FREQUENTLY ASKED QUESTIONS

We recommend placing NeoPUTTY with a plastics instrument, Hollenbach instrument, amalgam carrier, or an MTA carrier. The material can be gently spread with a moist cotton pellet, amalgam plugger, or ball burnisher.

Yes, the mixture is immediately washout resistant so you can complete the restoration immediately after placing NeoPUTTY. NeoPUTTY will harden/set underneath the restoration. NeoPUTTY is dimensionally stable when placed with no shrinkage and negligible expansion.

• NuSmile does not manufacture a light-curing MTA. We prefer to maximize the concentration of bioactive powders in NuSmile products and deliver them in a formula that allows the bioactive powders to readily hydrate and form Ca(OH)2 for hydroxyapatite formation5. • Light-curable and dual-cure MTA products contain resins which dilute and inhibit the MTA’s bioactivity. • Resins never cure 100%. Uncured resin leaves cytotoxic monomers in the MTA-resin matrix and in contact with the pulp. • Resins shrink during curing; they are not dimensionally stable. NuSmile bioactive cements (MTAs) expand very slightly to ensure sealing. 5Formosa L M, Mallia B, Camilleri J The chemical properties of light and chemical curing composite with mineral trioxide aggregate filler. Dent Mater. 2013 Feb;29(2):e11-9.

It’s not required but a quick and easy method is to apply a layer of a flowable composite, light-cure glass ionomer, RMGI, IRM®, ZOE or any other restorative material over the NeoPUTTY prior to the final tooth restoration. If you use a flowable composite that requires etching, etch the tooth, not the NeoPUTTY, then proceed with the restoration.

Working time at room temperature is >1 hr. Unlike NeoMTA 2, NeoPUTTY is formulated with a water-free organic liquid. When applied, the water from the apical tissues, dentinal tubules or pulp causes the product to set.

• For a pulpotomy, liner, base or pulp cap apply a layer at least 1.5mm thick. • For root apexification gently compact the NeoMTA product in the apical region to create a 3 to 5mm apical barrier.

• Both products are bioactive bioceramic MTAs. • Both products release calcium and hydroxide ions promoting the formation of hydroxyapatite from the surface to seal and support healing. • Both products are resin-free for maximum bioactivity. • Both products have initially high pH (alkaline/basic) when applied. Literature has shown such products to be antimicrobial in-vitro1. • Both products are color stable, non-staining, containing tantalum oxide (tantalite) for radiopacity. Neither NeoMTA 2 or NeoPUTTY contain bismuth oxide, which causes tooth discoloration2 . • Both products are immediately wash-out resistant when placed. • Both products have low water solubility (<3%) when set. • Both products are dimensionally stable with negligible expansion on setting. • Both products contain extremely fine, hydraulic tri/dicalcium silicate powders. 1 The anti-microbial effect against enterococcus faecalis and the compressive strength of two types of mineral trioxide aggregate mixed with sterile water or 2% chlorhexidine liquid. Holt DM, Watts JD, Beeson TJ, Kirkpatrick TC, Rutledge RE. J Endod. 2007 Jul;33(7):844-7.

There are 12 indications for use. Read IFU prior to use, See "Useful Links & Downloads"

Kit Size/ Dose0.65gm - 9 applications2.4gm - 32 applications*Dose size varies depending on the treatment. In this table a dose size of 0.075 gm was used.

NeoPUTTY is a premixed bioactive bioceramic root & pulp treatment consisting of an extremely fine,inorganic powder of tricalcium/dicalcium silicate in a waterfree organic liquid. The product is packagedready-to-use. No mixing is required. NeoPUTTY is designed to set in vivo in the presence of moisture fromthe surrounding tissues."

NeoPUTTY does not need mixing – it is a uniform, firm, non-tacky putty from beginning to end with no dry out between uses. • NeoPUTTY has about 25% higher radiopacity than NeoMTA 2 (8.1 vs 6.5 mm equivalent aluminum). • NeoPUTTY syringes have zero waste – the syringes allow efficient unitdose dispensing to the end of the syringe which has a positive placement plunger tip. • NeoMTA 2 is a Powder/Gel hand-mix product designed for 10 vital pulp and endodontic uses, including obturation and sealing (refer to NeoMTA 2 IFU).

Use any convenient instrument, to deliver a small cone or cylinder of NeoPUTTY to the site. A Messing gun, amalgam carrier, Dovgan MTA carrier, or the MAP™ system may be used. Reversed paper points or gutta percha points can guide the putty in the root to the apex for apexification.

