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Today, I want to use this session as a refresher for all the skills and knowledge that I had learnt last here. This means to effectively place a rubber dam, simulate a satisfactory lesion which requires the competent use of my hand pieces as well as effectively applying fissure sealants that require minimal polishing.

Today I want to effectively apply fissure sealants onto the teeth of focus by taking a conservative approach whereby I try to avoid applying excess amounts of the product onto the teeth and assessing the teeth carefully to remove any excess amounts so that when the teeth set, there is minimal need to polish and re-contour and that the anatomy of the tooth is maintained.

I am hoping to demonstrate an effective cavity preparation on the buccal of 37 and the palatal of 16. I believe this may be a difficult task as I am used to creating cavities on the occlusal aspects of the molars. I am hoping to restore the teeth of focus effectively and seamlessly with composite resin as we have had lots of practice using this material throughout last year.

The placement of the rubber dam on the 36 was very efficient as I was able to attach the clamp onto the tooth without any complications.

I feel like my placement of the rubber dam is competent but still needs refining. When placing the rubber dam onto the mannequin with the clamp in, I should tug onto the other side of the rubber dam to ensure that it is taut. In doing so, it will ensure that there isn't any loose fabric hanging close to the clamp and allows for a seamless placement of the rubber dam that ensures moisture control around the tooth of focus, in particular for multi-tooth isolation which requires isolating multiple teeth. I noticed this as I did not pull on the rubber dam when doing the multi-tooth isolation and this resulted in inconsistent spreading of the rubber dam which gave way to gaps being present at the teeth adjacent to the clamp.

I believe my application of the flowable composite as a a fissure sealant for the 36 tooth is fairly satisfactory in that I was able to retain majority of the anatomy of the tooth once I had light cured it. This was because I was able to carefully remove the excess using the ball burnisher when running it along the pits and fissures of the 36. I did notice a small amount of excess in the occlusal pit which may have occurred as the flowable gravitated distally. This could be improved by using a microbrush to soak up the excess and doing so hastily as the product can set fairly quickly.

I believe my ability to create the cavities on the palatal and buccal aspects was better than I had expected. Because I am more familiar with cavity preparations on the occlusal aspect, I organised myself and evaluated what factors I needed to consider when accessing the tooth with my high speed bur. As I was more careful and meticulous with how I angled my bur, using indirect vision and trying to coordinate that with my hand piece position, I achieved a fairly satisfactory cavity. Restoring the tooth with composite resin was fairly easy and successful for me as I was able to create a seamless resin with minimal polishing and made sure to not apply excessive amounts of the product when packing it into my cavity. There could be more room for improvement in my precision when creating my cavity preparation.

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Fissure Sealant - GIC Application on the 46

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Fissure Sealant - GIC Application on the 46

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On the 37 buccal pit, creating a cavity of about 3mm to a 3mm depth, then using composite resin to restore the tooth and bring back the anatomy.

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In this session, I want to be able to improve my strokes with the EMS instrument as I am removing my simulated calculus. I want to make sure that I am not stopping as frequently as possible as in a real life scenario, my patient could be discomforted by the stopping and starting of the instrument, especially when it is against the tooth surface.

I notice that probing the teeth prior to picking up the EMS instrument is extremely helpful as it is indicative of the location of the calculus and where the EMS should be used. I felt that I was able to achieve featherlight strokes and after being demonstrated the lateral and vertical techniques using the lateral end, my removal of the calculus was fairly effective. I am still trying to understand which fulcruming technique works best for me as I find that cross arch sometimes works better for me in some quadrants, however, poorer in others, and those are where I may use either on a nearby tooth or the chin cup technique. I can see the importance of the fulcruming as it helps me stabilise my instrument handling and am able to roll my EMS instrument so that I can achieve a seamless and minimally interupted removal of the calculus. This rolling of my EMS instrument is also facilitated by my ability to have a competent modified pen grasp on my instrument. Sometimes I am struggling to completely remove the calculus in the interproximal areas, however, I find that after I've done the areas of focus, I can go back into just the interproximal areas alone and do vertical strokes to resolve the remaining calculus.

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This is my debridement procedure using the EMS on the facial surface of quadrant 2.

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This is my debridement of the buccal surfaces of quadrant 3 using the EMS instrument.

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And this is my debridement on the lingual surface of quadrant 3 using EMS.

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In this session I used scalers to debride the teeth of quadrant 1 and 4. I found that my modified pen grasp is getting significantly better and this is also facilitated by my ability to fulcrum in the correct places. As a result, my strength in activating the blade against the tooth surface and thus, my ability to debride is improving. I am still trying to figure out which side of the curettes is the working end, however, upon more practice, I am figuring out that it is usually when the blade and the shank of the scaler engages with the tooth surface. The V to D approach also helped for the 13/14 gracey and 11/12 explorer. As I am still trying to figure out the best possible position for my debridement, I am noticing that I do not have to follow the guides we were given for our positioning in each quadrant. I find that working indirectly in the palatal aspect of quadrant 1 is difficult for me despite being told to work from an 11 o'clock position, however, I notice that when I rotate my body to a 8 o'clock position and safely work above my patient's chest, I can use direct vision and successfully debride. This class has been a good session to refresh my knowledge on debridement as well as find my bearings in my positioning.

