Dental Labs Archives - Cbite Dental Products

Periodontal Disease

lynn — Thu, 18 Jun 2026 00:59:56 +0000

Periodontal disease and tooth decay are the two biggest threats to dental health across the world. With gum disease as the leading cause of tooth loss in adults, it is an undiscussed pandemic. However, it is largely preventable through daily oral health maintenance.

Periodontal disease is an infection of the oral tissues that support the teeth in place. It is mainly the result of inflammation and infections that occur around the gums and bones that support the teeth. It occurs when a sticky film of bacteria called plaque builds up, persists, and hardens into tartar or calculus. Over time, plaque can spread and grow below the gum line, and release toxins that stimulate a chronic inflammatory response. At this point, only a dental health professional is able to safely remove the tartar and stop the periodontitis process.

The body’s immune system essentially turns on itself in an attempt to fight the bacteria. The toxins and the body’s enzymes meant to fight infections will start to break down bone and connective tissue that secure the teeth in place. In turn, the inner layer of gum and bone is separated from the teeth, forming pockets and space to collect debris. With the progression of the disease, the pockets deepen as more tissue and bone are destroyed, no longer anchoring the teeth in place and causing them to be loose, fall out, or need to be removed professionally.

The diagnosis of periodontal disease is classified by stage and grade. Stages range from initial to severe and describe the acuteness of the disease. The grade communicates the rate of progression and determines the anticipated treatment response.

Periodontal disease is common in the United States and is specifically prevalent among adults. Reports from the Centers for Disease Control and Prevention (CDC) found the following statistics regarding periodontitis in the United States:

47.2% of adults aged 30 years and older have some form of periodontal disease.
70.1% of adults 65 years and older have periodontal disease.
56.4% of men have periodontitis compared to 38.4% of women
65.4% of those living below the federal poverty level have periodontitis
66.9% of those with less than a high school education have periodontal disease
64.2% of current smokers have periodontal disease

Periodontal Disease Symptoms

Periodontitis can be difficult to identify for the untrained eye. However, symptoms increase in severity as the disease progresses:

Bad breath or taste in the mouth
Receding gums
Exposed tooth roots
Sensitive teeth and gums
Pockets formed between the gums and teeth
Tooth pain
Loose-feeling teeth

What is Gingivitis?

In its early stages, periodontitis is known as gingivitis. Gingivitis is the inflammation of the gums caused by the build-up of bacteria in plaque. Over time, the bacteria release acids that attack the teeth’s enamel and lead to decay. Plaque hardens into tartar after 72 hours, lining the gums, and making it difficult to clean the teeth and gums without professional intervention. The buildup irritates and inflames the gums over time, causing gingivitis.

Gingivitis is common with most people experiencing it at some point in their lives. However, the mild symptoms and little to no discomfort make it easy to ignore, leading to a more destructive oral disease. With gingivitis, no irreversible damage to the bones or tissue has occurred and the teeth are still firmly planted in their sockets. To the untrained eye, this disease is subtle and difficult to identify as a risk. However, during this stage, the gums are red, sensitive, swollen, and easily bleed when touched.

Gingivitis is reversible and can be prevented and treated by brushing and flossing every day along with regular dental checkups and cleanings. If left unchecked, gingivitis can develop into periodontitis or lead to other long-term consequences.

Risk Factors of Gum Disease

Gingivitis and periodontal disease are typically caused by poor oral hygiene–poor brushing and flossing habits that allow tartar to form on the teeth.

However, other risk factors include:

Smoking
Diabetes
Stress
Defective fillings
Heredity
Crooked teeth
Underlying immuno-deficiencies
Taking medications that cause dry mouth
Ill-fitting bridges

Female hormonal changes, such as with pregnancy or the use of oral contraceptives.

Prevention and Treatment for Gum Disease

Daily oral hygiene and routine dental exams are key when it comes to gum disease prevention. Brushing twice a day with fluoride toothpaste paired with regular flossing helps to remove plaque between teeth. Special toothbrushes, toothpicks, or water flossers are recommended. More severe forms of periodontitis require more extensive treatment, such as deep cleanings below the gum line, medications, or corrective surgery.
Both immediate and long-term care is necessary for treating periodontal disease. The dental professional will evaluate and determine the best course of action.

Scaling and root planing is a common method of treatment. It is a more intensive version of cleaning and is aimed to remove plaque and tartar above and below the gum line. Tartar is removed from the tooth’s surface and crown, and the root surfaces are also smooth to prevent bacteria from collecting.

In addition, laser therapy or antibiotics may be recommended. Extra monitoring, routine cleanings, and dental visits may be required as well. Those with severe decay and periodontitis will need to undergo surgery. Again, the dentist will determine the long-term plan for maintaining good oral hygiene post-treatment.

