Can't Drill

[nos23]

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[Hannah Banana]

I have been working at drilling very intensely. We are doing Class I, II, and V amalgam and composites on typodonts, with a narrow deadline, and I have yet to complete a single one. I asked my professor for guidance, and she said to come in extra hours. I already do that. I was in the lab an extra 20 hours this week alone, and I am not getting any better. I try to stay positive, but it is hard to not become heartbroken that, so far into my education, I may not be cut out for this field. There have been other indications - I failed to make an ABO study model with the correct dimensions, I couldn't properly mount a cast on an articulator, my prior drilling exercises were subpar but passable. It's all adding up to me not being able to drill. Sure, more time and guidance would make it doable, but time is not a luxury in dental school, especially when you are in a classroom at least 5 hours a day (mandatory) and required to do research at the same time.

I want to be able to do this, especially 2 years and $200,000 into the game, but I am wondering if this is the time to just say it isn't the field for me and figure out my life. I have really not gotten any better, and I don't know what else to do at this point.

Don't give up just yet!
Do you know what's wrong with your preps? (ex: too rough, too wide, too deep, etc.)

 

[nos23]

Thanks for the encouragement and reply. I've been telling myself not to give up for the entire preclinical year... not sure it was worth my investment, unfortunately.

So far they are all too wide, the wrong M/D dimensions, not cervical enough on the Class V, uneven depth at the pulpal floor, and only after about 2 hours of working on the same tooth do they ever get smooth. I just keep having issues with all of the preps and can't seem to figure it out, and I push the doubt and fear away to survive the week only to become a mess by Friday night. I even thought I should seek help of a counselor so I don't become this way each week after failing so miserably in school, and, lo and behold, our school neither has counselors for us nor allows us excused absences to meet with self-pay counselors (as if anyone could afford that). I can't imagine that anything in life is worth this, and my professors are offering no assistance other than saying 'practice.' The thing is, you could tell me to practice riding a bike for years (I'm 25!) and I still won't be able to bike in a straight line; practice doesn't always make for success, and I am very worried this is the case in dentistry. I just simply don't understand what you supposed to do when you struggle so much with the handskills...

 

[Hannah Banana]

Thanks for the encouragement and reply. I've been telling myself not to give up for the entire preclinical year... not sure it was worth my investment, unfortunately.

So far they are all too wide, the wrong M/D dimensions, not cervical enough on the Class V, uneven depth at the pulpal floor, and only after about 2 hours of working on the same tooth do they ever get smooth. I just keep having issues with all of the preps and can't seem to figure it out, and I push the doubt and fear away to survive the week only to become a mess by Friday night. I even thought I should seek help of a counselor so I don't become this way each week after failing so miserably in school, and, lo and behold, our school neither has counselors for us nor allows us excused absences to meet with self-pay counselors (as if anyone could afford that). I can't imagine that anything in life is worth this, and my professors are offering no assistance other than saying 'practice.' The thing is, you could tell me to practice riding a bike for years (I'm 25!) and I still won't be able to bike in a straight line; practice doesn't always make for success, and I am very worried this is the case in dentistry. I just simply don't understand what you supposed to do when you struggle so much with the handskills...

Sometimes things can get frustrating when I thought everything was good and then the faculty found a tons of flaws. I have very little to no patience so I applied more pressure on the bur than I probably should have and at max speed (got told by some adjunct faculty). Since then, I use slower speed and/or smooth/fine bur when I think I might damage it and always under-shooting the measurement. For example: if ideal depth is 1.5 mm to 2 mm, I will drill normally until 1 mm or so and then I decrease the pressure applied by my hand as I am approaching 1.3 mm and turn down the speed if needed beyond 1.3 mm.
Another thing I notice is that everybody's bur selection and techniques are different. Some faculty told us to use "A" bur and "A" technique but I sometimes found "B" bur and "B" technique work best for me. They did not teach us to use diamond burs for preps (not crown prep) but to use carbide burs and I don't like how rough it turns out. They never tell us we only can use a certain bur on tests so we all have been experiencing different burs and methods.
I believe you can drill good prep too but maybe not at someone-who-is-naturally-talented's speed. I hope you can find your favorite burs and methods soon.

 

[Screwtape]

Well you are right about one thing. You've come to far in your education to give up. Find a D4 or D3 (?) or possibly even faculty who can sit down with you for a couple of hours and show you how they do it and watch you when you do it. Be open to criticism. Sometimes an angle, an instrument, or a bur can make a world of difference. Good luck.

