October 2019, Volume 12 Issue 10

CR is the original and only independent dental product testing organization with funding only from dentists! ISSN 2380-0429

Carbide Burs—Update 2019

Gordon’s Clinical Observations: Low-cost diamond rotary instruments have long been accepted as similar in performance to diamond
instruments that cost ten times more. What about carbide burs? Are they all equal? Do some break more often? Are they all concentric? Do they
meet the International Standards Organization (ISO) sizes and shapes? This CR study evaluates low-cost carbide burs both scientifically and
also clinically.
Since CR’s last evaluation of carbide burs just a few years ago, several additional brands have become available, some at attractively low prices
(as low as $1.00 per bur). Because of the continued popularity of carbide burs for operative dentistry among North American dentists, CR has
compared and tested these newly available carbide burs.
This report compares the quality, price, and cutting efficiency of various brands of carbide burs.
Continued on Page 2

Laser Dentistry: Where are we today?

Gordon’s Clinical Observations: Lasers have been used in dentistry for many years. Today it is estimated that about 20% of general dentists
have a laser, with the majority being diode lasers. Many clinicians prefer their laser, while others prefer conventional scalpel or electrosurgery
for soft tissue and rotary instruments for hard tissue procedures. Which clinical tasks are best accomplished with a laser? Are there advantages
to one type of laser over another? Can they help to treat the present dilemma of implant failure? CR scientists
and clinicians address these questions in the following report.
Lasers are now in their 60th year, and dental-specific lasers have been available since 1989.
• Use of lasers is gradually increasing as accumulated clinical experience provides a clearer understanding
of their capabilities.
• Initial hopes have not been fully realized—to cut like a “light saber” or target only diseased tissue.
In general, dental lasers continue to be expensive, slow, large, and highly technical compared to
conventional instruments. Class I caries removal using the
infrared beam of a dental laser
• Lasers offer some advantages over conventional modalities in various clinical situations.
The following report provides an update on dental laser technology, shows current developments for treating failing implants, reviews
current laser options, and provides clinical tips on laser implementation.
Continued on Page 3

Effective Products for Isolation and Evacuation

Gordon’s Clinical Observations: There are many types of devices available to provide isolation, retraction,
and evacuation during treatment. They vary significantly in function and cost, and some are reported to be better
than others. Some are unique and address specific needs. This report examines accessories and techniques that
can solve challenges that you may experience in your practice.
A dry field is mandatory for most restorative procedures. The rubber dam is considered the gold standard,
but the ubiquitous cotton roll is probably the most common form of isolation and moisture control used
worldwide. It is supplemented by absorbent gauze; high and low volume evacuation; tissue retraction devices;
and numerous other accessories to create an open and dry field for optimum dental treatment. Numerous other accessories can be
attached to suction valves besides the
The following report highlights effective isolation and evacuation products of various types with their common HVE tip and saliva ejector.
specific functions.
Continued on Page 5

Products Rated Highly by Evaluators in CR Clinical Trials

The following four products were rated excellent or good by CR Evaluator use and science evaluations.
Predicta BioActive Core: Dual- OneFile G Reciprocating Dust-X: Disposable bag with Comlite Software: Intra-office
cured core build-up composite is File: High quality, inexpensive hand holes isolates debris when communication made easy with
easy to use and cuts easily when reciprocating endodontic file adjusting dentures and prosthetics lighted buttons and audible
cured chairside chimes
Continued on Page 8
Attend a CR Dentistry Update near you! For a listing of course dates and locations, visit www.CliniciansReport.org.
A Publication of CR Foundation® • 3707 N. Canyon Rd, Bldg 7, Provo UT 84604 • 801-226-2121 • www.CliniciansReport.org
©2019 CR Foundation®
Clinicians Report 2 October 2019

Carbide Burs—Update 2019 (Continued from page 1)

Improving Your Operative Technique
u Gordon’s “Go-To” Burs for Operative Dentistry
• The following burs are ideal for Class I–Class VI preparations:
– 329, 330: round-end pear, ideal for operative dentistry
– 1156, 1170: round-end straight or tapered fissure burs, for deep box forms
– 1/4, 1/2: small round burs, for adding mechanical retention to facial/lingual aspect of box form
• Bur size for conservative Class II preparations:
– 329: diameter of bur is adequate for width of isthmus on premolars
– 330: diameter of bur is adequate for width of isthmus on molars
• Conservative tooth preparations: Small, conservative preparations reduce chair time, use less
restorative material, preserve tooth strength, and can increase restoration longevity. 329 330 1156 1170 1/4 1/2
• Cross-cut burs (example 557, 556) are NOT advised for operative dentistry. These burs were
designed for now obsolete “belt driven” handpieces. The aggressive cross-cut designs cause heavy chipping of both enamel and dentin. The
flat, non-rounded shape creates sharp line angles in preparations which concentrate stresses and may lead to microfractures and cracks.

