how to not hit the adjacent tooth while doing distal preps

[deleted844701]

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I struggle with hitting the adjacent tooth when doing distal preps such as #3 or #14 DO's or slot boxes.

I usually wedge with a blue wedge and use a titanium matrix band or fold my tofflemire band into 4 and stick it to protect the adjacent tooth (a D3 told me to do that). Although this usually works, during my last practical, when I was prepping the proximal box, the pressure from the high speed made the tofflemire fly out and my bur knocked the adjacent tooth 😱

Needless to say, I was horrified and disappointed.

 

[deleted844701]

Do you usually place the wedge first and then the folded tofflemire or vice versa?

 

[ApicalStop]

Just took (and passed!) the operative section of the WREB doing two slot preps on DO lesions. My advice would be to try not to rely on wedges or placing a matrix... as your experience tells you, it still won't prevent you from nicking the adjacent tooth if you don't have good control over the handpiece. Find a good solid fulcrum and don't start cutting until you know you have a stable position. Use a bur you feel comfortable with... I like using a carbide 256 (or even a 330), but you can use a tapered diamond too. A Carbide bur seems to give more control than diamond since it's less efficient at cutting. It's also nicer to the adjacent tooth if you do slip. If you are still in preclinic cutting plastic teeth, enamel gives much more resistance than the plastic typodont teeth. It's much easier to control on real teeth.

Rather than going straight into the embrasure, try to leave yourself a little shell of enamel and start prepping your box without touching that very outer surface that's in contact with the adjacent. Focus on your angulation and make sure you aren't tilting the bur mesial-distal and that you are parallel with the long axis of the tooth. If you get it right, by the time you get down to the gingival aspect of the contact, you should be in the right spot and the enamel will usually just flake off. If not, try using hand instruments like a GMT, hatchet, or chisel to chip it away, or slowly work your bur towards the contact while moving buccal-lingual to remove the remaining enamel. I don't know if your school has it, but I really like using an oscillator to open the contact once I'm close (one side of the tip is diamond coated and the other is not, so you can rest it against the adjacent tooth while bevelling the margin and removing the lip of enamel formed by the round burs.) Practice, practice, practice. If you nick the adjacent tooth, polish it out with a polishing strip or soflex disc, but it's obviously best to avoid this when possible.

Hope this helps.

 

[DocMon16]

I really like what ApicalStop said. I dont rely on wedges or tbands...in my 2nd year of school I really worked on handpiece control and utilizing a really firm fulcrum. I dont use a band because it impairs my ability to see and my direct line of vision. Ultimately it comes down to practice practice practice....and figure out what works for you. Don't keep doing the same thing if you aren't successful with it the first time or two that you perform it that way.

 

[deleted844701]

Thanks guys! This was helpful 🙂

 

[CanaDMD]

I'm surprised your school doesn't teach you to leave an outer shell while prepping. Definitely do that

 

[OhioDMD]

If I absolutely didn't want to leave a mark on the adjacent tooth I'd use a fender wedge for peace of mind.

 

[Ari Rezaei]

I'd practice making the enamel shell like CanaDMD said and getting good at controlling your handpiece, but use a fender wedge during practicals just in case.

 

[Bis-GMA111]

wedge and have a good fulcrum, as others have stated. leaving a thin shell of enamel is fine for typodont teeth, but no one really uses hatchets and hoes to break it ultimately. be proficient with the high speed and low speed..it will take practice.

also keep in mind that typodont teeth are more prone to abrasion just by the nature of the material being ivorine. actual teeth are more resilient, but again, practice with a wedge and good finger rest

 

[toothdriller2k17]

.

 

[ncide]

wedge and have a good fulcrum, as others have stated. leaving a thin shell of enamel is fine for typodont teeth, but no one really uses hatchets and hoes to break it ultimately. be proficient with the high speed and low speed..it will take practice.

also keep in mind that typodont teeth are more prone to abrasion just by the nature of the material being ivorine. actual teeth are more resilient, but again, practice with a wedge and good finger rest

You don't need to use hatchets and hoes to break it ultimately, you are free to use your own bur after dropping the box and establishing a clean axial wall.

 

[deleted844701]

Thank you! I will look for fender wedges. They dont give D1's those at my school. I dont know why

 

[Ari Rezaei]

Thank you! I will look for fender wedges. They dont give D1's those at my school. I dont know why

Because they're $1 each. And they want you to get better without relying on them which is understandable. Try to get one from the clinic supply, I reused the same one all semester.