Clinical Dentistry Tips: 3 Keys To The Perfect Bisque Trial

 

Clinical Dentistry Tips: 3 Keys To The Perfect Bisque Trial

 

On one end of the ladder is leaving the crown high and telling the patient “Settle ho jaega” and on the end is over reducing the prosthetic crown thinking “yeh supraerupt hoke contact mein aa jaega”

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Unfortunately both these can have long term deleterious effects on the patients dentition and thus we clinicians should refrain from such erroneous practice.

 

As ethical clinicians, it is imperative that we do not introduce any interference in the patient’s mouth when crowning a tooth and this makes adjusting the occlusion at the bisque trial phase one of the most critical steps in fixed prosthodontics.

Occlusion at bisque trial should be adjusted in two separate steps:

 

1. Static Occlusion: Where the bite is adjusted in Maximum Intercuspation with POINT contacts on functional cusp tips, mesial/distal marginal ridge and/or central fossa only. 

This should ideally be done with 40 micron Blue colour articulating paper.

 

2. Dynamic occlusion: Where excursive contacts are checked (in working side excursion as well as non-working side excursion) and any LINE markings are eliminated completely. It is important to remember that posterior teeth should contact only during Maximum Intercuspation and should be completely disoccluded in every excursive movement.

This should ideally be done with 40 micron Red colour articulating paper

 

Let’s see how to go about doing a Bisque trial for tooth number 17 diagrammatically.

 

 First static occlusion is adjusted to achieve 4 points of contact in MIP using blue paper.

 

 

 

Next with red paper working excursion is checked. As depicted a line is seen on the buccal cusp. This line is a working side interference and thus should be completely eliminated.

 

 

 

 Following this the non working excursion is checked and any red line marking is eliminated.

 

 

 

This concludes the bisque trial and the crown is now ready for glazing.

 

 

 ”Dots at the Back and Lines in the Front” is the key to achieving an interference free occlusion.

Source : DentistFriend

Dental Photography: Are You In Focus?

 

Dental Photography: Are You In Focus?

Despite having innumerable hours of experience with shooting I have met many dentists who pursue dental photography in the AUTO mode.

I have nothing against the use of AUTO mode but I feel there is a HUGE need for the dentists (AND OTHER MEDICAL EXPERTS) to understand that by using the camera in auto mode one fails to realize the true potential of ones DSLR (or other camera) The AUTO mode is nowhere close to what a DSLR camera can really achieve.

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It’s actually like a monotonous robot who fails to have a mind of his own.NO creativity, No BRAIN, NO Ambition and NO experimentation … what a dull life.

Despite being a boring mode to shoot in the AUTO mode has innumerable drawbacks one of the greatest drawbacks being the loss of freedom to choose the right focus point.

This post shall be helpful to all the beginners in dental / medical photography who want to understand WHY despite innumerable attempts they do not get a sharp image in any particular situation”

It’s invariably important to have a rough idea of the composition of an image in your mind, not a difficult job for a dentist considering we have few options for standard type of photography. (Of course if you would like to be creative Sky is the limit … but that’s not the point for this post)

 

We now have a set composition and a magnification to shoot at. We know the settings to shoot at.

 

The Next step is to focus accurately.

 

In semiprofessional cameras there is a box (actually meant for face recognition) to help you focus on the area of interest.

 

In AUTO mode this box tends to change place and even before the dentist knows the box shifts to a place which the camera feels is the desired region for focus and the result is a blurred image.

The reason for this is that the camera will focus on the easiest spot as soon as possible and this usually is a well-lit area with high contrast (be it intra oral or extra oral photography) this area need not be the area where the dentist wants to focus.

So is there a way the dentist can change the focus spot? The answer is yes

In semiprofessional cameras too you can switch to manual focus and manual mode of shooting and shift the box to where exactly you would want to focus.

Remember SMALLER the box … greater will be the accuracy of the spot where you would like to focus.