Testing of Carbide Burs

Since our last evaluation of carbide burs (January 2017), CR has identified several brands which were not previously evaluated. CR tested
five different brands of (FG 330) carbide burs, compared them to previously evaluated burs, and measured the following characteristics: bur
dimensions (compared to ISO standards), cutting efficiency on plate glass, resistance to breakage, and clinical tactile rating.
Cost/ Head Sterile Overall Cutting Clinical Tactile
Brand, Company Bur Length Packaging Construction Quality Efficiency Rating Overall Grade
Peter Brasseler C-Series 330 FG, Brasseler USA $2.00 2.0 mm No Single Piece Excellent Excellent–Good Excellent Excellent
EdgeBurs FG 330, EdgeEndo $1.00 2.0 mm No Two Piece Excellent Excellent–Good Excellent–Good Excellent
Midwest Once FG 330, Dentsply Sirona $2.32 2.0 mm Sterile Single Piece Excellent Excellent–Good Excellent–Good Excellent–Good
Carbide Burs FG-330, SS White $2.05 1.8 mm Available Single Piece Excellent Good Excellent–Good Excellent–Good
Carbide Burs FG 330, Microdont $2.09 2.1 mm No Two Piece Excellent Good Good Good
Observations from testing:
• Cost/Bur: Price varied from $1.00–$2.32 per bur (distributor pricing per 100 burs shown).
• Head Length: Longer head lengths were generally preferred; longer heads facilitate smooth, fast side-cutting and
improve access in deeper preps.
• Sterile Burs: Available from some companies; generally more expensive than non-sterile versions.
• Bur Construction: Many factors affect bur performance. Single-piece burs experienced less breakage in CR testing,
but overall performance can vary depending on lot or batch (factors beyond control of clinician).
While these FG 330
• Cutting Efficiency: Multiple cuts made through standard plate glass over set time to determine removal rate. burs each meet ISO
• Clinician Tactile Rating: Qualitative grade of bur operation judged by CR clinicians. standards, dimensions vary
• Previous CR Choice Burs (2017) include: Alpen 330 FG by Coltene, FG 330 by Henry Schein, and NeoBurr FG significantly across brands;
important consideration
330 by Microcopy. when cutting preps, using as
depth gauge, etc.
Clinical Tips
• Operative Dentistry Tooth Preparations can be more refined if at least finished with an electric handpiece. NSK, Kavo Kerr, and BienAir
are excellent proven brands. See Clinicians Report May 2018.
• Improving Visibility: Air–water lavage cools teeth and removes debris during heavy cutting. However, light refinement of operative or
crown preparations can be done safely dry without heating pulp; this improves visibility, thus ensuring complete removal of caries and
smoother cavosurface margins.
• Caries Excavation: Removing soft caries using hand instruments (example: spoon excavator) or a slow-speed handpiece and round bur
provides improved tactile ability and reduces unnecessary removal of healthy tooth structure.
• Interproximal Tooth Shields (e.g., FenderWedge by Garrison or Parkell; Triodent Wedgeguard by Ultradent) protect proximal surfaces of
adjacent teeth from inadvertent damage during a Class II preparation.
• Cost Effectiveness of Sterilization and Reuse. 2/3 of clinicians surveyed will sterilize and reuse operatory carbides, often more than once.
Consider the potential costs of reusing burs:
– Reduced cutting efficiency (dulling): On average, burs tested lost 40% of their original cutting efficiency after use and sterilization
(results varied widely) suggesting that reusing burs may increase procedural times and/or require additional force while cutting
(accelerates handpiece wear, increases heat in tooth, etc.).
– Time and supplies for bur processing: Staff members must clean, package, and sterilize burs prior to subsequent reuse.
– Infection control risk: Risk to patients is minimal; however, instrument processing is a common source of sharps injury among staff.
CR CONCLUSIONS: All brands of 330 carbide burs evaluated were clinically acceptable. Carbide burs with highest overall ratings in CR testing
were: Peter Brasseler C-Series 300 FG by Brasseler and EdgeBurs FG 300 by EdgeEndo. Cross-cut carbides and flat-ended burs can lead to
microfractures and decreased longevity of restorations. Single-patient use of dental burs offers improved infection control as well as improved
cutting efficiency (requiring less time and less force for procedures resulting in better outcomes and fewer handpiece repairs).
Clinicians Report 3 October 2019

