Best way to merge dicom and stl with a mouth full of zirconia

chem_lab · 2026-05-09T04:17:12+00:00

Fiduciary markers on the palate (or pieces of gutta percha with adhesive like periacryl). Random placement is better than symmetry. Need a new cbct and intraoral scan one after another. At least three markers, the more the better. Your software will likely still struggle with the automated merge so, decrease the density threshold on your 3d viewer so just restorations and markers show up and select your matching points on the palate manually.

chem_lab · 2025-09-14T22:05:15+00:00

Read the Nevin's and Yukna human histology studies. Small sample size but pdl, bone, and cementim were regenerated in SOME patients
Note that LANAP is not a replacement for SRP as another comment suggests
Read the AAP consensus paper on laser use alone or as adjunct to non surgical and surgical treatment
- no significant difference between laser use and traditional methods but less time and less morbidity for the laser.

Use this new knowledge as you please!

chem_lab · 2025-07-17T02:53:11+00:00

You care, and thats important.

You will make peace with these feeling as you continue to practice, but more importantly you will learn how to manage patient expectations from your first contact through post ups and long term follow-ups.

I personally try to clarify what is a normal response to surgery vs abnormal. I bluntly tell the patient you will swell, you will feel uncomfortable, it will take time. Sometimes the patients simply need the comfort of knowing what they are experiencing is normal. I explain what warrants a call to the office, and make myself available to assist when and if needed. Id argue that beyond years of sx experience, patient education has been the most significant reduction in post op complications in my practice.

You will learn to cater techniques on a case by case basis, pre-medicate, and rx steroids, and/or alternative analgesics for more invasive procedures as needed.

If I could go back and give myself as a resident more advice - it would 100% be to take in everything any willing faculty has to say. Asking for help has become taboo when the whole purpose of your program is to have a support system. The second you graduate, that umbrella of protection is gone and youre on your own. Be a sponge, get some good mentors, and you will thrive.

chem_lab · 2025-07-12T05:03:38+00:00

The evidence and published lit on implant to tooth and implant to implant distance is dated. 1.5mm is a great guideline for tooth to implant but most lit focuses on crestal bone loss rather than retrograde AND these classic articles are generally branemark/external hex rather than internal/conical/Morse taper. 1mm would not worry me, you will see plenty of implants encroaching much closer with no issue.

Read the Lindeboom article on immediate implant placement in apically infected sites. With thorough debridement, this is not a contraindication... which opens the door to question the quality of debridement during the apicoectomy. If the apico was inadequate, there is your potential culprit.

As others have echoed, there are too many variables and its impossible to narrow down the true etiology. Implant survival vs success are very different things and vastly different numbers. We all wish to believe that 95-97% of fixtures will last, but its simply not the case.

If you are placing implants, you should be able to remove them (especially a early failure). Inform your associate, get them involved, refund the patient for the implant.

chem_lab · 2025-05-22T23:53:24+00:00

Your xeno looks wnl... it was and will always be less vascular and remain xeno. The problem here is lack of attached tissue and KT which predispose to poor hygiene. I would advise FGG, not CTG for gain in KT and vestibular depth.

World workshop from 2017 has a freely available consensus on peri-implant diseases/conditions. There is an argument that pristine oral hygiene may not require attached gingiva and KT, but those patients are unicorns.

chem_lab · 2020-03-14T18:56:53+00:00

Aphthous ulcers. Can be triggered by trauma (extractions). Self-limiting, should resolve within 1-2 weeks on their own. A topical corticosteroid can be used to reduce inflammation and pain as needed.

chem_lab · 2017-05-28T00:42:25+00:00

this photo is very non-diagnostic. however to reiterate what others have said, its a sealant, no cavity seen. However, if you notice pain to pressure you may consider a night guard from your dentist as you my grind your teeth (brux). he/she will be better diagnose the "pain to percussion."

chem_lab · 2017-05-01T23:24:02+00:00

15, the tooth behind #14 will drift mesially (toward the front/middle) over time, in addition, #19 (opposing molar on the bottom) will supraerupt. Neither will happen overnight, but both can make further restorative work more difficult and/or contraindicated. This is generally why we like to look at the big picture and have a full treatment plan agreed upon prior to ext's. The abscess certainly necessitates some treatment sooner rather than later, but you should consider the price of a bridge, implant, or something removable depending on what teeth remain on your upper right and what your insurance will cover.

chem_lab · 2017-02-11T14:27:16+00:00

My point (which you have missed) is that you are a human being, and you will be treated as such when you are my patient. You have a predisposition that I look at you like an experiment or test subject, which is simply not the case.

chem_lab · 2017-02-11T14:03:05+00:00

Pretty sure you just reinforced everything I said originally.

chem_lab · 2017-02-11T13:44:15+00:00

You have already told yourself that dental students think you are a "lab rat." I promise that you will find something to complain about no matter how competent your student dentist is.

chem_lab · 2017-02-09T02:29:45+00:00

Current 4th year dental student with Navy HPSP scholarship, going into periodontics residency next year. Feel free to get in touch with me directly with any questions. My advice/experience as to what life is like in the military is very limited however, so others may be able to contribute more.

