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Pearls for Your Practice

Aug. 25, 2016
Joshua Austin, DDS, FAGD, reviews Tempsmart crown and bridge material by GC America, the Anutra Medical local anesthetic buffering system, and the Jiffy Universal ceramic finishing system from Ultradent Products.

Tempsmart by GC America Inc.

Three weeks ago, I was prepping an eight-unit anterior case when I started to get a familiar feeling—the same feeling I always have about halfway through my preps on bigger cases like this. My thought is always, “I am dreading having to provisionalize this!” The feeling grows as I get closer to needing to fabricate the provisionals. But I inevitably reach the point of provisionalization . . . when I am forced to take a deep breath and just do it. This case was no different. I exhaled and jumped in. I filled my putty stent with Tempsmart by GC America Inc. and started the stressful journey. Fifteen minutes later, I was cementing the best, most esthetic, multiunit anterior provisional I’ve ever made.

Tempsmart is a dual-cure, bis-acrylic composite provisional crown and bridge material. It has a novel combination of microfilled resin and nanofillers that yield a smoother, more polished surface than other temporary crown and bridge materials on the market. These help it retain its polish in situations like the one I described above, when the provisionals are going to be in place for longer than usual. Tempsmart also features a high-density polymer network, which makes it one of the strongest, most fracture-resistant provisional materials on the market today. This is incredibly valuable because broken provisionals cost us time and money.

Esthetically, I found Tempsmart to be very, very attractive. It polished so well that it almost had a ceramic-like luster to it. Tempsmart is available in shades A1, A2, A3, A3.5, B1, and Bleach White, so there is a wide array to choose from. Tempsmart can be purchased in 48-mL cartridges (1:1 gun) or 10-mL syringes if you don’t have a gun.

One other positive feature of Tempsmart is the working time. Its working time and setting time are relatively short since it can be light cured, which also shortens your chair time for provisional fabrication. GC America has a great track record for making quality materials, and Tempsmart is no different. It’s an excellent choice for provisionals with both esthetics and strength. Line-shot double into the power alley for GC America on Tempsmart!

Anutra Medical local anesthetic buffering system

Anesthetic buffering is sort of like Taylor Swift. Five years ago, I had never heard of it, but now, I can't go a few days without hearing something about it. So what is all of the fuss about? Well, she's tall and attractive, and her songs are pretty catchy. Oh, wait-I think this "Pearl" is supposed to be about the Anutra Medical local anesthetic buffering system. So, to get back on topic, what is buffering anesthetic all about? It's essentially basic chemistry: Lidocaine is way more acidic than the natural pH of the human body. By adding sodium bicarbonate to neutralize lidocaine's acidity, we accelerate and enhance its ability to produce numbness, making it faster and the results more profound. For the patient, this means a more comfortable injection. For the clinician, it means less waiting for anesthesia and more consistent, predictable effects. Many of our physician colleagues have been buffering anesthetic for a while. But over the past few years, much like Taylor Swift has infiltrated your radio, anesthetic buffering has infiltrated dentistry.

I had zero experience with local anesthetic buffering before Anutra Medical sent me their system. The system is simple. It starts with the Anutra Dispenser, which looks sort of like a small tower. Inside of that goes the Anutra Cassette. This is what mixes the lidocaine and sodium bicarbonate for optimal results. A large vial of 2% lidocaine with 1:100,000 epinephrine attaches to one side of the cassette, and a vial of sodium bicarbonate attaches to the other. Once attached and primed, the sodium bicarbonate vial is good for seven days, so one cassette will last for a week. The cassette slides inside the dispenser, and after priming, the setup is ready to deliver buffered anesthetic.

Since the lidocaine and sodium bicarbonate are mixed in the cassette, you must use a luer-lock syringe for Anutra's buffered local anesthetic. The Anutra Syringe looks similar to a traditional metal dental syringe, except it's single-use and does not have a carpule. The syringe twists onto the dispenser, and the buffered anesthetic solution is drawn directly into the syringe. One big advantage to this system is that you can draw up more than one carpule's worth. If you were planning to use a couple of carpules' worth of local anesthetic, you could simply draw up as much buffered anesthetic as you want and deliver the bolus all with one injection, instead of using multiple injections as you would with traditional carpules. For me, injecting with a plastic syringe felt slightly different from injecting with a metal syringe at first, but after a few injections, that difference became negligible.

