BY Paul Feuerstein, DMD
I was recently asked what new products had the most impact on my practice productivity. As I thought about a list of items (power cords, batteries, flashing LEDs), I realized that during the past two years some nontech items have been the most important.
Orthodontics was known as the "mystic cult" when I was in school. Other than bending a wire to spell LUMO, I have not touched one after dental school. Then came clear aligners, and after my team became trained in Invisalign and ClearCorrect, we realized there was an increase in production that was not back breaking and would not cause internal stress.
Still, we had some issues where compliance was not stellar, and where a few patients bailed before treatment was complete. Then I met Ryan Swain, who introduced me to Six Month Smiles (6monthsmiles.com). I had never considered this since it seemed to involve bonding on brackets and using wires.
After procrastinating, I decided to go to New York City and take the two-day course. It was quite different from what I expected. I was not just blindly sending in a case, but I had to diagnose and I was given the tools to do so. When I found the first case, I went to the Six Month Smiles support group of practitioners who mentor the newbies, and who have no air of superiority.
Photos, emails, and phone calls can be easily exchanged so that cases proceed smoothly. At one point, I made an error using the wrong wire and was told by an online mentor how to continue without worry. I continue to post progress notes and photos, and I'm being guided.
After you learn what to do and how to diagnose the case, you send it to Six Month Smiles and receive a box with wires, brackets, bonding agent, burs, strips, a mouth retractor (OptraGate), and more. The brackets are preset in a clear retainer-type of holder, and can be placed and bonded in about two minutes. I recommend taking a close look at the company's website, and then taking the course.
Extractions are something else that defied me. Since my surgical training was limited, I probably took out one tooth per year in 30 years, and those had +3 mobility. I saw the Physics Forceps from Golden Dental Solutions (physicsforceps.com) at a seminar. After some coaxing by the product manager, I agreed to a 30-day trial. On day 29, I tried the forceps. The mechanics are much kinder to patients, with no luxating and rotating, but even, slow pressure.
As a result, I've done more than 30 extractions in the past year, more than in my entire career previously (at a net profit of more than $4,000). I still perform only the "easy" ones, so my surgeon does not feel threatened. But it has opened up a new bag of tricks for me. Also, if I'm doing the extractions for an immediate case, I don't have to wait for "that call" when the surgeon cannot trim out an undercut or overextension.
Crown removal is another challenge. There are two types — one in which you want to salvage a crown or bridge, and the other in which you just want to cut it off. For the latter, I often cut a groove up the buccal, over the occlusal, and down the lingual. This sometimes damages the prep and margins.
It's also a bit scary for a patient when you use one of the spreaders and see and hear porcelain popping in the mouth, or exert pressure on the adjacent teeth with the spreader. I came across an odd product, the WAMkey, reintroduced to me by the people at physicsforceps.com. I had used Metalift with some success, as well as the "tapper," which often took the prep with it.
When I used the WAMkey initially, I did not follow the prescribed angle and had to revisit the video instructions. You make a hole in the buccal or lingual near the top of the prep, insert the metal "key," and give it a twist. If I have to remove an old, conventionally cemented crown, I make the hole, put in the key, twist, and "pop" it off.
The typical reaction from patients is "Is it off already?" Now that I'm better at it, I've been able to remove a couple of bridges in which one abutment was loose, and I've repaired the hole and porcelain to salvage the case. I suspect in the future one of my cases may have to be returned to the lab for repair. But in this situation, the patient wins.
Finally, soft denture relines have been a messy process. I use Bosworth's Softone for interim relining and functional impressions. Other products such as COE-SOFT (GC America) and DENSTPLY Permasoft work well, but the drippy mess and cleanup are less than desirable.
Tokuyama came out with Sofreliner and Sofreliner Tough (in five consistencies). These are in cartridges that are mixed in standard impression syringes. There is also a hard reline powder/liquid. Besides ease of use, these are durable and do not get stiff or rough over time. If you have to remove the liner, there is a liquid release agent.
If you're not familiar with Tokuyama, the company also has a great array of composites and bonding agents. The company's opaque composites and unique color matching system help in dealing with difficult direct esthetic restorations.
I encourage you to take a look at these products in more detail at the respective company websites.
Paul Feuerstein, DMD, installed one of dentistry's first computers in 1978. For more than 20 years, he has taught technology courses. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a website (www.computersindentistry.com), and can be reached at [email protected].