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The New Universal Composite: One shade

for every BY TERRI LIVELY patient The New Universal Composite: One shade for every patient

omposites are a vital and useful outcomes with new technology for shade match- tool in the dental practice. Not ing. OMNICHROMA is a single-shade, struc- only do they facilitate excellent turally-colored universal composite designed to restorations, but they also look match every tooth shade with a single shade of just like the natural tooth when composite. OMNICHROMA is the first and only the final restoration is complete. composite to use one shade to match the entire That is, composite restorations look natural VITA Classical Shade Guide, from A1 to D4. Cafter a concentrated effort to match the pa- In this eBook, you’ll learn more about this tient’s natural teeth to one of the shades in the revolutionary product. We’ll share how OMNI- guide, in the optimal environmental lighting CHROMA’s unique design and features allow and interior design. Plus, you must have the it to match the 16 VITA classical shades with right shade of the proper category of the com- only one shade of composite. You’ll also learn posite in inventory — that hasn’t expired. Or how it eliminates the need for shade select- maybe the composite restoration looks natural because of your finesse, time and care with ing. Furthermore, you’ll see how it reduces shade blending to get that unique hue your the composite inventory needed, so you have patient presents. fewer wasted materials that expire before they In other words, composite restorations look can be used. Finally, we had 25 doctors rate fantastic, but shade matching is a time-con- OMNICHROMA’s performance on nearly 1,000 suming process. restorative cases and we’ll share what they had Or, rather, it was a time-consuming process. to say about its performance. Tokuyama Dental’s OMNICHROMA can But first, let’s take a closer look at composites improve your practice efficiencies and clinical in general.

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A QUICK OVERVIEW OF COMPOSITES suited to posterior restorations. Microfills are Composite resins were designed for esthetics. still in use for certain restorations today. Tooth-colored by design, they replace healthy • Hybrids: When you combine the strength of a tooth structure for restorations and serve all the macrofill with the esthetics of a microfill, you same biological and functional jobs as a natural get the hybrid composites. The sizes of the tooth would. Many times, after the composite particles are different as a result of the com- resin restoration is complete, one can’t tell the bination of macrofills and microfills. Many of tooth ever had a cavity — if it’s done well. But the composites clinicians use today are in this at the same time, it can be difficult and time- category. consuming to attain a perfect esthetic match. • Nanocomposites: The latest composites are called nanocomposites. The particle size is Many times, after the as small as 20nm. However, the small par- composite resin restoration ticles form nanoclusters, which are groupings of smaller particles that function as a larger is complete, one can’t tell the particle. The nanoclusters allow the nanocom- tooth ever had a cavity — if posites to enjoy more strength and durability but still look great. There are also nanofilled it’s done well. But at the same resins and nanohybrids. There are a few of time, it can be difficult and these products available today. Composites also have different product cat- time-consuming to attain a egories, which include: perfect esthetic match • Universals: As the name implies, universal composites are designed to be used any- where in the mouth and produce long-lasting Composites have been around since the 1960s. and natural-looking dental restorations. However, the first materials weren’t durable enough for the work surfaces of the posterior teeth. • Flowables: Flowables have more fluidity to Today’s composites have addressed the strength their composition and are mostly used for and durability issues of the early materials. smaller restorations and as liners and bases. There are a few different types of composites, • Bulk fills: Unlike the other two product cate- including: gories of composites, bulk fills can be layered • Macrofills: Macrofills were the first compos- thicker in preparations with less curing. Many ites. They had large particles, from 10-15 mi- times, bulk fills are used for posterior restora- crometers, and were strong but not esthetic. tions, but the use of bulk fills is always evolv- The large size of the fillers made them difficult ing as materials improve. to finish and polish. For all of these reasons, Universals are the most versatile of the three they’re no longer commonly used. product categories. When it comes to universal • Microfills: Following the macrofills were the mi- composite performance, there are a few char- crofills. They had smaller particles, in the range acteristics clinicians should consider. of 0.03 to 0.05 micrometers. They looked bet- • Strength: How will it hold up when the patient ter than macrofills, but they were weak and not is using compressive force?

