Ask five dentists which cement they prefer for crowns and bridges, and you’ll likely receive five different responses. Some favor resin cements, while others prefer glass ionomers. Ultimately, the “best” cement depends on the material being used, the retention provided by the preparation, and your personal preferences regarding cleanup and working time.

That said, a few types of cement consistently deliver reliable results, while others are better suited for specific situations.

Key Considerations for Crown and Bridge Cement

Most dentists prioritize the same essential qualities:

• A strong, dependable bond

• Easy cleanup (no one enjoys chasing excess material with a scaler)

• Low sensitivity after application

• Compatibility with newer materials like zirconia or lithium disilicate

Recommended Options for Most Situations:

Resin-Modified Glass Ionomer (RMGI)

This cement is a favorite among many dentists. It bonds effectively to tooth structure, releases fluoride, and provides sufficient strength for most zirconia or metal-based crowns.

Dentist favorite: FujiCEM 2 — easy to dispense, sets reliably, and cleanup is straightforward if addressed promptly.

Self-Adhesive Resin Cement

For materials with less natural retention, such as short preparations or all-ceramic crowns, resin cement offers a stronger bond. These cements work well with E.max, zirconia, and CAD/CAM crowns.

Reliable option: RelyX Unicem 2 — eliminates the need for separate etching or bonding steps, saving time and minimizing post-operative complications.

Temporary Cement

When using provisional crowns or when you need to remove a crown later, temporary cement is the best choice. Opt for a non-eugenol formula if you plan to bond permanently soon after.

Go-to: Temp Bond NE — provides a secure hold but removes cleanly when necessary. 

Final Thoughts

In a busy practice, you don’t need a dozen different cements on hand. Most dentists can effectively manage their needs with just three: a reliable RMGI, a solid resin cement, and a temporary cement that won’t cause issues later.

At Sky Dental Supply, we offer trusted brands like 3M, GC, and Kerr, along with some surprising options that excel in both price and performance.

Explore our complete selection of dental cements and find what truly works for you, rather than just what’s currently popular. 

When you’re adjusting wires, placing brackets, or working in a tight oral space, the last thing you want to deal with is a loss of grip. For orthodontists, gloves aren’t just about protection—they’re tools that directly impact how efficiently and precisely you work. That’s why more ortho professionals are paying attention not just to the type of glove material they use, but to the texture.

So, what’s the difference between textured and smooth nitrile gloves, and which is better suited for orthodontic procedures?

The Basics: What Sets Them Apart

Both textured and smooth nitrile gloves are made from the same latex-free synthetic rubber. The key difference comes down to surface feel and grip.

• Textured nitrile gloves typically feature micro-roughened fingertips or palm surfaces. This helps create friction, improving your grip on instruments even in wet or slippery conditions.

• Smooth nitrile gloves offer a clean, soft finish. They’re comfortable, flexible, and great for general use, but don’t provide the same level of tactile grip.Why Texture Matters in Orthodontics

Orthodontic procedures demand small, repeated movements using precision tools. Bracket placement, wire changes, and ligature adjustments all involve fine motor control. If you’ve ever dropped a bracket tweezer or had difficulty holding onto a slick wire, you already know the issue: lack of grip.

This is where textured gloves make a noticeable difference. They allow for better control without needing to over-tighten your hand or readjust frequently. For busy ortho offices, that can mean faster patient turnover and less hand fatigue.

When to Choose Textured Over Smooth

Textured nitrile gloves are ideal for:

• Wire bending or trimming

• Bracket bonding and placement

• Procedures requiring moisture control or suction
  
  

Smooth nitrile gloves might work better for:

• Routine consults or exams

• Low-intensity tasks where maximum grip isn’t necessary

• Orthodontic assistants with grip-sensitive skin or comfort preferences
  
  

Some practices even stock both types, using textured gloves chairside and smooth gloves for admin tasks or light clinical use.

What to Look for in a Glove Supplier

Not all gloves are created equal. In orthodontics, consistency matters. Look for:

• Reliable sizing (especially small and medium for detailed handwork)

• Consistent texture and quality across batches

• Latex-free and powder-free to minimize allergic reactions

• Strong resistance to punctures without sacrificing feel

• Our Recommendation

At Sky Dental Supply, we offer a range of nitrile gloves designed specifically for dental professionals—including textured options that are a favorite among orthodontists. NewTech Gloves strike a balance between grip and comfort, making them a top choice for daily ortho procedures.

If you’re still using smooth gloves and finding yourself frustrated mid-procedure, it might be worth trying out a textured alternative. The difference is subtle—but once you feel it, it’s hard to go back.

Explore our full line of nitrile gloves to find the right fit for your ortho team.

Ultrasonic scalers are either ‘magnetostrictive’, where energy is converted to elliptical strokes in the unit's metal rod, or ‘piezoelectric’, where strokes go in a linear pattern, back and forth, regulated by crystals in the ceramic handpiece. These both work well in calculus and stain removal, and they both have a variety of inserts for things like heavy deposits or root planing.

We stock every variety of descalers here at Sky Dental, and we invite you to browse and ask questions.

But let’s talk about the two kinds of ultrasonics. Which is better?

Magnetoscriptive tips, which are pretty convenient for you at chairside (easy to work with and handily interchangable among manufacturers), are a little buzzy and uncomfortable for some patients, particularly if you use the distal end of the tip, which really rotates. Useful as those tips can be, especially for digging at heavy deposits, they sometimes make patients complain. Metal stacks on magnetoscriptive inserts, which can bend, can make vibration even worse. By comparison, piezo tips are more fiddly for you to change out, but they’re gentler on your patient. You only use the sides of this kind of tip, and it doesn’t whirl like an Evinrude propeller. The clinical effect is about like that of a Gracey curette. The handpiece is wide, too, which makes it easier for you to work with.

