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8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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24/10/201
BY Dr
Mohamed H. Ghazy
Professor of Fixed Prosthodontics
October 10, 2013
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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ClassificationAccording to their uses
Diagnostic
Cutting
Restoring
Accessory
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Diagnostic instrument A. Traditional diagnostic instruments:
Mirror
Indirect vision
Light reflection
Retraction
Tissue protection
Explorer (Probe)
Distinguish areas of calculus.
Distinguish decay.
Distinguish areas of discrepancies on teeth.
Cotton Pliers (Tweezers)
Carry, retrieve and place small objects. Locking Non-locking
4. Periodontal probe
Measure the depth of salcus
. Articulatin a er and holder
B. New diagnostic instruments:
1. Digital radiograph.
2. Diagnodent Laser
3. Operating Microscope
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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4. Intra-oral camera.
5. Loupes.
6. DIFOTI (Digital Imaging Fiberoptic Trans-
Illumination
Cutting instrumentsDepending on whether mere hand or mechanical forceare utilized to work out these instruments:
Hand cutting
Powered rotary cutting
Laser equipments
Other equipments
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Hand cutting instruments
Manufactured from Carbon steel
Stainless steel
Carbide steel Other alloys of nickel, cobalt, chromium
Instrument design Blade(Working End)
Portion of the instrument designed for aspecific function
Shank Part of the instrument that attaches the
working end to the handle
Handle
Portion of the instrument where theoperator grasps
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Examples of Hand cutting instruments:
Chisels Hatchets Hoes
Marginal Trimmers Angle Formers
Examples of hand cutting
instruments.
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G.V. Black describe a way to name dentalinstruments:
1. The purpose of its use e.g. excavator, condenser,scaler.
2. The position or manner of their use e.g. push, pull.
excavator condenser scaler.
G.V. Black describe a way to name dental
instruments: .
3-The form of its working part, hoe, hatchet, chisel etc.
4-The number of angles in the shank, straight- no angle’
mon-angle (one angle), bin-angle (two angles), triple-angle (three angles), quarternary-angle (four angles).
hoe hatchet
chisel
s t r a i g h t
m o n - a n g l e
b i n - a n g l e
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Powered (rotary) cutting
Instrument
Power sources for dental units
Electric motor
driven
Compressed air
•What does the term rotary mean?
• (Rotary is a part or device that rotates around an axis.)• In dentistry, rotary instruments are attached to a handpiece.
Handpiece is a device for holding rotary instruments transmitting power to them and for
positioning them intra orally
ccording to shape
Straight handpiece
Contra angle handpiece
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Rotary speed ranges
Low speed (below 12000 rpm)
Medium speed (12000-200 000 rpm)
High speed (above 200 000 rpm)
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Disadvantages of low speed
1- Ineffective
2- Time consuming
3- Require a relatively heavy forceapplication
Initial preparation of grooves and pinholes
Cleaning of teeth
Caries excavation
Finishing and polishing procedures
Uses of low speed
Advantages of high speed Faster removal of tooth
structure with less vibrationand heat production
Better control and greaterease of operation
Patient is less apprehensive
because annoying vibrationand operating timedecreased
Instruments last longer
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Cutting tools
Dental rotary burs
Dental rotary abrasives
The rotary tools used in removing tooth structures may be
classified into burs and abrasives depending on whether
they work by an actual cutting or an abrading process.
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Design features
Shank
Neck
Head
Shank design Definition It is the part that
fit into the handpiece, and
accepts the rotary motion from
it
Long shankUsed with straight handpiece
Short latch shanksUsed with latch type contra angle
handpiece
Friction grip shanks sed with ultra high speed handpiece
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Neck design
It is the intermediate portion of an instrument thatconnects the head to the shank
Function: transmit rotational force to the head
Head designIs the working part of the instrument, the
cutting edge or portion of which performthe desired shaping of tooth structure
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Characteristics of the head 1. Type of cutting: Bladed (bur).
