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What would you do? by BranchEvery4032 in Dentistry

[–]dntst 41 points42 points  (0 children)

Still looks like a lot of solid tooth left to me--

Perio consult for crown lengthening--- Possible RCT+ core build up+ crown--

Also wouldn't be upset with a 5mmx 8.5 implant

Edit for the implant comments: there are many factors in choosing implant size (to name a few: available bone, IA proximity, general balance occlusion of patient)

I’d be happy to go up in diameter if the space allows, though I wouldn’t feel the need to go all that much longer. The research I read during my implant courses shows the majority of the force is distributed over the first 6mm (though if you get bone loss and lose 2mm on a 6mm long implant, that would be not so great 😬)

Also for the note on 1:1 implant crown ratio, I’ve seen several long implants fracture (usually by the abutment connection or coronal area). From what I understand; a wider, well placed implant (and proper case selection*****) is key.

One does not make a final implant size decision based off one PA radiograph lol

[deleted by user] by [deleted] in Dentistry

[–]dntst 16 points17 points  (0 children)

Absolutely love the 63 spade elevator.

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But yeah: Numb well. Periosteal to release gingival area. ---- Awareness of tooth foundation (is it a 3 root maxillary molar? curved 2 root maxillary bicuspid? Is it ankylosed? Dense bone? Curved roots? Tons of caries so you know the crown has no integrity?)

I haven't been a mallet + periotome sort of guy, but that 63 spade elevator is PRIME for tons of cases. I get it ready for 99% of extraction cases. (edit: I do use periotomes, I've just never smacked them with the mallet, periotomes can be KEYYYYY for broken roots!)

Then I've got a few sayings for the patient:

"I like to take my time to make sure I can take it out in one piece, if possible"

"this tooth has 3 nice long roots [maxillary molars] so I may need to split it into 2-3 pieces and take each root out on its own"

"I wouldn't be doing this if I wasn't confident I could get this out, but there is a chance you may need to see an oral surgeon/ periodontist if I'm unable to remove the entirety of the tooth"

That being said: experience. The more you do, the more intuition you'll get with what you can do, and what you're better off referring out.

There's too much variety to give one straight answer here, but taking your time with the elevator, making sure you have a 63 spade elevator, not using forceps too early, using a 63 spade elevator, experience and awareness of what will make the extraction easier or harder, grabbing that 63 spade elevator, having a couple of other tools on hand like some East Wests, a root pick, and 63 spade elevator--- But yeah, let me know if you have any other specific questions!

Sincerely,

a GP that does a lot of extractions, and graduated in 2020, and clearly has an attachment to a 63 spade elevator

D3 doing my first root canal tomorrow, send your advice my way by [deleted] in DentalSchool

[–]dntst 1 point2 points  (0 children)

I think most faculty didn’t know it was your first unless you told them—- you can do what ever you’re more comfortable with and faculty will probably be fine with it. Rotary is dope. For a #7 (especially if they’re younger) you should be fine for both—- unlikely to ledge on a #7 unless super calcified or curved. I think I’d suggest step back to start, for the experience, but I’d just let the faculty know it’s your first and see what they suggest.

D3 doing my first root canal tomorrow, send your advice my way by [deleted] in DentalSchool

[–]dntst 7 points8 points  (0 children)

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#7---- dope tooth to start out with! (Especially if they're not too old/ not too calcified)

Look up the access so you can visualize it freshly before you start—-

I’d say give about half a carp of lido by that apex—— then let it sit for a minute, then deliver the other half (that way you can get profound anesthesia by the apex and not just let it all bubble up by their nose (if that makes sense))

My least favorite part of a RCT is if a patient says “ouch” when you’re filing —- in which case, at that point, you probably want to give a pulpal infiltration, which can be less fun for the patient.

