The Hands, the Handpiece...or a Little of Both?

You're listening to the Phil Klein Dental Podcast Thanks for joining us. I'm Dr. Phil Klein. We can all agree that the dental handpiece is the workhorse of our practice. We need it to perform reliably day after day. So in this podcast, we're going to dive a little bit deeper into why having the right handpiece, the right kind of handpiece is so critical to a smooth running practice and to achieve predictable clinical results. Our guest is Dr. Chad Duplantis. He maintains a small group private practice in Fort Worth, Texas, focusing on aesthetic and restorative dentistry. Dr. Duplantis is an author, a lecturer, and a key opinion leader in dentistry. His interests are mainly in digital, implant, and restorative dentistry. In 2020, Dr. Duplantis co-founded the Facebook group Dentists in the Know, which is designed to keep the dental industry well-informed. I would like to mention that Dr. Duplantis will be presenting a live webinar on VivaLearning.com. It's titled Prepare for Success, Preparation Pearls for Powerful Restorations. It's scheduled for Monday, August 21st at 7 p.m. Eastern. If you're on the West Coast, 4 p.m. Pacific. Simply visit VivaLearning.com to register. The webinar is free and you can earn live interactive CE credit. Dr. Duplantis, it's a pleasure to have you on the show. Always a pleasure to be here with you, Phil. Thank you. Let's talk first about indirect restorative dentistry. I assume when you do indirect restorative dentistry, you have a mental checklist of the important steps that you need to perform. So if you would, tell us about your thought process when you're preparing for and actually doing an indirect procedure. And I'm talking about types of restorations, material selection, and actually how much of all this resides in the lap of your chair-side assistant. How much is he or she doing? with these indirect restorations? You know, that's a great question. It's obviously a very open question, but, you know, I think everything that we do in dentistry, direct or indirect, just starts with an appropriate diagnosis. I mean, you've got to assess the situation and figure out what the best restorative solution is for that particular situation. So your diagnosis and, you know, the problems that present with the tooth dictate your prep design. You know, your material selection plays a part in that as well. And then after you've prepped everything, you know that you're going to have to come up with some sort of whether it's digital or analog impression. And then you've got to come up with a solution for temporization, cementation. And then once it's on there, you've got to make sure that it's got the appropriate occlusion. And when you take all of those things into consideration, the last thing that we've got to check off is what's the longevity of this restoration. It's kind of a cyclical process that we go through on every single one. Obviously, as far as my assistant is concerned, I'm involved with the diagnosis, but they help me in every step of the way. And we've worked together for so long, they kind of know where my mind is leaning before we start on a procedure and are able to appropriately anticipate the next steps and whatnot. So out of all those things you mentioned, How much of this mental checklist is actually set up prior to the patient sitting in the chair and how much is actually done on the field? You know, diagnosis is done before the patient gets in there. You know, hopefully that's been done in a hygiene appointment or in a limited exam appointment. Some days it's done the same day. You diagnose and then you start treatment. But as soon as I'm diagnosing. I'm thinking about my prep design and, you know, is it going to be a full coverage restoration? Is it going to be an inlay or an onlay? Or is it just going to be a direct restoration that's done chair side? And so hopefully the diagnosis, the thought of the prep design and the material selection is done beforehand. But everything else is once you get in there and get started, I always say that we could have the best prep designed in our mind, but ultimately carries and. The pre-existing restoration is going to decide what that prep looks like. And so we have to be prepared to pivot. Yeah, exactly. So when you have this thing planned out, at least prior to the patient coming to the office, it does help with workflow, I assume, right? Because your setup is going to be already prepared, ready to go. And it's all about having systems in place and anticipation from those that you work the closest with. So let's talk about handpiece technology a little bit. We kind of take for granted the handpiece. A lot of us look at a handpiece as kind of a commodity, and some shop on price, some look at the ergonomics of it. The handpiece is something that really needs to operate dependably, reliably, and it has to operate in a manner where you can get predictable clinical outcome. So in addition to dependability, what else are you looking for in a handpiece? I think dependability is obviously number one. Ultimately, it's all in the hands of the operator, but the handpiece does play just such a vital role. You want something that's dependable. You want something that's lightweight. You want something that's not going to stress you out. And one of the things that we dismiss is the appropriate torque of the handpiece and the power that is delivered. when you're working on the tooth. I mean, everything can sound great within the handpiece, but without