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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