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Hygiene Tribune Middle East & Africa Edition

hygiene tribune Dental Tribune Middle East & Africa Edition | July-August 20156B < Page 4B production of CrossAction pos- sible therefore required a large investment in new production technology and personal invest- ment by all involved. This is a great example of a company in- vesting in what it knows. Oral-B was very committed to changing the way in which toothbrushes were made, to improve the oral health of consumers. Developments and Concllu- sions With the development of the CrossAction toothbrush, we achieved results that exceeded our expectations and repre- sented a true paradigm shift for toothbrush design. Multiple studies and reviews have since continued to demonstrate its superiority in removing plaque on accessible surfaces and hard to reach approximal surfaces, compared to traditional tooth- brush designs. A recent CrossAction design, the CrossAction Vitalizer, in- cludes two rows of rubber tips (non-latex)thataidoralhygiene while stimulating the gingivae. We still use the fundamentals we learned from the develop- ment of CrossAction for tooth- brush innovation. We have evolved our techniques to le- verage modelling and simula- tion in ways which were very difficult (or even impossible) before - thereby significantly increasing our ability to under- stand filament behaviour at the high-speed movements of pow- er toothbrush bristles. For me personally, being in- volved in the research and de- velopment of CrossAction was a great experience. It was won- derful to lead our single fila- ment research program and to be so proud of the end result. The CrossAction toothbrush is designed for superior perfor- mance, is still clinically supe- rior to manual brushes with other design fundamentals, and offers a great brushing ex- perience that is recognised by consumers and dental profes- sionals alike! References 1. Beals et al Scroll text Beals D, Ngo T, Feng Y, Cook D, Grau DG, Weber DA. Development and laboratory evaluation of a novel brush head design. Am J Dent 2000;13 (Spec Iss): 5A-14A 2. Cugini, Warren Cugini MA, Warren PR. The Oral-B Cros- sAction Manual Toothbrush: A 5-year literature review. J Can Dent Assoc, 2006; 72(4): 323a- k. Prem Pract Dent 2014;April (Manual) – Used in July-Au- gust Edition. Published in ppdentistry.com Karen Claire-Zimmet MS BS She is a senior scientist at The Procter & Gamble Company. She began her career in oral care research and development with Oral-B in 1996. She received her master of science (MS) degree in physical chemistry from Stan- ford University, and her bachelor of science (BS) degree in chem- istry from Binghamton Univer- sity, New York. Karen has ap- plied insights from fundamental understanding work such as that described here to both manual and power toothbrush designs, resulting in numerous oral care patents. Visit: dentalcare.co.uk About the Author How implant prosthesis design influences implant maintenance access By Shirley Branam, USA and Gerhard Mora, USA A chieving a balance be- tween implant-support- ed restoration esthetics and maintaining periodontal health is important in an over- all successful outcome of the prosthesis. The goal is to create an emergence profile design that allows for minimal tissue displacement while achieving optimal cervical contours for esthetics. It is important in the design to allow access for prop- er cleaning by the patient and clinician (Fig. 1). There are two types of im- plant restoration designs com- monly used in single-tooth replacement prosthetics. They are a screw-retained crown or a two-piece abutment and cement-retained crown. The screw-retained crown design is the technique more commonly used in Europe. Whereas, the cement retained crown pros- thesis is more frequently used in the United States. The screw-retained restora- tions contain a small chimney access hole where the screw retaining the restoration is in- serted. The crown is screwed directly into the implant and the access chimney is typically closed with a tooth-colored resin (Sarmont, 2009). There are two main advantages of this restoration design. First, since cement is not used in this method, the opportunity for subgingival residual excess ce- ment to remain on the prosthe- sis cannot occur. When excess cement is left, it can create the opportunity for inflammation and peri-implantitis to develop in the implant sulcus site. Sec- ond, the screw can be easily removed from the restoration, allowing for crown removal if necessary during any mainte- nance procedures. The two-piece abutment and cement-retained crown resto- ration has an abutment that is designed to provide the subgin- gival emergence profile and al- lows the crown to be cemented onto the abutment (Fig. 2). The emergence profile refers to the subgingival contours that lie between the implant platform and the emerging abutment and crown (Sarmont, 2009). Using a custom designed abut- ment