Terri Lively

	Dental impressions are vital to many dental procedures. From crowns and bridges to implants, from orthodontics to prosthetics, cosmetic dentistry and more, making a great impression matters.

	Although dental impressions are a significant part of a dental practice, they are also a significant source of frustration. Perfection is both essential and elusive. Many factors will affect the outcome, and many of them are out of the dental professional's control.
	Everyone has his or her secrets for taking the best impression, whether using a digital or traditional method. We talked to clinicians, a dental assistant and industry experts to learn a few. Here's what our experts told us.

	"What is a good impression? A good impression is going to be a technique that gives you the perfect negative impression of the teeth, the gum and the sulcus," says Dr. Eric Caron, a prosthodontist with Dental Wings. " Not only the tooth surface. We need a full copy."

	Continue to the next page to see the top 10 ways to guarantee a good impression. 

	1. Expand your time with tissue management.

	Dr. Marc Geissberger, Professor and Chair of the Department of Integrated Reconstructive Dental Sciences at University of the Pacific, asserts that "proper tissue management is essential." Although there are many techniques used for tissue management, there are some absolutes, according to Dr. Geissberger. "The field must be free of contaminants and must not bleed. So number one is focusing a little more time and attention, not so much to the actual squirting of the impression material, but to the tissue management during the procedure."

	Dr. Caron agrees. "So the difficulty of the procedure is not related to the use of the material because a dentist with a high skill level is going to handle any material. It's not the material that is responsible; it's how you manage your tissue. It's how you're going to control the saliva and be sure nothing is going to push your material away from the side of the tooth.	 	

	Tissue retraction is key to taking a great impression. The dual-cord or double-cord impressions technique is an excellent way to retract the gingival tissue and allow for adequate access into the sulcus. "Retraction and isolation are the two key points. If you have that, then you're going to have a good impression," Tija Hunter, dental assistant and vice president of the American Dental Assistants Association, says.

	Dr. Caron explains: "When you're going to extract your impression after the polymerization, it needs to have a minimum of material. If you do not have that minimum, and you remove your tray, the material is going to break, and it's going impair the quality of your restoration. So we need to do a certain amount of retraction. Some studies say that every time you take a regular impression, you're going to add 0.3 mm of gum retraction, even if you're the best, because you traumatize your gum. You need that retraction to be sure you have the space for your material."

	"A lot of times dentists are looking for the cheapest stuff out there, not necessarily quality," says Dr. Tim Bizga of Parma, Ohio. "But impression materials are not all created equal. There are impression materials you pay more for because they're better. It's not necessarily because a big company label is going on it or whatnot."	 

Dr. Caron believes you should choose a material, become a master of it and then stick with it. "You don't want to change the material each time one comes out and have a new learning curve every six months," he says. "I need to know how that material is going to flow in my syringe. When you stick to something, and you get success, you do not want to change; you don't want better than that. New material is not what's going to be the secret. It's going to be how you work and how you control your tissue."

	John Aguirre, regional product line manager for Carestream Dental's CS Solutions CAD/CAM portfolio, agrees. He believes that every person is unique and has their tricks for getting the results he or she wants from impressions. Whether using a digital scanner, polyvinyl or alginate, honing your skills for what works best for you is essential to capturing a good impression. "It's really old school, but people took impressions with alginate no problem because they'd honed their technique so well, they could just make it work," Aguirre says.	 

	4. Switch focus from the margin to the sulcus.

	When dentists take an impression, they concentrate on the margin. Dr. Geissberger says to forget that and instead focus on capturing the sulcus: "If they focus on taking an impression of the sulcus rather than the margin, by default they capture the margin because they're below the margin."

	Dr. Geissberger, who is also in private practice in Greenbrae, California, says when people take impressions they tend to seat the tray gently. However, a quick, forceful motion is far better to move impression material where you need it, particularly down in the sulcus. "Tell the patient, ‘When I seat this impression tray, I'm going to push quickly. It won't hurt, but it's going to be forceful and fast,'" he suggests.

	6. Always work distal and mesial in two paths.

	When taking traditional impressions, one must consider the flow of gravity. Since the patient is lying on his or her back, the material will drip, following the pull of gravity. Dr. Geissberger wants dental professionals to work with gravity, not against it. "Start your impression from the distal lingual corner of the tooth working towards the mesial lingual, capturing all of the lingual margins first," he advises. "Then lift the syringe out, rotate it 180 degrees and go to the distal buccal.

	"From there, you capture all of the buccal margins working mesially to the mesial buccal. Then you cover the occlusal feature tray, and you're good to go," he says. "By starting with the distal, the material is always dripping away from you, which allows you to see the entire procedure. If you inadvertently started from the mesial, the material would start dripping back and obscure your view of capturing the margins.	 

