Dental Materials and Techniques for Special �eeds Patients:

from children to the frail elderly

Robert E. Rada DDS, MBA

Clinical Associate Professor – UIC College of Dentistry

Private Practice - LaGrange, IL

bobr759@sbcglobal.net

Porcelain repair/bonding technique

Kits: Pulpdent Embrace Restoration and PFM Repair Kit

Bisco – Intraoral Repair Kit

Opaquing Agents - Pulpdent – Embrace Esthetic Opaquers

Cosmedent - Creative Color Opaque Kit

(both have a pink opaquer for dark grey/ metal)

AESTHETIC REHABILITATIO� OF A� EXISTI�G PFM BRIDGE

http://www.dentistrytoday.com/component/content/article/184-fixed-partial-denture-repair/2668-aesthetic-

rehabilitation-of-an-existing-pfm-bridge

Evidence Based Clinical Recommendations for Dental Sealants and Sealant

Programs, and Other Sealant Program Resources

http://www.mass.gov/eohhs/provider/guidelines-resources/services-planning/workforce-

development/oral-workforce-dev/dental-hygienist/toolkit/evidence-based-clinical-

recommendations-for.html

Some products mentioned in the lecture

Cervitec Plus (Ivoclar Vivadent) http://www.ivoclarvivadent.com/en/competences/all-

ceramics/prevention-care/cervitec-plus

Fluor Protector (Ivoclar Vivadent)

http://www.ivoclarvivadent.com/en/all/products/prevention-care/fluoridation/fluor-

protector

Vanish XT (3M ESPE)

Chemfil Rock (Dentsply Caulk) http://www.chemfilrock.com/

Ketac Nano (3M ESPE)

TheraCal (Bisco)

Biodentine (Septodont)

Beautiful II, BeautiSealant (Shofu)

GLASS IO�OMER PRODUCTS FROM THE BIG THREE

CoCure Technique References

A Temporary Alternative for the Inlay or Onlay: The Co-Curing Technique

http://www.sdi.com.au/images/stories/modules/Module_Download_Files/Co_curing_tech

nique_Article_ENG.pdf

Using Bioactive Materials to achieve Proactive Dental Care

http://www.catapultelite.com/pdf/Comisi_article.pdf

GIOMERS The term “Giomer” refers to any product containing Shofu’s proprietary Surface Pre-

Reacted Glass, or “S-PRG” filler particles. S-PRG filler uniquely releases 6 ions:

Fluoride, Sodium, Strontium, Aluminum, Silicate, and Borate; all with known bioactive

properties. Additionally, S-PRG filler has been shown to inhibit plaque formation, and

possess remarkable acid neutralization capabilities. Unlike glass ionomers and

compomers which require water absorption following photocure to release fluoride;

Giomers contain a multifunctional glass core that undergoes an acid-base reaction during

manufacturing and is subsequently protected by a surface modified layer.

Key Benefits:

S-PRG filler material has been clinically shown to:

• Recharge fluoride when treated with fluoridated products

• Decrease acid production of cariogenic bacteria

• Neutralize acid on contact

• Slow demineralization, while promoting remineralization of enamel

• Demonstrates an anti-plaque effect

From: http://www.shofu.com/en/restoratives/187

http://www.giomer.com/

Pulp Cap Treatment of an exposed vital pulp by sealing the pulpal wound with a dental

material such as calcium hydroxide or mineral trioxide aggregate to facilitate the

formation of reparative dentin and maintenance of vital pulp.

Vital pulp cap – points to consider

• Was the exposure due to caries, trauma or mechanical?

• Consider using an endodontic explorer

• Only a vital pulp can be capped; non-vital needs root canal treatment

• Cold test remains #1 to check for vitality

• Use a rubber damAvoid exposing the pulp. Seal in residual caries.

• Control hemorrhage with water, saline, anesthetic, sodium hypochlorite

• Provide a well sealed restoration.

• RMGI’s work very well over Ca(OH)2 and MTA

102

DENTISTRYTODAY.COM • MARCH 2013

INTRODUCTIONOperative dentistry not only requires tech-nical expertise and an in-depth understand-ing of materials science, but knowledge incariology and pulp biology is also essential.We no longer need to create a preparationthat may far exceed the boundaries of thediseased tooth structure. Instead, with theadvances in adhesive dentistry, tooth prepa-ration can be much more conservative.Even the amount of potentially diseasedtooth structure that must be removed isbeing called into question.

