Dr. Samuel Waknine talks to New York Cosmetic Dentist Dr. Judy Johnson, Chief Medical Officer; Dental Visits Midtown Manhattan NYC Center for Cosmetic Dentistry, about the importance and advantages of using optimum materials in modern restorative dentistry. Dr. Waknine is President of DRM Research Labs, which is mostly involved in research and development. He lectures at the academic and private sector level, providing either operative or technological instruction to clinicians and technologists all over the world.
(Question) New York Cosmetic Dentist Dr. Judy Johnson: Do you think markets in the United States, or Central and Eastern Europe are ready for products with high aesthetic quality and state of-the-art materials?
(Answer) Samuel Waknine DDS: I think so! I have had a vast amount of experience lecturing worldwide and interacting both in the industrial sector as well as in the clinical and academic sector with many technologists, professors and clinicians whether it is in Lithuania, the Czech Republic, Poland or Russia. Indeed such materials are becoming more and more popular in those venues due to the fact that firstly, they are easier to use, secondly, they require less machinery and equipment in the laboratory and thirdly, chair-side time is significantly reduced.
The main disadvantages to this more sophisticated material is that it requires a dry field of operation during the momentary placement procedure, however, I think the advantages outweigh the disadvantages due to the fact that one has a material that is functional, aesthetic, matches tooth color, that is serviceable and is biocompatible, healthier overall compared to the traditional silver amalgam fillings and the standard crown and bridge alloys; nickel chrome, chrome-cobalt and silver-palladium products.
With traditional materials it takes two to three days and an innumerable amount of equipment, instruments and adjunct materials before a crown or a bridge is fabricated, whereas with our materials one is able to fabricate a rather vast or large restoration in less than one hour. So from a time, effort and equipment perspective, this is the preferred methodology for the laboratory.
(Question) New York Cosmetic Dentist Dr. Judy Johnson: Are there any other advantages of modern restorative materials?
(Answer) Samuel Waknine DDS: If we looked at a dental restoration in a chronological manner from infancy to adulthood, from pediatric dentistry to geriatric dentistry, we start out with a little tiny one-surface cavity, that escalates to a two-surface filling, then possibly leaks and has to be repaired and becomes a pin-retented three - or four-surface silver amalgam filling undermining the surrounding enamel, and then onward to a crown (usually poorly adapted or sealed), followed by endodontic treatment and a post/core build-up encapsulated by a crown prosthesis and possibly an extraction, even a bridge, usually non precious alloy (porcelain fused to metal), subsequent alveolar bone resorption and then possibly a removable prosthesis; partial or denture followed by ridge augmentation and possibly an implant.
Because silver amalgams are very limited they usually have to be repaired somewhere down the line. By the time they have to be repaired, the carious lesion site usually has progressed so vastly that it invariably turns into a three-quarter crown or a full crown. On occasions, one even has to resort to crown and bridgework.
The approach with the new modern poly-ceram restorative materials is that if one can achieve a very good seal at a tooth restorative interface, which is really the hub or area of concentration of the technology, and then one can reduce the possibility of having to remake the restoration and ensue this very tedious and complicated voyage. This is not the case with the advanced restorative materials. If there is a failure it tends to be rather minor and require very quick patch-up and repair at the adhesive interface and so the incidences of secondary caries, remakes or repairs is significantly lower in potential expenditure and tooth loss. Which is a massive advantage whether you are in Prague, London or New York City.
(Question) New York Cosmetic Dentist Dr. Judy Johnson: What about the issue of durability?
(Answer) Samuel Waknine DDS: That is a very good point. There is a propensity to judge today’s restoratives of the poly-ceram category by ‘bunching them' with those of 40 years ago, particularly among dentists who were accustomed to those products then. However, composites or bonding materials from 40 years ago are a far cry from what is available today. Since then, we have gone through about seven generations of products and probably tens of thousands of research projects documented in the form of manuscripts and patents, so there has been a good deal of innovative progression in this field of technology.
Consequently, today there are several products that are very reliable. From the perspective of wear resistance, today’s restoratives are able to sustain wear that is as low as three micrometers per year - which rivals actual enamel. This compares with 40 years ago when it was 150 micrometers per year. According to statistics from pooled clinical data, today’s restoratives have an average half-life of 17-22 years, which is very close to a silver amalgam restoration and or porcelain fused to metal crown. From a color stability perspective these products no longer have residual oxide by-products, they tend to be very stable and tend to maintain their anatomical form, contour and texture and overall physico-mechanical functional state. So yes, there are still some materials today that are not very reliable, and then, there are a few materials that are extremely advanced and are capable of rivaling any metallurgical or ceramic adjunct material.
(Question) New York Cosmetic Dentist Dr. Judy Johnson: Would you say that while these materials might perhaps be slightly more expensive, in the long run they save so much time that they work out to be more economical?
(Answer) Samuel Waknine DDS: Well, cost is certainly one element, but in today’s society people are more health conscious and aesthetically aware, which are also factors that need to be considered. I think that a silver restoration for a posterior molar tooth is 50/50. No one looks back there so it may not be too important. However, for an anterior restoration there is really no choice in the matter, the thought of seeing gold or silver as you smile is rather awkward, therefore, more aesthetically pleasing materials become a matter of necessity. So for the anterior sector of the intra-oral environment it is a necessity. Furthermore, as far as the laboratory technician is concerned, modern materials are quicker and easier to use so there is really no reason why they should not be chosen.
Author Resource:-
New York Cosmetic Dentist Dr. Judy Johnson and Dental Visits Midtown Manhattan NYC Cosmetic Dentistry Center now accepts dental insurance health plans for most dental care. For more information about this New York Dentist, cosmetic dentistry, dental implants, veneers or topics on dental visits http://www.dentalvisits.com
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