Friday, 26 February 2016

Dental life : Chapter 2.1 - Secondary Cast

Yesterday was a whole day of franticness and chaos. Everyone was so engrossed with their works that a friendly chat in between seemed diliberately unnecessary. Well I think some have better luck than others and I am always thankful that I'm quite lucky myself. I wouldn't say that I really did have the right technique because sometimes I don't really. It's just that I'm really persuasive and maybe I like to gain sympathy from the person who marked my work which is definitely the worst trait of a working professional. I have to make sure the next time I do something, it's for the sake of learning and producing high-end products and not because I wanted to be better or faster than others. Well I am a student so learning is just an included necessity in the whole process. If I forget that part, there's no use in learning at all because I gained nothing.

After having to take the secondary impression, we had to pour immediately soon after because Alginate is known to distort overtime and it won't produce the exact imprint if not poured right away. So we (the girl I told you in my previous post) both rushed to the casting room and straight away mixed stone with water. We have to reach the right consistency for this particular procedure since having it too thick will not allow the stone mix to reach and fill in the whole area in the impression whilst too much water will just produce too much air bubble in the mix.

We opened the vibrator to allow the mix to flow smoothly into the impression. We brought our lecron (a two-end carving instrument. It looks a bit like a long wand with a knife on one end and a small carver on another) and used it to assist the flow of the mix into the cavity and made sure there wasn't any air bubble.

Air bubble will just ruin the whole cast and might just remove the necessary recorded landmark and details in the impression and made a hole in the areas. That's why it's so important to produce a well even out cast with no air bubbles on its surface.

Then we made the base out of plaster of paris and made a lump onto a tile. And turned the impression over and placed it onto the lumped POP. I've made sure that the orientation of the impression is already correct so that we would save so much time readjusting it later on. Make sure that the retromolar pad is higher and the orientation of the teeth is at the right degree. After a while, the whole thing set. And we opened up the impression and how relieved we were to see that there was little air bubble.

This is my cast. There were a lot of air bubble that I had to cover them up by adding a bit more stone. I have to keep on reminding myself that this procedure requires patience and scrutiny. If I forget to pour it down gently then I'll trap more air bubble. So I have the top with stone and Plaster of Paris (POP) as the base of the cast.
Occlusal View.
Note that this is my cast and not my friend's cast. Hers was much better and more refined. I wished that I had produced something better. There are a lot of uneven surfaces. and my recorded rests were not detailed. I had to use my lecron to refine the details which is a definite no-no in this step. I would not have the same end result as the patient's real cavity prep that I've done if I were to do it in real life. Since this is not done on a real patient, it's okay for now. 

What I like the most about helping people is the smile on their faces. And I know I shouldn't be telling others about my deeds. It's just that I think it's necessary since I learned a lot while helping people and I wanted everyone else to do the same. Actually you're not only helping other people, you're also helping yourself. You'll learn new things in the process as well. And maybe redeem the mistakes in your previous work that the whole thing would be another experiment to know whether if you were to do it any differently would it produce different result?  And also you would just remember everything better since you are doing the same thing all over again.
Well I think that's all for now. And pray that I'd be a great dentist. Amin. :)

Dental life : Chapter 2 - Secondary Impression Using a Special Perforated Spaced Tray

Hi diligent readers! Today I had my prosthetic lab and I have been meaning to include some pictures into the post so that you could see and understand everything better but unfortunately I didn't have the time to do so. Well the bell rang before I could grab my phone. - Should have brought the phone earlier. Sighhhh...

Anyway, I've finished my secondary cast a session earlier so today I pretty much had nothing to do. So me being me, I wandered around and trying my best to be helpful to others. Harhar. I decided to help a friend of mine since she had trouble taking the secondary impression.

To tell you the truth, impression taking is my number one weakness. I hate mixing the materials and the time constraint made the whole experience a lot worse. Just imagine having to mix everything so that it would be homogenous both in colour and consistency under a very limited amount of time. It stresses me out sometimes. I'm only doing it on a soulless phantom head for now but just imagine having to do it on a real patient. It'd be a nightmare if I've overmixed or too slow in putting it into the patient's mouth that it set beforehand. And impression taking is definitely a very messy procedure.

I've worked with ZOE ( Zinc Oxide Eugenol ) before and it's very messy and it sticks everywhere. So the next time I'd use it on a real patient, be sure to remind me to use vaseline and apply it on the region of the mouth so that it won't stick and irritate the patient. This time around, I was introduced to a new impression material; alginate, which is much easier to work with and the indication of it's usage is when there's undercut or when you are taking impression of a dentulous (with teeth) patient. Alginate is an elastic material so it would record better details and the only downside of it is that you'd need extra retention on your tray. That's why I had to prepare a perforated special tray. And adding adhesive to the tray will help immensely.