This article will explore management ofthe deep carious lesions and look at some ofthe following questions being considered inthe dental literature. Do all caries need to beremoved (when the excavation extends nearthe pulp) in every clinical case? Can cariesprogression be arrested? What type ofrestorative materials should be used toensure the best outcome for the patient?

Traditional Concepts In his classic text (1908), G. V. Black said, “Itis better to expose the pulp of a tooth thanto leave it covered only with softened den-tine.” However, G. V. Black also stated that itis imperative that dentists understand thepathology of the caries process or they willonly be considered as mechanics. Obvi -ously, dental science has advanced ourunderstanding of the carious process andthe ability to create a restoration with well-sealed margins and associated grooves andfissures.1,2 G. V. Black may have altered thisassertion 100 years later.

The traditional concept of completecaries removal in very deep preparations hasbeen challenged.2 Complete carious dentinremoval may not be a prerequisite to arrestcaries progression. It is well known that bac-teria in the dentin cause pulpal inflamma-tion. This inflammatory process may be abenefit for pulp regeneration.3 Leaving somecarious tissue beneath a restoration does notnecessarily interfere with treatment success.Short-term studies of 36 to 45 months, inwhich carious dentin was sealed in, showedlack of progression of the lesion and a de -crease in the number of microorganisms.Remineralization of the remaining carious

dentin was detected both biochemically andradiographically. Calcium hydroxide linerswere used in these studies.4

Leaving caries beneath a restoration is avery controversial issue. The traditionalconcept of an indirect pulp cap usuallyrequired that the dentist place some type ofinterim restoration. After a period of weeksor months, the tooth is then reentered, theremaining caries excavated, and a defini-tive restoration placed. Frequently a calci-um hydroxide liner is placed beneath theinterim and definitive restorations.

In indirect pulp treatment, demineral-ized carious tissue is left at the deepest sitesof the cavity preparation so as not to exposethe pulp. Indirect pulp treatment is limitedto teeth that have no signs or symptoms ofirreversible pulpal pathology. Completeremoval of all carious tissue from the pulpalwalls is essential to control microleakage.The lesion may be slowly or rapidly pro -gressing. Clinical, radiographic, and bac ter i -ologic studies have shown that car ies can bearrested. A well-sealed restoration, withoutmarginal defects, is essential.5

The classic indirect pulp cap has a rela-tively high clinical success rate, pulp expo-sure is usually avoided, and the tooth isusually asymptomatic. Dentin upon re-entry is described as dryer, harder, and dark-er. From a microbiological perspective,there is a substantial decrease in any culti-vatable flora. There is a possibility that thedental material may have an effect on theoutcome, but very few studies address thisin a controlled manner. “Indeed, a cautiousapproach may be preferable to vigorous

excavation because fewer pulps will beexposed and sealing the dentin from theoral environment encourages arrest of thelesion progression. The reparative processof tubular sclerosis and tertiary dentine areencouraged, thus reducing the permeabili-ty of the remaining dentin. The remainingmicroorganisms are entombed by the sealof the restoration on one side and thereduced permeability of the remainingdentin on the other.”1

Changing EvidenceIt has been well accepted that sealants pro-tect the underlying tooth structure, prevent-ing plaque accumulation and dissolution ofminerals. More recently, an increasing bodyof evidence indicates that arrest of noncavi-tated carious lesions is possible with dentalsealants. Yet noninvasive management ofcaries has not been widely adopted in theseinstances by dental practitioners.6,7

The outcome of stepwise excavation ver-sus direct complete excavation has been com-pared. In this study,8 when a temporaryrestoration could be properly placed, no fur-ther excavation was carried out; leaving soft,wet, and discolored dentin centrally on thepulpal floor. A calcium hydroxide lining mate-rial was applied over the remaining cariousdentin and the cavity was temporarily sealedwith glass ionomer. After 8 to 12 weeks, thecavity was reentered and the final excavationwas carried out. A calcium hydroxide liner wasapplied and the cavities were restored withcomposite resin. The authors8 observed signif-icantly fewer pulp exposures after stepwise

Robert E. Rada,DDS, MBA

New Options for Restoring a Deep Carious Lesion

continued on page 104

Figure 1. Large carious lesion in a tooth with minimal symptoms.

Figure 2. Partial caries excavation was carried out,leaving soft, wet, and discolored dentin.

