Wednesday, February 29, 2012

Episode 303/500: Esthetics Smile Design in Provisionals

It's been a continuum of uploads to my Youtube page consisting of provisional video after another.  I apologize.  I'm in the midst of studying for written board exams and clinical footage is the easiest to prep...and...I have a couple of patients in full maxillary provisional restorations.  Perhaps this information will come in handy some day.....or maybe not.  In any event, smile design/esthetics is widely taught everywhere in CE, etc.  But, when you walk away and look at your notes a few months later - it's like - hmmm...what exactly was that speaker talking about?


Most of what we learn in life is from experience - not books.  (my colleague Dr. In.Saini used to say the opposite, but now he agrees).  I'd like you to experience what my mentors have taught me, especially with regards to esthetics.  I've always dreamed of preparing a case like this - having the opportunity to modify the esthetics to exactly what the patient and I are happy with.  The beauty of a general dentistry residency is that all procedures have been completed by us as residents.


Come along for the journey.


Cheers


Ashley





Monday, February 27, 2012

Epsisode 302/500: Provisional Removal Forceps/Hemostats

It seems like the past 2 months have consisted of alot of "on the bus/off the bus" with respect to provisional restorations.  I'm talking about taking them on or off - often - especially for the few large cases that I've been working on.  Here are a few of the many reasons I've been fooling w/ provisionals:



  1. Recontouring a provisional (for esthetics)
  2. Refabricating one in a different material for strength
  3. Reprepping the tooth (margin inadequacy, insufficient tooth reduction)
  4. Adding to a margin
  5. Adding to develop contours
  6. This list is almost infinite - like my grey hair after 1.5 years in a residency.



I've learned the hard way to try to ease a provisional restoration off a preparation as carefully as possible - especially when you intend on reusing that exact provisional.


So, the right instruments are key to success - that's arguable - I often compare it to golf.  No, I don't golf regularly - I take the boys out to the driving range to hit balls (ages 4,2,&0 - is zero an age?).  However, I'm sure that a pro golfer can still hit fairly well with mediocre clubs - but - the better clubs just tweak the game....and..I'm sure it's the same for dentistry.  The mediocre handpieces that we have in the clinic are ok for inline country dancing (clunky, but fun)- but - get your mitts on a few Kavo handpieces, and dentistry becomes a ballet (fluid and.....I"m at a loss for descriptive words).


So, as I'm studying for board exams and do not legally have time to write this post, here's what I"m talking about:



Sunday, February 26, 2012

Episode 301/500: Anterior Guidance

I will never forget it.  8 years of dentistry and I couldn't understand why the amalgam restorations (onlays), that I restored a patient's shortened arch with, kept fracturing.  (Shortened arch - here is a basic definition). I wish I had photos to show, rather than tell the story, but, the patient had supraerupted 2nd maxillary molars almost touching the molarless mandibular edentulous ridges.  The entire tuberosity came with the teeth - only if I knew then about intrusion, what I know now.  There was no restorative space even for a Kennedy Class I Distal Extension RPD.


From what I remember, the patient couldn't afford crowns, and I elected to place onlay amalgams on his bicuspids (maxillary/mandibular), and I couldn't understand how he kept fracturing the amalgams over several months.


Sure enough, as my British Prosthodontist colleague taught me,  the patient did not have any anterior guidance, especially with regards to lateral excursive patterns.  The canines were worn flat and the shearing forces on those poor old amalgams were huge.


I restored both maxillary canines with some composite, informed the patient that it will feel weird for a few days (and that he'll probably wear the composite away and it will need replacing), and we'll see him in a week. 


Bam.  One problem fixed.  No amalgam fracture.  I became a believer.  Now - if only I could see him today and intrude those maxillary molars and place 2 implants to support a mandibular distal extension RPD.  Matt, where are you?


So, I wasn't surprised when Patient MS showed up w/ fracture Bis-acryl provisionals.  This time, however, I knew how to fix the problem.


