely all day long. My assistants turn it on in the morning and load it with compules. The composite stays hot all day long and is not affected by repeated heating and cooling cycles.

Heated composite is a great way to make the material more viscous and flowable without trading strength and wear resistance. Try it!

In this month’s issue of General Dentistry, there is an article highlighting the use of azithromycin in periodontal therapy. I have never used a lot of antimicrobial therapies in my periodontal patients. Every once in a while I will prescribe 100mg of doxycycline to patient after scaling and root planing, but to be honest I could not give a reason as to why I would or would not on any particular patient. I have never really looked at any of the data on the low-dose antibiotics like 20mg of doxycycline daily for perio maintenance patients. For my practice, I really need to see a significant difference to justify adding another step into my patient’s routine. Compliance is a major issue with all patients, whether you think it is or not.

This study took 100 patients with moderate to advanced periodontitis and treated them with scaling and root planing plus three courses of azithromycin during the hygiene phase. The patients were re-evaluated and necessary surgeries and or extractions were performed (32 patients needed this extra treatment). All were then put on maintenance with four month recall visits. Clinical parameters were recorded at baseline, six weeks after hygiene phase, and 96 & 192 weeks into maintenance. The results showed that probing depths, bleeding, and supparation were reduced significantly at re-evaluation.

One of the most interesting parts of this study is that this was not a double blind study. All patients received azithromycin. There was not a control group to compare the azithromycin groups results with. This is a prime example of how sometimes the fine print of a study must be ready to determine it’s value. Azithromycin may be the greatest periodontal adjunct treatment in the history of man kind, but this study does not prove that. This study does not prove anything actually. In my opinion, the only thing this study shows is that periodontal patients that receive non-surgical intervention followed by close evaluation, surgery when needed, and continuous maintenance have reduced probing depths, bleeding and supparation. Because azithromycin was not isolated as a variable, there is no worthwhile evidence for it’s use.

Sometimes you need to read the fine print on studies to determine their effectiveness. Based on this, I will not be administering azithromycin to my periodontal patients.

There is a literature review in the March 2010 issue of The Journal of Evidence-Based Dental Practice regarding failures of posts. The writers examined multiple randomized control trials evaluating failures of endodontically-treated permanent teeth with different post types.  The trials compared metal posts to fiber posts. The results of the review showed fewer failures with carbon fiber posts as opposed to metal posts.

This seems to be concordant with the widely accepted thoughts about posts. Carbon fiber posts have a modulus of elasticity closer to natural tooth than do metal posts. In addition, carbon fiber posts are generally passive and tapered which decreases chances of perforation or root fracture when preparing. One disadvantage to carbon fiber posts is the necessity to “bond” them in with a self-etching resin. Bonding is very problematic at depths in the root and can create a point of weakness if the proper technique is not followed.

As an industry, we are doing less and less posts. I feel the literature supports this, however there are some teeth that just need posts no matter what. I find that these teeth are more often premolars and anterior teeth in my practice. Because of this, I general use the smallest posts available. Probably the biggest key to post success is amount of vertical tooth structure and ferrule remaining. In dire situations with little ferrule, no post system has a shot of success.

As far as my practice goes, I use 3M’s Rely-X post system. I find the system to be easy to use with few steps and yields good results. There are plenty of other good systems on the market. As with anything the key to success is your familiarity and comfort.

As documented here before, I am a big fan of isolation techniques.  I am a rubber dam believer and still use it in my practice.  I also use an Isodry in my practice.  An article in the March 2011 issue of JADA compares temperature and humidity of mouths when different isolation methods are in place.  The study compared rubber dam, Isolite I2, Coolex, and no isolation.  All three methods decreased the temperature and relative humidity intraorally.  Rubber dam decreased both the most, but there was a very little difference between the rubber dam, Isolite, and Coolex.  This study definitely emphasizes the importance of dry0field isolation techniques.  All three of these systems work far better than nothing.  A rubber dam is obviously the cheapest of the options, but both the Isolite and Coolex are affordable and offer a good value for the ease of use.  I know I could not practice without my Isodry.  If you have had issues with isolation, I would definitely look into this study and these methods.  They will help improve your dentistry!