But there are other concerns with the two types. Magnetostrictive handpieces are not always safe for patients with old-style, unshielded pacemakers, importantly. Piezo ones are pacemaker-safe. Piezo ones also use less water to control heat, a conceivable safety factor for patients who may have trouble breathing. Why use the magnetostrictive scalers at all? Because they’re faster. By a lot.

Informal literature suggests that patient preference is split evenly between the two types of ultrasonics. Most dental practices use only the magneto kind; a minority use both. Only a few use the piezos alone, though the number is growing. The price differential between the two is not very big, if one shops carefully. Surveyed hygienists, confusingly, strongly prefer the results they get with magnetostrictives, but also believe that piezoelectrics, because they’re gentle and seem modern and advanced to patients, are the way of the future.

Recent investigation of patient preference is turning up surprises, however. A careful study [1] in Japanese patients undergoing supragingival scaling with both instruments, evaluating discomfort, pain, sound, vibration, hyperesthesia, and treatment time, showed amelioration of complaints in 74%, 65%, 80%, 67%, 57% and 53% of subjects in magnetostrictive treatment, respectively. Patients preferred the old-fashioned way, in other words.

[1] Ikeda Y, Kawada A, Tanaka D, Ikeda E, Kobayashi H, Iwata T. A comparative questionnaire study of patient complaint levels between magnetostrictive ultrasonic scaler (Cavitron^® ) and piezoelectric ultrasonic scalers. Int J Dent Hyg. 2021 Aug;19(3):273-278. doi: 10.1111/idh.12478.

Let’s do a little deep-dive.

One of the orthodontic things we supply is kits full of space-maintainer bands, for kids who lose molars early. As you know, the idea is to keep gaps open for the eruption of new molars. During this time, the concern is for good hygiene around those bands, for healthy gingiva.

We’re asked sometimes, ‘Why bands? Is there any difference in gingival health between stainless steel crowns and band and loop space maintainers?’

There’s a study about that. It’s a split-mouth randomised controlled trial of 46 children (22 female), 4 - 9 years old, who had stainless steel crowns on one side of their mandibular arches and band and loop space maintainers on the other side.[1] Split-mouth, of course, is a form of repeat measure controlling, to correct for differences in patients’ oral hygiene practices.

In this study, investigators evaluated bleeding on probing (BOP) and Loe and Silness gingival index (GI) rating in each of these patients.

Thirty-one children stayed for the whole study. At one month, both BOP and GI were significantly more favorable (p<0.05) for the crown than for the band and loop. At three and six months, however, gingival health improved in both groups, with no significant difference between them. This was ascertained by Friedman and Mann-Whitney analyses.

There was a difference in gingival health across the timeline within the groups, in other words, but no difference between the groups in the end. The answer is, you can use either method of space-maintaining.

We like keeping up to date on these studies. It means that when you ask us good questions like this one, we have the answers for you.

[1] Fathima A, Jeevanandan G. Comparative Evaluation of Gingival Health Among Children With Stainless Steel Crowns and Stainless Steel Bands: A Split-Mouth Randomized Controlled Trial. Cureus. 2024 May 16;16(5):e60473. doi: 10.7759/cureus.60473.

See Your Patients, Not Your Instruments
Designed for enhanced performance, our HD Black Line Mirror is engineered to optimize clinical outcomes by delivering superior visibility throughout any dental procedure. The Diamond Like Carbon (DLC) coating of the handle and mirror frame reduces glare up to 80%!* The durable black matte finish in combination with the superior brilliance and color of our proprietary HD Mirror glass facilitates quicker and more accurate visibility of the mouth.

Points of Performance

DIAMOND LIKE CARBON (DLC) COATING
The durable black matte coating reduces the glare by up to 80% compared to a standard metal mirror head and handle.* This helps to reduce strain and fatigue as the user does not need to adapt their viewing position due to unwanted shine.

ENHANCED CONTRAST & VISUAL ACUITY
The black color of the coating creates a distinct contrast between the instrument, the tooth and/or the surrounding tissue allowing for easy identification intraorally.*

SUPERIOR BRILLIANCE & COLOR
HD Mirror provides superior brilliance and color for quicker and more accurate visibility of the mouth. ^†

• 113% reflection factor for exceptional image clarity. ^†
• 38.5% brighter than rhodium coated mirror glass. ^†
• 50% brighter than other front surface mirror glass. ^†
  

ERGONOMIC HANDLE
The large diameter handle increases control, provides maximum comfort and reduces hand fatigue, creating an ergonomically friendly handle option.

Producing an exceptional restoration for a damaged tooth involves a series of complex, inter-related steps. When a set of restorations are completed together, such as for a smile makeover or full mouth rehabilitation, each step’s importance increases.  One mismanaged piece can turn a masterpiece into a disaster.  From planning to the final polish, the delivery of excellence rests on crucial principles.

The management of the soft tissues during procedures often gets overlooked, but it plays a significant role in the final outcome of a carefully orchestrated case. Many dental materials include a resin-based component, including adhesives, composites, and cements. Therefore, it’s essential to keep the area free of blood and saliva contamination. Acid-etching, placement of matrix bands for facial composites or core buildups, or extension of crown margins below the gingival level can cause bleeding. 

Crown and bridge techniques demand precise, clean models for final restorations with sealed margins. When blood, crevicular fluid, saliva, or tissue overlays any part of the margin, the area becomes a weak link in the case.  One study showed that 89% of impressions submitted to labs for custom restorations contained errors that could impact the fit of the final restoration. Many of these problems begin and end with incomplete management of the gingival tissue.

Whether records involve traditional physical impressions or digital scans, a dry, clear field helps ensure a beautiful, long-lasting restoration with a low failure rate.

The Two-Cord Technique

A two-cord impression technique is a tried-and-true method for capturing quality master impressions or scans for full-coverage and partial-coverage restorations. In this case, a small-diameter cord is tucked into the base of the sulcus, and a larger diameter cord is gently pressed along the level of the restorative margin. The master impression needs to duplicate the entire margin and about 0.5 mm of the tooth surface apical to the margin. Retraction aims to create a micro-space for light-bodied impression material or precise optical scanning.

