PDF Version - Glidewell Dental Labs

Chairside® 

A Publication of Glidewell Laboratories • Volume 7, Issue 1 

Photo Essay 

An Esthetic Challenge for 

BruxZir ® Solid Zirconia 

Page 23 

Navigating the New Era of 

“Wants-Based” Dentistry 

Dr. Robert Lowe 

Page 14 

Dr. Ellis Neiburger 

The Routine Adult Pulpotomy: 

Has Its Time Come Again? 

Page 42 

One-on-One Interview 

Officite’s Glenn Lombardi on 

Optimizing Your Online Presence 

Page 32 

Dr. Michael DiTolla’s 

Clinical Tips 

Page 9 

COVER PHOTO 

Linh Dinh, Human Resources Assistant 

Glidewell Laboratories, Newport Beach, Calif.

Contents 

9 Dr. DiTolla’s Clinical Tips 

In this issue, I showcase Ultradent’s Opalescence ® 

Trèswhite Supreme preloaded teeth-whitening trays, 

which provide an easy way to deliver same-day bleaching 

trays. Also featured are: NTI ® Superflex Diamond 

Discs from Axis Dental, my top instrument pick for trimming 

and shaping provisionals; the KaVo QUATTROcare 

Automatic Handpiece Maintenance System, which I trust 

to keep my favorite handpieces in tip-top shape; and 

NoMIX ® Temporary Cement from Centrix, a necessity for 

short-term cementation. 

14 Upgrading Porcelain Veneer Restorations: 

A Case Report 

Have you had patients come to your office requesting 

an upgrade of perfectly serviceable restorations based 

solely on esthetics? Dr. Robert Lowe presents one such 

case in his article that outlines the process of upgrading 

veneers to satisfy a patient’s esthetic demands. He 

discusses a new age of “wants-based” dentistry, which 

is often purely esthetic in nature, and how to navigate 

customers’ wants and perceived needs in this era of 

elective dentistry. 

23 Photo Essay: BruxZir ® Solid Zirconia 

Anterior Esthetic Challenge 

This photo essay illustrates our laboratory’s latest 

advancements in improving the translucency and esthetic 

properties of BruxZir Solid Zirconia. To showcase this 

product, we put it to the challenge of replacing old 

crowns on tooth #8 and #9. After viewing the case, I 

think you will see why we decided to give the BruxZir 

Solid Zirconia motto an upgrade as well. 

32 One-on-One with Dr. Michael DiTolla: 

Interview of Glenn Lombardi 

In a day and age when a business’s success and growth 

often hinges on online reviews and other social media 

standards, some dental practitioners would like to believe 

they are safe from this type of information technology, yet 

they simply are not. Now, more than ever, it is important 

to ensure your practice is up-to-date on its social media 

practices. Glenn Lombardi, president of Officite LLC, a 

leading national provider of premier websites and turnkey 

Internet marketing solutions for the dental community, 

talks about what dentists can do to optimize their online 

presence. 

Contents 1

Contents 

42 Is It Time to Do Routine Adult Pulpotomies? 

Due to the current dampened state of the economy, a 

growing number of patients are unable to afford traditional 

endodontic treatment, yet the need for root canal therapy 

continues to rise. Dr. Ellis Neiburger discusses the oftenoverlooked 

pulpotomy as an alternative to traditional endo, 

its long history and how it fits into today’s dental practice 

in this must-read article. 

52 In Praise of Electric Handpieces 

As Dr. Elliot Mechanic explains, dentists have come a long 

way from being regarded as “drillers, fillers and billers,” to 

now increasingly being seen as artists and healers. With the 

advent of “smart” technologies such as the electric handpiece, 

dentists can treat their once-fearful patients with a 

greater level of ease and increased efficiency. Dr. Mechanic 

outlines the use and benefits of electric handpieces, including 

the important role they play in crown preparation. 

56 The Remake Debate 

How do you handle remake cases? Maribeth Marsico, senior 

editor at LMT Communications, explores the remake process, 

the biggest remake culprit and what can be done to 

cut down on these “cases-gone-wrong.” There will always 

be remakes in dentistry, but as this report shows, it is the 

duty of the lab, the technicians and the dentists to work together 

to ensure the patient gets their final desired result. 

Glidewell Publications for iPad 

iPAD APP Chairside is now available on 

your iPad. Search “Glidewell” in the iTunes 

Store and download the free app. 

60 Digital Impressions for an 

Immediate Denture 

Versatility, accuracy and ease of use are just some of the 

benefits digital impression technology offers over conventional 

impression techniques. This case study from 

Dr. Dean Saiki illustrates how digital impressions are not 

only equal to conventional impressions, but are in some 

instances the only appropriate option. 

ALSO IN THIS ISSUE 

8 By the Numbers 

64 The Chairside Photo Hunt 

2 

www.chairsidemagazine.com

Publisher 

Jim Glidewell, CDT 

Editor-in-Chief and Clinical Editor 

Michael C. DiTolla, DDS, FAGD 

Managing Editors 

Jim Shuck; Mike Cash, CDT 

Creative Director 

Rachel Pacillas 

Copy Editors 

Jennifer Holstein, 

Megan Affleck, David Frickman 

Statistical Editor 

Darryl Withrow 

Digital Marketing Manager 

Kevin Keithley 

Graphic Designers/Web Designers 

Jamie Austin, Deb Evans, Joel Guerra, Audrey Kame, 

Lindsey Lauria, Phil Nguyen, Kelley Pelton, 

Melanie Solis, Ty Tran, Makara You 

Photographer 

Sharon Dowd 

Clinical Videographer 

James Kwasniewski 

Illustrator 

Wolfgang Friebauer, MDT 

Coordinator and Ad Representative 

Teri Arthur 

(teri.arthur@glidewelldental.com) 

If you have questions, comments or complaints regarding 

this issue, we want to hear from you. Please e-mail us at 

chairside@glidewelldental.com. Your comments may be featured 

in an upcoming issue or on our website: 

www.chairsidemagazine.com. 

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Chairside is a registered trademark of Glidewell Laboratories. 

Chairside ® Magazine is a registered trademark of Glidewell Laboratories. 

Editor’s Letter 

Ahh, the Internet. Like many of you, I grew up in an era 

where most arguments were never really settled. Unless 

one of the arguing parties actually owned an Encyclopedia 

Britannica and the argument was about which bird can 

hover (answer: the hummingbird), most $20 bets entered a 

permanent state of limbo. In 2012, this is no longer true. I 

was recently marveling at how nearly any fact can be pulled 

up on the Web in less than 10 seconds. (Wikipedia should 

be getting a cut of all the bets it’s helping to settle!) 

While the power of the Internet to transform our everyday 

lives is undeniable and largely positive, as dentists we 

are faced with something dentists in the “golden age of 

dentistry” never had to deal with. Do you remember the 

“golden age”? Dentistry was great back then! The golden 

age is loosely defined as the time period 10 years before 

you graduated from dental school — for me that’s 1978. 

Back then, all patients were independently wealthy, and 

they lusted after full-mouth rehabilitations. When they were 

happy, they said “thank you.” When they were unhappy, 

they told six to eight people. 

Today’s patients — happy or unhappy — are increasingly 

Internet savvy, and with the increase in social media platforms 

and participants, managing these communication 

channels becomes necessary. We can’t please every patient, 

and we are going to disappoint some. Unless we learn how 

to manage social media, we just have to hope that the ones 

we disappoint are blood relatives or in-laws. 

It’s inevitable that you will eventually have a bad review or 

two on Yelp or another social media site that doesn’t even 

exist today. Read my recent interview with Glenn Lombardi 

to find out how you can use this new form of communication 

to your advantage. I know the dentists back in the 

“golden age” didn’t have to deal with this, and you never 

signed up for this, but it’s here. Appoint a staff member to 

lead your team’s social media efforts and follow Glenn’s 

well-reasoned advice! 

Yours in quality dentistry, 

Dr. Michael C. DiTolla 

Editor-in-Chief, Clinical Editor 

mditolla@glidewelldental.com 

Editor’s Letter 3

Letters to the Editor 

Dear Dr. DiTolla, 

First of all, I want to thank you for helping 

me with anterior crown preps! I, too, find 

that as soon as I begin preparing, I lose 

my frame of reference. I have tried various 

depth measurement methods, but your 

Reverse Preparation Technique is priceless. 

Also, your in-depth video demonstration of 

its use is outstanding. Thank you so much 

for transforming my technique and for my 

newly gained confidence in accurately doing 

anterior crown preps in a timely manner. 

I have a question for you: From the brief 

view I got of your dental unit on your video, 

it looks like you have an A-dec unit (Continental 

style). Also, the electric handpiece, 

if I viewed it correctly, is an A-dec/W&H 

electric motor. However, I noticed that you 

use the KaVo ELECTROtorque high-speed 

attachment. I did not know that KaVo electric 

handpieces were capable of connecting 

to A-dec/W&H electric motors. Do you 

need a special coupling/adaptor, or are you 

able to simply snap it on the same way you 

would if you used an A-dec/W&H electric 

handpiece? Also, I have the same A-dec 

unit plus A-dec/W&H electric motor, but 

I use the A-dec/W&H electric handpieces. I 

find them to be very good, but I must admit 

I have never tried the KaVo ELECTROtorque 

electric handpiece. Have you used or tried 

the A-dec/W&H electric handpiece? If so, 

4 

www.chairsidemagazine.com 

how does it differ from the KaVo electric 

handpiece that you use? 

Thank you very much for your time. Again, I 

enjoy watching and reviewing your instructional 

videos! 

– Larry Kolar, DDS 

Chicago, Ill. 

Dear Larry, 

Thanks for the kind words! 

The KaVo electric handpieces do snap 

directly onto the A-dec motor; no 

adapter is needed. I have never used 

anything but KaVo handpieces, even 

going back to my air turbine days, so 

I guess that means I’ve been pretty 

satisfied with KaVo. 

I know KaVo is doing a special promotion 

where, if you go to www.trykavo. 

com, they will send you an electric 

handpiece at no charge that you can 

snap on for a few days, prep some 

teeth and see which one you like better. 

Let me know what you think! 

Best, 

– Mike 


I was wondering which is the strongest 

anterior bridge material besides monolithic 

zirconia? I have had failures with IPS 

Empress ® II and IPS e.max ® (Ivoclar 

Vivadent). Fractures usually occur when 

patients unknowingly bite into a hard bone 

(meat that is supposed to be boneless), or 

forget they need to be cautious with the 

restorations and chomp on something like 

a hard baguette. The bridges in these cases 

have had solid, broad connectors. Could 

you comment on IPS e.max versus zirconia 

with layered porcelains (e.g., 3M ESPE 

Lava )? Is it possible to make the lingual 

occlusion of an anterior maxillary bridge 

in zirconia and layer just the facial with 

porcelain, using the same concept of metal 

occlusion in a PFM? I am sitting on a case, 

so a quick response would be appreciated. 

Mahalo for your input. 

– Todd Okazaki, DDS 

Haleiwa, Hawaii 

Dear Todd, 

Good question! First of all, you are 

correct in thinking that monolithic 

zirconia, such as BruxZir ® Solid 

Zirconia (Glidewell Laboratories), is the 

strongest all-ceramic bridge material 

that we have. This time last year, I would 

have hesitated to recommend that a 

dentist prescribe BruxZir Solid Zirconia 

for an anterior bridge. The esthetic 

nature of BruxZir restorations has really 

improved over the last year, although 

it hasn’t quite caught up with its 

monolithic brethren, such as IPS e.max. 

An anterior PFM bridge is probably 

the strongest solution, although the 

ceramic material can certainly chip 

off the metal understructure, and the 

esthetics can be compromised by the 

lack of translucency and possibly 

exposed metal margins. 

I am not sure I would want to go with 

the zirconia-layered-with-ceramic option 

you mention, as we have noticed 

more chipping with that combination 

of materials than we have with porcelain 

fused to metal. In fact, porcelain 

fused to zirconia would probably be 

my last choice after BruxZir Solid Zirconia, 

IPS e.max and PFM. 

You also asked about making the lingual 

of the bridge in solid zirconia, 

similar to a metal lingual on a PFM 

restoration. While we do fabricate 

bridges like that on request from dentists, 

we don’t get many requests for it. 

Perhaps the reason is that the strength 

of BruxZir Solid Zirconia comes from 

its monolithic nature — the fact that 

it doesn’t have any ceramic material 

fused to it. As a result, it fractures and 

chips less than any other restoration 

in the lab (except cast gold, of course). 

When we do make a BruxZir restoration 

like that, we typically place the

ceramic material on the facial and 

carry it from the gingival down to the 

incisal edge, without wrapping the 

incisal edge. We want to allow the 

patient to function in protrusion on 

the zirconia, rather than the porcelain. 

But doing this takes it from being a 

monolithic BruxZir restoration to a 

bilayered restoration, which is more 

prone to chipping. 

While there are no absolutes, my first 

choice today is IPS e.max for a 3-unit 

bridge in the anterior on a patient 

who does not show a lot of wear. For 

that same bridge in a patient who 

does show signs of wear, my choice is 

BruxZir Solid Zirconia, especially if the 

patient has previously chipped a PFM 

restoration. As the size of the bridge 

increases beyond 3 units, I begin to 

consider PFM as my choice because 

of the superior strength of the metal 

connectors when compared to any allceramic 

system, especially when there 

is a lack of room for the connectors. 

As always, your mileage may vary. 

Hope that helps! 

– Mike 

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I haven’t talked with my wife for days. She can’t stop! 

– Tom Novak, DDS 

Weatherford, Texas 

Letters to the Editor 5

Contributors 

Michael C. DiTolla, DDS, FAGD 

Dr. Michael DiTolla is a graduate of University of the Pacific Arthur A. Dugoni School of Dentistry. As 

director of clinical education and research at Glidewell Laboratories in Newport Beach, Calif., he performs 

clinical testing on new products in conjunction with the company’s R&D department. Glidewell dental 

technicians have the privilege of rotating through Dr. DiTolla’s operatory and experiencing his commitment 

to excellence through his prepping and placement of their restorations. He is a CR evaluator and lectures 

nationwide on both restorative and cosmetic dentistry. Dr. DiTolla has several clinical programs available 

on DVD through Glidewell Laboratories. For more information on his articles or to receive a free copy of 

Dr. DiTolla’s clinical presentations, call 888-303-4221 or e-mail mditolla@glidewelldental.com. 

Glenn Lombardi 

Glenn Lombardi is president of Officite LLC, a leading national provider of premier websites and 

turnkey Internet marketing solutions for the dental community. Since 2002, Officite has built thousands 

of websites for healthcare practices around the world, which have generated hundreds of thousands of 

new patient appointment requests. Glenn is a frequent speaker at national and state dental association 

meetings, including the AGD and D.C. Dental Society annual meetings. His presentations focus on 

professional website development, search engine optimization, and how to seamlessly integrate the Internet 

into your practice to attract new patients and increase case acceptance. Contact him at 800-908-2483 or 

glombardi@officite.com. 

Robert A. Lowe, DDS, FAGD, FICD, FADI, FACD, FIADFE 

Dr. Robert Lowe graduated magna cum laude from Loyola University School of Dentistry in 1982 and was 

a clinical professor of restorative dentistry at the school until its closure in 1993. Since January 2000, 

Dr. Lowe has maintained a private practice in Charlotte, N.C. He lectures internationally and his work is 

frequently published in well-known dental journals on esthetic and restorative dentistry. Dr. Lowe received 

fellowships in the AGD, ICD, ADI, ACD and IADFE, received the 2004 Gordon Christensen Outstanding 

Lecturers Award and, in 2005, Diplomat status on the American Board of Aesthetic Dentistry. Contact him 

at 704-364-4711 or boblowedds@aol.com. 

