Size and Shape Matter in Operative Dentistry

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Selection of the proper burr can make your operative dentistry more efficient and less traumatic to the patient. Thinking about what the burr needs to do to the tooth before starting the procedure will make your burr selection easier and dentistry better. Today we'll discuss why burr selection is important and try and get you out of your burr comfort zone. Our guest is Dr. Martin Jablow. He's a general dentist in Woodbridge, New Jersey, and chief development officer of Celerant Consulting. Dr. Jablow has been recognized as a top speaker by Dentistry Today and has lectured worldwide on dental technology and materials. Before we get started, I would like to mention that Dr. Jablow’s webinar titled Size and Shape Matter in Operative Dentistry is now available as an on-demand webinar on VivaLearning.com. Simply type in the search field Jablow, J-A-B-L-O-W, and you'll see his webinar. It's an excellent webinar for every dental team member to watch. Dr. Jablow, it's a pleasure to have you on Dental Talk. Thanks, Bill. Always a pleasure to be here. Yeah, so we're talking about burrs now. And most of us are pretty familiar with a dental burr. It's part of our profession. You talk about size and shape matter as the title. How many different burrs do you think you use on a routine basis? You've got a great amount of the work that you do is class two restorations, right? Because interproximal decay is pretty prevalent. So you're dropping boxes and you're doing MOs, DOs, MODs. You're doing crown preps. I don't know how many veneers you do. What kind of what's your typical crown prep looks like? But what are we looking at as far as armamentarium, as far as inventory of burrs, sizes and shapes? How many do we need? So everybody's going to have a different take on this stuff. I try and keep it to a minimum. All right. Now, that doesn't mean I can't go into the drawer and get another burr that's specialized for whatever I need. But, you know, if I'm doing a class two restoration, I use a carbide burr. I may have a very fine, like a mosquito diamond where I can, you know, put a bevel where I need it, open a contact minimally where I need it so I can drop my matrix in, things like that. You know, I try not to overthink them in terms of what I'm going to do. I try and keep it simple. That way we don't have to stock inventory, which, you know. Dentists are notorious where you've seen those burr blocks, you know, with 20 burrs on it for just doing operative, but which they're not using 20 on a regular basis. When it comes to crown and bridge, it's the same idea. You know, I'll have different sizes and shapes based again on what I'm looking to do. Obviously, you know, the size of a lower incisor is different than, you know, a maxillary canine and or a molar. so you know i have a smaller footprint diamond different lengths um and then you know football if i need to do an occlusal reduction or sometimes again you know how many planes are you looking to do these become personalized on how you prep and then finer diamonds to smooth things out Also, it depends how you want to, you know, what the preparation is going to look like. Do you want, you know, your margins? What do they look like? How are you going to finish them? Can you turn the bird, you know, the handpiece down low enough and really, really finesse the margin if you need to? Are you going, you know, interproximately enough? Do you need to, you know, cut into those areas with a very fine diamond? So there's a little bit more for my crown and bridge, I would say, than there is for. my my basic operative setup and that's only because there's going to be a lot more to try and figure out what i need which goes back to what am i wanted to look like in the end and then take the proper size and shape birth to accomplish that you know a tapered burr versus a you know a cylindrical burr isn't going to necessarily give you your taper you're going to get a straight up and down you know preparation which you then need to go back in and modify again it's an individualized thing But I try not to have it over. We try not to overthink it because we don't need that kind of inventory. The bottom line is you need quality cutting tools because you want to minimize heat, friction, vibration. It sounds like to me that you're focusing on one use is the best way to go. Absolutely. I think that's the surest thing you can do. One use burrs. I mean, Microcopy has a lot of them and they're all disposable. There's other companies, too, that make disposable burrs. I'm not a big fan of that, like I said, that 100-pack or the 500-pack where they're all just thrown in. You have no idea what the quality of those burrs are. And in most cases, and we've tried them. I don't want to tell you I haven't. You know, we find that they just don't cut as efficiently