Pearls For Your Practice

Joshua Austin, DDS, FAGD

myTAP by Airway Management Inc.

A few years ago, I attended a continuing education course called "Sleep Prosthodontics," taught by Jeffrey S. Rouse, DDS. Never before had I been so inspired by a CE course. A fire was lit inside me, and treating sleep-disordered breathing became a passion of mine. That fire burns to this day. Unfortunately, however, treating sleep disorders is not always easy. Many new issues are emerging in the treatment of sleep disorders, and one of the biggest obstacles for my practice has been dealing with medical insurance. Mandibular advancement appliances are considered to be medical devices, but many medical insurance plans either don't cover these appliances, or they have high deductibles. As a result, I always thought it would be nice if there were a way to fabricate a temporary appliance for a patient to try-something to show the patient the benefits of treatment to reinforce the value of the appliance. We administer provisional crowns, so why shouldn't we administer provisional sleep appliances?

myTAP from Airway Management Inc. is the perfect option for just this! Made with ThermAcryl, the myTAP appliance is prefabricated but later customized with a hot water bath in the dental office, which takes approximately 15 minutes. After the upper and lower pieces have been fitted separately, each piece is dunked in ice water, which hardens the material to a firm set. After cooling, the pieces are assembled to form the final appliance. The protrusive mechanism is in the anterior, similar to the Thornton Adjustable Positioner (TAP) family of appliances, and the level of protrusion can be adjusted with a turn screw. The appliance can be reshaped at any time with hot and cold water, as described above.

I have found this appliance to be perfect for patients who are awaiting insurance approval, who aren't sure about their ability to comply with wearing a mandibular advancement device, or who just need to be sold on treatment with an appliance. Patients I have treated with myTAP have noticed significant improvement in their sleep issues and in sleep quality while wearing myTAP. myTAP isn't made to last like the TAP 3 Elite or other laboratory-made appliances, and that's OK. For shorter-term treatments, myTAP is a great option.

A single myTAP will cost approximately $99, which should allow you to keep the cost to the patient reasonable. I usually make a couple of these appliances per month because this appliance gives both my patients and me options when it comes to treating their sleep disorders. It's a home run for us!

OptraPol by Ivoclar Vivadent Inc.

Finishing and polishing resin is an easily overlooked and often-skipped step during resin composite restorations. By the time I reach this point during procedures, my hygienists are usually calling me over the headsets for their exams, or another patient next door is waiting for anesthetic. By the time I've adjusted occlusion with my finishing burs, things are looking OK, so it's tempting to just sit the patient up and move on. Compounding this urge is the multistep process required by many polishing systems. In dental school, we were taught to use a three-step composite polishing system-green, yellow, and white-every single time. That worked well when I had three hours to do a restoration, but times have changed. I would love to spend that kind of time, but it's just not feasible due to average direct restoration reimbursement rates. I need a single-step composite polisher that gets real results. I've been looking for one that I like for a long time, and I think I've finally found it.

OptraPol by Ivoclar Vivadent Inc. does exactly what I need, economically in a single step. OptraPol works on all direct restorative materials, including resin composite, glass ionomer, compomer, and amalgam. The polishers are filled with 72% microfine diamond crystals, which give the composite a long-lasting natural luster. The polishers are available in small flame, large flame, cup, and lens shapes, each of which works well for different purposes. While flames and cups are ideal for occlusal surfaces, the lens shape works well when used in the anterior and while defining embrasures. I find it to be frustrating that many similar one-step composite polishers are single-use only. It always seems like so much of the polisher is left after just one use, but because it can't be appropriately sterilized, it has to be trashed. OptraPol can be sterilized up to 20 times, so at approximately $7 per polisher, the cost per use is approximately 35 cents. That's an excellent value compared to all of the single-use polishers on the market. Polishing resin composite restorations probably won't make or break the success of the restoration, since isolation, decay removal, bonding technique, etc., are all vital as well. But polishing can take your restorations from good to great, and finding a product that performs well at a good value is difficult. I don't think you can do better than OptraPol by Ivoclar Vivadent Inc. Solid double down the line!

Upgraded wand for the 3M True Definition Scanner

It's been no secret in either this column or in the Product Navigator newsletter that I am a huge fan of my 3M True Definition Scanner. Let this be said: I have no bias. 3M doesn't pay me to review the scanner or anything like that. I paid full price for my scanner, just like everyone else. Recently, I also paid full price for the upgraded wand, although I have to admit that I was skeptical when my 3M digital rep, Sarah, called to tell me all about the wand and how great it was. The machine is only about 18 months old. Why should I drop another $3,400 into it? It was a head-scratcher. I decided to listen to what she had to say, although I had no real intention of buying the new wand. Despite my initial attitude, I knew I had to have the wand after demoing it for only five minutes.

The first-generation scanning wand for the True Definition Scanner had been fine, but it had some issues capturing data when held close to teeth. As a result, there was always a chance that scanning would be impossible on patients who could not open as wide as others, especially when second molars were vital to the scan. Oftentimes, the camera just could not focus enough with the space available between the two arches. And in those situations, I had to use polyvinyl siloxane (PVS). With the upgrade, the optics have been moved back in the wand, which allows the head of the wand to be slimmer so the wand can rest right up against the teeth where it can still focus and capture. This makes scanning remarkably easier and faster. With the upgraded wand, I can routinely capture an operating quadrant in less than a minute and an opposing quadrant in 30 seconds. Full arches now take me approximately four to five minutes to capture. In addition to being able to scan more quickly, I can also scan a higher percentage of my cases with the new wand. With the old wand, I had cases that I couldn't scan, just because the patient couldn't open wide enough. Those cases are gone. I have scanned almost 100% of my digital cases since upgrading to the new wand. The only cases I don't routinely scan now are veneer cases.

My staff also considers scanning to be easier now, which has improved their confidence and performance. I generally allow my staff to scan opposing arches and bites, and I check them before we submit them. Their increased confidence means that I can rely on them a bit more for scanning these areas when I have to go anesthetize another patient or do a hygiene check. This makes my life easier because it makes my days run more smoothly.

If you've been delaying your jump into the digital impression game, I think now is probably a good time to look into it. The 3M True Definition with the upgraded wand is not only a phenomenal piece of dental equipment, but it is also the most affordable digital impression scanner on the market. With its integrations with Straumann, Biomet 3i, Invisalign, and two different milling units, I don't think that you can go wrong. Three-run home run for 3M!