	Bleeding from the gums is a problem, but not bleeding the material cartridge and the tip is, too. Bleeding the cartridge ensures the material enjoys a proper mix so it sets up after you seat the tray. Hunter says she sees that mistake with new dental assistants.

	"If you're in too big of a hurry, and you're not bleeding it, that first little bit that doesn't get mixed is probably going to be right where you need your impression the most. And that always presents a problem. So if you're not bleeding your syringes before you put your material in the tray, that's a huge mistake," she says, "And gosh, talk about a mess. It's hard to clean up!	 

When you take an impression, you have to focus on the finishing line of your future restoration, explains Dr. Caron, who notes that poor impressions are responsible for the black lines that are sometimes visible on restorations. "That crown is not sitting perfectly, and the bacteria comes in, so the gum retracts and you see the lid of the final restoration," he says. "You need to be sure the finish of the line is below the gum, making sure that we do not see the future crown and the line between the future crown and the tooth itself."

	This requires extra attention to the tissue prep, particularly to bleeding gums. "If blood comes when you inject your material," Dr. Caron notes, "even if the polymerization of the material is possible, the pressure that makes the blood come inside of the impression is going to push away your material, and you're going to have some bad definition of your finishing line."

	Some professionals believe digital tools might help the final result."Digital is just the way to go. I talk about that all the time," Hunter says. "I know there are so many people out there still taking impressions, and I just want to know why. The digital impression is much more precise and accurate. It takes out human error. You don't get a void. You don't get tearing of the impression material where you're taking it out. It takes out all that human error and gives you a much better product."	 

	There are many implant manufacturers-both big and small-and manufacturers can decide to make a proprietary scan body type for digital impression scanners. Therefore, in an implant workflow, communication is critical because the doctor must know what design software their lab uses. "Every time a doctor starts asking me about the impression workflow, I say ‘Talk to your lab. Find out what they use,'" Aguirre says. 

	One of the biggest challenges any dental professional has no matter his or her skill level taking impressions is managing the patient during the uncomfortable procedure. Dr. Geissberger says most clinicians give patients the wrong advice.

	"They tell patients, ‘Don't move your tongue.' What you have to tell patients prior to the impression at the moment you're about to squirt the material is ‘Do not swallow.' And you keep repeating that to patients."

	Dr. Geissberger tells his patients how swallowing lifts the saliva from the floor of their mouth into the impression material or scanning area and that then they will have to take the impression again. "Now if you don't remind patients not to swallow, inevitably, they're going to feel gaggy," he notes. "They're trying their best, but they will swallow during the impression and flood the field with moisture."	 

... Most patients prefer digital impressions?

	"We did a survey years ago with our patients about the digital experience. When we asked the question, ‘Would you prefer this to a conventional impression?', the results were 98 percent favoring a digital impression," says Dr. Geissberger.

	... There is less of a learning curve with digital impressions?

	"We prefer digital because it is so much easier of a workflow and there is less of a learning curve when it comes to digital because you're capturing images rather than trying to squirt that material on an area that sometimes you can't really see well," says Aguirre.

	... Your practice makes a better impression on patients with digital impressions?

	"We like knowing that our healthcare is up-to-date with technology, too. When patients see that you have the technology to do this, which makes it more convenient for them, they're all over it," says Hunter.

Articles

It’s critical to patient outcomes to have an accurate impression. Here’s what you need to know about both digital impression systems and traditional methods.

10 Ways To Make a Great Impression

	Communities of color suffer the most when it comes to unmet health needs related to dental care. According to new analysis from The Pew Charitable Trust’s Dental Campaign, these communities enjoy fewer dental visits and preventative treatment than the white population and suffer more untreated tooth decay and tooth loss.

, Director of Research for Pew, said the findings show the dental care delivery system is not working for a large portion of Americans, particularly those on Medicaid and those without dental insurance, which is a significant part of the population. According to a 

report released by the Centers for Medicare & Medicaid Services

 last month, there are over 72 million individuals enrolled in Medicaid and CHIP as of January 2016. The 

 asserts that 114 million Americans had no dental coverage at the end of 2014. 

	“It’s also not working for people in areas where dentists are scarce. The Federal government finds that more than 48 million people are living in areas that are known to have dentist shortages,” Koppelman says. “So there are a lot of Americans that are left out of the dental care market, and unfortunately, we’ve seen a problem that is most urgent for people of color.”

