Monday, December 14, 2015

MiniComfort - “Best Brux Guard Ever Made”

Wearing Her MiniComfort
MiniComfort, a U.S. Patented product, is the outcome of a six-year research and development project by Dr. John C. Kline DDS, a practicing dentist of 40 years, who used both his practical experience and personal observations to create a different kind of bruxism appliance. MiniComfort sets a new standard for comfort and fit while protecting the teeth and decreasing symptoms. ROE is pleased to have been selected as the exclusive U.S. manufacturer of MiniComforts.

MiniComfort is a mandibular, self-seating, zero-adjustment, deprogramming device, light and flexible, that does not protrude from the lips. It can be worn day or night and will simply amaze your patients, particularly those who currently wear a traditional splint or NTI appliance. Due to its very thin design, it will not interfere with a person’s speech or appearance. 

Almost Invisible - no speech issues!
The secret to MiniComfort is two discluding elements (rigid 4-6mm therapeutic bands), which are placed just behind the canines to keep the teeth separated at a patient’s normal freeway space. The Elements deprogram by minimizing the patient’s bite force, similar to an NTI appliance, preventing the patient from fully occluding, and thereby maintaining a comfortable position. Due to this deprogramming design, wearing the appliance at night contributes to less clenching during the day. When worn during the day, the appliance is almost undetectable. As with any partial coverage appliance, it is important that the patient be instructed to wear the appliance only for a portion of the 24-hour day, at your discretion, depending on the stability of the patient’s dentition.

Dr. John Kline’s extensive research, patent trials and use of MiniComfort reveal:

• Almost 100% of participants in the study adopted use of the MiniComfort and continued to wear it because of its comfort and undetectability

• 98% of participants were pleasantly surprised with the excellent fit

• Participants were asked to wear MiniComfort during waking hours including work and social situations. Nearly all of the participants reported satisfaction with day time performance

• Participants who suffered from headaches reported a drastic reduction in the frequency and severity

• Upon examination, participants who wore MiniComfort on a daily basis had no damage to their teeth related to clenching or grinding

• A MiniComfort should last between 12 to 36 months, depending on the user’s severity of clenching and/or grinding

MiniComfort affords the dental practice a self-seating, five-minute-appointment appliance. Because the two therapeutic bands are the only points of occlusal contact, adjustment is a thing-of-the-past. Once seated, the appliance forms a hydro seal over the dentition and mucosa, providing very good retention and comfort. Auxiliary staff can manage the seating appointment.
2 Discluding Therapeutic Elements 

MiniComfort also offers two more unique advantages, an Instant Wear guarantee and a digital record for easy reorder. Due to the nature of the appliance, MiniComfort is designed to be replaced periodically. For this reason, we include a second complimentary appliance (Instant Wear guarantee). We also digitally archive each case to simplify the reorder appointment. Allowing appliance to be reordered without taking another impression, provided the patient’s dentition has not changed.

Order MiniComfort for your next patient suffering from bruxing, clenching, headaches and TMD. If for any reason you and your patient are not thrilled with the appliance, a conventional appliance will be made at no charge.

Best Bite Registration Materials

The correct bite position is clearly one of the most critical steps in restoring a case. Consequently, the bite registration protocol and choice of material are a continuous subject of discussion between our clients and us. When recording a bite for single crowns, or for bridges, there are a few crucial considerations. We recommend using rigid materials, avoiding ones that are rubbery with bounce that distort when articulated. Rigid materials provide a positive stop similar to that of natural teeth. It is equally important that bite materials not be brittle when set. This causes the bite to fall apart when trimmed, or after repeated use.  Three of our favorite materials are Futar Fast Bite - Kettenbach LP, Blu-Bite HP - Henry Schein Dental, Vanilla Bite – DenMat.

