As we enter a NEW YEAR, I always like to look back and see what PRODUCT OR TECHNIQUES HAVE HELPED ME THE MOST in the previous calendar year. So, in no particular order, here is Part 2 of the list of products that made dentistry faster, easier, or better for me in 2007.
I would not want to practice without the Ultrapak knitted retraction cord from Ultradent Products Inc. Contact the company at (800) 552-5512. I have been using this knitted retraction cord for years, and would not consider returning to a solid cord. I believe that twisted and braided cords cannot offer ease of packability and tissue displacement comparable to Ultrapak. Composed of 100 percent cotton, the cord is knitted to form an interlocking chain of thousands of tiny loops. This makes it easy to pack below the gingival margin.
Following placement, the unique knitted design exerts a gentle, continuous outward force as the knitted loops seek to open. Ultrapak cord is designed to enhance the ViscoStat/Astringedent and Dento-Infusor tissue management technique; however, conventional techniques using alum and aluminum chloride also are enhanced when using the plain knitted cords since they carry significantly greater quantities of hemostatic solution than do conventional cords.
I use Ultrapak in a two-cord impression technique. As soon as I break the contacts, I place a 00 cord around the entire preparation, making sure to keep the ends flush and the entire cord subgingival. This first cord retracts the gingiva approximately 0.5 to 0.75 mm. I place my gingival margins at this new gingival level, so when this cord is removed, the margins of the crown will be just slightly subgingival.
At the end of the preparation, I place a 2E cord on top of the 00 cord. The 2E cord retracts the gingiva so when it is removed, there is sufficient room for the syringe impression material. Since the bottom 00 cord remains in place, no bleeding occurs when the 2E cord is removed. I think this is one of the significant advantages of the two-cord technique. The 2E cord is impregnated with epinephrine. If you prefer to use no medicaments on your cord, simply substitute a 2 cord for a 2E cord.
For more information and a presentation of how to perform the two-cord technique, take a look at the Reverse Preparation video available at www.glidewell-lab.com.
For a strong topical anesthetic, I recommend Profound Lite, which is compounded by Steven’s Pharmacy in Costa Mesa, Calif. Contact the pharmacy at (800) 352-DRUG. I have written previously about how Profound allows me to do much gingival recontouring and other soft tissue procedures without the need for local anesthesia. Profound also provides for the near elimination of lower blocks from my daily practice.
If I squirt Profound into the furcation of a lower molar, wait 60 seconds, then slowly inject one-half to two-thirds of a Septocaine carpule into the furcation, I can achieve instant pulpal anesthesia without tongue or cheek numbness. By using this product, I can help patients avoid painful blocks while not numbing half of their lower jaw for three hours.
Like many dentists, I now use Profound for other clinical uses, as well as in my hygiene rooms. Originally designed to be used on attached gingiva and in furcations, I began to make several observations after using the anesthetic in the vestibule as a pre-injection topical.
First, patients do not feel any pain! My technique is to leave the Profound on for 60 seconds, rinse it off, and then pierce the mucosa with a 30-gauge needle as I pull the tissue taut. With this technique, patients simply do not feel the needle.
I am a big fan of the Anatomic Comprecaps from Coltene/Whaledent. In the two-cord technique, after the top cord is placed, the Comprecap is situated atop the preparation. The Comprecap achieves two important goals. It keeps pressure on the gingiva and the cord, and helps keep both dry.
It is important to leave the Comprecaps in place for eight to 10 minutes in order to see the full effect. When I am forced to impress a preparation in which the gingiva is not as healthy as it should be, and after 10 minutes with a Comprecap bit in place, the mouth looks entirely different. This always amazes me.
Comprecaps are now available in anatomical shapes that allow the cap to put adequate pressure on the interproximal areas of the prep, as well as the buccal and lingual margins. Through the years, these compression caps have saved many impressions for dentists. I believe they are certainly a worthy product to try.
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.