Protrusive Dental Podcast

Jaz’s Introduction:
And so sometimes I use a bur and I hadn’t inspected it and I find that, oh my goodness, this is taking way longer than it should. And of course I have to ask my nurse to go to the stock room to get a brand new bur. But this is frustrating. Like when you are using a bur with less cutting efficiency. It is annoying and it’s actually downright dangerous for the tooth. So how can you tell? Is there an objective way to tell and subjectively, how can you tell exactly the moment when you should bin a bur? So you avoid that horrible scenario.

Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. I’m joined today by Günter Smailus and Marcella Roba who represent Intensiv. Intensiv is a Swiss based company which specializes in diamonds, so who better to find out more about the use of diamond burs and everything to do with diamonds. It’s a very geeky episode, but I feel diamond burs and diamonds in dentistry, we use them so much, we rely on them so much. I think it’s worth an episode, it’s worth discussing about different diamonds in dentistry.

I have no financial interest with Intensiv, this is not a sponsored episode. But this is very much for the pursuit of knowledge and disseminating information to Protruserati, i. e. you guys, and making everything to do with diamonds clinically relevant.

Dental Pearl
The Protrusive Dental Pearl I have for you is when you’re cutting off a zirconia crown. I know that dreading feeling, that anxiety you get about drilling off zirconia crowns. And the top tip is, do not be tempted to use a coarse or a super coarse bur. Maybe you know this already, but actually when you use a coarse bur or a super coarse bur on a zirconia, you are not being efficient. You will be slow and it will generate too much heat.

Instead, go for finer diamonds, go for standard blue grit or go for even red grit diamond. You will actually end up being more efficient at cutting that zirconia. To find out the scientific explanation of why this happens, you’ll have to wait till the end of the episode to find that out. Let’s join now the main interview and I’ll catch you in the outro.

Main Episode:
Günter Smailus and Marcella Roba, welcome to the Protrusive Dental Podcast. I mean, for those of you listening right now, Günter is this tall man wearing this lovely red bow tie and in a slightly difference in height, but probably just because Günter’s so tall. We have Marcella and they’re both looking very slick and they’re joining us today from Switzerland. How are you guys?

[Marcella]
Thank you very much. Doing great. Thanks.

[Günter]
You’re great on the sunny side.

[Jaz]
Well, I’m fantastic. I’m really looking forward to a nice geeky discussion about diamonds, because as I was telling you before we hit record, trust me, no matter what you think. When we qualify, we know nothing about the bur codes, about which diamonds indicated when there’s little intricacies.

I think this would be a nice geeky chat and there’s a lot in there for any dentist, because we rely so much on our tools. We rely so much on diamonds. And we ought to know a little bit more and this will actually, I think, make us better clinician. The most frustrating thing ever is when you’re drilling a tooth, removing caries, right?

And things are going slow. And that is not only damaging to the patient’s pulp and the tooth, but it’s also losing us money because time is money. So there’s so much we can gain from this conversation by using the right materials in the correct way. And diamonds are a big part of that. Before we delve in deeper, Günter and Marcella, please can you tell us about yourself? Günter, let’s start with you. Tell us about yourself.

[Günter]
Okay. My name is Günter, as we said. I’m in dentistry since more than 40 years now. Let’s say I grew up in dentistry. I’m running this company and the third generation, the company that was more than 80 years on the market. And my background is not dentistry, my background is economics.

So I get it. I’m running the company here with 45 people. And as I said, the third generation and I took already 20 years duty and still I have to do one other 10 years because the first one gets 10 years, 10 years, 30 years, and then myself 30 years or 90 years is my goal here.

[Jaz]
Very good. And Marcella, tell us about yourself.

[Marcella]
Hi. So I’m Marcella and I come from Italy, but I live here in Switzerland. I’ve been working in Intensiv since 11 years now. I started off as quality manager and now I’m responsible for regulatory affairs. My background is biomedical engineering and surface science, and I’m in this field since, yeah, 11 years.

[Jaz]
Fantastic. And I first met you Günter recently, in Valencia. I know we saw each other online and stuff, but we saw each other in Valencia. We did a really cool IPR workshop working with the Swingle and that’s creation by Intensiv. So, before I discovered Intensiv diamonds, I just saw, oh, the Swingle.

And then I discovered that, oh my goodness, Intensiv is this huge brand in diamonds and burs and stuff. And so that kind of came to me like, whoa, that’s so fascinating. In terms of the range of products that you guys do. So you are in a great position to teach us about diamonds. And what I like about you Günter is when I had that chat with you in Valencia planning this, the position you came from was very much education.

