Cone Beam Volumetric Imaging has many advantages over simple panoramic film and digital images, including enabling accurate visualization of head and neck structures and reducing X-ray doses. It has been rapidly adopted and is becoming the “standard of care” for several applications and preferred for others.

The local anesthetic drugs presently available and used in dentistry represent the safest and most effective drugs in all of medicine for the prevention and management of pain. The dental profession purchased in excess of 300 million local anesthetic cartridges in the United States in 2006, making local anesthetics the most-used drugs in the dental profession. One drawback associated with intraoral local anesthesia is patients’ fear of injections and the perception that these are painful. Recent advances have resulted in the use of computer-controlled local anesthetic delivery vehicles to regulate the delivery and rate of flow of local anesthetics at the injection site, lessening potential discomfort associated with injections. New injection techniques that provide reliable anesthesia have also been introduced, and depending on the technique used and area of anesthesia necessary, they do not result in undesired extraoral soft tissue anesthesia. These new injection techniques have been aided by the use of computercontrolled local anesthetic delivery systems.

Educational Objectives The overall goal of this course is to provide the reader with information on computer-aided design/computer-aided manufacturing (CAD/CAM) dentistry and digital impressions in the dental office. Upon completion of this course, the clinician will be able to do the following: 1. Know the requirements for ideal impression and model materials 2. Understand the differences between complete in-office and chairside digital impression CAD/CAM techniques 3. Understand the potential impact of CAD/CAM dentistry on productivity and accuracy 4. Know the potential impact on clinic-laboratory communication of chairside digital impression making and digital photography.

The increased use of direct composite restorations can be mainly attributed to patient demand for esthetic restorations and the availability of composites with high strength and excellent esthetics. While early composites were weak and suitable only for anterior restorations, current composites are highly esthetic and offer high strength for their intended purposes. Techniques have also evolved, with sophisticated bonding techniques and single-shade, dual-shade, and multilayering techniques to optimize esthetics. It is important to consider not only the individual case, relative strength, and esthetics of different types of composites but also the technique to be used when selecting a restorative material.

Dentinal hypersensitivity has been referred to as one of the most painful and chronic dental conditions, with a reported prevalence of between 4% and 57% in the general population and a higher prevalence in periodontal patients. It may also occur as a result of, or during, dental treatment. Clinicians must screen for dentinal hypersensitivity and diagnose by exclusion, determine appropriate treatment, and provide treatment and preventive recommendations. Consideration should also be given to treating dentinal hypersensitivity associated with dental treatment. Traditional treatments have included adhesive resins, fluoride varnishes, HEMA,iontophoresis, gingival grafts and desensitizing dentifrices. Other technologies include the use of bioglass particles,ACP, as well as 8% arginine and calcium carbonate paste.

Upon completion of this course, the clinician will be able to do the following: Understand the evolution of the use of microscopes in dentistry, know the improvements in treatment precision obtainable using a microscope, and understand how the integration of microscopes into the dental office can improve ergonomics and documentation, as well as aid communication.

Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) was first introduced to dentistry in the mid-1980s. Both chairside and chairside—laboratory integrated procedures are available for CAD/CAM restoration fabrication. In selecting which procedure to follow, consideration should be given to esthetic demands, chairside time, laboratory costs, number of visits and convenience and return on investment associated with CAD/CAM equipment. Depending on the method selected, CAD/CAM ceramic blocks available for restoration fabrication include leucite-reinforced ceramics, lithium disilicate, zirconia,and composite resin. In order to determine which type of ceramic to use, the practitioner must take into account esthetics, strength,and ease of customizing milled restorations. CAD/CAM gives both the dentist and the laboratory technician an opportunity to automate fixed restoration fabrication and to offer patients highly esthetic restorations in just one or two visits.

The posterior restorative material of choice depends on the individual clinical situation and patient. Amalgam has a long history of use and clinical success. Esthetic restorations are increasingly in demand, and include glass ionomers, compomers and composite resins. Fluoride release is a desirable attribute in a restorative material, as are wear resistance, low polymerization shrinkage and low polymerization stress. Recently, technologies have been incorporated into composite resins that lower polymerization shrinkage and stress.

