Don t Worry About Rising Gold Costs

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1 The Crown with More Brawn than Beauty Introducing: BruxZir Total Zirconia Crowns Benefits of BruxZir Total Zirconia Crowns An esthetic alternative to posterior PFMs with metal occlusals and full-cast crowns. Made with biocompatible medical-grade zirconia. Keller also saves you money with our Free Shipping Program. When you ship multiple cases to Keller in one box, your shipping is FREE. No Shipping Charge. No Bundling Charge. No Kidding! (*Offer only valid in the contiguous United States. Additional charges will apply for overnight service.) Fabricated using CAD/CAM technology for consistent fit. Keller Laboratories, Inc. 160 Larkin Williams Industrial Court P.O. Box St. Louis, MO PAID U.S. POSTAGE PRESORTED STD Address service requested St. Louis, Missouri Louisville, Kentucky Indianapolis, Indiana Kansas City, Missouri ST. LOUIS, MO PERMIT NO After BruxZir: Are You Using The Most Reliable All-Ceramic Material? W Before BruxZir: Keller Locations Education News News from from Keller KellerLaboratories Laboratories Education Lithium Disilicate 2009 Keller Laboratories especially for severe bruxers. BruxZir Total Zirconia Crowns from Keller Laboratories are a new option for posterior restorations. With these virtually unbreakable allceramic crowns, you can provide your patients the strength to withstand severe parafunctional activity and avoid metal restorations. BruxZir is a full contoured solid zirconia crown or bridge with no porcelain overlay. It is glazed with a smooth surface but designed specifically for the posterior with more emphasis on brawn than beauty. Tougher than your average crown, BruxZir restorations are sintered for 12 hours at 1,530 degrees creating a nearly indestructible material. Consider that zirconia is the same element used to make military armour. It simply doesn t get any stronger than this. Because BruxZir has no porcelain veneer, it is more resistant to chipping, cracking or breaking in the mouth than other all-ceramics. Next time you see a patient with a broken crown give BruxZir Total Zirconia a try. Your patient will appreciate the metal-free esthetics and you can appreciate peace of mind knowing that BruxZir is the strongest crown you can provide. Call Keller at for more information or visit us on the web at www. kellerlab.com. IPS e.max Lithium Disilicate: $109 per unit. Captek (high noble): $139 per unit. KZ3 Zirconia: $139 per unit. Conservatively prepare as thin as.1 mm with feather edge margins, much like you would cast gold. Monolithic material makes the restoration completely chip-proof. restorations don t always need to Posterior be pretty, but they do need to be strong, old prices are out of control. The shiny commodity is now selling on the stock exchange for over $1100 an ounce (as of press time). Gold has never been so expensive. We could go into the reasons why the price of gold is skyrocketing but this is a dental newsletter not an economic journal. The important thing to note is Keller has gold-free options for you: Total Zirconia Crowns Ideal for bruxers & grinders who have destroyed other restorations. Don t Worry About Rising Gold Costs G SPRING Fall 2009 hat if I told you that there was a crown and bridge material available with beautiful allceramic esthetics that was as durable as a traditional PFM? IPS e.max monolithic Lithium Disilicate crowns from Keller are the revolutionary material you ve been waiting for. Recent tests led by NYU researcher Dr. Van Thompson, have revealed e.max monolithic Lithium Disilicate to be the most robust all ceramic system to date. Dr. Thompson has tested many materials during his 30 years in biomaterials research including PFM s, zirconia, IPS Empress. Crown specimens in the NYU study were subjected to mouth-motion cyclic fatigue testing which is able to mimic the forces found while chewing. The test is performed by loading the crown specimens through several thousand cycles at a predetermined load. These studies show that e.max has an extremely high strength threshold that challenges even traditional PFM s and outlasts veneered zirconia supported crowns in every measurable way. The weakest link in traditional PFM s and other ceramic restorations is the porcelain layer over An NYU Study Shows e.max Lithium Disilicate Crowns are the Most Robust All-Ceramic System to Date.* the substructure. In many cases the porcelain can chip or fracture from the substructure and ultimately cause the restoration to fail. The Clinicians Report (CR) by Gordon Christianson recently investigated IPS e.max citing new interest in Lithium Disilicate crowns. A survey of the CR Evaluation Group revealed 94% of e.max users would recommend it to a colleague. 97% would purchase it again. And 99% rate it as good or excellent. The CR report concludes that single restorations demonstrate higher in-vitro strength values than any other conventional monolithic and polycrystalline ceramic materials (i.e. IPS Empress CAD or zirconia-based). The CR report also went into detail about the advantages of IPS e.max. The publication asserted that IPS e.max CAD had improved strength over any other ceramic, was highly esthetic with multiple layers of translucency and confimed in-vitro studies demonstrating high durability. Don t forget that you have the option to cement or bond e.max. Give us a call today for more information on IPS e.max Lithium Disilicate crowns from Keller at *Mouth Motion Fatigue and Durability Study; Petra C Guess 1, Ricardo Zavanelli 2, Nelson Silva and Van P Thompson, NYU 1