NeoPUTTY should be stored at room temperature with the syringe cap tightly closed in its protective aluminum container. Refrigeration does not extend the shelf life and thickens the putty too much for immediate use.

• The product has a 3-year shelf life. • To prevent hardening of the NeoPUTTY, immediately recap after each use. Store the syringe in the protective aluminum container provided.

No applicator tip is needed. Remove the syringe cap and express the desired amount of NeoPUTTY on a pad. Use the instrument of your choice to deliver the putty to the treatment site. Immediately recap the syringe and replace in its protective aluminum container after each use.

Unlike inert, resin-based materials containing some MTA,… NeoPUTTY is: • Bioactive; NeoPUTTY releases calcium and hydroxide ions from the surface, promoting the formation of hydroxyapatite to ensure bioactive sealing. • Formulated with pure tri/dicalcium silicate powder and a radiopacifier. • Dimensionally stable – unlike resin-based materials that shrink. • Biocompatible, non-cytotoxic. • More versatile, having more treatment indications. • More radiopaque. • Resin-free for maximum MTA concentration and maximum bioactivity. [Resinbased materials containing only some MTA-type cement have not consistently shown biocompatibility in cell cultures3,4, demonstrating a toxicity that may be attributed to incomplete resin curing.] 3 Adıgüzel M, Ahmetoğlu F, Eldeniz AÜ, Tekin MG, Göğebakan B. Comparison of cytotoxic effects of calcium silicate-based materials on human pulp fibroblasts Mehmet. J Dent Res Dent Clin Dent Prospects. 2019;13(4):241-246. 4 Collado-González M, García-Bernal D, Oñate-Sánchez RE, et al. Cytotoxicity and bioactivity of various pulpotomy

NeoPUTTY will set in vivo in about 4 hrs. Setting begins in the presence of moisture from the apical tissues, dentinal tubules or pulp tissue. NOTE: To prevent premature hardening of NeoPUTTY, immediately recap after each use.

Yes, NuSmile manufactures NeoPUTTY™, a premixed Root & Pulp bioactive bioceramic MTA paste packaged in a syringe.

Yes, but make sure it's a high-quality, coated pad that doesn’t absorb water; otherwise the Gel will be absorbed by the pad. We highly recommend using a glass slab for mixing NuSmile NeoMTA products. A glass slab also provides a more stable, firmer surface for complete mixing. Glass slabs are available for purchase separately

The Powder/Gel ratio can be varied to suit the case and your preferred application technique. Procedure / Approx. Gel amount required For pulpotomies and apexification, a thicker consistency is usually preferred 1-2 drops of Gel. (Dispense 1 drop of Gel near the Powder. A second drop can be placed nearby to adjust the viscosity or to rewet the material before it sets.) For pulp capping and base/liner, a thinner consistency is usually preferred 2 drops of Gel. (Incorporate Gel into Powder gradually until desired consistency is achieved.) *The Ratio of powder to gel should be adjusted to meet clinician’s preference.

Yes, 4cc Gel is provided in the 2.5 gm Kit, which is more than enough Gel for the Powder.

No, this doesn’t help extend the shelf life, and the humidity of the refrigerator may cause the Powder to absorb more moisture and deteriorate.

Working time at room temperature is about 14 minutes when mixed as a putty, and 21 minutes when mixed to a thinner consistency. The working time can be extended if needed by covering the mixed cement with a moist gauze “tent” or a dappen dish or by rehydrating the mixed material with more Gel.

• Add a small amount of Powder (less than 1 scoop). • Alternatively, spread out mixture to a thin layer on the glass slab to allow some drying. Then use the edge of a metal spatula to gather the material into a putty or other desired consistency. • To prevent a sticky mixture, for future mixes use less Gel when mixing.

• For a pulpotomy, liner, base or pulp cap apply a layer at least 1.5mm thick. • For root apexification compact the NeoMTA product in the apical region to create a 3 to 5 mm apical barrier.

