The fully automatic Ceramill Map 600+, Amann Girrbach’s new scanner flagship for open articulator scanning, excels with outstanding precision for perfect restorations and optimally supports dental technicians in their work.

This new high-performance scanner heralds the advent of Industry 4.0 in the laboratory. The intelligent software algorithm automatically assigns the upper and lower jaws, thereby eliminating the vestibular scan and thus up to 30 percent of the manual steps in the laboratory. Due to its integrated universal carrier plate for all common types of articulators, the Map 600+ saves time-consuming plate changes and the intelligent scan height control automatically moves the object to be scanned into the best possible scanning area.

In parallel, Amann Girrbach has equipped the Map 600+ with an Ultra HD camera. The highly sensitive industrial 3D sensor with Blue Light technology ensures outstanding depth of field and a scanning accuracy of 4 micrometers. The reason being that making optimal use of the advantages of digitization and a seamless workflow, requires the model situation from the real articulator to be converted into a data set with maximum precision.

The new, more efficient calculation algorithm also reduces the matching time by up to 35 percent, depending on the indication. This reduces the active waiting time of a scanning process by up to 25 seconds. Depending on the indication, the Ceramill Map 600+ therefore provides time savings of between 15 and 38 percent.

About Amann Girrbach

As a pioneer in dental laboratory CAD/CAM technology, Amann Girrbach is one of the leading innovators and preferred full-service providers in digital dental prosthetics. With its high degree of expertise in development and commitment to customer orientation, the ambitious Austrian company creates sophisticated system solutions and highest quality materials for tomorrow’s workflows. Its customers in around 90 countries worldwide are mainly made up of dental laboratories and dental technicians. Amann Girrbach employs a total of around 500 people. In addition to the R&D and production sites in Koblach (headquarters) and Rankweil (Austria), Amann Girrbach operates sales offices in Pforzheim (Germany), Verona (Italy), Charlotte (USA), Singapore (city), Curitiba (Brazil) and Beijing (China).

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In these times, practicing efficiently is critical. We need the tools necessary to help create beautiful posterior composites quickly, resulting in minimal chair time and less strain on the body. As composites become a larger part of our revenue stream, we focus on better adhesives, curing lights, matrix systems, isolation, etc. Still, in many dental offices, the composite is delivered, packed, and sculpted with the same instruments used for amalgam! Clinicians worldwide share ideas of how best to place matrices and wedges, inject, pack, layer, build anatomy, cure, adjust occlusion, polish, and perhaps glaze. All of these techniques have relevance in direct composite restorations. Still, no system takes the approach of a “slight” overfill of the preparation, followed by rapid sculpting of the cured composite into a beautiful anatomic replication.

Why complicate things? Most of us had a favorite 21B acorn burnisher we used to quickly sculpt amalgam restorations. There was an acorn burnisher with an angulation that replicated the cuspal angles of the posterior teeth—as depicted in the Linek Carving Manual—not too flat and not too pointed. It is that 97º angle that inspired the development of a new set of carving/finishing burs as well as a 4-headed posterior packer and sculptor (Figure 1).

Based on that logic, the Posterior Packer Sculptor (PPS) (Strauss Diamond) incorporates 2 packers on one end: a 1.5-mm for medium-to-large restorations and a 0.8-mm for narrow isthmus, fissurotomy, and box-only preps. The other end of the PPS incorporated a robust ball burnisher opposed by the 97º acorn burnisher. Regardless of the size of the preparation, the Class I or Class II can very quickly be packed, burnished/smoothed, and sculpted quickly with just a flip of the wrist—no more passing of instruments—all in one easy motion (Figure 2).

Figure 1 The angulation of the acorn head of the Posterior Packer Sculptor (PPS) (Strauss Diamond) matches the angulation of the Acorn burs.	Figure 2 Four heads on the PPS eliminate instrument passing: Just flip the wrist to the next step.
Figure 3 The ball burnisher of the PPS promotes slight overfill: The acorn starts the pits and planes.	Figure 4 The acorn end pre-sculpts soft composite and light hardens the same, the acorn bur finishes sculpting, and the Xmas tree finishes and polishes the surface.