6 

www.chairsidemagazine.com

Elliot Mechanic, DDS 

Dr. Elliot Mechanic has been practicing general and esthetic dentistry in Montreal, Quebec, since 1979. 

Dr. Mechanic serves as Oral Health’s editorial board member for esthetics, and is a member of numerous 

professional organizations, including the International Academy for Dental-Facial Esthetics, Academy of 

Laser Dentistry and the AACD. Dr. Mechanic takes great pride in his work, which has afforded him the 

pleasure to work with executives, professionals, celebrities, international stars and everyone in between. He 

can be reached at 514-769-3939. 

Ellis J. Neiburger, DDS 

Dr. Ellis “Skip” Neiburger graduated from the University of Illinois at Chicago College of Dentistry in 1968, 

where he did postgraduate work on pulp histology in the Department of Oral Pathology. Dr. Neiburger 

currently practices general dentistry in Waukegan, Ill. A former vice president of the American Association 

of Forensic Dentists, Dr. Neiburger has been the association’s journal editor since 1978. He also was 

publisher/editor for Dental Computer Newsletter (the journal that introduced computing to the dental field). 

Contact him at 847-244-0292 or eneiburger@comcast.net. 

Dean H. Saiki, DDS 

Dr. Dean Saiki graduated from USC School of Dentistry in 1988. He maintains a private practice in North 

County San Diego, Calif., specializing in cosmetic, laser, implant and digital dentistry. He has been a 

member of the ADA, CDA and San Diego County Dental Society since 1989, as well as other advanced study 

clubs including the Trojan Dental Study Club. Dr. Saiki is trained and certified in dental soft tissue lasers 

and CAD/CAM technology. He has been voted a “Top Dentist” in San Diego by his peers for the past five 

years. Contact him at 760-732-3456 or dentist@deansaiki.com. 

Contributors 7

Numbers 

by the 

143 

CEREC 

Number of 

dental labs now 

offering BruxZir ® 

Solid Zirconia 

restorations 

5,400 

is a registered trademark of Sirona Dental Systems Inc. 

Number of modelfree 

BruxZir ® Solid 

Zirconia bridges 

and single-unit 

crowns Glidewell 

Laboratories 

fabricated for 

CEREC ® Connect 

dentists in 2011 

18,427 

BruxZir is a registered trademark of Glidewell Laboratories. 

Number of 

dentists who 

have prescribed 

a BruxZir ® Solid 

Zirconia restoration 

Percentage 

of veneers 

prescribed with a 

VITA 3D-Master ® 

shade in 2006 

16% 

Percentage 

of veneers 

prescribed with a 

VITA 3D-Master ® 

shade in 2011 

25% 

17.1% 

41.6% 

Percent rate of 

rampant decay in 

children whose 

primary language 

is English 

Percent rate of 

rampant decay in 

children whose 

primary language 

is not English 

Percentages based on 56,251 veneers fabricated at Glidewell Laboratories 

3D-Master is a registered trademark of VITA Zahnfabrik. 

Findings from the Spokane Regional Health District’s 2010 Smile Survey 

(www.srhd.org/news.asp). 

66% 

Percentage of dentists who have 

received a negative online review 

As reported by The Wealthy Dentist ® 

8 

www.chairsidemagazine.com 

The Wealthy Dentist is a registered trademark of Du Molin & Du Molin Inc.

Dr. DiTolla’s 

CLINICAL TIPS 

PRODUCT........ NoMIX ® Temporary Cement 

SOURCE........... Centrix (Shelton, Conn.) 

800-235-5862, www.centrixdental.com 

Until every dental office is doing one-appointment crowns, temporaries will continue to be part of our 

day-to-day life. I am always amazed by the patient (typically male) who doesn’t appear to have ever 

flossed in his life, but when we put on a temp and tell him not to floss, flossing becomes an obsession 

— and, of course, he knocks off his temp. This is why all patients with possible non-retentive preps are 

sent home with a uni-dose of NoMIX Temporary Cement to use for short-term cementation, in case their 

temp comes off. As its name implies, there is no mixing, and the cement is moisture activated. After 

exposing the cement to water, have the patient hold their teeth together for five minutes while it sets, 

and you just saved yourself a Saturday trip to the office to re-cement a temp! 

Dr. DiTolla’s Clinical Tips 9


CLINICAL TIPS 

PRODUCT........ NTI ® Superflex Diamond Discs 

SOURCE........... Axis Dental (Coppell, Texas) 

800-355-5063, www.axisdental.com 

If you told me I could only use one instrument to trim and shape provisionals, I would have to go with 

one of Axis Dental’s flexible, perforated NTI Superflex Diamond Discs in an electric handpiece. At higher 

speeds, I can use the double-sided disc to trim the margins on posterior temps, and then shape the 

mesial and distal contacts more smoothly than I could with a bur. But the disc really shines with anterior 

provisionals, where I can turn down the speed and really dial in the gingival embrasures, so I avoid 

blunting any papillae. There also is no better way to develop facial embrasures than with the flexible 

disc, which helps provisional bridges look a little more lifelike. 

10 www.chairsidemagazine.com


CLINICAL TIPS 

PRODUCT........ Opalescence ® Trèswhite Supreme 

SOURCE........... Ultradent Products Inc. (South Jordan, Utah) 

888-230-1420, www.ultradent.com 

Years ago, we started offering complimentary bleaching trays to patients who had undergone some 

kind of esthetic procedure, typically the replacement of some older crowns on the maxillary anterior 

teeth. We wanted to be able to deliver the trays the same day, but we often faced backups in our 

tray production. A friend of mine introduced me to Opalescence Trèswhite Supreme last year, and 

the product has become an easy way for me to deliver same-day bleaching trays. My friend offers 

free teeth whitening to new patients, and he says using this product is the only way he can pull that 

off. These disposable, preloaded teeth-whitening trays definitely are the easiest way for patients to 

bleach their teeth, and they offer a great alternative to store-bought whitening systems. 

Dr. DiTolla’s Clinical Tips11


CLINICAL TIPS 

PRODUCT........ QUATTROcare Automatic Handpiece Maintenance System 

SOURCE........... KaVo Dental (Charlotte, N.C.) 

888-275-5286, www.kavousa.com 

I’ve made no secret of my love for my KaVo ELECTROtorque handpieces. The torque is so high I can turn the speed 

down to a measly 3000 rpm and still have enough power to cut tooth structure, and because the speed is so low, I can 

do it without water! I also need that immense torque to properly polish intraoral restorations when I have to make an 

adjustment after cementation. To maintain my investment in these handpieces and keep them running smoothly, my 

assistant loves her KaVo QUATTROcare. It automatically cleans, lubricates and purges the handpieces with the push of 

a button, and then they go straight into sterilization. In case your Italian is weak, the “quattro” in QUATTROcare refers to 

the fact that it will service up to four handpieces at a time. 


Upgrading Porcelain Veneer 

Restorations: 

A Case Report 

– ARTICLE and CLINICAL PHOTOS by Robert A. Lowe, DDS, FAGD, 

FICD, FADI, FACD, FIADFE 

Placement of indirect labial veneers (porcelain or composite) continues to be an excellent option to correct many esthetic 

complaints that our patients have with their smiles. Some of the more common indications for their clinical use include: 

1. Minor corrections of anterior tooth morphology and emergence angles to fill in spaces in the gingival embrasure 

areas when these spaces are an esthetic concern for the patient. 

2. Minor corrections in tooth position (rotation, labio-lingual arch position and crowding) if orthodontics is either not 

indicated or not accepted as a treatment option by the patient. 

3. Diastema closures and corrections of anterior tooth proportion (golden proportion). 

4. Establishment of anterior guidance and canine disclusion in patients where preparation for full-coverage restorations 

would necessitate unnecessary removal of healthy tooth structure. 

5. Improving tooth color for a patient where tooth whitening was not a treatment option or did not yield a satisfactory 

result for the patient. 


Tooth Preparation 

The amount of tooth reduction required depends 

on the specific clinical situation. In general, 0.5 to 

0.7 mm of tooth reduction is needed. In some cases, 

where “nature” has done the tooth preparation or 

natural tooth contours are less prominent, “no prep” 

options are also possible. If changes in tooth position 

are required, some areas of the tooth may be 

prepared more, others less. 

It is recommended to first contour the teeth to their 

ideal position using a cylindrical diamond, then use 

depth cutters to remove a uniform amount of tooth 

structure to compensate for the thickness of the restoration. 

In extreme situations in which the dental 

pulp is encroached upon, root canal therapy is recommended 

rather than overcontouring the restoration. 

In cases where a low value (dark) preoperative 

tooth color is to be changed to a high value (light) 

color, more tooth structure may need to be removed 

(1.0 to 1.5 mm) to create enough space for opacious 

dentin or opaquers to block out the darkness. For 

some patients, preoperative tooth whitening may 

be indicated to increase the value of the underlying 

tooth structure, allowing for less tooth structure to 

be removed during the preparation process. 

Gingival margins should be placed at the gingival 

crest or slightly above. The interproximal margins 

should be carried into the lingual portion 

of the contact area. If diastemata are present, the 

interproximal margin of the preparation should be 

carried lingually to the linguoproximal line angle. 

Also, when closing spaces, it is important to prepare 

the gingival margins far enough into the proximal 

areas so that the restoration margins are not visible 

from a three-quarter or oblique view (when the 

patient turns their head to the side). 

After the preparations are finished, it is recommended 

to use a fine cylinder finishing diamond to make 

the preparations as smooth as possible. Aluminum 

oxide strips can be used to smooth and polish 

interproximal surfaces without compromising the 

proximal contact. 

Impressions 

As the gingival margin of most veneers will be 

slightly above the gingival crest, a very thin retraction 

cord, such as a #00 or #000, can be placed 

in the sulcus and left in place during the impression 

process. If a particular case requires subgingival 

margins, a #1 retraction cord is placed over 

the #00 or #000. When taking the impression, pull 

the #1 cord and leave the #00 or #000 in place. 

This “double-cord” technique will produce flawless 

intracrevicular impressions time after time. 

There is also a technique that can be used that will 

allow for an “anesthesia-free” and “retraction cordfree” 

procedure. First, a stock tray is selected to fit 

the patient’s maxillary arch form. Next, a heavybodied 

tray material is injected into the tray and 

placed in the patient’s mouth. This will convert the 

“stock tray” to a “custom tray” filled with set heavybodied 

impression material. 

The next step will be to wash with a light-bodied 

material, but a very important technique difference 

from a traditional “putty-wash” technique is used. 

When most clinicians perform a wash of a heavybodied 

impression, the papillae between the tooth 

indentations are removed and the space is completely 

filled with light-bodied wash material and 

reseated in the patient’s mouth. It is very difficult 

to displace the large amount of light-bodied material 

when seating the tray, and a less-than-desirable 

end result ensues from an incomplete seating of 

the tray. The difference here is the amount of lightbodied 

material that is used. It is very important to 

inject only a small amount of light-bodied material 

around the periphery of the tooth indentations in 

the heavy-bodied material. The heavy-bodied material 

will then force the light-bodied material into 

the intracrevicular spaces around the teeth. The 

smaller amount of light-bodied material allows the 

operator to more accurately seat the impression 

and gain sufficient “retraction” to force the lightbodied 

material into the crevices. 

Pull the #1 cord and leave the #00 or #000 in place. This “doublecord” 

technique will produce flawless intracrevicular impressions. 

Upgrading Porcelain Veneer Restorations15

Provisionalization 

A fast and simple technique to fabricate provisional 

veneers utilizes a preoperative wax-up as a 

template. Create a plastic provisional stent of the 

corrected tooth positions using a vacuum former and 

.040 plastic materials. After tooth preparation and 

final impressions, fill the stent with a bisacrylic provisional 

material and place over the teeth for two 

minutes. The patient can close in centric occlusion 

over the stent material during this time. After initial 

setting of the bisacrylic material, it can be removed 

from the stent and contoured with abrasive discs and 

fine laboratory acrylic carbide burs. 

Any repair or addition to the provisional restoration 

is accomplished using flowable composite material 

and light curing, either at the lab bench or intraorally 

while the provisional restoration is in place on 

the preparations. It is not necessary to use bonding 

agents prior to the addition of the flowable resin if 

the surface is first roughened to create micromechanical 

retention. Also, the secret to successful addition 

of flowable resin to bisacrylic provisional restorations 

is to create a long bevel on the bisacrylic 

material, add the flowable resin to the repair area 

and continue to “feather” the flowable composite 

over the beveled surface of the bisacrylic 3 to 4 mm 

beyond the repair area. Finally, finish with abrasive 

discs to original tooth contour for a seamless repair. 

Cementation 

Placement of porcelain veneers can be accomplished 

using dual-cured or light-cured resin 

cements. The veneers are first tried on individually 

to check margins, then collectively to evaluate contact 

and esthetics. A drop of water on the inside 

of the veneers can help to hold them in place for 

evaluation by the doctor and the patient. For most 

cases, transparent or clear resin cement will be the 

cement of choice. 

There are some clinicians who report a color change 

with time when using dual-cure tinted cements. It is 

the opinion of this author that color change in older 

veneer cases occurs because of color change in the 

tooth, not in the 10-micron layer of cement between 

the porcelain and the tooth. 

The reason dual-cured cements are selected by 

some clinicians is because of the ease of the cleanup 

process. These types of cements will reach a “gel 

phase” about two minutes after mixing. At that time, 

the operator can use an explorer or fine curette to 

remove cement excess prior to light curing. Dental 

floss can also be passed through the interproximal 

areas to be sure they are free of cement. While performing 

the cement cleanup during the gel phase, 

the dental assistant stabilizes the restoration using 

finger pressure. Once the excess resin cement is 

removed, the restorations are light-cured. Using 

this technique will minimize any rotary finishing, 

and polishing should also be kept to a minimum. 

Light-cured cements can be used successfully if the 

operator has a tacking tip on the curing light and 

selectively “tacks” the center of the restoration on 

the tooth while leaving the cement at the margins 

uncured. The marginal excess is then removed with 

a brush and floss is used to clear the interproximal 

areas while stabilizing the restoration. A total cure 

is done once the cleanup is complete. 

As previously mentioned, some clinicians and 

researchers believe that dual-cure resin cements 

change color over time and affect the visual shade 

of the restoration. This may be true in the lab, but is 

this really happening clinically? If one takes a clear 

shade of resin cement and an A3 shade, places a 

drop of each on a glass slide, and squeezes another 

slide on top of the cements to simulate a restorative 

interface, an interesting thing occurs. It is difficult, 

if not impossible, to distinguish between the two 

colors because the cement layer is so thin. How 

much color can be squeezed into a 10-micron 

layer of cement? How does that “change” become 

visible behind an opacious layer of dentin porcelain 

followed by body porcelain? The “contact lens” 

effect does allow the color of the tooth to affect 

the final shade of a restoration if the ceramist does 

not lay down an opacious material first or if the 

restorative gap is too large so that the cement layer 

is too thick. 1-5 

Color change in older veneer 

cases occurs because of 

color change in the tooth. 


