The Incredible Bur
A relatively small component generates big sales for dental reps.
Editor’s note: First Impressions would like to acknowledge Meisinger USA (Centennial, Colo.) for its contribution. It would also like to acknowledge Dentsply Professional (York, Penn.) and SS White Burs Inc. (Lakewood, N.J.).
It’s the sale that keeps on selling. If properly introduced, burs, or rotary cutting instruments, often sell themselves, according to experts. Indeed, depending on the size of their practice, dentists typically spend between $2,500 and $8,000 each year on rotary instruments, and for some dental reps, they account for as much as 25 percent of their annual sales.
What is a bur?
Bur is the generic term for all dental rotary cutting instruments. They are comprised of a shank (the part of the bur that fits into the hand piece), a neck (connects the shank with the head and transmits rotational forces to the head) and the head (the working part of the instrument, including the cutting edges designed to shape the tooth).
Burs are usually made of tungsten carbide or diamond particles. General dental practitioners use both carbide and diamond burs. Carbides are used to remove caries, composite material, old amalgam and/or other filling materials, as well as for crown removal, bone contouring and the removal of impacted teeth. Diamond burs generally are used for reducing tooth structures in order to place a crown or porcelain veneer. Today, some carbide burs are designed for crown preparation in lieu of diamonds.
Once a diamond bur has been used to prepare a tooth for a crown, trimming-and-finishing carbides may be used to smooth the walls of the prepared tooth, providing cleaner, better-defined margins, which enable the fabrication of a better-fitting crown. Both carbide and diamond trimming-and-finishing burs may be used to smooth, refine and polish composite and/or porcelain materials. Orthodontists commonly use trimming-and-finishing burs to remove the bonding material used to place the brackets of braces.
Carbide burs may be used for more applications than diamond burs, and they are less expensive. As such, they account for a larger percent of the market (60 percent carbide, 40 percent diamond). Carbides are available in one- or two-piece construction. Single-piece carbides (entire bur is made of carbide) are less likely to break; however, two-piece carbides (stainless-steel shank with a carbide head welded on) are less expensive to make and, therefore, less expensive for dentists to purchase. Because dentists often discard carbide burs after use, they generally prefer less expensive, two-piece carbides. Diamond burs generally are constructed via an electroplating process, which bonds the diamond particles with the stainless-steel shanks. Diamond burs are manufactured from natural or synthetic diamond particles.
Carbide and diamond burs produce different outcomes: Carbide burs slice or chip away at material, leaving the tooth surface smooth. Diamond burs grind away at material, leaving a rough tooth surface, which requires much polishing in the end.
Bur shapes
Burs come in a variety of shapes and sizes. Straight fissure burs, with their sharp edge, are designed to cut into the fissures of a tooth, place secondary anatomy, grind out old filling material and quickly reduce tooth material. Round burs are designed to remove caries in the pits and fissures. Tapered fissure burs are used for sectioning teeth, as the bur is strong and its shape facilitates visibility and a wedge effect when dividing the tooth into sections. Inverted cone- or pear-shaped carbides are used to create undercuts, which permit composite and other restoration materials to be locked into the prepared site, preventing filling material from coming out.
Small-diameter burs work best to remove material while leaving as much of the tooth structure intact as possible. Smaller burs reach more easily into pits and fissures.
Style
Carbides are available in both smooth-cutting (trimming and finishing) and coarse-cutting (operatory) styles. A carbide bur with more blades produces a smoother cut or finish. Carbides also are designed with straight flutes, or with cutting blades with cross cuts. Cross cuts, also referred to as chip breakers, facilitate quicker removal of material, as the cross cuts break up and grind material. Some doctors favor burs with cross cuts for procedures involving cutting enamel, cutting through old crowns, removing amalgam or for general use. Burs without cross cuts produce a smoother surface.
Bur positioning
Different heads permit different positioning of burs. Some hand pieces extend the bur straight out; these typically are used in laboratories and oral surgeons’ offices. Typically, the bur is placed at a 90-degree angle to the head, enhancing visibility and facilitating access to posterior regions. General dentists usually use high-speed friction burs, which are designed for most applications, and slow-speed right angle burs, designed for more delicate procedures or polishing and finishing a tooth/crown surface.
