Dental Reflections 008

seems like i've been doing a lot of big-ass CRs here. the irony being of course the absence of such basics as primer and B-shades... have kinda developed a technique for doing massive CR direct inlay-onlay work to restore occlusal surfaces or even VD...

1) caries free and any cavity prep necessary or possible. in the absence of decent dentine bonding systems, fling Vitrebond with abandon at all visible dentine.

2) place matrix system of choice (or lack of choice *coughcough*) and get 3/4 of the occlusal height needed. cure, check for clearance

3) vaseline the opposing tooth

4) re-etch the tooth if needed. splooge a generous dollop of CR onto the tooth, shape it roughly to look sort of like a tooth.

5) bite and grind! beware the patient with weird bite/posturing.

6) cure. check occlusion. curse under your breath if the patient has only just revealed said wierd bite.

Dental Reflections 007

been a couple of things ive wanted to write about but never got round to, so here i am with an urge to write and some time to kill!

1) the nefedipine hyperplasia patient

uncle Carranza tells me that a good 1 in 5 of these patients will have some form of gingival hyperplasia. at the least, this makes SAP into a messy affair as they will bleed like animals in a slaughterhouse. at worst... a week or 2 ago, i saw a patient who had nifedipine hyperplasia superimposed on severe generalised chronic periodontitis. his papillae were swollen to the point where they were actually touching his CEJ. in 20min i could only root plane half his mouth...

considering that the hyperplasia is actually a fibrotic overgrowth of tissue that will not go away by itself even after OH improves or nefedipine is substituted (the only improvement being reduction in oedema) there really should be a lot of business for gingivoplasty via either the gingivectomy or modified Widman technique...

2) the periodontal abscess patient

with no Graceys, can there be adequate debridement? since im not exactly equipped with the funkiest of root planing ultrasonics, it usually means some form of hand-instrumented root planing will be needed. and when the fall-back is a set of single-ended 2L+2R... gyaaaa!

Conquering New Territory

Queenstown. not exactly terribly awe-inspiring when one rolls the name around the inside of ones head. but here i am. the sun is shining wanly through my room window and the nurse has gone on tea-break. and i think i'm pretty happy, all things considered.

of course, it stands to reason that i miss my old place. the availability of company is a greatly important thing. and the availability of a PA machine as well... it really is turning out that our work is being hindered by the simple inability to do PAs. not to say that diagnoses of simple conditions are impossible, but when one wants to advise on prognoses of teeth with either cuspal coverage or perio issues...

on the bright side, the scalers rock. the machines are just 6 months old, and both an inbuild chair unit and a trolley-mounted cheong-Cavitron are available for me to rape calculus at my leisure. you have to love it when the Cavitron-clone has a Turbo button, the usage of which will make patients shriek with sensitivity! rocking!

Triangler - Gabriela Robin