Ordering instruments and supplies for a dental startup practice is a tedious and a time consuming process. But it’s an important step in your startup journey!
Thinking about all the equipment, instruments, and supplies that you’re going to need before you open the door to your office can be overwhelming.
That’s why I wanted to write this post to help you get started.
When you’re starting out, you’re going to want to have just enough to get started. You definitely don’t want inventory of stuff sitting on the shelves and in the drawers. Remember, cash flow is king – especially when you’re starting out.
As dentists, we’re all comfortable with different things when it comes to certain products or brands. I always believe in using whatever works best in my own hands, so you should stick to what works for you. What works for me may not work for you.
To stay organized in this step, you should have a list or a template so you can start checking things off as you order them.
First step is to break down everything you need into different categories: Restorative, Crown & Bridge, Oral Surgery, Lab supplies, Endo, etc.
For your convenience, I’ve also included an excel file with a list of all instruments and supplies I started with. While reading this post, you should reference the excel file. I will not bore you by writing out the entire list here, but I’ll discuss some important elements you should keep in mind.
So, let’s dive right in!
I’m still a fan of using Matrix bands and Tofflemire retainer when it comes to class II composite restorations. I never got used to using the sectional matrix system.
I’ve used the Tofflemire since dental school. I find that it works for me and I get great contacts. But I have worked with colleagues who swear by the sectional matrix systems. Here’s a picture of the V3 Ring – Sectional Matrix System by Ultradent:
There are tons of bonding agents on the market. I use the Prime & Bond NT. I’ve used it through my residency training as well as my associateships. You may have used another brand that you find comfortable for you – stick to it!
I do place amalgam restorations in my practice, although minimal, I find it useful to have everything I need in case I run into those patients that are completely AGAINST the composite resins because their insurance won’t pay for it. I also use it when there are those deep subgingival margins on the second molars due to deep decay and isolation is an issue.
Majority of the instruments you see in the excel file under restorative are amalgam placement instruments. I usually use only two instruments for composite placement: a condenser, and a flat double ended composite instrument.
Provisional / Temporization matrix material – There are bunch of options with varying costs. There are putty based systems where you mix the base and a catalyst and the resulting putty is placed into a tray for taking an impression of a tooth prior to starting your crown or bridge procedure. I use this system. This is what I use – Defend Putty – Regular set, PVS Impression Material
In other offices where I worked, some doctors have used the heavy body PVS material that’s extruded out of the cartridge – the same material that is used for final impressions. This will get expensive.
For fabrication of temporary matrices for crown & bridge, the putty system seems to be the most efficient & least expensive option. If you really wanted to save, you could also use alginate as the impression material to load into a quadrant tray – but you may find that it may not be as efficient. Again, try all and see what works for you.
Provisional / Temporary bis-acryl material: I use two different products in my office. For most cases I use the Defend Temporary Crown & Bridge material which comes in a 50ml (76g) cartridge.
For bigger cases such as anterior six-unit veneer or multiple all ceramic crown cases, I use the Luxatemp material.
The temporary material cartridges you see above are different sizes than the impression material (Heavy, Light & Medium body) cartridges, so you’ll need separate dispensing guns to use the two types of cartridges.
To dispense the temporary material, you’ll need a 10:1 dispensing gun, and for the impression material you’ll need a 1:1 / 2:1 dispensing gun.
I occasionally do make block temps from acrylic and monomer liquid when I don’t have enough tooth structure to start with. So when starting out, I would still recommend you have this in your inventory when you need it.
Gingival tissue retraction: When it comes to tissue management, there are several options available. I’ve used the retraction cord since I took my first crown impression in dental school. I’ve tried using other systems, but I find this works best for me.
