Profitable dental (impressions)

New technologies for “impressions” continue to hit the market makingthis necessary task easier and more predictable. Regardless of the tech-nology used to obtain the impression, one factor remains critical to get-ting a good impression: Tissue management, the ability to effectivelycreate and maintain a dry field with adequate retraction. *

This article discusses techniques to help achieve this task so thatwhether you take a traditional or digital impression, you’re more likelyto get the results you desire.

Ideally, a first impression on a prepped tooth will be all that is need-ed to create a well fitting restoration. In many offices, this is fre-

quently not the case. Many times, multiple impressions are taken to ren-der one the lab can work with. Or worse, problems arise when a techni-cian has to call requesting additional definition of the margin. Evenworse, the lab attempts to create a restoration from the questionableimpression. Then upon attempting to seat the restoration, it does not fitrequiring additional remakes, patient appointments, and lab involve-ment. This problem is not only frustrating and often times embarrassing,but it is the cause of lost revenue to the practice.

Profitable DentalImpressions:

You intend for impressions tomake you money, but often times

they can cut into your profits.

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TA large number of offices complain of retakes andremakes. In discussing this issue with a number of labs, acommon issue is poor tissue management. While thereare a number of things that can contribute to problemswith an impression, this article will deal with tissue man-agement and the tools available to provide the best pos-sible field for recreating the margin with dental impres-sions.

When creating a cast or ceramic restoration, the abilityto record the prepared margin is a critical factor in fabri-cating a well fitting result. Soft tissue management for afinal impression is dependent on the ability to create suf-ficient space to visualize the prepared margins whilemaintaining a dry field. This is true for traditionalimpression materials as well as for the newer digitalimpression systems. Even with CAD/CAM systems, theoperating field must be well isolated during the imagingprocess to record an accurate image of the margin.

Tissue Management consists of two key elements:hemostasis and retraction. These can be achieved in anumber of ways. It is best to keep a few different tools atyour disposal depending on the situation. Commontools include:

A. Hemostatic Liquids/GelsB. Retraction CordsC. Retraction PastesD. Electrosurge E. Lasers

Hemostatic Liquids/Gels - come in different chemicalcompositions that react differently with tissue.

Buffered aluminum chloride has been a traditionalchemical that gives adequate hemostasis in most sit-uations. A well known product containing thischemical is Hemodent by Premier Dental.

Epinephrine is a well known hemostatic agent dueto it’s ability to constrict the vessels. It is limited touse on patients with no known heart conditions.Gingi-pak makes Orostat, an epinephrine solutionthat pellets, cords and other cotton products may bedipped in. Many retraction cords come impregnatedwith epinephrine.

Ferric Sulfate is a very popular fast acting agent givingrapid coagulation. In some patients, ferric sulfate hasbeen known to blacken the tissue, leading to the need toclean the area prior to taking the impression. In manycases, this can often cause hemorrhaging to recur.

What causes Ferric Sulfate to stain the soft tissues?The so-called “staining” is the ferric ion combined with thecoagulum plugging the once bleeding blood vessels. Becauseof this, in thin tissue patients or areas with an excessive num-ber of open vessels, the coagulum plugs may be more visibleand discoloration of the affected tissues would be noticeable.This will clear in the normal 24 to 48 hours.

Sometimes when ferric sulfate is used for fluid control, a stainis left around the gingival margins and has been know to last20 days or more in some cases. The "staining" that the den-tists are seeing may be the coagulum plugs in the cut capillar-ies. Like any cut tissue injury, it will take time for the tissue toheal and the coagulum to dissipate, at which time the tissuesshould return to their original state. It is important for thedentist to rinse really well with a firm air/water spray afterplacing the ferric sulfate and cord as well as when the cord isremoved. This will wash any residual chemical off the tissues.Note: If ferric sulfate is used with epinephrine there is a reac-tion that can cause the gingival tissue to temporarily turn adark blue or black color. It is best to use ferric sulfate withplain, non-impregnated cords. It is also important to thor-oughly rinse any residual chemical from the site prior tobonding. (A hibiclens or CHG wash can further assure aclean site for bonding.)

Poor Retraction - Insufficient Tear Resistance

Poor Retraction and Syringing Technique

* This article assumes that the practitioner is attaining adequate axial and occlusal reduction and is maintaining adequate biologic width. It also assumes that the correctinstrumentation is being used to create the appropriate margin for the restoration type selected. These things being true, tissue management continues to be critical in finalimpression accuracy.

