FAQ

Yes, Implantmed Plus from serial no. SN01001.

No, thanks to the automatic tip detection and the special design, W&H offers a closed system.

Yes.

Yes, but different software updates are necessary.

Yes, all SI-10XX devices.

No, not compatible.

No, it has a different connector and is not compatible.

No, the SPI dongle does not fit.

No, it has a different connector.

The abbreviation ISQ stands for Implant Stability Quotient. It is a value between 1 and 100 and gives the surgeon an insight of the implant stability after placing the implant. With the ISQ value the surgeon can monitor the osseointegration.

> To measure the ISQ of an implant, you first screw a so called SmartPeg into the placed implant. The SmartPeg, with its magnet on top, works like a small tuning fork. The magnet on the SmartPeg is ‘hit’ with magnetic pulses, from the probe, which makes the SmartPeg vibrate. Due to the stiffness in the interface between the implant surface and the bone the SmartPeg will vibrate accordingly. The more dense the bone is the higher stability and the higher ISQ value.

Please contact your local W&H partner
The sale of SmartPegs will be defined per country
The surgeon will receive 5 free SmartPegs. A voucher will be provided with the delivery of the product.

Torque is a one time, static measurement at the time of placement of the implant and cannot be repeated later on in a non-invasive way. Osstell ISQ measures the lateral stability of the implant and the measurements can be repeated in a non-invasive, dynamic way to monitor the development of osseointegration.

Yes. All control units SI-1023, SI-1015 and SI-1010 can be upgraded with the W&H Osstell ISQ module

The surgeon or dental nurse can easily attach the module to the right side of the Implantmed with the help of the provided quick manual. The module is plug-n-play via a USB connection.

No. The new motor has a new technological basis and is the shortest available

The LC stands for Light Contacts. This means that we have integrated an electrical connection into our new motors. The Light Contacts deliver power to our new contra-angles to offer our customers the best light at any rotation speed. For oral surgery handpieces from W&H, the LED remains in the head of the contra-angles

Yes. All W&H surgical contra-angles and handpieces can be attached to the new motor EM-19.

No. In order to deliver the best balance we shortened the inner coupling length. Therefore contra-angles with only an L suffix cannot be attached to old motors

Yes. At W&H the letter "S" always communicates, that the surgical contra-angle is disassemble. The letter "I" communicates, that the surgical contra-angle cannot be disassembled (e.g. WS-75 L vs. WI-75)

No. The new cable foot control S-N2 is based on the industrial CAN standard. So connecting the old foot control S-N1 is not possible.

W&H introduces a new concept in oral surgery and implantology. Via dongles (receiver), which can be connected to the unit by the doctor, the wireless foot control S-NW communicates with the surgical units of W&H.

It depends but basically yes. The following units can be retrofitted
Implantmed SI-923 REF16929000
Implantmed SI-915 REF16929001
Elcomed SA-310 REF15933100/15933101/15933102/15933103
Please contact your local W&H Partner to find out if the wireless foot control is already registered in your country

No, the speed in program P4 is 15 rpm when in forward operation and 30 rpm in reverse operation. In program P5 (thread cutter function) the speed is 20 rpm in both forward and reverse operation and only the torque can be set.

The generator in the contra-angle handpiece requires at least 300 rpm to produce enough electricity for the LED. The rotary speed is between 15 and 50 rpm when positioning an implant.

No, the Implantmed/Elcomed motor does not need greasing. The motor bearings require no maintenance. Any additional greasing would reduce the service life of the bearings.

Yes, if the thermal washer disinfector has a drying cycle and the motor bears the sign that it is "Thermo washer disinfectable".

No. The new generation of motors have to be sterilized without cap.

Regular servicing of function and safety including the accessories is necessary and should be carried out at least once every three years, unless shorter intervals are prescribed by law. Detailed information can be found in the user manual at chapter "Servicing".

The torque can be adjusted in P4 & P5 only. In- or decreaseing is done via either "+" or "-" button. A detailed description (factory settings, adjstable range,…) can be found in the user manual.

For applications which do not require accurate torque (drilling, grinding,…), any handpiece with ISO 3964 connection can be used. Please be informed that hand pieces from other manufacturers might not be able to handle the torque of your unit/motor and therefore might get damaged.