DENTAL MATERIALS

DENTAL MATERIALS104

excavation than after direct completeexcavation in adult teeth. Also, a signifi-cantly better success rate was found forstepwise excavation at one year of fol-low-up versus direct complete excava-tion, when considering unexposed pulpswith sustained vitality without apicalradiolucency. This observation empha-sizes the importance of maintaining anunbroken dentin barrier against thepulp, even if there remains some caries.8

Most recently, the need for step-wise excavation is being questioned.Indirect pulp capping is simple, morepatient friendly, and less expensivethan root canal treatment. Althoughsome microorganisms may survive,these are rarely enough for the cariesto progress, and tertiary dentin isdeposited resulting in mineral gain inthe radiolucent zone is promoted.3Infected dentin should be removedcompletely from the preparationwalls but selectively from the pulpalfloor or axial wall. Removal of all ofthe infected dentin in deep cariouslesions may not be required in everyclinical situation, “provided that therestoration can seal the lesion fromthe oral environment effectively.”2

Dental Liners: Effects on the Pulp Liners are frequently used beneathdental restorations to reduce the po -tential for postoperative sensitivity.Several properties are necessary for anideal liner: (1) the ability of the mate-rial to kill bacteria, (2) induce miner-alization, and (3) establish a tight bac-terial seal.9 Postoperative sensitivityis partially related to the remainingdentin thickness (RDT) following cav-ity preparation and presence of bacte-ria on the cavity walls. There is nomaterial better to protect the pulpthan dentin. The remaining dentinthickness between the base of the cav-ity preparation and the pulp is one ofthe most important factors in protect-ing the pulp from toxins.9 A 0.5 mmthickness reduces the effect of toxinsby 75%. A 1.0-mm thickness reducesthe effect of toxins by 90%. Remainingdentin thickness of 2.0 mm (or more)results in little or no pulpal reaction. Itis at the 0.5 mm region that liners be -come most im portant. As the re -maining dentin thickness decreases,odontoblast survival and pulp—den -tin repair be comes compromised.9

Reactionary dentin depositionwas observed beneath cavities with aRDT above 0.5 mm as well as beneathcavities with a RDT below 0.25 mm;

however, maximal reactionary dentinappeared to be beneath cavities withan RDT between 0.5 to 0.25 mm. Thearea of reactionary repair was alsoinfluenced by the choice of restora-tion material (from greatest to least:calcium hydroxide, composite, resin-modified glass ionomer [RMGI] ce -ment, and zinc oxide-eugenol). Odo -ntoblast numbers were maintainedbeneath cavities with a RDT above0.25 mm.9,10

Calcium hydroxide has been usedas a lining material since the 1920s.Because of the basic pH of about 11,calcium hydroxide is both antibacteri-al and can neutralize the acidic bacter-ial byproducts. The high pH creates anenvironment conducive to the forma-tion of reparative dentin. In addition,calcium hydroxide has the capacity tomobilize growth factors from the

dentin matrix, causing the formationof new dentin. Calcium hydroxide isan ideal lining material for the verydeep cavity preparation and also con-tinues to represent an option for boththe indirect and direct pulp cap.10,11

Adhesive resins can be acidic andcause pulpal irritation. Many dentinbonding agents and resin-reinforcedglass ionomers are actually detrimen-tal to the pulpal tissues. In contrast,calcium hydroxide has been shown toprovide a significantly improvedpotential for pulpal repair comparedto adhesive resins.12

Unfortunately, the self-setting cal-cium hydroxide liners are highly solu-ble and subject to dissolution overtime.13 Traditional calcium hydrox-ide liners are easily lost during acidetching. Dentin bonding agents thatcontain water, acetone, or alcohol can

also detrimentally affect the proper-ties of calcium hydroxide. A hermeticseal of the cavity may stabilize thelesion and arrest caries progression.Therefore, when a restoration of com-posite resin is planned, glass ionomercement should line the cavity prepa-ration, sealing over the calcium hy -droxide material, if used.14

Restorative materials that exhibitantimicrobial benefits are useful inminimal intervention and other typesof dentistry.15 Some studies show thatRMGIs were about equal to conven-tional calcium hydroxide liners.3Remaining softened, demineralizeddentin covered by glass ionomer be -comes remineralized, presumablyunder the influence of the fluoriderelease and the presence of calciumand phosphate ions from the cement.This phenomenon is also referred toas the “healing of affected dentin.”However, in other studies, RMGIswere found to cause the greatestreduction in odontoblast numbers. Itis frequently recommend that a thinliner of calcium hydroxide be appliedto the cavity floor of deep prepara-tions before RMGI is placed.16 Thisappears to provide improved pulpalprotection from injury and bacterialmicroleakage.17