Sources:

Periodontal Treatment
Periodontal Disease
Periodontal (Gum) Disease
Gingivitis and Periodontal Disease (Gum Disease)
Gum Disease Information

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The Future of Tooth Replacement: Why Dental Implants Are Changing Dentistry

lynn — Thu, 28 May 2026 22:48:35 +0000

Losing a tooth is more than cosmetic — it affects chewing, bone health, and confidence. While bridges and dentures have long been the standard, dental implants are redefining tooth replacement. This blog explains why implants are rapidly becoming the preferred solution for both patients and clinicians.

What Is a Dental Implant?

A dental implant is a biocompatible post (titanium or zirconia) that integrates with the jawbone through osseointegration. It acts like an artificial root, supporting crowns, bridges, or even full-arch restorations.

Preserves bone by stimulating natural function
Doesn’t require cutting down adjacent healthy teeth
Provides long-term stability and natural esthetics

Why Implants Are Outperforming Older Options

Stability & Function

Because they fuse to bone, implants provide biting power comparable to natural teeth.

Bone Preservation

Bridges and dentures can’t stop bone loss. Implants maintain ridge height, helping retain facial structure.

Longevity & Low Failure Rates

Large studies show implants succeed at a very high rate — one analysis of over 158,000 implants showed only ~2.2% failure, mostly early in healing.

Natural Look & Feel

Modern abutments and CAD/CAM crowns ensure esthetic results that blend with natural dentition.

When Bridges or Dentures Still Make Sense

While implants are often ideal, bridges and dentures remain useful in certain situations:

Patients with limited bone or medical contraindications
Short spans where a bridge is simpler
When cost is the deciding factor

Option	Benefits	Drawbacks
Implant-supported crown	Long-term, bone preservation, independent	Requires surgery, higher upfront cost
Bridge	Quicker turnaround, no surgery	Involves adjacent tooth, bone loss under pontic
Removable denture	Affordable, adjustable	Less stability, more maintenance, resorption over time

Advances in Implant Dentistry

Digital Planning & Guided Surgery: CBCT and planning software create precision surgical guides.
Nanocoatings & Surface Modifications: Engineered surfaces speed healing and improve bone contact.
Immediate Loading: Some implants can be restored the same day if stability allows.
Smart Implants: Experimental designs with micro-sensors to monitor load and bone health.
Future Research: Proprioceptive implants aim to mimic the sensation of natural teeth.

Implants are not just “one more option” — they represent the future of restorative dentistry. With advanced workflows, labs and clinicians can deliver function, esthetics, and long-term value.

Sources:

Dental Implant Survival Rates: Comprehensive Insights (PMC) — Keywords: dental implants, survival rate, osseointegration
Advances in Dental Implant Technology (Luker Dental) — Keywords: implant innovations, guided surgery, immediate loading
Nanostructured Dental Implants Review (MDPI) — Keywords: nanotechnology, implant surfaces, bone integration
Exciting Innovations in Dental Implants 2024 (InsMyle Dental) — Keywords: smart implants, surface engineering, future tech
Natural Tooth Proprioception and Implants (Nature) — Keywords: proprioceptive implants, sensory feedback, future research

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Are Electrolyte Powders Bad for Your Teeth?

lynn — Tue, 05 May 2026 00:57:53 +0000

By: General Dentist Paige Kitzing

Electrolyte powders have become a go-to solution for hydration, whether you’re working out, recovering from illness, trying to stay energized throughout the day, or, let’s face it, after a night out with too many cocktails. But while they help replenish vital minerals, many people don’t realize they may also be impacting their oral health.

So, are electrolyte powders harmful to your teeth? The short answer is: it depends on the brand and how you consume them.

Let’s explore the potential dental risks and how popular electrolyte brands stack up from a dentist’s perspective.

What Makes Electrolyte Powders a Risk to Oral Health?

From a dental standpoint, the two biggest concerns with electrolyte drinks are acidity and sugar content.

Acidity

Many electrolyte powders are flavored with citric acid or similar ingredients. While these give the drink a refreshing taste, they also lower its pH, making it acidic. Regular exposure to acidic drinks can:

Erode tooth enamel
Increase tooth sensitivity
Make teeth more vulnerable to cavities

Sugar

Some electrolyte powders contain added sugars that feed the bacteria in your mouth. This leads to plaque buildup and acid production, both of which contribute to tooth decay. Drinking these throughout the day, especially when your mouth is dry (like during or after exercise), can make the problem worse.

