October 2008 | Dental Products Report
Technique
Removing gross soft decay using a ceramic bur.
By Dr. Lou Graham, Glenview, Ill. Information provided by Komet USA.
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All-ceramic round bur
Features • Highly efficient all-ceramic round bur for minimally invasive excavating • Exceptional tactile feeling • High cutting efficiency in infected, soft dentin • Minimizes the risk of reducing healthy tooth structure |
Komet USA
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The most common procedure for many dentists is removing tooth decay. Dentists have gone about the process for years using carbide burs in lowspeed handpieces at 20,000 rpm. When the decay is deeper than they expect, they may have to use spoon excavators, explorers and caries indicating solutions.
This has been the methodology for years, yet most practitioners still feel uncertain if all the infected dentin has been removed. Too often, dentists drill beyond what they need to, resulting in excess dentin removal. This leads to either direct pulpal exposure or long-term adverse outcomes.
This year, Komet USA introduced the K1SM CeraBur, a new ceramic slowspeed bur. With multiple sizes in round configurations (2, 4, 6 and 8) and with gentle application, the K1SM CeraBur allows the dentist to feel the intersection of the infected and affected dentin. The specific ceramic material removes infected dentin efficiently at specific speeds of approximately 1,000 to 1,250 rpm. Any slower or faster defeats the purpose of the K1SM CeraBur–making this a critical issue. At proper speeds this bur will slowly remove the remaining infected dentin. Clinicians can feel when they reach the healthy dentin.
The technique used in the operatory is to remove gross soft decay at the same speed with a new carbide bur. Once removed, caries detectors and transillumination are used to verify the remaining infected dentin. Using this all-ceramic round bur allows practitioners to finalize the decay removal process and leave what is most important–healthy and intact dentin that is unharmed. At these speeds, dentists will see they have a far greater awareness of what they are removing and when to stop. The following sequence explains a brief technique used:
Common steps
Access treatment site using Komet’s Fissure/Anatomy Kit 4520 instruments or Komet’s Micro Preparation Kit 4519.
Use a customized lowspeed handpiece (e.g., Ceratorq from Medidenta) at 1,250 rpm, and a round carbide bur allowed for the removal of softened decay.
Apply a caries indicator and rinse.
Use transillumination to visualize the area.
At the same speed of 1,250 rpm, use the K1SM CeraBur for the final careful removal of infected caries. Fig. 1 shows the infected dentin being removed at 1,250 rpm with the K1SM CeraBur in the incisal region of a canine.
Re-apply the caries indicator and transillumination, and repeat the procedure with the K1SM CeraBur if any suspicion remains.
Clinical case
A 51-year-old patient came into the office with transient cold sensitivity beneath an amalgam filling that was 30 years old (Fig. 2). X-rays revealed the filling was already deep in the tooth. Careful excavation was absolutely essential for the success of this procedure.
After removing the amalgam with the Amalgam Remover H32, rinse the area. Use a lowspeed handpiece at 1,250 rpm in combination with a #4 round carbide bur to remove the infected dentin.
Rinse the area again, this time with a caries detecting dye solution (Fig. 3) and transilluminate (Fig. 4). This allows for the removal of the final infected decay using the K1SM CeraBur (Fig. 5).
After confirmation of decay removal, place a glass ionomer base and insert composite resins. Fig. 6 shows the restoration completed for both teeth.
In dental literature, careful removal of infected dentin can result in long-term successful outcomes in restorative treatments. Literature also has shown that it is better to leave some minor amounts of infected dentin than to remove excessive dentin and encroach on pulpal tissue.¹, ²
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| Fig. 1 Example of decay being removed using K1SM CeraBur (separate from clinical example). | | | | Fig. 2 A pre-operative image. |
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Fig. 3 The caries indicator. | | | | Fig. 4 Transillumination.
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Fig. 5 K1SM CeraBur in place for final removal of infected dentin.
| | | | Fig. 6 Final restorative procedure completed for both teeth.
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References
1. Frencken JE, Songpaisan Y, Phantumvanit P, Pilot T. An atraumatic restorative treatment (ART) technique: evaluation after one year. Int Dent J. 1994;44(5):460-464.
2. Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA, et al. Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc. 1998;129(1):55-66.
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