Happy Easter!!!

Happy Easter!!!

Don't let chocolate eggs and bunnies do their job...

My Week

Ah, had a rough week.. Finally it's Saturday, I can relax and focus on my blog and dentistry. Went only once to Maxillofacial clinic this week because had to study a lot... The funny things is that tyring to do everything right I managed to miss a lecture somehow haha I mean, I did not do that on purpose, I just thought that it will be later than it actually was.. Anyway, I finished with my studies (for a week) and starting from Tuesday I will go to Maxillofacial clinic EVERYDAY! Yay! Counting days! 

Many people ask me if I do practise besides oral surgery. Well not really. I have been in Periodontics once because a friend of mine suggested to assist him and another field where I had a chance to visit unofficially is Oral Hygiene. I had never seen before how dentist do an oral hygiene, so one time (also with an invitation) I went there. But that's all... Oh, well, there was also one time when older dentistry student taught me to work with Gutta-percha haha The first tooth didn't went so well, but the second was not bad ;) 

Now that I will have some free time I promise to write more about Prosthodontics and maybe other things related with dentistry. The topic I am planning to post is THE METAL-CERAMIC CROWN PREPARATION, so keep updated dears!! 

Treatment Planning for Single-Tooth Restoration

The successful use of single-tooth restorations is based on thoughtful treatment planning, which is manifested by choosing a restorative material and design that are suited to the needs of the patient. In a time when production and efficiency are heavily stressed, it should be restated that the needs of the patient take precedence over the convenience of the dentist.  The selection of the material and design of the restoration is based on several factors:

1. Destruction of tooth structure. If the amount of destruction previously suffered by the tooth to be restored is such that the remaining tooth structure must gain strength and protection from the restoration, cast metal or ceramic is indicated over amalgam or composite resin.

2. Esthetics. If the tooth to be restored with a cemented restoration is in a highly visible area, or if the patient is highly discriminating, the esthetic effect of the restoration must be considered. Sometimes a partial coverage is required in such an area, the use of ceramic in some form is indicated. Metal-ceramic crowns can be used for single-unit anterior or posterior crowns, as well as for fixed partial denture retainers. All-ceramic crowns are most commonly used on incisors, although they can be used on posterior teeth when an adequate amount of tooth structure has been removed and the patient is willing to accept the possibility of more frequent replacement.

3. Plaque control. The use of a cemented restoration demands the institution and maintenance of a good plaque-control program to increase the chances for success of the restoration. Many teeth are seemingly prime candidates for cast metal or ceramic restorations, based solely on the amount of tooth destruction that has previously occurred. However, when these teeth are evaluated from the standpoint of the oral environment, they may, in fact, be poor candidates for cemented restorations. If extensive plaque, decalcification, and caries are present in a mouth, the use of crowns of any kind should be carefully weighed. The design of a restoration should take into account those factors that will be enable the patient to maintain adequate hygiene to make the restoration successful. The patient must be motivated to follow a regimen of brushing, flossing, and dietary regulation to control or eliminate the disease process responsible for destruction of tooth structure. It may be desirable to use pin-retained amalgam provisional restorations to save the teeth until the conditions responsible for the tooth destruction can be controlled. This will give the patient the time necessary to learn and demonstrate good oral self-care. It will also permit the dentist and staff to reinforce the skills required of the patient and to evaluate the patient's willingness and ability to cooperate. If these measures prove successful, cast metal, ceramic, or metal-ceramic restorations can be fabricated. Because these restorations are used to repair the damage caused by caries and do nothing to cure the condition responsible for the caries, they should not be used if the oral environment has not been brought under control.

4. Financial considerations. Finances influence all treatment plans because someone must pay for the treatment. That may be a government agency, a branch of the military, an insurance company, and/or the patient. If the patient is to pay, the dentist should provide good advice and then allow the patient to make the choice. A conscientious dentist must walk a fine ethical line. On the one hand, a dentist should not preempt the choice by selecting a less-than-optimum restoration just because he or she thinks that the patient cannot afford the optimum treatment. On the other hand, a dentist should be sensitive enough to the individual patient's situation to offer a sound alternative to the optimum treatment plan and not apply pressure.

5. Retention. Full coverage crowns are unquestionably the most retentive. However, maximum retention is not nearly as important for single-tooth restorations as it is for fixed partial denture retainers. It does become a special concern for short teeth and removable partial denture abutments.

