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QUICK TIPS
SHARING OUR KNOWLEDGE
DIAGNOSIS, TREATMENT PLANNING AND PRESENTATION
With complex cases, diagnostic casts are the most realistic way to show patients their broken, missing, shifting teeth. They can be fabricated in minutes with Mach-2 quick set model material from Parkell while preparing for the treatment presentation.
Patients don’t understand dental language, but by visualizing the procedure on a treatment presentation software like Guru or Consult Pro, will greatly increase your acceptance rate.
PREVENTIVE DENTISTRY
After the completion of multiple fillings, crowns or bridges, make your patient suck-down fluoride trays and have them apply fluoride gel to prevent sensitivity, decay around the margins, extending the life of your restorations.
ANESTHESIA
Before administering a mandibular block, inject a drop of Septocaine just under the epithelium of the injection site. This will make the mandibular block injection virtually pain free.
PEDIATRIC DENTISTRY
Giving a mandibular block to a young child can be tricky, painful and they often become uncooperative. Buccal and lingual infiltration with Septocaine is usually enough to numb even the deciduous molars.
Not every deciduous tooth needs a SSC crown after pulpotomy. They are from the amalgam era, when there were no composites. If more than half of the tooth is healthy, perform a composite filling.
RESTORATIVE DENTISTRY
Complete etching turned out to be the responsible factor in post-op sensitivity after composite fillings. Self-etching primer and bonding systems are simple to use and greatly reduce sensitivity.
When performing two Class 2 restorations facing each other, never fill both at the same time to avoid open contacts. Fill and cure one and burnish the other sectional matrix against this new filling to create tight contacts.
ENDODONTICS
You should always remove the old crown when doing root canals for better visibility, to remove all the decay and old build-ups. If this is not possible for financial reasons and you feel this would compromise your dentistry, refer the patient.
Placing an endodontic post is always risky. You can perforate or crack the canal wall. Advancements in self-etching bonding systems have eliminated the use of posts almost entirely.
According to statistics, GP’s have only 80% success rate with root canals, which is unacceptable. GP’s should learn a safe, predictable and simplified root canal technique and new advancements in endodontics have made this perfectly possible.
FIXED PROSTHODONTICS
If there aren’t enough opposing teeth to establish a bite, personalized wax rims can be made by measuring the position of the upper incisal edges with the Alma Gauge and communicating this to the technician to fabricate the wax rims, including the proper occlusal plane.
EXTRACTIONS
GP’s should be efficient in basic surgical extraction techniques, because seemingly simple extractions can turn out to be complicated. Also these skills can lead to other profitable procedures like post-extraction bone grafting and simple implant placement.
SOCKET PRESERVATION, BONE GRAFTING AND RIDGE AUGMENTATION
Alveolar ridges resorb after extraction, because the epithelium migrates faster than bone cells to fill the socket. You have to block the migration of the epithelium with membranes and allow the bone cells enough time to fill the bone grafting material.
Use bovine or human grafting material when you want to place implants within 12 months. If the patient needs more time or under pontics, partials and dentures use synthetic material, because these won’t resorb as fast.
MINI DENTAL IMPLANTS
Ideally you need minimum of 4 Mini Dental Implants to retain a lower denture and 6 for upper dentures.
You need at least 4mm bucco-lingual bone thickness for Mini Implants and they have to be spread at least 6mm on center, otherwise the
O-ring caps will not have enough room.
Mini Implants can be used under single crows in tight spaces like upper laterals and lower incisors. Make sure there is good quality bone and the crowns have very light or no occlusal contact.
Mini Implants can be immediately utilized if they are used to anchor tissue supported dentures, because the rubber O-rings act like shock absorbers.
DENTAL IMPLANTS AND IMPLANT RESTORATIONS
Custom abutments are always better, however when cost is an issue and the margins of the generic abutment are not deeper than 3mm,
you can use the generic abutment in the
non-esthetic zone saving you hundreds on your lab bill.
You can utilize implants or mini implants to retain removable partial dentures in cases where there aren’t enough anchor teeth available or metal clasps would be very unsightly.
Not every implant placement requires a flap. If there is plenty of quality bone, using a tissue punch will provide sufficient access, saving significant discomfort and healing time for the patient.
When to load an implant depends on the quality of the bone, the size of the implant, splinting the implants, the restoration, parafuntional activity, the patients general health etc. Healing time can be from 0 month in the lower anterior and up to 8 months in the upper posterior area.
PARTIAL DENTURES
You can make unsightly metal clasps on a partial denture lot less visible by sandblasting their buccal surface. The matte finish looks like a shadow and blends in very well in the mouth.
COMPLETE DENTURES
Border molded functional impressions for dentures are useless unless your lab properly boxes the impression before pouring, so make sure they do.
The percentage of the edentulous population is decreasing, but as the older segment of the society grows, the number of edentulous people will greatly increase in numbers. By 2020 over 40 million Americans will wear some kind of a denture.
The esthetics and function of complete dentures can be much more predictable if personalized bite rims are used, which can be fabricated with a single measurement of the upper incisal edges. This measurement is taken with the Papillameter or the Alma Gauge and communicated to the lab.
REPAIRS and RELINES
I found C&B Metabond from Parkell to be the best system to repair porcelain on PFM restorations.
When adding a tooth or repairing a denture, always take the impression with the partial or denture in the mouth and make sure they are properly positioned in the impression while being poured up.