Indirect Vision

[shamrock2006]

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Anyone else have/or had issues w/ this at some point? We just started doin this today. Preppin #'s 12 and 14. Of course, as a DS1, using the mirror to try and drill that "perfect" converging and diverging prep with that smooth pulpal floor when you're doing it basically upside down is completely new. I just got really frustrated b/c I kept destroying the preps. They either came out too wide..I blew out a ridge (or 2)..it just kept getting worse and worse. What a pain. It's like I had no control over any of it. Hopefully all my fellow newbie dental students pick up on this faster than I am!

 

[armorshell]

Some people at my school thought inverting the X and Y axis on their computer mice helped them get used to the movements required.

You could also try drawing shapes in your bathroom mirror at home. Personally, I would just practice more preps. Eventually you may get to the point (like me) where you prefer maxillary preps to mandibular preps. It's much easier to get decent finger rests and decent visualization.

 

[I'mFillingFine]

I agree with armor...once you practice more, you can actually see much better with maxillary preps. It's difficult with certain teeth, but in general since you can move the mirror wherever you want, you can see better than mandibular teeth (you can position it so you can see right through an embrasure, tilt it so you can see what angle you're holding the handpiece in, look directly down on the occlusal, etc. etc.) I try using a mirror in lower teeth, but I'm still getting the hang of it (just not enough room for both hands.)

We're SO new at this...think of it as studying an art, not a science. You get better at one aspect, so they tell you to work on another. You're never THERE and finished and good at everything. Enjoy the evolution, or you'll just get frustrated at every new thing (and there are like 203592368 new things every day.)

Guess I'm talking to myself here, too 😉

 

[tinman831]

It definitely gets better over time. My first attempts at preps for maxillary teeth looked like swiss cheese. I've gotten a little bit better since, but there's still room for improvement.

 

[vize]

I agree with all the posters. I know what helped me was to take home my mirror and to practice writing things while looking through the mirror only. So that the words look upside down directly, but look upright indirectly. Eventually, after practice, I was up in labs pumpin' out maxillary preps equivalent to the instructor.

P.S. Go slow. You're not a dentist on a time-schedule just yet, so go slow and you'll see better results.

 

[dentheartthrob]

is this a standard procedure that you guys follow? Coz when I was in dental school we werent really required to do to indirect vision when doing resto preps in the maxillary since most of the simulators could be adjusted to incline to an acceptable degree. I mean we could do it but the CI's or Lab profs weren't really that anal about it. BUt doing prostho preps, was another matter.

 

[DrJeff]

No short cut here, just log some hours prepping plastic teeth(without the back bend cheating😉) And it will become second nature before you know it!

 

[armorshell]

is this a standard procedure that you guys follow? Coz when I was in dental school we werent really required to do to indirect vision when doing resto preps in the maxillary since most of the simulators could be adjusted to incline to an acceptable degree. I mean we could do it but the CI's or Lab profs weren't really that anal about it. BUt doing prostho preps, was another matter.

Wow, really? The instructors here would throttle you for doing anything outside of ultimate ergonomic position for both patient and operator.

 

[crazy_sherm]

Practice, practice, practice and you'll get the hang of it eventually. No real secrets, but I would advise trying to limit your motions at first to one axis. For example, if you're working on #3 from a 12 o'clock position, keep in mind that any buccal-lingual motion you make in the mirror with the handpiece will be the same as if you were using direct vision. It's the mesial-distal motions that get reversed in the mirror. It's not so hard if you limit yourself to one axis or the other at a time as you get started. Also, try a few dry runs to make sure your moving the handpiece in the proper directions before even stepping on the rheostat. Try avoiding too many diagonal (MB-DL) type motions at first, those are what screw you up. Good luck! 👍

 

[dentheartthrob]

Wow, really? The instructors here would throttle you for doing anything outside of ultimate ergonomic position for both patient and operator.

looks like Ill have to start practicing what one of the guys was saying about writing while looking in a mirror, but the thing is, is that it was done in the simulator room, (not a phantom head thats clamped on a table) and it was suppose to simulate real life clincal scenario. I guess the logic was if both the patient and the operator are comfortable and visualization can be attain thru direct vision then why not. Coz when I did max preps (resto) on patients while I was in clinic all I would do is adjust the height of the chair and incline it to a position thats comfortable. The problem I have with indirect vision before, even with all the anglation with the mirror, is getting good visualization when doing the pulpal floor.

