Tuesday, January 31, 2012

Episode 279/500: Implant Surgical Stent - Old School

This post is for Dr. In.Saini, who approached me today w/ pouting eyes, hoping that I could save him.  Of course, amigo - I'm here to help!  I'll help you fabricate this stent tomorrow aft.

Here is one of many, many methods to create an implant surgical stent.  I've tried all types, and the best stent is an image guided surgical stent (CBCT w/ a CAD/CAM stent).  However, that's not always an option, nor, a necessity.  Here is an easy method of creating a surgical stent (based on diagnostic casts).

There are situations that require the development of a diagnostic waxup (multiple implants, changing VDO, posterior mandible w/ limited landmarks),however, in this single tooth example, this technique works well.  The only restoration will be the implant itself, therefore, I would consider this straightforward.

Cheers

Ashley


Episode 278/500: Sticky Wax

Bar Retained Overdenture
Implant Retained Overdenture

This case has been a great learning experience.  What to do and of course, what not to do.  A bar overdenture can be a great treatment option (obviously), however, they are a lot of work - from treatment planning to execution.  Here's one little tip during the execution phase:

Sticky wax the occlusal rim to the bar.  B/c the bar has to be hand torqued down each time you want to make an adjustment to the rim intraorally, the wax starts to move around b/c it becomes heated to body temperature.  Of course, I'm a beginner, so, this process of in and out is fairly slow.  You can also use a wax that melts at a higher temperature....I"m in the Army, so this is all we have.

Dr. K also mentioned that the occlusal rim can be sticky waxed to the denture base!  Whoa.  Where was I when this was being talked about.  No more wax rims sliding off the denture base.

Thanks Dr. K

Cheers

Ashley


Episode 277/500: Oral Surgery Tips for the General Dentist

The weakest link: Exodontia.

Here is a continuation in a series on exodontia for the general dentist.  Dr. Partridge (ret'd Col) is a comprehensive dentist with a great deal of experience is extremely willing to pass on his tips to others.  In this broadcast, Dr. Partridge discusses different types of impactions and the "dental plan of attack".

The entire powerpoint lecture can be found here:

Oral Surgery Hints for the General Dentist

The next few episodes will have Dr. Partridge showing his techniques that he has discussed.

Thanks Dr. P for your enthusiasm to teach and mentor us little people.

Cheers

Ashley


Monday, January 30, 2012

Episode 276/500: Interocclusal Rest Space -Niswonger Technique


Niswonger, M. E. Rest position of the mandible and centric relation. JADA 21:1572, 1934.

Old school or what?!  I"d like to present to you the Niswonger/Dray Technique of determining interocclusal distance.  (Freeway space = interocclusal distance).

Until I was taught this technique by Dr. Dray, I was lost.  This is what I'd have the patient (dentate/edentate) do, "Ok, just rest your jaw".  Wow.  Was I incredibly nieve to think that people can understand that - and - think that I would be able to get repeatable result.  Niswonger described the technique that I was newly taught by Dr. Dray (it's modified as well).  The key to dentistry, IMHO, is the ability to obtain repeatable results, time after time. Literature based decisions.


Let's take for example the classic Centric Relation Record.  The literature is abound w/ different techniques on how to accomplish this basic record.  It still remains controversial.  However, EVERYONE can agree that the most important aspect to a CR record is that it is repeatable.  Now - think about your technique.  Are the results repeatable time after time?  Or is it a wrestling match w/ patient + denture and registration material?  It was for me... I have been taught the secret!

After 8 hours of a great lecture on functional esthetics, I have been thinking about how to incorporate what I learned, into videos for you to learn.  We were provided a basic "functional" esthetic checklist for use during the diagnostic stages of treatment.  One of the portions included interocclusal distance - ie - whether or not the patient has sufficient vertical dimension, or, either needs an increase or decrease the current dimensions.


  1. Rest Vertical Dimension: ________________mm -­‐ Occlusal Vertical Dimension: ___________mm =
    Interocclusal Rest Space: _________mm


    In this patient's example, she had approximately 3mm of interocclusal rest space.  Plenty! 