Not recommended. Due to different specifications (material, dimensions) it could cause problems like leakage, insufficient cooling or even damage the unit. For propper tubing see "correlation of tubing" or user manual.

Please find a detailed description in the user manual at chapter "Starting operation - General".

Please find a detailed description in the user manual at chapter "Hygiene and Maintenance".

For propper tubing see "correlation of tubing" or user manual.

For more information, please refer to Chapter 7 of the Instructions for Use 51037.

In order to benefit from the advantages of the LatchShort system and to support the longevity of the contra-angle handpiece (PL-66 W), we recommend using W&H Prophy cups.

However, it is possible for Prophy cups from standard latch systems (with a shaft of 2.35 mm) to be used.

Yes, providing that your W&H handpiece or contra-angle head carries the relevant sterilization symbol.

Yes, providing that your W&H handpiece or contra-angle head carries the thermal disinfection symbol.

The rechargeable battery normally lasts for around one working day (8–12 patients with a polishing duration of 4–6 minutes [actual time the foot control is ‘on’]).

The Proxeo Twist Cordless has a Li-ion rechargeable battery (like many smartphones). That said, you can’t compare the Proxeo Twist Cordless with a smartphone in this context. Smartphones have apps and updates installed on them which require more processing capacity and are also updated in the background. This shortens the life of the smartphone’s rechargeable battery and means it needs to be recharged more often, even though it only loses a small amount of capacity.

Yes, we recommend charging the battery from time to time (e.g. during the lunch break), in order to achieve optimal performance.

The rechargeable battery lasts approx. two months based on average use (5 working days with 8–12 patients/day for 4–6 minutes).

The Proxeo Twist Cordless can be fully disinfected by wiping down. The handpiece sleeve can be sterilized and thermally disinfected. The foot control can also be disinfected by wiping down. You will find further information on this in the Instructions for use 50928/51037/51036.

The Proxeo Twist prophy angle cups from W&H fit the PL-40 H, providing outstanding benefits. You can, however, use all conventional prophy angle cups with the Doriot system.
For the PL-40 HW, different contra-angle heads are available. The PL-44 can be used with Proxeo Twist disposable Angle Cups from W&H or all commercially available disposable cups with Doriot system.
With the PL-64 contra-angle head you can use all Young (screw-in connection) cups.
The PL-66 W contra-angle head can be used with the LatchShort Prophy cups/brushes from W&H.

You will find further information on this in the Instructions for use 50928/51037.

If you are unsure of the cause of the problem, it is better to contact your service department first and talk to a technician. Together with the technician, malfunctions can sometimes be resolved, or it may be determined which items need to be sent for repair.

The max. noise level of Lexa is 65 dB.

No. The air polishing handpiece can be disinfected by wiping. The removable spray attachments can be disinfected in a thermo washer and are sterilizable.

No. The air polishing handpiece can be disinfected by wiping. The removable spray attachments can be disinfected in a thermo washer and are sterilizable.

The Proxeo Aura air polishing handpiece and the relevant powders were developed as a complete treatment system, in order to achieve the best possible treatment results and to ensure the reliability of the system. The use of other powders is not approved. This can lead to increased abrasiveness and risk of blockage or reduced efficiency.

The Proxeo Aura air polishing handpiece is available with connections for W&H Roto Quick, KaVo Multiflex, NSK and SIRONA.

This depends on the manufacturer’s specifications for the relevant air polishing handpiece/device.

No, the Proxeo Aura periodontal tips are single-use products. They are delivered individually in sterile shrink-wrapped packaging.

It is recommended that you empty the powder tank at least once every day.

This depends on the manufacturer’s specifications for the relevant air polishing handpiece/device.

Set the power regulator to “OFF”. Connect the control unit and the foot control using the cable. Press and hold the function button for 5 seconds.

Yes.

No.

Yes, the compatibility of these devices has been assessed in application.

The rechargeable battery lasts approx. two months based on average use (5 working days with 8–12 patients/day for 4–6 minutes).

If you are unsure of the cause of the problem, it is better to contact your service department first and talk to a technician. Together with the technician, malfunctions can sometimes be resolved or it may be determined which items need to be sent for repair.

No, they are not compatible because they have different threads.

There are symbols on the tip, the tip changer and the handpiece identifying which system they belong to.

