Howard Speaks by Howard Farran, DDS, MBA, MAGD

One night last month, sitting in my underwear, reading the online DentalTown message boards, a frequent poster, August reported "I have problems with little annoying voids within my fillings." That statement really got me thinking about how those voids seem to only occur in fillings and not when I'm pouring models. So, what's the difference? A vibrating device! Just think about it for a minute…if we poured up our models without a vibrating device, we would have voids galore.

Then, around midnight, all four boys were asleep, I had a vibrator in my hand...and a solution finally hit me! To solve our voids we should be touching a vibrator to the tooth. In fact, I think Centrix should put a vibrating device into their syringe. Wouldn't it be awesome if when you squeezed the Centrix syringe it started to vibrate?

That's what I really love about the Townies (message posters) of DentalTown. They are ALWAYS talking about something interesting–something that always forces me to evaluate my own equipment, products and procedures. If there is one thing I can say without a doubt, dentists are brutally honest on these boards, even when referring to themselves. Take a dentist named Dan for instance. Recently while participating in a discussion about latex gloves and the ongoing cautions about allergic reactions, Dan stated "I have non-latex around, but only use it on allergic patients because I'm a typical cheap-ass dentist." A cheap-ass dentist! Yes, he said it and a lot of other dentists agreed with him that they were just as frugal at times.

Speaking of cheap, dentists continue to place more amalgams than composites, because of their varying economic demographics but the amalgam dentist never seems to get any respect.

After the September 11th terrorist events, the only airline that made a profit AND expanded by adding more routes was Southwest Airlines. All the high-priced players went begging to Uncle Sam for a bailout but not Herb Kelleher, President of SWA. Knowing your costs and your customer's needs and wants (and the difference between the two) are essential to every successful business plan. So, if you're in a rural area of Ohio, like our Townie, Marshall White, and your patients continually tell you that they “can't afford that, doc” you need to adjust your practice to your consumers’ demands. If though, you are still packing amalgam because you are afraid to include composite fillings on your practice menu, I recommend you attend seminars at the Pankey Institute, Pac~Live, or LVI. Just don’t let these institutes change your Wal-Mart business model. Remember, when you live in Walmartville, you better focus on Fords and Chevys, while you still make the occasional Mercedes Benz.

So, what is my latest cheap ass dentist discovery? That would be .06 tapered gutta percha cones made by Meta Dental Corp (718-639-7460 or www.metadentalco.com).

I have always loved Thermafil because it was faster, easier and cheaper than lateral condensation. But what bothered me was that all of my endodontist friends never used it because they did not like leaving any carrier–plastic or metal–down the middle because it makes it harder to re-treat, if necessary. The .06 tapered gutta percha cones are the exact same shape as the .06 tapered Tulsa Dental ProFile files. These cones drop into place exactly and are as easy to use as the Thermafil obturators, plastic or metal. They even have the same markings on them with a line at D2 16mm, 18mm, 19mm, 20mm, 22mm, & 24mm. And to top it all off, you can get a box of 60 for $10. That's 16 cents apiece!

Here is my root canal technique. First, I prepare the tooth for the final restoration. Usually this is preparing an MOD amalgam with recurrent decay for a full coverage crown. I place my Ultradent zero cord, then one cord. When the tooth is prepared for the final restoration it is faster, easier and cheaper to access the canals. I go crown down. I only use Tulsa Dental ProFile .06 tapered NiTi files. Every other file that I have used has broken at least once every 3 to 4 months. When a file breaks it ruins my day! I hate it. All of my endodontics friends switched to .06 tapered files over a year ago for the same reason. I can honestly tell you that you will almost never break a Tulsa Dental ProFile .06 tapered NiTi.

I start with a 45 file in the Tri-Auto ZX–a cordless 300-rpm drill with the J. Morita Root ZX built in to it! Talk about sweet! After the 45, I drop to 40, sometimes, 35, and sometimes a 30 or even a 25 if the canal is extremely curved. Then I rinse with NaOCl, 1 part Clorox bleach to 10 parts water. After rinsing with bleach I then fill up the canals with NaOCl and agitate each canal for 60 seconds with either the last .06 tapered NiTi file, or an ultrasonic file in a Medidentia 1500. This is mandatory if you want to pick up pretty little lateral canals routinely. The bleach turns to a thick white milky sludge and you know you cleaned the canal beyond the shape of the file. I use AH-26 sealer. And now, Meta Dental Corp .06 tapered gutta percha obturators. I use the touch & heat to seer off the cones. I condense the gutta percha. I then clean out the area with a Danville Microetcher with 50-micron aluminum oxide particles. Place Clearfil SE self etching primer and bonding agent. I then place Dentsply Fluorocore build up material and cure with Den-Mat's Sapphire light. Refine the prep. Pull the one cord leaving the zero cord in place. Use ESPE Impregum from the Pentamix mixer. Inject with a syringe around the tooth and then firmly blow down on the material with an air syringe. Load a Premier sideless triple tray. And voila, you have a $19 PA, a $15 bitewing, a $55 exam, a $705 molar root canal, a $175 build up and a $754 crown, for a total of $1723, and all done in 90 minutes.

Isn't dentistry the greatest? See you online.