More to follow.

Cheers

Ashley





Sunday, January 29, 2012

Episode 275/500: Anterior Maxillary Denture Teeth Setup

Dr Dray,

A true legacy and educator.  Here he is showing you how he sets anterior maxillary denture teeth on a patient we're going to follow through until denture delivery.  The patient presented with loss of VDO following delivery of an immediate denture - 8 years ago!  I've captured some video during the wax tryin for the patient w/ Dr. Dray discussing tips in the background - here - the patient is discussing what his chief complaint was.

 I've included a copy of his anterior tooth setup - it's a classic as well.


Cheers

Ashley






Episode 274/500: Dental Implants and Bone Graft

Alright - the implants have been placed in the patient that I blogged about regarding the ramus graft procedure:

Ramus Graft Posts

I transferred the patient to a junior colleague (Dave McTalkaLot) to complete the comprehensive care - as - I'm running out of time in the residency, and it wouldn't serve the patient any benefit for me to place the implants and then have another resident restore them.  Additionally, the patient requires a few endo's and apicoectomies.  He's better off w/ Dr. McTalkaLot.

You know, I feel that there is a litany of great informational videos regarding implant placement and I really don't think I can add much to the mix.  Dental implant placement - implants are the sexy "in thing" right now - we need more removeable shots from Removeableman!

In any event, implant placement went well.  We do have some concern regarding a possible ingrowth of connective (fibrous) tissue between the ramus and the cortical plate.  A CBCT sagittal section (I will shoot some video soon regarding the CBCT) shows the possibility of some fibrous tissue, however, upon flap refection, there was no path to trace:

This was Dave McTalkaLot's first implants placed in his life - and - he did a great job.  Thanks Dave for taking care of this young man.  DMcT has now advanced his ability to treat patients w/ another modality.

Cheers

Ashley

Bone Graft (Ramus) 7 months post operatively. There is a small groove at the edge of the graft
however, the graft is stable


Osteotomies complete (Nobel Biocare Replace Select)
Guide pin in place for a radiograph


Implants placed to depth.  The lateral incisor (left implant) will have
some particulate bone placed + membrane to cover the coronal 2 threads

PA Radiograph of the implants



Friday, January 27, 2012

Episode 273/500: Dentistry and Photography - Pain Prevention

I just upped my knowledge (and slowly yours), regarding anterior dental esthetics.  We had a great lecturer for the past 2 days - let's call him Dr. Somar - a prosthodontist who has a passion for esthetics.  Incredible lecture.

In the clinic, we reviewed a basic esthetic evaluation form that I will be using on patient AS next monday.  I'm excited, as I have been motivated to provisionally build up her anterior maxillary segment in composite (no bonding agent) to evaluate the esthetics.  This is in addition to my diagnostic waxup and in advance of developing true provisional restorations.  

I've been wanting to post this photo to show you how critical it is to take photos during your procedures.  Yes, it's a pain. 


During our esthetic wax tryin appointment, I evaluated the patient's midline and determined that it was sufficient - albeit, it was off a little.  The literature shows that a minor amount of midline discrepancy (1/2 a tooth off) is not noticeable to a layperson.  However, when I reviewed the photos at a later date, I thought to myself:
  1. This patient has not had a complete "functional" dentition for several years.
  2. He has been waiting for 1 year following extractions for a denture.
  3. The patient's anticipation is increasing with each appointment.
  4. Photos will be taken by his family and at some point, the midline discrepancy may be noted.
Solution: Reset Anterior Segment

One of many mantras I try to live by:

A little pain up front prevented a lot of pain down the road.

Chers

Ashley

Episode 272/500: Removeable Partial Denture

A picture is worth a thousand words.  Here are 143,000 words (143 photos) - Dr. Dray's removable denture photos that will be placed into his videos at some point in time.

Please take a look - he has included a few partial denture designs which are worth their weight in....chromium cobalt.  Ok, bad joke.


