AVA lecture notes 2005 - Basic Equipment Overview


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AVA lecture notes 2005 - Basic Equipment Overview

  1. 1. BASIC EQUIPMENT OVERVIEW Dr Rod Salter BVSc MACVSc (Veterinary Dentistry) Melbourne Veterinary Referral Centre 70 Blackburn Rd Glen Waverley 3150 Abstract: A plethora of pathology affects the oral cavity. To offer a complete Veterinary Dental service numerous disciplines are involved. Catalogues offer a bewildering array of equipment of equipment and supplies. This presentation provides an awareness of these disciplines and what, in essence, is required to perform “all matters dental”. You may not wish to acquire it all at once but with this lecture you will have an awareness of the big picture – from here you can pick and choose the elements you wish to cover initially. This is a checklist presentation from a practitioner, for practitioners who wish to establish ( or expand ) a veterinary dentistry department in their own general practice. The obvious response to the above sentence is “why bother”. I have found that in both a general practice scenario and a referral centre, Veterinary Dentistry is fulfilling, challenging and satisfying. Most importantly we have the skills, the information and the technology to change DENIAL into DENTAL. To coin a phrase – it’s a win, win, win situation. The pet benefits through better health and function. The owner has a happier, healthier pet. The vet benefits through a job properly and expertly done. Dentistry is undoubtedly a profitable exercise, whose returns compare most favourably with all other aspects of practice. I would suggest to not bother is at least an inefficient use of a practice and probably is negligence. The entire field of veterinary dentistry can appear complex and bewildering, thus to simplify the decision making as to what to get and why, the “field” has been dissected into components. There is an almost never ending array of instruments, materials and equipment. In this lecture, I will present my choices and experiences. I would suggest the real value of this presentation is the checklist – use it to catalogue your clinics inventory, and from this to determine what deficiencies you have. Filling these deficiencies should enable a high quality of Veterinary Dentistry to be performed in an efficient, profitable practice These components should be of most importance to the general practitioner •GENERAL EQUIPMENT •ORAL EXAMINATION •RADIOLOGY •PERIODONTOLOGY / PROPHYLAXIS •ORAL SURGERY
  2. 2. The remaining disciplines are included for completeness sake. In some cases you may initially elect to refer cases in these disciplines however they are areas for future expansion of any practice. My personal choice was to become involved in these areas once I was full kitted up for ( and comfortable with ) the above five areas. •RESTORATIVE •ENDODONTICS •ORTHODONTICS 1. GENERAL EQUIPMENT Unless you are commencing a new practice, your building, and consulting rooms are established. A significant amount of “selling” Veterinary Dentistry occurs here but that is a topic for another lecture. Your dental operatory is where you perform Veterinary Dentistry. It may be in a dedicated area or as part of a multi purpose room. It should be comfortable and as spacious as possible. Ensure appropriate drainage with a purpose built table and grid or absorb water via towels etc The dental base is the biggest investment. We purchased a second hand unit from a Dental wholesaler after determining the costs / benefits of new versus used units. Important – ensure after sales service is readily available HANDPIECES • high speed - a work horse • get a good one and it will last • fibreoptics is nice but necessary ??? • slow speed - air motor + contra angle plus multiple extras • Prophy angle • Latch head ( for endo ) • Straight nose cone ( for ortho ) LUBRICANTS !!!! • Lubricate both hand pieces daily BURS - Multiple types • Tip – buy an introduction pack (s) – and then with experience, reorder • specific / preferred burrs • Burr changing tool – type depends on your handpieces EQUIPMENT YOU ALREADY HAVE • Anaesthetic machine – I prefer Isoflurane • Apnoea monitor • Pulse oximeter
  3. 3. COMFORTABLE WORK PLACE • The bench at your height • A comfortable chair for you and your assistant DENTAL MODELS • Many available – I prefer those with clear acrylic and removable teeth AND with pathology demonstrated INSTRUMENT SHARPENING Via WHEEL / STONES • Sharpen regularly 2. ORAL EXAMINATION • EXAMINATION MIRRORS • MAGNIFICATION - 3X I find these make precision work much easier • LIGHTING This is probably a given in an established practice It should be retractable and a cool light • MOUTH GAGS The flexible ones are an extra pair of hands for tongue retraction, positioning Xrays etc • CAMERAS SLR ( ideally with a macro lens and ringflash ) and / or digital Have them available or !!!! 3. RADIOLOGY Dental Radiology can be performed with a general Xray unit but a Dental unit is superior. DENTAL XRAY UNIT • Mobile or wall mounted – better as they are cumbersome • The second biggest investment – and profit centre !! • Fixed KV and Ma – time is the variable • Long cone – short cone • Safety distance and equipment • Check state licensing laws • Readily available second hand from dentists / dental wholesalers CHAIRSIDE DEVELOPER • Dentistry needs lots of Xrays – this is the quickest and most convenient
