Stressed about operative!

[siouxsieQ]

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Hi everyone - I'm new to SDN forums but it looks like a great resource for advice and support for a newbie to the dental world like myself.
We just started operative dentistry at my school last week after the holidays and I'm trying to keep my chin up and not get discouraged but it's so tough already. Some people in my class seem to be naturals already so I'm a little concerned about my awful preps. I am ready to work hard for this, but I guess I'm just worried if I'll be able to improve enough with the limited time we have available in lab and the limited extra practice hours we have outside of class.
So far, we've had to do a class 1 cavity prep on mandibular first and second molars for composite resin restorations. We were instructed to use the high speed with the 330 bur and were to assume that the entire occlusal fissure system is carious and make the prep only as wide as the bur diameter and approximately 2 mm deep at the mesial and distal. I had a really difficult time keeping the prep that narrow. It seems that everytime I go in to deepen/extend the prep or smooth the floor, it gets wider. My demo wants me to smooth the walls too, but I'm concerned about making the prep wider again. Any tips?
I am itching to get in for some extra practice but we're not allowed to until sometime next week. I would turn to my demo for help but he's not very accepting of student questions.
I would really appreciate any tips you may have about class 1 preps or just operative in general.
Thanks a lot!

 

[HupHolland]

Hi everyone - I'm new to SDN forums but it looks like a great resource for advice and support for a newbie to the dental world like myself.
We just started operative dentistry at my school last week after the holidays and I'm trying to keep my chin up and not get discouraged but it's so tough already. Some people in my class seem to be naturals already so I'm a little concerned about my awful preps. I am ready to work hard for this, but I guess I'm just worried if I'll be able to improve enough with the limited time we have available in lab and the limited extra practice hours we have outside of class.
So far, we've had to do a class 1 cavity prep on mandibular first and second molars for composite resin restorations. We were instructed to use the high speed with the 330 bur and were to assume that the entire occlusal fissure system is carious and make the prep only as wide as the bur diameter and approximately 2 mm deep at the mesial and distal. I had a really difficult time keeping the prep that narrow. It seems that everytime I go in to deepen/extend the prep or smooth the floor, it gets wider. My demo wants me to smooth the walls too, but I'm concerned about making the prep wider again. Any tips?
I am itching to get in for some extra practice but we're not allowed to until sometime next week. I would turn to my demo for help but he's not very accepting of student questions.
I would really appreciate any tips you may have about class 1 preps or just operative in general.
Thanks a lot!

Step 1: relax. If you're this stressed out about simple operative I don't even want to know what you'll be like when you start fixed 😉

Remember, you will suck at everything in dental school on your first few attempts. You're not expected to be perfect right away.... if that we're the case then dental school would be a few measly months.

I'm a bit confused about your prep dimensions because they seem a bit unrealistic (keeping the prep diameter the width of the bur?), but from what it sounds like, it is more an exercise of manual dexterity than caries simulation. When you get deeper into the course you will be making "ideal" preps that are much wider than the diameter of the bur, so it will become easier.

To answer your question, the 330 bur is only 1.5 mm in length. Therefore, I suggest you grab a 245 which is 3 mm and eyeball the bur during the prep, making sure AT MINIMUM 1/3 of the cutting surface is visible at all times (in other words... just under 2 mm of the bur will be hidden inside the tooth, and just over 1 mm of the bur should be visible above the tooth). You will want to make your prep a bit shallow so when you smooth it out, you don't go too deep. Once you prep with the high speed go in with the 556 at slow speed and refine your walls.

Hope this info helped. I'm a 2nd year and haven't done a cavity prep in about a year so hopefully what i said made sense. Remember to relax 🙂

Hup

 

[Darya]

Are you practicing on ivorene teeth?

I used to have a hard time preping ivorene, but once we moved to extracted teeth, I found it much easier!!


Finger rest and feather touch are the key. Make sure you are resting your pinky and ring finger on the occlusal surface of one of the adjacent teeth or opposing arch and don't put too much force on the hand piece! Treat it like a painting brush, light storkes and alway pull the hand piece towards you rather than pushing it away e.g if you are preping class I on # 20, I would rest my ring/pinky on # 19, start at distal and pull it towards you!

I hope this helps!

 

[siouxsieQ]

Step 1: relax. If you're this stressed out about simple operative I don't even want to know what you'll be like when you start fixed 😉

Remember, you will suck at everything in dental school on your first few attempts. You're not expected to be perfect right away.... if that we're the case then dental school would be a few measly months.