Parafunctional activities associated with the stomatagnathic system include lip and cheek chewing, fingernail biting, and teeth clenching. Bruxism can be classified as awake or sleep bruxism. Patients with sleep bruxism are three to four times more likely to experience jaw pain and limitation of movement than people who do not experience sleep bruxism. Signs and symptoms of bruxism and parafunctional activity include hypertrophied masseter and temporalis muscles, myocitis of these same muscles, morning jaw stiffness, and sensitivity in a tooth or teeth. Additionally, migraine is associated with parafunctional activity. Dental professionals are responsible for diagnosing and managing parafunction. Patients can be managed with oral appliances of various designs.

Upon completion of this course, the clinician will be able to do the following: Know the incidence of oral cancer in the United States and understand the risk factors, be knowledgeable about the signs and symptoms of oral cancer, understand screening methods available for the detection of oral cancer, and understand the role of chromosomal aberrations in the risk of malignant transformation

Bruxism is a parafunctional occlusal activity, that may exist as either sleep bruxism or awake bruxism. Bruxers have more noticeable signs of dental attrition, abfractions, and occlusal pits on their natural teeth than other patients. Clinical approaches to managing bruxism can be categorized as acute, preventive and chronic, with the approach depending on the patient’s signs and symptoms. Preventive intervention is required if a patient presents with tooth wear. A primary preventive approach in the treatment of bruxism is the fabrication and utilization of a nightguard.

Obturation is a critical component of root canal therapy, and must both provide a complete seal for the root canal system and eliminate all avenues of leakage from the oral cavity. Historically, gutta-percha cones have been the standard material of choice for root canal obturation, used together with a sealer/cement. The first gutta-percha carrier-based obturating techniques were developed more than two decades ago. More recently, obturating techniques have been introduced that include resin-based sealers and obturators,syringe-applied heated gutta-percha, and the use of guttapercha as an outer coating on obturator carriers composed of plastic or metal. It is important to select an obturation technique that offers consistency and is easy to use.

Upon completion of this course, the clinician will be able to do the following: Understand the range of diseases for which stem cell therapies are being investigated, be knowledgeable about the various sources of stem cells and the advantages and disadvantages of each source, understand the fundamental reasons for the effectiveness of stem cells and the meaning of tissue differentiation, and understand the basics of cryopreservation and the banking of stem cells.

Cone beam computerized technology (CBCT) offers 3-dimensional visualization and more complex and more accurate imaging compared to analog and digital radiographs. It is an accurate tool for many clinical oral-maxillofacial indications, with lower radiation doses than computerized tomography. The clinician must determine the risk:benefit of imaging for each patient. Clinicians are rapidly realizing the significant advantages of CBCT imaging. Factors to consider in determining whether to purchase a CBCT device or to refer patients to imaging centers include cost, training, time required to generate images and reports, data transmission and storage,and responsibility for interpretation and pathology review.

There has been dramatic progression in the adhesion of dental adhesives and resins to enamel and dentin in the 40 years since Buonocore1 introduced the technique of etching enamel with phosphoric acid to improve adhesion to enamel. The first dental adhesives bonded resins to enamel only, with little or no dentin adhesion. Subsequent generations have dramatically improved bond strength to dentin and the sealing of dentin margins while retaining a strong bond to enamel. With more patients demanding metal-free dentistry, the use of dental resins as cements as well as direct and indirect restorations will continue to increase. This article discusses the progression of dental adhesives up to the most recent generation, in which all components are contained in a single bottle or unit-dose container and applied using a one-step technique that requires no mixing.

The prevalence of periodontal disease and estimates of provided treatment are indicative of treatment needs. Current technology offers standardized probing, automated charting, risk assessment, differential diagnosis and suggested treatment plans, as well as enabling clinicians to involve patients in the process. Patient awareness and treatment acceptance can be encouraged with full evaluation, a consistent protocol and message, and through the use of technology.

Primary tooth pulp therapy can preserve primary teeth until ormal exfoliation when clinical conditions permit. Therapeutic options include pulpotomy, indirect pulp treatment and pulpectomy. The appropriate therapeutic options depend on the health of the pulp. In order to determine which treatment option should be pursued, it is necessary to clinically and radiographically assess the tooth. Options for vital primary teeth include pulpotomy and indirect pulp treatment. Provided that careful attention is paid to detail during the clinical procedure and follow-up, as described in this article, both techniques have similar success rates and can save primary teeth.