Laser Dentistry—Where are we today? (Continued from page 1)

Dental Laser Technology
The interaction between lasers and oral tissues is ultimately photothermal, meaning the optical energy is converted into heat, which
vaporizes the tissue. In the case of carbon dioxide and erbium lasers, the laser beam itself most frequently is used to vaporize the tissues. In
the case of diode and neodymium lasers, the beam is usually absorbed in a darkened glass fiber tip converting them into strictly thermal cutting
devices. Like other cutting modalities, observation of the tissue interaction is crucial to adjusting the clinical parameters such as hand speed,
distance, and settings to achieve the desired result. As with other thermal cutting instruments (e.g., electrosurgery), poor control can result
in deep thermal necrosis and osteonecrosis of bone.
u Key Advantages
• Patient Appeal: Factors that positively influence patient perception include high-tech instrumentation; elimination of rotary instrument sound
and feel; perceived analgesic effect; and reduced post-operative sensitivity.
• Precise Control: Wavelength selection, power setting, pulse duration, focus control, etc., allow optical lasers to have precise interaction with
target tissues with minimal collateral damage to surrounding tissues. Lasers with thermal cutting tips are less precise.
• Different Modality: Lasers offer bleeding control, unlike cold steel; no radio-frequency energy, unlike electrosurgery; and no frictional
heating, unlike rotary burs. However, thermal absorption must be carefully monitored.
u Key Limitations
• Cost and Complexity: Most lasers are expensive optical instruments that require knowledgeable operation and careful maintenance of delicate
parts. Solid state diode lasers are generally smaller and less expensive, but still require knowledgeable use.
• Slow: Lasers are primarily end-cutting instruments with minimal tactile feedback. Modification of clinical technique is required. When
properly set to minimize thermal damage to surrounding tissue, they can be significantly slower than other cutting modalities.

When are Lasers Advantageous?

The following examples illustrate some of the clinical situations in which lasers offer advantages.
• Need for quick thermal hemostasis or coagulation • Patients on anticoagulants where simultaneous hemostasis is desirable
• Minor tissue removal without bleeding • Patients unable to receive conventional anesthetics
• Gingival troughing for fixed prosthodontic impressions • Pediatric patients or those with dental anxiety
• Patients with pacemakers or other medical implants where radio- • Reduced post-operative sensitivity related to minimal tissue trauma,
frequency energy is contraindicated swelling, and infection
Virtually any tissue cutting or thermotherapy procedure can be accomplished with an appropriate laser. Those who have become proficient with
lasers recognize their capabilities and are able to use them exclusively or as an adjunct for many clinical tasks.

Laser-Assisted Implant Rescue

Studies with CO2 and erbium lasers demonstrate their abilities to decontaminate periimplantitis sites—removing diseased tissues, cleaning
implant threads, and stimulating bone regrowth with greater improvement than conventional therapies. CO2 lasers are well proven to have
minimal absorption by metal, improving their safety when used directly against implants.

u Non-Surgical Intervention (Stage 2): Narrow tips are inserted into the pocket and direct laser energy toward the soft tissue wall and the
implant body. Tips that direct the energy radially can facilitate the procedure.
A. Radial-firing B. Side-firing
Example Protocol: Example Tips:
1. Ultrasonic debridement for gentle initial soft-tissue debridement (Biolase models shown)
around the implant. A. Radial-firing tip directs energy
2. Laser debridement of the pocket. radially in all directions
simultaneously.
3. Laser decontamination of implant, directing energy to clean
exposed threads. B. Side-firing beveled tip directs
energy in direction indicated by
4. Laser decortication to detoxify and stimulate the bone to handle. Handle swivels the tip
regenerate. to aim.

Example Case:

Initial observations by CR Clinician Evaluator: Implant

maintenance performed using laser resulted in cleaner
appearing implant body on radiograph. At 6-week recall,
the tissue health was superior to previous treatments using
conventional instruments. Recall interval was increased to three
months instead of one month.
Pre-op 6 weeks post-op

u Surgical Intervention (Stage 3): Lasers can be used to lay the flap, remove granulation tissue on implant, debride the soft tissue, and for
bone decortication (with or without subsequent bone grafting).
Clinicians Report 4 October 2019

Laser Dentistry—Where are we today? (Continued from page 3)