Case Report 

Placement of the Initial 

Porcelain Veneer Restorations 

In 2002, my wife Michele expressed a desire to have 

porcelain veneers placed to enhance the esthetics of 

her smile. She presented with a Class I occlusion and 

had very thin, opalescent enamel that did not respond 

well to tooth whitening (Figs. 1–3). Her desire was to 

have a “brighter, more youthful-looking smile.” 

Following the methodology described above, the teeth 

were prepared using a minimal preparation technique 

(Fig. 4), master-impressed and then provisionalized 

using bisacrylic provisional material. A bleached white 

color of feldspathic porcelain was chosen, and the restorations 

were fabricated and finally cemented with 

a clear, dual-cured resin cement. Figures 5–7 show 

Michele’s retracted full-arch, postoperative full-smile 

and full-face views, respectively. Michele was thrilled 

with her new smile makeover! 

Figure 1: A preoperative full-face view of Michele prior to placement 

of her original set of porcelain veneers in 2002 

Figure 2: A full-smile preoperative view 

Figure 3: A retracted full-arch preoperative view 

Figure 4: A view of the maxillary and mandibular minimal veneer 

preparations. Note the value (brightness or darkness) of the prepared 

teeth. When fabricating porcelain veneers, the ceramist will lay down 

a thin opacious layer based on the “preparation shade” (stump shade) 

to block out the overall influence of that shade on the final visible 

shade of the restoration. 

Figure 5: The completed first set of maxillary and mandibular porcelain 

veneer restorations after delivery 


Seven Years Later 

Michele had never specifically commented that she 

noticed her veneers were not as bright as they were 

when placed because there was such a gradual change 

over time (Figs. 8–10). Compare the post-cementation 

photo, Figure 5, and the seven-year postoperative photo, 

Figure 9. A significant color shift is very noticeable 

when performing a direct comparison of these photographs. 

Being surrounded by the dental field, Michele 

was also aware that newer porcelains were being developed 

that were brighter in value than those that were 

available when her initial esthetic restorations were fabricated. 

She therefore expressed a desire to have her 

veneers redone. 

Although a color change was observed (Fig. 11), from a 

purely dental perspective, the initial restorations were 

still very serviceable, with no signs of fracture, wear 

or marginal breakdown. Knowing that conventional 

removal of these veneers with rotary instrumentation 

would result in removal of more healthy tooth structure, 

the dilemma was whether to intervene and replace 

the veneers, or wait until the restorations broke down 

and required replacement. As with most patients, 

Michele was not concerned with the potential loss of 

0.1 to 0.2 mm of tooth structure — she wanted brighter 

porcelain veneers! 

Figure 6: A full-smile view of the completed initial esthetic makeover 

Figure 7: A full-face view of the completed initial esthetic makeover 

Figure 9: A retracted full-arch seven-year postoperative view of the 

initial esthetic reconstruction. When compared with Figure 5, a definite 

change in tooth color of the restorations is apparent. 

Figure 10: A full-smile, seven-year postoperative view 

Figure 8: A full-face view of the initial esthetic makeover seven years 

after placement. Compare this to Figure 7. It is difficult at normal speaking 

distance to perceive a change in the color of the restored teeth. 


It was decided to grant her request and upgrade her 

esthetic restorations. During this period of time, as an 

all-tissue laser user, it was discovered that the laser could 

be used to conservatively remove porcelain veneer 

restorations without further loss of tooth structure. 

It is believed that because the laser wavelength of 

the Er,Cr:YSGG laser seeks water, the resin cement is 

denatured and expands, causing the veneer to fracture 

and separate from the tooth. The veneer can then be 

easily removed using a scaler (Fig. 12). Michele had 10 

porcelain veneers on her maxillary arch, all of which 

were completely removed with the laser in less than 

10 minutes! The cement layer remained visible on 

the preparation surface (Fig. 13). Next, an Enhance ® 

point, a composite polishing point (DENTSPLY Caulk/ 

DENTSPLY International; York, Penn.), was used to 

remove the cement from the preparation. Air abrasion 

can be used for this as well. After minor marginal 

adjustment of the preparations to compensate for a 

small amount of gingival recession on the mid-facial of 

some of the preparations (Fig. 14), a retraction cord was 

placed (Fig. 15), a new master impression was made and 

bisacrylic provisional restorations were placed (Fig. 16). 

Figure 11: The shade based on the VITA Lumin shade guide (Vident; 

Brea, Calif.) of the existing restorations is B1. The original restoration 

shade was “Hollywood White,” or bleached shade (B0). The patient’s 

desire is to have an upgrade to Bleach1 (BL1), which is the highest 

value of restorative material available. 

Figure 12: The Waterlase MD with a 600-micron tip is used to atraumatically 

remove the existing veneer restorations. 

Figure 13: The preparations after laser veneer removal. Note the resin 

cement is still present on the teeth. 

Figure 14: The preparations after polish with Enhance point and 

minor margin refinement 

Figure 15: Retraction cord is placed prior to making of the master 

impression. 


The ceramist then fabricated the newer, high-value porcelain 

veneers. Figure 17 shows the finished central 

incisor restorations. A new light-cured cement (Kleer 

Veneer [Pulpdent Corporation; Watertown, Mass.]) was 

used to cement the newly fabricated porcelain veneer 

restorations (Figs. 18, 19). Note that this veneer cement 

is totally transparent, unlike many other “untinted” 

resin cements on the market. It is the author’s opinion 

that this type of cement is particularly useful for very 

thin “no prep” veneers when blocking out tooth color 

is not required. 

At a subsequent visit, the process was completed on 

the mandibular arch. Figure 20 shows the mandibular 

veneers being removed with the Waterlase MD (Biolase 

Technology; Irvine, Calif.). The completed porcelain 

veneer esthetic upgrade can be viewed in Figures 

21–24. Note that clear porcelain was used at the gingival 

margins to gradually blend the root color at the restorative 

interface and make the margin less apparent. 

Figure 16: Bleached shade provisional restorations that were placed 

after completion of the master impression 

Figure 17: A view of the newly fabricated high-value maxillary 

central incisor porcelain restorations (Venus ® Porcelain [Heraeus; 

South Bend, Ind.]) 

Figure 18: Kleer-Veneer light-cured veneer cement being placed into 

the porcelain veneer restoration. Note the complete lack of color in 

the cement. 

Figure 19: The upgraded high-value porcelain veneers cemented on 

the maxillary arch. Note the difference in value when compared to the 

mandibular restorations that have yet to be replaced. 

Figure 20: Removal of the initial mandibular ceramic veneers with the 

all-tissue laser 


Conclusion 

Figure 21: A retracted full-smile view of the completed esthetic 

porcelain veneer upgrade 

“Wants-based” dentistry, especially that which is 

purely esthetic in nature, is often on a different 

timetable than conventional restorative or rehabilitative 

dentistry. Its “useful life” is not determined 

necessarily by marginal or occlusal breakdown, but 

by what the patient sees in the mirror. For some 

dentists, it is hard philosophically to remove and 

replace “serviceable” dental restorations. However, 

in this day of elective dentistry, we must realize that 

replacement of existing restorations can now be 

determined on esthetics alone … and this, at any 

moment, is done at the sole discretion of the 

“wearer.” In the author’s case: “Happy wife, happy 

life!” CM 

Dr. Robert Lowe is in private practice in Charlotte, N.C. He also lectures 

internationally and publishes on esthetic and restorative dentistry. Contact 

him at boblowedds@aol.com or 704-364-4711. 

Figure 22: A full-smile view of the completed esthetic upgrade 

Figure 23: A full-face view of the completed esthetic upgrade 

acknowledgment 

The author would like to acknowledge the artistic expertise of Vincent 

Devaud, CFC, MDT, of Vincent Devaud Dental Laboratory, Pasadena, 

Calif., for his work on this case. 

References 

1. Strassler HE. Minimally invasive porcelain veneers: indications for a 

conservative esthetic dentistry treatment modality. Gen Dent. 2007 

Nov;55(7):686-94. 

2. Malcmacher L. No-preparation porcelain veneers — back to the 

future! Dent Today. 2005 Mar;24(3):86, 88, 90-1. 

3. Etman MK, Woolford MJ. Three-year clinical evaluation of two 

ceramic crown systems: a preliminary study. J Prosthet Dent. 2010 

Feb;103(2):80-90. 

4. Guess PC, Strub JR, Steinhart N, Wolkewitz M, Stappert CF. Allceramic 

partial coverage restorations — midterm results of a 5-year 

prospective clinical splitmouth study. J Dent. 2009 Aug;37(8):627-37. 

5. Lowe RA. Shade instability: examine a root cause of mismatched 

ceramic restorations. Dental Products Report. 2008 Sep:116-122. 

Reprinted by permission of Oral Health, April 2011 

Figure 24: “Happy wife, happy life!” 


Photo Essay 

BruxZir ® Solid Zirconia 

Anterior Esthetic Challenge 

– ARTICLE by Michael C. DiTolla, DDS, FAGD 

This photo essay illustrates our laboratory’s recent advancements in improving the esthetic properties of BruxZir ® Solid 

Zirconia. Since the launch of the crown & bridge material in 2009, we have talked about BruxZir Solid Zirconia being “More 

Brawn Than Beauty.” As our R&D department refines our processes, improving the material’s translucency, the esthetics 

have continued to improve dramatically. What better esthetic challenge could there be for a material than using it to 

replace old crowns on tooth #8 and #9? BruxZir Solid Zirconia rises to the challenge in this case, but keep in mind, I have 

the advantage of in-house dental technicians, which always makes it easier to deliver great restorations. High-quality digital 

photographs can result in the same high-quality restorations almost as easily. After this case, we decided to upgrade the 

BruxZir Solid Zirconia motto to “More Brawn and Improving Beauty.” Continue reading to see if you agree! 

BruxZir Solid Zirconia Anterior Esthetic Challenge23

Figure 1: First Appointment — We are going to replace the PFM 

crowns on tooth #8 and #9 with BruxZir Solid Zirconia crowns. This 

will be a good test for our newest translucent formulation. You can 

see how inflamed the gingiva is with the old crowns in place, which 

could be an allergic reaction to the existing base-metal PFMs. 

Figure 2: The first step of any restorative procedure in the anterior 

should be to take the shade before the teeth become dehydrated. 

This is especially true when using lip and cheek retractors, as we are 

doing here (SeeMORE [Discus Dental; Los Angeles, Calif.]). 

Figure 3: I am using the VITA Easyshade ® Compact (Vident; Brea, 

Calif.) in the middle third of the tooth, with the tip flush against the 

tooth. I will shoot the shade in three spots in the middle third, in case 

I land on any shade anomalies. 

Figure 4: The VITA Easyshade Compact displays the shade in both 

VITA Classical shades and VITA 3D-Master ® shades. Having used 

both shade guides for many years, I strongly prefer the 3D-Master 

shade guide because of how well the shade tabs match natural teeth. 

Figure 5: After taking the shade, I hold the selected 2M1 3D-Master 

shade tab to the tooth, along with the 1M1 3D-Master shade tab for 

contrast. Of the spots I checked with the VITA Easyshade Compact, 

two were 2M1 and the third was 1M1, so I want to see how both 

shades look in the mouth. 

Figure 6: Now we photograph the shade tabs in the mouth. This is 

probably the most important part of communicating shade to the 

technician, so he or she can see how the natural teeth look compared 

to the selected shade guides. Rarely are they an exact match. 


Figure 7: I then use an Ultradent syringe to place PFG gel (Steven’s 

Pharmacy; Costa Mesa, Calif.) into the sulcus of tooth #8 and #9. The 

gingiva is so irritated that it starts to bleed just because I bumped into 

it with a soft brush tip. This is never a good sign. 

Figure 8: Next I use my STA Single Tooth Anesthesia System ® device 

(Milestone Scientific; Livingston, N.J.) to individually anesthetize tooth 

#8 and #9. Infiltrations of the maxillary central incisors are some of 

the most painful injections we give as dentists, and there are some 

patients who really hate them. This was one of those patients. 

Figure 9: The STA has a pressure sensor that lets me know if I am in 

the PDL during these injections, which helps me determine whether I 

have profound anesthesia. I used to give these types of injections by 

hand, but I never knew if I was giving an effective injection. 

Figure 10: The Razor ® Carbide bur (Axis Dental; Coppell, Texas) is 

an aggressive carbide bur that easily cuts through porcelain and 

metal substructures. When used in combination with my KaVo 

ELECTROtorque handpiece (KaVo Dental; Charlotte, N.C.), it is 

simple to cut through an existing PFM in almost one continuous cut. 

Figure 11: Here I am torquing the crown with a Christensen Crown 

Remover (Hu-Friedy; Chicago, Ill.). As we continue to use more and 

more high-strength, all-ceramic crowns that are more difficult to 

remove, there will come a day when we will reminisce about how fun 

it was to remove PFM crowns. 

Figure 12: We will be removing some of the unhealthy tissue to 

improve esthetics and gingival health, so I use a periodontal probe 

to sound to bone, ensuring I have enough biologic width to safely 

remove some tissue. To eliminate the chronic inflammation, we will 

need a minimum of 3 mm from the free margin of the gingiva to the 

crest of the bone. 


Figure 13: I use my NV MicroLaser (Discus Dental) to remove 

1.5 mm of tissue. In addition to removing the unhealthy tissue, the 

diode laser helps me expose the crown margins that were buried 

subgingivally. This almost certainly contributed to the unhealthy 

gingiva that surrounded these two crowns. 

Figure 14: With the margins now clearly exposed, I use an 856-025 

bur (Axis Dental) with the water off and my KaVo ELECTROtorque 

handpiece set to 4000 rpm to slowly drop the margins to the new 

gingival level. We will finish the preps at the next appointment. 

Figure 15: There is really no way to take an impression today after 

our gingival recontouring and still have the crown margins in the right 

place, so my assistant is relining BioTemps ® Provisionals (Glidewell 

Laboratories) on tooth #8 and #9 with Luxatemp provisional material 

(DMG America; Englewood, N.J.), to help the tissues heal over the 

next two weeks. 

Figure 16: Using a thin, perforated diamond disc (Axis Dental), my 

assistant opens the gingival embrasures between the temps to avoid 

blunting the interproximal papilla. She also makes sure the gingival 

margins aren’t overextended and the emergence profile is flat. 

Figure 17: We use TempBond ® Clear (Kerr Corp.; Orange, Calif.) 

to cement the BioTemps and avoid cement show-through in thinner 

temps. A word of caution with TempBond Clear: Use loupes to 

inspect around the temps and in the gingival embrasures to ensure 

no excess cement is left in place. This is an easy mistake to make 

with this clear cement. 

With the margins now clearly 

exposed, I use an 856-025 bur 

(Axis Dental) with the water off 

and my KaVo ELECTROtorque 

handpiece set to 4000 rpm 

to slowly drop the margins to 

the new gingival level. 


Figure 18: Second Appointment — After two weeks, we remove 

the temps and clean the preps with a KaVo SONICflex scaler. I know 

of no better way to ensure all the temporary cement is removed from 

the preps than by using this scaler, especially for cases where we 

have used Durelon (3M ESPE ; St. Paul, Minn.) as our temporary 

cement for its retentive properties. 

Figure 19: There is still minor irritation around the gingival margin, so 

I do a little trimming with the diode laser right at the gingival margin 

prior to placing the first retraction cord. I was worried there would be 

bleeding during the cord placement if I didn’t take care of this now. 

