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Smart Buys Louis Malcmacher, DDS, MAGD

More by this author (9)
Smart Buys
by Louis Malcmacher, DDS, MAGD
Every quarter, Dr. Louis Malcmacher scours the dental equipment landscape for the latest innovations that will have the greatest impact on dentists and their patients. Dr. Malcmacher studies the trends, responds to peer recommendations and in some cases puts these products to use in his own practice to test their mettle. This month, Dr. Malcmacher turns his focus on products from Trident Dental Laboratories; Coltène/Whaledent, Inc.; OraPharma, Inc.; and Dentatus USA.
BiteSoft Anterior Splint from Trident Dental Laboratories





BiteSoft Anterior Splint		 It is estimated that nearly one third of people in North America are bruxers and clenchers. A good bruxism appliance protects the integrity of your dental work and the investment patients make in their smiles. More often than not, the demand for an aesthetically pleasing smile goes hand in hand with patients committing to a major investment for their restorative treatments. Over time, bruxism and clenching can damage natural dentition and dental restorations if left undiagnosed.

When I lecture, the one question I get all the time is, "Which bruxism appliance do you use in your practice?" Like most dental offices, I have been through quite a few. Each bruxism device has distinct advantages and disadvantages and I could not use one bruxism appliance routinely for all the different restorations, aesthetic cases and reconstructions that I do. Until now ...

Now I use one bruxism appliance everywhere — the BiteSoft Anterior Splint by Trident Dental Laboratories. The BiteSoft Anterior Splint is a custom-fitted appliance to be worn over the six upper anterior teeth from cuspid to cuspid as much as possible. It has a patented lingual ramp that helps establish mandibular stability and relaxation of tense jaw muscles. It also has a patented soft material on the inside of the appliance and a hard polymer resin on the outside. Why does this matter? If I have just done a veneer case or anterior crowns, a hard acrylic snap-in-place bruxism appliance, whether it covers two or 16 teeth, is going to put a lot of stress on anterior porcelain restorations. This can cause me a lot of stress when patients return with loose crowns or microcracks in their porcelain restorations that were not previously there. Patients of mine who've found full-mouth splints cumbersome are much more able to tolerate the BiteSoft splint for its comfort.

I have my patients complete Trident's self-assessment test for bruxism provided in their BiteSoft brochure, which helps my patients determine if they have experienced any symptoms most likely associated with bruxism. Trident also provides the dentist with a free BiteSoft Anterior Splint model for demonstration to the patients.

Why not protect your patients' investments and the integrity of your dental work? If a patient is having six or more units of indirect restorations done, I just give them a BiteSoft appliance and build it into the entire fee.

Smart Buy Summary: When discussing restorative options with patients, make sure you factor in the importance of protecting the integrity of your work with BiteSoft. It helps provide that extra assurance in preventing bruxers who just received new veneers from coming back to your office because they fractured or popped off a veneer. Put your patients into a BiteSoft Anterior Splint — they will be more comfortable and sleep better, and you will sleep better knowing the dental treatment you provided is better protected.

Affinis Precious from Coltène/Whaledent, Inc.

Affinis Precious		 Not all impression materials are all alike; there are major differences in certain properties such as readability, flow rates and tear strength. Coltène/Whaledent was the first company to introduce A-silicone impression materials back in 1975 and now, with its latest vinylpolysiloxane (VPS), the company offers a higher level of performance from a wash and heavy body combination — Affinis Precious — and it has become my favorite wash material for achieving accurate, void and distortion-free impressions.