Current Dental Lasers
The following is a concise summary of current dental laser technology based on CR’s training, use, and
observation of numerous clinical lasers. Capabilities and indications of individual devices may vary. Initiated tip

u Diode Lasers Lightweight fiber optic

and handpiece
• Infrared wavelengths of 810, 940, 980, and 1064 nm; principle chromophore (absorber) is tissue
pigmentation, but beam is usually absorbed in initiated fiber tip.
• Primary indications are soft tissue procedures, including soft tissue management for fixed prosthodontics.
• Flexible fiber optic delivery with lightweight handpiece; small, solid state devices
• Most frequently used with “initiated tip” for contact cutting. “Initiation” is darkening the tip to absorb laser energy to Epic Pro (Biolase)
become extremely hot. Hot tip becomes thermal cutter for vaporizing tissue. diode laser
• Simple and fast for small sites: “bleeders,” tissue tags, gingival troughing, etc.
• Slower and more shallow cutting than either scalpel or electrosurgery.
• Typical cost range: $2,500–$10,000 LightWalker ATS (Fotona) dual
• Example brands: Epic Pro (Biolase), Picasso Lite (AMD Lasers), Gemini (Ultradent) Nd:YAG and Er:YAG laser

u Neodymium Lasers (Nd:YAG)

• Infrared wavelength of 1064 nm; principle chromophore is tissue pigmentation, but beam is usually absorbed in initiated fiber tip.
• Primary indications are soft tissue procedures and photobiomodulation (laser-induced thermotherapy).
• Flexible fiber optic delivery with lightweight handpiece.
• Extensive use in medicine including dermatology, cosmetics, hair removal, etc.
• Higher wavelength can be more selective for diseased tissue and pathogens (sulcular debridement, for example).
• Pulse control can produce deep tissue penetration for thermotherapy (example: tissue tightening to open airway and reduce apnea).
• Example brand: LightWalker ATS (Fotona) $75,000
Waterlase Express (Biolase)
u Erbium Lasers (Er:YAG; Er,Cr:YSGG) Er,Cr:YSGG laser
• Infrared wavelengths of 2940 and 2780 nm; principle chromophores are water and hydroxyapatite.
• Primary indications are hard and soft tissue procedures.
• Delivery systems vary: semi-flexible fiber optic with lightweight handpiece or waveguide in articulated arm.
• Usually non-contact cutting with beam emitted from various types of tips. Solea (Convergent Dental)
• Good absorption for ablation of hard and soft tissues with minimal thermal damage. CO2 hard and soft tissue laser
• Typical cost range: $45,000–$75,000
• Example brands: Waterlase Express (Biolase), LightWalker ATS (Fotona)
u CO2 Lasers
• Infrared wavelengths of 10600 nm (soft tissue) and 9300 nm (soft and hard tissues); principle chromophores are
water and hydroxyapatite. US20 (DEKA)
• Primary indications are soft and hard tissue procedures. CO2 soft tissue laser
• Delivery systems vary: semi-flexible waveguide with lightweight handpiece or waveguide in articulated arm.
• Usually non-contact cutting with beam emitted from various configurations of handpieces and tips.
• Excellent absorption by water for rapid ablation of soft and hard tissues with minimal thermal damage.
• Typical cost range: $25,000–$125,000
• Example brands: UltraSpeed 20 (DEKA); LS-2010 (LightScalpel), Solea (Convergent Dental) LS-2010 (Light Scalpel)
CO2 soft tissue laser
Clinical Tips
• Advanced Training: The unique capabilities of each laser wavelength and specific features of each laser brand make it prudent to seek
training in all wavelengths before purchase and to carefully review the options to ensure that your choice best suits your desired clinical uses.
• Patient and Procedure Selection: Utilize the laser where its unique capabilities provide the best opportunities for improved treatment and
outcomes. As your experience builds, the laser will increasingly become a valuable adjunct to existing instrumentation.
• Protective Eyewear: Laser radiation is invisible and potentially damaging to the eye. The patient, operator, and auxiliaries should all wear
filters for the specific wavelength used. This precaution should be noted in the patient record.
• Laser Plume: The smoke plume (like electrosurgery) can harbor toxins and pathogens. High velocity evacuation should always be used to
capture the plume. High filtration respirator masks provide better protection from laser plume than conventional aerosol masks.
CR CONCLUSIONS: Clinical use of lasers continues to grow, and they are having a greater impact on dentistry and medicine as a whole.
• Medical lasers are well accepted in ophthalmology, otolaryngology, plastic surgery, dermatology, etc.
• Dental lasers are still considered optional by most clinicians, but have proven to be a valuable adjunct and may be the preferred treatment
modality based on the need for hemostasis, lack of radiofrequency energy, precision interaction with tissues, analgesic effects, etc.
• High cost, training requirements, modification of clinical technique, and overall complexity of lasers are significant limitations.
• Lasers can assist in building a practice through patient perception of high-tech instrumentation and a different treatment experience.
After 60 years, lasers still evoke a certain mystique, for better or for worse. Today, their clinical capabilities and limitations are better
understood which has increased their successful and beneficial use. Recent developments in laser-assisted treatment of failing implants is
showing particular promise.
Clinicians Report 5 October 2019

