Operative!

[aphistis]

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(incidentally, I suspect that SDN will become a running IUSD curriculum summary as we progress through our coursework 😀)

We started Single Tooth Direct today--430,000 RPMs of enamel-shredding, air-powered (IUSD is still in the Dark Ages, Gavin 😉) glee. Our first assignment is cutting a few geometric shapes into our ivorine blocks--straight lines, a T, a cross (think #19 occlusal), and a square and triangle. Initial observations:

1) I remember Tom saying that ivorine is more resistant to cutting than natural enamel...if that's the case, these burs (I used a 329 today) must tear through teeth like butter. The ivorine cuts fairly readily.

2) Scorched ivorine dust stinks.

3) The initial learning curve isn't as steep as it was for waxing. It took me four weeks to really get good at waxing, but cutting seems to be coming more easily.

4) I really wish our cafeteria sold caffeine-free Coke at lunch. Sprite is gross.

5) 1.8mm is a whole lot more space to work with than I expected it to be. Some people were burying their burs, but I didn't have much trouble cutting to the right depth.

6) Straight lines, however, are a vastly different story. It took me no fewer than 10 tries to cut three parallel lines to spec. Any advice, old-timers? 😀

I know *I* could really use any advice the upperclassmen and practicing docs have to offer, and I figured this might be a good place to collect pearls of wisdom for subsequent classes. Any takers?

 

[ItsGavinC]

Originally posted by aphistis

We started Single Tooth Direct today--430,000 RPMs of enamel-shredding, air-powered (IUSD is still in the Dark Ages, Gavin 😉) glee.

Bill, congrats on an awesome day!

And don't worry about the dark ages. Arizona is the ONLY school to be using electric handpieces, although UNLV will be using them next year.

Sounds like you had a blast playing with your "toys" 😎

 

[UBTom]

LOL that's because you are using a new sharp carbide bur today, Bill.

When that puppy gets juuuuust a little worn, it will become harder and harder to control, and that's when you will find yourself using excessive finger pressure to stiffen up your grip in an effort to keep the high speed from going out of control. If you use light pressure, it won't cut. But if you exert juuuust a little more pressure, it runs away from you. This doesn't happen with real enamel-- You'll see.

Back when I was cutting crown preps on ivorine it takes me the better part of 3 hours to do it. This Friday afternoon I cut a #13 crown prep on a real patient and it took me 40 minutes.

Burnt ivorine gunks up the cutting grooves too and that also exacerbates the control problem.

Keep fresh carbides handy and give diamonds a try (they give better control at the cost of wearing out even faster on ivorine).

"keep your nose to the grindstone" seems an appropriate comment just about now heh heh..

P.S. The groove pattern for #19-O is actually the structure representation of 2,3,4-trimethyl-pentane. The cross pattern is actually that for #18 and #31. 😀

 

[markymark]

from my experience, carbide burs cut ivorine a lot quicker than it cuts enamel.
anyway, be careful of the bur running away from you that UBTom mentions. also, the prep for #'s 19 and 30 (Class I) don't really assume the shape of a cross due to the presence of the distal (fifth) cusp.

 

[aphistis]

Right, my mistake. I wasn't thinking straight when I made the original post--it's fixed now. Le sigh 😳

 

[UBTom]

Sounds like you are more or less enjoying yourself in Operative Bill. I'm sure you will do dandy! 👍

 

[ItsGavinC]

Originally posted by aphistis
(incidentally, I suspect that SDN will become a running IUSD curriculum summary as we progress through our coursework 😀)

We started Single Tooth Direct today--430,000 RPMs of enamel-shredding, air-powered (IUSD is still in the Dark Ages, Gavin 😉) glee.

Bill, just rereading some old posts and I realized something that I failed to recognize when I read your post 5+ months ago: 430k RPMs is a LOT of RPMs!

Our electrics don't come near that.

 

[aphistis]

Originally posted by ItsGavinC
Bill, just rereading some old posts and I realized something that I failed to recognize when I read your post 5+ months ago: 430k RPMs is a LOT of RPMs!

Our electrics don't come near that.