Figure 20: With the irritated tissue gone, I can now place my first 

cord, Ultrapak ® cord #00 (Ultradent; South Jordan, Utah). Because 

this cord is hollow, it goes into place quite easily. I use this cord without 

solution (contains no epinephrine and has not been dipped in a 

hemostatic solution), as it could be in place for up to 45 minutes. 

Figure 21: I cut the cord on the lingual with curved scissors, while 

my assistant removes the cut end with cotton pliers. I cut the cord 

intraorally to make sure the two ends can be positioned flush to each 

other and do not overlap. This ensures there will be room for the 

second (top) cord. 

Figure 22: Because the placement of the first cord did not make 

the margin visually obvious, I place a second cord prior to 

refining the preparation. This top cord is an Ultrapak cord #2E 

(Ultradent). “E” refers to the epinephrine contained in the cord to 

help prevent bleeding. 

Figure 23: As I pack the #2E cord on tooth #8, you can see how this 

second cord has exposed the margin on tooth #9. Once each top 

cord is in place and the margins are exposed, we can begin the final 

finishing of the preps, which should take about 60 to 90 seconds 

per tooth. 


Figure 24: Now that I can finally see the margins, I use the same size 

bur I used before, but with a different grit (a fine grit 856-025 bur 

[Axis Dental], as indicated by the red stripe around the shank). The 

30-micron diamond particles will smooth the prep, especially on the 

margins where our coarse bur broke off chunks of tooth. 

Figure 25: Two ROEKO Comprecap Anatomic compression caps 

(Coltène/Whaledent; Cuyahoga Falls, Ohio) are moistened internally 

and placed on the preps. The patient is instructed to bite with medium 

pressure for 8 to 10 minutes. The Comprecaps ensure that the patient 

does not disrupt the cords with their tongue, and the pressure on the 

marginal gingiva provides added protection against bleeding. 

Figure 26: After my assistant removes the Comprecaps and pulls the 

top cord from tooth #9, I syringe medium body impression material 

around the preparation. Note the wide-open sulcus on the mesial of 

the tooth, which makes it almost impossible to miss this impression. I 

use medium body for my syringe material to prevent the material from 

tearing in the sulcus. 

Figure 27: For me, an ideal impression needs to have the prep 

margin clearly visible 360 degrees around the tooth, as well as 

1 mm of impression material beyond the margin. This extra 1 mm 

of impression material beyond the margin represents an impression 

of the root surface, leading to ideal margin placement and optimal 

emergence profiles. 

Figure 28: Here you can see how my assistant has placed the bite 

registration material exactly where it should be, covering the incisal 

third of the prepared teeth and the incisal third of the opposing teeth. 

Ideally, there should be no bite registration between the unprepared 

teeth and no contact with any soft tissue. The temporaries are then 

replaced, and the patient is asked to come back in two weeks for 

the try-in. 

Figure 29: Third Appointment — It’s been two weeks, the temps 

are off, the BruxZir Solid Zirconia crowns have been tried in and 

approved, and we are now placing a layer of desensitizer on the 

teeth (G5 All-Purpose Desensitizer [Clinician’s Choice; New Milford, 

Conn.]). Dr. Gordon Christensen’s research shows that two coats 

of this glutaraldehyde/HEMA solution actually increases the bond 

strength of adhesive cements. 


Figure 30: I use a Warm Air Tooth Dryer (A-dec; Newberg, Ore.) 

for 10 seconds after applying both coats of the G5. Meanwhile, my 

assistant places Z-PRIME Plus (Bisco; Schaumburg, Ill.) inside the 

BruxZir crowns, and then we air thin that for 10 seconds. Z-PRIME 

Plus is a zirconia adhesive that helps strengthen the bond of the 

cement to the crown. 

Figure 31: After my assistant loads the BruxZir crowns with a resinmodified 

glass ionomer cement (RelyX Luting Plus Automix [3M/ 

ESPE]) and the crowns are seated, I use a pinewood stick (Almore 

International; Portland, Ore.) to make sure they are fully seated. I then 

turn the stick sideways and hold it against the two incisal edges to 

verify they are the same length. 

Figure 32: One of the advantages of the new RelyX Luting Plus 

Automix is that you can tack cure the cement for five seconds with 

your light and then clean up the excess immediately, or you can do 

what you did in the past and wait two minutes for it to self-cure. It’s 

the only RMGI with a tack cure option available today. 

Figure 33: Here is an immediate, non-retracted shot of the BruxZir 

crowns on tooth #8 and #9 with the lips at rest. This is probably the 

easiest shot to take for crowns to look good because we are looking 

only at the incisal half, where reduction is nearly always adequate. The 

gingival third is where crown & bridge tends to look fake. 

I use a Warm Air Tooth Dryer (A-dec; Newberg, Ore.) for 

10 seconds after applying both coats of the G5. Meanwhile, 

my assistant places Z-PRIME Plus (Bisco; Schaumburg, Ill.) 

inside the BruxZir crowns, and then we air thin that 

for 10 seconds. Z-PRIME Plus is a zirconia adhesive that 

helps strengthen the bond of the cement to the crown. 


Before 

After 

Figure 34: A retracted view of the BruxZir crowns on tooth #8 and 

#9. I used to always under-reduce in the gingival third before I started 

doing the Reverse Preparation Technique, which ensures 1 mm of 

reduction in this area. Thanks to this technique, these crowns look 

decent even in the retracted view. 

Before 

The other amazing thing I 

notice is the facial anatomy 

that you see on the crowns 

in the lateral views. That flat 

facial profile in three planes is 

what makes a tooth look real. 

Because that anatomy is built 

into the CAD/CAM database, 

we are able to deliver it every 

time — provided the doctor 

gives us enough reduction. 

After 

Before 

Before 

After 

After 

Figures 35 a–c: Looking at this series of “after” pictures, the most amazing part is that there is not any porcelain on these BruxZir crowns; they 

are solid zirconia. This is why they have superior strength and are stronger than all other restorative materials, with the exception of cast gold. 

The other amazing thing I notice is the facial anatomy that you see on the crowns in the lateral views. That flat facial profile in three planes is 

what makes a tooth look real. Because that anatomy is built into the CAD/CAM database, we are able to deliver it every time — provided the 

doctor gives us enough reduction. The promise of CAD/CAM dentistry is being able to deliver predictable esthetics because the restoration 

contours are based on a library of ideal teeth, not on a technician’s skill level or whether he or she is having a good day. As BruxZir Solid Zirconia 

has become more translucent, I find myself more willing to use it for challenging esthetic cases like this one. While I’m not suggesting that you 

suddenly switch all of your anterior restorations to BruxZir crowns immediately, you may want to consider using it for patients with parafunctional 

habits, or patients with old PFMs like the ones in this case, where an esthetic improvement is essentially guaranteed. CM 



Interview with Glenn Lombardi 

– INTERVIEW of Glenn Lombardi 

by Michael C. DiTolla, DDS, FAGD 

Interview with Glenn Lombardi33

34 

Dr. Michael DiTolla: Glenn, I like to bring 

you back at least once a year, sometimes more 

often, because in addition to doing websites for 

dentists, you now help them with their online 

presence and social media needs. This is an area 

that is changing so rapidly that I feel like I need 

to check in with you every couple months to find 

out what we, as dentists, should be doing. Talk 

to me about how social media has changed, and 

what you’d like to see dental offices doing. 

Glenn Lombardi: Well, it has progressed 

quite a bit in the last year. While most dentists 

are familiar with Facebook and Twitter, 

which are continually growing and evolving, 

there are now new social sites emerging like 

Google+ and location-based social platforms. 

We’ve also seen a rise in the influence of online 

reviews, which have become an essential 

piece of the whole social media aspect. It’s 

now more important than ever that dentists 

are aware of what is being said about them 

online, and that they are also being proactive 

in trying to interact with and influence positive 

dialog. 

MD: It seems like, despite your best intentions 

and attempts to treat every patient right, there 

are going to be times when you disappoint 

somebody, whether it’s clinically or whether it’s 

estimating what the insurance is going to pay. 

You just can’t hit it right on the head every time. 

And if the patient happens to be one of the people 

who spends a lot of time online, I think it’s fair 

to say that, even as a great dentist trying to do 

everything right, you can end up with a bad 

online review. I don’t think you have to kill a 

patient for that to happen, right? 

GL: Right. Just look at your favorite restaurant 

around the corner. You can go online and find 

100 good reviews, but for every 100 positive 

reviews, there will inevitably be an additional 

five or 10 negative reviews. And, unfortunately, 

the people who are typically most apt to give 

a review are those who are unhappy with 

a service. As a dentist, you can’t possibly 

satisfy every patient who walks through your 

door, but you can, in combination with great 

customer service, encourage your most loyal 

patients to give you a good review online on 

the major review sites, such as Yelp, Yahoo 

and Google. 

A dentist can do a couple things to make that 

happen. There are a handful of services out 

there that send patients an e-mail following 

their appointment that asks: How was the 

process? How was the service? Can you review 

us? At Officite, we offer a more hands-on 

approach. We provide our clients with simple 

instruction cards for giving a review that can 

be given to the patient as they leave the office. 

The patient can then give the dentist a positive 

review from their home computer. We also 

offer an in-office review solution, which 

allows a patient to review the dentist right 

there in the office, directly from their mobile 

device. While a dentist might get three, four 

or five negative reviews over time, if they’re 

encouraging patients throughout the year 

to leave positive reviews, by the end of the 

year they will have garnered enough positive 

reviews to offset a handful of negative ones. 

MD: Are dentists comfortable with this? For 

example, we’ve been hearing at practice management 

seminars for the last 15 years that we 

should be asking for referrals from our patient 

base, especially from the satisfied patients who 

we know get along with us and the staff. Also, 

we’ve always been told that, as the dentist, we 

should ask for the referral personally because 

that’s really powerful. But the reality is, a lot of 

dentists are uncomfortable asking for that type 

of referral. Are most of the dentists you’re working 

with comfortable asking for positive reviews, 

or are they done up front by the staff? 

GL: It’s really been a staff process. A dentist 

needs to train the staff on who to ask and 

what makes a patient a good candidate for a 

positive review. Some of the things you want 

to identify as a patient comes through are: Did 

they have a positive, outgoing personality? Are 

they consistently pleased with your services? 

Do they already have accounts set up on 

Google or Yahoo? Once you narrow down the 

“right” patient to ask, the process becomes 

a lot easier and more effective. You’re just 

asking a select few patients for reviews, 

not necessarily everyone who comes through 

the office. 

MD: That makes sense. I can see dentists being 

much more comfortable with your approach. 

You mentioned smartphones and iPads. My 

mom and I were sitting at one of my son’s hockey 

games, and I asked her a question about a book 

she was reading. She whipped an iPad out of her 

purse, and I was at once really proud of my mom 

and also horrified to see her with a piece of high

technology because it made my iPad seem slightly less cool. But I 

realize that for some people who are intimidated by computers, 

the iPad is actually a solution that doesn’t feel as intimidating 

as maybe the keyboard and the mouse did because you get to 

interact with it on a different level. Are you finding with these 

different platforms, like the computer, the iPad and the smartphone, 

that there are things that need to be optimized for the 

dental practice? 

GL: Most definitely. While a lot of people still use their 

home computers, there are now more than 250 million 

mobile phone users. Ninety million of those are using the 

Internet on those devices. There are some incredible stats 

out there on what is happening with smartphones, iPads 

and other portable devices. The number one thing you want 

to do is make sure your website is compatible with those 

devices. So if someone searches for your practice via an 

iPad, a Droid or an iPhone, you want to make sure that 

when they pull it up they get a mobile- or iPad-friendly 

version of the site. If someone is looking at your website 

via smartphone, they’re probably looking to call you, 

get directions, those sorts of things. They’re probably not 

looking to read up about flossing. You want to make sure 

the navigation is presented clearly, so that while they’re on 

that device they can get to the information they are looking 

for with a touch of a finger. 

In fact, last week I was at Google’s campus in California 

for a meeting, and they stated that there will be more local 

searches on mobile devices at some point in 2013 than there 

will be on personal computers. So this shift is happening 

fast. If more searches are being done on a smartphone or 

tablet device, then you need to make the necessary changes 

to ensure that your website is accessible from those devices 

because that’s where your patients are. 

MD: That makes sense, and I think that might actually be true 

for me as well. I have a nice computer at home, but it’s easy 

for my smartphone to get on the Internet and it’s easy to do 

searches. Plus, my phone is always right there with me. 

GL: Exactly. Think about all the patients that you communicate 

with in the office that then go and refer people back to you, 

be it their friends or acquaintances at work. If they’re sitting 

there talking to someone and they say: “Hey, you really 

need to see Dr. DiTolla. He’s great.” And the person says: 

“Wow, I’m looking for a new dentist. How can I reach him?” 

If they are sitting at a restaurant or wherever they might be, 

they might go straight to their iPhone or their Droid and 

pull up the information to read about that dentist and even 

make an appointment. So it’s a very simple concept that 

all these patients who are being referred to you, in most 

cases, are probably searching for you online before they 

come into your office or even contact you. So, again, not 

knowing what device they’re going to be on, you want to 

make sure you’ve optimized your website for that potential 


new patient, whether they’re accessing you on a tablet, a 

work computer or an iPhone. 

MD: I agree with what you’re saying about the significance of a 

website. Recently I had to go see a physical therapist for an injury, 

and the first thing I did was pull him up online. I just wanted to 

see a picture of what he and his staff looked like. I don’t know if I 

expected them to look evil so I would know not to go there, but there 

was just something that made me feel more comfortable seeing 

who they were and what they looked like before I went. You 

know what I mean? 

GL: Yes, I understand that. It’s just a comfort level. Whether 

you’re being referred to a urologist or a dentist, it’s just 

human nature to search for them online. That is a big 

change from the traditional phone book. Just because your 

site may not be iPad-compatible today, it’s OK; it’s part of 

the process. So if you don’t have a website and are going 

to get one, it’s important to make sure the vendor you’re 

considering also offers a mobile solution. And if you already 

have a site, go back and revisit this with your provider and 

talk about how you can move, over the next couple months, 

from just a computer-centric website to one that can be 

accessed from any mobile device. 

MD: I guess at some point most of these things will be designed 

mainly for mobile devices and computers might be kind of an 

afterthought. 

GL: Yep. In fact, I was at a BIA/Kelsey conference last week, 

and they stated that less than 2 percent of the websites out 

there today are mobile-friendly. So while mobile is where 

we are headed, many people still need to take the next step 

to make their sites mobile-ready. 

MD: Yeah, I absolutely agree. In fact, our site, www.glidewell 

dental.com, has been entirely redone to be easily accessible 

from mobile devices. We’re big believers in what you’re saying. 

Going back to my physical therapist example, not only did 

I want to see what he and his staff looked like, I wanted to 

find their hours and see where they were located because I 

didn’t recognize the address. So it made it really simple for me 

to get there. And I can almost honestly say that, even though 

the referral was from a friend of mine, if they hadn’t had a 

website, I would have been a little bit leery about going over 

there. If a doctor doesn’t have a website, I guess it says to me 

that they’re just not trying hard enough; that they don’t care 

enough to help out their patients. Maybe he’s the best physical 

therapist in the world, but if he’s not willing to take that effort 

to make it a little bit easier for me to do business with him, I 

almost don’t want to deal with someone like that. On one hand, 

that sounds kind of lame, but on the other hand, I think a lot of 

people feel that way. 

