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Showing posts from March, 2020

Free gingival graft harvest

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Some tips on free gingival grafts I picked up at the course: -Measure your surgical site before cutting. The palatal tissue is taut and will tend to shrink after it is released from the bone so tend to make the graft wider and long than you think you need. -When cutting the outline of the graft you need to overlap your cuts at the corners. This is because the scalpel blade is rounded up towards the tip and so the tip of your blade will not be at the full depth required (see Figure 1) -A 15 blade is wider than a 15c and so is more useful to reflect the tissue when harvesting                                        Figure 1: Overlap the cuts to ensure that the corners of the harvest are at the                 ...

Blunt end roots

Not sure if I've made a post about this before. I am treating a case at the moment where premolar extractions and orthodontics in the past has resulted in root resorption of the remaining premolars and incisors. The combination of this and perio has resulted in very early mobility of the teeth in question. Orthodontics and root resorption is a separate issue but I wanted to make a post on the possible causes I could think of of short roots on an xray. In this case I noted the short premolar roots but didn't question it until I noticed that 4 premolars were missing. I then questioned about orthodontics and put two and two together. Other differential reasons I could think of were: -Apical periodontitis causing apical resorption: As far as I have seen, it is more likely that this resorption is oblique as the apical foramen tends to occur away from the radiographic apex whereas orthodontic resorption seems to occur symmetrically resulting in a generalised flattening of the roo...

Tips from a prosthetist

-Coat the mounting plate of your articulator in a thin layer of vaseline, it is easier to remove the model from the articulator -For denture addition impressions take a pickup impression of the denture. Always check if the denture is stable before the impression. If not, a reline may be needed at the same time. Fill the intaglio surface of the denture in the deficient areas with greenstick to support the denture in occlusion. Then take an impression with ZOE or PVS on the intaglio surface of the denture. The excess material will be extruded from under the denture bearing area. Before it sets, use an instrument to remove the impression material from tooth undercuts on the adjacent teeth. This is because it can lock in on the undercuts and tear on removal. Then take a pickup impression of the denture -When pouring up models or articulating models place them on a tile. If you need to move it you can pick up the tile. If you don't do this then you have to wait till the stone sets bef...

Implant course

I was recently at an Implant live course part 1 of 3. It was an interesting structure and way of teaching and I'll be posting a few of the lessons I picked up along the way. At the course there were a wide variety of procedures spread across 10 dentists participating. These included sectional extractions, socket grafting, implant placement, soft tissue grafts and sinus lifts. This isn't 100% relevant to me currently working out of the public system but I did learn a lot about confidence and what is safe to do and what isn't. It's hard to be afraid of minor oral surgery when you've seen all the patient's lingual tissue peeled back to the muscle attachment. I'm looking forward to posting on a few topics about what I've seen and am going to see over the next year.

Where do we need finesse?

Dentistry is a profession that undertakes procedures that would satisfy the most anally retentive person. We deal in microns and millimetres and therefore demand a certain level of quality and finesse in our day to day practice. However there is a time for finesse and a time for haste in our work. The two tend to be inversely related. Yesterday I watched a new graduate colleague attempt to section a splinted 5 unit bridge where all three of the abutment teeth were to be extracted. It was 4:45pm when he started to section with a work day supposedly ending at 5pm. The speed at which he was sectioning was painfully slow and we would have been there till 6pm if no adjustments were made. In this case my advice would be that the bridge sectioning should be the fast part of the procedure as the bridge is going in the bin. There is no need to make precise cuts and minimal consequences of cutting too deep (what is below the bridge? Soft tissue. This will heal well even if you cut too deep a...