How Popular Brands Compare

Here’s a breakdown of several popular electrolyte powders and how they measure up in terms of oral health:

Six Dentist-Recommended Tips for Safer Use of Electrolyte Powders

You don’t need to give up electrolyte powders altogether, especially if they help support your health. Instead, be smart about how and when you use them:

Choose sugar-free options. Brands that have zero sugar are better choices for your teeth.
Drink quickly, not slowly over time. Frequent sipping prolongs acid exposure on your enamel.
Rinse with water afterward. This helps neutralize acids and wash away residue.
Wait before brushing. Brushing right after drinking something acidic can spread the acid around your enamel. Wait at least 30 minutes.
Use a straw. A straw helps minimize contact between the drink and your teeth.
Avoid drinking them right before bed. Saliva production slows while you sleep, so sugar and acid can sit on your teeth longer.

The Bottom Line

Hydration is essential for your health—and that includes oral health. Electrolyte powders can be a helpful tool, but not all are equally tooth-friendly. Brands with high sugar and acidity can increase your risk for enamel erosion and cavities.

If you regularly use electrolyte powders, opt for sugar-free, low-acid formulas and follow smart dental habits to protect your smile. And when in doubt, ask your dentist for recommendations based on your specific needs.

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How Dentists Can Boost Business During Slow Summer Months

lynn — Tue, 21 Apr 2026 01:40:56 +0000

By: Bill WIlliams

How Dentists Can Boost Business During Slow Summer Months

Summer often brings a seasonal slowdown for many dental practices. Families travel, school routines are on pause, and patients tend to postpone non-urgent dental care. But instead of letting productivity dip, proactive dentists can use this time to strengthen their practice and attract new patients. Here are several actionable strategies to increase business during the slower summer months.

1. Promote Summer Specials and Limited-Time Offers
Create urgency by offering seasonal promotions. These could include discounts on teeth whitening, free consultations for new patients, or family check-up bundles. Market these offers through email newsletters, social media, and local advertising to drive traffic during this quiet season.

2. Focus on Preventive Care Campaigns
Encourage patients to use summer break for preventive visits. Emphasize the importance of routine cleanings and exams, especially for families with children. Remind parents that now is the ideal time to schedule appointments before the back-to-school rush.

3. Optimize Appointment Scheduling
Use slower periods to fill gaps with procedures that require more chair time, such as crowns or cosmetic treatments. Offer flexible appointment times, including early mornings or evenings, to accommodate patients’ summer schedules.

4. Strengthen Community Engagement
Sponsor or participate in local summer events such as health fairs, school fundraisers, or community festivals. Set up a booth to offer free oral health screenings or giveaways. These events boost your visibility and help build relationships with potential patients.

5. Refresh Your Online Presence
Use this time to update your website, improve SEO, and enhance your online reviews. Add fresh content such as summer dental tips or blog posts addressing seasonal concerns like dehydration and oral health. Encourage satisfied patients to leave positive reviews on Google or Yelp.

6. Reconnect with Inactive Patients
Reach out to patients who haven’t visited in over a year. Send personalized reminder emails or postcards offering an incentive for scheduling a summer appointment. Re-engaging lapsed patients can fill your schedule and renew long-term loyalty.

7. Invest in Staff Training and Office Improvements
Take advantage of the lighter workload to conduct team training, update systems, or reorganize the office. Improving workflow and morale now sets the stage for better performance in busier months.

Summer may be slower, but it doesn’t have to be stagnant. With strategic planning and creative outreach, dentists can make the most of the season and build momentum that carries through the rest of the year.

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ADA urges Congress to increase oral health funding, restore leadership

lynn — Mon, 13 Apr 2026 01:28:33 +0000

Olivia Anderson

The ADA and three partner organizations are urging Congress to strengthen federal support for oral health programs and restore senior-level dental leadership within the U.S. Department of Health and Human Services as part of the fiscal year 2027 appropriations process.

In a joint letter to House and Senate appropriations leaders, the organizations outlined the need for sustained and increased investment in public health programs, workforce training and research to improve oral health outcomes nationwide. In addition to the ADA, the letter was signed by the American Academy of Pediatric Dentistry; the American Dental Education Association; and the American Association for Dental, Oral, and Craniofacial Research.

“We respectfully request your support for funding of programs vital to dentistry and oral health in Fiscal Year 2027. We thank you for your commitment to dentistry and oral health over the years, and we urge Congress to continue its support of programs critical to the nation’s oral health,” the organizations wrote.

The letter highlights the widespread impact of oral disease, noting that untreated conditions continue to create significant health and economic burdens. According to the letter, about 34 million school hours and 92 million work hours are lost annually due to unplanned or emergency dental care, and nearly $46 billion is lost each year due to untreated oral disease.