| 1. Retraction Cord | ||
|---|---|---|
| Ultrapak by Ultradent |  | I keep two different sizes in stock. Size 0 and size 2. Use sizes that you’re most comfortable with. There is also an option of “Ultrapak E” – which simply means the cord is impregnated with epinephrine. |
| 2. Paste Systems | ||
| GingiTrac by Centrix |  | It’s a flowable PVS (poly vinyl siloxane) based material that is dispensed from a mixing gun. It comes with GingiCaps which can be filled with material and placed over the preparation. |
| Expasyl by Kerr |  | It’s a 15% Aluminum Chloride based agent and requires a special gun to be dispensed. |
| Traxodent by Premier |  | Contains 15% Aluminum Chloride as well as Hemodent. It is used sometimes in conjunction with a cord. You don’t need a special delivery system here, it’s dispensed from the convenient syringes. |
| 3. Laser or Electrosurge | ||
| Lasers have other uses besides gingival retraction around preparations. There are various wireless lasers as well as the popular Picasso laser by AMD, which needs to be plugged in. I have the Picasso laser and it works great! Although an important investment, you can do without it in the initial phase of your startup. | ||
Make sure to refer to the full equipment list in the excel file.
Model Trimmer: I bought a used model trimmer online from ebay for half the price and had it hooked up to the exiting plumbing below the sink by my contractor’s plumber when the office was being built.
It needs to be connected to your plumbing so you can have water flow instead of cutting models dry.
Plaster Trap:
You need a Plaster Trap to capture and dispose of the model trimming waste.
The two hoses will connect the trap to sink tail pipe and the sewer tail pipe. You should be able to purchase this from your equipment company you decide to work with. If not, you can purchase one from Buffalo Dental.
Here’s a convenient pdf you can refer to for all you need for plaster trap: http://www.buffalodental.com/pdfnew/traps.pdf
Your work-horse equipment is what runs your practice – the Air Compressor and the Vacuum Pump. Without this, you can’t see patients. If it breaks on you or malfunctions, your operatories cannot function until you either have it repaired or completely replace the equipment.
If there’s something I wouldn’t buy used – it would be my compressor and the vacuum pump. Sure you can probably find something used online or through a used equipment re-seller – but I’d rather buy this brand new with the safety net of a warranty from my equipment company when i’m starting out.
When you speak with your equipment company, they’ll probably ask you to project how many simultaneous providers there will be in the office at any given time.
Whether it be multiple doctors with one hygienist or multiple hygienists, you need to think of not only when you’re starting but also in the future when you’re busy with associates and hygienists using multiple rooms at the same time.
The number of handpieces that are running and the number of HVEs that are running at the same time will determine which type of compressor and vacuum you need. It is best to talk to your equipment company to see what they recommend.
The picture above is of my utility closet in the office. On the left is a stacked organization of the compressor and vacuum, and on the right is the amalgam separator.
Here’s a close up of the compressor I bought: Air Techniques AirStar 22 Single Head Oilless Air Compressor
And here’s the vacuum pump: Air Techniques VacStar 50H Dual 1HP Vacuum Pump with built-in Hydromiser Water Recycler
Water Filter – Air Techniques 3/4″ Water Filter Solenoid Valve, 24 Volt with Transformer Assembly
The picture above is my water filter with solenoid valve located in the same utility closet. The black box you see on top portion of the image is the remote water control valve transformer, which allows you to shut the water off when you’re not in the office by a quick switch in the control panel you see below.
I have a Tuttnauer 2540M 10″ Manual Autoclave in my office.
There are manual and automatic sterilizers. After speaking with two different equipment companies, both recommended to go with a manual since they tend to break down less and have less repair issues.
The automatic ones let your staff forget about the machine once they’re started. What that means is that the entire cycle of filling, sterilizing, exhaust and drying can occur when your assistant pushes one button. The automatic autoclaves may have a keypad instead of an analog gauge on a manual one.
After talking to some doctors, the consensus was this: digital ones will fail more often than manual ones. I didn’t think more about it after.
I went with the manual one. With the manual one, my staff has to actually pay attention when they’re sterilizing.
Here’s what I have in my office:
You need to clean your instruments prior to putting them in the autoclave to sterilize. There are several ways to do this.
I’ve worked in an office that used cassettes to organize instruments. The casettes can then be put inside an ultrasonic to be cleaned, and then put into an autoclave for sterilizing.
I did not go this route. We use the conventional bags / sterilization pouches to bag instruments after they’ve been cleaned in the ultrasonic machine.
Using cassettes vs the sterilization pouches for efficiency and organization is a whole another conversation I’ll leave for another post in the future.
But if you’re going to go with cassettes, just make sure the sizes you purchase will fit into the ultrasonic as well as the autoclave.