Both products are bioactive bioceramic MTAs. Both products release calcium and hydroxide ions promoting the formation of hydroxyapatite from the surface to seal and support healing. Both products are resin-free for maximum bioactivity. Both products have initially high pH (alkaline/basic) when applied. Literature has shown such products to be antimicrobial in-vitro1 . Both products are color stable, non-staining, containing tantalum oxide (tantalite) for radiopacity. Neither NeoMTA or NeoMTA 2 contain bismuth oxide, which causes tooth discoloration2 . Both products are immediately wash-out resistant when placed. Both products have low water solubility (&lt;3%) when set. Both products are dimensionally stable with negligible expansion on setting. Both products contain extremely fine, hydraulic tri/dicalcium silicate powders. Both products have shorter setting time (approximately 14 minutes when mixed to a putty consistency) compared to traditional MTA. Both products include a proprietary Gel that allows the product to be mixed to a firm putty (like ZOE or IRM ). The anti-microbial effect against enterococcus faecalis and the compressive strength of two types of mineral trioxide aggregate mixed with sterile water or 2% chlorhexidine liquid. Holt DM, Watts JD, Beeson TJ, Kirkpatrick TC, Rutledge RE. J Endod. 2007 Jul;33(7):844-7. Marciano MA, Duarte MA, Camilleri J. Dental discoloration caused by bismuth oxide in MTA in the presence of sodium hypochlorite. Clin Oral Investig. 2015;19(9):2201-2209.

• The products have a 3-year shelf life. • Do not leave the Powder or Gel containers open. The Powder can absorb humidity, which reduces shelf life by increasing the set time and reducing the compressive strength. After expiration, the Gel may be too thin to be satisfactory.

• When the powder is mixed to a putty-like consistency using the gel, the resulting putty is immediately wash-out resistant. • A thick mixture takes about 14 minutes to set within the tooth. • A thinner, sealer-type mixture will set in about 1 hour 10 minutes.

• NeoMTA 2 is designed to be easier to mix. • NeoMTA 2 has about 30% higher radiopacity than NeoMTA (6.5 vs 5.0 mm equivalent aluminum as a putty-like mixture). • NeoMTA 2 is brighter white.

Unlike inert, resin-based materials containing some MTA,… NeoMTA products are: • Bioactive; releases calcium and hydroxide ions from the surface, promoting the formation of hydroxyapatite to ensure bioactive sealing. • Formulated with pure tri/dicalcium silicate powder and a radiopacifier. • Dimensionally stable – unlike resin-based materials that shrink.• Biocompatible, non-cytotoxic.• More versatile, having more treatment indications. • More radiopaque. • Resin-free for maximum MTA concentration and maximum bioactivity. [Resinbased materials containing only some MTA-type cement have not consistently shown biocompatibility in cell cultures3,4, demonstrating a toxicity that may be attributed to incomplete resin curing.] 3 Adıgüzel M, Ahmetoğlu F, Eldeniz AÜ, Tekin MG, Göğebakan B. Comparison of cytotoxic effects of calcium silicate-based materials on human pulp fibroblasts Mehmet. J Dent Res Dent Clin Dent Prospects. 2019;13(4):241-246. 4 Collado-González M, García-Bernal D, Oñate-Sánchez RE, et al. Cytotoxicity and bioactivity of various pulpotomy materials on stem cells from human exfoliated primary teeth. Int Endod J. 2017;50 Suppl 2:e19-e30.

When mixed to a putty: • The radiopacity of NeoMTA is 5.0mm Al equivalent. • The radiopacity of NeoMTA 2 is higher, 6.5mm Al equivalent.

No: While both Portland cement and MTA contain tricalcium silicate, they are not the same. Portland cement is: • An impure industrial grade construction product • A coarse powder that sets slowly • NOT a medical device • NOT cleared by the FDA • NOT radiopaque • NOT a highly refined powder. Portland cement cannot meet the international dental standards, including ISO 6876, ISO 9917-1 or ADA 57 requirements. NuSmile NeoMTA products meet all dental quality standards and are manufactured in Houston, TX USA in an FDA-registered factory certified to ISO 13485.

Use alcohol or water for cleanup. If the MTA is completely set, soak the glass slab or instrument in vinegar or water until the cement softens.

Gel is recommended. Mixing the Powder with the Gel provides superior handling and immediate wash-out resistance so you can immediately complete the restoration with or without covering the MTA product depending on your preference.

We have one kit size for sale in the US and Canada, the 2.5 gm Professional Kit . Number of treatments: • 25 applications using the 0.1 gm large scoop • 50 applications using the 0.05 gm small scoop

Yes, you can complete the restoration or cement a crown immediately after placing the NeoMTA product. The NeoMTA product will harden/set underneath the restoration. The NeoMTA product is immediately wash-out resistant and dimensionally stable when placed with zero shrinkage and negligible expansion to ensure gap-free sealing.

Use the spatula sold by NuSmile or a medium stiffness metal spatula. Metal spatulas are preferred over plastic spatulas because they allow easier mixing and fast incorporation of the fine powder and gel.