Effective Products for Isolation and Evacuation (Continued from page 1)

Comparison of Concepts
The following categories of products have proven to be popular and effective. Example brands are listed; numerous additional brands are available.
Cotton Rolls and Gauze High Volume Evacuation (HVE) Saliva Ejector

Features: Simple; fast; low cost; disposable;
absorbent; can be trimmed to fit; provide some
retraction and protection of surrounding tissues;
specialized holders are available
Limitations: Frequent replacement; can impede access
or snag instruments and burs
Absorbent Wafers
Features: High flow captures aerosols, debris, and
lavage close to where they are generated; simple;
fast; low cost; disposable; strong enough to retract
lips, cheek, or tongue
Limitations: Noisy; heavy hose; tip can lacerate
patient gingiva
Consider: Soft-coated tips; vented tips to allow easier
break-away when soft tissue inadvertently occludes
opening
Features: Simple; fast; low cost; disposable; bends
to desired shape; quiet; intermittent or continuous
evacuation of pooled liquids; positioning can be
delegated to patient
Limitations: Heavy hose; too flexible for effective
retraction; backflow concerns when patient closes
around tip
Consider: Built-in wire or malleable material to bend
to desired shape for access or positioning

Lip Retraction Rubber Dam

Features: Simple; fast; low cost; disposable; covers

salivary gland; absorbent; protects underlying
tissue; reflects light for better visibility; available
for both cheek and sublingual areas
Limitations: Occasional replacement; may not stay
in place; may adhere to tissues (use water spray to
release)
Approximate cost: 3¢–36¢ each
Example Brands: NeoDrys (Microcopy); Dri-Angle
(Dental Health Products); DryDent (Directa/
Parkell)
Hands-Free Saliva Ejectors
Features: Simple; fast; disposable; hands-free
retraction of lips and cheeks; excellent for anterior
procedures (restorations, veneers, bleaching, crown
seating, etc.)
Limitations: Experience required for quick and
effective placement (moisten before insertion); lips
can sometimes slip out
Approximate cost: ~$2.00
Example Brand: Optragate (Ivoclar Vivadent)
Combination Isolation Systems
Features: Gold standard for isolation; relatively
simple; low cost; disposable; retracts tongue, cheek,
and lips; inverts gingiva; protects against aspiration
or swallowing of debris; provides excellent
visibility
Limitations: Training and experience required for
quick and effective placement
Consider: Hygenic Dental Dam and clamps by
Coltene; Non-latex dams with built-in frame (e.g.,
Flexi Dam Framed by Coltene; Insti-Dam by Zirc)
Bite Blocks / Mouth Props

Features: Simple; fast; low cost; disposable;

evacuates pooled liquid; hands-free; deflection of
tongue
Limitations: Can be bumped out of position
Approximate cost: 18¢–$1.18 each
Example Brands: Hygoformic (Orsing, Directa, or
others); Dentapops (Primotec)
Consider: Some have built-in mouth prop (e.g,.
Dentapops); others are malleable for customizing
tongue retraction (e.g., Hygoformic)
Features: Retracts tongue and cheek; evacuates
liquid and aerosols; protects against aspiration or
swallowing of debris; built-in bite block to maintain
opening; excellent visibility
Limitations: Large, not tolerated by some patients;
expensive initial setup; occupies a high velocity
line; cleaning and sterilization of some parts
Approximate cost: ~$2.50/patient (initial setup as
high as $1,900)
Example Brands: Isolite i3 (Zyris); Mr. Thirsty One-
Step (Zirc); DryShield (DryShield)
Consider: Isolite i3 provides built-in illumination; see
Clinicians Report May 2015 for additional details
Features: Simple; fast; disposable or reusable
versions; maintains access; allows patient to relax
Limitations: Jaw discomfort after use; concerns about
swallowing
Approximate cost: 49¢–$17.00 each
Example Brands: RINN EZ-Prop (Dentsply Sirona);
E-Prop Mouth Prop (Practicon)
Consider: Some bite blocks are designed to hold the
saliva ejector, and some evacuators have built-in
mouth props