The groups emphasized the importance of federal investments in prevention and public health infrastructure, including programs administered by the Centers for Disease Control and Prevention’s Division of Oral Health. These efforts support states and territories in tracking oral disease and implementing evidence-based prevention strategies such as community water fluoridation and school-based dental sealant programs.

In addition to funding, the organizations called for the restoration of dental leadership within HHS and its agencies to improve coordination and accountability.

“Restoring senior-level dental leadership and technical expertise across the Department of Health and Human Services would ensure public health investments are effectively administered, coordinated and accountable,” the organizations wrote.

The letter also underscores the role of Health Resources and Services Administration oral health training programs in building the dental workforce, noting that these Title VII programs are aimed at improving workforce supply, distribution and diversity. The organizations said most program graduates go on to serve in medically underserved communities or primary care settings, helping expand access to care.

Research funding is another key focus of the request, particularly for the National Institute of Dental and Craniofacial Research. The organizations pointed to the institute’s contributions to advances in pain management, regenerative medicine and diagnostic technologies, as well as its role in studying the connection between oral health and overall health.

For fiscal year 2027, the organizations are requesting $22.25 million for the CDC Division of Oral Health, $46 million for HRSA oral health training programs and $570 million for the National Institute of Dental and Craniofacial Research, among other funding levels.

“The modest programmatic increases we are requesting, together with the continuation of programs, will help achieve the goal of ensuring optimal oral health for all Americans,” the organizations concluded.

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The impossible’s now possible with new gel that can rebuild enamel

lynn — Mon, 10 Nov 2025 22:22:58 +0000

A new protein-based gel can regenerate lost enamel—something once considered impossible—and may offer a fluoride-free solution for repairing erosion and sensitivity.

Meg Kaiser

Key Highlights

New gel seeps into tiny cracks and holes, capturing calcium and phosphate ions from saliva to rebuild enamel.
The treatment is safe, easy to apply, and designed with both clinicians and patients in mind.
Regenerated enamel exhibits properties similar to healthy natural enamel, even after exposure to typical oral stresses.
This technology could significantly reduce the need for temporary treatments and improve long-term dental health.

New protein-based gel can repair eroded or demineralized tooth enamel.

An unprecedented advancement in dental technology has emerged through a new protein-based gel that can repair eroded or demineralized tooth enamel. The new gel could be available commercially as early as next year.

Scientists at the University of Nottingham’s School of Pharmacy and Department of Chemical and Environmental Engineering created the compound that’s designed to restore eroded or demineralized enamel. Their innovative process mimics the natural growth processes of tooth enamel and is made from proteins that imitate those responsible for natural enamel formation early in life. Their findings were published in Nature Communications on November 4.

Why this matters: Current enamel loss treatments only offer temporary protection

Because enamel cannot regenerate, dentistry has long focused on prevention and temporary protection. Current fluoride varnishes and remineralization products offer temporary relief but have never been able to rebuild lost enamel.

In their tests, the scientists applied the fluoride-free gel in a thin layer over teeth to form a protective coat that repairs and regenerates damaged tooth enamel. This is something that, until now, has been impossible. Scientists say the gel can help prevent cavities, repair exposed dentine, reduce sensitivity, and improve how restorations bond to the tooth surface.

Applied like fluoride treatments, the gel forms a coating by seeping into teeth’s tiny cracks and holes and filling them in. It then captures phosphate ions and calcium from saliva, which form into new enamel through a process called epitaxial mineralization.

How the gel works: Mimicking natural enamel formation to rebuild tooth structure

“Dental enamel has a unique structure, which gives it its remarkable properties that protect teeth throughout life against physical, chemical, and thermal insults,” Dr. Abshar Hasan, a lead author of the study, explained to Science Daily. “When our material is applied to demineralized or eroded enamel, or exposed dentine, the material promotes the growth of crystals in an integrated and organized manner, recovering the architecture of our natural healthy enamel. We have tested the mechanical properties of these regenerated tissues under conditions simulating ‘real-life situations’ such as tooth brushing, chewing, and exposure to acidic foods, and found that the regenerated enamel behaves just like healthy enamel.”

“We are very excited because the technology has been designed with the clinician and patient in mind. It is safe, can be easily and rapidly applied, and it is scalable,” explained Professor Alvaro Mata, lead investigator on the project, to Science Daily. “Also, the technology is versatile, which opens the opportunity to be translated into multiple types of products to help patients of all ages suffering from a variety of dental problems associated with loss of enamel and exposed dentine. We have started this process with our start-up company Mintech-Bio, and we hope to have a first product out by next year.”

