Topical Antioxidants

March 17, 2020 Lee Ann Brady DMD

It used to be a challenge for me to help patients who came in with recurrent aphthous ulcers, lichen planus or erosive lichen planus, burning mouth, burning tongue, or geographic tongue that was uncomfortable. I’d worry about the pharmaceutical reactions of prescription options such as prednisone, steroid mouth rinses, and lidocaine rinses. Now, that challenge is greatly reduced due to the success we have had treating these problems with nonprescription topical antioxidants. 

There is a group of nonprescription topical antioxidant products that I rely on weekly from PerioSciences. These products not only promote healing but also provide significant relief from soft tissue pain, xerostomia, and burning sensations in the mouth. This is PerioSciences’ AO ProVantage line of mouthwashes, gel, and toothpasteThey are without a doubt the best products I have come across in my career for oral medicine applications. They were developed by dental scientists and other researchers and contain two antioxidants from the skin of apples. The products are marketed to help with a number of things in addition to oral wound healing, for example, to treat superficial gingivitis and to maintain patients who are at advanced risk of perio inflammation.  

In my practice, I have two patients who have chronic erosive lichen planus. We discovered that the application of the AO ProVantage gel to a lesion, four or more times a day, allows the body to heal the lesion. Within three to four weeks, the lesion is gone completely. After lesions are gone, my patients stop using the gel and start using AO ProRinse three to four times a day to prevent the outbreak of another erosive lesion. If they get another lesion, they go back to using the gel. The mouth rinse has reduced the number of outbreaks for these patients, and having these products on hand, has allowed my patients to successfully manage outbreaks on their own. 

I have lots of older patients who suffer with burning mouth or burning tongue. AO ProRinse mouth rinses have worked well for them. Some of my patients have severe dry mouth in association with the burning—some with Sjogren’s syndrome, some with Lupus disease. We start them on the hydrating formula of AO ProRinse, and they rinse their mouths four to six times a day with remarkable results. It’s also been of great value to my patients going through chemotherapy to keep their mouths hydrated and comfortable.  

The PerioSciences products are nonprescription and now readily available via AmazonOnce introduced to the products and given guidance, my patients have found it easy to determine when to start using the products and how often to use them. Topical antioxidants are just one more example of industry breakthroughs I am grateful to have in my clinical toolkit and widely available to patients.  

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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LuxaCrown in Clinical Practice

March 9, 2020 Lee Ann Brady DMD

LuxaCrown is a new material that was released by DMG America last year. LuxaCrown is a dual cure composite material that comes in a convenient chair-side cartridge. Because it has the physical properties of composite, it is much stronger and longer lasting than bisacryl provisional material. The manufacturer says it can last in the oral environment up to five years, maybe longer. It is stainresistant and color stable, so you can leave it in the mouth for long periods without concern that the color will change. I though it would be helpful to share the situations in which I now use LuxaCrown instead of a bisacryl material for provisionals. 

Multi-Unit Restorations 

In my own practice, I don’t use LuxaCrown for single crown preps where the provisional will be in the mouth for a couple of weeks, perhaps a month, or a little more. But, the strength of LuxaCrown and the color stability of this new composite material make it what I consider to be an incredible new clinical tool in my practice to provisionalize multiple units where there is pontic space. With LuxaCrown, I no longer need to reinforce the pontic with Ribbond or orthodontic wire. I don’t have to do anything to make sure we don’t get fracture at the connectors, because the material is strong enough and durable enough it to hold up, even long term.  

Anterior Veneers 

The other situation in which I use LuxaCrown routinely is with my shrink wrapped provisionals for anterior veneers. The strength of the material makes it more durable in a partial coverage anterior setting. And the color stability is appealing because the veneer may be in provisional for two months or three months, depending on how long it takes us to get patient approved provisionals for shape and contour that the patient really loves. Not having to worry about the color changing over time has been a huge bonus.  

