Wednesday, June 21, 2017

Opaquer dental

Comparison of different opaquer dental materials

Opaquer dental materials are made to block out dark metal in dentistry. As a result we often use dental opaquers for endodontic access on a crown that has metal like a PFM or on metal abutments for dental implants.

Comparison of 5 opaquer dental materials

My favorite opaquer for implant abutments is the BlueSkyBio product and my favorite opaquer for teeth is the Pentron product. The more yellow tone products are nice for teeth that you are not trying to make as white, so darker shades. Also the yellow works nice on PFM crowns that have very thin occlusal layer since the white tends to show through on these. The following products are cured on black paper.

opaquer dental

First of all, it is impossible to say anything definitive from my unscientific tests. However, my guess is the order of whitest to darkest is whiteMetal then Flow-It and Creative Color close together followed by IPS and finally Clearfil.

opaquer dental materials

First test without the fifth one but shows colors better.

The order of how well they actually opaque is also not possible from this test, however I did put four of them on a crown and cured it. The order here is….

  1. Creative Color Opaquer White
  2. IPS Empress Direct Opaque
  3. Clearfl St Opaquer
  4. whiteMetal Opaquer

The results are that they all work so it really comes down to what color are you trying to get to and how much room above the dental opaquer do you have to get to that shade?

opaquer dental comparison

 

Links to the 5 dental opaquer dental products

Flow-It ALC Flowable Composite by Pentron

Creative Color Opaquer White by Cosmedent

whiteMetal Opaquer by BlueSkyBio

IPS Empress Direct Opaque by Ivoclar

Clearfl St Opaquer by Kuraray

Cost of opaquer dental materials

All of these costs are for the year 2017 and are what we pay for a single syringe or container.

 

Flow-It ALC Flowable Composite by Pentron is

Creative Color Opaquer White by Cosmedent is $61.

whiteMetal Opaquer by BlueSkyBio is $55

IPS Empress Direct Opaque by Ivoclar is

Clearfl St Opaquer by Kuraray is

 

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Wednesday, June 7, 2017

Dental insurance issues

Dental Insurance issues that a dentist cares about

Collection of dental insurance issues I have seen come up and see asked again and again.

Is it legal to waive co-pays?

Well that depends. Never for government programs like Medicaid. My opinion is that it legal as long as you follow some of the rules. Here is a great dentaltown thread on the exact same question.

In network

You can waive the co-pay but you need to notify the carrier. Delta considers, emphasis on Delta considers, it fraud if do not notify the carrier that you do not attempt to collect co-pay. However, if you are in network it is likely against your contract so there would probably be some contractual issue. If the contract is silent on the issue then a waiver is permissible according to CDA.

Out of network

Do not advertise that you waive co-pays. Jason Wood’s opinion seems to be that OON can do what they want. Probably best practice to just put it in the remarks section.

 

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Monday, June 5, 2017

Looking for a great dentist in your area?

Looking for a great local dentist in your area?

Here at Bauer Dentistry and Orthodontics we have people ask us on a regular basis whether or not we know anyone in such and such city.  Often a friend, family member or even a patient of ours that is moving is in need of a new dentist. To make things easier we are going to use this page to compile a list of dental offices that we know and believe are solid recommendations. Some of these recommendations are more local Chicago-land and some are spread out throughout the rest of the US.

Illinois Dentists

 

Greater Chicago area Dentists

Geneva dentist – McCall Family Dentistry

Wheaton dentist – Bauer Dentistry and Orthodontics

Hoffman Estates dentist – Forest Edge Dental

Downers Grove – Oral Health Care Professionals

 

US dentists excluding Illinois

 

 

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Tuesday, May 30, 2017

Zirconia dental implants

What are zirconia dental implants?

Zirconia dental implants are similar to titanium dental implants except they are made from a zirconia instead of a titanium alloy.

Who can get zirconia dental implants?

Well anyone can get a zirconia dental implant but the real question is who should get a zirconia dental implant.  The answer depends on who you ask. The most likely candidate has one of several conditions. They are someone who has a high smile line, which means they show their gums when they smile, and they have thin tissue biotype, which means you can see through their gums.  The ideal patient would also be someone with high esthetic demands. The success rate of zirconia dental implants v titanium dental implants is lower by about 5% Elnayef JOMI 2017.

What do zirconia dental implants cost?

We have an entire post on the cost of zirconia dental implants. However, in brief form we can say that zirconia dental implants cost is typically slightly higher than titanium dental implants. The slight increase in fee is often because the doctor has taken on additional risk of failure if there is any kind of guarantee of the dental implant.

 

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Porcelain veneers and composite veneers

Thinking of porcelain veneers or composite veneers?