Cheers


Ashley



Thursday, February 23, 2012

Episode 300/500: Capture Your Provisional Restorations

I was just about burned today.  Patient MS (bruxer, not boxer), whittled through his bis acryl anterior restorations.  He has a mandibular bruxism splint, but, he awoke at 3am last night to the sound of crunching plastic.  He couldn't return to sleep for a few hours following his ordeal.

My fault - poor anterior guidance development.  This is the discussion for the next post.

Luckily, I made a quick PVS impression of his provisionals from 2 days ago, and was able to use that to fabricate Radica provisionals today.  Yes, I do have a diagnostic waxup, however, the provisionals are fairly different from the original waxup.

I did make an alginate impression of the new Radica Provisionals.  I didn't take a photo b/c the gingival tissue looked terrible following the last 3 days of gingival torture.  I will be seeing him often over the next 3 months, and will take plenty of photos.

I did, fabricate a quick vacuum formed soft 2mm temporary bruxism splint (maxillary), to help prevent future breakage......I hope.

Cheers

Ashley





Wednesday, February 22, 2012

Episode 299/500: Gates Glidden Drills - Endodontics

Gates Gliddens.  They are, perhaps the workhorse of endodontics.  Maybe a little old school and......maybe a fairly safe rotary instrument if properly used (you can argue that one anyway you want).  They are typically used to open orifices and obtain straight line access to the middle third of the canal.


EVER WONDERED THE ABOUT THE DIAMETER OF THE DRILL?

ME NEITHER. 

Aren't they 1,2,3,4,5,6?

No.

I was pimped...and failed miserably, "uhhh...the diameter of a #1 gates glidden drill is a #15 file"

No.

#1 = #50 file
#2 = #70 file
#3 = #90 file 

...and so on, increasing the diameter by 0.2mm


Monday, February 20, 2012

Episode 298/500: Oral Surgery Hints



Well, Dr. Patridge finished his powerpoint slideshow.  I even relearned a few hints that I missed - and - I work under his tutelage!  Tomorrow, I"m hoping to get him to discuss a basic exodontia instrument setup, and then - show us some examples of tooth extraction, table top.


Here are the videos that make up his powerpoint lecture.  You can download it from SlideBoom


Thanks Dr. P.


Cheers


Ashley











Saturday, February 18, 2012

Episode 297/500: Roth's Sealer


@FluorideNinja tweeted a question about the ratio of Powder:Liquid required for Roth's Endodontic Sealer (801).  Just like every other question, I googled it and came up with nothing....hmm..I wasn't looking for a study (or I'd delve deep into PubMed), I was looking for technical details.  The company webpage looks like an old photograph from a printed catalog. (http://www.rothendo.com/) - but - I suppose it serves its purpose.


In any event, nowhere is the directions for use for Roth's 801 sealer.  I was prepping to snap some video regarding the current choices of CAD/CAM materials - and studying for boards (if my wife ever reads this..) when I received a 404 text from @fluorideninja asking another question.  Bam. Down to endo to see if I could find some Roth's.  Sure enough - not only do we have 801, but the new and improved 811.  What's the difference?  Not sure - the labels, recipe, and directions for use are EXACTLY the same - but - there is a 1 in 811 where the 0 was in 801.


The endoblog (http://www.theendoblog.com/2007/10/resorption-of-endodontic-sealer.html) has a clean and neat posting about why he uses Roth's.  Take a look there for a few points - and - if you have time, wander to PubMed to make a literature based decision for yourself.  I'm mute on what we use (AH Plus).


I was taught a few hints from Shea about 10 years ago on how to properly mix Roth's....I remember it now like it was yesterday, "Grasshopper, make sure you smooth out those granules from the powder and get a creamy mix" Those words aren't in textbooks.


Cheers


Ashley




Look at these badboys.  I couldn't resist photographing the crooked eyedropper hat. 
Directions for Use - We found you - Side one of the card


DFU - Side 2







Thursday, February 16, 2012

Episode 296/500: e.max RPD Abutments

The end is near.  I'm about 2 months from completion of the comprehensive treatment for patient MS.  His overall treatment plan is here:

http://www.allthingsdentistry.com/2012/01/full-mouth-rehabilitation.html


....it's been a long road and there's still more to go wrt fixed and removable restorations.


