hi I'm Megan strong and welcome to episode 156 of chairside life we have a great show for you
today with two fun and informative segments come with me as I venture outside of the studio and
onto the lab floor to discover our process for manufacturing ruksar crowns but first
dr. Paresh Patel joins us as this week's guest contributor dr. Patel is a leading lecturer on
small diameter implants and a regular contributor to our inclusive magazine he's here today to talk
about his protocol for buffering and aesthetic for an effective way to numb your patients quickly and
with reduced pain and inflammation let's check it out good afternoon everyone beresch Patel here
to talk to you about the benefits of buffering your local anesthetic a really hot topic now for
everybody because we want to treat our patients with the most effective anesthesia possible
have that anesthesia take effect as quickly as possible and reduce all the other damages that
we do and get our patients numb so let's talk about that for just a minute it's not going to
be really important to understand that we want to reduce the amount of injection pain for our
patient the sting that the patient feels so if we can buffer that anesthetic we'll reduce that
sting there's gonna be less inflammation or less tissue damage because we have to remember that
our local anesthetic has a pH of around 3.4 which is in the acidic category if we can raise that up
closer to the biological ph of 7.2 we're gonna have less of that inflammation occurring in the
tissue faster onset who wants to wait around for 10 minutes while our patient gets numb has dentist
I've never found any of us that are really able to go in there give a patient in the shot have them
wait 10 minutes and then come back we really want to get in there get our patient numb and get to
work makes a point faster for our patient makes our production better it makes everything more
efficient and it's more effective in the presence of infection how many of us have had the problem
where we go in there and we try to get our patient numb we have an abscess we have infected tissue
because the tissues already acidic it doesn't have the capacity to buffer that solution take
that 3 percent of the ionized form and take it all the way up to the physiologic pH of 7.2 so
we're going to talk about how we can do that ahead of time so in the presence of infection
we can get that effective anesthesia that we want for our patients so what are we going to need to
buffer our local anesthetic for our patient prior to them getting there well most of the
supply you're gonna have you're gonna already have a syringe needle you're gonna have your
favorite syringe the things that you may or may not have in your practice are gonna be the main
star which is the buffering solution itself which is the eight point four percent sodium bicarbonate
it comes in a 50 mil vial you can order this through any of your surgical supply houses the
cost of this is absolutely inconsequential this bottle probably cost five to eight dollars it's
gonna cost more to ship it to your office than it is free to get it the other thing that you may or
may not have in your office is that you may not have this Biddy syringe this happens to be a 50
unit syringe right here and it comes with various lengths of needles on it I like to use the one
that has the half inch needle on it so make sure that you get the Biddy syringe that has the half
inch needle at the end right there these come in boxes of a hundred and I think this is probably
less than ten dollars as well the last thing that you may or may not have is just now call cleansing
pad and you're gonna use that to clean off the top of your sodium bicarbonate bottle okay so
let's get to it let's talk about buffering the 2% lidocaine 1 to 100,000 the formula for buffering
is about 1/2 1/10 okay so one milliliter of the anesthetic to one tenth of the sodium bicarbonate
in our example here since this is a 2% solution we're gonna need to express out about 25 units
of anesthetic so in this case that's about where the grey plunger hits the red line right there
okay so in the 2% solution we're gonna express out about 25 units or bring that plunger about
to the red line on a 1.7 millimeter cartridge of our local anesthetic solo transect just like you
would get whatever needle tip that you want to engage your anesthetic you don't have to twist
the cap on all the way you're really just gonna get out here and you're just gonna express out
about 25 units of that to make the space or make the volume for your sodium bicarbonate to go back
into the cartridge right there after you've expressed that out you can go ahead and remove
your anesthetic you can see that we've expressed out about 25 percent or 25 units of anesthetic
the plungers almost to the redline right there so now we can go ahead and work with our sodium
bicarbonate we'll get our alcohol wipe and we can clean off the top of our 8.4% sodium bicarbonate
okay once that's done we'll get our Biddy syringe we'll go ahead and remove the cap and we want to
take out about 25 units of the sodium bicarbonate so we'll Express or pull in about 25 units of air
so we can inject that into our bottle so we don't create a vacuum in there so we've got about 25
units right there pulled back of air and now we can go ahead and put that into our bottle and
we can inject the air into the bottle and we're gonna draw out 25 units of our buffering solution
okay so we have 25 units and now we can inject that back into our 2% lidocaine solution and
we're just going to push that right back into our syringe and you'll notice as I inject this the
plunger starts to go back and that's why we needed to make that space so we can have enough volume to
buffer our anesthetic so now you have effectively and very easily buffered this anesthetic so we've
gone from about three percent of this anesthetic being buffered to about 97 percent of this being
dumped buffered so you've effectively made this cartridge one hundred percent ready to be buffered
inside of the patient now a lot of people ask me doctor why do the companies not go ahead and
have this buffered from the very beginning well the shelf life of this say anesthetic is you can
see right here this doesn't expire until 2016 the 10-month of 2016 right there so we have about a
year shelf life on this anesthetic the shelf life of this anesthetic right now that we've buffered
it at most is about a day to a day and a half so that's the reason because we want that acid
in there to keep that anesthetic from being not effective so now that we've buffered it we have to
use this within a day okay so normally what we're doing is we're going ahead and buffering right
before the patient comes in for the surgery we're going to be able to perform the procedure the way
we want to and not have the patient worry about having so much discomfort thank you dr. Patel on
behalf of patients everywhere myself included dr. Patel frequently lectures for the perio Institute
and will be in Seattle Washington coming up on December 4th and 5th stay tuned at the end of the
show for more upcoming lecture dates by dr. Patel and be sure to visit www.mptv.org/outdoorwisconsin
even Kievan making strong chairside live hi I want to know how do we achieve our precise fit
of the Brooks or Crown oh let me show you okay let's go look Megan I don't have to tell you it
starts with a good impression we know that yep so as much as possible we block out whatever
little undercuts is necessary to idealize it but as we scan afterwards what we've done is we've
developed parameters whether it's a clues about 60 microns or axial wall at 90 microns to optimize to
take into consideration the drill compensation during milling and things like that also we know
that dirk oniy as the material has become very predictable so we know that how much it's going
to shrink during centering so these parameters allow us to absolutely every time come out with
the same result what we also do is we design when we're designing externally the contour we actually
make the contacts open 10 microns that's because we've tested the top 10 brands of floss on the
market and the average thickness of those floss is 40 microns so we know that by allowing it to
be open when the doctor drops it into place it's easier to insert and yet still catches floss so
that kind of predictability with the software and the materials gives us that kind of consistency
that hopefully the doctor is looking for great well there we have it thank you so much for that
look into how we achieve our precise fit well that about wraps it up for this edition of chairside
live I had a lot of fun exploring the lab and our processes and I hope you did too I'll see you next
week and don't forget to earn while you learn with free CEO WWE will dental calm thanks for watching
you