Restorative Dentistry

[Yah-E]

Well, we D-Is at Nova just started our Restorative (Operative) dentistry courses this semester! So far we're doing Class I preparations (#30 occlusal, #20 occlusal, #3 OL and #7 lingual pit). Although starting up our hand pieces with 330 and 329 burs are exciting, doing preps with INDIRECT vision are TOUGH!!!

I want to move the bur up and it goes down, I want left, it goes right!

We do both bench and mannequin preparations, I must say doing a prep with the mannequin in the maxillary arch with indirect vision using a mirror is pretty challenging! Do any of you other D-Is out there feel the same?

I did an OL on #3 this afternoon on the manniquin and OMG, it looked like CRAP! Bench preps I can do and it looks good, but indirect vision I have to practice for sure!

Let me know how you guys feel or are doing out there?

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[Blue Tooth]

Honestly it's pretty funny remembering how hard it was to use a mirror for the first time, and that was only 4 months ago. I probably did 40+ preps (form 1, not a real prep, just a practice rectangle that we use here at UM to learn indirect vision) before I felt comfortable. Now, doing class III's, IV's, finishing composites, etc isn't that hard. Using the mirror is like second nature now. Just give it time and practice A LOT, it'll come to you quick.

 

[cusp of carabelli]

i've been working on class II preps and yeah...it's just killing me!!!
especially trying to get the proper depths of the preps....these ivorine teeth aren't exactly the most cooporating either! but yeah...i already have built a grave yard for all the destoryed and mangeled teeth from trying to do these preps right...but yeah....when working on the maxillary, i've stoped relying solely on being in the 11 o'clock position to moving to the 8 or 9 o'clock position to try and get a better view on the prep. hopefully with more practice these preps will get easier but yeah...we'll see...

 

[Yah-E]

Hey guys....how much $$ have you spent on extra ivorine teeth so far? At Nova, they cost $1.30 each or something like that! Class II on #30...WOW....what a pain. Do you guys learn the "S" curve on the buccal wall also?

I use a 329 bur to be conservative for the occlusal isthmus and then move onto 245 bur to drop the proximal boxes, use latch 330 bur on a slow hand-piece to smooth the walls, hatchet and other hand instruments to clean the floors, break the interproxial contacts, and carve the axial walls. => pain in the @ss!

Oh check this out, in addition to all that, it has to be on the manniquin with a rubber dam on! If it's on the maxillary arch, then I'm screwed! Indirect vision still kills me.

Mangled teeth you say? I have about $200 worth of them as well. (sigh)

 

[Frank Cavitation]

what's ivorine? at my school it's just "plastic", and they cost the equivalent of $2.00... We use a 169 to do the proximal boxes... and when I'm done an MOD it costs me $6, because I scratch up all the adjacent teeth!

 

[dientesfuertes]

Yah-E,
All I can say is that I feel your pain!! We have a practical coming up next Tuesday. Class II #3 MO and DOL. And we have to place the MO amalgam.
Needless to say, I am freaking out! We have about 3.5 hrs, but man it is a tricky little SOB to do with indirect vision.

Remember....baby steps...baby steps......

 

[cusp of carabelli]

teeth here cost about $1.20 or so....and burs are about $1.40 per...so yeah the expenses are adding up!...they sure don't tell you about these expenses at the interview! =oP I have a problem sharpening my hand instruments cuz i don't wanna lose the angle of the cutting surface but i can't help it when sharpening it on the block....any advice from anyone?

The "s" curve....so far i haven't had a problem with that...we were told to just drill out the proximal box after making the initial outline form and then blend in the facial surface and the s-cuve'll come.

We just had a practical last thursday on doing a 4 MO prep. and a #3 modbl lg. amalgam filling restoration in 2 hrs. talk about pressure!

i'm glad we have spring break now...in the middle of winter...go figure...

 

[Yah-E]

Cusp:

Spring break right now?! Especially, in the New England states, it's more like a Winter Break for y'all, isn't it? What are dental schools doing to us having our spring breaks middle of no where!? Our spring break isn't much better either! Ours in the middle of April! I guess that they don't want us partying with the undergraduate students in the month of March and get all crazied up.

Oh yeah, I forgot about replacing them burs, so far I've broken a 330 and a 329. I also broke one of my hand instrument, the hatchet.