u CR Suggested Products for Isolation, Evacuation and Moisture Control

• HVE: Soft-coated tips for patient comfort (Soft Touch Oral Evacuation Suction Tips by Mydent; Safe-Vac Evacuation Tips by Safe-Vac; etc.)
• Saliva Ejectors: Soft-coated tips for patient comfort (Total-Comfort Aspirators by Practicon; etc.)
• Absorbent Wafers: NeoDrys by Microcopy; Dri-Angle by Dental Health Products; DryDent by Directa; etc.
• Rubber Dam: Considered standard of care for endodontics; Hygenic Dental Dam, Clamps, and Wedgejets stabilizing cord by Coltene;
light-cured resin for repairs of rubber dam leaks (Chairside Block Out Material by Zest, OraSeal by Ultradent)
• Hands-Free Saliva Ejectors: Hygoformic Saliva Ejector by Orsing, Directa, others; Dentapop by Primotec
• Combination Isolation Systems: Isolite i3 by Zyris; Mr. Thirsty One-Step by Zirc; DryShield by DryShield
Clinicians Report 6 October 2019

Effective Products for Isolation and Evacuation (Continued from page 5)

Comparison of Concepts (Continued)
The following chart summarizes key features and capabilities of major types of isolation and evacuation products. Individual brands may have
additional features. If you experience challenges maintaining a dry field, this chart and the preceding explanations can guide you to suitable
solutions.

Surrounding Tissue
Debris, and Lavage

Maintains Opening
Removes Aerosols,

Illuminates Field
Retracts Gingiva
Removes Pooled

Retracts Tongue
Protects Airway

Retracts Cheek
Blocks Liquid

Retracts Lips

Protects
Liquid

Category
Rubber Dam — — 4 4 4 4 4 4 4 — —
Combination Isolation System 4 Some — — — — 4 4 4 4 Some
High Volume Evacuation — 4 — — — — 4 4 — — —
Hands-Free Saliva Ejector 4 — — — — — Some — — Some —
Lip Retraction — — — — — 4 — 4 — — —
Absorbent Wafers — — 4 — — — — Some 4 — —
Cotton Roll — — 4 — — — — — 4 — —
Saliva Ejector 4 — — — — — — — — — —

• No single product type provided all desired isolation and evacuation features.
• Multiple products are required, depending on the clinical situation, to provide optimum dry field results.

Clinical Tips
• Protecting the Oral Mucosa: A common post-procedural patient complaint is soft tissue laceration caused by the high velocity tip.
Auxiliaries should be attentive to not leverage the tip into the tissue. Tips with soft coatings may also help prevent injury.
• Rubber Dam Clamps. Properly sized clamps which fit the tooth, and heavy, tear-resistant dam material make placement more predictable.
Gordon’s suggested rubber dam clamps:
– Anterior: #9, (#212 class V on single rooted teeth)
– Premolar: #0, #00,
– Molar: #4, #5, #7, (14A, 8A for partially erupted molars)

Rubber Dam Clamp #9 Rubber Dam Clamp #212 Rubber Dam Clamps #0, #00 Rubber Dam Clamps #4, #5, #7 Clamp #14A Clamp #8A

• Attentive Assistants: Educating and involving auxiliaries in dry field is vital. In many situations an additional assistant may be needed to
maintain adequate isolation.
• Surgical Suction Tips: Small diameter tips remove blood with minimal disturbance of soft tissue, but appropriate
steps should be taken to ensure sterility. Suction valves and lines are highly contaminated. An autoclaveable
adapter (ACE, Salvin, etc.) attaches to the high velocity valve which remains anchored in its holder and provides
an attachment point for lightweight, autoclaveable, silastic tubing. Various surgical suction tips can then be used,
providing safe, ergonomic evacuation.
• Back-Flow Prevention: Instructing patient to close around suction tip can facilitate removal of oral fluids, but studies Surgical suction adapter
show increased risk of back-flow (with possibility of cross-contamination). Anti-back-flow valves are available. CR with attached lightweight
has not yet been able to confirm or refute these claims. silastic tubing (Salvin)

• Amalgam Separators: A future Clinicians Report will specifically address amalgam separators on the evacuation line.

CR CONCLUSIONS: A dry field is mandatory for many dental procedures. Train and utilize auxiliaries to help accomplish this goal. Rubber dam
provides the highest level of isolation and is considered the gold standard, especially for endodontic procedures. Select and use appropriate
products to prop the mouth open; retract lips, cheek, and tongue; protect soft tissue; evacuate water and aerosols; and maintain good visualization.
Numerous accessories exist to address specific challenges beyond the utilitarian HVE and saliva ejector tips.