Diamond abrasive.
2. Material of Construction:
Carbon steel.
Tungsten carbide.
Diamond ships.
Sand.
3. Head size4. Head shape
Finishing
End cutting
End and side cutting
Wheal
Pear
Fissure
Inverted cone
Round
Dental bur(shape)
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Burs flute design
Cross cutPlain
Diamond abrasive instruments
Advantages
Long life
More effective in cutting enamel and dentin
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Diamond abrasive instruments
Fine60-74µm
Medium88-125µm
Coarse125-150
µm
Very fine38-44µm
Particlesize
Diamond abrasive instrumentsThe wheel stone
Round and oval shaped
stone
Cylindrical stone
Tapered stone
Inverted cone stone
Cup shaped stoneBarrel shaped stone
Pear shaped
Bud shaped
Root facer stone
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Wheel Round Spezial shapes
Pointed Torpedo Torpedo tapered
Cylinder Cylinder round Cylinder pointed
Pear Cone Trapered
Tapered round Wheel Round
Cylinder Cylinder round
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Pear Cerafil Egg
Flame Grenade Cone
Bud Tapered Tapered round
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Oval or flame Shaped: used to reduce palatal and
lingual surfaces of anterior teeth.
Wheel Stone: used to reduce incisal
edges in anterior teeth and occlusal
planes of cusps of posterior teeth.
Wheel Stone may be with f lat end,
round end or tapered ended stone.
Barrel and Pear shaped stone: used
to reduce occlusal surfaces of
premolars and molars.
Tinker Stone: used to perform
shoulder with bevel finishing line for
PFM restorations.
Fisssure Stone as:
a. Tapered with round end used to perform
chamfer finishing line for full metal
restoration.
b. Tapered with flat end used to perform
shoulder finishing line for all ceramic full
coverage restoration.
c. Cylindrical stone. (long/short) used to
do grooves for partial coverage
restorations.
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According to function
Reducer
Cutter
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Finishing
Guidance Stone
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Root Facer
Tissue Trimmer
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Discs
Abrasive rotary instruments used for proximalslicing or reduction.
Supplied either mounted or demounted
Used with conventional or slow speed
Discs classification
According to the
abrasive material
Carborandum
Diamond
Metal
Sand paper
According to size
Small 3/8 inch
Medium 5/8 inch
Large 7/8 inch
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Discs classificationAccording to shape
Flat shaped
Cup shaped
According to the side of
abrasive material
Safe sided
Double sided
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Accessory instruments and items.
Ultrasonic Hand piece
Design Attached to the dental unit.
Powered by electricity.
Primarily used for prophylaxisappointments.
Attachments are similar in appearance to
scaling instruments. Delivers a pulsating spray of water
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Uses of the Ultrasonic
Handpiece Remove calculus
Remove stain
Remove bonding materials from toothsurface after orthodontic appliances areremoved
Remove cement after orthodontic bands
are removed
Laser Handpiece
Design Uses a laser light beam instead of
rotary instruments.
Laser is conducted through a fiber-optic cable.
Resembles a standard handpiece. Maintains a water-coolant system.
Maintains an air-coolant system.
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Uses
Cauterizes soft tissue.
Vaporizes decayed tooth structure.
Advantages
Usually painless.
Patient usually does not require anesthesia.
Proceed with procedure faster.
Disadvantage
Cannot be used on teeth with existing restorations.
Air-Abrasion Handpiece Design
Small version of a sandblaster.
Produces a high-pressure delivery of aluminum oxide particlesthrough a small probe.
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Uses•Prepares teeth for sealants.
•Removes external stains.
•Class I through class VI preparations.
•Endodontic access.
•Prepares a tooth surface for the
cementation of a cast restoration, such as
a crown or veneer.
Any Questions….
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BY Dr
Mohamed H. Ghazy
Professor of Fixed Prosthodontics
October 20 2013
Student question
What is the finish line?a line indicating the location of the finish of a race
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Rotary cutting equipments. Low-Speed Handpiece.
