Dear Dr. DiTolla,

I have really enjoyed your articles and video presentations over the years. They are very informative and helpful.

I have a question regarding your success rate with the Milestone Scientific STA^® System (Livingston, N.J.). I have been using it now for more than a year, and it seems to be hit or miss, just like the mandibular block. I love it when it works, but I find it very annoying when I have to go back and do a block. I wonder what you might be doing differently. I use 4 percent articaine with 1:100,000 EPI and usually deposit the anesthetic for 15 seconds after I have reached the PDL (about one-third of a carpule). I have tried both buccal and lingual placement, as well as mesial and distal. Many times it does not even get to three bars on the graph LED. Any thoughts you may have as to why this is happening would be greatly appreciated.

– Jeffrey Olson, DDS
Irving, Texas

Dear Jeffrey,

Thanks for the kind words! I did have a period of time where my effectiveness with the STA System went down, albeit very slowly. My initial enthusiasm for the unit slowly waned and then, luckily, the unit stopped working completely. I sent it back to Milestone Scientific, and they sent me a loaner to use in the interim. It was like magic! I was getting the PDL alert on every single tooth! I was in heaven. I realized that the problem was with my unit. When my STA System came back I was reluctant to return the loaner. I kept it in the office for a week, until I verified that my old one was working. My suggestion is that you send your unit in for some maintenance to ensure it’s working properly.

I usually start in the buccal furcation with an extra-short needle, and if I get the PDL alert there I am usually good. If there is perio involvement, I usually go to the ML corner, where it is the norm to get the PDL alert, and then I also go to the DL corner. If the patient is phobic or sensitive, I do all four corners. Sometimes I have to go back in with a little more in the PDL, but I have never had to go back and give a block. I usually see patients whose last dentist couldn’t get them numb with a block, and I’m able to with the STA System.

Keep me apprised of your experience because I recommend the STA System to everyone.

– Mike

Dear Dr. DiTolla,

I recently discovered your Rapid Anesthesia Technique on YouTube, and I have tried it a few times. What are some of the post-op complaints, and how do you address them? Thank you for your help.

– Seada Damiano, DDS
Cicero, N.Y.

Dear Seada,

I don’t get that many side effects now that I use the STA System to deliver the Septocaine^® (Septodont; Lancaster, Pa.). When I was doing the Rapid Anesthesia Technique using a hand syringe, I used too much pressure, which caused some tearing of the PDL and resulted in the tooth being sensitive to percussion or biting in some cases. The STA System has eliminated the speed and pressure issues, so I don’t see that anymore. Post-op complaints are almost nonexistent now — nowhere near where they used to be when I was routinely giving lower blocks.

– Mike

Dear Mike,

Thank you for your prompt reply. I really appreciate it. I have tried the technique (manually) about six times. Yesterday a patient I had seen about a week ago for an occlusal on tooth #31 came back and complained of pain in the gingival area. The tooth was fine on percussion. Maybe I used too much pressure or too much solution. I think this technique is fantastic, and I will look into the STA System. Thanks again, and have a great day!

– Seada

Dear Seada,

I’m not an STA System salesman, but when I started using it my confidence with the technique really took off. I had a patient come in last week who left her dentist of 15 years because he couldn’t get her lower molar numb on two consecutive appointments to finish a crown prep. I used to dread these types of patients, but I actually look forward to them now because I have been able to anesthetize all of them so far. In those cases, I inject in the furcation and the buccal and lingual sulcus, but it has always worked. You truly become their hero.

– Mike

Dear Dr. DiTolla,

I wanted to thank you for the excellent veneer video you made. I learned a lot: putty-wash index, the Rapid Anesthesia Technique and fixing alignment before depth cutting! Those were big, and I feel like I became a better dentist from watching your presentation.

One question: When you use a putty-wash index of the wax-up, do you use lubricant? I broke a few wax-up teeth (glued them back easily though) when I took my putty index. The impression material sucked up all the moisture from the model and adhered to certain waxed teeth on the model.

– Ruslan Korobeinik, DDS
White Plains, N.Y.

Dear Ruslan,

I have done that as well, although once the putty-wash matrix is done, I really don’t need the wax-up anymore. Of course, you could always have the lab make a duplicate stone model of the wax-up, making it easier to work with. I hope that helps!

– Mike

Dear Dr. DiTolla,

As usual, I read Chairside^® magazine cover to cover as soon as I received it (I can’t say the same for some of the other periodicals I receive). In the most recent issue, I was glad to see that you mentioned Glidewell Laboratories is a CEREC^® Connect laboratory (Sirona Dental Systems, Inc.; Charlotte, N.C.). (I don’t think it has been properly advertised, and Glidewell is very good at advertising.) This might be a good topic for a future article.

I wrote an article on the subject that has not yet been published, and I am attaching it for your opinion. I hope you find the time to send me some feedback.

– Carlos Boudet, DDS, DICOI
West Palm Beach, Fla.

Dear Carlos,

Thanks for the kind words. I would love to review the article you sent. Our only requirement is that it is accompanied by outstanding clinical photography! I look forward to reading it.

– Mike

Dear Dr. DiTolla,

Congratulations on your latest issue of Chairside. I very much enjoyed the article “Simplifying Lab Communication: The Dental Midline Position, Incisal Cant and Incisal Horizontal Plane” by Dr. Leendert Boksman. The article seems uniquely appropriate when one looks at the front cover and observes an absolutely beautiful young lady with her upper midline at least half a tooth to the left of her facial midline and her left eye fully 6 mm higher than her right eye. Literally everyone has some facial asymmetry, including Dr. Boksman whose glasses have a pronounced uphill slant to the left. The point is that our stepbrothers, the cranial osteopaths, and the rather few practicing cranial orthodontists have shown that they are able to produce dramatic improvement and, occasionally, correction of these asymmetries. The others simply say that such asymmetry is “acceptable” (which it must be if one does not know or understand how to correct it). I don’t know if this information would be of interest to Chairside magazine, as it is more of an orthodontic concern, but the article in your magazine was absolutely fascinating to me, and I intend to order several OneBite™ (Precision Dental Products; Draper, Utah) facial plane relators immediately. Thank you so much!

– Gerald W. Spencer, DDS
Sedalia, Mo.