Tuesday, November 29, 2011

Episode 221/500: Sectioning a Crown - with a 330 bur?

I was sectioning an FDP (bridge) on this patient yesterday and Dr. K waltzed up to my operatory (dental cubicle) and suggested I use 330 bur to section the crown.

??

It worked like a charm.

Cheers

Ashley


PS:



Note the Rubber dam technique for this 4 unit FDP; explained here:











Monday, November 28, 2011

Episode 220/500: Promotion to Major

Today was a special day - a little out of the ordinary - I was promoted to Major.  It was supposed to be a "secret", but Dr. K likes to verbalize his emails as he reads them.  I was sitting in his office, waiting to discuss a case, as he started reading an email - "Don't tell Captain Mark, his promotion is a surprise".....and then...he continued to finish the 400 word email.  Upon finishing this email, he turned and looked at me and said, "Uh oh......you didn't hear that from me!".

Thanks to my beautiful wife for preparing the surprise luncheon that I helped cook the potato salad for...all day Sunday.

...and of course, Iris, Dave, Katie, and Jess for all your help and coordination.

Ashley


Until several years ago, the insignia for Dental was CFDS
Canadian Forces Dental Services - or - to a lesser extent:
Canadian Forces Dance Squad

Sunday, November 27, 2011

Episode 218/500: Adhesive Posts - the future or past?


I started this post as a reply to a comment on Episode 217 - custom dowel post.  But...it turned out to be longer than I initially thought it would be, so - as in the words of Latte Ice - "here we go"


Anonymous said...

What do you mean by adhesive technology? You use fiber posts/cores (ie. with luxacore?) Could you elaborate a little? Thanks!



You raise a great point.  After reading your question, I  actually started second guessing what I meant as well.  I am referring to using fiber reinforced composite posts and a dual cure adhesive.  I reviewed the literature this morning and afternoon on the current status of post systems.  This article summarizes almost everything, except Cast Post and Cores.



Ok, so - here is where I was about 1.5 years ago.  I was trained to use 1 of 3 techniques to retain a core.

1.  Good ol' metal serrated post.  I believe that the idea is to passively fit the post into the canal system, lute it with some cement and build up the coronal portion with amalgam....and maybe composite?  I think the composite was old school (I just saw an article from 1987) - but - that was newer school than I was before the residency.  The worse part of using these is drilling the post space.  I can't stand it.  Even today, after 10 years of practice.






2.  The golden beast.  I've fabricated a number of these and although the idea before starting the procedure is entertaining - fitting one always seems to be a challenge.  Also, once the tooth is broken from one of these - it's really broken.


3. Amalgam Radicular Core - something like this radiograph below.  I still use these on occasion.  We have access to 3 CAD/CAM machines, therefore, the use of amalgam is fairly low at the moment.




Fiber Reinforced Composite Post and/or Ribbond


I'm not an expert by any stretch of the imagination, and, I've asked a number of really smart folks here and they don't know the answers either when it comes to using adhesives and posts.

Metal Posts

 Fairly straightforward - Fence post in ground to a decent depth so the wind won't blow fence over,  concrete the base -let set, finish fence.  Got it.

Adhesive Posts


Here is a great place for some material reviews D.T. Light-Post Review by the Airforce

What are we really trying to achieve with a fibre reinforced post?  Is it:
  1. Monoblock structure of composite in the canal? 
  2. Post adhered to the dentin walls with shrinkage gaps between the post and cement?
  3. Long parallel sided post for "mechanical" retention?
  4. How long does the post now need to be if I"m adhering it?
  5. Do we need a post at all?  What about Fibers - ie - Ribbond?
As far as I can see, there are a number of factors affecting adhesive posts.  I've now come to question what we're trying to achieve with a post anyways.  I mean, if we're trying to adhere to the inner canal system - why use a post? Why not just place some luxacore down the canal system and build up the core on that?  I"m sure that's not a great idea secondary due to composite shrinkage, C-factor and many other little details.