We suggest using small amounts of bite material in key areas, such as over the prepared teeth or edentulous areas, and where centric stops do not exist. Overuse of material can obscure the centric stops, making it difficult to confirm that the remaining teeth fully interdigitate. We find that clients who, after taking the bite registration, trim the bite down to an area just over the preparation and adjacent teeth, test in the mouth to confirm, experience the most consistent success with minimal occlusal adjustment.  When preparation involves the terminal tooth, or when multiple preparations exist, full arch impressions are highly recommended. This allows visual verification on the articulator via the contralateral side.

If you have made the leap to digital impressions, some systems offer an opportunity to digitally trim the bite. It is important that care is taken when trimming, and that a similar  method is used as described above, in order to achieve an accurate orientation of the casts.

When restoring a large case, where a patient is provisionalized and there is no natural tooth-to-tooth occlusion, bite tripodization is required to accurately capture the bite position. To maintain the newly established bite position, the provisional should be removed in small sections and bites recorded in these areas. This should be accomplished bilaterally and anteriorly, and again we suggest trimming and verifying the bite as previously explained.

We share these suggestions from our experience. By all means, if you are having great success we encourage you to maintain your current technique. Please contact us any time to discuss the best bite technique for your case.

Malocclusion - a Sign of Civilization

Click for Intriguing Lecture
UK, declares that of the 4629 mammals, only humans exhibit malaligned teeth. In the British Dental Journal, an article featuring Dr. Mew explains that “in the fields of both anthropology and archaeology, malocclusion is considered a sign of civilization. It is not present in any of our pre-civilized ancestors, who had well aligned teeth (regardless of attrition) from birth until death. The origin of malocclusion does not follow a genetic pattern but appears wherever and whenever cooking and tool-making appear, and progresses from mild imbrications to skeletal manifestations as civilization advances. There is also no evidence that we should not accommodate 32 well-aligned teeth today or that there has been any genetic change.” The causes of malocclusion, according to Mew, are environmental factors, mainly soft diet, high-nutritional/calorie foods, lowering the amount of chewing, and nasal obstructing allergies. Both lead to long-term postural lowering of the mandible, effectively shortening the space for teeth. Dr. Mew humorously suggests that the best method for young people to achieve ‘normal’ maxilla-facial architecture, is to stand up straight, chew multiple pieces of gum at the same time for 2 hours per day, and keep the mouth shut (“just like your parents taught you,” adds Mew). 

Cement Tips for Implants

During a recent CE course, ROE gained some valuable insight from Matthew Palermo DDS, Interim Chair Department of Restorative Dentistry at Temple University. One recommendation is the use of densely radiographic cement for implant seating. With the prevalence of peri-implantitus, the ability to observe and remove cement is critical, and TempBond and ZincPhosphate are ideal. He suggests checking your current implant cements for radiopacity. 

Keeping the amount of cement to a minimum is advantageous. Dr. Palermo shared a method of minimizing the amount of cement using an extra-oral technique. Apply one thickness of Polytetrafluoroethylene (PTFE) inside a crown and then fill it with bite material. Before setting, insert a cotton tip. Once set, remove this plug and fill the crown with cement. Reinsert the plug (essentially creating a duplicate of the prep) until excess cement exudes; then quickly deliver the crown. This will provide approximately 50μ of cement.

Staub Cranial Dentures - Receive a Maxillary Set-Up for the Bite Appointment

Since the 70’s Staub Cranial Dentures has delivered tooth set-ups from master casts. Fully edentulous Maxillary and mandibular casts are measured and the recordings are entered into a software. This information instructs technicians where to set the teeth, while a special Staub device articulates the maxillary cast. From these two records, doctors receive a full maxillary set-up and mandibular bite block ready for the bite registration. Once captured, doctors have the option of a full try-in or going directly to finish. This highly successful denture technique will prove itself on 
the first case. If the setup is not ideal, send reset information for another try-in or finish. You’ll agree that this is a big improvement over the traditional two bite block appointment. It is Imperative that shade, gender and age is sent with master casts!

Thursday, July 30, 2015

Monolithic Zirconia in the Anterior?