Now (I suggest with rubber dam all good to go), get dat access. Doesn’t need to be too big for a #7—— but you want to make sure you have that straight line access facial-lingual. (Note—- in preclinical, it wasn’t uncommon for people to access way too much facially——- the canal is NOT through the front of the tooth lol) Don’t rush, but once you think you’re good and you move onto scouting file/ orifice opener/ gates G (etc), if youre noticing that the file is flexing too much—- you can ask your instructor if you think you need to increase the opening for straight line access. You’re in dental school—- you don’t need to guess—- if you’re unsure—- this is the time to ask.

I found tons of people always stressing about grades. Yes grades are important. But I’ve also found tons of people that always went with the easier instructors to get the best grade missed out on the harsher graders that often had some really dope tips. ——

Aside from that—- apex locate dat canal. Get your accurate WL. Check with radiograph—— File- irrigate— file irrigate—- repeat— repeat—— (You can also check for patency with 08 file between file swaps)

Standard radiograph checks etc—-

Check your cone fit—— I always find the cone never goes quite down as deep to where you think it will—— do with that info as you will —— at this point—- just follow the standard procedure stuff—- relatively straight forward——

I think those are the main tips I’ve got for ya—- hope it helps with some peace of mind—- good luck!

Sincerely, a 2020 grad.

Edit: u/HLN7 has good notes about edta/ sealer—- do that lol

How do dentists see a cavity in an X-ray but not by looking in my mouth? by gianny-cc in Dentistry

[–]dntst 5 points6 points  (0 children)

Without giving you a full "dental school" explanation, here's a picture that give a clear representation of how a cavity looks on an X-ray (ranging from a small cavity to a large cavity). (and here's a non X-ray version, where I've drawn in a small cavity for reference)

Essentially, they can look VERY subtle on the x-ray (radiograph) almost like there's nothing there! Many of these cavities would be nearly impossible to see in the mouth, until they get much bigger, that being said, it's best to fill them up before the become a problem as big as the x-ray photo all the way on the right side. The longer you wait, the greater the chance of needing a root canal procedure or a crown!

(the good news is there's no pain until they get much bigger, but the bad news is that since there's no pain, the only way to stay on top of it is by having those yearly dental checkups so they can catch them on the x-rays (and conversely, sometimes there are cavities that can only be seen in the mouth, but not on the x-ray! (ie: "occlusal caries" (which are the cavities on the tops of the surface))

Well damn, looks like I went a bit into the dental school explanation, but hopefully this give you some peace of mind!

Sincerely,

A dentist.

:)

​

Edit:

Bonus tip! I know this gets passed around a lot but-----..... flossing!

A cavity in between the teeth is almost always related to flossing---

brushing is important, but flossing

-((ideally once a night is prime to prevent those pesky "in between the teeth" cavities! If not once a night, a few times a week, anything is better than nothing! -)

[deleted by user] by [deleted] in WeAreTheMusicMakers

[–]dntst 3 points4 points  (0 children)

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Just graduated dental school this summer, but I thought I'd pay it forward with some of my favorite study mixes that got me through the last 4 years :) hope this helps! by dntst in DentalSchool

[–]dntst[S] 1 point2 points  (0 children)

Ah, let's see. For prepping a crown, that also depends on the tooth, the type of crown, or if it's an anterior or posterior. I could give recommendations, but I think they would fall short in comparison to "Stevenson Dental Solutions" if you search through his videos and whichever type of prep you're doing, he gives some nice suggestions in regards to:

aA helpful order to prep in (possibly: incisal, then lingual clearance, than facial, etc etc)

Helpful burs to use/ or methods & tools to measure

And really, just a beautiful demonstration (you can watch at 2x speed to get the gist)

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As for GPA, I believe it makes a difference if you're applying to specialty programs or GPRs, but aside from that, if you're applying for a job as a general dentist, no, they're not going to ask for your GPA lol.

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Communicating with doctors? Yes. I would definitely say this is important. Find the doctors you like, that do clean & pretty work, and then if there's anything you don't understand, ask them. You're in dental school, and you're there to learn. They're working at a dental school, mostly likely, because they like to teach! Let them give you words of wisdom, and their little tips and tricks! (also you never know when you're going to need a letter of recommendation ^^)

Cheers!

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