Removeable Denture Photos







Thursday, January 26, 2012

Episode 271/500: Overclosed Denture

We've all learned about those patients with a reduced VDO (vertical dimension of occlusion).  Yes, the human has a significant ability to deal w/ changes to our body, including VDO.  However, sometimes, an excessive reduction of VDO (> 3-5 mm freeway space) can cause several changes:

  1. Corners of the mouth turned inferiorly b/c the orbicularis oris and its attachments are pushed too close to their origin
  2. Loss of muscle tone giving the face an appearance of flabbiness vs firmness;
  3. Increased possibility of angular cheilitis
  4. TMJ pain;
  5. Myofascial pain;

(Boucher's Prosthodontic Treatment for Edentulous Patients (11th Edition))


As usual, there is a plethora of photos and text describing what a patient feels.  How about a video?





Episode 270/500: Premolar Endo Access

A subscriber emailed me regarding information about bicuspids and if the CEJ was at the same level as the pulp chamber ceiling as determined by Deutsche and Muskiant in their 2004 article:


Well, they published another article and here is an image from that pdf:

http://www.edsdental.com/articles/pulpout/Morph%20BicusJOE%208_05_.pdf

This time, they examined 107 premolars to determine what relationships wrt anatomy can be garnered.

In general, they concluded that:


  1. In furcated premolars, from the cusp tip to the ceiling of the pulp chamber, the average number was 7.0mm (Measurement D)
  2. Once you hit the pulp chamber ceiling, you have 4.5mm before perforating the furcation (Measurement B).
Therefore, if you mark off a bur @ 7-7.5mm, you should be able to drill into the centre of the pulp chamber without fear of perforation.



Cheers

Ashley



Tuesday, January 24, 2012

Episode 269/500: Bone Graft


There are a number of ways to increase the width of an edentulous ridge in preparation for implant placement - block onlay graft, particulate bone graft + membrane, splitting the ridge, etc etc.

The following is a neat technique to use when augmenting horizontal ridge deficiencies prior to implant placement. Dr. Block published an article (http://www.ncbi.nlm.nih.gov/pubmed/15332183) describing the technique presented in this video. 

It is the horizontal augmentation of an edentulous ridge using a subperiosteal tunnel and osteoconductive, particulate bone graft. There is a significant decrease in the postoperative pain/swelling as compared to other horizontal ridge techniques, and it can be completed under local anesthesia within 30 mins. 

The patient was prescribed antibiotics and analgesics post operatively. This technique will not allow for the vertical augmentation of edentulous ridges. 

Thank you Dr. Block and to my OMS mentor, Dr. Kris Hart.


Episode 268/500: Molar Endodontic Access


This is one post in a series regarding endodontic access using some of the more recent literature articles that have been published.  This clip is based on the lit article by Deutsch and Musikant, titled: Morphological measurements of anatomic landmarks in human maxillary and mandibular molar pulp chambers.

If you google those exact words, you should be able to find a pdf of the article somewhere on the internet (other than the abstract).

Essentially, these gentlemen concluded that from the cusp tip to the pulp chamber ceiling is 6.0,,, distance from the pulpal floor to the furcation is 3mm, and the average height of the pulp chamber is 1.5-2mm. The pulp chamber ceiling is found at the level of the CEJ 97 and 98% of the time.  Remember - this doesn't mean that this will be true for all teeth.  This can be especially helpful with less of tactile perception due to calcifications.

Thanks also to Dr. Hargreaves for the tip provided to us during his lecture.
More to follow.

Here is the abstract:

http://www.ncbi.nlm.nih.gov/pubmed/15167463

Morphological measurements of anatomic landmarks in human maxillary and mandibular molar pulp chambers. J Endod. 2004 Jun;30(6):388-90.


