The Dentist's Network #109

Two Things I Wouldn’t Want To Practice Without
by Dr. Ryan Swain DMD

I’m sure you’ll agree that one of the best aspects of getting together with other dentists is the sharing of ideas and recommendations that occurs amongst colleagues. At CE events, much of the information shared during the lectures is valuable, but some of the best learning happens over drinks after the meeting has concluded. In my experience, those sessions often include recommendations from each dentist at the table of “things they wouldn’t want to practice without.” I’d like to share two things that I wouldn’t want to practice without.

1. Physics Forceps
I have done plenty of extractions during my career. I’ve done full mouth extraction cases and I’ve dealt with just about every type of tooth that exists. I always liked to think that I was pretty capable when it comes to extractions. However, no matter how many teeth I extracted, I never felt fully relaxed and confident during the procedures. That all changed when I started using Physics Forceps.

Physics Forceps are a unique type of extraction forceps that provide the following:

Predictable and efficient extractions
No need for elevating
Very little operator movement needed
Atraumatic extractions

All dentists want these things, and in my experience very few dentists know that they can have them. The unique design of Physics Forceps allow for light but constant pressure to be applied to the tooth which leads to chemical changes in the PDL and subsequent release of Sharpey’s fibers. Once the tooth releases, it can be removed simply with a rongeur or even just fingers. It is a huge leap for dentistry!

2. Dropbox
Dropbox is a software program for MAC or PC that is simply incredible. It provides for easy and free file sharing between people or sharing between your own computers. Many people seem to send files using websites such as yousendit.com, but in my opinion Dropbox is much better.

The Dropbox software can be downloaded free and easy at www.Dropbox.com. Once the software loads on your computer, you will have a folder in your “My Documents” folder that is called “My Dropbox.” Anything you drag and drop into that folder can be easily shared with other people, and everyone can use up to 2GB of storage for free. To share data from any of your Dropbox folders (you can have multiple folders within your main Dropbox folder) all you have to do is “right-click” and then click on “share.” You then type in the email address of the recipient and a message will be sent to them with a “share request.” Once the recipient receives the message they can begin viewing your files as soon as they download the Dropbox software. Here’s the best part! Once you have a shared folder with another person, you can easily share files with each other by just dragging and dropping the files into your shared folder. So, if you drop a movie of the kids into the folder that you share with your mom, that file will automatically show up in the folder on her computer… voila!

Besides sharing data with other people, Dropbox is incredible for sharing data between your own computers (work, office, iPad etc.). All you have to do is put the Dropbox software on each computer and you can share your files easily between your computers. This provides tremendous opportunity for improving your visibility between the office and home. Imagine that it is six o’clock and you need to head home. But, you are reviewing some patient photos and working on a treatment plan for that patient. You can simply drag and drop the photos into your Dropbox folder and the photos will be available for you to view on your home computer. This also provides you with the ability to do easy and automatic backups of your data because if one computer dies, you have the data available on the other computers.

One other aspect of Dropbox provides some icing on this already sweet cake. All of your data is stored for you at Dropbox.com, so if you don’t have access to any of your own computers, you can still access your files through any computer that has internet access. So, if your office floods and your computers are ruined, any files that you had put in your Dropbox folder will be sitting safely and comfortably on the internet for you to download easily. Can it get any better than that?! 100GB of storage is just $200 per year. As mentioned previously, up to 2GB is free and provides enough room for most people to share plenty of files with each other (a typical mp3 file is only 2-3MB).

So, there you have it - two things I wouldn’t want to practice without. We all welcome things that reduce stress and increase efficiency. Physics Forceps and Dropbox do both… and in a big way!

Dr. Ryan Swain is a graduate of the University of Florida College of Dentistry. He practices in Rochester, NY and focuses on Short Term Ortho and other conservative cosmetic dental procedures. He is president and chief clinical instructor for Six Month Smiles. Dr. Swain is a pioneer in the field of Short Term Ortho and constantly on the forefront of GP orthodontics. He has trained dentists internationally and prides himself on de-mystifying orthodontics for GPs.

