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Medical Forum / General / Dentistry / March 2005Deep boxes, filling problems
Greetings all... If you will look at the before and after here, you'll see that I'm having real problems with this lady (an old patient from the DownTown Kombat Zone). before: http://tinypic.com/1ymph4 after: http://tinypic.com/1ympp0 The old composites that I placed about 5 years ago (I think) are breaking down, and I attribute this to parafunction, material strength limitations, and the most important: my use of SingleBond (3M) one-bottle system, which gave a too wide film thickness of bonding material. This means that residual caries in the boxes could ensue, seeing that a layer of SingleBond on the gingival floor is too weak to resist carious onslaught. I put on AutoMatrix bands, a piece of Tofflemyer band vertically to complete the insulation, shoved in some wedges, used a football diamond to modify them to get the best lock in, and evaluated the situation. There was no way I could keep a dry field enough to use standard composite with etch and bonding. So I Fuji 9'd it. As you can see, there is still a gap on one side, and the fill is thin on the other. Does anybody have any ideas, short of doing the same thing again with a flap procedure? I seem to be getting a lot of these cases lately. Thanks SP  SignatureNot a real Addy, yet >Greetings all... > [quoted text clipped - 33 lines] >Thanks >SP Nice endo. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>Greetings all... >> [quoted text clipped - 35 lines] > >Nice endo. What's in the pulp chamber of the first molar ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com ... after SP blathered: > >>I seem to be getting a lot of these cases lately. > >> [quoted text clipped - 5 lines] > What's in the pulp chamber of the first molar ? > -- IIRC, it was a cotton pellet soaked in adhesive. I wanted to make sure we could re-access the canals in a hurry when it came time to do the crown (I REALLY insisted on that, as the lower molar hitting it was constantly breaking the filling on the first molar, at the distal marginal ridge). In the meantime, I wanted to be able to pack the composite against something; ergo, the pellet. As you see, she never got it done. They'll spend 2000$ CDN on clothes and cigarettes, but won't invest a dime more that the minimum for their teeth. I should-a said EXO 5 years ago. I firmly believe that had I known about the NTI five years ago, there wouldn't be this breakdown, nor many of the pulpal insults, today, as we speak. SP SignatureNot a real Addy, yet >... after SP blathered: >> >> [quoted text clipped - 17 lines] >invest a dime more that the minimum for their teeth. I should-a said EXO >5 years ago. We see the same thing here. >I firmly believe that had I known about the NTI five years ago, there >wouldn't be this breakdown, nor many of the pulpal insults, today, as we >speak. >SP Agreed. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Nice endo. > -- > > W_B > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com 10-Q ... Took forever... all done with hand files... no coffee warmer.... but still working out ok.... for the moment. We'll see if the carious exposures of the gp's have resulted in contamination of those canals. SP SignatureNot a real Addy, yet My dear Friend Stovamatic, You need to be doing an indirect restoration here. That way you only need to isolate long enough to put it on and hit it with the light for a few seconds. The distal box looks very deep on the PAx. It may be just the angle, but the restoration at the distal box appears to be sub-osseous. This is a case of simply educating the patient and then doing what-ever they want. Tell them that they need the crown and possibly crown lengthening surgery. If they allow you to do dentistry in the fashion you have been trained by school and experience, you will stand behind the work and take care of any failures for a reasonable amount of time (insert what-ever time frame you are comfortable with -- usually 5 years is good). If they insist on tying one of your hands behind your back, you will go ahead and do the treatment, but you will be charging them full price for every failure of the material. Make it plain and simple. If they refuse proper therapy, fine, but they will need to back it up with their own money, not yours. I do lots of sub-gingival CEREC's which do very well. I draw the line at sub-osseous. You have seen the case in person, not me, so you are the better judge in this case. