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Pearls for your Practice: File system, polishing kit, Wand injection

June 25, 2015
Dr. Josh Austin discusses what he likes to use in his dental practice so you can determine whether it's a good fit for you.

Tango-Endo by Essential Dental Systems (EDS)

It takes two to tango, apparently. Since I am not a dancer, I didn't get the joke right away, but Essential Dental Systems (EDS) has named its system "Tango-Endo" because it requires only two files. When I asked Kade Roundy, DMD, an endodontist I work with, about his cleaning and shaping armamentarium, my head started to spin. Most endodontists use hybrid systems of different files for different situations that they have honed throughout their careers. But as a general dentist, I want to keep my system simple. It seems like Tango-Endo can help me do that.

Tango-Endo is a reciprocating file system, meaning that it doesn't rotate a full 360 degrees. It rotates, reverses, and then repeats. Reciprocating file systems have an advantage in that they reduce the risk of file separation because the files don't grab the canal walls and torque as much. Other reciprocating file systems on the market require a specialized motor and handpiece. Tango-Endo does require a specialized handpiece, which is included in the introductory kit, but it can work with your existing endo motor or any e-type electronic or air motor. This greatly reduces the cost of equipping.

The Tango-Endo files themselves are efficient and fast cutters, but because the reciprocating action prevents them from engaging the walls as much, they are very safe. The patented noninterrupted flat along the entire canal length creates space for debris to be carried out of the canal and makes them efficient cleaners. Included are size-matching gutta percha points for accurate obturation. The Tango-Endo files can be reused up to three times each, making them extremely economical. Combine that with the time saved by quickly and efficiently cleaning and shaping the canals with only two files, and you have one of the most cost-effective endo file systems on the market.

Tango-Endo was simple and easy to use, and I did not find it to have much of a learning curve. Within the first case, I was quickly and easily moving through the system, on to final irrigation and obturation. We all understand that pretty much any endo file system on the market can work well if used with care and attention to detail. Good irrigation with proper antibacterial irrigants is vital to success with any endodontic file system. If you are looking for an endo file system that is simple and safe, Tango-Endo is an excellent choice that is also very cost-effective. Sharp single over the

Shofu's Super-Snap X-Treme Finishing and Polishing Kit

We've talked about finishing and polishing resin composites several times here in "Pearls for Your Practice." I think finishing and polishing is a lot like the short game in golf. It's a part of the game that is often skipped or hurried through, but when some attention is paid to it, it can take us from good to great.

The Shofu Super-Snap X-Treme Finishing and Polishing Kit is an excellent choice for anterior resin composites. I was trained in dental school to finish anterior composites with discs. The discs I was trained with had little metal rivets that allow you to snap them onto mandrels. But the problem with those is: If the metal ring touches your composite during the process, which can happen easily, you get a nice gray line across the composite, which must then be dealt with. Shofu Super-Snap X-Treme discs eliminate that metal so you don't scuff up the restoration. Shofu's discs attach to an included special mandrel with a rubber cup, and they are stable.

Like other good finishing and polishing systems, Shofu's requires multiple steps. Each of the four color-coded discs corresponds to a step in the process. To give the enamel that wet, glossy look, go through the four-disc system. Starting with black, we contour. Purple finishes. Green polishes, and pink "super polishes." Each disc is available in two different sizes-8 mm and 12 mm-and the purple, green, and pink discs are double-sided.

Once that is complete, the Super-Snap SuperBuff discs, which feel like velvet, can be used with DirectDia paste for the final high luster. DirectDia paste is a 20% diamond polishing paste that works very well with the velvety SuperBuff discs for that final touch that takes the restoration from good to great. Interproximal polishing strips are also available for finishing contacts.

The Shofu Super-Snap X-Treme Finishing and Polishing Kit is an excellent example of an anterior composite polishing system. This kit can serve as your one-stop anterior composite polishing solution. It is simple and intuitive, and it yields an excellent result. Great work, Shofu. Hard-hit double in the gap!

The Wand STA by Milestone Scientific

I typically do the exact same thing for every patient I anesthetize-same topical, same needle tips, same cheek shaking, same slow speed of injection. But for patients, it's such a subjective experience. Some are dumbfounded at how painless the injection is. Others act as though I shot them in the face with a .22-caliber Sig Sauer and then forcibly made them stub a pinky toe on a wrought-iron bed frame, while laughing maniacally at their discomfort. All of us have patients like this in our practices all the time. How do we deal with them? I don't know if there is a single great answer, but you can arm yourself with some tools to improve their experiences. Prescription compounded topical and the Dental Vibe are nice to have around, and the Wand STA by Milestone Scientific is definitely worth a look for any clinician who routinely administers local anesthetic.

I know that the Wand isn't new. The original Wand debuted in the mid-1990s, and the current generation debuted a decade later in 2007. Since then, the Wand STA has been building a core group of clinicians who absolutely adore it. My friend and colleague, Dennis Stansbury, DDS, of Temple, Texas, called me raving about his love of the Wand STA after learning that I was taking over the "Pearls for Your Practice" column. He even set up a meeting between an Aseptico rep and me. I had obviously known about the Wand for years, but I had always been skeptical. How could this be a wise investment for my practice? After having used the Wand STA for the past few months, I can tell you that it generates an immense amount of interest and questions from patients, which I feel will lead to more referrals and less transiency.

Anything that can reduce discomfort to patients is good for your practice. The Wand STA does this, and it also allows for different types of injections that you can't really do without it. STA stands for "single-tooth anesthesia" and involves using the Wand for what is essentially a periodontal ligament (PDL) injection. Due to the slow and steady drip of anesthetic, Milestone claims that profound anesthesia can be achieved on a single tooth, even in the mandible. The slow, steady drip also allows for more complex palatal injections that block different areas of the maxilla-but in a comfortable way for the patient. There is definitely a learning curve to performing these injections. With the limited time I have had with the machine, I have not yet developed full confidence in my technique with these injections, as I have been using it primarily for traditional blocks and infiltrations.

Most patients really seem to notice and appreciate the decreased discomfort that they feel when having an injection done with the Wand STA. But bear in mind that there are some tradeoffs. For example, the machine itself is not inexpensive. Costing approximately $2,500, it will probably not be an impulse buy for your practice. It will also add time to your injections because it is slow, and it's supposed to be. That's why it doesn't hurt as much. If you are a run-and-gun, Type-A clinician who hates waiting, the Wand STA might drive you crazy. Your patients will be experiencing painless injections while you are stricken with anxiety. The other caveat is an increase in disposable costs since the handpieces needed for the Wand STA, running at over $2 a piece, are more expensive than needle tips. That can add up significantly if you are on a PPO fee schedule and cannot adjust your fees.

Purchasing a Wand STA is not a simple decision. If you see a fair number of highly anxious patients or would generally like to be as painless as possible, the Wand STA is a no-brainer. If you are on the fence, hunt down the Aseptico Inc. booth at an exhibit hall and play with it. I did not think I would enjoy using it at first, but as it turns out, I have enjoyed it. I think it would be a great thing to have around for pediatric patients, as well as for those who are anxious, apprehensive, or sensitive. I think the Wand STA is a Texas League double. It's not for everyone, but some of you are going to really love it!

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