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• Esthetics: Will the composite match the pa- luster. It takes time to analyze all these factors. tient’s other teeth? Let’s look at some of the challenges with get- ting the shade right. • Shrinkage: Will it shrink during polymerization and create problems for the patient long- OPERATORY FACTORS term? • Lighting: Poor quality lighting will make a sig- • Polishability: Will the restoration maintain its nificant difference in the perception of tooth luster and have a life-like appearance? shade. • Handling: Do you like how it feels to work with • Interior design: The colors of the walls, cabi- and can you produce the results you want netry, and furniture items, like the dental chair with the material? upholstery, influence what you see for the shade of the teeth. Composites aren’t perfect, however. Some composite types lack durability and have low • Lack of proper tools: Technology like Opto- flexural strength. Others have poor wear resis- electronics that detect and control light in its tance. Some clinicians think composite materi- visible and invisible forms can enhance the als systems could be simpler to use. Others feel shade-matching process; however, not every like the esthetics could still be improved more, office has invested in this technology. including the shades of composite available. SHADE GUIDE FACTORS Materials are constantly improving. Further- • Comparing the tooth with a classic shade more, not all composites are created equal — guide: Classic shade guides have subjectiv- and we mean that in the literal sense. Knowing ity to them. Experts say that digital guides are your product, what its strengths and limitations more objective than traditional shade guides. are, and which type of cases you have the most success with that product is key to avoiding • Using an old shade guide: Over time, the clean- some of these challenges. ing products we use will change the colors on However, there’s an area of opportunity. Most the shade guide. Not replacing shade guides composites have tried tackling or have tackled means that the colors will fade in time and cre- this opportunity by having good shade match- ate problems with accurate shade matching. ing abilities (i.e., chameleon effects, etc.), but • Not comparing and contrasting: If you only use none so far have perfected it to result in a one- one type of shade matching, you have only one shade composite that works for every shade of resulting match. When you use more than one tooth. Let’s take a closer look at shade match- way to shade match, whether that is a different ing in more detail. manufacturer’s shade guide or an electronic THE CHALLENGES OF SHADE MATCHING version, like a colorimeter or spectrophotom- Many challenges exist with shade match- eter, you have confirmation, or at the very least, ing teeth. Some difficulties arise based on the more information about the shade. operatory, while others happen as a result of the materials. Still others stem from the processes PROCESS FACTORS: clinicians use — or don’t use. • Skipping the picture: If you don’t take pictures Also, dentists must consider many things (which takes time), you could be missing es- when matching materials to a patient’s natural sential tools for patient education. Moreover, teeth, including shape, contour, texture and pictures help you communicate and collaborate

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with the lab, where your technician can help Structural color doesn’t rely on added pigments or create a better match than the clinician alone. dyes to color match but instead uses a combina- tion of the visible light and how it interacts with a • Shade matching at the wrong time: If you’re physical object to create the color you see. Struc- tired, your eyes don’t catch the same amount tural color is expressed by the physical properties of detail. If your patient has been in the chair of light working together with nanostructures. for a while, his or her teeth are drier than usual. Shade matching at the beginning of Nanostructures are tiny objects that range in the appointment can be more successful than size between microscopic and molecular-sized. shade matching at the end. Nanostructures improve reactivity, meaning • Eyesight problems: Perception depends on optical health; if the viewer has deficiencies, it OMNICHROMA is a new can affect the shade matching. universal composite by • Mixing and matching materials: All the sys- Tokuyama Dental that matches tems have variance; mixing and matching materials and using materials in multiple lay- the entire VITA Classical Shade ers can change the final result and affect the Guide, from A1 to D4, with just shade match success. All these factors can affect the quality of the one shade of composite. It was shade match. With all these variables, it can be designed with new technology a time-consuming process with many opportu- nities to go awry. for shade matching. However, composites are always improv- ing. OMNICHROMA has addressed the shade they have quantum effects on what we see at a matching challenge in a whole new way. larger scale. In other words, nanostructures are WHAT’S NEW IN UNIVERSAL COMPOSITES? so small that they interact with light differently OMNICHROMA is a new universal composite by than particles on the visible scale. This varied Tokuyama Dental that matches the entire VITA interaction means that we see colors differently Classical Shade Guide, from A1 to D4, with just than we would when light interacts with larger one shade of composite. It was designed with particles. new technology for shade matching. Some color we see is created by the reflection Most composites rely on dyes and pigments of light through these tiny, physical structures to match specific shades. Successful matches and can change the color we see depending on require selecting the exact shade to get the our angle of view. Examples of this type of struc- match. However, composites with added dyes tural color occurring in nature are iridescent bird and pigments are limited in their shade-match- feathers, beetles’ backs and butterfly wings. For ing ability. example, the morpho butterfly’s wing reflects a OMNICHROMA doesn’t use pigments or dyes blue light and is therefore visible as blue. to create color. Rather, OMNICHROMA comes Unlike the blue of the morpho butterfly, the col- in one shade that matches every patient’s natu- or of natural teeth fall in the range of red-to-yellow ral teeth using structural color. color. When the light interacts with OMNICHRO- WHAT IS STRUCTURAL COLOR? MA in the tooth, the composite creates the red-to-