provides greater flexibil- ity in determining the proper shape of the emergence profile compared with pre-fabricated standard abutment design. To obtain a pleasing resto- ration, the subgingival con- tours must start at the small circle of the implant head and emerge from the tissue with an anatomical profile (Sarmont, 2009). The result should be an emergence profile that allows for minimal displacement of the surrounding tissue while creating an esthetically pleas- ing appearance (Fig. 3). This design allows for easy access into the implant sulcus area so cleaning and maintaining can be easily achieved by both the patient and the clinician. Over or under contouring of the abutment and/or restoration can result in biofilm retention and peri-implantitis. It is im- portant for the emergence pro- file to resemble that of a natural tooth. Often the adjacent teeth can be used as a guide to deter- mine the proper contours. The protocol for margin loca- tion of a standard Implant res- toration is still under debate. As the location of the crown abut- ment margin is placed deeper subgingival, the ability to ac- cess and maintain the site be- come more difficult (Linkevi- cius, 2012). What does this all mean for the clinician and pa- tient in the maintenance of the implant prosthesis? Access to the subgingival area of the implant prosthesis for proper maintenance is vital to the health and success rate of the prosthesis. As margin lo- cation and emergence profiles extend farther subgingival, the ability to maintain these sites becomes more challenging. Evidence has shown that power scalers with nonme- tallic tips can be beneficial in maintaining the implant pros- thesis (Sato, 2004). Several manufactures offer tip designs that will accommodate the dif- ferent types of power scalers. DENTSPLY Professional has an insert whose unique design al- lows a polymer sleeve to be as- sembled to the active tip area of this ultrasonic implant insert (Fig. 4). When fully assembled, the Cavitron® SofTip™ Ultra- sonic Implant Insert can eas- ily be incorporated into a cli- nicians’ implant maintenance procedure. Incorporating ultrasonics scaling into the implant main- tenance protocol may have several benefits. Combining mechanical movement and lavage can aid in the removal of biofilm and other debris in the implant prosthesis sulcus. Wilkins wrote in 2012: “Studies indicate cavitation is capable of destroying surface bacteria and can remove endotoxin from the root surface.” And: “Oscillation of the ultrasonic tip causes hy- drodynamic waves to surround the tip. This acoustic turbu- lence is believed to have a dis- ruptive effect on surface bacte- ria” (Wilkins, 2012). Multiple in vitro studies have discussed that cavitation may have the potential to disrupt the cell wall of the bacteria, and acoustic turbulence is believed to have disruptive effect on the surface bacteria (Baehni, 1992; Mc- Innes, 1993; Walmsley, 1990). However, further in vivo stud- ies need to be conducted to de- termine if the same outcomes are achieved in the sulcus. Another benefit to incorpo- rating power scaling into the maintenance procedure is the ability to adapt the active tip area into the implant sulcus. Incorporating vertical adapta- tion of the active tip, at a zero- to 15-degree angle, to the im- plant restoration can allow for significant subgingival surface contact for efficient deposit re- moval. When the emergence profile follows the anatomical shape of a natural tooth, this instrumentation technique can be an effective method of main- taining the site. Finally, easy access for the pa- tient is extremely important in the success of the implant pros- thesis. There are a variety of interdental brushes, cleaners, and floss options available to the patient. It is important that the cleaners be easy to use, not cause tissue trauma in the im- plant sulcus, or surface dam- age to the esthetic materials in the restoration. Dental implants are increasing in demand in part by their high success rates and the improved esthetics they provide the pa- tient. A key to this success is having the proper design in- corporated into the restoration. When designed properly, the implant restoration can be eas- ily maintained by both the pa- tient and clinician. Shirley Branam, RDH, MBA, is a clinical educator for DENTSPLY Professional, serving the central region of the United States. Gerhard (Gary) Mora, CDT, BS, is director of dental labora- tory support for the University of Michigan Dental School. About the Authors Fig. 1: Emergence profile and crown should resemble that of a natural tooth so the patient and the clinician can easily maintain the implant prosthesis. (Photos/Provided by G P Mora, CDT) Fig. 2: Custom abutment and crown design. Fig. 3: Ideal sulcus formation created by proper emergene profile of the implant abutment Fig. 3: Cavitron SofTip Ultrasonic Implant Insert (Photo/Provided by DENTSPLY Professional.)

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