Let’s educate the dentists about diamonds and stuff because it’s an important topic rather than from a commercial background. Yes, you represent Intensiv. Yes, you own a company. But you were very much on board that yes, education, education is so important. And I saw that in action teaching with you in Valencia.

That was real good fun. And there was so much I’ve never seen anyone. I told you this. I’ve never seen anyone plan a lecture minute by minute by minute. Please. I was amazed. You literally made all the slides for me. I just had to enter my photos. That was fantastic.

[Günter]
Yeah. And then growth by growth almost.

[Jaz]
It was phenomenal. It was a lesson on leadership as well. So I admire you as a person, as a leader as well. And it was great to have some good food and drink with you there as well, but getting back on topic. Okay. Where do we start? I think we should start here, right? Basic, basic, basic bur codes, right? So when we are using, let’s say a bur for a crown preparation or a round diamond, for example, to remove some caries, can you just tell us about how the bur codes, the system of naming a bur?

[Günter]
Okay. The system of the bur is historical. Historical because in the beginning, when it starts with the burs, we had only let’s say five or seven different forms. And I just said the ball, the cylinder, or as you see here, the football or the egg, we had only five or four. And they said, then this is 800, this is 801, this is 802.

And then they start creating more and you say, okay, did you call that 023? And this is called size 010. So it is a really grow up, step by step. And we still orientated on this. Standard codes for the different forms in total.

[Jaz]
So that’s the first part. So like a bur code is actually quite a long number, full stop, long number, full stop. So that’s the first part. The first part describes the shape.

[Günter]
That’s right. That’s the shape. But you’re referring now to the number, which is called ISO number. The ISO number is something different. This is complicated stuff because this is almost 12 different digits. And they start actually not with the form number, they start with the shank, if it is in friction grip or the low speed bar, which you have in the contra-angles, that’s a little bit different.

[Jaz]
So the friction grip is 314, from memory it’s 314, right?

[Marcella]
Friction grip is 314 and 204 is the RA. So the right angle, these are the most common, let’s say, so yeah.

[Günter]
I believe me, even if we start teaching, we talk about that since the decades already and dentists, they’re never aligned to the ISO codes. So we do have some companies in the sector that have the ISO codes. Intensiv, never jumped into the ISO codes. We do have the standard form numbers, which we follow, which is a very easy to learn, and then we have our own article numbers. There are companies outside, they have their own article numbers.

For example, when you see this thin bur next to me here, the long one, this one, this is called, well, that’s a D6. Just a D like Delta and then six, that’s easier. So we try an Intensiv to bring barcodes more closer to the customer, making the ball is just a 200 or 199 or 201. It’s more easier, more easier for the assistants instead of having the 12 digit number, because they can error very easy.

So I can tell you, I must tell you, all students, it’s almost better to start with the form numbers and then getting the idea of the different numbers from the industries, because in the industry, they do a lot with ISO codes. None of them works with ISO code. This is something which has been invented sometimes and then was never really followed because there’s a reason behind it.

Just guess just if we would use the ISO code and my colleague my competition would use the ISO code for the same instrument the ball there would be a confusion. Because if I don’t say this is the Intensiv ISO coder, this is the Komet ISO code, that’s not possible. So the ISO code makes a reunification of one Industry, but it’s not we have very many industry and we differ a lot. So one of them could use a different setup from the other one.

[Jaz]
That’s a really insightful and just to talk about that difference. So it is an 802 with one company, the same as an 802 with another company.

[Günter]
The phone number. Yes.

[Jaz]
So it would describe the same shape.

[Günter]
Yeah, the shape. We have about one of the different shapes in the line. And even our competitors, they have, it’s about 100, some they have 90, some they have 110, depends what you define as a shape or a different shape.

But these numbers, they are common. They are common because they are historically grown. And then we have it called the article number or the reference number, and everybody is free. Everybody is free to choose. His own reference number and Intensiv being 80 years on the market far before ISO came in place, and why should we change our article numbers because generation of dentists, they know that this wonderful diamond here is called D6.

So when we start making a 12 digit number for that article, we would lose a lot or they would not cite of that anymore and they would just send it out and they would get from any industry something because they have the same ISO code. ISO code is just telling you this is the length, this is the form, this is the grid size. And that’s it.

