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  • When I graduate will I be expected to do basic surgical extractions?

    If I work somewhere not close to a dental hospital and a tooth breaks when I'm doing a forceps extraction would it be expected that I lift a flap and remove some bone etc...?




  • You'd be expected to work within your capabilities, but also not to leave the patient at a disadvantage....
    For this reason, I would strongly recommend to work in a practice with at least 2 other more experienced dentists on site for the first few years at least.
    You might only need to call on them once or twice a year, but it's great backup to know they're around& can lend a hand if needed. Also it gives you the opportunity to shadow them/watch& learn more.
    There's an OS on this forum who will be able to advise better, but there's a lot to be said for flapless extractions/sectioning roots. Avoids sutures, less trauma, more bone preservation.
    & of course never ever attempt an impacted lower wisdom tooth! ;)




  • Hi Dianthus.
    I have seen enough wisdom tooth surgical extractions to know that haha.

    People I have been talking to have told me that a lot of general dentists will do basic surgical extractions especially in places like Canada etc..
    I don't know what the situation in Ireland is though.




  • Realistically you'll always need to have basic surgical skills alright. Narrow roots, curved roots, divergent roots, retained roots, extensively decayed teeth, bruxists.....the list is endless




  • I know they didn't allow students to use luxators/periotomes when I was training, but they are brilliant tools to have when you are faced with decoronated teeth. I rarely need to do surgical extractions, I'd prefer to spend a little longer with a luxator than remove bone, much better Ito preserve the buccal plate if the patient might want an implant down the line.

    Impacted lower 8s are for OS's, even if you do a great job, the patient will still think you butchered them. Send them to an OS, they will thank you for leaving it to an expert.


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  • If you have a long canal , say in a canine.
    Guidelines say 7-8mm post length and 4mm GP left at apes.
    If you have a long straight canal would you increase the length of the post? How do you know how long to make the post in this case? As long as possible I.e canal length minus 4mm?




  • If you have a long canal , say in a canine.
    Guidelines say 7-8mm post length and 4mm GP left at apes.
    If you have a long straight canal would you increase the length of the post? How do you know how long to make the post in this case? As long as possible I.e canal length minus 4mm?

    You have to use your judgement based on the length and morphology of the canal, personally I try to make the post at least as long as the crown.

    I tend to prep the canal first with gates gladdens, then with parapost drills, starting with the narrowest and working up. I like threaded posts, I heard reknowned prosthodontists claim that both threaded and cast are better than one another.

    My experience with carbon fibre posts has been poor, I don't use them at all now. But if you haven't tried luxacore resin core material, try it, it is fantastic stuff.




  • Generally you make the post.
    1. Below Bone level.
    2. Leaving 3-5mm GP.
    3. One third the width of the root.
    If you can make it longer than the crown while following the above thats fine, if its shorter than the crown in order to avoid any of the above thats fine too.

    Post material doesnt matter much in the presence of good ferrule. In the absence of ferrule cast posts are less prone to fracture. Customs cast posts and prefabricated posts show no differences. Parallel are preferred to tapered for root fracture reasons. Threaded or smooth doesnt matter. Flexure of the post doesnt matter (its the flexure of the cement that matters.

    At the end of the day the best post is no post at all. The teeth that last 30 years with a post and core likely didnt need a post in the first place. The only reason to have a post is to retain a core, and if you can do that without a post then do that. After that use whatever works for you. I like glass fiber posts and titanium paraposts. I dont do any cast, as I feel once you think you need one the tooth is really in very poor nick.




  • I think it was Lloyd Searson who said at a lecture that he never did a post crown that he wasn't worried about it coming out. If it needs a post, prolonged retention of the tooth is a real bonus.




  • Does reducing the distal aspect of upper 6s and 7s get any easier..


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  • Does reducing the distal aspect of upper 6s and 7s get any easier..

    Crown prep? Get some short crown prep diamonds. Everything gets easier the more times you do it, except molar endos, those ****ers never get easier.




  • Yes crown preps.
    I use the very thin diamond to break the contact but then I swap to normal diamond crown bur and sometimes over reduce the distopalatal margin. Just need more experience with them.
    Usually fine for crown preps but trying to get both bridge preps done in time can be tricky at the moment.




  • Does reducing the distal aspect of upper 6s and 7s get any easier..

    You have to pick a line and go for it, practice makes perfect.




  • speed increasing handpiece, two handed prep, good magnification and illumination, ALSO do your occlusal reduction first , it lets you see more of the distal and remember to move the patient not yourself to get as much direct vision as possible.




  • Would you use a canine with 50% bone loss and perio pocketing as a RBB abutment for a 32 ? Opposed by F/

    Or double wing 31 and 33 and use as splint as abutments g1 mobile.

    Patient accepts SDA but left with extracted 32. Implant not an option. Wants tooth replaced.

    Could stabilise perio before restoration.




  • yes but leave the pontic out of occlusion




  • And make sure you clearly outline the limitations of the treatment to the patient giving the worse case scenario, potential loss of both teeth. If this was me, I'd package it as a way of avoiding a denture for a while longer, but not indefinitely.