That's interesting to hear, Gavin. What speeds do your handpieces operate at? I don't trust my memory 100%, but I think I remember hearing last fall that a high-speed needs to be at least up in the 200,000 RPM range to be effective.

 

[MarkFitzsimmons]

I had no idea that a handpiece reached that many RPM, thats insanely fast.

 

[drPheta]

I love my highspeed handpiece. WHIIIIIIIRRRRRRRRRRRR 😀



WWWWHHHHHHHHHHHHEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE 😀 😀 😀

 

[ItsGavinC]

Originally posted by aphistis
That's interesting to hear, Gavin. What speeds do your handpieces operate at? I don't trust my memory 100%, but I think I remember hearing last fall that a high-speed needs to be at least up in the 200,000 RPM range to be effective.

Bill, you're correct. 200,000 is the minimum for a high-speed, with 300k being what most high-speeds run at. I think ours are at about 370,000, but I'll have to verify that.

 

[3rdMolarRoller]

Well we had a class II #19 prep exam today and I smoked it...well atleast I know I passed bec I didn't have an email telling me I failed. Finished that sucker in 30 min

Thur we have a class II exam on #3 or #14. Personally I thought indirect vision would be much harder.

The best part with these preps is filling them!

I've done probably 15 class II's already and they are so much fun...can't wait to have a real person.

 

[larryt]

Originally posted by aphistis
That's interesting to hear, Gavin. What speeds do your handpieces operate at? I don't trust my memory 100%, but I think I remember hearing last fall that a high-speed needs to be at least up in the 200,000 RPM range to be effective.

I thought of 750,000 RPM... nah... it's too fast.

 

[3rdMolarRoller]

Geez man...these things are that fast. Here is one at 400,000 rpm

http://www.itldental.com/hs1000.php

 

[ShawnOne]

Hey Brochnizer,

Have you guys learned to administer local anesthetic? I am amazed to see how much first year students have learned already.

I cant wait!!!

 

[ItsGavinC]

Our electrics are 420,000, so I guess Bill's first post wasn't too far off.

 

[DrJeff]

Originally posted by Brocnizer2007
Well we had a class II #19 prep exam today and I smoked it...well atleast I know I passed bec I didn't have an email telling me I failed. Finished that sucker in 30 min/B]

The really interesting thing is that in a few short years, in that same 30 minutes, you'll anesthetize the patient, cut and restore that class 2 composite, do 2 hygiene checks, answer 3 or 4 questions that your front office staff will have for you, and still find time to read the sports page 😀

Congrats on your early preps, and your learning/speed curve will truely be amazing real soon!

 

[jrd29]

Originally posted by ItsGavinC
Bill, congrats on an awesome day!

And don't worry about the dark ages. Arizona is the ONLY school to be using electric handpieces, although UNLV will be using them next year.

Sounds like you had a blast playing with your "toys" 😎

Actually, UNLV has been using electric handpieces from the beginning. I am a second year and we started using electric handpieces during the second semester of our first year.

 

[ItsGavinC]

Originally posted by jrd29
Actually, UNLV has been using electric handpieces from the beginning. I am a second year and we started using electric handpieces during the second semester of our first year.

Most excellent--my buddies in your class hadn't informed me of that. 😀

 

[aphistis]

We've been doing resins the last couple weeks...they're absolutely awesome 😀 😀 Amalgam wasn't too bad, but I didn't particularly care for the limited working time, or its working consistency. So far, we've done class I, III, IV and V resins, and we'll do a II on Friday. I prepped, restored, and finished a class IV #8 mesial fracture in 90 minutes today; at the rate this is going, I'll definitely be running an amalgam-free practice simply for the sake of my enjoyment. 😉

 

[omsres]

Nice speed, at this rate you'll pay your loans off in the year 2150. Just kidding. Anterior esthetic restorations are very rewarding for you and the patients are usually very appreciative. Keep practicing for perfection.