Anterior Onlays 

Another situation in which I am using LuxaCrown is for partial coverage onlays in the posterior. So often we experience bisacryl onlay provisionals popping off the teeth, but LuxaCrown provisionals stay where you put them.    

Phased Dentistry 

And, I use LuxaCrown whenever I am phasing dentistry…when I am doing what I call “interim restorations” and the provisional restorations will be in the mouth multiple months before the patient receives ceramic restorations. Perhaps, the patient will be in provisionals six to 24 months while they go through orthodontics and we do final restorations in quadrants or even sextants of the mouth. Patients don’t mind having LuxaCrown in their mouths for long periods, because in addition to its stability, it polishes pristinely smooth and is glossy.   

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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A Fantastic New Temporary Cement

October 4, 2019 Lee Ann Brady DMD

The search for temporary cements has been a long one over the last decade as my practice has moved away from porcelain fused to metal full coverage as the “go to” indirect restoration. The difference in mechanical retention, aesthetics and final placement protocols places different demands on our temporary cements. There are quite a number of criteria we want out of a temporary cement, and finding it all in one product was the challenge.

  • Great Retention
  • Easy to Remove
  • Easy to Clean the Prep
  • Eugenol Free
  • Easy to Clean Excess During Cementation
  • Esthetic/Translucent
  • No Sensitivity
  • Doesn’t grow black Scuz

Having played with many of the temporary cements on the market there are many that meet most of the criteria, but I hadn’t gotten everything I wanted until I started to use TempoCem ID from DMG America.

Why I am so pleased with TempoCem ID:
  • It is a resin-based temporary cement that actually changes from slightly opaque to translucent when you move through the curing process.
  • The initial opacity that remains — even at the gel phase, makes cleaning away the excess very easy.
  • Once all the excess has been cleaned off, a final cure takes you to fantastic retention and a beautifully esthetic cement.
  • The chemistry allows you to place the final restoration without worry of incompatibility with adhesive or traditional cement systems.

Whether for full or partial coverage TempoCem ID has become the temporary cement of preference in my office.

 

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Capturing an Exquisite Crown & Bridge Impression

August 28, 2019 Lee Ann Brady DMD

Capturing an exquisite final impression is our goal every time. Getting this result can be one of the most challenging things we do in dentistry. In addition to being masterful in taking an impression and handling the materials, we also must manage the oral environment properly.

Improving the Gingival Tissue Prior to the Impression Appointment

For crown and bridge impressions this process has to begin with optimal tissue management, and tissue management always begins before tooth preparation. Old restorations with poor margins often compromise hygiene with resultant irritated and inflamed gingival tissues. If the tissue is inflamed at the time, we recommend the tooth be crowned, we apply chlorhexidine varnish (Cervitec Plus – Ivoclar Vivadent). When the patient returns for impressions, tissue health is vastly improved.

Managing the Gingival Tissue for Tooth Preparation

Tooth preparation itself can result in difficulty managing the tissue. My preference is always to leave margins supragingival if that is clinically appropriate. My second choice is equigingival, where the margins are right at the crest of the tissue. If the margins are to be placed subgingival, I want to avoid cutting the tissue and then having to manage bleeding. If my initial margin placement is equigingival, I place a primary cord to move the tissue out of the way. This allows me to now drop the margin subgingival with minimal trauma to the tissue.

Retraction of the Gingival Tissue for the Impression

Once tooth preparation is complete, retraction creates a space for the impression material to go past the margin apically so that we can create the proper emergence profile of the restoration. There are many ways to retract prior to an impression. I personally use a second or top cord with a larger diameter than the primary cord I placed to move the tissue for subgingival preparation. If the tissue is bleeding after the placement of the top cord, I place 3M’s “Retraction paste” as a hemostatic agent. This allows for optimal control of bleeding without worry of negatively impacting the set of my impression materials or staining the prep or gingival tissues.