What makes Affinis Precious unique is a combination of extraordinary readability and flow properties. With its silver and gold metallic colored pigments, Affinis Precious delivers unmatched visual clarity of margin detail. The pigmentation drastically reduces the light-scattering effect, thus improving the readability of the margins. This makes it much easier for me to assess the impression result, which is a major advantage. Additionally, these unique colors provide an increased contrast between the wash and tray materials. Since working with this material, the guessing game of perfect margins is eliminated and I no longer require re-takes because of unfound inaccuracies.
Improving on the properties of its predecessors (President and Affinis), the Precious materials provide exceptional flow, and self-leveling properties. There has been a recent push to include surface optimizers in the impression technique. One thing I do not need is another step to add to my impressions. With Affinis Precious, there is no need for expensive and time-consuming surface optimizers. When applied around the preparation, the low-contact angle significantly improves adaptation of Affinis Precious to the tooth and gingiva, thereby providing excellent detail of the preparation margins. With a maximum working time of one minute and a minimum oral setting time of two minutes, I can easily syringe material around single- and multiple-unit preparations without slumping and dripping, which is especially important in the maxillary arch.

The other end of a perfect restoration involves the technical expertise of my dental lab. And my lab technician could not be happier with my choice of materials. He contacted me recently and commented on how easy it was to work with Affinis Precious. This is because, once Affinis Precious is cured, the wet gypsum can flow easily into the impression, thereby producing more accurate models, which are essential for the lab technician to create proper fitting restorations.

I am also a huge proponent of the wide variety of impression material dispensing systems and tools available from Coltène/Whaledent. In addition to the standard 50ml cartridge system, Affinis Precious is also available in Coltène/Whaledent's microSystem delivery dispenser. The microSystem packaging contains four 25ml cartridges of silver or gold wash, 20 mixing tips and 20 oral tips. We like it because the compact and ergonomic design of the dispenser provides greater intra-oral control. I also save a lot of money because the microSystem dispenser reduces mixing tip waste as compared to traditional mixing tips. For tray material I prefer the unique 75ml Heavy Body cartridge that provides 50 percent more material than the standard 50ml size. Now, we can do two full-arch or four quadrant impressions without changing cartridges.

Smart Buy Summary: Affinis Precious wash material provides the perfect balance of excellent working properties and results. Its unique flow properties and readability make it easy for the dentist and the lab technician to seamlessly work together to obtain perfect fitting restorations. In combination with Affinis Heavy Body, I found it to be an excellent wash material that takes the VPS category to a new level.

Arestin from OraPharma, Inc.

Arestin		 Everyone is looking for faster, easier and better minimally invasive dentistry. These concepts also apply with treatment of the supporting structures, including the periodontium. Periodontal therapy is completely different presently; it is not the same as you learned during dental school. We did not have the armementarium that we have today.

Arestin is a perfect example of this. If there is a periodontal infection, Arestin allows us to put the antibiotic right where it belongs to treat it effectively. It is a locally administered antibiotic (LAA) that is indicated as an adjunct therapy to scaling and root planing (SRP) and periodontal maintenance procedures for reduction of pocket depth in patients with moderate to severe periodontitis. It's really important to understand that it is an adjunctive therapy and that is when it works best.
Arestin is minocycline hydrochloride 1mg and uses a unique microsphere technology delivery system to kill the bacteria and reduce the inflammation that cause periodontal disease. Arestin requires no preparation and is easy to administer. Arestin microspheres are bioadhesive, bioresorbable polymers in powder form produced by a microencapsulation process. Once Arestin is administered, it immediately adheres to the periodontal pocket. The crevicular fluid hydrolyzes the polymer causing water-filled channels to form inside the microspheres. These holes provide "escape routes" for the encapsulated antibiotic for sustained release. The active drug dissolves and diffuses out of the microspheres through the channels into the surrounding tissue. Eventually, the microspheres are completely bioresorbed. Arestin maintains therapeutic drug concentrations for up to 21 days, and the localized delivery provides an effective drug concentration at the site of infection.

Clinically, the application is so easy. Arestin is supplied in pre-filled cannulas with a special applicator. It looks like a syringe and I always make it a point to tell patients that they are not getting an injection. The cannula is loaded into the applicator and then is placed right into the freshly scaled gingival pocket. That's it — the application time takes about two seconds. You can treat many sites on a single patient with Arestin in just minutes.

