Dental Cyberweb/Dentists: Gold Nuggets
Doc Doty gives monthly tips on how to improve your techniques. If you've got a tip, please contact us at the Dental Cyberweb! We'd love to hear it and will credit your submission.
- December 1997: Impression Techniques
Submitted by Craig Fine
Many times doctors who are using a putty-wash technique ask me how to avoid the tendency for the putty to displace most of the wash material in the gingival margin areas, where detail is so critical. The solution is simple. When your assistant hands you the tray of putty for placement, before seating use the thumb or index finger to create a trough where your prep is. Then inject more of your wash material in the depressed area. (You can have the assistant quickly snip off the intra-oral tip to increase the speed and volume of this step.)
Also, you mention about the benefit of quicker setting materials. We have recently introduced President Fast -- a polyvinylsiloxane that sets in two minutes, with plenty of working time on the front end. I invite you to find out more about this and other innovative products at my website.
- December 1997: Time-Saving Tip
Submitted by Dr. Meir Aviram
When preparing a cast core already cemented to the tooth for a crown, using a Zakaria carbide burr (normally used for surgery) instead of a diamond saves a lot of time and gives a great smooth finish.
- September 1997: Polyvinyl Siloxane
New polyvinyl siloxane impression materials that set in 2 ½ minutes are terrific for denture impressions. The old 5 minute wait was too long! They also taste better!
- May 1997: The Single Stage Implant
I have found the single stage implant to have many benefits. Not only is only one surgical procedure required but these systems eliminate the parts interface beneath the gum tissue. I don't care how well the parts fit, that metal to metal margin has to be a source of irritation to the gum tissue. Also, when placing the second stage parts you may catch a piece of tissue in the joint or not fully seat the second part. Lastly, you have another screw to weaken the structure. It just makes so much more sense to me to use the single stage implant! I am using the ITI system. I am not aware if there are any other single stage implant systems out on the market.
- April 1997: Implant Restorations and Your Local Hardware Store
A few years back I had a very frustrating experience with an implant restorative attempt. I want to pass along a solution to my frustration for all of my fellow dentists to make their lives easier. I decided to use 4 ball type attachments to attach a lower denture to 4 implants. I first screwed the ball attachments into the implant heads. I hollowed out the lower denture to ensure enough room for the ball and the socket that would be part of the denture. I placed the sockets on the ball and some self cure acrylic in the denture. I tried to block out the undercuts around the ball with some wax but the wax wasn't staying in place very well.
Needless to say, after the acrylic cured some had engaged the undercuts and also made little room for the female sockets to give and disengage the undercuts. I spent about an hour drilling acrylic to gain access to the sockets to free them up. I looked for a better way to accomplish my goal.
I went to my local hardware store and purchased some clear plastic tubing that would fit over the ball and part of the socket attachment. Not only does this block out the undercuts, but it also gives the socket prongs some movement room and holds the socket in position as you wait for the acrylic to set. When the acrylic has set you just pull out the denture and the very short piece of tubing you had placed and you are finished with no problems!
- February 1997: Quick Tip For Screw-Type Implants
Most instructions have you start your bone preparation with a slow speed round burr. I found that to be very difficult. The burr would chatter around and I would wind up not having the starting hole in the exact location I had chosen to place the implant. I have been gently using my high speed with a 1157 carbide burr, just to get a starting hole in the cortical bone. I find that I can control the implant placement position with a far greater degree of accuracy. This technique doesn't seem to damage the bone or cause any saucering around the neck of the implants. I emphasize that I am only making a very slight preparation with the high speed, and then going to the normal implant saline cooled low speed.
- December 1996: Keeping Clean Keyboards
We were reassessing various infection control procedures at our last staff meeting. One area of the office that we all felt needed improvement was our ability to clean the computer keyboards in each opertory. Disinfecting the keyboard between patients seemed very difficult if not impossible. We also were afraid of moistening it to the point that the contacts would short and generally destroy the keyboard. We tried covering the keyboard with Saran wrap but this approach turned out to be very frustrating. The wrap would keep falling off and fold etc. making it very difficult to type.
Our final solution was to use the same plastic covers we use on our trays. This fit over the keyboard nicely. Not only did they cover the keyboard but they pretty much stayed in place. We could disinfect these between patients and periodically just change them.