Taking the Final Impression

The final impression is taken with Flexitime impression material (Kulzer). I have my assistant load the tray with heavy body material. I first wet the top cord, so I do not cause bleeding upon removal. The area is now thoroughly dried to allow for proper contact of the impression material to the tooth and tissue surfaces. I inject Flexitime CorrectFlow (Kulzer) and then seat the impression tray. I hold the tray for the full intra-oral set time and do not allow patients to close or bite on the tray, as movement can negatively impact the accuracy of the impression.

Is the impression perfect?

Once removed I inspect the impression using magnification to assess that I have adequate flash beyond the margins of the light body, no pulls, voids, drags or evidence that the impression moved. There is no way to correct an impression for errors. If errors occur, we repeat the process from the beginning to take a new impression.

Check out some of my short videos about impressions on Restorative Nation at https://restorativenation.com/?s=impression.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Are You Communicating Brand Preferences to Your Team?

June 24, 2019 Lee Ann Brady DMD
There may be times when you see an unfamiliar brand of material on the tray before you. If you do notice, it’s likely because the brand of this particular material has come to matter to you.

You know the brand you prefer is predictably reliable, and you have worked with it a lot.

A while back, I went to take a Centric Relation bite record for a patient so we could fabricate an occlusal appliance. After I dried the upper teeth and reached for the bite registration silicone, I realized it was an unfamiliar material in the gun. While trying to complete the procedure, I rotated the gun to read the label. Sure enough, it was bite registration silicone, but not a brand I had used before.

After the procedure was completed and the patient dismissed, I found a few minutes to talk to my assistant that handles ordering. She has been very effective in managing supplies and an incredible team member. I started with a simple question that I hoped would not sound accusatory. “That was a new bite registration material I haven’t used before.” She was pleased to say the brand was less expensive and they were having a special, so it was even less expensive than usual.

Now many of you might think all bite registration silicone is created equally, and I learned my assistant thought so as well. Her cost-saving thought process works well for many for the things we use in the office where I don’t have a brand preference, such as 2 x 2 gauze. However, I do have a strong brand preference for bite registration silicone. They are not all the same hardness, and they do not all have the same set time or moisture tolerance. This was not the staff member’s fault because I had never communicated this to her.

This has prompted me to take a moment, sit with my staff and go through the materials we order and identify any other places where my preferences are very brand specific. While doing this, I explain why I have each preference.

From time to time, I try new materials and brands of materials, adopt some and reject others. My preferences change. Therefore, I offer this little story to remind myself and to suggest to others that we periodically review with our teams the brands we like, the ones we don’t like, and the ones we would like to try.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Creating Dental Anatomy in Composite with Disposable Tips

June 17, 2019 Lee Ann Brady DMD

One of my goals with composite restorations is to do as much of the forming and shaping prior to picking up a curing light as I can.

The material is easy to sculpt before it is cured, and access to the surface of the tooth is easier with hand instruments. Once I have placed all the composite and have a dense fill, I remove as much of the excess sitting above the final occlusal surface as I can. With this step accomplished, I turn my attention to creating the occlusal anatomy.

My OptraSculpt handle and disposable tips from Ivoclar Vivadent are perfect for this. The various tip shapes allow me to create incline planes, occlusal grooves and the curve of the marginal ridges into the occlusal embrasures. This process often removes and shapes the composite. My assistant holds a two by two that has been moistened with rubbing alcohol to remove the excess off the end of the instrument. I can place a different shape on each end of the instrument, or I can interchange them as I need them.

Using a series of disposable tips enables me to work without the composite sticking. This has reduced the necessity for meticulous management of expensive instruments which frequently need replacement. And, I resist the desire to use dentin adhesive or an unfilled resin on the instrument to reduce sticking.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Triple Tray Versus Full Arch Impressions

February 7, 2019 Lee Ann Brady DMD

Indirect restorations are the mainstay of most general practices.