	In 2000, the Surgeon General released a report on oral health, the first from that office addressing oral health, which described a delivery system that left one third of Americans out from the dental care delivery system. Koppelman was disheartened that the gap had not been closed more by now.

	“In 15 years with all of the efforts and all of the activities that have been going on in the healthcare arena and with healthcare reform, it’s striking to me that we still have significant disparity by race and by income,” she says. 

More dental news: A game changer: 2017 will bring new CDT code for gingivitis

	Pew addresses needed changes in business as usual

	Pew is working on changes to address this gap. The first is to diversify the dental workforce for efficiency and flexibility. Koppelman suggests proliferating the mid-level dental provider model with the addition of dental therapists. Dental therapists are trained to do a smaller number of procedures than dentists and, as a result, can treat tooth decay competently and effectively-and more economically-than the dentist.

	“One need is that dental therapists can make it more profitable for dentists to treat people on Medicaid,” Koppelman says.

	Koppelman asserts that two thirds of dentists do not treat patients on public assistance in large part because the payments are too low and the paperwork too burdensome. For the more than 72 million people relying on Medicaid for dental insurance, finding a dentist can be difficult.  However, the use of a dental therapist can make that more affordable for dentists. 

	In addition, the dental therapist can also make it to satellite clinics in rural areas where dentists don’t usually practice or where it is hard to have a full-time practice. This not only provides more care for more people, but it also can improve profitability for the practice as well. Pew did a 

 of a private practice that hired a dental therapist in Minnesota, which was the first state to authorize dental therapists statewide. 

	“Talk about surprising findings! Within a year, he increased his Medicaid patient population by 50 percent, he increased his overall patient population, and he increased his profits by about $24,000. And he did this working in a state with perhaps the lowest Medicaid reimbursement rate in the nation,” Koppelman says. 

To download the full study, please click here or visit the website at www.pewtrusts.org. 

	The second change Pew suggests is to increase the number of school-based dental programs around the country that that provide sealants to low-income kids. Research shows that low-income children are almost twice as likely as high-income kids to suffer from dental decay. Koppelman says school-based sealant programs that target low-income kids have been found reduce tooth decay by an average of 60 percent over five years. A low-cost treatment, a sealant is one third of the cost of a filling. 

	“We know they work and we know that low-income kids need them the most,” Koppelman says. “Schools are where we know we can find children every day. So it makes sense to bring the care to the children.” 

	To achieve this change, Pew explores removing, improving or modifying state-wide policies that get in the way of increasing these programs. 

More dental news: Study finds disparity in tooth decay rates in Hispanic, non-Hispanic white children

	What can you do to bridge the gap in dental care?

	Pew’s dental campaign facilitates access to dental care for those hardest hit by promoting policies that increase the number of available providers in the affected areas, as well as by working at the state and federal policy levels for improvements to expand the reach of preventative services. However, there are things individual clinicians can do to bridge the gap for dental care access, too, including:

	• Hiring a dental therapist to accommodate more patient care in office and in underserved areas in states where they are authorized.

	• Supporting their local oral health primary care association’s action agenda.

	• Extending office hours outside of business hours for working people and their families.

	“A lot of people don’t have the flexibility to be off during traditional business hours. Being open later in the evenings or on weekends would open access to a lot of families,” Koppelman says. 

According to New analysis from The Pew Charitable Trust’s Dental Campaign, these communities enjoy fewer dental visits and preventative treatment than the white population and suffer more untreated tooth decay and tooth loss.

Addressing the gap in dental delivery care for all Americans

	Time is money in a dental office. Bien-Air has always looked for ways to provide top quality equipment that helps clinicians meet their potential for both exemplary patient care and practice management.

	Their latest Micro-Series Instruments, the MX2 brushless micromotor is no exception. Here Dr. Matthew Nejad, a graduate of the acclaimed University of Southern California School of Dentistry who has been practicing since 2010, explains how using Bien-Air handpieces helps him in his California practice.

	What Dr. Nejad, DDS, had to say about the MX2 LED Micromotor

 in school. I liked them so much that when I started practicing, I invested in electrics right off the bat. Two years ago, my partners and I bought a new practice. I started using the MX2 in the new office. I was happy with my previous handpiece, but these were so much better than the one I was using.

Related reading: 5 reasons to consider an air-driven handpiece

	It was much smoother and had more torque and power. It would never slow down. You couldn’t stop it, whereas my other handpiece had been uncertain on materials like zirconia.
	
	The water spray is another one of my favorite things. It’s consistent. You get four different water ports which operate perfectly whether you want high- or low-water cooling. My experience with my other electric handpieces is less impressive. The water ports do not consistently work and many times only one port would operate when the water level is turned down low.

