We're doing class II preps in sim lab this semester, and I am having a hard time visualizing and prepping the proximal box when doing MO preps on the mandibular molars... I have a good hang of it when prepping benchtop because I can visualize the entire occlusal surface from a top view, but when it is inside the manikin head I can't see the mesial box I'm making because the manikin mouth can open only so much and because the box is kind of "hidden" by the adjacent tooth. Is there a specific way to position the manikin head when doing these preps? I'd appreciate detailed suggestions, not just "practice, practice, practice"... thank you!
Having a difficult time in sim lab...
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I dunno how you've been taught, but something that helped me a ton was dropping the box first, then moving to the occlusal prep. Do the whole box, finish it as though it were a simple slot prep, then do the occlusal. When I did it in that order I had much more success because I could see exactly how much tooth structure I had taken away without the occlusal prep taking part of my view away.
Make sure you have good control of your handpiece though (parallel to long axis, etc), because you're going pretty deep on the box relative to the occlusal.
The other answer would be to use indirect vision for the proximal. Takes a lot of getting used to, but can be a useful skill.
Personally I like both options, but for me dropping the box first was a game changer.
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Thank you for the reply. How should I position myself around the manikin head if I'm working on #31? Given that I'm right-handed, should I be at the 9 o'clock position or more towards the 11 o'clock position to get the best occlusal view of the mesial box?
For 31 MO I usually sit at 11 o'clock to do the occlusal first, then when I do the box I switch back and forth between to 9 and 11.
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I know you aren't going to like my answer, but my answer is practice practice practice.
One day it will "click" and you will be amazed. I like to draw parallels to learning a language. You sit and learn and learn...and nothing gets through to your brain. And one day you wake up and it just clicks. That's how dentistry is like.
Regarding 30-31 MO- I use direct vision. 18/19 I find to be the hardest for most operators who are right handed. That takes "feel" and drillling without looking in a sense. But after doing it so many times, you can sorta feel and know where your drill is. That takes time and practice. But for the most part, drill feel look with mirror drill feel look with mirror, until you can do it without really stopping.
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I never got the hang of using indirect vision for the mandibular teeth. I usually end up sitting about 9 o'clock, usually have to be retracting the tongue with a mirror (for 18-19) and then I drill and look, drill and look. After a while you get the hang of what it feels like to clean out what is left and you don't have to look a lot.
Sometimes I cheat and lean over to the assistant's side to get a better look.
Sometimes I cheat and lean over to the assistant's side to get a better look.
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Indirect vision is your friend. Start practicing without water first. Also, know your occlusal plane. Your 330 bur naturally has pear shape that can create the taper you need if you just line up the back of your handpiece parallel to the occlusal surface. Practice without fender wedges if you cannot see with it on. Always evaluate the prep when it's clean and dry. Wet and dirty prep can be deceiving.
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First: Just remember, SimLab does not matter. It's a pointless exercise that doesn't really prepare you for real patients. Therefore, you just need to think about how to pass. Unless you're getting graded on posture, it doesn't matter if the manikin is in trendelenburg, completely upside down, whatever it takes to see. So...
1. position the manikin however you want if there's no restrictions.
2. All the matters is to pass at this point. Although you're practicing for good posture, you can practice that any day. When it comes to exam time, just tilt your head to see. The more important point is that you don't need to see, what you should be practicing is to know where your drill is located without seeing. Tactile sensation is dulled in ivorine teeth, so you should use the most dull bur you have. A high speed, dull bur will make it more forgiving in the preparation. Also, a dull fine fluted bur will give you nice cavosurface margins/line angle. Need a flat gingival floor for occlusal or gingival floor of a class II? Use an end cutting fine diamond bur for smoothing.
It also depends on how you get graded. Is it via practical or does your bench instructor go to your bench to grade your prep. We had some lab exercises that the bench instructors would evaluate in the manikin. All I can say is don't make it easy for them to see. If you have to throw ivorine tooth powder on your mirror, prep, and dim the light source on your bench, go for it. If it's a practical, you should know who's grading, and what that grader wants. Some love sharp line angles, some prefer more aggressive preps, some prefer ultraconservative preps (might as well call them PRR's). That's why schools can be quite unfair due to this subjectivity.
In real practice, I only have one position. 9oclock. I never deviate from that, and I can do everything from that position. Then again, I stand up for everything. Try standing up and see if improves your visibility. I see the patient like a vehicle on a garage lift. Once they are up, I can see everything. Unless the patient is having a medical emergency, you should never have the patient in trendelenburg. Think what would happen if a vehicle is in trendelenburg.
I hope this helps a little bit. Good luck and hope you see patients soon!
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It's doesn't sound like you're in a unique predicament. I'm sure everyone including myself has butchered through a series of practice teeth before it suddenly "clicked" and practice became fruitful.
- Obviously adjust the manikin so that the head sits on your lab maybe a little above your lap
- Tilt and hold the manikin chin's to its chest with your nonworking hand and you can get a little more vision if you have to
- Use the mirror and go slow; use your pinky finger rest
- Finessing the box-shaped movement involves a straight-line translating motion of your forearm; you use wrist/fingers for making curves (going around isthmus)
- Jam the biggest wedge (pink one?) all the way in between the two teeth and you'll get a better view of the interproximal; this obviously won't work for most patients but it's okay for sim
- Be cognizant of where your eyes are focused; when you're first cutting into the tooth, focus should be on the tip of the bur while also paying attention with your peripheral vision to the tooth you're cutting; once you've entered the tooth, your focus should be the superior-most aspect of the fluted/cutting edge of the bur so you have control over depth
- Obviously adjust the manikin so that the head sits on your lab maybe a little above your lap
- Tilt and hold the manikin chin's to its chest with your nonworking hand and you can get a little more vision if you have to
- Use the mirror and go slow; use your pinky finger rest
- Finessing the box-shaped movement involves a straight-line translating motion of your forearm; you use wrist/fingers for making curves (going around isthmus)
- Jam the biggest wedge (pink one?) all the way in between the two teeth and you'll get a better view of the interproximal; this obviously won't work for most patients but it's okay for sim
- Be cognizant of where your eyes are focused; when you're first cutting into the tooth, focus should be on the tip of the bur while also paying attention with your peripheral vision to the tooth you're cutting; once you've entered the tooth, your focus should be the superior-most aspect of the fluted/cutting edge of the bur so you have control over depth
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