Diamond tip in an single stone. Presentation

Transcription

1 Presentation We have the pleasure to present CVDentus to you, an innovative solution for the dental treatment that uses the ultrasound equipment. Allied to your ability, the CVDentus tips will provide the base for an exceptional quality of work and significant impact in the comfort of your patients. The CVDentus tips had been created with a new technology for artificial diamond synthesis, CVD diamond, initially conceived by the founders of the Company for use in aerospace applications, in the Brazilian Institute for Space Research (INPE). Now available for professionals in dentistry, CVDentus is an exclusive product with singular characteristics. The high adherence between CVD diamond and the connecting rod of the tips, allows its innovative use with ultrasound equipment, which opens a new set of possibilities of applications in dentistry. CVDentus is a key alternative for dental cavity preparation in perfect accordance to the principles of the new dentistry. Its great cutting precision and efficiency combine the concepts of imum preservation and minimum restoration, necessary to a less invasive dentistry. It is an innovation which use is intrinsically different of the professional's habitual procedures. Therefore, it is necessary to demonstrate the form of use of the CVDentus tips to allow the surgeon-dentists to develop the necessary ability and reach the best efficiency. Read attentively this booklet to learn the working principles and the basic operations necessary for the efficient use of CVDentus tips. The skillfulness in the technique is simple and, many times, the auto training is enough. If necessary consults us on an attended training. Diamond tip in an single stone The CVDentus tips are a genuinely new product, patented, that brings a new perspective to the dental treatment, with a new concept of abrasion and cutting. The use of the ultrasound equipment facilitates the localized wear, with low impact and low noise. The effective results of the extensive use of ultrasound in dental cavity preparation had only become possible due to the high adherence of the CVD diamond layer to the active part of the tips. CVD technology (initials of Chemical Vapor Deposition), is a new form of production, that allows to grow a single diamond stone to coat all the active part of the CVDentus tips. The integrity of the diamond and its high adherence to the metallic rod make the key difference. It allow its extensive us with great durability. The CVDentus tips are made in different formats and sizes, all in a single diamond stone with roughous and well ordered surface. This roughness controls the quality of finishing and the speed of cut. The photos below show clearly the difference between CVDentus and the conventional diamond tips. CVDentus is durable and is the only one that can be used extensi- vely with ultrasound. Welcome to the CVDentus. CVDentus Tip: single diamond stone Conventional Tip: diamond grains immersed in a mettalic matrix READ INTENTLY The correct use of the CVDentus tips is already proven and assures: preparation efficiency durability of the tips Comfort of the patient However, the use of CVDentus with the habits of use of the high-speed rotary system is disappointing. Therefore, understand how to use the CVDentus tips to take all advantage of its efficiency. LEARN ABOUT CVD technology is very interesting. It is pure scientific development, that allows to produce artificial diamond with properties even superiors to the natural diamond. A general vision of this technology can be seen in: UNDERSTAND THE DIFFERENCE The CVDentus tips are formed by a single diamond stone, with well ordered rough surface and, do not suffer appreciable wear with the use. Therefore, they have much longer useful life. Conventional tips have diamond grains added in a metallic matrix and they wear out quickly due to loss of the diamond grains.