The aim of this in vitro study was to measure critical morphology of molar pulp chambers. One hundred random human maxillary and mandibular molars (200 teeth in total) were used. Each molar was radiographed mesiodistally on a millimeter grid. Using a stereomicroscope, the measurements were read to the nearest 0.5 mm. Results were as follows (mean, mm): pulp chamber floor to furcation, maxillary = 3.05 +/- 0.79, mandibular = 2.96 +/- 0.78; pulp chamber ceiling to furcation, maxillary = 4.91 +/- 1.06, mandibular = 4.55 +/- 0.91; buccal cusp to furcation, maxillary = 11.15 +/- 1.21, mandibular = 10.90 +/- 1.21; buccal cusp to pulp chamber floor, maxillary = 8.08 +/- 0.88, mandibular = 7.95 +/- 0.79; buccal cusp to pulp chamber ceiling, maxillary = 6.24 +/- 0.88, mandibular = 6.36 +/- 0.93; and pulp chamber height, maxillary = 1.88 +/- 0.69, mandibular = 1.57 +/- 0.68. The pulp chamber ceiling was at the level of the cementoenamel junction in maxillary, 98%, and mandibular, 97% of the specimens. The measurements showing the lowest percentage variance were buccal cusp to furcation (approximately 11%) and buccal cusp to pulp chamber ceiling (approximately 14%). The measurements were similar for both maxillary and mandibular molars.





Episode 267/500: Endodontic Post Development


Imagine: Oral Board Exams, small office, surveyor in hand - surveying a cast for a removable denture and the question arises: So, Dr. Mark, tell me about endodontic restorations.......

What?

All I could remember was ferrule. The other 2 important points were positive vertical stop (prevent wedging of the post/core into the tooth and causing a vertical fracture), and anti rotational elements.

Regardless of the actual material you use to restore these situations, the above 3 points remain key to the post/core's success.

Thanks Dr. Dray!

Ashley


Monday, January 23, 2012

Episode 266/500: Oral Surgery Tips for the General Dentist

Dr. Partridge (Col ret'd) is a wealth of knowledge.  He is a comprehensive dentist who has spent over 40 years in the military, including many years instructing residents on exodontia (tooth extraction).

Having spent almost 2 years in a residency program, the fog is a little thinner with respect to exodontia.  Here are my thoughts on exodontia under local anesthesia (ie, not IV sedation):
  1. Adequate local anesthesia is absolutely critical to extract teeth without sedation.
  2. Local anesthesia (IAN block) is extremely poorly taught in dental school.
  3. Exodontia is poorly taught in dental school.  
The above 3 reasons are why I wanted to tap into the wealth of knowledge that Dr. Partridge embodies.  He is one of our staff exodontia mentors (our chief of Oral Surgery is an Oral Surgeon) who has put many hours into developing a technique based lecture on exodontia.

His discussions and demos will consist of a series of videos.

Without further adieu, Dr. Partridge.

Here is the powerpoint presentation for download:

http://www.slideboom.com/presentations/479963/Dr.-Partridge---Oral-Surgery-Hints-for-the-General-Dentist




Saturday, January 21, 2012

Episode 265/500: Complete Denture - Intaglio Surface

Here is a great tip that Dr. Dray passed onto us as residents:  Check the intaglio surface of the denture before the initial try in.  Here is a comment from a viewer who brings up a great point:


thanx for the video but maybe the usage of cotton can leave more bristles trace which is more noticeable than the gauze
second why cant we use micro-engine with stone burs to smooth the rough surface which is safer and more efficient than knife
just asking with my best regards
@ThunderofBabylon You're right. You can really do whatever you want - just feeling with your fingers can be sufficient. You can use a bur as well. This is the beauty of life - as long as it works for you - continue. The real learning point for me was the feeling of the intaglio surface prior to try in. I can't remember being given that instruction before and would go directly to try in before even reviewing the intaglio surface. Great Point.

Friday, January 20, 2012

Episode 264/500: Oral Pathology 1 - Melanoma, Blue Nevus, Amalgam Tattoo

During our forensics workshop, the presenter, Dr. Lisa Franklin (oral pathologist), was kind enough to provide us with some oral path lectures.  No doubt, oral path is the LAST thing I want to listen to.  But, Dr. Franklin has a great, funny way of teaching - making a terrible lecture - interesting.