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16MO Proximal Occlusal Cavity Preparation and Restoration

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16MO Proximal Occlusal Cavity Preparation and Restoration

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Goals: I want to improve my hand eye coordination with the high speed hand piece using indirect vision to access my cavity preparation. I want to be considering the depth that I am creating when extending my cavity and making sure to consider minimal intervention. I also want to consider the anatomy of the tooth when restoring it with composite.

​​​​​​​Reflection: I was able to not over extend my cavity and maintain the depth when creating my cavity. I found that I was able to successfully pack the tooth with composite and maintain the anatomy of the tooth as I used an incremental placement of composite and made sure I was adding it to the walls as well. I feel that I could improve on my indirect vision a little bit more as I struggled to orient my bur so that it was accessing the enamel wall towards the axial plane.

I felt that my ability to create a preparation took longer than expected as I was overly concerned with my depth. Upon assessing the location of the two caries, I noticed a step was needed and had to extend the depth on my mesial caries a little bit more to achieve this.

i also noticed when doing my cavity preparation i shouldn’t just go along with the depth I assume at the start. i noticed that the shadowing created from the caries made it appear bigger than it actually was when I had accessed it.

Using indirect vision was not too difficult, I took my time to make sure I was being careful. I wish I was quicker at knowing when to create the step however this will improve with more practice.

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Cavity Preparation

Goals: My goal is to ensure the angle of my bur enables me to create a cavity that has a beveled contour which will assist me to pack composite resin as my filling seamlessly. I want to make sure I am considering the depth of my cavity as I do not want to compromise the tooth structure considering the anterior teeth are thinner than the molars.

Reflection: I believe my goals were achieved - I was able to angle my bur well that I could create a bevel in my cavity. I ensured that I cleared the caries whilst also considering the depth I was accessing my cavity where I had accessed just under 2mm. I should consider how incisally I am extending my cavity as I do not want to compromise the tooth structure.

Adhesive Restoration

Goals: I also want to be able to recreate the curvature and anatomy of the tooth when I am packing the composite resin into the tooth. I will be using an incremental layering technique so that I can avoid any voids or deficiencies and achieve a seamless restoration.

​​​​​​​Reflection: I was able to achieve a competent finish on my restoration of the cervical aspect of my 34 premolar. I was able to pack my composite incrementally and extend it to the borders of the cavity to ensure that I did not have any voids or deficiencies in my restoration. The use of the polishing discs really was a game changer and helped me remove any overhangs, roughness and was the finishing touch to creating a shine and smooth restoration.

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Cavity Preparation

Goals: In this session, I want to carefully access my cavity by having a stable fulcrum as the tooth structure of anterior teeth are not as wide as molar teeth. I want to make sure I am constantly reassessing my angulation of the bur to not remove more enamel structure then I should.

Reflection: I feel that my angulation of the bur was consistent throughout the cavity preparation. I made sure to pause from time to time to assess my depth of my cavity and assess how much further I needed to extend to clear the caries. This allowed me to create a cavity that did not compromise the tooth structure. This cavity preparation was assisted by my isolation of the teeth using the rubber dam as I made sure to isolate from premolar to premolar which did not compromise my vision. More improvement would be needed in my assessment of whether the tooth structure I have left behind is supported and if it is not, I should extend it to the marginal ridge so that there is no unsupported enamel remaining.

Adhesive Restoration

Goals: I want to also ensure a smooth finish of my composite resin with the marginal ridge so that minimal deficiencies or catches are present when I light cure it. When polishing, I want to be able to evaluate which tool is best to smoothen my restoration to minimise any compromise of the restoration I have created and the possibility of having to add more restorative material.

Reflection: I was very happy with my restoration in the end as a smooth finish was able to be created. This came with a lot of polishing however as catches and flashes were present on the palatal and interproximal aspects of the 11 respectively. Going back to packing my cavity with composite resin, I was able to adapt the Mylar Matrix strip to the interproximal space and use it over the palatal surface with the ball burnisher to adapt the resin to the tooth surface. If I had dedicated more time and effort into using the ball burnisher, I could have minimised the need to polish that much. Polishing strips and the enhancer were used to successfully create the smooth finish and remove the catches and interproximal flashes in the end.

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Cavity Preparation

I want to be able to efficiently remove caries by making sure not to remove excessive amounts of sound enamel so that I don't compromise too much tooth structure. I want to create cavity margins that are consistent and smooth so that there is no unsupported enamel present.

I believe my ability to remove caries is significantly improving. This is probably due to my constant reassessment of my cavity outline during the process of the removal where I ensure that my angulation of the bur, the depth of my cavity and the margins of my cavity are appropriate. I am making sure that I consider the angle I access my caries so that I don't remove too much of the sound enamel. I am making sure that I protect the adjacent teeth by placing a wedge and band and am also finding that it gives me confidence to extend my cavity towards the proximal margins. All these considerations for my caries removal is making the process allowing me to be more efficient with my time.

Adhesive Restoration

Today, I want to also be successful at creating a smooth finish for my anterior approximal restorations whereby the margins of thee composite resin aligns with the marginal ridge. By doing this, it will allow me to polish confidently without having to go back to reapplying more composite.

When packing the composite resin into the cavity, I made sure to push the material towards the walls of the matrices that were used in the proximal surfaces. In doing this, it allowed me to create a smooth finish whereby my composite resin at the proximal walls had no catches. There were overhangs present, however, this was easily refined by polishing using polishing strips, and polishing burs. At every step of filling my restoration and polishing, I considered the anatomy of the incisor and this definitely attributed to creating a smooth finish to my adhesive restoration which I am very happy with.