A single cord may also be adequate to retract gingival-level margins in healthy tissue. This method can also be useful when placing Class V restorations or deep Class II composites. 

Alternative Solutions

Braided retraction cord is a proven technique in restorative dentistry.  When the right materials are placed with careful handling, it works exceptionally well. However, other methods and materials offer alternatives to consider in different clinical situations.  Compression caps, syringe gels, and kaolin clay all deserve a place in a well-designed clinical protocol.

Regardless of the technique you choose, consider the critical components of gingival retraction and fluid management.  Mix-and-match to create a solution for every situation:

Stop The Bleeding:

Any amount of moisture can cause a poor impression or a distorted scan. Here are three products to consider when you’re looking for ways to keep a dry gingival sulcus:

FS Hemostatic: This 15.5% ferric sulfate liquid helps stop challenging bleeding cases and doesn’t contain any epinephrine. One drop on a cotton pellet, retraction cord, or syringe dispenser creates an efficient solution.

GingiAid 25% Aluminum Chloride A buffered aluminum chloride solution, GingiAid offers another epinephrine-free method to control moisture. This product comes in two convenient sizes for economical choices.

Racegel Hemostatic Gel This kit features the benefits of aluminum chloride in a convenient, syringe-based gel that sits right where you place it. Disposable brushes help controlled placement with a gentle scrubbing action for maximum effectiveness.

Retract and Hold

Retraction cord remains a staple of good tissue management, but it’s not the only option. Retraction pastes also provide a viable alternative and work well in some cases.

Gingi-Pak® Z-Twist Weave Braided Cord offers dependable handling characteristics. It’s easy to place and stays where it belongs with minimal effort. Clinicians can choose between plain cord or versions hand-impregnated with dl epinephrine HCL or aluminum sulfate to deliver a consistent 0.5 mg of solution per linear inch of cord.

AccessFLO is a low-viscosity, flowable gingival retraction paste. It contains the active ingredients kaolin clay and aluminum chloride to help control bleeding and prevent seepage. Prefilled unit-dose tubes allow easier placement of material in the gingival margin region. It rinses away quickly and offers an atraumatic approach to tissue management.

Racelett Hemostatic Pellets These Individual 100% cotton pellets come in two sizes and epinephrine concentrations: Size #2 with 1.15 mg racemic epinephrine HCl per pellet and size #3 with 0.55 mg racemic epinephrine HCl per pellet. Dip in water to activate, place where it’s needed, and keep procedures moving.

Handle The Process

Regardless of the materials used, the instrumentation starts in the clinician’s hands. The right tools help make the process flow smoothly. Here are must-have components to have within arm’s reach:

PT-55 Cord Packer All cord packing instruments aren’t created equal. Eliminating hand fatigue can prove career-sustaining, and the PT-55 helps. The silicone grip produces a tactile feel and more comfortable handling than an all-metal body. Yet, it withstands autoclaving, chemiclaving, cold sterilizing, and ultrasonic cleaning for years.

Nordent #N222 Cord Packer If you’re looking for a classic original straight-blade design, this instrument belongs in your cassette. These unique cord packers feature 12 mm blades that easily maneuver around any tooth. The tips are thin enough to access the tightest sulcus, and you can order them in plain or serrated tips.

ROEKO Comprecap compression caps stop bleeding naturally by compression of the tissue. The anatomical form includes semicircle-shaped spaces on two opposite sides that can easily be placed on adjacent teeth.  Compression caps can be used with or without hemostatic gels or liquids.

Design Your Strategy With More Options Than Ever.

Exceptional restorative dentistry that protects the integrity of the gingiva revolves around key components, including tissue management. In some cases, epinephrine may be the right choice. In other cases, it should be avoided. Thin tissue may be damaged by the two-cord technique and benefit from lanolin clay retraction. Regardless, keeping the right supplies in your operatory reduces stress and delivers excellence.

More than 15 million root canals are completed annually in the U.S., and general dentists do nearly 11 million of them. Five million dental implants will be placed, too. Each situation requires a series of decisions to determine the best option.

While there are multiple factors to weigh, remember these three key facts in your clinical decision-making process:

• Endodontics proves successful: Studies show that endodontically-treated teeth show a 95%-97% success rate after eight years.
• Minimal follow-up is needed: A 2008 study showed that only 1.4% of root canals required additional intervention.
• Patients prefer conservative care: A 2020 survey showed that 84% of patients would choose a root canal over an extraction.

When endodontic treatment fits as the best option, the right instruments help deliver results that ensure long-term success.  Few procedures involve an array of tools as specialized as those used in endodontics.  Here are three key instruments and recommendations for each to include in your clinical flow:

Apex Locator: Debriding, shaping, cleaning, and obturating the canal system requires precise navigation to the apex. But instrumenting beyond the apex may create an inflammatory response that leads to unnecessary discomfort and after-hour calls. A state-of-the-art apex locator belongs in every set-up and enhances the precision of your treatment.

One study evaluated six different apex locators and compared the results to radiographs. 86.3% of cases showed acceptable working length determined by apex locators, and there were no significant differences between models.  The combination of x-rays and apex locators offers essential data to produce satisfactory results.

Two To Consider:

• J Morita’s Root ZX II offers the most popular apex locator worldwide. A 97.5% accuracy rate that’s not distorted by blood, suppurative discharge, or electrolytes offers unmatched accuracy you can count on. An oversized color LCD screen gives a clear, animated display with high contrast. Root ZX II also provides a lightweight, low-speed handpiece that integrates with the apex location functionality.
• I-Root Apex Locator: Meta-Biomed’s 5th generation device dual-frequency operation allows exceptional accuracy in dry or wet canals. A clean color display and audible tone operates on a long-lasting battery with auto-off functionality and includes a self-test to ensure accurate operation.