 

[ItsGavinC]

Originally posted by aphistis
We've been doing resins the last couple weeks...they're absolutely awesome 😀 😀 Amalgam wasn't too bad, but I didn't particularly care for the limited working time, or its working consistency. So far, we've done class I, III, IV and V resins, and we'll do a II on Friday. I prepped, restored, and finished a class IV #8 mesial fracture in 90 minutes today; at the rate this is going, I'll definitely be running an amalgam-free practice simply for the sake of my enjoyment. 😉

Bill, smooth. You guys started your operative much earlier than we did (we just started this week), so I enjoy reading your posts and seeing what I have to look forward to.

 

[DrJeff]

Originally posted by aphistis
I'll definitely be running an amalgam-free practice simply for the sake of my enjoyment. 😉

Bill, you'll likely start singing the praises of amalgam the first time you try and restore in a patients mouth, #18 or 31 Lingual, or the DB line angle of #'s 2 or 15. Of course in all the cases, your patient will be a gagger with macro glossia and minimal opening abilities 😀

No doubt, composite can be great stuff, but I hope that I always have amalgam as an option in my practice, if not for the ease of placement, then for the "squeak" when I'm carving it with my trusty dental school issue discoid-cleoid😍 😀

 

[aphistis]

Originally posted by DrJeff
Bill, you'll likely start singing the praises of amalgam the first time you try and restore in a patients mouth, #18 or 31 Lingual, or the DB line angle of #'s 2 or 15. Of course in all the cases, your patient will be a gagger with macro glossia and minimal opening abilities 😀

Yeah, the thought occurred to me after lab yesterday that access is pretty easy on a typodont. When I'm treating a patient, I'll have a hard time convincing them to let me dissect away their buccal mucosa for better access & isolation 😱

 

[thisisit]

The guy who is trying to sell me electric hand-pieces is the guy who fixes my traditional ones. He told me that the electric ones are rated with lower RPMs but they do not fluctuate. The turbine ones are rated at 400k or above but that rate drops to 250K as soon as you touch the tooth structure.

I hated ivorine teeth and blocks. I thought ivorine cut a lot faster and you had less control of your bur than working on enamel/dentin. We use to use old burs on ivorine to gain more control. Just watch out for burn marks, they may deduct from your grade if you apply too much pressure.

 

[aphistis]

Definitely, I have a heck of a time keeping an ivorine prep completely free of burn marks. It hasn't been a problem in natural teeth at all.

 

[DrJeff]

Originally posted by aphistis
Yeah, the thought occurred to me after lab yesterday that access is pretty easy on a typodont. When I'm treating a patient, I'll have a hard time convincing them to let me dissect away their buccal mucosa for better access & isolation 😱

I keep "offering" to place zippers in my patients cheeks but they won't let me!😀

 

[3rdMolarRoller]

I only get burn marks in the plastic teeth when the burr is too old. I like new burrs anyway....man they zip through stuff quick. I'm the type of person that likes to make one pass and thats it. I hate going a little..then stop to see what you did...then go some more. I LIKE SPEED!

Doing good on my preps so far. Got a 95 on the past one. Think I got the same for yesterdays exam.

 

[DrJeff]

Originally posted by Brocnizer2007
I only get burn marks in the plastic teeth when the burr is too old. I like new burrs anyway....man they zip through stuff quick.

My friendly UPS delivery man just delivered my big order from Brasseler today that I placed last weekend. In the big scheme of things this means that the $100 or so of new shapes that I oredred I'll try over the next week or 2 and then go back to my "old faithful" shapes and grits!


I'm the type of person that likes to make one pass and thats it. I hate going a little..then stop to see what you did...then go some more. I LIKE SPEED!

Spoken like a true big restorative dentist in the making!!

Doing good on my preps so far. Got a 95 on the past one. Think I got the same for yesterdays exam.

Keep up the great work, practice makes perfect!

 

[ItsGavinC]

I'm in SERIOUS need of some uplifting encouragement/words of advice from fellow SDNers.

Today we did a #19-O in our Kavo mannequins, and mine looks horrible. Actually, horrible would be a *nice* term for the pathetic job I did on that tooth (technically, two teeth).

My margins suck, my walls are like stepping-stones, and my floors are ridiculously sloped. We followed the central groove with a 330 and then moved on to use a 245 per the lab assignment.

The drill felt ridiculously awkward in my hands, although I felt just fine doing preps on the benchtop. Having it in the mannequin was another story.

