May 2009, Volume 2, Issue 5

Take the Test for CE Credit while Reading this Report

While you are reading the Report each month, take a simple test and earn up to 11 credit hours each year (one credit hour per issue). Its fast, easy, and inexpensive. Enrollment details and this months test are on page 5.

Clinicians Report: Making Dentistry Better

Now Offering CE
Tests available online at www.cliniciansreport.org

Resin Veneer CementsThe Clinical Differences

Gordons Clinical Bottom Line: Veneers must be cemented with resin cements to provide adequate bond to tooth structure and optimum strength. However, the pre-polymerization color of resin cements sometimes varies significantly from the post-polymerization color, causing a displeasing and irreversible esthetic appearance. CR research has identified several veneer cements that demonstrate many of the ideal characteristics desired. Providing ceramic veneer restorations has increased dramatically during the past five years as patients demand for esthetic dentistry has risen. The popularity of thin veneers continues as manufacturers advertise directly to the public and simplified techniques make the procedure more predictable. However, dental clinicians are still challenged with accurately matching adjacent teeth, masking stains and discolored enamel, and selecting and properly using a resin cement for bonding veneers. This article will address the accuracy of try-in pastes for shade matching, color change on polymerization, color change of polymerized cement over time, color differences between light-cured and dual-cured veneer cements, CR survey results, and clinical tips for ceramic veneer cementation.
Before After

Patient desiring esthetic enhancement and treatment of occlusal disease

Completed ceramic veneers using proper cement choice and ceramic thickness

FPhotos provided by a CR Product Evaluator

Continued on page 2

Illuminating the Field: Top LED Headlamps for 2009

Gordons Clinical Bottom Line: Dental operatory lights are excellent, but they are seldom aimed at the right location. Historically, dental headlamps have been hot halogen headbands or loupe attachments plugged into the wall. An impressive array of bright, lightweight LED headlamps now available provide excellent lighting of your operating field, improving vision and increasing clinical quality. The LED DayLite and Solaris provided the most desirable overall features in CR research. In an earlier report (Jan. 2007), we felt LED headlamps promised to revolutionize intraoral illumination. Today, the latest models have lived up to expectations and show significant improvements in constant power output, higher intensity, well-defined spots, and truer color. To many clinicians, intraoral lighting provided by LED headlamps is as important as the loupes they wear for magnification. Intraoral illumination has become the next major advancement after magnification, and combining the two gives the practitioner greater satisfaction through enhanced visualization. Headlamps direct light parallel to the line of vision providing optimum illumination by minimizing shadows and reducing the need to frequently adjust the chair light. With such an impact, it is important to analyze and compare some of the best headlamps for 2009. Continued on page 3

Antibiotics in Dentistry: What to Use and When to Use It

Gordons Clinical Bottom Line: Why do you prescribe certain antibiotics? When should you provide any antibiotics and for what clinical situations? Are there more adequate antibiotics than those you commonly use? Based on current research, most frequent use, and international data, CR staff and Evaluators have provided useful guidelines on antibiotics for use in your practice. Penicillin VK and Amoxicillin are the most prescribed antibiotics for oral conditions requiring antibiotic coverage. Antibiotics are vitally important in the adjunctive management of dental, oral, and facial infections. They do not replace the need for eliminating the foci (etiology) of infection! However, when used properly, they can shorten its duration and lessen associated risks. Antibiotics are also necessary to prevent the joint and heart sequelae to high-risk patients by bacteremias associated with certain dental procedures. Since a previous Clinicians Report (Feb. 2008) has already reviewed this topic and presented suggested situations in which prophylactic antibiotics are recommended, this aspect of antibiotic therapy will not be covered here.
Submandibular space Infratemporal space abscess abscess with neck extension, with orbital extension, abscessed tooth #31 abscessed tooth #1

This article identifies why and which drugs, doses, and durations you should prescribe. Continued on page 4

Evaluators Reports and Clinical Tips

The Little Dental Drug Booklet: Indispensable, fast, and easy drug reference booklet (Page 3)
A Publication of CR Foundation 3707 North Canyon Road, Building 7, Provo, UT 84604 801-226-2121 www.cliniciansreport.org

