Indirect Clinical Skills

Before: Patient unhappy with staining, wear, and cracks on #7-10

After: Veneers placed on #7-10 and composite restortion placed on #6

Measureable Outcomes: 27

Total Hours: 162

Total Procedures Completed:

#30 (2) Monolithic Zirconia 

#17 Monolithic Zirconia, Terminal tooth in Mouth, Digitally Impressed

#18 Monolithic Zirconia, Digitally Impressed 

# 14 (3) Monolithic Zirconia

# 2 (2) Monolithic Zirconia

# 5 Monolithic Zirconia, Subgingival Margins, Digitally Impressed

#30 PFM, terminal tooth in mouth

#30 Gold, Terminal tooth in mouth, Subgingival Margins

#7, 8, 9, 10, Ceramic Veneers, Esthetic Case

#2-4 Monolithic Zirconia Bridge

#19 and #30 Monolithic Zirconia Implant Crowns, Terminal Teeth in Arch

#13, 19, 20 Monolithic Zirconia Implant Crowns

Procedures In Process:

#2-4 Monolithic Zirconia Bridge

#29 Monolithic Zirconia, Digitally Impressed, Subgingival Margins

#14 Monolithic Zirconia

Crown Materials:

Majority of the crowns I treatment planned and restored were monolithic zirconia because of their excellent esthetics and strength. Prepping the tooth for a zirconia crown is the least conservative, however, my patients wanted teeth with superior esthetics which led us to avoid PFM or gold crowns. I did get to restore one PFM crown and one gold crown. I did like how conservative I was able to be with the gold and PFM restorations and in the future if a patient wants to preserve more tooth structure and didn't care about esthetics I would opt to do a PFM crown.

This #30 Zirconia Crown was the second crown I completed in clinic during my D2 year. When I was preppping the tooth I decided to keep the margins more supragingival with the rationale that this patient is only in his 50s and it is possible that later in life he will get recurrent decay on this crown and it will need to be redone and to avoid crown lengthening it is wise to keep the margins as supragingival as possible. The provisional went well but the impression took me three tries. I struggled with impressions initially and had a hard to maintaining isolation and not getting any bubbles around the flash. The CIMOE however went perfectly and the patients was please and had no idea he was my first crown patient.

Digitally Impression of #17 and #18

This patient was passed down to me by my big and he had tried to get the PVS impression 6 times over the span of 2 appointments. Capturing #17 was extremely hard because it was difficult to maintain isolation and capture the margins. It was decided that a digital impression would be beneficial and when I saw the patient i was able to refine the prep and take the scan and the patient was pleased. The crowns also came out perfectly and require no adjustments, which was a great way to end my first digitally impressed case. I like digital impressions much more than conventional impressions. I feel that the patients are much more confortable and I like that after scanning you can look at your prep and make any adjustments and simply re-scan rather than take a brand new impression.

This patient has missing teeth at sites #3, 13, 19, and 20 for which he wanted implants. On the CBCT scans we found that #3 required a sinus augmentation which was pushed to the Fall of 2023 but the bone was sufficient at #13, 19 and 20 and after they were osseointegrated we moved on to restoring the implants with permanent restorations. Since the whole process was so fast paced and the patient was used to not having teeth that the missing sites we opted not to make provisionals. After 2 months of osseointegration I took a closed tray impression for #13 and open tray impression or #19 and #20. At the time of CIMOE the teeth had very tight contacts and high occlusion, so it took me the entire clinic session to get all three restorations properly restored.

Indirect Competency Exam Self Assessment:

Preparation and Temporary:

I was able to complete a build up, preparaion and create a provisional with very few problems and finished the competency with an hour to spare. I did minorly struggle with the build up because there was deep caries and I was being slow and cautious to avoid exposing the pulp.

Final Impression

It took me two tries to take my final impression for my competency patient which isn't ideal. I think I get nervous doing final impressions because they are what I struggle with the most and I am hard on myself everytime I don't get the impression on the first time. I need to slow down and have more intention when I take my final impressions and for my competency it should have only taken one try.

CIMOE:

My competency patients' final restoration had an open contact on the distal, but luckily Carlos the lab technician was able to add some porcelain onto the distal contact and I was able to CIMOE the crown to standards. I was proud of myself for how quickly I was able to coordinate getting the porcelain added and the patient and I were both pleased with the crowns fit, occlusion and esthetics.

Clinical Reflection:

During my time at the UOP clinic I have had a lot of exposure to restoring zirconia crowns, particularly on posterior teeth. I feel competent and confident doing posterior zirconia crown restorations but I feel that I could have had more practice doing crowns on anterior teeth and PFM or gold crowns on posterior teeth. The only anterior indirect restorations I completed outside of the simulatio lab were anterior veneers on a patient and I had help from faculty. I also feel that majority of the crowns I restored were due to recurrent decay on existing crowns so very few of my crowns were made on virgin teeth. I wish I had had more virgin teeth to restore so that I could get faster with crown prepping a virgin tooth. The biggest adversity I faced during my indirect procedures was patients getting antsy with how long the process takes. I hope to further develop my skills so that I can prep, temp and take an impression on a tooth during a single appointment. I also wish I had more exposure doing inlays and onlays because I know the office I am working for after graduation does many of these restorations. I had very little help from faculty during my indirect procedures so I would guess that 99% of the time I finished the procedures without any intervention. During my two years in clinic a faculty member has only stepped in once to help with a final impression. I feel very competent in prepping, making provisionals, and CIMOE'ing but I could use more practice taking final impressions since I have only once gotten an impression on the first try.