Design and Print Your Own Customized Orthodontic Brackets!

Posted on August 2, 2021 by Quintessence Publishing
Reading time: 8 minutes

A customized orthodontic appliance is one that is made specifically for an individual patient to effect a predetermined orthodontic result. Such custom orthodontic appliance systems are based on a “setup” of the dentition, which affords the clinician a direct method of visualizing multiple treatment outcomes, “keeping the end in mind.” The orthodontist can predict the final occlusal result in the setup, which will also serve as the basis for the designing and printing of the conceptualized customized fixed appliances. This digital customization can be applied to even the most basic orthodontic appliance—the bracket itself (Fig 1).

Fig 1 (a) Canine customized bracket. (b) Customized bracket base.

Any customized appliance requires special technologies and materials. In a scenario where an orthodontist would be able to design and manufacture customized orthodontic brackets, the following would be needed:

  • Surface scans of the dental arches
  • Digital panoramic and cephalometric radiographs or CBCT scans
  • Digital photographs
  • Orthodontic CAD software in order to perform the digital setup
  • Predesigned virtual orthodontic brackets that would be customizable
  • Dedicated orthodontic software that would virtually place and adapt customized orthodontic brackets onto the digitized teeth
  • Special materials for 3D printing or milling
  • 3D printer or milling machine for the manufacture of the customized brackets
  • IDB tray for bracket bonding
  • Wire-bending robot for the manufacture of wires or a prototype wire exported from the orthodontic CAD software that would be manually copied and used in all treatment stages

With customization, the value lies in the predictability.

This is a long list indeed, and so the question becomes: Why should orthodontists invest in all of this new technology and the learning curve to use it? After all, the usefulness and efficacy of customized fixed orthodontic appliances remain a point of controversy in the orthodontic literature. However, multiple studies have shown that appliance customization enables the orthodontist to deliver optimal, efficient, safe, and reproducible orthodontic treatment, reducing round-tripping tooth movements by reducing bracket repositioning or wire bending. With customization, the value lies in the predictability.

UBrackets software

A dedicated orthodontic CAD software is needed in order to bring the in-house bracket customization concept to reality. This software must be user-friendly and fast and offer automations and tools for performing the needed bracket customization. Orthodontic CAD company Coruo has partnered with Nearchos C. Panayi, author of DIY Orthodontics: Design It Yourself, to create the UBrackets software for in-house customized bracket design. The first stage in bracket customization with UBrackets is to perform a digital setup in the software adhering to the following steps:

  1. Maxillary and mandibular dental scan importing
  2. Dental model bases design
  3. Segmentation
  4. Local axes definition
  5. Setup procedure

In the next stage, the operator chooses the customization procedure, selecting between the customized bracket bases option and the customized brackets option.

Steps in the customized brackets module

The customized brackets module shares approximately the same interface as the customized bases module. The steps of the module are as follows:

  1. The operator chooses the customized brackets option.
  2. The orthodontist has to specify which kind of orthodontic treatment will be undertaken—labial or lingual.
  3. The bracket brand is selected.
  4. The software will automatically align the slots of the brackets in a continuous arch-shaped wire (0.018 × 0.025 inch). The brackets are now at a distance from the teeth, which will be filled by the extrusion of the base to the tooth surface in order to create a customized base. The same archwire will be exported as an STL file and a 1:1 image file. This will be the prototype wire that will be replicated for the rest of the archwires throughout the orthodontic treatment.
  5. Manipulation of the whole bracket-archwire complex provides the ability to move them in a vertical direction or in a left and right differential vertical movement (upward movement for the left buccal segment and downward movement for the right segment or opposite). In addition, each bracket can be manipulated mesially or distally, labially or lingually, or horizontally rotated, with the slot kept in the same line while sliding on the wire. The operator can also define the center of rotation of the archwire-bracket complex in such a way that the entire complex can be moved around this center of rotation.
  6. A tool exists to show the brackets bonded to the setup or to the initial malocclusion.
  7. Design of the IDB tray can be done in one, two, or multiple units.
  8. The software is able to calculate the volume of each bracket in mm³.
  9. The files that can be exported are:
  • The STL files of the brackets
  • The archwire in STL and 1:1 image file
  • The IDB trays
  • The initial and setup model (brackets and dental model)
  • The initial and setup model (brackets, dental model, and archwires)

The brackets are then sent/exported for printing or milling to be printed in metal or resin. The initial models, including the brackets, can be printed in order to manually create the IDB tray using transparent silicone impression material.