[Jaz]
You were pointing to the red grit diamond behind you. So let’s talk about the different colors. If you just describe, do they like K files, for example, they follow ISO colors, basically do diamonds generally follow the same coloring system, i. e. white would be the finest and going up to green and black.

How many different grits of diamond are there and is this standardized? So is a green grit with one company, the same as a green grit in another company? So I want to know that as well, but just give us a little overview flavor of different coarseness of diamonds.

[Marcella]
Yeah. So yes, the colors identify the diamond crystal grain sizes, and they are given by standard. There is an eyes of standard, which specify which color corresponds to which range. In the eyes of standard, there are six colors, which identify a certain range, which is quite broad. Here in Intensiv, just to give an example, we range from finer diamond grain sizes, which is 8 microns in orange, and then we go up to the 150 micron grain size of the diamond crystal, which is identified with the black color which is the super coarse, let’s say, and then there are all these grains in the middle.

So the standard gives six color specifications. What happens here in Intensiv is that we follow the standard, but we also have more colors because we have a special feature. Maybe I could start mentioning something about this now, which is about the dimension distribution of the grain sizes in a lot of diamonds.

So here at Intensiv, we have a very narrow distribution. So if you think of the Gaussian distribution curve, which shows the percentage of diamond crystals inside the population, which have a certain size, the Intensiv Gaussian distribution of its diamonds, it’s very narrow and tall, meaning that, for example, if we’re talking about a 40 microns, a really high percentage of diamond crystals in this plot, they are actually 40 microns. And you have a very, very small percentage, which differ and are a bit lower or a bit higher.

[Günter]
In other words, ISO says, okay, if you have the red ring, that gives you medium, medium grit size and the code then for 25 to 60. So the grade coarse goes from 25 to 60, and in the middle you got most than 40, but you have 25 and 60. Intensiv, they have 25, we have 40, we have 50, and we have 60. So we have instead of one red, one for all four, we have four different ones because we are able to get that crystals much better sorted.

[Jaz]
Are there any advantages? So, for example, if you have a bur that’s red grit and it has some percentage 25, some percentage 40, some percentage 60, how will that result in a clinical difference to a burr that has just 50, for example, throughout?

[Marcella]
Maybe, yeah, so if you have a bur, which is very precise, it’s in its distribution. This is fantastic because this means that you are very precise and very efficient with your cutting with the abrasion performance. If you have a bur where the distribution of the diamond crystals is not so precise and it’s broader, then you have a high percentage of crystals which are lower in dimension.

This means that the bur is less efficient and then you have also a high percentage of crystals which are higher in dimension. This means that the surface is not As smooth as it should be, because maybe you have some cuts and some scratches given by these bigger sizes of crystals. If it is very precise, you don’t have this problem. Efficiency and precision.

[Günter]
This is especially valid for medium and fine grit because of the scratches. If a dentist relies on a red ring bur, they say, okay, this is medium. And they find two, four, five, ten crystals. I enlarge it in, they get scratches on the composite fillings. And that’s always bad, you know that, they take this and that, smoothen that, another rubber polisher to get it smooth because a scratch on a filling is always bad that bad notice, so with Intensiv, we guarantee that there’s no scratches. Absolutely not. When it comes to-

[Jaz]
It makes sense. And I imagine if you were to blow it up and zoom in on a scanning electron microscope, you would see that difference based on uniform, grit versus a variable grit. Just give us an overview if you don’t mind both of you on when bur producers are making different grit burs.

Just a classical indications. For example, when I’m finishing a composite, I might like to use a red or a yellow. When I’m preparing, I’ll pick up the blue green or when do you recommend the black? What is the indication for the black, the super coarse one? I don’t see many of those burs around. Is it because they’re more expensive or is there because there’s not much use in dentistry?

[Günter]
Well, there are not much use. Let’s say that, in the past we had a tendency to the coarse grits because the speed of the turbines, everything was not that good developed and dentists tend to get coarse grits to get the job done as you said before. We count in minutes maybe five or ten minute blocks. I would like to get that preparation done so when they choose when the dentists choose the one the 150 or 125 black or green marked grit they get it faster done, of course because of the corset grain. But it is some kind of traumatic as well for the tooth because it’s really rough that get some cracks. It is a risk of cracks, and you know what a crack mean after 10 years. And that’s why we from Intensiv, we recommend for preparation, the blue one, the blue is 80 micron.

It’s wonderful. Today, it drove by electric tow bike. Red ring is a constant 200, 000 or 160, 000 tons a minute. And that’s wonderful. That’s a wonderful job. The actual bike, I understand that the actual bike, you tend to get that coarser because when you press, you come down from 200 to 100, 000 or 80, 000 turns because you’re pressing, you’re blocking that air system.