I'm sure we can all agree on these points:

1.  No one wants to learn from books.
2.  Storytelling from someone w/ a specific syndrome or "thing" will sear that specific syndrome into your memory forever.
3.  A great lecturer can pass on some points to remember.

Thanks Dr. Franklin,

Ashley


Thursday, January 19, 2012

Episode 263/500: Complete Denture Delivery Tips

This is my delivery of my complete dentures based on the Non Balanced Lingualized Denture Occlusion.  Dr. Dray is an old hat at keeping things simple and I wanted to capture him evaluating (briefly), my occlusion during delivery.  I have already completed a laboratory remount (w/ my remount jig.....), Pressure indicating paste try in of both dentures (separately), and now - attempting to obtain

"SIMULTANEOUS BILATERAL POSTERIOR CONTACTS"

This is the mantra by which I live when developing and delivering this occlusal scheme.  Dr. Dray also throws in a little hint for new denture wearers to help them keep that lower denture in place.

Hope this helps - it always does for me!

Cheers

Ashley


Episode 262/500: Dental Forensics

As an Army Dentist, we can be called to a mass disaster to provide medical triage, etc and/or dental forensic consultation.   We all know that every disaster has a number of forensics folks that volunteer to assist in the identification of persons....and....teeth can withstand high heat (up to 1600 F for a period of time) and can be valuable in assisting in identifying remains.

One tip that I learned was that tooth identification is much cheaper and faster than the classic CSI DNA test.  DNA tests take approx 6-9 months process vs getting some radiographs of the remains and comparing them to antemortem records.

However, this was my first seminar/lecture series on dental forensics, and wanted to share with you a couple of cases that Dr. Dray and myself had to figure out.  The residents (and Dr. Dray - the only mentor) were tasked to identify 20 bodies during an airline disaster.  We had to develop antemortem and postmortem records (those take the bulk of the time) and compare those to attempt to identify remains.  True to real life, the scenario thickens w/ extra antemortem charts showing up, people phoning about missing persons, wrong people on the flight manifest (list of people on the airline), and random tidbits of information flowing in from various sources.

It was a great learning exercise.

Here is the intro and practice exercise #1. Additionally, here is a link to an Airforce dental forensics PPT.

Dental Forensics Brief







Wednesday, January 18, 2012

Episode 261/500: Lava Ultimate CAD/CAM Composite Crowns


This image is from 3M's website:  Lava Ultimate.  It is a CAD/CAM Composite block based on their "nanotechnology".  

Since we are in a residency, we try all kinds of techniques and materials.  I tried the Lava Ultimate blocks for the first time last week.  This is a new material which does not have any literature associated with it at the moment.

Here is the secret to obtaining a polished crown exactly as they have on their website:  Diasheen Polishing Diamond Polishing Paste.  No, I don't get paid for advertising these materials!

Cheers



Episode 260/500: IGI Image Guided Implant Placement

Approximately 1 year ago, I started researching different guidance methods for implant placement.  I found the literature full of articles discussing stereolithographic stents fabricated from a Cone Beam Computed Tomography image (CBCT).....and...comparing those stents to some sort of real time, CBCT based, futuristic "watch the implant on the monitor as you place it" ...thing.

Fast forward 1 year, my case report is finished - and it's time to present my senior lecture.  I phoned this company, IGI (www.denx.com), to discuss their product for my lecture. They invited me to a webinar.  Wow.  It was a great learning experience.

Thanks to Dr. Uri Sonenfeld for spending an hour with me, educating me on the placement of implants and how he used the system to complete an apicoectomy!

These photos are courtesy of Dr. Dan Eustaquio from DentalTown:

This is the IGI system. The overhead "satellite" is an infrared sensor
which acts to locate the handpiece in real time

This is the implant placement handpiece (Kavo comes w/ the system) w/ the
LED based guidance system on the handpiece


The surgeon's view of the implant placement in real time






Here are some videos of the system for you to get an idea of what I'm talking about:


1) VIDEO DR. ROBERT EMERY (Washington D.C., IGI Case, Oral Surgeon)

2) VIDEO DR. MICHAEL MORGAN (OH., Live Surgery at Javits Center:
Periodontist)


3) VIDEO DR. DAN EUSTAQUIO (CA., Live Surgery: General Practitioner)



And my webinar session:


Monday, January 16, 2012

Episode 259/500: Cantilever Bridge

Dr. Dray...again.