Labial customized brackets

Just before Dr Panayi’s book went to press, he was able to accomplish something really exciting: He was able to PRINT labial orthodontic brackets designed in the UBrackets software in-office! The author used Formlabs 3B SLA printer using Formlabs’s permanent crown resin in A3 color.

The author designed the fixed orthodontic appliances in the UBrackets software for a healthy 13-year-old boy. UBrackets in its latest version will include a tool to design positioning tooth keys for each bracket to be bonded. In this way, there is no need for IDB tray manufacture. Another option that is included in the UBrackets software is the connecting bar tool. This tool gives the ability to design bars that connect the bracket keys or any other part of the printed brackets. In this way, all the brackets and positioning keys are connected together, forming a “bracket-keys-bar net.” The advantage of this configuration is that the IDB tray is avoided and that less composite is used for bonding, avoiding composite flowing around the bracket (compared to the conventional IDB tray).

The author separated the “net” into three pieces: the four anterior teeth, the right teeth, and the left teeth (canine to molar; Fig 2a). In this way, printing was easier and more accurate. Figure 8-2b presents the maxillary incisors’ IDB net bonded, while Fig 2c shows the brackets without the bar and the keys. The composite used to bond the brackets was Enlight (Ormco). The individual brackets and the bracket-keys-bar net were placed on the Preform software in a specific orientation (Fig 2d), and they were printed using the permanent crown resin by Formlabs.

Figure 2e presents a printed bracket with its supports and base after the postprinting procedure (IPA washing, UV curing, polishing, etc). The mandibular teeth were bonded using the bracket positioning key configuration (Figs 2f and 2g). Continuously, the positioning keys were removed and a 0.012 Ni-Ti wire was inserted (Figs 8-2h and 8-2i).

Fig 2 (a) The IDB net (bracket, positioning key, bar) in three pieces. (b) The IDB net (bracket, positioning key, bar) bonded on the teeth. (c) The positioning keys and the bars are removed. (d) Placement of the virtual brackets on the platform of the Preform software. (e) Close-up photograph of a printed bracket with its supports and base after the postprinting procedure. (f) Frontal view of the brackets and positioning keys bonded on the mandibular teeth. (g) Occlusal view of the brackets and positioning keys. (h) Occlusal view of the brackets after removal of the positioning keys and insertion of the Ni-Ti wire. (i) Left lateral view of the brackets after the removal of the positioning keys and insertion of the Ni-Ti wire.

It is a fact that the permanent crown resin used here is not intended to be used as a material for bracket printing. However, the author’s intention is to present the capabilities of 3D technology in bracket 3D printing, not the problems involved; further studies are currently being carried out in order to be able to have a consistent bracket printing outcome.

Learn what is possible with digital

This article offers just a glimpse into the world of digital design and customization. To learn what is truly possible with digital technology, check out Dr Panayi’s new book, available now. To preview the book, click here.

Digital technology can make a good orthodontist better, but it will not transform a bad orthodontist into a good one.

Nearly any appliance can be customized and printed for the benefit of your patients, and you owe it to them to keep yourself informed and educated on the possibilities in the field. But remember: Digital technology can make a good orthodontist better, but it will not transform a bad orthodontist into a good one. Technology is an aid to better treatment, not a replacement for understanding the basic principles of orthodontic mechanics.

Nearchos C. Panayi, DDS, DOrth, MOrth, is an orthodontist based in Limassol, Cyprus, and is currently a PhD candidate in the Experimental Surgery Department at the National and Kapodistrian University of Athens Medical School (Greece). He studied dentistry at Athens Dental School (1992–1997) and orthodontics at Tel Aviv University (1998–2001) before building his private practice, which has grown into two fully digital orthodontic offices in Limassol and Larnaca, Cyprus. His passion for digital technology encouraged him to use it in orthodontics, and as a huge fan of the in-house 3D designing and printing concept in orthodontics, Dr Panayi has helped develop concepts, ideas, and methods that will transform traditional orthodontics to customized-centered digital orthodontics. He is the inventor of the orthodontic CAD software UBrackets for in-house designing of customized fixed orthodontic appliances, and he introduced the use of general-purpose CAD software in orthodontics for orthodontic appliance design. Dr Panayi is also a researcher for direct aligner printing. He is married and has six children.

