tips and tricks

 When I was taught at uni by the clinical instructors in endodontics I was given a mix of advice on how to negotiate canals with hand files. One instructor said she never precurved hand files, another said to do it when there is a curve in the canal and push apically with the curve in different directions until you can bypass the curved area. Some provided no instruction at all. In hindsight, my endodontic instruction at university was misguided, limited and in some instances completely counter to sound endodontic principles.   The best way to solve a ledge is prevention and the best way to cause a ledge is to enter a canal with files that are too stiff to early and to put them in without precurving then. Below is a photo I got off the internet that shows a precurved file. You want a gentle curve as a sharp curve will concentrate stress and have more risk of breakage. You don't want too much of a curve as it will straighten itself out when you put it into the canal. A sli...

When making an occlusal splint, we need to provide the lab with an upper and lower impression (digital or analogue) and a bite registration. One arch record is used to make the appliance, the opposing is used to gain the correct occlusion and the bite record is used to mount the models so that the occlusion can be adjusted. The most common bite record that I see taken by my colleagues is either a bite registration in maximum intercuspal position or no bite record at all. This can work out sometimes but from my perspective it is not an accurate bite for splint construction. Essentially, I see a splint as a removeable tool to reestablish the patient's occlusion at an open vertical dimension. When the patient wears a splint, their vertical dimension is opened, and the teeth should ideally contact evenly all around the splint and dynamic movements should be controlled as well. This is what we are aiming for with tooth-tooth occlusion as well. Therefore, the bite records for a splint sh...

 I'm continuing the theme of photography and records with this post with a few of the most common photography errors that I have made and learned from, but still make from time to time. These errors may harm the diagnostic quality of the photos. If we are going to the effort of capturing the photos in the first place it is important that we try our best to make them the best quality and as useful as they can be.  I made a post previously about some basic camera settings which may be useful for complete camera newbies: https://dental-tidbits.blogspot.com/2020/04/basics-of-photography.html  Buccal shots should be perpendicular to the teeth   This is one I learned at the Orthoed Minimasters. For orthodontically diagnostic images, the buccal shots must show the canine and molar relationship accurately. This means that the photos should be taken perpendicular to the posterior plane of occlusion. Most commonly, the buccal shots are taken angled from the anterior as we...

 I have been doing more stainless steel crowns this year. In fact, prior to 3 months ago I hadn't done one at all. We learned about them briefly during the pediatric dentistry lectures at university and I attended a course on stainless steel crowns and pulpotomies at ADAQ as a new graduate. However I was always put off from doing them, partly because of my percieved complexity of the procedure as well as my stubbornness to change the way I do things. I thought that because I had more experience with doing composite resin fillings, that would be the way to go. Actually, I have always found appointments with kids quite intimidating. I have done a fair few fillings on kids over the years, some successful and I am sure a lot unsuccessful. When undertaking procedures that intimidate us, we tend to hesitate from going all the way with the procedure. Essentially this means that things aren't done properly. I was afraid to give local anaesthetic to kids, so I was afraid to prep the car...

 I was going to make a post on caries detector dye because I find it to be such a useful aid during restorative procedures. Then I realised I had already made a post about in 2020. See below. https://dental-tidbits.blogspot.com/2020/09/a-note-on-caries-detector-dye.html  I pretty much agree with my thoughts on the previous post. At the time in 2020 I was using the dye fairly regularly as they had it at the public clinic I was at. I think my use dropped off as I transitioned to private practice and not every clinic I worked at had access to it. Now if I worked at a clinic without access to caries detector dye it would be something I would be requesting or purchasing myself.  Not that I need it to practice, no one needs it, but using it regularly will assist in consistency of your restorations. For proper adhesion to tooth structure, you must ensure that you are bonding to sound enamel and dentine. Therefore caries must be removed to an acceptable standard, clean margins ar...

For some reason, I had a long period of no denture cases coming in. For maybe 1-2 years I did a couple of fractured denture repairs but no new denture cases. Lately there have been some new ones coming in which have been enjoyable to work with. I thought I would make a post regarding modification vs remaking of dentures. Of course by modification I don't mean something simple like adjusting a denture sore spot, where we obviously wouldn't remake a denture, but for where there is a significant discrepancy between what the denture should be like and what it is like e.g changes to the fit or teeth. One common dilemma when a patient comes in with an old set of dentures is do we do nothing, do we try to improve the current denture, or do we start again and create a new set for the patient. My take on this is simple, if I can make an improvement to their current denture and this improvement will make a significant difference to the patient then it is justifiable to do something for t...

 I have been taking a standardised set of clinical photos for my patients for a few years now. Mainly for new patients or existing patients to the practice which I am meeting for the first time if they have something that requires in depth discussion. I find this to be hugely useful in communication and patient acceptance of their condition. I will try to go through my approach to photography in future posts but I mainly wanted to show the set of photos that I take on a daily basis. My photos aren't perfect, there are some things I would like to start doing when I can be bothered, like paying attention to the magnification ratios on the lens to standardise my photos more. However my photography has improved a lot since I started to play around with it back at dental school. Basic new patient photo set in sequence:  Close up smile Retracted frontal Retracted frontal half open Retracted right buccal in occlusion  Retracted right buccal half open Retracted left buccal in occ...