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yellow structural color we see reflected back. Our practice, too. In addition to matching whatever eye perceives that the composite matches the shade the patient presents, it also reduces chair surrounding tooth, whether that tooth is A1 or D4 time on a procedure. on the VITA Classical shade guide. Doctors no longer have to hold up a shade guide next to a patient’s tooth to match a PARTICLE SIZE MATTERS WHEN IT COMES TO STRUCTURAL COLOR shade. Moreover, it’s no longer necessary to OMNICHROMA can create structural color be- use multiple shades to get the desired effect for cause of its unique filler size and how it’s pro- all the patients whose teeth don’t have a per- duced. Filler size is a vital factor in composites, fect match with one of the shades. Since OM- as it affects the physical and esthetic character- NICHROMA uses the surrounding tooth color istics of the restoration. in its structural color process, it streamlines the You’ll recall that macrofills are generally shade matching process by reducing the chair- strong but not esthetic and microfills are es- side time and eliminating the need for artistic thetic but weak. Most of the composites today finesse that shade-matching other composites are hybrid fills, with a mix of large and small sometimes requires. particles. Some new composites are nanohy- Furthermore, with OMNICHROMA, a practice brids, which take the tiny particles and com- needs fewer products on the shelf. With the bine them into larger clusters, so they have the present system for composites, doctors have strength of larger hybrids. to maintain inventory for all these composite Whether a hybrid or a nanohybrid, most com- shades from A1 to D4 and beyond. All of the posites are crushed glass materials that are shades have expiration dates. When you have milled to a particular size. However, the size shades that you don’t use often, you might buy and shape of the particles aren’t uniform. them and then never use them before they ex- OMNICHROMA is a supra-nano filled com- pire. When you have one composite on the shelf posite that has uniform particle size. The par- that matches all teeth, you don’t need all the ticles are uniform because it’s manufactured incidental shades in inventory. As a result, the using the Sol-Gel Method. In the Sol-Gel Meth- practice throws out less composite that would od process, the fillers are grown in an organic typically expire because of being rarely used. solvent rather than milled from glass particles. Benefits are great, but results are better. This process allows the fillers to develop in a Let’s see how OMNICHROMA performed in spherical shape and maintain a uniform size. actual cases. The uniformly sized fillers in OMNICHROMA HOW OMNICHROMA PERFORMED IN TESTING generate the red-to-yellow structural color which We asked 25 doctors to evaluate OMNICHRO- matches the color elements of a natural tooth, the MA, which they did in 841 restorative cases. first composite to accomplish that. Using the red- The cases covered the gamut of tooth shades to-yellow structural color and combining it with and restoration classes, ranging from small Class reflected light and the color of the surrounding I cases to large and complex Class IV cases. teeth, OMNICHROMA generates and matches The doctors rated the new universal com- the tooth color — no matter what shade it is. posite on color matching, polishability, stability SIMPLIFYING SHADE MATCHING under ambient light and handling. Their op- PROVIDES UNIQUE BENEFITS tions were Excellent, Good, Average, Fair, Poor OMNICHROMA’s unique shade matching ap- and No Response. proach has many other benefits to a dental Here’s what they found.