Their ultimate goal? To help patients increase the longevity of their own healthy teeth and redefine modern dentistry while they’re at it. We now know—think oral-systemic link—that a healthy mouth ultimately leads to fewer health problems in the population overall. There’s not a much better outcome than that.

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Tooth-in-eye surgery performed successfully in Canada for the first time

lynn — Thu, 02 Oct 2025 01:08:44 +0000

A rare surgery called osteo-odonto-keratoprosthesis, also known as “tooth-in-eye” surgery, was recently performed in Canada for the first time. Dr. Jason Auerbach comments.

Sarah Butkovic, MA, BA, DentistryIQ Editors

Ian Tibbetts lived without his sight for 16 years due to a freak accident involving flying scrap metal in 1997. But in 2013, he was able to see his 4-year-old twins for the first time, thanks to a little-known operation that restored his sight with the use of his tooth called osteo-odonto-keratoprosthesis (OOKP).¹

What is tooth-in-eye surgery?

OOKP, also known as “tooth-in-eye” surgery, is a medical procedure that can restore vision in the most severe cases of corneal and ocular surface patients. It includes removal of a tooth from the patient or a donor. After this, a lamina of tissue cut from the tooth is drilled and the hole is fitted with optics. The lamina is grown in the patient’s cheek for a period of months and then is implanted upon the eye.¹

Canada’s first OOKP surgery

In Tibbetts’s case, Dr. Christopher Liu at the Sussex Eye Hospital in Brighton, UK, inserted the lens into a hole drilled through the tooth, which was then implanted in Tibbetts’s eye. Recently, however, Providence Health Care ophthalmologist Greg Moloney successfully performed this procedure on three patients in Canada, making their cases the first in the country.²

The procedure was performed on Canadian woman, Gail Lane, at Mount Saint Joseph Hospital.

“I haven’t seen myself for 10 years,” She said. “If I’m fortunate enough to get some sight back, there will be wonderful things to see.”²

As for Tibbetts, he was also grateful to regain his vision, but it went beyond just that.

“I have my independence back now and I can start looking after the kids while my wife is out at work.” He said. “Before, the kids were just shapes. I couldn’t make them out. I had to actually learn to tell them apart by their voices … I would do anything to get some sight back. I had to try something.”¹

How this procedure works

OOKP was pioneered by the Italian ophthalmic surgeon Professor Benedetto Strampelli in Rome in the early 1960s. By mostly relying on the body’s own biological material, this procedure is intended to minimize the risk of a patient’s body rejecting a foreign implant.

According to Dr. Liu: “Patients who have the surgery are often able to see immediately and the quality of sight can be extraordinarily good. However, it is only suitable for certain types of blindness, specifically patients who have severe and irreversible corneal damage.”¹

The risks involved in this procedure limit surgeons from performing it in only one of each patient’s eyes. Even still, it has been performed in 10 countries with a relatively high success rate; a 2022 study from Italy determined roughly 94 percent of implant recipients could still see even 27 years after having the procedure. Not only that, but recipients from previous studies were reported to be able to drive cars after recovery.²

Photos from the surgery can be viewed here.

Response from Dr. Jason Auerbach, DDS

Dr. Auerbach, practicting dentist and Dental Economics contributor known as @bloodytoothguy on Instagram, believes this type of surgery is both genius and extremely risky—one that should only be performed by a highly-skilled team under very specific circumstances. He has agreed to share his thoughts on OOKP following the success of the most recent procedure in Canada.

Do you think this procedure will ever become popular?

“I do not think this is mainstream and nor will it become mainstream. It’s reserved for extreme cases that are typically patients with severe corneal damage and no other options. That’s what makes it so special at the same time. It’s the kind of last-resort miracle that pushes the boundaries of medicine and shows what’s possible when surgical disciplines collaborate without ego or limitations.”

With so many risks involved, is OOKP worth it?

“When done in the right hands and for the right patient, it’s definitely worth it. OOKP is reserved for where basically no other options exist. For patients who are otherwise permanently blind due to severe corneal disease or chemical burns, this is sometimes the only shot they’ve got at seeing again. That makes the risk not just acceptable. It makes it sometimes necessary.”

Would you recommend it to the right patient?

“100%. If I had a patient whose ophthalmology team determined they were a viable candidate, psychologically prepared, medically stable, and committed to the process, I would absolutely advocate for it. The idea that we can take a tooth and restore vision with it? That’s the kind of cross-disciplinary brilliance and creativity that I love.”

What does the future hold for OOKP, in your opinion?

