Tom Giblin's Fixed prosthodontics course Day 1

 Today I attended day 1 of the fixed prosthodontic course. In contrast to the removable prosthodontic course, I'm less keen on fixed pros though I don't mind it too much. He spent quite a while going over the basics of the topic including the theory behind bur design, some material science and advocated "prep design with intent". I sense he advocates against a cook book approach or a matrix within which to make decisions and rather advocates understanding the reasoning and thought process behind WHY we make the choices we do. Using this knowledge we can make treatment decisions individual to each patient and clinical situation.

He does advocate crowns over veneers for upper anterior teeth and tends towards onlays for posterior teeth. The reasoning behind this takes into consideration the forces that each restoration is put under and the reason why the restoration is done i.e upper anterior veneers are upt under tensile stress so tend to fracture and debond more than if the veneer was carried around the palatal surface to form a crown that would allow you to control the occlusion. Onlays on the posterior to cover root filled teeth for example would preserve more tooth structure and allow enamel bonding on a tooth that is already quite compromised due to the root canal treatment. This is modified based on other factors i.e if the tooth is an upper or lower tooth, the patient's aesthetic requirements, if the tooth is dark, if the tooth is already heavily restored.

He also spent quite a bit of time discussing the rationale behind the different types of materials and how they affect prep design i.e knowing how crowns are milled makes it obvious that the prep should be round and retentive features can't be too narrow. 

This is the first time he has run this particular course in the manifestation we are receiving it so it tended to be quite disorganised but it will obviously become refined over time. I found it less riveting than the denture and occlusion course but that may be a combination of me being less interested in the topic and having slept poorly the night before. I found myself losing concentration and zoning out.The practical side was on portable handpieces preparing different types of restorations on itero resin milled models i.e full crown for PFZ, Onlay on a premolar, 3/4 gold crown prep. It was clear that the bur choice needed to be tailored to the design and that a one size fits all prep wouldn't work for all types of restorations in all types of situations. I hope that on reflecting on the knowledge I've gained today I'll be able to have more appreciation of this. Even writing this now I'm realising that I've picked up things over the course of the day.

The models were very soft and it was very easy to overprep the models so any mistakes were very exaggerated. This was a good way to develop the tactile sensation that will make prepping on natural teeth a lot easier. Any technique errors would stand out very much on these models. The switch between practical and lectures and the length of the day is probably another reason why I was zoning out.

Tomorrow seems like a super packed day even more than today. Things like soft tissue considerations, aesthetics, impressions, temporaries and insertions seem to be on the agenda as well as more preps and a live patient for impressions/insertions. Just like the denture course I reckon he could easily fit this into a 3rd day of the course but it will be interesting to see how tomorrow goes.