So far, it's been:  Anderson medical model (caries as an infectious disease), #9 endo retreatment, 12 months fixed ortho, #18 implant placement,  #14 intrusion, #14/6 crown lengthening.....all completed by myself w/ the amazing help and guidance by our resident mentors.

The mandibular arch is to be restored with a combination of an implant supported partial denture and survey crowns.  We have a CEREC/E4D machine and we wanted to see how easy/difficult it was to contour and mill e.max crowns to serve as RPD abutments.  It was - let's say - a moderate amount of work.  But, that's what a resident is for - spend lots of time learning how to do/create/fabricate things.  I hammered these out in 1 day.....


Implant and the RPD - Support only with a healing abutment

The choice of a healing abutment as the restorative decision for the implant was partially guided by a recent literature review of this article - and - the angulation of the implant (yes, I placed it, but it was my second implant ever - and - I was guided by......a mentor).  We're going with support only, versus retention and support (as with something like a locator abutment)


The master cast has been poured, and I"m waiting for Dr. Dray to approve the design (after a casual resident beating).  I will review the design/survey process.


I hope this sheds a little light on the things you can do with implants and partial dentures.  Next step for this patient is the bisacryl tryin for the provisional development.


Here are the pictures


Full Series of Pictures
Cheers


Ashley






Adjusting the contours inraorally.  
Contours are pencilled to prevent 20 second amnesia
btn pencil drop and handpiece pickup.

0.01" inch undercut MB for a cast clasp (no I-Bar - to be discussed soon)
Milled crowns before cementation (e.max)
The premolar design is based on my waxup for the maxillary arch
The crown doesn't appear to fully complement the max arch at this moment..with time, young Jedi.
That white FDP is a bisacryl provisional bridge that was fabricated to:
1.  Prevent the intruded #14 (FDI #27) molar from supraerupting.
2. Aid in developing a vertical stop for our CR Record aka bite registration, aka MI registration.....











Tuesday, February 14, 2012

Episode 295/500: Dental Composite Staining

You've just finished placing a composite veneer, large class 4 composite, or some large restoration involving esthetics - and - the patient returns requesting a shade change.  "Doc, these 2 front teeth are too white" (I know, it's  rare to hear this, but hear me out.)

Before you start removing composite and adding another layer of a different shade - think about the possibility of adding stain to the surface.  Yes, I'm talking about decreasing value (lightness of the shade) by an additive technique; yes, it may be abraded away in the near future;  yes, it's a fast technique to see what shade you want to end up with.

Take this example.

CC: 44YO male presents w/ a CC of "I don't like my flipper denture"
HPI: Patient lost his anterior maxillary central incisors 20+ years ago and has had an acrylic partial denture ever since.
MED: No med conditions, no medications, no allergies, none smoker, no ETOH
CE: 5-7mm generalized maxillary probing depths, low caries risk, Periodontal Dx: Generalized Moderate Chronic Periodontitis, Generalized Miller 1-2 mobility.
RAD: Generalized 3-5mm horizontal bone loss
ASSESS:  Partially endentulous patient w/ Gen Mod Chronic Periodontitis - does not want a removeable prosthesis
PLAN: Open flap debridement (some osseous resection) + Ribbond Fixed Partial Denture to replace #8/9 (#11/21)

So - I completed the osseous resection - Bleeding on Probing decreased significantly (it doesn't bleed when he brushes) and Probing depths are 3-4mm.  Mobility has decreased to a generalized Miller Class 1. Great. I placed the Ribbond FDP - and - uhoh - the Value of the teeth is way to high.  The denture teeth look and smell fake.

Instead of replacing the entire FDP (or removing the denture teeth and weakening the prosthesis), I discussed this case (over a casual resident beating) w/ Dr. Dray regarding an appropriate plan of attack.  He agreed that shade changing is a quick, simple method....but on denture teeth?   Composite won't bond - but - the basic chemistry behind the plastics is fairly similar.  Well - here's what I did, and the patient was satisfied.

