tips and tricks

-Roast chicken analogy: Put a chicken in the oven at the highest heat and when it looks good on the outside is it cooked well? -Irradiance: power/area -Power->Watts -Bulk filling: Light tip has to cover the restoration completely. Some MFRS are smaller diameter which is smaller than a molar M-D distance. -Uncured CR, Uncured monomers at the deepest part esp pulpal area-> Doesn't have the physical properties that MFR intends.  "Pt is biting down on a sponge" common reason for Cr to fail. Low conversion rate causes leakage of monomers and photoinitiators. -Overcuring can cause damage: cook the pulp, damage the gingiva, Follow MFR instructions. Can cure longer but should have a break e.g 5 seconds or blow air over tooth -Ramp cure and pulse lights, no beneficial effect shown. Ramp effect needs to increase over minutes not seconds to be actually effective in reducing problems -Variation within composites: Shade-> can have maximum increment size differences -C...

Today I had to extract lower 3-3 for the insertion of a full lower immediate denture. I was hesitant to give bilateral IDBs and asking around it seemed as though the other dentists would be as well. I got around it by giving bilateral mental blocks and lingual infiltrations. There were no premolars for intraoral landmarks so I palpated extraorally then intraorally to find the mental foramen. I retracted the soft tissues with my finger to have an intraoral reference to penetrate the mucosa. Lingual infiltrations I placed around the lateral incisor area and it seemed to be sufficient to anaesthetise one tooth either side. The OPG also helped in approximating the position distal to the canines.

This is the composite resin protocol I've been using recently including instruments: 1. LA, Rubber dam, prewedge and cavity prep (Lately I've had difficulty with larger spaces between teeth, the largest wooden wedge hasn't binded and stayed in place. I may try a plastic wedge in the future. It has the benefit of sitting down into the gingival sulcus and inverting the dam) 2. Matrix band and burnish against the next tooth a) 1-2 walls missing interproximally: Sectional matrix band/s. If the buccal and lingual extensions are too severe and the use of a ring will crush the band then use a wooden wedge to seal the gingival margin. The band can be adapted into the gingival sulcus for adaptation against the tooth but most likely i'll need to trim the excess material post placement b) 3 walls missing: Tofflemire band and wooden wedges or plastic wedge and separating ring c) 3.5-4 walls missing: Automatrix and wooden wedges 3. Bonding procedures 4. With the composite re...

I recently had a patient that required extraction of a heavily filled lower 6. The last xray we had was a PA 2-3 years old. I told him that I would like to take a new Xray to plan the extraction. HE kicked up a big fuss about the cost of the xray. I compromised and said I would take the tooth out with the old xray. Big mistake. The crown fractured and the roots kept fracturing with elevation. The extraction would have been just as difficult with the updated xray but medicolegally I don't think I would have a good defence if things went sour. I took a PA halfway through anyway to check the progress of the extraction. It scared me because at the angle I took it, the IAN overlaid the roots. Then I realised I should have taken the xray at the start. In the future if a patient kicks up a fuss about the cost of necessary diagnostic tests I would either straight up refuse to perform the treatment or give the xray for free. It's 30 seconds work to save a lot of headache down the track....

-Full smile For this shot, a point-and-shoot camera should be switched to macro mode; DSLR macro lenses should be used at approximately 1:2 magnification. Attempt to take the photo from directly in front of the patient, avoiding a downward or upward angle of view. The patient should exhibit a natural smile, with framing of the photo extending from the right to left corner of the mouth. Point of focus for this shot is on the central or lateral incisors. The horizontal midline should be the incisal plane; the vertical midline should be the anatomic midline.  -Anterior retracted Patient seated with dentist in front. Cheek retractors used with the cheeks pulled outwards away from the teeth. A common mistake is to pull the lips outwards and backwards which pulls the buccal area inwards. Use the largest retractor possible to avoid the centre of the upper and lower lip from appearing in the photo. Air dry the teeth. the teeth should be in MIP but they can be slightly apart to aid in...

Preliminary restoration for crown is the code 627. I believe that this code is too all encompassing. I restored a tooth with composite resin today, lower molar 5 surface. If my core buildup was only 3 or 4 surface the cost would be the same, I think that there should be an increase in cost for larger buildups which perhaps relates to the cost of the correstponding 5-- code. e.g Half the cost of the 5-- code. Such problems would be less obvious if we used a dual cure composite core buildup system which involves a single layer which would be a timesaver. If I have to buildup the whole tooth in CR with incremements then running costs increase significantly.

Today I placed a large 12MIDL composite resin without rubber dam. Not sure about my reasoning about the lack of rubber dam but it would have been difficult to place due to the subgingival nature of the prep. This is not an excuse however and the patient's inflamed gingiva kept bleeding onto the composite resin. Long term, this increases the risk of staining and secondary caries. I placed a retraction cord but didn't place it interproximally. Instead i placed it flowing onto the gingival margin of the adjacent teeth. I think that the lack of cord in the interproximal allowed bleeding onto the composite resin. If I could restore this tooth again, I would pack cord or teflon tape then rubber dam from premolar to premolar and use floss ties to invert the dam into the sulcus +/- an anterior cord. Also, the contralateral lateral incisor was missing which made it difficult to form anatomy till symmetry. Additionally the ipsilateral canine was buccally and labially positioned. A cont...