References:

http://cdn3.buzztides.com/wp-content/uploads/2016/03/teeth.jpg

http://randental.com/wp-content/uploads/2011/03/iStock_000013325752Medium.jpg

http://69.89.31.84/~smilesf5/wp-content/uploads/2013/08/dental-scaling.jpg

http://mikeiamele.com/wp-content/uploads/2014/11/Money-Bag.jpg

"Fundamentals of Fixed Prosthodontics" Fourth Edition by Herbert T. Shillingburg, Jr, DDS; David A. Sather, DDS; Edwin L. Wilson, Jr, DDS, MEd; Joseph R. Cain, DDS, MS; Donald L. Mitchell, DDS, MS; Luis J. Blanco, DMD, MS; James C. Kessler, DDS;

Introduction to Prosthodontics

A few days ago on my Instagram account (www.instagram.com/odontology.student) a person named wrote me that he needs an information about prosthodontics. I am really happy that finally someone decided to ask me for it - I mean, that's why I created this blog! So today I decided to make a short introduction to prosthodontology.

Prosthodontology is the branch of dentistry concerned with construction of artificial appliances designed to restore and maintain oral function by replacing missing teeth and sometimes other oral structures or parts of the face. 

The ADA (American Dental Assosiation) has defined prosthodontics as “the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.”

A prosthodontist has three years of extended training in several areas of restorative dentistry, including dental implants, crowns, bridges, complete dentures, partial dentures, esthetics, occlusion, and facial and dental birth developmental defects. As you can see it is super wide specialty which you can talk and write about really a lot, so I decided each time to write a different article related with prosthetics: planning and preparation, clinical procedures such as major and minor connectors, dentures, the metal-ceramic crown preparation, implant-supported fixed prostheses, evaluation, characterization and glazing, luting agents and cementation procedures, postoperative care, etc. and laboratory procedures, for example, wax patterns, pontic designs, retainers for partial removable dental prosthesis, metal-ceramic restoration and more. 

As requested, I am also planning to make a separate post about other specialists in prosthodontology who can provide you with some additional information.

There are many different books on the Internet and in most libraries in the universities where you can find a lot of information about this field. I will use mostly the information from the books below: 

 “Comtemporary Fixed Prosthodontics” Fifth Edition by Stephen F. Rosenstiel, BDS, MSD; Martin F. Land, DDS, MSD; Junhei Fujimoto, DDS, MSD, DDSc

McCracken’s “Removable Partial Prosthodontics”Eleventh Edition by Alan B. Carr, DMD, MS, FACP; Glen P. McGivney, DDS, FACD; David T. Brown, DDS, MS; 

“Fundamentals of Fixed Prosthodontics” Fourth Edition by Herbert T. Shillingburg, Jr, DDS; David A. Sather, DDS; Edwin L. Wilson, Jr, DDS, MEd; Joseph R. Cain, DDS, MS; Donald L. Mitchell, DDS, MS; Luis J. Blanco, DMD, MS; James C. Kessler, DDS;

You can also search "Prosthodontics" on Youtube where you can watch various videos. Here is one of them (OLDIE BUT A GOLDIE):

You can also find many information, ebooks just by searching for it on Google. Scientific articles might be find on www.PubMed.com

P.S. If you also have some inquires and want me to write about something specific, please let me know :)

References: 

https://www.prosthodontics.org/assets/1/7/1.What_is_a_Prosthodontist_and_the_Dental_Specialty_of_Prosthodontics__-_approved1.pdf

http://www.prosthodonticslimitedpc.com/wp-content/uploads/2014/05/dentures1.jpg

https://www.dentistry.uiowa.edu/sites/default/files/icombined1_0.png

http://www.masterdentalclinic.com/wp-content/uploads/2015/07/partial-prosthesis-fixed-bridge-.png

Implantology

As I told you on my first post I am first year student, so I have no cycles (lectures) related with odontology yet. Some of them will start next year, some of them on my 3rd, 4th, 5th year. However, I have a chance to practise in oral surgery (as far as I know I am the only first year student who practises there but how I got an opportunity to come I will tell you the next time) and watch some different cases. One surgeon last week told me that he will have an implantation on Tuesday, so I decided to skip my one lecture (not very important, of course :D ) and go to watch the operation. While I was waiting for surgeon to come another one came and ask me to assist him, I thought "OK, I have an hour, I think I will finish with this extraction on time and then will go to operation". But then while we were going to the dental chair I realized that I was asked to assist in implantation. OH - MY - GOD... This is soooo cool!!!! My dream finally came true! Maybe for some of you this is daily life but  for me it is something more. I haven't finished with anatomy, I have no idea what is histology, physiology and what to talk about dentistry... Anyway, by practising and learning on my own I have quite a lot of knowledge in oral surgery. Actually today I was talking with one boy who is last year student in dentistry and he said that he had never seen an implantation, so yes, I know more than even some last year students. I don't want to talk about myself as the best one because I really don't think this way about me. Though the point is that doesn't matter how old or which year student he/she is, it all about his/her motivation, dedication and determination. All depends on a person and his/her wishes/dreams/goals. The most important, of course, is to LOVE WHAT YOU DO. And I love dentistry, I love everything what is related with this proffesion and I will work hard because I want to be the best. I don't want to an average dentist, I want to be on the top. I don't know how I will reach this, but I will manage somehow and I will not stop until I get what I want. Okay, enough of this chit chat. Let's go on with implantation.