Speaking about DSLR we have a much professional way to solve the issue

Every DSLR has specific focus points (Number of focus points - 9, 11, as many as 100 or more)

A dentist can pre-select the focus point of choice based on the composition of the image in his/ her mind.

 

For e.g., selecting the top focus point instead of the center focus point might give greater sharpness to the central incisors which are the subject of conversation in the image.

The focus point can be easily selected using the main dial in Canon cameras. The focus point selected turns RED in the optical viewfinder and also on the LCD screen.

The only thing left NOW is to shoot … hey but wait a minute … we have still not finished actual focusing.

It is always a good choice to set magnification first in the camera and set the lens and camera to manual mode and manAnchorual focus.

Before pressing on the shutter release button one has to make sure that the desired spot is accurately in focus in the optical view finder

If it is not in focus at the desired magnification it is ALWAYS recommended to move your own position rather than change rotate the lens for focusing because that will again change the magnification ratio.

In canon cameras once we achieve accurate focusing the camera gives out a small beep and the focus point flashes red again when we HALF CLICK

(Half clicking is a very good habit that needs to be cultivated because this will tell us if we are correctly focusing or not)

I used a Nikon camera and surprisingly Nikon camera did not give out a BEEP in manual mode during half click – I was a bit uncomfortable with that.

Lastly we need to understand that Focus point is the center of an imaginary sphere (of focused area) Maximum sharpness is in the center and focus reduces as we come towards the periphery.

Hence we should always focus in a spot in between the desired area of depth of field

E.g If we want the entire upper arch in focus it is a good idea to focus on Canines rather than the incisors to avoid wastage of the sharpness in depth of field

Source : DentistFriend

Being Dentist: Let My Country Awake...

 

Being Dentist: Let My Country Awake...

They say- TO ERR IS THE HUMAN... but I think it’s not applicable for doctors..

 

An incident that happened recently in Pune is making me write this.. A 3 year old girl accidentally lost her life while going a RCT at a dental clinic. The media got an opportunity to raise their TRP'S; they declared the doctor as murderer & this ruling by media was without even knowing the facts. 

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It's not uncommon these days..Death of a patient in a hospital/dispensary and that’s it..

 

Some opportunists nowhere related people will come over to do so called justice which includes physical abuse, destroying clinic as if the doctor has done it intentionally...I would like to bring to people notice that we are doctors & not God...even God have made mistakes isn't it...??? Few born deaf, dumb and with many such abnormalities...!!! How come people expect that doctor can produce results with every case... Human engineering done by God is sooo complicated that we are still trying to fully understand it...

 

 

To add onto it judiciary has included doctors into consumer act...

 

I don’t understand; whether we are sellers or what??? If yes, then why so much of noise when this seller charges for selling his skills? At one end you say doctor should serve and then you only make him a seller... how can a doctor serve fearlessly with free mind if he would be under so much of pressure every time?

 

People need to understand that amongst thousand cases one case MAY go wrong... In one case results may come compromised... that doesn't mean that doctor has done it intentionally...

 

 

Can a doctor afford to do wrong intentionally?

 

I wonder if same principles can be applied to judiciary also when lower courts decisions and higher courts decisions contradicts each other... 

 

Would you go to the consumer court for it...??? It’s not possible right..?? Coz then judges won’t be able to give decisions with fearless mind right...???

 

Same way doctors should also be exempted from this... not to go on killing people but to HELP THEM WORK MORE FREELY...FEARLESSLY...TO ENABLE THEM DOING WHAT IS NECESSARY THAN WHAT IS POSSIBLE... like they have shown in munnabhai na-" k form baad me bhara maamu; pehle patient ka ilaaj kar..."

 

This is not an excuse for non performance nor I'm telling doctors to play with patient's life..I am just asking people and media to ACT SENSIBLY.

 

Every doctor works for the well being of patient. If something goes wrong with the patient..then its the doctor who spends sleepless nights after patient's close relatives.

 

 

Which doctor won't like to have a smiling feedback from the patient?