The PPS has excellent ergonomics, with its generous diameter and non-slip surface yet weighing in at only 1 oz.

With a slight (10%) overfill and ball burnisher-smoothed margins, the instrument is flipped, and the acorn starts the basic planar anatomy: ie, pits and grooves are defined quickly. It is at this point (after composite curing) the Occlusinator Pro sculpting and finishing burs (Strauss Diamond) are utilized (Figures 3 and 4).

The Occlusinator PRO system comes with 3 different-diameter acorn-shaped diamonds and 2 Xmas tree-shaped diamonds that vary in grit pattern. The acorn-shaped burs are coated with 50-µm diamonds, and the Xmas trees have 15-µm diamonds (Figure 5).

The acorn burs have a safe edge/limit stop on the periphery of the bur head that prevents enamel nicking or scarring as well as carving too deep and are calibrated to leave the surface in occlusion.

Figure 5 The safe edges/limit stops on acorns and safe zones on Xmas trees eliminate scuffing of enamel as well as over-carving of the occlusion.	Figure 6 A failed restoration and marginal ridge fracture on a maxillary right first premolar.
Figure 7 Small and large Packer tips were utilized to direct bulk-fill composite into the preparation. The Premier X5 Sectional Matrix System (Premier Dental), ring is disposable.	Figure 8 After smoothing margins with the ball burnisher, the acorn forms the planes and pits. Isolite and cotton rolls provide a clean/dry area in anterior.

The Xmas trees have 2 different-sized diamond zones that allow the diamond-free safe zone to engage the remaining enamel without nicking or scarring it. Traditional football diamonds or carbides will over-carve or concave the surface when making final adjustments by virtue of their convex shape. They also create “bur tracks” in the enamel if they come in contact with it.

The 3 safe-edged acorn burs and 2 Xmas tree burs are “prescriptive” in their use—all different sizes of occlusal restorations are accommodated safely. In addition, large and small Class V composites are addressed with the appropriate-size diamond zone on the Xmas trees. The diamond-free safe zone of the Xmas tree—running above the occlusal margin of the Class 5—will not nick or scar the enamel should it come in contact. Whether one is dealing with a large or small isthmus width, a fissurotomy, a box-only prep, or a large or small Class V, the Occlusinator PRO system meets the challenge.

Figure 9 A small acorn with a safe edge finishes the planes and pits, leaving a smooth surface.	Figure 10 The Xmas tree with polishing grit defines the pits and planes. The safe zone protects the enamel and margins.
Figure 11 The PPS instrument, acorn and Xmas tree burs create well-defined anatomy quickly–without requiring further polish.

CASE REPORT

In a case done by Dr. Schmedding, a patient presented with a failed restoration needing replacement on the upper right first premolar (Figure 6). After cavity preparation and the application of appropriate bonding materials, a bulk-fill composite was injected into the proximal boxes. The small condenser utilized on the PPS instrument directed the composite toward the deepest part of the box forms (Figure 7). The composite was cured according to manufacturer’s instructions.

After the placement of composite in the main channel at a slight overfill (approximately 10%), the acorn burnisher on the PPS instrument helped to establish pits and fissures as well as cuspal inclines (Figure 8).

After light-curing, the small acorn bur created the initial steps of finishing the pits and fissures of the restoration (Figure 9). There are 2 larger sizes of acorn burs in the kit for larger restorations or wider isthmuses.

Once the anatomy was formed, the Xmas tree diamond bur was utilized to redefine the cuspal inclines safely without ditching the enamel-composite interface (Figure 10). 

The finished restoration, with proper anatomical contours and definitions, is shown in Figure 11.F

ABOUT THE AUTHORS

Dr. Roetzer is a Fellow in the American and the International Colleges of Dentistry and a member of the Pierre Fauchard Society. He has served as professional relations director at Danville Materials/Zest Dental Solutions and consults with several other manufacturers. He currently serves as a full-time associate professor and co-director of the International Dental Student program at the University of the Pacific, Arthur A. Dugoni School of Dentistry, where he had served as the director of operative dentistry. He is a member of the Consortium of Operative Dentistry Educators and serves as a grader in the Western Regional Examination Board. Dr. Roetzer is an international lecturer and has developed and patented a number of dental devices. He can be reached at paddyraptor@gmail.com. 