What about the fact that the adhesives don't bond to the posts very well - and - what about the obturation junk left on the canal walls, including AH+, Roths, NaOCl, EDTA?  Yikes.  A poor dentin bonding MPa of RelyX Unicem of 7 mPa to fresh dentin isn't surely going to bond well to canals with mud on them - even after you clean them mechanically...But then, do you really need 3.5 mPa of shear strength to retain a post?  The data is in the document below.



So, maybe the idea is to create a monoblock structure, try to reduce adhesive shrinkage, reduce C-factor (or manage it) - what about something like Ribbond?  What I like about this idea is:
  1. No need for a drill like a parallel sided post (I haven't perforated during post placement - I've perfed other times during endodontic access, however....) 
  2. Perhaps the best attempt at creating a monoblock structure in the canal system.  
  3. The fibers are used to decrease the amount of cement shrinkage
  4. No post to shrink away from.
  5. The ends of the fiber are placed in the pulp chamber to bond to as well as to decrease C-factor  on the pulpal floor.
More to follow...the never ending post discussion.

Let me know what you think.

Ashley
    Adhesive shrinkage away from the fibre reinforced post

    It was there, now it's not!

Saturday, November 26, 2011

Episode 217/500: Custom Dowel Pattern

Cast Post and Core - This is what I believed in before I joined the residency in order to fix a severely broken down tooth.

Now - Adhesive technology.

However, for something to remember (like the days of cassette tapes), here is an excellent video describing one way of creating a custom dowel core.  Thanks to Allen Dray for providing this video.


Thursday, November 24, 2011

Episode 216/500: Dental Anticipation - The Good Kind....perhaps?

This is you.

You have:

  1. Been edentulous in the Anterior Maxilla for 25 years.  
  2. Severe Generalized Chronic Periodontitis and recently underwent maxillary osseous resection w/ apically placed flaps bilaterally (both procedures were successful in the eyes of the patient - he doesn't have blood on his toothbrush anymore).
  3. Generalized Miller mobility of 2
  4. A desire to have fixed teeth. Period.  The ol' valplast just isn't working.
  5. Inadequate ridge width for implant therapy and insufficient time for an implant based overhaul.
Ok.  This one is a shoe in.  An easy case to hammer out esthetically.  A classic fixed prosthesis is perhaps frowned upon w/ the miller mobility of the abutments - however - Ribbond is in.  BTW, he is a great patient.  Funny, quiet and very appreciative of what we've done so far.....

We selected the shade preoperatively, and the patient was happy - C4.  Unfortunately, in the process of adapting the teeth to the ridge and Ribbond, the dentin shading of the teeth was removed...and..the teeth became....B1 maybe?






Edentulous for 25 years

Edentulous for 25 years


No problem.  Here's what you started with (Valplast) and yes, what I ended up bonding to the Ribbond was much lighter - but - you've been edentulous for many years and I'm assuming this is better than what you had, right?


Valplast

Removed the dentin shade in the denture teeth.
 Hollywood white, right?

Well, we've decided to revisit the denture teeth shade issue and in January, I will replace the 2 denture teeth with either composite or Radica based teeth.  We'll do our best to match the shade.  Maybe I didn't discuss expectations well enough with the patient.

The point of the above case is:  
Anticipation.  

I don't really have time to read anything other than literature and/or dental stuff - and - with blogging....well...time is limited (Not to mention child #3).  But, I do have time to listen to audiobooks to and from work and this book:



has really made me think about patients and anticipation of the final result - be it - orthodontics, surgery, periodontics, and restorative....maybe endo?

Here is a great snippet from his book - perhaps the above patient's wife had been anticipating all his teeth matching?