I bought the Whaledent Biosonic UC300 Ultrasonic Cleaner – a 3 gallon unit as recommended by my equipment company:
I started with three high-speed handpieces, two slow speed handpieces, two slow speed latch heads and two slow speed straight attachments.
I added more as I got busier. Unless you’re seeing operative patients back to back all day, you should be fine with 3-4 high speed hand pieces when you’re starting out. Your assistant can always run the autoclave at lunch.
For one doctor, no hygienist when you’re starting out – if you’re doing bread and butter procedures – 3-4 handpieces are more than adequate.
Electric handpieces are nice because they tend to be quieter. They tend to be heavier but will give you better control. Main advantage with electrics are that their torque is constant – even if you’re cutting through crowns.
Fiber optic handpieces are great, but are expensive. I use non fiber optic handpieces, and are much much cheaper. I have a good set of Lumadent (Lumadent.com) headlights on my loupes. Again this comes down to what you like. You may not like wearing a headlight – then you should use handpieces with optics built in.
Price can range from ~$150 – all the way to $1000. Electric handpiece systems are even more. Cheaper is not always better. But paying $800 for an air-driven handpiece doesn’t mean it’ll deliver more value.
I started out with Dentex M3-ss Standard Head, Non Optic (NSK Compatible) high-speed handpieces. They work well for me and I paid about $230 each. I’ve ordered more recently from a company called Avtec Dental.
I also have four high-speed handpieces that I ordered from ebay. Search for “4Hole NSK PANA MAX style Dental Standard Head Push button High Speed Handpiece ” on ebay to look it up.
I ordered them two years ago, and one out of four stopped working about a year later – but at a price of $17 for each, I’m not losing sleep over it.
I use these for removing older crowns, bridge – or any demanding restorative procedure that may put more stress on my other Dentex handpieces.
During the process of deciding on which handpieces to try, you should go to a local dental supply company showroom. They will let you try the different brands and the types of handpieces available. At least you’ll get a feel for it in your hands.
Kavo offers a free trial of handpieces for you to try on your patients. Here’s the link: trykavo.com. You can try the handpieces risk free for five business days.
I usually order from two different places when it comes to dental supplies.
One place is for my regular orders that are not urgent. But you do need to have some sort of system in place where you delegate this responsibility to a chair side assistant. On a regular basis, a list is kept up to date for things that need to be ordered that are not needed on an urgent basis.
I’m aware of the turn around time for shipping once I place an order – so I can figure out when I need to place an order by. I usually place orders twice a month for all things my assistants have added to a list.
The second place is for more urgent things that you may need next day: This is usually the big names (Henry Schein, patterson, Benco) – that may be able to get it to you next day. These supplies are usually at higher cost.
I’ve worked in offices that swear by ordering everything ONLY from Schein or Patterson. One reason they do this is they form a relationship with the local rep of the company. Depending on the frequency and $ amount of the order, the rep may provide a discount, free samples of new products, and provide recommendations on things you may need in the office depending on volume of procedures.
Safco (safcodental.com): I buy 90% of everything I need from this supply company. When you’re thinking of buying any supplies, sign up on their website and they’ll send you their entire catalog. I’m happy with the ease of ordering online and also their customer service. I haven’t had any issues with them at all.
Ebay: I buy my disposables (bibs, sterilization pouches, suction tips, cups, etc.), extra handpieces for crown removal ( that i don’t mind breaking because of extremely low cost), Intra-oral Cameras, Cavitron Tips from here. You will save a good amount of money compared to buying from a “dental” company.
Net32 (net32.com): I’ve not ordered from here, but this is a dental supply marketplace. For the different supplies you need, the website will show you all vendors that sell you that item as well as the price. This way, you can directly compare prices of different supply companies.
Creating a checklist of equipment and supplies for your dental practice startup will keep you organized.
There are a gazillion brands out there for a single product. Don’t get overwhelmed. Remember, stick to what’s been working for you. Avoid buying gadgets or something you’ve never used before. You can try all new things once you have some cash flow.
Modify it to your needs, and it’s there just in case you forget about something, which is easy to do because you’re trying to do thousand other things to open the doors of your office to your first patient.