I presented this patient to Dr. Dray and here's what he said," Why whittle away 3 teeth for 2 when you could get 2 for 2?"

Need I say more?


Episode 258/500: Curved Dental Anesthetic Needle

Thanks to Dr. Partridge,

Here is an idea that I had never thought of - ever.  Curving the Dental Anesthetic Needle.  The dental literature is filled w/ dental needle articles regarding broken needles secondary to child movement (30 gauge needles) and/or bent needles.  Additionally, there is some literature indicating that needle deflection/placement/bevel does not influence anesthesia.

I started writing a long piece on the ability to properly evaluate what a study has concluded and how to use its conclusions to justify what your techniques are....I stopped.  It's for another post.  Thank Dr. Saini for enabling me to second guess a number of issues which is great - then - I argue back w/ some other literature.

In any event, my message is that it is important to review the most current literature on any given subject b/c - in the event someone studies the curved needle technique and finds out that it deflects just as much as a non curved needle - you need to decide whether it is still a useful technique in YOUR practice - not anyone else's.  Dr. Partridge finds it useful for the ability to decrease deflection (and possibly place anesthetic more accurately)...and...access.

Saini....

Without further adieu,

Dr. Partridge.


Sunday, January 15, 2012

Episode 257/500: Check Occlusion on New Crowns

I received a gold and porcelain crown from the lab,
I used articulating paper to mark the occlusion, but couldn't see a thing,
I coated it with vaseline,
And now I can see everything,
Good bye to grinding the occlusal surface for nothing

....admitted, it was a poor attempt at a poem, but I figure that you got the point.  

Use KY Jelly, try in paste, or vaseline to coat (lightly) the occlusal surface of a new crown to aid you in marking a freshly fabricated crown.

Cheers

Ashley



Friday, January 13, 2012

Episode 256/500: Mineral Trioxide Aggregate

There are a few situations where it may actually be beneficial to obturate the canal w/ MTA.  I remember clearly approximately 1 year ago when Dr. Crossfit, now Dr. Paleo, suggested I obturate a canal w/ a custom fit GP point.  I was like, "?".  Yes - the apical constricture = a 90 file and it just didn't feel "round". (Nothing is perfectly round, come on Ash)......

However, there is another method of obturating canals that are either fairly large (ie >70-80 file size), blunderbuss, or - planned for apical surgery.  I've completed several apical surgeries (apicoecomies), and, I'd rather obturate the canal w/ MTA prior to the surgery - having only to resect the apical portion and that's that.  Apical preparation followed by retrograde fill w/ MTA can be frustrating at times.

Here's some food for thought.

Cheers

Ashley



Thursday, January 12, 2012

Episode 255/500: Bulk Provisional Margins - Stent Fabrication

Hints are passed on to us from mentors during a number of situations, including:

  1. Watching us as we make procedural errors and/or
  2. Wondering what we're doing by spending so much time fiddling around with something, 
...thennnnnnnnn... they cave in and help us.
    Dr. Dray is understandably obsessive compulsive (prosthodontist) when it comes to systematic treatment planning and  execution of the plan in a logical fashion.

    Everyday I learn something new from him.  He was watching me fabricate a 4 unit FDP provisional and suggested the following hint in an effort to "help" me in during toils.  It did help!

    Thanks again - "Removeableman"

    Ashley




    Wednesday, January 11, 2012

    Episode 253/500: MTA - Mineral Trioxide Aggregate - Mixing Hints

    This material has now been around for a number of years - and - I'm not going to review what it is, how it works, etc.

    However, often what is missing - is how to handle it.  Over the past 10 years and now more recently, I've watched several folks handle MTA.

    Here's my take.