Prospection and Emotion


"We daydream about slamming the game-winning homer at the company picnic, posing with the lottery commissioner and the door-sized check, or making snappy patter with the attractive teller at the bank—not because we expect or even want these things to happen, but because merely imagining these possibilities is itself a source of joy. Studies confirm what you probably suspect: When people daydream about the future, they tend to imagine themselves achieving and succeeding rather than fumbling or failing. Indeed, thinking about the future can be so pleasurable that sometimes we’d rather think about it than get there. In one study, volunteers were told that they had won a free dinner at a fabulous French restaurant and were then asked when they would like to eat it. Now? Tonight? Tomorrow? Although the delights of the meal were obvious and tempting, most of the volunteers chose to put their restaurant visit off a bit, generally until the following week. Why the self-imposed delay? Because by waiting a week, these people not only got to spend several hours slurping oysters and sipping Ch√Ęteau Cheval Blanc ’47, but they also got to look forward to all that slurping and sipping for a full seven days beforehand. Forestalling pleasure is an inventive technique for getting double the juice from half the fruit. Indeed, some events are more pleasurable to imagine than to experience (most of us can recall an instance in which we made love with a desirable partner or ate a wickedly rich dessert, only to find that the act was better contemplated than consummated), and in these cases people may decide to delay the event forever. For instance, volunteers in one study were asked to imagine themselves requesting a date with a person on whom they had a major crush, and those who had had the most elaborate and delicious fantasies about approaching their heartthrob were least likely to do so over the next few months."

Gilbert, Daniel (2009-02-24). Stumbling on Happiness (Kindle Locations 386-395). Random House, Inc.. Kindle Edition.

It all comes back to ensuring that we discuss expectations before treatment, b/c, as in the wise OLD words of Dr. Allen Dray:

"Explanations after the fact are just excuses"

Cheers

Ashley

Tuesday, November 22, 2011

Episode 215/500: Articaine Infiltration 3rd Molar Extractions

Oral Surgery Clinic

wisdom tooth, third molar, extraction mesioangular, impaction, surgery


3rd molar extractions - full/partial bony impactions under local anesthesia.  Lots of fun on the receiving end of this stick.  I compare the central sensitization theory on pain to tickling my sons.  Once you start the tickle train, all you have to do is look at them, and the boys will start laughing.

It appears that this may be similar to molar extractions.

Assume local anesthesia is completed (2% lido, 0.5% marcaine) and I ensure that I have adequate anesthesia (numb lip test does not indicate pulpal anesthesia)....more on that topic later....I let the patients "marinate" for approximately 15 mins to ensure "solid" local anesthesia.  I have another lit article on the times required for anesthesia - more on that later as well!

Let's pretend we're now just completing the ostectomy on the mandibular left 3rd molar, and just about to section the tooth and.........the patient winces.  Oh no.  It has been my experience that once the patient experiences pain during a procedure - all bets are off.  It's like heroin (always chasing the first high?) - I just can't get back to that complete level of solid anesthesia.  The patient is seemingly always experiencing something.  Perhaps, they are experiencing allodynia.  The definition of allodynia is "is a pain due to a stimulus which does not normally provoke pain".  Of course, on a normal daily basis, poking around 1cm into someone's mandible would elicit a painful response.  Therefore, I need to clarify that I think I'm referring to sensations such as pressure - that are now being perceived as pain.  Or - the patients are so wound up by this point (I would be also), that, any little movement (remember tickle train) is in anticipation of a painful response.  

Anyways, like the tickle train, I've extracted enough 3rd molars to know that once on the tickle train, it's a really bumpy road to the finish.  Enter ARTICAINE!  I believe this made a SIGNIFICANT, although empiric, difference in my ability to achieve complete mandibular anesthesia.  No tickle train like usual today.

Thanks to Dr. Elyassi for chop crushing not only on paperwork and administrative responsibilities, but also for reminding me about these 2 articles that we recently reviewed in our current literature seminar:
Quick point
  1. Use 1.7 mL Articaine to infiltrate the buccal mucosa for mandibular molar extraction, in addition to the standard IAN block using Lido 2% and Marcaine 0.5%.
  2. Use Articaine to infiltrate Maxillary molars (don't forget the greater palatine block)
CONCLUSION:

The IANB injection supplemented with articaine buccal infiltration was more successful than IANB alone for pulpal anaesthesia in mandibular teeth.