 

[sgv]

(1) Find an upperclassman who's known to have had success in operative and is also a decent teacher. I would assume most dental schools have tutors but specifically finding that one upperclassman could help you find out some specific nuanced technique that may work wonders. For example, in fixed prosthodontics, I learned proper mannequin position, chair position, and the method of using two hands to stabilize the bur have been critical to my success.

(2) For operative, I remember I struggled with depth and often cut too deep with my 330. I found out that the reason why I cut too deep was because my reference point for depth was to bury that 330 bur down to its cutting length. Unfortunately, the cutting length of 330's is 1.6 mm. It's no wonder my depth was too deep. So I learned to change my reference point to leave a sliver of cutting length above the occlusal plane.

(3) Passing the learning curve requires you to be able to make cuts accurate to <0.25 mm. If you want to improve as efficiently as possible, everytime you practice, get a piece of paper and write down where and how you messed up and how you plan to improve it. If a MD width at the box is too wide, write that you'll switch to slowspeed or that you'll use a 245 rather than 56 bur. If you have a success, write down how you achieved it by saying that maybe you used a bigger wedge and used a hatchet to break contact (a trick totally achievable on plastic teeth). Here's how you can find out if you need improvement in accuracy: draw a perfect prep on a tooth with a permanent marker. Then try to see if you can stay within the marking using accurate cuts. If you can cut to the marking, you're good and your problem lies elsewhere. If not, then repeat the exercise until you notice improvement. Again, take notes on your shortcomings and new techniques that you'll try to address them. Sometimes stabilizing the bur with your thumb from the other support hand can help.

(4) Practice harder. Practice from when the lab opens til it closes. Be the first one to enter and last to leave. Don't compare yourself to others. You do what you need to do to be a better dentist.

Based on what people are talking about on other threads, make sure you have prismatic 3.5x loupes or greater. I'm not saying that these loupes will magically improve your handskills because they won't. They will allow you to see greater details in your cuts and help you learn to make 0.10 mm cuts by letting you see what 0.10 mm movements with your fingers looks like.

 

[dp93]

Try to fix one thing at a time. If you've got a lot of things to fix (depth, dimensions, smoothness, etc) then just say "ok, next prep its gonna be really smooth" and then slowly work the rest in. Dont bite off more than you can chew at once. And as others have said, a right bur/instrument makes a huge difference. I know at my school there are some burns in the clinic that we dont have access to in the preclinical and it makes life a lot easier.

 

[schmoob]

Practice practice practice. Then practice more. Get yourself good loupes. Ask advice from everyone and see what works best for you.
Use the cutting length of your bur as a guide.
Finger rests.
Go nice and easy, you want the bur to feel like it's gliding.
Make sure your hatchets are sharp, and don't use too much pressure.

Take information like that and keep adding it on until you find what works.
Good luck!

 

[Greyangel6]

All great advice from posters above! I struggled a lot at first too so I figure I'd share some of the things that helped me!

So first, if I were you, I'd ask a classmate or an upperclassmen or a tutor who is kind enough and decent enough to help you out or give you some guidance (or at least watch you while you practice for a bit and give advice and ways you can try). I found that practicing without guidance is a dangerous thing (this is from personal experience). So I started just chatting up my classmates/upperclassmen/faculty, and just brought up the things that I'm struggling with and ask how to fix it during lunch, etc.

2) Another thing that helped me was keeping a journal. So the things I included in the notes are: dates, name of the procedure, criteria, list of mistakes + any possible solutions to my mistakes
- I wrote my notes after I self-eval my practice. The next time I practice, I take a look at the notes, especially the latest date and tell myself I wouldn't make that mistake today.
- Another reason for me to take notes after is to train myself for when I do my clinical notes after procedure (I'm so thankful I built this habit now as a D3 haha).

3) Have specific goals/gameplane in mind when you practice
- What I mean by that is, you don't have to solve all your problems at once. Just focus on one area to improve on. For me, I was heavy-handed so I made sure that my pulpal depth is not over prepared.
- If you have to, write out all the steps that you will do. Then it's easier to find out where you went wrong. Take notes, and write down possible solutions (look for solutions from friends, classmates, upperclassmen, faculty, etc.)

4) Make sure you have good fulcrum + best chair position + best visualization
- So I was not stable at at with my hands when I first started, I often overextended all my dimensions and made everything rough, with lots of unsupported enamel (on the plastic teeth). What helped me was doing the preparation and the restoration on the bench first. To see how it feels and to visualize better and to know what I should be expecting. Then I'd do it in the mannequin without rubber dam (coz sometimes the rubber dam makes it harder to reach certain places if you're still not that good at rubber damn placement and ligatures. Then I'd do it with rubber dam.