DIY Orthodontics: Design It Yourself
Nearchos C. Panayi

Since its recognition as the first specialty of dentistry, the practice of orthodontics has been influenced by the development of new materials, techniques, bracket designs and prescriptions, appliances, and software. However, never before has there been as revolutionary a change as digitization. Digitization and automation are transforming the entire landscape of how orthodontics is practiced, and the consequence is the “do it yourself” concept. With the technology available today with intraoral scanning, CBCT imaging, and CAD software, we can create the virtual patient and manipulate dental models virtually. Not only does this enable better and more precise treatment planning, but it also facilitates better communication with the patient. Perhaps most exciting is that it permits in-house designing and printing of the majority of orthodontic appliances. This book describes the current digital technology that is used in orthodontics, including volume and surface scanning, 3D printing, CAD software, and artificial intelligence, before delving into a “design it yourself” guide presenting the application of this technology in all aspects of orthodontic treatment. It describes all the necessary technologic ingredients to be used in a self-sufficient digital orthodontic clinic, and it focuses on the in-house design and production of tailor-made appliances by digitally diagnosing and evaluating the virtual patient and then creating an individualized treatment plan. Now you can design your own expanders, retainers, clear aligners, brackets, indirect bonding trays, and even wires with a wire-bending robot. It is incredible what technology has to offer; we just have to have the courage to learn and experiment with it. For the benefit of our patients, the challenge is laid.

232 pp; 534 illus; © 2021; ISBN 978-1-64724-051-6 (B0516); US $155

Posted in Multidisciplinary, Orthodontics, What's New | Leave a comment

How Do You See the Mandible? A Study of Different Types of Anatomical Images

Posted on June 21, 2021 by Quintessence Publishing
Reading time: 5 minutes

When you think of a mandible, what image comes to mind? Is it a panoramic radiograph, a standard profile view of the bone, or what you see in a real patient when you’re performing a procedure? When you’re taking a deep dive into anatomy, you should be able visualize all of these things and more! That’s why Dr Al-Faraje’s Clinical Anatomy for Oral Implantology features so many different types of images of all the different parts of the oral cavity and surrounding areas. Here, using the mandible as an example, we will take a look at the types of images found in this book and what each one means as an educational tool.

Drawings

Drawings of the mandible from different angles to show various anatomical features.

The oldest form of written communication, the drawing has never gone out of style. And for good reason! Illustrations allow the features to be recreated in bright contrasting colors to easily see what goes where. For example, veins, arteries, and nerves are represented in blue, red, and yellow, respectively, so the reader can easily distinguish them, though they would appear similar in other mediums. Drawings also allow certain features to be “cut” away to easily see what would be behind them. And, of course, drawings can be represented much larger than life. We’ve partnered with expert medical illustrators to create dozens of drawings for this book, and they are truly functional works of art.

2D and 3D Radiographs and CT Scans

2D and 3D radiography of the mandible to provide a useful look at what the clinician can expect to encounter when treatment planning implants.

Radiographs have been used in medicine for over 100 years, but the technology surrounding imaging techniques has continued to explode with advancements. 2D images provide a quick and easy view of characteristics such as the distance between various features like teeth, implants, and the alveolar nerve. Comparing radiographs of patients with different levels of alveolar resorption demonstrates the different classification systems of these types of patients and shows real-life examples of what the clinician will need to treat. And of course, CBCT scans and other 3D images that take advantage of the most cutting-edge digital technology have a huge range not only in treatment planning, but in getting a complete 360-degree look at actual patient anatomy.

Intrasurgical

Intrasurgical images provide the most realistic picture to help surgeons learn new techniques.

