The effective drills

Updated: Sep 13, 2021

When I graduated as a dentist, it was a rare sight to encounter a burr block in practice. Most clinics had one big block with every burr imaginable on display. Either on the unit's tray, or at best slightly behind the patient on a table. Some clinics had a small cup into which the used instruments were dumped after use. In the cup there was some kind of chemistry that dissolved the dirt that was on the burs. At the end of the day, the cup with the burr-cleaner and burr was put into the sterilisation room, into a tub of water, into a microwave oven and then into the autoclave.

Yes it was relatively disgusting with the free standing burr blocks, seen with today's eyes. Fortunately, we are evolving to become better and better versions of ourselves (hopefully).

Effective routines

The reason I'm addressing a topic like burr blocks today is that I've spoken with several young colleagues who spend a phenomenal amount of time on many of the treatments that involve an angle piece. After observing how a number of these young colleagues work, a few details stand out:

  1. They work very meticulously

  2. There is little or no system

  3. There are an extreme number of start-stop-check-start again sequences

  4. There are many changes of drills.

I would say that most dentists basically work almost equally fast. There are variations, but they are few. The vast majority of dentists, are very meticulous with their work. Just as they generally follow the same quality control throughout a given treatment.

Where I see the big differences in effectiveness is in the degree of systematization and structure. With the right systems and structures to carry out the work, processing time can be significantly reduced. Which frees up time to focus on the patient, as a person and not "just" a set of teeth. If you have been following the blog for any length of time, you may remember that this focus on the person is a fundamental element in the ability to achieve treatment acceptance.

The dental practice must be ready

In the following, I assume that the practice is ready for treatment when the patient enters and sits in the chair. That is, ALL materials and instruments to be used during the procedure are laid out and ready. The suction is fitted. Just as all the contra-angles and other machines that will be used are mounted and ready. The first drill to be used is already mounted in the handpieces. All tips of EMS, sandblaster etc. are attached and ready for treatment.

If we have to change a filling, 95% of experienced dentists will start with the same type of drill each and every time. So obviously it's ready in the handpiece. When ready, the experienced dentist will place the drill and remove 98-100% of the old filling material before switching to a new drill.

Effective treatment

We can set up a few guidelines for the effective dentist:

Guideline No 1:

Overview of the treatment before we start the drill.

Guideline No 2:

When a drill is removed from the angle piece, the aim is NOT to reinsert it into the angle piece.

Guideline No 3:

Be consistent but careful. (Don't fiddle back and forth 200 times to probe whether there is still caries or not). It goes without saying that we exert greater caution when approaching the pulp champer.

Guideline No 4:

The burs in the burr block are structured and set up according to the order of the procedure.

I go into more detail about how the practice can actually save several hours a week by using colour codes, structures and systems in the Teamboost dental assistant courses that we run in different places in Europe.

Effective drill blocks

Are autoclavable and colour-coded by procedure, making them easy for the team to find - if they are not already packed in the treatment cassette. The entire bur block belongs to the individual procedure and goes in the dishwasher and autoclave after use. The drills are set in a structured sequence that is identical in all blocks with the same colour code.

Example of colour coding:

  • Red = Composite

  • Blue = Prep

  • Green = Aligners

  • Yellow = Posts

Burr guide

Keep it simple.

I have worked in practices where there were 28 different sizes of round burrs. Honestly, I'm pretty sure most people can get by with 3 sizes: small, medium and large.

So my recommendation is pretty straightforward:

Take a look at your drills for each procedure. Be completely honest with yourself and select the absolute minimum of burrs that you will be able to complete the procedure with. Organize these burrs in your burr holder in the order you will be using them in the procedure. The remaining burrs, which you may find yourself using in special cases, organise in a separate container, which will only come out when it is absolutely necessary to use the burrs in it.

After 3 months, you will typically find that you almost never use the very special burrs that you previously thought were absolutely essential to have out in the burr block.

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Adaptation of composite fillings

Yes, you might find a rare indication to use that unique red diamond burr that you pick up once a quarter. But can you live without it or find an alternative - honestly?