5) Make sure you are able to see most, if not all of what you're doing
- Loupes are important!!
- I had to switch from 2.5x Heine to 3.8x Orascoptic and I don't regret ever making that decision.

6) It's ok to fail! (during practice)
- I basically tell myself that every time I practice because it's better to fail on practice than to fail on the psychomotor or on real patients
- What's important is you acknowledge your mistakes, find out how to fix it, and move on.

7) Make the most out of your practice session
- So for example, if I ruined my pulpal depth, I just made sure other dimensions are ok. Wrote down my mistake, possible fix. Then I'd deepen every other dimensions and practice restoration. Don't let a ruined experience interfere with your progress.

I know I said a lot but I empathize with you. Good luck! You're almost there!

 

[nos23]

So far, nothing has made a difference. I have drilled eight hours a day since this post and have nothing to show for it. Of course, the school has also run out of teeth, so I can't practice the preps until next week. It's just incredibly hard and I am the very bottom of my class. I lack the stamina to drill any more than that in a day after sitting in lectures for 5+ hours, and am just completely overwhelmed. And I end up so tired that I have neglected all my studying since the drilling began three weeks ago. When I ask the professors about the repercussions of not finishing by the deadline, they just say to keep coming in and I will finish ... but that sounds rather unlikely at the rate I am working. If I make a smooth prep, it takes 4 hours and is the wrong dimensions. If the dimensions are passable - never just right - the floor is too deep, too shallow, all jagged... None of my preps are coming out right, even with the help of everyone around me. It's like my hands just lack the coordination for this career. The scariest part to me is that I was bad at wax-ups, I was bad at making ABO models, I was bad at the drilling exercises that preceded this typodont work... the school pushed me through, but it's all adding up to this defeating mess of not being able to do a thing right. I literally hate waking up in the morning and find myself in tears of defeat and exhaustion at the end of the day. I don't know how much longer I can stick with dental school. Professors are saying they won't accept loupes greater than 2.5x, too; I asked. Nothing is working. Nothing is worth this.

 

[sgv]

So far, nothing has made a difference. I have drilled eight hours a day since this post and have nothing to show for it. Of course, the school has also run out of teeth, so I can't practice the preps until next week. It's just incredibly hard and I am the very bottom of my class. I lack the stamina to drill any more than that in a day after sitting in lectures for 5+ hours, and am just completely overwhelmed. And I end up so tired that I have neglected all my studying since the drilling began three weeks ago. When I ask the professors about the repercussions of not finishing by the deadline, they just say to keep coming in and I will finish ... but that sounds rather unlikely at the rate I am working. If I make a smooth prep, it takes 4 hours and is the wrong dimensions. If the dimensions are passable - never just right - the floor is too deep, too shallow, all jagged... None of my preps are coming out right, even with the help of everyone around me. It's like my hands just lack the coordination for this career. The scariest part to me is that I was bad at wax-ups, I was bad at making ABO models, I was bad at the drilling exercises that preceded this typodont work... the school pushed me through, but it's all adding up to this defeating mess of not being able to do a thing right. I literally hate waking up in the morning and find myself in tears of defeat and exhaustion at the end of the day. I don't know how much longer I can stick with dental school. Professors are saying they won't accept loupes greater than 2.5x, too; I asked. Nothing is working. Nothing is worth this.

What tooth and prep are you working on? What burs are you using?

Have you tried cutting the bulk of the prep (80% of ideal dimensions like cutting 1.2 mm out of the 1.5 mm) with a high speed and then finishing the remaining 20% with slow speed? Be more descriptive with yourself when you say the prep is not of the right dimension. Is it the mesial isthmus that's too wide? Or the buccal extension that's overextended? You need to be descriptive of where you performed poorly on a prep. Write it down. When you do the next tooth and approach the area you performed poorly, go slowly and maybe switch to slow speed and just focus on correcting that one mistake.

It's highly unlikely that you're at the extreme end of the bell curve for hand dexterity that would eliminate dentistry as a career. You've made it this far. Dentistry is also a skill. It's not a reflection of any innate feature that you're born with. It is not conducive to think that your ability to cut a tooth is an unchangeable qualitative feature. You have to believe that this is a skill that can be improved.