Gates Glidden Drills: Once access is established into the pulp chamber, success hinges on complete debridement and cleaning of the canals.  Gates Glidden drills open canal orifices in a way nothing else can. Coronal binding of files can lead to fracture or transportation of instrumentation in the apical third.  Good flare also helps the delivery of disinfectants and medicants into the full extent of the canal system.

A study published in 2018 showed that the occurrence of underfilling, overfilling, and ledge formation was more common among dental students who didn’t use a Gates Glidden in their workflow.  Providing direct access with coronal preparation of the canals limits the risk for any provider.

Two To Consider:

• Premier Dental makes quality dental instruments for many clinical procedures, including endodontics.  This 6-pack offers a solution for every situation with size gradients that can be used independently or in series. Shafts feature indentations that make picking up the right size easy. Plus, shafts are designed so that if they break, they separate near the top for easy retrieval.
• Essential Dental Systems line of endodontic armamentarium includes quality Gates Glidden drills in convenient 5-packs. Color-coding makes it easy to choose the right size for enlargement of the upper portion of the canal or removal of gutta percha.

Barbed Broaches: Sometimes, clinicians rush to start shaping the canals, and they inadequately debride pulp tissue.  But a barbed broach quickly removes most tissue, and that leads to faster cleaning and shaping. Plus, irrigants reach deeper, and instruments encounter less resistance and deflection during mechanization.

Two To Consider:

• Roydent Barbed Broaches set the standard for this simple, indispensable tool in a complete endodontic set-up. Their extra sharp and highly-flexible design also features a rounded tip to follow the curve of the canal. Color-coding is a simple characteristic, but it cuts eye-strain and helps make endodontics a little more efficient.
• Premier Dental Plastic Handle Barbed Broaches offer a high-quality alternative in affordable packs of 144.  Each broach features 40 spiraled barbs in highly-flexible stainless steel, and the barbs change angulation when navigating narrow canals.

Exceptional endodontic results start and end with the best clinical armamentarium. Whether establishing working length with the latest apex locator or removing hyperemic tissue with a barbed broach, choose quality products.  An uncompromised clinical setup reduces stress for the clinical team and helps you deliver long-term success for your patients. 

Choosing a Temporary Cement

Dentists regularly use various temporary restorations for procedures such as inlays, onlays, crowns, bridges, and implants. The most common cement in this category includes eugenol-based, non-eugenol based, resin-based, and glass ionomer products.

If a dentist needs maximum retention, such as for a short crown preparation, a resin-based cement may be the best choice. But some resin-based types of cement bond to composite core materials and can pull the buildup from the tooth when removing the temporary restoration. Most dentists end up keeping more than one type of provisional cementation product available for different situations. With the right strategy, you can meet a range of needs with a handful of products.

Temporary cement requires a balance of characteristics to serve the intended purpose. A clinician should find that they provide:

• Easy handling
• Excellent retention of restoration, yet not difficult to remove at the final delivery
• Ideal working and setting time
• Gentle to soft tissue and tooth pulp
• Easy clean-up
• No inhibition of the bonding of the final restoration
• Good shelf life

What Do I Choose?

Today, there are many temporary cement choices on the market, but consider these six unique products to solve various challenges that every dentist faces:

Access Automix Temporary Cement: You rely on clinical efficiency in the operatory. Multiple tubes that require hand mixing take additional time to use, and it’s harder to guarantee a consistent mix by hand. Convenient automix designs make finishing a provisional restoration quick and easy. This non-eugenol formula from Centrix won’t inhibit bonding of the final restoration. A calcium hydroxide additive prevents mold growth and discoloration of the preparation. 

NoMIX Temporary Cement: Every dentist knows the frustration of a temporary crown that falls off on a Saturday evening. This single component, moisture activated, non-eugenol temporary cement is an affordable way to reduce stress. If you have patients who are traveling, or you’re concerned about the retention of their crown or bridge, dispense one of these easy-to-use packs after their preparation appointment. Your patient can use NoMIX to recement their restoration if it displaces before final delivery. They appreciate the thoughtful gesture, and you enjoy more peace-of-mind.

SensiTemp Resin: Sometimes, you need a strong, reliable cement, but you suspect that sensitivity will plaque your patient. If a patient has complained of thermal discomfort before preparation or has a cracked tooth sensitive to chewing, SensiTemp may be a solid choice. Sultan Healthcare adds potassium nitrate to this product to help reduce post-op sensitivity. Consider using a desensitizing agent, such as HurriSeal Desensitizer first, and then cementing with SensiTemp. As a bonus, this product provides a good option for permanent (yet reversible) cementation of implant-retained crowns.

HY-Bond Polycarboxylate Cement Polycarboxylate cement arrived on the scene in 1968. As the first dental cement to exhibit chemical bonding to tooth structure, the product has been used for permanent and temporary cementation of every type of restoration. Polycarboxylate cement has lost favor in recent years. However, they still offer an excellent choice for sensitive teeth or for preparations that are close to the pulp. HY-Bond contains tannin fluoride and serves a dual purpose as an indirect pulp-capping material. The large size of the polyacrylic acid molecule helps prevent sensitivity with minimal thickness and excellent thermal insulating.

FREEGENOL Some of the first temporary cement contained zinc-oxide powder and eugenol liquid. Eugenol has a soothing effect on the pulp that helps prevent sensitivity. But one of the problems with eugenol-containing cement is that it hinders the setting process of acrylic resins.

Manufacturers created eugenol-free cement to overcome the challenges of ZOE versions. These products are slightly more rigid, hold restorations better, and clean up is easier than the original formulas. FREEGENOL is a eugenol-free option from a reputable brand used by many clinicians.

