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Clinical Overview

(Photo: Clinician’s Choice)
0 Comments Feb 27, 2017 | Overview USA

CleanCut extended diamond burs: Truly a diamond in the rough

Post a comment by Douglas Harvey, BSc DDS

Precision is the hallmark of prosthodontics. Careful thought and consideration must be given to the impact of occlusion, esthetics, the type of restoration and the amount and location of tooth reduction. Models and mock-ups are frequently used before the tooth is even prepared. While planning is essential to the success of the case, it is the precision of the preparation that will provide the best foundation from which your lab can build the perfect restoration.

The diamond bur is the workhorse of the crown and bridge procedure, yet its significance is often overlooked.

Diamond burs of varying quality and cost are available in similar shapes and grits from a multitude of manufacturers. At first glance, there may not be a lot of difference between them. Upon closer inspection, one starts noticing the variations within and between diamond burs. It’s when the bur is rotating on the tooth that the discrepancies and differences become more obvious, both in feel and result.

Having the right diamond bur is key to establishing the most desirable restoration. Unfortunately, there are often shortcomings of the diamond burs that we use that can result in preparations that are poorly defined, rough, inaccurate and require additional burs and time to refine.

Diamond burs are classified as either disposable (single case) or multi-case. Most diamonds, disposable and multi-case alike, are manufactured using an electroplating process. An electrical current is applied to a bath of diamond particles suspended in nickel. This causes the suspended diamond particles and nickel to attach to the steel or stainless-steel bur blank that has been placed in their midst.

The distribution and density, along with the height and orientation of the diamond particles, is not easily controlled. The result can be a significant variation between diamond burs from the same manufacturer and between manufacturers. The composition of bur blanks range from tool steel to stainless steel; their diameter strictly controlled or not.

In the case of a lower quality diamond bur, it may not fit the handpiece properly and lacks true rotation, causing noticeable vibration and ineffective cutting. There is a tendency for more diamond particles to attach closer to the tip of the bur because of the nature of the electrical current. This lack of an even distribution of diamond clusters is made even worse by the variation in the pattern in which the particles are submerged in the nickel plating.

The diamond particle may sit atop of, partially or totally submerged in the nickel plating. Those diamond particles that sit above the more embedded particles are the first to contact the tooth. Early particle loss and gouging/scratching are common with this occurrence, to the extent that many practitioners follow up the cutting of their preparations with a finer diamond or carbide bur to smooth the cut surface and refine the margins.

Those particles that have only part of their cutting surface exposed wear quickly and are inefficient at cutting tooth structure. Orientation of the individual particle is randomized with the electroplating approach to diamond bur production. Asymmetrical particles may have their sharpest surfaces embedded within the nickel matrix, leaving their smoother, less efficient cutting surfaces to handle the tooth reduction. With an inconsistent distribution and concentration of diamond particles, it increases the chances of clogging in the area between these clusters.

Not only does a clogged, inefficient diamond bur result in a preparation that is unpredictable in both time and accuracy, this bur can generate heat that may be harmful to a vital pulp.

A valuable rotary dental instrument

Dentists who consider a smooth, precise tooth preparation to be an integral part of a quality indirect restoration can also appreciate the importance of doing this as effectively and efficiently as possible.

Once the pre-treatment diagnosis and planning have been done, it is time to prepare the teeth. A diamond bur needs to have the ability to produce a smooth and accurate preparation efficiently, without the need to refine, and possess none of the previously described downsides of an electroplated diamond bur. In order to control all the variables that may lead to a poor quality diamond bur, Clinician’s Choice Dental Products has turned to a controlled diamond placement technology that enables it to have a predictably randomized distribution of its diamond particle clusters.

CleanCut Extended Use Diamonds are constructed of synthetic diamond particles that are extremely uniform in their size, shape and orientation, positioned directly onto the stainless-steel shanks to create consistent outer edges and permanently held in place by a proprietary permanent bonding system. The result is a balanced rotary instrument, the cutting surface of which is consistent in height and aggressiveness.

Distinct, debris-clearing channels emerge from these clusters. These channels allow for significant, continuous flushing of debris and water away from the bur, keeping the diamond clusters exposed for optimal cutting while cooling the bur and surface of the tooth. The resulting preparation is smooth and accurate with little need for refinement. Once the preparation is complete, the CleanCut diamond bur can be autoclaved and retains its cutting efficiency, case after case.

Popular shapes, aggressive grits: Prepare to be amazed

CleanCut Extended Use Diamonds are manufactured to exact specifications. This attention to detail ensures predictability and reliability in the area of the prosthodontic appointment where precision is demanded.

Feedback from the handpiece has its origin on the tooth with no interference from the rotating bur. Diamond particle clusters all act in unison while debris-clearing channels keep the cutting surface clear and cool, giving an aggressiveness to the bur that belies its grit designation: Medium grit CleanCut handles more like a Coarse grit diamond bur.

Depths of reduction and margins appear precisely where the operator has guided the handpiece, and the cut tooth surface is impression-ready with little to no need for smoothing.

Quality preparations are essential to a quality restoration; providing this level of dentistry while minimizing chair time and instrumentation is an effective way of cutting overall costs without compromising quality or integrity. CleanCut diamond burs may be a small part of the armamentarium but provide a big, positive impact on your crown and bridge cases.
 

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E-Paper

DT U.S. No. 7, 2017

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