- November 1996: Frustrated Hygienists and Beeping Doctors
We have just implemented a great idea to solve a very frustrating problem in our office. We have 6 opertories in our office. The hygienists (many times we have two working at once) need to notify the doctor when they are ready for him to do the exam. In the past we had the hygiene assistant come over to where the doctor was working and verbally let him know that the hygiene patient was ready to be checked. She often would have to search for the doctor (he may be in his office or the lab) and they wait to tell him so she wouldn't interrupt him while he was talking. Sometimes, he would be so involved in a procedure that he would forget he was summoned. A very frustrating situation indeed.
We solved the problem by going to our local Radio Shack store and purchasing a local paging system. The cost was $80 and included a base station and a pager. When hygiene is ready they simply page the doctor and code in the opertory in which he is needed. He can shut the beep off after the initial signal or leave it activated. If he leaves it activated it will remind him every 60 seconds. If he deactivates the beep he can press the button on the beeper and the opertory number is displayed again so he knows which room to check. We really love the system.
- October 1996: Restorative Work Under Partial Dentures
Here's some advice Dr. Richard Ehrlich of Bolton, Ontario, gave to another dentist ("Jules A.") regarding restorative work under partial dentures.
Jules A. wrote:
My first patient tomorrow wants me to do all her restorative and take an impression for a new partial denture and deliver it in about 2 weeks before she returns to Germany. Has anyone had any bad experiences with using posterior composites under partial denture rests? I thought they might be more subject to fracture than amalgams. If I have to do amalgams it will end my streak of not doing any for over a year. I'll have fallen off the wagon! Thanks for advice.
Jules, for a heavily restored tooth the strongest partial abutment is a crown, as I'm sure you know, especially if you can incorporate an attachment. Resin has a good advantage over amalgam as a partial rest though- better adaptation to the rest of an existing cast denture.
You can build up most of the resin under rubber dam, them remove the dam and add more resin. Next, you coat the partial denture's rest with glycerine, such as the celebrated KY jelly. You can seat the denture and cure the resin partially around the rest. When you remove the partial denture, re-cure, coat with sealer and re-cure, you shuld have an excellent fit to the rest. I've had to do this fairly often, and it works much better than the old trial-and-error fitting of an amalgam.
I know this is a bit of a tangent, as you'll do the resin before the partial, but the resins in this case seem to hold up fairly well. The usual caveats apply- if the resin isn't too big, too subgingival or too messy a field. I haven't seen an unusual number of resin fractures under partial denture rests bearing these selection factors in mind.
- September 1996: My Thumb and I
Our office has recently come across an exciting development in handling those tough questions about curing a child of the habit of thumbsucking. For more details of the program see our patient article for August about thumbsucking and/or call Carol Mayer.
Carol A. Mayer, M.S., C.C.C./Sp., C.O.M. has authored a book/workbook called "MY THUMB AND I". This illustrated book details a proven ten step program to eliminate a digit sucking habit. The book guides six to ten year old children and their parents through the program using a glove and a parent guide. The book with glove costs between $29.95-$24.95 depending on quantity.
- July 1996: Temporary Bridges and Memosil
When you need to make a temporary bridge in a tooth colored material, instead of using the customary alginate impression before prepping the teeth, use Memosil. It is a relatively clear material that allows you to use tooth colored Triad to make your temporary bridge. I usually take the starting memosil impression without a tray so my light curing can penetrate better later. I cut a connection between the abutments to make room for Triad in the pontic area with a scalpel. After preparation of the bridge abutments I place the tooth colored Triad material in the memosil impression, have the patient bite down into the impression then light cure the accessible areas first. After those areas are cured then I have the patient open and cure the occlusal and lingual areas. I take off the memosil impression and carefully remove the now partially hardened Triad temporary bridge. I place the temporary bridge in the Triad unit while I am taking the final impression for the bridge. As the final impression is setting I trim the temporary and I am usually ready to place the temporary after removing the final impression. Typically, only minor occlusal adjustment is needed since the triad shrinks far less than the average acrylic temporary bridge.
- June 1996: Makeshift Suction Units
The next time your central suction unit goes down during the day and cannot be quickly repaired, simply attach your portable home Shop Vac to the end to power the suction unit. Until the repair man arrives, you can still function perfectly with the help of this $75.00 Shop Vac vacuum cleaner, available at any Home hardware store!
Nugget submitted by Dr. Greg James.