High-Speed Handpiece.
Ultrasonic Handpiece.
Laser Handpiece.
Air-Abrasion Handpiece.
Laboratory Handpiece.
Ultrasonic Hand piece Design Attached to the dental unit.
Powered by electricity.
Primarily used for prophylaxis appointments.
Attachments are similar in appearance toscaling instruments.
Delivers a pulsating spray of water
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Uses of the Ultrasonic Handpiece Remove calculus
Remove stain
Remove bonding materials from tooth surfaceafter orthodontic appliances are removed
Remove cement after orthodontic bands areremoved
Laser Handpiece Devices which produce beams of very high
intensity light
Design Uses a laser light beam instead of
rotary instruments.
Laser is conducted through a fiber-
optic cable.
Resembles a standard handpiece.
Maintains a water-coolant system.
Maintains an air-coolant system.
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LASER WELDING
The effect of laser depends on the power of thebeam and the extent to which the beam is absorbede.g. CO2 and ND:YAG Laser
Uses
Cauterizes soft tissue.
Vaporizes decayed tooth structure.
Advantages Usually painless.
Patient usually does not require anesthesia.
Proceed with procedure faster.
Disadvantage
Cannot be used on teeth with existing restorations.
8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures
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Air-Abrasion Handpiece Design
Small version of a sandblaster.
Produces a high-pressure deliveryof aluminum oxide particlesthrough a small probe.
Uses•Prepares teeth for sealants.
•Removes external stains.
•Class I through class VI preparations.
•Endodontic access.
•Prepares a tooth surface for the cementation of
a cast restoration, such as a crown or veneer.
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Impression Trays Quadrant tray Covers one half
of the arch.
Section tray Covers the anterior portion of the arch.
Full arch tray Covers the entire arch.
Perforated tray Holes in the tray create a mechanical lock to hold the
material in place.
Smooth tray Interior of the tray is painted or sprayed with an adhesive to
hold the impression material.
Types of Stock Trays
Metal perforated trayMostly used for preliminary impression
Metal water coolant trayMostly used with reversible hydrocolloidimpression
Plastic perforated trayMostly used for preliminary and finalimpression
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Crown remover
Hand instrument. Crown remover.
Manual crown remover.
Pneumatic crown remover.
Brass ligature wire.
Chisel and hummer.
Sectioning. Crown slitter.
The manual back action hammer is the
classic method for removing prostheses.
It produces the desired force by means
of a weight that slides along a shaft
Spring-loaded back action hammer
allows forces to be directed in a more
controlled manner.
Manual crown remover
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Automatic Crown & Bridge Remover
Non-traumatic way to remove crowns,
bridges and inlays
This water soluble, pliable resin adheres to porcelain, enamel,
gold, acrylic and will not damage restorations. Works quickly
and safely. Ideal for the removal of temporary or permanently
cemented crowns.
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Cord Placement Instruments
Crown Collars and Scissors Used to trim temporary crowns, gingival
cord and matrix bands.
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Instrument Sequence on a Tray Instruments set-up from left to right
Basic set-up
Additional examination instruments
Hand cutting instruments
Restorative instruments
Accessory items
Preset restorative tray
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Cleaning and Sterilization of dental instruments
All instruments need to be cleaned and thoroughly
dried before they are sterilized.
Cleaning
Hand Scrubbing Ultrasonic Cleaning Automated Washer
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Classification of Patient-Care Items
In order to determine the appropriate
treatment for any item that has beenused in patient care, you will need toclassify them into one of the followingthree categories based on the risk ofinfection associated with their intended use.
Critical
Semicritical
Noncritical
Critical Items Are defined as those
used to penetrate softtissue or bone
Since the risk oftransmission would be
high, they must be heatsterilized
Examples:
Surgical instruments Scalers
Forceps
Scalpels
Bone chisels
burs
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Clinical Application
What do you use clinically everyday
that is considered a critical item? How do you treat these items before
they are used again?
