tips and tricks

Suturing is vital to the success of aesthetic and functional soft tissue work. The handling and theory of soft tissues is something that is terribly taught in dental school. The exposure to this subject should be through oral surgery and periodontics experience but this is something that is often absent either due to the lack of appropriate patients, lack of appropriate training staff or due to interdisciplinary politics. The placement, direction and tension of sutures matters hugely to how well the soft tissues react in the healing process. When primary closure is possibly this will result in the fastest healing and sutures can be removed earlier. Loss of primary closure can result in poor or failed grafts. Below are some tips I picked up at the course on how to go about the suturing process. -There are two types of suture : Anchoring and approximating. Anchoring sutures are far from the wound edge >1cm (approximately the length of the needle) where there is more blood supply ...

Adapted From Beginner's Digital SLR crash course ebook I have just finished a short ebook indroducing a few concepts about DSLR functions. I was discussing camera features with one of my colleagues and realised that I had forgotten most of the theory about photography. Although in my day to day practice photography doesn't require much thought due to the standardised nature of the photographic framing and lighting it is useful to know about the theory behind those photos to troubleshoot when the image doesn't seem right. Also, to achieve high level photographic effects it is important to know the basics so you can play with certain aspects of the exposure and lighting. This ebook was about general photography and so describes how to play with camera settings in different situations. Much of it is not relevant to dental photography so I will summarise that which I would find useful to know about dental photography. I also supplemented this knowledge includi...

Some information about socket grafting from the implant course. -Socket grafting is a procedure that is done immediately post extraction aimed at preventing bone resorption to preserve bone and soft tissue volume. This is most commonly prior to planned implant placement. The aims of the procedure are to pack the socket with bone grafting material, secure the material so it doesn't move and protect the blood clot around the graft material. -Xenografts are heated at high temperatures which denatures porcine proteins essentially turning the bone into ceramic. This is not recognised as bone and will not resorb. However, the blood clot between graft particles will eventually differentiate into bone.  Histologically it will appear as particles of ceramic with human bone interspersed between. -When using allograft, as it is technically human bone, the graft material will be resorbed by the body and replaced by autogenous bone. However, you must use allograft that is processed with sup...

Some clinicians advocate the use of a small gutta percha point inserted into a draining or non draining sinus to track to the apex of a tooth then taking a PA radiograph. In my opinion this makes for a nice photograph but isn't always necessary. It is true that the abscess may not always be located directly next to the infected tooth (especially in kids whose bones are much less dense) but often the signs should be there along with a radiolucency on the PA to allow sufficient diagnosis without the addition of the GP point. Situations where a radiolucency may not be apparent may be where the root apex is fenestrated or closely situation to the buccal bone so little to no bone loss has occuredto allow the pus to drain through the soft tissues. The apical formamen may also be located a few mm from the anatomical apex on the buccal aspect so no apical bone is required to be resorbed to drain the abscess. There may also be overlapping of other structures e.g maxillary sinus that may h...

So I was waxing up a case last week and realised that I had completely forgotten what front teeth looked like. So I caught up on some anterior aesthetic lectures and wrote down the tips and rules to follow when designing anterior teeth. As long as you stay within these rules, your restorations end up looking more natural and aesthetic. There is room for creativity within the rules but the rules themselves are quite important to stick to: -When designing your smile digitally you want to move from macro details to micro. Start with aligning your full face smile photograph making sure the teeth will be designed straight. -Look at lip at rest photographs to see the incisal display. Older patients will tend to show less upper teeth and more lower teeth. Lower teeth tend to be more visible during speech and upper teeth tend to be more visible during smiling. This photograph will start to give you an idea where you want your incisal edges to finish. Use your judgement in the context of the...

So at my new job I've started to make dentures again. My first job had a prosthetist making all the dentures and my next job didn't offer denture services. The last full denture I made was probably 4 years ago in dental school. Starting to make dentures again is an exciting prospect because they were a part of dental school that I quite enjoyed. I am finding that I am remembering small tips here and there and learning new ones as I go along. Dentures are the most aesthetic restorations we can provide as we have full control over tooth shape, size, position and shade as well as gingival aesthetics. Each surface of a denture is important for different reasons. -The fitting surface is obvious important for a good fit against the soft tissues with no trauma to specific areas. -The peripheries are important in achieving a border seal to exclude air to allow a suction effect for retention. -The vertical aspects of the flanges seat against the ridges for resistance to horizontal ...

So I was having a shower (a place where thoughts emerge) and I was thinking about how I used to be as a person when I started this blog and how I am now. I've experienced slow but steady growth and maturity but looking back it seems like a remarkable change. I understand now that although dentistry is a big part of my life it isn't my whole life. We don't live to work but work to live. For some, dentistry is a daily grind and a part of their life that it is necessary to tolerate. For others it is a major part of their life and they spend most of their waking time thinking about it. Most dentists will lie between the two. For me, dentistry serves as a metaphor for my life. As I have grown as a person, I have grown as a dentist. As I have matured in my personal life, I have matured in my work and will continue to do so. Maybe we should all take a step back and instead of focusing so hard on developing our careers, work on ourselves and watch things fall into place.

If something became apparent over the days at the implant course it was that the actual drilling and placement of the implant was the simple part of the procedure. Proper placement is vital and should be prosthodontically driven but it is not the difficult part of the procedure. Flap design, handling of soft tissues, hard tissue grafting and suturing were the aspects of the procedure that would make or break the success of the final functional and aesthetic result of the case. Even before this, careful extraction and socket grafting were important in producing a surgical site that would easily accept an implant. When going to implant courses it is important to choose a course or a combination of courses that will teach you these aspects of treatment because the majority of implant cases would benefit from some form of hard or soft tissue grafting and the lack of these can be considered a compromised result. Courses that allow a bulk placement of implants in a short period of time may...