• Add ½ drop of Gel to gradually break up the matrix to achieve the desired consistency. This method works well before the mixture is set within the first ½ hour after mixing. Alternatively, cover the mixed MTA with a moist gauze “tent” or a dappen dish to avoid drying out.

Use any convenient instrument, to deliver a small cone or cylinder of NeoMTA product to the site. A Messing gun, amalgam carrier, Dovgan MTA carrier, or the MAP™ system may be used. Reversed paper points or gutta percha points can guide the putty in the root to the apex for apexification.

• NuSmile does not manufacture a light-curing MTA. We prefer to maximize the concentration of bioactive powders in NuSmile products and deliver them in a formula that allows the bioactive powders to readily hydrate and form Ca(OH)2 for hydroxyapatite formation5 . • Light-curable and dual-cure MTA products contain resins which dilute and inhibit the MTA’s bioactivity. • Resins never cure 100%. Uncured resin leaves cytotoxic monomers in the MTA-resin matrix and in contact with the pulp. • Resins shrink during curing; they are not dimensionally stable. NuSmile bioactive cements (MTAs) expand very slightly to ensure sealing. 5 Formosa L M, Mallia B, Camilleri J The chemical properties of light and chemical curing composite with mineral trioxide aggregate filler. Dent Mater. 2013 Feb;29(2):e11-9.

• Large scoop – 0.1 gm, enough for a pulpotomy on one or two primary posterior teeth. • Small scoop – 0.05 gm, enough for a pulpotomy on a primary anterior or posterior tooth, or for a direct or indirect pulp cap.

Read IFU prior to use. To obtain, See Right hand side of this page under "Useful Links & Downloads"

• Dispense a level scoop of Powder onto a glass slab. • Dispense 1 drop of Gel. • Using a medium flex spatula, pull half of the first drop into the Powder. Mix the Powder and Gel thoroughly with a spatula. (Note: Always mix the Gel into the Powder, not the Powder into the Gel. Otherwise, the Powder can become too wet and waste may occur). • Gradually add more Gel for desired consistency. • If too dry, dispense another drop of gel, gradually add enough gel for desired consistency. If too wet, add more powder. • If not using immediately, cover with dappen dish or damp cotton gauze to delay setting.(Once practiced, it takes less than 1 minute to mix to the desired consistency)

No: White MTAs that contain bismuth oxide as the radiopacifier (e.g. ProRoot White MTA) will cause staining. All NuSmile MTA-based products, including NeoMTA 2, contain tantalite as the radiopacifier, which does not cause staining.

One important characteristic that affects the performance of MTA-type products is its stability when placed in a tooth. A way to test the product’s stability is through wash-out testing. NeoMTA products are immediately wash-out resistant. You can gently rinse and complete the restoration or cement a crown, immediately after placing NeoMTA products

It’s not required but a quick and easy method is to apply a layer of a flowable composite, light-cure glass ionomer, RMGI, IRM®, ZOE or any other restorative material over the NeoMTA product prior to the final tooth restoration. If you use a flowable composite that requires etching, etch the tooth, not the NeoMTA product, then proceed with the restoration.

We recommend placing NeoMTA products with a plastics instrument, Hollenbach instrument, amalgam carrier, or an MTA carrier. The material can be gently spread with a moist cotton pellet, amalgam plugger, or ball burnisher.

Yes

NuSmile NeoMTA and NeoMTA 2 have the same indications:There are 10 indications for use. Read IFU prior to use, See Right hand side of this page under "Useful Links & Downloads"

The Gel is a water-based (>50% water) liquid with proprietary ingredients. The Gel is non-cytotoxic, non-allergenic and non-sensitizing. All the components have been used successfully in other medical implant devices. The Gel enhances the properties of the Powder/Gel mixture for better handling, longer working time, immediate wash-out resistance and easier placement.

NeoMTA 2 is a Powder & Gel system consisting of an extremely fine, inorganic Powder of tricalcium and dicalcium silicate, which is mixed with the supplied water-based Gel to initiate the setting reaction. The Powder is supplied in a protective desiccant-lined container for freshness. This material is both bioactive and radiopaque.

Yes.

NuSmile SSCs are made of surgical grade 316 stainless steel.

Yes, we will provide a sample of our NuSmile SSC which also includes our Technical Guide/IFU explaining the product in more detail. Please call NuSmile Customer Service to request a sample.