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> Nice endo. [quoted text clipped - 9 lines] > canals. > SP > usually 5 years is good). If they insist > on tying one of your hands behind your back, you will go ahead and do the > treatment, but you will be charging them full price for every failure of the > material. Make it plain and simple. If they refuse proper therapy, fine, > but they will need to back it up with their own money, not yours. Yes.... this DOES sound reasonable, yes. In fact, much of my dentistry smacks of the same error. The compromise is THEIR decision, not mine. Of course, this is not the first time I'm hearing this kind of advice.... But it IS perhaps time to let it SINK IN... Thanks DrS SP SP SignatureNot a real Addy, yet Good job Dude! Joel >I put on AutoMatrix bands, a piece of Tofflemyer band vertically to >complete the insulation, shoved in some wedges, used a football diamond [quoted text clipped - 13 lines] >Thanks >SP > Good job Dude! > > Joel What good job???? They are both under filled or with open gingival margins.... SP SignatureNot a real Addy, yet >> Good job Dude! >> [quoted text clipped - 3 lines] >margins.... >SP Still a good job. They have gotten about to the 'herodontics' phase. Getting a good crown prep is going to be tough (and maybe impossible considering your description of how likely the patient is to comply <G>). Next time they fail, hasta lavista. JMO, Fawks >>What good job???? They are both under filled or with open gingival >>margins.... >>SP > > Still a good job. -- > They have gotten about to the 'herodontics' phase. Getting a good > crown prep is going to be tough (and maybe impossible considering [quoted text clipped - 4 lines] > JMO, > Fawks I disagree. Keep the patient, but charge them for every re-make. Also, the price should be 10-20% higher than normal due to increased liklihood of folow-up visits. What I will sometimes do is offer to reduce the crown fee by what they spent on the filling, providing they come in and get the crown within the next two months. ~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... >>>What good job???? They are both under filled or with open gingival >>>margins.... >>>SP >> >> Still a good job. > What I will sometimes do is offer to reduce the crown fee > by what they spent on the filling, providing they come in and get the crown > within the next two months. Again, this also makes sense. Good incentive. Also, FWIW, I'm pretty sure SF was talking about these two teeth (salvage/EXO), and not the patient per se. By the way: Congratulations on being the 'Dentist to be Called on the Telephone' SP SP SignatureNot a real Addy, yet Yep. Sorry if I wasn't clear. I can't see where 2mm of tooth structure is going to come from on the interproximals for a crown, and I think even a die hard Cerec user might have a little trouble with contamination trying to cement a restoration there too. (especially the first molar) Poor indirect restorations also fail and then you do look like a bad guy. If I kicked every patient out of the practice that didn't listen and obey 100%, I'd get pretty lonely. Fawks >>What I will sometimes do is offer to reduce the crown fee >>by what they spent on the filling, providing they come in and get the crown [quoted text clipped - 9 lines] > > SP Use a dead soft matrix band as part of your isolation. You can keep it dry so long as you can get the matrix band past the preparation. It will deform as you press the restoration into place and move out of the way. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > > Yep. Sorry if I wasn't clear. I can't see where 2mm of tooth structure [quoted text clipped - 24 lines] >> >> SP > Use a dead soft matrix band as part of your isolation. You can keep it dry > so long as you can get the matrix band past the preparation. It will deform > as you press the restoration into place and move out of the way. Getting a dead soft to tuck itself in under the prep, especially in this case with knife edge sub-gingival margins, is the whole problem, IME. They will fold or crease or tear as you try to go in axially or rake the hell out of the already inflammed gum gissue ( and crease ) if you try to slide them in buccolingually like if they were dental floss. You seem to have good experience with them. If you have any pointers, I'd be interested. Also: what technique would you use to get your impression in the first place (assuming you didn't have a CEREC machine)? Thanks SP