No, they are not compatible.

No, they are not compatible.

Yes, as long as your handpiece or contra-angle handpiece carries the mark “sterilizable up to the stated temperature”.

Yes, as long as your handpiece or contra-angle handpiece carries the mark “thermo washer disinfectable”.

Yes.

In order to benefit from the advantages of the LatchShort system and to support the longevity of the contra-angle handpiece (WP-66 W), we recommend using W&H Prophy cups. However, it is possible for Prophy cups from standard latch systems (with a shaft of 2.35 mm) to be used.

Generally, prophylaxis contra-angle handpieces feature a seal on the head that prevents the ingress of saliva and paste. This extends the lifespan of the contra-angle handpiece.

The most effective removal of discolouration that at the same time protects the enamel and dentine as much as possible, depends on the polishing speed, i.e. revolutions per minute, among other things. With a speed ratio of 4:1 (four revolutions of the motor mean one revolution of the cup), the revolution speed of the Prophy cup is reduced. This means during application, there is no risk of paste splattering.

Yes, providing that your W&H handpiece carries the relevant sterilization symbol.

Yes, providing that your W&H instrument carries the relevant thermal disinfection and sterilization symbol and the thermo disinfector should have a drying cycle.

Yes, if your Primea Advanced Air Turbine is labelled with the symbol "thermo washer disinfectable".

It is not sufficient to purchase the Primea Advanced Air Turbine alone. In order to be able to operate it, you need the entire Primea Advanced Air System – consisting of a turbine, control system, user interface (UI) and the supply hose with Roto Quick coupling. You can add this as an add-on or built-in solution to/in your dental unit.

W&H can offer you the Primea Advanced Air System as an external add-on which you can connect to your dental unit. To do this, you need a spare supply hose for your dental unit, a minimum operating pressure of 5 bar and the possibility to connect the control system to the mains power supply. Please contact your authorized W&H service partner to check the inlet pressure of the additional air supply hose. The Primea Advanced Air Built-in System is integrated into a dental unit by selected dental unit manufacturers or their service technicians.

Yes, the RG-97 L is equipped with an LED to illuminate the treatment area. The RK-97 L offers you shadowless illumination of the treatment site thanks to 5x Ring LED+. Both turbines have a mini-head and five spray ports, as well as a scratch-proof surface coating.

The Primea Advanced Air System is integrated into a dental unit by selected dental unit manufacturers or their service technicians.

You can connect the external Primea Advanced Air System to the dental unit. To do this, you need a spare supply hose for your dental unit, a minimum operating pressure of 5 bar and the possibility to connect the control system to the mains power supply. Please contact an authorized W&H service partner to check the inlet pressure of the additional air supply hose.

If you are unsure of the cause of a problem, it is better to contact your authorized W&H service partner first and talk to a service technician. Together with the service technician, malfunctions may be resolved or it may be determined which items should be sent for repair.

Please contact your authorized W&H service partner to check the Primea Advanced Air System.

Primea Advanced Air Turbines with small heads (Model RG-/RK--97 L): 16 mm to 21 mm The diameter of the working part is limited to a maximum of 2 mm. Follow the operating instructions of the manufacturer. When using longer or shorter rotary instruments the user must ensure by correct selection of the operating conditions, that there is no danger to the user, patient or third parties.

Within the adjustable speed range of 60,000 to 320,000 revolutions, you can set the maximum permitted speed for the respective rotary instrument as specified by the manufacturer.

Primea Advanced Air Turbines with small heads (Model RG-/RK-97 L): 16 mm to 21 mm

Pull the retention sleeve of the Roto Quick coupling back. The turbine can now be easily removed from the Roto Quick coupling. Forcefully pulling the Primea Advanced Air Turbine may cause damage. If excessive force is required to remove the turbine, make sure that the retention sleeve of the Roto Quick coupling can be moved without any problems.

For detailed instructions, see the chapter "Hygiene and maintenance" in the respective instructions for Use.

The built-in electronic components do not need to be serviced separately. However, regular servicing should be carried out together with the dental unit at the legally required intervals. This will ensure the proper functioning and safety of the components. For details, see the chapter "Service" in the respective instructions for Use.

