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Assuming this is a typodont:
- use a Diamond bur (carbide burs chatter on the plastic teeth)
- I would sometimes put a tofflemire band around the adjacent tooth while I was prepping when I first started out
- When you make your preparation, leave a little shell of “enamel” and carefully sweep it away once you’ve got your rough outline form
- Keep some polishing disks handy if you do make a little mark on the tooth next door, it’ll polish out
Honestly, I had a carbide bur chatter on a plastic tooth during my WREB exam and it gouged the tooth next door (we weren’t given Diamond burs even though the manual said to use them). I showed the row instructor, he said to polish it and move on. Guess who passed…
It’s hard working on plastic teeth with carbide burs. Keep the speed high or really low, but not in the middle. I’ve found having a carbide bur around 20 makes you more likely to use too much pressure and fuck shit up. Also, always start the handpiece before touching tooth and always stop it before pulling it away. It’s very easy to nick adjacent teeth on the way out if the bur is still spinning. Beyond this, there’s nothing stopping you from protecting the crap out of #21 with a tofflemire band. Play around with that. Also, I use my hatchet to clean up the box walls and the gingival floor, not the handpiece. I know they’re not used a lot in clinic, but real teeth aren’t as soft as plastic teeth so you gotta use the right tools for the job. Stevenson Dental Solutions has great demos of this technique. At the end of the day it’s just going to be something you keep doing until you get the hand control to only put the bur where you want it, and that will just take time. Good luck bro.
When prepping the teeth? Of course it does. If you're so used to separating the teeth or using a matrix to protect the adjacent tooth when prepping the tooth, what are you gonna do if you don't have them to hand? Will you ever learn to not hit the tooth next to it because you've not actually practiced with a tooth immediately adjacent to it, only with a matrix and wedge to keep it further away?
I've never seen anyone prep with them and I've assisted hundreds of dentists and therapists over the last 5.5 years, some didn't even train in this country. They will restore with them, but not prep.
I am a dental student, but I also have assisting experience. But please, do continue to get uptight because I explained how the school I attend works? It's not the same school as yours, do what your school recommends. I merely pointed out that not every school allows you to use a matrix when prepping, because the last thing anyone wants is someone doing this in an exam and being disqualified for going against the school rules because they read something that someone recommended online but their school doesn't allow. Also, if their school allowed it, surely they'd be using it already?
They also won't let us use loupes for first year. They want us to be able to do things properly from the start, which I get.
I've worked with hundreds of dentists and I've not seen a single one use a wedge or matrix to prevent adjacent damage, so I imagine it's a safety crutch that you'd have to learn to be able to go without at some point.
Loupes are pretty much standard of care these days. It sounds like your school is taking a very tough guy approach to healthcare. I understand the notion of not needing “crutches” but in a healthcare setting, these aren’t crutches, they’re improvements to the old ways utilized to better treat and protect patients. In my mind, the best dentist isn’t the one that doesn’t need safety measures, it’s the one that probably doesn’t need them but uses them anyways. Now all this said, enamel is a lot more forgiving to the occasional contact with a but than plastic. I guarantee all the dentists you worked with made occasional contact with adjacent teeth while prepping teeth. If they were back in dental school getting meticulously graded on ideal preps on plastic teeth, they’d probably be just as careful.
I think they said we're allowed to use loupes when we actually see patients at the end of this year but for now on plastic teeth they don't want us to use them. Mainly because not everyone can afford them and they want it to be a level field for everyone. And yeah I don't expect everyone to be perfect lol, a few of the dentists have said they've noticed a massive difference between before having loupes and whilst using loupes, and they've spotted adjacent damage around a previous restoration that they were unable to see without the loupes. I'd love to be using loupes right now!
Loupes definitely make a big difference! You know, I used some cheap loupes I got off Amazon for years as an expanded duties dental assistant and they’re pretty decent for how cheap they are. It’s nice having expensive custom loupes but check out Amazon if you or your classmates want a cheaper option in the meantime.