It always amazes me the change in value/hue/chroma restorations undergo when the patient stands up and looks into a bathroom or sink mirror (don't give them one in the chair to zoom into their teeth).

Cheers

Ashley


Sunday, February 12, 2012

Episode 294/500: Dental Explorer

Another great hint that was passed to me years ago.

On the explorers w/ a small hook on the end (Tufts 23/17), that little hook is 2mm long or tall (whatever direction you want to call it).  It's useful for quick measurements including amalgam reductions (cuspal coverage)...and..porcelain clearance on working (functional) cusps.

Tufts 17/23 explorer - quick for 2mm measurements



Saturday, February 11, 2012

Episode 293/500: Removable Partial Denture Design and Lab Rx

One of my weakest links is removable.  It was poorly taught, I didn't really pay attention (I was 22 years old at the time), and....I failed to grasp even the simplest of procedures.  Luckily, I've been able to become immersed in as much removable as I want - and - learn the ins and outs of partials and complete dentures.

Key points:

Partial dentures - keep the design as simple as possible and don't clasp every tooth in the arch!  This was a huge fault of mine - or - more realistically, I'd just "redo" what the patient had.

Complete dentures - Lingualized non balanced.  Simple.

Here is an overview of an RDP/RPD that I treatment planned recently (and I have video of delivering it as well).  I'm discussing the plan and how I was instructed to draw the design on the prescription - an often problematic step.

Cheers

Ashley



Episode 292/500: Class III Composite Tips

I remember when I was just starting out, a great colleague (Shea), showed me many many tips - he had been practicing dentistry for approximately 10 years and I was a newbie.  He called me Grasshopper - or Grass for short (I think he called everyone Grasshopper...)   Now that I think about it, it was him, who really started me on this path to try to spread the word about little hints/tricks that make practicing dentistry just a little easier.

Being in the Army, we work with many different folks daily - each who has their own experience and way of doing things.  I've tried to learn other people's tips in an effort to keep bettering my own practice.

A viewer requested some tips on class III composites. This is one of the classic tips that Shea taught me - use a slow round bur to gently remove composite from the palatal side of incisors in an effort to NOT whittle enamel. I still use this trick today.  Yeah, it's bumpy for the patient.  But, a little of "Mr. Bumpy" goes a long way when finishing composites - fast - without gouges.

Thanks Shea - You've been an influence in my entire life. I think of you often and wish we were closer.

Grass.



Wednesday, February 8, 2012

Episode 291/500: 3rd Molar Case Discussion

It's oral surgery week, and I've been fortunate enough to learn a significant number of things this past week.  Today, the patient below was referred and booked on my books for extraction of his 3rd molars.

CC:  25 yo male presents with a chief complaint of: "it hurts on my lower left when I eat"
HPI:  Patient points to mandibular left retromolar pad - it's been hurting since March 2011.
Med: No medical conditions, no meds, no allergies - healthy young man
CE: #1 erupted, #16,17,32 impacted. Probing depths >6mm distal of mandibular 2nd molars
RAD: #1 erupted, #16 vertical partial bony impaction, #17 and #32 mesioangular full bony with possible IAN intimacy
Assessment:  Patient symptomatic #17, probing depths >6mm (Mandible)
Plan:  Extract 1,16,17,32 under IV conscious sedation. Ensure written/informed consent and describe possible neurosensory deficiency outcomes.

Please comment on what you see in this panoramic radiograph regarding the 3rd molars.

wisdom tooth, 3rd molar, extraction, surgery, tooth

Learning Points:  Even if you refer teeth to an oral surgeon, it is in your best interest to know what the current guidelines are (established in the literature) indicating retention/extraction of 3rd molars.  Yeah, they change - often - but, it's our job as the front line folks to know the basics - and keep up with the changes.

