tips and tricks

I attended Mike's course in Sydney at the end of August and found it a decent set of lectures. Nothing ground breaking as I have explored a little bit into occlusion in the past but it definitely served  to clear up a few misconceptions I had and consolidate a few concepts I was unsure about. There will be recordings available through restoring excellence so I will probably purchase this when it becomes available and make a few posts on occlusion. The good thing about Mike's lectures and philosophies is that it combines multiple points of views from different occlusal schools into a predictable and workable treatment flow. Topics I will be blogging about are things like: splints: designs and uses: ideal occlusal contacts, how to check lab work before it is inserted, concepts of CR, the uses of leaf gauges, how to manage cases taking into account structure, engineering and aesthetics etc.

Just a spot where you can get caught out when clearing dentine removal. Make sure you have removed all enamel overlying the carious dentine and also have a clear DEJ before you switch to a slow speed for carious dentine removal. It is easy to get focussed once you have switched to the slow speed on the depth of the cavity while you risk failing to clear carious dentine at the DEJ. The other day I was preparing a wide, shallow class 1 carious lesions and in the name of "conservative dentistry" I failed to clear some enamel overlying the carious dentine. the slow speed round bur was clearing carious dentine well but there was one "island" of dark tooth that was not being cleared. It was easy enough to recognise by cleaning and drying the tooth and recognising that there was still some translucent material overlying the dentine. Switching back to a high speed diamond to clear this and clear the enamel margins to a clean DEJ allowed me to complete the preparation well...

Root canal systems calcify and dentine undergo scleroses in response to function, ageing and insults to the pulp such as repeated thermal or chemical insults (erosion, caries). As the dentinal tubules close, the ability for fluid movement to stimulate the pulp is reduced. Deposition of secondary and tertiary dentine increases the bulk of avascular tooth structure between the environment and the pulp tissue. This is beneficial for protecting the teeth against further insult but does raise difficulties during diagnosis of dental pain. When we are diagnosing pain we want to identify the odd tooth out e.g if there is a pulpitis we want to identify which tooth has an exaggerated response to stimulus compared to the surrounding teeth or if there is a pulp necrosis we want to see which tooth has no response compared to the surrounding teeth. Dentine sclerosis and pulp recession makes all responses less obvious and can complicate diagnosis. Technically the majority of tests we utilise for ...

Today as I stared at an extracted upper 8 covered in subgingival calculus, I mused on the difficulties of non surgical periodontal therapy. Removal of bioburden to the periodontal tissues is one of the long standing main aims of the treatment of periodontal disease. I don't dread treating perio but what puts me off is how difficult it is to do it well. I believe that if you are doing something you should do it right but perio is one of those tricky fields where things are stacked against you... Subgingival anatomy is hard. On the extracted tooth I held there was a multitude of anatomy unrecognised on simple 2D films. There was tight furcations between narrow roots, the interproximal root surfaces were concave and sloped upwards towards a very bulbous CEJ. I would imagine that I would spend quite a bit of time cleaning around this anatomy on the extracted tooth (and this is out of the mouth!) Of course the tightest spots are usually interproximal where the gingiva and neighbouri...

Natural undercuts on teeth are important for the retention of partial dentures, dental appliances and rubber dam clamps. It is undesirable interproximally next to denture saddle areas and when preparing a tooth for a crown or other indirect restoration. When assessing a patient for a partial denture or before rubber dam placement it is important to use your eyes to survey around the teeth to check for useful undercuts. Some molars have exceedingly straight buccal and lingual walls which makes retention of clasps and clamps difficult. Lingually tilted molars can make denture design difficult as it will result in a large open space under the lingual flange. You may want to design the denture so it sits anterior to teeth like this or fiddle with the path of insertion. Alternatively, mouth preparations can reduce these undesirable undercuts. With rubber dam placement, lack of undercuts may force you to use subgingival clamps or to clamp the soft tissue. You should be able to pick the t...