Triple tray crown and bridge procedures: a guide to how dental assistants can assist the dentist: part 1.

The manual dual-arch (or triple tray) technique is an efficient way of making a definitive impression and making temporary provisional restorations for crown and bridge procedures. This article demonstrates how a dental assistant can assist a dentist during triple tray crown and bridge procedures. This is the first part of a two-part article, and explains mixing impression materials, making pre-operative dual-arch impressions, deciding in what situations to use separate arch impressions instead of the triple tray, and introduces the topic of making provisional restorations. In the future, in-office CAD-CAM scanning and milling of restorations, or digital scanning of tooth preparations, followed by e-mailing the scans to a dental laboratory, may reduce the frequency of use of the manual triple tray impression technique. However, its intrinsic efficiency may prevent it from becoming obsolete.

Triple tray crown and bridge procedures: A guide to how dental assistants can assist the dentist: Part 2.

This is the second part of a two-part article, and explains the techniques of making provisional restorations, such as the shell technique, the bulk technique for making a temporary restoration from scratch, or the basic technique of using the mold of the unprepared abutment in the preoperative impression, to form the temporary restoration.

Assembly and clinical use of the XCP dental x-ray film holder and orientation devices in dentistry.

XCP dental x-ray film positioning devices help to increase the dimensional accuracy of dental x-ray images. (XCP stands for "extension cone paralleling." Some dental assistants refer to them as "Rinn" devices, after a company that manufactures them.) The XCP device has a collimator ring that is parallel with the film-holding plane of the x-ray film holder. This positioning helps an assistant to align the plane of the unseen, intraorally located x-ray film parallel with the plane of the cross section of the x-ray beam. XCP devices also help to prevent dental x-ray film cone cuts, since the extraoral collimator ring helps to indicate the boundary of the unseen x-ray film. Unfortunately, the devices can be confusing to assemble because each device consists of three pieces that can be assembled in multiple ways, and there are three types of such devices for anterior, posterior and bitewing radiographs (in addition to a fourth accessory device for taking endodontic radiographs). It can be challenging to determine which piece goes with which type of XCP, and to choose the correct XCP assembly for taking a desired x-ray. This article describes some clinical techniques of assembling XCP radiographic film-holding devices, describes the clinical use of XCP devices, and ways of overcoming intraoral obstacles to device placement.

Clinical techniques of performing suctioning tasks and of positioning the high volume evacuation (HVE) attachment and inlet when assisting a dentist. A guide for dental assistants: Part 1.

When assisting a dentist, an assistant may need to hold the high volume evacuation (HVE) attachment and use it to suction aerosols produced by the dentist's tools, particularly the high speed hand piece or the cavitron. The main objective of suctioning is to hold the inlet of the HVE attachment close enough to the source of aerosols to evacuate those aerosols, while avoiding suctioning of the patient's intra-oral soft tissues, and avoiding contact of the HVE attachment with the hand piece, cavitron or other instrument that the dentist is using. In general, assisting a dentist with suctioning is a somewhat complex skill that may require months of experience before an assistant develops an intuition for suctioning. This is the first part of a two-part article. The first part describes the basic concepts and clinical techniques that an assistant should be conscious of in order to be able to properly assist a dentist in performing evacuation tasks, describes retraction techniques for use while suctioning, and describes use of the saliva ejector and surgical suction attachment.

Assembly and clinical use of the XCP-ORA: a three-function dental X-ray film positioning device for taking anterior and posterior periapical and bitewing intraoral radiographs.

This article describes the assembly and clinical use of a newer type ofXCP dental X-ray film positioning device, called the XCP-ORA. The previous version of the XCP consists of three separate devices for taking anterior, posterior, and bitewing radiographs. The XCP-ORA dental X-ray film holder combines all three of these dental X-ray functions into one device, in contrast to theprevious generation ofXCP holders. The large paralleling ring of the device contains three color-coded square-shaped holes that attach to a metal rod. This single metal rod with two right angle bends contains two sets of corresponding color-coded prongs that attach the anterior, posterior and bitewing X-ray film holders. One set of prongs consists of two red prongs that correspond to the insertion points of the bitewing X-ray film holder. The other set of prongs consists of one prong that is yellow colored, and another prong that is blue colored. Both of these prongs fit into the insertion holes of either the yellow (posterior) or the blue (anterior) film holders. The multi-function XCP-ORA device reduces the total number of XCP parts that are needed to take intraoral dental radiographs. Fewer parts make the device less confusing to assemble and reduce the number of steps that are needed to prepare the XCP-ORA parts for autoclaving.

