tips and tricks

Setting an ideal position of  teeth for a lower full denture is of the utmost importance due to the almost universal instability of the lower full denture. One of my pet peeves is how the technician wants to set everything with an "anatomic" class 1 relationship. Tooth position can be in a wide range in the natural dentition but this is anchored in bone with periodontal ligament support. Because of this, natural dentition tooth position can exist outside the zone of soft tissue influence a la the neutral zone concept. The influence of external factors on tooth position becomes more obvious as there is loss of periodontal support in diseased states which allows buccal and lingual soft tissues as well as the occlusion to move the teeth resulting in flared teeth and diastemas.  In contrast to the natural dentition, full dentures are at the mercy of the movement of soft tissues during speech and function which can affect their success if denture base extensions are improperly des...

 I think it is important to take some time and effort at every stage of your journey to look back at the successes and failures we have encountered. With time the successes may have faded in their effect and the failures may still be haunting you but they are a part of our past nevertheless. For me in dentistry it comes from looking at my clinical records and appreciating how far I have come. Improvement is a continuum and it comes in stages rather than a constant flow. Looking back I can see that there are diagnoses I have missed and procedures I have completed in a substandard way. These are more likely than not to work out fine as the next clinician will come in, judge my work and fix it up the best they can. If not then it isn't the end of the world either way. My mistakes have come at the cost of the patient but as well at the cost of my disappointment in what I have achieved. However the benefits of these mistakes are multiple in that it gives me the insight to ensure that I ...

 I was helping out one of the younger colleagues in the extraction department the other day with a very difficult case. This was one of the times I would say that the tooth was genuinely difficult to anaesthetise due to a hot pulp. In the past I had quite a few cases where I failed to achieve anaesthesia and blamed hot pulps only to realise it was probably my own technique that was inadequate and the excuse was just too convenient. This tooth was a heavily carious upper premolar with a significant curve on the root which bordered the maxillary sinus. The curve was to the mesial which was strange and it seemed to follow the outline of the sinus so we can assume that the expansion of the sinus at the time of tooth formation led the tooth root to curve to the mesial.  Challenges involved in the anaesthesia of this patient were: -Very dense bone: which I noted as we were elevating the tooth. Elevation and forcep movements hardly produced any movement of the tooth which is common w...

 Today I had a situation where I had to heat test some teeth to diagnose where the patient's pain was coming from. The situation was lingering pain from a lower molar elicited by hot and cold stimuli. The cold test was being inconsistent and wasn't reproducing the lingering pain that the patient was describing. I was given a Q tip to carry the cold spray but I find that looser materials such as cotton rolls or cotton pellets are better at carrying the liquid and will retain the cold for longer. It may have been that my method for cold testing wasn't efficient enough at carrying the cold into the tooth. The carrier for cold will warm up quickly once in the mouth and it may not be cold enough to elicit a response from the pulpal nerves. I wasn't getting anywhere so I decided to heat test the pulps. It has probably been about 5 years since I've had to do this but in the odd time that it is used, it is very useful in reproducing their pain. A few methods for heat testin...