 

[JavadiCavity]

Who needs mirrors? I pretend I'm doing an endo...I close my eyes and just feel the prep. Comes out perfect everytime. LOL!

 

[ivorinedust]

Use a slow speed handpiece with a friction grip head to start with. It gives you more control so you can actually see how the prep is cut and you can adjust your bearing accordingly. Once you learn the dexterity part, you can move on to high speed. When using high speed, remember not to floor the foot pedal and use fresh burs if possible. Sharp hand instruments are useful to refine your prep walls.

Ivorinedust

"Apolonia, relieve my toothache!"

 

[shamrock2006]

Use a slow speed handpiece with a friction grip head to start with. It gives you more control so you can actually see how the prep is cut and you can adjust your bearing accordingly. Once you learn the dexterity part, you can move on to high speed. When using high speed, remember not to floor the foot pedal and use fresh burs if possible. Sharp hand instruments are useful to refine your prep walls.

Ivorinedust

"Apolonia, relieve my toothache!"

See...this is another thing. They told us to a.) use the high speed only (i think)..and when using it..keep it floored the entire time b/c it makes a much smoother cut. Weird.

 

[crazy_sherm]

See...this is another thing. They told us to a.) use the high speed only (i think)..and when using it..keep it floored the entire time b/c it makes a much smoother cut. Weird.

That's lame, it's all about the stall out.

 

[Soflex]

See...this is another thing. They told us to a.) use the high speed only (i think)..and when using it..keep it floored the entire time b/c it makes a much smoother cut. Weird.

Wow, I don't get that advice. When I go "pedal to the medal" it just BURNS THE HECK out of those plastic teeth. You have better control with the high speed if you dial it back a bit.

 

[shamrock2006]

well they're not plastic..they're ivory..but yea they tend to burn as well. although when the bench instructor demonstrated it he did it full blast and perfectly in less than a minute. I dunno. Practice will make semi-perfect I guess

 

[LIer2010]

well they're not plastic..they're ivory..but yea they tend to burn as well. although when the bench instructor demonstrated it he did it full blast and perfectly in less than a minute. I dunno. Practice will make semi-perfect I guess

It's actually plastic - sometimes it's called ivorine, but that's because of its appearance, not composition. Ivory harvesting and selling are illegal in most countries.

 

[armorshell]

well they're not plastic..they're ivory..but yea they tend to burn as well. although when the bench instructor demonstrated it he did it full blast and perfectly in less than a minute. I dunno. Practice will make semi-perfect I guess

Well, remember "ivorine" is a sythetic ivory made from plastic...so you're both sort of right.

 

[armorshell]

That's lame, it's all about the stall out.

👍 There's still no reason to pick up a slow speed though...at least not yet.

 

[Soflex]

I know what helped me was to take home my mirror and to practice writing things while looking through the mirror only. So that the words look upside down directly, but look upright indirectly.

Thanks Vize, I've been trying to do this all morning since reading your post...it is really helpful!

At my school, they just told us: "learn how to do indirect vision or you'll ruin your back" but never gave us any actual instruction (what a shock). They also won't give us any extra teeth to practice on either (but that's a subject for another thread).

 

[JavadiCavity]

👍 There's still no reason to pick up a slow speed though...at least not yet.

