Todd Snyder, DDS, FAACD, FIADFE, ASDA · TODD SNYDER, DDS, FAACD, FIADFE, ASDA Accredited Fellow, American Academy of Cosmetic Dentistry Fellow, International Academy for Dental Facial

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TODD SNYDER, DDS, FAACD, FIADFE, ASDA

Accredited Fellow, American Academy of Cosmetic Dentistry

Fellow, International Academy for Dental Facial Esthetics

Member of The American Society For Dental Aesthetics

Former Faculty, UCLA Center For Esthetic Dentistry

Speaker, Catapult Education

LEGIONpride.com, Online Training Challenge for Dentists

Todd Snyder, DDS, FAACD, FIADFE, ASDALaguna Niguel, CA

Aesthetic Dental Designs®

[email protected]

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Are you still diagnosing with this??

50%accurate

Adrian Lussi - 1994 paper in Caries Research demonstrated that an explorer only detected caries in 14% of teeth that actually had decay histologically (Low sensitivity)

How do you diagnose decay??

Is it thru conventional radiographic analysis?Approximately 25% demineralization must occur to see a cavity on a conventional

radiograph. Equates to 40-60% demineralization on the tooth surface.

Radiographs miss 70-80% of occlusal cavities.Digital radiographs provide the ability to manipulate image size and appearance.

67%accuracy

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Thru intraoral photographic interpretation?

How do you diagnose decay??

Pathology Driven Diagnostics

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1896

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Fiber Optic TransilluminationMicroLux Kavo DiaLux 2300L

Fiber Optic Transillumination

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Fiber Optic Transillumination

CariVu Fiber Optic Transillumination

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Routine Bite Wings

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Clear View

Contrast

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Intra Oral ImageWhat do you see #20D

No question D1 caries on CariVu

Bitewings versus CariVu

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From 2014…faint sign on 20 distal, nothing really in 2015…but now we have CariVu

2014 2015

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Huge Marketing Opportunity• Non Ionizing Diagnostic Tools

• Minimally Invasive Dentistry

• Longer Lasting Restorations

• Community Educational Programs

• Internet and Local Media Advertising

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Everyday Go To Minimally Invasive Burs

0512C1300F0710C 0116C

How will you diagnose?

How will you treat?

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◼ Access, viscosity, small areas

◼ Deep, narrow, preparations

◼ Lots of enamel

Flowables

Flowable

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Crystal Structure DiagnosticsThe Canary System Detects Cracks & Cavities not

Visible on X-rays

+ Around & beneath intact margins of fillings & crowns

+ Under sealants (including opaque sealants)

+ On proximal surfaces

+ On smooth surfaces, pits & grooves

+ Around orthodontic brackets

Measures tooth structure breakdown, allows for early

treatment

+ Restore conservatively

+ Remineralize back to health

+ Seal with confidence

Research claims validated by 60+ papers

15+ case reports & 2 FDA CFR 21 clinical trials

The Science Behind The Canary System

• Pulses (2 Hz) of laser light hit the tooth surface.

• Tooth glows (Luminescence, LUM) and releases heat (Photo-Thermal Radiometry, PTR).

• Defective tooth crystal structure affects the retained heat and luminescence signatures.

➢Energy Conversion Technology

Temperature

increase < 1oC

not harmful

• Detected signals reflect the tooth’s condition.

• Detects 50 micron lesion up to 5 mm below the surface.

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Delegated Scanning & Whitening Assistant

Sensitivity & Specificity Study: University of Texas October 2012

Study Design• 20 tooth surfaces selected with

range of clinical conditions from healthy to early caries

• Visual ranking by 2 dentists • Canary Scan• DIAGNODent• Polarized Light Microscopy used as

the gold standard to confirm presence of lesion & depth in that section

Caries Detection Method Canary System DIAGNODent

Sensitivity 100% 18%

Specificity 100% 100%

Spearman Correlation with Lesion Depth

.84 .21

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Canary is Superior to X-Rays for Proximal Caries DetectionJan J et al. Caries Res 2014;48:384–450 DOI: 10.1159/000360836

Objective:

To compare the accuracy of The Canary System, ICDAS-II and bitewing radiographs in detecting proximal caries

in vitro.