Zinroc. Multi-use products increase efficiency and help control excess inventory. Plus, a product that can be used for several purposes is less likely to expire and be thrown out. Zinroc gives clinicians three distinct uses:

• It can be used as a base under deep restorations.
• It seals root canal access openings.
• It serves as a reliable temporary cement when more retention is needed.

Patients also report less sensitivity with Zinroc compared to some types of cement. And resin reinforcement of the formula provides more wear-resistance than most temporary products.

Keep It Simple

Dentists face dozens of product choices in every category, and there isn’t just one formula that meets every clinical demand. At the same time, boxes of unused specialty products take up space and consume your supply budget. Consider adding some of the products mentioned here to simplify your temporization tasks and cover several bases with one product. 

Dental staff who perform procedures on patients find themselves at risk or exposure to many pathogens.  The highest risk develops from splatter to the face of clinicians and to the nasal region of patients. Periodontal procedures using ultrasonic and sonic instruments transmit the greatest number of droplets. Air polishing, use of the air/water syringe, and the operation of a high-speed handpiece also produce aerosols.

Although aerosols don’t present a new challenge in dentistry, COVID-19 raises recent concerns. COVID-19 can stay suspended in the air after completion of a procedure and the patient has left the office.  While there’s still a lot to learn about this virus, some of the findings suggest that the virus:

• Remains viable for up to 72 hours on plastic and stainless steel surfaces.
• Remains viable up to 24 hours on cardboard surfaces.
• Remains viable in micro-aerosols for up to three hours.

How Can Dental Practices Reduce Production of Aerosols?

Dental treatment that produces aerosols can rarely be avoided, but several key steps can be taken to control their spread. 

• Use a High Volume Evacuation (HVE) suction system with an evacuation volume of at least 300 l/min.
• Use saliva ejectors to reduce saliva volume.
• Add multi-functional devices to make procedures safer and easier.
• Consider extra-oral suction devices to capture aerosols.
• Maintain essential HVE systems at optimal capacity.

HVE is a first-line protective mechanism against the spread of aerosols. Studies have shown that HVE can decrease aerosols by up to 98%. Precise, comfortable use for patients and providers serves to protect the safety and ergonomics of everyone. Look at options to increase the effectiveness of HVE in the clinical setting.

Angle Ease Adjustable HV Tip: This innovative tip features 12 locking angle adjustment positions to meet every treatment and clinician scenario. The tips offer ideal ergonomics and comfort for operators by lowering fatigue and wrist strain. The tips adjust from a straight bayonet position to a 90° angle to reach any area of the mouth.

Saliva ejectors remove a steady volume of saliva and reduce the source of aerosol production.  Placing a Low Volume Evacuator (LVE) near the back or side of the mouth provides a steady reduction in saliva pooling.

Pink Petal attachments are an excellent addition to armamentarium during procedures. With easy attachment to a saliva ejector, they protect the cheek and help absorb moisture from the Parotid Gland through the Stensen Duct.  This tool works with almost any saliva ejector, and they’re available in packs of 50.

Combining HVE and LVE devices offer a simple way to protect against aerosol production. But devices that incorporate bite support, tongue retraction, cheek protection, and suction help make many restorative and hygiene procedures safe and effective. 

Mr. Thirsty One-Step is a cost-effective, multi-purpose device that helps meet ADA, CDC, and state guidelines to reduce aerosols during dental procedures.  Available in different sizes, most patients discover they like the comfort and assurance from these devices.

Extra-oral suction devices offer another line of defense to keep splatter and droplets from propelling into the operatory environment.  HVE and saliva ejectors help stop the formation of aerosols, but they don’t completely prevent them.  Chairside floor units protect providers and patients, and they send a visible message about safety to your patients.

DuraMax X1 Extraoral Suction System is an exceptional aerosol reduction system that features the ultimate in additional protection. With ten power levels, its four-layer filtration system includes HEPA filtration plus germicidal UV light.  A flexible tubing system can be placed in any position around the mouth during procedures. The unit also features remote control operation and wheeled portability for ultimate convenience.

HVE systems in dentistry have always been essential, but COVID-19 places more demand than ever on their operation.  Proper maintenance protocols keep them operating at the recommended peak capacities and ensure they’ll stay operational without interruption. Plus, protocols help decontaminate vacuum lines from harmful pathogens and biofilm buildup.

The Biotrol Easy 1-2-3 Atomizer is patented to deliver Vacusol Ultra or NeutraVAC solution through the vacuum system with maximum effectiveness. The device draws air and liquid simultaneously, which is how dental HVE pumps are made to function. 

Conclusion - Simple, Safe, Effective

COVID-19 will continue to produce many changes in dentistry and other aspects of healthcare.  Many of the changes will be driven by emerging research, but patient and staff expectations will also drive trends.  

Dental practices must consider the safety and expectations of the people they serve. Reducing aerosols is paramount, and engineering controls, like extraoral suction units, fit the guidance from OSHA and other regulatory bodies. While not required, patients and staff appreciate the efforts practices take to put safety first.  

Evacuation products offer maximum effectiveness at the lowest cost without major modifications to space and protocols. Find what works best for your team by trying these simple devices, many of which have been developed by real-world providers.

Dental practices should take the opportunity to educate patients about the steps they’ve taken to keep clinical spaces safe. Social media posts, blog articles, emails, and website updates about new equipment help patients learn about your office and commit to offering the best healthcare experience.

Skydentalsupply always keeps in view the needs of its customers and we focus on devising different forms of the alloys to be used in all situations for achieving the strongest restorations in posterior teeth.  Amalgam alloy fillings and restorations have an added advantage of being economical with adequate strength. Bonded alloy material has revolutionized the concept of alloys fillings. Dental resin composite fillings have been always debated by the clinicians and opponents of alloys to be conservative of tooth structure due to their ability to make a micro-mechanical bond with enamel and dentine. This added advantage of composite filling material has been now equalized by the development of bonded amlagam alloys. Now, the only superiority of composite fillings over amalgam alloys is their whitish color and esthetics which is not a greater concern for most patients in the posterior teeth, the molars where an extra chewing strength provided by the alloys is always beneficial.