Dr. Schmedding graduated from the University of Puget Sound prior to getting his DDS degree at the University of the Pacific, Arthur A. Dugoni School of Dentistry. For 17 years, Dr. Schmedding practiced in Seattle prior to relocating to California. He held a position as an assistant professor in the Department of Integrated Reconstructive Dental Sciences at the University of the Pacific, Arthur A. Dugoni School of Dentistry. In addition to his pursuits in academia, Dr. Schmedding enjoys his private practice in Walnut Creek, Calif, and enjoys lecturing nationally and internationally on topics ranging from advanced dental materials and products to complex restorative procedures. He has published articles both nationally and internationally regarding dental restorative materials and procedures. Dr. Schmedding is a current member of the ADA, the California Dental Association, and the American Academy of Cosmetic Dentistry. He is one of 450 dentists worldwide to be an accredited member with the American Academy of Cosmetics. He can be reached at troy.schmedding.dds@gmail.com. 

Disclosures: Dr. Roetzer designed and patented both the Occlusinator and the Posterior Packer Sculptor.  Dr. Schmedding has no financial interest in any of the products mentioned in this article. 

Dental therapy is Michigan’s newest licensed profession, and its potential is recognized by a variety of stakeholders. In Michigan, organizations such as the Michigan Council for Maternal and Child Health, Michigan Primary Care Association, American Association of Retired Persons Michigan, Michigan Association of School Nurses, and many more have publicly endorsed dental therapy, according to MI Dental Access. 

Nationally, more than 170 organizations have signed on in support, and that list continues to grow. Yet despite its popularity, dental therapy faced opposition from a number of dentists during its legislative push in Michigan.

Strong arguments and evidence supporting how the new profession could contribute to better access to care were acknowledged, and with the leadership of the bill’s sponsor, Senator Mike Shirkey (R), SB 541 was passed on December 27, 2018. Administrative rules have recently been promulgated, and Michigan can officially license dental therapists.

The Need for Dental Therapy

There is a reason dental therapy has gained so much support. It is widely recognized that the existing oral healthcare system creates greater barriers to care for some communities than for others, and the resulting disparities in oral health are vast.

Compared with their white counterparts, Hispanic and non-Hispanic Black children are less likely to receive dental sealants and have much higher cavity rates, and by adulthood these groups are more likely to experience tooth loss than white adults, as reported by Michigan State Oral Health Plan 2020.

Communities of color and those with low socioeconomic status also experience a significant shortage of providers. Dentists are unevenly distributed in favor of affluent areas, and dental provider recruitment and retention is an ongoing problem in underserved areas. This is where dental therapy can help.

Under the statute, dental therapists are permitted to work only in underserved areas, providing services to the communities that need them the most. Practice settings include, but are not limited to, safety net settings such as federally qualified health centers (FQHCs) and tribal health clinics; settings where at least half of the patient base is uninsured, on public insurance, or low income; and in federally designated dental Health Professional Shortage Areas (HPSAs). A dental HPSA is an area with a ratio of at least 5,000 patients to each dentist, and Michigan has 243 of them.

Even some affluent counties in Michigan have dental HPSA areas, highlighting the stark disparities that exist for communities of color and low socioeconomic status. By and large, dental HPSAs encompass rural areas and urban centers that lack sufficient numbers of oral healthcare providers.

Because dental therapists may practice without their supervising dentists being physically present, they can reach into the hearts of underserved communities, working in non-traditional settings and during times when patients can more conveniently access their services.

Hospitals, nursing homes, school-based health centers, correctional facilities, and mobile units are just a few practice settings where dental therapists can help bring care to patients, sidestepping barriers such as transportation, missing work or school, fear of the dental clinic, and lack of providers in the area.