Clinicians Report

Page 2 No color change on polymerization No color change over time Multiple color choices Accurate try-in paste/gels to cured cement Viscosity options

May 2009

Resin Veneer CementsThe Clinical Differences (Continued from page 1)

CR Laboratory Tests and Results

Desired Characteristics of Veneer Cements

Radiopaque or radiolucent Lower cost Easy removal of excess cured cement Low film thickness Long working time Insoluble/no microleakage

A total of 972 fine-particle feldspar ceramic block samples (Vident Vitabloc Mark II, Shade 1M2) of three thicknesses (0.3 mm, 0.6 mm, and 1.0 mm) were cemented to 3.0 mm thick composite stumps (Septodont NDurance, shade A2). All samples were cemented under equal pressure. Measurements were recorded for the following: 1. Color match of try-in pastes to 1. All the try-in pastes demonstrated differences in color from the polymerized veneer cement. polymerized cements. Ultra-Bond Plus was the most accurate. 2. Color change of uncured veneer cement 2. The color change upon initial polymerization was not visibly to polymerized veneer cement. detectable through test ceramic veneers, and all cements tested were acceptable. Calibra Esthetic Resin Cement demonstrated the 3. Color change over time of the least overall color change upon immediate polymerization with in-vitro testing. polymerized veneer cement at one week. 3. At one week, all cements demonstrated only slight differences in color. Clearfil Esthetic Resin Cement, Ultra-Bond Plus, Choice 2 (A future report will provide results on Veneer Cement, and Calibra Esthetic Resin Cement demonstrated the least change in color at one week. long-term color change of veneer cements 4. Dual-cure and light-cure veneer cements performed equally well upon immediate polymerization and after storage for one week. under ceramic veneer restorations.) 5. In the majority of the tested veneer cements, increasing the thickness of the veneer did not overcome the change in color caused 4. Color differences between light-cured by immediate polymerization or color change at one week. and dual-cured cements. 6. At one week, a majority of the cements demonstrated a slightly lighter change in value (lightness/darkness).

12 Resin Cements Indicated for Final Cementation of Veneers

Product Company Accolade PV Danville Materials Calibra Esthetic Resin Cement Dentsply Caulk Choice 2 Veneer Cement Bisco Grandio Flow Veneer Voco Mojo Veneer Cement Pentron Clinical RelyX Veneer Cement 3M ESPE Variolink Veneer Ivoclar Vivadent Insure Cosmedent Insure Lite Cosmedent NX3 (Nexus 3rd Generation) Kerr Vitique DMG America

Results

Tests

All of the following cements are recommended by the manufacturer for veneer cementation. Overall Grade

Cost Color Match No Color Change No Color Change Flow under Number per ml* to Try-in Pastes on Polymerization over Time Pressure of Colors Other Features and Kit Contents Excellent Good Good Excellent Good Excellent Good Excellent Excellent Good Good Excellent Good Excellent Excellent Excellent Good Excellent Good Good Excellent Good Light Cure Excellent Medium Good High Low Excellent Medium Medium Excellent High Excellent Excellent Excellent Excellent High Medium High Low Medium Medium High Composite try-in paste; includes cement, try-in paste, adhesive, etchant, silane Includes cement, try-in paste, adhesive, etchant, silane, activator, catalyst for two viscosities Includes cement, try-in paste, adhesive, etchant, silane, bonding resin, duo-link/biscem Includes cement, try-in paste, silane Includes cement, try-in paste, adhesive, silane Includes cement, try-in paste, adhesive, etchant, silane Includes cement, try-in paste, adhesive, etchant, silane, liquid strip

$21.53 $26.15 $19.57 $35.21 Premarket $44.53 $49.38

6 5 11 12 4 6 7

Excellent Excellent Excellent Excellent Good Pre-Market Excellent Good Excellent Good

$41.68 $34.52 $64.91 $39.83

Excellent Excellent Good Excellent

Light-Cure with Dual-Cure Option Excellent Excellent Low Good Excellent Excellent Medium Good Good Low Good Excellent Medium Excellent Good High