And that’s why the trend with the red ring contra angle. It comes more and more to the smoother grains like 80 or we call it standard grain means silver, no color on the bur. And that’s, that’s, I’m happy to see that I must tell you, after all that years being in the sector, I do not like the cost first.

Because even for the patient, it’s really tough having that vibration because they’ve got a lot of vibration in the jaw, and that’s not comfortable. So I always teach dentists, especially young dentists, start with 80. You’re good enough. It’s fine for abrasion. So when you start abrading something, take the 80 micron, the blue ring, and then right here, you can take them the 40.

For the red ring for shaping and then the yellow one for finishing and polishing. We have then in between the 60 micron, the gold bar, we call it gold ring, gold bur. And this is more something in between. You can guess it. That’s 80, that’s 40 and we have 60. Guess what? Veneer preparation, we’d like to have a minimal invasive prep done, just a little bit, maybe partial just a little bit, so we take the 50 and that’s it, we just start with the 50. We do not need a smooth surface for that because we have some adhesion and then that’s why we have that medium grits in between.

[Jaz]
Very good. And I think the next question from this is when we are looking at the different types of burs, because it makes sense to me why there’s so many blue now that I see because your answer just answered that. But now we’re seeing also some clinics that are using the disposable one time single use diamond.

So I would love to know when I speak to some clinicians, they say, I am a prosthodontist and I need to prep quickly. And so I don’t want to use a diamond that’s already been used because the efficiency is less. So if I’m using single use diamonds, yes, it might cost me initially to open the packet.

And this is single use, you don’t get to use it again, but because the efficiency benefits it gives me, they prefer it. Do you think there’s any truth to this? Do you have any opinions or arguments in terms of, okay, what is better for a clinic? Or does it depend? Is a single use better or something that is a multi use like we traditionally have in clinics?

[Günter]
We would say that the single use is probably, if you’re in the high performance, it’s good for a very short job. Let’s say if three minutes or five minutes separation, that’s okay. But then the performance starts going down. So in multiple use bur, they have much longer performance.

From Intensiv, you can easily count on 30 minutes performance. So just guess, making a crown preparation and choosing a single bur half of the job or quarter of the job, you need to reload a new bur. Then you get the second bur, then you reload again and get that bur you know, that’s what we know, that what is feedback from our clinicians that the single bur drives me crazy because I have to reload always because they get weak very fast.

The multiple job bur gets works much longer for longer jobs. For the shorter jobs, of course, it’s wonderful because we have multiple use. You would name the cost, single burs. I always tell dentists when they come to me and tell me why I’m taking seeing it, but cost only $1 that you’re very rich, you know, we are really rich because a multiple bur costs you $10 and use it 20 times. So you pay half, so okay. I didn’t know that. And maybe sometimes people then do not make really calculation what it means having a single per year, maybe the one cost, maybe good.

[Marcella]
Then I’ll supply it by all the time you need to get a new bur. And another thing is that the feedback we have from our doctors and clinicians we talk to, we feel that multiple use is still the major direction that dentists are going towards.

And for various reasons what Günter mentioned now, but also, the fact that to have a sustainable, just single use on the market industry is not ready yet. Because this would mean a lot of raw material. Think about all the burs that we need to multiply by 10, 20 in comparison to what is already now around. There might be in the future, we don’t know, maybe for regulatory reasons, some pressure worth to go in that direction. But, not so far.

[Günter]
Not seen on the horizon. Nothing seen. And we see some trend in some countries, especially the United States, the United States, you may divide already a little bit half of them, they’re using single coarse, but not really single, what we know is they take it a second and third time, and then the other one, they take the multiple ones.

What Marcella said is about the industry, it’s right, if you would guess 500 million words per year in production worldwide, just the guess, I don’t know that this is exact, but more or less it should work. And then you multiply that by 10. The industry is not ready.

We do not have the capacity to do that. And the other point is we can’t get the cost down, you know. What I have heard from many friends from myself is that they say, you know I would go for single bur if I pay 30 cents or 40 cents per bur. It makes sense to do that, I say yes, this is probably the multiple bur cost by time. It’s okay. But yeah, we have metal as raw material. We have diamond crystals. It’s not feasible. The raw material doesn’t deliver that cost. It’s simply not possible to do so.