The Scope of Practice

The scope of practice for a dental therapist includes both preventive and restorative procedures, making them versatile additions to the dental team. Although the list of allowable procedures is smaller than that of a dentist, the dental therapist’s training must be of the same quality and depth as that of the dental student for the services within his or her scope.

Also, dental therapy programs must meet the standards of the Commission on Dental Accreditation (CODA), the body that ensures appropriate education for all dental programs. Patient education and disease prevention are the foundation of a dental therapist’s practice, and treatment plans are decided upon in collaboration with the supervising dentist.

All treatment that is outside of the scope or comfort of the dental therapist is either referred to the supervising dentist or to a dental specialist. The scope of a dental therapist includes, but is not limited to:

• Comprehensive oral evaluations
• Dental cleanings for children and adults
• Preventive services such as fluoride and sealants
• Diagnostic services such as x-rays and pulp testing
• Composite and amalgam restorations on children and adults
• Stainless steel crowns on primary teeth
• Extractions of primary teeth and periodontally involved teeth with class III+ mobility
• Periodontal services such as sutures and changing dressings

Education and Training

The underlying spirit of dental therapy is providing access, not only to oral health services, but also to joining the oral health professions. Institutions considering dental therapy program development are encouraged to innovate and reduce barriers for aspiring students.

A community-focused education model would broaden the current restrictive pathway to dentistry into a more inclusive and attainable pathway for dental therapy students. Recruiting students from the communities in which they will practice would improve provider recruitment and retention, diversity within the dental profession, and cultural competence among dental providers.

Educating dental therapy students closer to home while utilizing community colleges, virtual didactic courses, and FQHCs as clinical education sites would open doors for those who are unable to attend one of the two dental schools in Southeast Michigan.

Unique community-based opportunities to complete the clinical hours required during education could also give graduates experience in underserved communities and prepare them to work within their practice settings upon licensure.

To become a dental therapist in Michigan, individuals are required to complete:

• Three academic years in a dental therapy program that meets CODA standards (degree level to be determined by the educational institution)
• 500 hours of clinical practice under the direct supervision of a dentist (to be completed during the three-year education period)
• A comprehensive, competency-based clinical exam
• Application for licensure

Dental therapy education programs have not yet emerged in Michigan, but there is great demand among potential students and employers. As colleges and universities begin to foster opportunities for aspiring dental therapists, we will witness the development of a new workforce of highly skilled oral health professionals. This is an exciting time to be part of a movement that has tremendous potential to positively impact our state.

Ms. Davis is an oral health program specialist with the Michigan Primary Care Association. She can be reached at mdavis@mpca.net or at (517) 827-0879.

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The United States Patent Office has issued patent number 10,984,529 to Pearl for “Systems and methods for automated medical image annotation,” which covers the technological system underpinning the user interface (UI) of its Second Opinion assistive dental radiology artificial intelligence (AI) device.

Second Opinion displays AI-detected pathologies, restorations, and other dental conditions for dental practitioners and patients in the clinical setting. The machine learning models responsible for producing an accurate radiologic assessment express their findings on the nature and location of any detected features as a raw data stream.

Pearl’s patented system takes that data and translates it into a user-friendly visual representation, the company said. When a patient’s X-ray is displayed within the UI, the device draws viewers’ attention to any AI-detected dental conditions by circumscribing the location of the detection within a labeled bounding shape overlay.

“This patent further illustrates Pearl’s dedication to enhancing the dental category end to end,” said Pearl chief technology officer Cambron Carter.

“AI-assisted radiology is our core focus at Pearl, but no technology is effective unless it is easy to use as a tool. The United States Patent Office’s recognition of the unique value of our user interface is a testament to the importance of user experience to technological innovation,” Carter said.

Second Opinion, which recently received the CE mark certification required for distribution in European Union member territories, is Pearl’s first AI solution developed for patient-facing clinical use.

Capable of detecting and measuring a wide assortment of pathologies, existing restorations, and natural anatomy in dental X-rays, Second Opinion was developed to serve as a second set of eyes for dentists, helping them ensure the reliability of their radiologic evaluations, Pearl said.