By now you’ve seen anterior BruxZir advertised in the dental journals. Did you ever think fullcontour zirconia would be indicated for anterior restorations? Although the new BruxZir is only ½ the strength, it is much more translucent and is specifically designed for anteriors. 

We are producing this product now, along with our TLZ for anteriors, and although it is still new, there is promise in translucent zirconia; we will keep you updated.

Did You Know that ROE is a Leading Provider of Surgical Guides?

Since 2004 ROE has produced more than 12,000 surgical guides for a national and international clientele. Today, guided surgery is accessible for all doctors wishing to place implants. Our simple protocols work with practically any treatment situation. The process is so efficient that with most cases the office simply provides a CT scan (with patient biting on cotton rolls), master or digital impressions, and a bite. In a few days we are on-line with you planning the final position of the implants. A few days later your guide arrives with a simple-to follow Drill Report, applicable for any implant system. Complex cases may require a diagnostic work-up, which will add one more appointment. Call for your CT Welcome Package today.

What’s new with Guided Surgery this year?

• We unveiled our new improved CombiGuide II – a
two-piece bone reduction osteotomy guide for quick
accurate surgery. Images can be viewed on the
Surgical Guide page on our website.

• ROE has been selected as a Premier 3Shape
Implant Studio Laboratory in the USA. For Implant
Studio users, this means domestic support, training,
and easy-to-order guide sleeves.

• Digital impression scans are accepted for quicker
turnaround, lower cost, and model-free guide cases.

ROE On-Line Saves Time

ROE clients now have online access to their cases where they can view current case status and return dates, check case history, and even add images, DICOM, and other files … all of this from a computer or device! This is a great solution to today’s demand for communication. If you would like access to your account, and have worked with us in 2015, email and request “online access”. We will email you an invitation promptly. If you have not worked with us this year, visit our web site, click the “Upload” link on the top right of the home page, click the Red Button “I am new to ROE” and create an account. If you are a Dentrix DDX customer you will be automatically connected. Search for ROE in your DDX account and start sharing your digital fi les and records today. Send your E4D fi les, photographs, Rx’s etc. (Is this last sentence complete?)
 ROE web site log in page

Beyond All-On-4 - The RAPID Appliance / CombiGuide

The All-On-4 protocol has become very popular and successful. Patients can predictably leave the surgical
visit with a new, fixed, provisional prosthesis and enjoy an improved quality of life. According to plan, the patient should now have an ideal set-up and VDO. The patient enjoys this provisional for a few months and returns for the final prosthesis. At this point, we ask the question: If the provisional denture was well thought-out, and the patient is comfortable with the prosthesis, why start all over again with implant-level impressions and bite blocks, why not work from what is established and accepted? Our RAPID (ROE Advanced Prosthetic Implant Device) is our answer to this question.

With the RAPID we've developed a chairside procedure that allows us to create a master cast and capture tooth position, the VDO, and verified implant position on the day of surgery! With these records, during the first restorative appointment the doctor will simply reline our RAPID Appliance with impression material to capture the healed tissue surface. From this impression, we skip 3 clinical appointments and progress right to the tooth set-up and bar fabrication. The case is tried-in, reset if needed, and taken to completion. We think this is an excellent method of saving time and appointments, reducing variables and significantly increasing profi tability. If you restore or place implants using an immediate All-On-4,5,6 protocol, we encourage you to call us to discuss how the RAPID appliance can accelerate the restoration of the final hybrid or Prettau bridge.

CombiGuide II

One Step Further
ROE will soon announce a product called the CombiGuide for All-On-4, which will
revolutionize the All-On-4 surgical visit, and facilitate a much quicker surgery and rapid conversion process. For surgery, the doctor will receive a bone model, two-piece bone reduction/osteotomy guide (image to the right), transfer and seating bites, and an immediate flange-free provisional that is seated via the bites, rather than jaw manipulation. We will  also provide an immediate conventional denture as a backup, when initial torque is not achieved. We will explain

PALA & Avadent Digital Dentures - Amazing Technology

We are proud to be one of only two laboratories in the country to offer both PALA and Avadent Digital Dentures. With either of these systems, two and three appointment dentures are now possible.