Occlusal reduction bur
When dentists prepare a tooth for a crown, different materials - such as gold, porcelain fused to metal and ceramic - require various degrees of occlusal surface reduction. In fact, labs often complain that dentists have a tendency to over- or under-reduce the occlusal surface, making it difficult to achieve the proper fit and look of a crown. If the surface is reduced too much, an excess of restorative material must be used, and the resulting opacity and translucence does not mimic that of a natural tooth. In addition, if too much tooth surface is removed, more restorative material is needed. In the case of gold, which is more expensive, the procedure becomes too costly for patients.
An occlusal reduction bur is designed with a self-limiting stop, enabling the dentist to reduce the exact depth required for each preparation. By comparison, surface reductions with round or pear-shaped burs lack precision.
Efficiency and durability
Today, burs are more efficient and durable then ever before, according to experts. More sophisticated production technology, laser measuring devices, grinding materials and coating materials all contribute to advanced cutting properties. And such products as the one-piece carbide, can now be produced at a more affordable cost. Diamonds are now impregnated into the bur shanks with greater durability, enabling diamond particles to remain in place during a greater range of procedures.
The lifetime of burs varies, depending on the procedure they are used for. Today, both diamond and carbide burs may be coated with a diamond-like material called carbocer, which enhances their cutting efficiency and extends their life. Cutting through a metal crown tends to dull a bur relatively quickly. Carbides generally should not be used long to ensure patient safety and optimal results. New carbides are sharper and more efficient. And, the dentist needn’t press as hard, reducing the risk of a microfracture to the patient’s tooth.
Burs range in cost, depending on the type/style. Carbides cost between $1 and $1.80 each. Trimming and finishing burs and specialty cutters cost between $5 and $8 a piece. Diamonds are available as both disposables (less expensive) and reusables, and they range in cost from $1.50 to $13. Of the hundreds of styles and shapes of burs available, dentists typically rely on between 12 and 15. For example, a dentist may use three or four operative carbides, four to six diamonds for surface reduction and a combination of four or five carbides and diamonds for finishing. In addition, he or she may require specialty carbides and diamonds for crown cutting, surgery, lab work and slow-speed work.
Reusable diamonds may be used for multiple procedures, and generally may be used for six or more crown preparations. So, dentists often prefer spending more for reusable diamond burs, rather than purchasing disposable diamonds.
Carbides should only be used once or twice, and then properly disposed of. By changing carbide burs frequently, dentists increase patient and user safety, provide better results, improve the life of the hand piece and ultimately achieve a greater return on their investment.
How to sell
Don’t underestimate the value of bur sales. Reps often neglect to bring up burs to their dental customers, because they believe it’s an insignificant percentage of their sales. But, with most dental practices spending about $5,000 annually on burs, sales do indeed add up.
Distributor reps should begin by asking their customers if they purchase burs from direct rotary companies. If the answer is yes, they should follow up by introducing alternative bur products. Manufacturers provide bur wallets, which distributor reps should use as sales tools. Simply by opening these wallets in front of the dentist can lead to a discussion of rotary instruments, according to experts. In addition, reps should ask some good probing questions, such as the following:
- "Doctor, are you currently placing any zirconia crowns? If so, do you have the proper shape diamond required to prepare teeth for these procedures?"
- "Doctor, do you practice minimally invasive dentistry? May I show you a set of carbide burs that will permit you to remove decayed dentin while leaving healthy tooth material in place?"
- "Do you have difficulty cutting off old crowns once a restoration has failed?"
- "Do you ever need a longer shank bur for work in posterior regions of the mouth?"
- "Do you have enough surgical and slow-speed carbides?"
Reps should emphasize the value of purchasing new, sharp burs, which perform more efficiently and save time and money. Indeed, when each minute of chair time costs the dentist as much as $10 or $20, a $2 bur becomes that much more valuable to his or her practice.
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