Hey who do you guys have for the hand pieces? We have Kavo.

Frank:

I think we're thinking of the same type of teeth here, whether it's plastic or ivorine. Our is plastic too, but they call it the ivorine teeth.

I didn't do too well on my 1st practical. We did an occlusal (Class I) preparation on #30 and a Class I amalgam restoration on an already prepped #19. My first cut with 329 on the occlusal isthmus was awesome. Then I went in and attempt to smooth the walls with the hatchet, needless to say, I opened up the isthmus a bit too much.

We measure the isthmus width with a plugger that's 1 mm on one end and ~1.5 mm on the other end. If the ~1.5 mm end of the plugger can flow/travel through the occlusal isthmus then your prep is too wide.

I had a great prep as far as smoothness, convergent wall towards occlusal, and the right depth. Unfortunately, it was too wide, we're talking about 0.01mm here! Oh well, good thing I'll have enough other opportunities to pull up my performance. Next practical, a Class II prep and restoration!

 

[gryffindor]

Thinking about pre-clin operative days makes me shudder.

If you guys are going through burs like crazy, you might want to look into Axis to buy more. When our bur issues ran out, a number of us ordered from Brassler and paid about $1.50 per carbide bur. Diamond burs for fixed are even more expensive - something like $3 or $5 per bur. Axis is so much cheaper - especially for the diamond burs. The diamonds are like $1.50 per bur! Carbides are probably cheaper than that from Axis. Their buying policies are a little better too. I really like the Axis diamond burs and don't mind saving the money too.

We used to pay $2 per ivorine tooth. But we were given a lot of them in our issues, so sometimes you could find upperclassmen who had tons of them left over from their pre-clin days.

 

[DrJeff]

Axis vs Brasseler. For the ivorine teeth, the axis burs will work great and save you a few bucks, you might also want to check out premier burs, they're another decent "economical" bur company, especially there two stiper diamonds for gross reduction. The big benefit with Brasseler is when you're working on "real" teeth, they just flat out hold there sharpness better, especially on sclerotic dentin. I'll routinely get only 1 crown prep out of a premier and/or axis bur and 5+ out of a Brasseler, so in the big picture while an axis/premier may save you $$ initially, in the long run on "real" teeth you'll spend more. If you really want to dull a bunch of burs in a hurry, try and cut off some crown and bridge work on someone who had it made and inserted in Eastern Europe, I guarentee you'll see sparks flying when the bur hits the metal!

 

[Kung Foo]

Thanx for the tip about axis! Buying diamond burs from OSU costs something like $3-$4, and even with copious use of the "clean-a-diamond," the ivorine teeth run the diamond burs way too quickly for my budget!

Also, do you buy them from the axis website? Do they offer a student discount? I just checked their website, and it looks like they're selling a diamond bur 5 pk for 33.75 ...... which is $6.75 per bur - maybe I'm looking in the wrong spot?

cusp - i agree - dental schools never mention the "instrument management" part of your dental school education

buying teeth - ahahahaahahh (molars for the columbia typodont are $2.30 at OSU - we usually are issued a handfull for each restorative class for whichever typodont we're using) Funny story - before our first crown prep practical/in class assignment, our class of 104 managed to go through 1500 #30's ... crazy amounts, and the dispensory ran out and the teeth were back-ordered ... people went nuts.... but now, with a few insane weeks of practicals/exams behind us, pretty much everyone has slipped into a state of quasi apathy - no way will i spend 8 hrs on a weekend practicing crown preps again!!! ... just so i can turn in something extra pretty for a daily grade - lololol

posterior operative - 330 for initial occlusal cuts and then 245 to drop the proximal boxes (sounds so easy....) our kits came with an extra 5-pk of the 330s ... good because i've broken 3 so far... the head just spins itself off... guess i'm a.) applying too much pressure or b.) not moving the burr enough

lol - just think - in a few years we'll all be pros at this ...... like the part time pre-clinic instructors who are still practicing and say things like " eh, so the prep's too wide - the patient'll never see that!" *sigh* maybe not until the tooth breaks.... or until the instructor grading the practical measures it =)

 

[hopefully]

I am in the same boat as all of you! I spent more than 4 hours in the preclinical lab today trying to place the rubber dam on the mannequin and practicing class II prep. I always thought I had good hand skills, but dental school changed all that. I have small hands, but I realize my hands are still too big for the mannequin's mouth and trying to place the rubber dam was nearly impossible. Ivorine teeth cost around 1.30 and it looks like I'm going to have to purchase more since I knicked the adjacent tooth when making my proximal wall. I wonder if I'll ever be proficient to be a dentist at this rate.