[Jaz]
I bet that most of the Protruserati, our colleagues listening and watching today did not know that a standard bur should be used for 30 minutes before it starts to lose its cutting efficiency. So, I will include that as one of the questions in the quiz for the certification at the end. So for those listening, watching, remember this answer of 30 minutes at the end. And I think, you know what? There’s always a role of something, right? And I do think that perhaps the kind of environment where the single use could be beneficial is if you run an emergency clinic.

And trying to disinfect things is maybe a bit more difficult between patients. And you need to literally go inside and get to the pulp and put some medicine in and that’s it. And you’re just drilling time is two, three minutes only. That might make sense in emergency clinic. But for someone who’s doing preparations and crown preps, it makes sense that you get more, a better cost effectiveness of using a more traditional bur.

Now, when we are talking about cutting efficiency and time of cutting. Basically, you mentioned something very interesting at the Valencia lecture, and you meant you were talking to the dentist. You were saying that your diamonds are I think you used the word natural. Is that right? Your diamonds are naturally sourced.

And later I asked you is I have no idea what that means. What’s the difference between naturally source and what’s the alternative. So teach us about where your diamonds come from and why is that significant?

Interjection:
Hey guys, it’s Jaz. It’s interfering to ask you, have you joined Protrusive Guidance yet? It is the community, the nicest and geekiest dentist in the world. We have kind of geeky discussions just like these. We talk about cases, we talk about clinical techniques to improve our success and ultimately benefit our patients. We do manually verify that each person applying to join the community is a dentist.

So we will ask for certification and we will look you up. So bear with us in our manual verification checks, but this is super important to create this a safe and thriving network. You can access on your laptop or your phone by going to protrusive. app. That’s the website, or you can just download it on iOS, Android by typing in protrusive guidance. If you love Protrusive, you’ll love Protrusive Guidance. I hope to see you there. Let’s join back to learn more about diamonds.

[Marcella]
Yeah, I can start. So, first of all, diamond is the solid form of carbon in a crystal matrix, okay? So, it, in nature, it is produced over time with extremely high pressures and extremely high temperatures down underneath in the earth mantle, 150 to 250 kilometers usually.

And in billion years they develop and then after volcanic eruptions, maybe they come up third phase. They are brought up by the volcano and then they can be harvested and then they can be used .So, through this process you get a natural diamond, which has a very unique feature. Well, in general, diamond is the hardest material on earth, and so it can basically abrade any surface, any material.

This is why it’s so important in dentistry. And also, the diamond crystals are very irregular, and they have sharp edges. And these features make natural diamonds perfect for doing this abrasive job in dentistry. I don’t know if you want to add something.

[Günter]
Maybe the audience may be interested how we get that, how we get that small pieces, so that’s in it. We do not take this one, the brilliant, no, no. This is for jewelry. Everything what is found larger than a millimeter or two goes to jewelry. We get these piece of very, very small crystal, like a sugar crystal, or even less, more than a little bit crystal.

And this you find in the sand of the desert. For example, in the desert of the southern Afrikan part, it was million of years, this was volcanic area. There’s a lot of diamonds, the most diamond mining is in that areas. And they find it in the sand in the sea sand in the desert sand. So let’s take 20 tons of sand filter that and get then the crystals out, the small small 1%. This is for industry a big profit from this we get it from this. Then these are sorted out in different microns, we take out all the 14 microns all the 16 microns. And as Marcella said, we are very good at making the sortings, the sorting of it.

The other companies, they say, okay, ISO allows me to get a broader range, so I can make a more or less sorting, and Intensiv would take a very precise sorting of these crystals. But interesting is that we take it really from nature. Industrial means that they just take carbon, put it in the oven, making heat. Making pressure and get it out some hours later. So the difference is millions and some hours, and then that’s-

[Jaz]
And so how does that relate to the, is that actually imparting difference in the quality of the final product in terms of the cutting efficiency, this in the oven, a couple of hours versus millions of years. Is that actually a difference?

[Günter]
Well, we would say, yes, there is a different, especially in the shaping and in the pureness of diamonds. When you get that naturally done, you need to get forms for that. And you need to build that into forms. Normally they use metal forms. Then all these diamond crystals, they have metal substances in.

And you’re taking the bur on 200, 000 turns per minute, and with the metal substances you get heat. You have much more heat and with the diamond crystal from nature, it has nothing just carbon. And although that that’s one of the major difference in using the heat, the cutting, the performance of the diamond is different.