Any gems of wisdom? I KNOW that this is my first time with my drill in an enclosed space, but I thought I'd at least have *something* to show for it, but my outcome on the teeth was fairly embarrasing.

 

[aphistis]

Originally posted by ItsGavinC
I'm in SERIOUS need of some uplifting encouragement/words of advice from fellow SDNers.

Today we did a #19-O in our Kavo mannequins, and mine looks horrible. Actually, horrible would be a *nice* term for the pathetic job I did on that tooth (technically, two teeth).

My margins suck, my walls are like stepping-stones, and my floors are ridiculously sloped. We followed the central groove with a 330 and then moved on to use a 245 per the lab assignment.

The drill felt ridiculously awkward in my hands, although I felt just fine doing preps on the benchtop. Having it in the mannequin was another story.

Any gems of wisdom? I KNOW that this is my first time with my drill in an enclosed space, but I thought I'd at least have *something* to show for it, but my outcome on the teeth was fairly embarrasing.

Observations from a fellow first-year: 😉

First things first: get rid of the 330 and use a 329, at least for now. If you're using the 330, any slight twitch or other accident will enlarge the prep beyond what you're aiming for. The 329, being a little smaller, is more forgiving in that respect, and you can always go back to refine & expand if necessary (use a slow-speed at first if you're concerned about the bur running off on you). Take another look at your finger rests, too; if it doesn't feel comfortable, it's not going to help you guide the bur. Since I figured that out, smooth pulpal floors have taken care of themselves.

Once you've got the rough outline established with your high-speed, switch to slow and start refining. This might be a good time to pull the 330 back out if you want to speed things up a little. Just take your time, and remember it's always better to be a little conservative if you're uncertain. If you need to place flares, I've come to prefer a 271 over the 169L recommended in our lab manual.

I'm surprised they started you out on a mandibular first...that's a lot of occlusal anatomy for your first in-mannequin prep. Doing #18 (if you're left-handed like me) or #31 (if you're a rightie) is a lot simpler, just two perpendicular lines. Bottom line, just keep at it and remind yourself that, no matter how impossible it seems at the time, you WILL get better. I can't believe the gains my prepping skills have made in just the space of this past month; like I said above, I'm actually having fun with school for the first time since we started last July. Good luck! 😀

 

[DrJeff]

Originally posted by ItsGavinC
I'm in SERIOUS need of some uplifting encouragement/words of advice from fellow SDNers.

Today we did a #19-O in our Kavo mannequins, and mine looks horrible. Actually, horrible would be a *nice* term for the pathetic job I did on that tooth (technically, two teeth).

My margins suck, my walls are like stepping-stones, and my floors are ridiculously sloped. We followed the central groove with a 330 and then moved on to use a 245 per the lab assignment.

The drill felt ridiculously awkward in my hands, although I felt just fine doing preps on the benchtop. Having it in the mannequin was another story.

Any gems of wisdom? I KNOW that this is my first time with my drill in an enclosed space, but I thought I'd at least have *something* to show for it, but my outcome on the teeth was fairly embarrasing.

I think that most of here have been through that at one time or another. I can remember my first typodont preps as looking at it was prepped using a combination of a jack hammer and a few sticks of dynamite (hey every now and then in a few funky locations you still might think that I'm prepping teeth with that combination😀 )

A few things to keep in mind though. It does get ALOT easier with practice, and yes, I still have some of my original ivorine "prepasters" that I'll look at once or twice a year for a laugh or two!

More importantly, Ivorine teeth and real teeth have about as much similarity as apples and oranges, and just about everybody will find natural teeth much easier to prep. The fact that your school has all the high tech tools such as the electric hand pieces in my opinion would actually make it tougher to prep a nice ivorine tooth due to the constant torque factor. Since burs like to "grab" and subsequnetly jerk in ivorine, an air driven handpiece that often stalls for a second or two when the bur grabs will allow you to "salvage" the ivorine prep whereas the "truth" will come through with the constant torque electrics (this constant torque factor makes crown preps on real teeth SWEET!! 😀 )

I know it may seem tough to believe right now, but real soon you'll be laughing about these early preps.