2 2 NTI-tss Plus Builds Momentum in Medical Community The evidence continues to pile up in support of the NTI-tss Plus as a conventional treatment for migraine headaches. The device is already FDA approved and has been shown in case upon case to successfully reduce pain in the lives of migraineurs. Dr. Andrew Blumenfeld, director of the Headache Center of Southern California in Encinitas, presented an NTI study at the September meeting of the International Headache Congress. The randomized study of 60 patients showed that symptoms of migraine headaches were greatly reduced when NTI therapy was combined with preventive medication. We believe that you can do a lot with medications, but adding in additional treatments like dental splints makes a huge difference to the outcome, Blumenfeld told Medscape Neurology. We can add in a dental device without any [adverse effects] being added to, as opposed to adding a second medicine. The study was reported on in Medscape Medical News. Medscape is a free resource for Physicians, featuring Free CME (Continuing Medical Education), medical journal articles, MEDLINE and medical news. From Medscape Medical News: Dr. Blumenfeld reported that there were no systemic adverse effects with the splint alone, and it did not exacerbate the adverse effects of valproic acid (VPA) when used in combination. He concluded that the known efficacy of VPA for headache prevention could be enhanced by using the NTI splint while avoiding worsening of adverse effects that may arise if the VPA dose were to be increased, as VPA adverse effects are dose-related. Side effects from VPA include weight gain, fatigue, alopecia, hirsutism, tremor, and liver function abnormalities. For a copy of Dr. Blumenfeld s study and poster please contact us at or log on to. NTI-tss Plus CE Opportunities Hands-On NTI for Parafunctional Control with Dr. Barry Glassman Learn how to make your patients more comfortable so they are able to have the dentistry they want and you want to give them. This combined lecture and demonstration by Dr. Barry Glassman will give you all the training you need to incorporate NTI into your practice in an efficient manner. When does Occlusion really matter to your patient? What are the myths of Occlusal Therapy and why have they failed patients? Dr. Glassman will discuss current occlusal theories and how they often hinder patient acceptance and treatment success. There will also be an introduction to dental sleep medicine principle and a discussion of Oral Appliance Therapy for snoring. Dr. Barry Glassman has lectured extensively about the topics of the NTI protocol, pain management, and Oral Appliance Therapy for the treatment of sleep disordered breathing. He is a dynamic speaker that has presented seminars around the globe. For more information and to register for any of the dates below, log on to and click on NTItss Plus Hands-On Workshop Presented by Dr. Barry Glassman under the Recent News section. February 26, 2010 in Houston, TX February 27, 2010 in Dallas, TX March 5, 2010 in Orlando, FL March 6, 2010 in St. Petersburg, FL May 7, 2010 in St. Louis, MO May 8, 2010 in Kansas City, MO Dr. Barry Glassman

3 3 Valplast An Ideal Option For Temporaries in Implant Cases By Dr. Shalom Mehler, A 1989 graduate of the University of Medicine Dentistry of New Jersey. Dr. Mehler practices in Teaneck, N.J. Dr. Shalom Mehler contacted Keller about the lack of literature on the use of temporaries following implant and bone graft placement. He has utilized numerous temporization techniques with various levels of success. In his personal experiences Dr. Mehler has found Valplast to be an excellent option for temporary prosthesis over implants. He spoke to us about his experiences with various temporization appliances and with the process itself. What is your preferred temporary material? I ve been using Valplast exclusively in terms of posterior teeth. For anterior teeth I occasionally use Snap-on Smile, a modality that is fully tooth borne. The advantage is that it places no pressure on the gum tissue and is therefore non-irritating. However, I dislike the fact that usually I must cross the midline even to temporize a single posterior tooth. That s why my first choice is Valplast. I can make a one tooth Valplast flipper appliance for the anterior region or a nesbit for the posterior region. They are extremely retentive, they fit well and they serve my goal of space maintenance as well as providing occlusal function for the patient during the few month interim period. What do you take into consideration when choosing your temporary materials? Most importantly, I consider the timing of when a temporary should be inserted. Inserting a temporary immediately