I had pretty good results with buffered local anesthetic. With inferior alveolar blocks, my patients seemed to become numb more quickly, and the results seemed to be as profound or more so, compared to traditional anesthetics. But I will admit that there is a learning curve for both you and your staff when instituting buffered anesthetic. With the Anutra Medical local anesthetic buffering system, you will need to load a new cassette with fresh sodium bicarbonate weekly. It must be fully primed after loading and primed to a lower level daily. Obviously, there is a cost to this, and you will probably have to designate a staff member to be in charge of managing the Anutra system on a daily and weekly basis. You will also be locked into using Anutra Medical's disposable plastic syringes or any other luer-lock syringes, which can raise your disposable cost if you aren't an Anutra Medical Platinum member (Platinum members get needles and syringes free of charge).

I have yet to see any possibility of billing for additional codes when using buffered anesthetic. If you are a fee-for-service office, you could obviously raise your fees to account for this jump in costs. If you are a PPO office, you will have a harder time with this. Anutra Medical will tell you that you can recoup the extra expenses with shortened procedure times since you won't be waiting as long for anesthetic to kick in. I think you would have to jump all in and use the Anutra Medical system full-time to achieve that. Given all of this, I think buffered anesthetics can have a big impact on the dental practice. Just be willing to do the training, get past the learning curve, and jump in feet first! Sharp single to left field for Anutra Medical.

Jiffy Universal ceramic finishing system from Ultradent Products Inc.

In a perfect world, the Texas Rangers would win every single game. It would be 72 degrees and sunny outside with a slight breeze perpetually. And every single crown would drop in requiring no occlusal or interproximal adjustments. Obviously, the world is not perfect. The high is going to be in the 100-degree range today in San Antonio. The Rangers don't win every game, and it seems like every single crown I deliver needs at least some very minor adjustment. In today's monolithic age of lithium disilicate and full-contour zirconia, we need to be aware of how we adjust these materials so we don't irreversibly damage or weaken the materials. We also need to be able to adjust and polish these restorations both inside the mouth and out. A high polish on ceramics helps reduce the wear on opposing dentition. Having dedicated, curated kits to do this simplifies the process for everyone. That's what Ultradent has done with its Jiffy Universal kits.

Ultradent makes a Jiffy Universal kit both for intraoral and extraoral use. Having both of these around will cover all of your adjusting and polishing needs for high-strength ceramics. The extraoral kit has wheels and points for grinding and polishing. The green and yellow wheels and points are for grinding, while the dark orange and light orange are for finishing and polishing. The green products are great for bulk adjustments, recontouring, or even sprue removal for CAD/CAM restorations. The yellow products are more suited for minor grinding and adjusting. Once adjustment and grinding are done, it's time to use the finishing and polishing products. Dark orange is used to "prepolish," and light orange is used to achieve a nice, glossy final polish. Again, this kit is for extraoral grinding and polishing. When these products are used at a speed of about 10,000 rpm in a straight handpiece, microcrack generation will be minimized in the new restoration.

The Jiffy Universal intraoral kit is designed for restorations that have already been cemented yet require some minor adjustment. Again, in a perfect world, the need for this product would not exist. But again, the world is not perfect. The intraoral kit starts with a couple of different tips with diamond particles that are designed to adjust high-strength ceramics. When used between 15,000 and 20,000 rpm with copious amounts of water, these diamond particles can safely and accurately adjust ceramics. Once gross adjustments are done, finishing and polishing are done with dark and light orange points and cups. These are similar to the finishing and polishing products in the extraoral kit, but they're made in shapes for intraoral use.

In addition to all of the burs, wheels, points, and cups, the Jiffy Universal ceramic finishing system kits come in aluminum autoclaveable blocks. All the burs, wheels, points, and cups are autoclaveable as well. The diamond particles in all of the products are designed to last, reducing replenishment costs.

After using the Jiffy Universal kits for a few weeks, I have found them easy to use. With these products, I can achieve a finish similar to what a final lab glaze would give. Simplicity makes these kits a real winner. Solid base hit up the middle for Ultradent on Jiffy Universal!

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