Indirect 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 Indirect (Fixed) Dentistry, procedures completed and in progress.

  • Number of hours spent on Indirect: 250

  • Number of cases delivered: 9

  • Number of cases in progress: 2

• A description of the cases that you treated; how many conventional crowns, implant crowns, digitally-impressed crowns experiences, location of these cases in terms of anterior or posterior, cuspids, esthetically challenging situations, last in the arch, sub-gingival prep margins etc.

  • Conventional Crowns: 8

  • Implant Crown: 1

    1. Almost all of my crowns that I delivered featured a margin location of juxtagingival. I made it easy on myself by discussing with my patients that the higher the crown margin is, the more that the gingivae would react nicely to it, the easier that it would be for them to maintain. I did not have any anterior cases unfortunately and nothing really too challenging.

• Describe the different type of crown materials you have used, why you chose it and any modifications made to the tooth or treatment plan to ensure success.

  • I delivered Lithium Discilicate, Zirconia, and FVC crowns. I did not have to make any modifications to the treatment plans that I had. I worked extensively with my faculty to choose an appropriate material choice that provided the functionality and aesthetics for each specific case. Of the 9 delivered, I have had 9 crowns that my patients could not be happier with.

• Reflect on one conventional and one implant case reflecting on what went well and what was unexpected during each stage (Prep, Provisional, Impressions, or CIMOE). What you learned in the whole process with the case.

  • My implant case had almost everything go wrong with it at the CIMOE stage. We had to send it back to the lab multiple times and the patient has a TMJ disorder that causes her to anteriorly displace after 4 minutes. Luckily, she was the the most relaxed patient and we ended up getting it right as seen in the slides above.

• Compare and reflect on digital and conventional impression cases you have experienced.

  • I did not have any personal experience using the digital scanners for impressions but I assisted on a lot of cases. The digital scanner is great but with all technology, I feel like knowing the technologies limitations are important. I really enjoy taking conventional impressions. The heavy body, light body method is far inferior to the 2 step putty wash, light body technique in my hands specifically. It took me 10 impressions each on my first 2 cases until I realized how silly that was. After that, I never had to retake an impression due to accuracy. If I had to retake one, which I did once, it was because my preparation was subpar.

• Describe the variety of clinical situations that you encountered, what did you learn and do to accomplish the treatment even under adverse circumstances.

  • As mentioned, I had some very difficult patient management cases with fairly straightforward technical dentistry. But, I made sure to use almost every material, Duralon, Ultratemp, Tempbond, to every size cord, to every single indirect bur that we have at the clinic. Moreover, I used the heavy body/light body and 2 step technique many various times. So what I learned was how to be adaptable - primarily because my patients made me have to be that way. Lastly, what my biggest takeaway was, almost anything that we do is fixable so if it isn't what we wanted it to be the first time, we learn from it and fix it.

• Self-assessment of how you performed on an Indirect Competency Exam.

  • I received a perfect score on my competency exam. The competency was a #30 Lithium Disilicate full-coverage crown on an endo-treated tooth. The taper, margin location and margin depth were right where they needed to be. That was the best thing that I had done in clinic up to that point and arguably one of my proudest days in dental school. I finished the prep and temp in an hour and a half and I would have really liked to have seen that be less than an hour.

• Describe the percentage of the Indirect Preps, Provisionals, Impressions, CIMOES's 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 Indirect (Fixed) Dentistry.

  • On my first two crowns I had about 50% for the preparation and about 75% on the temporaries. From then on, I really practiced in the sim lab after making friends with the class under me to work on my crown preparation/temporization. Starting with my third crown prep, I did not have any help with a preparation other than the #5 where I had Dr. Stephens show me how to approach the preparation. I struggled a lot with temporaries but I did not receive any hands-on help from faculty. In order to achieve such little hands-on, like I mentioned in the direct section, I took things slower. I ensured that my patients would be getting my absolute best work and that is why they did not mind me trying and learning continuously. I am no master in any means when it comes to fixed dentistry but the basics I have down. Create a nice taper, be mindful of your preparation design, give your lab a nice smooth margin that can be seen circumferentially in your nice impression, and do not cement anything you wouldn't want in your mouth.