Used in a clinical setting, dentists can point to Second Opinion’s AI detections to fortify patient confidence in a diagnosis, the company said.

“We are proud of the work we’re doing to usher AI into the dental industry,” said Pearl founder and CEO Ophir Tanz.

“No matter how advanced the technology underlying the AI products Pearl brings to market may be, we strive always to maintain focus on making our AI accessible for the people who are using it. Today’s patent news is really about Pearl’s commitment to the belief that for AI to make dentists better, we have to make AI better for dentists,” Tanz said.

The patent follows two other patent grants for Pearl’s AI technologies this year, including one for enhancing the restoration fabrication workflow, and another for automating insurance claims processing.

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Sumita Mitra has won the European Patent Office (EPO) innovation prize in the non-EPO countries category of its 2021 European Inventor Awards for her work in developing nanotechnology for dental materials.

“Sumita Mitra took an entirely new path in her field and demonstrated how technological innovation, protected by patents, can transform a sector, and in this case bring benefits to millions of dental patients,” said EPO president António Campinos.

“Her invention remains commercially successful nearly 20 years after its launch, another reason why she is an inspiration to the next generation of scientists,” Campinos said.

While working in 3M’s oral care division in the late 1990s, Mitra became aware of the limitations of existing materials used in dental fillings, which were either too weak to be used on biting surfaces or quickly lost their polish. At the same time, nanotechnology was emerging as a field of research.

Mitra decided to explore how these new developments could be applied to dentistry. She began working on nanotechnology-based solutions for a new dental material, driven by a desire to use her expertise in polymer chemistry and materials science to develop inventions that solve real-life problems, the EPO said.

Mitra and her team developed a technique for creating linked clusters of nanoparticles they called nanoclusters that combine single nanoparticles of varying diameters to create a strong, durable, and shiny material, the EPO said.

By adding tiny amounts of pigment and altering the chemical composition of the nanoparticles, the team also was able to create a range of different shades that could be matched to individual teeth and layered to create a more natural finish, the EPO said.

“The use of nanotechnology have me the opportunity to make a new material,” Mitra said. “It restores people’s smiles and improves the quality of their lives.”

Following this development, Mitra worked with 3M’s patent attorneys to draft the patents to protect her research. Although several new generations of the material have been developed since its launch in 2002 at Filtek Supreme Universal Restorative, the current line of products is still based on her European patents.

The EPO noted that Mitra’s legacy can be seen in how 3M was named one of the top three manufacturers of global composite fillings in the dental restoration market in 2019. She retired from 3M in 2010, but products based on her inventions have been used in more than a billion tooth restorations worldwide, the EPO said.

Mitra continues to contribute to research and development through her own consulting company, Mitra Chemical Consulting, which advises companies on new technology development, product design, commercialization, and mergers and acquisitions.

Also, Mitra enjoys volunteering at schools and colleges, passing on her enthusiasm for science to young people.

“Curiosity and exploration are the essential points of starting an innovation. It is something that we really need to cultivate in our children,” Mitra said.

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Researchers at the Ohio State University College of Dentistry say they have tracked the origins of microbiota in aerosols generated during treatments including ultrasonic scaling, implant osteotomy, and restorative procedures, proving that the risk of transmitting SARS-CoV-2 during these treatments is low.

The researchers collected samples of saliva and irrigant from 28 patients undergoing these procedures before each procedure began. Thirty minutes after the procedure, the researchers then collected condensate from the face shields of the operator and the assistant as well as from the patient’s bib and from an area 6 feet distant from the site of the operation.

The researchers then combined reverse transcriptase qPCR to identify and quantify SARS-CoV-2. They also used 16S sequencing to characterize the entire microbiome with fine-scale enumeration and source tracking.

The results show that it is possible to trace the source of contamination through DNA microbiome analysis and that the major source of microbes in aerosols came from the dental irrigant. Saliva did not significantly contribute, as infection control measures such as pre-operative mouth rinses and intraoral high-volume evacuation were used.