Profitable Dental ImpressionsProfitable Dental Impressions...... continued from page 17continued from page 17

Aluminum Sulfate is a fast act-ing chemical that contains noepinephrine and is safe on heartpatients. While hemostasis isslightly slower than the ferricsulfate products, aluminum sul-fate achieves excellent hemosta-sis and tends to leave a cleanerfield with less need for clean upbefore impressions are taken.

Hemostatic gels have become verypopular because of their ease ofplacement and ability to controland lubricate the cord for easierpacking. A clear version is availablefrom Pascal that aids in visibilitywhen packing the cord.

Retraction Cords come in a wideselection of sizes and composition.Each type has its benefits. Themost common types of cords aretwisted, braided & knitted. A com-plete listing of cords can be foundon page 23.

Twisted Cord -G i n g i - p a k ’ sOriginal 2-Ply andCrown-Pak® 4-Ply retraction cordswere the first impregnated dry packcords produced for the dental pro-fession. Introduced in 1955, theyremain the product of choice forthose dentists who want the abilityto adjust the physical quantities ofthe cord to match clinical situa-tions. The soft 2-ply and 4-plycords are loosely wound and thestrands are easily separated, twistedor combined to make it readilyadaptable for use in the gingival sul-cus, regardless of the sulcus size andis suitable for all techniques, includ-

ing the 2-cord technique. Severalcompanies now offer a twistedcord.

Knitted cord con-sists of 100% cot-ton cord knittedinto interlocking chains to facili-tate easy packing of the cord intothe sulcus. This minimizesunraveling and fraying duringpacking. During crown prepara-tion knitted cord will not entan-gle diamond burs. Cord can besoaked in a hemostatic solutionof choice. Knitted loops absorband transport significantlygreater quantities of hemostaticsolution or gel providing moreeffective hemostasis.

Braided cord has aunique braided con-figuration giving the100% cotton cordexcellent handling characteristicsthat packs easily and remains inplace. The tight weave resists pene-

tration by even the smallest of pack-ing instruments. Because of theunique weave characteristics, thebraided cords create a more visibleretracted tissue than knitted cordsbecause they do not collapse underpressure.

Regardless of whichcord is chosen, the

most recommended technique forachieving and maintaining a dryblood free field for impressionmaterial is the double cord tech-nique where the first cord is left inplace for the impression. This cre-ates a “V” shaped sulcus which aidsin the impression material captur-ing the margin much better.

Syringe a hemostat-ic gel around the

sulcus. This not only begins thehemostatic reaction but it also lubesthe cord and helps to facilitate pack-ing and retention of the cord. (Note:When using a hemostatic gel, or wetting acord with a hemostatic solution, differentchemicals should not be mixed. Thiscould cause temporary and even perma-nent discoloration of the tissue. Be sure touse like solutions if wetting impregnatedcords.)

Choose two sizes ofcords. The first is a

small size cord packed to help withhemostasis and to open the tissueup. The second cord is a larger cordthat achieves the primary objectiveof retraction. Leave the cords inplace for 3-5 minutes.

Slowly remove the top cord. Rinseclean and dry the area leaving thefirst cord in place. Take the impres-sion before removing the secondcord.

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STEP 1STEP 1

STEP 2STEP 2

STEP 3STEP 3

Expasyl™ GingivalRetraction System -KerrA fast, safe and painless alter-native to packing retractioncords. Expasyl is a paste forgingival retraction that not onlyopens the sulcus but alsoleaves the field dry, ready forthe impression taking orcementation.

Starter KitContains: 6 Capsules Retraction Paste (1g each-6g total) 12 ApplicatorTips, Applicator Gun32379 . . . . . . . . . . . . . . . . . . . . . . . 345.59

Capsules (20/pk)31172 . . . . . . . . . . . . . . . . . . . . . . . 304.99

Applicator Tips (40/pk)31173 . . . . . . . . . . . . . . . . . . . . . . . . 85.39

Applicator Tips (100/pk)32264 . . . . . . . . . . . . . . . . . . . . . . . 159.69

Applicator Gun33167 . . . . . . . . . . . . . . . . . . . . . . . 337.59

Magic FoamCord -Coltene WhaledentThe first expanding VPSmaterial designed for easyand fast retraction of the sul-cus without pressure or pack-ing.