What is the difference between porcelain dental veneers and composite dental veneers? Well this weeks case of the week we ended up using both styles of dental veneers and crowns for Greg.

Greg had some issues with decay around an old veneer in front.  Although esthetics was not his major concern we thought now would be the time to change things if we were ever going to.  Since esthetics was not the major concern for Greg, rather than doing everything in porcelain, which costs considerably more, we opted to do some of the veneers in composite instead. This type of smile upgrade takes about 3 or 4 visits with only one visit taking over an hour.  The other visits are typically 20-40 minutes long.

Do you think you can tell which are porcelain veneers, dental crowns, and composite veneers?

Composite veneers and porcelain veneers

The final result turned out very nice.  Although Greg was not initially concerned about the esthetics of his smile, once we were done he was very happy we had urged him to complete the work at this time.

If you or someone you know has interest in improving their smile, then give us a call! Although this type of work is not cheap there are options to make it more affordable.

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Bruxzir crown fracture

Bruxzir crown fracture

Yes, Bruxzir crown fracture does occur. When it does it is often due to poor prep design or poor handling of the material. If you want to see some zirconia framework fractures click here.

Bruxzir crown fracture due to poor prep design

The main prep design issue is not giving the laboratory enough space.  Technically the minimum occlusal reduction is 0.5 mm, but 1 mm is ideal. Personally I aim for 2mm knowing I will end up short somewhere. Another issue is dentists prepping for Bruxzir brand zirconia but using some other zirconia product. Not all zirconia is the same and the prep clearance requirements will vary.  For instance, BruxZir anterior restorations require a minimum occlusal reduction of 0.8 mm and 1.25 mm is ideal.

Another prep design issue is leaving sharp corners or edges.  This can induce a point of contact where crack prorogation can begin.  Stress concentration occurs at the point where the sharp edge of the tooth meets the zirconia.

stress concentration bruxzir crown fracture

Bruxzir crown fracture due to poor material handling

The are many ways the lab that manufactures the material can cause fracture and there a ways the manufacturer of the product can as well, however I will focus just on the dentist’s issues. As dentists the way we can cause a Bruxzir crown fracture is by drilling on the crown, especially without copious water spray. This is done while adjusting a crown to fit on the tooth preparation. Adjusts that cause Bruxzir crown fracture can be inside the crown, interproximal, or occlusal. Of course an endodontic access also requires significant drilling of the zirconia crown. The only time I have seen this be a problem is with endodontic access of a tooth that has a Bruxzir crown.  This is the cause of one of the two zirconia products I have personally seen fracture.

bruxzir crown fracture

Bruxzir crown fracture from endodontic access and probably insufficient thickness, as this is a Bruxzir Anterior.

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Tuesday, May 16, 2017

Sedative filling dental code d2940

The sedative filling dental code is d2940

The sedative filling dental code has not changed from d2940 but the definition has changed somewhat.  D2940 dental code use is still the same.

What is the ADA description of dental code d2940?

The current description for a sedative filling from the ADA is below.

D2940 dental code protective restoration

Direct placement of a restorative material to protect tooth and/or tissue form. This procedure may be used to relieve pain, promote healing, and prevent further deterioration. Not to be used for endodontic access closure, or as a base or liner under restoration.

sedative filling dental code d2940

Clarification of the sedative filling dental code shows that it is not an endodontic access closure filling or a final liner or base.  Typical materials that dentists use are IRM, Cavit, and glass ionomers.

When does a dentist use a sedative filling?

Typically, we use dental code d2940 when there is a lot of decay and we are unsure how the tooth will do after the decay removal. We also use the sedative filling dental code when doing extensive decay control before making a definitive plan or we use it on an emergency basis.

Will insurance pay for dental code d2940?

The answer like many less often utilized codes is maybe.  Some plans do not allow you to perform another dental procedure on the same tooth for 30-90 days.  Some have restrictions on how often an individual tooth can receive that filling.  If you use some other restorative or endodontic code on the same tooth on the same day, d2940 payment will be denied by insurance.

What fee should I charge for sedative filling dental code d2940?

You can charge whatever you want for this procedure but it is traditionally not a very high fee.  I use fair health consumer to help dictate some of my fees but the fee for dental code d2940 is too low in my opinion.  We charge around $150 in 2017, which is definitely still a huge money.

What is the sedative filling dental code for a primary tooth?

The dental code d2941 is what we use to code for a sedative temporary filling on a primary tooth.

D2941 dental code interim therapeutic restoration: primary dentition –

Placement of an adhesive restorative material following caries debridement by hand or other method for the management of early childhood caries. Not considered a definitive restoration.

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