Here is the link to the AAOMS White paper on 3rd Molars

https://docs.google.com/viewer?url=http://www.aaoms.org/docs/third_molar_white_paper.pdf&pli=1

Here are some images of tooth #17 (FDI: 38). I am posting these so you can get a feeling for what the apical anatomy of #17 actually was in 3d.  There was no furcation to section - "only" section the crown and then remove the roots as one portion.  The IAN was not visualized in either extraction.

wisdom tooth, 3rd molar, extraction, surgery, tooth
Add caption

wisdom tooth, 3rd molar, extraction, surgery, tooth

wisdom tooth, 3rd molar, extraction, surgery, tooth

wisdom tooth, 3rd molar, extraction, surgery, tooth











Tuesday, February 7, 2012

Episode 289/500: Dental Suture Needles

Dr. Partridge has some great, useful, practical knowledge.  I was assisting the oral surgeon this morning and he called for an RB-1 and/or an SH needle.  I was like?  He explained that these are tapered needles (only the tip cuts) and are great for delicate tissues - and/or - inflamed tissues that recently had surgery, but need to be reapproximated.  Wow.  I had no idea.  I thought the world revolved around P3 needles for tissue paper gums.  Apparently not.

Continuing w/ this theme of suture needles, Dr. Partridge has shown me a few tips before regarding the selection of needles, especially for oral surgery.
I asked him to discuss a few basic principles - and - here's what he had to say.  The 3 senior residents were huddled around him, trying to soak as much knowledge as possible.

Thanks Dr. P

Ashley



Sutures, Dental Sutures, suture needles, gut, chromic, vicryl

Sutures, Dental Sutures, suture needles, gut, chromic, vicryl

Sutures, Dental Sutures, suture needles, gut, chromic, vicryl













Monday, February 6, 2012

Episode 288/500: Anterior Iliac Crest Bone Graft - The Harvest

Dr. E, the operating Oral Surgeon, was kind enough to voiceover the video that I captured in the operating room.  The intent of this series of posts is to give you familiarity with treatment planning and the execution (to some degree) of these complex plans with several moving parts.

The anterior iliac crest chosen b/c our treatment plan called for 3 onlay grafts to increase the horizontal ridge width of both the patient's maxilla and mandible in preparation for implant supported crowns.






Here are the preoperative photos:  http://www.allthingsdentistry.com/2011/12/hip-bone-graft.html

An overview of the treatment plan (presented to our local implant board) is here:http://youtu.be/KGaBTmwBbf4. During the implant board, it was decided to augment both maxillary ridges - I was only betting on the left side for augmentation and implant placement for fear of rejection of overall plan.  The board said go for gold.

I shall have placement of one of the 3 onlay grafts posted soon.

Cheers

Ashley










Episode 287/500: No Stent, Need Provisional Crown - No Problem!

We see this situation occasionally:  fractured crowns and/or partially edentulous ridges.  Without having diagnostic casts on hand for a quick provisionalization, here is a technique that I've been using for sometime.  I've using tried ion crowns, polycarbonate crowns, SSCs - and - quite frankly, I spend more time fooling around trying to fit those things, then enjoying myself.  They are - NO FUN.

But, we all know how to manipulate composite - that's something we do well.  I use basic rope wax to create an intraoral waxup, snap a triple tray impression - and voila - you have your provisional stent.  Better yet, if the crown is fractured before a definitive restoration is luted/bonded into place, you have a stent to reuse.  No need to reinvent the wheel a second or third time.

Cheers

Ashley



provisional crown, temporary crown, crown, dental crown,

provisional crown, temporary crown, crown, dental crown,

provisional crown, temporary crown, crown, dental crown,













Sunday, February 5, 2012

Episode 286/500: Removable Partial Dentures and Undercuts

What a great photo.  This describes my sad state of affairs just only 2 years ago.  I'd either just remake what the existing partial denture design was (I only completed 2 frameworks in 10 years in the Army), or, survey and almost do exactly what this tells you not to do:

In essence, all the abutment teeth are conical without any undercuts - however, if you tip the cast on the surveyor just enough, you'll create some under cut on the abutment teeth.

But, when the framework is cast and tried in, it just doesn't want to stay put....probably b/c the undercut you thought you created, was, for all intents and purposes, pretend!





Here is some footage regarding undercut that I captured for a subscriber.  The second video is  discussing some framework designs that I found in a drawer.