I love the slow-speed, although I used to hate it. My scores went up dramatically when I used a slow speed with a carbide bur to refine my preps--made 'em shine. I always felt like the slow speed didn't cut the ivorine teeth well enough to use it for gross reduction. However, clinically, I was doing a class II the other day with the director of operative dentistry. I thought it would be a good idea to cut a really pretty prep and have him evaluate it. I used the slow-speed for the first time to refine the prep, and I finished the prettiest looking class II I've ever done. It cuts enamel and dentin much more efficiently than ivorine. It has it's place and it does a swell job too.

 

[armorshell]

I love the slow-speed, although I used to hate it. My scores went up dramatically when I used a slow speed with a carbide bur to refine my preps--made 'em shine. I always felt like the slow speed didn't cut the ivorine teeth well enough to use it for gross reduction. However, clinically, I was doing a class II the other day with the director of operative dentistry. I thought it would be a good idea to cut a really pretty prep and have him evaluate it. I used the slow-speed for the first time to refine the prep, and I finished the prettiest looking class II I've ever done. It cuts enamel and dentin much more efficiently than ivorine. It has it's place and it does a swell job too.

Do a sharp bur when you're refining with the slow speed? I was thinking about this the other day and it seemed to me like a slow speed on full tilt would be just about as effective as a high speed on stall out.

Like pretty much everything else, I keep getting conflicting advice from 2nd years and faculty

 

[1992Corolla]

The only problem with doing indirect vision for me with high speed is water spraying all over my mirror. In less than .1 seconds I go from indirect to no vision. I need someone to suction for me.

Slow speed is too slow for the amount of time we get to prep and provisionalize a tooth in practicals.

 

[shamrock2006]

Do a sharp bur when you're refining with the slow speed? I was thinking about this the other day and it seemed to me like a slow speed on full tilt would be just about as effective as a high speed on stall out.

Like pretty much everything else, I keep getting conflicting advice from 2nd years and faculty

EXACTLY!

 

[Elipar]

The only problem with doing indirect vision for me with high speed is water spraying all over my mirror. In less than .1 seconds I go from indirect to no vision. I need someone to suction for me.

Slow speed is too slow for the amount of time we get to prep and provisionalize a tooth in practicals.

It's true that an assistant will help tremendously with keeping the mirror dry. BUT, another way to do it is to move the mirror further away from the tooth. Between your eyes and the tooth, you can place the mirror in an infinite number of distances and angles to be able to see what you're doing. If one does not work, then change it. Using magnification will allow you to move the mirror further away from the tooth while not losing detail.

As far as ivorine burning, that's going to be the case any time the thing heats up. So using a high speed for a long time, using a dull bur, or not using water spray will all cause burns.

Slow speed or high speed at slower rates should produce the same thing. The only real difference between the two is top speed.

Using a slow speed to get smoother preps is great, but it's "cheating". Eventually you're going to want to learn how to control the drill so well that you'll have to do minimal, if any, refining. After a few years of practice, you'll find that your preps will look pretty good after the first bur. In my opinion, one or two passes with a VERY WELL controlled hand will produce the prettiest preps, especially on an ivorine tooth.

Mirror skills are invaluable. Sure, you can sometimes see maxillary teeth with the patient on his head, but why? You can make the patient a little more comfortable, all the while you're comfortable as well using a mirror. There are going to be instances where you CANNOT see without a mirror. Impossible. Developing mirror skills elevates your abilities tremendously. The sooner you do it, the better you get, and the more you'll realize that.

The best advice I can give on getting better at mirror skills, other than continual practice, is trying to limit motions to a completely vertical or horizontal motion at first. Meaning if you're cutting a box on the distal of #13, turn the maniquin head such that the box will be parallel to the floor. That way you're going to make a familiar motion, which is a straight horizontal one. When making the isthmus prep, it's perpendicular to the floor, so it's completely vertical. Those two motions are inherently easier than trying to make a diagnal motion 10 degrees above horizontal.

 

[1992Corolla]

It will probably be easier to use a mirror at a further distance when my loupes come this week. I have tried to hold it back farther but can't see anything because the image becomes too small.