4 Mistakes you Don't Need to Learn the Hard Way
Remember matrix checks? I even remember etch checks! Which is ridiculous because after waiting the typical 15 minutes for a check the dentine had desiccated and I'm sure the crevicular fluid would've reached the margin. Gone are those days. But don't let your guard down just yet. Some of those checks were for a reason!
The Mistakes you Don't Need to Make
While a lot of the checks in dental school felt laborious, they were there for a good reason. When we get out we start to work a lot faster, the pressures start to stack up especially time pressures. Many people stop using rubber dam or forgo steps in the polishing process. Yet some of the short cuts young dentists (and some older dentists who seem to turn a very blind eye) make will end up making you take the long road. And more importantly lead to faster failures and more out of pocket expense for your patients.
There are a few key areas graduates make mistakes in that they really shouldn't. It's often rushing or simply not thinking it matters that much. Yet simply double checking and adjusting as necessary when the problem is small saves a lot of trouble for both you and your patient.
Simply double checking and adjusting as necessary when the problem is small saves a lot of trouble
1. Matrix Adaptation
For me, this one is key. I'll confess my faults. I have seen a poorly adapted matrix and gone with it, only to find an overhang worthy of a cliff warning sign. The time it took to reprep and do it right was much much more than just sticking some Teflon in the space and sorting it out.
The key areas I find this to be an issue are:
- The mesial of an upper 4 due to the canine concavity - use Teflon either around the wedge or after the wedge to push the matrix to adapt with the interproximal surface.
- Very deep class 2's - again, Teflon is your friend. Depending on the surface, once you get to the root of a molar it may not easily adapt. Using Teflon as above solves this.
- Distal without an abutment - cant wedge here. Tofflemires often don't adapt well. Try the saddle matrix from Orien Dental or a greater curve tofflemire band which tightens real tight gingivally.
2. Proper X-rays
Overlaps, cone cutting and missing the apex happens. However there was a reason you took it and usually this means you didn't quite meet that goal. Take the time, retake the image and get the diagnosis right.
3. Impressions
Whether it's analog or digital impressions the goal is the same. Clear unimpeded impression of the teeth. I use Cerec and to be honest I'm rusty on PVS impressions however in the end it doesn't matter, they're the same.
- Use the second cord when you need it, you were taught that at uni because it works. Leave the cord long enough (prep faster so you have the time?) and get the perfect margin.
- In some situations a gingivectomy is necessary. Try a Dura-White stone or a Thermacut bur on high speed without water. Use Haemodent straight after to ensure haemostasis. This is especially useful in deep interproximal areas.
4. Caries removal and a clean, dry cavity to bond to
We do it all day. Prepping teeth, removing decay and placing fillings. Yet it's the things that become too routine that can lead to mistakes. Don't become complacent with caries removal especially at the margin. Leaving some affected dentine to save the pulp has many benefits yet leaving some at the margin that will spread/expedite breakdown of the margin is not cool.
There has been quite a push lately to consider the biofilm in bonding. Dr Lincoln Harris recommends and uses a sandblaster to clean preps. I don't currently have access so I use pumice and an ultrasonic regularly to ensure the bond is as good as possible. "You can't bond to plaque" - Dr Lincoln Harris.
Dentistry is hard. So don't make it harder for yourself! Hold yourself to these critical check points and solve problems early, do better dentistry and enjoy work more.
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