tips and tricks

 Just finished the course 3 of 8 of the IAADent comprehensive orthodontics and orthopedics course. I've been quite busy lately and haven't really had much free time to jot things down in this blog. I'll put own a few thoughts about the course here. The first two sessions was a lot of revision for me having attended the first couple of EODO ortho sessions about diagnostics. The philosophy taught by IAADent and Derek Mahony run pretty parallel with a focus on a triad of airway, TMD and sleep and considering facial aesthetics. From what I gathered at EODO, Kenneth Lee has more of a focus on TMD and incorporating this into diagnosis and management prior to commencing any orthopedic or orthodontic changes. I could be wrong but although TMD isn't absent in EODO, it isn't as deeply ingrained into the philosophy they teach which is more heavily airway and sleep focussed. However, knowing a bit more about the subject now, I guess you can't really separate the three from ...

 I had a relatively difficult day at work today. It was one of those days where one thing went wrong and then another and then it seemed to snowball all throughout the day. I think a lot of how difficult the day was was due to my mindset. Each challenge I encountered along the way in isolation wouldn't have been an issue on any other day. But it was the way I reacted to the first challenge that was key.  It's days like this that make me realise that I may not be as mentally strong as I think I am or seem to be. Everyone has bad days, it's important to admit that. But luckily for me these are few and far in between. They're like a cloud sitting over your head that affects your judgement and amplifies the impact of errors. I wonder how people function who feel this way on a chronic basis. In any case, tomorrow is a new day and new opportunity so I will keep trying to look upwards and forwards.

 Today I had an interest observation in the student clinics. It so happened that all the students I was put with were doing Root canal treatments at the same time. I noticed that when they were assessing their working lengths, they were all using the measure function on the dental xray program. This is fine for a preoperative assessment of the tooth and perhaps to estimate how short of working length you are but is by no means an exact science. Firstly, the measurement too l needs to be properly calibrated as the objects in the image can be elongated, foreshortened or distorted so a reference point is needed that is measured in the mouth eg the width of a tooth. This can then be used by the program to work out the ratio of enlargement of the xray compared to the actual objects imaged in the film.  However, it turns out they were taught to measure the width of the film (41mm) and input that measurement into the software as a calibration. I may be wrong but this doesn’t make any...

Warning: This is not a course review but a rambling. Day two was a very draining experience not because of he volume of work or content but just the monotony of the exercises given. I mean this in the sense that we were just prepping plastic teeth the whole day. This highlights the importance to me of taking breaks and refreshing your mind and eyes. I didn't really do this and about three quarters of the way through I was developing quite a headache and eye strain.  After courses like these I find that I don't really know what I've gotten out of the course until a day or two afterwards and I will discover new things as I mull the information and experience over in my head. I came home after the end of the course pretty tired, had dinner and went to bed. I won't write too much about the second day itself because I don't actually recall too much about what we went through. It was essentially discussing the dimensions of the preparations we were expected to do and the...

 Just finished day one of two of a fixed prosthodontics course "Masterprep VIP". It's a fairly popular course that a few colleagues had done but isn't particularly well advertised so it mainly gets circulated by word of mouth. The first day is relatively long starting at 8:30 and running relatively non stop until 6:30pm. They said they have shifted the course structure over the years and have put the majority of the theory into the first day and all of the hands on component into the second day because splitting up the exercises throughout the two days wasted time in the transitions between lecture and hands on. This is certainly something I have noticed at hands on courses in the past and in addition, when the hands on component comes along, some people are listening, some are trying to get ahead and if the presenter wants to make an interjection,  it can sometimes be drowned out in the noise and activity. Every one tends to work at different speeds and moving the gr...

 Today I reattempted an impression on a crown preparation with a deep subgingival margin. It was a very heavily filled lower molar with a subgingival buccal GIC restoration. I knew that the tooth was compromised but had not placed any of the restorations so I didn't know how extensive the restorations were and it was not obvious radiographically. When I removed all the restorations and caries to place a core, I was surprised how deep gingingival the mesiobuccal restoration went. It is hard to tell on the photographs but the midbuccal and mesiobuccal margin was about 4-5mm below the gingival margin. Halfway through the procedure, I didn't many places to go other than to keep going ahead with the plan and see how it turned out. What was surprising was how non inflamed the gingiva was preoperatively despite having such a deep margin. Partly this may be due to the patient's thick gingival biotype or partly it may be due to the margin being buried so deep that the inflammation w...

Today I tried an Endo Z bur to open the access cavity for an upper molar. I've used one before but not the way it was intended and not very successfully. The Endo Z bur is a bur specifically designed for the endo access, the bur has tungsten carbide cutting flutes and a non cutting tip (Figure 1)     Figure 1: Endo Z bur design The bur is designed to be inserted into a cavity once the pulp chamber has been opened and moved around to widen the access (Figure 2). The non cutting tip is supposed to be held against the floor of the pulp chamber and when the wall of the chamber is encountered the bur will theoretically stop cutting. It is supposed to make the process of cutting the access foolproof. Note: This is only relevant in multi rooted teeth. It can still be used in single canaled teeth but shouldn't be used with any apical pressure.   Figure 2a: caries is extending into the pulp horn or an access cavity into the pulp horn. 2b: The endo Z bur is inserted into the cavity...