Often, patients have dentures with worn teeth and/or multiple repairs. They may like their dentures, but it is time for an update. With Avadent, a doctor can use a patient’s existing denture as a guide to fabricate the ideal denture. When these cases present, the denture can be duplicated using a Lang duplicator, to be washed with medium- or light-body polyvinyl, and border-molded. This, along with an opposing

model and full-arch bite, are sent to our laboratory to be scanned and digitized. If you are local,
you can complete the wash impression and bite and send the patient to us for a convenient 45-minute scan. Be sure to schedule this appointment.

Avadent offers milled and, now, color gradated teeth for added strength. This is our standard for hybrid and overdenture cases when vertical space is limited. Please visit our web site for examples of our fine work

With PALA, from Hereaus Kulzer, doctors can complete full dentures in 3 appointments. They also have the benefit of a trained Hereaus representative who provides all the necessary materials and over-the shoulder assistance free-of-charge! During the fi rst appointment, all the records are captured using special trays that perform a Gothic Arch tracing. Then, PALA uses algorithms calculated from twenty-six anatomical landmarks to digitally create the ideal tooth position. During the second appointment the patient tries-in a 3-D printed, resin prototype of the final denture. At this point adjustments can be made for a second try-in, or simply taken to finish. We are excited to be a digital partner and have seen very
promising results.

CONUS Overdentures - A New Development

For many years ROE has fabricated the Conus Overdenture using CAD 4 degree tapered abutments combined with Locators for a rigid, retentive, removable overdenture that is hygienically friendly and durable. Now, Atlantis offers a system called the Conus Concept. This is a ROE-fabricated all-acrylic overdenture (recommended with FiberForce® or metal substrate) that utilizes 4 or more precision-milled, friction-fi t, Atlantis telescopic abutments and copings. These abutments are either stock or custom, depending upon the angle of the implants. When implants are parallel, stock parts are ordered. This product is a patient- and doctor-pleaser. The parts are not subject to wear and therefore require little maintenance. When restoring a case with minimal VDO, Conus can be combined with a milled Avadent denture for added strength.

PCC - Milled Copings We’d Like You to Try

When ordering PFM’s, we’d like you to consider porcelain-fused-to-chrome cobalt (PCC), a restoration we’ve been raving about for more than a year. PCC copings are precisionmilled, utilizing intuitive software that produces copings far superior to any conventional casting. There is no porosity or miscasting and no margin finishing errors. There are clear transitions on bands, precise die space, and great fit. And, because PCC is a well tested base metal, there is considerable cost savings. We hope you’ll make the switch from your current alloy to PCC. 

Thursday, April 23, 2015

Did you Know? Submitted by Hobe & Lucas CPA’s Inc

The state of Ohio has been stepping up its efforts to collect more revenue! Taxes based on the “honor system”, like sales tax, are lucrative targets. Did you know that buying dental products such as implants, Invisalign, and other tangible property out-of-state does not protect you from paying Ohio sales tax? If out-of-state vendors are not charging sales tax, the purhasers are responsible for paying use tax to the state of Ohio. Recently, Ohio has audited vendors such as Straumann Implants and Invisalign and determined that they are not charging sales tax properly. During the audit process Ohio auditors have extracted names of vendors’ dentist customers, and consequently audited them as well. This has been quite a gold mine for Ohio when you factor in tax plus sizable interest and penalties. 

One other thing…unclaimed funds audits are picking up in Ohio. Does your dental practice have old accounts receivable credit balances or uncashed refund checks that are over 3 years old? In many cases, these must be remitted to Ohio. 

Honesty is the best policy – if you don’t have a usetax account, you probably should; if you aren’t remitting unclaimed funds, maybe you should be. Contact Hobe & Lucas CPA’s Inc. or your tax advisor, or go to: http://www. and gov/unfd/HolderFaq.aspx for more information.