Deciding whether to take triple tray or full arch impressions is a process that represents the classic dilemma we all face. It feels like we are deciding between “quality” and “economics”. In truth I think there are “quality” and “economic” pros and cons to both types of impressions.

From an economic perspective triple tray impressions are a straightforward decision.

A triple tray and the VPS to take it represent about $10 in materials compared to two full arch trays, VPS material, facebow and bite registration at a cost of about $25 in materials. Additionally a very important economic factor is productive chair time. A triple tray impression should take about 5 minutes of chair time, whereas full arch impressions and all the accompanying records take approximately 15 to 20 minutes.

The balance to the chair time on the front end is the chair time required to seat and adjust the case. In order to do an accurate comparison of the seat appointment we need to discuss the technical risks and benefits of the two approaches. We are going to assume on the front end that both techniques are done with proper retraction and accurately represent the prep and margins. A triple tray impression captures the occlusal information at maximum intercuspal position extremely accurately, but it is the only functional position they can replicate.

Full arch impressions taken without a facebow transfer, either hand articulated, or with a bite registration only over the prepared teeth only give the same information about maximum intercuspal position to the laboratory as a triple tray.

The advantage to taking full arch impressions is that they can be mounted with a facebow transfer and allow the laboratory to see the interaction of the teeth in excursive and end to end positions. A facebow records the relationship of the maxillary arch to hinge axis in all planes of space, and then transfers this information to an articulator. It can also be used to communicate esthetic information about the relationship of the incisal and occlusal plane to the horizon if the bow is leveled when the record is taken.

So the ultimate difference between a triple tray and full arch impressions is the addition of functional information about excursive movements and end-to-end positions. This requires taking a facebow record, and can be increased in accuracy by setting the condylar elements on a semi-adjustable articulator either with a protrusive bite record or an end to end retracted photograph. Using either technique the most accurate bite record is always captured with the unprepared teeth in full occlusal contact. So the decision between the two approaches really depends on the functional and esthetic risk factors of the case. The more esthetic and functional information we send to the laboratory the higher our chances of managing the esthetic and functional issues of the case precisely.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Utilizing Chair-side Air Abrasion

January 13, 2019 Lee Ann Brady DMD

Chair-side air abrasion has numerous advantages, especially today when we use adhesive retention so much of the time.

The advantages for many years have been outweighed by the logistic challenges. With the advent of small, lightweight, easy to use air abrasion handpieces this is no longer true. When I became aware of the etchmaster I was skeptical, but I am now a believer and use air abrasion int he operatory all day long.

The Clinical Applications

One of the first things that many of us will utilize air abrasion for is to “etch” zirconia restorations for bonding during final seating. The only way to prepare the inside of a zirconia restoration is with 30-50 micron aluminum oxide. The particle size and type is critical. The ideal pressure is 1 bar (15psi). Next on my list is to clean tooth preparations prior to bonding and cementation. To me there is no better way to assure the removal of temporary cement and prepare a tooth for maximal adhesive retention than with 30 micron aluminum oxide.

My list goes on as I have started to prepare small class one cavity preparations using small glass beads in my chair-side unit. Cleaning out the occlusal grooves prior to a sealant and etching un-prepped enamel for anterior esthetic composite margins are other uses. In addition sodium bicarbonate can be used to remove stain. Now that I have a convenient, easy to use unit, I find more and more reasons everyday.

Air Abrasion Made Easy

When I first began to experiment with air abrasion the biggest challenge was the equipment and managing the logistics.  The Etchmaster is a small 3 to 4 inch attachment that connects to either a 3 or 4 hole line on your unit. The pressure is precisely controlled, for great clinical outcomes, and it means the patients mouth is not full of powder when you are done. The powders come in pre-filled tips that slide into the top of the hand-piece. You can choose from a variety of sizes and particle types and sizes. This means no more filling a reservoir with powder, wondering if you have too little or too much. It also means not wondering what particle type and size is in the reservoir the next time you go to use the unit.