Dr. Swain can be reached at Drswain@thedentistsnetwork.net

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Louis Malcmacher
DDS MAGD
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Change
by Dr. Louis Malcmacher DDS MAGD

They say that the only constant in life is change. Things are forever changing, and although we always hope it’s for the better, many times we don’t know if change is good until we look at a 20 or 30 or 40 year historical perspective. With the conservative nature of dentistry in general, change has always been slow and most dentists have been resistant to change. Now that I have been in dentistry for 30 years, it is interesting to take a look back with a historical perspective as to how things have changed in the careers of dentists my age.

When I first started dentistry, gold was (and in many clinical instances, still is) the restorative material of choice. Silicon dioxide based resin materials were just coming into vogue to replace amalgam. We weren’t even etching and bonding these materials into place, we were just placing them into anterior teeth for restorative use, and thus began cosmetic dentistry. There was an outcry by many dentists - how dare you replace the restorative material that has served us well with some new-fangled tooth colored filling who’s life expectancy was unknown. Seems funny now, but it was quite the controversy then.

Imagine then the next outcry when adhesive dentistry started its rumblings and you could then bond a piece of porcelain to a tooth. Heresy! How dare you even think about replacing gold that has been cemented to teeth with zinc phosphate cement - which has sky-high microleakage numbers, but could usually serve in the mouth for 40 to 50 years.

Let’s look at impression materials. Hydrocolloid was serving dentistry very well with rubber tubes to your waterline, and its accuracy and hydrophilic ability allowed you to take impressions almost underwater and still be accurate. Polyvinylsiloxane became available and there was a big controversy as to whether or not this new-fangled impression material would be accurate or not.

Implants came in all weird forms with blades and subperiostial meshes, which were the standard for a long time. Root form implants were introduced and I remember many in dentistry saying there is no way that the biomechanics make sense with root form implants and they were destined to fail. Implants are still controversial today. Whenever you talk to the different specialties, some want to claim that implants have a higher success rate than endodontically treated teeth, so it is better to extract and place an implant than do an endo. Others will claim the exact opposite.

When whitening first came out 30 years ago, there was a tremendous outcry by dentists stating that we are not cosmetologists, peroxides will kill teeth and dissolve enamel, patients are only interested in relieving pain and function, and besides, patients won’t pay for this treatment because it is not covered by insurance. I remember when a newly founded dental company put out for sale a tube of 10% carbamide peroxide at its booth for dentists to purchase for teeth whitening and the dental organizations hosting the event came and confiscated the product!

I could go on and on about further controversies and things that have changed in dentistry – CADCAM, digital impressions, lasers, occlusion, and sleep apnea. Some of these categories still create a little bit of controversy here and there, but most of these therapies are now fairly well accepted in dentistry. And there will always be new controversies – today it is about the use of Botox and dermal fillers. The funny thing about this controversy is that Botox does have a history in dentistry that goes back quite a few years as a therapeutic agent and it is taught at many dental universities today. But to many dentists, the concept is new and therefore a little bit challenging and scary. Now that nearly 20% of dentists provide Botox and dermal fillers to their patients, and it’s the fastest growing part of dentistry, it is quickly going from controversial to mainstream.

In dentistry, are you going to change or are you going to be left behind? The one constant in life and in dentistry will always continue to be change. Change is good - where would we be in dentistry if we were still doing what we were doing 30 years ago? One of the biggest motivators to change in dentistry has also been the patient - your patient has changed over the years and so have you as both as a consumer and as a dentist. Change brings controversy, controversy brings attention, attention brings research and experience, and then it is up to you and I to determine which treatment modalities are best for our patients.

Dr. Louis Malcmacher is a practicing general dentist in Bay Village, Ohio, an internationally known lecturer, dental consultant and author, and is President of the American Academy of Facial Esthetics. Interested in knowing more about how to truly enjoy dentistry? Click here.

Interested in having Dr. Malcmacher speak to your dental society or study club? Click here. To reach Dr. Malcmacher, email him at DrMalcmacher@thedentistsnetwork.net or call 1.800.952.0521.