  4. 4. DENTAL XRAY –FILMS, HANDLING, ID & STORAGE • #2 and 4 • Cheap !!! • Film clips for handling • Store in envelopes / bank $ bags SAFETY EQUIPMENT Nothing specifically extra for dentistry VIEWING BOX • A hot light is great – as X - rays are small • View with magnification • Ideally a horizontal viewing box – can lay multiple X - rays flat RAPID CHEMISTRY CHEMICALS • Cheap and quick ( 1 minute ) • From photographic labs • Or ordinary developer / fixer • Automatic processor – tape to a lead film • Dental automatic processor – expensive • Digital X – ray 4. PERIODONTOLOGY / PROPHYLAXIS (MECHANICAL) SCALERS are either - ULTRASONIC or - SONIC ULTRASONIC scalers • The most popular choice – because they’re the quickest - care with their power • If possible INCORPORATE the unit INTO the DENTAL BASE • Great features to aim for ( use a plumber and electrician) • BUILT IN WATER & AIR LINES • Safe ELECTRICITY source – as NEAR WATER • REMOTE AIR COMPRESSOR ( eg in the roof space ) • EXTERNAL VENTING • If possible have a BACK UP UNIT - attaches to dental base power & water or separate supplies (eg for Zoo work) MAGNETOSTRICTIVE OR PIEZOELECTRIC OR ODONTOSON !! SONIC • Most dental bases have a triplex plus 3 airlines – h/s, l/s and sonic
  5. 5. • Gentle but slow • You only need to buy a handpiece HAND SCALERS (above) & CURETTES (below the gums) see your wholesaler – plethora of types buy an introductory perio kit • the micro scalers / curettes are great for cats /toy breed dogs • buy several • keep them sharp PERIODONTAL EXPLORERS & PROBES • use them in a consultation and in an oral examination under GA FLUORIDE PRODUCTS • gels-post prophy • Bifluorid ( VOCO ) • long acting fluoride paint – anectodally – great for early FORL’s !! PROPHY / POLISHING PASTE • big tubs / little tubs – these aren’t expensive !! but • use sparingly - excess flies off POLISHING ( PROPHY ) ANGLES and CUPS • Snap on ( or screw on ) • Cheap but don’t use forever !! PERIODONTAL TREATMENT / SURGERY PRODUCTS • Perioglas / Consil is used for bone replacement in deep perio pockets • Doxyrobe ( the newest ) – for local AB treatment of deep perio products DENTAL CHARTS • dogs ,cats, guinea pigs • pads or electronic ( PU ) HOME CARE PRODUCTS • Tooth brushes ( electric / hand ), chewable treats, dental chewable “toys”, POD pads, “Maxiguard”, TD diet, dental hand outs • Dedicated dental care section of waiting room display 5. ORAL SURGERY EXTRACTION FORCEPS • Needed but use carefully and as the last tool
  6. 6. CALCULUS REMOVAL FORCEPS • Designed for bulk calculus removal ELEVATORS • Multiple sizes and types including the curved Fahrenkrug’s • Winged elevators are the latest • Need to be kept sharp COUPLANDS / LUXATORS • Use these as the major tool for tooth extraction • Keep them sharp PERIOSTEAL ELEVATORS • Variety of shapes /sizes • Orthopaedic tool also CURETTES • Bone curettes – left and right RONGEURS • I have these but really don’t use them very much • They’re probably not needed if you have a HS handpiece – it has better control ORAL SURGERY KITS • routine suture kits / materials PLUS some specials / extras • small instruments - needle drivers, forceps, scissors • the confines of the oral cavity make these a bonus • wire - othodontic & surgical uses • acrylic ( eg Protemp Garant ) – another option for # repair • suture materials – many choices; Monocryl (4/0) is easy to use & non irritant LOCAL ANAESTHESIA EQUIPMENT • Specific dental ( aspirating ) syringes and needles are robust and effective • Choice of Xylocaine or Bupivicaine • Great analgesia The remaining sections are included for guidance. Each discipline is significant and has its own check list of equipment, material and supplies. I have attempted to simplify each discipline using this or a similar framework. 6. RESTORATIVE
  7. 7. MATERIALS The basic categories of restoratives are:  Amalgam  Glass Ionomers  Composite – including flowable composites EQUIPMENT The above materials can be all mixed and used by hand but this is made easier, more precise and quicker via the use of an Amalgamator and a light curing machine. Miscellaneous items of note include acid etches for preparing the tooth surface and mixing pads for material preparation INSTRUMENTS Placement of fillings may seem easy but in a confined space and to do it precisely requires: - Explorers - Scoops - Condensers - Excavators - Carvers - Mixers Once placed a filling needs to be polished – so that it is non plaque retentive and aesthetically appealing RUBBER BASE IMPRESSION MATERIALS These could also be listed under orthodontics They’re included here as they form the prerequisite for a dental model for a crown 7. ENDODONTICS This can be a complex discipline. Think of it as an abscess treatment – in this case of the tooth. The stages we need to proceed through are: a. OPENING & CLEANING THE CANAL • Gates Glidden help to open the canal • Files clean the canal b FLUSH THE CANAL • NaHOCl + EDTA are used to flush the organic and inorganic debris from the prepared canal c. FILL THE CANAL
  8. 8. • An inert rubber material ( Gutta Percha ) and an apical sealant are used ( eg Zinc Oxide Eugenol CALCIUM HYDROXIDE PRODUCTS These are mentioned separately and specifically for their relevance to Vital Pulpotomy – a very practitioner friendly technique 8. ORTHODONTICS Another large but fascinating discipline. Tooth movement requires planning and the use of hardware. a. MAKING IMPRESSIONS In a bowl with an alginate that’s placed in an impression tray Bite registration confirms the occlusion of maxilla to mandible. b. MAKING MODELS Stone models are the next step – they allow study and planning and the fabrication of appliances c. MAKING APPLIANCES Jet acrylic is convenient and easy. It may require wire reinforcement and trimming / smoothing, adjusting d. APPLIANCES USING ACTIVE FORCE - BRACKETS AND ELASTICS where the case requires constant force, brackets and elastics (power chain) are used. These need to be positioned and cemented SUMMARY IT IS WORTHWHILE START SMALL AND BUILD UP