SignatureNot a real Addy, yet I use the dead soft band in a toffelmyer retainer. Place it slowly and carefully, and I seldom have problems. I can get one around 90% of the deep boxes I come across. I only give up on the band if I don't have a buccal or lingual wall to brace the retainer against. I have to be careful. My polyvinylsiloxane tends to expire before I use it. I only use it for bridgework. With any impression material, if you can see all the margins in the mirror without moving the mirror, and the tissues are not bleeding, the impression is dead easy. The trick is getting redundant tissue out of the way, and stopping any bleeding. I generally pack a "plain" cord or a cord with "alum" in it. If doing conventional CO&B, I pack a size #0 first, refine the margins, then pack a #1. If the cord disappears, I pack a #2. I then wet a cotton pellet in hemodent and rub the cord with the wet pellet. If the tissues don't dry up in 20 seconds of this, the electrosurg cords get plugged in. A couple of light touches with the coagulant ball usually does the trick. I don't do any indirect restorations on inflamed gingiva. The patient has to clean up firs. >> Use a dead soft matrix band as part of your isolation. You can keep it >> dry [quoted text clipped - 15 lines] > Thanks > SP > A couple of light touches with the coagulant ball usually does > the trick. I don't do any indirect restorations on inflamed gingiva. The > patient has to clean up firs. Excellent! 10-Q Berry Much.... Since I don't have an electrosurg, (and the next bix expense will be to get the Stat-IM overhauled) I'll see about getting some silver nitrate 'matches', like the Mad Dogs use in the operating rooms. They would burn a bit, but used sparingly, they could be OK for bleeding gums. I have ViscoStat (UltraDent) as well, and that works well (Sometimes...) if you have the time. The trick there is to RAKE the SH*T out of the tissue going round and round the sulcus, with the infuser tip, PROMOTING bleeding. The FeSO4 is supposed to plug those torn capilliaries up.... Sometimes..... Thanks again SP SignatureNot a real Addy, yet >> A couple of light touches with the coagulant ball usually does >> the trick. I don't do any indirect restorations on inflamed gingiva. The [quoted text clipped - 13 lines] >Thanks again >SP Geez guyz, in the absence of cardiac probs, or other contra-indications a drop of epi on a cotton pellet works like a charm. None of that nasty hemodent coagulation product either. You can get it in a multi-dose vial, don't forget some 1cc syringes. Only a drop or two is required and it need not be injected. The syringe is to just to get a bit out of the multi-dose vial. You can also use the single dose vials but this is an excessive quantity for C$B use. Also cut your cord 2-3x as long and wrap around two to three times. Another trick is a plain untreated cotton pellet of appropriate size stuffed in the sulcus for mechanical displacement on top of the cord. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > Another trick is a plain untreated cotton pellet of appropriate size > stuffed in the sulcus for mechanical displacement on top of the > cord. > > -- > W_B thanks again for all this SP SignatureNot a real Addy, yet > By the way: Congratulations on being the 'Dentist to be Called on the > Telephone' > SP > > SP I am still waiting for the certificate > They have gotten about to the 'herodontics' phase. Getting a good > crown prep is going to be tough (and maybe impossible considering [quoted text clipped - 4 lines] > JMO, > Fawks Yes.... I hope to save them, but who knows.... I will insist she get an NTI.... even if she has to pay it over 12 months. By the way: Congratulations on being the 'Also Good Dentist' Thanks SP SignatureNot a real Addy, yet You got mentioned in the third round. We're just not in the 'high rent' district <G>. Other than maybe an endo film and a mediocre picture of some of my 20 year-old composites, I don't think anyone has actually seen any of my work. Dan knows I did OK in school, but that's about it. I need a new camera and scanner. Maybe someday I'll get time. Fawks > By the way: Congratulations on being the 'Also Good Dentist' > Thanks > SP > I need a new camera and scanner. Maybe someday I'll get time. > > Fawks You'd have to have a reason to do that. Myself, as you know, need all the help I can get, so I've learned to use a digital camera with a close up lens to post stuff for input from y'all at the SMD. It seems to me that Bill has