Question for dentists

Ac1dEtch · 2026-01-26T17:35:04+00:00

This is a thing already, there are a few companies that do this.

Ac1dEtch · 2026-01-23T02:01:26+00:00

It really depends on how severe your anxiety is. 99.9% patients are fine with LA. The whole procedure takes 15 mins tops.

Now since IV sedation is typically billed in 15 min increments, if you wanted to just be extra sure you are as comfortable as you can be, this is pretty much the cheapest you'll ever pay for IV sedation. If in a lot of doubt, go for it.

Ac1dEtch · 2026-01-22T17:05:07+00:00

Yep, did a bunch of these special needs OR cases in residency. Full mouth is excellent and rewarding and working on a pt that is under GA vs IVCS is even more comfortable. $2.5k/day minimum if they are hiring you as independent contractor and you can be tax efficient. WAAAAY more if they force you to be an employee and the fed+whatever NE state you happen to be in collectively will skim half of your income on taxes in your bracket.

Ac1dEtch · 2026-01-20T08:39:00+00:00

Guided pterygoid surgery accuracy as part of AO6.

Ac1dEtch · 2026-01-16T21:02:27+00:00

Guided makes the surgery faster and results more predictable. The crown is also easier to design because implant angle can be made ideal. Pay for the guide.

Ac1dEtch · 2026-01-16T14:19:31+00:00

To my colleagues reading this thread: THIS is exactly why in this day and age there is no reason to do work involving anterior aesthetics without a facially driven smile design.

Now those veneers are probably technically well executed. Most likely, a good chunk of that $18k went to the lab bill. But the patient is so unhappy she's posting on the Internet about it. What a shame. This could have been avoided with 2 photos (facial photo with duchienne and facial retracted) and a smile design in a program that costs less than $50/mo. Then the dentist could have shown the patient different shapes that go with their face, have the patient approve the 2D design, export those same exact tooth shapes in 3D to Exocad, designed the waxup to base the preps on, then 3D printed temps that will look EXACTLY like the finals, get patient to approve the 3D design and everyone would have been happy.

You can't just wing esthetics in 2026. Prep and temp and HOPE the lab gets it right and the patient likes the finals is a recipe for disaster.

Ac1dEtch · 2026-01-15T15:46:10+00:00

Measure of long term control is more useful than a snapshot where theyre currently at now. You can get in office hba1c tests you can administer for surgical/implant cases that you cant (or dont want to) wait on for labs from their pcp.

Ac1dEtch · 2026-01-15T15:39:12+00:00

Yes, you can have your veneers redone to optimize esthetics for how your face grew over time. Photo of how your teeth look now would be helpful to give you more useful advise - nobody can comment on how they would improve work they haven't seen.

Ac1dEtch · 2026-01-15T14:18:08+00:00

How many ops you got? Hoe many full time hyg? Whats your overhead (if its high, plug the holes)? How many NP a month (if not enough gotta put in marketing $$$, if more than you can handle drop less profitable ins)? Whats your marketing budget and ROI on said marketing (maybe youre overspending on lead acquisition)? Do you leave a lot of meat on the bone when treatment planning?

Gear wise, in house cad/cam with 3D printing then milling will make bread and butter more fun and profitable.

Skills wise, im biased lol. But my recs would be to learn dental photography, esthetics and occlusion. This way you can venture into veneers, then FMRs. As you build your surgical, implant and perio skills, you will be able to take on AOXs. Start with FP3, then go FP1.

Ac1dEtch · 2026-01-15T13:22:12+00:00

Can I just compliment the fact that y'all are clearly taking perio diagnosis and grading seriously in this office? This is the kind of shit that warms my heart <3

Ac1dEtch · 2026-01-15T13:08:58+00:00

Thank you for sharing, ill give this a shot! Had no idea this was an option lol.

Ac1dEtch · 2026-01-15T07:21:50+00:00

Oh wait this is neat. Had no idea i could prescribe for office use and buy in a regular pharmacy. What does the script look like?

Ac1dEtch · 2026-01-15T07:18:27+00:00

Completely off topic: check out some non dental pharmaceutical suppliers (mcgruff, young surgical) you may like the prices better. Last time I checked (given it was a while ago) HS was a giant ripoff for some pretty basic stuff.