the appropriate torque, you might be cutting forever. And so I want something that's lightweight, that's fast, that's efficient, and that does the job appropriately that I don't have to worry about ongoing maintenance on. It's kind of like having a dependable car. You want something that's going to work day in, day out. be a workhorse, and be comfortable as well. So with these new ceramic materials, torque is really a factor now versus the old days. We cut through gold, we cut through some porcelain-fused metal, cut through big amalgams. Now we're talking zirconia, of course, is crazy hard. But still, torque is a big factor. And some people are using electric handpieces because of it, but there are air-driven handpieces out there that are performance-driven. and provides the torque that you're looking for. And I think it's always nice to use an air-driven handpiece because it's kind of lighter. Isn't it ergonomically more fun to use? Well, to me it is, you know, and I think that's something that we dismissed a little bit when we're talking about what's important about a handpiece. I mean, that's one of the biggest decisions that we have to make in our practice when we're choosing a handpiece is are we going to go air-driven or are we going to go electric? And I know that there's proponents on both sides of it. You know, we also think about, you talked about it as well, zirconia, you know. I laugh because when I talk and I say, hey, you know, if you ever have to cut through a zirconia restoration, inevitably, you're going to get somebody in the audience that says, well, I don't have to cut through my zirconia restorations. Well, you know, you want to clap for them and then you want to say, well, you know what? I guarantee at some point in time, you or your endodontist has. And I also guarantee you at some point in time, whether it's yours or not, somebody else's restoration may come in that's got carries underneath it and you're going to have to cut through it. It's not a fun process, you know, and a lot of people will sell burrs. Ultimately, yeah, the burr plays a part, but the handpiece plays the biggest part. And so we want something that's going to be powerful enough. And it used to be that electric was the most powerful to do so and going to provide the best results in doing so. Right. And that's not the case anymore. So you're saying that there's air -driven handpieces that are actually more powerful than electric? No, I'm not saying that. I'm saying that there's air-driven handpieces that are starting to rival the power and the torque of the electric handpieces. And Dental Ease is the manufacturer of one of those handpieces that's really got a nice torque to it that's really unheard of in the previous versions of the air handpiece market. Yeah, that's the Aeros 500. I want to talk to you about that. So one of the things I want to mention about torque, you not only need the torque to cut through these zirconia type materials, but also as we move more into ceramics, the wear and tear on the turbine is going to increase because... maybe the handpiece will cut through that material for 10 preps, but on the 11th prep, it dies. So the question is, it not only needs to have the torque, but it has to hold up over time to that kind of abuse. If I use the term abuse, maybe I shouldn't use that word, but you're beaten on that handpiece to cut through it. So, you know, address the durability of these new handpieces, and maybe they've worked on these turbines to withstand more stress because of these materials. Right. And I think that they have. I mean, you know, knock on wood, we have not had any issues with the Ares 500 that we've had in terms of a turbine replacement. But inevitably, it's going to happen. You know, you're going to have to replace a turbine. And being an advocate of air-driven handpieces, that's one of the biggest problems. You know, the turbine goes out and then all of a sudden you're like, crud. What do I do? OK, well, let's take it out of commission. Let's send it in. You know, we keep a log, a notebook of where the handpieces are at all times. A week later, you're going to get a call back from wherever you send it to. They're going to give you a price that's going to make you scratch your head. And they're going to say, you know, this is the price for basically a knockoff. This is the price for the name brand. You know, this is. This is how much it is with a warranty. This is how much it is without a warranty. And it, you know, it gets to be rather frustrating at that point. You're like, OK, my answer is usually what's going to get it back to my office, you know, the most quickly. And so that we can be back in production, because, you know, when you're down a handpiece, you're you're theoretically losing dollars. And that's that's not very fun. You know, like I said, inevitably, you're going to have to replace turbines. And unless. You're a handpiece repair person, which not many dentists are. I mean, hell, most dentists can't even read an instruction manual and get through it and do things appropriately. And I put myself in that category. You're sending it off. And so, you know, one of the innovative features of these is that they have a really quick and easy way to just snap off the back of the handpiece, pull out the previous turbine, in place the new turbine, and you do it in your office. Who does that in your office? Knock on wood, we haven't had to. I'd imagine the first time it's going to be me, just because I'm kind of the kid that used to