As the name indicates one has contoured walls (pre-contoured) while the other has straight walls. NuSmile SSC’s allow you to obtain a classic "snap fit" when the tooth is properly prepared and the crown size is correctly selected. This allows the crown to grab onto the tooth to achieve mechanical retention, regardless of the cement being used. The "snap fit" also helps to insure a good marginal seal over time, especially if a pure glass ionomer cement is used, since glass ionomer cements are water soluble and can wash out over time if the margin is open. Although straight-walled crowns can be trimmed, shaped and contoured by a skilled clinician to achieve the same result, doing so is time-consuming and technique sensitive. Most clinicians have switched from using straight-walled stainless steel pediatric crowns to using pre-contoured crowns since the price difference is small (if any) and the time savings using a pre-contoured crowns is very significant, more than compensating for any difference in price.

NuSmile SSCs should remain intact until the tooth exfoliates, unless the child is a very heavy bruxer, in which case it is possible, though rare, that the occlusal surface could wear through. Stainless steel crowns have been used effectively for primary tooth restoration for many years. You can expect the same good results with NuSmile SSC’s.

For NuSmile SSCs use NuSmile BioCem® Universal BioActive Cement or a high quality glass ionomer cement. Completely load the crown with cement so there are no voids. The NuSmile SSC should have a "snap fit".

Pulpal therapy should not be needed for a NuSmile SSC placement unless dictated by the extent of caries.

Cold sterilization, autoclave or steam sterilization according to the manufacturer of the sterilizers standard instructions are all acceptable methods.

Yes

For NuSmile SSC Pre-contoured crowns use: D2930 – Prefabricated Stainless Steel Crown - Primary Tooth

Yes, NuSmile SSCs may be shortened using either our shortening bur if only minor shortening is required or with crown and bridge scissors if significant shortening is required. If the crown is shortened such that a significant amount of the contour is lost, then crown crimping/contouring pliers may be used to re-contour the crown in order to achieve a snap-fit.

Our website contains information regarding research and studies that have been done with NuSmile Signature crowns. Stainless steel crowns have been used effectively for primary tooth restoration for many years. You can expect the same good results with NuSmile Signature crowns.

With NuSmile Signature crowns you should expect to have a 95% success rate or greater of the coating on anterior crowns and an 85-95% success rate of the coating on posterior crowns. The coating on NuSmile Signature Cuspid crowns are the most susceptible to fracture and wear.

While this is acceptable, you will see some color change (darkening) of the esthetic coating. We recommend keeping a separate stock box for autoclaved crowns. Many times these darker crowns are suitable for single crown placement situations. Do not chemiclave NuSmile Signature crowns.

For anterior NuSmile Signature crowns, it is highly recommended to replace the crown if a portion of the esthetic coating is displaced or lost rather than attempting to repair the defect. There are a couple of repair techniques that provide adequate results intraorally, but, all are time consuming and tedious. It is probably reasonable to cut a window to repair an occlusal chip or wear area on a posterior crown if you wish. NuSmile will replace at no charge the occasional chipped crown if you will return it to NuSmile after replacement. Before returning a NuSmile crown for replacement please contact NuSmile Customer Service.

For NuSmile Signature crowns use NuSmile BioCem® Universal BioActive Cement or a high quality glass ionomer cement. Completely load the crown with cement so there are no voids. The NuSmile Signature crown should have a passive fit and be held in position until the cement self-sets.

Yes, we recommend using our shortening bur to avoid damage to the facing. A flame shaped fine fluted carbide should be used at a low range speed with a water spray to safely circumferentially shorten and feather the gingival margin of NuSmile Signature crowns. NuSmile offers two burs to use: A fine fluted finishing carbide #H48LF-012, used to shorten circumferentially and the gingival margin of the NuSmile Signature crown. A yellow finishing point, composite polisher is used to restore the luster on the NuSmile Signature crown after adjustments or shortening. Many doctors prefer to order a selection of Short NuSmile Signature Anterior crowns to eliminate the need for crown shortening during operatory procedures.

The buccal and occlusal surfaces of posterior NuSmile Signature crowns are coated with the esthetic material.

NuSmile Signature crowns are less technique sensitive than strip crowns and they offer the same full coverage protection as a SSC (SSC-8% failure; Tate et al, Pediatric Dentistry 2002; 24:69-71). NuSmile Signature crowns take less time to place and are more durable than strip crowns (strip crowns-51% failure; Tate et al, Pediatric Dentistry 2002; 24: 69-71). Of 226 NuSmile Signature Anterior crowns evaluated, 88% resisted coating fracture, 99% resisted coating crazing, 99% were retained to the tooth, 99% were color stable and 91% maintained a good to excellent appearance overtime (Waggoner et al, Pediatric Dentistry 2007; 29:377-381).