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• Color Matching: Ninety-two percent rated it class. These clinical outcomes result from the either excellent or good (60.8 percent and technology and innovation behind the material. 31.9 percent, respectively). HOW DOES OMNICHROMA IMPROVE PRACTICE EFFICIENCIES? • Polishability: Ninety-two percent rated it either In a dental practice, time is money. Finding ways excellent or good (60 percent and 32 percent, to work smarter without compromising patient care respectively). is a significant factor in boosting revenue for the • Stability Under Ambient Light: Ninety-two practice. Simplifying the shade matching process percent rated it either excellent or good (44 is an example of innovations in universal compos- percent and 48 percent, respectively). ites that can help improve practice efficiencies. For example, OMNICHROMA’s shade match- ing ability means you can skip some of the Finding ways to work smarter shade selecting chairside with patients. That sounds great, but what does that mean in prac- without compromising patient tical terms in a day-to-day perspective? care is a significant factor We spoke to 141 dental professionals to get an idea of what this would mean. The major- in boosting revenue for the ity of the respondents were dentists with the practice. Simplifying the shade other respondents in different roles ranging from clinical lead to office manager to hygiene matching process is an example manager and more. Our survey results show that 52 percent of of innovations in universal respondents spend up to 30 to 60 seconds on composites that can help shade matching per patient. Let us determine what this means in time. If improve practice efficiencies. a doctor sees an average of eight to 12 patients in a day, let’s use 10 patients as our estimate. Ten patients per day adds up to 50 patients in a five-day work week, 200 in a month and • Handling: Ninety-six percent rated it either 2,400 in a year. excellent or good (52 percent and 44 percent, If half of the patients require shade match- respectively) ing for their treatment, a doctor could save 20 Very few respondents recorded average or hours over the course of a year. If the shade below average responses. Color Matching matching drops down to a third of the patients had 52 cases that were rated as average (6.2 the dentist sees, he or she could save 13 percent), seven cases were below average (0.8 hours. Furthermore, these 30 to 60 seconds percent), and three cases were unknown (0.4 are only the initial comparison against the percent). For Polishability and Stability Under shade guide for the shade matching process. Ambient Light, eight percent had no response. Imagine the amount of time dental profes- For Handling, respondents rated four percent sionals could save by not blending shades or of the cases as average adjusting a shade after the initial match. With few exceptions, OMNICHROMA matched If there was a way to gain back this time, how the natural shade of teeth for every restorative could the dental team use it in a practice? They

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could use the time to see more patients, includ- percent) have from one to four brands of a ing devoting time to treating underserved popu- composite in their inventory. The two most lations, who aren’t currently getting adequate significant reasons given for having multiple dental care. Alternatively, the opposite could oc- brands were handling capabilities (63 percent) cur. Doctors and staff could have fewer clinical and esthetic outcomes of specific procedures hours per week to gain back a work-life balance with a particular product (66 percent). Some or reduce the day-to-day pace in the office. said they like to try the newest composites (11 Some dental professionals might use it to percent). A few respondents said they like vari- spend more time with patient education, help- ety in their composite materials (9 percent). ing patients understand how oral health care However, with OMNICHROMA, one compos- can affect a person’s overall health. Others ite shade adapts to any tooth shade. Dentists might use the time to incorporate new tech- can use this universal composite for multiple nology and health analysis for patients. Some patients and almost all cases. It will not only doctors might even invest in more continuing reduce excess inventory but also cut costs for education for themselves or their staff. the dental practice because they don’t have to All of these investments will improve patient stock all the shades. care and boost morale at the dental office. Also, there’s much less of a chance of the Also, from a business perspective, the time composite expiring on the shelf. Many prac- saved could result in more revenue-generating tices employ a ”first in, first out” strategy with activities for the practice. composites. Composites in the less frequently HOW OMNICHROMA used shades might not ever get used before RESULTS IN COST SAVINGS they expire. However, since OMNICHROMA The survey of 141 dental professionals also can be used in so many cases, it won’t have a suggested cost savings for a practice that uses chance to expire on the shelf. OMNICHROMA. Let’s take a look at how they OMNICHROMA’s unique design and fea- manage their material inventory now. tures match the 16 VITA classical shades with Survey results show 47 percent of respon- only one shade of composite. Not only that, it dents throw away up to five percent of their eliminates the need for chairside shade taking, composite inventory because it expires on which increases your productivity and improves the shelf. Twenty percent said they dispose your patient experience. of up to 10 percent. Another seven percent Also, the one-shade composite eliminates the of the respondents said they throw out up to need to stock all the composite inventory you 15 percent. One practice said they throw out currently need on the shelf. It means you could up to 30 percent of their composite inventory have fewer wasted materials (and wasted mate- because it expires. rial budget) from composites that expire before The composite expiring on the shelf is usually you can use them. a shade the practice doesn’t use often. Sixty We also heard what doctors had to say about percent of respondents said this was the case how OMNICHROMA delivered excellent results for their practice. However, 25 percent said on nearly 1,000 restorations. In almost every it was due to poor organization and nearly 13 case, OMNICHROMA received top marks for its percent said it was because the material has performance. never been swapped out for another. Composites are versatile dental materials in Furthermore, most of the respondents (90 today’s dental practice. Finding ways to make