	The touchpad is a great part of it, too, because you can program so many different settings and have your favorites stored on it. Some of the other ones just have a couple of memory options, like the one I had. But with the programming on the MX2, I can have my settings, and my partners can have their settings.

For more on handpieces: Category Cruncher: Handpieces

What have been the results and patient responses?

	Patients noticed the sound difference. It’s quieter. It doesn’t have that whistling sound. Also, the fine control results in more precise margin finishing. It’s easy to run at a lower speed to finesse the margin, and that is something that is difficult with an air turbine. You don’t have to feather to rheostat or compensate for low torque when you are using an electric handpiece. It’s simple and I like that. My lab and I benefit from better preparations and patients are happier about a smoother and less noisy appointment.

	What benefits to the practice have you experienced?

	The electric handpiece has made my dentistry more predictable and more enjoyable. It’s something I use all day, every day. I love that I am using the best tool, and it allows me to do my best work.
	The number one benefit for me is the improvement in my restorations and preparations. I am able to do better preparations and restorations with the control the electric handpiece provides. As a result, my restorations look better, and the number of restorations that we have to send back due to any issue is almost non-existent.
	On top of that, it speeds up the average appointment by 10 or 15 percent, especially when you’re cutting through certain materials, like zirconia or IPS e.max. They’re both incredibly hard to cut period, but with the electric, you can control that better and cut through it and keep at it with a high torque. It can help speed that up. This combined with the time I save in finishing my preparation margins results in significant additional time I can use to treat patients every day.

	Why would you recommend this product to your colleagues?

	It’s fantastic because of the smoothness, the options, the reliability, price points. I mean, there’s really no downside to it, and that’s what’s been the most amazing thing to me. You just have to spend a little more right up front. But with that, you’re getting so many better options that I think long-term, you’re going to get much more use and ease of use out of it.

	The latest from Bien-Air’s micromotor series, the MX2 LED brushless micromotor is exceptionally stable and powerful. The MX2 is effective at low speeds (as low as 100 rpm), due to the Smart-Logic electronic control. The unit is also 30% shorter and 23% lighter when used with the new 

 Micro-Series Instruments. Because the MX2 is equipped with lifetime-lubricated ball bearings, you can sterilize it and still be maintenance free. Following in the footsteps of its famous predecessor the MX, the new MX2 also delivers consistent power, speed, torque and reversal of the direction of rotation. The MX2 brushless micromotor is unparalleled in both comfort and balance for today’s clinician. For more information on Bien-Air products, visit 

Bien-Air’s latest micromotor, the MX2 brushless, is shorter and lighter, but according to this dentist, every bit as robust, stable, and consistent as it’s predecessor the MX

Using Bien-Air’s latest micromotor, the MX2 brushless

	There is beauty in simplicity, particularly in a busy dental practice. When it comes to the products you need day in and day out, having one product that serves as a simple yet versatile solution is critical to an efficient practice.

 Dual-Curing Universal Adhesive is one product designed to have multiple uses. It responds beautifully to the need for simplicity in the day-to-day practice of dentistry-at least as far as providing a reliable and durable bonding agent for direct and indirect restorations.  

What Dr. Brett Leemaster, DDS, had to say about the VOCO Futurabond U

	We have used multiple VOCO products in our practice for years.  I previously was a long-time 

 user. Then, my Patterson rep introduced me to Futurabond U. We have been using it ever since. 

Related reading: Easy-to-use VOCO materials allow for natural-looking esthetics

	I initially switched at the recommendation of my Patterson rep and I really liked that it was indicated for almost all clinical applications. I like to use the same brand across all products in my bonding procedures because I know that the company has specifically formulated them to work together, which means better results. With that in mind, Futurabond U is what I use for all of my direct resin restorations and build-ups since I also use VOCO’s 

 and Rebilda DC for each, respectively. 

	I like that it can be used for almost all clinical applications and that I don’t have to have a different bonding agent for every procedure. I also like that you have the choice to selective etch, total etch, or self etch. 

	However, my favorite feature is that it comes in a unit dose delivery system. If you use a product that comes in a bottle that you have to squirt a little out of every time, and you don’t recap it immediately, some of the solvents will evaporate. Over time, the mix of the product won’t be what it should be and at some point you have to question whether that product is going to work properly. I appreciate that with Futurabond U there is really no guesswork.

More from VOCO: How to use VOCO's Admira Fusion Universal Light-Cured Nano-ORMOCER

	 Since using Futurabond U, I have noticed very few instances where patients report post-op sensitivity. It’s not a practice builder to have every patient with a new composite filling walking around for the next month complaining that they can’t eat anything cold! 

