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Showing posts from October, 2021

Observing prosthodontics 4

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A few months ago I went for another day to observe a prosthodontist in private practice. I had the notes from the day written down but had put off posting it due to laziness. Below are some of the procedures I observed on the day: - Review of suckdown resins to close black triangles: The patient whose consultation that I observed at a prvious visit had had his resin additions done with a suckdown technique to close the black triangles. His black triangles were as a result of triangular teeth with mild recession therefore required a prosthodontic solution. I was observing the review appointment where the teeth were to be separated. Embrasures were cut into the teeth a the bonding visit and spaces opened to allow piksters to go through. Line angles and the location of the proximal contact was defined with the waxup but the teeth were still stuck together. Suck down resin veneers will stain at edges making areas that aren't bonded easier to see staining at first review but doesn'...

Customising wedges

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Wooden wedges are very useful tools in restorative dentistry. They allow for the protection of soft tissues during tooth preparation, retraction of the rubber dam, separation of the teeth to protect the adjacent tooth, seal the matrix band against the cervical margin and separate teeth to allow a contact point to be formed accounting for the thickness of the band, thickness of bonding agent and shrinkage of restorative material. The issue with most wooden wedges is that they are too large in an occlusogingival direction so tend to displace and deform the matrix band away from the adjacent tooth. This requires some customisation of the wedge to fit each specific cavity that it is being used on. Burnishing the band doesn't tend to overcome this and just leaves a lumpy surface on the interproximal surface. Ideally we want the band sitting passively against the adjacent tooth without having to force it there.  The next time you prepare a class II cavity, look at the interproximal area ...

Why teach?

This was a post that I started writing at the start of the year when I thought that I would be starting clinical teaching last semester. It was a bit of a journey to be onboarded and so it took until semester 2 to start and definitely wasn't the role that was advertised but the concepts that I started to explore are still the same. I think at the time I was questioning my motivations to teach to form a clear picture in my head what I wanted to get out of this. I wrote 4 points down in the draft which I will elaborate on: - My teachers were bad:   At university we had some quite good people teaching and supervising us but later on we also had some very bad ones. There was a point about halfway through our degree where university changes i.e school changing faculty and subsequent funding changes resulted in a massive pay drop for the supervising staff. As a result, all the quality teachers left to better paying jobs. For most of them I doubt it was the money that caused them to leave...

A note on the medical history

The medical history is something that is only important when it is important. By that I meant that the vast majority of people we encounter will have no medical conditions that will significantly affect the way we do our work but when we have a patient with significant comorbidities it is vital that we identify these so we can plan accordingly. This may involves modifying our treatment plan, omitting certain procedures or consulting with our medical colleagues for advice or to arrange multidisciplinary treatment. Some patients who are significantly ill are not suitable to be treated in the general practice setting and may have to be referred onto colleagues with experience treating medically compromised patients or have to be treated in a hospital setting. A common mistake we make in private practice is that the medical history is often left to the patient to fill out and there is often not enough emphasis from the practitioner on the importance of this legal document. The issue with t...