2 Ultrasound The ultrasound is a wave or vibration that propagates through the movement of atoms and molecules of the material. The difference between sound and ultrasound is only in the vibration frequency: The sound is audible and has frequency between 16 Hz and 20,000 Hz. The ultrasound has frequency above of Hz and it is not audible. The ultrasound for odonthological use operates between Hz and 35,000 Hz. Currently, there are three technologies to generate vibration for odontological use, as follow: Sonic turbines that operate with compressed air (vibrate with frequency around Hz) - the movement of the insert extremity is elliptical. Advantages: simplicity and low cost. Disadvantages: audible treble noise, absence of power control and, absence of the beneficial effect of the ultrasonic cavitation. Magneto-strictive Ultrasound (there are equipment that vibrate in Hz and 30,000 Hz) - the movement of the insert extremity is in the form of elongated "8". Advantages: rapidity in the exchange of the inserts, robustness and, promotes ultrasonic cavitation. Disadvantages: it cannot be used in patients who use pace-maker, handpiece is large and heavy. Piezo-electric ultrasound (most of the equipment are of this type and operates between Hz and 35,000 Hz) - the movement of the insert extremity is linear. Advantages: light handpiece, it is modern and, promotes ultrasonic cavitation. Disadvantages: it is necessary to screw the inserts at each exchange. Ultrasound in the dentistry before the CVDentus The ultrasound was introduced in dentistry about 50 years ago, when it was discovered that it was able to cut the dental material with the aid of an abrasive slurry composed of aluminum oxide. During the decade of 1950 dentists uncovered the following advantages of the dental cavity preparation with ultrasound: cutting of the tooth with very light pressure; absence of pain in the majority of the procedures; absence of harmful effect on the pulp; precision of cut and excellent quality of finishing. However, in the decade of 1960 the dental cavity preparation with ultrasound was abandoned due to the inconvenient use of the abrasive slurry and the relatively low cutting speed. It was surpassed by the high cutting efficiency of the high speed turbines, more adjusted for a dentistry of invasive concept, based in the preventive extension and retentive preparations. From then on, the ultrasound started to be used as accessory in processes of cleanness and asepsis, as removal of tartar, periodonty and endodonty, or in processes that needed the high ultrasound energy, as in the condensation of inlays/onlays and the removal of bolts and crowns. Great part of the dental doctor's offices have ultrasound equipment for use in one or more of these applications. The advantages of the dental cavity preparation with ultrasound, as described above, are in accordance with the necessities of the modern dentistry, in which the concepts of imum preservation and minimum restoration are fundamental. However, to be efficient more adequate tools are necessary to eliminate the necessity of the abrasive slurry. Some ultrasound companies supply some conventional diamond tips to use in their equipment, which are recommended only for minimally invasive cavity preparations. CVDentus is the only technology that enables extensive use of ultrasound in dental cavity preparation. DOES THE CVDENTUS TIPS WORK WITH ANY ULTRASOUND? The CVDentus tips work in any one of the two types of ultrasound equipment. There are adaptors for many of the different available equipments. They work in the sonic handpieces operated with compressed air, but the advantages with the use of an ultrasound equipment are muc larger. The ultrasonic cavitation is a physical phenomenon caused by the ultrasound in liquids. It is responsible for the characteristic cleanness and asepsis attributed to ultrasound. For more details consult: IF THE ADVANTAGES ARE AS MUCH, WHY ULTRASOUND USEFOR CAVITY PREPARATION WAS ABANDONED IN THE DECADE OF 1960? Simply because the CVDentus tips had appeared only now. The CVD technology is the only one capable to support the impact due to the vibrations of ultrasound. The CVDentus tips enabled the extensive use of the ultrasound in any type of dental cavity preparation. It is an excellent alternative to the preparation with high speed, laser or airabrasion, supplying a work of high quality with incomparable comfort of the patient and the surgeon dentist.

3 The union of the ultrasound with the CVDentus tips The technology of the ultrasound and the technology of the CVDentus tips form an innovation base. In the modern dentistry the cutting precision is basic to preserve healthy structures. Precision of cutting and efficiency, are the main characteristics that resulted of this union of technologies. The most important advantages are: minimum noise; absence of pain in the majority of the cases, preventing the use of anesthesia; total visibility and access; cutting precision; minimally invasive preparation; selective cutting of hard materials; it does not cut soft materials, as gingive or tongue; it does not cut rubber levee and it does not roll in gauze or cotton; it minimizes the bleeding; it does not add residues on the tip, facilitating the cleanness; it minimizes the smear layer. It is the modern age of the dental cavity preparation with ultrasound, which gives superior quality and efficiency. It presents all the advantages observed in decade of 1950, but, moreover: the ultrasound equipment had evolved very much, with light and comfortable handpiece; the concept of dental cavity preparation changed with the objective of being minimally invasive and; the most adequate tools, the CVDentus tips, are now available. WHY CAUSE LITTLE PAIN? Because it causes much less heating of the tooth. Because the vibration movement does not causes the hydrodynamics suction of the odontoblasts. Because the very light pressure of use prevents pain. IT IS WORTH TO REMEMBER: The CVDentus tips make available all the advantages already observed in the decade of 1950 and add advantages of a much more adequate tool. With these characteristics, the CVDentus tips come to meet the demands of modern dentistry. The set of CVDentus tips There are different models with the most diverse functions. They do not rotate, they cut by vibration. This allows formats without cylindrical symmetry and, also, allows folds that facilitate the access to regions of very difficult preparation with any another technology. This extends the format possibilities, always with the objective to facilitate your work and to increase the comfort of your patient. An important characteristic is that all have the connecting rod with same diameter, therefore it is universal, making possible its use in the most diverse existing equipment of ultrasound in the market. UNIVERSAL USE The standardization of the connecting rod of the CVDentus tips, makes possible its use in any equipment of ultrasound. DIVERSE FORMATS AND FOLDS The various formats and folds facilitate your work and increase the comfort of the patient. STERILIZATION The tips are made of molybdenum and highly adherent CVD diamond, therefore, any method of cleanness and sterilization available in the doctor's office can be used, without any restriction or reduction of its useful life. The CVDentus tips must always be sterilized before use.