 

[cusp of carabelli]

hey hopefully...
i feel your pain about the rubber dam. Have you tried to loosen the teeth on the typodont like about 1/4 turn or so? I used to have a hard time putting on the rubber dam too but the profs just said to loosen the teeth to simulate a real mouth more...since real teeth will usually have a little give to them. Also those rubber dam hole templates have helped too...instead of marking the center of each tooth with a pen...=oP

yah-e:...yeah...i think the admin just wanted to make themselves think it's spring since there's at least 2 feet of snow outside...it's a good thing i escaped and am spending the week in Cali.......hehehehe...

I'm kinda glad this subject about preps came up....i was begining to think i was the only one that was struggling with these things! You don't know how many times i was gonna throw my typodont out of the third floor pre-clinic window b/c of all the frustration! ....Thanks guys!

 

[DrJeff]

Another tip for rubber dam application to a typodont. Back in my school days, we used to use just a little KY Jelly to the "tissue side" of the dam after you punch the holes, just before applying it over the ivorine teeth. That combined with the forementioned 1/4 turn loostening of the screws made things alot easier.

BTW, in general you will almost never isolate entire quadrants of teeth in private practice. In general I go just one tooth past the one one/ones I'm working on for interproximal restorations, and just a single tooth for an occlussal restoration Also the teamwork between my assistant an myself has the proceedure down to the point where eveen if I am isolating 4 or 5 teeth it will only take about 30 seconds to have the dam in place. Practice, practice, practice, this stuff will eventually become second nature to you.

 

[Big_Poppa DDS]

We used to use the sawflex finishing strips and sand the interproximal contacts of the dentoform teeth to make the rubber dam slip on easily for practicals.

 

[Blue Tooth]

Yeah the KY works great. They had some set out in pre-clinic for us to use when we were learning rubber dams. What was funny was how the tubes magically "disappeared" when some long weekends or other breaks came up. I guess people started to use the "personal lubricant" for something more personal.

Another thing, am I understanding some of you guys correctly in that you have to buy your burs and teeth yourself? They don't give you extras when you use them all up? And you actually have to order them from the manufacturer directly? That seems like a real pain, both in the butt and wallet.

 

[Yah-E]

Blue Tooth:

You got it right! We started initially with 5 extra ivorine teeth for each tooth from our kits. Intracoronal burs, we just start with one of each type. Everything else after that if you loose it or break it, you'll have to buy news ones from our equipment/supply store at our dental school, Henry Schein store.

Don't even tell me at U Mich, you get EVERYTHING provided to you for free? Free burs and extra teeth?

Today, I got my butt kicked with the MO/DO on #14 assignment with indirect vision and rubber dam. Let's just say, I killed two #14s, bought 3 more #14s and I NEED practice.

 

[Blue Tooth]

yeah pretty much. some stuff if you break it you have to buy replacements but so far I haven't had to pay for any teeth or burs and I long ago lost count of how many I've used. That really sucks, the cost has to really add up.

 

[Kung Foo]

HOORAY FOR A RESTORATIVE-FREE WEEKEND!!!



LOL - just finished my second practical of the week - so both of my typodonts have disappeared into the grading abyss -- Hooray for a drill-free weekend!!!!! Unfortuantly they failed to confiscate my articulator with the never-ending waxing assignment - Do y'all use the Lundeen steno-style book for waxing too?

side note - spent the afternoon making a lime green provisional crown - drop me a line if you know any aliens who need some dental work


Have a GREAT weekend!!! (I'm planning on catching up on sleep... and everything else!)

also - we just use petroleum jelly on the back of the rubber dam - ok as long as you're not using composite - there's also a special rubber dam lube in the lab - but that's entirely too much work when you have a tube of pet. jelly in your box already. Also, the bench instructors claim you can use lq. soap from the dispensors when you need something water soluble (for composite) and don't want to fetch the special lube stuff. I've also found that using the largest hole punch for all the teeth works great... not like you're really controlling for moisture on the plastic teeth.... however i may have to modify that strategy for the practical where the rubber dam is graded =)