TLZ-SR - Compatibility for A Great Solution

TLZ-SR is an incredibly popular restoration for restoring single and multiple unit implant cases. As we mentioned in a previous newsletter, screw-retained has made a big comeback due to the absence of intraoral cementation, the low fee ($299), and the high quality. However, not all TLZSR cases are the same! If we do not have what’s called a Ti base, the stock component attached to the crown, then we must order a stock abutment from the manufacturer and raise the fee an additional $100-$180. When completing the work authorization request that we call to discuss pricing.

Check out our compatibility and implants that require special parts and fees: 

Digital Dentures - A Quantum Leap

Avadent Digital Denture
Leading the Way For more than 5 years, Avadent has offered a digital option for dentures. Its product is very impressive, and can be reviewed on our web site. If a patient has an existing denture, and it is time for an upgrade, you simply duplicate the denture chairside, capture a reline impression
and bite and send to ROE to be digitized. In 3 days you will receive a virtual preview, and in 2-3 weeks an amazing new denture. If you are within driving distance of ROE, you can capture the records using the existing denture and ask your patient, or our currier, to deliver the case to ROE for sameday scanning! We call this our 35-minute denture! Call us for more information.

Pala Digital Denture - A New Heraeus Product

Heraeus also offers a digital denture. Its system is more ideal for patients who do not have an existing denture. With Pala, the doctor selects one of four sized Gothic Arch Tracing devices, captures an impression, adjusts the device to record the vertical dimension, then is functionally manipulated to capture centric. Pala then uses science to map tooth location based upon the arch-form and other anatomical
features. The case can be returned for try-in, if desired, prior to fi nishing.

LabTrac - Keep Your Cases On Track

In our continuous efforts to provide superior restorations in a timely fashion, we invested in a magnificent new software platform; one that is more robust and user-friendly, and that allows our clients enhanced communication. Our new software is called Labtrac. Internally, Labtrac manages case-fl ow based upon the tasks involved, employee skill level, and volume of case load, and even allows our customers to have assigned technicians. With this sophisticated software, we now have the ability to micro-manage every aspect of your case to ensure that you and your patient receive exactly what is expected. With Labtrac’s web-based portal, customers can track the progress of cases, receive emails when cases are received, shipped, or on hold. Doctors can request pick-ups, print Rx’s for case-shipping and records, and upload information such as images, digital impressions, and DICOM

DAMAS - An FDA-Type Compliance Certification

Since 2007, in the interest of our valued customers, their patients, and our organization, ROE has devoted thousands of man-hours and a large financial commitment to become accredited by DAMAS. We are pleased to report that ROE recently joined the approximately .4% of dental laboratories in the United States to become DAMAS-certified!

You might ask, what is DAMAS and what does it mean for you, our customer? DAMAS stands for Dental Appliance Manufacturers Audit Scheme (DAMAS). It is an internationally recognized standard for quality that validates the materials and processes utilized to produce prosthetic devices. These standards closely mirror a strict protocol that follows the U.S. Food and Drug Administration’s Quality System/Good Manufacturing Practice (QS/GMP) specifications, which are required of all dental laboratories conducting business in the United States. DAMAS provides a clear-cut method for documenting every facet of laboratory operations, including dental prescriptions/work authorizations; patient contact materials; subcontractor/supplier agreements; material and equipment purchases; employee training; maintenance and calibration of equipment; labeling; customer complaints, and cleanliness. Due to the strict standards of DAMAS, only 30 of 6700 dental laboratory in the United States have achieved the DAMAS status and we are proud to be one of them. It is noteworthy that only 20 of these laboratories are, like ROE, independent.

The DAMAS certification ensures that the laboratory environment operates in such a way as to ensure product and patient safety. It provides a formula for improved documentation of many aspects of dental lab activity from dental prescriptions to material traceability. Celebrate this achievement with us. You can be proud to inform your patients that restorations produced by ROE are made under the strictest guidelines and that your laboratory is among an elite group. We hope our efforts provide comfort and peace-of-mind to your patients. With DAMAS we emphasize our commitment to excellence every day.