“Some species that live in your mouth can closely resemble those in water and the environment. Using this method, we don’t even have to know the names of these organisms. You can tell whether they are exactly genetically identical or genetically different,” said lead author Purnima Kumar, BDS, MS, PhD, professor of periodontology.

“If you use this granular approach to see these very nuanced differences in the genetic code, you can very accurately identify where they’re coming from,” Kumar said.

No matter the procedure or where the condensate had landed, microbes from irrigants contributed to about 78% of the organisms in aerosols, while saliva, if present, accounted for 0.1% to 1.2% of the microbes distributed around the room.

Salivary bacteria were detected in condensate from only eight cases. Of those, five patients had not used a pre-procedural mouth rinse. SARS-CoV-2 was identified in the saliva of 19 patients but was undetectable in aerosols in any of the cases. The contents of the spray mirrored what was in the office environment.

The findings are reassuring, Kumar said, but also make sense. Irrigant dilutes saliva by a factor of 20 to 200, Kumar said, and the research is validated by a 2020 study reporting a less than 1% positivity rate among dentists.

“Getting your teeth cleaned does not increase your risk for COVID-19 any more than drinking a glass of water from the dentist’s office does,” said Kumar.

The researchers concluded that the risk for transmission of SARS-CoV-2 and other respiratory pathogens from aerosolized saliva in dental operatories is moderately low and that current infection control practices are adequately robust to protect personnel and patients alike.

“Dental surgeons and hygienists are always at the forefront of the war against bacteria in the mouth, and they of course did not feel safe because they are front-line workers surrounded by aerosol,” said Kumar.

“Hopefully this will set their mind at rest because when you do procedures, it is the water from the ultrasonic equipment that’s causing bacteria to be there. It’s not saliva. So, the risk of spreading infection is not high,” she said.

“However, we should not lose sight of the fact that this virus spreads through aerosol, and speaking, coughing, or sneezing in the dental office can still carry a high rate of disease transmission,” said Kumar.

“Understanding the sources of microbial load in aerosols is important, not only for infection control in dental operatories during the COVID pandemic, but also to inform best practices in aerosol reduction, mitigation, and abatement in the long term,” said Nicholas Jakubovics, editor in chief of the Journal of Dental Research, which published the study.

“While further studies are needed with larger sample sizes, this study sets the stage for future work on risk of microbial transmission in oral healthcare settings,” said Jakubovics.

“These findings should help us open up our practices, make ourselves feel safe about our environment, and, for patients, get their oral and dental problems treated. There is so much evidence emerging that if you have poor oral health, you are more susceptible to COVID,” Kumar said.

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The Chelsea School Dental Center at Williams Middle School in Chelsea, Massachusetts, has reopened after being shut down for eight months due to pandemic restrictions. The clinic is staffed by five providers from the Boston University Henry M. Goldman School of Dental Medicine (GSDM) and five dental assistants.

Before the pandemic, these providers saw students five days a week after school, treating approximately 500 to 600 patients each year by providing basic restorations, prevention, and oral health education to students in the Chelsea Public School System.

“Regardless of insurance, we see everyone who is living in the city of Chelsea and is enrolled in the Chelsea Public Schools,” said Dr. Lina Benslimane, member of the GSDM Department of Global and Population Health, clinical instructor of Health Policy & Health Services Research, and provider at the clinic.

When the COVID-19 pandemic struck in March 2020, Chelsea’s schools shut down, and the dental center had to close. Chelsea was one of the hardest hit communities in the state, GSDM said, with the highest COVID-19 infection rate in Massachusetts at one point.

Benslimane said the Chelsea School Dental Center fills an important hole in the community that was left gaping open during the eight-month closure.

“There is no dental health center for kids,” Benslimane said. “All are private offices, and there are a lot of people who are in need. They don’t have insurance. Regardless of insurance, we’re seeing everybody, and it’s important for kids to get oral healthcare.”

By January 2021, with approval and protocols in place, the Department of Global & Population Health was ready to provide care again. A construction mishap shut off power in the first floor of the school and a winter snowstorm further delayed the dental center’s reopening, though, but it was operational by February 2021.

