Direct Restorations

**Research and relevant reflection from this presentation located in the comments section of the Powerpoint presentation. These notes are vital for the presentation and to view these notes, please download the file at the top right corner of the slides titled "Pop-Out"; or by email: j_barnett@u.pacific.edu. Thank you.**

• Measurable outcomes e.g., total number of hours dedicated to the Discipline of Direct (Operative) Dentistry and procedures completed

  • Number of hours spent on Direct Restorative: 250

  • Number of procedures: 64

• A description of the cases that you treated, how many of each type of G.V. Black cavity classification (I-VI) that you treated.

  • Class I: 12

  • Class II: 25

  • Class III: 6

  • Class IV: 5

  • Class V: 16

• Provide two examples of cases reflecting on what went well and what was unexpected during the procedure. What did you learn from the case.

  • Case 1: My first Class IV was nerve-racking. It was on an Ellis Fracture Type I in Enamel that was the inicisal-gingival distance of the entire tooth. I had made a putty and practiced prior to procedure. Everything was going great until I stuck the wedge in and the patient started bleeding profusely. I had to stop the bleeding and rework how I would get proper isolation. I used the rubber dam with floss ligatures and got great isolation. The case turned out beautifully.

  • Case 2: I had a patient start taking a blood-thinner and he did not tell me. Now this is my fault but I had seen the patient 7 or 8 times prior to this appointment all in a short time. So we went through the medical history update pretty quickly and he "forgot" that he started taking Apixaban. As I placed my matrix band, the gums began to bleed heavily. I had to use local with epi and moderate pressure to stop the bleeding. After the bleeding stopped, the Class V looked incredible. "Better than I thought you could have done."

• Reflect and describe the variety of clinical situations that you encountered, things that you learned and did to accomplish the treatment even under adverse circumstances.

  • Dr. Edwards, my GPL, and I had an understanding that I wanted to work with difficult patients. Throughout my time as a 3rd year, I had 5 patients that were border-line BTS due to behavioral issues, 2 of which were actually BTS but Dr. Edwards did a work around to keep them in our practice. These patients were yell at me throughout, use the bathroom excessively, be late, etc. What I developed is the ability to gain control of my chair. At the core, most of my patients were just scarred and I took the time to calm them down. After I learned how to control my patients, the dentistry was fairly straightforward and that is not because I had simple cases - please refer to the above powerpoint. I had many difficult cases but the more that I did, the more confident that I became, and the better my outcomes became.

• Self-assessment of how you performed on the Direct Mock WREB exam in December, if you did not have a patient use a Direct Daily Work Competency Exam.

  • I easily picked the most difficult patient for Mock WREBs and I did so on purpose. I figured that WREBs would be the most stressful environment and I tried my best to simulate that with my patient. The patient is well known for being borderline BTS due to behavioral issues. The prep was a #3 DO, it is captured in the above powerpoint. The patient was 30 minutes late, used the restroom 5 times during the exam, and the preparation went subgingival and I received a 3 overall. The prep was rough but the restoration received almost a perfect score other than the high occlusion that I was not able to polish down due to time. That was stressful but I was in control. It made me better equipped to handle a high stress situation.

• What percentage of the procedures were completed largely independently, about how many times did you require a significant amount of faculty intervention to get things done; and why you feel that you are competent in the discipline of direct (operative) dentistry.

  • My first filling, I worked on a number #14 OL and Dr. Thornton was the attending faculty. Dr. Thornton showed me how to adjust the occlusion more efficiently. Other than that, I have been the only one to touch any of the 64 direct restorations that I have placed in the clinic. I think that this was reflected in the amount of time that some of my fillings took in the main clinic. There were many times that I had a faculty member have a look at what it was that I was doing to give the reassuring go ahead but other than that I have been solely responsible for the actual hand work. I have had many good outcomes and had to redo a filling once when I knew that my hands were not there that day. I feel very confident doing any direct restoration on any tooth in the mouth.