Skydentalsupply offers the innovative and state of the art Alloybond kit containing the resin adhesive for amalgam bonding with the natural tooth structure makes a tight seal which helps in overcoming the major drawbacks of conventional amalgam fillings. Our latest, ingenious and cost-effective ALloybond kit  ensure decreased microleakage problems, lesser chances of caries recurrence, lesser post-operative sensitivity, enhanced fracture resistance, reduced tendency of cuspal deflection, decreased pulpal inflammation leading to greater retention, durability and long term restoration success. Bonded amalgam alloys have largely solved the compromised treatment options for cracked cusps and teeth conserving natural tooth structure. Skydentalsupply also presents the most economical Amalgam bucket, Amalagam well Miltex and Amalgam well for an opportunity to restore maximum number of decayed teeth with utmost ease and cost-effectiveness. Our prime products D650N digital amalgamator, Ultramat 2 high speed amalgamator, GS-80 Spill capsules & Permite amalgam caps will surely reduce your appointment time span with the fastest mixing, trituration and placement with Amalgam carrier DE metal increasing the overall revenue and efficiency of your staff. Skydentalsupply has the most diverse range of alloys, their mixing mechanics, the instruments needed and finally, the smooth finishing for achieving restoration longevity. 

Here is the gist: Of course infections are possible in a dentist’s office. What the risk is, is not completely known, amazingly. It is clear that more infections happen when practices grow lax in infection control measures. Again, no real surprise – but it’s nice to see it confirmed.

The 3 major transmission routes that bugs take in dental practices are direct contact, blood-to-blood contact, or transmission by water or aerosols. Your correspondent admits he was quite surprised by the water vector.

Statistically, it’s known that herpes simplex 1 and 2, norovirus, and coxsackie go by direct contact most often; on the bacterial side this is also true of Staph. aureus and E. coli.

Blood-to-blood, the risk is for Hep-V, C, and D, and for N. gonorrheae and Treponema.

By sneezing or by exposure to dental unit water, the virus risk is for cytomegalovirus, measles, mumps, rubella, and the various respiratory bugs. For bacteria, it’s Strep, TB, Legionella, and Pseudomonas.

It’s more nuanced than that, of course. MRSA, the methicillin-resistant Staph superbug, probably transmits directly and indirectly. Dental students get it on their hands and in their noses more often than non-students do, so it’s in practices for sure, though to what extent is not known. Carrying the pathogen isn’t the same as being infected, either.

There is some concern about transmission through biofilms on dental instruments, particularly the hollow kind. Data does exist for this, and the popular press took up the worry for a while recently. But there has been no real academic follow-up.

The highest-risk transmission vector is blood-to-blood. In the developed world, say the epidemiologists, where vaccination is common, that risk doesn’t appear to be very high. In the developing world, however, it’s a problem. Healthcare-related infection accounts for over half of all Hepatitis C cases in some countries.

The interesting risk load is in dental unit water and aerosols. Contamination of instrument cooling water is very possible, it turns out, from patient-side backfire or from incoming pathogens in the water lines. Water is a super place, particularly at room temperature, for the formation of biofilms. They like to bond on polymer surfaces, too, like inside hoses. Contaminated water is where we got the famous outbreak of Legionnaires disease. Studies are proliferating on this curiously overlooked source of contagion. And yes, legionellosis has been reported in at least 2 dental practices that we know of.

It’s an interesting time we live in. Expect a lot more research into disease transmission in healthcare venues. Also expect the epidemiology to grow complicated, as we age, and as the virulence of some of the current bugs increases.

Want some good advice? Keep your practice clean. 

If you’re looking for practical ways to do that, we’ve got some very good products you might have a look at. Check out https://www.skydentalsupply.com/infection-control/

Personalities vary. Some clinicians are pretty impatient with the whole concept of toys in the office. Others, possibly the ones with little kids of their own, think it’s a good idea. They put things to play with out in the waiting area, and sometimes let them come right into the operating room with their little patients.

Personality and preference aside, which is better – toys absent, or toys present? And how can you know which is ‘better?’

You’ll be glad to know, having been trained in evidence-based medicine, that there is research into this. A lot of it is recent, and it exists on a rather large scale.

The most recent study, and one of the most painstaking, is that of T. Jayakaran, et al.,¹ conducted in the Meenakshi Ammal Dental College and Hospital in Chennai, in southeast India.

Most kids don’t naturally cooperate with the dentist, notes Dr. Jayakaran, and it’s generally because they’re frightened. Addressing this, and optimizing the medical outcome, is partly a matter of the relationship between patient and practitioner, and partly a matter of environment. Kids like to be in spaces that seem like they’re for kids, his experience tells him.

So, to find out what it is that they like, he and his team put together this study. It was cross-sectional, using descriptive data, derived by survey. It surveyed boys and girls 6-10 years of age who visited the department. (Mean age was 8.1± 1.17.) Basically cooperative behaviour was one of the inclusion criteria. Numbers were crunched by the OpenEpi stats package for public health. Covariables included color of the walls, design on the walls, scent in the air, music (presence and kind), doctor gender, color of doctor’s clothes, cartoons playing, parents present, and yes – toys. These were all chosen because of their presence in existing literature. Final analysis, chi-squared and everything, was done with the same SPSS tool that the other studies used. P value was < 0.05.

The salient preferences they found were these: 

• 96% of the kids wanted music playing; when asked what kind, most said ‘rhymes’.
• 94% wanted pretty scents in the air.
• 88% wanted the doctor to explain what was happening first.
• 76% wanted cartoons on TV.
• 76% wanted cartoons on the walls.
• Most of the boys wanted male doctors; most of the girls wanted female doctors. The kids liked their doctors to be in blue or yellow uniforms, as a rule.
• 68% wanted mom or dad there.
• 82% wanted toys – and they wanted them there in the operating chair with them.

