Putting the Right Spin on Your Preps and Restorations

You're listening to The Dr. Phil Klein Dental Podcast Welcome to Dental Talk. I'm Dr. Phil Klein. Whether removing decay, reducing tooth structure, accessing the pulp, or simply adjusting a pristine ceramic surface, it's important to know your burrs and how they can improve clinical outcome. Today, we'll be discussing how to put the right spin on your preps and restorations. Our guest is Dr. Lori Trost. She is a recognized dental educator, author, and clinical consultant who maintains a comprehensive restorative practice in the greater St. Louis, Missouri area. Before we get started, I would like to mention that Dr. Trost's webinar titled Putting the Right Spin on Your Preps and Restorations is now available as an on -demand webinar on VivaLearning.com. Simply type in the search field Trost, T-R-O-S-T, and you'll see it. It's an excellent webinar for the entire dental team. Dr. Trost, it's a pleasure to have you on Dental Talk. Thank you, Phil. I appreciate it. What are some of the new features of today's dental births? Great question. So, you know, births is kind of like one of those topics like impression material. And, you know, they're around you. You've probably come out of dental school, perhaps maybe taken some courses. Maybe you have colleagues that have mastered some or really have understood what the innate abilities are, but we don't really always talk about what's used. And really, if you absolutely decide clinically what is super effective for you in your practice, not only does it really elevate how you practice, as can any kind of, say, technically in freshman year, because it sounds like a ho-hum-drum kind of topic. But burrs are something we use every day. And if there's any two things ever in your practice that go down, one can be your handpiece, which you never want that to happen. But really, you need to think about what's in that handpiece. It's your burr. So new features are really critical for that burr. The other thing is you never want your sterilizer to go down, right? Those are the two things. But with new features, the burrs are manufactured now in such precision. that we're able to use a cutting, I mean, it's literally a hot knife and butter on most of these cutting devices. And if you do, I think, proper selection of these rotary tools, your practice, your preps, everything elevates, you're going to have a better experience for the patient. The designs are better. Most of these companies now have extremely excellent IOSO type international standards that they abide by. And because of that, We can use that cutting tool, that burr, as, you know, bottom line, a measuring gauge and a depth gauge. So for our preps, for our reductions, for how far we are, where we're at within the prep, we can really use that not only as just a cutting tool, but also as a measuring tool. And because of that feature and the standards that everyone bites by, I think you really have a great start to really prep correctly. prep with uh with conservatism which is an important thing we all want to do and and follow those guidelines and fundamentals so i think the birds are excellent they the new designs too they also many of the birds in the past and i've practiced long enough i don't know about you phil but I've seen burrs break off in the mouth. That feeling that you look up at your assistant like, did you catch that? Did you get that? And you're really worried. If you're not using a rubber dam, I'll tell you, say you're crown prepping or something, there's nothing worse than looking around for a burr head. I don't care what it is, but it's really a scary moment, right? And hopefully everything's... caught and and removed but now the burrs are much more predictable and if you're using good quality burrs i think single-use burrs that's another reason you want to use them you don't want to over stress these burrs but many of these burrs now and some of the companies are really switched up their design but uh one one in particular company that i really uh i really lean on microcopy because of their design and you just want to reduce any of those kind of fractures but the design of the burr rather than having any welding on the burr the cutting tool along into the shank they literally create the burr out of one component so therefore they can keep the strength there there's no weld you don't have to worry about anything failing so it makes a stronger cutting tool so i think you need to look at companies that really offer designs that are really tried and true and i think microcopy in this essence is my go-to for that choice That's interesting because when I practiced endodontics back in the day, 95% of the burrs that I used was a round burr. We just had tons of round burrs all over the office. And, you know, we'd sterilize them at that time. So how does a burr influence the actual handpiece performance? You always think of the handpiece first and then the burr is secondary, but the burr could actually influence the handpiece. How does that happen? Absolutely. So repetitive use, obviously these handpieces we use now, whether they're electric. or whether they are air-driven, you've got high rotation. And because of the high rotation, you're leaning into that burr, and you're cutting, and you're doing all kinds of varieties. I don't care if it's enamel, dentin, or pulp. But then you start to look at the harder substances. You start to look at the different metals we're doing, the different ceramics, the zirconias. Because of that, and the different types of surfaces and materials, you really push that burr and often the burr overheats often the burr loses its effectiveness because either the diamonds or the carbide design perhaps has just really lost its its effectiveness because it's lost its cutting ability and and the durability of the cutting process and then once that starts to happen the the burr then becomes literally lopsided and because of the lopsidedness and how it circumferentially is spinning It literally then starts to affect the turbine. And even if you're using electrics, that still can play out into that. It's not even just air driven, but it's also electrics because they have the quick connects. So you have to have a good burr design. I think you need to buy quality burrs. I think they need to be single use. You don't need to stress them. Use a lot of water. And that really makes a huge difference. Yeah. And the company you mentioned, Microcopy, they've been around a long time and they have really upped the game. in burrs over the years. So, and they have, they provide a lot of support for their users. If the dentist wants more information on the burrs, there's someone there to get information from, which is important. Tell us about single use burrs. Is that something that's really cost effective? Because it sounds like to me, it's wasteful just to throw a burr out after one use. You know, it's interesting. I think the second that you say single use, two things come into mind. One is going to be expensive. And two, maybe perhaps the quality or the durability