Pearls for Your Practice: Vivera retainers by Align Technology, Evanesce by Clinician’s Choice, and Structur 2 SC by Voco

Vivera retainers by Align Technology

Frustrations abound in dental practices: trying to place a matrix on a deep class II preparation, getting a ridiculous insurance denial for a crown on a broken tooth, having a dental hygienist call in sick at 8 a.m. with a day full of patients, and these are just a few. But one of the most frustrating moments in dentistry is ortho relapse after finishing an aligner case. Ugh! As we all know, retention is important. Relapse happens, but it happens less when you use a retention system like Vivera.

Vivera retainers are a retention system made by Invisalign and Align Technology. They can be ordered using a scan from your iTero scanner or from polyvinyl siloxane impressions. After scanning or taking impressions, you fill out a prescription for the Vivera retainers. The only choice you need to make as a clinician is whether you want bite ramps. Bite ramps are sort of like bite turbos in the retainer that cause posterior disclusion. I use this frequently on patients who clench or grind. This allows their Vivera retainer to serve as a de facto occlusal splint as well. Patients are typically pretty happy when they hear that they just have to wear a retainer and not a night guard! At 0.04 inches, Vivera retainers are strong and rough. They hold up well and cleanse well.

A set of Vivera retainers consists of four upper and four lower retainers. The point of this system is to provide the patient with a backup. I’ve had patients lose their retainers. One patient’s dog chewed them up. I even had a patient who dropped their retainer in the toilet and couldn’t bear the thought of using it again. We’ve all had instances like this with retainers.

The problem is that traditional lab-made retainers are a cottage industry. There is no way to make more than one without doubling the cost, so patients have no redundancy. With Vivera, they always have a backup. I find that if my patients take care of their retainers, each one can last well over a year. That gives us long-time retention for a small price.

Another great feature of Vivera is that patients don’t have to have undergone Invisalign treatment to use the retainers. You can order Vivera for any patient in your practice; just submit a prescription on the Invisalign Doctor Site and take a scan with your iTero—it couldn’t be easier. Each set of retainers comes with a sleek case that’s very high-level. It adds a nice touch of class.

The cost of Vivera varies along with your Invisalign rewards level, but for most clinicians it ends up being a lab cost of around $40 per retainer. It’s economical for us and for our patients. Vivera retainers are by far my first choice for retention for both aligner and nonaligner cases. Triple to deep center field for Align and Vivera retainers!

Evanesce by Clinician’s Choice

The early 2000s was a weird time for music. Limp Bizkit, Linkin Park, and Korn were tearing up the airwaves, and I couldn’t have disliked it more. I was still jamming to Gin Blossoms, Oasis, and Dave Matthews. The new sounds were not my favorite. One of the bands I hated most from that time was a band from Arkansas named Evanescence. Their big hit was called “Bring Me to Life.” I hated it. HATED it. It was so bad.

Naturally, when Clinician’s Choice came out with a resin composite named similarly to that horrible band, I wasn’t thrilled. I wouldn’t even try the material because it made me think of that terrible song. I never gave Evanesce a chance. However, I recently needed a resin material that blended and polished well. A colleague recommended Evanesce, so I tried it. I must say, I loved it! The band Evanescence still sucks, but the composite Evanesce is great!

Evanesce is a nanohybrid composite made by Clinician’s Choice. It comes in 22 Vita shades over three opacities, three bleaching shades, and three FX shades. It is, quite simply, a whole thing! You can use Evanesce to restore any shade of tooth you run across! In Enamel shades (80% opacity), you can choose among A1E, A2E, A3E, A3.5E, B0.5E, B1E, and B2E. In Universal shades (85% opacity), you have these choices: A1U, A2U, A3U, A3.5U, A4U, B0.5U, B1U, B2U, C1U, C2U, C3U, BL1U, and BL3U. With Dentin shades (90% opacity), you’ve got these: A1D, A2D, A3D, A3.5D, B1D, and C4D.

There are several options in this kit that you don’t see very often. The B0.5 shades are awesome for situations where we need lighter than B1 but not quite a full bleach shade. And for those patients who have bleach shades, we have those options too! The FX shades are used to enhance and add esthetic enamel characterization. These aren’t shades I use every day, but they’re nice to have when I need them. The choices are FX White, FX Incisal, and FX Clear. They are all more translucent than the other Evanesce shades, so they should be used only in situations requiring more characterization for better blending.

This nanohybrid composite material is strong and polishes beautifully. It handles a bit like putty, meaning it has some body and won’t slump. Evanesce is excellent for anterior restorations where that is needed to get the primary anatomy required for a great restoration. However, this material is not just for anteriors. It can also be used for posteriors, but it is an incremental fill product and should not be used in increments deeper than 2 mm.

When ordering Evanesce, you have the choice of either syringes or 0.3 gm compules. A trial kit is also available with five different shades so you can try out the material. Evanescence the band certainly won’t bring you to life like their lyrics state but Evanesce composite by Clinician’s Choice will! Single to left field for Clinician’s Choice.

Structur 2 SC by Voco

Anecdotally, I would argue that most general and restorative dentists enjoy indirect restorative appointments more than direct restorative appointments. That may not be true for 100% of dentists, but most of my colleagues seem to feel this way. I know I do. Indirect restorative appointments are a bit simpler and more structured, in addition to being more profitable. The biggest issue is that patients usually have to come back for a second appointment. That second appointment is typically two weeks or so after the prep appointment. In my mind, how easy that second appointment goes is solely reliant on one thing—the provisional. The better the provisional, the easier the delivery is going to be. One way to ensure we have a good provisional is to use good provisional material. One of the good ones is Structur 2 SC by Voco.

Structur 2 SC is a bis-acryl GMA material for all indications of provisional restorations. From inlays and onlays to full crowns and even veneers, Structur 2 SC has the strength to hold up in any of those situations. It is a self-cure material, and it has no light-cure component to it at all. This is the only aspect of Structur 2 SC that I wish I could change.

For veneers, I like to use a clear PVS matrix and cure the temporary material through the matrix. But this can’t be done with Structur 2 SC. It does, however, self-cure quickly, which helps make up for that. Structur 2 SC can be removed from the mouth after 90 seconds, and it can be trimmed and finished after two-and-a-half minutes. Because of this quick set, it’s more reasonable to use for veneer provisionals. Since it comes in eight shades, it also allows you to get a really good shade match on your provisionals.

The polishability of Structur 2 SC is very high. It can easily be polished with whatever point, wheel, or disc you use to polish your resin composites. In addition to being highly polishable, it is also very color-stable. I recently had a patient who I prepped for four veneers in Structur 2 SC temps for around six weeks and saw zero color change during that time. Structur 2 SC held its polish and shine well. Cementation can be done with the provisional cement of your choice. I like Provicol QM by Voco.

Another feature of Structur 2 SC that I like is the ability to do a final glaze of the provisional when finished. This takes esthetics to the next level by giving it a porcelainlike shine. Easy Glaze by Voco is a great choice for this; it’s a light-cure material that makes it fast and easy to go from good to great.

Having a strong, esthetic, economical, and fast choice for provisionals will make your life easier. The better your provisional, the easier the insert will be. That makes all of us happy! Double to left center field for Voco on Structur 2 SC provisional material!

Editor's note: The article appeared in the May 2024 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

Joshua Austin, DDS, MAGD, is a graduate and former faculty member of the University of Texas Health Science Center at San Antonio School of Dentistry. Dr. Austin lectures nationally on products, dental technology, online reputation management, and social media. He maintains a full-time restorative dentistry private practice in San Antonio, Texas. You may contact Dr. Austin at [email protected].