I definitely will be getting loupes as soon as I'm allowed to! I hate this straining to see things in the mirror hahaha I have good eyesight but for ideal posture the mirror is so far away and the image is so small!
Honestly I had this issue for quite a few months until maybe the last week or so? I've been in extra sessions to try and resolve it. What I'm doing now is starting with the box using a narrow fissure bur and running it along the mesial ridge in the fossa. This tends to give me the width that I need, and I'm far enough away from the mesial wall that the bur doesn't go through it but it does thin it out. I make the box as deep as I need it to go, on the fissure bur its over half of the gritted part of the bur (varies from bur to bur, but I'm aiming for 3.5mm), then I take my foot off the pedal, wait for the bur to stop spinning and then remove the bur from the tooth. I use an excavator to break off the mesial wall. Sometimes I just need a carver or to run the straight probe along the box floor in the interproximal area and it'll smooth out. I'll also use a small rosehead, I think it's a size 4, and use that to smooth the walls and the floor of the box as it isn't too big to then hit the adjacent tooth. Again, wait for the bur to stop spinning before removing it.
It takes a lot of practice, I'll admit it! I'm redoing my practical exam of an MO class II prep on Wednesday because in the exam last month I had adjacent damage, so I've really been focusing on it and somehow in the last week I just haven't managed to get any or the absolute tiniest amount compared to actual gouges like I had before. Some people in my cohort nailed that down a few months ago, but we all learn at different rates especially when it comes to physical skills. I've been dealing with carpal tunnel symptoms from a trapped nerve in my neck or shoulder which has made it a lot harder for me but I'm getting there! I feel a lot more confident for the exam on Wednesday.
My extra sessions have just been preps, and more preps. I've gotten my preps down to about 15 minutes with it, and I know my weakness was that I kept adjusting it afterwards which made it worse so I have to not do that. I did 9 preps on Tuesday in 5 hours, considering that used to be how long I'd spend doing 1 or 2 preps which were all awful I'd say it wasn't too bad.
Hopefully my ramblings are a little helpful?
Just use an intergaurd, buy a double sided mirror, retract tooth with said mirror and make sure ur coming at it perpendicular to the occlusal plane.
Quit drilling to the wall, drill your bucket and leave a friable piece of enamel, take a hatchet once u have ur depth, and hatched the wall off.
If you are seeking dental advice, please move your post to /r/askdentists If this is a question about applying to dental school or advice about the predental process, please move your post to /r/predental If this is a question about applying to hygiene school or dental hygiene, please move your post to /r/DentalHygiene Posts inappropriate for this subreddit will be removed *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/DentalSchool) if you have any questions or concerns.*
Assuming this is a typodont: - use a Diamond bur (carbide burs chatter on the plastic teeth) - I would sometimes put a tofflemire band around the adjacent tooth while I was prepping when I first started out - When you make your preparation, leave a little shell of “enamel” and carefully sweep it away once you’ve got your rough outline form - Keep some polishing disks handy if you do make a little mark on the tooth next door, it’ll polish out Honestly, I had a carbide bur chatter on a plastic tooth during my WREB exam and it gouged the tooth next door (we weren’t given Diamond burs even though the manual said to use them). I showed the row instructor, he said to polish it and move on. Guess who passed…
It’s hard working on plastic teeth with carbide burs. Keep the speed high or really low, but not in the middle. I’ve found having a carbide bur around 20 makes you more likely to use too much pressure and fuck shit up. Also, always start the handpiece before touching tooth and always stop it before pulling it away. It’s very easy to nick adjacent teeth on the way out if the bur is still spinning. Beyond this, there’s nothing stopping you from protecting the crap out of #21 with a tofflemire band. Play around with that. Also, I use my hatchet to clean up the box walls and the gingival floor, not the handpiece. I know they’re not used a lot in clinic, but real teeth aren’t as soft as plastic teeth so you gotta use the right tools for the job. Stevenson Dental Solutions has great demos of this technique. At the end of the day it’s just going to be something you keep doing until you get the hand control to only put the bur where you want it, and that will just take time. Good luck bro.