You can take the natural diamond is probably more compact than the crystal of the industrial diamond. So when we say to our dentists, they say, sometimes the diamonds are smaller on the bur. No, no. It’s not, you’re just seeing the diamonds deep into the matrix. You just see the iceberg, not really the diamond, the other diamonds, which has been before on the earth, they’re gone, they’re off, they’re not used up, never a diamond, the natural diamond never used up, they won’t break.

[Jaz]
And so I guess the next logical question is how are the actual diamonds fixated to the metal shank? What’s the technology used to actually put the diamond on the metal?

[Günter]
That’s something for Marcella.

[Marcella]
I can try to explain. So we use the electroplating technique. This means that we have a special electroplating containers containing the liquid for electroplating. And then we have diamond crystals inside this liquid and of course we have our instrument inside as well which needs to be coated. So the electroplating starts, we have metallic ions, which are deposited through electroplating on the surface of the bur, and as they deposit and they form a metallic layer, they embed the diamond crystals, which are inside liquids.

Now, to give you an idea, maybe it would be nice to have a picture, like an image in mind. So, we can think about a nice mountain lake, for example. So this lake has all sorts of parts, pieces inside, wooden pieces, for example. Yeah, they’re floating on the surface, or maybe inside if you’re soaked with water.

What happens when winter comes? So the lake, the water freezes, and as it freezes it gets harder, and these pieces which are embedded inside, they get fixed. They are stuck inside the frozen water. So you can think of the diamond coating on a bur just as this mountain lake. So the frozen water is like the metallic matrix and the wooden pieces inside are like the diamond crystals which get fixed, embedded and fixed and hard, very, very hardly stuck inside the metallic matrix. And I hope this maybe was a nice picture to imagine how the process works, but the official term is electroplating.

[Jaz]
And so when we’re using these burs, and they are losing their efficiency, so let’s say we’re getting to a bur that’s been used for maybe 40 minutes, beyond that 30 minute, is the diamond, and maybe you’ve already mentioned this so I apologize, but is the diamond actually becoming smaller, or is it becoming less sharp, or is it actually breaking away from the metal? How is it losing its efficiency?

[Marcella]
The diamond is staying exactly the same. It’s not getting smaller in shape, it’s maintaining its sharp edges. It’s just the fact that it’s been released from the matrix.

[Günter]
Break out.

[Marcella]
It breaks out.

[Günter]
Yeah. It breaks out with the time. We have an outbreak already in the first minute, because we have some always on the shank, which is not anchored that much into the lake. In the frozen lake, let’s say, and then there are pieces that are much deeper into the frozen lake, it’s half in or two thirds in, they stay down there. So then you can estimate that at the end, you may believe that they are used up or gone bad, you’ll see only the small tips out of the frozen lake and then the hot the large pieces inside. So because you can’t use up the nickel matrix, oh, that’s not possible. You can’t get the other ones, the ones and the nickel markets inside. They’re gone They are in.

[Jaz]
This is when we’re looking at a bur that we’ve used for a long time, we see that the color, there’s almost like a color difference, right? You’re seeing more metal show through. So my final question is a very clinically relevant one is the following.

And we have this problem in our practice where we use burs that go to the autoclave and they come back and we have these certain bur pots and all the dentists use them. And the most frustrating thing as a dentist is picking up a bur and it’s no longer fit for purpose or already been used too much.

And I hate that so much. So I’m very hot on, if I see a bur that is a bit knackered because look, the bur does not tell us, oh, I’ve been used for 27 minutes. I’ve been used for five minutes. I’ve been used for four or five days. We need to look and guess. And so can you give us any clues for our dental assistants, nurses, and dentists, when we are looking at a burr, how much magnification do we use, what are the telltale signs that maybe it’s time to order a new bur?

[Marcella]
So I can mention maybe about the signs, which allow to understand if a bur needs to be replaced. When you see that, if it’s totally metallic in color, you don’t see any more diamond means that it’s totally worn out. When you see 50 percent of diamond coverage, that means that it needs to be replaced.

Half, more or less half. This means that it needs to be replaced. I would say that. May I add also another thing that if the bur looks white, then this means that it has enamel or ceramic debris clogged or composite clogged. And so maybe, okay, it’s not no longer efficient. The doctor tries to use it and has to apply a lot of pressure to compensate.

It looks like it’s no longer working. And it will give heat, exactly. But the only thing is that it needs to be rinsed. And cleaned, and this debris and clogging removed. To resume it, to make it proper.

