A Less Invasive Way to Explore and Restore
Two conservative burs from SS White for preparation, exploration, and decay removal are designed to maintain healthy tooth structure with less postop sensitivity for the patient
Patient-Friendly. Conservative. Minimally invasive. It’s likely you have used these words to describe some of the cornerstones of your practice’s treatment philosophy. But more and more dentists are adding another word to their list, and that word is “fissurotomy.”
The days of using a “wait and see” approach to potential caries are gone, and many of today’s practitioners have realized the multiple benefits of using the fissurotomy bur for access to explore and restore suspicious pits and fissures.
One such dentist is Howard S. Glazer, DDS, in Fort Lee, NJ. “I am a big believer in minimally invasive dentistry, and SS White has a wonderful bur called the Fissurotomy that helps me in that mission,” Dr. Glazer said, adding that using this preparation and exploration bur allows him to identify lesions that don’t necessarily show up on a radiograph. “In dental school, we’re taught to look in these fissures, and if your explorer sticks, it’s probably decay—but you may not get that all the time. In fact, most of the time, a radiograph is not going to show a minimally invasive amount of decay, which may be purely in enamel. That’s where the value of SS White’s Fissurotomy bur comes into play,” he continued.
Remove the Guesswork, Not Tooth Structure 
Absent a fissurotomy bur, many clinicians finding questionable pits or fissures would need to drill out or channel through the fissure system, which can end up removing more tooth structure than necessary. The SS White Fissurotomy bur is a minimally invasive carbide bur with a fine carbide tip that can remove 91% less tooth structure than other instruments, such as 557 carbide burs. Additionally, Dr. Glazer estimates that around 90% of his procedures do not require anesthesia, which increases patient comfort while reducing chair time and cost.
“Prior to the fissurotomy bur, the design of those burs resulted in us being more aggressive when it came to removal of tooth structure. You really had to take a broad stroke to accomplish what a ‘narrow brush’ like the SS White Fissurotomy bur can do,” Dr. Glazer explained. “It’s literally an innovative and safe way to explore and restore in less than 5 minutes.”
The more intact a tooth remains, the longer it will survive. That’s because once there is a break in the enamel and the decay process begins, if left untouched, it could progress into the dentin and potentially down into the nerve. “Then you’re into root canals and buildups and crowns,” noted Dr. Glazer. “So, if I catch it in its earliest stage and restore it in the most minimal sense, that may be the only time that tooth has to ever be touched for the extent of the patient’s life."
"The fissurotomy procedure has added many additional years of vitality to restored teeth in my practice. When teeth are left untreated or are prepared by conventional methods, greater expense and discomfort occur to the patient. Why anybody would consider not using this as the first route of entry is beyond me, because it’s the only way to really preserve tooth structure as you go forward,” he continued.
“Why anybody would consider not using this as the first route of entry is beyond me, because it’s the only way to really preserve tooth structure as you go forward.”
- Howard S. Glazer, DDS
A Smart Bur Combo That Works
Speaking of going forward, if decay is identified after access using SS White’s Fissurotomy bur, SS White’s SmartBurs II can remove soft carious dentin without cutting healthy enamel, dentin, amalgam, or composite. That’s because the burs are engineered to differentiate between hard and soft tissue by deforming when they encounter harder, healthy dentin. Other burs are not designed to do this, which means that they may over-reach the removal of healthy tooth structure and lead to more extensive restorative procedures than originally intended.
“No water is needed, and no heat is generated,” Dr. Glazer said of using SmartBurs II. “I’m not going to cause an inflammation of the pulp because this is not heat-generating, and the risk of iatrogenic pulp exposure is reduced as well. It also minimizes patient trauma by reducing postop sensitivity, since there is less of a friction-generated inflammatory response. By using SmartBurs II, I just simply am going to remove that which is infected in the decay process,” Dr. Glazer added. “I’m not going to remove additional tooth structure,” he said.
Dr. Glazer reports overwhelmingly positive responses from his patients treated with the SS White Fissurotomy bur and SmartBurs II. “So many of my patients—at the end of the procedure—have said, ‘Wow, that’s terrific’ because there’s no postoperative discomfort,” he reports.
