Nathaniel Lawson, DMD, Ph.D., started using the PrepStart H2O Hydro Abrasion System from Zest Dental Solutions to clean cavity preparations with air abrasion. Lawson found the system excelled not only with that process, but others as well.
Lawson, an assistant professor and director of the Division of Biomaterials at the University of Alabama School of Dentistry, shared his experience with PrepStart H2O, and some recommendations for clinicians considering the system.
DPS: How did you become interested in air abrasion of your preparations?
Lawson: I first became interested after seeing pictures of smooth and clean preparations in dental magazines and online publications. I researched the topic a little further and found positive reviews of the PrepStart H2O from colleagues and online.
I did additional research and found that air abrasion of preparations did not negatively affect the bond to tooth structure, and in some cases, it actually improved the bond. So I acquired a device and began to use it both clinically and to perform some laboratory tests.
DPS: How effective is the PrepStart H2O in cavity preparations?
Lawson: For me, the biggest advantage of using PrepStart H2O is in finishing cavity preparations. Direct composite restorations are extremely technique sensitive, and each detail of the procedure can have a big impact on the lifetime of the restoration.
As part of running clinical trials, I observe high-magnification intraoral pictures of composites over a several year period of time. I have noticed that any defect or gap at the margin of a restoration only worsens with time. As a believer in conservative dentistry and preservation of tooth structure, I hate having to remove a slice of tooth structure with a bur just to achieve a clean margin (extension for prevention). I have found that air abrasion can clean the margins and internal surface of my preparation by removing stain, remnant restorative materials, amalgam stain, infected/affected carious dentin and biofilm.
DPS: How were you cleaning your preparations before using PrepStart H2O?
Lawson: Prior to obtaining the PrepStart H2O, I had nothing similar in my armamentarium for cleaning preparations. I typically use a self-etch protocol, so I don’t use phosphoric acid to “clean” my dentin. After looking at high-resolution images of my preparations using the PrepStart H2O, I realized how many unwanted artifacts that I left in my preparations that I could not see with my loupes. For this reason alone, this device has made the practice of dentistry much more enjoyable—and I have also enjoyed finding new uses for this device.
DPS: What additional uses have you found?
Lawson: Although my initial reason for getting the PrepStart H2O was for cleaning cavity preparations, I have found many supplemental uses for the device. Air abrasion is extremely efficient for cleaning temporary cement off of crown or onlay preparations prior to bonding. The device can also be used extraorally for cleaning cement out of temporary or debonded crowns.
In our research testing laboratory, we also tested the device’s ability to sandblast zirconia to create surface texture for bonding. The PrepStart H2O was able to create that texture and a resulting bond that was similar, if not better than, a texture and bond created by a laboratory sandblaster.
DPS: How have your patients responded to your use of the PrepStart H2O?
Lawson: One of my first concerns when using the device was if the patient would need to be anesthetized prior to use of the PrepStart H2O. However, when I have used this device on enamel, most of my patients have responded that it felt no different than spraying water on their tooth. I have never required anesthesia when using PrepStart H2O on enamel.
When using this device to clean temporary cement off of dentin on a crown preparation, I have experienced the same level of sensitivity as would be expected with water and air on a tooth. Some of my patients require anesthesia, and some do not.
Another concern was my patients’ perception of me “sandblasting” their tooth. I explain to them that air abrasion is an additional step that I use in my bonding procedure to make sure that their tooth is completely clean prior to bonding. I have even shown my patients before and after pictures of the preparation (although many patients do not want to see a large picture of the tooth with a hole in it). The responses from my patients have all been positive, with some even experiencing the “Wow!” effect.
It also helps that I typically use a rubber dam to prevent sand particles from entering their mouth and creating a gritty feeling. But if I use it without a rubber dam, for example, to clean temporary cement off a preparation, I find that high volume evacuation, a 2v2 gauze in the throat, and a thorough rinse afterward keeps patients satisfied.
DPS: What do you recommend for clinicians looking to increase their profitability with PrepStart H20?
Lawson: If you are purely looking at this device as something that will provide return on investment by allowing you to do new procedures, it will be a harder sell. But this device does allow increased efficiency and quality for most of my routine restorative procedures.
To learn more about PrepStart H2O, visit zestdent.com.