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 and the site will bleed anyway from the extraction. The consequences are slightly more bleeding after bridge removal and the long term consequences would only be important if this was an implant case which is was definitely not).
The finesse in this procedure is the removal of the abutment roots which were heavily carious. Care needed to be taken to find an ideal purchase point, direction of elevation, curettage of the sockets and suturing. Spending too much time on the bridge section delicately cutting layer by layer and stopping to check where you are only takes away from the more crucial part of the procedure. It will lead to fatigue and time wastage which will leave you stressed and more likely to make a mistake where it counts the most.
When sectioning this bridge he needed to ideally use an electric handpiece (which we didn't have), press down on the pedal all the way and put the full length of the bur against the full height of the bridge and push against the bridge non stop until he reached the other side. The only time he is allowed to stop is to change to a fresh bur. He did well in the end and we finished the procedure at 5:30pm. Fatigue is a major factor in poor dentistry and it is important to note that this procedure was at the end of a long day.
As time goes on I am learning which areas I can do quick work and which areas I need to take time to do fine work. I am learning how much force is safe to apply and when to be gentle. I am learning that things that we were scared of in the past like raising a flap, sectioning teeth etc aren't all that scary when you've seen and done enough of them.
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 and the site will bleed anyway from the extraction. The consequences are slightly more bleeding after bridge removal and the long term consequences would only be important if this was an implant case which is was definitely not).
The finesse in this procedure is the removal of the abutment roots which were heavily carious. Care needed to be taken to find an ideal purchase point, direction of elevation, curettage of the sockets and suturing. Spending too much time on the bridge section delicately cutting layer by layer and stopping to check where you are only takes away from the more crucial part of the procedure. It will lead to fatigue and time wastage which will leave you stressed and more likely to make a mistake where it counts the most.
When sectioning this bridge he needed to ideally use an electric handpiece (which we didn't have), press down on the pedal all the way and put the full length of the bur against the full height of the bridge and push against the bridge non stop until he reached the other side. The only time he is allowed to stop is to change to a fresh bur. He did well in the end and we finished the procedure at 5:30pm. Fatigue is a major factor in poor dentistry and it is important to note that this procedure was at the end of a long day.
As time goes on I am learning which areas I can do quick work and which areas I need to take time to do fine work. I am learning how much force is safe to apply and when to be gentle. I am learning that things that we were scared of in the past like raising a flap, sectioning teeth etc aren't all that scary when you've seen and done enough of them.
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