Cheers

Ashley






Episode 285/500: Vertical Dimension of Rest (VDR)

....the saga will continue forever.   Just like Ford vs Chevy, Toyota vs Honda, Edmonton Oilers vs Calgary Flames (I know...you're like who? {I'm Canadian, remember} - opinions abound in dentistry, backed with their own lists of literature.  Topics that come to mind that are very opinionated:

  1. Denture Occlusion
  2. Vertical Dimension of Rest
  3. Amalgam vs Composite for large posterior restorations
  4. Lateral vs Vertical Condensation (endodontics)
  5. Autogenous Bone Graft vs Allograft (in reference to morbidity and associated success)

I"ve blogged about VDR before, but a viewer, who brings some credible comments to the table (@thunderofbabylon) raised a great point that "it changes through life due to aging factor muscles activity .. bone resorption .. habitual occlusion that patient may develop etc.."  I'll be honest, before this program - I didn't even know that VDR could stay the same or change.  I just wasn't introduced to it - or -probably...uh.. I was instructed and I fabricated so few dentures, that I forgot.

We follow the constant philosophy..but..who really knows?

However, after a year and a half of getting pimped on everything about dentistry and including the length of my eyebrows (I know..like...?..that's what I was thinking as well), I'm now at a place where I can defer to the literature (and lectures) to show that well, no one really knows.  Below is a list of authors who have either measured a change in VDR or no change!

Right column - VDR = same throughout life
Left Column - VDR varies

So - what do you do?  Pick something easy, that's dependably repeatable for you - and stick with it.  Just like our resident mentor rodeo rider pedodontist says, "easy cheesy".  I'm sure that we can all agree that the art and mystique of denture fabrication is poorly taught initially.... and then easily forgotten due to lack of proper "practice" when out from under the hands that guided us.  Consider for a second that the US is expected to see an increase of edentulous people in the next 10-15 years (millions of them)....That's a heck of a lot of poorly fitting dentures!

Here's the literature from Niswonger that we base our VDR decision.  Yes - if Dr. Dray instructed us that VDR was not constant, well - then I'd be probably writing something different.

I think it's important to understand that most of what we are taught is still opinion...
...based on some literature...
...somewhere...






With that being typed, and, I'm supposed to be studying for board exams (Super Bowl 2012), without further adieu, the Niswonger/Dray Technique for determining VDR - which - according to Niswonger and the other left columners (see above) - is constant throughout life.

Cheers
Ashley






Saturday, February 4, 2012

Episode 284/500: Endodontic Irrigants - Fresh Scent?

If you have a hard time with the full aromaticity of 6% sodium hypochlorite, you can safely use the spring fresh version without any decrease in its antimicrobial activity. (Harrison et a. 1990)

Comparison of the antimicrobial effectiveness of regular and fresh scent Clorox


I can almost smell the freshness nowl.


The reasons we use NaOCl:

  1. Dissolves Tissue (Moorer & Wesselink 1982)
  2. Antimicrobial (Siqueria 1998)
  3. Removes pre-dentin and pulpal tissue (Baumgartner 1987)
  4. When used in combination w/ EDTA, it can remove the organic portion of the smear layer (Yamada 1983)

Don't dilute it!


Old School


  1. Hand showed in 1978 that by decreasing the concentration of 5.25% NaOCl (now 6%), by 1/2 (50%), it decreased the effectiveness for dissolving tissue by 1/3 (33%).
  2. According to Clegg (JOE 2006), 6% NaOCl was the only "irrigant capable of both rendering bacteria nonviable and physically removing the biofilm."

Hence, keep it strong and try Spring Fresh if the Classic Scent isn't your style.

Cheers

Ashley

Thanks to Dr. Paleo (formerly known as Dr. Crossfit) for his continued excellence in endodontic mentorship.

Episode 283/500: Stripped Implant Abutment Screw

I'm under the impression that implants are the sex of dentistry.  Perhaps esthetic dentistry is in there as well, but when you mention, "I've placed x or restored x number of implants", you know you're sexy.  But it's not sexy when you have problems with implants.  It seems like it's pretty black and white.  The implant is restorable or not, it's esthetically placed or not - and when something fails, it usually creates a huge detour in the treatment plan.

