Anaesthesia just got a whole lot easier
Andy Johnson, of Holland House Dental Practice in Lincolnshire, describes features of the new Quicksleeper 4
Last year I wrote a review of the Quicksleeper 3 (QS3) anaesthetic system which can be used for all anaesthetic applications.
The unit may be used for traditional infiltrations which are delivered at a slow rate eliminating any discomfort and reducing the risk of tachycardia. Alternatively, anaesthetic may be delivered through the cortical plate into close proximity with the root apices. Such a technique eliminates the need for block anaesthesia including ID blocks from the practice.
Where anaesthetic is placed within the cancellous bone it will have an instant effect of unparalleled efficiency. There is the additional benefit of anaesthetising multiple teeth with no soft tissue anaesthesia. The risk of tongue or lip biting disappears and the patient experience improves.
Each anaesthesia can be customised in duration by selecting a suitable vasoconstrictor (more vasoconstrictor lengthening the anaesthesia) and a suitable volume of anaesthetic agent (again more anaesthetic longer duration and wider spread of effect).
The Quicksleeper is recommended for any dental procedure requiring anaesthesia of less than one hour. A small volume of anaesthetic will create a profound anaesthesia for a short time and this is welcomed by patients.
By understanding the spread of the anaesthetic within bone the operator can choose the most accessible entrance point through the cortical plate. If the application site is remote from the working site the volume of anaesthetic is simply increased to ensure adequate anaesthesia in the desired area. This facilitates enhanced operator efficiency as the clinician can select the most convenient site to deliver the anaesthetic, taking into account root morphology and bone density etc.
In general up to eight teeth may be anaesthetised in the maxilla, the same is true of the anterior mandible, whereas in mandibular molar regions the reliable field of anaesthesia is one tooth behind the application point and two in front.
I have used the system now for the better part of two years and it has proven a firm favourite with patients. During that time I have not encountered a single case that required block anaesthesia – there is always a way to deliver anaesthetic with the Quicksleeper.
I still happily use infiltration anaesthesia, but this is delivered painlessly with the Quicksleeper which has huge benefits for every age group. For the paediatric patient the first dental anaesthesia can be painless, for the geriatric patient a much reduced volume of anaesthetic is used therefore there is less risk of toxicity.
The device saves surgery time and in that fashion payback time is short. Another business advantage is produced because patients talk and good experience will promote the practice.
I set pen to paper again to review the latest model of the Quicksleeper (QS4). My comments are based on a three-month testing period in my general practice.
The Quicksleeper 4 is the latest evolution of the system. In its design Dental-Hitec of France has been responsive to customer comments collected from QS3 users. This information guided the design process, and this, I believe, will guarantee product success.
It is important to note that all techniques and the protocols followed remain the same, so if you own a QS3 you will understand the QS4. The differences relate to handling cosmetics and efficiency.
Some found the handpiece of the QS3 rather heavy and unbalanced. This was normally fully accommodated during the learning curve of use and not a long-term issue. The handpiece of the QS4 has been redesigned in plastic, not aluminium, and the weight and dimensions significantly improved, this enhanced ergonomic design improves handling and will speed up the achievement of competence.
The QS3 had a single illuminating scale showing anaesthetic delivery and, unless great care was taken, this was not always visible during anaesthesia creating a certain amount of nuisance to some users initially.
The Quicksleeper 4 has LED lighting which wraps around the entire circumference of the handpiece. This ensures the delivery markers are always fully visible. The same markers give warnings if excessive pressure is being used during perforation of the cortical plate, or if the normal pressure of injection is exceeded, all of this useful information is therefore fed back to the user much more reliably.
The Quicksleeper 4 unit itself is much reduced in size and there has been a stroke of sheer design brilliance with the foot pedal wireless and free from both batteries and power supply. This is achieved by a built-in dynamo which generates sufficient current when any control is activated to produce a wireless signal which communicates with the base unit.
It has not, as yet, been possible to create a wireless handpiece because this would involve the power supply for the handpiece being built-in and the weight of a suitable battery pack would be prohibitive. The balance and handling qualities of the new handpiece more than compensate for this.
With QS3 there was an intermittent flushing of local anaesthetic through the needle between periods of rotation. This was to cool the needle and reduce the risk of boney debris causing needle blockage. The QS4 now continuously flushes throughout the rotation cycle and this further reduces the chance of blockage which can otherwise complicate the injection protocol.
The final significant change is to the delivery capsule that holds the anaesthetic cartridge. It is the cartridge that allows rotation and the penetration of bone. The QS3 had a cartridge composed of an outer metal shell and an inner plastic cartridge held together by a C-clip. This assembly had to be regularly dismantled following sterilisation to dry and clean the plastic insert.
In addition to the inconvenience that this caused there was a further complication in that if the insert was wet or contaminated with oil then a frictional force between the plastic sleeve and metal cartridge reduced the efficacy of the rotation and made penetration of bone less reliable.
The QS4 has an ingeniously designed one-piece cartridge whereby rotation is controlled by a ring of ball bearings at the hub. This is lubricated before autoclaving and requires no other maintenance. There is no contact between the glass anaesthetic cartridge and the new stainless steel cartridge. This simple design modification has dramatically improved the unit.
While the motor of the QS4 remains similar to that in the QS3, the absence of the friction means the torque of the new machine is improved, and the penetration of the cortical plate is a much simpler event. The delivery cartridge also features a built-in soft tissue guard to eliminate the risk of frictional trauma from the rotating hub to the patient. Being integral it is also made from stainless steel and is sterilised with the cartridge. It replaces the separate plastic tissue guards which came with the Quicksleeper 3 and needed occasional replacement because of deterioration caused by heat sterilisation.
The various modifications described should shorten the learning process.
Anaesthesia has just become a whole lot easier, and you can’t say that of many things related to dentistry these days! Both models of Quicksleeper represent a massive step forwards for any practitioner prepared to spend time mastering the technique.
Andy Johnson qualified at Newcastle in 1989. After working in the Midlands he joined Holland House, and became a partner in 1995.