The pandemic has required some operational changes, Benslimane said. It now runs four days a week instead of five, as the school is closed on Friday for sanitizing purposes. It also has reduced its patient load from seven or eight patients a day to four. Providers wear full personal protective equipment including N95 masks as well.

“There’s much more paperwork and much more screening over the phone,” Benslimane said. “[We’re] asking really detailed questions, and when they come we take their temperature and ask another screening.”

Despite the changes, Benslimane said that she and the other providers are happy to be back.

“This is what my life is,” she said. “To work with patients, mouth to teeth.”

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The European Patent Office (EPO) has nominated Sumita Mitra as a finalist in the Non-EPO Countries category for the European Inventor Award. She was was the first chemist to apply nanotechnology to the production of dental materials, according to the EPO.

Mitra’s work led to 3M’s Filtek Supreme Universal Restorative, which was first commercialized in 2002. The material was designed to overcome many of the limitations of previous dental composites, which were either too weak to be used on biting surfaces or quickly lost their polish and became physically unattractive.

The material also is more versatile than other composites, the EPO said, so it can be used in any area of the mouth, simplifying the filling procedure for dentists. It is now used by dentists around the globe, the EPO said.

“Mitra’s invention takes what was an emerging technology at the time, nanotechnology, and applies it to a new sector to provide a solution for dentists and relief for patients,” said EPO president António Campinos. “Patents have protected Mitra’s material and helped ensure that her invention remains commercially successful nearly 20 years after its launch.”

The winners of the 2021 European Inventor Awards will be announced on June 17 during a digital event.

Until the late 1990s, the EPO said, dentists who wanted to perform natural-looking tooth repairs relied on a combination of composite microfills, which were aesthetically pleasing but too weak to be used in teeth toward the back of the mouth and biting surfaces, and stronger but less attractive hybrid composites.

The size of the filler particles suspended in the resin to give it strength, color, and opacity was a key problem, the EPO said. These fillers traditionally consisted of dense, large particles such as quartz or glass milled into finer particles. But as the resin wore away, they began to protrude from the material or were plucked from its surface, resulting in bumps or craters that scattered light. Fillings then quickly lost reflectivity and polish.

While working in 3M’s oral care division, Mitra became aware of the limitations of existing composite materials. At the same time, nanotechnology was emerging, and she decided to explore how it could be applied to dentistry. She began developing nanotechnology-based solutions for a new dental material, using her expertise in polymer chemistry and materials science, EPO said.

Mitra replaced composite fillers with nanoparticles, which are ultrafine particles measuring between 1 and 100 nm in diameter. They also are smaller than the wavelength of visible light, so they don’t scatter it, resulting in a material that retains its shine.

At first, Mitra and her colleagues incorporated uniform nanoparticles measuring less than 20 nm into resins. But although these materials were strong and attractive, EPO said, they were difficult to mold, making them unsuitable for dentistry. 

The researchers then developed a technique for creating linked clusters of nanoparticles they called nanoclusters, combining them with single nanoparticles of varying diameters to produce strong, durable, and shiny material with excellent handling properties, EPO said.

By adding tiny amounts of pigment and altering the chemical composition of the nanoparticles, the researchers also created a range of different shades that could be matched to individual patients’ teeth and layered to create a more natural finish.

“The use of nanotechnology have me the opportunity of making a new material,” said Mitra. “It restores people’s smiles and improves the quality of their lives.”

After the successful development process, Mitra worked with 3M’s patent attorneys to construct the patents to protect her work. In addition to her work on the Filtek line, Mitra is named as inventor on 58 granted European patents for inventions that have resulted in various dental innovations including resin-modified glass ionomers and new adhesives that can be found in other 3M products, EPO said.

“The patent was essential for safeguarding the invention so that others could not infringe on the technology,” she said.

Though several generations have followed since Filtek’s introduction in 2002, the current line of products is still based on Mitra’s European patents. 3M regards the material as unique because it combines durability with aesthetic qualities not reached by competing products that rely on micro-hybrid or nano-hybrid fillers instead.

