Polymer Preparation Persuades Patients

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22 Dentollown Mogozine. The introduction of the SS White. SmartPrep"', the first polynrer cavity preparation instrument, ofl'ers a techno- logical solution to theĀ ...
ISMARTPREPGlinical Product Profile

PolymerPreparationPersuadesPatients George Freedman DDS, FAACD, FACD & Jaffar S. Pakroo DDS, FADFE y tar the most prevalent linriting factors on dental practice success are the patientswho never see the dentist.Why do these individuals,who have teeth like everyone else, who have dental pains and problems like everyone else,and who otien have dental insurance like many others, deliberately and consciously choose NOT to seek dental treatment? The answer is simple; fear and pain. This information has been provided both anecdotally and by research.Fear is by far the more important of the two, becauseat this time, dentistryhaslargely conqueredpain; as dentists,we have a multitude of techniquesand productsto contol and alleviate discomfon, including local and topical anesthetics, desensitizers, and skill. Unfortunately, the very anesthetic techniquesthat eliminateoperativepain arouse new fearsdue to the presenceof the intraoral "needle" portion of the syringe. Discomfort can also be caused by the applicationof cool water and,/orair to the tooth surface during high speed cavity preparation. The temperature difference betweenthe tooth (body at 37'C) and the water/airspray (room at l6"C to l8'C) can stimulate the dentinal fluid in an open tubule to migrate away from the odontoblast,causingnegativepressurewithin the tubule, and therefore,pain.

The introduction of the SS White SmartPrep"', the first polynrer cavity preparation instrument, ofl'ers a technological solution to the above-mentioned dilemmas. The most significant innovation of this instrument is that insteadof a metal body and cutting edge, the SmartPrep is made of a specifically designed polymer. This polymer rs designed to selectively remove diseased dentin, but leave healthy tooth structure Fig. 1: Amalgamwith recurrentdecay (both enameland dentin) intact.

The technologybehind this f'eatureis selfevident: healthy dentin has a Knoop hardness of 70-90 (the hardnessof enamel is 360-430 Knoop). Diseased dentin has a hardnessof 0-30 Knoop. The SmanPrep instrumenthasbeendesignedwith a hardness of 50 Knoop. Thus, it will NOT cut herllhy dentin. while easily removing decay. If the SmanPrep instrument does come into prolonged contact with a surface harder than itself (healthy dentin, enamel.composite,amalgam), it tends to Fig.2: GreatWhitebur creatingaccess wear away, and become blunted, rather to decay than affect the opposingmaterial.

Inside the tooth, the round SmartPrep functions as a diagnostictool; it is able to differentiatebetweenhealthyand diseased dentin.and to removethe latter selectively. In eliminatingthe minimum possibletooth structure, the SmartPrep is a tool of advancedminimally invasive dentistry. SincetheSmanhep is incapableofopening For additional discomfort, metal and diaup intact dentinaltubules,it can usually be mond burs remove both healthy and used without the needfor local anesthetic, decayed dentin indiscriminately. While tt,ith cornplete patient comfort. This the removal of diseaseddentin is unlikely improved treatment comfort encourages to cause any discomfort whatsoever (no and motivates patients to seek necessary pain receptors), the opening of healthy dental treatment,and can begin to access dentinaltubulescan again stimulatedentithe 507o of the population that generally nal fluid movemenlandodontoblast sensistays away from the dentist. Once their tivity, and hence cause pain. Thus, the discomforts, and particularly fear, are processof drilling unanaesthetizedtooth overcome,this large,under servicedgroup structureswith metal and diamond can be beginsto seekdentalcarefrom thosepracan uncomfortable experience for the titioners who are able to answer their patient, and a stressfulone for the dental concems. team. 22 DentollownMogozine

Fig. 3: Oecayed dentin is revealed

Using the SmartPrep Technique D The decay in the offending tooth identified radiographically or tactile (Fig. l), and the most conservati accessroute is chosen.

E The accessroute is crcatedor enlargedt the useof an SS White GreatWhite rFi; 2) until the amalgam and/or enamel a: removed to reveal the decayed dentir

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SMARTPREP" Remove Decaved Dentin

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Fig.4: SmartPrepselectivelyremoving decaved dentin

Fig 6: Single bottle, single step iBond for adhesion

Fig.7: Completed restoration (Fig. 3). (This step may also be accomplished with a Fissurotomy bur, depthlimited to the approximatethicknessof the enamel layer This means that the typical Fissurotomypreparationextends into the enamel only to the level of the DEJ, a processshown to cause little or