  • Looking for some opinions on this case.
    Patient in 30s.
    26,36,46 xla, unrestorable.
    All other teeth good.
    7s and 5s unrestored.
    Can't afford implants.
    Wants teeth replaced after I extract them.

    Is there any ideal option in this case?
    No chance of conventional with virgin abutments.
    Not going to RBB a 6 off a 7 or 5.




  • What options do you think this patient has and how are you going to do the extractions?




  • Sometimes leaving a gap (in the short-medium term) is the best option.
    Always think - what would I do in this case if this person was my own brother or sister? Makes your decision process& stance a lot easier.
    Patient wants& desires are relevant of course but ultimately you know what the most predictable & successful option is, & consider whatever allows you sleep at night.


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  • Best option here in my opinion is to leave the gap and save for implants.
    Only concern would be space loss with the 7 drifting mesialy affecting future treatment. Even though I know this is unpredictable.
    However I feel that the risk of this happening is still better than damaging healthy abutments.




  • Bang on, if 16 is present, then 46 is the first implant to consider. Tell him about post xla resorption and that the sooner he can have an implant(s) the better. If any of the teeth fracture during removal, split the roots and carefully remove with a luxator/periotome making sure to preserve the buccal plate of bone, if you break the buccal bone with forceps/surgical, an implant becomes a lost harder.

    Your/our job is to lay out the options giving the benefits/drawbacks and then if asked, give a recommendation, but you can't make a patient chose an option. I always finish that conversation with "there is no right or wrong option, all I ask is that you consider all options and decide what is best for you"




  • I would also add to this that you have a choice in what type of treatment you yourself choose to provide. The best quote I ever heard was from a prosthodontist who said "I'm a dentist, not a lifeguard. I have the option of choosing who& what I put myself at risk for".
    Also, when you're talking virgin abutment teeth, any pt who is shown an image of what an actual bridge prep/core entails, will unfailingly opt to preserve their healthy& intact teeth. So make the consent a very full& informed one.
    'Re drifting- consider Essix retainers to preserve the space?




  • removable partial denture if not willing to place a bridge.its predictable durable functional.




  • The conversation I have here is based on the survival of the teeth either side of the gap...
    Implant placement better than (>) no treatment > bridge > partial denture...




  • SM35 wrote: »
    The conversation I have here is based on the survival of the teeth either side of the gap...
    Implant placement better than (>) no treatment > bridge > partial denture...

    Have to disagree with you there, no treatment after loss of three of four sixes means significant reduction in chewing capacity, drifting/tilting/over eruption of multiple teeth, significant difficulty in later pros treatment and probable cosmetic implications. If the patient can't afford implants now but might in the future, space/axial maintenance is important. Even intermediate marylands/ partial denture with a thin lingual bar connector should be considered before doing nothing at all.

    Missed the last sentence of fishorsealants post about not doing RBB off 5/7, if he/she preps small rest seats on opposing surfaces, RBBs would be ideal intermediate solution for a couple of years provided bone loss is not excessive.




  • how unrestorable are the 6s? hemi section and cantilever crown (obviously with careful occlusal management and mticulous periodontal assessment) could buy you a few more years. Not easy to do but in the right hands and with the right case selection could work well.




  • davo10 wrote: »
    Have to disagree with you there, no treatment after loss of three of four sixes means significant reduction in chewing capacity, drifting/tilting/over eruption of multiple teeth, significant difficulty in later pros treatment and probable cosmetic implications. If the patient can't afford implants now but might in the future, space/axial maintenance is important. Even intermediate marylands/ partial denture with a thin lingual bar connector should be considered before doing nothing at all.

    Missed the last sentence of fishorsealants post about not doing RBB off 5/7, if he/she preps small rest seats on opposing surfaces, RBBs would be ideal intermediate solution for a couple of years provided bone loss is not excessive.

    I was recently at an ITI talk where the visiting prosthodontist presented long term rates of survival of teeth either side of a gap, and the odds ratio of survival of teeth adjacent to an implant was almost 100 times that of teeth adjacent to a partial denture over ten years.. I agree a hygienic partial or maryland bridge will help preserve occlusion, but if the patient was considering implants within a few years, I would be inclined to do nothing for a while..




  • Looking for some opinions on this case.
    Patient in 30s.
    26,36,46 xla, unrestorable.
    All other teeth good.
    7s and 5s unrestored.
    Can't afford implants.
    Wants teeth replaced after I extract them.

    Is there any ideal option in this case?
    No chance of conventional with virgin abutments.
    Not going to RBB a 6 off a 7 or 5.

    I’d say I see this case about 4 times a day!
    Gross caries. Tx options are rct or xla. The molar is extracted because the px can’t /won’t afford
    Rct. Yet they think that they will have an implant in a few months/years/ ....etc

    You px may need 3 implants. It’ll cost him between 5-10 k depending upon where he goes.
    He’ll get no implants if he can’t afford bridgework now! won’t wear partial dentures and you’re asking for hassle putting a rbb there.

    I’ll bet ya a few beers in the gingerman he’ll have no tx to restore those molars so do yourself a favor and don’t waste your time!


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  • Where can I find the new criteria for using amalgam?


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