Clinical Corner: Information on Dental Procedures

Articles

What's Hot: Dr. Glazer on Jazz
Combating Hidden Decay with Early Detection
Atraumatic Removal of Defective Crowns
Balancing: The Art, Science and Business of Dentistry
Intra-Oral Preparation of Titanium Abutments in Order to Obtain Ideal Angulations and Contours
SS White Express Line High Speed Laboratory Metal Finishing Burs
Direct Preparation Of Preexisting Implant Abutments For Case Rehabilitation
Flextime Xtreme: The 80/20 Rule
Fast and Smooth - Efficient Crown Preparation With Carbide Instruments
When Advancing the Bur, One Can Feel the Presence of Dentinal Caries
Precision Trimming and Finishing of Current Dental Restorations Using the Safe End Bur System
Indirect Restorative Tooth Preparation: Extreme Efficiency and Accuracy
Creating Maximum Efficiency and Accuracy In Indirect Restorative Tooth Preparation
Preparation Protocol To Ensure Predictable Aesthetic Restorations
Tooth Preparation Mastering Quality and Efficiency
Fissurotomy: Proactive Treatment for Incipient Decay
Anatomically Adapted Carbide Finishing Burs - Creating Super-Smooth Composite Surfaces in Two Steps
Directions for Use: Dr. David Clark Kit
Placing Traditional Sealants with Enhanced Magnification: Methodology to Increase Both Short-term and Long-term Success - David Clark, DDS
How to Quickly and Conservatively Restore a Natural Shine after Orthodontic Bracket Removal
SS White Surgical Length Oral Surgery Burs: Atraumatic Removal of Teeth for Maximum Bone Preservation

"Tooth Preparation: Mastering Quality and Efficiency"

Howard S. Glazer, DDS, FAGD, FASDA, FACD, FICD, DABAD 

Before defining the set of parameters necessary for tooth preparation, clinicians must ask themselves what tools are required to produce optimal dental care. For both operative and restorative dental procedures, this list should begin with magnification loops. The visualization of the tooth that being prepared is vital to the success of the restoration. Second, before beginning the preparation stage of any restoration, insure that the correct instruments to task are at your disposal.

By maintaining a strict set of preparation protocol for any given procedure, increased quality can be fostered through repetition. A byproduct of repetition is a marked increase in efficiency. Efficiency translated to a savings in energy expanded, time and money (time=money). However, efficiency by any definition should never be at the expense of providing a quality service and/or product to your patients.

For well over a century, the dental bur has been the workhorse of the dentist. In actuality, the word bur can is often misleading. Specific to dentistry, the word bur is defined as a rotary cutting instrument with a bladed cutting surface; a diamond is not a bur. Today, there are as many bur designs as there are bur manufacturers.

Dental burs are designed with different flute angles and cutting characteristics specific to the task they are to accomplish. For example, finishing burs (Figure 1) have more flutes, closer together and more shallow for the fine finishing and polishing of dental materials. Operative, or cavity preparation burs have flutes (sometimes called dentates) that are cut deeper and wider creating a higher degree of aggressive cutting of enamel with increased speed and efficiency. Typically, these operative burs are either straight bladed (plain) or crosscut. Straight bladed burs cut smoothly but are slower, especially with harder materials; crosscut burs can cut faster.

Figure 1 Multi blade trimming and finishing bur (SS White, Lakewood, NJ)

Figure 2 Uniquely engineered with sharpened dentated cutting blades, the Great White #2 Bur can cut the hardest dental materials smooth and efficiently

Figure 3 The Great White #2

Today, there is a bur that is faster and smoother cutting and does not “grab”, “catch” or stall in hard to cut materials. Great White Burs (SS White, Lakewood NJ) are engineered to be more sharply dentated (Figure 2) than a crosscut bur and have a unique geometry in the design of their blades which creates a bur that cuts faster with less vibration when cutting into tooth structure or dental materials (Figure 3). The resulting benefit of this design is less stress on the tooth, its supporting periodontal structures and less friction to the pulp. Also, because of the aggressive nature of this unique bur design, there is less pressure required by the dentist to initiate and complete a cut, this factor coupled with reduced vibration and chatter creates less stress and wear on the bearings of the handpiece.

A side-by-side comparison (Figure 4) of bur blade geometry of the Great White Bur and standard operative burs shows that the standard # 557 bur has a flat area or “land” between the crosscuts. The absence of these “land” areas of the Great White Bur between the numerous cross-cuts, combined with sharpened dentates, or blades, allows the Great White Burs to cut all hard materials quickly and smoothly.

Figure 4 A comparison of a straight fluted bur, a crosscut bur and the sharply dentated Great White Bur

Figure 5 SS White Great White Gold Series carbide bur shape selection

SS White has increased the availability of sizes and shapes in their Great White Bur line (Figure 5). There are now twenty-four different Great White Burs available to offer clinicians increased flexibility with instrument to task requirements. For example, the GW557S, with its shorter head, makes pediatric dentistry easier and increases the access to distal surfaces of the posterior teeth, the GWSL6R and GWSL557 are ideal burs for creating endodontic access preparations and the GW #2 is ideal for crown removal.

Figure 6 Great White #1 (SS White, Lakewood, NJ) cutting through non-precious crown in preparation for removal

When removing a crown (Figure 6), the dentist often does not know what type of metal was used to fabricate the “failed” crown. In these situations, an aggressive metal cutting bur should be used. The Great White fulfills this requirement. The GW#2 Bur is optimal for all phases of restorative dentistry. Because of the unique design of the Great White it is an effective and efficient bur for removal of amalgam, composite resin, cast gold and direct gold restorations that are being replaced. When cutting through a porcelain crown in which you want to maintain the integrity of the porcelain, it is recommended to use a diamond to first cut through the porcelain and then use the Great White Bur to section the metal substructure. Great White Burs can also be used for tooth preparations as well as for the preparation of titanium implant abutments.

When speaking of cavity preparation, it has been shown that the GW2 creates many shallow troughs or corrugations on the cut surface, which may result in an enhanced and stronger bond between the restorative material and the luting agent. .

SS White has engineered a truly unique dental rotary instrument in the Great White Burs. These innovative burs cut quickly, efficiently and smoothly through metals, composites, enamel and amalgam saving time and money for clinicians. The beneficial byproducts of this unique design are less chatter and vibration, which reduces hand strain and fatigue. In clinical use, Great White Burs consistently outperform operative carbides in both the cutting of tooth and dental restorative materials. Great White Burs are designed to help make restorative dentistry uncomplicated and more efficient, and ultimately provide a beneficial service to the patient.

References:
i Nemetz, H., Seibly, W. S., “A guide to successful posting. Passively placed posts in corrugated post spaces”, Oral Health, 1994, January, pages 29 - 34

ii Seibly, W., Nemetz, H., “Passive Post Placement Technique. Description of a technique”, Oral Health, 1994, April, pages 9 - 16