taken better quality photos off his negatoscope (as I do) using a digital WITHOUT a closeup using a camera that was a small fraction of what I paid for the Fuji 6900S. If you want to make more intra-oral movies, I'd suggest collaring the local whiz-kid working in the photo store and having him/her do the technical stuff. Great thing to have on their CV. The point is, for the amount of presentations you're gonna do in yer life, that little camera and a couple of orhto mirrors (with an assistant who can blow air on them in the mouth) are about all I think you need. Cheers SP SignatureNot a real Addy, yet > >> Good job Dude! > >> [quoted text clipped - 5 lines] > > Still a good job. Thanks... from someone with your years' experience, that is good to hear. Cheers SP SignatureNot a real Addy, yet Nice job on that distal of #14! I agree that this fine effort is beginning to look like "herodontics." (Do many patients really appreciate how darn hard we work for them in these situations?) Those deep interproximals are such a bear to fill. I hope she gets the crown done before she splits the tooth, after all the work you've put in. Does she wear an NTI? What's going on at that mesial margin on #15? I hope she's not packing a lot of food interproximally. I've seen some patients who fail to floss, fail to get crowns, and sometimes destroy their interproximal bone faster than the caries can destroy the teeth. Best regards, - dentaldoc > Greetings all... > [quoted text clipped - 33 lines] > Thanks > SP If at the very least, Stovarino manages to keep these teeth in this patient's head for a few years longer, it will have been worthwhile. The only crucial thing is that the patient understand how tough this situation is. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Nice job on that distal of #14! I agree that this fine effort is > beginning to look like "herodontics." (Do many patients really [quoted text clipped - 54 lines] >> Thanks >> SP >If at the very least, Stovarino manages to keep these teeth in this >patient's head for a few years longer, it will have been worthwhile. We agree. Joel > >If at the very least, Stovarino manages to keep these teeth in this > >patient's head for a few years longer, it will have been worthwhile. > > We agree. > > Joel Good... Thanks loads for all your input. I really appreciate it. SP SignatureNot a real Addy, yet > If at the very least, Stovarino manages to keep these teeth in this > patient's head for a few years longer, it will have been worthwhile. I agree. > The only crucial thing is that the patient understand how tough this > situation is. Believe me, I am sure she does. I am not a person who can hide what his feelings are. I wouldn't say I was sweating on this one, but I was at least smokin' under the collar. I even told her that were it not for the existance of Fuji 9, we would be talking EXO already. She _does_ know that we are at the 'limits' here. Thanks SP SignatureNot a real Addy, yet Cases like this point out some of the very difficult parts of dentistry. The patient brings you a bad situation. You do a good job of stemming the downward spiral. The patient does not follow through with further treatment. Now the challenges are even more difficult. We all deal with it almost every day. Fawks > If at the very least, Stovarino manages to keep these teeth in this > patient's head for a few years longer, it will have been worthwhile. > > The only crucial thing is that the patient understand how tough this > situation is. > We all deal with it almost every day. > > Fawks Yes.... there's certainly a reason why she decided to come uptown, out of her stomping grounds, away from the DownTown Kombat Zone clinic... two even: 1) The guy who finally bought it now has photos of himself in mountainbiking competitions and boxing matches all over the clinic: "Hey! Look at me!!! I'm great and I'm gonna CHARGE YA for it...". I didn't last THREE MONTHS working under him... I picked up a couple of his impressions one time to see how 'the master' does it .......!!!!....... And he actually sent them off to the lab... At least MY lab gets a signature from me that reads: SVP: Do NOT compromise. Look at it under your microscope, and if there is something missing, send it back with a note. And they don't hesitate. This, of course, is after I've inspected the impression myself with my 2.5X loopes. 2) I've already developed a reputation as a guy who is gentle and doesn't hurt when he injects (topical one minute, and GO SLOW...) This is quite apart from the LASER, as I didn't have it back then, either. 