In recent years, mineral trioxideaggregate (MTA) preparations havebeen introduced (ProRoot MTA[DENT SPLY Tulsa Dental Specialties]).These silicate cements are antibacteri-al, biocompatible, have a high pH, andare able to aid in the release of bioac-tive dentin matrix proteins. MTA is apowder consisting of fine hydrophilicparticles of tricalcium silicate, trical-cium aluminate, tricalcium oxide,and silicate oxide. It also containssmall amounts of other mineral ox -ides, which modify its chemical andphysical properties. Hydration of thepowder results in formation of col-loidal gel with a pH value equal to 12.5(similar to calcium hydroxide) thatsolidifies to form a strong imperme-able hard solid barrier in approximate-ly 3 to 4 hours. It is hypothesized that

DENTISTRYTODAY.COM • MARCH 2013

New Options for Restoring...continued from page 102

Figure 3. Biodentine (Septodont) interimrestoration.

Figure 4. Radiograph of the Biodentinerestored tooth. Remaining caries is evidenton the radiograph. Depending on the clinicalsymptoms, the dentist may choose to prepare this tooth, leaving some of theBiodentine as a base beneath the definitiverestoration.

Figure 5. Definitive distal occlusal compositerestoration.

Figure 6. Deep excavation with discoloreddentin of an uncertain quality.

Figure 7. TheraCal (BISCO Dental Products), alight-cured resin-modified calcium silicate lining material, is delivered into the preparation.

Figures 8 and 9. Acid etching and replacement can be done directly onto this material, without disruption of the liner.

DENTAL MATERIALS

the tricalcium oxide reacts with tissuefluids to form calcium hydroxide.13

The material has a low solubilityand a radiopacity slightly greater thanthat of dentin. Because it has low com-pressive strength, it should not beplaced in functional areas. Another sig-nificant disadvantage for the restora-tive dentist is that the setting timesmay take several hours. As a result, 2-step procedures are frequently neces-sary, requiring interim restorations. Aspreviously discussed, recent evidenceindicates that an indirect pulp capshould be performed in a single treat-ment appointment. Any immediaterestoration will require coverage with alayer of RMGI cement.18 MTA is anexcellent material for direct vital pulpexposures and numerous endodonticapplications. The material has goodlong-term sealing capabilities, andsome studies show greater success thanconventional calcium hydroxide.19

CASE REPORTSCase 1

A 30-year-old patient presented with alarge carious lesion in the lower firstmolar (Figure 1). The patient reportedthat the tooth was sensitive to cold,but otherwise asymptomatic. A coldtest did verify the transient sensitivityto cold, which dissipated at approxi-mately 30 seconds. A periapical radi-ograph confirmed that the caries wasin close proximity to the pulp. Thecaries was excavated until the prepa-ration was excavated to a depth esti-mated at less than 1.0 mm from thedental pulp (Figure 2). Biodentine(Septodont) was used as the therapeu-tic interim restoration (Figure 3). Thetooth was allowed to heal for about 4months. During this time, the toothwas asymptomatic. A cold test wasused to verify pulpal vitality, and aperiapical x-ray was taken (Figure 4).It was decided to restore the toothwith a direct distal occlusal compositeas a definitive restoration (Figure 5).

Material Discussion In the author’s experience, Biodentineis a relatively more user-friendly ma -terial for the restorative dentist ascompared to traditional MTA prepara-tions. Biodentine is an active biosili-cate material useful in direct and indi-rect pulp capping, and it also hasendodontic applications. In addition,it is different from the usual MTA for-mulations. The manufacturing pro -cess of the active biosilicate technolo-gy eliminates the metal impurities.The setting reaction is a hydration oftricalcium silicate, which produces a

calcium-silicate gel and calcium hy -droxide. In contact with phosphateions, it creates precipitates that resem-ble hydroxyapatite. “An evaluation ofthe dentin-Biodentine interface de -monstrated an increase in the carbon-ate content of interfacial dentin,which suggested intertubular diffu-sion and mineral tags of Biodentinehydration products creating a hybridzone.”20 Biodentine resists microleak-age similar to RMGI cements21 andalso has an antibacterial effect.22