[Günter]
Never accept the white bur. And should never accept the silver bur. And absolutely hate the black bur. Because when the bur comes, black is burnt off, that’s gone, ultimately gone, but if you arrange between white and silver, it’s really good to tell the assistants, if you have a white bur, clean it until you can’t see any white spots on that, because we do not need them.

It’s from the patient before and then the other one is if you see less than half average, take a new one in my bur block because it’s better for me, with the half coverage, I can’t work anymore. So it’s-

[Jaz]
I like this guideline of a half coverage. So this is a visual inspection that we do. I imagine it’s better with magnification, using loops and having a good look and seeing, yes, what kind of coverage there is. I wish there was like a quick test that you could do like, okay, yep, this is gone. This is not, but we have to rely on visual and hopefully before we start using the bur and realize that way.

[Günter]
We have the same wish, the same wish. So far we haven’t find the right feasible technique because it’s too much reflecting. The diamond is transparent, the metal is reflecting and whatever we try to do, it doesn’t work because it gives us different results. And, but anyway, what is properly nice for the office, for the assistant in the sterilisation room, you place some two photographs, the good one and the bad one, the half coverage and the full coverage.

And they said to their assistant, when you see that with a half coverage, that’s gone. Whenever you see close to what I see completely, leave it, place it again, please. So to support that with the picture, because people love picture like this.

[Marcella]
People love picture.

[Günter]
Just telling them, look, is this half? I don’t know. Maybe just start this one. I don’t know.

[Jaz]
Comparison photo makes a lot of sense. If anything, someone’s going to be a superstar. Here’s what they do. They get a brand new bur photo and then they use it for like one patient and then they can photo, and then they use the second page, take it to photo.

And then they have a series of the same bur. That would be, then you’re like the nurse kind of charting it. Like, where is it? Like a scale. That would be cool. Maybe you have this photo already and you can send it to me.

[Günter]
We haven’t done that yet, but we could make it, but please, there are more parameters, not just the usage, you know. I must admit that the 30 minutes with a status, it’s variable. There are dentists, they have good muscle. They are, right, strong, and they press. And then the 30 minute goes down to 20, because the burs goes off easier, because you’re pressing too much. Then there are very feminine dentist, they have a soft plan, very nice, very sensitive, they even give you 40 minutes, no problem.

[Marcella]
It’s actually the diamond which is doing the work, the creation, not the strength. So this is a very important concept.

[Jaz]
And the other thing to bear in mind here then is depends what you’re cutting, the substrate. Like if you’re cutting soft caries, that’s not going to do anything to the diamond. Whereas if you’re cutting ceramic and metal and you’re removing all, you’re cutting old crowns off and you’re having to work hard, that would obviously reduce that time. Is that a fair statement?

[Günter]
That’s absolutely correct. The most worth is zirconia. Zirconia is the most worth for diamond burs. Then we come really in the multiple yield bur becomes a single yield bur because of the material. However, industry is especially intense that we place a special bur for that with a special coating, a special extra coating to get the bonding better done. Because the key for zirconia bur is to leave the crystals in place. That was our goal and we found that after years of testing we found the bonding, which is more expensive of course, but it works much better to cut zirconia. So many dentists-

[Jaz]
I’ve heard and I’ve tested as well that a red grit or a yellow grit diamond is going to be better and more efficient at cutting zirconia. And, but yes, you’ll need to use a few of them than using a coarse burr to cut zirconia.

[Günter]
Of course, because the coarse is clogging, the coarse is clogging. In fact, in seconds, the fine grid, you must just imagine that’s fine or medium grid. You have many crystals on that piece. And the part in between the crystal is not that large. If you have larger crystals, automatically the path between the crystal becomes larger. But there are large neighbors, the neighbors.

So that’s why the coarse ones are clogging much faster than the fine ones and the medium ones. You’re absolutely right. We are from the industry, we say the blue one. The blue one is the ideal one to start cutting zirconia. Oh, it’s good. And double water. Double water helps because of washing of the instrument. Yeah, the rinsing is really important. And then for secondia, just have an extra water supplied. It works better. It’s not because of the heat, it’s because of the cleaning.

[Jaz]
That’s very helpful because often in this scenario, we may need to cut off a zirconia. I personally have been using red grit diamond with good success. Yes, I’m able to use two, but I’m much quicker. Yeah. But if I change that bur quickly, I can get the crown off sooner than if I use, like, if you use a green, like just like you said, it makes sense. Like it’s too coarse. The clogging is happening. So, you’ve given a scientific reason for that.