Semicritical Items Touch mucous
membranes or nonintact skin
Have a lower risk oftransmission. However,if an item can be heatsterilized, it should beheat sterilized.
Examples:
Mouth mirrors
Amalgamcondensers
Impression trays
X-ray film holders
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Semicritical instruments which cannottolerate the high temperatures of
sterilization must be processed byusing a sterilant or high leveldisinfectant .
These products achieve sterilization(kills all forms of life including spores)after immersion in the solution for 3
to 10 hours. Follow manufacturer’sinstructions for the product in youroffice.
Which items do you use daily whichare considered semi-critical?
Do you routinely sterilize theseitems?
If not, what is your method forassuring that they have remained in
the disinfectant or sterilant for thenecessary length of time?
Clinical Application
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Immersion Disinfectants FDA- Approved for use in dentistry
Sterilants:
Gluteraldehyde -6 to 10 hour contact time
Hydrogen peroxide (7.3%) 6 hour contacttime.
Gluteraldehyde and phen0ol/phenate-12hour contact time
Hydrogen peroxide and peracetic acid-3hour contact time.
High level Disinfectants Ortho-phthalaldehyde (12 minute contact time)
Gluteraldehyde- 20 to 90 minute contact time
Hydrogen peroxide- 30 minutes contact time
Gluteraldehyde and phenol/phenate- 20 minute contacttime
Hydrogen peroxide and peracetic acid-15 minute contacttime.
(You must always use personal protective equipment (PPE),including utility gloves, mask, eyewear, and protective
clothing, when processing instruments)
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Definitions to remember….
Sterilization is the process that kills all
microorganisms and is considered thehighest level that can be achieved. It isaccomplished by the proper use ofimmersion chemical sterilants or by heat.
High level disinfection is used when asemicritical item cannot withstand heatsterilization. Used correctly, it is
intended to kill disease producingmicroorganisms but not spores. Theseproducts are not used for surfacedisinfection, but for immersion.
Noncritical Items Contact intact skin only.
Have a low risk of diseasetransmission.
Some of these(*) should beprecleaned and disinfectedor barrier protected. Examples:
Blood pressurecuff
*X-ray cone
Stethoscope
*Lead apron
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Universal Sterilization
“…means that all reusableinstruments and handpieces aresterilized (rather than disinfected) between use on patients.This provides the highest level ofpatient protection.”
Miller & Palenik, p. 196
Steralization 1. Steam autoclave:
Most effective.
Steam, heat (270 ° F), pressure (27 PSI).
for at least 6 minutes.
2. Unsaturated chemical vapor:Best for carbon steel instruments.
Heat (270 ° F), pressure (20-40 PSI).
for at least 20 minutes.
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3. Dry heat oven:
Heat (230 ° F) for 2 hours.
Temperature above 350 ° F may causepremature instrument failure.
4. Chemical solution:
Used for materials that can not withstand heatsterilization process.
Not recommended for metal dentalinstruments.
Instrument processing flowchartRemove
Items fromoperatory
Use holdingSolutions ifnecessary
Sterilize
Clean by AutomatedOr manual
method
Store
Package
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Ultrasonic cleanerThis solution is consideredhighly contaminated. Retrieveinstrument cassettes while wearingutility gloves
Don’t forget to closethe lid during
operation to reduceaerosols!
A commercial all-purposeultrasonic cleaner.(Courtesy of Certol.)
An enzyme ultrasonic cleaner intablet form.
(Courtesy of Crosstex.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Take care not to overload steamheat sterilization equipment.
If steam cannot circulate andpenetrate, instruments may not
be sterile.
Packed handpiece
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Process Indicators
Do not indicate sterility. Simply indicate that the
autoclave reached acertain temperature.
Show at a glance if a loadhas been run.
