Dear Dr. DiTolla,

I really love the Reverse Preparation Technique. It has made my life so much easier! One question, though: I still find that I don’t have enough reduction on the lingual surfaces of tooth 8 and 9. Any suggestions on how I can make sure I have enough reduction in these areas?

– Dr. Darryl Duval
Jacksonville, FL

Dear Darryl,

Good question! I usually eyeball it, but as we both know that doesn’t always work. When I have doubts, I use The Reduction Ring. I find it to be pretty fail-proof; in fact, I should use Reduction Rings all the time and put them in the Reverse Preparation Technique video.

Please email me back and let me know if you like them, as there are other brands out there you may like better.

– Dr. DiTolla

Dear Dr. DiTolla,

I recently read your article in Dental Economics^® and was very interested in learning more concerning the STA™ System anesthesia technique (Milestone Scientific; Livingston, N.J.).

I have many of your DVDs and use your Reverse Preparation Technique religiously. The STA System technique piqued my interest, but after seeing you use and endorse it, it made me want to learn more. Do you currently have a DVD for this technique? Also, is it an easy technique to learn or does it take practice? Any additional information you can provide would be greatly appreciated.

– Dr. Rick Bray
Pennsburg, PA

Dear Rick,

For a single mandibular molar, I start in the buccal furcation, right at the buccal midpoint on the STA setting, not the normal or the more rapid setting. I wait for the lights to increase to show that the pressure is correctly increasing for a PDL injection. If I don’t get proper pressure in the furcation, I move the needle to the MB line angle and try it there and then move it to the DB line angle. Due to localized periodontal conditions, you may need to move the needle to an area that is healthy enough for this type of injection. If I get a good injection in the buccal furcation, I typically do not go to the lingual, although there is certainly nothing wrong with doing that. I know some dentists who give the injection at the ML and DL line angles instead of the furcation, and they report very good results with that technique, too.

Basically, it doesn’t matter where the needle is as long as you are getting good pressure feedback on the unit, which tells you it has been a successful PDL injection. I like it best when it works in the buccal furcation because I know I will get great pulpal anesthesia with that single injection.

For typical maxillary infiltrations, I use the normal setting if I am starting in the area of the bicuspids and moving anteriorly. If I am just anesthetizing 8 and 9, for example, I will usually start the injections on the STA speed (the slowest speed), even though it is not a PDL injection. This is the most comfortable setting for the patient and halfway through the injection, when the patient is partially anesthetized, my assistant or I will switch it to normal speed. I hope that helps!

– Dr. DiTolla

Dear Dr. DiTolla,

I have happily used Glidewell Laboratories for several years. I even came down from Northern California to tour the impressive facility, where I saw you working.

My question is: What cement do you recommend for zirconia? Different lecturers and manufacturers give various strength numbers. I have been using Panavia™ F2.0 (Kuraray Dental; New York, N.Y.) and RelyX (3M™ ESPE™; St. Paul, Minn.) successfully for many years.

– Dr. Richard Jergensen
Fairfield, CA

Dear Richard,

Panavia F2.0 is a great choice. RelyX could be referring to either RelyX Luting Plus Cement or RelyX Unicem; either is a great choice as well. The RelyX Luting Plus Cement is a resin-reinforced glass ionomer used for conventional cementation, and Unicem is a self-etching resin cement. Both are highly acceptable choices for zirconia-based restorations.

– Dr. DiTolla

Dear Dr. DiTolla,

I recently watched your Rapid Anesthesia Technique on the Glidewell website. I think I understood most of it, but is it basically a PDL injection?

Also, what gauge and length needle do you use for this technique? I have had a hard time finding a heavy enough needle short in length to use in my conventional PDL gun.

– Dr. Mark Pelletier
Irmo, SC

Dear Mark,

The Rapid Anesthesia Technique is a PDL injection that is done in the furcation space of a lower molar. I used to do them by hand, but I now use the STA System from Milestone Scientific (stais4u.com). In fact, I now do all my injections with the STA System — I love it.

I used to have a problem with my 30-gauge extra short needles bending as well. Since I switched over to the STA System, you have to use their needles. They hold up much better, but you can only use them with their system. Otherwise, I prefer Accuject^® needles from DENTSPLY International, Inc. (York, Pa.), but they still bend a little at times.

– Dr. DiTolla

Dear Dr. DiTolla/Dr. Lowe,

I was wondering what type of camera was used in Dr. Bob Lowe’s article on pages 24–29 of Chairside^® Volume 3, Issue 2. The photos were great, and I would like to get all the information I can on the process used.

I’d also like to know if Dr. Lowe learned this technique on his own or if he attended a class and, if so, where. Finally, what settings does he keep his camera on? Thank you for any information you can provide.

– Tracy Lindamood, CDA
Jacksonville, FL

Dear Tracy,

These pictures have been taken over a period of many years. Some were taken with a Fuji S-1 Pro, others with a Canon 5D. The Fuji had a ring flash, and the Canon 5D has a side-by-side dual flash. While a ring flash is easier to use, especially in the posterior region of the mouth, it tends to make images look more two-dimensional. The side-by-side flash takes a little practice to learn how to bounce light to capture posterior exposures. The anterior exposures are much more three-dimensional than those taken with a ring, particularly if you concentrate the light a little more on one side.

Dr. Shavell, my mentor, was an outstanding dental photographer. He had two rules. The first rule: Fill the frame with your subject. To show a photo of one tooth, you need to go two-to-one. Today, with digital, this can be done with Adobe^® Photoshop^® (Adobe Systems; San Jose, Calif.) and cropping, but that takes time. I prefer a 2x teleconverter to take the photo at 2x, then no manipulation with computer software.

The second rule: Line up the buccal surfaces of posterior mirror shots parallel to the top of the viewfinder. Center facial and labial shots using the occlusal plane as a guide.

The AACD has a good pamphlet on taking intraoral photos as far as settings, which vary from camera to camera, flash set up to flash set up. The nice thing with digital is you can see if the exposure is too light or too dark and adjust the flash intensity and/or f-stop accordingly.

Lastly, my friends Dr. Tony Soileau and Dr. Jim Dunn teach excellent photography courses. Google them to get more detailed contact info.

I hope this helps and good luck!

– Dr. Lowe