    Cheers

    Ashley




    Epsiode 251/500: Case Review

    Here is an overview of a case that I'm trying to complete before the end of the residency.  The really neat part of this case is the Forced Eruption of #6 that we performed successfully.  In the original plan, I had intended on crown lengthening.

    http://www.allthingsdentistry.com/2011/09/tooth-extrusion-forced-eruption.html


    Diagnostic/Preparatory:  (NS/SRP)
    1. Andersen Medical Model - caries removal:  #2,14, 27
    2. Crown lengthening Maxillary Right Quad (#2-6)  Maxillary Left Quad (#12-14)
    3. #19 Endodontic Retreatment
    4. #12 Implant removal/CT Graft
    5. FDP Provisional #11-13
    Corrective:
    1. Post/Core:  #4,5,6
    2. E.max crowns: 3,14,19, 18?
    3. Empress Crowns: 4,5,6,
    4. FDP:  #11-13, 29-31
    5. Veneers:  7,8,9,10
    Maintenance:  
    Periodontic:  NS/SRP Q 4 months
    Endodontic:  Annually
    Prosthodontic:  BID first year, then annually
      

    Tuesday, January 10, 2012

    Episode 251/500: The Best Time to Photograph New Restorations

    I must thank Dr. K for this hint.  The best time to photograph new restorations is prior to final cementation. After luting a restoration, you have to remove excess cement within a specific period of time - and - some of it ends up subgingival - leading to hemorrhage during cement removal.  Normally, I have cement all over the place, and, I can't get every little bit....

    Additionally, you and the patient won't feel as rushed b/c in your minds once that restoration is cemented......"let's get out of here!"

    Otherwise, you can of course, have the patient return and take photos at a later date (especially if crunched for time and/or multiple appointments are scheduled).  As a resident - I never know if my patient's will return - therefore - I have to capture the images before they hit the door.

    Cheers

    Ashley


    Sunday, January 8, 2012

    Episode 250/500: Half Way and Top Ten Hints "Up To Here"

    Well, I'm half way to 500.  The blogger tracker software indicates that I actually have 270 posts, but somehow, I've forgotten how to count.

     I've had a great response - so thank you to all.  Some folks who have given me a boost:
    Twitter:
    @endoexcel - You really are the man.
    @nileshrparmar - Some great conversation
    @murphy1050 - Fellow Dental Army Officer still in dental school
    @sameerdossa - Fellow Canuck in Dental school in the UK (I'm still confused...)
    @Nushkies - Another fellow resident

    Dhru (Dentinal Tubules) - thank you so much for your support
    Dr. Allen Dray - Removeableman - need I say more?
    Dr. Crossfit
    Dr. E
    Dr. Latte Ice
    Dr. WPG
    Dr. K{(orea)}
    Dr. DR
    My wife Katherine our and 3 boys (Liam, Kaleb, and Baby Michael)


    Here is a review of the top 10 posts in the past few months (not in any specific order):


    1. Posterior Palatal Seal
    2. Periosteal Release - Secret Revealed
    3. Pulpotomy instead of a Pulpectomy
    4. Crown Sectioning w/ 330 bur
    5. Painless Extractions - Especially Mandibular 3rd Molars
    6. Interocclusal Space Check - Section Blue Mousse
    7. Simple Ortho to Move a Single Tooth
    8. Denture Border Molding
    9. Cone Beam Guided Implant Placement + CEREC Provisional
    10. The Flap That Necrosed On Me :(

    Upcoming material - Tunnel Ridge Augmentation, Tunnel Connective Tissue Grafts, Voice over of Iliac Crest Graft, Possible Orthognathic Case (Surgery in OR), Intentional Reimplantation Video (finally)


    Cheers

    Ashley

    Episode 249/500: Vita Shade Guide

    Here is how the Vita Classic (VMK 68) Shade Guide is arranged as discussed by Dr. Dray (Removeableman).  The main idea is sorting the shades according to Value (remember his cronies Hue and Chroma).  Honestly, I probably didn't ever travel past A3 as I was always concerned w/ receiving crowns/FDPs that were too dark - I think I'm still concerned! (Perhaps this is a reason for CAD/CAM today - amongst other ideas)