	What practice benefits have you seen since using Futurabond

	I feel like I routinely get a reliable bond in all clinical applications, and it is quick and easy. I can’t ask for much more than that. 

	It’s cost effective; it is a great product without a hefty price tag. It is quick and easy because the unit dose package means no mixing or multiple bottles and we don’t waste bonding agent by having it go bad over time. We also have very few restorations de-bond with Futurabond U

VOCO’s Futurabond U Dual-Curing Universal Adhesive is one product designed to have multiple uses. It responds beautifully to the need for simplicity in the day-to-day practice of dentistry-at least as far as providing a reliable and durable bonding agent for direct and indirect restorations.

How Futurabond U provides simplified solutions for one practitioner

	There are a lot of demands for today’s composites. Patients want a restoration that looks and feels natural. Clinicians want a composite that is easy to handle with just the right mix of translucency, durability and wear resistance. 

Herculite™ Ultra Universal Nanohybrid Dental Composite

 proves to meet the needs of patients and clinicians alike. 

What Dr. Bruce LeBlanc had to say about Herculite Ultra: 

	I’d been a loyal original Herculite user since the early 1990s. At that time, Herculite was the gold standard for hybrid composites due to its strength and ease of color matching. It became my workhorse for years. As nanohybrids were formulated - adding smaller particles to the hybrid materials for improved polish and luster - it made sense to do the same with Herculite, which then became Herculite Ultra. So you could say I have been using the Herculite brand of composite for 25 years with great success and confidence.  

Trending article: Products that are team members' best friends

	Over the years, I have clinically evaluated many of the other well-known composites on the market. I have observed superior performance and longevity in the Herculite brand, personally evaluating the results at recall appointments for my patients.

	In my hands, the material blends nicely without the need to use multiple shades for tooth color matching. Herculite Ultra maintains the same strength as the original formulation, but the added nanoparticles create what I call a self-polishing effect, which means as the patient brushes at home the material keeps or even improves its polish and luster. We observe this when we see the patients for their follow-up appointments. 

Related reading: How Kerr's products have become the cornerstones of dental practices

	Since patients want a restoration that looks and feels natural, they love the results. In our practice, direct composite restorations allow us to remove minimal tooth structure to restore teeth and rebuild the tooth from the inside out. Patients appreciate having this option and consider it less invasive. 

	What benefits to your practice have you seen since you began using Herculite Ultra?

	We are able to create restorations that solve many of our patients’ problems with direct composite techniques that are long-lasting and highly esthetic. In the end, that is what is important to our patients. Solving problems leads to happy patients and in turn, I’m a happy dentist.

Trending article: The latest fee data for 18 popular procedure codes

	Not only would I, but I enthusiastically and routinely do. I give seminar presentations around the country, as well as hands-on technique courses at LSU in New Orleans. I only advocate products that I have used with success and have verified that success clinically. To me, trust is everything, and when I am advising my colleagues on product choices, I feel that truthful advocacy is important. 

	Herculite Ultra is my direct composite of choice and the product I highly recommend for my seminar presentation because it is universal in application with predictable long-term results. As a general rule, I follow up with as many of my course attendees as possible and ask them if they are getting the results we expect from the products for which we advocate. The answer as it regards to Herculite Ultra is yes.

	To me, if I had one composite to recommend as a universal composite that can be used in all areas of the mouth, with confidence, it would be Herculite Ultra.

Trending video: How to make faster, easier posterior restorations with Kerr Dental's SonicFill 

There are a lot of demands for today’s composites. Patients want a restoration that looks and feels natural. Clinicians want a composite that is easy to handle with just the right mix of translucency, durability and wear resistance. Kerr Dental’s Herculite™ Ultra Universal Nanohybrid Dental Composite proves to meet the needs of patients and clinicians alike.

How Herculite Ultra helps one clinician deliver great results

	The CDC unveiled the “Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care” on Tuesday, March 29. The two new resources released by the CDC include the summary, which outlines basic infection prevention expectations for safe care in all dental settings, and an Infection Prevention Checklist.

	“This is not a replacement for the 2003 guidelines, but rather a repackaging of the most important elements presented in that document,” Dr. Jennifer Cleveland, Dental Officer and Epidemiologist in the Division of Oral Health at the CDC said.

	The enhancements to the 2003 guidelines also include two new elements of standard precautions for 

cough etiquette and safe injection practices

. They didn’t update the guidelines further because in their review of literature they didn’t see sufficient scientific evidence present to do so.

	The tools were developed using the guidelines of many of the other divisions at the CDC. They were necessary as many of the transmissions the CDC had investigated since 2003 were a result of a breach in infection prevention protocols.