after graft or implant placement may irritate the tissues and prevent the area from healing properly. Is it healthier to place a relatively bulky tooth and tissue borne acrylic nesbit which does not apply any pressure to the gums underneath or a completely tissue borne Valplast that, if misused, has the potential to irritate the tissue? I ve heard of cases where a bone graft and implants have been lost because temporaries have been misused. Have you had any struggles using Valplast as a temporary material? I had one case a few months ago where an implant was placed and we inserted a Valplast temporary immediately. Within two weeks the tissues were friable and inflamed. Radiographically I discovered bone loss around the implant. After questioning the patient I learned that because the Valplast was so comfortable she was wearing the appliance 24 hours a day! We took the temporary away from her for a short period of time and within a week everything came back to normal. The tissues healed completely and the bone loss stopped. Since that experience I have learned to give explicit instructions to the patient regarding the appliance and the amount of time that it should be in function intra-orally. I just tell my patients that they need to give the underlying tissues time to rest. What is the most important factor in a successful temporary case? As I stated previously, clear instruction to the patient is crucial to the success of a temporary. I deliver a Valplast temporary with very explicit instructions. The appliance should be worn a few hours daily to provide space maintenance and the appliance may be worn when eating or when esthetics are crucial. The rest of the time the patient should remove the appliance in order to allow for proper integration of the implant and healing of the bone graft. The key point is to minimize excessive and irritating forces on the tissues. Patients are anxious for the implant to be successful so the compliance rate is high. Contact Keller to learn more about Valplast. *Do you have a suggestion for a topic in the Newsletter? Give the Keller Newsletter Desk a call at Valplast Temporary over Implant Dentistry & Photos by Dr. Shalom Mehler Appliance by Keller Labs

4 Keller is a certified Advanced Valplast Laboratory. Metal is Hard. Valplast is Easy. Tips for Rebase and Adding Teeth to Valplast Preparation for rebase or adding a tooth: Before making any change to a Valplast partial, it is essential to remove all pastes or adhesives from the appliance and the tissue-surface before taking the impression. For tooth addition: Place partial and take pick-up impression. Pour the model promptly and forward it to Keller with instructions to add the missing tooth or teeth. For rebase: Take a light body PVS wash inside the partial and then take a pick up impression. Step-by-Step Rebase and Pick-up Impression Instructions: 1) With appliance seated view the orientation in relation to adjacent teeth and occlusal contacts. 2) Apply tray adhesive to all tissue areas to be relined. Create a reline impression inside the appliance, making sure orientation is the same as before the impression was taken. Have the patient close into occlusion to verify the bite relationship is the same as before the impression was taken. 3) Allow the reline impression material to fully set. 4) With the appliance seated and the reline impression in the mouth select a full arch tray that will fit over the appliance and fully capture all the remaining natural teeth. 5) Take an alginate or VPS impression over the entire arch. 6) Remove the impression when it has fully set. The appliance should remain in the impression, if the appliance remains in the mouth it needs to be removed from the patient s mouth and FULLY seated back in the pick-up impression. If there are any gaps between the appliance and the impression, remove the appliance from the alginate impression and clean out any interfering tag ends of alginate that prevent it from full seating. Only remove the small tags of material that interfere with complete seating of the appliance in the pour impression. 7) If alginate is used pour the impression immediately. If VPS is used continue to #9. 8) Allow stone to set 30 minutes and remove the alginate impression. You should have a model with the appliance seated AND with the reline impression inside. 9) Do not separate the appliance from the model. Forward to the lab as is. 4