Regular servicing of the Primea Advanced Air Add-on including the accessories should be carried out at least once every three years, unless shorter intervals are prescribed by law. The regular service must only be performed by an authorised W&H service partner. For details, see the chapter "Service" in the respective instructions for Use.

This is possible. In order to operate standard turbines (from W&H and other manufacturers), the control system of the Primea Advanced Air System can be changed over to standard turbines mode. Turbines which can be connected to the standard 6-hole connection are then operated with a constant 3 bar operating pressure.

In "Power" mode, the set speed is also constantly maintained when pressure mounts on the rotary instrument, which translates to a higher removal rate. The "Tactile" mode permits a reduction in the removal rate when pressure mounts on the rotary instrument.

During the maintenance process in the Assistina TWIN, the rotating parts are lubricated with oil and the spray channels rinsed with cleaning solution. These liquids are introduced to the handpieces using compressed air, which produces aerosols that may contain potentially contaminated body fluids (e.g. blood and saliva). In order to ensure that the apparatus poses no risk to the user, the patient or third parties, the law stipulates that aerosols must be prevented from leaking out of the apparatus. We make sure of this by using active suction and the HEPA filter. This HEPA filter must of course be changed regularly, which is why the lifespan of the filter is matched exactly to the capacity of the two cartridges. The HEPA filter therefore reaches the end of its service life once one set of cartridges has been used.

HEPA is short for 'High Efficiency Particular Air', and the filter is classified as HEPA class E11. This means that the filter retains all particles larger than 1 µm, which includes, among other things, a wide range of bacteria and viruses, suspended particles such as dust and respirable aerosols.

The intelligent process monitoring system documents the number of maintenance cycles that have been performed, thereby automatically calculating the number of instruments that can be serviced with the remaining quantity of fluid. The user receives an alert 300 cycles before the cartridge needs replacing (the oil and cleaner LEDs on the top of the unit turn yellow in colour).

The consumption volumes for each instrument are 0.07 ml of oil and 0.07 ml of cleaning solution. This gives a maximum capacity of 2857 cycles. In reality, the value is around 2800 to 2850 cycles, as initial filling is also required and the fill quantity of the cartridges is subject to certain tolerances that are regulated by the applicable standards.

The two cartridges and the filter can be changed easily without any tools. As with the Assistina 3x2/3x3, the fluid is supplied via tapping needles in the bottom of the cartridge spaces that penetrate the cartridge membrane, thereby drawing the fluid out of the cartridge. The two cartridges have different shapes to ensure that the two fluid types cannot be mixed up. In addition, it is only possible to install the HEPA filter incorrectly by using force, which is not necessary.

The oil is atomized in the Assistina TWIN before it is enters the instrument. This ensures full coverage of the gear parts, eliminating the need for technically complex and time-consuming rotational lubrication. However, there is no negative impact on the maintenance quality: the results of a maintenance operation correspond to those achieved with the Assistina 301 Plus.

If you are not completely sure of the cause of the problem, it is better to contact your W&H service partner first and speak to a technician. It is sometimes possible to resolve malfunctions together with the technician and decide what needs to be sent in for repair.

The brushless electric motor is considerably less susceptible to wear than a brush motor, which in turn translates to minimised service and maintenance work. This also means less downtime for the user when servicing proves necessary.

The W&H Synea series – the glass rod elements are optimally suited for use together with the EM-12 L motor and its integrated LED+.

The EM-12 L electric motor can be integrated into a dental unit by selected dental unit manufacturers or their service technicians.

To connect the EM-12 L electric motor to your dental unit as an Add-on you require a free turbine hose on your dental unit and the possibility of connecting the control to the mains via the included power supply unit. You can control the EM-12 L electric motor using the foot control of your dental unit.

Yes, if your EM-12 L electric motor features the symbol “Sterilizable up to the stated temperature”.

No, that is not possible.

The Built-in electronic component does not require separate maintenance. However, regular servicing together with the rest of the dental unit should be performed at the intervals prescribed by the pertinent legislation. This makes it possible to guarantee proper function and safety. More detailed information on this topic can be found in the “Service” section of the respective instructions for use.

The EM-12 L electric motor as an Add-on version including accessories requires a regular check once every three years unless shorter intervals are prescribed by law. The regular service must only be performed by an authorised W&H service partner. More detailed information on this topic can be found in the “Service” section of the instructions for use.