Biodentine reaches a final set inabout 10 to 12 minutes. This is muchfaster than the time required for MTAand also demonstrates higher compres-sive strength. Therefore, it can serve asan excellent interim restoration. As ofyet, the manufacturer recommends thematerial be used in a 2-step procedure.At a subsequent ap pointment, the clini-cian cuts the ideal cavity preparation,leaving the Bio dentine as a liner or adentin substitute base under the defini-tive restorative material.23

Case 2The lower molar in Figure 6 had anexisting defective amalgam restorationwith recurrent caries. The res torationwas removed and the caries excavated.A thin layer of TheraCal LC (BISCODental Products) (a light-cured, resin-modified calcium silicate lining materi-al) was placed over the deepest portionsof the preparation using the conven-ient syringe delivery system (Figure 7)and then light-cured for 20 seconds.The cavity preparation was etched(Figure 8), rinsed, coated with adhesive,and then air-thinned and light-cured(Figure 9); ready for composite resinplacement to complete the restoration.

Material DiscussionTheraCal LC, another recently intro-duced material, is in simplistic chemi-cal terms, a material that offers the pul-pal/dentin benefits of both calciumhydroxide and RMGI in one product.The material demonstrates strong phys-ical properties with low water solubili-ty and can be light-cured up to a thick-ness of 1.0 mm. TheraCal LC is FDAapproved as an apatite stimulating linerwith the ability to induce apatite crystalformation, similar to commerciallyavailable self-curing MTA products.24,25

Dentinal fluid absorbed by Thera -Cal LC results in a sustained release ofcalcium and hydroxide ions. Calciumis necessary for rapid apatite stimula-tion, and hydroxide ions are requiredfor providing an “alkalinizing effect”for wound healing propagation.Thera Cal LC is intended for use as an

internally placed pulpal protectantliner over both occlusal and axialdentin. When performing a directpulp cap, use of a rubber dam toreduce bacterial contamination, apexdevelopment, and control of pulpalhemorrhage are among the essentialfactors for success. This material willappeal to the clinician who wants theease of placement of conventional cal-cium hydroxide liners along with thebiological benefits of the newer calci-um silicates. TheraCal LC allows forthe one-step indirect pulp cap.

IN SUMMARYThe ADA describes evidence-baseddentistry as researching the best avail-able clinical evidence, using one’sclinical skills and judgment alongwith careful considerations of thepatient’s needs and preferences.Today’s dentist needs to follow theseprinciples in order to practice the bestdentistry possible and provide opti-mum patient care. There exists a sig-nificant amount of literature indicat-ing the overall success of the indirectpulp cap. On the other hand, litera-ture reviews of direct pulp caps, espe-cially in mature teeth, do not describethe same success in avoiding the needfor root canal therapy.26 There mayhave been times when the dentistchose to place an indirect pulp capand reenter the tooth at a later time toexcavate the remaining caries.

As this article demonstrates, step-wise excavation is not always neces-sary. The newer calcium silicatecements may be especially useful inachieving even greater success inthese cases. More clinical studies willbe necessary before the dental profes-sion generally accepts this concept.There are certain instances when rootcanals cannot easily be accomplished,such as the frail, elderly, severely med-ically compromised, or developmen-tally disabled populations. In addi-tion, indirect pulp capping may be areasonable choice in specific publichealth settings where root canals arenot financially feasible. Dentistsshould be aware that there are timeswhen the indirect pulp cap can nowbe incorporated into a definitiverestoration without reservation.�

References1. Kidd EA. How ‘clean’ must a cavity be before

restoration? Caries Res. 2004;38:305-313.2. Thompson V, Craig RG, Curro FA, et al. Treatment

of deep carious lesions by complete excavationor partial removal: a critical review. J Am DentAssoc. 2008;139:705-712.

3. Gruythuysen RJ, van Strijp AJ, Wu MK. Long-termsurvival of indirect pulp treatment performed inprimary and permanent teeth with clinically diag-nosed deep carious lesions. J Endod.2010;36:1490-1493.

4. Maltz M, Oliveira EF, Fontanella V, et al. Deepcaries lesions after incomplete dentine cariesremoval: 40-month follow-up study. Caries Res.2007;41:493-496.

5. Casagrande L, Falster CA, Di Hipolito V, et al. Effectof adhesive restorations over incomplete dentincaries removal: 5-year follow-up study in primaryteeth. J Dent Child (Chic). 2009;76:117-122.

