My electric handpiece

[ItsGavinC]

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It feels nice in my hand, but boy did I screw over those preps I did today in the lab.

Any pointers or advice?

Who else really botched their first round of preps?

 

[drPheta]

Yeah, my first preps were hideous, too!

It's getting better...slowly but surely.

 

[UBTom]

One of these days I'm going to invest in the company that makes these ivorine teeth. They must be making a KILLING what with freshmen dental students mangling them by the bushel (which I also did, LOL). 😀

Seriously though, here are my tips:

1. Use a real sharp carbide. Somehow even a carbide that is juuuust a little dull becomes hard to control-- Normal finger pressure causes no cutting, but "runs away" when you try to apply more.

2. Start off the prep using an end-cutting bur (like a #1 round bur) rather than a side-cutting bur (such as the #169 or #55/55L/556/56).

3. If possible, try cutting a prep on the benchtop first to get a good idea of a) how it's supposed to look like and 2) how much finger pressure to apply to cut a particular part of a prep.

I've said it before countless times, but cutting real human teeth is a lot different than ivorine, so don't worry if it seems than handpiece is hard to control while you work on ivorine-- Human teeth don't tend to cause the bur to "run away."

HTH!

 

[drPheta]

Thanks Tom,

I've too noticed that my control exponentially gets worse when the carbide dulls.

I've been told that diamond burrs will be much better when we use them...but they suck on ivorine. Is that true?

Either way, we WILL be fine. Just think about those upperclassmen who are doing fine now. I'm sure many of them did just as poorly as we are doing, if not worse.

I just wish I had an unlimited supply of burrs and ivorines. BOO.




Oh yeah, Tom. Any tips on how to start an MO or MOL? I seem to ge too deep on the mesial and end up with a 2mm depth on the O and like 3.5 - 4 mm on the M. I'm practically at the gumline/below it when I'm done making my proximal box. I've done about 4 of these preps, and even though my outline is pretty decent, my depth is worrisome.

 

[UBTom]

LOL yeah I spent a total of $143 on extra ivorine teeth during my freshman year. 😛

I think I actually have better control with diamond burs when cutting ivorine... Diamonds dull off when the abrasive particles are worn off, and does not tend to accumulate ivorine debris like carbides do on the cuttiing surfaces. These two things make the diamonds less prone to "run away" than carbides on ivorine.

On cutting Class-II preps... You want to do what you feel comfortable with. My method (works for me but might not work for you): I start by cutting the proximal box first. To do that, I use a #1 round bur to cut a shallow "guide" slot on the marginal ridge, then move on to a #169 to deepen the slot and extend the slot buccally and lingually to where proximal contact to adjacent teeth just breaks. Clean up the box outline with the #55/55L/556/56 in a slow speed and "plane" the gingival seat (either with the bur or with an enamel hatchet), and refine with hand instruments.

How much to deepen the slot? This is where cutting a test prep on the benchtop first pays off-- You can see just how much of the bur's cutting tip needs to "disappear" to get to the right depth.

Once the proximal box is cut, you have an unobstructed view of the axial wall of the box. That's where I start the occlusal groove portion of the prep using a side-cutting bur and I can see I'm cutting at just short of the right depth when I start. Once the occlusal slot prep outline is cut, I go back with a #55/55L/556/56 in a slow speed to square up the occlusal slot and "plane" the pulpal floor to the right depth. The slow speed handpiece will ensure that the bur won't cut quite as aggressively.

HTH!

 

[gryffindor]

Wow Tom. You definitely know what you're talking about. I am nowhere near as methodical in cutting my preps. They just sorta happen as I mosey along and pray that my patient really is numb and stays numb. I usually start with the occlusal though.

I hope you are signed up to do the operative teaching elective next semester. With the amount of operative you do in clinic, those second years will definitely listen to every word you have to say and think you are an operative god. (That's after they come to me and realize I am an operative dimwit!)

 

[UBTom]

Hey classmate,

Yep, that's one of the selectives I signed up for! 😀 Now if only Dr. Margarone would open up the OMFS selective course for more people.. 😡

All the "cool" selective courses disappeared so fast that I got whiplash.. 😛

 

[ShawnOne]

Hey Tom,

I have a quick question for you. When it comes time to take the NERBs (I assume this is the clinical test), do they expect a certain way operative is "supposed" to be done? or can you do what you like as long as the job gets done?

Also, what type of procedure is typical on these exams?

Thanks
S1

 

[UBTom]

Hi Shawn,

The clinical portion of the NERB requires 3 procedures:

Prophylaxis procedure (cleaning and scaling) - It requires a patient with calculus on certain teeth. You have to make sure the patient's teeth is sparkling clean by the time you are done. 😛

Class-II Amalgam procedure - There are certain parameters to screening a patient for an acceptable "board lesion" so that you can do as close to an ideal Class-II amalgam as possible. You have to follow the universal rules taught in pretty much every school (i.e. G.V. Black's principles of cavity prep) to doing this portion, and the resulting restoration has to satisfy universal criteria, such as closed contact, proper adaptation, etc.

Class-III Resin procedure - Also have to follow the universal rules taught in pretty much every dental school in doing the prep and restoration.

HTH!

 

[no2thdk999]

I'm just jealous you get to use electric.

I think there are two secrets to refining your skill with the handpiece.
1. practice
2. practice

I would bet UBTom agrees that the $143 he spent on practice teeth did more to get his refinement/speed up than anything else.

This is not something you are born good at. I remember my first preps and when I TA'd the 1st years as a 4th year and all of our work looked like it was done with a poorly trained beaver instead of a precision dental instrument. Throw in learning to look and think in mirror vision at the same time and you're lucky to hit the right tooth let alone put .5mm retention locks .2mm past the DEJ.

There are some things I think you can do to make the learning curve shorter and your practice more efficient.
- Get some sort of magnification. Your fine motor skills will be easier to train if 1mm looks like 2.6mm. This is the only legalized cheating that goes on in dental school.
- Good visualization and finger rests. It's always easier when you can see what you're doing and have a steady hand.
- Start with the end in mind. I would always ding around on the tooth a bit with the drill and it wouldn't look right so I'd ding around a little more. Just fixing things as I saw them, no real progression or order. If you know where you're trying to go getting there is just a matter of simple steps.
- Watch a professor do it. It's easier for me to copy someone else.
-I do it differently than Tom in that for the majority of class I & II preps I use one high speed bur for the outline of the prep (usually a 245 bur, it's end and side cutting, with slightly rounded edges, and has just enough taper to produce your undercuts) I'll bury it to the depth I want and do the occlusal part first and then extend it out to the proximal until I can see the DEJ, not breaking the contact yet. Drop the box with the bur straddling the DEJ, then extend it to break contact. This way you've got better vision for the tricky part (which for me is not dinging the tooth next door).

Remember, if you were already good at this you'd be wasting your time and money on dental school. 😀

JMHO
Rob

 

[ItsGavinC]

Rob, Tom, and all,

Thanks for your posts! I got a little more practice in today and have found that even with minimal practice it does become much easier (even though the preps are still very shabby).

My electric handpiece, coupled with my loupes, makes for a good looking performance, but the preps aren't great yet.

Thanks for the tips and tricks.

EDIT: And for those who haven't used electric--it's a hoot. Much different than air, that's for sure.

 

[kdanderson1]

How much are you guys getting charged per tooth? We get charged $2 whereas a precision made carbide bit only costs us a buck. Go figure!!! Also, anyone know where the "teeth" are a little less expensive?

Thx
D