Saturday, January 14, 2017

Affordable Prophy Polishing

In the past, we just changed the prophy angles and wiped our hygiene handpieces.  Then we started to sterilize the nose cones.  Some states may be requiring we sterilize the motors, too.  With each hygienist seeing 6-10 patients per day, this is going to require a lot of additional motors.  At $600-$1600 for a brand name hygiene handpiece, this is a significant expense. I've been experimenting with a lot of solutions that are much, much less in both start up cost and disposable cost, as well.

TL;DR version: Most hygienists will like the Osseo Scientific Handpiece

Read on:

A good solution should be:
1) autoclaveable or disposable
2) modular - components should be interchangeable, should they break or become separated in sterilization
3) economical - none of my solutions will cost more than $240 per setup.  We also use components that are so inexpensive, replacement will be cheaper than the repair shop
4) ergonomic - they should fit well in the hand and in the mouth.  These all do to varying degrees
5) reliable - they need to "just work" day in, day out with minimal fuss

After two years of trial and error, I have three different setups for your consideration.

Setup #1 - small and svelte

the Osseo Scientific hygiene handpiece
Pros: smallest physicial size, quiet, smooth, compatible with most disposable prophy angles. The nose cone swivels like a dream.

Cons: Most expensive of the three solutions here. nose cones are small, and easily lost.  $70 a piece to replace if you do.

Shop for the Osseo Scientific Handpiece on eBay

This is hands down the favorite of everyone on staff.  The handpiece is small, smooth, strong, and quiet. The nose cone reliably engages the Twist prophy angles my hygienist insists on using.  Twist prophy angles reciprocate 90 degrees (think endo watch winding motion) so the paste almost never spatters--helpful if you have a lead foot on your team.   It uses an e-type connection.  There is plenty of torque at low RPM--enough to use this as a restorative slow speed if you don't need reverse rotation.  My assistants have inadvertently stuck my restorative contra-angle on these and I just motor filling excavation and crown polishing no problem.

You can buy these for $240 a piece, or $2090 for 10 of them.  Lares sells this setup for about twice as much.  Ultradent has a very similar setup for about three times as much.

Electric version: If you use an electric handpiece with e-type connection, or you don't want to sterilize the motor every time, you can order the nose cones a la carte for about $70-100 each.  You have to message the seller directly; he doesn't sell them online.

Bonus tip: SmartPractice sells Splatrfree prophy angles.  They are less expensive, smoother and quieter than the Twist prophy angles.  They spin in one direction like most other prophy angles, but have some strategically placed grooves to stop spit from flinging about.

Setup #2 - the big green twister

Shop for 4:1 reciprocating contra angles on eBay

These $75-100 contra-angles were designed for endo, but they will work great with prophy polishing.  The 4:1 gear reduction means even a lead foot will spin it at 5,000 rpm tops.  Gear reduction also makes it harder to stall when you bear down on those stains.  (be careful--heavy pressure on the polisher heats up teeth quickly) It doesn't engage as smooth as a $900 hygiene handpiece, but it's also one sixth the cost.  And like the twist prophy angles, it reciprocates, so it's almost impossible to fling paste around.

Shop for slow speed motors on eBay

Slow speed motors can be had on eBay for about $15 a piece.  They have a little water spigot that I plug up with a dot of blue bleaching tray resin. They are inexpensive enough to be essentially disposable when they break.  I have had very few break, even without regular lubrication. The main flaw is that they have terrible low RPM torque...they won't move with much less than 70% throttle on your foot pedal.  So you START spinning around 15,000 rpm.  That's way too fast for prophy polishing, but the 4:1 contra angle above slows it down to comfortable speeds.

One complaint is that the head is too big. You will have trouble reaching the upper molars on the buccal sides.  We just tell the patient to bite down a bit, which moves those pesky coronoid processes out of the way.

The third ingredient is what makes this setup the least expensive over time: the 8 cent prophy cup.

Pros: Almost no spatter because it reciprocates. Very low cost per patient. 4:1 gear reduction slows down lead foot operators.

Cons: Bulky. Moderately loud.

Setup #3 - Straight Up Electric

If you have electric micro motors, and aren't afraid to let the hygienist use it, this is the least expensive setup of them all.  You can run any prophy angle you want on these nose cones.

Shop straight nose cones on eBay

What I like best about these nose cones is that they are simple, reliable, and inexpensive.  They are easy to grip, easy to wipe down, and work fantastic with electric motors.

You will often see these nose cones bundled with the slow speed air motors I linked above.  That combination is fine for routine restorative, adjusting nightguards and dentures, or even chairside porcelain polishing.  But poor low RPM response of these $15 motors (really, were you expecting perfection for $15?) make it a poor choice for coronal polishing.  Push lightly on your foot pedal, and you'll get no spin at all, and then suddenly it takes off like a rocket.

An electric motor, by contrast, is smooth at any RPM.  So you can dial in your RPM at 4000 for smooth, comfortable polishing every time.

If you want to really strip down your cost, get the 8 cent prophy cup. You can use them in your electric handpiece and a $15 standard contra angle at around 4000 rpm.  It's a bit bulkier than a prophy angle, but it's less expensive, too.

The main reservation with using the electric motor is that most people don't have one in the hygiene room.  Others don't want to let the hygienist mess with the expensive electric motor, which is understandable, too. So I don't recommend using this type of setup unless you have electric motors everywhere, and your hygienists are comfortable using them.

There was a day when our dental unit was working so we rolled in the endo motor with these cheap nose cones. It was as smooth as butter cream frosting, and quiet, too.  But neither I nor my RDH are comfortable using the special purpose endo motor for prophy polishing.

One other use case for these cones: lab polishing.  I have used the same nose cone day in, day out for a year and a half of Cerec crown polishing in the lab.  I repurposed an endo motor with 4000, 8000, 12000, 20000 and 30000 rpm presets.

I've tried them all

There are other cones on eBay with bright blue rubber handles.  We tried those, but they tended to jam.  Same with the 4:1 gear reduction nose cones, which were smooth, but jammed up over time.  I think we've tried almost every other combination of slow speed motor, attachment and prophy cup we could over the last couple of years. It started when my Midwest Rhino motor died, and the repair bill several hundred dollars  That's when I started getting into imported eBay handpieces.  They weren't perfect, but I started to figure out how to make them work for all that we do with them.   The osseo scientific is the best solution overall for most offices, but the setup #2 works well for us, also.  You may just want to try them both out before you commit to buying a fleet of them. Dentistry is expensive, but there's no reason to make it more expensive than it needs to be.