	“The summary is intended to be a user-friendly compilation of the most important facts in the 2003 Recommendation and emphasizes the importance of standard precautions. The checklist can be used to ensure that dental care has the appropriate infection prevention policies in practice including appropriate training and education of dental healthcare personnel on infection prevention practices,” Dr. Cleveland said.

Organization for Safety, Asepsis and Prevention’s (OSAP)

 Chairman of the Board, Dr. John O’Keefe explained that OSAP is helping spread the word about the new resources. He described them as a new resource that summarizes and complements the CDC’s seminal 2003 Guidelines for Infection Control in Dental Healthcare Settings, which he described as, “

	“The whole emphasis is a move to create user-friendly, practical resources. OSAP and CDC are working closely together on this to bring infection control, patient safety, and education out to where it is needed,” Dr. O’Keefe said. 

RELATED: Dr. O'Keefe and more experts discuss infection control's hot topics

	The CDC also urges all practices to designate an individual to serve as the Infection Prevention Coordinator to ensure compliance with the CDC’s basic prevention guidelines, from training to equipment acquisition, to enforcing standard operating procedures. The checklist is designed to evaluate compliance with infection prevention, which includes the administrative policies of the practice as well as the observation of personnel and patient care.

	OSAP is a global organization and the world’ s leading provider of education that supports safe dental visits. In support of the implementation of the updated CDC guidelines, OSAP created additional resources for clinician’s designed to help dental teams comply with the CDC guidelines in 

From Policy to Practice: OSAP's Interactive Guide to the CDC Guidelines

, a free online course with seven modules that break the guidelines down into easily understood principles.

CDC Guidelines:  From Policy to Practice by OSAP

, a self-study workbook that walks users through the CDC guidelines. Each chapter contains practical how-to instructions, charts and checklists, pictures and captions, answers to common questions, and guidance for making sound clinical judgments. 

OSHA & CDC Guidelines: Interact Training System

, a program that combines requirements for OSHA annual training with the CDC Guidelines.

OSAP Dental Infection Control Educators' & Trainers' Toolkit, 

a coaching workbook delivered via CD designed to assist with the development, planning, and promotion of successful, high-impact infection control and safety programs and presentations.

	“The more that we can disseminate this information to the better, even outside of the dental health community. The more people that can have this the better and the sooner, the better,” explained Dr. Cleveland.

HOT READ: Is dentistry prepared for another Ebola?

	The new tools from the CDC are available at 

. The CDC also welcomes comments regarding infection control tools and policies at 

The CDC releases an important update to the “Infection Prevention Bible” from 2003

CDC unveils new guidelines and checklist regarding infection prevention practices in dental settings

	Nancy Miller, RDH, BA, is a practicing clinician in Green Bay, Wisconsin. Since 1998, she has also been a Clinical Advisor for Jameson Management and a technical advisor/key opinion leader for several companies, including Hu-Friedy Manufacturing of Chicago. She has used ultrasonic instrumentation with thin or modified inserts for 25 years.

Hu-Friedy XT Triple Bend Ultrasonic insert

	Why did you start to use the XT Triple Bend Ultrasonic Insert?

	I was already using their Swivel XT [Extra Thin] insert because of its ability to get to the bottom of deeper pockets and to finish scaling in tight spots like lower anteriors. Tip geometry makes a difference in aggressiveness in removing older, more mineralized calculus. A typical universal insert is round or oval in cross-section that allows the energy wave to flow smoothly around it. While the front and back of the insert’s working end exert more power than the lateral sides, an insert that has a ridge or “edge” on it concentrates the energy wave along that ridge which gives it a burst of increased power. This feature makes removing calculus much easier.

	The XT Triple Bend is diamond shaped in cross-section, which creates bevels along the working end. This allows for fast and thorough removal of deposits and stains. Making the tip thinner than standard allows for better access to deeper pockets and tight, crowded areas.

More from Hu-Friedy: Hu-Friedy introduces disposable prophy angles

	How does it compare to others on the market?

	There are other thin tips on the market that work well and also allow access to the areas I mentioned, but I have always liked the alloys Hu-Friedy uses in its products. The metal seems denser and more compact, which allows for a much smoother delivery of the energy with less ”chatter” and discourages the tendency of the tip to get stuck between teeth or in tight areas.

	The alloy in their XT Triple Bend (and XT) is manufactured to endure high power settings without creating excess heat or strain on the tip, decreasing patient sensitivity and increasing the rapidity of deposit removal. Hu-Friedy also has its exclusive Swivel Insert Mechanism that allows me to roll smoothly around line angles and easily go back and forth interproximally. Hu-Friedy has the XT Triple Bend in two styles: the Swivel Direct Flow option mentioned previously and a non-swivel option with a wide resin handle called Streamline Direct Flow.