Intro KitContains: 2 - 50 ml cartridges, 30 mixing tips yellow (C6550) and 30oral mixing tips (C6555), 10 each Comprecap Anatomic #1, #3 and#5.C6735 . . . . . . . . . . . . . . . . . . . . . . . 139.99

RefillContains: 2 - 50ml cartridgesC6737 . . . . . . . . . . . . . . . . . . . . . . . . 112.99

ExpasylExpasyl

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Every so often, a product is introduced that has asignificant impact on the way we practice den-tistry. When that product provides quick, pre-

dictable soft-tissue management for crown and bridgeprocedures, it's a certain success. Expasyl has proven tobe a valuable adjunct for taking accurate impressions.One significant advantage of Expasyl versus convention-al retraction methods is its time savings. Also, the controlof soft-tissue deflection combined with hemostasismeans the quality of final impressions and the fit of labo-ratory restorations are significantly improved. Expasylalso creates the ideal environment for bonding of finalrestorations.

Expasyl is a paste-like material that is used for gingivalretraction and hemostasis leaving the prepared fieldclean, retracted and dry, ready for impressions or forother restorative procedures. This product is primarily

composed ofkaolin (a clay sub-stance) and alu-minium chloride(an astringentthat controls gin-gival bleeding).

It is dispensedinto the sulcuswith a specialdelivery gun. It is thick and firm allowing the material togently displace the gingival tissue. The hemostasis isachieved with the presence of the aluminium chloride. Itcreates a beautifully dry and clean sulcus that is ready foran impression or restorative procedure in a much short-er time than conventional techniques and is gentler tothe soft tissues.

Alternative Retraction Materials & Pastes Alternative Retraction Materials & Pastes

Images courtesy of Kerr Dental and Dr. Christopher CK Ho, BDS HONS (SYD), GRAD DIP CLIN DENT (ORAL IMPLANTS), Sydney Austrailia

The lower price of diode lasers has put them in the forefront as a viable instrument of choice for this procedure.While this option does not offer speed, with practice, it can become as quick as cord assisted management withmore predictable hemostasis. With careful control of the power settings and fiber tip movement, the diode laseroffers excellent tissue management and hemostasis with little risk of recession after healing.

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LLaasseer Tissur Tissue Me Managemeanagementnt

The use of electrosurgery to excise gingival tissues has been a common choice for clinicians for some time. The elec-trosurge will cut and simultaneously create effective hemostasis. One key cosmetic concern with electrosurgery isthe heat generation due to misuse that can lead to irreversible damage to the alveolar crest. This effect can lead torecession having a negative effect on the gingival margin. The PerFect® TCSII by Coltene Whaledent claims a choiceof settings that fine tune the instrument for this sensitive procedure. When used as recommended, the PerFect®TCSII has been successfully used in this procedure with uneventful healing.

Spring 2009 Edition

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OFFICE MAINTENANCE - EQUIPMENT ROOM

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TrTroughinoughing with an Eg with an Eleclectrtrosuosurrgege

PerFect®

TCS II S8115 -

$1,289.00Includes: 115 Volt Unit, Cord Assembly, handpiece

holder, 3 sheaths: coag ball, 45•

straight knife, 45•

straight loop, user guide/technique video

Receive Free 8 pack of

electrodes whenyou buy a

complete unit.

Gel Cord Blue - 25% Aluminum Sulfate30g Jar (bulk jar for dispensing into a dappen dish anddipping the cord into or applying with a microbrushapplicator.)15-510 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22.69Pro Pack 12 SyringeContains : 12 - 1gm syringes and 14 tips15-540 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.99

Pro Pack 40 SyringeContains : 40 - 1gm syringes and 50 tips

15-545 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111.79

Gel Cord Clear - 25% Aluminum Sulfate30g Jar (bulk jar for dispensing into a dappen dish anddipping the cord into or applying with a microbrushapplicator.)15-810 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19.99Pro Pack 12 SyringeContains : 12 - 1gm syringes and 14 tips15-840 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.99

Stat Gel FS - 15.5% Ferric Sulfate30g Jar (bulk jar for dispensing into a dappen dish anddipping the cord into or applying with a microbrushapplicator.)15-710 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19.99Pro Pack 12 SyringeContains : 12 - 1gm syringes and 14 tips15-740 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.99

Pro Pack 40 SyringeContains : 40 - 1gm syringes and 50 tips15-745 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111.79

Quick Stat FS Gel -15.5% Ferric Sulfate -Vista DentalValue Pack (40 prefilledsyringes with stat-flo deliverytips)502800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76.39

Stasis® - Gingi-Pak

A 21% liquid ferric sulfate hemostypticformulation offering unsurpassed hem-orrhage control, when measured againstany non-epinephrine solution. 40ml

13115 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34.69

FS HemostaticSolution - PremierA 15.5% ferric sulfate liquidsolution. Epinephrine Free.