Mitra’s invention has contributed to 3M being named one of the top three manufacturers for the global composite filling in the dental restoration market in 2019, EPO said. According to Mitra, the material’s strength is its versatility.

“You have all the desired properties of a tooth filling in one material. That is why this technology has been used to make so many different types of tooth restorations around the world,” she said.

Although Mitra retired from 3M in 2010 after more than 30 years, EPO said, the enduring success of her invention continues with Filtek products used in a billion tooth restorations worldwide. Today she continues to contribute to research and development through her own consulting company. She also volunteers in her community and hopes to inspire young people to develop an interest in science.

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Students at the University of Leeds School of Dentistry are now using SimToCare haptic simulators, which simulate tactile feedback through a dental handpiece to give students a realistic learning experience.

With the simulators, the university said, students can safely practice drilling teeth while gaining valuable experience in clinical scenarios that otherwise may be challenging to simulate using traditional phantom heads.

The school’s digital dentistry group said it has a unique working relationship with the team of developers behind the SimToCare system, resulting in the direction of development being informed by the needs and use-cases identified at Leeds.

World-leading, in-house software has led to Leeds being the first dental school in the world to offer custom haptic training cases based on real patients’ dental models, including anatomically correct contact points and gingival margins, which are both crucial during crown preparation, the school said.

The simulators also offer haptic cases aligned to the bespoke 3D printed training models currently used in the preclinical skills laboratories, with additional cases lined up to be produced physically and virtually in the future.

Future work will focus on expanding students’ clinical awareness of the high biological variation encountered in root canal morphology by presenting a catalogue of true, scanned tooth root morphologies, enabling students to gain an understanding of natural variation within endodontics. To support this work, the school said, it has invested in a new nano CT scanner.

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BDA Northern Ireland has urged the European Commission to reconsider its plan for a full phase-out of amalgam by 2030. The organization believes that a phase-down, rather than a phase-out, is the only viable way forward that can avoid destabilizing health systems already under considerable strain and exacerbating health inequalities.

A report by the European Commission to the European Parliament and Council says that the phase-out of dental amalgam, which is the largest remaining intentional use of mercury in the European Union, “is technically and economically feasible before 2030.”

Even though the United Kingdom has left the European Union, under the Northern Ireland Protocol, European proposals on amalgam would apply to Northern Ireland but not to England, Scotland, or Wales.

Alongside the Council of European Dentists and the FDI World Dental Federation, BDA Northern Ireland said that it supports a phase-down approach to dental amalgam use.

However, BDA Northern Ireland said, dentists must continue to have the full range of restorative materials at their disposal and that at present, there is no direct replacement for amalgam for durability, cost-effectiveness, and ease of use.

Alternative materials also are much less extensively researched for their impact on the environment and direct effects on human health, BDA Northern Ireland said.

COVID-19 has dramatically altered the dental landscape, BDA Northern Ireland continued, meaning that the feasibility study undertaken before the pandemic must be reviewed in respect of the different context that dentistry finds itself in.

A phase-down, not phase-out, of dental amalgam is the only viable way forward, BDA Northern Ireland said. This would avoid destabilizing health systems already under considerable strain, the organization continued, and exacerbating health inequalities.

BDA Northern Ireland also said that it wants to see an increased focus on prevention as well as additional research into mercury-free alternative materials.

Further, BDA Northern Ireland said that it is concerned about many aspects of the feasibility study undertaken by Deloitte that underpins the basis of these phase-out proposals, not least the data being incomplete.

Any move to phase out dental amalgam as a low-cost restorative material will have the greatest impact on those most disadvantaged patients, increasing inequalities, BDA Northern Ireland said.

These issues go to the heart of the right to access affordable healthcare and must be properly considered in a full impact assessment, BDA Northern Ireland said, adding that its response urges the European Union to take a more considered phase-down approach to what is largely an environmental issue.

Regardless of what happens, BDA Northern Ireland said, this serves as an important reminder of the need for governments closer to home to step up in prevention. The organization said it will continue to liaise with officials to mitigate any impact of these developments on the profession.

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