tips and tricks

A mockup is a trial run in the mouth of a functional and/or aesthetic restoration. This can be done in a multitude of ways. Small aesthetic restorations, even mockups for bridge pontics can be done freehand. Models can be take and waxed up to their final form. This may be more time and cost effective when multiple teeth need to be restored. A putty stent can then be taken of this waxup and transferred to the mouth with self cure resin e.g temporary crown material. The question is why is this an important step? -It is important to get the patient's approval of the aesthetics before the final restorations are put in place. You can discuss finer points of the patient's aesthetic rehabilitation beforehand but nothing is as effective as a visual representation of the possible appearance of the patient's future smile. The best time to find out what the patient likes or doesn't like or if they have unrealistic expectations is before the final restorations are placed and espec...

I mentioned this briefly in a previous post but I thought that I would expand on the point further. The argument is: "is it better to have smooth crown preparations or rough ones." The answer to this is relevant as it dictates what steps we take after rough preparation is done and to what level we take the polishing of our preparations. I don't think anyone is debating the usefulness for macroscopically rough and bumpy preparations as these are likely to incorporate undercuts in the walls of the prep, lead to thin areas in porcelain which greatly increase the crack potential and generally don't look good. However, it can be argued for a neat preparation that is microscopically unpolished and rough to potentially increase the microscopic retention as well as the surface area of the cement or bonding resin. In any case, rough bumps and imperfections in your preparation can't be polished out with discs or polishing cusp. The preparation needs to be pretty much th...

Something that I learned recently about tofflemire retainers. There are two types of Tofflemire retainers: Universal and contra-angled (Figure 1). The universal retainer "U" loop is perpendicular to the long axis of the retainer. The contra angled is intuitively at an offset angle to the long axis of the retainer. When the band is tightened onto the universal retainer it will sit parallel to the retainer. When the band is tightened onto the contra-angled retainer, the retainer will be angled occlusally. Figure 1 The universal retainer is for cases when the retainer sits to the buccal of the tooth being restored ("Classic technique"). Contra-angled retainers are used when the buccal tooth structure has been lost and the operator wishes to position the retainer on the lingual aspect. The offset angle of the retainer is designed to allow the retainer to sit over the incisal edges. If a universal retainer is used it will sit parallel to the occlusal plane and the ...

 Writing in retrospect about the second day of the occlusion course in Mona Vale. Day 1 was more basic setting up for TMJ anatomy, and some occlusal concepts. We mounter our own models with the records taken in the course Day 2 was about occlusal concepts, some basic TMD concepts and parctical equilibration on the models.  I think it was a fairly good course, explained concepts that were alluded to in university and is probably the way they should have been taught the first time around. Tom explained things well and was very patient with my constant barrage of questions. I have a thick pad of notes that I wrote down in the course and hopefully will start to write them up as posts probably at the end of the year once I am done with primaries.

Just an incident that manifested today which I'll recount and add my thoughts afterwards: A patient that was seen in emergency by a new graduate colleague about 6 months ago. The patient didn't speak English and the appointment was done through an interpreter service. The patient was complaining about pain in the second quadrant and the only tooth with an issue was the 27 which had a short root canal treatment but no periapical lesion. The diagnosis was difficult because there were multiple teeth tender to percussion and pain wasn't localised to the 27 tooth. Bitewings were taken and periapicals of the first and second quadrant.  No definitive diagnosis was made but, the patient was sent for extraction of the 27 but this didn't eventuate for some reason or another. Fast forward 6 months and the patient has been booked into see me for extraction of the 27 based off the previous referral. The patient says this tooth isn't sore but there is pain in the 4th quadrant. I ...

Caries detector dye stains less mineralised dentine and therefore can be useful in the detection of carious infected dentine. However they can also stain other types of demineralised dentine including affected dentine, DEJ and dentine near the pulp. I found it very useful as a new graduate in detecting areas where I had incomplete caries removal. I wouldn't put 100% confidence in it due to the risk of overstaining but it can be useful in ensuring that the margins are caries freed. It should be used in combination with other methods to detect caries e.g tactile sensation. Switching to a spoon excavator for stained caries near the pulp can ensure that you don't overprepare dentine in a critical area. I find caries detector dye especially useful in quickly progressing lightly coloured dentine as it closely resembles the colour of sound dentine. Often times when I thought I have cleared all caries in such cavities there is significant amounts of remaining caries often at the base o...

 Day 1 of 2 over for Tom Giblin's Occlusion course in Mona Vale. It was a solid day which was hands on as compared to Michael Melker's lectures. The day was about 50% didactic learning and 50% practical learning how to take occlusal records (impressions, leaf gauge bite, protrusive bite, facebow) and mount the models in a semi adjustable articulator. Tom gave many tips on different subjects and I'll be peppering some blog posts of these random tidbits when I find time. This year has been quite interesting and I have found that I reached a stagnant state due to restrictions on dental practice and delay of dental courses but attending this course has been cathartic in a sense and I can feel some interest and passion in prosthodontics rising again. Looking forward to day two which sounds like it will delve a bit more into the theory of occlusion and how to use this knowledge practically.