A woman told me the other day she’s switching her dentist 

because his office still calls her home voicemail to confirm 


appointments instead of texting her. She doesn’t 

want to go home and check her messages or 

check them remotely. She just wants to get a text 

message to see whether she has an appointment 

and what her appointment time is. 

GL: (laughs) Well, there you go. 

MD: Do you have any idea what percent of dental 

offices have a website today? 

GL: There are varying numbers out there. 

I think we can estimate that somewhere 

between 30 and 40 percent of all practices 

have what I would call a “functional” website. 

There’s probably another 20 to 30 percent 

that have something very simple or brochurelike 

that they might have put up four or five 

years ago that’s probably not functional at this 

point or visually appealing. But even here at 

Officite, half of the clients coming to us for 

new websites already have one. If you bought 

a site three, four or five years ago, it is also part 

of the process that you need to refresh and 

update it, both from a technology standpoint 

and from a look-and-feel standpoint. Your site 

is oftentimes the first impression a patient 

has of your practice. You don’t want your 

outdated site to send the message that your 

practice isn’t up to speed. 

MD: What do you think is keeping the other 40 

percent from getting a website? 

GL: I think the biggest issue is fear of the 

process; that it’s going to be too involved 

and too difficult. In a lot of cases, it might 

be somebody who is not technology savvy. 

Someone might be a great dentist, but when 

it comes to the Internet and computers, 

they’re still hesitant. Building a website can 

be a simple process, and if you pick the right 

provider, they will hold your hand through 

the whole process. They’ll walk you through 

all the things they need from you, and in 

some cases can have a site up and live on 

the Internet, within an hour of your time. So 

I think the biggest fear is of the process, and 

what dentists need to know is that it’s easy, 

and the longer they wait, the further behind 

they get. 

MD: So it’s not a money issue for most of the 

doctors you talk to? As it’s really not all that 

expensive, it seems like it wouldn’t be a money 

issue like investing in an expensive piece of 

technology would be. 

GL: No, it should not be a money issue because 

the return on investment is very clear and 

very simple, and you can measure it monthly, 

if not daily. If you just get one new patient a 

month, you’ve paid for the site in six to eight 

months. So it’s really not an investment issue, 

it’s an ease-of-process issue. 

When speaking with dentists without a 

website, I’ll often recommend that they do a 

search on Google for their name or practice 

name. In many cases, the search will show 10 

to 12 results from various directory listings, 

all with varying information on the dentist 

including patient reviews. So on the first page 

of the search results you’ve got 12 different 

sites telling everybody who you are and what 

other patients are saying about you. But if you 

have a site and you Google your name, your 

website is going to come up, and below it 

will be the directions to your practice, contact 

info, any articles you might have written, your 

blog. So the top half of the page is going to 

be links to your website where you are now 

telling your story. The patient won’t have to 

sort through directory listings that may or 

may not have accurate information about you 

because your website pages will be the first 

to appear. So not only is it important to have 

a website, but more importantly, you want to 

take control of your online presence. That’s 

just one of the things you have to look at. 

Every time someone refers a patient to you, 

they’re going to search your name online. Do 

you want a handful of directory sites telling 

your story, or do you want to tell your own 

story with your website? 

MD: It’s funny you mention that because I sometimes 

get e-mails from dentists who I want to call 

because they’ve asked a question that requires 

a longer answer. I’ll Google their names, and 

you’re exactly right, I get healthdirectory.net, 

doctoroogle.com, and all this other stuff that 

are not official pages by them. You wonder if 

the information or phone number is accurate. 

There are even friends of mine who don’t have 

a website. I’ll search their name, and you’ll 

see a review or two of them and it’s completely 

uncontrolled. 

When you talk about dentists not doing a website 

because of the work that is involved, do you 

think there’s a perception among dentists that if 

they do a website they’re going to have to start 

blogging? Is blogging one of the things where 

37

38 

they think: I can’t write, I don’t take clinical photographs, 

this is going to be a big problem, I don’t 

want to get invested in this? 

GL: You’re right, that is probably another fear 

they have. Obviously, you don’t have to blog, 

but it is a great educational tool. But even 

here at Officite, we will actually do the blogging 

for you, if you’d like. 

MD: Really? 

GL: Yeah, we think it’s a helpful service because 

blogging is an important part of taking 

control of your online identity. 

To take control of your online presence, you 

first want to have a website, so when someone 

searches for your name, your information 

comes up. If someone is on Facebook talking 

to their friend and their friend just had teeth 

whitening or new veneers and posted a 

picture, you want them to be able to link back 

to another Facebook page when they ask their 

friend who their dentist is. If they’re driving 

to your office and looking for directions and 

they pull up your site on an iPhone, you want 

to be able to give them directions quickly 

off that iPhone. So no matter where they’re 

looking or what they’re doing, you want 

to make sure you’re telling your story and 

you’re communicating with them on whatever 

device they’re using to look for you. Again, 

people go to Yelp. Have you gone onto Yelp 

and claimed your page for your practice and 

updated the information? Those are the things 

you need to do. If it’s too much for you, there 

are providers out there who can manage all 

of that. They can set up your Google Places 

page, set up your Yahoo page, complete your 

profile on Insider Pages, Citysearch, wherever 

it might be. You have no idea where the 

patient is going to look for you online, but 

you want to make sure when they do, you’re 

telling your story. You want to take control 

of your entire Internet presence. By having a 

provider do that, you take all the guesswork 

out of it because they’re doing it for hundreds 

of other dentists. Anywhere a patient looks 

for you, your story is going to be told and it’s 

going to be told by you. 

MD: That’s a great point. For somebody who 

has been out of school a little more than 20 

years now, I don’t think it was ever part of 

the deal when I graduated that one day what 

you did as a dentist would be rated online by 

non-professionals — not by other dentists, but by 

patients — and written up on a site like Yelp. It 

almost boggles the mind that dentists are being 

subjected to this scrutiny on a site like Yelp, 

but on the other hand, it probably has some 

positive benefits as well because it’s going to 

force dentists to try to be a little better. Or, it will 

force them to do at least what you’re saying and 

take control of that online presence. It’s a brave 

new world here when all of a sudden dentists 

are being subjected to online reviews on Yelp, as 

though they were the local dry cleaner down on 

the corner. 

GL: I agree. I don’t think it’s necessarily fair, 

but it’s no different than if that patient walks 

out of your office and tells the next 10 friends 

they see that they had a horrible experience. 

It’s really the same concept, except it’s online. 

Sometimes you don’t know that a patient left 

your office and said all those negative things 

about you, so the good news is an online 

presence allows you to improve yourself 

because you can always be monitoring what’s 

being said about your practice. You need to 

monitor your online reputation, and when 

there are negative reviews, maybe there is 

something to be learned from them. Maybe 

there is something you’re doing wrong or 

some way you are communicating improperly. 

Maybe a staff member is not communicating 

in front the way you think they are when 

you’re back working in the operatory. So from 

one aspect, it’s a great way to learn about your 

practice and maybe improve it, but secondly, 

you do want to take control of that online 

presence. While you might get some negative 

reviews, you want to make sure all those 

people who had positive reviews get online, 

so that it goes out to the community online. 

MD: You know, there might be a disgruntled 

patient who leaves your practice and tells 10 

people. I guess it could come up 10 times in 

conversation — they’d have to have a pretty 

strong vendetta against you — but when you put 

it online and there’s the potential for thousands 

of people to see it, including your family 

members, friends and other people, it seems like 

it has the potential to be a lot more damaging. So 

there is an absolute need to control this because 

one patient telling a few of their friends seems 

like a lot less of a big deal than somebody going 

online and saying it, where it has the potential 

to really spread. It’s unfortunate, I guess, for 

some dentists that they are going to have to take

control of this, but they’re probably going to be reviewed online 

whether they want to be or not. Some might say, “Hey, I never 

signed up for this.” Well, you don’t have to, right? 

GL: Right, you don’t have to sign up, it just happens. That’s 

why you want to put together some sort of plan to get 

positive reviews online because you can have the same 

positive experience happening to offset that negative. 

When talking about additional ways of communicating 

with the community, another great idea is getting your 

patients to “Like” your Facebook page and integrating 

the blog from your website into your Facebook page, so 

every time you or your service provider updates content 

on your blog and one of your patients “Likes” it, it’s going 

to show on their Facebook page and to their 250 friends. 

If you’re putting out good content, or if the provider is 

writing the blog for you and it’s quality, interesting content 

that patients are going to find helpful, what ends up 

happening when they “Like” those things on their Facebook 

page is that it then spreads exponentially to all their friends. 

So another great way to communicate positive things and 

educate your community is by using a simple blog and 

Facebook page. It’s not rocket science, but it’s a great 

way to maintain that positive presence about you and 

your practice. 

MD: I actually didn’t know that it worked that way. That’s really 

interesting. It sounds like your company will do the blogging 

for the dentists if they want you to, but can they also set up 

something where you guys would do the blogging for them for 

three months? And then if the doctor has an interesting case 

and takes some photos, or he wants to write something, could 

he write something for one month and then you guys could do 

the next three months? I mean, is it possible for the dentists to 

be able to intermittently blog and have you guys provide the 

content the rest of the time? 

GL: That’s exactly how our blog management program 

works. We’ve actually partnered with a company called 

Dear Doctor, publisher of Dear Doctor – Dentistry & Oral 

Health, a quarterly dentistry magazine written exclusively 

by dental healthcare professionals for the education and 

well-being of the general public. Articles they have written 

for their magazine can be posted to our clients’ blogs every 

week. It’s an automated process, so it requires little to no 

effort from the practice, but they are still getting highly 

educational and credible posts. If the dentist chooses, we 

can also craft personalized articles for the practice to give 

the dentist more input into each article without having to 

write them. 

MD: I had no idea you guys offered that second option. So if 

a dentist goes to a course and learns how to start delivering 

sleep apnea devices or snoring appliances, he can request blog 


entries from you guys on those topics and you will write something 

and put it on his site to help attract those new patients? 

GL: Exactly. We’ll actually write the content for them based 

on different topic areas. It’s a great service and a great way 

to educate your patients on a regular basis while populating 

your website and social media sites with new, valuable 

information. Again, it’s all about making it easy and simple 

for the dentist. Most dentists have barely enough time in 

the day to see their patients, so it’s not always possible for 

them to write a blog post as well. That’s where Officite can 

really help out. 

MD: That’s a great idea. I don’t want to sound jaded, but for 

20 years we’ve told many people about brushing and flossing, 

and I’m not sure the message is getting through — at least not 

to males — so I can see a lot of dentists thinking: Hey, let’s blog 

on something other than brushing and flossing. Let’s do something 

on bleaching! I’ve got a bunch of bleach here that’s going 

to expire in three months. Or let’s do something on snoring, or 

let’s talk about this new all-ceramic crown. For them to be able 

to pick the topics and have you guys come up with information 

sounds like a great idea. 

To recap, it sounds like you certainly encourage dentists — 

almost say it’s mandatory — to have a website. It just doesn’t 

seem like there’s anything you can do for your practice that will 

give you as much bang for your buck as getting involved with a 

nice, up-to-date website and some active blogging. 

GL: Right. Today’s patients expect you to have a website 

that is current and educational. It’s not that expensive or 

difficult to launch a professional website, and the return on 

investment is very high. Nowadays, not having a website 

speaks louder than having one. CM 

Glenn Lombardi is president of Officite LLC, a leading national provider of premier 

websites and turnkey Internet marketing solutions for the dental community. Contact 

him at 800-908-2483, www.officite.com or glombardi@officite.com. 


Is It Time to Do 

Routine Adult Pulpotomies? 

“Any intelligent fool can make things bigger and more complex. … It takes a touch of 

genius — and a lot of courage — to move in the opposite direction.” 

– Albert Einstein 

– ARTICLE and CLINICAL PHOTOS by 

Ellis J. Neiburger, DDS 

INTRODUCTION 

Two patients walked into two dental offices with the 

same problem. They each had a molar with deep caries, 

a pulp exposure, pain and fear. One patient chose traditional 

endodontic treatment and, after making several 

40-minute visits to his dentist, paid $1,200 and left “cured.” 

He later got a $1,000 crown to restore the tooth. The second 

patient had a one-visit pulpotomy and an alloy filling, 

which took 25 minutes. He paid $250 and left “cured.” 

Who got the better deal? For whom was the deal better, 

the dentist or the patient? 

As our nation’s prosperity continues to decline during this 

recession, and business, insurance and government benefits 

rapidly erode, fewer patients can afford traditional 

root canal therapy, yet the need for endodontic treatment 

is continually greater. The more people who delay routine 

dentistry (exams, prophylaxis, restorations) because 

of finances, time and other “excuses,” the more exposed 

pulps will eventually come into our offices. We are seeing 

this now. Fewer and fewer patients can afford or want 

root canal treatment. Endo is becoming the treatment of 

the rich and well-connected (insured), primarily because 

of the high cost of therapy (Fig. 1). 

So great is the cost of endo that extraction and implants 

have become a viable, though high-priced, alternative. 

Average U.S. prices for a molar endo range from $900 to 

$1,400. But for most patients, even those with a paltry 

$1,000 maximum on their dental insurance policies, 

extraction is generally the only practical and affordable 

treatment offered. They cannot afford the price of endo 

and often choose low-cost extractions as their only 

alternative. This unfortunate state of affairs will continue 

— if not grow — as our economy languishes and 

widespread un- and underemployment continues. And 

when “prosperity” does come back, in a year or three from 

now, it will never be (economically) the way it once was. 

Insurance and other employment benefits will be lower. 

Government-sponsored dental plans (e.g., Medicaid) will 

opt for the least expensive treatment. Endodontics, as we 

know it, will have to change. 

The average patient needs a low-cost, quick and comfortable 

alternative to traditional endodontics, besides extraction. 

They do not have the money, patience or resources 

to afford traditional endo in the way we have done it 

in the recent past. Many do not have the money to get 

implants, fixed bridges and other expensive replacement 

dental treatments, yet they want to save their teeth. 


Figure 1: Example of traditional endodontic treatment. Pulp is 

removed and root canals are cleaned and sealed. 

Figure 2: Pulpotomy with amalgam restoration. Treatment done 

19 years ago. No symptoms reported. 

Endodontics is not the only issue, however. Usually the 

tooth, after endo treatment, will require an expensive 

crown and recommended post, which further stresses 

limited economies. 

Wouldn’t it be nice to offer our patients a cheap, quick 

and comfortable “magic bullet”; a medicine and filling 

placed in the infected or nonvital tooth which will 

render it asymptomatic, stable and serviceable for long 

periods of time? That is what a pulpotomy can be, and we 

can offer it without any special kits, training or expensive 

equipment. 

We dentists are morally obligated to help the growing 

mass of financially strapped patients, and the only technique 

that will meet this need, short of mutilating extractions 

and free endo, is the adult tooth pulpotomy. 

PULPOTOMY 

A pulpotomy is the removal of the dental pulp and 

the placement of medication that will halt infection 

and preserve the tooth. 1–3 There are numerous types of 

pulpotomies, such as the pulpectomy (removal of the 

pulp), partial pulpectomy, shallow pulpotomy (and its 

“deep” analogue) and radicular pulpotomy. All of these 

remove the pulp tissue, more or less. The emptied pulp 

chamber is filled with a germicidal medication, which 

destroys infective organisms and mummifies (fixes) any 

remaining tissue that could later contribute to a septic 

condition around the tooth. 1–6 Formocresol (FC) has 

been very popular with dentists for more than 100 years. 