Ever thought about the actual nut and bolt mechanics and what to do if some mechanical (not biological)  problems to occur, such as:

  1. Odd implant manufacturer that you don't have the proper instrumentation.  Normal for us when folks have implants placed before joining the Army and we're trying to figure out the correct drivers and abutments
  2. Old abutment screws re-used. (That's another post)
  3. Old abutment screw drivers - just like a hex key that get's used time after time, the metal corners start to round


I've been waiting for this experience to occur in the residency - only for the sole reason to learn how a seasoned prosthodontist would approach removing a stripped abutment screw.  It was on Thursday:

3i implant and I needed to remove the abutment screw for the screw retained crown (#30 FDI #46) that I seated approximately 4 months earlier.  The patient was unhappy with a diastema between #29 and #30 (FDI #46/45) and we have elected to fabricate an FDP from #29-30.  During screw removal, the driver continued to spin.  Not a good sign.  Thankfully, Dr. K was around, so he took the reigns....



Lateral shot showing the slot (philips screwdriver) preparation
that Dr. K made

Top Down of the mess








Friday, February 3, 2012

Episode 282/500: Osteosclerosis aka Condensing Osteitis

Dr. In.Saini gave a great lecture on Cone Beam CTs.  Of course, he is an oral radiologist who had nothing better to do with his time, other than join the Army and enter into a residency program...again....for like the 10th time in his life.  His poor wife.

Let's talk about....Condensing Osteitis

We know what it looks like on a 2d radiograph - but what about on a CBCT?  This may change your mind about what it really is.

Thanks Saini.

Ashley









Thursday, February 2, 2012

Episode 281/500: Esthetic Dentistry

This is an absolutely fantastic technique for developing a patient's functional esthetics - Dr. Somar, a seasoned prosthodontist, gave an 8 hour lecture series on esthetics.  This is one of many little pieces that make up the esthetic component.  Smile design is as elusive as removable prosthodontics.  Lots of planning and little execution.  However, if you're unable to execute, then the plan was a waste of time!

Hence the start of this series on "how to" esthetics.  I'm no expert - please keep that in the back of your mind.

For starters, a wax up really helps.  I know, I know.  However, a few hours of time put into a good diagnostic waxup will save many hours of the most expensive time - chairside time.

Get the lab to develop a waxup for you and use this technique to quickly validate the proposal.

This technique takes all of 5 mins and can really help drive the train on what small pieces are needed to change before tooth preparation and creation of provisionals.  It's much easier to add wax to a waxup, rather than add composite to a provisional and try to "better" the provisional esthetics - I'm talking contour development and not so much shade.

The additional beauty is that if you're happy with this bisacryl provisional setup, you can speed your way through provisionalization, and get to the end.

Thanks Dr. Somar,

Ashley

Here is the patient's regular smile
Lips at repose in natural dentition
For a female, 2-4mm of tooth display is normal.
For some folks, more the better as long as the patient can speak normally.

Bisacryl Provisionals placed (some flash on the left canine - that's ok)
Patient is happy w/ phonetics and esthetics

Lips at repose - we have 2-3 mm of incisor showing. As well, it appears that
I can increase the length of the left maxillary lateral incisor and canine









Wednesday, February 1, 2012

Episode 280/500: Arteriovenous Malformation

I am in the middle of abstracting the folloowing literature article for removable prosthodontics: Implant-Supported Versus Implant-Retained Distal Extension Mandibular Partial Overdentures and Residual Ridge Resorption: A 5-Year Retrospective Radiographic Study in Men.  I usually go to the repository of old abstracts and use the headings from them.  I came upon an article from JADA that I abstracted  over a year ago, and learned a significant amount from it.  AV Malformation (arteriovenous).


In light of our new videos from Dr. Partridge regarding exodontia, I invite you to read this abstract regarding this case involving a 13 yr old female during extraction of tooth #18 (FDI #37).  It is an interesting and insightful article.


Cheers


Ashley