It’s a little different. You are going to remove approximately 2 mm off the buccal and 2 mm off the occlusal, with greater circumferential reduction as well, to get the crowns to passively seat. In all cases you will be using at least one or two crown sizes smaller than if you were using traditional SSCs. If necessary, you can remove some of the esthetic material in the interproximal/buccal and interproximal/occlusal areas on the crown with a rubber point or wheel to help with seating. You can try using a contralateral upper posterior crown for a lower restoration when there has been mesial-distal space loss. Some doctors will reduce the distal of the deciduous canine a little if necessary.

Yes, but you will always need to use a crown size that fits in the space and prepare the tooth accordingly. It will usually be at least one or two crown sizes smaller than if traditional SSCs were being used, maybe more if there is space loss. This always requires preparation of the tooth to fit the crown. With lower posterior crowns, you might find that an upper contralateral crown may work best. NuSmile Signature Posterior crowns are also available in a size 1 (straight wall).

Short crowns are manufactured 1mm shorter.

You can crimp slightly on the lingual, but it is very important to avoid a "snap fit" and seat the crown with finger pressure only. All NuSmile Signature crown performance and durability testing and studies have been done without any crimping.

Yes, we will provide a sample of our NuSmile Signature crown which also includes our Technical Guide/IFU and QuickStart guide explaining the product in more detail. Please call NuSmile Customer Service to request a sample.

With a properly fitted crown, good gingival response is expected within 7-10 days. With reasonable hygiene, good gingival health should remain long-term.

Yes, NuSmile Signature Cuspid crowns are available and are universal in shape for maxillary, mandibular, right or left side use. The smaller sized maxillary lateral crowns may be used for lower incisors.

No, NuSmile Signature crowns must be seated with finger pressure only. If the crowns will not seat passively, more reduction of the tooth structure is required.

Yes, we offer a technical video available on our YouTube Channel that demonstrates preparation and placement procedures (on actual patients), used for achieving the highest degree of success and efficiency when using both anterior and posterior NuSmile Signature crowns. You can access this video titled "NuSmile Signature Anterior Clinical Technique 1" from NuSmile’s YouTube channel at: https://youtu.be/RqL5akTBoMI. With your first order, our DVD "NuSmile Signature Technique Essentials, Mastering Cosmetic Pediatric Crowns" will be sent to you. This DVD is also available on our web store.

Cold sterilization according to the sterilant manufacturer’s instructions.

Similar, however NuSmile Signature crowns require more tooth reduction than for SSCs. NuSmile Signature crowns require about 20% more reduction than a SSC around the entire circumference of the tooth. The occlusal reduction is approximately 1.5mm more than for a SSC. When using NuSmile Signature crowns you will use one or two sizes smaller than for a traditional SSC. If you use the same size as you would for a traditional SSC, the restoration will look bulky and unnatural. Also, the gingival response will be poor overtime if the appropriate size is not used. Always prep the tooth to fit the crown and remember that a "snap fit" is contraindicated for NuSmile Signature crowns.

Similar to SSC restorations, pulpal therapy should not be needed for NuSmile Signature crown placement unless dictated by the extent of caries.

Scientific research, specifically a study by Kern, et al, published in Dental Materials 24, 508 (2008), showed that saliva contamination on zirconia adversely affected the bond strength of the cement to the zirconia material. Utilizing the NuSmile Try-In crowns ensures optimal cement retention because it allows you to avoid any saliva or hemorrhage contamination to the actual NuSmile ZR crown being cemented.

NuSmile ZR crowns are not crimpable.

Due to the structural nature of zirconia, no manufacturer’s zirconia crowns, including NuSmile’s, are repairable. If a NuSmile ZR crown fractures, which is very rare, it should be replaced. NuSmile will replace at no charge the occasional fractured crown if you will return it to NuSmile after replacement. Before returning a NuSmile crown for replacement please contact NuSmile Customer Service.

NuSmile ZR crowns are less technique sensitive than strip crowns and they offer the same full coverage protection as a SSC (SSC-8% failure; Tate et al, Pediatric Dentistry 2002; 24:69-71). NuSmile ZR crowns take less time to place and are more durable than strip crowns (strip crowns-51% failure; Tate et al, Pediatric Dentistry, 2002, 24:69-71). NuSmile ZR crowns, once seated, should last until the tooth exfoliates. Zirconia crowns have had a history of more than 10 years of success in adult dentistry and more than 5 years of success in pediatric dentistry.

