Day to Day Technology to Improve Your Practice



Day to Day Technology to Improve Your Practice

• Lasers

o Erbium Lasers

▪ Hard Tissue

▪ 3 Delivery Modes

• Fiber

• Hollow Wave Guide

• Articulated Arm

▪ Purchasing Suggestions

• Hands-on before you buy

• Return policy?

• Delivery system?

• Consumables

• Service policy?

• Training?

• After purchase costs?

▪ Things I’m frequently asked:

• Is anesthesia ever necessary?

• Do I prepare all teeth without existing amalgams with the laser?

• How can I predict the caries depth

o Diagnodent

o Spectra

o Midwest Caries I.D.

• How do I protect adjacent teeth?

▪ More things I’m frequently asked:

• Does the purchase cash flow?

• Does it work as advertised?

• Do patients like it?

• Will I get referrals?

• Will I use it?

• Is it hard to learn?

o Diode Lasers

▪ Currently 3 wavelengths

• 980, 940, and 810 nanometers

• Great for soft tissue

• Small

• Affordable

• Excellent hemostasis

• Delivery either through optical fiber or single use tips

• Some have wireless foot controls

• Many units are now “handhelds”

▪ Ivoclar Navigator Diode

• Charger stand

o In stand – use or charge

o Out of stand 45 minutes of power

• Cordless foot pedal

• Unidose fiber tips

o 2 lengths 3.5mm & 6mm

▪ Kavo GENTLEray

• 980nm wavelength

• Sturdy

• 30 Pre-Programmed settings

• Corded

• Touch screen

▪ Discus NV

• 810nm

• Cordless

• 6.3”L x 0.65” diameter

• 1.9 ounces

• 2.0 Watts Maximum

• Wireless foot pedal

• Charger stand

• Fiber tips

o Nd:YAG

▪ Delivery is done by a glass optical fiber (usually 200 or 300 microns)

▪ Fiber is cleaved and autoclaved after use

▪ Units are larger than diodes

▪ Wavelength is 1064nm

▪ Generates less overall heat than diode, but delivers more power per pulse

▪ More expensive than diodes

▪ Can provide variable pulse widths

▪ Variable power

▪ Variable repetition rates

▪ The design and electronics that create the Nd:YAG beam allow for extremely precise control

▪ This allows the operator an unparalleled ability to remove only the desired target tissue and nothing else

▪ Control of the firing of the laser allows the operator the luxury of a “what you see is what you get” experience

▪ Manufacturers

• Millennium Dental Technologies

o Why Nd:YAG and Diode?

▪ Frenectomies

▪ Soft tissue crown lengthening

▪ Troughing of crown margins

▪ Biopsies

▪ Hemostasis!

▪ Herpetic lesion treatment

▪ Aphthous lesion treatment

▪ WYSIWYG cosmetic re-contouring

▪ Laser perio treatment

• LED Curing

o Enables curing equal to fast halogen lights

o Diodes are incredibly long lasting

o Minimal heat during curing

o Low power

o Quiet operation

o LED’s generate slight heat at the light guide tip, but do generate heat on the diode substrate

o Ask manufacturers how they dissipate heat in their lights, especially in sealed devices

o Ask questions regarding spectral output

▪ Should be in the range of 450-470nm

o LED Advantages

▪ Most are cordless

▪ High speed cure

▪ Low heat

▪ Quiet

▪ More efficient output

▪ Better depth of cure

• Drug Databases

o More than 1.5 million Americans are injured every year by drug errors

o At least 25% of all medication related injuries are preventable

o 4 out of 5 U.S. adults take at least one medication or dietary supplement every day; almost 1/3 take at least 5

o The average 75 year old has 3 chronic conditions, regularly uses 5 prescription drugs and multiple OTC products, and sees more than one physician

o 65% of patients who walk into a physician’s office leave with a prescription

o Solutions

▪ Books

▪ Online databases

▪ PDA’s

▪ Local network databases

o Books

▪ Disadvantages

• Big

• Slow

• Easily outdated

• Not green

▪ Advantages

• Difficult to lose! (

o Online databases

▪ Disadvantages

• Requires a computer

• Requires an Internet connection

• Requires a subscription in most instances

▪ Advantages

• Time savings

• Fast!

• Computerized – Copy & Paste

• Reliable

• Constantly updated

• Drug interaction database

• Fully searchable

• Easy to use

• Photos

▪ Cost

• $60-325

• Price depends on product

• There are free versions, but they don’t have as much information

▪ My favorites

• Lexi-COMP Online for Dentistry

o lexi-

o Eight Databases

▪ Drug Information

▪ Drug Interactions

▪ Dental Office Medical Emergencies

▪ Oral Soft Tissue Diseases

▪ Manual of Clinical Periodontics

▪ Lexi-Natural Products Online

▪ Clinician’s Endodontic Handbook

▪ Your Roadmap to Financial Integrity in the Dental Practice

• ePocrates Online

o

o Prescription Medications

▪ Adult & pediatric dosing

o Alternative Medications

o Pill Photographs

o Tables

o MultiCheck Interaction Database

o Ability to print info for patients

• Endo

o Apex Locators

▪ Elements Diagnostic Unit

• Sybron Endo

• Apex locator and pulp tester in one unit

• Satellite unit can be placed where convenient

▪ Root ZX II

• J Morita

• Can be upgraded with an optional 0-800 rpm low speed handpiece

o Resilon

▪ Resin percha

▪ Flexible points that bond to the canal wall

▪ Used with a special self etching dual cure sealer

▪ Can be heated for warm vertical

▪ Can be used in Obtura

▪ Handles like gutta percha (only better!)

