first of all get good 3.5x loupes and a light. i struggled with operative but you know what? i dont think it was even hand skills that much. its just knowing HOW to get through practicals. here are some tips i discovered that really helped me that i wish someone had told me:
1. use the smallest burs you can. especially to touch up things. if you use a bigger bur and just slip a little it could throw off your prep by 1/2 a mm and mess up the whole thing. smaller burs give you more leeway.
2. i cut the initial outline with a highspeed, then i must refine it with a slowspeed bur. you probably wont do this in clinic, but its necessary to refine it with a slowspeed for practicals. also, fyi: putting your slowspeed on "forward" cuts the tooth but putting your slowspeed on the "reverse" setting doesn't cut, it only polishes. this is because burs only cut on one side, so when its in reverse its not cutting its only polishing. so use forward to cut and reverse to polish.
3. use hand instruments to finish and scrape and smooth!! dont be afraid to get in there and really scrape hard to smooth with hand instruments and water. this is the way to make it really smooth and nice looking.
4. if you need to break contact by just a little bit more, don't be afraid to stick a wedge inbetween the tooth you're cutting and the one right next to it. this gives you more space to work so you dont need the tooth and cant get in sideways with the hand instruments. did i mention using hand instruments. use them.
5. also, one thing i have found to be really important when you start doing class IIs and dropping boxes....make dropping the box the very last thing you do. be sure to establish proper depth of your pulpal floor and get everything converged/diverged and the right outline form and all of the BEFORE you drop the box. that way you don't drop the box then have to go back and make your prep deeper b/c its not deep enough then have to drop the box again. just do everything, then drop the box last. use a small round bur to drop the box. just kind of dig it out slowly (dont rake it straight across, just go in little stroke movements with the round bur to make a box) THEN use straight burs and converging/diverging burs to finish the box.
6. when you're condensing amalgam, make sure you've burnished your matrix band against the tooth and you have a wedge stuck in there and the matrix band is placed correctly. BEFORE you start condensing amalgam so you get contact. make sure you condense the amalgam really well otherwise your ridge is going to fracture. also picking at it toooo much will also make your ridge fracture off. when you're taking the matrix band off, don't just pull it straight up b/c this can make the amalgam pull up with it. teeter totter it out or gently pull it out the sides.
7. when carving amalgam, really use the anatomy of the remaining tooth to guide you on carving it. i like using a really small ball burnisher to make my grooves and pits and it turns out nicely. i also like to use an explorer to shave off excess on the marginal ridge to make sure the marginal ridge is the correct height. place it against the tooth and keep it at the same angle when you're carving the marginal ridge so this will give you a good shaped embrasure.
8. when doing composite, try to get the composite as shaped as ideally as possible before you cure it. once you get a shape you like, then cure it. i like to use the football shaped burs to take away any excess (and then can also use the football bur on slowspeed on reverse to polish since the reverse setting only polishes) and once you get it looking reasonably smooth then you can just cure PQ1 on it and it will make it shiney so you dont have to bother with polishing because trying to polish sucks.
9. when doing practicals dont necessarily try to get things exactly at the ideal width. learn to underprep if necessary, if they autofail you for being over like 2.5 mm or something. if you can be within 1.5-2.5 mm without autofailing, then aim for cutting the minimum 1.5 mm first. that way when you go to smooth you can afford to take a little down without overshooting it.