6. Peters MC. Strategies for noninvasive demineral-ized tissue repair. Dent Clin North Am.2010;54:507-525.

7. Tellez M, Gray SL, Gray S, et al. Sealants and den-tal caries: dentists’ perspectives on evidence-based recommendations. J Am Dent Assoc.2011;142:1033-1040.

8. Bjørndal L, Reit C, Bruun G, et al. Treatment ofdeep caries lesions in adults: randomized clinicaltrials comparing stepwise vs. direct completeexcavation, and direct pulp capping vs. partialpulpotomy. Eur J Oral Sci. 2010;118:290-297.

9. About I, Murray PE, Franquin JC, et al. The effect ofcavity restoration variables on odontoblast cell num-bers and dental repair. J Dent. 2001;29:109-117.

10.Estrela C, Holland R. Calcium hydroxide: studybased on scientific evidences. J Appl Oral Sci.2003;11:269-282.

11.Weiner R. Liners, bases, and cements: materialselection and clinical applications. Dent Today.2005;24:64, 66-72.

12.Modena KC, Casas-Apayco LC, Atta MT, et al.Cytotoxicity and biocompatibility of direct andindirect pulp capping materials. J Appl Oral Sci.2009;17:544-554.

13.Hilton TJ. Keys to clinical success with pulp cap-ping: a review of the literature. Oper Dent.2009;34:615-625.

14.El-Araby A, Al-Jabab A. The effect of some dentinbonding agents on Dycal lining cement. SaudiDental Journal. 2004;16:102-106.

15.Peters MC, McLean ME. Minimally invasive opera-tive care. II. Contemporary techniques and mate-rials: an overview. J Adhes Dent. 2001;3:17-31.

16.Murray PE, About I, Lumley PJ, et al. Cavityremaining dentin thickness and pulpal activity.Am J Dent. 2002;15:41-46.

17.Murray PE, About I, Franquin JC, et al. Restorativepulpal and repair responses. J Am Dent Assoc.2001;132:482-491.

18.Mente J, Geletneky B, Ohle M, et al. Mineral tri-oxide aggregate or calcium hydroxide direct pulpcapping: an analysis of the clinical treatment out-come. J Endod. 2010;36:806-813.

19.Witherspoon DE. Vital pulp therapy with newmaterials: new directions and treatment per-spectives—permanent teeth. Pediatr Dent.2008;30:220-224.

20.Strassler HE, Levin R. Biodentine tricalcium-sili-cate cement. Inside Dentistry. 2011;7:98-100.

21.Raskin A, Eschrich G, About I, et al. Biodentinmicroleakage in class II open sandwich restora-tions. J Dent Res. 2010;89(special issue A).Abstract 630.

22.Valyi E, Plasse-Pradelle N, Decoret D, et al.Antibacterial activity of new Ca-based cementcom pared to other cements. J Dent Res.2010;89(special issue A). Abstract 312.

23.Biodentine Active Biosilicate Technology.Scientific File. ndd.no/images/Marketing/Info -senter/Biodentine%20Scientific%20File_web_dokumentasjon.pdf. Accessed October 19, 2012.

24.Gandolfi MG, Siboni F, Taddei P, et al. Apatite-forming ability of TheraCal pulp-capping material.J Dent Res. 2011;90(special issue A). Abstract2520.

25.Gandolfi MG, Suh B, Siboni F, et al. Chemical-physical properties of TheraCal pulp-cappingmaterial. J Dent Res. 2011;90(special issue A).Abstract 2521.

26.Komabayashi T, Zhu K. Innovative endodontictherapy for anti-inflammatory direct pulp cappingof permanent teeth with a mature apex. Oral SurgOral Med Oral Pathol Oral Radiol Endod.2010;109:e75-e81.

Dr. Rada received his DDS from the Universityof Illinois College (UIC) of Dentistry and com-pleted a general practice residency at LoyolaUniversity. He is currently a clinical associateprofessor in the department of oral medicineand diagnostic sciences at UIC and maintainsa private practice in LaGrange, Ill, focusing onrestorative and aesthetic dentistry, as well asdentistry for special needs patients and hos-pital dentistry. He can be reached at (708)482-3636 or at bobr759@sbcglobal.net.

Disclosure: Dr. Rada reports no disclosures.

105

MARCH 2013 • DENTISTRYTODAY.COM