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Figure 8: Next, I use my Wand ® STA ® device (Aseptico; Woodinville,
Wash.) to give anesthetic. This anesthesia system has removed so
much stress from my time spent in the operatory, especially when
it comes to giving anterior infiltrations — a simple injection to give
in a very sensitive area of the patient’s mouth. It never occurred to
me that I was tensing up during these injections and concentrating
on giving the anesthetic as slowly as possible. With the STA, I can
set it to the slow speed and tell my assistant jokes, creating a lowstress
environment for the patient.
Figure 9: The first step in the Reverse Preparation Technique is to
break the proximal contacts. We will be prepping all of the patient’s
anterior teeth, so we start by simultaneously breaking the contact
between tooth #8 & #9. Usually we use a #56 bur for this; however,
by using an 856-025 bur (Axis Dental; Coppell, Texas), we not only
break the contact, but we also begin to form our interproximal margins
at the same time.
Figure 10: Here we are starting to break through the contact,
pushing the bur toward the palatal. With my KaVo ELECTROtorque
handpiece (KaVo Dental; Charlotte, N.C.) spinning at 40,000 rpm,
this big bur easily makes its way through the contact. The one thing
to watch out for is nicking the gingival papilla. We also go to great
lengths not to go subgingival, unless the existing crown has subgingival
margins.
Figure 11: I then move on to the rest of the interproximal contacts
using the 856-025 bur to create separation and begin the formation
of the interproximal margins. When I reach the most distal tooth I
am going to prepare, I can still use the 856-025 bur on the mesial,
but I must switch to the 856-016 bur (Axis Dental) on the distal
to avoid over-preparing the tooth or damaging the adjacent tooth.
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