Best advice, its Friday night, grab a beer, relax a little, and then spend a couple of hours in the simulation lab during the next week or so and it will be much better😀 Until of course you try your first Class II on a maxilary tooth(indirect vision and ivorine teeth are a nasty combo )

 

[3rdMolarRoller]

I do not think this was mentioned in the previos posts, but you need to rest your hand firmly for great stability. Use the modified pencil grip and I use my pinky finger as the "hand stabilizer". My profs are amazed at the accuracy.

I see some classmates that do not rest their hand properly and they have the same problem you do. When you start doing class III's, you will need a very steady hand since the preps are so small.

Just get a good solid finger rest somewhere and that should solve 90% of your problems.

 

[3rdMolarRoller]

Oh and one more thing. I liked to use a #1556 when I did my class I and II. And To make the box look really good I touched it up with a #35

I use a 330 on class III

Seems like as many students there are....there are that many ways to do a prep.

 

[larryt]

Originally posted by Brocnizer2007
I do not think this was mentioned in the previos posts, but you need to rest your hand firmly for great stability. Use the modified pencil grip and I use my pinky finger as the "hand stabilizer". My profs are amazed at the accuracy.

I spent nearly 10 hrs just to practice this modified pen grasp and fulcum position on each quad. I rested my ring finger on the occlusor surface then my pinky finger stabbilized outside on the cheek of manniquin

 

[omsres]

Just a question. Are you in dental school? The class of 2008 hasn't started yet. Is there a five year shool I don't know about.

 

[omsres]

Sorry, that last question is directed towards larryt.

 

[larryt]

Originally posted by omsres
Just a question. Are you in dental school? The class of 2008 hasn't started yet. Is there a five year shool I don't know about.

Nah.. I'm not in dental school yet .

 

[UBTom]

to Gavin:

Your situation brings back VERY familiar memories. 😀

I was in your exact situation when preclinic started for me 3 years ago.. Lots of charred ivorine that would have scared away every patient I have treated so far if they ever got a look at them.

My tip: Try to develop a systematic way of cutting your preps. Don't get greedy and try to develop your final outline form in one shot-- Go multiple passes, use burs that cut predictably, such as a side-cutting bur with a blunt tip like a 169 or 56. I think it's hard to jump right in with a 330 because it is side *and* end cutting and is harder to control. Refine your preps with the slow-speed which does not cut quite as aggressively.

Gotta learn to walk before you fly. Once you get better at hand control, then move on to the more-difficult-to-control burs like the 330. By the end of the semester you will be flying along cutting 15-minute preps with that 330 and hardly ever have to touch the slow-speed!

Luck!

 

[DrJeff]

What will really be scary is that before you know it, you'll be in private practice and all you'll be using is diamonds, diamonds, diamonds for all prepping

To be honest with you, the only time I don't have a diamond in my handpieces are when I've got the carbide finishing burs or the porcelain adjust points. And I know that this next one may be really tough to believe, but I don't think that I've had an actual carbide 330 in a handpiece in over 5 years

 

[ItsGavinC]

Guys,

Thanks for all the helpful advice--the reassurance is really needed.

In regards to the 300 bur--that was the assignment from the instructor. Use the 330 to cut an initial groove and then get the needed depth and finish it off with the 245.

I would have MUCH rather used a 56 or a 169, both of which I love much more than the 330 or 245.

I have more to post, but I'll do it later...

 

[larryt]

Originally posted by DrJeff
What will really be scary is that before you know it, you'll be in private practice and all you'll be using is diamonds, diamonds, diamonds for all prepping

To be honest with you, the only time I don't have a diamond in my handpieces are when I've got the carbide finishing burs or the porcelain adjust points. And I know that this next one may be really tough to believe, but I don't think that I've had an actual carbide 330 in a handpiece in over 5 years

It's completely true. I am lost when people listed diffirent kinds of burs. All I see at our office are diamond and diamond burs.... SSC diamond burs, football shape diamond burs.... and some of other strange shape diamond burs use for crow prep which I don't even care to ask for their name. 🙄 🙄

 

[Supernumerary]

I love the 330 bur. It gives the perfect amount of convergence and is just the right depth to satisfy the requirements of the practical. Just put that baby in, follow the grooves, and you're done. Well, maybe not quite that easy. 😉 A lot of people in my class like to use the lowspeed to finish, but I prefer my highspeed. I just barely touch the footpedal until it sound like it's about to stall out while cutting. It makes everything nice and smooth but with more control and less material removed than with the lowspeed - at least, in my hands it does.