Intrasurgical images are one of the most valuable clinical educational tools in use today. They show step-by-step views of what the surgeon actually sees when performing the various procedures, and they demonstrate the specific steps to take when you find yourself in the same position. Photographs also tend to be enlarged to larger than life and color corrected to show more detail than is actually visible during surgery.

Dry Bones

Dry bones show shape and resorption patterns and demonstrate the mental canal and foramen, as well as the shape of the mandibular condyle, ramus, and body.

These types of images show actual human bone exposed, with no soft tissue to get in the way. They can be cut to view the cross section, viewed as a whole or in parts, and turned in different directions to see how the bone looks from multiple angles. Examples are provided both with and without teeth to see how the models differ and how resorption occurs on an actual bone.

Cadaver Specimens

Cadaver specimens can show real-life anatomy in a way no other type of image can.

The use of human specimens to demonstrate the orofacial anatomy is one of the defining features of this textbook. Unlike intrasurgical images, these are free of blood that may hide certain features, and dissections can be performed to identify nerves and vessels without any risk to a patient’s health. The specimens can be treated so that certain features may show a different color than they naturally appear, and areas can be sectioned to focus on any specific region or angle. This is the human body at its most fundamental.

Conclusion

Each of these images demonstrates something unique and different to provide a complete picture of the region in question. With over 500 images, many of which take up a half page or more for maximum detail, this book has everything you could want in a clinical anatomical text.

Clinical Anatomy for Oral Implantology, Second Edition
Louie Al-Faraje, DDS

Anatomical knowledge is vital not only for the safe and successful execution of surgical procedures, but also as the basis for accurate diagnosis and treatment planning. This in-depth anatomical text is designed with the practicing implantologist in mind, and it has been revitalized to have the utmost relevance to the clinical reality of oral implantology today. Impeccable full-page illustrations demonstrate a detailed view of each anatomical area, and clinical photos, radiographs, CBCT scans, and cadaver specimens provide a complete picture of what the clinician can expect to encounter. As in the previous edition, the aim of this book has been to present the necessary anatomical material in a readable and interesting form, and every effort has been made to sequence the information in a logical manner. This book is a must-have for any implant surgeon.

320 pp; 565 illus; © 2021; ISBN 978-1-64724-038-7 (B0387); US $228 (final), $182 (prepub)

  1. Arteries, Veins, and Innervation of the Maxilla and the Mandible
  2. Muscles of Facial Expression and Mastication
  3. Posterior Maxilla
  4. Zygomatic Bone
  5. Anterior Maxilla
  6. Posterior Mandible
  7. Anterior Mandible
  8. Bone Density and Adjacent Teeth
  9. Anatomy for Surgical Emergencies
  10. Topographic Anatomy of the Maxilla and the Mandible
  11. Venipuncture

Louie Al-Faraje, DDS, is a private practitioner as well as the founder and director of the California Implant Institute, which offers continuing education through advanced surgical and prosthodontic programs, including a master program and live patient surgical externships. Since 2001, more than 2,000 dentists from over 20 countries have received training at the institute. He is also the founder of Novadontics, an all-in-one implant practice management platform. Dr Al-Faraje studied dentistry at the Kiev Medical Institute and at Loma Linda University in California. He is a Fellow of the American Academy of Implant Dentistry and a Diplomate of the International Congress of Oral Implantologists and the American Board of Oral Implantology. Dr Al-Faraje lectures nationally and internationally.

Posted in Books, Implant Dentistry, Oral and Maxillofacial Surgery | Leave a comment

AMHypo and Why One Surgeon Devotes His Practice to Curing It

Posted on April 29, 2021 by Quintessence Publishing
Reading time: 5 minutes

The baby with Pierre Robin syndrome born with a small jaw. The Class II adolescent with braces and impacted third molars. The middle-aged overweight person with sleep-disordered breathing (SDB) and a new diagnosis of obstructive sleep apnea (OSA) supported by a high apnea-hypopnea index (AHI) score. These are all the same person but at different stages of life. What unites them is their small mandible, or what Dr Paul Coceancig calls AMHypo.