4 Adaptation of the CVDentus tips to the ultrasound The CVDentus tips are adapted to the ultrasound equipment by means of an acoustic impedance matching, or simply an adaptor. Each equipment of ultrasound has a different coupling between its inserts and the hand piece. The adaptors had been developed to allow the use of the CVDentus tips in the most diverse hand pieces of different manufacturers. Each adaptor has, in its behind part, the specific thread of each one of these manufacturers. The front part of all the adaptors is equal, containing a small specific mandrel for the CVDentus tips. For the use of the ultrasound in dentistry and dental cavity preparation in general, the system uses the adaptor, the nut to tight the mandrel and the CVDentus tip. This set was designed and tested to transmit efficienciently the vibration to the extremity of the CVDentus tip. Assembly of the CVDentus tips to the ultrasound The adaptation of the CVDentus equipment is very simple: tips to the hand piece of the ultrasound First loosen the existing insert off the hand piece and remove it. After, screw the adaptor in the hand piece. It is necessary to tight it firmly, with the aid of the appropriate wrench. With the loosen nut, insert the desired CVDentus tip firmly in the interior of the mandrel, pushing it until leaning in the stop. Finally, tight the nut with the wrench. The CVDentus tip is ready for the use. Adaptor Fastening nut CVDentus tip The mounted set. A stop in the mandrel defines the position of the CVDentus tip and sets waterflow orifice. ONE ADAPTOR FOR EACH ULTRASOUND EQUIPMENT There are adaptors available for many of the ultrasound equipment in the market. INDEPENDENT OF THE ULTRASOUND TECHNOLOGY There are adaptors for ultrasound equipments of all technologies, either piezoelectric, or magneto-strictive. It also adapts to sonic hand pieces, acted by compressed air. IMPORTANCE OF THE GROUNDING Piezo-electric ultrasound equipment needs an efficient grounding to prevent the risk of electric shock. Great part of the cases of sensation of pain by the patient is due to the lack of an efficient grounding. SUBSTITUTION OF TIPS If the adaptor is already mounted in the hand piece of the ultrasound equipment, it is enough: to loosen the nut by 1/4 turn; to remove the CVDentus tip; to place a new CVDentus tip, until leaning in the stop and; to retighten the nut. That is simple and fast.