> To measure the ISQ of an implant, you first screw a so called SmartPeg into the placed implant. The SmartPeg, with its magnet on top, works like a small tuning fork. The magnet on the SmartPeg is ‘hit’ with magnetic pulses, from the probe, which makes the SmartPeg vibrate. Due to the stiffness in the interface between the implant surface and the bone the SmartPeg will vibrate accordingly. The more dense the bone is the higher stability and the higher ISQ value.

Please contact your local W&H partner
The sale of SmartPegs will be defined per country
The surgeon will receive 5 free SmartPegs. A voucher will be provided with the delivery of the product.

The Osstell ISQ technology is proven by over 700 scientific studies. These studies have shown, that torque and ISQ correlate.

Torque is a one time, static measurement at the time of placement of the implant and cannot be repeated later on in a non-invasive way. Osstell ISQ measures the lateral stability of the implant and the measurements can be repeated in a non-invasive, dynamic way to monitor the development of osseointegration.

Yes. All control units SI-1023, SI-1015 and SI-1010 can be upgraded with the W&H Osstell ISQ module

The surgeon or dental nurse can easily attach the module to the right side of the Implantmed with the help of the provided quick manual. The module is plug-n-play via a USB connection.

Please contact your local W&H partner
The sale of SmartPegs will be defined per country
The surgeon will receive 5 free SmartPegs. A voucher will be provided with the delivery of the product.

The Osstell ISQ technology is proven by over 700 scientific studies. These studies have shown, that torque and ISQ correlate.

No. In order to deliver the best balance we shortened the inner coupling length. Therefore contra-angles with only an L suffix cannot be attached to old motors

Yes. At W&H the letter "S" always communicates, that the surgical contra-angle is disassemble. The letter "I" communicates, that the surgical contra-angle cannot be disassembled (e.g. WS-75 L vs. WI-75)

The generator in the contra-angle handpiece requires at least 300 rpm to produce enough electricity for the LED. The rotary speed is between 15 and 50 rpm when positioning an implant.

Yes, providing that your W&H handpiece carries the relevant sterilization symbol.

Yes. In order to extend the live span of the clip, W&H recommends to remove the clip from the hand piece and sterilize it separately (hand piece and clip in one pouch but separated).

Both assure maximum performance. The WS-75 can be dismantled and therefor it can be cleaned more thoroughly.

Internal and external parts are of high quality stainless steel (including the contra-angle handpiece head).

Yes, W&H handpieces with LED and generator are both sterilizable and thermodisinfectable .

See detailed description in user manual or Video.

The handpieces in the new Alegra range have been tested and approved for the following applications removing cariogenic materials, preparing cavities and crowns, removing fillings and finishing tooth and restoration surfaces. The use of the handpieces in other application areas is not permitted and the user bears all responsibility in cases where this instruction is disregarded.

No, because they are usually operated with coolant air. In addition, the LED contra-angle handpieces are equipped with an internal spray function, which guarantees additional cooling.

Compatible LED light – the instruments in the new Alegra range have LED light, which is supplied with energy by an integrated generator. The instruments are therefore independent of the light supply of the motor and the dental unit and offer the possibility of working with light compatible with any unit. The technology of the integrated generator means that there is only illumination when the instrument is running.

Because the energy for the LED light in the new Alegra instruments is generated by an integrated generator, the brightness of the LED depends on the motor speed (at least 9.000rpm).

Yes, providing that your W&H handpiece carries the relevant sterilization symbol.

The optimum speed of fast-running burs can easily be achieved using the WE-99.

Yes, W&H handpieces with LED and generator are both sterilizable and thermodisinfectable .

Yes, the straight and contra-angle handpieces of the new Alegra range can be used on any motor with an ISO connection. .

Yes, it not only can but must be prepared in a thermo washer disinfector and then sterilized in accordance with recognized standards.

We always inject from the vestibular side. A palatal application is subject to your own discretion and the responsibility of the person performing the treatment, but we do not recommend it. For patients who are sensitive to pain, a palatal/lingual surface anaesthetic can be used in addition (gels are particularly effective here), meaning palatal/lingual penetration can be avoided. The palate is shaped like a Gothic arch, particularly in the case of patients with narrow faces. If there is not sufficient palate height, certain areas cannot be treated using Anesto. In these cases, a topical anaesthetic is required.

