Episode 401: The Impact of ORMOCER Technology on Hypersensitive Teeth

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com.
Welcome to the show. I'm Dr. Phil Klein. Today we'll be discussing how new technology is
addressing dentinal hypersensitivity. Our guest is Dr. William Paveletz, a graduate of Temple
Dental School. He also speaks nationally and internationally for dental organizations, learning
institutions, and national and local dental study clubs. Before we get started, I would like to
mention that Dr. Paveletz will be presenting... a live webinar on VivaLearning.com titled The
Magic of Prevention. It is scheduled for Tuesday, July 19th at 7 p.m. Eastern time on VivaLearning
.com. As always, the webinar is free and you can earn live interactive CE credit. Dr.
Paveletz, it's a pleasure to have you on Dental Talk. Thanks for having me, Phil. This is some
very interesting stuff we're going to be talking about today because Ormister technology is kind of
new and we're very curious to see what the chemistry is and how it affects especially
hypersensitive teeth. and how it's used procedurally as a direct restorative bonding and so forth.
So to begin, tell us what ormersers are. Sure. Actually, what they're made of is actually within
their name. They are an organically modified ceramic particle.
And they are produced in a lab. And as the first part of that definition is organic,
they are modified to a certain extent, but they have the properties of a ceramic material.
How is this different than materials that are out there now? Is this unique in its own way where
you can't get this anywhere else other than through Voco, who sells it? Well, interesting enough,
ormesters have been used in other industries. Eyeglasses, both of us are wearing eyeglasses right
now. They use it as a coating over cable lines for water resistance. Some of the benefits that you
get out of using an organically modified ceramic is longer wear resistance,
longevity of the material. They can be used, as you stated, in a bonding.
or a restorative material, but used as hypersensitivity desensitizers,
you're looking at something that goes on like a bonding agent. There's no acid etch prior to the
material. And after light curing the material, it stays on the tooth surface up to 24 months
without wearing off. Quite unusual when you compare it to the predecessors that we've seen as
desensitizers. I know some hygienists would actually use fluoride varnish,
or you can use something that is resin-based, like a bonding agent, but I probably wouldn't want
to incorporate that etch in that procedure because the patient's tooth surface is sensitive.
Okay, so we have a patient that comes in tooth number 27. There's some gingival recession. The
patient's complaining of some hypersensitivity to hot and cold or more to cold. And I'm a retired
endodontist, so of course that's going to... Okay. That's going to... know, some bells will go off
there when they say they're sensitive to hot and cold. But let's say it's very minor and it lasts
two to three seconds and it doesn't happen all the time. What do you do for that tooth using the
Ormiser material? So, you know, one product specifically, the Admirer Protect,
which is an Ormiser-based desensitizer. The clinician, whether it be the dentist or the hygienist,
actually makes sure that the area is clean. You're going to massage the agent,
the Amira Protect, on that surface. You're going to light cure it, and you're going to repeat.
So it should take them less than two minutes, and the results are instantaneous.
You can actually take any kind of agent, as you stated, maybe the patient is sensitive to cold or
ice, water, air, and actually place that. stimulus over the area that you just covered and
instantaneously it covers off those dental tubules and the patient doesn't feel it. So other than
the fact that you don't need acid etch with this material, which is a big thing because you
certainly don't want to use acid etch if you don't have to on a tooth that's already
hypersensitive, what else does the Ormiser chemistry offer? Well, I think the chemistry is quite
unique because there are certain... resin-based desensitizers in the marketplace.
They might be a macro or a micro hybrid chemistry, but they generally only have a short staying
power, maybe six months up to a year. But with the Ormisers,
because of the chemical bonds between the particles and the matrix of the material, it allows for a
higher bond strength onto the surface and that wear resistance. Somebody would have to be a
constant toothbrush, a braider over and over to even try to make a dent into an ormiser compared to
some of the micro or the macro chemistries out there. Right. So I can see why the wear resistance
is better because of the ceramic part of it. But how does it adhere to the tooth without creating
that hybrid layer, you know, where the collagenous fibers? Sure. So again, relying on mechanical
retention, the material. Interlocking with the dental tubules, the smaller particle size of the
material allows the adherence more surface area contact with the material.
Obviously on enamel, it should do very well. Exposed dentin versus cementum,
any kind of change in treatment or it's all the same? It's agnostic. No, that's a good question,
Phil. When you look at it, the possibilities of this material, again, on enamel,
cementum, smooth root surface, Think about it even with like an open margin on a crown or on a
restoration. That patient may have already exhausted their dental benefits, but a simple procedure
of sealing off that exposed area with something that takes the clinician less than two minutes to
do can actually get them through maybe the rest of the year or through the time that they're able
to then have the restoration either replaced or repaired. So you've used other types of
desensitizing agents in the past in your career. Sounds like you really sold on Ormiser technology.
