All it takes to put a damper on a day in my practice is finding an open margin on radiographs for a recall patient, when I know I did the restoration. The cascade of emotions and thoughts I am sure are loud enough for both the patient and hygienist to hear even when I am not speaking. There is not much that is more disheartening. In tomorrow’s post I will talk about the balance between our priorities in practice and how e manage them in these situations. One of the most important things I have discovered over the years is that whenever I am uncomfortable, there is great learning to be had. Despite the instinct to explain it away, I have made a commitment to myself to step into the situation. One of the things I want to do is ask myself what I could have done such that this wouldn’t have happened.
What feels overwhelming in these situations, is the magnitude for both the patient and I of now scheduling time and going through the procedure of cutting off the restoration, re-preparing the tooth and fabricating a new restoration. I have spent quite a bit of time analyzing the way in which I prepare teeth, gain retraction and take impressions to minimize the incidence of open margins. Even with all of that, I am clear from time to time the factors will align such that the restoration that comes back from t e lab does not fit the tooth precisely enough. Given this I asked myself the question of what I could do to catch these situations prior to the cementation. Recently we started routinely taking a radiograph at the seat appointment prior to the final bonding or cementation. After the restoration has been tried in, margins checked and the contacts perfected we take an image. We have the patient biting lightly with a cotton roll between the restoration and the Rinn instrument to hold it in place. It doesn’t make it fun to tell a patient that their new restoration doesn’t fit and we need to take another impression, but it is far better than having that conversation after cementation. It demonstrates to our patients the extent that we are committed to their health and the quality of what we do, instead of as an oops!