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Chris J. Lampert, DMD
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The Secret of Rotary Glide Path Instrumentation
by Chris J. Lampert, DMD

After the introduction of nickel-titanium rotary instrumentation, new techniques, concepts, and terminology developed. Terms such as taper lock and smear layer did not exist prior to rotary instrumentation. As technology continues to improve and more sophisticated manufacturing processes become available, new instrument designs continue to evolve. Once again, new instruments are leading to new techniques and terminology that will define the next advancement in endodontics. A recent trend that will become common practice is the use of rotary instruments to create a glide path.

Glide path is used to describe the unimpeded path from the canal orifice to the canal terminus which rotary shaping files can follow. Creating a .02 tapered glide path is critical for the safe use of larger tapered rotary instruments. Traditionally, the glide path has been created with size 10, 15, and 20 stainless steel hand files. Often, creating the glide path can be the most demanding part of the entire procedure. The gap between a size 10 negotiation file at patency and a size 20 file at the canal terminus is huge. Many hours are lost, canals are messed up, and frustration is tested in this .10 mm diameter space. This is where ledges are formed, canals are transported, and hand files separate. At this point, many cases are won or lost. This is the glide path.

I firmly believe that most canals naturally have an unimpeded path to the canal terminus. This means we create most of the impediments that are encountered during canal negotiation. The two main causes of canal blockage are tissue compaction (pushing pulp tissue ahead of the file) and ledge formation. In both cases, it is the vital pulp tissue within the canal that is the ultimate problem. This is the same reason necrotic cases are much easier to instrument. Without tissue in the canal (necrotic canals) there is nothing to impede the file tip and nothing to force the file tip laterally and create a ledge.

Recently, multiple manufacturers have introduced small sized rotary nickel-titanium instruments designed specifically for creating a glide path. These new instruments have small tip sizes (less than 20) and small tapers (2%) so they are extremely flexible. To increase instrument torque strength, the cross-sections are square, thereby increasing the central core of the instrument. These glide path instruments are resistant to breakage because their fatigue limits are so high. Another reason they rarely separate is due to the fact that their small sizes prevent them from engaging much of the canal wall. The primary function of these instruments is not to shape the canal, but to remove tissue from the canal and create a glide path.

The benefits of using a rotary instrument to create a glide path are numerous. First, the flexibility of nickel-titanium is well tested and well proven to prevent ledge formation and transportation when compared to stainless steel. This reason in itself addresses a common cause of lost patency during negotiation. Second, the rotary action of the file severs and moves vital pulp tissue out of the canal in the coronal direction. The rotary action prevents compaction of pulp tissue in the apical direction. This benefit is completely opposite to what is seen with stainless steel hand files. Stainless steel hand files push pulp tissue in the apical direction, which has a tendency for blocking the canal and inhibiting patency. After a short time of using rotary glide path instruments you will notice the flutes are full of tissue. This result is not seen with hand files.

I believe there will always be a need for small stainless steel hand files - however their uses will be limited. Stainless steel hand files will primarily be used for length determination with an apex locator, negotiating extreme curvatures that require a sharply curved instrument to slip past the impediment, and for patency maintenance. The use of rotary instrumentation to create a predictable glide path has changed the way I negotiate canals. It is one of the few changes I have made to my clinical technique that I can say is both faster and safer. Rotary glide path is the future.

Chris J. Lampert, DMD maintains a fulltime Endodontic practice in Portland, Oregon, and is involved with research, testing, and development of new endodontic products. Dr. Lampert received his DMD from Oregon Health and Sciences University and his Endodontic post-graduate degree from Boston University.

Dr. Lampert can be reached at drlampert@thedentistsnetwork.net

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Two Things I Wouldn’t Want To Practice Without by Dr. Ryan Swain DMD

Change by Dr. Louis Malcmacher DDS MAGD

The Secret of Rotary Glide Path Instrumentation by Chris J. Lampert, DMD

Two Things I Wouldn’t Want To Practice Without
by Dr. Ryan Swain DMD

Change
by Dr. Louis Malcmacher DDS MAGD

The Secret of Rotary Glide Path Instrumentation
by Chris J. Lampert, DMD