24 DenfolTown Magozine

yes

No

MicrcAbrasion

MetalRound

Not Well

Yes

Yes

Yes

Anesthesia Required

NOt Often

Not often

Yes

ot 3uJo";,unno",,"

yes

No

llo

Messy

No

Yes

No

Predictable

Yes

No

Yes

Targeting LearningCurve

No

Yes

No

no patient discomfort in most cases single-component,single-step,iBon (and thereforeoften requiring no local (Heraeus-Kulzer)(Fig. 6). anesthesia)-Once the decayeddentin Insert the selected composite into th is visible and accessible, the prepared cavity using a layered tecl Fissurotomy step is complete.) nique. (We chose Venus, a color ada D The SmartPrep instrument is then tive matrix compositethat is availableI brought into gentle rotary contact 27 shades,including fanslucent, bod with the decay (Fig.4); diseased and opaque.It has excellentchameleo dentin. and only diseaseddentin. is like or color-blendingproperties.) selectively removed from the cavity. Light cure. A light touch on the decayedareasis probably the best techniquefor maxi- Q The completed polished composi restoration(Fig 7). mizing the useful cycle of the SmartPrep instrument. The tactile SmartPrep offers an edge proprioception from healthy and What are the advantages of th decayeddentin are quite easy to dif- SmanPrep polymer preparation wit ferentiate, and are either already' respectto someofthe existingminimall familiar to the dentist or easily invasivedentalprocedures? leamed. (We tend NOT to use caries Cgnventional stainlesssteel round but detecting dyes becauseof the high .'will remove dental tissues effectivel incidenceof false positivesassociatld but target healthy and.diseaseddenti with this technique,causingclinically equally' In most cases,it is advisablet unnecessaryextensions of the too; usethese burs with local anesthetic'pa preParationinto the healthy dentin.) ticularlvin deeoersepments -most of the toot D Once all the decay has been removed 16" attack anele of stainlessste (Fig. 5), the cavity preparation is round burs is quite aggressive fr ready for adhesion and restoration. increasedefficiency; unfortunately,th Note that on occasion,there may be also tends to .'lead" these burs deepr some discolored dentin remaining into the cavity. occasionallv removrr after the SmartPrep preparation. more tooth tis;ue than is intended. Before you rush to rcmove this tissue with a metal bur, check it with an Air abrasionhas been available to der explorer! The discoloration is most tist for more than 70 years,with the mo likely to be secondary(affected but recent surge in popularity occurring not infected) dentin that is the body's the last decade.Air abrasioncan effe, responseto decay,and should be left tively remove hard tooth structu (enamel and some healthy dentin) ar lntact. composite restorations,but is relative O Bond the prepared cavity surface, ineffective againstsoft, decayeddenti hereusingthe 7'rgeneration adhesive. Thus, its most important target is lea

aflecteclby tlrc techniquc-In many cases.air abrasioncan bc rvhichis a posilivc. Howcvcl.it usetlwithoutlocrl rnestlretic. is dillicult to lircusthe sandstrclnrandthe procedureinvolves a lcalningcL|Ive.Tl]c lfc lrnentis alsomessyinsidethe nrnuth ud oul. lncl the lbllision c[lst nrry dcgrrdcdcntalmiuors and oll'rcrinslrLlflentsand ecluipnrent. SnrutPrcppolyrnet instrumcntstar-gct ONLY cliscasccl dcntin.They lre in llct sir}rr.rltr neousdiagnosticiucl prcparationl(x)ls.lssislingin rlinimally They ciurofien be usedwithoutthe needtirr invrsiveclentistry. local aneslhctic.Whcn tlle Snlil Prep inslrurneDt eDcounle$ healthydentin ol cntrucl it sinrply rvcarsawily. Thc allilck angleis tlrLrsa nrurt point.Thete is no nressinsicleor outside thc mouth (cxccpl lin tlrc clcbrisol' thc clislt gecl cliscitsecl thitl dentin).llndthereis no Dcgltivccllcct oDolhcf inslnrnrcnts arc usedclt.rling lhe treatnrenl. Dr. Freedman is the Associate Director of the Esthetlc /l Jh , t Deltistry EducationCentre at SUNY BLrtlalo,dnd Direclor oi the Posl.GradualeProg.arrs n FsrhelrcDe1lislryal le severaluniversities.Dr- Freedmanis a Founding Member, X'l rlr past President,and fellow of the American Academy of Cosmetic Dentistry.He maintainsa private practice in Toronto, Canada.

Order a SmartPrep'"InstrumentsIntro Kit and get a FREEFissurotomt' Bur Kit...

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For a limitedtime, SS White is offeringa great opportunity to try the SmartPrep" Systemwith an lntroductoryKit that lncludes:CariesAccess Block:A selectionof recommended carbideburs in an autoclavablebur block for creating accessto decay,which includes::(2) each of FG 169L;(2) (original); (2) each each of FG 329; (2) each of Fissurotomy@ o1Fissurotomy@ NTF (narrowtaper fissure);(1) GreatWhite No. 1: (1) GreatWhite No. 2

SmaftPrep Instrumentsfor SelectiveDentinRemoval: ::il,.. The hil3i,1ii1'^1i11:3i,?,il:"#lJ""::i';''iff are availablein three sizesand are nestedin a pliablenonautoclavabledispensingwafer,which contains(10)instrutr ;::T"ff ments each of sizesRA#2,RA#4and RA#6. Detailson the :il:: :fl:il*nl';,"lfi :.TT fl:t,."{ Fissurotomy"Bur Kit providedbelow. ,$i'

Internarioral collegeof oral l'nplantologyand a Fel'ow

tionallyon estheticand implantdentistry,whilemaintaininga fulltime clinicalpractice.

Moy 2003

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Denfollawn Mogozine