7 7 5 8

Color modifiers for chairside adjustment; includes Excellent cement, catalyst; try-in pastes sold separately Good Color modifiers for chairside adjustment; includes Excellent cement, catalyst; try-in pastes sold separately Amine-free initiator system; includes cement, Good try-in paste, adhesive, etchant, silane Includes cement, separate try-in paste for both Excellent light cure and dual cure, catalyst for 2 viscosities Good

Dual Cure Clearfil Esthetic Resin Cement Excellent Excellent Medium Includes cement, try-in paste, adhesive, etchant, $23.70 Excellent 5 Excellent Kuraray Good Good High silane Ultra-Bond Plus Includes cement, try-in paste, etchant, silane, Excellent $54.88 Excellent Excellent Excellent High 6 Den-Mat Holdings bond enhancer Good *Based on refill syringe cost May be clinically insignificant Initial data at one week; six month results will be reported in a future issue Average for NX3 light/dual cured

Results from Survey of CR Evaluators

RelyX Veneer (3M ESPE) and Variolink Veneer (Ivoclar Vivadent) are the most commonly used cements for veneer cementation. 95% of clinicians are satisfied with their choice of veneer cement. 98% of clinicians would recommend it to a colleague. 60% of clinicians are using try-in paste prior to veneer cementation. 71% of clinicians reported the color of the try-in paste matched the cured cement. 16% of clinicians observed a change in color of the ceramic veneer restoration after a period of time in the oral cavity. 68% of clinicians who noticed a change in color observed it six months or later. 44% reported their patient being aware of the change.

Clinical Tips

FPhotos on page 1 provided by Tyler Lasseigne DDS

Use appropriate try-in pastes/gels to evaluate the effect on the veneers. Avoid desiccating the teeth. A dry working field is necessary; use of an isolation technique is recommended (such as cheek retractors or OptraGate by Ivoclar Vivadent). Contamination by blood, saliva, and hemostatic compounds must be controlled to avoid staining of margins and color changes of the restoration. Avoid relying on shaded veneer cements to correct severe color discrepancies or sub-standard lab fabrication of ceramic veneers. Trial cure a sample of the cement and compare it to the try-in pastes/gels and uncured cement prior to use. View under natural lighting conditions and show proposed effect and restorations to patient. Glutaraldehyde desensitizers can be used after etching to prevent chromogenic bacterial staining. Thickness of veneer and type of veneer material influences the overall shade. Dual-cure cements are desirable for use with inlays, onlays, and some all-ceramic crowns.

CR Conclusions: Try-in pastes can assist the clinician in obtaining only a general idea of the effects of the veneer cement and should not be

used as a predictor of final shading. Consideration should be given to the differences in thickness and the choice of material for the veneers. All cements performed well and can be used successfully to cement veneers. The low film thickness of the veneer cement in a clinical application minimizes the overall effect of the color on the veneer. Accolade PV, Calibra Esthetic Resin Cement, Choice 2 Veneer Cement, Clearfil Esthetic Resin Cement, and Insure Lite demonstrated the best overall combination of cost, tested characteristics, and accuracy in color.

