Essential Dental Systems: PulpOut Bur Technique By: Allan S. Deutsch, DMD & Barry Lee Musikant, DMD
EDS Co-Directors of Dental Research

One of the irreversible complications of endodontics is perforation into the furcation while gaining access to the pulp chamber of molar teeth. Perforation can sometimes be repaired but often results in extraction of the tooth. Currently access preparations are done by a qualitative method involving feel. Can you feel when the bur drops into the pulp chamber? The bur goes from cutting dentin to cutting nothing (pulp tissue in the chamber). This type of approach can often lead to the undesirable result of perforation into the furcation. A careful tactile sense is needed because the length of the bur may be overextended, and the floor of the chamber can be drilled away (Fig. 1).

Calcification of the pulp cavity will also make it difficult to feel when the chamber has been reached, in this situation the pulp chamber roof and floor approximate each other, and perforation may result when the bur traverses the relatively thin floor. Since the diameter of the bur is larger than the height of the pulp chamber as soon as the bur goes through the ceiling it contacts the floor. In this situation you cannot “feel” a drop into the chamber. Since there is no tactile feel, it makes it very easy to perforate.

Recent published research by Deutsch and Musikant have shown that there is a consistent depth from the cusps of molar teeth to the ceiling of the pulp chamber. This depth is approximately 6.3 mm for molars (Fig. 2).

We therefore designed the PulpOut Bur to have a critical depth of 7.0 mm from the cutting end to the non-movable stop (Fig. 3).

This 7.0 mm critical distance is designed to place the cutting ball somewhere in the middle of the pulp chamber for average sized pulp chambers (Fig. 4). For calcified pulp chambers the 7.0 mm distance will place the tip of the PulpOut bur on or at the floor of the pulp chamber. This gives the dentist a starting place to look for the canals.

Technique
There are two rules to follow:

1. One or more cusp tips of the tooth must be intact (either natural or crowned) in order for the PulpOut bur to attain the proper depth. If a tooth is either missing the cusps for measurement or the cusps are appreciably worn down from attrition or the tooth is prepared for a crown DO NOT use the PulpOut bur.

2. Always cut WET.

Technique
Using water spray, in teeth with furcations and at least one intact cusp tip, drill the access opening into the pulp (Fig. 5). If the tooth is restored with a porcelain restoration use a diamond bur first to go through the porcelain. Make a rough outline of the pulp chamber using the PulpOut bur. The correct depth has been reached when the circular stop of the PulpOut drill is prevented from further apical movement by any of the remaining cusp tips (Fig. 4).

Refine the axial walls of the access preparation using the non-end cutting diamond “Shaper” bur. This is done by leaning the diamond shaper against the axial wall and going around the entire access opening outline (Fig. 6). This smoothes the axial walls, lets more light in and makes it easier to find the canals (Fig. 7). You are now ready to look for the canals.

Dr. Allan S. Deutsch attended Tufts University Dental School, receiving his DMD in 1973. An internship at the French and Polyclinic Hospital (1973-1974) and Endodontic specialty program (1974-1976) at Columbia University Dental School completed his post-graduate studies. Dr. Musikant is a graduate of the University of Pennsylvania, receiving his BA in 1965 and DMD in 1969. An internship at the Jewish Memorial Hospital (1967-1970) and Endodontic residence at Kingsbrook Jewish Medical Center (1970-1972) completed his post-graduate studies.

Dr. Deutsch and Dr. Musikant are members of the American Dental Association, American Association of Endodontists, Academy of General Dentistry, The Dental Society of New York, First District Dental Society, Sigma Xi Research Society, Alpha Omega Dental Fraternity, and the American Society of Lasers and Advanced Technologies in Dentistry. Dr. Deutsch is also a Fellow of the American College of Dentistry (FACD). Dr. Deutsch is Executive Vice President of Essential Dental Systems and Dr. Musikant is the president of Essential Dental Systems.

Dr. Musikant’s and Dr. Deutsch’s lecture schedule have taken them to over 200 international and domestic locations. Their dynamic speaking style and ability to direct dentists to the very heart of stress-free techniques is what sets them apart. It is often said that they introduce a logic and common sense that is undeniable. They have co-authored over 200 articles in dentistry in major dental journals, domestic as well as international as well as hold 16 patents for co-inventing revolutionary Endodontic Access, Obturation, Instrumentation, Post and Composite Systems. As partner in the largest Endodontic practice in Manhattan, Dr. Deutsch’s and Dr. Musikant’s 60-plus years of clinical experience have crafted them into the top authorities in Endodontics.

References:
1. Deutsch A and Musikant B. Morphological measurements of anatomic landmarks in human maxillary and mandibular molar pulp chambers. Journal of Endodontics 2004;30(6):388-390.
2. Deutsch A and Musikant B. Morphological Measurements of Molar Pulp Chambers. J Dent Res 2004;83(Special Issue):Abstract #3303.