Methods:

ICDAS-II (Direct Visual Examination): Blinded examiners ranked 100 proximal surfaces using ICDAS-II by

direct visual examination of the surfaces

Manikin mouth models: The teeth were then set in manikin mouth models, creating contacting proximal

surfaces that very closely resemble in vivo situation.

Histological validation: All surfaces were examined by polarizing-light microscopy to confirm the presence

and depth of the caries lesions.

Conclusion:• BW radiographs could only identify 26.7% of the lesions which questions its ability to be the

gold standard

• The Canary System is the only method examined with both high sensitivity and high specificity.

• The Canary System is more sensitive than bitewing radiographs in detecting interproximal

caries

Interproximal Caries Detection

Bitewing radiograph did not detect caries.

Caries located on buccal aspect of the contact area

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Demineralized enamel

Caries Detection Method

The Canary System

DIAGNOdent

Sensitivity 83% 64%

Specificity 79% 46%

• Canary Numbers >20 when scanning sealants (3M™ ESPE™ Clinpro™ Sealant) placed over pit & fissure caries.

• The caries detection ability of the Canary System was not affected by sealant & was more accurate than DIAGNOdent.

Sensitivities and specificities for pit & fissure caries detection after sealant placement.

Canary Number 66

Canary Number 37Caries into dentin

Post-sealant

Pre-sealant

Cross-section

Sealant

Detection of Caries Beneath Sealants

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After all the cleaning and diagnostic technology being used, what if you find something?

Topical Therapies• More caries resistant• Remineralization• Desensitization

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Minimally Invasive Treatment

• Apply MIPaste Plus for 3 minutes

• Patient applies at home 2x/day

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MI VARNISH™ WITH RECALDENT™ (CPP-ACP)Bioavailable calcium, phosphate & fluoridefor an enhanced varnish treatment

Bacteria

Produce Acid

Attack Enamel

Demineralization

DECAY

Xylitol & ProBiotics

MI Paste, Enamelon

Remineralize

Other Systems

Radiograph

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How will you diagnose this?

How will you prepare

and treat this?

Total-Etching

Bonding to Enamel/Dentin

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Dentin

OdontoblastDentinal tubule

Smear layer

Adhesion process – Total Etching

Dentin fluid

Dentin

OdontoblastDentinal tubule

Smear layer37 % Phosphoric acid

Adhesion process – Total Etching

Dentin fluid

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Adhesion process – Total-Etching

Adhesive

Etched dentin

Post- Operative Sensitivity

Adhesion process – Total-Etching

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Mpa MAX (Clinician’s Choice)

▪ MPa MAX 5th Generation

Total-Etch Adhesive produced

the highest bond strength to

dentin, enamel, zirconia and

lithium disilicate.

▪ MPa MAX is one of the

few adhesives that contains

0.2% CHX to help prevent

adhesive bond degradation

caused by MMPs

▪ G5, a gluteraldehyde-based desensitizer that prevents post-operative sensitivity.

▪ G5 is placed after etching and before MPa MAX adhesive placement.

▪ G5 works by coagulating the intratubular fluid, helping to seal the dentin and prevent stimulation of the odontoblast processes.

Mpa MAX (Clinician’s Choice)

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Composite resin

Post- Operative Sensitivity

Adhesion process – Total-Etching

Problem with Total Etch Bonding(Over drying phenomenon)

Dentin

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Problem with Total Etch Bonding(Over drying phenomenon)

Dentin

Phosphoric acid

Problem with Total Etch Bonding(Over drying phenomenon)

Water

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Problem with Total Etch Bonding(Over drying phenomenon)

Dentin

No filtration into the collagen fiber Excess drying

Dentin

Shrinkage of collagen fiber

Problem with Total Etch Bonding(Over drying phenomenon)

No filtration into the collagen fiber Excess drying

Adhesive

Dentin

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Problem with Total Etch Bonding(Over wetting phenomenon)

Adhesive

Water

Insufficient drying

Dentin

SciCan

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Handpiece Lubricants

Disposable Single Use Diamonds

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Everyday Go To Minimally Invasive Burs

0512C1300F0710C 0116C

Long term failure occurs at gingival margins and adhesive interfaces.