Yeah, the Ormiser, I mean... Even though it seems new to dentistry, it's been out in other
industries for so long. I mean, you know, our iPhones actually have an ormissure protection over
the glass to stop it from fracturing and its impact with dentistry.
And I think with this day and age where our patients and even as a clinician, the biocompatibility
of the material, something that's more organic that. doesn't give off a lot of those harmful
monomers that some of the other earlier desensitizers may have. So is this a material that would
replace the traditional varnish that hygienists typically put on a tooth that's hypersensitive?
Well, I think it wouldn't replace a varnish because this is generally for spot treating.
Somebody on lower anteriors or cervical root exposure. If a hygienist or a doctor,
he or she would actually apply it to all of the tooth surface, they're sealing off all of the
dental tubules. And it acts as almost like car wax over your car or a fine.
clear nail polish for somebody who just had their nails done. You want to protect that undercoating
but nothing is going to penetrate that. So again fluoride varnish is ideal for that overall
fluoride release. This is something for that patient who has something that is an area where
they're constantly complaining about issues. with pain or sensitivity. Right, because the fluoride
varnish, obviously, that carries protection, preventing dentistry, right? Okay, so reimbursement as
far as profitability for dental offices. That's another amazing thing with the Ormiser or resin
-based desensitizer. The CDT actually changed their description of a resin-based desensitizer.
The old code 9910 would be used as a general desensitizing agent.
And you can use that with glutealdehyde or another type of desensitizer that isn't resin-based.
But they actually changed that definition with the code 9911. And it is a resin-based desensitizer
that is light cured. So it changes the... The procedure itself,
not anything added onto the Armentarium other than a curing light. And the payout for a resin
-based desensitizer anywhere on the average is between $15 and $40 per tooth,
where the earlier desensitizing, you'd probably only get $5 to $10 for glutealdehyde desensitizing
application. It's very profitable.
Desensitizers are actually now packaged in single blister dose.
Something that costs the doctor less than $1.20 for two minutes of their time or the hygienist's
time is very profitable. So what's the chief complaint that the patient typically presents with
where Admirer Protect would come into play? They're usually telling us the same area of the mouth,
that one particular tooth. It's, you know, very sensitive. You know, when I'm eating or drinking,
maybe even getting up on a cold morning when you're in the East Coast and kind of breathe in and
they have that sensitivity issue right in the area. And the doctor, he or she examines the area.
You know, nothing is catching in my shepherd's hook, but I still want to treat the patient's
discomfort. And I would actually go with the route of a Lycure desensitizer and then watch it over
a period of time. And as I said, many of these Ormiser-based desensitizers have longevity up to 24
months. So I think there's a lot of patient compliance too to say, hey. You did that on that tooth
in the front, maybe the canine or the premolar. I have something in the back, maybe a molar that
has the same issues. So they're definitely asking for the procedure by name. Right.
So the initial complaint would be sensitive to hot and cold. But then, of course, you do some
investigation and rule out any endodontic implications. That is correct. Yes. As soon as you don't
see anything radiographically, no swelling, no extended pain for more than three seconds.
It doesn't throb. These are the kind of things, obviously, you're going to look at as an endodontic
potential issue, but you're pretty sure that using this material,
especially after you do some restorative work, because that's something where post-operative
sensitivity might occur, using this material, you're pretty sure that that patient will feel
comfortable immediately after you put this on. Yeah, I'm a firm believer of trying what I talk
about. And I'm actually a patient who has some cervical erosion around my canine and premolar on
the lower left. And I've actually had my clinician place it.
And it's been in place for over a year and a half. And I don't experience the sensitivity that I
had prior to it.
I believe in what I preach. That's been great information, Dr. Paveletz. Do you have a webinar coming
up, I think, right? Yeah, I mentioned that in the introduction. Yes. We do. We do with Viva
Learning. So we're going to go into a little bit more of the chemistry and talk about the impact of
the ormissers and even nanotechnology, which go hand in hand with the ormisser-based materials.
So it should be quite interesting. Yeah, I mentioned that in the intro. That is July 19th, 7 p.m.
Eastern Time on VivaLearning.com. And sign up for that webinar. It's free, as I mentioned, and
you'll get live interactive CE credit. Thank you very much, doctor. And we look forward to having
you on future podcasts. And we look forward to your webinar coming up on July 19th. I appreciate
it, Phil. Thank you very much for your time. Have a good day.