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Page 3

May 2009

Illuminating the Field: Top LED Headlamps for 2009 (Continued from page 1)
LED Headlamp Comparison
Product* Company Weight Illumination Minimal Glare Orange (loupe mount) Quality Battery Power (in patients eyes) Filter Warranty Overall Grade LED DayLite 41 g Excellent $995 ExcellentGood Excellent Yes Lifetime Excellent Designs for Vision GoodFair (inc. 2 batteries) Solaris 29 g Excellent Optional $845 Excellent Good 1 year Excellent PeriOptix ExcellentGood (inc. 2 batteries) $75 Radiant Headlight 31 g $1095 ExcellentGood ExcellentGood ExcellentGood Yes 1 year ExcellentGood Q-Optics ExcellentGood BrasselerVE Light 28 g $1095 ExcellentGood ExcellentGood Good Yes 1 year ExcellentGood Brasseler ExcellentGood Infinity Ultra 34 g $995 Excellent ExcellentGood Good Yes 1 year ExcellentGood Sheervision Good LED Headlight 28 g $995 ExcellentGood ExcellentGood Good Yes 1 year ExcellentGood Salvin ExcellentGood Ray 42 g $595 Good ExcellentGood Excellent Yes Lifetime ExcellentGood High Q Dental GoodFair Zeon Apollo 24 g $895 Good Good Fair Yes 1 year ExcellentGood Orascoptic Excellent Odyssey LED 31 g Good Optional $845 GoodFair Excellent 3 years Good SurgiTel ExcellentGood (inc. 2 batteries) $25 Lumis II 40 g $550 GoodFair Excellent Excellent No 6 months Good Lumisoptic GoodFair OptiStar 4 40 g Good $695 Good Fair No Lifetime Good OptiVision Industries GoodFair (inc. 2 batteries) *Many companies offer additional models not included in this study. Includes: color, intensity, spot size, and spot edge sharpness Cost

BrasselerVE Light

Infinity Ultra

LED DayLite

LED Headlight

Lumis II

Odyssey LED

OptiStar 4

Radiant Headlight

Ray

Solaris

Zeon Apollo

Advantages
Greater visual acuity: Operator can see details that are difficult to visualize with conventional chair light. 70% of users felt a headlamp was essential. White light: LEDs produces more accurate tissue colors than halogen chair lights, although a faint blue hue is still evident from some models. 67% rated the light quality as excellent. Portable: Small light mounts on loupes and battery pack is worn at belt, eliminating tether to countertop power supply. Durability: 89% rated durability as good to excellent.

Disadvantages
Weight: User must become accustomed to the extra weight on the loupes and nose or headband. Cost Dangling cord: The cord from the battery pack can be difficult to position and is easily snagged. Maintenance: 64% of users have experienced some type of problem, and 55% have used the warranty. Limited battery life: 17% noted inadequate battery life and the need to turn off light between procedures to conserve battery power. Frequent aiming adjustment: Headlamp is easily bumped, especially when loupes are removed between procedures.

Clinical Observations and Tips

All headlamps tested could be attached to most loupe designs with custom or universal mounts. 60% of users indicated compatibility with loupes was the most important factor in headlamp choice. Headlamps are essential for oral surgery, endo, implants, or any procedure that is difficult to adequately illuminate. 86% use their headlamp in conjunction with the chair light. Consumer LED headlamps may be adequate for emergency treatment, but lack the intensity, focused spot, stable output, and mounting options of professional models. Less than one third of survey respondents currently use headlamps, revealing significant growth potential for this helpful clinical adjunct.

CR Conclusions: LED headlamps are a logical adjunct to loupes and provide greater visual acuity which enhances treatment and reduces
stress due to poor illumination. Current models show significant improvements in intensity, color, and spot quality. The main disadvantages continue to be the cost and the clinical adjustment to having more equipment mounted on the head. LED DayLite (Designs for Vision) and Solaris (PeriOptix) had the best overall combination of features. All brands tested performed well and were clinically useful.

Indispensable, Fast, and Easy Drug Reference Booklet

This 88-page pocket-sized booklet is updated yearly and designed as a quick reference for the drugs most commonly used in dental practice. It contains practical, practice-oriented suggestions; a section on prescription writing; and prescription requirements. One section covers specific medical situations and the appropriate medications to be used, including: Anxiety/Sedation Oral Soft Tissue Problems Pain Management Infections Prophylactic Antibiotic Coverage Tobacco Cessation

The Little Dental Drug Booklet by Peter L. Jacobsen, PhD, DDS

Lexi-Comp
1100 Terex Rd, Hudson, OH 44236 866-397-3433 www.lexi.com/lddb

$8.95 Each CR Conclusions: 96% of 25 CR Evaluators stated they would purchase The Little Dental Drug Booklet. 100% rated it excellent or good and worthy of trial by colleagues.