5 Adjustment of the water flow to the CVDentus tips After the assembly of the CVDentus tip in the hand piece of the ultrasound equipment, it is ready for the use. However, a last very important detail is still necessary: to adjust the water flow to the tip. The flow does not need to be extreme. It is enough to make water to drip in the extremity of the active tip. It is interesting to note that, by effect of the ultrasound, the water drains adhered to the connecting rod and, even in positions of difficult access, the water reaches the active tip. Even for tips of multiple folds the water drains adhered on the connecting rod, making an efficient refrigeration of the treated area. Depending on the ultrasound power, it can cause a certain spreading of water around the CVDentus tip. In some equipment this spreading is sharper and, in these cases, it is necessary to regulate the ultrasound power and the water flow to guarantee the refrigeration of the treated area. Different ultrasound equipment presents different possibilities of refrigeration. The majority of them are simply connected to the water reservoir that feeds equips of the doctor's office. There are some that has the possibility of independent refrigeration, either through a peristaltic pump or an independent reservoir pressurized with compressed air. In these cases, other liquids or solutions of refrigeration can be used, in accordance with the recommendations of the manufacturer of the ultrasound equipment. There are no restrictions of use of the CVDentus tips with other liquids of refrigeration recommen- ded for the procedure in course. Limits of operation of the CVDentus tips There are various models of CVDentus tips already developed, and others will still be, depending on the necessities of the surgeon-dentists. You know which is the best application of each one of these formats in dental cavity preparation, but it is necessary to clarify which are the best conditions of use of each one of the CVDentus tips. The vibration of ultrasound is aggressive for the material of the connecting rod and for the interface between the CVD diamond and the connecting rod. It is even able to cause its rupture by fatigue. The ultrasound power is the main parameter to be controlled to prevent this premature fatigue and to draw out the useful life of the tips. The amplitude of vibration due to ultrasound increases with the reduction of the cross section area of the material in which the ultrasound propagates. This implies that in tips of finer extremity the amplitude of vibration is bigger. Based in this concept and the experience of use, the limiting power of use had been defined for each type of extremity of the active tip. This limit is described in terms of the percentage of the imum power (P ) supplied by the ultrasound equipment. The majority of the equipments have the same range of imum power (P ); therefore the table below shows the powers of use in a generic form. Cone 0,3 mm: 20 a 30% P Inverted Cone : 40 a 50% P Round 1 mm: 40 a 50% P Cone 0,5 mm: 60 a 75% P Cilinder 1 mm: 60 a 75% P Cilinder 1,2 mm: 80% P Avoid to use power above the recommended one to assure the high durability of the CVDentus tips. DETAIL For the finishing tips always use power at least 20% less of the indicated ones. Smaller powers promote better finishing. Never use the CVDentus tips without the adequate refrigeration. A good refrigeration is necessary for the high durability of the CVDentus tips. Search in the site if you have doubt in relation to the power limits in specific equipments; If you want to see details of power of use for each CVDentus tip.

6 Formats of the CVDentus tips and its functioning The amplitude of vibration, due to the ultrasound, increases with the reduction of the cross section area of the material in which the ultrasound propagates. Therefore, finer tips vibrate more in the extremity and have a greater cutting ability. This concept is exactly contrary to the usual one in rotary systems, where with the increase of the diameter it increases the tangential speed, increasing the cutting speed. The vibration of the CVDentus tips The CVDentus tips have a characteristic fold that forms an angle of 60º relative to the hand piece axis. This fold provide better access to the area to be treated, offering the best ergonomic condition for the great majority of the necessary operations to the dental cavity preparation. Moreover, this fold offers a condition of vibration of the tip that characterizes the operation of the CVDentus tips. Under the action of the ultrasound and due to fold, the active region of the CVDentus tips vibrates back and forth (or either, in the antero-posterior direction) in the same plane defined by the fold of the tip. From the technical view point the truncated cone CVDentus tip is the one that better cuts. The finest truncated cone one (6.1107), although it is to be used in low power, it cuts as efficiently as much thicker tips used at higher power. The thickest truncated cone one (8.1117) is more robust and has a high cutting ability. It is the tip of choice for the most difficult works, as the initial opening of sound enamel. In the cut by vibration the tips suffer innumerable impacts (about impacts per second). With spherical tips (8.3231), due to its format, these impacts tend to occur on a single point, which causes a tendency of premature fatigue of its surface at that point. For this reason, from the technical viewpoint, it is better to prevent the use of the spherical tips in the opening of sound enamel or the removal of resistant old restorations. Preferably use spherical tips in dentine. The inverted trunkated cone format (8.4131) was conceived to make mechanical micro-retentions in the base of the cavity and, also, it has been used successfully in the removal of old restorations. The cylindrical tips are general purpose for the formatting of the cavity. The great freedom of movements and the complete visualization of the cavity during its execution, allow the formatting of the cavity without necessity of many different tip formats. Other formats of tips are being developed and all suggestions are welcome in order to improve the product and to favor the performance of the professional. Antero-posterior Vibration movement This antero-posterior movement divides the surfaces of the active tip in distinct regions. The part of the front and the behind part provoke impact on the surface to be cut and therefore they are good for cutting. Due to fold angle the behind part is the most efficient. In the two lateral surfaces there is little impact, since they are in planes parallel to the antero-posterior movement. These lateral surfaces are more appropriate for scraping and finishing. The conical tips are the ones that better cut, because they amplify the vibration of ultrasound. The spherical tips or of rounded extremity should be used, preferentially, in dentine. Detailed Information with the recommendations of use of the CVDentus tips can be found in the site: The antero-posterior movement is better defined for piezo-electric hand pieces. In magneto-strictive hand pieces the movement form an elongated 8, which promotes a larger impact in the laterals, but small if compared with the front part and the behind part. The result is very similar to the piezo-electric system. In sonic hand pieces the movement is elliptical and the impact in the laterals is comparable to the front part and the behind part. Therefore, its cut is symmetrical and the laterals do not give finishing characteristics.