Yes, we offer technical videos on our YouTube Channel that demonstrate preparation and placement procedures (on actual patients) used for achieving the highest degree of success and efficiency when using both anterior and posterior NuSmile ZR crowns. You can access our clinical videos at: www.youtube.com/channel/UCAsG3apKAwtgCPNikyXjOSQ. NuSmile also conducts both live "hands-on" workshops and web-based trainings periodically in major cities in the US and Canada, and through our distributors worldwide. See our listing of upcoming training opportunities.

No, most doctors do not remove the identification mark. The identification mark on the lingual is fairly indelible. It will fade over time (usually within 6 months – 1 year), however, it can be removed with a zirconia crown polishing bur. We recommend a rubberized zirconia polisher. We offer two polishers that work well which are included in our NuSmile ZR Adjustment bur kit: ZR Green medium point #W16MZR, used after adjustments or shortening for pre-polishing. 2 - ZR Orange fine point #W16FZR, used after adjustments or shortening for final polishing.

Cold sterilization, autoclave or steam sterilization according to the manufacturer of the sterilizers standard instructions are all acceptable methods.

NuSmile ZR adjustment burs can be used to circumferentially reduce & feather the crown margin. It is important to use a light touch and a continuous water spray. NuSmile ZR crown polishers should be used to restore a smooth surface to the crown following any adjustments.

Yes, we will provide a sample of our NuSmile ZR crown which also includes our Technical Guide/IFU and QuickStart guide explaining the product in more detail. Please contact NuSmile Customer Service if you’d like to receive a sample.

You can repair the opening in the crown the same as you would for an open-face crown technique (with some mechanical undercuts under the opening and by slightly roughening the zirconia at the opening) and repair the void with composite.

Our website contains information regarding research and studies that have been done with NuSmile ZR crowns. Zirconia crowns have been used effectively for permanent tooth restoration for many years. You can expect the same good results for primary teeth.

The mesial-distal width of the Narrow 1st Primary Molar crowns is 0.5 mm narrower than the regular 1st Primary Molar crowns. Both types of crowns have the same buccal-lingual dimension.

Gingival response is excellent due to the anatomically correct contours and high biocompatibility of NuSmile ZR. With a properly fitted crown, good gingival response is expected within 7-10 days. With reasonable hygiene, good gingival health should remain long-term.

For NuSmile ZR Anterior and Posterior crowns use: D2929 – Prefabricated porcelain/ceramic crown – primary tooth.

NuSmile ZR crowns are made of high quality Japanese Y-TZP monolithic zirconia ceramic.

NuSmile ZR crowns do not chip or stain and should last until the tooth exfoliates. Zirconia crowns have had a history of more than 10 years of success in adult dentistry and more than 5 years in pediatric dentistry. When placed according to instructions a success rate of 99% or greater should be expected.

We recommend pumicing the crown surface and cementing the band or space maintainer with NuSmile BioCem® Universal BioActive Cement.

Similar to SSC restorations, pulpal therapy should not be needed for NuSmile ZR crown placement unless dictated by the extent of caries.

No, NuSmile ZR crowns must be seated with finger pressure only. If the crowns will not seat passively, more reduction of the tooth structure is required.

Similar, however NuSmile ZR crowns require more tooth reduction than for SSCs. The tooth preparation for NuSmile ZR crowns is slightly more conservative than for NuSmile Signature crowns, especially occlusally. NuSmile ZR crowns require about 20% more reduction than a SSC around the entire circumference of the tooth. The occlusal reduction is almost the same amount as for a SSC. Always prep the tooth to fit the crown and remember that a "snap fit" is contraindicated for NuSmile ZR crowns.