3) I've never come across as one who proposes the highest $$$ options right off. (Mostly because I know my limitations. One of the reasons I'm here is to push those back as far as I can). Cheers SP SignatureNot a real Addy, yet > Nice job on that distal of #14! Thank You Bill; like JME's comments, that is much appreciated. >I agree that this fine effort is > beginning to look like "herodontics." That is one of the reasons I decided to Fuji 9 it vs use a flap procedure. >(Do many patients really > appreciate how darn hard we work for them in these situations?) Sure... when they finally lose those teeth.... > Those deep interproximals are such a bear to fill. I hope she gets the > crown done before she splits the tooth, after all the work you've put > in. So do I, but her personal values just aren't there. If I _do_ do the crowns, the interproximal margins will be on Fuji 9 instead of sound tooth structure, as there is none in those boxes, unless we DO do a crown lengthening.... and even then.... > Does she wear an NTI? No. When I was in the DownTown Kombat Zone, I didn't know about the NTI. I didn't have an Internet connection. In fact, it has only been about a year since I _have_ known about the NTI, as it was _then_ when I connected to the SMD. It is Due ENTIRELY to you folk. ;-) > What's going on at that mesial margin on #15? That surprised me. Fuji 9 comes in a capsule with a spout on it. You shake it up in your Amalgammator, put it in the pliers, and inject it in. I was surprised that I missed the gingival floor of that mesial box. It was not the deepest one. I think my technique was off: I might have pulled the stuff back out as I withdrew the spout. >I hope she's not packing a lot of food interproximally. I'm sure she is at this point. I had planned to let the gum tissue calm down and close the contact using composite and a Parkell ring and matrix. When I can get the matrix piece well wedged and ringed, I can get a very good contact, sometimes even too tight. FYO: Parkell are now making sectional matrices (for their rings) that have a gingival wing on them. This helps with those deep boxes somewhat. They look a bit like boomarangs. >I've seen some patients who fail to > floss, fail to get crowns, and >sometimes destroy their interproximal > bone faster than the caries can >destroy the teeth. > Yes, I'm sure gonna try and not let that happen. What I'm gonna do: Put an AutoMatrix band on the 2nd Molar with a piece of Tofflemyer stuck down the mesial to the gingival limit again. This time, it should be easier, as there is now filling material to push against. Then, I'm gonna go down the box with a # 700 surgical length bur on the high speed (for good visibility). I'll measure the depth to the floor of the box on the B/W and mark the bur. I'll clean it out in Buccal/Lingual direction with the bur, but leave the mesial portion (against the matrix) intact. Then (I should have thought of this before...) I'll take the Danville MicroEtch II and blast away the remaining compomer (against the matrix). I'll use the MicroEtcher so as not to tear/puncture/displace the matrix combination and then fill the thing again. Then after some gum healing, we'll talk crowns. But first, we dance.... [I MEAN....] first, we talk NTI. If it works out, I'll post the results. Thanks SP SignatureNot a real Addy, yet This a great argument for indirect restorations. By the time you work of the tooth 3 times to get it within acceptable boundaries, you could have placed a porcelain onlay. Steve (what's an impression?) Mancuso >> Nice job on that distal of #14! > [quoted text clipped - 73 lines] > Thanks > SP > This a great argument for indirect restorations. > > By the time you work of the tooth 3 times to get it within acceptable > boundaries, you could have placed a porcelain onlay. > > Steve (what's an impression?) Mancuso Yes, provided you can get good sound tooth structure under the porcelain. (Correct me if I'm wrong, but I always thought you're supposed to have your finish line on sound TOOTH structure, not synthetic stuff). I don't believe you can here, especially on that first molar. As SF said, fixed prostho has an aura about it... If the crown and tooth fail, you end up looking like a sh.....t. Especially when the work costs such a high percentage of her take-home pay. I'd rather do acrobatics and tomfoolery like this and then prepare her for getting implants when the time comes. Thanks