- May 1996: Eliminating Bubbles from Impressions
To help eliminate bubbles from your impressions consider this hint. After placing the syringe material around the teeth use your air syringe and lightly blow some air into the material around the sulcus of the preparation area. You will find that this helps eliminate many of the annoying bubbles that you seem to have at the marginal areas of your impressions.
- April 1996: Temporaries for Anterior Missing Teeth
We've all had those cases where a patient looses more than one anterior tooth, maybe has nothing distal to canine. How do you make a quick temporary until you can construct a more permanent solution? A new retainer technique called the "Essix" retainer can offer a solution. We talked about these retainers last month. Last month had link to their WWW site.
Take a model of the arch you wish to construct your temporaries for, then pour it up in a hard stone. Use triad to form replacement teeth (we are not worried about using these replacements in temporary, we just need shape to suck down Essix retainer). Cure the triad then procede to make a normal Essix retainer. When retainer is complete rough up the inner surface of the pontic areas and use tooth colored triad, shaping them in such a way that undercuts are not created at the mesial and distal gingival (path of insertion must not bind pontics). Cure the triad. Your temporary bridge is ready to wear. The patient will probably have to be careful and remove when eating but at least they look better.
The temporary can be used to make a new traditional temporary when they come back for a fixed bridge. At the bridge appointment remove pontics and use triad in former temporary Essix to fabricate a fixed temporary bridge after teeth are prepared.
- March 1996: Essix Retainers
Essix retainers are the nugget for this month. If you haven't tried them I think they are terrific. They are basically much like bleaching trays but the plastic that is used is much tougher and more resilient. Their wonderful attributes include: they are much easier for the patient to wear, you can make minor adjustments in tooth position with them, and they do not get out of adjustment like Hawley retainers. The only drawbacks that I have seen so far are: one-if you had posterior crossbites or rotations I don't feel comfortable in extending the coverage back to the molar area because of the bite opening effect. two- if your patient is a bruxer or clencher they wear the retainer out rather quickly. The company that developed and markets essix retainers has a web page at essix.com
Next month: A tip on how to use the essix retainer for a temporary partial.
- February 1996: A tried a true New Patient Machine!
I know you have heard this many times before, but this tidbit has been used by our office for 10 years with a resulting inflow of new families of at least 20 per year. If the average family has 4 members then we have brought around 80 new patients per year to our office. Not bad for a program that costs us very little.
The program is aimed at 3-4 year old children attending nursery schools in our area. As a field trip from nursery school the kids come to our office for a puppet show and office tour (incorporated into the puppet show). What a win-win situation. They are educated about dentistry and their probable first dental visit and we are a shoe in for their family to choose our office for dental care. (By the way: moms come along as drivers so they see our office too.) We have around 600 kids come through our office every year. The program benefits staff also. Not only does it make them feel that our office is involved with dental care in our community, but it also gives them a break from routine dental office procedures. They can be creative and have some fun!
You can develop this program yourself or a shortcut would be to purchase the plans for the puppet theater (by the way it is fully mobile if you want to take it to the kids) and you might want to purchase the puppet show script. You can click here to see some pictures of the show and puppet theater.
- January 1996: Quick And Easy Colored Temporaries
For the last couple of years I have made quick and easy tooth colored temporaries using Triad tooth colored material. For single teeth I just take some of the putty like Triad material and form it over the tooth, have the patient bite down, shape as best I can with a metal plastic instrument, then cure the visible part with a regular composite light. I then have the patient open and cure other areas of the tooth. I carefully remove the somewhat cured temporary and place in Triad curing unit for 6 minutes. Then I go ahead and take my triple tray impression. As the impergum is setting I remove the temporary from the curing unit trim and polish. They make excellent, strong temporaries with little bite adjustment necessary. Also no pre-preparation impression is needed.
- December 1995: Cheap And Easy "Thank You" Gifts For Referral Sources
I don't know about you but I am always looking for a good way to thank referral sources. I have tried many types of rewards, most of which involve going to the post office to get things weighed and mailed, etc. The expense has been rather prohibitive.
I have finally found the perfect gift. One that can be mailed for 32 cents with a thank you letter. One that everybody can use. Simply - A PHONE CARD.
These plastic cards (like a credit card) have a number to dial with a credit of $10, $20, or $50 worth of long distance calls. You can buy the cards at a discount, so it costs you less than the value the referring patients will receive. I can get the cards for you for $8.50 per card in units of 10 cards. If you are interested in this great practice builder eMail me and I will e-mail back to you with further information.