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:
They work very meticulously
There is little or no system
There are an extreme number of start-stop-check-start again sequences
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?
Polishing: make it as simple as you feel defensible. Ask yourself: is this polishing burr REALLY necessary? How often do I really use it? (If in doubt, ask your clinical assistant. There are probably a lot of instruments and drills in your drawers, making her shake her head)
Make it a little easy for yourself and your team to navigate during any proceedure. It makes it much much easier to work 4-handed and efficiently.
If you want to use disposable steel round burrs, fit them as the last step before packaging the cassettes to prevent corrosion. Just as they are thrown away before the block is carried to the sterilisation area.
Systematic Burr-block design
Set up your blocks with the drills positioned in the sequence you want to use them.
Example from my block: E-max prep setup:
Drill no. 1: 1 mm. green torpedo-shaped cylinder (depth cut and setting up the preparation)
Drill no. 2: 1.6 mm./ 1.8 mm. green torpedo-shaped cylinder ( Depth cut occlusal)
Drill no. 3: Flat round diamond (Oral prep of incisors)
Drill no. 4: Red American football ( Final adjustment of oral surfaces of incisors)
Drill no. 5: 1.6 mm red torpedo-shaped cylinder (Polishing and final adjustment of the preparation)
Drill no. 6: Conical white stone with flat tip (Ensures an ideal prep border + polishes without the gingival tissue starting to bleed)
Drill no. 7: Brownie point (Final polishing)
Once a bur is replaced, it does not come back into the angle piece again, unless I have made a mistake.
Does that make sense?
Note
Remember this is my setup that I picked up on a prep course abroad - yours probably looks different and you may have a different sequence in your way of working. So spend some time to find the best protocol for your dental practice.
If you are several dentists in the same clinic, it takes a bit more time to work out the optimal workflow covering all practitioners. If you want to have efficient workflows, it is important that you take the time to find the optimal burr block. It may take a long time to reach agreement, but it pays off in the long run in the dental surgery.
Share your own Tips & Tricks
I hope this post contains a simple tip or 2 that you can use in your dental practice. I'm not going to write about clinical tips and tricks here, as that's beyond the scope of this blog. However, you are always welcome to write to me directly if you have any questions or would like some advice.
You can also let your dental assistants participate in the Teamboost course we offer.
Now, if you have some specific tips that you think would be useful for some of our colleagues. I'd be delighted if you'd post them in the comments section below. Alternatively, you can post them on my Facebook page.
Make a difference
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Many kind regards
Jesper Hatt DDS
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