CONCLUSION:

The efficacy of 4% articaine was superior to 2% lidocaine for maxillary buccal infiltration in posterior teeth.

Monday, November 21, 2011

Episode 215/500: Blue Mouse to Check Crown Prep Interocclusal Clearance

Well - it's hard to imagine that everyday I learn something new.  The basics just keep reinventing themselves.  I also wish that I could openly verbalize the issues that really frustrate the heck out of me - but -  of course, that is an entire waste of time and energy.  Thank goodness for lunchtime workouts.

BTW, this Movember gig is just about over!

Ok, back on track.  So - there are many methods to checking crown interocclusal clearance - usually using some sort of caliper device.


  1. Wax
  2. Interocclusal tabs (1.0, 1.5, 2.0mm)
  3. BlueMousse
  4.  ?
  5.  ?
  6.  ?
  7.  ?
Dr. Dray mentioned this small hint today, as he watched from a far, closely, at what I was fumbling with in my hands.

Prosthodontists!

Cheers

Ashley





Friday, November 18, 2011

Episode 213/500: Simple Orthodontics to Move Single Teeth

Yesterday - 17 Nov 11.

0730hrs.  Ready to cement a CAD/CAM crown - I wasn't extremely happy about the contours of the crown. However, I had milled three different variations to try to achieve a functional result, and, the intertooth distance btn #14&15 (FDI #26,27) was limited.

"I"m sorry Dr. Mark, but, the palatal contour of this crown just isn't perfect.  Let's move the 2nd molar and redo."

??????????

Dr. K wanted me to distalize the left 2nd maxillary molar to gain approximately 1.5mm restorative space for a crown on #14 (FDI #26). I had the crown milled, fired and ready to go for insert.  I was like..come on?  After 2 rounds of kickboxing...or well...gentlemanly discussion, he proposed that I prosthodontically distalize the 2nd molar.  You know - the ol' move teeth by adding provisional material to your provisional crown each week after you place separators - for like - 8 weeks.

I figured I could meet him halfway - with - simple orthodontics.

"Sir, I"ll meet you halfway.  I really don't foresee the 'place separators and followup once a week, then add interproximal bisacryl to the #14 provisional - and do that for 8 weeks - taking 8 weeks.  With our schedule, it will take months."  "However, using simple orthodontics to distalize that tooth and see the patient once in 4 weeks"  He conceded. I won.  Not really.  We both gained by learning each other's techniques.  I am his grasshopper.

End learning tip.  If you need to distalize a tooth, you have several options:


  1. Prosthdontically (Provisional restoration, ortho separators, addition of provisional material at each followup period)
    1. Pros:  Cheap (don't need brackets, wires), easy to do
    2. Cons: Slow, clinician painful, need patient followup weekly
  2. Orthodontically (either TADs, removable ortho, or fixed)
    1. Fixed
      1. Pros:  Easy, fast, stable, only 1-2 visits
      2. Cons:  Need basic ortho supplies




Wednesday, November 16, 2011

Episode 212/500: Orthodontic Debonding

Patient MS has now had 4 hours of relief from fixed orthodontic appliances.  As of today, he is 3 grams lighter (I really have no idea) since we removed both maxillary and mandibular braces.  It's a fairly straightforward process.  This is an interesting case b/c it was my junior comprehensive treatment planning board patient.

Here is the treatment plan:

  1. Fixed orthodontic Appliances (~12 months) 
    1. Goals: 10% overbite, 2 mm overjet, intrusion #14
  2. Implant Supported Mandibular RDP
    1. Placed Implant #18
    2. Changed to Kennedy Class 3 RDP w/ Implant #18 to be crowned
  3. Crown lengthening #14 (and possibly a few other areas)
  4. Maxillary Crowns and FDP #11-14 (yes, I realize this is a 4 unit, however, it will oppose plastic teeth)
  5. Mandibular RDP (tooth/implant borne)
We're now approaching Phase 3

Cheers

Ashley


Tuesday, November 15, 2011

Episode 212/500: University of Oklahoma - Crown - Waxing Start and Gold Finishing

