As we reach the midpoint of the year, I already have seen three products that have helped me perform better dentistry. One is a new formulation of an existing product that I already love, while the other two are new products from the same company.
The first product is a strong topical anesthetic called Profound Lite, compounded by Steven’s Pharmacy in Costa Mesa, Calif. (Contact the pharmacy at (800) 352-DRUG.) I have written before about how Profound has allowed me to do much gingival recontouring and other soft tissue procedures without the need for local anesthesia. The topical also has permitted me to nearly eliminate lower blocks from my practice. I have noticed that I can squirt the topical into the furcation of a lower molar, wait 60 seconds, and then slowly inject one-half to two-thirds of a Septocaine carpule into the furcation. By doing this, I can achieve instant pulpal anesthesia without any tongue or cheek numbness. I became a hero to my patients by preventing painful blocks, and not numbing half of their lower jaw for three hours!
Like many dentists, I began to use Profound for more clinical uses, as well as in my hygiene rooms. Since the topical originally was designed for use on attached gingiva and in furcations, when I began using it in the vestibule as a preinjection topical, I noticed a few items. First, patients felt no pain! My technique is to leave the topical on for 60 seconds, rinse it off, and then pierce the mucosa with a 30-gauge needle as I pull the tissue taut. Patients simply no longer feel the needle.
However, I also noticed something else. If I did not rinse off the topical completely, some patients experienced a dehydration of the tissue resulting in the formation of a white patch on the tissue. I called the pharmacy about this reaction. They were surprised to hear that I was using it in the vestibule. The strength of Profound was based on what was necessary to do laser surgery without a local - not as a preinjection topical. With this in mind, Profound Lite was formulated for those dentists who use it more for preinjections than for laser surgery. It still has the same powerful combination of prilocaine, lidocaine, and tetracaine. But the ratios have been adjusted to make it friendly to all oral tissues.
Since switching to Profound Lite, I no longer see tissue dehydration. In addition, patients still don’t feel the penetration of the needle. I keep a tube of the original topical in each operatory for the gingival recontouring touchups that seem to develop in almost all of our esthetic cases. Since we prefer not to give palatal injections, my dental assistant also uses it on the lingual tissue when a patient can feel the cord packing.
Profound and Profound Lite are both available in 30- or 45-gram tubes. My staff then dispenses some of the topical into Ultradent syringes with disposable 18-gauge tips for injection into molar furcations and gingival sulci. Steven’s Pharmacy no longer ships syringes because of excessive breakage in transit. The rest of the topical stays in the original tube so it can be dispensed on cotton-tipped applicators for use as a preinjection topical.
The other two products come from Axis Dental and are huge timesavers. The first one is a new carbide bur known as the Razor. This bur will easily fly through porcelain and metal on any PFM. Previously, I used an old diamond to cut through porcelain, then switched to a 57 or 557 bur to cut through the coping. In addition to having these burs snap far too often, the chatter they made as they cut through the metal was horrible! In contrast, the Razor flies through the porcelain and continues through the metal with no chatter. On certain cases (most likely those with semiprecious or high-noble substructures), I have used the same Razor bur to remove four or five entire crowns. If you order a couple of these burs in a 57 size and shape, you will see what I mean. This is particularly true if you have an electric handpiece like I do.
Also from Axis Dental is the new Zir-Cut. This product fills a need just created recently. Zirconia-based restorations entered the market a few years ago, and are now hitting their strides. Two of the newer systems (Lava from 3M ESPE and Prismatic CZ from Glidewell Labs) are so strong that nothing previously would cut efficiently through their zirconia substructures - not even the aforementioned Razor! Enter the Zir-Cut burs. I recommend them when replacing all-ceramic, cementable restorations. Even if you are not currently placing zirconia restorations (which I now do routinely), one day you will most likely have to remove a zirconia crown placed by another dentist. Having some Zir-Cut burs on hand will be most beneficial.
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 clinical programs available on DVD through Glidewell. For more information on this article, or to receive a free copy of one of Dr. DiTolla’s clinical DVDs, e-mail him at [email protected].