LUMINEERS Destination Education is sponsoring an event this April in Orlando and May in Las Vegas. It’s a very exciting CE event featuring Dr. Bill Dorfman as Keynote Speaker and a very strong line-up of educators and teaching clinicians. As a new dentist, it is the perfect opportunity to not only be exposed to some of the top thought leaders in the profession, but also to learn leading edge clinical technologies and procedures.

ASCR LUMINEERS® DESTINATION EDUCATION

ORLANDO (APRIL 8-10) &
LAS VEGAS (MAY 27-29):

Transforming Continuing Education for Practice Growth

Dr Bill Dorfman, “America’s Dentist,” featured dentist on ABC’s Extreme Makeover and founder of Discus Dental, will headline the LUMINEERS Destination Education program this April in Orlando and again over the Memorial Day weekend in Las Vegas.  He will address the challenges facing today’s general practitioner, offer insight and suggestions based on what’s worked in his highly successful practice, and highlight the role that transformational products like Snap-On Smile can play in achieving new levels of success.

The Orlando program is set for April 8-10 at Walt Disney World’s Swan & Dolphin Hotel and the Las Vegas event takes place over the Memorial Day Weekend, May-27-29, at the Aria Hotel and Casino. To register or for further information, call 800-445-0345 or go to www.ascredu.org.

The fine folks over at J. Morita make more than the Root ZX apex locator we know and love.  They have been producing some very nice consumable products recently as well.  I had a chance to demo their provisional cement, PowerTemp and I have nothing but good things to say about it.  Provisional cement is one of those things that you never think about until you have a problem.  There are lots of different options on the market.  For me, there are certain hall marks I am looking for in a provisional cement.  Those hallmarks are:
1- The dispensing system should be easy.  I hate having to mix things.  Syringe-mixed provisional cement is easy, neat and quick.
2- It needs to be non-eugenol.  I use strictly resin cements.  Eugenol based provisional cements can interfere with the set of of resin or resin modified glass ionomer cements.
3- It needs to hold tightly.  I hate having to waste time with recementing provisionals.
4- It needs to hold tightly but come off when I want it to.  I also hate having to cut of provisionals because I can’t remove them.

PowerTemp passed all these tests with flying colors.  It is easy and neat to dispense and load a provisional crown.  It sets relatively quickly and cleans up easily as well.  In every case we have used it, no provisional has came loose.  I also never had to cut a provisional off.  PowerTemp is non-eugenol so there is no chemical inhibition of resin curing.  Like most provisional cements there were some areas of the preparation where the PowerTemp was a bit difficult to remove.  This was mainly on resin buildup materials.  I used a cotton pellet with chlorhexidine to get those areas clean.

PowerTemp is competitively priced with other provisional cements.  I would highly recommend it if you are looking for a provisional cement that is easy to use and does it’s job well.

http://www.morita.com/usa/cms/website.php?id=/en/products/dental/partner/auxiliaries/powertemp.htm

In the Fall 2010 issue of The New Dentist Magazine, I wrote an article addressing new dentist’s fear of endodontics.  We received the following letter from a practicing endodontist with his opinion.

Josh,

It’s good to see you staying active in the community and advancing yourself with CE courses, especially the Seattle Study Club, of which I am also a member.

Congratulations, too, on your growing dental practice.  The pictures on your website show a very nice office.  I enjoy seeing the successes of dentists that I went to school with.

I read your articles from time-to-time and am glad you enjoy writing them.  You may even be on the lecture circuit one day if that’s what you enjoying doing.  Writing a quick article on endodontics is very difficult, and your coverage was good for the amount of words and space you were limited to using in the Fall 2010 edition of the New Dentist.