“Do I think it’ll become more common? Probably not widely. It may evolve though. Because it’s so complex, and the indications are too rare, OOKP isn’t likely to replace LASIK or corneal transplants. But it’s a surgical option that can open doors. And as tech evolves, particularly in biomaterials and regenerative medicine, one could see some of its principles being adapted and scaled. The idea of using living tissue as a scaffold for long-term ocular implants is not so farfetched. Overall, it’s a testament to what can happen when we stop seeing disciplines in silos and start seeing the human body and surgical possibility, as one integrated creative system.”

References

Man regains sight after doctors replace his eye with a tooth. GMA News Online. October 7, 2013. https://www.gmanetwork.com/news/scitech/science/329791/man-regains-sight-after-doctors-replace-his-eye-with-a-tooth/story/
Paul A. Surgeon implants teeth in patients’ eye to restore vision. Popular Science. March 4, 2025. https://www.popsci.com/science/eye-in-tooth-surgery/

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Want a better toothpaste? Just add wool

lynn — Wed, 20 Aug 2025 02:54:22 +0000

Andrew Paul

Researchers hope to have their new additive available to the public in the next 2-3 years. Credit: Deposit Photos

A protein found in hair and fingernails may help restore enamel.

A new, sustainably sourced toothpaste additive may soon transform how we strengthen—and even restore—weakened or lost tooth enamel. However, this potential game changing dentistry ingredient isn’t harvested from rare or complex sources. Instead, the protein can be found in everyone’s hair, skin, and fingernails.

Tooth enamel doesn’t replenish itself, and retaining it isn’t easy. The natural protective barrier lining our chompers inevitably erodes over your lifetime, but highly acidic diets and poor dental hygiene often also exacerbates the deterioration. Losing the exterior layer frequently results in tooth sensitivity, acute pain, and ultimately tooth loss. Fluoride remains one of the safest treatments to prevent deterioration, but it’s not capable of fostering enamel regrowth or replacing what has already disappeared.

“Unlike bones and hair, enamel loss does not regenerate,” King’s College London prosthodontics consultant Sherif Elsharkawy said in a statement. “Once it is lost, it’s gone forever.”

Recently, Elsharkawy and colleagues wondered if a very resilient protein called keratin could somehow help reinforce teeth. After extracting keratin from sheep’s wool, the team added it into a composite mixture that they then applied to the surfaces of human molars. They soon realized that the protein quickly combined with saliva’s naturally present minerals to form a well-organized, crystalline scaffolding structure that shares a remarkable similarity to enamel. Once adhered to a tooth, the layer kept attracting phosphate and calcium ions to continue growing a new, protective coating—effectively regenerating lost enamel. Their results were recently published in the journal Advanced Healthcare Materials.

“Not only is it sustainably sourced from biological waste materials like hair and skin, it also eliminates the need for traditional plastic resins, commonly used in restorative dentistry, which are toxic and less durable,” explained study first author and restorative dentistry clinician Sara Gamea.

Gamea added that unlike plastic resins, keratin simply looks more natural and can be altered to more closely match an original tooth’s color.

Elsharkawy and Gamea believe that their groundbreaking solution to the nearly ubiquitous dental concern may only be 2 to 3 years away from becoming publicly available. They anticipate the keratin-based mixture could be added to over-the-counter toothpaste like fluoride, or used in targeted repairs at a dentist’s by applying it like nail polish.

“With further development and the right industry partnerships, we may soon be growing stronger, healthier smiles from something as simple as a haircut,” Elsharkawy said.

The keratin-infused enamel repair is one of the latest in the growing waste-to-health industry, which aims to repurpose discarded materials for medical solutions.

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EU Commission Bans Use of Dental Amalgam from 2025

lynn — Mon, 17 Jul 2023 19:19:12 +0000

The European Commission

The European Commission has published draft legislation to phase out dental amalgam in 2025. The revision of the EU Mercury Regulation has been expected since December 2022 and includes a ban on mercury-containing light bulbs and lamps.

Since there are viable mercury-free alternatives, dental amalgam shall no longer be used for dental treatments of any member of the population from January 1, 2025. The proposal also includes a ban on its manufacture and export, making an important contribution to reducing mercury emissions internationally.

The use of dental amalgam for children under the age of 15, as well as breastfeeding and pregnant women, has already been banned in the EU since 2018.

Amalgam consists of 50% mercury, one of the world’s most toxic substances. Despite all precautions taken in dentistry, mercury inevitably enters the environment, where it transforms into the even more toxic form methylmercury and contributes to mercury accumulation in the fish we eat.

Before the Commission’s proposal can take effect, it must be approved by the European Parliament and the Council. Given the delay, however, the Parliament will have to move fast to complete all the formalities before the 2024 parliamentary elections.