Figs 1 and 2

Anterior mandibular hypoplasia, or AMHypo, is the most common form of the small mandible in people of Caucasian descent. AMHypo arises because of a small anterior tongue (with normal jaw joints), and it leads to dewlap (poor chin-neck contour), dental crowding, impacted third molars, a range of dental malocclusions, and retroglossal tongue displacement into the upper airway (with associated neck posture issues). A person born with a small mandible relative to the rest of their body will always have that disproportion as their body ages (Fig 1); overbites, camouflage orthodontics, big tonsils, and eventually OSA often follow in its wake (Fig 2). It is why most youths today end up in the orthodontist’s chair, because a small mandible isn’t just short—it is also narrow and relatively squat, meaning it can contain fewer teeth, resulting in dental crowding, impacted teeth (especially third molars), and worse, a bad bite. However, traditional orthodontic treatment does not address the cause of these issues—the AMHypo itself—and instead only treats these dental effects, leaving these patients in the same anatomical situation they were in prior to orthodontic treatment (Fig 3).

Fig 3

Figs 4 and 5

With modern medical imaging, we can now explain the link between the small mandible, bad neck posture, a receding profile, and of course the very real medical dangers associated with snoring and OSA. As someone who personally traveled the journey from camouflage orthodontics to jaw pain and breathing difficulties and eventual OSA, Dr Coceancig has devoted much of his career to treating patients with AMHypo, developing several surgical protocols that cure the problem entirely. His true workhorse is IMDO, or intermolar mandibular distraction osteogenesis, which expands the mandible (Figs 4 and 5) to eliminate the problems of crowding and impaction while supporting the profile and facial esthetics of the patient (Fig 6). More important is that as distraction advances, the back of the tongue is pulled forward as well, eliminating the potential for OSA (Fig 7).

Figs 6 and 7

Of course, IMDO is not always possible, which is why Dr Coceancig has developed GenioPaully, BIMAX, SuperBIMAX, custom PEEK, and SARME as well. Together with IMDO, these make up his 6Ways to Design a Face, and he has compiled all of them into a new book of the same name. In it he explains and demonstrates why small jaws are common, what causes them, the problems they create, and more importantly, how to treat them to eliminate those problems. His unique journey has enabled him to see the problem for what it is and find solutions that work in real life. Read his story and preview chapter 1 here: http://www.quintpub.com/PDFs/book_preview/Coceancig_Preview.pdf

6Ways to Design a Face: Corrective Jaw Surgery to Optimize Bite, Airway, and Facial Balance
Paul Coceancig

In this innovative and paradigm-busting book, the author asserts that almost all bad bites have their origin in a small mandible, what he calls anterior mandibular hypoplasia, or AMHypo, and further claims that surgical management is the only means to correct it. AMHypo arises because of a small anterior tongue, and it leads to dewlap (poor chin-neck contour), dental crowding, impacted third molars, a range of dental malocclusions, and retroglossal tongue displacement into the upper airway. Traditional orthodontics often camouflage the small jaw by extracting “extra” teeth that don’t fit and controlling growth with various appliances, effectively leaving the patient in the same medical predicament they were before having their teeth straightened and their occlusion fixed. After all, for every patient with a bad bite, there are three combined, interwoven, inseparable treatment considerations: occlusion, airway, face. In this book, the author outlines the anthropologic underpinnings of the small jaw and then outlines his six surgical methods of designing the face to optimize bite, airway, and facial balance: IMDO, GenioPaully, custom BIMAX, SuperBIMAX, custom PEEK implants, and SARME. IMDO, or intermolar mandibular distraction osteogenesis, is a surgery less invasive than third molar surgery that can expand the mandible by as much as 16.5 mm and effectively bring the tongue forward to eliminate the potential for airway issues down the line, not to mention improve the patient’s profile dramatically. The surgeries and protocols in this book will have you rethinking your approach to patient care and asking yourself how you can better care for your patient now AND in the future. The author sees no reason why we should not expect to carry all 32 of our teeth for our adult lifetime in a Class I occlusion and free of crowding or impactions or airway collapse. Do you dare to join him?

