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Clinical Tips

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WE HOPE YOU FIND THE CLINICAL TIPS BELOW USEFUL

This page is dedicated to share clinical tips which apply in general and specialist practice within the field of Restorative Dentistry

 

If you have a clinical tip that you’d like to share on this website for everyone to benefit, please send us a video of your clinical tip and a brief paragraph of what your clinical tip is.

Clinical tip 10:

Consent form for Resin Bonded Bridges

Please find attached a document you may find useful. Please amend and use as clinically applicable to your case.

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Describe your image

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Clinical tip 9:

Dr Megna Shah, a foundation dentist and part of the ACE FD committee, discusses and demonstrates how to create floss ties

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Clinical tip 8:

Dr Sorabh Patel shares his clinical tip on managing deep sub gingival caries Click on the slideshow to view the sequence and read the caption under each image

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Here is an example of you’ll need to cut the band on the opposite side to the cavity (mesially in this case) to allow the band to slide lower down the tooth distally; as the mesial part of the band is no longer stopping the distal aspect going deeper

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Preoperative radiograph showing deep caries distally

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3month review. Tooth is vital, healthy and functional.

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Here is an example of you’ll need to cut the band on the opposite side to the cavity (mesially in this case) to allow the band to slide lower down the tooth distally; as the mesial part of the band is no longer stopping the distal aspect going deeper

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Every now and again in dentistry we come across a few tricky cavities and there is nothing more challenging than those pesky deep sub gingival class II’s. 

Rubber dam, tissue retracting clamps, floss ties and matrix adaption will all become essential parts of your armamentarium. 

Matrix Adaptation
Take your humble omni-matrix system and adapt it into a precision tool to help you achieve a perfect sub gingival seal. 

Say you have a deep sub gingival cavity distal of a 6. 
you’ve clamped the 7 and isolated 7,6,5,4,3 to give you a great field of view and optimal isolation. 

You’ll need to cut the band on the opposite side to the cavity (mesially in this case) this is because it will allow the band to slide lower down the tooth as the mesial part of the band is no longer stopping the distal aspect going deeper 

Clinical tip 7:

Dr Jose M Rodriguez shares a clinical tip on taking good primary and secondary impressions Click on the slideshow to view the sequence

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Here is a case for C/C dentures. As you can see, the bone resorption on the ridges is quite severe, especially on the lower. To make a set of dentures that will fit well, your secondary impressions in particular have to be very accurate.

Primary imps: Make sure you take good primary impressions, otherwise you’ll have to spend ages modifying your special trays. I use compound with an alginate wash on top.

Secondary imps:

  • Take your time to take secondary impressions. In severe cases like this, I sometimes take a primary, get a tray, take a secondary, get a tray, and take a tertiary impression so I can really refine the periphery. Dentures in these sorts of patients stay in with a 50:50 combination of good border moulding that offers a peripheral seal, and prayer. 

  • I advise using green stick to really customise your tray. 

  • My go-to impression material for secondaries is zinc oxide eugenol. It’s lovely, it’s accurate, and the best part is that you can add to it. So if you fail to capture an area, or have a bubble, you just mix some more, add it to the top of the previous material, and it will stick.

Clinical tip 6:

Dr Jose M Rodriguez shares his clinical tips on managing flabby ridges Click on the slideshow to view the sequence

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To tackle flabby ridges, I take a 2 part impression with the window technique

  • First, I apply green stick and ensure I have boulder moulding everywhere.

  • I then take a muco-compressive impression in the non-flabby areas with compound

  • With the second tray, I use zinc oxide eugenol and sit it on top of the window to record the flabby ridge

  • You end up with another very pretty picture with an impression in two different materials

Clinical tip 5:

Etching the enamel required 37% orthophosphoric acid

This is a tip i learnt from my colleague Dr. Jose Rodriguez, Prosthodontist and Restorative Consultant, on how to improve the effect of the etchant on enamel.

Continuously rubbing the etchant means the concentration of the etch does not decrease

Here we were splinting the teeth in preparation for periodontal regeneration but the same principles can be applied in cavities. 

Clinical tip 4:

Dr Dipesh Kothari shares this great tip which can be used to do a quick smile design for a patient, whilst they wait in the chair.  - Click on the slideshow to view the sequence

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The same technique can be used to compare the symmetry between teeth or when fitting a single unit crown/veneer to see if it matches the contra-lateral tooth. The uses are unlimited.

Clinical tip 3:

Dr Jaz Gulati who also runs Protrusive Dental Podcast (check it out) shares his tip on how to manage sub gingival caries - Click on the slideshow to view the sequence

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Step 1 - Consent the patient. She needs an indirect - but it is high risk of RCT. Let us restore first directly (also had restored several other carious lesions in this COT)

 

Step 2 - Gingivectomy using a Thermacut bur (no water - max RPM - fast handpiece. Note the lack of bleeding). Without this, you cannot access the caries. The rubber dam has no hope of isolating unless we remove the gingiva.

 

Step 3 - Caries removal

 

Step 4 - Isolation

 

Step 5 - get some sort of a matrix to achieve a cervical seal. Build a 'hip' of composite. Now the situation is easier to manage.

 

Step 6 - Restore the contact (not 100% essential - for me, cervical seal is a priority over a decent contact point for caries stabilisation cases).

Clinical tip 2:

Say NO to rubber dam stamps

Isolating multiple teeth with rubber dam is best served by customising the rubber dam holes using the patients arch form, either directly in the mouth or using a study cast/wax up.

Here is an example where a wax up was used.

We hope you enjoy learning from this short clinical tip from ACE.

Clinical tip 1:

When replacing a tooth with a crown to be used to support a denture, consider the design of the denture and the crown as this will influence your crown prep

We hope you enjoy learning from this short clinical tip from ACE.