of the burr is not as good. So therefore, you're thinking it's kind of, you know, second rate and it's not there. Well, what we've all learned and been through the past few years, we know now more than ever, infection control is paramount. And there's great studies out that show that the contamination, the ability not to be able to properly clean or sterilize any burrs to reuse them is true, too. The CDC has come out. They've talked about it. They've mandated in ways and said, hey, burrs are, you know, even like endodontic files. I mean, I don't know anyone who would want to use an endodontic file repeatedly. And just because, number one, you can't clean them, it's practically impossible, right? And secondly, the fatigue that you can put on those, right? So you've got two elements you need to consider. But with single-use burrs, and I think you go to a quality company that has, that they're a leader. I mean, they've researched this. They know the strains of the metals. They can put a quality product together, but they can also make it cost -effective. And I think at the end of the day, you have to look at what happens. do you want to have your assistants literally trying to scrub burrs individually okay then you have to put them through an ultrasound probably scrub again and then they go into sterilizer and you start to look and do the math you are way money ahead if you do single use because you can prep quicker faster easier better You don't have to worry about broken burrs. You don't have to worry about infection control. Me, those are all mindful things that literally I can carry through, have everything pre -packaged when I come in to do a crown prep. I literally have my four burrs that I use absolutely every time. They're right there in the package. The patient sees that. I think that's a great selling point. And we advertise that we use single-use patient burrs. I mean, that's a big deal. Yeah, no, that makes a lot of sense. I was actually going to ask you, how many different burrs typically is on your setup? for let's say crown and bridge and also for operative yes absolutely so and here again uh You know, it was interesting during COVID and some of that time, that downtime, I really honed every procedure that we do in the practice. And we fine-tooth combed it. And when you start to look at what do you really use, you can start to cost-effectively erase certain things that are frivolous maybe, okay? So I literally now I use four burrs every time I do any kind of indirect restoration, period. It works every time. Okay, that's a beautiful thing. For operative, I go to three burrs, and I can promise you any composite, literally I know I need a rounded design to prep. I need to have a finishing burr that will be usually fluted if I'm doing a class two, and I need to have either a round or a pair of carbide. I just know that that's going to be a given. So the other thing is, you know, the setup and the breakdown, especially the setup, literally. your assistants can have everything right there ready for you to use and it's fresh it's clean you have good cutting effectiveness time is money in dentistry and i'd rather spend the time building a relationship with the patient creating a great experience versus having my assistants buzz around trying to clean something that drops on the floor gets knocked over spilled and can't be found later only to lose that time the time it needs to be focused on the patient doing excellent care yeah i know that makes a lot of sense and it's so true i mean Dentistry is complicated enough with all the procedural things that we have to learn, the technique-sensitive procedures to cut down your inventory on burrs, knowing these four will work no matter what, pretty much any tooth. And once in a while, you might need to grab something else, right? But it's rare. Right. And it just makes things so much simpler, keeping things simple on the inventory side. It's a huge thing, though. I mean, what you're talking about, again, is just knowledge. And again, if everyone can be standardized and understand what you're using, you then are focusing on the patient. And you want to talk about what builds a patient experience. Why does that patient come back to you? It's a good experience. You know, most people, you can sit there, whatever it takes to get that procedure done. Really think about what you can, how do you achieve that? get to that end point. What do you use? Start to track what you're using, what works best in your hands. Take some courses, ask some colleagues. And I promise you, you don't need 39 births to do the job of what three or four can do. You've kind of answered my next question, which is great. So if you could add any more to it, that would be also great. But the question is, what suggestions would you give a new dentist regarding birth selection? Now you covered a lot just there. Anything else you'd like to add? Oh, I get asked these questions all the time. What do you recommend? How do you prep? Well, we know for sure that we need to have with modern day composite resin chemistries, even crown preparations, indirect restorations, we've got to have rounded everything. So you've got to move to rounded type cutting instrumentation. So that's first and foremost. So you need to really master all that. You know, take courses, ask questions, see, look at preps, read articles, look at what is, what can create that. parallel or that best taper. And work with that in your hands. Work on some models. Again, just because we leave school and we think that's behind us, no, it's in front of us. Because get that in your hand. Get your magnification on and look at the cutting surface that remains after you've prepped something and really get a close-up on that because carbides and diamonds are different compared to even white stones, for example, or even a round burr. So I think we've got so many good options. Talk to your colleagues. you know read look at what other people are doing talk to your lab because your lab wants to see a really defined margin and especially for all these beautiful ceramics that we do now make sure that they are recommending to you hey we need to see you know modified round shoulder here or etc we know we can't have a chamfer here we've got to have delineation here those are just key elements in your birth selection so as a new dentist i think if you communicate colleagues communicate to your lab those are great I think, starting points. Super great points you've just made, Dr. Trost. And for our audience, if you're interested in seeing some more detail on prep design, birth selection, Dr. Trost has some great webinars on VivaLearning .com. As I mentioned, she's been a contributor for years to our program. And so just invaluable information that could help you with your practice for years to come. Dr. Trost, thank you so much. It was an excellent podcast. Try to enjoy the rest of your day. I know it's beautiful weather in Missouri, St. Louis right now. So you worked a long day. Enjoy yourself. You deserve it. Thank you so much for being here. Thanks, Dr. Klein. Have a good day.