Join Gordon for a CR Dentistry Update!

Visit www.CliniciansReport.org for dates and locations.
Clinicians Report 7 October 2019

You read the report, now earn easy affordable CE!

REQUIRED: Participant Information: please print. For additional participants, copy this page and list requested information.

Name__________________________________________________________ Email__________________________________________________________

Address________________________________________________________ Phone_________________________________________________________

City___________________________________________________________ State_________________________ ZIP____________________________

q  Please send my test results directly to the Academy of General Dentistry. AGD#______________________________________________________________

Annual Enrollment Fee for 2019. Select one: Payment Method:  q Visa q MC q AMEX q Discover q  Check payable to CR Foundation
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CID___________
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Earn 1 credit hour for successfully completing each test. Tests are also available at www.CliniciansReport.org. This is a self-instruction program.
At the completion of this test, participants should be able to:
• Compare and evaluate carbide bur brands • Contrast isolation and evacuation products of various types
• Discuss current laser technology in dentistry • Evaluate new products and their potential clinical usefulness
Self-Instruction Test, October 2019, 1 CE  Check the box next to the most correct answer.
1. Which of the following is not a benefit of using single-use burs? 6. Which statement regarding isolation and evacuation is false?
q  A. Improved cutting efficiency CE te st on lin e q A. Rubber dam is considered the gold standard for isolation and dry field.
Take your
q  B. Improved infection control ce iv e im m ed ia te results! q  B. Combination isolation systems provide the greatest number of
and re org
iansRepor t.
q  C. Use fewer burs www.Clinic simultaneous isolation and evacuation functions.
q  D. Reduced time processing/sterilizing burs q  C. Saliva ejectors must be continuously held and positioned by the
clinician or staff.
2. Which of the following statements regarding FG 330 carbide burs is true?
q  D. High velocity suction tips collect aerosols and debris close to
q  A. All 330 burs are identical, per ISO standards.
where they are generated.
q  B. All 330 burs have a round-end pear shape, per ISO standards.
7. Predicta BioActive Core:
q  C. All 330 burs have a welded, two piece construction.
q A. Has confirmed release and uptake of calcium, phosphate, and fluoride.
q  D. All 330 burs are available in sterile packaging.
q  B. Is available in two desirable viscosities: flowable and stackable.
3. Which statement regarding dental lasers is false?
q  C. Is available in both white and tooth shade.
q  A. Laser photo energy is converted into heat, which vaporizes tissue
q  D. Both B and C
and water.
q  B. Thermal damage and tissue necrosis can result if heat is not 8. OneFile G Reciprocating Files:
properly controlled. q A. Utilize a unique motor and handpiece and require proprietary settings.
q  C. Patients are afraid of lasers and do not want to be treated with q  B. Are fabricated from flexible stainless steel.
them. q  C. Are produced with a unique shape from memory NiTi alloy.
q  D. Lasers are safer, in some aspects, than other cutting instruments. q  D. Are premium priced.
4. Which statement regarding dental laser applications is true? 9. Dust-X:
q  A. Soft tissues usually bleed when cut with a laser. q  A. Is an inexpensive way to contain debris while trimming chairside.
q  B. Some lasers can be used to decontaminate implant bodies without q  B. Reduces the mess and dust from trimming dentures and other
laying a flap. prosthetics chairside.
q  C. Lasers usually cause more swelling, inflammation, and post-op q  C. Is easy to use.
sensitivity than conventional cutting instruments. q  D. All of the above
q  D. Because dental laser radiation is invisible, it can’t hurt the eyes. 10. Comlite Software:
5. Which of the following suction devices is often least effective for cheek q  A. Adjusts the amount of blue light emitted from computer monitors
and tongue retraction? to provide a calming effect.
q  A. Saliva ejector q B. Requires wiring light boxes into each operatory, lab, and office space.
q  B. High velocity evacuation tip q  C. Utilizes the existing computers and monitors throughout the
q  C. Hands-free saliva ejector practice to display staff and patient activity.
q  D. Combination isolation system q  D. Uses voice activation to record patient, staff, and doctor activity.