take my toys apart to see how they work. So I'd imagine it's going to be me at first, and then I'll probably have one of our assistants who handles all of our technology and our 3D printing and milling. She'll probably be the one that takes care of it. But I've watched the video to make sure I know how to do it, and it's just an incredibly easy process. As a matter of fact, when we bought the handpiece... The gentleman that sold it to us, he showed us how to do it right there in the office. Let's talk about the Aeros 500. You mentioned there were a few things about this handpiece that were unique to it and also very beneficial to the dentist. What are those? Well, the first is that it almost has 40-pound watts of torque, which is very impressive compared to some of its competitors. You know, second, we already mentioned that, you know. The turbine replacement is just super easy to do. As far as the looks and the feel, it feels exactly how I want an air-driven handpiece to feel. It's not clunky. It's not heavier because it has extra torque. So it's very easy to use in our hands. One of the features that it offers, and it really depends upon your office as to what you want to do, is they have one that is lubricated and they have one that is lubricant-free. And that's designed to make it easier to maintain. And then finally, the last thing that I'll mention that I find pretty cool, I don't know that we really have a need in our office because it's a smaller office, but they have RFID technology, which is basically a radio frequency identification technology. And so for these larger group practices, you have a reader that scans the device, you know, and so you can know where it is at, you know, it allows you to track and keep a closer tab on the maintenance. and record keeping of that particular device. And for these larger practices, you know, especially we have so many DSOs out there today with multiple doctors, multiple assistants, multiple handpieces in place. That technology is pretty invaluable to have in that practice to be able to track and maintain these devices. Once you develop a workflow with these handpieces, I guess you know how many you need to buy for your practice. How many operatories do you have in your practice? We have three restorative operatories in our practice. So how many hand pieces do you have floating around through sterilization and actual performance? I think we've got, it's funny, I took tab of this the other day. I think we've got 10 hand pieces. So let's say we have 10 hand pieces. We kind of did the math. If we convert to all Ares 500s, we only have that in one room right now. I think we can. eliminate two of those hand pieces and have eight in circulation, just be able to rotate through them as the day goes on without any downtime. Do you mark any of these hand pieces based on which ones are newer or you just rotate them all? Yeah, well, we have a log with all of the serial numbers of the ones that are in the rotation and the ones that we've taken out of the rotation. So in addition to the 10 that we have that are working, we do have a handpiece graveyard as well. So one last question as we wrap up this podcast, and it's been very interesting. Why would a doctor want to lubricate his handpiece if he could purchase one that's lube-free? That's a really great question. And so what we're using right now is the lube-free handpieces. I think that, don't quote me on this, but I believe there's a difference in the warranty of the lubricated versus the lubricant-free. And I don't know, it defies everything that you know, but we haven't had any issues with the lubricant-free for the time that we've been using them in the practice. My opinion would be go for the lubricant free. I mean, it's one less thing that we have to do on a regular basis. I mean, you still sterilize them, of course, but, you know, lubricating them is quite a chore before sterilizing. And as we're closing, I think one of the last things that I really want to say is we said there's proponents of electric. We said there's proponents of air driven. And I've just just maybe I'm an older dentist, but I'm a big fan of air driven hand pieces. And nowadays, it's very nice that although it's not. quite as powerful as an electric handpiece. We have something that's really rivaling an electric handpiece from an air-driven perspective. And I think that's really important to me because I just really am used to my air-driven handpieces. Talk about your Facebook group in 30 seconds, Dentist in the Know. Sure. So we have a Facebook group called Dentist in the Know, and basically it's open to all members of the dental community, whether you're a dentist, whether you're a hygienist, whether you're an assistant or even a dental manufacturer or even people like you, Phil Klein. But no, we're open to everybody. We really promote and further the profession basically through education. It's an open forum, and every week we have a live guest that's an industry leader or influencer. we'd love to have anybody join. Excellent. Excellent. The Facebook group is called Dentists in the Know. So check that out. Dr. Duplantis, always our pleasure to have you on the show. Great stuff. And we look forward to having you on another one. And also we look forward to your webinar, as I mentioned in the introduction, on August 21st, 7 p.m. Eastern. If you're on the West Coast, 4 p.m. That's called Prepare for Success, Preparation Pearls for Powerful Restorations. Have a great evening. Thank you so much. Thank you.