Yiu CK, Hiraishi N, King NM, Tay FR. Effect of dentinal surface preparation on bond strength of self-etching adhesives. J Adhes Dent. 2008 Jun;10(3):173-82.

Higher bond strengths when using tungsten carbide burs with SE adhesives

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Dentin

OdontoblastDentinal tubule

Smear layer

Adhesion process - Self-Etching

Dentin fluid

Use Carbide Burs Large layers inhibit acidic monomers

Duration of exposure& acidity

Dentin

OdontoblastDentinal tubule

Smear layer

Adhesion process - Self-Etching

Dentin fluid

Self-etching adhesive

Use Carbide Burs Large layers inhibit acidic monomers

Duration of exposure& acidity

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Dentin

OdontoblastDentinal tubule

Smear layer

Adhesion process - Self-Etching

Dentin fluid

Self-etching adhesive

Use Carbide Burs Large layers inhibit acidic monomers

Duration of exposure& acidity

Adhesion process - Self-Etching

No Post- Operative Sensitivity

Excellent sealing and desensitizing

Fixing

Odontoblast

Sealing

the Dentin

Hybrid layer

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Composite

Adhesion process - Self-Etching

Bonding

No Post- Operative Sensitivity

Excellent sealing and desensitizing

Fixing

Odontoblast

Sealing

the Dentin

Hybrid layer

Bond Degredation

▪ Pashley DH, Tay FR, Imazato S. How to

increase the durability of resin-dentin bonds.

Compend Contin Educ Dent. 2011

Sep;32(7):60-4, 66.

Resin-dentin bonds are not as durable as was previously

thought. Microtensile bond strengths often fall 30% to 40%

in 6 to 12 months.

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Factors that compromise bond durability in restorative dentistry

“The major shortcoming of contemporaryadhesive restoratives is their limited durability in vivo.”

alarming

words …

but

the

reality

we

face

should

trigger

alarm

Hydrophilic dentin bonding (1956 - )

Factors that compromise bond durability in restorative dentistry

alarming

words …

but

the

reality

we

face

should

trigger

alarm

Hydrophilic dentin bonding (1956 - )

(RFA-DE-10-004) “Tooth-colored resin restorations have an average replacement time of 5.7

years due to secondary caries precipitated by bond failure.”

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Factors that compromise bond durability in restorative dentistry

Hydrophilic dentin bonding (1956 - )

We challenged that current dentin adhesive designs that incorporate increasing concentrations of hydrophilic monomers are going in the wrong

direction

Water sorptionPolymer swelling

Decline in mechanical propertiesLeaching of hydrolyzed resin components

Factors that compromise bond durability in restorative dentistry

Hydrophilic dentin bonding (1956 - )

Intact hybrid layers created by a simplified etch-and-rinse adhesive in caries-affected primary dentin partially disappeared after 6 months of

intraoral function

Instability of hybrid layers- problem may be more severe than we realize

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Factors that compromise bond durability

Hydrophilic dentin bonding (1956 - )

MMP-8MMP-2MMP-9

Demineralizing dentin is like openingthe Pandora’s box, releasing

endogenous enzymes (Matrix Metalloproteinases - MMPs)

that were trapped withinthe mineralized dentin matrix.