A resident colleague sent me a link to an RPD test from the University of Oklahoma College of Dentistry website.  We're in the midst of studying for December board exams as well as our ABGD March Board exams.

http://dentistry.ouhsc.edu/rpdreviewquestions/

Then, I started peaking into some of the other resources available on their site and I found this one.  Start to finish, waxing and finishing a full gold crown.  Here are a few videos and the link to the entire page.

http://dentistry.ouhsc.edu/fpd/Clinical%20Aids/visualLabguide_fgc/Pam%20waxing%20Session/index.html#Margins


video


video

video
video
video

Episode 211/500: Dental Dad Diary


I'm not sure how this guy has time to blog, but he does.  "Dental Dad" is a second year dental school student who blogs on his endeavors in preclinical labs.  His latest posting on "#11 ProTemp Provisional" really caught my eye.  This guy has either talent or sheer determination to make plastic look that good.

Please take a look at his blog.  I enjoy reading it because it reminds me dearly of what I escaped....barely.







Monday, November 14, 2011

Episode 210/500: Denture Border Molding

I"m not sure that I"ll ever get this correct - denture border molding.....

I remember sitting in dental school, hands covered w/ border molding compound and ZOE paste wash (if you don't know what this is - be thankful!)...and...the patient's face entirely coated in this white ZOE paste. We had to vaseline their faces, otherwise, they'd be going home w/ white paint on their face.  It was bad.  Even worse, the stuff was really brittle and you couldn't add to it.

What I've relearned in the residency is that the last place you want to short cut is with........dentures.  Period.  Even seasoned prosthodontists still use green stick compound and a light PVS/VPS wash for a final impression.  It is really obvious how overextended an alginate impression can get - even with "aggressive" border molding.  I thought I was a fool for using green stick after graduating from dental school, on the 1 denture that I did in 10 years.

I had heard that some folks just use alginate impressions and bam - denture returned in 2 weeks and good to go.  Well, maybe not.

Here is a great demonstration on border molding, thanks to Dr. Allen Dray and Dr. Potter.  There is sound at around 4 mins...

Please enjoy,

Ashley


Saturday, November 12, 2011

Episode 210/500: Titanium

Titianium  I use this material everyday. I was inspired by this Naval Clinical Update

Points
  1. Discovered 200 years ago in Cornwall, UK. First produced in 1791 (Germany)
  2. 4th most abundant structural metal in the earth
  3. Extremely costly to extract from ores, therefore expensive
  4. Biocompatible, corrosion resistance, can be alloyed with other metals easily
  5. Uses: Dental implants, orthodontic wires, endodontic files and to a limited extent crowns, fixed partial dentures and removable partial dentures.





Refs:

Friday, November 11, 2011

Episode 209/500: Cone Beam Guided Dental Implant - Nobel Guide + CEREC Provisional Crown

Well, I have finally "almost" completed the series on a CBCT Guided Implant Placement.  I would like to thank the following people for helping me get to this point in my residency training:

Dr. Kris Hart - OMS - He not only taught me how to complete a ramus graft, but also inspired me to go guided.  Thanks Kris.  He was the surgeon in this case.
Dr. Latte Ice - Periodontics - You never say no.
Dr. West Point - Comprehensive - You also never say no.
Dr. K(orea) - You said go "13mm", and we did!  Thanks for your wonderful instruction.
Becka - The time on the phone, back and forth, was always greatly appreciated.

Thanks to Becka and Bret of Imagdent (San Antonio) and Nobel Guide for making this a reality.  The folks at Imagdent provide a comprehensive treatment planning service and are absolutely dedicated to ensuring that every detail is covered.  They offer a first time free trial - I took advantage of this offer.

I"m all typed out.  Assumed, but now realize, how much more busy the family is with 3 children!

The playlist (10 part series including preclinical workups) is below.

PS:  Here are some of the "things" that I used:
1.  Nobel Replace Select 4.3 x 13mm
2.  Esthetic Abutment Straight
3.  CEREC AC
4.  MZ100 Composite Block
5.  Ribbond

Please enjoy.