1oz Dropper Bottle9007057 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.19 2oz Refill Bottle9007058 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.29

Hemodettes(Unit-Dose) 20% buffered alu-minum chloridelubricating hemostatic gel with saturated cotton pelletspackaged in unique plastic cups with attached finger ring.Unit-Dose packaging eliminates cross-contamination.Light blue color indicates area of placement. The gel vis-cosity enhances placement and eliminates migrationfrom the site. Cranberry flavor.

13150 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22.49

Styptin - DUX20% buffered aluminumchlorideA fast-acting, hemostatic solution ina lubricating base. The blue color shows the operatorwhere the solution is placed. The increased viscosity pre-vents the solution from migrating from the site. Squeezebottle allows easy dispensing and minimizes the possibil-ity of cross-contamination. Cranberry flavor.15ml Squeeze bottle13157 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.49

Hemogin-L - DUX25% aluminum chlorideA lubricating glycerin base. An eye dropperis provided to eliminate cross contamina-tion. Applied with cotton pellets to the gin-gival tissue, or pre-saturate retraction cord.10cc dropper bottle13057 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.9940cc bottle13052 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.99

Stat-Flo Hemostatic Delivery Tips -Vista Dental

19ga Prebent (Yellow) Single Use - Disposable Tip Curved cannula for optimal entry. The soft bristle endallows for non-evasive brushing of solutions. Has a uni-versal luer lock style hub to be used with any luer locksyringe. Polyester bristle allows for spreading of viscoussolutions while stiff enough to avoid metal canula contactwith soft tissue.20pk refill312102 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.99100pk refill312100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.49

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HHememostostaatitic Agec Agentsnts

GingiBRAID+ Braided Retraction Cord -Specially treated braid for faster absorption allowingimmediate use and effectiveness. Braided retractionmaterials are made of cotton fiber that will not split orcollapse in the sulcus. The retraction braids have abackground color (for medicament identification) witha second color to identify diameter. 6 feet (72 inch-es/183 cm) of braid per bottle. GingiBraid also comesunit dose as UniBraid.

Epinephrine/Alum 87 - A solution of approximately 8%Racemic Epinephrine (a vasoconstrictor) and 7% AluminumPotassium Sulfate (an astringent); impregnated and dried.Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.89 13170 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0 fine, blue13171 . . . . . . . . . . . . . . . . . . . . . .#1 small, blue w/purple strand13172 . . . . . . . . . . . . . . . . . . . .#2 medium, blue w/green strand13173 . . . . . . . . . . . . . . . . . . . . . . . .#3 large, blue w/pink strand

Aluminum Potassium Sulfate - A 10% solution; impregnatedand dried.Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.89 13210 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0 fine, yellow13211 . . . . . . . . . . . . . . . . . . . .#1 small, yellow w/purple strand13212 . . . . . . . . . . . . . . . . . .#2 medium, yellow w/green strand13213 . . . . . . . . . . . . . . . . . . . . . .#3 large, yellow w/pink strand

Non-ImpregnatedEach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.89 13217 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0 fine, white13214 . . . . . . . . . . . . . . . . . . . . .#1 small, white w/purple strand13215 . . . . . . . . . . . . . . . . . . .#2 medium, white w/green strand

13216 . . . . . . . . . . . . . . . . . . . . . . .#3 large, white w/pink strand

UniBRAID -Pre-cut sterileunidose pkg.Great for tub set-ups.Epinephrine/Alum 87 - Each . . . . . . . . . . . . . . . . . . 14.79

13370 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0e fine, blue13371 . . . . . . . . . . . . . . . . . . . .#1e small, blue w/purple strand 13372 . . . . . . . . . . . . . . . . . . .#2e medium, blue w/green strandAluminum Potassium Sulfate - A 10% solution; impregnatedand dried. Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.79 13360 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#0a fine, yellow13361 . . . . . . . . . . . . . . . . . . .#1a small, yellow w/purple strand13362 . . . . . . . . . . . . . . . . .#2a medium, yellow w/green strand