    This is the order according to Value (Highest to Lowest)


    B1,A1,B2,D2,A2,C1,C2,D4,A3,D3,B3,A3.5,B4,C3,A4,C4

    Of course, if you're using any other shade guide, you probably haven't read to this point......If you do use this shade guide, watch here:



    Cheers

    Ashley

    Saturday, January 7, 2012

    Episode 248/500: Shade Selection

    Dr. Allen Dray is an old school prosthodontist who continues to roll with the times.  He can cut "caps" and hammer out removable prostheses like any other champ.  The difference with "Removeableman", is that he can teach - and teach well.  He is an amazing performer in front of a dental audience willing to listen and learn.  This video is the unveiling of Dr. Dray - or - whom I like to call Removeableman.

    Without further adieu, "Removeableman"

    Cheers

    Ashley




    Friday, January 6, 2012

    Episode 247/500: Lingualized Denture Occlusion

    According to Lang (Dent Clinic 1996) in his review of denture occlusion, "no one denture occlusion is superior"  Thank goodness.  I think I was terrified of dentures previously b/c of lack of experience in namely setting teeth.  In dental school, I was taught Anatomic Balanced Occlusion.  As if.  How am I going to try to replicate that occlusal scheme in the real world after completing 3 dentures in school (including my 2nd year table top set)?  No chance.

    Dr. Dray.  (Former prosthodontic instructor in some Texas university...)  For all the belittling, you are our hero.  Ok, maybe not hero, but if there was a "Removeableman" - it'd be you.  (My middle son {2yrs} was biking up and down the drive way and started calling himself "Juggleman"?  It was really cute.  I have no idea where Juggleman came from.)

    Thanks to Removeableman, I have learned a better way.  Damned if you disagree. But, for a general dentist, the lingualized occlusion is a straightforward occlusal concept that can be successfully and easily repeated on most patients.  I'm not treating fully edentulous patients everyday and my removeable skills will never reach those of a prosthodontist - just ask "Removeableman".

    Complete denture occlusion (Lang 1996)
    Lingualized occlusion revisited (JPD 2010)


    Thursday, January 5, 2012

    Episode 246/500: Posterior Palatal Seal

    I was trained to fabricate a posterior palatal seal w/ a simple line scribed into the posterior portion of my maxillary cast.  I'm born again w/ this design.

    A posterior palatal seal compensates for shrinkage of the denture base upon processing - all plastics shrink when cured.  I'd like to put in a joke here about shrinkage, but I just can't think of one wrt plastic- perhaps someone can comment and I'll put it in here!

    The beauty (?) of this design is that in the event you need to shorten the length of the denture in the posterior region - you will have a more difficult time removing the palatal seal - as compared to a single line.

    Thanks Dr. Dray.

    Cheers

    Ashley


    Episode 244/500: Full Mouth Rehabilitation

    One of many valuable learning pieces that I have gained from this residency is how to develop a detailed, comprehensive treatment plan.  I use "learning" in the loosest sense - presentation after presentation of treatment plans to mentors -  scrutinized by all mentors - formally and informally - tends to train someone to look big, then small.  It also forces you to think about and support your clinical decisions - be with literature or long standing clinical evidence/success.

    Before this residency, I really had no idea of what a treatment plan consisted of.  I thought I did, however, I wasn't trained to comprehensively evaluate the entire patient. 

     I remember fondly a fellow Canadian posted to Belgium with us who had all mandibular molars extracted when he was in his early 20's.  Supraeruption of the maxillary molars (the ones remaining) eliminated the restorative space between the arches.  Now, I (and you.....it's on Youtube), can easily intrude those molars (1mm per month) and obtain restorative space.

    Ok, back to studying.  Here is the problem list, treatment plan and justification for SM's treatment.  Please go easy - it was my very first formal treatment planning presentation and there are mistakes.

    Cheers

    Ashley