I am also a big advocate of dentists (cosmetic, general, family, classify to your liking) performing endodontic treatment.  However, as an endodontist, a large part of my practice is retreating teeth that have failed (some teeth even treated two months prior by their family dentist) or repairing same-day perforations in different areas of the tooth.  Bottom line, the dentists that attempted these particularly difficult endodontic treatments should not have opened the tooth from the start.  Granted, it takes experience to extrapolate what one reads from the radiograph into what the tooth may be like during treatment.  I am passionate about this topic because the patient is the one who ultimately suffers.  If the tooth is perforated, ledged, zipped, blocked, you name it, the treatment becomes exponentially more difficult and expensive for the patient.  Or worse, they end up losing the tooth.

These are some of the reasons why the American Association of Endodontists created the Endodontic Case Difficulty Assessment Form that is available in the Dental Professionals section of the AAE website (http://www.aae.org/caseassessment/).  I included a copy of the form and the accompanying article in this email for your reference.  This form really does help a dentist create their own boundaries for when to start treatment or when to refer to an endodontist.  After using it a few times, it becomes a standard part of a dentist’s thought process.  Since we are both big advocates for continuing education, I thought you would appreciate this.  Also, this may give you an idea for one of your future articles.

There is a saying among endodontists: ‘There is no easy root canal.’  Knowing this, it’s sometimes okay to not set “terror aside” and just use your best clinical judgment for what’s best for the patient, even if that means not making your practice more profitable as you mentioned in the article.

May God bless you and your practice.  I look forward to seeing you at future alumni events and will keep looking for your articles.  Have a Happy Thanksgiving and a Merry Christmas!

Warmest regards,

Michael Larsen, DDS

Southlake Endodontics, PLLC

1100 E Southlake Blvd, Ste 400

Southlake, TX 76092

(817) 488-3636

www.southlakeendo.com

I think Dr. Larsen brings up some great points here.  As with anything, the key in Endodontics is case selection.  This is not a secret.  In no way do I advocate a young general dentist taking on all endodontic challenges that walk in the door.  Endodontists are a very needed member of the team of specialists a general dentist must use to treat more complex patients.  My concern is that many new dentists refuse to take on the challenge of endodontics because their predoctoral education did not prepare them well enough for private practice.   Many colleagues I graduated with are still frightened of endodontics.  They refuse to treat anything posterior to a premolar for fear of the complexity of a molar.  I am sure Dr. Larsen will agree that this philosophy is fool-hearty.  There are many endodontic cases with molars that are much simpler than many premolars.  Many very difficult endodontic cases are lower incisors with multiple canals.  Many new dentists would gladly jump into a mandibular anterior case  without thinking but avoid a molar at all cost.

Young general dentists need to seek good continuing education in endodontics.  There are plenty of really great endodontic lectures out there.  Personally, I have seen Dr. John West and Dr. Cliff Ruddle.  I think they are both great educators.  There are other great ones out there as well.  My main contention is that young dentists need to stop being afraid of endodontics and get comfortable with it. There are many simple cases that general dentists can treat very well.  Equally as important, don’t get too cavalier with your endodontic case selection without proper post-doctoral education.  Dr. Larsen provided a link to the AAE’s assessment protocol that can help general dentists triage difficult endodontic cases effectively.  This would be a great document to review.

At the end of the day, whether or not to perform endodontics is every general dentists choice.  The opportunity exists for new general dentists to add to their patient base by performing endodontics.  I encourage every new dentist to take some endodontic continuing education and begin to enhance your skills in the area.

Finally, we are reaching the conclusion of our summary of bonding agents! I know everyone will be thoroughly excited to talk about something different.

Seventh generation bonding agents are truly one bottle systems. Within that bottle, etch, primer, and adhesive resin are all present. Seventh generation products do not require a preemptive etch, just prep, isolate, and apply. Unlike sixth generation adhesives, seventh generation adhesives do not require mixing. As incredibly convenient as these products could be, they do not perform well in trials. Bond strength is consistently lower than both 4th and 5th generation adhesives.

While I think that seventh generation bonding agents could simplify bonding considerably, the data does not support their use in practice. With some tinkering, it is possible that a one bottle system will emerge with good clinical success and ease of use, but that product is not here yet. Stick to 4th or 5th generation. You and your patients will be happier!