I'm a bit confused about your prep dimensions because they seem a bit unrealistic (keeping the prep diameter the width of the bur?), but from what it sounds like, it is more an exercise of manual dexterity than caries simulation. When you get deeper into the course you will be making "ideal" preps that are much wider than the diameter of the bur, so it will become easier.

To answer your question, the 330 bur is only 1.5 mm in length. Therefore, I suggest you grab a 245 which is 3 mm and eyeball the bur during the prep, making sure AT MINIMUM 1/3 of the cutting surface is visible at all times (in other words... just under 2 mm of the bur will be hidden inside the tooth, and just over 1 mm of the bur should be visible above the tooth). You will want to make your prep a bit shallow so when you smooth it out, you don't go too deep. Once you prep with the high speed go in with the 556 at slow speed and refine your walls.

Hope this info helped. I'm a 2nd year and haven't done a cavity prep in about a year so hopefully what i said made sense. Remember to relax 🙂

Hup

Thanks a lot for the advice, Hup!
I know I need to work on relaxing and being more patient. I'm enjoying the course so far and just wishing I had more time to play around at this point rather than just worrying about getting things signed off. I'm glad to hear that you find the width unrealistic. I'm going to give your suggestions a try - thanks again and good luck with your second year! 🙂

 

[siouxsieQ]

Are you practicing on ivorene teeth?

I used to have a hard time preping ivorene, but once we moved to extracted teeth, I found it much easier!!


Finger rest and feather touch are the key. Make sure you are resting your pinky and ring finger on the occlusal surface of one of the adjacent teeth or opposing arch and don't put too much force on the hand piece! Treat it like a painting brush, light storkes and alway pull the hand piece towards you rather than pushing it away e.g if you are preping class I on # 20, I would rest my ring/pinky on # 19, start at distal and pull it towards you!

I hope this helps!

Yeah, we're prepping the ivorine teeth right now but we did a benchtop exercise last week with natural teeth which seemed to cut nicely compared to the ivorine teeth. Always pulling the handpiece towards myself sounds like a great idea - I was going in both directions today but I don't think I have as much control when pushing the handpiece away from myself. Thanks for the advice!

 

[ziptree]

Hi everyone - I'm new to SDN forums but it looks like a great resource for advice and support for a newbie to the dental world like myself.
We just started operative dentistry at my school last week after the holidays and I'm trying to keep my chin up and not get discouraged but it's so tough already. Some people in my class seem to be naturals already so I'm a little concerned about my awful preps. I am ready to work hard for this, but I guess I'm just worried if I'll be able to improve enough with the limited time we have available in lab and the limited extra practice hours we have outside of class.
So far, we've had to do a class 1 cavity prep on mandibular first and second molars for composite resin restorations. We were instructed to use the high speed with the 330 bur and were to assume that the entire occlusal fissure system is carious and make the prep only as wide as the bur diameter and approximately 2 mm deep at the mesial and distal. I had a really difficult time keeping the prep that narrow. It seems that everytime I go in to deepen/extend the prep or smooth the floor, it gets wider. My demo wants me to smooth the walls too, but I'm concerned about making the prep wider again. Any tips?
I am itching to get in for some extra practice but we're not allowed to until sometime next week. I would turn to my demo for help but he's not very accepting of student questions.
I would really appreciate any tips you may have about class 1 preps or just operative in general.
Thanks a lot!

You're not allowed to practice preps until next class?

Make it 1.5mm deep at the center and make the pulpal floor flat. Due to the rising cusp ridges, you'll get your 2.0mm at the mesial and distal pits.

Smoothing the axial walls takes a bit of practice to do it well without widening the prep much.

Hint: Use a 329 bur. But since it's not deep enough, keep that in mind. It's smaller in diameter though, so that'll help.

Good luck. 👍

 

[ObliqueRidge]

use the 556 on slow speed (as high as the slow speed goes..i think its 40,000 rpm..something like that) and it will smooth out the gingival wall as well as the mesial, distal, buccal, and lingual walls. On high speed it is very hard to get a precise gingival floor..it is mainly for the initial outline and then the slow speed will refine it. It is much easier on the real patient, so don't worry. On a real patient you only excavate caries with slow speed round burs and spoon excavators. The high speed only gives the ideal prep for retention. hope that helps. don't worry about everyone else that is natural at artistic work b.c. when it comes to the real patient it doesn't matter.

 

[mamelons]

Don't get discouraged. When I first started cutting preps back in July, I was having the same problem -- making them too wide. What I found helpful until I got more comfortable, is to place a "pilot groove" to get your prep started. I did this with a 1/4 round bur.

Pilot grooves serve as guides to your preparation. They help control the bur path to avoid over-preparation -- which can ultimately weaken the remaining tooth structure. I don't use these on "ideal" preps, but for manual dexterity exercises, they work great, until you get the hang of it.