In the presence of water (such as thatderived from water sorption or from

adhesives, MMPs (2,8 & 9) can breakdowncollagen fibrils that are not protected

by intrafibrillar minerals

Sukala et al. (2007)Mazzoni et al. (2007)

Franklin Tay & Dave Pashley Med College of Georgia

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More useful for etch-&-rinse adhesives as CHX can be applied to acid-etched dentin

Potential ways to extend bond longevity

-MMP inhibition with chlorhexidine

Potential ways to extend bond longevity

Without

chlorhexidine

With

chlorhexidine

as a MMP

inhibitor

Chlorhexidine prevented degradation of hybrid layers created by

Prime&Bond NT after 12 months of intraoral function

Brackett et al. Chlorhexidine preserves hybrid layers

but not nanofillers in vivo. Oper Dent (2009)

MMP inhibition with chlorhexidine

Potential ways to extend bond longevity

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4th6th5th

7th

▪Courtesy Pacific University (Dr Marc

Guisberger)

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•Courtesy Pacific University (Dr Marc Guisberger)

InstroN

▪ Ultra Tester (Ultradent)

▪ Ultra Jig (Ultadent)

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Average Shear Bond Strength to Dentin: 24.2 MPa

Courtesy Pacific University (Dr Marc Guisberger)

Shear Bond Test Results - 2012

Maximum/Minimum Shear Bond Strength per Bonding Material

Courtesy Pacific University (Dr Marc Guisberger)

Shear Bond Test Results - 2012

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Drawbacks of Any Composite Resin

▪ Material placement techniques

▪ Variable substrate

▪ Polymerization stress & shrinkage

▪ Water absorption

▪ Hydrophobic bonding agents

▪ Decreased adhesive bond strength over time

▪ MMPs and Cathepsins

▪ Microleakage

Decreased Bond Strengths due to

▪ Substrate

▪ Preparation technique

▪ Bur selection

▪ Hand piece oils

▪ Bonding technique

▪ Curing device and position

▪ Material selection

▪ Layering technique

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What substrate are we treating?

Class I or II

:Composite Preparation

3x Tubule Density Equals Higher Fluid &

Increased Difficulty for Bonding

%30 Degrease in Bond Strengths with most

bonding systems.

“Adhesive dentistry could be expressed as a

simple relationship between bonds and

stress. If the bonds can withstand the

stress, the restorative technique will be

successful.”

Unterbrink and Liebenberg (1999)

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“C-Factor” Definition

Configuration Factor:

“The ratio of bonded to un-bonded (free) surfaces”

Feilzer, DeGee, Davidson (1987), Universtiy of Amsterdam, ACTA

Lowest Stress

Low Stress

Medium Stress

High Stress

Highest Stress

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Excellent Flow & Handling Base/ Lining

“C-Factor”

Dentin Replacement with Composite Cap?

◼ Dentin substitute

◼ Flowable Resins

-3%-6% vol. shrinkage

-1.6-3mpa shrinkage stress

-What bonding agent?

◼ Glass Ionomers

◼ Enamel Replacement

◼ Modern Composite

ADA reports flowable resins

are used by 82% of dentists

as bases or liners.

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Tokyo Medical & Dental University, 2010 J. Tagami et al

Flowable Composite Shrinkage(2mm Bulk Fill w/ 71%/wtFlowableON DENTIN ONLY)

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Resin to Dentin Hybrid Zone

Preparations > 2mm

▪ Traditionally, numerous increments have to

be placed to diminish polymerization

shrinkage as well as stress on tooth structure

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Technique

0.5mm Flowable & Bonding Agent?

Composite

Normally….

Technique

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Bond Strengths Related To Tooth Structure

0

5

10

15

20

25

30

35

40

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DEJ Superficial(Sound)Dentin

BeveledEnamel

DeepDentin

AffectedCariousDentin

InfectedCariousDentin

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30 30 30

10

Irie m, suzuki k, watts dc, 2004, marginal gap formation of light activated restorative materials, affects of immediate setting shrinkage and bond strength. Dent Mat 18, 2002; 203-210

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Caries Detector

Caries Detector by Kuraray

Dental is the original caries

detecting stain material. It was

developed by Dr. Fusayama &

Kuraray Dental at the Tokyo

Medical & Dental School in 1978.

