First Class I Operative Experience

[happy_6523]

I’m a D2 student, and I just did my first Class I restoration on a real patient today.

I was very nervous before working on the patient. I did cleaning and denture in the clinic before, but I had never done any invasive procedures on a real person. I was afraid of taking too much tooth structure off because there’s no way to put it back.

The overall experience was fine. I don’t know why I couldn’t hit the bone every time I did IAN blocks. The patient couldn’t get numb enough after I deposited the anesthetics. My D4 student had to do a few more injections to get him numb. When I put bur in, it dropped quickly when I hit the dentin, so I think I might have gone too deep. To me, I think the hardest thing to work on patients is the positioning. I was working on #31, so I was supposed to be able to use a direct vision. However, I couldn’t see buccal wall clearly. I’m very petite. The patient chair was already the lowest, and my chair was the highest. I didn’t know how to position myself in order to see things clearly. I had to use the mirror to see the buccal wall (indirect vision is hard). My restoration was slightly under-contoured, but the instructor said it was okay. I realized I need to imagine patients as an ‘object’ when working on them in order to for me to perform well…

The patient was very nice. Everyone said I did good, and I know I did okay as my first time. But honestly I’m not quite satisfied with my performance. I didn’t know what I was doing because I couldn’t see things clearly. I know I could better. I feel kinda bad for my patient being my ‘first trial’. I also know one of the students didn’t do much polishing because he went out of time. I feel bad for that patient too. They shouldn’t be charged for the fillings imo

What are your experiences first time working on patients?

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[Big Time Hoosier]

When I put bur in, it dropped quickly when I hit the dentin

Congratulations, you found caries! It’s a lot different than drilling on plastic teeth, isn’t it?

Big Hoss

 

[Lemillion]

I’m a D2 student, and I just did my first Class I restoration on a real patient today. Congrats, that is a milestone! Everyone typically remembers their first restorative appointment...for better or for worse.

I was very nervous before working on the patient. I did cleaning and denture in the clinic before, but I had never done any invasive procedures on a real person. I was afraid of taking too much tooth structure off because there’s no way to put it back. This is a common concern for students as they begin working on patients. Ultimately it will happen again. You slip, the patient moves, you thought something looked suspicious so you opened the area up. IT IS OKAY. Removing too little is also an issue (caries, inadequate prep, demineralization, etc.) As you gain more experience, you will be able to delineate how far to extend things.

The overall experience was fine. I don’t know why I couldn’t hit the bone every time I did IAN blocks. The patient couldn’t get numb enough after I deposited the anesthetics. My D4 student had to do a few more injections to get him numb. *You will get better with time. I do not always hit bone with every IAN block. More important to know your landmarks, aim higher rather than lower. 2nd permanent molars can also be difficult to numb with certain patients. Watch YouTube videos of IAN techniques, ask to watch your faculty member administer local as a learning experience.

When I put bur in, it dropped quickly when I hit the dentin, so I think I might have gone too deep. *Could have been caries that made it drop quickly. If this is an older patient, you were likely far away from the nerve as it has regressed due to time. Place a base and liner is a good idea if you find yourself close to the nerve due to caries. I place MTA and Fuji Liner over deep permanent tooth restorations. To me, I think the hardest thing to work on patients is the positioning. I was working on #31, so I was supposed to be able to use a direct vision. However, I couldn’t see buccal wall clearly. I’m very petite. The patient chair was already the lowest, and my chair was the highest. I didn’t know how to position myself in order to see things clearly. I had to use the mirror to see the buccal wall (indirect vision is hard). My restoration was slightly under-contoured, but the instructor said it was okay. I realized I need to imagine patients as an ‘object’ when working on them in order to for me to perform well. *#31 and 2nd permanent molars are hard in general. Positioning, angle of hand piece/bur. vision, isolation. The list could go on. It will get easier with experience.

The patient was very nice. Everyone said I did good, and I know I did okay as my first time. But honestly I’m not quite satisfied with my performance. * Good trait to have, keep pursuing growth and ways to improve. I didn’t know what I was doing because I couldn’t see things clearly. I know I could better. I feel kinda bad for my patient being my ‘first trial’. I also know one of the students didn’t do much polishing because he went out of time. I feel bad for that patient too. They shouldn’t be charged for the fillings imo. *Patients that sign up at the dental school essentially know that it is a teaching institution. From having students work on them, the longer waits and bureaucracy, patients typically are understanding. If they don't then they should go to private practice. As for the fees, it is fair for them to pay. All the chair time, equipment and faculty all have costs. Big picture wise, there is probably another classmate of yours that had a similar patient experience. If all these situations had a write off, it would ultimately compound to thousands of dollars lost.

What are your experiences first time working on patients? *Did #4-MOD. Patient was my classmate. He handled everything well. Thankfully everything was in my favor that day. He got numb on first try, caries were just into dentin. Easier isolation. Had 3 hours to do the filling ha!

Here are my thoughts. Don't be too hard on yourself. Make notes of how things could have gone better and how you can improve. What done is done. Use this experience to enhance the care for your next patient. Good luck!