5 The Crown with More Brawn than Beauty Introducing: BruxZir Total Zirconia Crowns Benefits of BruxZir Total Zirconia Crowns An esthetic alternative to posterior PFMs with metal occlusals and full-cast crowns. Made with biocompatible medical-grade zirconia. Keller also saves you money with our Free Shipping Program. When you ship multiple cases to Keller in one box, your shipping is FREE. No Shipping Charge. No Bundling Charge. No Kidding! (*Offer only valid in the contiguous United States. Additional charges will apply for overnight service.) Fabricated using CAD/CAM technology for consistent fit. Keller Laboratories, Inc. 160 Larkin Williams Industrial Court P.O. Box St. Louis, MO PAID U.S. POSTAGE PRESORTED STD Address service requested St. Louis, Missouri Louisville, Kentucky Indianapolis, Indiana Kansas City, Missouri ST. LOUIS, MO PERMIT NO After BruxZir: Are You Using The Most Reliable All-Ceramic Material? W Before BruxZir: Keller Locations Education News News from from Keller KellerLaboratories Laboratories Education Lithium Disilicate 2009 Keller Laboratories especially for severe bruxers. BruxZir Total Zirconia Crowns from Keller Laboratories are a new option for posterior restorations. With these virtually unbreakable allceramic crowns, you can provide your patients the strength to withstand severe parafunctional activity and avoid metal restorations. BruxZir is a full contoured solid zirconia crown or bridge with no porcelain overlay. It is glazed with a smooth surface but designed specifically for the posterior with more emphasis on brawn than beauty. Tougher than your average crown, BruxZir restorations are sintered for 12 hours at 1,530 degrees creating a nearly indestructible material. Consider that zirconia is the same element used to make military armour. It simply doesn t get any stronger than this. Because BruxZir has no porcelain veneer, it is more resistant to chipping, cracking or breaking in the mouth than other all-ceramics. Next time you see a patient with a broken crown give BruxZir Total Zirconia a try. Your patient will appreciate the metal-free esthetics and you can appreciate peace of mind knowing that BruxZir is the strongest crown you can provide. Call Keller at for more information or visit us on the web at www. kellerlab.com. IPS e.max Lithium Disilicate: $109 per unit. Captek (high noble): $139 per unit. KZ3 Zirconia: $139 per unit. Conservatively prepare as thin as.1 mm with feather edge margins, much like you would cast gold. Monolithic material makes the restoration completely chip-proof. restorations don t always need to Posterior be pretty, but they do need to be strong, old prices are out of control. The shiny commodity is now selling on the stock exchange for over $1100 an ounce (as of press time). Gold has never been so expensive. We could go into the reasons why the price of gold is skyrocketing but this is a dental newsletter not an economic journal. The important thing to note is Keller has gold-free options for you: Total Zirconia Crowns Ideal for bruxers & grinders who have destroyed other restorations. Don t Worry About Rising Gold Costs G SPRING Fall 2009 hat if I told you that there was a crown and bridge material available with beautiful allceramic esthetics that was as durable as a traditional PFM? IPS e.max monolithic Lithium Disilicate crowns from Keller are the revolutionary material you ve been waiting for. Recent tests led by NYU researcher Dr. Van Thompson, have revealed e.max monolithic Lithium Disilicate to be the most robust all ceramic system to date. Dr. Thompson has tested many materials during his 30 years in biomaterials research including PFM s, zirconia, IPS Empress. Crown specimens in the NYU study were subjected to mouth-motion cyclic fatigue testing which is able to mimic the forces found while chewing. The test is performed by loading the crown specimens through several thousand cycles at a predetermined load. These studies show that e.max has an extremely high strength threshold that challenges even traditional PFM s and outlasts veneered zirconia supported crowns in every measurable way. The weakest link in traditional PFM s and other ceramic restorations is the porcelain layer over An NYU Study Shows e.max Lithium Disilicate Crowns are the Most Robust All-Ceramic System to Date.* the substructure. In many cases the porcelain can chip or fracture from the substructure and ultimately cause the restoration to fail. The Clinicians Report (CR) by Gordon Christianson recently investigated IPS e.max citing new interest in Lithium Disilicate crowns. A survey of the CR Evaluation Group revealed 94% of e.max users would recommend it to a colleague. 97% would purchase it again. And 99% rate it as good or excellent. The CR report concludes that single restorations demonstrate higher in-vitro strength values than any other conventional monolithic and polycrystalline ceramic materials (i.e. IPS Empress CAD or zirconia-based). The CR report also went into detail about the advantages of IPS e.max. The publication asserted that IPS e.max CAD had improved strength over any other ceramic, was highly esthetic with multiple layers of translucency and confimed in-vitro studies demonstrating high durability. Don t forget that you have the option to cement or bond e.max. Give us a call today for more information on IPS e.max Lithium Disilicate crowns from Keller at *Mouth Motion Fatigue and Durability Study; Petra C Guess 1, Ricardo Zavanelli 2, Nelson Silva and Van P Thompson, NYU 1