Instrument ProcessingSterilization Monitoring
Do not use instrument packs if chemical ormechanical monitoring indicate inadequateprocessing.
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Personal Protective Equipment
(PPE)
Protects the skin &
mucous membranes of
the eyes, nose, and
mouth from exposure
to blood or OPIM
Use of PPE is dictated
by the exposure risk,
not the patient.
Masks and Protective Eyewear Wear a surgical mask and
protective eyewear with solidside shields to protectmucous membranes of theeyes, nose, & mouth
Change masks betweenpatients, or during treatment
if it becomes wet
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Protective Clothing Wear long-sleeved reusable or disposable
gowns, clinic jackets, or lab coats to
protect skin of the forearms and clothinglikely to be soiled with blood, saliva.
Change immediately if visibly soiled
Protective coverage
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Clinical Contact Surfaces
Housekeeping Surfaces
Environmental IC Use surface barriers to protect clinical contactsurfaces, especially which are difficult to clean.
Change barriers between patients
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Digital Imaging
General Considerations
Equipment difficult, if not impossible, to cleanand disinfect
Barrier-protect clinical contact surfaces
FIXED EQUIPMENT AND PRODUCTS
Microblasters
Porcelain Ovens Burnout Ovens Microscopes Die Pinning System Casting Machines Porcelain
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Microblasters
Many options available:
Choose from number of tanks
Air pressure adjustment location
See Synopsis of Laboratory Air-Abrasion Units on the DISwebsite
Renfert Basic Master
Vaniman Sandstorm Expert
Porcelain Ovens
Ivoclar Vivadent Programat P100
Electronic vacuum control systemhelps prevent firing errors if vacuumis set incorrectly
$3,876 w/pump
———
Jelrus VIP Vision 300
User friendly
Keypad let's you "Name ThatProgram" from A-Z
$2,399
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Porcelain Ovens (cont.)
VITA VACUMAT 4000
Two thermocouples within thechamber provide bettertemperature control
Automatic temperaturecalibration after 100 hours ofusage
Internal memory for up to 500programs
Portable, detachable keypad $5,836.50
Porcelain Ovens (cont.)
Whip Mix Pro Series
Fast-cool feature
Pressing furnace hasadvanced cycles for
Inceram, Procera, pressingand porcelain firing
Pro Press 100 - $3,351
Pro 100 - $2,500
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Burnout Ovens
Whip Mix Apollo II
Unique feature is its bottomloading lift platform that raisesand lowers investment rings
Has an optional foot-controlswitch
Reduced heat blast
Microscopes
Meiji BM
Dependable and inexpensive
Easily adjustable
$549
———
Renfert Mobiloscope Swivel arm microscope
Space saving
$1,111
$1,438 w/fiber optic light
Meiji BM
Renfert Mobiloscope
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Microscopes (cont.)
Nikon SMZ-645 Versatile lab microscope $2,141 w/fiber optic ring light
and light source
Die Pinning Systems
Renfert TopSpin
Tool-free drill bit replacement
Two working positions via swivel footon base
$599
———
Whaledent Pindex
Foot-controlled or Hand-controlled
Both are laser guided
$599
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Casting Machines
KerrLab Centrifico
Reliable broken-arm castingmachine
Easy to use
$479.50
Induction Casting Machines
Dentsply Ceramco SuperCascom
100 program digital memory
Vacuum/pressure assistedcasting
$15,000 retail price———
Bego Fornax T
Compact design
Short heating time due toinfrared controller
$12,473 retail price
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Porcelain
Ivoclar IPS d.Sign Porcelain
Produces esthetic restorations
Mixes easily with minimalslumping
Comparable price to otherporcelain systems used in theUSAF (basic system-$717)
Rated Acceptable by DIS
Porcelain
Vita Omega 900-3D
Low-fusing ceramic
Used for crowns, bridges,laminates
Reportedly compatible withwide variety of metals
Wear is reportedly similar tonatural teeth
Standard kit - $1,696.00
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