Advantages:
Excellent resource and references including useful internet websites Portable size for convenient, quick use Easy to read and well organized Provides common abbreviations Inexpensive

Disadvantage: Augments but does not replace a drug reference book or website

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May 2009

Antibiotics in Dentistry: What to Use and When to Use It (Continued from page 1)
Localized vs. Spreading Infections
Determine the nature of an infection and whether it is localized or spreading. In either case, incision and drainage may be warranted. A spreading infection is more likely to require the help of a specialist such as an oral and maxillofacial surgeon. Characteristics of a local infection: Periapical abscess confined to bone Percussive tenderness Chronic fistula Gingival swelling Local pericoronal infection without lymph node tenderness or swelling See table for treatment recommendations. Although Penicillin VK (or generic) is empirically the first choice for this type of odontogenic infection, patient compliance increases from 42% to 70% by twice-a-day dosing with Amoxicillin 875mg. Characteristics of a spreading infection: Swelling or tenderness of an anatomic space defined by muscle boundaries (i.e. vestibular, canine, sub-mandibular, masticator (such as pterygomandibular, submasseteric, and temporalis), paraphryngeal, etc.) Skin erythema Trismus Systemic involvement (such as fever and/or malaise) Sinus infection Presence of a draining fistula through the skin Some spreading infections have the potential to close the airway or extend to the brain. The earlier the referral to an oral surgeon, the better. See table for treatment recommendations.

Antibiotic Therapy in Treatment of Odontogenic Infections

Treatment dictated by determination of local vs. spreading infection. Use QD or BID dosing schedule to maximize patient compliance. Assess Degree of Infection Localized Infection Treatment of Localized Infection
Non-Penicillin Allergic Amoxicillin 875mg BID x 7 days Penicillin Allergic Azithromycin Z-pak #1 as directed Tri-pak #1 as directed Clindamycin 300mg TID x 7 days

Debridement*

Treatment of Spreading Infection

Non-Penicillin Allergic Penicillin Allergic Clindamycin 300mg TID x 7 days Azithromycin Z-pak #1 as directed Add Metronidzole (Flagyl) 500 mg TID if necessary. Caution patient not to drink alcohol (antabuse effect). The Ultimate Cheat Sheets 2008, reprinted by permission Augmentin 875mg BID x 10 days

Spreading Infection Debridement* Types of Spreading Infections

Cellulitis Sinusitis Brain abscess Facial fistulization Retropharyngeal space Distant seeding

*Debridement: surgical removal of devitalized lacerated or contaminated tissue or purulence (i.e. RCT, Extraction, I&D) When to add Metronidazole: If no improvement of spreading infection is evident after 48 hours of initial regimen, then add metronidzole (Flagyl).

Pediatric Doses
Antibiotic

lbs to kg

Cases Requiring Antibiotics

Implant surgery Purulent pulpitis for RCT (Root Canal Therapy) ANUG (Acute Necrotizing Ulcerative Gingivitis) Pericoronitis Third molar impaction surgery (elective and controversial) Apicoectomy in presence of infection Mucosal graft Socket preservation (elective and controversial) Odontogenic infections (see box above) SBE prophylaxis Prosthetic joint prophylaxis (as indicated) Immuno-suppressed patient

Dose 25 lbs 12 kg Amoxil/Trimox 40mg/kg/day in divided 50 lbs 23 kg (Amoxicillin) BID or TID doses Augmentin 45mg/kg/day in divided 75 lbs 35 kg (Amoxicillin-Clavulanate) BID doses Zithromax 12mg/kg/day QD for 5 100 lbs 47 kg (Azithromycin) days Cleocin 20mg/kg/day in divided 125 lbs 59 kg (Clindamycin) TID doses QD = every day; BID = twice a day; TID = three times a day

Good References 1. Lockhart, P.B., et.al. The evidence base for the efficacy of antibiotic prophylaxis in dental practice. JADA 138(4):458., 2007. 2. Fang, L.S.T.; Fazio, R.C.; and Menhall, T. The ultimate cheat sheets, the practical guide for dentists. 2008 edition. 3. Epstein, J.B.; Chong, S.; and Nhu, D.L. A survey of antibiotic use in dentistry. JADA 131(11):1600, 2000. 4. Moore, P.A. Dental therapeutic indications for the newer long-acting macrolide antibiotics. JADA 130(9):1341, 1999. 5. ADA Council on Scientific Affairs. Antibiotic use in dentistry. JADA 128(5):648, 1997.

