An air abrasion dedicated newsletter: Web version
1st quarter, 2000 Volume 2, Issue 1
Q. " I have questions and feel uncomfortable about this new wave of preventive restorations being promoted by air abrasion people; what kind of criteria is utilized to differentiate between which teeth we should abrade and which we should not?"
A. This is one of those subjects that has elicited much controversy within our profession. Part of this, I believe stems from the assumptions by many dentists as well as irresponsible suggestions by some lecturers as to when to intervene. I wish to be clear on my stance; in no way do I condone or subscribe to the rhetoric that suggests opening and disclosing EVERY posterior tooth that comes into your office.
My recommendations stem from private practice experience as well as that of many dentists with whom I have discussed this matter. I think that as in most of our clinical decisions, several variables need to be considered before one takes deliberate action along these diagnostic lines. I propose that the clinician first look at the individual patient's caries experience, as well as their past clinical history and whether or not they have been exposed to long-term fluoridated water intake. Furthermore, I would consider their oral hygiene and dietary habits. Based on these variables I would make the decision as to whether or not to intervene with pit and fissure debridement and exploration. The clinical protocol for this procedure has been written about in the past by this and other authors. Although basically similar in nature, everyone of us has differences in their individual preferences. In the interest of illuminating this subject further let me recapitulate my preferred method.
After thorough assessment of predisposing factors and deciding to explore target teeth, I would isolate with a rubber dam, particularly if an entire quadrant is in question. Utilizing low air pressure (40psi), a .46mm tip and a low powder flow setting, the nozzle tip is placed in direct contact with the tooth surface and run along the pits and fissures in order to remove the organic plug and debris in this areas. Once satisfied that these are clean (remember to use magnification), disclose with caries disclosing dye. Any areas that demonstrate active decay should be excavated using higher air pressure (60-80psi) in order to remove the decalcified enamel at a higher rate. the cycle is repeated until all affected tissue is removed and subsequent disclosing yields no evidence of decay.
Restoration is a matter of high individual preference. I feel the flowable composites (the higher the percentage of particulate filler the better) are adequate for small, narrow cavity outlines. Any cavity outline that is significantly larger calls for a highly filled hybrid or microfilled composite specifically designed for the loads and wear parameters typical of posterior restorations. I have seen far too many early, diagnostically not-evident lesions change into very destructive large ones in a very short period of time. After taking everything into consideration I suppose one must ask themselves the proverbial question: "If that patient were my son/daughter, what would I do?"
Editorial: Powder Mess, is it unavoidable?
Editor: Angel S. Figueras, D.D.S.
After countless conversations with clinicians from around the world I've developed a better understanding of generalized objections to air abrasion. One of the leading objections is the misunderstood situation of excess powder ejected extra orally.
My sincere desire is to dispel the widespread belief that this is a universal evil associated with the modality. Once and for all, here it is; If the equipment is properly designed, it utilizes the optimal amount of powder for the specific air pressure and nozzle size the dentist is using. Properly tuned equipment uses very little powder. The HVE should remove the vast majority of the powder used in a given procedure.
I see two primary reasons leading to this unfortunate situation regarding powder mess. One is the prevalence in the market of equipment that introduces too much powder into the air stream. I believe this is due to inherent design compromises that were at one time considered acceptable. The field of air abrasion today has advanced to the point where this scenario should no longer be considered the standard.
Secondly, and of lesser importance is the use of 50 micron powder which due to its larger mass, projects further extra orally and with more energy. This makes its aspiration by the HVE more difficult and consequently leads to a bigger mess in the operatory.
The solution lies in properly designed equipment and in clinical technique.
Doctor Profile: Dr. Michael Stern
It gives me great pleasure to introduce to you this very excellent clinician and proponent of air abrasion. Dr. Michael Stern is a real pioneer in the use of air abrasion, particularly at lower air pressures. More on this later. For now let me state for the record that Dr. Stern is a graduate of the Ohio State University School of Dentistry and has carried out a mini-residency at the University of Florida Facial Pain Center. He has a long list of credentials covering temporomandibular joint disorders as well as being a fellow in the Academy of General Dentistry. In addition he has been an adjunct lecturer at Case Western Reserve University and is currently a staff member of Meridia South Pointe Hospital. Dr. Stern is in private practice in Willoughby Hills, Ohio. For more information you can visit Dr. Stern's web site at < www.nodrillingfillings.com >, a site that you will find very entertaining, as well as informative.
He has been involved with air abrasion since 1996. After seeing how highly esteemed the Crystalmark air abrasion machine was held by members of the Internet Dental Forum, he decided to purchase one. Her received his first DV-1 air abrasion machine in April of 1997 and Dr. Stern states that "it has forever changed my dental career in the areas of increased productivity, stress reduction and practice marketing growth". His learning curve was accelerated by attending one of Dr. Bob Davis' seminars in Watsonville, California and recommends that anyone new to air abrasion get some hands on training by an air abrasion veteran (Editor: I agree).
