A Little Free-Association!
FRST OF ALL, a happy spring to you all. It was a rough winter to say the least, but we made it. We managed to weather the cold and snow right through to the s@#t-storm in Japan and the uprisings in the Middle East. But chin up: if the Mayans have their way, in a year and a half or so none of this will seem so bad.
So, out of the cruel world and into the world of dentistry. How’s that for free association? Here is an update on last issue’s review of the DentalVibe. All I have to say is “duh, winning!” The DentalVibe is continuing to prove itself a fantastic asset in my everyday practice. “Why?” you may ask Or maybe you might even ask, “How?” Well, M I C K E Y . . . Y? Because apparently it works. When I add the DentalVibe to my technique, painless injections seem to be the opinion of the majority of my patients, particularly when I am administering a mandibular block injection, which tends to be the more uncomfortable injection! The DentalVibe also works as well for a very sensitive palatal infiltration. How do I know that it works? Because patients are asking me to use it over again when I have used it on them before, and they apparently loved it! So, all in all, I’m still loving it. Thus, in the words of George Bush, Sr., “Painful injection bad, DentalVibe good!”
An Endo Tip
OKAY, let’s keep free-associating. Here’s a good endo tip. You know what I hate? Did you ever put a 45-degree bend on the tip of an endo instrument and struggle to negotiate an apical dilaceration only to try to repeat it with the next instrument and find that you can’t reiterate the path? Don’t you hate having that happen? I do! Well here’s what you should do. If you look at the rubber stop, you will see that there is a black line on it. If you align that line with your bend in the instrument, you will always be able to duplicate your insertion orientation and re-negotiate the apex. A Kase’s Case Update
TO MAKE a long story short . . . I don’t know if you remember a case I did a few years ago about a separated 25/.08 Niti SafeSiders® reamer that projected about 4 mm through the apex because a patient bit down on the reciprocating handpiece during instrumentation. Of course you don’t remember! At least I hope you don’t remember, because there are certainly more important things to remember than this case. Anyhow, allow me to refresh your memory. The patient presented with the situation described above, and after a long and drawn-out battle I removed the instrument, sealed the perforation with MTA, and obturated the canals. Although the prognosis was guarded at best, the tooth was subsequently restored, and I am proud to say that after four years the x-ray looks great, the tooth is still asymptomatic, and the patient is functional, at least dentally (Figure 1).
Another Helpful Tip
HERE IS ANOTHER helpful tip to help you instrument a sharp curve or an apical bend. By placing that small 45-degree bend on the tip of a .06, .08, or .10 reamer, you can slowly find your way to the apical constriction by hand placement and very tight wristwatch movement. You then attach your reciprocating handpiece and—most importantly—move the handpiece in a very short vertical envelope of motion rather than taking long strokes. With vertical long strokes you would lose the guide path and potentially clog or ledge the apical portion of the canal when you are trying to renegotiate the apex. Once the instruments do their work in the shorter motion, you can start to take progressively longer strokes without losing your apical path. Believe me, this works!
A Little Good Advice
FINALLY, speaking dento-legally, please keep your charts legible. Writing in a language that needs an FBI cryptographer to break the code doesn’t work. Enter things clearly and legibly. This is what holds up in court! Also, if another treating dentist or physician needs information, legible charts allow it to be transmitted clearly and accurately for the benefit of the patient. Also, another good idea is to stay within in your comfort zone when rendering treatment. Treat what you can, and refer what you are not comfortable with. In the many cases for which I am asked to do professional review in defending my fellow DDS or DMD, “failure to refer to a specialist” is always listed in the bill of particulars. I don’t want to scare you, but this is the reality of the litigious world in which we practice. Sharing the responsibility and managing the risk will certainly benefit your patient and ultimately your practice.
SO, IN CLOSING, I hope this was a bit helpful as well as a little entertaining. Enjoy the spring and the coming warmer weather.
P. S. If anyone out there is ever interested in a one-on-one teaching session on the SafeSiders® technique, don’t be shy and please give the office a call to schedule a visit. We are all ready, willing, and able!
April - June 2011
Stay within your comfort zone when rendering treatment. Treat what you can, and refer what you are not comfortable with.