Have you explored the clinical advantages of air abrasion? How has this been beneficial in your practice?

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Four Great Reasons For Prep Scrubs

May 30, 2018 Lee Ann Brady DMD

One of the most common questions I get is about the use of a category of materials we refer to as prep scrubs, prep wetting agents or desensitizers.  The question is usually do they actually make a difference, and are they worth the cost. The answer is “yes” and “yes”.

There are 4 things we are trying to accomplish: prevent sensitivity, antimicrobial activity, moisten dentin for bonding, reduce bond degradation over time. The prevention of sensitivity is caused in two ways. The first is the inclusion of HEMA in products like Gluma from Kulzer. The HEMA occludes the dentinal tubules and prevents fluid movement that triggers a pulpal response. The second is the anti-microbial activity of either glutaraldehyde (GLUMA) or chlorhexidine (Consepsis by Ultradent). Fewer bacteria left behind int he dentin means lower chances of a pulpitis that causes sensitivity or the ultimate need for a root canal.

Both chlorhexidine and glutaraldehyde also minimize the production of MMP’s (Matrix Metal Proteinases) the biologic process responsible for bond degradation. This means our bonded restorations last longer before we see marginal breakdown, leakage and secondary caries. The last function is to moisten the dentin to allow optimal penetration of the primer in our dentin adhesives. This means better hybrid zone development and better bonds and sealing of dentinal tubules.

So the answer to do they have benefit is a resounding yes. I have used Gluma on every tooth I have prepared for many years. I consider it extremely cost effective as I am not sure how to put a price on greater restorative longevity and less patient dissatisfaction due to sensitivity or post operative issues. The true cost should be about $2 a prepared tooth if dispensed properly, so that’s hard to argue with.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Chlorhexidine Varnish & Tissue Management

May 23, 2018 Lee Ann Brady DMD

One of the challenges we face today in dentistry is managing tissue health during the time period our patients are in provisonal restorations. This has become even more critical as we have incorporated more resin bonding techniques to seat indirect restorations. Isolation is critical to the long term success and can be challenging after multiple weeks in a bisacryl provisional.

We all stress oral hygiene to our patients during this time period, but let’s be honest there are barriers to optimal tissue health at the seat appointment. One barrier is often patients are fearful that their hygiene procedures will displace the provisional. This fear has them brush less vigorously, floss less or not at all, and even sometimes avoid that part of their mouths completely. Even when patients are undeterred int heir hygiene the provisional itself is often a barrier. Contacts can be less then optimal and increase interproximal food impaction. The Bisacryl itself, tends to hold and attract plaque due to a different surface texture even when finely polished.

Given the barriers and the goal of super healthy tissue, Chlorhexidine varnish (Cervitec Plus by Ivoclar) has become one of my favorite products. We are all familiar with the incredible anti-microbial effects of chlorhexidine, and also the reasons we dislike it. Cervitec does not have a bad taste, does not cause the typical brown staining, does not effect the patients taste buds, and they don’t have to remember to use it. Cervitec plus is a clear liquid applied with a micro-brush. At the end of any appointment where we have placed a provisional my assistants will coat the gingival margin with Cervitec as the last step before the patient leaves.

I have been using this as a critical step in my restorative procedures for over 5 years now, and I swear by it. I see almost perfect tissue health at seat appointments, and it is rare for me to struggle with isolation due to poor tissue management.

Related Course

Utilizing Clear Aligner Therapy in a Digital Workflow

DATE: September 26 2024 @ 6:00 pm - September 28 2024 @ 2:00 pm

Location: The Pankey Institute

CE HOURS: 0

Dentist Tuition: $ 1695

Single Occupancy with Ensuite Private Bath (per night): $ 290

Enhance Restorative Outcomes This one-and-a-half-day course is designed for Invisalign providers who want to improve restorative outcomes with clear aligner therapy. The course focuses on the digital workflow for comprehensive…

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About Author

User Image
Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR