by Michael DiTolla, DDS, FAGD
As we start the new year, I always like to look back and see what products or techniques have helped me the most in the last calendar year. So, in no particular order, here is the first of two installments in which I discuss the products that made dentistry faster, easier, or better for me in 2007.
We offer Cyclone DS to most patients undergoing procedures who are not receiving local anesthesia. You might remember that about 10 years ago, there was a product named Dyclone. This was a topical anesthetic that patients could swish with for one minute to anesthetize gingival and palatal tissues. It was fantastic for hygiene patients who needed some anesthesia but did not want local infiltrations or blocks. It also worked well for needle-phobic, sensitive hygiene patients and patients who gag during impressions. I searched the FDA database and found that the company decided to stop producing Dyclone for its own reasons. The FDA verified that it had nothing to do with the safety or efficacy of the product.
Steven’s Pharmacy’s (800-352-DRUG) replacement product is called Cyclone. It is available in the original strength that we once used, 0.5 percent, and also in a double-strength solution called Cyclone DS. This is a 1.0 percent solution. We settled on Cyclone DS as our choice because we noticed no difference between the two solutions, except that Cyclone DS works better on most patients. Unlike the original Dyclone, which had an unpleasant taste, Cyclone is available in mint and several other flavors. This makes the anesthetic more palatable.
We use Cyclone on anyone who is worried about having impressions taken, whether for Invisalign, bleaching trays, or just study models. We use it on full-arch crown and bridge impressions when we are concerned about the patient gagging while we try to capture the detail of multiple preps. We even use it prior to taking digital X-rays on patients who are worried about gagging.
On the hygiene side, we use Cyclone for periodontal probing for patients with inflammation, as well as for gross debridement patients who are sensitive. We see many patients who are overdue for hygiene but do not need scaling and root planing.Typically, since we only use local anesthetic for root planing patients, the anesthetic helps fill the gap by being an easy-to-use topical that provides peace of mind for patients.
The bottom line is that we offer Cyclone to almost anyone having something done who is not receiving local anesthesia. We do not charge for this service, although there are dentists who have told me they charge a small fee (typically $5). These dentists indicate that patients are happy to pay a small fee. We do not charge for local anesthetic. We think that charging for this service falls into the same category.
In my opinion, Zir-Cut burs are absolutely necessary when replacing zirconia-based restorations.
These new burs are from Axis Dental, and fill a need just recently created. They are a huge time-saver, too. Zirconia-based restorations entered the market a few years ago, and are now hitting their stride. Two of the newer systems (LAVA from 3M ESPE and Prismatik CZ from Glidewell Labs) are so strong that nothing will cut efficiently through their zirconia substructures — not even the Razor carbide bur! I suggest using Zir-Cut burs when replacing all-ceramic, cementable restorations.
Even if you are not placing zirconia restorations, which I now do routinely, one day you will have to take off a zirconia crown placed by another dentist. This is a time when having Zir-Cut burs could be handy!
It would be difficult to practice quality crown and bridge without Ultradent’s ViscoStat hemostatic solution. I simply have not used anything that is as effective as this 20 percent ferric sulfate solution. To use it correctly, you must be somewhat aggressive with the material; this is not a product that you simply dab into place. Proper use requires using the Dento-Infusor tip to scrub the capillaries that are bleeding. At first this may seem counterintuitive, but when you see the results you will understand my resasoning.
In a perfect world, we would not need a product like ViscoStat. Our patients would all have healthy gingival tissue, and we would never nick the gingiva with a bur. But reality forces us to prepare teeth with edematous gingiva around it. In these cases, ViscoStat is a lifesaver.
I think that ViscoStat Clear, while not as effective as ViscoStat (it is aluminum chloride rather than ferric sulfate), is the material of choice when being used on tissue adjacent to all-ceramic preparations in which ferric sulfate solutions are contraindicated.
Dr. Michael DiTolla is the Director of Clinical Research and Education at Glidewell Laboratories in Newport Beach, Calif. He lectures nationwide on both restorative and cosmetic dentistry. Dr. DiTolla has several free clinical programs available online or on DVD at www.glidewell-lab.com. For more information on this article or his seminars, please contact him at www.drditolla.com.