Caries Indicator Dyes

▪ Roydent-To Dye For

▪ Kuraray-Caries Detector

▪ Ultradent-Seek/Sable Seek

▪ ProOptions-Caries Indicator

▪ Danville-Caries Finder

▪ Pulpdent-Snoop

▪ Vista-Caries Indicator

▪ Ronvig-See It

▪ Patterson-

▪ Henry Schein-

▪ Pearson-

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Caries Detector 86% Accuracy:

▪ As noted by Southern Illinois Dental School in-vitro research,

“Caries Detector Solution Identified 86% of Subsequently Confirmed Caries Lesions

After Sectioning”.

▪ Reference: Caries Detection Accuracy by Multiple Clinicians & Techniques, Thomas, Land, Wilson & Gregory Stewart DDS, Southern Illinois University School of Dental Medicine, IADR Abstract 3127, 1998.

Caries Removal Burs

▪ SS White

Single use

Polymer

Hardness

5000-10,000 rpms

▪ Komet

Multi use

Ceramic

Hardness

1000-1500 rpms

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Size 4,6,8

Round Burs (#6) Carbide CeraBur SmartBurs II

(SS White) (Komet) (SS White)

1,000-1,500rpm 5-10,000rpm

J Adhes Dent 2011 Feb;13(1):7-22. doi: 10.3290/j.jad.a18443.

Current concepts & techniques for caries excavation & adhesion to residual dentin.

de Almeida Neves A, Coutinho E, Cardoso MV, Lambrechts P, Van Meerbeek B.

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Round Burs (#6) Carbide CeraBur SmartBurs II

(SS White) (Komet) (SS White)

1,000-1,500rpm 5-10,000rpm

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▪ Indications

Anterior & Posterior Simple or Complex Bonding

Excellent Handling

Easy to Polish

Refractive Color Index Similar to Tooth

EVANESCE means to disappear gradually; vanish; fade away

Excellent Handling / Incredible Colors

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The Dental Advisor

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How Do We Restore?

• Composite, Veneer or Crown?

• Patient Input?

• Color?

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Initial Mockup

• Select Shade(s)

• Quick Initial Mockup (<3minutes)

– Free Hand

– No adjustments

– Prove Color(s)

– Prove Translucency

– Thickness Role

• Template

– Capture Lingual and Incisal

– Check Template

– Remove Excess

– Remove Composite

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Air Abrasion, Total Etch, Mylar

MPA Max, Template, Evanesce Enamel

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Evanesce Dentin

Sculpt Dentin, Cure, Add Enamel

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Discs to Contour

Discs to remove fine scratches

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Polishers for surface and interproximal areas

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Bulkfill Options

▪ Light Cured (C-factor issues and adhesion)

▪ Self Cured (More reliable)

▪ BulkEZ (Danville)

▪ HyperFil (Parkell)

▪ Activa (Pulpdent)

▪ Fill Up! (Coltene)

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Internal (Polymerization) Stresses of Composites

“A Simple Pain-Free Adhesive Restorative System by Minimal

Reduction & Total-Etching (1993)

Takao Fusayma DDS,

Tokyo Medical & Dental University

Test your light output and practice with your materials

Curing bulk fills remains a question

CRA questions the ability for most practitioners to place bulkfill materials

properly in addition to getting adequate curing.

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Lots of optionsWhat works best for your practice and skills?

How much time do you have?Bond Strengths?

Risks and Longevity?

?How are you restoring

these different preparations

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ORAL BACTERIA DEGRADATION OF RESIN RESTORATIONS

MORE RESEARCH

American Journal of Dentistry Oct 2017

• https://www.researchgate.net/publication/321184952_The_role_of_adhesive_mat

• erials_and_oral_biofilm_in_the_failure_of_adhesive_resin_restorations

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• Bioactive material

• affinity to tooth structure. when placing a glass ionomer a weak acid or conditioner is used to aid in releasing calcium and phosphate ions from the tooth structure. These calcium and phosphate ions combine into the surface layer of the glass ionomer and form an intermediate layer called the interdiffusion zone. This bond layer can be very strong and significantly reduce the microleakage that would occur at the margins of the restoration.