256 pp; 774 illus; ©2021; ISBN 978-0-86715-966-0 (B9660); US $178

Paul Coceancig is a Commonwealth-trained jaw correction surgeon—with a unique practice based in New South Wales, Australia—dedicated to the treatment, and surgical cure, of obstructive sleep apnea. From prevention to active management, Dr Coceancig has helped develop concepts, ideas, protocols, methods, and instruments that will revolutionize how we manage the small jaw and glossoptosis and malocclusion.

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Conservative Dentistry with Esthetic Post Systems

Posted on April 19, 2021 by Quintessence Publishing
Reading time: 6 minutes

For nearly 300 years, clinicians have written about the place­ment of posts in the roots of teeth to retain restorations. As early as 1728, Pierre Fauchard described the use of “tenons,” or metal posts screwed into the roots of teeth to retain bridges. The 19th century saw wooden posts and post-retained crowns with a porcelain facing, and the 1930s witnessed the birth of the iconic cast post and core system. Finally, in the 1990s tooth-colored fiber posts debuted as an alternative to these conventional metal post systems.

Current concepts supported by evidence-based research indicate that the primary objective of any post and core system is to replace missing coronal tooth structure, to retain the core, and to provide sufficient retention and resistance form to the final restoration to restore original form and function. However, the failure of these post-retained systems has been documented in numerous clinical studies, owing to recurrent caries, endodontic failure, periodontal disease, post dislodgment, cement failure, post-core separation, core fracture, post fracture, tooth fracture, root perforation, and root fracture.

In Douglas Terry’s new book, Restoring the Intraradicular Space: Esthetic Post Systems, he explains that “no single post system meets the demands for favorable biomechanical compatibility or provides the perfect restoration solution for every clinical circumstance, and each situation requires an individual evaluation.” His book explains when, how, and why you should consider post and core systems in restorative dentistry, as well as which type of system to use according to the individual patient’s clinical presentation and esthetic demand. In the case that follows, a gold post and core with metal-ceramic crown was replaced with a custom-made glass fiber post system to optimize esthetics and conserve as much natural tooth structure as possible.

Total-etch technique with Ribbond reinforcement fiber

The patient presented with concern regarding the variation in tooth color and the discoloration of existing large composite restorations on his maxillary anterior teeth (Fig 1). He indicated there was a discrepancy in size, shape, and orientation of both the natural teeth and existing restorations. He also revealed that he had never been happy with the existing metal-ceramic crown on the maxillary left central incisor. The patient was aware of the discoloration of the tissue in the cervical region and reported bleeding on brushing.

Upon clinical and radiographic examination, it was determined that the maxillary left central incisor had previously been endodontically treated, and an ill-fitting custom fabricated gold post was present (Fig 2). Marginal discrepancies at the interface of the metal-ceramic crown can result in bacterial infiltration and inflammation. The discoloration and shadowing of the gingiva at the cervical aspect of the tooth was a result of the incidental light being blocked by the gold post and the metal substructure of the crown (Fig 3). This causes the characteristic bluish shadow at the submarginal zone (Fig 4).

After removal of the metal-ceramic crown, the gold post was easily removed with an ultrasonic Piezo scaler (Figs 5 to 8). The gutta-percha was removed with a series of Gates Glidden drills (#1, #2, #3) to a newly established length; the length of the post channel was established as one-half the length of the root while maintaining an adequate apical seal (Fig 9). A post drill the size of the existing post space was selected to remove debris from the walls of the post channel without enlarging the diameter (Fig 10). The prepared post channel length was accomplished with minimal additional preparation because there is no designated orifice size with the use of bondable polyethylene woven reinforcement fiber (Ribbond-THM, Ribbond). This method can be used for retreatment of an enlarged post channel, and it provides improved internal adaptation to the surface irregularities of the root surface.

Before placing the adhesive or resin cement, a 2-mm-wide reinforcement fiber (Ribbond-THM) was selected, and the fiber was transported to the base of the post space with a Luk’s gutta-percha condenser (Fig 12). It is recommended to rehearse the placement of the fiber into the post channel to ensure proper positioning and complete seating of the material. The appropriate length of the fiber is determined by folding the material once in the canal and folding back on each end, which is approximately six times the height of the anticipated preparation. The plasma-coated ribbon is measured and coated with an unfilled light-cured resin bonding adhesive or a composite sealant.