The original Buckley’s formula for FC consists of 19 

percent formaldehyde and 35 percent cresote, plus 

fillers. 3–6 Glutaraldehyde, calcium hydroxide, zinc oxideeugenol 

(ZOE), mineral trioxide, ZOE with 6 percent 

paraformaldehyde (N2) and ferric subsulfate are some 

of the other medications in popular use. All of these 

cause cell death, mummify tissue and are theoretically 

mutagenic, though in the real world, no related cancer 

cases have ever been reported. 1,7 They render the infected 

tooth aseptic, and thus allow the tooth to remain in the 

mouth comfortably for years (Fig. 2). 

The typical pulpotomy procedure is to open the tooth’s 

pulp chamber, remove the decay and as much of the pulp 

tissue as practical, place the medication (e.g., FC) in the 

form of a cotton pellet or cement paste, and then close the 

tooth with a restoration (e.g., alloy, composite, crown). 1–4 

It is simple, quick and inexpensive. This is done in a 

The average patient needs a 

low-cost, quick and comfortable 

alternative to traditional 

endodontics, besides extraction. 

They do not have the money, 

patience or resources to afford 

traditional endo. 

Is It Time to Do Routine Adult Pulpotomies?43

Figure 3: Earliest pulpotomy discovered in a 200 B.C. Middle 

Eastern soldier. Note the radiolucency around the apex. There is 

no evidence as to when the pulpotomy was done clinically. 

Figure 4: Traditional endodontics 20 years after treatment. Note 

the periapical abnormalities and “short” root fill. Tooth is asymptomatic, 

signifying a successful treatment. 

single visit or several visits, depending on the initial infection 

and the response of the tooth. Since the advent of 

traditional endodontia, this technique has been usually 

reserved for deciduous teeth. 3 

Adult pulpotomies are not as popular with dentists today 

as they were 100 years ago. Historically, traditional endodontia 

has been reported to be a more reliable treatment 

than pulpotomy techniques, based on the rate of saved 

teeth and the longevity of their preservation. 8–26 However, 

new research is changing this view. 5,6,12–16 

The pulpotomy, as a therapeutic dental treatment, has a 

long history. It has been used for thousands of years. Zias 

reports a pulpotomy-endodontic treatment found in the 

tooth of a Middle Eastern, Hellenic-Nabatian soldier of 200 

B.C. 27 (Fig. 3). In this ancient case, the large radiolucency 

around the treated tooth’s apex shows a less-than-perfect 

therapeutic result, though the treatment may have been 

started just prior to death. Dentists throughout history 

commonly used adult tooth pulpotomies until the 1930s, 

when traditional endo was developed and promoted as 

being a more reliable pulpal therapy. 1–3,25,26 In 1964, endodontics 

became a recognized specialty. 

TRADITIONAL ENDODONTICS 

The object of traditional endodontics is to remove pulpal 

tissue and seal the canals to the apex area of the root 1–3,26 

(Figs. 1, 4). This is done with an ever-increasing complex 

of technology: devices and techniques such as Ni-Ti files, 

reamers, sealers, tissue diluents, microscopes, apex electronics, 

ultrasonics, lasers and piezo-electric actuators. 8 

By my count, there are 35 rotating file systems and five 

reciprocating instrument systems on the market at this 

time devoted just to cleaning canals. The progression of 

increasing complexity has caused the cost of doing endo 

to escalate to economically prohibitive levels for many 

people. The 4,000 endodontic specialists (with 253 new 

graduates per year) are not numerous enough to perform 

the estimated 24,000,000 root canal treatments needed 

each year. 8,18,19 This leaves most endodontics to be done 

by the general practitioner. 

Dentists throughout history 

commonly used adult tooth 

pulpotomies until the 1930s, when 

traditional endo was developed 

and promoted as being a more 

reliable pulpal therapy. 

Traditional endo has many drawbacks. Not only does it 

take much time, effort, investment (equipment cost) and 

skill, but to the long-suffering patient, it is often uncomfortable, 

involving anesthesia, rubber dams, long periods 


The Root Canal Anatomy Project 

http://rootcanalanatomy.blogspot.com 

Figure 5: Multiple large apical openings on an extracted 

molar. Would they all be sealed using traditional endodontic 

techniques? 

Figure 6: Variety of canal shapes and connections complicating 

traditional endodontia techniques 

with the mouth open, retreatments, post-op sensitivity, 

blow-ups, blocked canals, separated files, apicoectomies, 

hypochlorite leaks, ledges, excessive biofilms, lateral 

canals, anastomoses, deltas, overfills, underfills, cracks, 

perforations and microsurgery (Figs. 1, 4–6). Today’s endodontic 

sealers and canal obturators (e.g., gutta-percha), 

though often tolerated, form leaky seals, seldom fill 

all voids in the canals and are associated with chronic 

apical irritation from leaking pathogens 9,10 (Figs. 4–6). 

This is why 96 percent of in situ-biopsied, endodontically 

treated teeth often have large accumulations of lymphocytes 

(in response to infection) found in the apical tissues 

years after treatment 9–11 (Fig. 5). 

Even though traditional endo has its problems and hazards, 

it provides a relatively excellent, consistent result in 

saving teeth (Figs. 1, 4). This result has been far better and 

more consistent than what was once found with many 

older adult pulpotomy techniques. 1–3,25,26 New research 

and techniques are changing this view. 3,4,12–16 

SUCCESS 

Traditional endodontic therapy is intended to preserve 

the diseased tooth. Whether the treatment is traditional 

endo, with its completely sealed canals, or a pulpotomy 

with mummified pulpal tissue, the measure of success is 

an asymptomatic, functional and disease-free, long-lived 

tooth (Figs. 1, 2, 4, 7–9). Traditional endodontia defines 

success as the treated tooth being asymptomatic, with 

no periapical (radiographic) pathology, and the sealers 

(e.g., gutta-percha) extending to the anatomic apex of 

each root. 3,10,11,26 

As time progresses, increasingly more stringent criteria 

are applied to the definition of “quality endo.” Some of 

these criteria are questionable. Must the canal be sealed 

exactly to the anatomic apex (Fig. 4)? Must the periapical 

tissue appear perfectly “normal” around the apex as 

seen on the radiograph (Fig. 7)? Must the tooth last 10 to 

30 years post treatment? Is it a success if it survives only 

eight years? 

96 percent of in situ-biopsied, 

endodontically treated teeth often 

have large accumulations of 

lymphocytes found in the apical 

tissues years after treatment. 

Pulpotomy success has similar criteria, except the canals 

are not completely sealed to the apex, and in some cases, 

asymptomatic, nonprogressive periapical abnormalities 

(e.g., root scars) are noted and periodically observed 

(Figs. 2, 7–9). Both treatment methods define the lack of 


Figure 7: Two Sargenti (N2) pulpotomy treatments after 15 

years. This technique is a combination of traditional endo and 

pulpotomy that includes full pulp removal, gutta-percha cone 

and ZOE-paraformaldehyde sealer placed in at least 75 percent 

of the canal. 

Figure 8: Ten-year-old pulpotomy treatment. Tooth is asymptomatic, 

but exhibits a static apical radiolucency. 

tooth-related pain, swelling, fistulas, mobility and intercanal 

pathology as needed for “success.” 6,17 Success in both 

methods is often dependent on case selection, as well as 

the skill of the dentist, good fortune and the cooperation 

of the patient. A nonvital molar, with a large crack running 

through the crown, is less likely to be successfully treated 

than an intact, otherwise healthy, but recently exposed 

tooth, regardless of which treatment method is used. 

The failure rate of traditional endo is varied: 5.3 percent 

are associated with significant pain 17 ; 18 percent of treated 

teeth are eventually lost, with a relative rate of 2 percent 

being lost each year; 6 percent are reported lost in six 

years; and 50 percent are lost 30 years after treatment. 2 Of 

traditional endodontic failures over the years, 60 percent 

fail due to prosthetic problems (e.g., tooth cracks, internal 

resorption), 32 percent fail due to periodontal concerns 

Between 74 and 86 percent of 

endodontically treated teeth are 

retained, even though they may 

have some radiographic signs 

of periapical abnormalities. 

and 9 percent fail due to purely endodontic considerations. 

18 Generally speaking, between 74 and 86 percent 

of endodontically treated teeth are retained, even though 

they may have some radiographic signs of periapical 

abnormalities 11,19 (Fig. 4). 

The history of the pulpotomy presents a mixed collection 

of successes and failures. Pulpotomy for deciduous 

teeth are routine and dependable. The deciduous tooth, 

pretreated or not, responds well to pulpotomies and is 

required to last only a few years in the mouth before it is 

exfoliated (Fig. 10). Long-term pulpotomy success is not a 

consideration in deciduous teeth. Pulpotomies in permanent 

or adult teeth sometimes present failure because of 

fractured and leaking restorations. This is partially due to 

the expectation that a damaged/repaired tooth should last 

an ever-increasing lifetime. Another reason for past pulpotomy 

failures was an economic issue resulting in a weak 

restoration (e.g., amalgam) being placed in the treated 

tooth instead of a strong, but expensive crown. A large 

amalgam placed in a bombed-out tooth will often leak 

after a few years of wear. Recent reports have showed an 

increasing rate of success with adult pulpotomies, even 

for extended periods of time 4,6,12,13,16 (Figs. 2, 7–9). 

DeRosa has shown a 65 percent success rate of pulpotomies 

after eight years’ follow up. 20 Aguilar did a metaanalysis 

of PubMed adult pulpotomy studies, finding a 

73 to 99 percent success range over three years. 13 Witherspoon 

described a 95 percent success rate for pulpotomies 


Figure 9: Nine-year-old pulpotomy. Tooth is asymptomatic and 

fully functional. 

Figure 10: Standard deciduous tooth pulpotomy 

after 1.5 years. 21 Barrieshi-Nusair reported a 90 percent 

success rate of pulpotomies after two years. 22 Qudeimat 

presented a 92 percent success rate using CaOH pulpotomies 

after three years. 4 Noorollahian demonstrated a 94 

percent success rate after two years. 23 Honegger reported 

in a study of 123 teeth an 83 percent success rate after 

seven years. 24 These recent reports show adult tooth pulpotomies 

can have a success record approaching, if not 

surpassing, that of traditional endodontics. 10,17,19 

PULPOTOMY STUDY 

I did a study of 500 adult tooth pulpotomies over a sixyear 

period. Patients were selected on two levels: 1) they 

had pulp exposures in restorable teeth, and 2) they were 

given the option of traditional endodontics, pulpotomy or 

extraction. Those who chose pulpotomy paid the same 

fee as an extraction and were offered a free extraction 

if the results of the pulpotomy were not to their liking. 

The patients were fully informed of the options and 

potential problems. Economics was the major factor in 

their decision. 

The pulpotomy teeth were radiographed before treatment, 

and at six-month and two-year recall intervals. 

Only 302 patient pulpotomies returned for their two-year 

recall, making this, in reality, a study of 302 patients: the 

largest ever conducted to date. Semiannual checkups 

extended for most of the patients well into three years, 

after which time normal patient attrition reduced the 

numbers being followed on further visits. The longest 

patient pulpotomy followed was for 19 years. Success was 

measured by the asymptomatic condition of the tooth (no 

pain or mobility), and the absence of overt radiographic, 

intercanal or periapical pathology. Patients who experienced 

pulpotomy failure were encouraged to have the 

tooth retreated at no cost. 

The pulpotomy consisted of air rotor access to the pulp, 

removal of the coronal pulp tissue and decay, placement 

of a cotton pellet with Buckley’s FC formula, and then 

restoration with a ZOE base and amalgam filling. In a 

few cases where the patient could afford it, a cast crown 

was placed. Patients with “hot” teeth were given antibiotics 

and pain medications prior to treatment. Average 

operative time was 30 minutes. 

Here are the clinical results: 

8 percent had some degree of pain and needed 

pain medications 

8 percent had teeth that failed and were eventually 

extracted 

25 percent had problems requiring repeat of the 

pulpotomy 

68 percent had no problems 


There are theoretical concerns over the mutagenic effects 

of FC and other pulpotomy medications. Eugenol, glutaraldehyde, 

zinc oxide and silver points are also theoretically 

mutagens, however, and are used extensively in traditional 

endo. 5–7 None of these agents have been associated with 

overt neoplastic changes in the real world because so little 

of the material is used in pulp therapy. 5–7 They are perfectly 

safe. 

Figure 11: Formocresol pulpotomy. Placing the FC soaked 

cotton pellet into the pulp chamber of the tooth. 

Over the two-plus years of this study, patients experienced 

68 percent initial success. Most of the patients did 

well with their first pulpotomy. Another 25 percent experienced 

flare-ups and required an additional pulpotomy 

retreatment and new restoration. This was primarily due to 

large amalgam restorations cracking and allowing contaminants 

to enter the pulp chamber. Thus, 92 percent of the 

pulpotomies eventually succeeded, while 8 percent of the 

pulpotomies failed and resulted in extraction or further 

treatments using traditional endodontics. This degree of 

success is comparable to traditional endodontics. 2,11,18,19,25 

PROBLEMS 

In the past, major difficulties with adult pulpotomies involved 

them being unpredictable in outcome and a bias, 

especially in North America, favoring traditional endo as 

a competing technique. 1–3,25,26 Some pulpotomies present 

problems; often, a few years after treatment, the teeth may 

produce a static, periapical radiolucency on radiographs 

that is asymptomatic and seldom progresses 25 (Fig. 8). 

Some clinicians consider this a failure, while others do 

not because the patient is comfortable, asymptomatic and 

functioning for years 3-6,12–16 (Figs. 4, 9). Occasionally, cases 

of adult pulpotomy result in the tooth’s canals ossifying 

or exhibiting resorption, though this is also seen in traditional 

endodontic treatment. 23,25,26 These complications 

make traditional endo, when attempted at a later time, 

more difficult. Such problems may be due to inadequate 

amounts of pulpotomy medication being used or the coronal 

seal (restoration) leaking, allowing the loss of the 

medication and leakage of microbes into the tooth. 

When compared to the difficulty and the cost of traditional 

endodontics, pulpotomies excel. It only takes a few 

minutes to reopen a failing pulpotomy tooth, insert more 

pulpotomy medication (e.g., FC) and replace or patch the 

restoration (Fig. 11). What is needed is more research on 

the most efficient and dependable adult tooth pulpotomy 

techniques and medications. Though this need has been 

apparent for more than 50 years, little work has been 

done and there seems to be a sinister, ethical dilemma 

in play. 

ARE ENDODONTISTS BIASED? 

The endodontic specialty community controls endodontic 

research, including pulpotomy science. Compared to 

North American research involving traditional endo, adult 

pulpotomies research is, in comparison, minuscule and 

has been so for decades. An Internet PubMed search 

produced 144 adult pulpotomy papers in the literature, 

most describing molar treatments in young adults. Those 

involving mature teeth were most-commonly published in 

predominately non-U.S. countries. 4–6,12–17,20–22 In contrast, 

traditional endodontics has well over 10,000 articles 

recommending traditional endodontics. 1–3 This is not a 

simple coincidence. There is a reason for this imbalance, 

and I believe it lies with the endodontic specialty. 

An Internet PubMed search 

produced 144 adult pulpotomy 

papers in the literature, most 

describing molar treatments in 

young adults. … In contrast, 

traditional endodontics has well 

over 10,000 articles recommending 

traditional endodontics. 