Ashley

www.imagdent.com
www.nobelbiocare.com






Thursday, November 10, 2011

Episode 208/500: November 11 - Day of Remembrance

As a Canadian Forces Officer, Remembrance Day is a special time to remember fallen comrades.  Remembrance day was established to remember soldiers fallen during WWI.

"Armistice day"  - 11 November 1918 was started in 1919 - to forever engrave in history, the German signing of the Armistice @ the 11th hour.

Interestingly, when we were posted to Belgium, we learned that WWI started and ended within 5 kms of our house.  Incredible.

This photo shows the grande place of Mons just at the start of WWI - the grande place has not changed at all since this photo was taken.


I was able to do a number of things in Belgium, including bagpiping during Remembrance day at both Vimy Ridge and Beaumont Hamel.  Here is a really neat video that reminds me of a particular march in Belgium.



To our fallen comrades.

Wednesday, November 9, 2011

Episode 207/500: Baby Michael Arrives!

Although our third son's arrival has little to do with dentistry, I'll find a little hint/tip that relates.  Baby Michael arrived at 1159hrs on 5 Nov 11.  Here he is 30 mins old.  Little monkey.  Healthy as a little horse!

Baby Michael arrives
I'm a little short of time at this exact moment, however, here are a few things regarding natal, neonatal teeth:

Natal Teeth:  Natal teeth are relatively uncommon, appearing in about one in every 2,000 to 3,000 births. Although most natal teeth are isolated incidents, their presence may be associated with certain medical syndromes.
Natal teeth generally develop on the lower gum, where the central incisor teeth will appear. They have little root structure and are attached to the end of the gum by soft tissue and are often wobbly.
Natal teeth are usually not well formed, but they are firm enough that, because of their placement, they may cause irritation and injury to the infant's tongue when nursing. Natal teeth may also be uncomfortable for a nursing mother.
Frequently, natal teeth are removed shortly after birth while the newborn infant is still in the hospital, especially if the tooth is loose and the child runs a risk of aspiration, or "breathing in" the tooth.
Ref:  http://www.nlm.nih.gov/medlineplus/ency/article/003268.htm

..and from the AAPD..regarding neonatal/natal teeth

Sunday, November 6, 2011

Episode 207/500: Root Canal Calcification - Mandibular Incisor

Well, I learned another little hint in endodontics a few days ago.  We use both Global and Zeiss microscopes in endodontics, which greatly improves our visualization....but....this case shows you what I didn't know wrt the appearance of calcified pulpal tissue (tertiary dentin).

Case - SS

Chief Complaint - 30 YO male presents with no chief complaint
History of Present Illness - The patient was mugged 13 years ago and hit with a baseball bat in the face.  The mandibular incisors were laterally luxated and reapproximated by the attending dentist.  The patient has been asymptomatic ever since.
Medical -  No medical conditions, no medications, no allergies, non smoker, no ETOH
Clinical Exam -
  • Extraoral - No facial asymmetry, no pus, no hemorrhage, no lymphadenopathy
  • Intraoral - No pus, no hemorrhage
  • Endodontic Exam

Radiological Assessment:  See chart above

Assessment:

  1. #25, 26 - Necrotic Pulps w/ Asymptomatic Apical Periodontitis
  2. Large apical radiolucencies
  3. Possibility for SRCT #25,26

Treatment Plan:  #25, 26 - Orthograde RCT Treatment

Here's what I did:

  1. Standard mandibular endodontic access. I was trying to stay lingual to prevent perforation out the buccal.
  2. Started w/ highspeed and switched to ultrasonics fairly early.  Diamond coated BUC types.
  3. The tooth is slightly angulated distally, and I started tracking....................you guessed it.Mesially
  4. Then, the fun begins......I walk into our mentor's office (start video now)
Cheers

Ashley
Mesial Trackage - Microscopes are standard of practice for
our endodontic clinic thanks to Dr. Crossfit



Post Op: CaOH placement
I only had time for a 6 file (C+) to length

Saturday, November 5, 2011

Episode 206/500: Maxillo Mandibular Fixation - Bridal Wire Placement

Our OMS Mentor, Dr. Eli, brought in a Stryker rep to review maxillomandibular plating.  What is relavent to us as residents, is:
  1. Understanding the radiographic relevance of metal fixation hardware
  2. Simple maxillomandibular  fixation techniques
MMF - Maxillomandibular Fixation - wiring the 2 jaws shut

Open Reduction - Essentially you can visualize the fracture and reduce it
Closed Reduction - You cannot visualize the fracture, however, are capable of reducing it.