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 Clinicians Report 8 October 2019

Products Rated Highly by Evaluators in CR Clinical Trials (Continued from page 1)

Dual-Cured Core Build-Up Composite is Easy to Use and Cuts Easily when Cured
Predicta BioActive Core is dual-cured, zirconia reinforced nano-filled composite. Contains calcium, phosphate,
Predicta BioActive Core and fluoride (mineral release has not been tested by CR). This core material has both strength and enhanced
Parkell cutability. Two viscosities/consistencies available: stackable and low viscosity flowable. Both viscosities are
available in either white or tooth shade.
Advantages: Limitation:
• Convenient and easy to use delivery system • As with other resin-based materials, mineral
• Easy to cut once cured release is not expected to be high enough for
• Viscosities allow clinician to choose stackable or flowable sustained bioactivity.
CR CONCLUSIONS: 76% of 38 CR Evaluators stated they would incorporate Predicta BioActive Core into their
$70/5-ml Dual-Barrel
practice. 92% rated it excellent or good and worthy of trial by colleagues.
Syringe ($13.99/ml)

High Quality, Inexpensive Reciprocating Endodontic File

The OneFile G system is designed to efficiently shape canals in a reciprocating motion. They are compatible
OneFile G with all reciprocating handpieces. OneFile G are produced with a unique shape from memory NiTi alloy.
Reciprocating File Available in assorted pack or individual sizes.
Pac-Dent
Advantages: Limitation:
• Easy to use • Color-coded files are not labeled with
• Files are flexible and conform to the shape of canal text, and white color code used twice
• Files cut well, fast, and efficiently was confusing
• Similar performance as WaveOne Gold files at economical price
CR CONCLUSIONS: 75% of 20 CR Evaluators stated OneFile G was the same or better than the file they currently
use. 65% would incorporate it into their practice, and 85% rated it excellent or good.
$5.40/File

Disposable Bag with Hand Holes Isolates Debris when Adjusting Dentures and Prosthetics Chairside
Disposable bag made of 3 mil clear plastic has hand access holes on each end providing a way to adjust
Dust-X dentures and prosthetics chairside and contain the cutting debris that may be considered carcinogenic. Designed
Yates Motloid to minimize particles and aerosols generated during adjustment from the work environment and contain them
within the bag.
Advantages: Limitations:
• Easy to use • Plastic can be hard to see through
• Collects and reduces debris while adjusting chairside • Inserting prosthetics, handpiece, hands, and cutting
• Less mess and easier cleanup within bag can be challenging
• Good size
$30/Box of 20 ($1.50/Bag) CR CONCLUSIONS: Dust-X provides an inexpensive and convenient way to contain debris and aerosols when
adjusting dentures and prosthetics chairside. 78% of 23 CR Evaluators rated it excellent or good.

Intra-office Communication Made Easy with Lighted Buttons and Audible Chimes
Comlite Systems has provided simple intra-office communications since 1984. The new Comlite
Comlite Software communication software creates a visual view that displays staff and patient activity throughout the office.
Comlite Systems Comlite communicates on any Windows PC or Windows device as well as any mobile device, including tablets
and phones. It communicates by using lighted buttons and audible chimes to represent people, tasks, and
locations. It has text functionality and can be customized for individual offices and staff needs.
A recent survey of 44 users reported:
• Installation: 93% very easy to easy • 84% use Comlite with every patient
• Customize: 96% very easy to easy • 84% notify doctor and hygienist of patient arrivals
• Start utilizing: 83% very easy to easy • 82% notify doctor to come for a hygiene exam
$35/Month up to 6 • Provided training: 82% excellent to good • 84% improved flow and scheduling
computers • 91% pleased with technical support • 81% reduced patient wait times
$45/Month 7–15 computers
CR CONCLUSIONS: Comlite Software is a well-established and simple way to communicate within a busy
$60/Month 16+ computers
practice. 91% of 44 users stated they would purchase Comlite again after knowing what they have experienced
with the software.

Products evaluated by CR Foundation® (CR®) and reported in the Gordon J. Christensen Clinicians Report® have been selected on the basis of merit from hundreds of products under evaluation. CR® conducts research
at three levels: 1) multiple-user field evaluations, 2) controlled long-term clinical research, and 3) basic science laboratory research. Over 400 clinical field evaluators are located throughout the world and 40 full-time
employees work at the institute. A product must meet at least one of the following standards to be reported in this publication: 1) innovative and new on the market, 2) less expensive, but meets the use standards,
3) unrecognized, valuable classic, or 4) superior to others in its broad classification. Your results may differ from CR Evaluators or other researchers on any product because of differences in preferences, techniques,
product batches, or environments. CR Foundation® is a tax-exempt, non-profit education and research organization which uses a unique volunteer structure to produce objective, factual data. All proceeds are used to
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