Level-up your skills faster in an ideal, predictable working environment. In this piece, we’ll share 3 ways dental teams can make the prepping and bonding process faster and easier.
Watch this video to learn how the Isolite System helps you:
- Gain ideal access in your oral working field
- Ensuring your patient is completely protected from an accidental cut to the tongue or cheek
- Eliminate the need for extra hands in the mouth
Rolando Mia: Good day, everybody. Welcome to Dr. Tom’s tips Case of the Week. The purpose of this show is to give you an opportunity to get tips from Dr. Hirsch about how to use Isolite® in different types of cases. Today’s case is using Isolite® in cementation and bonding.
The Case: Cementation and Bonding on Number 3 and 31
Dr. Tom Hirsch: So, today what we’re going to do is share a few tips that I’ve learned over the years in cementing and bonding. I want to show you a couple gadgets that have made my life easier.
Today, we are bonding a crown to tooth number 3 and tooth number 31. I don’t usually do single procedures; I don’t like to do it. We’ve talked about this before, the concept of opposing procedures, upper right and lower, right. Just makes life really easy. It makes dentistry really profitable. Not that money is a good thing or a bad thing, but it’s better to have it than not to have it.
So, that being said, let’s get into this video where I’m going to be bonding up to tooth number 3 first and then down to 31. Let’s roll.
#1: Gain Ideal Access, Visbility, and Isolation for Your Prep
The first thing is, take a look at the Isolite® at tooth number 3. Remove the temporary. This thing is the coolest thing. I’m going to show you where to get this later on, but that is an articulating paper holder that holds articulating paper. Also, I use it for plain old Teflon tape, plumbers’ tape, to put that in between the teeth. Resin is a mess. It just bonds to everything to everything, it’s really a pain to get off. So, anything that you can do to mitigate the cleanup of resin cement, do it. So, with that little instrument right there I put the Teflon tape in.
I put the tape on the mesial of the number 2, and then I’m going to put it on the distal of number 4 keeps that area nicely isolated. I use a little Explorer or a Hartzell instrument to tuck that down under the gum line and make sure that nothing is getting past that area. That’s going to bond to the adjacent tooth.
You can see you don’t have to use two hands to put on Teflon tape anymore. You know, using two hands inside the mouth can sometimes be really a challenge. So, I’ve got everything isolated right now. We had already done our etching and we’ve already primed and bonded it.
So, now what we’re going to do is just get right into the cementation procedure. I am using the Medium DV Isolite Mouthpiece. One of the cool factors is I can utilize with the Isolite is the Amber filter. I can have really have great visibility without having to shut down lights so that we don’t prematurely cure the cement. Some of you may be lucky enough to have operatory lights that go Amber or headlights that go Amber; this is just another light that goes Amber.
So, we’ve dried the whole thing off, and I’ve got the crown filled up with the cement that I like to use. I think this was Relyx in this particular case. I then hold it in place and get a real quick cure. Just a spot cure for a second. Pause it right there for a moment, Ro, if you would please.
So, with all these different resin cements, a really important thing to do, is to test these things outside the mouth with your curing light, see just how long it sets. Some of these set, you blink, and the stuff was already set in hard.
Other ones, you’ve had a few seconds of light curing before it turns hard. So, always test these things outside the mouth. It’ll make life really easy for you, rather than waiting and curing the sink to a hard point. So, on this particular cement, with Relyx, it’s about a one second, a quick touch on the buckle. One second, quick touch on the lingual.
Rolando Mia: And I can see that the material just sits there. It’s not falling down the throat.
Dr. Tom Hirsch: I actually went back in there. It was still not quite set enough, so I use the little brush to get it off. I don’t have to worry about the cement setting and being bonded to the adjacent teeth.
Sometimes, getting the stuff out with the cotton plier can be a little challenging. I like the hemostatic better, but that just happened to be what we had in my hands. You can see, it’s a pain sometimes to get that stuff out, with cotton pliers, pick up a hemostatic, it comes off a lot nicer with the hemostat, or certainly it flosses out pretty easily.
So, after being frustrated with my cotton plier, I said, “Heck it, would give me a hemostat?” because the cotton plant just wasn’t gripping it. You know, I had an older cotton plier, and it just wasn’t gripping. And so we’re able to grab that with the hemostat and move it all out. There we go.
Most of its out, now we get the little, tiny piece. And if we can’t get it out with that we’ll go back in and floss it out. Yeah. Make sure your assistants hold it in place. You can see a little tiny shred of Teflon tape coming out. Then I always put a little glycerin over that because there’s always an oxygen inhibited layer that doesn’t set.
#2: Ensuring Proper Isolation and Protection With an Isolite® Mouthpiece
So, I utilize the Medium Isolite Mouthpiece in this particular one for the upper arch. I wasn’t thinking far enough ahead. You can see the Medium Isolite Mouthpiece cuts right across tooth number 31 on the lingual.
So, I’ve got a couple of ways I can address this. One, I can stick a cotton roll in there, which I’ll show you later on in a moment. However, what I ended up doing, I took that out put a medium DV Isolite Mouthpiece in instead. So, just remember that one picture and then remember what it’s going to look like with the Medium DV Isolite Mouthpiece.
The Medium DV Isolite Mouthpiece is fabulous for these lower second molars, right-hand or left-hand side. So here, I’ve got the Medium DV Isolite Mouthpiece, and you can just see the difference in the isolation potential that we have right there. The tongue’s out of the way, and everything is nice.
Here comes the next secret. Yeah, sometimes I use a cotton roll. Like I said, you could do this on the Medium Isolite. I use the medium DV Isolite. Use everything that you can that’s in your armamentarium. That’s a little extra added safety right there, just in case they swallow, and saliva comes up. With the Amber filter, you can see how nice that is.
So, these videos that you get from me, you know, these are just the down and dirty videos. These are the day-to-day procedures. I’m in the office and I’m working. I’ll have my assistant pick up my iPhone. So, this is just happening in the middle of day-to-day procedures. Nothing staged, no professional photography at all.
#3: Eliminate the Need for Extra Hands in the Mouth
Rolando Mia: You know, what’s interesting, Dr. Hirsch, it’s really nice to see. You’re the only one inside the mouth who has direct access to the entire procedure. I noticed the Teflon tape, the tip around that. Then, also the fact that the mouthpiece was riding on the occlusal surface of number 31. You could see that. So you just replaced it, which worked really nicely. Cotton rolls.
Thank you so much, Dr. Hirsch. We’ll see you all next Tuesday for the next installment of Dr. Tom’s Tips Case of the Week. COW.