As a comprehensive dentist, we treat mandible fractures with simple reduction techniques before the patient is able to be re-evaluated by an Oral Surgeon.  This provides the patient some pain relief and initiate the beginning of osseous healing.  Depending on the situation, the patient may/may other fixation techniques.

There are a number of ways to provide immediate relief for a mandible fracture:
  1. Ivy loops
  2. Erich Arch Bars
  3. Bridal Wires
  4. Embrasure Wires
  5. MMF Screws - aka - TADs (Temporary Anchorage Device)
Here is the beginning of a series on usage of Bridal wires in combination with Embrasure Wires/Erich Arch Bars to reduce a Mandible fracture.

I have a series on using Ivy Loops to reduce a fracture - an actual case that presented summer 2011.


Cheers

Ashley


Wednesday, November 2, 2011

Episode 205/500: Dental Bone Graft Implant - Ramus Graft Continued

The patient below is a continuation of a series on a Ramus Bone Graft.  I had to present this patient to an implant board and I've captured a screencast of that presentation.

http://www.allthingsdentistry.com/2011/10/dental-bone-graft-fixation.html




Patient SS - 


Chief Complaint:  30 year old male presents with a chief complaint  “I would like to have my tooth replaced”  pointing to to number 8.
History of Present Illness: Patient was mugged hit with a baseball bat at 17 years old. The patient lost tooth number eight at that time, tooth number seven had a horizontal root fracture at the osseous crest. 
Medical: No medical conditions, no medications, no allergies, non-smoker
Clinical exam:  Tooth#7 miller class 2 mobility,  insufficient alveolar ridge width anterior maxilla,
RAD exam: Tooth #7  horizontal root fracture, teeth #'s 25,26  have apical radiolucencies

Assessment:
  1. Tooth #7 non restorable
  2. Insufficient alveolar ridge width anterior maxilla - requires osseous augmentation
  3. Teeth #'s 25,26 require endodontic therapy
Treatment:
  1. Extraction tooth #7
  2. Osseous graft to anterior maxilla + socket preservation
  3. Endodontic treatment teeth #'s 25,26
  4. Implant Placement #'s 7,8 - after minimum 4 months ridge augmentation
  5.  Composite "buildup" tooth #9
  6. Abutment/crown placement #7,8
Anticipated time:
  1. Ramus Graft healing - 4 months
  2. Implant healing - 3 months
  3. Crown delivery - 8 months post initial visit














Tuesday, November 1, 2011

Episode 204/500: Asthma - 5 key questions to ask your asthmatic patient

I have written and oral boards coming up soon - so more practice for everyone with respect to the basics in all disciplines.

Name at least 5 key questions to ask a patient with Asthma.  What type of drug is Albuterol and how does it work?


  1. How many times have you been to the Emergency Department for an attack?
  2. What are some precipitating factors?
  3. Frequency of attacks.
  4. Severity of attacks.
  5. What medications are used and how they respond to the medication
Albuterol:  Beta(2) Adrenergic Agonist

  1. Bronchodilator that relaxes muscles in the airways and increases air flow to the lungs. 
  2. Albuterol is used to treat or prevent bronchospasm in people with reversible obstructive airway disease. 
  3. Albuterol is also used to prevent exercise-induced bronchospasm.



References:
1.  Petersons Contemporary Oral and Maxillofacial Surgery - 1998
2.  http://en.wikipedia.org/wiki/Beta2-adrenergic_agonist