• Very good fluoride and ion release helps remineralize tooth structure in the remineralization–demineralization process that naturally occurs in the oral cavity.

• They bond to enamel, dentin, and metals.

Why Glass Ionomers?

• They produce good marginal integrity.

• They shrink only one ninth the amount of composite material.

• They are fluoride-rechargeable.

• There are no free monomers in the material.

• The cavity preparation can be bulk-filled, making the materials easy to place.

• They exhibit excellent biocompatibility.

Why Glass Ionomers?

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148178/

(RFA-DE-10-004) “Tooth-colored resin restorations have an

average replacement time of 5.7 years due to secondary caries precipitated by bond failure.”

Fig. 15 – Graph representing the mean annual failure rates

per adhesive class, determined according to a systematic

review of Class-V clinical trials of adhesives during theperiod 1998–2004 [2].

Van Meerbeek B, et al. Relationship between bond-strength tests and clinical

outcomes. Dent Mater (2009), doi:10.1016/j.dental.2009.11.148

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Deep Preparations◼ Bonding Agent & Flowable composite

◼ Conventional Glass Ionomer or GI then Composite◼ Fluoride Release

◼ High compressive strength

◼ Hydrophillic

◼ Insoluble

◼ True chemical adhesion

◼ Minimizes microleakage

◼ No sensitivity

◼ Acid Base Resistant Zone

◼ Decreased gap formation & C Factor

◼ Coefficient thermal expansion similar to

dentin

LARGE SIZED LESIONS (>2MM)• Mostly dentin

• Dentin has more moisture and less substance

• Open and Closed defects

• Complications & Risks are higher

• Porous, Wet, Dentin Available

• Interproximal concerns

• Increased Occlusal Loading

• Remaining Tooth StructurePulpal

Proximity

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Seals & Protects the Pulp:• For Direct & Indirect Pulp Capping

• Light-curable, Radiopaque Liner

• Significant Calcium Release:

• Stimulates Hydroxy Apatite & Dentin Bridge Formation.

Resin-Modified Calcium Silicate Pulp Protectant/Liner

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THERACAL LC (BISCO)CONVENTIONAL GLASS IONOMER

GLASS IONOMER SANDWICH

•Class I, II, III & V posterior

restorations

•Open & Closed Sandwich

techniques

•Composite replacement

•Amalgam replacement

•High caries risk patients

•Pediatric patients

•Geriatric patients

•Special needs patients

•Long term resistance to

microleakage

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GLASS IONOMER MATERIALS• Dentsply-ChemFil Rock Restorative

• SDI-Riva LC, light cure HV, Riva SC, self cure HV

• G.C. America-Fuji II LC, Equia Fil (Fuji IX)

• VOCO-Ionolux, Ionofil Molar AC

• 3M/ESPE-Ketac Nano, Photac Fil Quick, Vitremer, Ketac Molar Quick, Ketac Fil Plus

• Shofu- FX II

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• GC EquiaFil Compressive Strength 255mpa

• Equia Forte 280mpa

• Riva SC compressive strength 271mpa

• Chemfil Rock Compressive 200mpa

• Voco Ionolux had higher compressive strength than Equia Fil or ChemfilRock

• Surefil SDR compressive strength 220mpa

• Dentin 280mpa-297mpa

• Enamel 384mpa

• Grandio SO HF has compressive 417mpa

• Fuji II LC 170mpa (RMGI) Compressive strength

COMPRESSIVE STRENGTHS

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GC AMERICA

MINIMALLY INVASIVE PREPARATIONS

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Komet & Kavo

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Komet SF1LM

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GLASS IONOMER INTERFACE

Inte

rfac

e A

na

lysis (TE

M)