GingiGEL (Gel-Coated BraidedRetraction Cord)This braid is made of synthetic fiber andpackaged in a hemostatic gel containing20% buffered aluminum chloride. Thebraid is completely saturated and has anextra layer of medicament coating. Thisthorough saturation allows easy place-ment and immediate hemostatic results. The gel keepsthe braid soft and pliable to prevent “pop-out” of thesulcus. 6 feet (72 inches/183 cm) of braid per bottle.Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.99 13165 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#1 small13166 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#2 medium13167 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .#3 large

GingiKNIT+ (Knitted Retraction Yarn)Constructed of many tiny, absorbent loops knit-ted in long, interlocking chains, GingiKnit+places easily without fraying or memory, and thecotton fiber won't "pop-out" of the sulcus.GingiKnit+ conforms to sulcular anatomy withgentle, outward force and cuts clean if touched bya high-speed cutting instrument (unique constructioneliminates inadvertent removal if used as a finish guide-line). Available in 6 diameters. 6 feet (72 inches/183cm) of knit per bottle

Aluminum Potassium Sulfate10% solution; impregnated and dried.Each . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.39 13509 . . . . . . . . . . . . . . . . . . . . . . .#00 fine, yellow w/blk strand13510 . . . . . . . . . . . . . . . . . . . . . .#0 small, yellow w/orng strand13511 . . . . . . . . . . . . . . . . . . .#1 med, yellow w/orng-blk strand13512 . . . . . . . . . . . . . . . . . . . . . . .#2 large, yellow w/red strand

Non-ImpregnatedEach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.89 13499 . . . . . . . . . . . . . . . . . . . . . . . .#00 fine, white w/blk strand13500 . . . . . . . . . . . . . . . . . . . . . .#0 small, white w/orng strand13501 . . . . . . . . . . . . . . . . . . . .#1 med, white w/orng-blk strand13502 . . . . . . . . . . . . . . . . . . . . . . . .#2 large, white w/red strand

RETRAX CORD CUTTER - PASCALStainless steel scissors designed for precision cutting of gingi-val retraction cord intra-orally or extra-orally. 26-440 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.89

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RetracRetractitioon Con Cordsrds

Original Cord - Gingi-PakTwisted RetractionCord

Epinephrine108” Length . . . . . . . . . . . . . . . . 11.49 10120M . . . . . . . . . . . . . . . . . . . . . . .2-Ply72” Length . . . . . . . . . . . . . . . . . 14.69 10130 . . . . . . . . . . . . . .4-Ply, Crown-Pak

Non-Impregnated108” Length . . . . . . . . . . . . . . . . 10.89 11120M . . . . . . . . . . . . . . . . . . . . . . .2-Ply

Soft-Twist Cord - Gingi-PakEpinephrine108” Length . . . . . . . . . . . . . . . . 11.49 10105M . . . . . . . . . . . . . . . . . . . .#1, Thin10110M . . . . . . . . . . . . . . . . .#2, Medium10115M . . . . . . . . . . . . . . . . . . .#3, Thick

Non-Impregnated108” Length . . . . . . . . . . . . . . . . 10.89 11105M . . . . . . . . . . . . . . . . . . . .#1, Thin11110M . . . . . . . . . . . . . . . . .#2, Medium11115M . . . . . . . . . . . . . . . . . . .#3, Thick

Z-Twist Cord - Gingi-PakBraided Retraction CordAluminum Chloride - Teal108” Length . . . . . . . . . . . . . . . . 11.49 12170M . . . . . . . . . . . . . .#00, Very Thin12171M . . . . . . . . . . . . . . . . . . . .#1, Thin12172M . . . . . . . . . . . . . . . . .#2, Medium72” Length . . . . .1 - 9.29 . . .3 - 8.8912173 . . . . . . . . . . . . . . . . . . . . . .#3, Thick

Z-Twist Cord - Gingi-PakBraided Retraction CordEpinephrine - Green108” Length . . . . . . . . . . . . . . . . 11.49 10170M . . . . . . . . . . . . . .#00, Very Thin10171M . . . . . . . . . . . . . . . . . . . .#1, Thin10172M . . . . . . . . . . . . . . . . .#2, Medium72” Length . . . . . .1 - 9.29 . . .3 - 8.8910173 . . . . . . . . . . . . . . . . . . . . . .#3, Thick