His clinical technique stands alone amongst many doctors in that Dr. Stern uses his DV-1 almost exclusively at an air pressure of 40 psi! He feels that this pressure gives him the ideal combination allowing him to treat with a very low likelihood of patient sensitivity. On the IDF, this technique came to be known as the "Stern low pressure mode" of operational settings. Crystalmark has since trademarked the DV-1's extraordinary capacity to reduce tooth structure at pressures as low as 10 psi as UltraLow. Dr. Stern states that he would much rather penetrate through enamel a bit slower at these lower air pressures than to risk patient sensitivity at the higher air pressures that are used by most clinicians. In this way, Dr. Stern can treat with greater peace of mind and can boast of a 2.5 year record of only 5% of air abrasion cases which needed anesthesia. He also feels it is essential for air abrasion users to incorporate into their arsenal Crystalmark's Air Abrasion Resistant mirror.
Dr. Stern's restorative technique typically utilized Bisco AllBond II and Jeneric Pentron FlowIt. He sites almost zero post-op sensitivity while utilizing this system. He places Heliomolar over any restoration that is subject to occlusal stress. What he does recommend is that the standard FlowIt syringe tips be replaced with the smaller Ultradent units. His experience as well as that of the author's is that in order to achieve a bubble-free, intimate adaptation of the restorative material to the pulpal and axial walls, a very small diameter delivery tip should be used.
Dr. Stern mentions that he bought his second DV-1 in 1998 and he cannot imagine practicing without it anymore. The incorporation of air abrasion into his practice has been the single most significant advancement that he has seen in dentistry during his career. (Editor: I have to agree) He has incorporated air abrasion deeply into his practice and he has without a doubt become a very qualified and experienced user of the modality. If any of you have any questions, you may contact him at his web site or you can call him at (888) 231-8292. Thank you Dr. Stern!
Point of Interest: Dr. Gallegos-Rivas
In this issue we have featured Dr. Michael Stern in our Doctor Profile. We would also like to introduce you to another air abrasion user, Dr. Carlos Gallegos-Rivas from Ensenada, Baja California, Mexico. Dr. Gallegos-Rivas jumped into the air abrasion world with both feet about two years ago. Since then, he has become the leading air abrasion proponent in our southern neighbor. He has lectured on the subject in Mexico and states that he could not imagine practicing without air abrasion ever again. Since embracing the modality he has developed his technique with the equipment to the point where he utilizes it in almost every operative or fixed procedure. This first picture is from a lecture/meeting I had the pleasure of doing for the Colegio de Cirujanos Dentistas de Ensenada, where many doctors had the opportunity to try air abrasion equipment for the first time. Dr. Rivas is second from the left and his father, also a dentist, is next to him on his right. Their enthusiasm is readily apparent in the accompanying photographs. Saludos! When's the next margarita Carlos? Should you have questions, please contact Dr. Gallegos-Rivas at 011-5261783777 in Ensenada, Mexico. Thanks to doctors like Dr. Rivas, air abrasion is leaving its positive mark on patients all around the world.
Here are some brief and helpful clinical aids by way of air abrasion: A really nice clinical tip came to me by way of Dr. Bob Davis, a leading expert in air abrasion. He utilizes air abrasion to roughen the inside of dentures for several applications. When he is either taking an impression for a reline or simply adding a soft liner, the roughening of the inside of the denture base with air abrasion aids in the retention of the substrate to the denture base.
Another application is in the texturing of the inside of metal restorations to check for fit. Using 80 psi, a large .66 or .81 mm nozzle and an appropriate powder flow you will obtain a very satin-like finish on the metal casting, perfect for detecting interference.
Here's another: After removing an existing amalgam restoration with a rotary instrument, you can utilize air abrasion to remove stains, affected dentin as well as rounding of line angles and cavosurface margins. You will be amazed at how effective it is in this application and it is very benign towards pulp tissue to boot!!
We will be present at the following venues. Please don't hesitate to talk with us and ask us questions, if we don't have the answer, we won't skirt the issue, we'll do our best to get it for you. Our marketing and sales approach is professional and informational first. We know that an uninformed customer will not be fully satisfied. Our long-term view is to have a fully satisfied customer base that will refer us new customers (not unlike the ideal dental office scenario).
CDA San Francisco September 15 - 17, 2000
ADA Chicago October 14 - 17, 2000
Greater New York November 26 - 29, 2000
NEW PRODUCT: New Patient Education Brochure
Crystalmark Dental Systems, Inc. is proud to present their new....
Patient Education Brochure:
For the waiting room, or as a promotional mailer, or for teaching children about painless dentistry in schools, this six-panel information piece created by Crystalmark Dental Systems, Inc. describes how fluoridation has changed the way tooth decay occurs. It then explains how air abrasion, in combination with caries detection dye, is used to investigate pits and fissures in a diagnostic mode--and if decay is present--as conservative treatment that gently and selectively removes it without anesthesia and discomfort. With simple diagrams, photographs and Snuffles™The Elephant as guide and lecturer, this informative brochure is both fun and readable.
They are still: 100 @ .30 each
500 @ .25 each
1000 @ .20 each
2500 @ .15 each
Crystalmark has finally brought into the market an articulating Hook Style Nozzle which retrofits into pre-existing swivel/articulated handpieces. The new recurved hook style allows for better visual access to the operative site as well as more light penetration. Overall, the clinician can now better access visually the area under treatment. Its slim shape combined with the articulating feature allows this nozzle better and more comfortable ergonomic use. The nozzle is available in four sizes; .36, .46, .56, and .66mm and sells for $75 each.