Intraosseous anaesthesia primarily affects only the target area of the N. alveolaris. To affect the nourishment area of the N. lingualis, I recommend the use of a surface anaesthetic. This is actually a separate treatment procedure, but nerve damage, as can occur with direct nerve puncture or application close to the nerve at N. mandibularis or N. lingualis, will not occur in future when taking this approach.

If the needle is blocked (this can also occur if the needle is twisted) and pressure is put on the lever, anaesthetic can leak from the needle injection site into the cartridge and then onto the handpiece. Corrective action is to: check the flow through the needle and change the needle if necessary.

If the mucous membrane is very thin, the hole in the mucosa can become stretched and consequently there may be a reflux of anaesthetic if excessive injection pressure builds up during the infiltration phase. The situation in the spongy bone is different, but reflux is also possible if excessive injection pressure builds up. Please take your time. The absorption speed in the tissue is just a few drops per minute. Please remember that the anaesthetic is a drug and is slightly alkaline. The chemical aspect alone and in large concentrations can cause local tissue damage if the quantity is too large in too short a period. However, this is not particular to Anesto. The feel for careful application is required in all anaesthesia procedures. If the needle is not centred, it will wobble and the puncture hole will become larger. Then reflux is a certainty.

If the needle is inserted too slowly, the drill holes can expand in the highly cancellous area. If there is too little rotation, the spongiosa are compressed. A high speed makes a jagged »rupture« in the spongiosa, thus creating little or no compression or clogging. In order to prevent this, it is important to precisely follow the information provided in the treatment protocol and in the handbook. Guide the stationary injection needle in accordance with the selected access techniques in the direction of the periosteum/bone until contact is made with the bone. Only use a discreet amount of penetration pressure and immediately depress the footoperated switch completely in order to achieve the speed set immediately (15,000-25,000 rpm). The needle will work through the bone on its own. No soft start, Sotherwise there is increased risk of the needle becoming clogged and the gums being torn by the rotating contact surfaces. Note: the drill hole in the cortical bone centres the needle. Our drill procedures should last for max. 3 seconds. The drill regions should be neither expanded nor jagged.

The injection pressure should be built up by slowly pumping the lever over a period of several minutes. This means the anaesthetic flows out better and there are no effects to vital systems, e.g. raised pulse. If too much is injected into an area, it will inevitably flow back. Slowly inject the anaesthetic into the spongiosa by repeatedly and carefully pressing the dosage lever. At least 10 seconds per injection are recommended. Therefore a total of 2-3 minutes should be scheduled for this treatment stage. Because the absorption speed is around 1 drop/second, the first injections should be administered very slowly. Too much injection pressure and too great a concentration of injection medium carry the risk of tissue rupture and necrosis.

Adrenaline in a concentration of 1:100,000 has optimal vasoconstrictor characteristics. The spongiosa themselves have a good blood supply, not least through the presence of bone marrow structures.

Using a non-rotating approach to perforating the bone or working at low revs can lead to the cannula becoming clogged with blood and pieces of bone. You should, therefore, avoid turning the device on too slowly and pressing down too hard in the first seconds of application. On the other hand, this problem can also be caused by a mechanical change to the needle point. When using Anesto, we have observed warping from 0 to 360°, which means a considerable restriction in the lumen at the needle point. If greater pressure is required on the dosage lever or if this lever cannot be pressed down, then the intraosseous injection needle is blocked and injection is not possible. Remove the intraosseous injection needle from the needle clamping device, replace it with a new one and repeat the process. The argument against the use of the initial drill hole is just that you have to locate it again. In the time you spend searching or the old perforation has expanded, you can create a new access point.

A standard cannula cannot meet the requirements for perforating bone. The needle specially developed for this system has a special cutting guide and a defined length-diameter ratio so it can withstand the rotational forces. Use in a clinical setting shows that the cannulas show deformations of up to 360°.

The injection cannulas are single-use products, firstly due to the risk of infection and secondly because re-use in a second drilling process is not possible due to the needle changes that occur.

Due to the risk of reflux of bacteria, blood components, etc. when the cannula is withdrawn, a new unused cartridge must always be used. The needle becomes deformed and could close up or fracture if it is used a second time. On our recommendation, the manufacturer of Anesto has included several protective caps and connectors in the kit. In cases where several types of injection must be given to the patient, this can be done quickly without any problem using a second pre-prepared system.