7 Basic operations with the CVDentus tips The best form to open a dental cavity with CVDentus tips is attained by two distinct actions: thrusting and planning. The thrusting action consists of removing dental material with the nib surface of the CVDentus tip, and the planning consists of extending the walls established by the initial thrust, taking advantage of the antero-posterior movement of the CVDentus tips. 1- THRUSTING The thrusting is made with the nib surface of the tip on the surface to be cut. Use very low pressure, with the tip always in contact against the material to be cut. It is important to make small pendulum or oscillation movements while it cuts, because it increases the cutting efficiency. Very light pressure against the cavity wall Thrusting first and planning later is more efficient for dental cavity preparation with ultrasound. Use very low pressure; 2- PLANNING Always keep the tip in contact with the material to be cut; Always keep the tip in movement (the best movement is perpendicular to the cutting direction); Never use the tip as handspike. To widen the cavity use very low contact pressure with the wall to be cut, keeping the tip always in contact, but at the same time making some kind of movement, either oscillatory, pendulum, circular, translation or up and down. The best movement is perpendicular to the cutting direction to guarantee a very low pressure against the wall to be cut. The movement increases the cutting efficiency. Due to the type of vibration movement the cutting it is more efficient in the anteroposterior direction. "Thrusting and planning" is more efficient, but, at the criterion of the professional, it is possible to go deepening and extending the cavity at the same time. The most important is to always keep light pressure with the tip always in contact with the surface and with some type of movement. The continuous movement prevents a single point of contact and liberates the tip to vibrate freely, which increases the cutting efficiency. ALWAYS REMEMBER Very light pressure against the surface Differences of habit while using CVDentus tips Now it is important to make clear the differences in the habit of the dentistry professional for the efficient use of the CVDentus tips. As it was already said from the beginning, to use them in the same way as you use the rotary instruments is disappointing, because some of the methods used inhibit the proper functioning of the CVDentus tips. The habits that need to be changed are: To substitute the intermittent use by the continuous contact. With high speed rotary hand piece the intermittent use is necessary to prevent the tooth overheating. With ultrasound the heating is much less and it can be used continuously. More than this, continuous use must be made to compensate its smaller cutting speed. Or either, despite the cutting speed being smaller with ultrasound, it becomes efficient with the continuous use; To allow small movements. With high speed rotary hand piece it is necessary great control and firm hand. With ultrasound the cutting speed is much smaller and the risk of cutting beyond the necessary almost does not exist. Moreover, to make small movements increases the cutting efficiency. To reduce the pressure on the tip while it cuts. The pressure necessary to cut with ultrasound is much smaller than with high speed rotary hand piece. In average, one third of the pressure is necessary. Since the cutting speed of the ultrasound is smaller, the tendency of the professional, in the first uses, is to pressure more (as if it was using a blind drill). This worsens the situation, because pressuring more hinders the vibration movement. Only with a very small pressure the tip vibrates freely and the cutting is efficient. To prevent cutting with the lateral. The best cutting positions are the thrusting with the nib of the tip and the planning with front and back surfaces. The laterals cut less and can be used for finishing. To never use as handspike. The use of the CVDentus tips as handspike can cause the delamination of the diamond and the reduction of its useful life. THE EFFICIENCY OF USE OF THE CVDentus TIPS DEPENDS ON: using always in contact on the surface to be cut; making small movements while it cuts (best movement is perpendicular to the cutting diretion); using with very small pressure; thrusting first and planning after; never using as handspike. TO USE EXCESSIVE PRESSURE: diminishes the cutting efficiency; reduces the useful life of the tips; may cause pain. TO FIND THE IDEAL PRESSURE OF USE IS FUNDAMENTAL observe the cutting noise, it depends on the pressure; vary the pressure while it cuts and determine the situation of imum cutting noise; the ideal pressure is smaller than that in which the imum noise occurs.