as the other ones. And I'd rather just spend a little, maybe it's a couple of pennies more and get something good. that I know is going to work. You also don't want those burrs snapping while you're preparing the tooth because the cutting part of the burr could fly into the patient's mouth and get lost in there. It's a small rotary. Yeah. So with that, I'd like to say it'll fall possible. Use a rubber dam. Use a dry shield or an isolate type of device. You know, something, something one, you get better results in a dry field. It takes the stress off you as a dentist. It's much easier to do. Doing it right the first time makes everything easier. Yeah, a rubber dam seems to be almost standard care now with, of course, the infection control aspect. Isolation is so important now for the safety of the patient and also for your working environment. And also, I just had a podcast with Dr. James Klim. It was very interesting. He mentioned he likes the rubber dam for all those reasons. In addition, the patient's not talking to him the whole time. That's a good one, too. Yeah, talk about efficiency. Right, patient management right there. Right, especially if you're doing, you know, two or three teeth in a quadrant or on a, you know, that, I mean, the nice thing with a, you know, that's for a rubber dam. If you've got an isolate, you can do top and bottom on the same side. Right. You know, and the same thing. Plus with that, actually with the, with the isolates and the dry shield type devices, the thing with that is it's actually less traumatic to the patient because if you've ever had to keep your mouth open for extended periods of time, like having an endo or a big, you know, operative or restorative procedures, it's not the easiest thing. You come out with a sore jaw. Well, now you're biting on that bite block and you've solved the problem. Yes, you can still bite on a bite block with rubber dam, but again. You know, it's a little bit more access than necessarily a rubber dam. So all the materials are meant to be placed in a dry field. Everything in dentistry is supposed to be done that way. I won't say I do it all the time, but you get the idea. Do it right the first time. Use good quality products, good quality handpiece, and you're going to get better results. Are you using an electric-powered handpiece for everything now? You're not using air-driven any longer? I haven't used air-driven handpieces. for restorative work in a very long time probably well over a decade um i need the torque the quietness the less vibration um i i always like to say if i had to go back to using air for most of this stuff i wouldn't want to do dentistry precision tools give you precision results um i happen to use bn air hand pieces and you know i can set that important part is i can set the rpms to exactly what i need i don't have to think about it and in many cases you need to look at what those rpm setting is are on some burrs especially when using finishing burrs or we're using zirconia cutting burrs or you're doing polishing burrs because they're not all set to high high speeds that's like i you i like to call if you use the shofu brownies and greenies i call them rubber bullets you know they fly off if you over rev them and they hit you, and you know you got hit. So they're rubber bullets. And if you set the speed properly, you don't get rubber bullets. Let me ask you this about carbide burrs, and we'll hit diamonds also. Are all carbide burrs basically the same today? No. There's nothing that's ever the same, all right? You know, it depends what you're looking to achieve again. If you're looking to do maximum cutting efficiency, a brand-new burr will always surpass anything that you use twice. Then you talk about sterilization. Then, you know, strength. You know, you can buy, you know, 100 557s or 558s in a package, in a plastic bag. Or you can buy them individually wrapped, sterilized, one use only. And then you don't worry about things of potential like overheating teeth or not having proper cutting efficiency. You know, these are the things that people need to be aware of. You know, they try and save money. You know, we all know what dentists are, for the most part, are very frugal. And, you know, with that, you know, trying to use a burr until it barely cuts anymore isn't good for efficiency, and it's sure not good for a tooth. Are you using disposable burrs on the carbide side? On the carbide side, we pretty much use disposable burrs, right? Take them, use them once, get to another one, because after two or three rounds with the sterilization, they don't cut well anyway. To me, I'd rather pick up one burr than pick up two or three in the course of doing what I'm doing. What about diamonds? What about the diamond burr? Diamonds, sometimes we use disposables. Sometimes we have non-disposables. It depends what's in the packaging that the assistants are setting up