How do we know if Arestin works? Recent clinical studies conducted and published on Arestin, the most widely used LAA, have proven that Arestin can reduces pocket depths, but more importantly, improves oral and overall health. It also offers clinicians more choices in where to use a long-acting, locally applied antibiotic. A study by J. Max Goodson, et. al., in the August 2007 Journal of Periodontology indicates the following: Arestin provides very specific periodontal pathogen-fighting activity that reduces the number of "bad" bacteria, while leaving the beneficial bacteria alone while also significantly reducing pocket depth, bleeding on probing and increasing clinical attachment level (CAL) much more so than SRP alone.

Several medical journals have also published articles on the oral-systemic link and leading researchers have stated Arestin improves cardiovascular biomarkers known to cause cardiovascular disease. As consumers learn more about the oral-systemic health connection, they will be much more interested in having needed periodontal therapy, especially if it is minimally invasive. I have already seen the growth of this in my own practice — anyone with heart disease, diabetes, or is pregnant is much more in tune with their periodontal health because of all this press.

Smart Buy Summary: Arestin is part of the fast growing minimally invasive periodontal therapies category and is a must for every single dental office that wants to treat periodontal disease with the latest technology.

Atlas Denture Comfort Implants from Dentatus USA, Ltd.

Atlas Denture Comfort Implants		 Most denture wearers hate their lower denture and most dentists I know hate making them. Implants can make you love the denture patient again, especially narrow diameter implants. For many of my patients, financial constraints, not enough bone, gross bone resorption and health issues severely limit ideal bone augmentation and conventional implant placement. I didn't think there was an alternative until I found out about and started placing narrow diameter implants.

Atlas Denture Comfort Implants made by Dentatus USA, Ltd., were developed in conjunction with New York University College of Dentistry Department of Implant Dentistry to be simple and affordable alternatives to conventional implant-supported dentures. The standard technique requires no surgical incision and no sutures — both of which are typical for conventional implants — and it can be performed in a general dentist's office in about an hour. What's more, patients can walk out of the office wearing their refitted dentures. Available in 2.2 and 2.4mm diameters, they can be placed in thin, atrophic ridges without the need for grafting procedures. This implant system is much more cost effective and easier to afford for my patients.
The Atlas technique utilizes a one-piece silicone reline (Tuf-Link) that grips the heads of the implants, known as Dome Keepers, for retention and cushions the patient's ridge for comfort. No metal housings are necessary for this system. The liner is held in place mechanically without the need for adhesives and bonding agents. The silicone liner exhibits less lateral forces, as compared to conventional O-rings and housings. What this means to you and your patient is that the narrow diameter implants do not have to be perfectly parallel, they are easier to place and the technique is accomplished faster.

The Atlas clinical technique is simple. In a nutshell, patients are anesthetized with local infiltration. Osteotomies are started with the needlepoint CePo Pilot drill under copious irrigation to the desired implant length. A reamer corresponding to the implant size is then used to enlarge the osteotomy to the desired size of the final implant. Implants are seated flush with the ridge using a manual driver or ratchet. This process is repeated until all four implants are placed.

The denture base is prepared with a series of specially designed burs creating a seamline undercut and adequate space for the implant heads. The Tuf-Link liner is dispensed into the denture base and on the implant heads, then placed into the mouth.

Once the liner has set, it is removed from the denture and excess flash material is trimmed away with scissors. The liner is then placed back into the denture base with gentle finger pressure. The implants are immediately loaded and patients are instructed to wear the denture for 10 to14 days without removal, except for cleaning to prevent edema of the tissue. Can you imagine what it was like for my patient, Mary, who could not use her lower denture for years? She had lost a lot of bone through resorption, is medically compromised and did not have the money for bone grafting and conventional implants. In a simple one-hour procedure, she has a completely functional lower denture that she can use to eat whatever she likes.

Smart Buy Summary: The use of Atlas Narrow Diameter Implants provides a viable and many times better alternative to traditional implant overdenture treatments. Atlas allows the dental practitioner to provide a suitable alternative to the edentulous patient's treatment options. I personally rate this as high as any type of aesthetic dentistry when it comes to changing patients' lives.
Dentaltown Magazine
September 2025
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