 

[CJ20]

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[tinman831]

Everyone feels like a complete doofus when handling a handpiece for the very first time. For some it comes easily, and for others, it takes practice. First year of operative will be like that. I don't know how many times I've nicked adjacent teeth/gingiva, or even the shroud of the typodont. Don't worry though, everyone manages to get by just fine.

 

[UCSF2012]

What I've realized is that using the high speed on real teeth provides the same resistance as using the slow speed on plastic teeth. I really don't understand the reasoning in their making us use the high speed on plastic teeth. It's just a catastrophe in the making.

As far as operative goes, I realized that using the right tool makes a world of difference. If you want to cut the occlusal surface without widening the faciolingual length, don't use a bur that cuts on the sides. The 330 and 34D are the most popular burs for the class I, but they both cut on the side. The ideal bur for a class I without widening the FL dimension is the rounded (ball tip) diamond. They come in fractions of a millimeter, so it's easier to not have the FL length wider than 1 millimeter.

I've gone ahead and learned about all the different types of burs available and have bought several hundreds of dollars worth of ...burs for experimentation. If you use the right tool, operative is AMAZINGLY easy. I really don't know why instructors have us use like...2 burs for everything. It's silly.

I use the slow speed to contour cavosurfaces of plastic teeth. It gets you that A quality work without much effort. Use the high speed if you want to botch things up.

 

[UCSF2012]

BTW, practice doesn't make perfection. Practice combined with cutting strategy and problem solving does. You have to understand what's causing problems with your output.

BTW, this cuts the occlusal surface without cutting on the sides as much.

If your hands are steady, then you can use the traditional bur, the 34D inverted cone.

 

[UCSF2012]

Thank God for this website! I have been feeling the EXACT same way. It's nice to be able to relate with other fellow dental students. Our first preps were yesterday and I felt so overwhelmed and disoriented. It felt so foreign to me and well, because it was and will be for a while, I assume. My hands are really small (which I thought would be a good thing) and the handpiece seemed so heavy and in the way. UGH! I'm just going to have to practice A LOT and pray that someday these stupid little hands can figure it out! I've been disappointed with my hands in dental school. I've always been the best student in science classes (we all have been!) and when it comes to the dental classes, I honestly feel like an idiot. Has anyone else felt like this? Upperclassemen? Will my hands start working? I sure hope so! Thanks everyone 🙂

Our first attempt at drilling was on a learn-a-prep. I keep it as a reference, because it is an indication of my first time and the misery of workmanship that it is. The quality of my preps have greatly increased, and I've gone into the clinic after hours 4-5 times in the past quarter to practice drilling. The biggest improvement came as a result of fixing my mechanics, not through practice. Hold the handpiece the right way, finger rest on the right position, angulate the mirror properly, and angulate the mannequin properly, ...etc.

 

[Thaxil]

You should not get into the habit of using multiple burs for one prep. For most case I use cross cut bur to prep and #4 round for gross caries removal. When you get out, the more steps involved lowers productivity.

 

[UCSF2012]

You should not get into the habit of using multiple burs for one prep. For most case I use cross cut bur to prep and #4 round for gross caries removal. When you get out, the more steps involved lowers productivity.

Literally takes 10 seconds to change a bur, and using the right bur makes certain cuts much easier. I'd gladly take 10s out to increase QC.

 

[TempleDMDKrazd]

-use a 245 bur for initial outline on molars
-use a 330 bur for initial outline on premolars
-use a 956 or 957 (955-961 burs) to flatten out the pupal floor and gingivial floors. why do you use this bur? because its an end cutting straight fissure bur. meaning it wont nick the other tooth or the sides of the wall because it only cuts on the end.

also if you want to help yourself train manual dexterity with just using the 245/330 bur without nicking the other tooth without changing burs put a matrix band between the teeth without the retainer, or if you have money to spend buy some interguards.

good luck

 

[cookand]

We just had our 1st practical and it was a Class I prep on 18. I like to establish my outline form with a 329 right now. I then go back with a 330 to get my depth and convergence under cusps. Once I have that 'rut' from the 329 its MUCH easier for me to keep good form with the 330. I then go back with a 245 on the slow speed to smooth and even the floors and walls. This also allows for 'gentle' adjustments for convergence and divergence where needed.

That's what I do right now, hope it helps.🙂

 

[jjash]

Does anyone have any tips on how to work with composite? I find the preparing side of operative much easier than the restoring side of it. I have the hardest time getting a smooth and contour outline. There always seems to be black gouges and gaps between my tooth and the composite. Can anyone offer any advice?