“This is a milestone. Finally, we get a regulation for dental amalgam, the largest remaining use of mercury in Europe and a serious threat to health and the environment,” says Florian Schulze, director of the European Network for Environmental Medicine, who has been pushing for the phase-out for years.

“Numerous countries, such as Sweden, Norway, Moldova, Lithuania, Switzerland, Bolivia, Ecuador, Indonesia, the Philippines, or Zambia, have already phased out the use of amalgam. Most recently, Poland had replaced amalgam with alternatives in the statutory health insurance,” explains Schulze.

FURTHER INFORMATION

Proposal for a REGULATION OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL amending Regulation (EU) 2017/852 of the European Parliament and of the Council of May 17, 2017, on mercury as regards dental amalgam and other mercury-added products subject to manufacturing, import, and export restrictions: https://ec.europa.eu/transparency/documents-register/detail?ref=SEC(2023)395&lang=en.

Global Overview of Countries Phasing Out Dental Amalgam: https://environmentalmedicine.eu/mercury-free-dentistry-for-planet-earth/.

FEATURED IMAGE CREDIT: Tobias Blad-Stahl/Shutterstock.com.

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Occlusion and caries: Ongoing zirconia challenges

lynn — Mon, 27 Feb 2023 16:29:25 +0000

Zirconia crowns are well known as the most-used ceramic restoration in dentistry. Dr. Gordon Christensen provides some potential solutions for a few of their most important challenges.

Gordon J. Christensen, DDS, PhD, MSD

“I have been practicing for many years, and most of the indirect restorations I have placed in the past could be cemented with correct occlusion as they came from the laboratory. However, in recent years, I am seeing some crowns that are not even close to touching the opposing arch of teeth, and others are too high. These crowns come from my usual laboratory that has had near-optimal occlusion on the crowns in the past. Additionally, I still have some zirconia crowns coming off in service. What can I do about these challenges?”

Dr. Christensen: Both you and I are seeing the same problems, and I have several potential reasons and solutions to share.

Labs are making crowns out of contact with the opposing arch (figure 1). Some labs are making crowns up to 0.5 mm too low (500 microns or the thickness of at least 10 human hairs) as measured by Clinicians Report (CR) scientists. This reduction in crown height reduces the completed restoration occlusal thickness, potentially compromising crown strength and causing tooth extrusion of both the tooth being crowned and the opposing tooth, as well as stress on adjacent teeth.

Figure 1: Note the significant lack of occlusal contact on this zirconia crown example as sent from a large dental laboratory.

Why would technicians do this? Currently, the most popular crown types—zirconia and lithium disilicate—are very difficult to reduce in height and difficult to finish and polish smooth in the mouth, taking clinical time and frustrating the dentist and patient. The technician and the dentist would like to have the patient say the crown feels just right when closing the two arches together. Making the crown shorter with no occlusal contact avoids removal of ceramic on the occlusal/incisal surface when seating.

Most zirconia and lithium disilicate crowns are initially one color without significant translucence. Thus, most ceramic crowns have a layer of low-fusing ceramic fired over them to provide individual characterization of color and translucence on the crown. If the occlusal/incisal crown surface is adjusted, removing the superficial layer of low-fusing ceramic, the underlying zirconia or lithium disilicate is exposed and the restoration’s color and translucence are compromised.

In discussions with CR scientists and clinicians, they disagree with placement of superficial low-fusing ceramic. They have proven that the superficial glaze and stain wear off over time and wear the opposing teeth until worn off (personal communication, Rella Christensen, PhD).

Successful cementing of zirconia crowns: Still a problem

Zirconia crowns in dentistry: Uses, clinical challenges, and solutions

Some labs are spacing the intaglio (internal) surfaces of crowns to reduce seating difficulty as measured by the CR science team (figure 2). You have probably noticed that many current zirconia crowns do not have a definitive seating location and tend to be mobile on the tooth until cemented. This unfortunate situation is directly related to internal spacing. So, how much internal spacing is necessary for optimum seating?

Figure 2: This crown came off in service and is from one of CR’s in vivo zirconia studies. It was placed only a short time before the photo was taken. Note the thickness of the resin cements as observed in the void area on the occlusal intaglio surface of the crown and the staining on the margins that occurred after a very short time.

You may remember when stone dies were the norm. A layer of lacquer was painted on the dies to allow space for the cement and reduce hydraulic resistance caused by the cement during seating. That layer was about 25 microns thick, which is probably enough even for the digital needs of today. However, if there are undercuts on the prep, those undercuts need to be filled with some material to avoid the digital directed milling device automatically overspacing the digital prep model. CR scientists have measured up to 500 microns (one-half mm) of internal spacing.