for the info Stove (what's quality of life?) Pipe SignatureNot a real Addy, yet Once you clean out the old restoration and caries, and the excavation is still above the osseous crest, you either pack cord and admire the nice view of clean fresh margins, or you electrosurg the redundant and granulation tissue before admiring the clean margins. If the tissue is too "yucky" to use elctrosurgery on, then,,,,,,,,,,,,,,,,,,,,,,,, place an amalgam, wait 3 weeks, and replace with onlay. You will be able to force good contours and proximal contact with amalgam easier an better in a case like this than you can with resin based stuff. Let the soft tissues heal, and do it right. Packing in an amalgam would only take a few minutes, and you can leave the occlusion Hypo. Don't put in any undercuts and the amalgam "pops" out easily in 3 weeks once you slit the center with a bur. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> This a great argument for indirect restorations. [quoted text clipped - 15 lines] > Thanks for the info > Stove (what's quality of life?) Pipe > Once you clean out the old restoration and caries, and the excavation is > still above the osseous crest, you either pack cord and admire the nice view > of clean fresh margins, BWAAAHaHaHaHaHaHaHaHaHaHaHaHa. What a funny.... ;-( >or you electrosurg the redundant and granulation > tissue before admiring the clean margins. Don't have one... The ALMIGHTY AOIFWOIUEP(*&)(*?%&*?$%*?$ LASER was supposed to come to my rescue here. FYI, Parkell now makes a BIPOLAR elcetrosurg (radiosurg?) unit that is supposed to do these kinds of things well. Since both electrodes are at the same tip, you can use it on Cardiacally Challenged cases with no risk. Or so said Ian Shumann in his lecture back in May... >If the tissue is too "yucky" to > use elctrosurgery on, then,,,,,,,,,,,,,,,,,,,,,,,, place an amalgam, wait 3 [quoted text clipped - 3 lines] > Packing in an amalgam would only take a few minutes, and you can leave the > occlusion Hypo. Now this: >Don't put in any undercuts and the amalgam "pops" out > easily in 3 weeks once you slit the center with a bur. You just cleared up many hours of heartache for me with this last statement. I've attempted to do just what you described above with Am, but once you try to drill it back out, and the turbine skittles into the SOFT TISSUE, I was back to square one... But.... Leaving out the undercuts... Leaving out the undercuts... Leaving out the undercuts... Leaving out the undercuts... Leaving out the undercuts... Leaving out the undercuts... Gads; why didn't _I_ think of that?!?!?!!? It certainly is true that it would facilitate matters. Thanks!!!!!!! SP SignatureNot a real Addy, yet Electrosurgical units are cheap enough that I keep one in each treatment room. They don't get used too much, but when I need it, I just have to plug in he cables and keep going. No need to slow down if everything is already at your finger-tips. >> Once you clean out the old restoration and caries, and the excavation is >> still above the osseous crest, you either pack cord and admire the nice [quoted text clipped - 46 lines] > Thanks!!!!!!! > SP > Electrosurgical units are cheap enough that I keep one in each treatment > room. They don't get used too much, but when I need it, I just have to plug > in he cables and keep going. No need to slow down if everything is already > at your finger-tips. Yep.... now that the LASER is dead, I'm gonna see about that Parkell unit... Thanks SP SignatureNot a real Addy, yet >> Electrosurgical units are cheap enough that I keep one in each treatment >> room. They don't get used too much, but when I need it, I just have to plug [quoted text clipped - 5 lines] >Thanks >SP I like some of Parkell's products. Got a 'Le Clean Machine' back in '89... Still going strong. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > Le Clean Machine Just what is the Le Clean Machine? Thanks SP SignatureNot a real Addy, yet >> Le Clean Machine > >Just what is the Le Clean Machine? >Thanks >SP It is an ultrasonic scaler. They have better models now. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>> Le Clean Machine >> [quoted text clipped - 5 lines] > >They have better models now. Thanks. I thought it was that new Japanese toilet that ends up shooting water then air to avoid wasting paper ..... > It is an ultrasonic scaler. > > They have better models now. > -- OK, thanks SP SignatureNot a real Addy, yet |
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