CARDOSO et al. J Dent 2010

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RESIN TO DENTIN HYBRID ZONE

A3.5 A3 A2

Glass Ionomer Bulk Fill

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EQUIA FORTEEQUIA™ FORTE is a complete system that is an ideal solution for posterior restorations:

•Class I, II, III and V posterior restorations •Composite replacement •Amalgam replacement •High caries risk patients •Pediatric patients •Geriatric patients •Special needs patients •Buildups•Long term provisionals

EQUIA FORTECaries control/quadrant dentistry

(Class II, III, V & core buildup)

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WHAT DOES EQUIA COAT DO?Fill porosities to increase physical properties of the restoration and offers a much smoother surface…

(SEM

im

ag

es

x1000)

100um 100um

Some voids are observed A smooth surface is obtained

EQUIA FilPolished by using silicon

carbide paper (#600)

EQUIA FilAfter coating

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SDI

VOCO

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ENDODONTIC SANDWICH TECHNIQUE

ENDODONTIC SANDWICH TECHNIQUE

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ENDODONTIC SANDWICH TECHNIQUE

ENDODONTIC SANDWICH TECHNIQUE

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ENDODONTIC SANDWICH TECHNIQUE

ENDODONTIC SANDWICH TECHNIQUE

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ENDODONTIC SANDWICH TECHNIQUE

ENDODONTIC SANDWICH TECHNIQUE

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ENDODONTIC SANDWICH TECHNIQUE

Open Sandwich with glass ionomer & nanohybrid composite

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Glass Ionomer vs. Open Sandwich

• 7 years later.

Glass Ionomer vs. Open Sandwich

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HOW DO WE CREATE THEM?

Interproximal Contacts

Problem & Solution

Tofflemire vs. Sectional Matrices

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PROBLEM & SOLUTIONTOFFLEMIRE

Universal V3 Ring Narrow V3 Ring

TrioDent has developed Narrow V3 Ring in addition to the

Universal V3 Ring to ensure ideal separation on smaller teeth.

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Note how the anatomical shape of the V3 Ring matches the

lingual contour of the molar while engaging the gingival undercut

Wave Wedge

Hole to fit with positive

grip Pin-Tweezers Inter-proximal contour for

a better gingival seal and

V-shaped concavity to

protect the papillae

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4.5mm

5.5mm

6.5mm

Tab can be bent 90˚ for

contra-angle placement

Holes designed to fit with

positive grip Pin-Tweezers

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by TrioDent

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3.5mm 4.5mm 5.5mm 6.5mm 7.5mm

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▪ A.S.A.P. Pre-Polisher (purple) (44 micron

diamond particles) reduces small surface

defects, without affecting anatomy, and

prepares the surface for a final high gloss

polish

▪ A.S.A.P. Final High Shine Polisher (orange)

(3-6 micron diamond particles) to provide a

life-like polish in as little as 20 seconds

▪ Both are autoclavable

ASAP Polishers (Clinician’s Choice)

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Access to the curing site = Energy to the resin

VALO’s footprintEVEN POWER AND WAVELENGTH DISTRIBUTION

COMPLETE COVERAGE

Images provided by Dr. Richard Price, Dalhousie University, 2014, Halifax Canada

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Machined from Aerospace Aluminum

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$200 $205

$321

$73

$175 $175

$11

$0

$50

$100

$150

$200

$250

$300

$350

Demi Demi Plus Elipar S10 SmartLite Max Bluephase Style Bluephase G2, 16-20i VALO

Curing Light Replacement Battery Cost

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Garrison Dental 3D Ring

System

Garrison Dental

XR = Extra Retention

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Fender Wedges & Slick Bands

Clinician’s Choice

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Composite Ninja

Composite Ninja

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Composite Ninja

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Lecture Handout

www.DENTOOLZ.comDigital Handouts, Products I Use & Special Offers

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Free Marketing Information & Handout

www.DENTOOLZ.com

TODD SNYDER(949) 643-6733

[email protected]

www.aestheticdentaldesigns.com

www.drtoddsnyder.com

www.toddsnyderracing.com

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