6 The Crown with More Brawn than Beauty Introducing: BruxZir Total Zirconia Crowns Benefits of BruxZir Total Zirconia Crowns An esthetic alternative to posterior PFMs with metal occlusals and full-cast crowns. Made with biocompatible medical-grade zirconia. Keller also saves you money with our Free Shipping Program. When you ship multiple cases to Keller in one box, your shipping is FREE. No Shipping Charge. No Bundling Charge. No Kidding! (*Offer only valid in the contiguous United States. Additional charges will apply for overnight service.) Fabricated using CAD/CAM technology for consistent fit. Keller Laboratories, Inc. 160 Larkin Williams Industrial Court P.O. Box St. Louis, MO PAID U.S. POSTAGE PRESORTED STD Address service requested St. Louis, Missouri Louisville, Kentucky Indianapolis, Indiana Kansas City, Missouri ST. LOUIS, MO PERMIT NO After BruxZir: Are You Using The Most Reliable All-Ceramic Material? W Before BruxZir: Keller Locations Education News News from from Keller KellerLaboratories Laboratories Education Lithium Disilicate 2009 Keller Laboratories especially for severe bruxers. BruxZir Total Zirconia Crowns from Keller Laboratories are a new option for posterior restorations. With these virtually unbreakable allceramic crowns, you can provide your patients the strength to withstand severe parafunctional activity and avoid metal restorations. BruxZir is a full contoured solid zirconia crown or bridge with no porcelain overlay. It is glazed with a smooth surface but designed specifically for the posterior with more emphasis on brawn than beauty. Tougher than your average crown, BruxZir restorations are sintered for 12 hours at 1,530 degrees creating a nearly indestructible material. Consider that zirconia is the same element used to make military armour. It simply doesn t get any stronger than this. Because BruxZir has no porcelain veneer, it is more resistant to chipping, cracking or breaking in the mouth than other all-ceramics. Next time you see a patient with a broken crown give BruxZir Total Zirconia a try. Your patient will appreciate the metal-free esthetics and you can appreciate peace of mind knowing that BruxZir is the strongest crown you can provide. Call Keller at for more information or visit us on the web at www. kellerlab.com. IPS e.max Lithium Disilicate: $109 per unit. Captek (high noble): $139 per unit. KZ3 Zirconia: $139 per unit. Conservatively prepare as thin as.1 mm with feather edge margins, much like you would cast gold. Monolithic material makes the restoration completely chip-proof. restorations don t always need to Posterior be pretty, but they do need to be strong, old prices are out of control. The shiny commodity is now selling on the stock exchange for over $1100 an ounce (as of press time). Gold has never been so expensive. We could go into the reasons why the price of gold is skyrocketing but this is a dental newsletter not an economic journal. The important thing to note is Keller has gold-free options for you: Total Zirconia Crowns Ideal for bruxers & grinders who have destroyed other restorations. Don t Worry About Rising Gold Costs G SPRING Fall 2009 hat if I told you that there was a crown and bridge material available with beautiful allceramic esthetics that was as durable as a traditional PFM? IPS e.max monolithic Lithium Disilicate crowns from Keller are the revolutionary material you ve been waiting for. Recent tests led by NYU researcher Dr. Van Thompson, have revealed e.max monolithic Lithium Disilicate to be the most robust all ceramic system to date. Dr. Thompson has tested many materials during his 30 years in biomaterials research including PFM s, zirconia, IPS Empress. Crown specimens in the NYU study were subjected to mouth-motion cyclic fatigue testing which is able to mimic the forces found while chewing. The test is performed by loading the crown specimens through several thousand cycles at a predetermined load. These studies show that e.max has an extremely high strength threshold that challenges even traditional PFM s and outlasts veneered zirconia supported crowns in every measurable way. The weakest link in traditional PFM s and other ceramic restorations is the porcelain layer over An NYU Study Shows e.max Lithium Disilicate Crowns are the Most Robust All-Ceramic System to Date.* the substructure. In many cases the porcelain can chip or fracture from the substructure and ultimately cause the restoration to fail. The Clinicians Report (CR) by Gordon Christianson recently investigated IPS e.max citing new interest in Lithium Disilicate crowns. A survey of the CR Evaluation Group revealed 94% of e.max users would recommend it to a colleague. 97% would purchase it again. And 99% rate it as good or excellent. The CR report concludes that single restorations demonstrate higher in-vitro strength values than any other conventional monolithic and polycrystalline ceramic materials (i.e. IPS Empress CAD or zirconia-based). The CR report also went into detail about the advantages of IPS e.max. The publication asserted that IPS e.max CAD had improved strength over any other ceramic, was highly esthetic with multiple layers of translucency and confimed in-vitro studies demonstrating high durability. Don t forget that you have the option to cement or bond e.max. Give us a call today for more information on IPS e.max Lithium Disilicate crowns from Keller at *Mouth Motion Fatigue and Durability Study; Petra C Guess 1, Ricardo Zavanelli 2, Nelson Silva and Van P Thompson, NYU 1

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