So I appreciate that. That’s all the questions that I had. Is there anything else you’d like to add that dentists should know about when working with diamonds. Like we covered a few important working tips, like, how to recognize when the diamonds worn out a few little tips about to think about the minutes we learned a little bit, a bit more about diamonds in terms of how it’s made and how it’s affixed to the bur. Is there anything else that you think educationally we should know?

[Günter]
Yes. We have many different sizes in the bur, the bur line. So many days that they ask and say why do I have a long cylinder short cylinder and so on and this is because when the time of burs used you better use a full surface of the bur.

Never use only the tip or only the middle part, you know. That’s not good for the bur, it’s not good for the tooth. So, whenever you have the application, watch on the tooth. The tooth at that size, then choose the right dimension of the bur for that, to applicate the full bur on the tooth.

When we have the occlusion to be done here, larger occlusion, larger egg. Smaller occlusion, smaller egg place. So, it helps a lot, because the burnout of the bur-

[Marcella]
More uniform.

[Günter]
Yeah, more uniform. The other one is, never use a bur for Endo, Exos because then you just get all this, I thought it grew out to make it old.

[Jaz]
So basically don’t use the standard crown prep bur that you rely on for making your margin for the endo access. Because yeah, you’re right, because we look at these burs and 99 percent of the bur looks amazing. And the most important bit, the tip is looking like pretty much metallic, the diamonds are gone and that’s not very good either.

[Günter]
Yeah, that’s right. That’s my addition here. Yeah, that’s right.

[Jaz]
Very useful. Very helpful. Günter and Marcella, thank you so much for your time. I appreciate learning about it. Please tell us more about dentists who want to start looking into different diamonds, your brand, how is it distributed? Where can they get in touch? Learn more about Intensiv. You obviously look after your product very much, your brand very much in terms of the quality of diamonds that you produce. I use your Swingle a lot in for IPR, as you know. Which is why we did the workshop together as well. But tell us more about how dentists can learn more for you guys.

[Günter]
Okay. Mostly dentists can learn on further education courses. We do support a lot of courses from university, from other institutes, but mostly dentists get our products in all markets through dental dealers. So we do work for dental dealer networks, like Shine Dental or Dental Director in UK or GACD in France or whatever, you know, name it.

But this is, we never sell directly to the dentist. However, we are in touch with dentists. We have a website, www.intensiv.Ch for Switzerland, and we get contacts to many dentists. So whenever dentists have questions, of course, they’re invited to contact us directly. We love that. We love to talk to dentists. We go on exhibitions every year, maybe 20 or 30 days of the year.

We are outside in exhibitions. We’re making ourselves a Congress in Lugano, which is a nice place to be because Intensiv is located in the south of Switzerland, in Lugano, in the Italian part. And we run a two day congress here every day, every year, with about 10 to 15 speakers from four different countries almost. And that’s a lot of things to get closer to Intensiv. And to learn more about application, about our instruments.

[Jaz]
I appreciate your time. And Marcella, you’re pretty much working full time with Intensiv at the moment. You’re a very scientific role. Thank you for your time.

[Günter]
Great. Thank you to the audience. A great thank you to you. You had wonderful work. Loved it. You are challenging us here a lot and look forward to getting more of that. Because it’s really good to get challenged and getting this discussion done. We love that. It’s nice.

[Jaz]
Amazing.

[Marcella]
So yeah, we look forward to more, hopefully.

Jaz’s Outro:
Appreciate it. Thank you so much. There we have it, guys. Thank you so much for staying all the way to the end. We now know why we should be using finer diamonds and not the super coarse diamond that you can find when you’re cutting off zirconia. And hopefully now we can actually be a little bit more astute when it comes to assessing our diamonds and knowing when it’s time to say goodbye and opening a fresh pack.

Ultimately, your efficiency will be better and you’re actually not heating up the pulp so much. I want to thank Intensiv for giving up their time, Günter and Marcella. And of course, I want to thank you, the Protruserati. You can get CPD. You can get 45 minutes CPD or CE credit and a certificate sent to you by answering our quiz on Protrusive Guidance.

There are hundreds of hours of CPD to be gained just from the episodes alone, let alone the premium content and the mini courses that we have on Protrusive Guidance. You can either pay monthly or pay an annual, and you get a bit of a discount when you pay annual as well. So if you’re not already part of the nicest and geekiest dentists in the world, do check out Protrusive Guidance.

And I thank you again for listening all the way to the end. I’ll catch you same time, same place next week. Bye for now.