▪ Significantly less leakage than GP

▪ Easily re-treatable

▪ Resilon Technique

• Proceed with your preferred instrumentation technique

• Dispense the sealer (self-etching)

• Place sealer in your usual manner

• Fill the root space with Resilon points using your usual technique

• Cure coronal portion with curing light

• Etch, bond, and seal using flowable (Ultradent Perma-Flow Purple)

• Place build-up or temp

• Sealer in root system will self cure in 25 minutes

• Can be used with System B

o Set temperature to150C and the power to 10

o Can be used with Obtura gun

o 25 gauge tip=160C

o 23 gauge tip=140C

o 20 gauge tip=120-130C

o Ultradent Endo-Eze

▪ Gutta percha coated with UDMA resin that bonds to the sealer

▪ EndoRez sealer that bonds to the canal and the point

▪ Conservative apical management

▪ Bonded obthration

▪ Ultradent also makes a ton of great endo products (too many to mention here)

▪ Mechanically file upper 2/3’s with reciprocating handpiece and Endo-Eze files

▪ Use rotary or manual instrumentation to prepare apical 1/3

▪ Placed EndoRez sealer

▪ Place EndoRez point

▪ Etch, bond, and seal using flowable (Ultradent Perma-Flow Purple)

▪ Place build-up or temp

o Doctor Comfort

▪ AnterioRest

▪ Back Support from the front!

o Addent Microlux

▪ 3 different uses

▪ Fiber optic mirror for all routine exams wherever more light and a mirror are needed

▪ Transillumination tip

▪ Oral tissue exam tip

▪ Endo canal locating tip

▪ Battery powered

• Quick Hits

o 3D Cone Beam imaging – Gendex GXCB-500

o Oral Cancer Detection

▪ Trimara Identafi 3000 Ultra

▪ Velscope

▪ Dentlight DOW

o Turbine Improvement

▪ ProDrive Systems

o Automated Patient Communication

▪ LighthousePlz

▪ DoctorBase

• Digital Operatories

o Electronic health records will soon be required by law

o Digital operatories are a must in the master plan of implementing a chartless digital patient record

o 2 monitor system recommended

▪ Use one computer with 2 monitor outputs

▪ Use Windows Extended Desktop to create a system to allow dragging between monitors

▪ Exorvision monitors are highly recommended

o Keyboard and Mouse

▪ Wireless Gyro-mouse

▪

▪ Sold as Go 2.4 Optical Air Mouse and Compact Keyboard Suite

▪ Available from website and retailers

o Digital operatories allow

▪ Digital radiography

▪ Digital photography

▪ Computerized BP

▪ Drug Databases

▪ Intraoral cameras with video capture

▪ Electronic charting

▪ Electronic chart notes

o Communication

▪ Family Service Radios

o Intraoral Cameras

▪ Acteon 717

▪ Gendex eZ1

▪ Air Techniques Polaris

o More benefits of operatory computers

▪ Video

▪ Movies/TV

▪ Patient Education

▪ Chart notes

▪ Medical History

▪ Lab case tracking

▪ Prescription writer/tracker

Digital Caries Diagnosis & Restoration

Devices:

• Midwest Caries I.D.

• Kavo Diagnodent

• Air Techniques Spectra

• Acteon SoproLIFE

Caries I.D.

• Uses LED to illuminate the tooth

• Works on “optical signature”

• Detects changes in refection and refraction of light passing through the tooth

• Requires calibration

• Works in a moist environment

• Indicates a “hit” with beeps

Diagnodent

• Uses 655nm diode laser (red)

• Detects fluorescence of decalcified & carious tooth structure

• Fluorescence is detected, measured, & scored

• Teeth need to be dry & free of organic debris

• Requires calibration

• Indicates a “hit” with increasing audible tone & numeric score

Spectra

• Uses 405nm LED’s

• Detects fluorescence of carious bacterial byproducts

• Picture is taken, photo is analyzed, caries or healthy tooth structure is displayed

• Teeth need to be dry & free of organic debris

• No calibration needed

• Indicates a “hit” with “Doppler Radar” type image

SoproLIFE

• Uses 450nm LED’s

• Detects fluorescence of disturbed/affected dentin

• Picture is taken (device also doubles as an intraoral camera)

• No calibration needed

• Has a detection & a treatment mode

• Indicates a “hit” with red fluorescence on image

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