More from Hu-Friedy: Hu-Friedy introduces periodontal maintenance curettes in collaboration with Anna Pattison

	Calculus removal is faster, easier and more complete than with a standard universal insert or using hand instruments. My patient’s perception is that their cleaning is faster and less aggressive on their teeth than with hand instruments. If I do have to resort to hand instruments in areas that I can’t get the ultrasonic tip angulated efficiently, there is a lot less scraping needed, which always makes the patient and me happier.

	What benefits to your appointments have you seen since using the XT Triple Bend?

	Less time spent instrumenting tooth surfaces translates to less wear and tear on my hand and the patient’s teeth.  Less time spent in instrumentation translates to more time to discuss treatment and health options with my patients.

	As a consultant, I have taught my colleagues what I have learned over my career. My mission is to help clinicians be as effective, efficient, and ergonomic as possible to bring more joy to their daily work and the best care to their patients. The XT Triple Bend fulfills those three parameters of my mission.

What makes Hu-Friedy XT Triple Bend Ultrasonic inserts special? One dental professional shares why she thinks they are one of a kind.

Why one practitioner loves the Hu-Friedy XT Triple Bend Ultrasonic insert

	When Dr. Mark Hyman started using the KaVo MASTERmatic handpiece and short motor combination, he expected to enjoy all the innovative features of the equipment. What he didn’t expect was to enjoy dentistry more.

so many different things that made it great

 - the smoothness of the cut and the preparation, as well as the predictability of the preparation. You also had a better experience with the patients because they weren’t jarred by an irregular cut. As a practitioner, you also had less hand fatigue,” Dr. Hyman explained. “So all that had a tremendous impact on enjoying what you’re doing and enjoying dentistry a whole lot more.”

	Dr. Hyman started using electronic handpieces 10 years ago, and he described the difference to his practice as “stunning.” In a recent treatment, he needed to use an old handpiece to adjust something for a patient in one of his hygiene rooms and struggled with the cut and even the feel of the handpiece.

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	“I remember thinking, ‘How did I use this for so many years?’ So I have to admit, I’ve become spoiled,” he said.

	Optimizing comfort and efficiency for your practice

	The KaVo electric high speed handpieces were designed to maximize ergonomics and productivity for the clinician. Featuring KaVo’s unique Plasmatec coating and Triple Gear system, dentists enjoy all the power of other electric handpieces but with a quiet and low vibration function. Dr. Hyman appreciates these benefits, as well as KaVo’s commitment to innovation.

Related reading: 5 common misconceptions about electric handpieces

	“I thought the KaVo electric handpiece that I used several years ago was the best thing ever, and then they built an even better attachment - the MASTERmatic. I love the innovation, and I love to know that a company I’m working with is going to try continually to do something better,” he said.

	In his family practice, he does a lot of cosmetic and reconstructive dentistry from kids to grandparents. The petite head on the MASTERmatic makes it easy to work on a patient with a smaller mouth (such as a child). The smaller head size and patented angle allow clinicians to work around different facial angles that are difficult or almost impossible to get to with a traditional handpiece.

	“The frustration for many dental practitioners occurs when you have to go so far back to get around a wisdom tooth or the distal of a 12-year molar and somebody has big cheeks,” Dr. Hyman said. “You work forever, bumping and cutting the cheek and then have trouble with your access and getting all the cavity out predictably.”

	Dr. Hyman describes his handpiece as the workhorse generating the “bread-and-butter” dentistry of his practice. He appreciates how the design allows him to focus on his patients’ treatment instead of whether the handpiece performs. This benefit translates into increased efficiency for his practice, a metric that is critical for today’s clinician.

Related reading: How to make sure you get the best electric handpiece for your money

	“I’ve seen it estimated that you save 10 minutes per hour on the prep time. That’s 80 minutes per day,” he explained. “Look at what you’re doing per day and think about where else you’re going to get back an extra hour of time? I say this in my seminars to other professionals: All you have is time. If you invest in quality equipment, you get an hour more a day than some of our colleagues do.”

	Productivity and efficiency are not the only benefits of the handpiece for Dr. Hyman’s practice. His patients have a better experience, as well. More specifically, the handpiece reduces the jarring sensation and the whining sound other handpieces make. The patented angle means no more “open wide” and therefore better patient comfort.

More on handpieces: 7 tips to extend the life of your dental handpieces

“In dentistry, we invade all five senses: sight, hearing, touch, smell and taste,” he said. “If you take each of those senses and enhance them, the patients have an extremely different experience.”