Non-Impregnated - Purple108” Length . . . . . . . . . . . . . . . . 11.49 1117TM . . . . . . .#000, Extremely Thin108” Length . . . . . . . . . . . . . . . . 11.29 11170M . . . . . . . . . . . . . .#00, Very Thin11171M . . . . . . . . . . . . . . . . . . . .#1, Thin11172M . . . . . . . . . . . . . . . . .#2, Medium72” Length . . . . . .1 - 8.49 . . .3 - 7.9911173 . . . . . . . . . . . . . . . . . . . . . .#3, Thick

H e m o d e n tCord - PremierBraided RetractionCordEpinephrine freehemodent cords arealready impregnated with hemodentliquid. Hemodent Cord is easily packedsubgingivally without fraying or disinte-grating. Cord remains placid whenplaced due to its hollow braiding.Packaged with self-cutting dispensercontainer.Each . . . . . . . . . . . . . . . . . . . . . . . 14.79 9007077 . . . . . . . . . .Regular Twisted #3 9007078 . . . . . . . . . .Regular Twisted #99007065 . . . . . . . . . . . . . . .Braided, Thin9007067 . . . . . . . . .Braided, Med/Thin

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Ivoclar - Odyssey Navigator

The Odyssey Navigator features technology thatprovides more convenience, easier operation,more flexibility and unmatched portability:

* Touch screen monitor* Intuitive design and navigation ability make

program simple and easy.* Inverted screen capability* Allow for incredible flexibility by keeping the screen

readable in any orientation.* Uni-dose fiber tips* No cleaving, no stripping of fiber just snap on and

you’re ready to lase.* Ergonomic hand piece design* Arc design fits comfortably in your hand* Lithium Polymer battery 45 minutes of portable

lasing• Portability

The Odyssey Navigator is the first truly portablediode laser. The unique design features a dockingcradle that secures the Odyssey Navigator on acountertop and provides a charging base for therechargeable battery. Incorporating a state-of-the-artlithium polymer battery allows you complete freedomto use the Odyssey Navigator in any operatory inyour office.

603302 . . . . . . . . . . . . . . . . . . . . . . . .$11,749.00*Six payments of $1,958.17 plus tax

Hoya - The DioDent Micro 980™

Represents the next generation of diode soft-tissuedental lasers from HOYA ConBio™. It is ideal fordental professionals who would like an affordableway to enter the world of laser dentistry. The versatil-ity, efficiency, and cost-effectiveness of the DioDentMicro 980™ allow for a rapid return on investmentand increased growth potential for dental practices.

The DioDent Micro 980™ is used for aesthetic smiledesigns, periodontal therapies, fibroma recoveries,gingivectomies, implant recovery, tooth exposures,gingival troughing, and frenectomies. Its light weightand portability make the DioDent Micro 980™ ideal fordental professionals with multiple operatories.

Why Choose the DioDent Micro 980™?* Next-generation diode laser — built on years of

experience * Single Strip laser fiber (The jacket may be C-Flex or

Silicon tubing) * Autoclavable laser fiber storage spool * Intuitive touch screen controls * Pre-programmed & customized presents * Grab-and-go handle * Dimensions: 9”W X 2”H X 7”D * Low entry price, rapid return on investment

658-0500 . . . . . . . . . . . . . . . . . . . . . . . .$8,249.00*Six payments of $1,374.83 plus tax

Kavo - GENTLEray 980 Classic

The GENTLEray 980 soft tissue diode laser, usedfor oral soft tissue procedures, is the easiest tointegrate into your practice.

The GENTLEray 980 diode laser delivers excel-lent clinical results and outstanding ease of usewith the handpiece design you know and trustfrom KaVo. The 980nm wavelength provides thebest combination of clean cutting and excellenthemostasis in a wide range of soft tissue indica-tions.