After an etch-and-rinse protocol and after adhesive was placed and air dried, a dual-cured composite resin cement was injected into the post channel with a needle tube syringe (Centrix). The resin material should flow easily, and the working time should be as long as possible. It is important to place the tip at the base of the post space; the resin material is injected as the syringe tip is slowly removed. This technique reduces the possibility of entrapping air bubbles and ensures optimal adaptation of the resin material to the post hole preparation. The fiber is immediately inserted into the posthole with the modified Luk’s gutta-percha condenser and the fiber is folded over so that the ends are pointing back into the post channel and between the emerging ends of the fiber (Fig 13). The folded ends are arranged into the desired shape of the core and light-cured for 60 seconds.

A dual-cured radiopaque core material was injected over the positioned fibers with a Centrix syringe tip (Accudose Low Viscosity Tube) and adapted with an interproximal instrument (IPC-L, American Eagle) and shaped with a flat sable brush (# 2 sable brush) to an ideal coronal preparation form and dimension (Figs 14 to 16). Finishing resulted in an ideal abutment with a 2-mm circumferential ferrule design to enhance mechanical retention and resistance (Figs 17 and 18).

With this technique, an optimal adhesive integration is achieved between the components of the post-retained system using the direct custom-made glass fiber post system (Fig 19). Figures 20 and 21 show the completed anterior restorative complex immediately after cementation with optimal esthetic results. Figure 22 shows the 3-year postoperative result, demonstrating stability at the interface and an improved gingival color.

Discover more

To see more cases like this and discover why esthetic post systems are a valuable part of any dentist’s armamentarium, check out Douglas Terry’s new book, available now. Hear him explain his philosophy here: http://www.quintpub.com/video_preview/B0561.mp4. And preview the book here: http://www.quintpub.com/PDFs/book_preview/Terry_preview.pdf.

Restoring the Intraradicular Space: Esthetic Post Systems
Douglas A. Terry

Too often patients with fractured teeth are referred for extraction and implant placement with little consideration given to the conservative option of post and core treatment. But it has been demonstrated that endodontic and implant therapies have equivalent results when the treatments are appropriately chosen and performed at a high level of expertise. After all, advancements in endodontic technology and instrumentation have allowed the clinician to visualize, identify, and treat complexities they could not have fathomed a decade ago, and advancements in restorative material formulations have expanded the treatment possibilities for the patient, clinician, and technician. This changing technology has allowed the clinician to treat many clinical challenges through simpler, more conservative, and more economical methods. As such, this text provides a detailed and scientific description of the evolution of the post and core system and the significance of the adhesive design concept when restoring the intraradicular post space. The author presents the various applications and restorative techniques that he uses on a daily basis for restoring the post space, and the esthetics speak for themselves. Every aspect is covered, from general design criteria and the components of the post and core systems to post materials, adhesive bonding and luting agents, material selection, core buildup, and finally, the extracoronal restoration. The clinical protocols are illustrated meticulously and with stunning quality, and additional scientific content can be accessed via QR code. If you want minimally invasive treatment with maximal esthetics, this book is for you.

268 pp; 895 illus; ©2021; ISBN 978-1-64724-056-1 (B0561); US $168

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Infectious Diseases and Dentistry: A Sneak Peek of Our Latest Perio Title

Posted on April 8, 2021 by Quintessence Publishing
Reading time: 5 minutes

It’s been inspiring to see the kinds of changes businesses have made over the last 12 months to improve safety for employees, clients, and customers. Everyone seems to be intimately familiar with the symptoms of COVID and knows where and how to get tested—but there are many other diseases that patients may not even realize they have. Many of these have symptoms that manifest in the oral cavity as lesions or blisters. Here are just a few to look out for:

Herpes simplex virus (HSV)

The herpes simplex virus can be transmitted several ways, including through saliva (HSV-1), and will remain in the body for life, though often it will be asymptomatic. Many patients may therefore be unaware that they are afflicted with the virus. However, when the virus does flare up, it can cause painful red ulcers in and around the mouth and lips (Fig 1). These symptoms generally occur during primary infection of the virus, but the virus can be reactivated by various stimuli.