Endodontics, as practiced today, is a complex, expensive 

operation with 4,000-plus specialists devoting their entire 

practices to the subject. In this specialty, as well as in 

general practice, traditional endo is a very profitable 

procedure producing high fees for minimal, though 

demanding, work and materials. It is a cash cow, and 

many dentists milk it. 

What would happen if a dependable, simple, quick 

and low-cost pulpotomy technique for adult teeth was 

promoted? It would, overnight, nullify the need for traditional 

endodontics and the people who practice it. GPs 

would do financially well because they could focus on 

restoring more teeth saved by the technique. Endodontists, 

unfortunately, would suffer greatly because their 

skills and service to the patient would be eclipsed. No 

one would want an expensive, time-consuming traditional 

endodontic treatment when they could have an inexpensive, 

quick, dip-a-pellet-in-the-pulp-chamber pulpotomy. 

Not only would endodontic specialists economically suffer, 

but the endo equipment manufacturers, distributors, 

dealers, book publishers, journal editors (paid advertising), 

dental school programs, educators and so on would 

suffer the economic losses caused by universal use of 

adult pulpotomies and gradual marginalization of traditional 

endo. There are exceptions to this scenario, but 

they are in the minority. 

In the real world, few people will willingly destroy their 

professions and livelihoods if they can help it, and the 

best way of protecting their turf is to isolate, denigrate 

and force adult pulpotomies to the margins of dentistry. 

It is the endodontists in dental school programs who 

write the textbooks, journal articles, approve the curriculum 

and teach the next generations of dentists. It is the 

endodontists who are most closely listened to (concerning 

endodontic matters) at professional meetings and the 

bureaucracies of many dental organizations. 7,28 These are 

the people who advise the journal editors (as to what is an 

acceptable endo paper for the journals) and state boards 

of dentistry (licenses), and serve as expert witnesses 

in malpractice trials as to what “proper” treatment (e.g., 

endodontic standard of care) should be. There is a lot of 

money riding on the status quo of traditional endo and, 

though there are some exceptions, most dentists involved 

in traditional endodontics are biased concerning one technique: 

their favorite technique, which they have invested, 

perfected, espoused and taught over their lifetime. 

I believe this bias is why so few pulpotomy articles are 

published or research encouraged. This is the present 

state of our profession. If you doubt this is or could be 

happening, study the 50-plus years of machinations surrounding 

the Angelo Sargenti endodontic technique (N2), 

where a paraformaldehyde-containing sealer (pulpotomy) 

is placed in the pulp chamber and roots of adult teeth. 3,28 

The technique is quick, easy and relatively inexpensive, 

popular in Europe, and there is some excellent scientific 

research supporting it. 28 Many in the endodontic community 

have been somewhat less than candid and fair with 

the investigation and research of this competing technique. 

3,28 If it can happen to the Sargenti technique, it will 

also happen to other adult pulpotomy techniques. 

How can pulpotomies withstand the pressure of traditional 

endodontics? Pulpotomy as a technique has three 

outstanding qualities that cause it to outshine other competing 

techniques: it is quick, easy to do and low in cost. 

In this economy, money talks the loudest. If an insurer, 

government bureaucrat or out-of-pocket patient can have 

a tooth treated for significantly less money (pulpotomy) 

than traditional endo (more cost), guess which technique 

will be approved and which will be rejected? 

WHAT CAN WE DO? 

More clinical research must be done, and it will probably 

be the general dentists who will do it. Different pulpotomy 

techniques should be documented and followed for years, 

as longevity of the treatment is the most important issue. 

The dental societies, journal editors and dental school 

alumni must encourage this effort. Dental journal editors, 

especially, must seek out broad-minded reviewers/ 

referees for endo-pulpotomy articles, not just dump them 

for review to a biased specialist. Dental school alumni 

should pressure their school’s endodontic departments to 

do more pulpotomy research and publish unbiased results. 

Dental society leaders must also be encouraged to support 

pulpotomy research. 

In our practices, we should do more pulpotomies in cases 

where our patients would otherwise have the tooth extracted 

due to economic considerations. This is becoming 

easier to do because fewer patients can afford the 

alternative of traditional endo. Inform the patient of 

the options, negatives and benefits of this treatment. 

Many will leap at the chance to save their teeth without 

We should do more pulpotomies 

in cases where our patients would 

otherwise have the tooth extracted 

due to economic considerations. 


expensive endodontics. If the pulpotomy fails, there is 

no net loss because the tooth would already have been 

extracted. Retreatment is easy and usually effective. Price 

adult pulpotomies at reasonable levels so more people 

will choose them. Keep track of your cases and publish 

results when you can. I find that formocresol pulpotomies 

deliver excellent results and present no ethical problems 

if the patient is fully informed of the advantages and disadvantages. 

It is important that their cases be followed. 

Try it. The time is right. 

SUMMARY 

As the new economic realities continue to mold our 

healthcare system, traditional endodontic treatment is 

becoming the treatment of choice for only the rich and 

well-insured. The average patient, with limited financial 

resources, needs a way of preserving their cariously exposed 

adult teeth, and adult pulpotomies are the answer. 

A pulpotomy can preserve the tooth, eliminate pain and 

infection, and be done quickly, inexpensively and with 

minimal effort. It can save teeth, and new research demonstrates 

that it can be as effective as traditional endodontics. 

This service should be offered to our patients. It 

is the ethical thing to do. CM 

Author’s note: With the exception of cropping (trimming), all images have not 

been digitally or otherwise edited or embellished by the author. 

Dr. Ellis Neiburger is a general practitioner in Waukegan, Ill. Contact him at 

847-244-0292 or eneiburger@comcast.net. 

REFERENCES 

13. Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth 

with cariously exposed pulp: a systematic review. J Endod. 2011 

May;37(5):581–7. Epub 2011 Mar 5. 

14. Bjorndal L, et al. Treatment of deep caries lesions in adults: randomized 

clinical trials comparing stepwise vs direct complete excavation, 

and direct pulp capping vs partial pulpotomy. Eur J Oral Science. 2010 

Jun;118(3):290–7. 

15. Eghbal MJ, Asgary S, Baglue RA, Parirokh M, Ghoddusi J. MTA 

pulpotomy of human permanent molars with irreversible pulpitis. Aust 

Endod J. 2009 Apr;35(1):4–8. 

16. Caliskan MK. Pulpotomy of carious vital teeth with periapical involvement. 

Int Endod J. 1995 May;28(3)172–6. 

17. Balto K. How common is tooth pain after root canal treatment? Evid 

Based Dent. 2010;11(4);114. 

18. Karabucak B, Setzer F. Criteria for the ideal treatment option for failed 

endodontics: surgical or nonsurgical? Compend Cont Educ Dent. 

2007 Jun;28(6):304–10. 

19. Friedman S, Mor C. The success of endodontic therapy: healing and 

functionality. Oral Health. 2005 May:25–41. 

20. DeRosa TA. A retrospective evaluation of pulpotomy as an alternative 

to extraction. Gen Dent. 2006 Jan-Feb;54(1):37–40. 

21. Witherspoon DE, Small JC, Harris GZ. Mineral trioxide aggregate pulpotomies. 

J Am Dent Assoc. 2006 May;137(5):610–8. 

22. Barrieshi-Nusair KM, Qudeimat MA. A prospective clinical study of 

mineral trioxide aggregate for partial pulpotomy in cariously exposed 

permanent teeth. J Endod. 2006 Aug;32(8):731–5. Epub 2006 Jun 23. 

23. Noorollahian H. Comparison of mineral trioxide aggregate and formocresol 

as pulp medicaments for pulpotomies in primary molars. Br Dent 

J. 2008 Jun 14;204(11):E20. Epub 2008 Apr 18. 

24. Honegger D, Holz J, Baume LJ. Long-term clinical supervision of 

direct pulp capping (performed by the students of the School of 

Dentistry, Geneva). SSO Schweiz Monatsschr Zahnheilkd. 1979 Oct; 

89(10):1020–41. 

25. Ward J. Vital pulp therapy in cariously exposed permanent teeth and its 

limitations. Aust Endod J. 2002 Apr;28(1):29–37. 

26. Weine F. Endodontic Therapy. 5th ed. St Louis: Mosby,1996:722–49. 

27. Zias J, Numeroff K. Ancient dentistry in the Eastern Mediterranean: a 

brief review. J Israel Exploration. 1986;36:65–7. 

28. Arzt A. Anti Sargenti research is flawed. J Am Endo Soc. 2011 

Summer;124:4. 

Copyright © 2011 by E. Neiburger. 

1. Seltzer S. Endodontology. 2nd ed. Philadelphia, Pa: Lea & Febiger, 1988: 

249–382. 

2. Torabinejad M, Walter R. Endodontics. 4th ed. St. Louis: Saunders, 2009: 

224–87. 

3. Ingle J, Bakland L. Endodontics. 4th ed. Philadelphia, Pa: Lea & Febiger, 

1994:26–30,224–9. 

4. Qudeimat M, Barrieshi-Nusair KM, Owais Al. Calcium hydroxide vs mineral 

trioxide aggregates for partial pulpotomy of permanent molars with deep 

caries. Eur Arch Paediatr Dent. 2007 Jun;8(2):99–104. 

5. Cohen BI, Pagnillo MK, Musikant BL, Deutsch AS. Formaldehyde evaluation 

from endodontic materials. Oral Health. 1998 Dec;88(12):37–9. 

6. Asgary S, Ehsani S. Permanent molar pulpotomy with a new endodontic 

cement: A case series. J Conserv Dent. 2009 Jan;12(1):31–6. 

7. American Dental Association, Council on Dental Therapeutics. The use of root 

canal filling materials containing paraformaldehyde. 1986. 

8. Nasseh A. The evolution of endodontics. Inside Dentistry. 2011 Jun;7(6):88–9. 

9. Hugh CL, Walton RE, Facer SR. Evaluation of intracanal sealer distribution 

with 5 different obturation techniques. Quintessence Int. 2005 Oct;36(9): 

721–9. 

10. Lin LM, Rosenberg PA, Lin J. Do procedural errors cause endodontic treatment 

failure? J Am Dent Assoc. 2005 Feb;136(2):187–93. 

11. Hollanda AC, Estrela CR, Decurcio Dde A, Silva JA, Estrela C. Sealing ability 

of three commercial resin-based endodontic sealers. Gen Dent. 2009 July- 

Aug;57(4):368–73. 

12. Asgary S, Eghbal MJ. A clinical study of pulpotomy vs root canal treatment 

of mature molars. J Dent Res. 2010 Oct;89(10):1080–5. Epub 2010 Jun 18. 



Elliot Mechanic, DDS 

in praise 

of 

electric 

Handpieces 

Dental manufacturers 

have 

provided the 

profession with 

“smart” technologies, 

making 

the daily delivery 

of dentistry 

much easier and 

more efficient. 

Dental technologies, techniques and 

materials allow us to achieve results 

that were considered unachievable just 

several years ago. The public’s appreciation 

for dentistry and its presence 

in the media is at an all-time high. 

Whereas dentists used to be associated 

with pain, held in fear and regarded as 

“drillers, fillers and billers,” today they 

are recognized not only as healers, but 

as artists. We have come a long way! 

Dental manufacturers have provided 

the profession with “smart” technologies, 

making the daily delivery of 

dentistry much easier and more efficient. 

Auto-mix materials, advances in 

adhesives, and computer and imaging 

technologies have revolutionized the 

profession. However, there has been 

little change to the piece of dental 

equipment that patients fear most: the 

“drill.” The handpiece is the most frequently 

used tool in the dental office, 

as it performs intraorally for tooth 

preparation and oral surgery, as well 

as extraorally for polishing and adjustments. 

Over the past several years, the 

use of electric handpieces in North 

America has been growing, and various 

manufacturers offer electric units. 

Although marked as a “new” technology, 

the use of electric handpieces is 

not new at all, as they have been used 

worldwide for many years. Dentists in 

many countries have long practiced in 

small single-room operatories in older 

buildings where air lines cannot be 

brought from a central compressor to 

a dental unit have been dependent on 

electrically powered units. 


Figure 1: Electric handpiece units 

Figure 4: Subsequent depth cuts 

Figure 2: Occlusal reduction with Great White 

Ultra carbide (GWU 856-018) 

Figure 5: Joining the depth cuts 

Figure 3: Initial depth cut 

Electric handpieces ... 

provide a greater 

concentricity of the 

rotating bur during 

tooth preparation, 

causing less “wobble” 

than air-driven units. 

Electric handpiece technology sits 

somewhere between the conventional 

air-driven high- and low-speed, as it 

generates up to 200,000 rpm of rotation, 

which is far less than the 400,000- 

plus rpm of air-driven units. However, 

they are far more efficient, as they 

have more than three times the cutting 

power (60 W vs. less than 20 W). 

The electric handpiece will not slow 

down, stall or stop when the bur is applied 

to tooth structure or restorative 

materials. It cuts continually with constant 

torque. Electric handpieces also 

provide a greater concentricity of the 

rotating bur during tooth preparation, 

causing less “wobble” than air-driven 

units. This creates more precise margins, 

less heat buildup and less bur 

chatter, resulting in a more defined 

and cleaner cut. They also don’t create 

the high-pitched whining sound that 

makes patients cringe in fear, which is 

a huge psychological bonus. 

In my operatories, both high-speed 

and slow-speed tasks have been 

assumed by electric motors. In fact, 

we use two units to eliminate the 

need for changing handpiece heads 

and settings (Fig. 1). However, one 

handpiece and controls can easily 

serve as both a high-speed and lowspeed. 

The electric handpiece has 

become an indispensable tool for 

crown preparation. 

Crown Preparation 

We begin our initial reduction using a 

Great White Ultra carbide #856-018 (SS 

White Burs; Lakewood, N.J.) in order 

to reduce 1.5 to 2 mm from the occlusal 

surface of the tooth (Fig. 2). 

This makes the subsequent axial reduction 

easier, as there is less surface 

area to reduce. Depth cuts are 

then placed (Figs. 3, 4) and are joined 

(Fig. 5), creating a consistent axial reduction 

of 1 mm. The Great White burs 

are large and cut very efficiently due 

to their dentated form. Conventional 

diamond instruments clog during bulk 

reduction in crown preparation, as 

their diamond particles clog with debris 

from the cut tooth and restorative 

material. Ninety percent of the crown 

preparation is accomplished with this 

one carbide. For the final finish, we 

switch to a KUT 3139 Coarse diamond 

(Dental Film Club; Montreal, Canada) 

(Fig. 6) to refine the axial walls and 

In Praise of Electric Handpieces53

a KUT 3833 Coarse diamond (Dental 

Film Club) to shape the occlusal surface 

(Fig. 7). We then complete the 

final preparation, switching to fine 

diamonds and polishers. 

1. Removing old porcelain 

to metal crowns 

Many of our daily dental procedures 

involve removing older crowns that 

need replacement. Air-driven handpieces 

are very inefficient for this 

task, as the porcelain and underlying 

metal of the crowns are difficult 

to cut, which creates heat and causes 

the bur to stall. These procedures are 

very hard on the air turbines, causing 

them to wear prematurely and 

necessitating expensive replacement. 