According to published scientific evidence it is very important to be sure that saliva or blood does not contaminate the internal surface of zirconia crowns. For this reason we provide NuSmile ZR Try-In crowns for use during try-in (test fitting) to avoid saliva or blood contamination of the actual NuSmile ZR crown to be used. All NuSmile ZR Try-In crowns are precision manufactured to be identical in size and shape to NuSmile ZR crowns, and can be used and autoclaved repeatedly for try-in purposes. If contamination of the internal NuSmile ZR crown surface does occur one of two processes is recommended for best retention of the cement to the crown. Sandblast the inside of the crown with pure aluminum oxide, or clean internal crown surface with Ivoclean (www.ivoclarvivadent.us/en-us/products/luting-material/accessories/ivoclean). NuSmile BioCem® Universal BioActive RMGI Cement, Ceramir, resin cement or other resin modified glass ionomer cement can be used to cement NuSmile ZR crowns. Though not recommended in most literature, some doctors do successfully use high quality glass ionomer cements to cement preformed zirconia crowns. Completely load the crown so there are no voids during placement. If pulpal therapy has been performed with a eugenol based material placed in the pulp chamber, cover the eugenol based material with pure glass ionomer before cementation unless using GI for cementation. The NuSmile ZR crown should have a passive fit and be held in position until the cement self-sets or is light cured.

First, make sure you have removed enough tooth structure to be able to passively seat the crowns. This will be a more aggressive preparation than for a SSC "snap fit" crown. When placing adjacent crowns or for cases with mesial-distal space loss we recommend using our NuSmile ZR Narrow 1st Primary Molar crowns. These crowns are 0.5 mm narrower than the regular NuSmile ZR 1st Primary Molar crowns. You can also try using a contralateral upper posterior crown for a lower restoration when there has been mesial-distal space loss. Some doctors will reduce the distal of the deciduous canine a little if necessary.

Yes, but you will always need to use a crown size that fits in the space and prepare the tooth accordingly. It will usually be at least one or two crown sizes smaller than if traditional SSCs were being used, maybe more if there is space loss. This always requires preparation of the tooth to fit the crown. With lower posterior crowns, you might find that an upper contralateral crown may work best. We also offer NuSmile ZR Narrow 1st Primary Molars specifically for these types of posterior cases. NuSmile ZR Central and Lateral crowns are available in a size 0 for these cases.

Due to a lack of clinical data, BioFlx crowns are not currently recommended for use with the Hall Technique or to be placed in situations where the occlusion is not well equilibrated. BioFlx crowns are not recommended in cases with bruxism.

BioFlx crowns will be available in narrow sizes to be easier to place in areas of space loss. Due their flexible nature and elastic memory, BioFlx crowns cannot be significantly altered in their shape or width with pliers. To fit BioFlx in areas of space loss, it is likely that circumferential reduction of the tooth will be needed to fit a smaller crown than would have been used if there were no space loss.

It is neither a “snap fit”, nor a “passive fit”. BioFlx crowns should fit snugly on the tooth, with slight resistance that can be described as a snug or active fit. It will flex over small convexities of the tooth.

You can trim with crown and bridge scissors, when needed; and may be able to slightly contour with Howe Pliers; but you should not attempt to crimp BioFlx crowns.

Robust in house wear testing demonstrates that BioFlx crowns are at least as wear resistant as stainless steel crowns, after 800,000 cycles at 80 newtons on a Leinfelder wear machine. However, clinicians may see a “dimple” develop on the BioFlx crowns in areas of heavy occlusion. This “dimple” appears due to the self-adaptable technology of the material. Rather than wearing, the material “self adapts” to reduce the pressure of the opposing occlusal surface. For this reason, and for best results, it is recommended that BioFlx crowns not be placed in high occlusion on teeth with little or no occlusal preparation.

The radiopacity of BioFlx crowns is similar to the radiopacity of enamel and should allow radiographic evaluation of adaptation of the crown margins and pulpal therapy.

It is not recommended to use any kind of rotary instrument to adjust the occlusion of a BioFlx crown. The occlusal surface of the preparation should be reduced 1.5-2.0mm. The BioFlx crown should NEVER be the first point of contact in occlusion.

Cold sterilization, autoclave or steam sterilization may be used according to the standard instructions of the manufacturer of the sterilant or sterilizer. BioFlx crowns, as other pediatric crowns, are provided in non-sterile packaging. Clinician may choose to sterilize before use.

A regular glass ionomer cement should be sufficient for cementing BioFlx crowns. A self-setting resin modified glass ionomer cement can also be used. A light cured cement should NOT be used because the opacity of the crown will not let light pass through to set the cement.

If BioFlx crowns are contaminated with blood or saliva during try-in, they can be rinsed with water, dried and then cemented without any significant effect on cementation.

It is ok to use a lot of pressure, including the plastic end of a band seater to sit a BioFlx crown. Using a bite stick or the serrated metal end of a band pusher is not recommended.

Bioflx crown is made of high impact, biocompatible, hybrid resin polymer used in the medical field where high strength, flexibility and durability are required. They are Bis-GMA free and contain no metal.