This situation is not without risk, especially if the needle has already been pushed deep through the cortical bone. All cases I know of occurred before penetrating the cortical bone and, therefore, removal was simple using tweezers. EIf the needle suddenly disappears into the mucous membranes, references are needed so you can orientate yourself in three dimensions. CPGM biteblocks which you have prepared yourself with a metal sphere as reference (defined diameter) and recorded in two planes on an x-ray enable orientation and a targeted approach to the removal procedure.

If you following the application guidelines, you will successfully inject into the spongiosa. It is unlikely that you will hit a larger blood vessel (e.g. N. alveolaris inferior). Please study the clinical handbook once again, as the injection sites are described here.

If you select the right injection site, the nerve and vascular bundle is rarely affected; it is more common to affect the nutritive vessels which are narrow in diameter and therefore unproblematic. The spongiosa have a good blood supply and respond immediately to the anaesthetic. Therefore there should be no intensive secondary bleeding.

Before selecting the injection site, please consider the shape of the tooth, the angle of the tooth and then the tooth x-ray to avoid damaging the periodontal tissue or the tooth root. In extreme cases, you may meet great resistance. You must immediately carry out another accurate check of the injection site.

Rupture of the mucosa depends on the characteristics of the mucous membranes. Thin mucous membranes will be easier to distend or lightly rupture than thick mucosa. In addition, you should be mindful of the effects of needle rotation. The needle torque goes against the slackness of the adjacent mucous membrane area. Therefore you need to start the motor with a speed of at least 15,000 rpm up to a maximum of 25,000 rpm. Always make sure that no soft start occurs; the mucous membranes and the cortical bone must be penetrated with full torque right from the start, otherwise there is increased risk of the needle becoming clogged and the gums being torn by the rotating contact surfaces. Carefully press the intraosseous injection needle through the attached mucosa and place it upright on the bone.

We have already addressed the risk of infection under the question about »changing cannulas«. Setting aside the fact that anaesthetic has a worldwide price of between 18 and 50 eurocents, there is the risk that blood and bacteria can run back into the needle when you withdraw it. Studies have shown that a vacuum appears at the rubber penetration (rubber fastener) for a fraction of a second at the moment of removal, which can effectively suck some of the material from the needle into the cartridge (Source: Walter Gräf in »Aktuelle Aspekte der Lokalanästhesie« September 1984, published by Firma Hoechst, author Prof. Dr.Dr. Walter Hoffmann-Axthelm, Freiburg im Breisgau, page 147).

A pre-operative prophylaxis is a procedure worth considering not only from a business point of view, but also because this stage leads to better pre-operative hygiene conditions, in addition to the standard pre-operative use of Chlorhexamed 0.1% or 0.2%, which alone reduces bacteria by a factor of 5,000. Creating fully sterile conditions in the oral cavity pre-operatively is wishful thinking and has nothing to do with reality. There are two known ways of managing the risk of an intraoral intervention responsibly. The first is to reduce the bacterial count through a pre-intervention prophylactic and intraoral rinsing for 2-3 minutes using a 0.1% or 0.2% Chlorhexamed rinse. The second is to use a single shot dose of antibiotics for the whole body. This recommendation is primarily aimed at oral surgical interventions. Normal preserving, prosthetic and also endodontic interventions do not require this level of risk management.Intraligamentary, infiltration and conduction anaesthesia also do not require any non-standard safeguards. If you consult the literature on this subject, the risk of infection after an intraoral injection when immune status is normal can be reckoned to be quite low. The only exception is in patients who require endocarditis prophylaxis as prescribed by an internist. (Kneist E. »Plaquekontrolle mit Chlorhexidin ZWR« – Das Deutsche Zahnärzteblatt 2011; 120 (4) page 156 – 167)

No, penetration, i.e. drilling through the cortical bone, is not painful. If the anaesthetic is applied carefully with the pumping mechanism, this process is also completely pain-free. Giving too large a dose of anaesthetic can lead to a reflux of anaesthetic, because the tissue simply cannot absorb this.