It all dovetailed perfectly with literature. It’s been known for a long time that kids like hospitals that are softened with color, generally yellows or blues. They do not like bare walls. They like seeing cartoon people they know. Is it because these things are distracting? Other research suggests no. It’s the familiarity they like, probably combined with the tacit knowledge that there are grownups in charge who trouble to do nice things for them. Nice smells? Aromatherapists have been saying for years that pulse and cortisol levels drop when the scents are right, and latterly there is research to show that in medical theaters this is true. Music? Studies conflict on this. Perhaps because musical taste can be so intensely personal, music sometimes seems in studies to be counterproductive.

As for toys, the majority was enormous. The toys’ power lay, as with the colors and the cartoons, not in their power to distract. They worked because they comforted.

The formula is clear, then. If you’ve got kids in your practice, make the walls blue or yellow, paint cartoons on them, put TV on, and yes, absolutely, if you can stand it, allow the kids to bring in toys. They’ll like it, and the research numbers do say your practice will run smoother for it.

¹ Jayakaran, T. Dent Res J (Isfahan). 207 May-Jun; 14(3): 183-187.

Lately there’s been a lot of discussion about guided bone regeneration, for alveolar ridge augmentation. The idea is to build up stable space for infiltration of osteogenic cells, and get angiogenesis underway as quickly as possible.

The choice of bone graft materials matters a lot to clinicians, though. Their choices are autogenous bone, allografts, xenografts, or alloplasts. Allografts are freeze-dried bone, sometimes demineralized. Xenografts are bovine-derived materials, sometimes de-proteinized. Alloplasts, which vary by type, are generally hydroxyapatite or they’re other calcium phosphate scaffolds. All these bone substitutes have different advantages and disadvantages, but not every operating implant dentist knows what they are currently. Fair enough, since these things change all the time.

We thought we’d offer a quick rundown from the literature, on what’s best. Almost predictably, the answer is not straightforward. Or more accurately, the answer as to what’s best finally depends on what you’re after clinically.

All evidence says that right now, autogenous bone is still the best intervention. It’s the fastest way to bone formation, far speedier than any bone substitute. The caveat is, however, that much depends on recipient conditions. Very often there needs to be supplementation with bone substitutes. Autogenous bone is not a silver bullet, in other words.

Bone substitutes, at least currently available ones, all share one limitation. As scaffolds, they do not induce osteoinductivity, at least to our knowledge. They elicit osteoconductivity.

Do they all make space the same way? That’s an important part of bone augmentation. The answer is no. Materials are made of differently-sized particles, for one thing. They have varying mechanical characteristics overall as well. Some of them are more vulnerable than others to dissolution by enzyme or chemical action.

And across the board, bone substitutes are not very biocompatible. Why? Nobody’s completely sure yet. It may have to do with irregularly arrayed collagen. There may be confounding effects from micro-particles. There may be showers of released calcium ions.

Here’s something you may have noticed. There’s an inverse relationship between bioabsorption and maintenance of volume. That’s logical, when you think about it. Why it happens is still being investigated. It seems to be a passive chemical mechanism in tandem with absorption by osteoclasts. The chemical factors that matter are water solubility and resistance to acid, which are really just functions of how the apatite structure is put together.

Is there yet a bone substitute that’s perfectly biocompatible, shows perfect bioabsorption, and maintains volume flawlessly? Of course not. You kind of have to decide whether you’re more concerned with reconstructed volume maintenance or the displacement that comes with regeneration. At the regeneration/bioabsorption end of that continuum, you want demineralized freeze-dried bone allograft. Or even better, a collagen sponge. At the volume maintenance end, opposite, it’s best to go for a synthetic hydroxyapatite, or thermally de-proteinized bovine bone, or else bovine bone that’s been chemically de-proteinized. Somewhere in the middle is the plain-old freeze-dried bone allograft, and beta-tricalcium phosphate.

There’s your answer, as far as it’s known. Have a look at what we’ve got, at Sky Dental. Drop us a note if you want to talk about it. Whatever your clinical choice, we’ll make sure you’re set up for it. 

This is very much the case in the matter of caries prevention. The two basic strategies are pit and fissure sealing and fluoride varnishing. They both work, and they’re both in wide use – but the relative effectiveness of the two is not at all clear, even after all their years in use. 

Being conscientious here at Sky Dental, as interested in your patients’ outcomes as you are, we’ve gone after the scholarship, to see at least what the data does say, to the extent that is says anything. For there have indeed been studies. Four years ago there was an enormous Cochrane database review, and more recently, at last, one properly controlled trial did emerge. 
We’re going to summarize all of that here. We thought you’d probably be interested. 

The big review study was undertaken by the Finnish Office for Health Technology Assessment.1 This was an update of earlier ones published in 2006 and 2010. Its compilers observed that, amazingly, there was as yet no systematic review in place, and even more amazingly, there was almost no real trial evidence worthy of the name. 

So they went after all the studies that treated relative effectiveness separately, or with both treatments together versus fluoride by itself. Secondarily, they tried to evaluate type of sealant material and length of follow-up. Their selection criteria, it should be noted, were aimed at children and adolescents, in occlusal surfaces in posterior permanent molars. This was because the basic topic of prevention is a longitudinal one, and also because preventive dentistry is actually a fairly recent thing in most of the world. Looking retroactively at older teeth would not make as much statistical sense. 

The authors found eight trials, four of which were new since the 2010 update, and ended up analysing the data from seven of them. 

The results? 