Consider the combination of up to one-half mm occlusal spacing and one-half mm internal spacing totaling one full mm thickness reduction on the occlusal surface of the crown. Is there any question as to why some crowns don’t have stability on the tooth until they are cemented?

I strongly suggest dentists should communicate with their lab technicians to minimize the external and internal spacing of zirconia crowns.

Open margins are a problem. When the crown internal is spaced digitally, the margin is also spaced. Are dentists using cariostatic cement to fill those open margins? Thankfully, most dentists (from CR survey data) are using resin-modified glass ionomer (RMGI). Popular and proven examples are 3M RelyX Luting Plus and GC FujiCEM Evolve, which release significant fluoride for potential reduction of future caries involvement on the margins. However, many dentists are using resin cements for zirconia crown cementation, which have at least 2% polymerization shrinkage, resultant microscopically open margins, and no cariostatic properties.

Assuming you have followed the narrative above, most zirconia crowns cemented with the resin cement technique are essentially a strong zirconia roof on a potentially cariogenic composite resin cement. Logic says future marginal caries will be present on zirconia crowns cemented with resin cement (figure 3).

Use resin-modified resin cement until additional long-term research is completed on my suggestion below.

Figure 3: Open margin on a crown with caries that almost exposed the pulp when removed was seated with resin cement.

A possible solution for the cement challenge with zirconia crowns. In the 1970s and 1980s, conventional glass ionomer (GI) cements were used routinely. Later, about 20% resin was added to modifications of these cements, resulting in RMGI cements as discussed above.

Why aren’t conventional GI cements popular in North America? Infrequently and without any supported research reason, significant postoperative tooth sensitivity was observed, which led most dentists to choose other cements. Can that be overcome today? Yes!

Clinicians Report Foundation scientists have accomplished long-term research on glutaraldehyde-containing materials such as Zest Dental Solutions MicroPrime G, Kulzer Gluma, and several others. This data has been published in Clinicians Report.¹ These liquids contain 5% glutaraldehyde and 35% HEMA. When applied to tooth preparations for two one-minute applications just before cementing a crown, they coagulate the tooth collagen, closing the dentinal tubules and effectively eliminating postoperative tooth sensitivity. Another major reason for their use is that the application technique also effectively disinfects the tooth preparation.

Proven conventional GI cements are available. Two well-known brands are 3M Ketac Cem and GC Fuji I. Such cements do not have the undesirable polymerization shrinkage of resin or the slightly less shrinkage of resin-modified cements. They have natural chemical chelation (bonding) to tooth structure, and they have proven preventive properties related to fluoride release.

Here’s a personal empirical observation from my long-term practice experience. Remember Dr. David Sackett’s classic statement about evidence-based medicine (EBM)? He is the person often credited with initiating and supporting evidence-based practice. This is a direct quote from Dr. Sackett: “EBM is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical experience with the best available clinical evidence from systematic research.”²

During the 1970s and 1980s, I accomplished many full-mouth restorative rehabilitations. The cements used were conventional GI and later polycarboxylate, which was popular as a cement having less postoperative tooth sensitivity than conventional GI but was not an adequate long-term cement. Some of these rehabilitations have failed over the years due to restoration failure, caries, or periodontal problems and have required re-treatment. When taking the GI-cemented crowns off, caries is almost never observed even though the crowns have served up to 40 years or more in the mouth.

Combine my empirical statement with the proven cariostatic properties of GI cement, the obvious microscopically open margins of milled zirconia crowns, and it appears we have a mandate to revisit glass ionomer cements.

Summary

Zirconia crowns are now well known as the most-used ceramic restoration in dentistry. However, there are continuing challenges with them. This article provides some potential solutions for a few of the most important challenges. Zirconia crowns are here to stay. They can be esthetically and functionally excellent if their physical characteristics are known and proper cements are used (figure 4).

Figure 4: The current generation of zirconia crowns can be both beautiful and functional.

Editor’s note: This article appeared in the February 2023 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

How to predictably reduce post-op tooth sensitivity and caries. Clinicians Report. 2020;13(10).
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312(7023):71-72. doi:10.1136/bmj.312.7023.71

Author’s note: The following educational materials from Practical Clinical Courses offer further resources on this topic.

One-hour videos:

Strong, Comfortable, Esthetic Rehabilitations with Zirconia (Item #V1942)
Cementing Restorations—Proven and Successful (Item #V1921)

Three-hour virtual course:

Christensen’s Most Frequent Failures and How to Avoid Them (Item #X4740)
Making Occlusion Work for Your Practice (Item #X3515)

For more information, visit our website at pccdental.com or contact Practical Clinical Courses at (800) 223-6569.

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