Electric handpieces make removal of 

existing crowns a snap. We first create 

a groove in the porcelain using a KUT 

2135 Coarse diamond (Dental Film 

Club) (Fig. 8), which is ideal for grooving 

porcelain and zirconium. Once the 

underlying metal is exposed, we permeate 

it with a #557 carbide (SS White 

Burs) (Fig. 9), and pry the crown off 

with an EB134 hand instrument (Brasseler 

USA; Savannah, Ga.) (Fig. 10). 

This procedure becomes fast and 

efficient with an electric handpiece. 

2. Use as a slow-speed 

I used to continuously fight and be 

frustrated by my air-driven slowspeed. 

It would stall, making shaping 

and adjusting acrylic and metal very 

aggravating. 

Electric handpieces never stop. Problem 

resolved (Fig. 11). 

New technologies and techniques 

serve to make the practice of dentistry 

better, faster and easier. Although electric 

handpieces may be considered to 

be expensive by some dentists, their 

benefits in time and efficiency are well 

worth the investment. CM 

Dr. Elliot Mechanic practices esthetic dentistry in 

Montreal, Quebec. He is Oral Health’s editorial 

board member for esthetics. 

Reprinted with permission of Oral Health Journal, 

Copyright © July 2009, Oral Health Journal. 

Electric handpieces 

make removal of 

existing crowns a snap. 

Figure 6: Refining the axial walls with a KUT 

3139 Coarse diamond 

Figure 7: Final occlusal shaping with a KUT 

3833 Coarse diamond 

Figure 8: Creating a groove in the porcelain 

using a KUT 2135 Coarse diamond 

Figure 9: Permeating with a #557 carbide 

(SS White) 

Figure 10: Prying the crown off with an EB134 

hand instrument (Brasseler USA) 

Figure 11: Electric handpieces never stop 

(Bien-Air USA; Irvine, Calif.). Problem resolved. 


THE REMAKE DEBATE 

– ARTICLE by Maribeth Marsico, Senior Editor at LMT Communications 

Mention “remakes” in a room full of laboratory owners and you know you’re in for a spirited discussion. 

It’s no wonder: not only do these cases-gone-wrong cut into your profits, but they can wreak havoc with 

your production schedule and erode the relationships you’ve built with your clients. 

Add to that the frustration expressed 

by technicians who feel the bulk of remakes 

are beyond their control; in fact, 

Lab Management Today (LMT) survey 

participants say more than three-quarters 

of remakes in their laboratories 

are due to dentist error. These laboratory 

owners and managers repeatedly 

say that — across all departments — 

most remakes can be traced back to 

an inadequate impression. 

Of course, the quality of the final 

impression is dependent on a number 

of variables, but what’s equally important 

is how cooperative the doctor is 

when problems are brought to his attention. 

While most of LMT’s survey 

respondents say dentists appreciate 

a call about inadequate impressions, 

they are divided on the most common 

outcome: 41 percent say the dentist 

generally sends a new impression and 

another 41 percent are usually told to 

“do the best they can.” 

To drive the point home and document 

potential problems, many laboratory 

owners are taking advantage of digital 

communication, saying a picture is 

worth a thousand words. “Providing 

dentists with photos of inadequate 

impressions enhances communication 

and eliminates the blame game,” says 

Jessica Birrell, CDT, Owner, Capture 

Dental Arts, Saratoga Springs, Utah, 

who annotates digital photos with 

captions and arrows using Photoshop 

software and e-mails them to the 

dentist. “Sometimes, I’ll also pour a 

stone model and send photos of that 


to point out specific problems. If the 

doctor still wants me to go ahead and 

guess at margin placement, I let him 

know I cannot guarantee the success 

of the case.” 

CASES GONE WRONG: WHO’S AT FAULT? 

LMT survey participants say that more than three-quarters of the remakes 

in their laboratories are due to dentists’ errors, usually inadequate impressions. 

NO ONE-SIZE-FITS-ALL POLICY 

More than half of all laboratories don’t 

have a defined remake policy, saying 

that it depends on the specific case 

and sometimes on the specific dentistclient. 

“When a case is returned, we 

have to determine the reason and handle 

it accordingly,” says Ross Gaiteri, 

Owner, Benchmark Castings Inc., Columbus, 

Ohio. “If the lab is at fault, 

there’s no charge. If the fault clearly 

rests with the dentist, we charge 50 

percent. However, if the dentist is 

repeatedly at fault for remakes — or 

we’re told to proceed when we call 

with concerns about his impression or 

model — we charge him full price.” 

In an effort to eliminate the blame 

game altogether, 17 percent of participants 

routinely split the cost of remakes 

and one quarter of them don’t 

charge at all for remakes, at least 

until a certain remake percentage is 

exceeded. (See next page for a closer 

look at participants’ remake policies.) 

22% 

of remakes are 

due to lab error 

SOURCE: LMT Research Dept. ©2011 

78% 

of remakes are 

due to dentist error 

AVERAGE REMAKE FACTOR: 2.5% 

Survey participants’ overall average remake factor is 2.5%. 

Here’s a look at average remake percentages by department: 

C&B: 2.4% Dentures: 2.8% Implants: 2.2% 

Partials: 2.9% Ortho: 2.8% 


To charge or not to charge is an issue 

that often divides laboratory owners. 

Some say laboratories shouldn’t routinely 

accept blame for cases that fail 

through no fault of their own. “If you 

don’t enforce a remake charge, it gives 

the dentist the impression that he can 

send you an inadequate impression 

or preparation at no risk to himself 

and, therefore, there’s no incentive to 

do a better prep or impression,” says 

Marc Posen, CDT, Owner, Posen Dental 

Laboratory, Birmingham, Mich. 

On the other side are laboratory own- 

ers who perceive free remakes as one 

of the value-added benefits they offer 

their customers. In most cases, they 

say, the cost of doing the remake is 

negligible given the value of a good 

account. “I have only a few clients and 

very low remakes, so my philosophy is 

that doing the remakes at no charge is 

part of the service I’m offering them,” 

says Paul Francoeur, Owner, Rogue 

Dental Solutions Inc., Ormond Beach, 

Fla. “When we do have that rare problem 

with a case, we communicate and 

work together to solve it, and they 

appreciate that I will take care of 

remaking it.” Of course, this approach 

requires laboratories to carefully monitor 

clients’ remake percentages and 

immediately address any issues. 

The bottom line: whether you have a 

defined policy or not, keeping an eye 

on your clients’ individual remake factors 

and having honest conversations 

with them when things go awry is 

your best bet. “We know our mistakes 

cost dentists chairtime, just as their 

mistakes cost us labor, materials and 

transportation costs. But we’re making 

a custom product for sometimes chal- 

The Remake Debate57

lenging, difficult patients, and the 

partnership requires both parties to 

be reasonable in their expectations,” 

says Jim Thacker, Vice President, Utah 

Valley Dental Lab, Provo, Utah. “A 

flexible, relationship-driven approach 

builds trust and value for both the 

laboratory and dentist.” CM 

We’re making a custom product for sometimes challenging, 

difficult patients, and the partnership requires both parties 

to be reasonable in their expectations. 

– Jim Thacker 

Utah Valley Dental Lab, Provo, Utah 

Maribeth Marsico is the Senior Editor at LMT magazine, where she has been covering the dental laboratory industry for more than 20 years. 

For more information, visit www.lmtmag.com. 

Reprinted with permission from LMT, March 2011, ©2011. 

A LOOK AT LABORATORY 

REMAKE POLICIES 

More than half of the laboratory owners 

and managers participating in LMT’s 

Remake Survey say they don’t have a 

defined remake policy. Here’s a closer 

look at how respondents handle those 

cases gone wrong: 

51 % 

Say it depends on the situation 

with the individual case 

20 % 

Offer remakes at no fee 

17 % 

Split the cost of remakes with 

dentists 

2/3 

of 

THE IMPACT OF NEW TECHNOLOGY 

Is the proliferation of digital technology 

having an impact on the industry’s 

remake factor? One effect is clear: 

two-thirds of laboratories that receive 

digital impressions say they result in 

fewer remakes than do conventional 

impressions. “The software for these 

systems tends to ‘force’ dentists to provide 

accurate reduction, enabling us 

to fabricate more ideal restorations,” 

says Jim Thacker, Vice President, Utah 

Valley Dental Lab, Provo, Utah. “Models 

created from digital impression 

laboratory owners say digital 

impressions result in fewer remakes 

technology are extremely accurate 

and allow us to create more consistent, 

predictable restorations for our 

dentists.” Milling, too, has had a positive 

effect, although to a lesser extent. 

While the majority of participants — 

67 percent — say it hasn’t changed 

their overall remake percentage one 

way or another, one quarter of laboratories 

say milling has caused their 

overall C&B remake percentage to 

decrease due to more accurate fits. 

LMT ASKED: WHEN YOU REQUEST A NEW IMPRESSION, 

HOW OFTEN DO YOU GET ONE? 

7 % 

Say it depends on the individual 

client 

5 % 

Offer remakes at no fee until 

the dentist exceeds a certain 

remake percentage 


44% Often 

27% Always 

25% Sometimes 

3% Almost Never 



Editor’s Note: Parke, Davis & Company, once the world’s largest pharmaceutical company, is credited with building the first modern pharmaceutical 

laboratory and developing the first systematic methods of performing clinical trials of new medications. One of the company’s products 

was a pure form of adrenaline, which emerged on the scene circa 1900 and was trademarked as “Adrenalin.” Because of the similarity of this 

name to “adrenaline,” the use of the alternative name “epinephrine” for generics was mandated in the U.S. and is used to this day. 

W 

ith 

a name like Adrenalin, it’s got to be good! Wait a minute, it’s a hemostatic 

and a cardiac stimulant? 1:1000? Is that all you’ve got? And it works for 

“spongy gums” and “other forms of capillary oozing”? Say no more! Except that 

it also works well as a heart tonic in “cases of collapse from chloroform or ether.”

Digital Impressions for an 

Immediate Denture 


Dean H. Saiki, DDS 

The following case illustrates 

how digital impressions are not 

only superior to conventional 

impressions, but in some 

instances necessary. 

A 60-year-old male presented with 

severe periodontal disease, tooth loss, 

hyper-eruption and a collapsed bite 

(Fig. 1). The patient had both posterior 

and anterior stops; however, due to 

the extreme mobility of so many of 

the teeth in occlusion, an accurate 

bite with traditional bite registration 

material would have been difficult at 

best. Traditional immediate dentures 

require accurate models mounted in 

proper vertical dimension. Sometimes 

the placement of bite registration 

material in the presence of tooth 

mobility makes it difficult to check if 

the patient is biting correctly. There 

was also a high risk in this case that 

many of the patient’s remaining teeth 

would be inadvertently extracted when 

removing a conventional impression. 

Figure 1: The patient presented with severe periodontal disease, 

tooth loss, hyper-eruption and a collapsed bite. 


One of the fears that kept the patient 

from seeing the dentist over the years 

was the “trapped” feeling of having an 

impression taken. 

Based on my experience with digital 

dentistry, I felt it would enable me to 

provide the perfect solution for this 

patient. By using the IOS FastScan ® 

Digital Impression System (IOS 

Technologies; San Diego, Calif.), I was 

able to save the patient the trauma 

of having a conventional impression 

taken, while reducing the inherent 

inaccuracy of this method and the risk 

of inadvertent extraction. 

Figure 2: Digital scan of the patient’s upper and lower arches 

(labial view) 

After scanning both arches and the 

palate, the scans were used to build 

the digital models and a bite scan 

was used to articulate the two models 

into occlusion (Figs. 2–4). The digital 

models were then uploaded to Glidewell 

Laboratories. 

One of the fears that 

kept the patient from 

seeing the dentist 

over the years 

was the “trapped” 

feeling of having an 

impression taken. 

Figure 3: Digital scan of palate (occlusal view) 

Figure 4: Digital scan of mandibular arch (occlusal view) 

Digital Impressions for an Immediate Denture61

Once the digital files were received 

at Glidewell Laboratories, a physical 

model was created using an Objet ® 

3-D printer (Objet Geometries Ltd.; 

Billerica, Mass.) (Fig. 5). The physical 

models were then sent to Glidewell’s 

Removables department, where an immediate 

denture was fabricated. 

The denture was then sent back to my 

office. I was impressed with the fit and 

occlusion of the immediate denture, 

which needed no adjustments (Fig. 6). 

No adjustments were needed due to 

the degree of exactness with which 

we were able to capture the bite. 

By using the IOS FastScan, I was 

able to complete an impression 

without any material in the way, no 

overclosure and no risk of premature 

extraction. CM 

Figure 5: Objet 3-D dental model 

Dr. Dean Saiki is in private practice in North County 

San Diego, Calif., specializing in cosmetic, laser, 

implant and digital dentistry. Contact him at 

dentist@deansaiki.com or 760-732-3456. 

Figure 6: Finished immediate denture in place in patient’s mouth 


Congratulations, Chairside ® PHOT 

A 

Hunt Winners! 

For each installment of the 

Chairside Photo Hunt, we 

have to dig pretty deep to 

keep everyone from finding 

every difference. This 

time, the most challenging 

to find were the ones 

on the lab cart against the 

textured concrete wall. The 

ones circled in green below 

tripped up the most people, 

separating the truly great 

from the merely excellent. I 

am tempted to check and 

see if the dentists who show 

the most attention to detail 

in this contest also send 

us the most accurate and 

detailed impressions! 

• First-place winners: 

23 dentists found all 21 

differences and will receive 

$500 in lab credit each. 

B 

• Second-place winners: 

30 dentists found 20 differences 

and will receive 


• Third-place winners: 

58 dentists found 19 differences 

and will receive 


Not sure what to use your 

lab credit for? Why not 

help your bruxing and 

clenching patients take a 

proactive step in protecting 

their existing healthy 

teeth by ordering a Comfort 

H/S Hard Soft Bite Splint 

or two? When you do, I 

think you will see why this 

clear custom splint is the 

most widely prescribed bite 

splint available, due to its 

comfort and fit. 

Chairside Photo Hunt Contest entries were individually 

scored after being sent to the lab via 

e-mail and standard mail. Prizewinners were 

notified by standard mail and/or phone. In total, 

111 prizes were awarded. 

Contest Results63

The Chairside® PHOT Hunt 

Once again, we’ve added clutter 

to the shot to give ourselves more 

hiding places! Here you see one of 

our technicians working at a CAD 

station. Thanks to IPS e.max ® and 

BruxZir ® Solid Zirconia, digital restorative 

dentistry continues to grow 

exponentially at our lab. 

A 

How many differences between the 

two pictures can you find? Circle 

the differences on version B below. 

Then, write down how many differences 

you found, tear out this page 

and send it to: 

Glidewell Laboratories 

Attn: Chairside magazine 

4141 MacArthur Blvd. 

Newport Beach, CA 92660 

Or scan your entry and e-mail it to 

chairside@glidewelldental.com 

Due to legibility issues, faxed entries 

will not be accepted. One 

entry per office. Participation grants 

Chairside magazine permission to 

print your name in a future issue or 

on its website. 

The winner of the Vol. 7, Issue 1, 

Chairside Photo Hunt Contest will 

receive $500 in Glidewell credit 

or a $500 credit toward his or her 

account. The second- and thirdplace 

winners will each receive 

$100 in Glidewell credit or a $100 

credit toward their account. 

B 

Entries must be received by 

April 6, 2012. The results will be 

announced in the spring issue of 

Chairside magazine. 

______________________________ 

Name 

____________________________ 

City, State of Practice 

____________________________ 

Phone 

Total Found:________

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