Dentaltown December 2020 - 46

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OkKad
Member Since: 04/17/17
Post: 54 of 82

Bur efficiency (new vs. old) and how " heavy-handed " you are with the amount of water is
what does it. The more you feel your hand pushing into the tooth, the more water you need
(or maybe even a new bur). The more " gliding " or " butter " feel means less energy is getting
transmitted to the pulp. It also means you can go faster.
Even more true with electric than air. With an air turbine, as the bur wears out, the speed
slows down because of the added friction from the bur not cutting. When I was a new grad, I
even used a few that stopped the air drill completely (crappy drills, chairs, too). My point is,
with air-driven you can tell that it's time to change burs and you basically have to change them
out. With electric, it's a double whammy of being 2x faster and it self-adjusts to keep the rpm up.
It is much more difficult to realize the bur is worn-out. If it weren't for my own impatience,
I'd cut multiple crowns with the same bur because it keeps going! Even though the bur is worn
out. I switch mainly for my own impatience. Old burs in electric for gross reduction isn't a good
combo, especially younger patients with big pulps.
I rambled a bit there, but I spent a little over a year in an air-driven office, about two years in an
electric office, and it took me a while to get a working feel for how these things impact the pulp. ■
9/18/2020

ddsbluejay
Member Since: 10/23/19
Post: 57 of 82

I want to follow up with this thread with what I have learned and changed.
All the advice here has been helpful. I changed three main things with the procedure.
These electric handpieces make it difficult to tell when a bur should be tossed. I now use
new coarse-grit burs for crown preparations. I also went from a large barrel to a skinnier straight
cylinder bur for the whole prep. Depth cuts first, then gross reduction, then refinement.
I have the water maxed out. It can get a bit messy, so I put a clean towel over the patients to
help with any inadvertent water spray. They tolerate it well and are understanding. It puts me at
ease to keep the tooth as cool as possible.
Also, I have been making my own temporaries, making sure margins are closed off and it is
out of occlusion. I have still been using TempBond Clear and it has been fine.
I was worried the patient I originally posted about would need endo on both teeth. I anesthetized the patient, cleaned the teeth thoroughly and used temporary cement with the crowns.
She had them on for 3 weeks. During that time, she felt significantly better and came back to
get them permanently cemented.
The crown preps I have done after this post have had excellent results with little postoperative discomfort. No follow-ups for pain and some normal cold sensitivity at crown seats, which
I usually anesthetize for.
I think patient population has to do with it a bit, because initially was treating a geriatric
patient population and transitioned to a much younger population. I used the same amount of
water upon transitioning and expected the same results. Also, the electric handpiece likely was
a factor as well.
Thanks again for everyone's input! ■

11/2/2020

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DECEMBER 2020 // dentaltown.com

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Dentaltown December 2020

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