Fig 1 Primary herpetic gingivostomatitis in a teenaged patient. The area demonstrated gingival erythema and multiple erosive areas or ulcers in the palate (a) and labial mucosa (b).

Human papillomavirus (HPV)

There are over 100 types of HPV, and it can be spread though skin-to-skin contact, sexual contact, and oral contact. It is an extremely common condition, though vaccines are available for certain types. Like HSV, HPV can be asymptomatic, and patients may not be aware that they have it. Though HPV often goes away on its own without treatment, certain strains may have oral symptoms such as oral lesions or warts, and certain strains of HPV can lead to cancer, including oropharyngeal cancer and cervical cancer.

Varicella zoster virus

Though most patients are familiar with the skin lesions associated with chickenpox, oral lesions may occur as well. It is even possible for oral lesions to manifest prior to skin lesions. Varicella zoster most commonly occurs in children, and though a chickenpox vaccine has been available since 1995, less severe breakthrough cases may occur even in vaccinated patients.

Hand-foot-and-mouth disease

Like chickenpox, this is most common in children, especially young children. Hand-foot-and-mouth disease often includes oral sores and blisters as well as skin rash. This viral infection also usually goes away on its own without treatment.

Oral candidiasis

Oral candidiasis is common and can be caused by Candida albicans as well as other Candida species. Table 1 and Fig 2 describe the different types of oral candidiasis as well as predisposing factors. It is important to identify and resolve the predisposing factors as a component treatment; treating only the symptoms will likely just result in recurrence.

Table 1 Most common types of oral candidiasis and Candida-associated lesions.

Fig 2 Predisposing factors to oral candidiasis.

This information came from the pathology chapter of our brand new comprehensive textbook Periodontics: The Complete Summary by Fernando Suárez López del Amo, available now. The chapter also includes information on developmental disorders, local soft tissue lesions, autoimmune diseases, pigmented disorders, potentially malignant disorders, neoplasms, odontogenic cysts and tumors, and other bone lesions. And that’s just the tip of the iceberg of this in-depth text, the purpose of which is to review everything aspiring periodontists need to know in a single place.

To see what else is covered, check out our preview here.

Periodontics: The Complete Summary
Edited by Fernando Suárez López del Amo

This expansive textbook covers a broad range of topics to prepare aspiring periodontists for exams as well as serving as a guide or reference for more senior practitioners. Concepts are explained in language simple enough for students but technical enough to communicate the important points and subtleties of the topic. Over 100 vocabulary words are clearly defined and explained in context to facilitate understanding of the material, and the text is accompanied by a great variety of tables, diagrams, and illustrations to allow readers to visualize the area and provide additional context for the information. The textbook begins with a basic overview of periodontal anatomy, then leads the reader through the process of diagnosis, identifying different diseases and potential risks before obtaining a prognosis and creating a treatment plan. This is followed by over a dozen chapters on various treatment methods from SRP to complex surgery and then maintenance. The book concludes with additional concepts important for young dentists to know, including an overview of relevant medications as well as abnormalities and emergencies that may be encountered in daily practice. Nothing is left out in this handy study guide, and both current students and recent graduates will find it invaluable in beginning their careers.

ISBN: 978-0-86715-960-8; 9780867159608; 368 pp (softcover); 270 illus; $118

Fernando Suárez López del Amo, DDS, MS, received his dental degree from the European University of Madrid in Spain and completed his Certificate and Master’s degree in periodontics at the University of Michigan in Ann Arbor. After graduation, Dr Suárez continued serving as an adjunct clinical assistant professor and research fellow at the University of Michigan, before becoming an assistant professor at the Department of Periodontics—University of Oklahoma. In addition to being a Diplomate of the American Board of Periodontology, Dr Suárez has been the recipient of several awards from the American Academy of Periodontology, the American Academy of Periodontology Foundation, and the Department of Periodontics and Oral Medicine at the University of Michigan. He has published numerous articles in peer-reviewed journals and serves as a reviewer for a number of journals in the fields of periodontics and implant dentistry. Dr Suárez currently works in private practice in Tacoma, Washington.

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