Anterior provisionals are an important way to differentiate your practice. Patients, their friends and family and specialists are amazed by exquisite provisionals and it clearly demonstrates your offices commitment to excellence. One of the key ingredients is the shade, matching value, chroma and hue whether we are doing a single tooth or a full arch. All of our provisional materials are monochromatic and can appear lifeless even when polished. With the simple step of custom staining we can add life, vibrancy and depth to the provisional.
Self-Etching Self-Priming resin cements, better known as “cem’s”, are a very popular option for placing indirect restorations. Dentists have jumped on board with this category of cement because of it’s many advantages. One of the major advantages is ease of use. The original packaging is a capsule that is activated and then mixed in an automatic mixer similar to a triturator. Newer versions of these cements come in syringe like dispenser with automixing tips. These cements are known for low post operative sensitivity, and their translucency makes them perfect for seating all ceramic crowns where esthetics are paramount. Clean up can be accomplished easily if we get the cement in the early stages prior to final set.
In yesterday’s post I looked at the light and color properties of composite and natural teeth. The combination of layers of composite with varying light and color properties is a key step in obtaining natural looking esthetics. As with a tooth, we want to have enamel layers on the lingual and facial with the layers of dentin in between. This multi-layer approach has many variations, but is the essential ingredient in a great result. The layering process begins on the lingual. Using a silicone matrix we create the lingual wall of enamel composite. This first layer should be between >5 and 1mm in thickness from the junction with the prep to the incisal edge. I prefer to capture the incisal edge int he matrix and build it in this first layer of enamel composite to capture the length and thickness of the tooth.
The esthetic appearance of natural teeth is produced because of the optical properties of both enamel and dentin. From cervical margin to incisal edge the appearance of a natural tooth changes due to the combination of enamel and dentin. When combined these two layers create the shade variety, translucency and opalescence we see in teeth.
Mimicking this effect with composite depends on understanding the light and color properties of natural teeth and the materials we are using. No one composite has the exact properties of enamel over dentin.
- You Only Treat What You Plan
- You Only Plan What You Diagnose
- You Only Diagnose What You See
I’ve heard the credit for this statement given to many influential people in dentistry. Whoever gets the credit, they truly understood the essence of what we do, and the balance between clinical excellence and success in business.
Alginate impressions are one of the main stays in a general dental practice. Think about all of the clinical procedures that we do whose success depends on an accurate alginate impression, from diagnostic planning on models to the fit of removable prostheses and more. In the face of the important role that alginate plays it is also one of the most overlooked and under trained technique we do. This week in my office we have had the opportunity to take a large number of alginate impressions and the conversation about how to take them and what the expectations are for success.
In a prior post I mentioned that the incidence of pulpal death following an indirect restorative procedure is approximately 13%. This number goes up to near 18% if the same tooth also had a buildup done as part of the process. The research is clear that the largest insult to the pulpal tissue is bacteria. Whether from caries, introduced into the tubules during preparation, or present from a leaking temporary restoration. Well fitting provisional margins are our best defense against leakage.
I had a patient in the office today for non-vital bleaching and found myself explaining to her we call it walking bleach, because you walk around with it in your tooth. It was the classic case of a tooth that had been traumatized years earlier. As a result the pulp died and the tooth turned a dark yellow color. This patient had the good fortune that the tooth was totally unrequested prior to the endo so we made the decision to do a conservative access and walking bleach followed by a composite as the final.
Last week the conversation for many of us turned to dental radiographs thanks to the news media and medical research. Yale School of Public Health completed a study of over 15oo people and correlated their “remembered” exposure to x-rays with development of meningioma. My first reaction to this is to rebuke the study, so I went to get the details. The first thing to consider is that the exposure to dental radiographs and frequency was based on the patient’s memory, even of their childhood years, not on hard data where they scoured through old dental records. The next challenge is that the average age of the patients they included was 58. Our current technology for dental x-rays is far different; more sensitive film speeds or digital along with better equipment have dramatically reduced the exposure. Current dental radiographs expose the patient to 2-3 mrads for four bitewings and 10-20 mrads for a full set. The problem is that all of this information makes those of us who work in the dental profession feel better about radiographs, but what about our patients?
I do not think it would be brash to claim that our morning huddle is the most important fifteen minutes of our day. The time we spend together is a valuable tool for focusing our energy and attention and maximizing our efforts. In our office the huddle takes fifteen minutes and no longer. The rule is that if it takes more than fifteen minutes we are either not prepared or off topic. The purpose of the huddle is to grant any team member who needs it an opportunity to clear their mind for the day. Every one of us has days when something personal is on our minds and can prevent us from being fully present at work. A good deal of the time if we can simply claim what is distracting us, the distraction seems to be less potent. On other days we need the rest of the team to pitch in for us.