To Prescribe or Not
See list of Cases Requiring Antibiotics at right. Inappropriate use of antibiotics can lead to resistant microorganisms. Extractions and other surgeries in healthy patients where there is no infection or the cause of infection is removed do not always require antibiotics. Other examples of wrongful use include faulty dosing (too low a dose or too long a duration), wrong choice of antibiotic (organisms not sensitive), and improper combinations of antibiotics.

When to Incise and Drain (I&D)

I&D is indicated if swelling has been present for more than 48 hours since a purulent exudate is likely present with or without a palpable fluctuance. I&D is indicated if drainage by extraction was not accomplished. It is imperative that the incision be done through the periosteum at the level of the apex (use a pointed mosquito for blunt dissection following mucosal incision) and a drain be sutured to keep the wound open for drainage.

To Extract or Not
A tooth is not worth a life. If deep, anatomic spaces are involved and infection is not responding to treatment, eliminating the foci of infection (extraction) is the best course of action.

Most Commonly Prescribed Antibiotics

Pen VK 500 mg QID x 710 days Amoxicillin 875 mg BID x 710 days

CR Conclusions: Effective treatment of odontogenic infection includes: 1) differentiating local vs. spreading infection, 2) eliminating the foci,

3) appropriate antibiotic(s) as indicated, and 4) early referral of spreading infections. Pen VK and Amoxicillin are the most commonly prescribed antibiotics and are the first choice for odontogenic infections. For additional information, see above references.

Clinical Success is the Final Test

Products evaluated by CR Foundation (CR) and reported in Gordon J. Christensen CLINICIANS REPORT have been selected on the basis of merit from hundreds of products under evaluation. CR conducts research at three levels: (1) Multiple-user field evaluations, (2) Controlled long-term clinical research, and (3) Basic science laboratory research. Over 400 clinical field evaluators are located throughout the world and 40 full-time employees work at the institute. A product must meet at least one of the following standards to be reported in this publication: (1) Innovative and new on the market; (2) Less expensive, but meets the use standards; (3) Unrecognized, valuable classic; or (4) Superior to others in its broad classification. Your results may differ from CR Evaluators or other researchers on any product because of differences in preferences, techniques, batches of products, and environments. CR Foundation is a tax-exempt, non-profit education and research organization which uses a unique volunteer structure to produce objective, factual data. All proceeds are used to support the work of CR Foundation. 2009 This Report or portions thereof may not be duplicated without permission of CR Foundation. Annual English language subscription $95 worldwide, plus GST Canada subscriptions. Single issue $8 each. See www.cliniciansreport.org for non-English subscriptions.

Clinicians Report

Page 5

May 2009

CE Self-Instructional TestMay 2009

Earn Up to 11 Credit Hours. Receive 1 credit hour for successful completion of each months test (January 2009 through November 2009). This is a self-instructional program. CR Foundation is an ADA CERP recognized provider and an AGD approved PACE program provider. Complete the Test. Tests for each issue of Clinicians Report will be available online at www.cliniciansreport.org or by calling 888-272-2345. CE Self-Instructional TestMay 2009
Check the box next to the most correct answer

1. Which of the following needs to be considered for proper use and cementation of ceramic veneers? A. Tooth shade before/after prep B. Ceramic material and thickness C. Cement shade D. All of the above 2. Which of the following is not related to the results for veneer cements? A. Color change upon initial polymerization was visibly much darker on all cements. B. At one week, all cements demonstrated only slight differences in color. C. Dual-cure and light-cure cements tested equally well D. The majority of the cements demonstrated a slightly lighter change in value at one week. 3. Which of the following characteristics of veneer cements are desirable? A. Short working time B. High cost C. No color change over time D. Color change upon polymerization 4. Current LED headlamps have improved in the following ways, except: A. Truer color B. Stable output power C. Well-defined spot D. Lighter weight 5. Which of the following is not an advantage of LED headlamps? A. Limited battery life B. Few shadows C. High intensity D. More accurate color