 

[TanMan]

I have been working at drilling very intensely. We are doing Class I, II, and V amalgam and composites on typodonts, with a narrow deadline, and I have yet to complete a single one. I asked my professor for guidance, and she said to come in extra hours. I already do that. I was in the lab an extra 20 hours this week alone, and I am not getting any better. I try to stay positive, but it is hard to not become heartbroken that, so far into my education, I may not be cut out for this field. There have been other indications - I failed to make an ABO study model with the correct dimensions, I couldn't properly mount a cast on an articulator, my prior drilling exercises were subpar but passable. It's all adding up to me not being able to drill. Sure, more time and guidance would make it doable, but time is not a luxury in dental school, especially when you are in a classroom at least 5 hours a day (mandatory) and required to do research at the same time.

I want to be able to do this, especially 2 years and $200,000 into the game, but I am wondering if this is the time to just say it isn't the field for me and figure out my life. I have really not gotten any better, and I don't know what else to do at this point.

You're too deep in already unless you have a lot of financial resources that give you the luxury of quitting now. All you have to do is pass. Just pass. Real teeth are a lot easier. The most profitable dentists are not the ones that can do the most ideal class II. They are the ones that can get over their hangups and think critically.

Subpar but passable is still passable. IF you have the luxury of having an easier professor grade you, go to them. Use the system and chaos to your advantage and don't listen to trolls. As long as you can pass the boards, WREB/NERB, etc... get your license, all your worries mean nothing at that point.

I think you may be worried about nothing, but I can't tell you to feel, but only to put it into the context of real practice. Preclinic doesn't matter. You're probably never going to mount a cast in private practice nor pour models yourself. You mentioned that the classes were mandatory... go skip them if there's no consequence to not going or if others can sign you in. Research? Why? Are you going to specialize or a requirement? Just chalk these things up to things that don't matter in real life (clinical dentistry). However, my word of warning to you would be: I have seen many colleagues that could never get past these things in their own preclinical, clinical training, and clinical practice. They are stuck as mediocre dentists that could never achieve their true maximum potential because of these mental blocks and being set on what their school taught them and nothing else. If you are unable to get past these issues by seeing that they don't really matter (besides passing), then you may be another one of those mediocre dentists stuck at associateship forever. (/rant)

You don't need to be the best dentist, you just need to be clinically acceptable to pass the boards; And the boards are not hard.

Just pass.

 

[DroppingBoxes]

Brah, you're 3 weeks in? Way too soon to throw in the towel, they are saying you will pass because as long as you are busting it dental school has a magical way of getting you through, and with the necessary skills. You may be the 'ugly duckling' in my opinion, some people (rare) get it right out of the gate, you may have to learn each mistake (by making and remaking it) and then in your mind you will say don't do that again don't do that again don't do that again while prepping and by default end up with perfection. Don't fall into the trap of beginning each procedure with the anxiety and stress of the 3 weeks of mistakes prior, take a deep breath, start, and when you start messing up don't get frustrated and just have a screw it attitude, pause, new breath, water break come continue. You may blossom into such a perfectionist by the end that I will beg you to be my dentist. If you quit I will be disappointed in you.

Boxes

 

[Faux]

I was really bad at waxing. 76 first practical, 70 on second practical, failed the last practical(to be fair, I couldn't have been any more emotionally distant that day, dog died). C for the course

Then direct(composite) came. Nothing higher than 80, always in the 70s. C for the course

Then fixed came, nothing but +90s(except one failure on a 4% practical). Ended course with 89 avg

Then direct(amalgam) came. 88/85/90 on practicals. Most of my Excellent categories were my preps.


For fixed and direct(amalgam), I hardly practice for practicals anymore after the first month or two. People told me that fixed wouldn't help with hand skills with other classes, but it obviously it helped me. Taught me to be steady with my hands, taught me what to look for and what looked ideal. I think about 30 or so people failed the first practical for fixed, and I had a 90. 100 on second.


So, please don't beat your self up too much. I did and it wasn't fun. I kept comparing my self to my peers who were faster and getting better grades. Keep practicing, keep getting feedback. Its one thing to practice a lot, its another to practice and get actual feedback. Don't over do it. I practiced so much for direct composite, it wasn't even funny. I'm a lot more laid back about practice now and I honestly believed it helped me. I pretty much only practice now to see if things go wrong and how to fix them. I also started using only my high speed now and not my slow speed. Thats how much more steady I am now.

 

[beannaithe]

I'm with Faux here. I'm a current dentist, 7 years out. It DOES get better and you will get better. It takes lots and lots of practice, but also time. You're getting there, but it's only been a few weeks? A semester?

