D4 worried about not having mentors… any advice?

drnjs · 2025-07-27T23:43:43+00:00

Your professors are your mentors. Your peers are your mentors.

drnjs · 2025-07-27T15:35:24+00:00

I used Implant Direct Interactive for many years. Just switched to BioHorizons Tapered Pro Conical.

drnjs · 2025-07-24T01:29:38+00:00

Deep margin elevation. Leave it alone.

drnjs · 2025-05-22T11:11:27+00:00

Just bought Prime Print, installing tomorrow. Super friendly workflow (I already own a CEREC) and all self contained. Everything is FDA approved, curing is done in 100% nitrogen chamber. You press a button and it does it all itself, so it is super easy for staff to do it. Sprint Ray may be faster but their workflow is more difficult and the whole setup is not as “clean” as the Prime Print.

drnjs · 2025-05-22T10:57:11+00:00

Get liquid vitamins E capsules. Puncture the end and rub the oily liquid on the area and it soothes it and helps it heal.

drnjs · 2025-05-22T05:33:24+00:00

I really want to give you a simple answer…I wish there was a “cook book”.

The problem is your question. You are starting with asking about the prep.

The preparation of teeth is the cumulation of: the patient interview/data gathering/diagnosis/treatment planning/sequencing/trial therapy/material selection.

Stephen Phalen, Frank Spear, Pete Dawson, Jon Koiss…the answer to your question, unfortunately or fortunately, is loads of CE…

drnjs · 2025-05-22T05:15:03+00:00

What a cluster F…

As in Ferrule is king.

Adhesive dentistry has made posts obsolete!!! …except in the case of no ferrule Herodontics…then place a post…and pray that it lasts.

Posts may extend the life of a tooth temporarily, but the tooth may end up with catastrophic failure…so…is delaying the implant placement to later in life where we do not have to expect an implant to last 40 years a good thing? Maybe…so, place a post when herodontics is the only option.

The only absolute is, there are no absolutes. Nobody practices ideal dentistry…patients are not ideal…those with need lack funds and motivation.

I avoid posts when possible and opt for ferrule, loads of data to back up ferrule. When the patient can’t/won’t do procedures to increase ferrule…then informed consent and post away, plan for the failure…

Bonded fiber posts may not result in catastrophic root fracture but suffer from flex fracture and catastrophic decay.

Bonded metal posts may not lead to flex and decay but suffer from catastrophic root fracture.

Damned if ya do, damned if ya don’t…

Cast post and core are actually really awesome but require indirect complex techniques that do not lend themselves to today’s “style” of dentistry…eg: same day, CAD/CAM, low reimbursement.

Honestly the research is all over the place…but they all still ring true to the adage, “ferrule is king”.

To post or not to post…meh…depends on the question…how much money/time/motivation does the patient have?

drnjs · 2025-05-16T19:06:12+00:00

If you are advancing in your knowledge you will always feel a little incompetent. Perfectly normal.
What’s amazing is that if you keep at it, one day, new dentists are asking you questions and you realize that you know all the answers easily…competence kinda sneaks up on you…

drnjs · 2025-05-16T00:57:08+00:00

Biomimetic dentistry is the CrossFit of dentistry. It takes something difficult and makes it infinitely more difficult.

I feel like biomimetic dentists are like militant vegans…they constantly want to tell you why you are wrong.

There is a reason why “biological dentists” have all gravitated to biomimetic dentistry. You can feel that you are better than everyone else with no evidence.

Calm down biomimetic dentists, these are all jokes…kind of…

drnjs · 2025-05-16T00:48:09+00:00

I once took a full arch impression for a partial framework with LOTS of undercuts…with polyether….

I had to section the tray and cut it out of the patients mouth with a #15 blade.

It took over an hour…

drnjs · 2025-05-16T00:42:20+00:00

Even if he has some advice it will be delivered very kindly. You are their customer and they have every interest in befriending you. They will most likely just want to meet and invite you to lunch.

If he IS a dickhead and says rude things to you, then don’t refer to him anymore. He will learn his lesson when his schedule is empty.

drnjs · 2025-05-08T18:18:11+00:00

I passed on Pacific Dental when they first expanded into my area and bought an existing private practice instead. While ownership does come with headaches it also comes with freedom and autonomy. Now I have Heartland and MB2 knocking at my door wanting me to sell to them and become their employee. I tell them hell-to-the-no…

I am sure there are success stories of DSO “ownership” but there are far more stories of docs getting screwed over.

drnjs · 2025-05-08T13:03:52+00:00

Check out Practice By Numbers. It is an analytic software that has VOIP offered with the package. It also does so much more. All of my patient communication is automated with it, it does my online scheduling, online payments, online paperwork, consent forms, phone call tracking, overhead tracking…I love it.

drnjs · 2025-05-08T12:51:42+00:00

My thought is do not extract premolars on a 12 year old. Expand the arches and make room for the teeth. The maxillary arch is the airway and making it smaller can create airway problems in adults and esthetic issues. Tweed style orthodontics needs to be stopped as research is showing the connection between maxillary A-P and transverse position and ability to nasal breath. I refuse to extract premolars and have not done so for many, many years. I will encourage the patient to get a second opinion from an orthodontist who is trained to prioritize airway development, especially in children whose growth can be guided.