	An investment that pays for itself starting Day One

	Dr. Hyman recognizes clinicians today face a lot of tough purchasing decisions. From $100,000 CAD/CAM machines to $100,000 CBCT radiology advanced systems, it can seem an investment in a handpiece is just another way to spend more money on equipment. He argues the increases in practice efficiency and treatment outcomes result in the investment paying off starting Day One.

Related reading: Electric handpieces solve many problems

	“There’s a temptation to look at advancements in dentistry and say ‘Gosh, now I’ve got to pay for another thing.’ That’s not what the winners in dentistry do. They say, ‘Thank you very much for enhancing my career,’ ” he said. “I want folks to look at electric handpieces, in general, and KaVo, specifically, and say ‘Thank you for making it easier for me to knock it out of the park.’ ”

	Dr. Hyman explained how the investment in the handpiece can pay for the more expensive equipment investments dentists may consider. Most dentists work around 200 days a year. If by gaining the extra hour each day with the efficiencies the handpiece provides translates to an extra $100 a day in treatment, the doctor gains $20,000 in revenue. That number can climb to hundreds of thousands of dollars if that additional hour yields an extra crown placement per day.

More on handpieces: 5 reasons to consider an air-driven handpiece

“Life is too short. I want people to love doing their dentistry. I want patients to have the highest quality dentistry and the highest quality experience,” Dr. Hyman explained. “If you can have an exquisite electric handpiece with a tinier head, less fatigue and more precise access to the tough angles, why wouldn’t you do it?”

	Dr. Hyman believes investing in better equipment you use every day is an investment in your success.

	“There are three magic words I learned from the Dale Carnegie organization, ‘Success leaves clues.’ Look at what the highly successful cosmetic restorative docs are doing throughout the United States. I can pretty much guarantee that 99.9 percent of them are using electric handpieces,” he said.

	“And I bet most of them are using KaVo!” he added.

Related readng: What do women look for in a handpiece?

When Dr. Mark Hyman started using the KaVo MASTERmatic handpiece and short motor combination, he expected to enjoy all the innovative features of the equipment. What he didn’t expect was to enjoy dentistry more.

How KaVo handpieces allow this clinician to enjoy dentistry more

	One clinician’s take on the advantages of incorporating Curve Hero as his practice management software.

Thomas Barrington, DDS, a Kingsburg, Calif., dentist who has been practicing since 2009, is not the normal dentist. He doesn’t take any insurance plans. His practice is a smaller, slower, more personal family dental practice. Curve Hero fits that personality of personal, simple, clean, useful and effective.

	I had worked in my father’s practice where he had old-fashioned charts. I also worked at a couple larger practices that had other practice management software options. I chose Curve Hero because the opportunity to be in the cloud was appealing, as well as the chance to run on a Mac operating system.

	Some of the other programs have fees associated with them that are pretty hefty, like a multi-thousand-dollar upfront fee and then a $50 maintenance fee, whereas Curve just has a monthly fee. From a start-up standpoint, that was nice because I didn’t have to come up with a lot of cash. And the monthly fee is very reasonable. Curve takes care of all the updates for you, too. There is no installation for them. There is no restart and reboot and no “download this CD” or “download this file” Internet messages. Updates just happen overnight between midnight and 3 a.m. The monthly subscription may be a little more than a maintenance fee, but what you gain in service, automatic updates and support is fantastic. Their team has been fantastic. From start-up to implementation to troubleshooting, they’re fantastic folks. And it isn’t hard to get help. You just call a number, and you are on the phone with them right away, and they help you out.

	The other really nice thing with Curve is I can be anywhere-home, office, traveling, at a friend’s house-and all I need is an Internet connection and I have access to my entire practice management software. That’s a nice plus. So the mobility advantage is huge. The storage in the cloud is a huge advantage. They are a great company that offers me a great service, and we love it!

What have been some improvements to your day-to-day operations as a result of the Curve Hero implementation?

	I’ll be honest; they (software) all have similarities functionally day-to-day, but, for Curve Hero, the ease of use is helpful. So back-office, primary-role teammates can go up front and do whatever they need to do or even do it on the MacBook Pro in the back. It’s not like they are  lost when they get out of their regular modules. With some of the more complex systems, the front-office people know how to do their stuff, and the back-office people know how to their stuff, but they don’t know each other’s. Curve Hero is pretty simple; you can get into any module you want, and it’s very user-friendly.

I had worked in my father’s practice where he had old-fashioned charts. I also worked at a couple larger practices that had other practice management software options.