6. Which of the following statements about headlamps is true? A. The chair light is no longer useful once you have a headlamp. B. A headlamp purchased at a local camping store works just as well as a dental headlamp. C. Once adjusted to match your loupes, a headlamp never needs adjustment again. D. Headlamps are particularly useful for surgical procedures, endodontics, and when access is difficult. 7. Flagyl (metronidzole) is indicated if the infection does not respond by: A. 1 week B. 5 days C. 48 hours D. 12 hours 8. Which of the following is not a characteristic of a spreading infection: A. Trismus B. Systemic involvement (fever, malaise, etc.) C. Periapical abscess D. Sinus infection 9. In a patient with a localized infection who is allergic to Penicillin, which antibiotic would be a good alternative? A. Flagyl B. Clindamycin C. Augmentin D. Tetracycline 10. To treat an infection: A. Eliminate the foci of infection B. Incise thru periosteum, place and suture drain C. Place and suture drain D. Prescribe appropriate antibiotic E. All of the above

Print Participant Information. For additional participants, photocopy this page and list requested information.
Name ____________________________________________________________________________ Address___________________________________________________________________________ City _____________________________________________________________________________ Email __________________________________________________ Phone __________________________________________________ State ___________ ZIP __________________________________

Please send my tests results directly to the Academy of General Dentistry. (AGD# ____________________________________________) Annual Enrollment Fee for 2009. Select one: $44 Clinicians Report Subscriber $66 non-subscriber Already enrolled
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Send your test answers and enrollment fee to: Clinicians Report, 3707 N Canyon Rd, Bldg 7, Provo UT 84604 or Fax 888-353-2121
Call 888-272-2345 now to sign up for the Clinicians Report 2009 CE Self-Instructional program!

2009
Presented by:*

Join Gordon, Rella, and Paul* for a fast-paced, information-packed course highlighting the best dental products and techniques for 2009. Course features at least 25 topics, including:
The latest clinical findings on zirconia-based restorations The best resin cements and their most appropriate uses Conventional implants vs. small diameter implants The easiest and best implant abutments Comparing endodontic sealers Is cone-beam radiography here? Foolproof impressions for fixed and removable prosthodontics Comparing resin restorative techniques and materials New surgical and medical concepts How do fluoride varnishes compare to 5000ppm fluoride? Cutting off and through zirconia-based restorations Digital impressions High-techpractical vs. hype Many other timely topics
*and other CR staff

Gordon J. Christensen, DDS, MSD, PhD

Rella Christensen, PhD

Paul L. Child Jr., DMD, CDT

Register Today! Upcoming Course Locations

Lake Tahoe, Nevada
June 19, 2009 Friday Hyatt Regency Lake Tahoe

At the completion of this course, participants will be able to:

Identify and discuss the most important new concepts, materials, devices, and techniques in all areas of dentistry. Compare the major resin-based composite techniques and materials. Select the most appropriate preventive materials and techniques for your practice. Compare conventional diameter and small diameter implants for your practice. Describe the best impression procedures for fixed and removable prosthodontics. Discuss the status of zirconiabased restorations. Identify the most appropriate pediatric restorative materials and techniques. Select which high-tech concepts you want in your practice. Describe clinical protocol for patients on bisphosphonates. Many other concepts important to dental practice in 2009.

Williamsburg, Virginia
July 31, 2009 Friday Williamsburg Marriott

New York City, New York

September 2, 2009 Wednesday New York Marriott Marquis

For more information or to register for a course, call 1-888-334-3200 or visit www.cliniciansreport.org

Boston, Massachusetts
October 16, 2009 Friday Hilton Boston/Woburn

Ski and Learn

CR Dentistry Update in Park City, Utah

Las Vegas, Nevada

October 30, 2009 Friday Venetian ResortHotelCasino

at the

CE Information6 CE credits available. Academy of General Dentistry Approved PACE

Program Provider FAGD/MAGD credit 1/2006 to 12/2009 CR Foundation is an ADA CERP recognized provider

January 15 and 16, 2010