Clinical techniques of performing suctioning tasks and of positioning the high volume evacuation (HVE) attachment and inlet when assisting a dentist. A guide for dental assistants: part 2.

When assisting a dentist, an assistant may need to hold the high volume evacuation (HVE) attachment and use it to suction aerosols produced by the dentist's tools, particularly the high speed handpiece or the cavitron. The main objective of suctioning is to hold the inlet of the HVE attachment close enough to the source of aerosols to evacuate those aerosols, while avoiding suctioning of the patient's intra-oral soft tissues, and avoiding contact of the HVE attachment with the handpiece, cavitron or other instrument that the dentist is using. In general, assisting a dentist with suctioning is a somewhat complex skill that may require months of experience before an assistant develops an intuition for suctioning. This is the second part of a two-part article, and focuses on how to position the HVE suction inlet at various locations intra-orally and on how to maintain and clean the dental office suction pipes.

A rationale for the use of high-powered magnification or microscopes in general dentistry.

This article argues that high-powered magnification (4x-6x or more) provides substantially more visual information for diagnosing and treating dental pathology compared to the use of unaided vision or entry-level 2.5x magnification. In all phases of general dentistry, the increased visual detail provided by high magnification reduces ambiguity in diagnosis and treatment decision-making, increases control in treatment implementation, allows a dentist to produce more ergonomic restorations that are less prone to recurrent decay, and arguably improves clinical outcomes compared to work performed with unaided vision. High magnification enhances a dentist's ability to diagnose caries and cracks in teeth, distinguish between different colors intraorally, detect the interfaces between different surfaces and materials, detect microscopic interferences in fixed and removable metal frameworks, adjust occlusal prematurities, and polish restorations. This article explains specific general dental applications for high-powered magnification in restorative dentistry, fixed and removable prosthodontics, endodontics, pediatric dentistry, periodontics, and oral surgery.

Amalgam matrix for class II and class V preparations connected at the proximal box.

BACKGROUND: The authors present a technique for placing and reinforcing an amalgam matrix around combined Class II and Class V preparations that connect at the proximal box. OVERVIEW: First, the dentist fills the Class V aspect of the preparation, using a temporary resin-based composite wall at the line angle to support amalgam condensation. The dentist then removes the wall and places a matrix band around the tooth, internally reinforcing the band with smaller pieces of matrix band and resin-saturated cotton balls that are light-polymerized and externally reinforcing the band with fast-polymerizing vinyl polysiloxane. Finally, the dentist condenses the line angle amalgam through the proximal box and condenses the proximal box and occlusal aspects. CONCLUSION: For connected Class II and Class V preparations, this matrix technique permits controlled amalgam condensation, even at the line angle aspect, where it is difficult to condense amalgam without voids or microleakage. CLINICAL IMPLICATIONS: This technique allows dentists to provide a stable, inexpensive direct restoration for teeth with connected Class II and Class V preparations, providing an alternative for patients who do not wish to have crowns placed.

Composite matrix for large, non-wedgeable Class III or Class IV preparations with gingival or subgingival margins.

Dentists sometimes are required to place a matrix to restore large Class III or Class IV preparations that have gingival or subgingival margins or are prepared in rotated or malposed teeth. In these situations, dentists sometimes cannot place a wedge between the prepared tooth and a neighboring tooth because the wedge cannot engage enough interproximal tooth structure to firmly anchor both itself and a matrix strip. This article presents a technique for placing a matrix around such large, non-wedgeable Class III or Class IV preparations.