So coming back to today's story, one of my friend was having difficulty of producing the exact negative impression of the phantom's mouth that she had to do it multiple of times, up to a point of severe frustration. If I were to be in her shoes, I'd definitely be frustrated, heck I'd be very pissed but she wasn't. How I admire her patience and I have to make sure to be as patient as her the next time I face the same problem. Okay, so I helped her remove some of the excess of the previous impression material and reapply vaseline on the tooth and all over the phantom's mouth. Although alginate isn't sticky but it's necessary since there's no saliva in the phantom's mouth so the impression material might stick. In the real patient, applying vaseline to the teeth isn't necessary.

And she came with a new batch of impression material and we were set to do it. During the previous mixing I noticed that she wasn't actually mixing it properly. You have to press the material on the side of the bowl to make sure that it would mix thoroughly. And when you put it on the tray make sure to even the impression out using the spatula so that you'd be taking a nice impression later on. Those were the things I did with the next impression taking. Thank god, the end result was alright. I wouldn't say it was perfect but it was okay that doctor in charge passed her. 

It was all a good day's work. Then we produced the cast out of the impression. This part I'll explain on  another lengthy post. So what I learned today? I learned that we have to always be patient and always remember to put in the right technique. That's why paying a good attention to the technique during demostration is a must. Jotting down everything will be a bonus mark to the whole process. And I also learned that friends are very important. :)

Thursday, 25 February 2016

Dental life : Chapter 1- Inlay Preparation MO on lower 6


It has been like more than 2 years that I hadn't been writing anything in this mundane blog of mine. The last 2 years I'd say was a bit tiring to an extent that 8 hours of sleep wouldn't be enough to compensate the sleep that I was deprived of.

Since I am now a second year dental student and constantly learning new things, I think what better way to retain all the knowledge that I've learnt than to write them all in here. Note that, all the facts are merely based on my experience and I am so sorry that what I'm going to write next wouldn't be of the correct information. Feel free to correct me if I'm wrong or to ask me anything.

Continue on...

This was my preparation on 36. I'm not too satisfied with my work but it'll do for now.

As the title suggests, today I had to do an inlay preparation on tooth 36(Note: I'll be using FDI notation as a simple way of expressing the tooth I was working on. In this case it was the second lower left molar) and let me tell you, it was absolutely tiring. I think it was because of the constant correction that I had to do on the same tooth that it drained my spirit wholly.

So what I learned today? To prepare an inlay tooth preparation, I had to make sure that there wasn't a single undercut present. This is to ensure that the inlay fitting would be possible. The walls of the cavity have to be divergent and this was the main problem of my cavity preparation just now. It wasn't exactly diverging. It was stated in the criteria that I had to make sure that degree of the walls would be 6-10 degrees. And that I did multiple times.

In the midst of making it diverged, hell break loose when I had to almost redo all of my heartfelt work since the cavity I did was almost 3mm. Well in the criteria it was stated that I have to prepare the intercuspal distance to at least 2mm. But the next time I make the same preparation, I have to make sure that it wouldn't be too big. And make sure to orientate my bur correctly from the very start.

Since I was too in a rush to finish early that I didn't pay enough attention to my hand orientation that it almost cost me a tooth today. So what bur I used today? It was  a high speed diamond tapered shape bur. This is very important in order to form the desired divergent walls as stated in the criteria.

Other than the obvious not so diverging walls, I had to make multiple modifications on the buccal margin on the mesial of the tooth. It didn't loose the appropriate contact from the adjacent tooth. So I have to make sure that it did. I used the same bur to round it of a bit and whilst I was doing that I accidently form an acute cavosurface angle on the buccal margin. This is a definite no-no in cavity preparation. Why? Well for obvious reasons of course, there would be an undermined enamel and I must remove it entirely and prepare the angle to an approximately 90 degrees.

I used a hatchet (A hand instrument which can cut enamel) to smoothen the side of the walls and remove the acute angle I made whilst using the hand rotatory instrument. It's best to use a hatchet since it'd be easier to control and so that I wouldn't injure the adjacent tooth. Using a bur would definitely do so unless you have an undeniably mad skills technique of controlling the bur.

Definitely today was a challenging day for me, I almost redid my cavity preparation but thank god I didn't and I had to remodify the model a couple of times before I could get the signature from the dr. But it was all for a good learning session. I'll make sure to not make the same mistake and to practice harder and get better marks in my labwork. :)

Ouhh,, just so you know I have two labworks for now. The first one involve operative techniques and the other one is for prosthetics. So today is my optech lab and tomorrow's gonna be my prosthetic lab. So pray for me for tomorrow's work. I want it to go as smoothly as possible. Will share with you the news ASAP. Goodbye for now!