Pearls for your Practice: BondSaver Desensitizer, Clearfil Majesty ES Flow Universal, Vac-Tak
BondSaver Desensitizer
I hate dealing with sensitivity in my practice. Whether it be deep decay or shallow, direct restorations or indirect, it is always a pain in my backside and costly to my practice in terms of chair time, assistant time, and disposables. Most of all, it is costly to my mental health. For direct restorations, or when I am bonding an indirect restoration, I have a solution. Desensimax by Vista Apex works very well for those situations, but its chemistry prevents RMGI luting cements from working. BondSaver Desensitizer by Vista Apex is a desensitizing solution that is made for indirect restorations and RMGI cement.
A partial explainer of sensitivity comes from moisture level. In order to get a proper bond with little to no sensitivity, an appropriate amount of moisture must be present. If the dentin is either too wet or too dry, we get a poor bond and sensitivity. BondSaver helps reach the appropriate moisture level and provides an initial surface that allows the luting cement to reach its full potential. It works to ensure long-term bond integrity by limiting the development of matrix metalloproteinases (MMPs) that have been cited as a contributor to bond degradation over time.
In order to use BondSaver, make sure the prep area is clean and dry. Apply a uniform coat to the dentin surface. Allow it to sit for five seconds. I typically hold the high-volume evacuation tip over the prep to suck off the excess. Make sure you leave a shiny surface behind with no pooled liquid, and then place the crown with the RMGI cement. One key point of using BondSaver is to shake the bottle vigorously for three seconds before you dispense. This will remedy any separation in the BondSaver liquid that might occur during storage.
In situations where I am delivering a zirconia crown, I always try to lute it in with RMGI cement. In the past, I did not have a way to help with sensitivity. If I was going to use a densensitizer, I would have to numb and use Desensimax and a resin cement. Not something I really wanted to do if a tooth was already sensitive. With BondSaver and an RMGI cement, I can treat the sensitivity and still get all the benefits of luting. Single to right field for Vista Apex!
Clearfil Majesty ES Flow Universal
In Chicago, Illinois, there is a statue of GV Black. It was installed in 1918 by sculptor Frederick Hubbard, commissioned and gifted to the city by the National Dental Association. Dr. Greene Vardiman Black was a legend and a name that dental students still learn today. When I was in dental school in the early 2000s, we were still taught GV Black-style preparation techniques. We were also taught the virtues and principles of minimally invasive dentistry. The two philosophies, however, are at odds. You cannot remove tooth structure for retention and resistance form and also be practicing minimally invasive dentistry. This is partially why we have seen an explosion in the use of resin composites in the posterior, in addition to the esthetic benefit. Instead of hogging-out teeth, we can simply remove caries and then restore, without worrying about depth, draw, etc. Many times, though, in an effort to be minimally invasive, we perform preps that are small enough that it becomes difficult to get paste-style composite into the preparation. A strong, esthetic flowable composite is great for these types of minimally invasive restorations. Clearfil Majesty ES Flow Universal fits the bill perfectly.
Clearfil Majesty ES Flow Universal is a high-viscosity flowable composite with properties equivalent to conventional paste-type composite resins. The enhanced strength for a flowable comes from the high amount of filler in it. At 78%, it is one of the most filled flowable composites on the market. Kuraray calls Clearfil Majesty ES Flow Universal “super low flow” which means that it has high viscosity and strength. It flows more than a paste for sure, but it is not runny. It flows enough and has enough body to really work well on minimally invasive preps and boxes with nooks and crannies that need some viscosity, but where we don’t want to sacrifice strength. In the category of flowables, Clearfil Majesty ES Flow Universal leads the way with over 152 MPa of flexural strength.
There are only two shades of Clearfil Majesty ES Flow Universal (U and UD). For the posteriors, go with U. If working in the anterior, use UD for shades B3, A3.5, B4, C3, A4, and C3. For any other shade, use shade U. This shading system is possible thanks to Kuraray’s light-diffusion filler matrix which makes restorations diffuse light in a similar way to the surrounding tooth structure. This technology makes this material polish well and hold its polish well.
From both a strength and esthetics standpoint, Clearfil Majesty ES Flow Universal is a great choice. Whether you use it as a solo restorative for small preps or as a base for larger ones, Clearfil Majesty ES Flow Universal is a material you will enjoy having in your kits. Triple to the left field corner for Kuraray!
Vac-Tak
When I think about stressful days in a dental practice, I think about days when a hygienist is out sick and there is a temp. I think about days when a patient is scheduled for a crown insert at 3:30 pm, but it’s still on the UPS truck and there’s no sign of the delivery driver. I think about seeing a third bite adjustment on that patient you really do not like. But most of all, I think about veneer delivery appointments. I love veneers, but the delivery is stressful. Taking off the temps, keeping isolation, and holding on to those thin veneers to get them into place without dropping them on the floor or down the patient’s throat is stressful. The Vac-Tak veneer placement instrument from Addent can help.
The Vac-Tak veneer placement instrument from Addent helps handle veneers without dropping. Using a suction tip, the off-angle instrument will grab and hold on to the veneer, so you don’t have to try to do it with your fingers. There are two sizes of suction tips, a smaller one that is great for lower incisors and laterals, and a larger one that is perfect for larger veneers. In order to get the best suction, place a small drop of water on the midbuccal of the veneer before attaching it to the suction cup of the Vac-Tak. In the Vac-Tak kit, a small water dropper is included. This will really keep the restoration suctioned to the Vac-Tak for easy placement.
There are two ends on the Vac-Tak veneer placement instrument in which a suction cup tip can be attached at different angles. I use either side depending on which side of the mouth I am working on. The handle itself is autoclavable, but the suction cup tips are disposable.
A great feature of the Vac-Tak is that the suction cups are clear, and there is an opening on the back of the instrument, making it possible to tack-cure the veneer while using the Vac-Tak to hold the veneer on. This makes for a less stressful delivery. Nothing is worse than not getting the veneer fully in the right spot before curing it. The Vac-Tak answers that problem and it answers it well! The Vac-Tak is affordable, easy to use, and lowers my stress on delivery days. That is a double to deep center field for Addent!
Editor's note: This article appeared in the February 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