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them more efficient and easier to use are vital PDF/1011cei_nuance_web2.pdf to today’s dental professionals. Tokuyama Dental’s OMNICHROMA is an Fahl, Jr., DDS, Newton. “Single-Shaded Direct Ante- innovative product that improves patient out- rior Composite Restorations: A SimplifiedTechnique comes and practice efficiencies. It is truly one for Enhanced Results.” shade for every patient. www.researchgate.net. Web. 12 November 2018.

If you would like to learn more about the Fondriest, James. (2003). Shade matching in restor- science behind OMNICHROMA, visit ative dentistry: The science and strategies. The Inter- omnichroma.com/us or tokuyama-us.com. national journal of periodontics & restorative den- tistry. 23. 467-79. 10.1016/j.prosdent.2004.03.015. SOURCES from PDF: https://www.researchgate.net/publica- tion/9006870_Shade_matching_in_restorative_den- “OMNICHROMA® Every Shade, tistry_The_science_and_strategies One Choice.” 2008. PDF File. REFERENCES Lavigne, Courney. “Dental Composites: Types and Recommendations.” www.speareducation.com. 1. Lavigne, Courtney. “Dental Composites: Web. 12 November 2018. Types and Recommendations.” Speareducation.com. Web. 13 December 2018. “Common Dental Shading Problems and Solutions.” Arrowheaddental.com. 2. Ibid. Web. 14 December 2018. 3. Ibid. 4. “Common Dental Shading Problems and Solu- Mendelson, Martin. “The Top 10 Problems with tions.” Arrowheaddental.com. Web. 14 December Shade Selection.” Speareducation.com. 2018. 28 March 2012. Web. 14 December 2018. 5. Ibid.

Smitha AJ, Savitha PN (2017) Shade Matching in Aes- 6. Mendelson, Martin. “The Top 10 Problems with thetic Dentistry – From Past to Recent Advances. Shade Selection.” Speareducation.com. 28 March J Dent Oral Care Med 3(1): 102. 2012. Web. 14 December 2018. doi: 10.15744/2454-3276.3.102 Accessed from Web. 7. Mendelson, Martin. “The Top 10 Problems with Shade Selection.” Speareducation.com. 28 March “What’s So Special about the Nanoscale?” 2012. Web. 14 December 2018. nano.gov. Web. 14 December 2018. 8. Ibid. Mehta, Angeli. “Structural Color.” 9. Smitha AJ, Savitha PN (2017) Shade Match- www.chemistryworld.com. 25 May 2018. ing in Aesthetic Dentistry – From Past to Recent Web. 14 December 2018. Advances. J Dent Oral Care Med 3(1): 102. doi: 10.15744/2454-3276.3.102 Accessed from Web. Lowe, DDS, FAGD, FICD, FADI, FACD, FIADFE, 10. Mendelson, Martin. “The Top 10 Problems with Robert A. “Composite Restorations: Subtleties in Shade Selection.” Speareducation.com. 28 March Shade and Technique.” Dentalacademyofce.com 10 2012. Web. 14 December 2018. October 2010. Web. 12 November 2018. From PDF: https://www.dentalacademyofce.com/courses/1972/ 11. Ibid.

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