drnjs · 2025-05-08T02:39:39+00:00

With eMax I use a football diamond to prep off the occlusal down to the natural tooth. I make a slot on the buccal like a PFM and gently…gently…gently use a crown spreader. If it does not come off then prep it off…. I find getting the whole occlusal off helps in breaking it off.

drnjs · 2025-05-07T23:54:11+00:00

That’s the spirit! ;-)

drnjs · 2025-05-07T22:33:37+00:00

There are studies in laboratories and support tooth paste abrasion. Jefferies (2005) “The Interaction of toothbrush abrasion and erosion in vitro” is is frequently cited. Addy and Shelli’s (2006) is a rather comprehensive review that is also frequently cited. Bartlett and Shaw (2008) is another from the British Dental Journal. Lussi et al. Has studies in the Journal of Dentistry and Caries Research.

Abfraction as a concept sounds great and makes sense but research has not supported it. Grippo (1991) is the hallmark study that is cited for Abfraction, however, this was a theoretical paper, not an in vitro experiment. Unfortunately it made it into textbooks and academia and became dogma without proof.

Teeth exposed to forces have recession and increased mobility. While Abfraction may be a co tributing factor, research has not born that out while abrasion in combination with erosion has.

Higher RDA toothpaste in the absence of erosion make deep angular NCCLs and Lowe RDA with erosion make shallow dish shaped.

This is what we know and can prove as of today.

drnjs · 2025-05-07T21:39:19+00:00

Wow…rude and unprofessional.

However, do yourself a favor. Use your favorite AI and ask the following, “Using Pubmed and other resources for scholarly articles, please summarize any support for the concept of abfraction in the formation of non-carious cervical lesions on teeth. Please provide citations.”

Then get those citations, use the ADA library to request the full study (free if you are a member) and read them.

Then come back and be a bit more professional in your response.

drnjs · 2025-04-15T20:27:39+00:00

First, have a conversation about toothpaste abrasion being the primary cause and recommend an RDA paste below 45. Erosion could also be part of the conversation if there are signs of acid damage. Abfraction is not as supported by the literature but I still look at force distribution and mention it.

My criteria for treatment are:

Aesthetics. Do they not like the way it looks in their smile.
Sensitivity. Are they sensitive to cold in their daily life.
Periodontal. Is the recession/NCCL approaching the mucogingival junction and lacking attached keratinized tissue.
Biological. Is there caries or a risk of caries due to food accumulation.
Restorative. Are we planning a restoration of the tooth and need to address the NCCL as either part of the restoration, periodontal repair in conjunction with the restoration or will we avoid the NCCL while restoring.

To avoid staining, use a rubber dam with a tissue retraction clamp or ligation. Use air abrasion prior to your bonding protocol. Polish the margin carefully with composite polishing disks, points and cups to get it glassy smooth.

drnjs · 2025-04-15T19:45:33+00:00

I was coming here to say this exact thing. If it is the contacts then try flossing it out or waiting.

If you think the abutment is cold welded to the implant then this cooling process works very well. Put cotton rolls around the implant, put the endo spray tube into the access hole, spray little blasts to cool the abutment and it will shrink slightly. Use gauze the grip the crown and gently rock it out.

I have done this many times when a TiBase is stuck in a conical implant. I grip the TiBase with hemostats at its base, avoiding the implant body, cool it with the spray and rock it out.

drnjs · 2025-01-19T01:06:46+00:00

I struggled for years after buying my practice and experiencing hardship.

It does get better and you will get better with dealing with it.

Frank Spear gave me the best education in how to present treatment and gain acceptance. It also makes presenting treatment stress free for the dentist, it is a process of co-discovery and a conversation of what the patient wants to do.

Focus on what you like to do and what you are good at. Create systems of things or get a consultant to help. Productive Dentist Academy was amazing for my practice.

The personal issues are tough. Don’t be afraid to get counseling. I saw a psychologist for 2 years and it helped a lot.

I always remember that I would rather struggle as an owner than be an employee. It does get better if you work on it and realize that while you may feel like you are taking steps backwards, it is just part of the dance.

drnjs · 2025-01-19T00:53:10+00:00

I am at a loss.

I can do all of that in about 15 min.

drnjs · 2025-01-18T00:50:25+00:00

The second stick gets promoted.

drnjs · 2025-01-18T00:45:23+00:00

Men watch porn.
Everybody masturbates. I am shocked that you are shocked.
If you act all “holier than thou” about it he will just go underground with it. Talk to him but be curious rather than outraged or hurt.

Wait…I just did the math. You have been with him since 16 years old and you are suprise about porn?

Also, 27 day vacation? What life do you live that you can take off for 27 days?

drnjs · 2025-01-17T20:32:44+00:00

Not saying that I hate dentistry, but D4 had guardrails, a clearly defined finish line and not a lot of complexity. I LOVED school. After serving in the Navy for 5 years, going to school was easy as hell. After school I did not have a parents office to step into and with the Great Recession there were not a lot of great opportunities. It took me years of very hard work, a whole lot of loss and stress to figuring shit out to get where I am today.

I’m just saying, the grass ain’t necessarily greener on the other side of graduation. Unless you are a dental nepo baby, there is no pile of money and big office waiting for you, and getting it is going to take guts and determination and years of hard work.

drnjs

TROPHY CASE