My hands sucked when I started. Like I drilled straight down to the screw the first time I tried to prep a class I and failed that prep. Ripped the gums up when I did my first class V. I nearly failed amalgam, did a little better in composite. When we got into fixed, I went from a C- up to a B+ and when I hit clinic, I started getting A's. And now, I'm a pretty decent dentist, but I still take my time. Keep in mind that for some people it will take longer than others. Some people need more practice and sometimes it just takes the time to get the muscle memory down. Just stick with it. I agree with the above advice to finish your preps with the slow speed because it'll help you gauge how smooth the walls are and take your time doing it. Try a 245 bur because I always found that the 330 was too short and would leave gouges in the prep. One of my instructors gave me the best advice that I still remember to this day: "The antithesis of good is better." If it's good enough and acceptable, don't try to it better because you'll probably just screw something up.

And remember: PLASTIC TEETH ARE NOTHING LIKE REAL ONES! Just get through preclinic, it's a whole different ball game in the mouth.

 

[debtist]

Have you tried marking caries with a sharpie? Try that to give yourself more guidance.

I struggled using the high speed at first, so why don't you try using the slow speed! Once you get better and holding your drill, practicing your fulcrum, and controlling the direction of your bur, switch to the high speed. On the high speed for any new technique I learn, I try to go VERY slowly. If you're having problems with going too wide, just go really slowly and think conservatively.

Have you tried using your hatchet and slow speed to smooth and refine your preps? I love using my hatchet and slow speed to refine and smooth out any roughness I have.

Ex. Let's say you're doing a Class II amalgam prep. Usually your pulpal depth is about 1.5-2.0mm, right? The 330 is about 1.3mm, just make holes in the grooves and go down the depth of the bur, you'll be ~1.3 and just hatchet it out. down to 1.5mm. If you have trouble with hitting the adjacent tooth, fold a tofflemeyer band 4x, shove a wizard wedge in and put the band in there to block yourself from nicking the other tooth. Not clinically ideal, but it helps with getting through the beginning phases...

Trust me, real teeth are so much easier to work with than plastic. You got this! You definitely can improve upon this! Please don't give up just yet.

 

[Alpha Centauri]

You won't get amazing overnight. Pick ONE aspect of what you are struggling with and eliminate it. Focus on it until you perfect it then move onto the next issue

 

[lemoncurry]

If you are using carbide burs, try using diamonds instead. I find they are a bit more forgiving. Real teeth are so much easier to drill on than the plastic ones. Make sure you're not running the handpiece at full speed. Do you have loupes and a light? IMO, you should go with at least 3.5x mag so you have a better close-up view of the depth and angle of the bur. I use 5.5x since my 3rd year and I will never go back.

EDIT: sorry for the necrobump.

OP, have things gotten any better 6 months later?

 

[Faux]

If you are using carbide burs, try using diamonds instead. I find they are a bit more forgiving. Real teeth are so much easier to drill on than the plastic ones. Make sure you're not running the handpiece at full speed. Do you have loupes and a light? IMO, you should go with at least 3.5x mag so you have a better close-up view of the depth and angle of the bur. I use 5.5x since my 3rd year and I will never go back.

EDIT: sorry for the necrobump.

OP, have things gotten any better 6 months later?

I recently used a diamond bur for the first time for an MO. Sooooo smooth.


I'm tempted to go from 4.5x to 5.5 too 🙁

 

[ncide]

I recently used a diamond bur for the first time for an MO. Sooooo smooth.


I'm tempted to go from 4.5x to 5.5 too 🙁

If I end up in GP, then I'm for sure getting microscopes. I'm not gonna give up my neck or back for this career.

 

[yappy]

If I end up in GP, then I'm for sure getting microscopes. I'm not gonna give up my neck or back for this career.

As long as your loupes as set up properly there is not be much gain in ergonomics from using a microscope.

 

[shendo]

As long as your loupes as set up properly there is not be much gain in ergonomics from using a microscope.

Loupes definitely give you better ergonomics than no loupes but I would say that with a microscope you will have the added benefit of less neck strain even with the most ideal Loupe setup since you will still have a neck declination angle. This is a picture I took of my aegd resident comparing the ergonomics of the different setups and you can see the microscope allows the neck to have minimal strain.

 

[shendo]

I also believe microscope dentistry will be the future, replacing loupes.

Nowadays there are already some companies developing 3d technology (3d glasses and tv) for clinical dentistry. Microscopes are good but the learning curve can be hard so I believe this 3d technology can be the future of dentistry as it gets developed more.