The surgeon implanted 2 MEGAGEN implants in the lower jower. I don't know a lot about this brand but I will definitely do some reaserch on it in the future. Maybe you know something and can tell me? :)

He did an incision, opened the gingiva and using different drills (beginning with the smallest and then taking a bigger one every time) he made a hole where he later put a fixture. I don't know why but I always imagined that an implant is bigger. I was quite surprised by its size (If I remeber correctly, he implanted 11.5 x 4.0). It looked so small and so fragile! You know, looking implantation videos on Youtube is not the same as watching operation live and even assisting. Anyway, they help you to understand the main idea of the operation. Here are some of my favs:










References:
http://www.megagen.com.ua/images/LOGO.png

Idiopathic Masseter Muscle Hypertrophy

On friday one surgeon came to me and asked "Can I touch your face?", "Of course" I said and lifted my head a little bit. He asked to open and close my mouth, to tense and relax masseter muscles. After examination he diagnosed me masseter muscle hypertrophy. I have never heard of this condition and I never noticed that something is wrong with my jaw because I have a square-shaped face, so it is quite wide from the day I was born. My masseter muscles are bigger than normal but it is also not so big to notice a pathology. Anyway, when I came back home I started to read more about hyperthrophy of this muscle and here is what I found: 

Masseter muscle hypertrophy is uncommon condition that can occur unilaterally or bilaterally.  Pain may be a symptom, but most frequently a clinician is consulted for cosmetic reasons because the majority complain of facial asymmetry (I don't feel any pain, for example, but i do have asymmetric face).

The Masseter muscle is essential for adequate mastication and is located laterally to the mandibular ramus, and thus plays an important role in facial esthetics.

Majority cases report that hyperthropy of masseter muscle is caused by clenching, bruxing, or heavy gum chewing and this occurs primarily in younger patients. Some authors associate it with defective teeth, temporo-mandibular joint disorder, congenital and functional hypertrophies, and emotional disorders (stress and nervousness).

Diagnosis can be produced from clinical examination (I was diagnosed by examination), directed interview, panoramic x-ray, and muscle palpation.

Therapy for masseteric enlargement is usually unnecessary, because it have no effect if it left untreated but for cosmetic reasons Masseter muscle can be cured both surgically or non-surgically. 

Surgical treatment usually involves resection of a portion of the Masseter muscle with or without the underlying bone.

(Intraoperative view)

(Hypertrophic muscle removed)

(Resected masseter mucle)

(Resected angle)

Non-surgical modality of treatment include reassurance tranquilizer or muscle relaxant, psychiatric care and injection of very small dose of botulin toxin type A (That's what treatment surgeon suggestested for me). When botulinum toxin type A is injected into a muscle it causes interference with the neurotransmitter mechanism producing selective loss of muscle function and a decrease in the mass of the muscle.

Sources:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275871/

http://www.cochrane.org/CD007510/MOVEMENT_botulinum-toxin-type-a-for-masseter-hypertrophy

http://www.scielo.br/img/revistas/rboto/v74n5/en_a24fig01.jpg

https://static.kenhub.com/images/library/997/content_content_Masseter_muscle.png

http://www.hindawi.com/journals/crid/2012/521427/

http://cdn2.anunico-st.com/foto/2013/01/azzalure_botulinum_toxin_xeomin_botox_botulinum_toxin_type_a_for_sale-50f84a94c5db43185d6acc86a.jpg

My thoughts lately...

 My thoughts lately....

Yesterday I spend the whole day in oral surgery and I saw many different situations. Many of them stuck in my mind, so today I want to give you some thoughts about one of them.

A mother with 3 years old child came to the clinic. A child was with swelled cheek. It look horrible. Surgeons diagnosed dental periostitis, as a consequence they hospitalized a child with his mother. The funniest and the sadest at the same time things is how people lie. "Why don't you brush your child's teeth?"asked a surgeon. "I do, I brush his teeth" told the mother. Seriously????? "With what? With Nutella toothpaste? " -  I wanted to ask. 

I mean, this child will have to live without teeth for 3-4 years. Can you imagine his psychology? Self-confidence level? I don't want to look pesimistic, but I think he will have a though period in his life especially when he will begin to go to kindergarden and later to the school. Children are quite cruel these years, they like to find someone they can laught of...