For those of you who are struggling a bit - are you using loupes? you won't believe what a difference that will make. It doesn't seem like a big deal until you've used them for a month or two; then you will wonder how you got along without them. Mine were in for repair for my last practical and my prep score went down nearly a full letter grade. Unless you've got eagle eyes, you just can't see all the detail that you need without them.

 

[ItsGavinC]

Originally posted by Supernumerary

For those of you who are struggling a bit - are you using loupes?

yes, and they are driving me crazy! On the benchtop they were excellent, but on the mannequin I'm just not feeling comfortable with them.

 

[aphistis]

Originally posted by ItsGavinC
yes, and they are driving me crazy! On the benchtop they were excellent, but on the mannequin I'm just not feeling comfortable with them.

Ditto. I've got the same set as Gavin, and thus far they've been much more trouble than they're worth.

 

[UBTom]

I think part of it might be positioning too.

The thing is, if we are cutting preps on mandibular molars, it might not be a good idea to sit in the standard 11-o'-clock position from behind the patient's or manniquin's right shoulder-- You can't really see how deep that bur is going into the tooth from that position unless you are really contorting your neck or back.

For mandibular preps, I prefer to sit facing the patient from the patient's 8-o'-clock position. From there it's a lot easier to see just how deep into the tooth I'm burying that bur.

I like having my flip-up Orascopic loupes because sometimes loupes do get in the way and I can just flick it up.

Funny thing today... My class was taking our mock board exam (not a particularly pleasant way to spend a Saturday, heh)... For the NERBS we need to cut an FPD prep (#19 and #21) and do endo on #8. On a manniquin! Makes me feel like a freshman all over again. 😀

 

[larryt]

Originally posted by UBTom
I think part of it might be positioning too.

The thing is, if we are cutting preps on mandibular molars, it might not be a good idea to sit in the standard 11-o'-clock position from behind the patient's or manniquin's right shoulder-- You can't really see how deep that bur is going into the tooth from that position unless you are really contorting your neck or back.

For mandibular preps, I prefer to sit facing the patient from the patient's 8-o'-clock position. From there it's a lot easier to see just how deep into the tooth I'm burying that bur.

I like having my flip-up Orascopic loupes because sometimes loupes do get in the way and I can just flick it up.

Funny thing today... My class was taking our mock board exam (not a particularly pleasant way to spend a Saturday, heh)... For the NERBS we need to cut an FPD prep (#19 and #21) and do endo on #8. On a manniquin! Makes me feel like a freshman all over again. 😀

Do you have to do Perio (1 quad) on the NERBS ? If I remember correctly, Perio was required on the WREBS in 1999. I was a DO gold and MO amalgam patient.

 

[UBTom]

Hi Larry,

The NERBs have a clinical component and a manniquin component. On the manniquin you are supposed to do an FPD prep and fabricate the provisional for it, and also endo (access, clean&Shape and obturate) #8.

The clinical component has three procedures on live patients: 1 quadrant of perio (yep), one Class-II amalgam and one Class-III resin.

HTH!

 

[larryt]

Originally posted by UBTom
Hi Larry,

The NERBs have a clinical component and a manniquin component. On the manniquin you are supposed to do an FPD prep and fabricate the provisional for it, and also endo (access, clean&Shape and obturate) #8.

The clinical component has three procedures on live patients: 1 quadrant of perio (yep), one Class-II amalgam and one Class-III resin.

HTH!

Thanx Tom !

They will eliminate live patient component in 2005. How will they test the applicant on Perio ? Do you happen to know ? Amalgam and resin procedures are easily to be tested on manniquin.

 

[Bickle]

Originally posted by larryt

They will eliminate live patient component in 2005.

Really? If this is true, it sure makes it easier to take more than one regional exam.