We should not forget that sensory suppression only applies to nerve structures or receptor areas – that is, just the periosteum area where there is the greatest density of receptors, along the desmodontal structures and in the areas around the nerves. The cortical bone, for example, is not innervated and so pain cannot be registered here. Therefore there is no need to suppress pain here. The injection should be made at the height of the transitional zones in the region of the middle lower root third. This is where the root structures start becoming narrower but there is still a large enough gap to the serious anatomical structures, such as the N. alveolaris inferior and the sinus maxillaris. The area between the lower premolars can be considered as a relative contraindication, because vessels can be punctured here and painful haematomas caused.

In the period from February 2010 to January 2011, we surveyed a total of 532 patients after first clarifying with them that they would be happy for us to anaesthetize them using Anesto. After the treatment, we asked them to tell us how they felt the desensitisation had worked. Patients were selected at random and participation in our study took place on a voluntary basis. There was no pre-selection based on injection areas, gender, age distribution or diagnosis. 478 patients were evaluated and we reported a success rate of 97%.

No adverse effects have yet been reported. It is important to observe the contraindications so the number of adverse effects reported remains small. Follow the instructions for use, leave yourself time and do not experiment.

If the speed is too high (> 25,000 rpm) or too much pressure is used, tissue necrosis can occur as a result of heat generation. However, this can be kept to a minimum by working intermittently. Because the absorption speed is around 1 drop/second, the injection should be administered very slowly. Injection pressure that is too great and an injection medium concentration that is too high carry the risk of rupture and necrosis to the tissue.

Classic anaesthesia failure can, of course, also be observed with IOA when the inflammation and associated shifts in pH-values are substantial enough.

It is important to explain to the patient that this form of anaesthesia has a high probability of success in every respect. Neither the new German dental fee schedule (GOZ) nor BEMA have a specific position on charging. In the German dental fee scale (GOÄ), something quite different is meant by bone puncture and intraosseous infusion. However, the new GOZ offers enough room for manoeuvre thanks to paragraph 2 and sub-paragraphs, so an agreement can be made in the range of EUR 25-40. Combining the charges with »The Wand« on the invoice is another possible recommendation. Anaesthetics and cannula tips are invoiced as consumables.

You can use any file systems on the market which are suitable for rotating preparation, have a 2.35 mm standard sheath and a torque of at least 0.5 Ncm.

Once the set torque is reached, the set mode (auto forward or auto reverse) is activated and Entran makes five attempts to remove the file. If it is not successful, Entran stops. It is recommended to restart it. If the file still cannot be removed, it should be released from the chuck system and removed manually.

It is not recommended to use Entran with a Gates Glidden bur as the low speed is insufficient to guarantee high removal efficiency.

In addition to the overview of the values on the file cards included in the Entran's scope of delivery, the file manufacturers also provide information on the files' maximum torques.

One fully charged battery is enough for over 20 treatments.

When the battery indicator starts flashing, there is enough time to finish the treatment. Afterwards, the ENTRAN needs to be charged.

If the battery is completely dead, it will take approximately 90 minutes to charge fully.

Use your thumb and index finger to retract the coupling's retention sleeve. The turbine can now be removed from the coupling without any problems. Pulling forcefully on the dental turbine can cause damage. If excessive force is required to remove the turbine, verify that the retention sleeve on the coupling can be moved without any problems.

A 6-hole connection for the turbine tubing is necessary to supply the turbine with electricity via electrical contacts. Other connections do not provide a power supply.

Yes. W&H also offers the "RM-34 LED" for Multiflex® connection.

No, thermodisinfection of the coupling is not permitted; sterilization in steam sterilizers can be applied at a temperature of 135°C. Hot air sterilization and/or cold sterilization (placing in liquids) are not approved.

Yes, providing that your W&H handpiece carries the relevant sterilization symbol.

A mixture of propane and butane (standard aerosol in all spray cans). It contains no CFCs and as such is environmentally-friendly.

In accordance with the national regulations for aerosol cans. More information on disposal can be found on the safety datasheet.

W&H recommends that W&H instruments are lubricated with W&H oil which has been designed and developed to enhance the performance of your W&H instrument.

W&H Service Oil F1 has long­term stability between –30 oC and +160 oC.

Extensive research and testing produced a formula which best covers the extreme demands of dental instruments. It consists of an all-synthetic special oil of the highest purity supplemented by the specially developed additive package.