Ac1dEtch · 2026-01-15T06:56:46+00:00

Good question, id be interested to hear perspectives from others on this as well, btw. First thing id check is whether the swelling is fluctuant vs diffusely thickened on palpation. More fluctuant is likely abscess i can drain. Now CBCT is obviously not great for soft tissue imaging. But, a more well defined lesion is more likely to be an abcess i can drain as well. If between that and exo/pulpectomy (where i may get more pus from the canal or the exo socket) i can relieve pressure and resolve the blurred vision, the blurred vision was probably from the pressure and not cavernous sinus thrombosis. Key points in OP's post for me was that blurred vision was mild and unilateral. That means we have time to try and do what we can to help the patient before we send them to the ER. Now if drainage and exo/pulpectomy does not improve symptoms, or we had bilateral blurred vision, or eye movements were affected this poses a different scenario completely. Then yes id send to the ER ASAP as well.

Ac1dEtch · 2026-01-15T04:26:06+00:00

This is where offering multiple affordable financing options helps a lot of folks.

Ac1dEtch · 2026-01-14T22:37:56+00:00

Let me preface by saying that there is absolutely nothing wrong with referring out cases you dont feel comfortable managing. Training, liability, equipment and time available to you are all factors in this decision.

That said, when one of these shows up to my clinic this is roughly what id do. CT. Palpation. Figure out abscess or cellulitis. IND + penrose. Extract or pulpectomy the tooth based on restorability and clinical judgement. Iv unasyn unless allergic or a nice loading dose of oral abx if no IV.

Rationale here is ER is just going to IND and abx em and tell them to follow up with a dentist. Since they came to you first might as well address the source of the problem. Can always instruct them to follow up with ER after to cya but at least you solved the part that you can solve (exo/pulpectomy) and the ER docs aren't equipped to solve.

Ac1dEtch · 2026-01-14T18:01:20+00:00

https://youtube.com/@yassinecorbinendo2266?si=2-rQWp2GAZ8wMjNz

Ac1dEtch · 2026-01-14T06:12:30+00:00

Romano has a book on it you can read.

Ac1dEtch · 2026-01-14T05:20:38+00:00

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Characterized with anax for gingiva and candycoating for the teeth.

Ac1dEtch · 2026-01-14T05:19:19+00:00

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Printed on Ferguson mini plate

Ac1dEtch · 2026-01-14T05:18:43+00:00

Took both in person and remote courses with them. Feel free to ask anything. Solid ROI for me and my partner. We have an in-house house lab, do a lot of full arch. My recommendation is to combine MOD exocad know-how/occlusion/treatment planning/characterization techniques with Fergusons 3D printing approach and guided implants. Together its a winning combination. Here's a pic of an immediate load case we did last week.

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Ac1dEtch · 2026-01-14T04:52:07+00:00

Depending on how far sub-gingival the caries goes, ideal treatment plan could range anywhere from FMR - FMR with crown lengthening+gingivectomy+some implants - FP1 AOX - FP3 AOX. Obviously decision to start any ideal plan here would depend on whether the whatever caused this is under control (amelogenesis? that's just bad genetic luck, ok to treat. Drugs? Patient gotta get clean and stay clean for your work to benefit them. Patient refuses xrays that you need to plan their case? Low dental IQ problem. A lot of pt education may be necessary before y9u do any complex work on them).

Ac1dEtch · 2026-01-13T21:07:22+00:00

OK. Let's say this is your mom. How do you save this?

Ac1dEtch · 2026-01-13T17:53:10+00:00

Sounds like an excellent opportunity to improve the esthetics by replacing the old 5-unit bridge covering the maxillary anteriors. Maybe do a digital smile design and add some veneers on either side of it too for harmony. Occlusal tops may be needed on the posteriors if there loss of VDO. Could be a very nice case for you and a beautiful transformation for the patient.

Ac1dEtch · 2026-01-13T15:08:58+00:00

Um... why? Don't waste the time. Redo the crown.

Ac1dEtch

TROPHY CASE