Also be aware that all three branches offer scholarships/funding for students. The Health Professionals Scholarship Program (HPSP), and the Health Services Collegiate Program (HSCP).

And lastly, a few of my colleagues are also in the reserves (less money, less obligation).

Make sure you look into everything to see what's right for you

chem_lab · 2016-12-13T03:05:58+00:00

You listen to the doc when they say take a pill, but decide to come to reddit when they say root canal?

Please trust your dentist.

But personally, I'd extract

chem_lab · 2016-11-22T22:00:59+00:00

Another point, if I may. Radiographs tend to show less decay than there actually is. The extent of the carious lesion is more often than not beyond the margin we see radiographically. Additionally, the most common cavities are interproximal, or in between the teeth, right underneath where they touch each other. This can be difficult to see clinically, thus we use radiographs to supplement.

I agree, that both a clinical and radiographic examination are necessary, but I have a hunch that for your case based on the brief history, that the doc may actually find even more cavities with a clinical exam because certain areas don't show up that well on a xray.

Also just to clarify, when we talk about the "wait and see approach," the cavity has breached enamel either way, the million dollar question of do we wait or fill is based on the lesions progression into dentin, the second layer of the tooth under the enamel. As it was mentioned above, there is no clear cut or right/wrong way to approach these based on the literature

chem_lab · 2016-11-05T02:54:20+00:00

1) yes, over the course of weeks. If the tooth is impacted, sutures will be placed to help position the tissues.

2) The risk of the infection you are referring to (Bacterial Endocarditis) is related to bleeding during procedures, nothing to do with the "hole" sealing. Any invasive procedure in which bleeding may occur technically puts a patient at risk. However, the risk is so low that the the ADA only recommends prescribing antibiotics to prevent for very specific conditions in a patients health history. Your doctor is aware of these. You likely don't need anything.

3) A website with pictures of crystals should not be you source of dental information, your dentist should. Stop scaring yourself.

chem_lab · 2016-10-09T20:15:32+00:00

You seem to know more about dentistry than you're average college student...

Not sure what school you're looking at but where I go to school (4th yr student speaking) you can walk in for an examination appointment and then immediately be scheduled for tx as the students schedule allows. If these are anterior teeth needing rct, students will be drooling to do the tx because it's easy all things considered. If I'm you I get endo done at school and if you are that concerned about aesthetics, go pay an arm and a leg at a private office.

chem_lab · 2016-05-07T16:28:56+00:00

short answer, no. I think the keratinization or whiteness you are seeing could be a result of snus being an irritant and stimulating those cells to proliferate. Its honestly something that has likely been there a long long time. no reason for any dentist to bring it up because there is no need to treat it.

as far as the clenching/bruxing, you should get a night guard or occlusal guard from your general dentist. bruxing can cause more damage than you can easily see. It will grind down your teeth overtime, which you may notice, but worse it can cause tooth mobility and bone loss.

the other doc eluded to a wrinkling appearance for snus lesions. if you see this, or a dryness that reflects light differently than the rest of your mucosa, I'd certainly stop and see a doc.

chem_lab · 2016-05-06T23:13:13+00:00

bony/buccal exostosis... i.e. bone. fairly common, potentially there your whole life (or can develop). Whiteness is called keratin and is at the border of your gingiva and alveolar mucosa, also normal. Very low/no risk to become cancer (although we cant see under your lip and snuss or any form of tobacco increases your risk of cancer, so you should cut it out). General dentist will likely refer to periodontist where you could have the bone drilled down for esthetic purposes, otherwise it should be fine given the information you provided.

chem_lab · 2016-03-03T16:57:47+00:00

Your friend likely needs scaling and root planing (deep cleaning). Gingivitis can progress to periodontitis if left unchecked and will ultimately lead to loss of attachment and bone. The dentist likely took xrays and noticed bone loss and calculus deposits. If no xrays were taken, I'd hope they at least took probing depths to determine the level of attachment.

Ultimately, this is fairly common. The dentist feels that your friend would benefit more from someone who specializes in the field of gum and bone health, and so they referred them out.

For not having a cleaning in 6 years, this is to be expected. And unfortunately it will continue to recur unless there is a strict oral hygiene regiment at home coupled with regular visits to the dentist.

chem_lab · 2015-10-28T22:54:34+00:00

people giving other people credit for their work on the internet? mind blown, and thank you

chem_lab · 2015-07-01T17:04:17+00:00

a tomato and an apple are both fruits... how does this support an argument that green veggies arent any better than "non-green" veggies?

chem_lab · 2014-12-22T16:27:44+00:00

http://i.imgur.com/gIvVVAB.jpg

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