 

Nothing would be gained from arguments & nasty behavior...  It will just widen the rift between doctor & a patient... LET'S CO-EXIST...!!!

 

We will have to understand limitations of doctor too... HELP US TO HELP YOU MORE EFFICIENTLY...BALL IS IN YOUR COURT...!!!

 

"Where the mind is without fear & the head is held high…

 

Where the mind is lead forward by thee into ever-widening thought & action...

 

Into that heaven of freedom...

 

My father..

 

LET MY COUNTRY AWAKE...!!"  

Source : DentistFriend

How To Deal, When You Are Asked For Guarantee On Dental Implants?

 

How To Deal, When You Are Asked For Guarantee On Dental Implants?

In initial days of my practice, one of the patients asked me “Doc, this implant would last lifetime, right?”  I was surprised with that sudden question.. I was really not used to all such bouncers but somehow I managed the situation of that time. The whole incidence had left me with the fear of facing such questions in future and that's when I decided to get answers to all such questions..

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The first thing that I tried to figure out was "Why do patients ask for guarantee of implant?" & I found the answer when I looked at the treatment option with patient’s perception. It is not that patients always ask for guarantee due the high treatment costs but sometimes it's due to the fear of surgery.

What patients ask is not wrong but as a clinician one should never forget that even after having best of knowledge, skills and vast experience, many things can go wrong and implants can fail. 

 

What best a clinician can do is; assure patient that things are done to the best of his knowledge, skills and experience; treatment results may last longer, subject to patient’s awareness, motivation and desire to follow clinician’s instructions and regular recall visits.

 

The word Guarantee is really dangerous.. 

 

As it literally means “promise” or “pledge”. How a doctor who is treating human body part (that is regulated by so many factors) can give LIFETIME GUARANTEE on a specific treatment.

 

"Guarantee" is fine with non-living objects but doesn't it sound weird with respect to living things?

Have you ever heard any experienced Cardiac Surgeon saying, “I have done a fantastic bypass surgery, now I guarantee you 10 years or 20 years of life”, probably you will never ever hear this. Forget about the cardiac surgeon even the Almighty has not given a guarantee of life. In my humble opinion “Guarantee” is not a word that should exist in the dictionary of a doctor. Being clinicians we all know that human body has complex mechanisms where many things are in simultaneous process. Above all every person reacts differently (Including both doctor and patient) in different situation so nobody can predict the longevity of treatment. 

 

In my practice there is absolutely no word called GUARANTEE, for your surprise some patients have even challenged me by saying, “Doctor if you can't give guarantee means you don’t trust your skills”, My polite reply to that was, "Sir I do trust my skills more than anything but what I don’t trust is YOU”. 

Overall studies have quoted success rate of single implants for more than 97% up to 10 years (less for implant supported full arch prosthesis), So that is what we can call life of an implant. After good surgical placement & implant prosthesis, If implant survives more than 10 years it would be all because of good maintenance and periodic recall visits kept by patient. 

 

Patients expect implant to survive till they die, which is not possible anyway. We need to make it very clear at consultation phase only that life of an implant would be up to 10 years sometimes it may be less than that (depending upon patient’s local & systemic conditions also).  I always tell my patients, “Huge amount that you are going to spend for an implant and using that implant all day for another 8 to 10 years, is a very long span, so spending on implant is completely worth; rather looking at the cost, look at the benefits like quality of oral functions you are going to get after dental implant treatment.

 

I never forget to mention that implant structure includes screw and crown, so there are equal chances of screw loosening and some damage or fracture to prosthetic structure due to wear and tear which can be managed subsequently with an additional cost. In case of an Implant failure, most suitable option at time would be suggested like an implant placement again or some alternative option with a reasonable cost. Never ever convince patients on the basis of promises that are beyond your control, be realistic and straightforward as it will give you long standing trustful relation with your patient and above all complete peace of mind. 

And last but not the least; don’t forget to tell your implant patients…

 

“Implants are lifeline but not for lifetime”. 

 

I wish you all a very Happy Implant Dentistry.

Source : DentistFriend