8 Dental materials and the CVDentus tips Each different dental material cuts different with the CVDentus tips. The following symbols are used: ( + ) slow cut, ( + + ) medium cut, ( +++ ) fast cut, ( x) does not cut, ( xx) do not use. Healthy enamel ( + ). The relatively slow cutting of healthy enamel allows to preserve healthy structures. Carious and de-mineralized enamel ( +++ ). The removal is very fast and efficient. Healthy dentine ( + + ). Cuts with certain easiness. Carious dentine ( +++ ). The removal is fast and efficient. Soft dentine ( x). The vibration of the CVDentus tips is cushioned in the soft material. If it is possible to cut close to the hard dentine wall, the soft dentine can be removed with efficiency. If its volume is large it is more efficient to remove with traditional methods, for example with one curette. Soft tissues. ( x). It does not cut to the gingiva or papilla. It allows sub-gingival preparations and removal of restoration excess on the gingiva and papilla. Composed resin ( +++ ). Cuts slowly but the removal is efficient because, in the majority of the cases, the restoration is released due to vibration. The substitution of restorations preserves the existing cavity, with low risk to widen it. Amalgam ( + + ). The direct cut is slow, but by cutting in specific places to reduce the mechanical structure, the amalgam is gotten loose due to vibration. Small or shallow restorations realease with easiness. Provisory cement ( +++ ). Cuts with great easiness, without risk of widening the cavity. Metals in general (brackets, prosthesis and bolts) ( xx). Damages the CVDentus tips. Ceramic Prosthesis ( xx). Cuts slowly and damages the CVDentus tips. Bones ( +++ ). The cut of bones allows the use in buccal surgeries. Indications of use of the CVDentus tips Dental cavity preparations for all the classes of Black. For any dimension of the cavity, the use of the CVDentus tips allows the minimum removal of healthy material. Minimum invasive preparations of ridges and fissures. The finer trunkated cone tip (6.1107) allows preparations with minimum opening of the ridges and fissures. Proximal and tunnel preparations. special folds facilitate the work and the access. Removal of provisory and definitive restorations. In the removal of restorations the main advantage is the preservation of the original cavity. Finishing of prosthetic preparations. The cutting speed in healthy enamel is low for use in prosthetic preparations. However, the quality of finishing is superior. CVDentus tips are ideal for finishing the prosthetic preparations. Aesthetic Ameloplasty. The great cutting precision allows necessary adjustments with great security. Gingival Peeling. This technique facilitates the removal of melanic spots of the gingiva, bringing great comfort to the patient, during and after the operation. Endo. Set of tips with longer connecting rod allows the localization of root channels and the preparation of the pulp chamber. Apicectomy. Special tips allow facilitated access to the apex. Surgery (osteotomy). Excellent cut on mineralized tissue without damaging soft tissue, which facilitates the preservation of delicate tissues in regions of difficult access. Pediatric and special patients. The low noise and low sensitivity are ideal for the conditioning of these patients. Domiciliary attendance. The ultrasound equipment with independent water reservoir is extremely portable. The CVDentus tips cut faster the carious material than the healthy material. This supplies great control, which allows a minimum invasive dentistry of great quality. REMOVAL OF CARIESES Attack directly the carious material, cutting a minimum of healthy material. REMOVAL OF OLD RESTORATIONS Cut the restoration with the objective of reducing its mechanical structure. Without mechanical structure the restoration releases with the vibration. Since the restoration is released, the original cavity, in general, may be kept without need to extend it. The above indications show the great versatility of the CVDentus tips, which make the ultrasound equipment extremely useful in the doctor's office. Consult the site: to see examples of cases that demonstrate these indications.