Dental Hacks(no pun) from the Trenches

[jwilson02]

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I rediscovered this forum recently after being away for nearly 15 years. I have owned my private practice for 15 years and would like to know if anyone would like a few dental hacks I have found useful over the years. It may or may not translate well to your currently dental school but I thought some might be helpful.

As a for instance, a ball of red wax is pretty quick and dirty way to judge crown prep height. Have them bite on it then remove. Look at it in the light, if no show through you are pretty good. However check your normal way your school wants you to. once you know what a good wax ball looks like you will consistently know how well you have reduced the occlusal. Makes for quicker crowns in private practice.

Looking to help where I can

 

[Mauricio45]

I like these. No more second guessing and your lab man will love you. No more under-reduced occlusion reduction and it makes occlusal reduction a breeze & efficient. They're called "Meisinger Occlusal reduction burs".

 

[jwilson02]

I like these. No more second guessing and your lab man will love you. No more under-reduced occlusion reduction and it makes occlusal reduction a breeze & efficient. They're called "Meisinger Occlusal reduction burs".

These are great, predictable. One thing to note, the more tools you use for one procedure the more you are in and out of the mouth. I know it doesnt seem like a big thing but at this point we can predictable start to finish a crown prep and buildup in 45 mintues with patient out the door. That is not rushing, just pure effeciency of procedure. If you can keep one and one single bur in the mouth for a prep, you gain time for other procedure elsewhere. Not knocking the meisinger as i used it and loved it but just an idea to keep in your head. Thanks for the reply

 

[Alpha Centauri]

These are great, predictable. One thing to note, the more tools you use for one procedure the more you are in and out of the mouth. I know it doesnt seem like a big thing but at this point we can predictable start to finish a crown prep and buildup in 45 mintues with patient out the door. That is not rushing, just pure effeciency of procedure. If you can keep one and one single bur in the mouth for a prep, you gain time for other procedure elsewhere. Not knocking the meisinger as i used it and loved it but just an idea to keep in your head. Thanks for the reply

What is your typical armamentarium for a crown prep?

 

[Molar Whisperer]

These are great, predictable. One thing to note, the more tools you use for one procedure the more you are in and out of the mouth. I know it doesnt seem like a big thing but at this point we can predictable start to finish a crown prep and buildup in 45 mintues with patient out the door. That is not rushing, just pure effeciency of procedure. If you can keep one and one single bur in the mouth for a prep, you gain time for other procedure elsewhere. Not knocking the meisinger as i used it and loved it but just an idea to keep in your head. Thanks for the reply

I agree if you keep your armamentarium and procedural steps as simple as possible, it will enhance your efficiency both in time spent and in supplies used. I use 2 diamonds for crown prep and if needed, 170 for retention grooves. I make the custom acrylic temp crowns before I take the final impr to check for occ clearance and good retention. I'm constantly learning new techniques, new supplies, and new instruments. What are some hacks to manage mutant monster tongues?

 

[TanMan]

Always important to understand how you can go faster and more efficiently. Doctor time is extremely valuable and no time should be wasted. If we look at prep time, we need to know how much we need to reduce and using time to check your prep reduction is extremely inefficient.

First thing is to look at your power source (the handpiece). If you're still using air driven handpiece, crank up the handpiece to 80-100psi. Your biggest enemy in air driven handpieces is stalling. Stalls result in dulling of the bur and reduction in cutting efficiency - ends up with duller bur, more friction, more likely to traumatize the nerve. In electrics, stalling can still be an issue, but not as much. Your biggest enemy with electrics is heat and debris generation. Heat is important in vital teeth, not so much on non-vitals. Debris is very important since these can reduce the efficiency of your bur. You should have a 3 port, high volume water spray to cool down your burs and wash all your debris out from the burs as much as possible. It is ideal to have the water ports spray directly on the bur. Ideally, you should use new burs for each prep, but given the costs of burs going up, this isn't feasible.

Next is the occlusal reduction. It is better to overreduce than underreduce. You also have to reduce based on initial presentation of the tooth AND occlusion. This bur (909) will allow you to do this quickly and efficiently. It's consistent that you don't need to measure occlusal reduction with third party tools. If the height is 1.5mm, you can level the area quickly, following the planes in a few seconds.

Next is axial reduction/bevels. 847/848 extra coarse bur Easier to cut through dentin than enamel. Strip the axial walls by cutting at the DEJ. Refine. With no stalling, this should be completed in a few seconds. Refine prep afterwards.



Always with the supercoarse. Less likely to stall, more efficient. When you're done with your prep, if allowed by your state, have someone take DI/design crown, move to next prep(s). If you're still in the analog impression stages, start the impression and have your assistant hold it/temporize. The less time you're drilling onto a tooth, the less surgical trauma you're inflicting on hard and soft tissue. Prep and cementation should be a few minutes of doctor time.

 

[schmoob]

When I have a gagger, whether it’s for radiographs or impressions, there are ways to mitigate this.

I will rub some topical on the base of the tongue. Give it a good rub, don’t scrub hard but don’t be overly gentle. This helps with the gag reaction. Another trick is to use just a little tiny pinch of regular old table salt on the base of the tongue. Works like a charm.