Preventing sharps, splash, and needlestick injuries in dentistry: a comprehensive overview.

This article presents a comprehensive collection of precautions and suggestions for preventing sharps, splash, and needlestick injuries in dentistry. The authors looked at studies of sharps and splash injuries in dentistry to determine which of these injuries are most common. They then assembled a set of precautions to prevent these injuries based on published literature, tips learned from other dentists, and their own clinical observations. Dentists must remember and apply many precautions to prevent the broad spectrum of sharps and splash injuries that could occur during the delivery of dental care.

Cracked tooth diagnosis and treatment: An alternative paradigm.

This article reviews the diagnosis and treatment of cracked teeth, and explores common clinical examples of cracked teeth, such as cusp fractures, fractures into tooth furcations, and root fractures. This article provides alternative definitions of terms such as cracked teeth, complete and incomplete fractures and crack lines, and explores the scientific rationale for dental terminology commonly used to describe cracked teeth, such as cracked tooth syndrome, structural versus nonstructural cracks, and vertical, horizontal, and oblique fractures. The article explains the advantages of high magnification loupes (×6-8 or greater), or the surgical operating microscope, combined with co-axial or head-mounted illumination, when observing teeth for microscopic crack lines or enamel craze lines. The article explores what biomechanical factors help to facilitate the development of cracks in teeth, and under what circumstances a full coverage crown may be indicated for preventing further propagation of a fracture plane. Articles on cracked tooth phenomena were located via a PubMed search using a variety of keywords, and via selective hand-searching of citations contained within located articles.

On the ferrule effect and the biomechanical stability of teeth restored with cores, posts, and crowns.

An abutment for a fixed partial denture may not contain enough tooth structure, such that the abutment does not provide an adequate 'ferrule effect'. A crown or bridge dental prosthesis that is cemented onto such an abutment/s may undergo biomechanical failure. Here, the tooth, core, and post complex, on which the crown is cemented, may fracture off from the abutment, causing the crown to separate from the abutment, while the cement that bonds the crown to the tooth, core, and post complex remains intact, such that the tooth, core, and post complex remains inside the crown when the crown separates from the abutment. This article reviews the dentistry literature on the ferrule effect, and presents alternative definitions for terms such as ferrule, the ferrule effect, and the ferrule tooth structure. The article also explains how the use of a surgical operating microscope, or high magnification binocular surgical loupes of ×6-8, or greater magnification improve the ability of a dentist to assess how much ferrule tooth structure an abutment contains, compared to the use of unaided vision.

The total occlusal convergence of the abutment of a partial fixed dental prosthesis: A definition and a clinical technique for its assessment.

The abutment(s) of a partial fixed dental prosthesis (PFDP) should have a minimal total occlusal convergence (TOC), also called a taper, in order to ensure adequate retention of a PFDP that will be made for the abutment(s), given the height of the abutment(s). This article reviews the concept of PFDP abutment TOC and presents an alternative definition of what TOC is, defining it as the extent to which the shape of an abutment differs from an ideal cylinder shape of an abutment. This article also reviews experimental results concerning what is the ideal TOC in degrees and explores clinical techniques of estimating the TOC of a crown abutment. The author suggests that Dentists use high magnification loupes (×6-8 magnification or greater) or a surgical operating microscope when preparing crown abutments, to facilitate creating a minimum abutment TOC.

A pin amalgam or composite core foundation technique for teeth with minimal coronal structure.

A common dental problem is restoring teeth with gingival or subgingival margins and extensive loss of coronal tooth structure. A technique is presented for doing so by making a wax foundation on the tooth and injecting vinyl polysiloxane impression material around the foundation to form a matrix for the tooth, using rubber dam clamps to stabilize the matrix.

Patient-fabricated denture prostheses: a clinical report.

This article describes 2 patients who presented with self-made dentures. Each patient had a different motivation for avoiding professional dental treatment. One patient made her own denture because she could not afford dental care, while the other could afford such care but avoided treatment due to a dental phobia. A discussion of diagnosis and treatment planning is presented for each situation.