The well-balanced, patented KaVo handpieceprovides individual adjustment of the fiber lengthin combination with superior touch and feel. Thedirect fiber running through the handpieceensures maximum transmission of laser energyreaches the treatment point.www.kavousa.com

1005.2900 . . . . . . . . . . . . . . . . . . . . . .$9,995.00*Six payments of $1,665.83 plus tax

Soft Tissue LasersSoft Tissue Lasers

6 mosZERO%*only on purchases of$5K-$15K


Kavo - GENTLEray 980 Premium

All the benefits of the GENTLEray 980 Classicplus:

• Includes water cooling accessories• Frequency 20,000 Hz, burst mode• 2 standard laser fiber handpieces• 2 water cooling handpiece kits• 2 Laser Fiber Diameter, 200ìm / 300ìm

Water Cooling provides fast healing andmore comfort for your patient• Reduction of heat effects results in lower painsensation for the patient before and after treat-ment• Reduction of charring and coagulation zones• Blood is removed from dental pockets after scal-ing and root planing, so that sulcular debridementcan be performed more efficiently• Increased efficiency and fast cutting results inless treatment time for doctor and patientwww.kavousa.com

1005.2899 . . . . . . . . . . . . . . . . . . . . .$13,295.00*Six payments of $2,215.83 plus tax



Ivoclar - Odyssey 2.4G

The Odyssey 2.4G Diode Laser is a high perform-ance soft tissue laser that combines 810 nm laserwavelength with excellent design, innovative anduser friendly features and consistency and safetyfor clinicians and patients.

The Odyssey 2.4G Diode Laser has severalunique features all of them providing operatorsefficiency, convenience and performance. For fulldetails, click on the featured items to the right.

• Features Laser wavelength of 810+/-20nm that has thehighest affinity hemoglobin and melanin making the lasera precise, least invasive and least traumatic tool to performsoft tissue procedures. • Aiming beam to assist with the location and placement ofthe laser. 630 nm laser pointer that serves as a guide • Aiming Beam Control – provides 5 Levels of illuminationin 20% increments. It is elective, does not need to be onfor the Odyssey 2.4G to be effective • Three user defined programs, each determines power,mode of operation and aiming beam intensity of illumina-tion. • Wireless Pedal – the first dental laser featuring wirelesstechnology for portability, flexibility and ease of use.

595126 . . . . . . . . . . . . . . . . . . . . . . . . .$9,915.00*Six payments of $1,652.50 plus tax

Ivoclar - Odyssey 3W

The Odyssey 3Watt Diode Laser is a high per-formance soft tissue laser that combines 810 nmlaser wavelength with excellent design, innovativeand user friendly features and consistency andsafety for clinicians and patients.

The Odyssey 3Watt Diode Laser has severalunique features all of them providing operatorsefficiency, convenience and performance. For fulldetails, click on the featured items to the right.

• Features laser wavelength of 810+/-20nm that has thehighest affinity hemoglobin and melanin making the lasera precise, least invasive and least traumatic tool to per-form soft tissue procedures.

• Aiming beam to assist with the location and placementof the laser. 630 nm laser pointer that serves as a guide • Aiming Beam Control – provides 5 Levels of illuminationin 20% increments.

• Offers two modes of operation – Continuous Waveand Pulsed Mode

603286 . . . . . . . . . . . . . . . . . . . . . . . . .$8,499.00*Six payments of $1,416.15 plus tax



* 6 mo financing

requires that pay-

ments be posted to

an approved creditcard.

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Dental Impressions have long been a critical step in the crown and bridge procedure. Getting a gooddental impression is still one of the most important aspects of producing a well fitting restoration thatrequires little adjustment. In order to achieve this, the dental profession as well as materials manufac-turers have developed hundreds of techniques and materials. All these materials claim to be a key fac-tor in reducing or eliminating retakes and remakes. In spite of these innovations and product enhance-ments, in the December 2005 issue of Dentistry Today, it was estimated that among US dentists,remakes cost the dental profession a combined total of $3.2 billion dollars in dental revenues. This wasdirectly linked to quality of dental impressions. This article will look at the newest technologies avail-able for getting a good impression and will compare traditional impression systems to the new digitalimpression technology.

Dental ImpressionTechnology Advances

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Impression Systems:Impression Systems:Traditional Dental Impressions:Traditional Dental Impressions:

Regardless of technique, some steps are alwaysrequired in order to get optimum results.Adequate axial and occlusal reduction, parallel

sides, good tissue management, and adequate mainte-nance of 3-4 mm of biologic width are some of the non-negotiable criteria that must be performed well to getthe desired results.

