tips and tricks

So there was a request to make a post on how to build healthy relationships with the staff at work. Admittedly i'm not the most socially tuned in person but you don't necessarily have to be a relationship superstar to build a healthy relationship with a coworker. Strategies and work dynamics are wildly different according to your position at work. Support staff, dental associates and practice owners all must have different approaches to interact with their coworkers to avoid friction and relationship breakdown. I will approach this post from a general point of view and as well from the view of the associate dentist and practice owner. It isn't mandatory to get along with everyone at work but if you intend on working at a place for some time or plan on not hating your job it really does help. Below are some thought's ive jotted down on the subject: General thoughts: Be honest: Humans have inbuilt bullshit detectors and lying breeds distrust which is a killer in any t...

What will magnification do for me? We can benefit from visual magnification for a number of reasons. These can be boiled down to two main reasons: Ergonomics and quality control. Wearing loupes or using an operating microscope allows us to see our work with good detail from a distance that non magnified vision would find difficult. Loupes also have a defined focal area and this forces us to sit upright to create enough distance between our eyes and the subject to bring things into focus. It causes less strain on our eyes to scan for finer details. Loupes allow us to see detail that is far beyond the capacity of our eyes to see unaided. There is no way that we can focus on the apex of a tooth through a root canal access without some heavy duty magnification and therefore finer procedures are opened up to us that were not available before magnification. Hand in hand with magnification is illumination. A headlight is a very useful tool as it brings a bright, even light into the oral c...

Review of case 6 months ago: http://dental-tidbits.blogspot.com/2018/12/case-report-cracked-tooth.html The lower 6 remains asymptomatic but the upper 6 has become symptomatic with cracked tooth syndrome. The other dentist in the practice has seen her and will perfom cuspal coverage of this tooth. On followup if I were seeing her I would consider taking follow up photos, pulp test and a PA radiograph. Muscles of mastication are painful to tenderness. She is likely a bruxer due to the significant wear on the 7, multiple cracks and pain in her muscles. The sign of heavy occlusion on the 7 is also a good sign that she may have her MIP anterior to her CR postition. Seating of the condyles into CR will result in posterior traction of the mandible and a slight separation of the anterior teeth. This tends to bring the most posterior tooth i.e the lower 7s into heavy contact. This can be reproduced by adding leaves in a leaf gauge to the anterior teeth and checking the occlusion of the pos...

The preparation, impression and provision of crowns is an essential procedure in contemporary dentistry. With the advent of new ceramics, bonding materials and preparation techniques the situations in which crown and bridge work can be utilised is broader than ever. However, with these developments comes increased procedural complexity which can lead to treatment failure. Crowns can fail for any number of reasons some of which are explored below: Structural failure: Failure in the crown or tooth substrate Poor preparation technique can result in failure of the crown. Insufficient tooth reduction will result in thin sections or restorative material that can easily fracture. Use depth cutters or calibrated burs to the reduction that you want. If the temporary crown fractures quickly this may be a sign that you have insufficient reduction Sharp angles in the crown preparation will make impressions and stone pouring difficult as the material has difficulty flowing around sharp corn...

Below is a general outline of the steps required to rehabilitate an arch or two in ceramic. Records are essential in these cases both for the success of the case and for medicolegal reasons. The more records we provide the technician the more chance we have of a successful case and less adjustments in the final. Supplemental procedures such as orthodontics, root canal treatment, implant placement and crown lengthening will fit in in certain stages of this protocol. Consultation appointment Case discussion, treatment and financial consent Radiographs: OPG/CBCT for screening supplemented with bitewings or PAs as needed Extraoral photographic records: Full face: Rest and full smile Lateral face photograph Smile close up Intraoral photographs: Retracted full anterior  Retracted 45 degrees left and right Buccal segments mirror Occlusal mirror maxilla and mandible Contrasted maxillary and mandibular arch Upper and lower impression in Medium body and PVS light body was...

Some tips from Lincoln's course The temporary stage is essential for diagnosis of aesthetics, phonetics and function as you can adjust the occlusion,  add material, change the aesthetics without damaging the final crowns or glaze. Avoid skipping the diagnostic phase in multi unit cases. When adjusting anterior aesthetics "make a box" by first adjusting the incidal edges then interproximals. This will make a block of material that you can then shape. Aim to "remove any material that makes it not look like a tooth. Polish the embrasures and then labial surfaces and then add secondary anatomy. When using bisacryl temporary material, take out the stent after the suggested time and leave on the bench for 1 minute to allow further set then slowly tease out. The bisacryl will still be slightly soft and prone to deformation as soon as it is removed. In very critical, full arch cases you might need to get your assistant to open the flanges of the stent to allow you to pul...

Vertical preparations or vertipreps are simply crown preparations with no defined finish line as it is prepared to a knife edge or feather edge. Vertiprep avoids traditional shoulder or chamfer margins and therefore is more conservative of tooth structure in the pericervical area. Additionally, as less thickness of tooth is removed, more ferrule can be preserved in borderline cases. Vertipreps can be taken far subgingivally with good tissue tolerance until the biologic attachment and therefore the crown can provide more of a ferrule effect than Supragingival or equigingival traditional preps. However, vertipreps are difficult and technique sensitive and therefore should be reserved for the cases that would benefit from them i.e teeth where there is insufficient tooth structure or ferrule. The difficulty arises as narrow burs are needed to fit subgingivally and it is hard to make smooth preps with these. They tend to dig into the tooth and cause grooves and bleeding. When considering ti...

Temporary crowns are used to protect the teeth between appointments. They cover exposed dentine to avoid dentine sensitivity, protect, fragile margins, hold the teeth in spatial relationship to adjacent teeth to avoid tooth tipping and overeruption. They are also of utmost importance in full mouth cases as they allow diagnosis of occlusal design problems. Early failure of temporary crowns can be an important indicator of insufficienies in preparation design or parafunctional forces in the patient's mouth. Failure of temporary crowns can be a common occurrence and can happen for multiple reasons: Flat preps: i.e not following the curvature of the cusps. if you flatten the cusps only they will be underprepped at the fissure area and the temporaries will be too thin (Figure 1).  Sink your bur in at an angle that matches the incline of the cusps to ensure there is sufficient occlusal reduction (Figure 2). Insufficient reduction in the secondary plane. The secondary plane of reductio...

When planning aesthetic cases one of the first thing you must decide is the position of the incisal edge. This has important implications in vertical dimension and soft tissue management. Wear cases often affect this. Altered passive eruption can occur in anteriorly positioned bruxers. It results when attrition results in overeruption of teeth with brings the bone and soft tissue with it. In anterior bruxist cases there will be minimal wear on the posterior teeth and no loss of vertical dimension. They will also generally show a disparity of the gingival margin heights with the maxillary incisor gingival margins being positioned too far incisally. Provided the aesthetics was acceptable before the altered passive eruption, these patients do not usually benefit from opening the VD or lengthening the incisal edges as the maxillary display will usually be too excessive. Instead, they may benefit from procedures such as intrusion of the incisors  to allow restorative space and move the ...