tips and tricks

 After seeing Tom Giblin's example of sectioning the premolar during a difficult extraction I decided to try the same today. He sectioned the tooth when the crown fractured off to avoid fracturing the buccal plate as he was grafting the site for a future potential implant. Today I had a carious upper premolar that fractured when I put forceps on it. The patient was elderly and the arch was slightly crowded so the premolar was lingually placed. What this meant was that althought I could fit forceps on the tooth, the force to the buccal was hindered as it pushed against the adjacent teeth. In hindsight I would've just gone straight to cutting the interproximal contacts to give space for the tooth to move into and avoid pressure on the adjacent teeth. Instead, the crown fractured off. In hindsight this is a benefit as it removes the interference of the adjacent teeth and allows an elevator to fit 360 degrees around the tooth. In my eagerness to try the new technique I went straigh...

Been pretty slack lately in making posts instead just jotting some notes onto a draft post and leaving it for later. I have just over 100 posts I have to sort through and write up so will try to find some time to do this. This post was from over a year ago from the full mouth rehab course. It will be good to look back and refresh myself on what I learned back then as well as have the opportunity to add on knowledge that I have picked up since then. It turns out I already posted a lot of the information on this post as it was from a draft where I had dumped notes from the whole course but I thought I Would repost it with some additional information I have picked up since then. The second stage of a fixed pros rehabilitation involves the refinement of preps and the records taken to guide the technician towards the construction of the restorations. It can be useful to think of the appointment this way i.e in terms of a set of objectives rather than a list of procedures. An overall guide o...

 Got a chance to follow up on the incident in this previous post:   https://dental-tidbits.blogspot.com/2021/04/extrusion-of-endodontic-materials.html The clinic got a call from the patient that she was in a lot of pain about 9 days after the appointment. She had seen her doctor and was on antibiotics. She was double booked in into the clinic on the next day and I spent the day before the appointment stressing about what I had done and what I was going to do. I spent the night before researching about hypochlorite incidents and the management of. A lot of the serious complications of hypochlorite extrusion requires the dentist to bind the syringe needle and forcefully push the irrigant out the end. As I had some irrigant left in the calcified canal and the irrigant was forced out with the cavit placement, the actual volume of irrigant that could have been extruded is quite small and so the amount of damage and inflammation would be minimal.  In the end it turned out that ...

 Today I had the worst denture try in that I've ever had. The situation was the construction of a full over partial denture. The patient has a current full denture which he doesn't like the aesthetics of feeling the teeth aren't visible enough. He is a person who is a bit past a mid life crisis and spends his days chasing after women half his age. But to be fair, the incisal display was inadequate and unless he had a very wide smile, he looked edentulous and unsupported lip-wise. Naturally I took my jaw registration intending to increase the incisal display and ordered the A1 teeth to be set.  I don't know how it was so wrong but the midline was off by about 5mm and the incisal edge was down by about 5mm. I have never seen a sight more horrible. To my annoyance, the wax rims I had sent up were still sitting in the lab box meaning the technician had supposedly used them to mount the case and then set the teeth up without it. They can make an index over the lower cast to ...

 Just finished the second day of the course. It was another full day and as usual went after the allocated hours but Tom was fine to stay back and finish things off and answer questions. He went through more theory, a lot on diagnosis and occlusion and we prepped some more on the model and he finished off with some case studies.  Prepping on the model was a lot better as we found the sweet spot dialing down the handpiece power and developed a lighter touch of the bur. I found that prepping benchtop was very awkward and I found that I had to redevelop the way I hold the handpiece and utilise the finger rest.  The course itself felt more like a stitch together of multiple other courses i.e implant, treatment planning, occlusion courses rather than a stand alone course which makes sense as he had not run this course before and had most of the slides from an onlay course he had run a number of years ago. It felt as though a broad base of the basics were covered which were goo...

 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 i...

Following up on the difficult impression appointment from a previous post: https://dental-tidbits.blogspot.com/2021/04/difficult-impression-appointment.html The aim of preparation is to convert a difficult task to an easier one. The impression that I sent off that day turned out the be absolute rubbish and completely inappropriate for the final impression.  I could approach the case with a clear head and cleaned the old impression off the tray and placed adhesive long before the appointment. This way there was enough time for the solvent to evaporate and the adhesive to be effective.  I used light body PVS in every single cavity to block it out. I thought this would be difficult to handle but it was quite simple and if excess bled out of the cavity I could push it back in with an instrument. I had to change tips half way through because I was too slow in the placement and the material had early set half way through the blocking out. One thing I would change is to dry the teeth...