Beyond this, there are critical issues specific to tradi-tional impression taking in order to get optimumresults. Factors that play into poor performance of agood material can include technique of the operatorand the patient’s ability to comply during the criticalintraoral set time of the material. A good impressionrequires the following:

1. Uniform, homogeneous mix of material(no air bubbles, no glove residue or hemostatic chemical inhibi-tion.)

2. Tray is sufficiently filled with impression material3. Thoroughly applied tray adhesive4. Rigid, sturdy impression tray5. No voids or pulls on margin detail (tissue mgmt is

critical as well as material strength and elastic properties)6. Detailed margins with no tears or rough surfaces7. No tray show-through of the impression material

(adequate syringe mtrl around prepped area is critical)8. Good blend between heavy body and light body

materials9. Strong bond between impression material and tray

10. No tooth contact with the tray (controlled, careful seat-ing of the tray and patient ability to comply during set)

11. Complete information about the impression material used provided to the dental laboratory (good communication with the lab and ability to adjust technique as needed)

When using traditional techniques, the choice of a highquality material is critical. While many different mate-rials are available: hydrocolloid, rubber base, alginate,addition silicone, polyether, and vinyl polysiloxane(VPS), the most prevalent are polyether (Impregum),and VPS materials. According to SDM, a companydedicated to market research of the dental materialsmarket, the top products sold in 2008 in the US marketwere Impregum(3M/ESPE), Aquasil Ultra(Dentsply

Caulk), and Imprint 3 (3M/ESPE). Due to theextremely hydrophyllic properties of these materials,they have captured the largest share of the impressionmaterial market.

Because this is such an important component in thecrown & bridge procedure, attempting to cut costs onimpression material is rarely a profitable decision. Withchair time ranging from $300 - $600 per hour, oneremake a month could cost an office from $3,600 -$7,200 per year. If purchasing an economy impressionmaterial saved the office even $1,000 a year, the netcost of this decision to the office would be a minimumof $2,200. So when choosing an impression material,make sure to invest in high quality materials.

While the properties of the material are not always thecause of a poor impression, quite often, a high qualitymaterial can help to minimize the effects of inadequatetissue management. It is very difficult to find an officethat is impression perfect one hundred percent of thetime. There are numerous parameters that can affectthe final results of this process. However utilizing goodmaterial and techniques can help to reduce the failures.

Nashville Dental stocks a majority of the best perform-ing impression materials sold. In addition, we stockeverything needed to choose your armamentarium fortissue management. If your impressions are not achiev-ing the optimum results, ask your representative to dis-cuss the various options that are available and allow usto find the right product for your technique.

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Digital Dental Impressions:Digital Dental Impressions:

Some of the common problems with traditionalimpressions include: patients with a strong gagreflex, selection of appropriate material, avoiding

residual sulfur or chemicals on the prepped area that caninhibit set, impression distortion, drags and pulls, mate-rial tears at the margin, retakes, and material waste.With new technology, the ability to eliminate theseproblems is quickly becoming a reality for the everydaydental practice.

The in-office CAD/CAM systems have been wellreceived in many offices; however, not all offices want toadjust their scheduling to accomodate the time requiredto deliver the restoration the same day, nor do theirbudgets allow for the up front costs of a milling station.For those offices that prefer to utilize their chair timewith traditional scheduling, the digital impression sys-tems are ideal.

The Digital Workflow, beginning with a digital dentalimpression, is a highly efficient, indirect restorativeprocess used by dentists and labs to deliver a comfort-able patient experience and a high-quality, precise-fit-ting restoration.

The efficiency begins with the very first step: capturing adigital impression with the Lava™ Chairside OralScanner C.O.S. As long as tissue management is good,this new system will allow you to quickly take digitalimpressions of the prepped arch, opposing arch and

occlusion. From there, theLava C.O.S. continues to maxi-mize productivity by elimi-nating steps at both thedental office and the lab.

Steps Eliminated at the Dentist Office » Tray Selection » Material Dispensing » Material Setting » Disinfection » Packaging » Shipping Impression

Steps Eliminated at the Lab » Plaster Pouring » Base & Pin » Die Cutting » Trimming » Articulation » Scanning

Whether you decide to use a traditional process, likePFM, or sophisticated CAD/CAM processes, includingLava™ Restorations, the Lava C.O.S. initiates the digitalworkflow by providing a highly accurate digital impres-sion resulting in an extremely precise model for creatingthe restoration desired.

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