for me. But again, it's the same principle. If you buy a good diamond... then you can definitely get more than one, two, three uses out of them. But you get to about five uses and you've lost cutting efficiency. And that's because things get clogged. Unfortunately, the staff doesn't always clean them properly. Sterilization cycles will also impact the cutting efficiency. So with all of those things, you have to take that into account. And sometimes where you think you're saving money, you're losing time. And time is your most valuable asset. So let me give you a couple of clinical examples and tell us what burrs you like to use. You're cutting through a porcelain-fused to metal crown, trying to get access. All right. So I'm going to access for endodontics through a porcelain -fused to metal crown. What I want to use is I still want to use something. I can use pretty much anything. It'll cut through it, all right? But I want something sharp. So I'm going to look for something new. And the reason I want to take something new is I want to cut down on vibrations. There's a high likelihood of fracturing porcelain in a PFM. uh i mean you you yourself have done plenty of accesses through them and you know that's the risk of going through a pfm crown is that you're going to fracture porcelain so i want to keep the bird chatter to a minimum for that i need something sharp so i'm going to go to a new burr whether you prefer to use a diamond or a carbide you know is one thing if i'm going to do an endo access i want a diamond again for that finer cutting and the abrasive part of it if i'm going to remove that pfm crown I'll pick up a 557 and I'll just cut through it. Now, it may take more than one to do that because the porcelain's hard and you'll wind up chewing up the burr. But again, you know, a 557 to cut the burr off in a PFM is no big deal. But if I want to be careful with an endo axis, I'm definitely looking for a finer diamond. Yeah. On the endo axis, what shape? That depends on your... Personal thoughts. I mean, I've done everything from the footballs where I can kind of lay them into the occlusal surface to, you know, an end cutting diamond where you can kind of control exactly where it's cutting a little bit more. Size of the tooth matters. Let's talk about Emax, getting through an Emax crown. When I start getting into Emax or Zirconia crowns, I like using the microcopy Z-class neo-diamond burrs. They also make finishing burrs for zirconia in Emax, which are really nice, too, in different sizes and shapes. But with that, I want to use one of those. Why? Because the diamond structure on those is very symmetrical. It's made to cut through these things. And most people complain about cutting through zirconia. All right? It's hard. You can't just pick up a carbide burr and cut through zirconia. That's not going to happen. very easily or efficiently. You can do it with a fine diamond, but even that, you can go through a bunch of those, burning them up. If you use a Z-class burn from microcopy with a lot of water, light touch, not a heavy touch, a light touch, you can access a couple of minutes. You can cut a crown off in a couple of minutes. It doesn't need to be this daunting task that a lot of dentists think it is, and part of that is not using the right armamentarium. A specialized burr to cut through zirconia is a must. And like I said, I use the Z-class neo-diamond burrs. And I personally like a handpiece, an electric handpiece. Why? It gives me more torque, but I don't necessarily need all that torque. What I usually do is I cut the RPMs down a little bit so I get that fine cut. Let the burr do the work. I think they used to say that in dental school. Let the burr... go through that zirconia, not me trying to force and put lots of pressure on it. So I usually do it about 100,000 RPMs and I can easily access for endo or cut the zirconia crown off. And the same thing for Emax. So is a Z-class neo-diamond burr a disposable burr or is it autoclavable? It's autoclavable, but they come in disposable packaging. So that's kind of how we do it. It's one and done. In your lecture that you gave, Size and Shape Matter and Operative Dentistry. What else did you cover? And I recommended that to our audience to check that webinar out in my introduction. What else do you cover in there that you could talk about in the next minute as we wrap up this podcast? So one of the things, again, is we don't think about birth because it's something we've been using since dental school. But don't overuse it. Don't take a birth until it no longer cuts. You know, think about it. If you want to use a non-disposable, how many times can you use it? You know, I don't think you should go over four or five times. We hope to have you on another podcast, another webinar soon. Thanks so much, Dr. Jablow. You're welcome there, Phil. Good being here, and we'll have another one in the future.