Sealants (these were resin-based, incidentally) appeared to prevent caries better in first permanent molars at two-year follow-up, but the data, from two pooled studies, was of low statistical quality (OR 0.69, 95% CI 0.50-0.94; p = 0.02; I(2) = 0%, n = 358). The apparent advantage was maintained at longer follow-up on one trial, but there was a high risk of selection bias in that study. Three studies examined glass ionomer sealants specifically. One was chemically cured, and two were resin-modified. Sealant again seemed to work better; the selection of sealant did not seem to matter. These studies were clinically so diverse that meta-analysis was impossible, however. Once more, it was low-quality evidence. For both treatments together, versus fluoride, there was only one study, a split-mouth trial of 92 children at two-year follow-up. There was a significant advantage to the two treatments together over single treatment. Even so, the authors judged, this single study remained statistically underpowered. The safety profiles of all these options, it should be said, were indistinguishable. No study ever reported any adverse events. 

The upshot is that, as of 2016, it still wasn’t truly possible to be sure about relative efficacy of resin-based fissure sealants and fluoride varnish. 

Along came a randomised, controlled trial the following year, from the Cardiff University School of Dentistry.2 This involved 1,015 6- and 7-year-olds with first permanent molars. The two arms were resin-based sealant and fluoride varnish, the evaluation intervals were 6-monthly, and the study concluded at 3 years. 

Only 82% of the children stayed in the trial. The proportion of kids who developed caries was lower in the fluoride group, but the difference was not statistically significant, especially adjusting for numbers of newly decayed teeth. It did seem that the overall cost to the health service would favor the fluoride treatment, this simply being cheaper to administer. Cost, in the end, may drive what Welsh dentists finally do – as it may in your own practice. 

It’s still not a closed book, in other words, as to which way of preventing caries is better. 

Whichever way you like, we have everything you need, at Sky Dental, to do either. If you’re shopping with us, you might have a look at the Aegis pit and fissure sealant kit from Keystone Industries, with amorphous calcium phosphate. It’s a light-cured system designed for slow release of calcium and phosphate ions, to help remineralize the tooth. Or see the D-Lish 5% sodium fluoride varnish microbrush from Young Dental. It’s a neat, no-mix way of delivering the highest concentration of fluoride available. The solution is translucent, so there’s no waiting around for the varnish to fade. There’s no aspartame or saccharine, and it’s even safe for patients who gluten-free. 

1. Ahovuo-Saloranta A, et al., Cochrane Database Syst Rev. 2-16 Jan 18;(1) CD003067. doi: 10.1002/14651858.CD003067.pub4.
2. Chestnutt IG, et al. Health Technol Assess. 2017 Apr;21(21):1-256. doi: 10.3310/hta21210.

But sealers aren’t all the same.

Ideally, every sealer should be easy to mix, and should adhese nicely, and should seal well, with no shrinking or staining. It shouldn’t dissolve over time, but it should be soluble enough that you can take it out easily if you need to. it should be bacteriostatic, and it should show up clearly in radiography. Above all, it should be as biocompatible as possible, so it doesn’t irritate periradicular tissue.

There is no sealer that does all these things perfectly. There are now half a dozen different types on the market, and each of them has its relative advantages and disadvantages. Some of these sealers are zinc oxide-eugenol-based, some are resin-based, or glass ionomer-based, or they’re silicone-based, or calcium hydroxide-based. The ones that aren’t these are the bioactives. (We’ve got the range of them at Sky Dental, and you can have a look.) Chemically, these sealers are built differently, so they work in different ways. That makes them difficult to compare. In the end, clinicians generally just choose the ones they like best overall.

The problem of irritation does come up a lot when our customers talk to us about how to choose. It’s not for us to tell you how to manage your patients, of course, but we do know quite a bit about the in vitro cytotoxicity studies out there, and the in vivo biocompatibility studies too. There’s been quite a lot done in this field. It’s pretty scattered, though, and the studies vary enough methodologically that easy conclusions about which sealer is kindest to tissue aren’t really possible yet.

Still, it’s worth knowing the rundown of the studies generally, on biocompatibility and the different kinds of root canal sealer.

Broadly speaking, without mentioning brand names, it seems warranted to say that in vitro toxicity is lowest in bioactives. The problem is, however, that the studies vary tremendously in parameters like setting time (ranging from an hour to a month), setting condition (freshly-mixed vs. set materials), and extract concentration. It seems that freshly-mixed and longer-setting materials are more cytotoxic, though nobody’s sure quite why. Higher concentrations, logically enough, also seem more cytotoxic, though it’s not clear how or if this translates into clinical practice.

In vivo? All sealers elicit inflammatory response. No sealer has shown itself to be unacceptable for clinical use in this respect, however. Interestingly, the severity of response – read this carefully – is, so far, independent of type. This seems surprising, on an intuitive level.

It’s worth saying that the methodology of these trials, as in the in vitro ones, is heterogeneous. Some studies assess periapical response, others assess subcutaneous response, others assess intraosseous response. Some focus on the influence of exposure time. (Inflammation seems to subside, but data actually conflict on this.) Across all the studies, whatever their focus, there is consistently high risk of bias. That’s a problem. In a number of the studies, it’s not even clear how randomized they were, or whether they were blinded properly, or even how they measured outcomes. The apparent findings of in vitro studies, to say it bluntly, have not been confirmed definitively by in vivo studies so far.

That isn’t to say that the answer isn’t forthcoming. There just isn’t enough data yet, harvested in methodologically sound ways. We’ll keep you posted on studies that compare similar conditions and concentrations, in clinical settings, or at least using human fibroblasts instead of animal ones (which is another problem). It will be a while yet, until we know – really know – which kind of root canal sealer to use if biocompatibility is your big criterion of choice.

In the meantime, if you’re shopping with us, you might have a look at a popular bioceramic sealer called BioRoot RCS, from Septodont. It’s mineral-based, for permanent canal obturation. It doesn’t stain, and there’s no post-op sensitivity. It’s easy to use, it stays leak-free for a long time, and because it’s got a high pH, it keeps the bacteria down. It’s biocompatible, in other words, and it’s even resin free. We offer it in a 35-application pack, with pipette and spoon, ready to use.