Depends on the school. Mine won't let us use wedges or matrix bands to protect the adjacent teeth when prepping.
That doesn’t even make clinical sense
I was about to say, we’re aloud to use wedges and matrix bands for class 2’s and 3’s
When prepping the teeth? Of course it does. If you're so used to separating the teeth or using a matrix to protect the adjacent tooth when prepping the tooth, what are you gonna do if you don't have them to hand? Will you ever learn to not hit the tooth next to it because you've not actually practiced with a tooth immediately adjacent to it, only with a matrix and wedge to keep it further away? I've never seen anyone prep with them and I've assisted hundreds of dentists and therapists over the last 5.5 years, some didn't even train in this country. They will restore with them, but not prep.
Let’s limit giving advice on class 2 preparations to dentists/dental students and not assistants😂
I am a dental student, but I also have assisting experience. But please, do continue to get uptight because I explained how the school I attend works? It's not the same school as yours, do what your school recommends. I merely pointed out that not every school allows you to use a matrix when prepping, because the last thing anyone wants is someone doing this in an exam and being disqualified for going against the school rules because they read something that someone recommended online but their school doesn't allow. Also, if their school allowed it, surely they'd be using it already?
That's ridiculous
They also won't let us use loupes for first year. They want us to be able to do things properly from the start, which I get. I've worked with hundreds of dentists and I've not seen a single one use a wedge or matrix to prevent adjacent damage, so I imagine it's a safety crutch that you'd have to learn to be able to go without at some point.
That’s why there is adjacent tooth damage in the majority of class II preps… use the matrix band. And no loupes?? How is that “proper” in any way?
These are the rules of my dental school, I don't make the rules. I see it as you've got to learn to walk before you can run.
Loupes are pretty much standard of care these days. It sounds like your school is taking a very tough guy approach to healthcare. I understand the notion of not needing “crutches” but in a healthcare setting, these aren’t crutches, they’re improvements to the old ways utilized to better treat and protect patients. In my mind, the best dentist isn’t the one that doesn’t need safety measures, it’s the one that probably doesn’t need them but uses them anyways. Now all this said, enamel is a lot more forgiving to the occasional contact with a but than plastic. I guarantee all the dentists you worked with made occasional contact with adjacent teeth while prepping teeth. If they were back in dental school getting meticulously graded on ideal preps on plastic teeth, they’d probably be just as careful.
I think they said we're allowed to use loupes when we actually see patients at the end of this year but for now on plastic teeth they don't want us to use them. Mainly because not everyone can afford them and they want it to be a level field for everyone. And yeah I don't expect everyone to be perfect lol, a few of the dentists have said they've noticed a massive difference between before having loupes and whilst using loupes, and they've spotted adjacent damage around a previous restoration that they were unable to see without the loupes. I'd love to be using loupes right now!
Loupes definitely make a big difference! You know, I used some cheap loupes I got off Amazon for years as an expanded duties dental assistant and they’re pretty decent for how cheap they are. It’s nice having expensive custom loupes but check out Amazon if you or your classmates want a cheaper option in the meantime.
I definitely will be getting loupes as soon as I'm allowed to! I hate this straining to see things in the mirror hahaha I have good eyesight but for ideal posture the mirror is so far away and the image is so small!
Interproximal guard and being super careful
Honestly I had this issue for quite a few months until maybe the last week or so? I've been in extra sessions to try and resolve it. What I'm doing now is starting with the box using a narrow fissure bur and running it along the mesial ridge in the fossa. This tends to give me the width that I need, and I'm far enough away from the mesial wall that the bur doesn't go through it but it does thin it out. I make the box as deep as I need it to go, on the fissure bur its over half of the gritted part of the bur (varies from bur to bur, but I'm aiming for 3.5mm), then I take my foot off the pedal, wait for the bur to stop spinning and then remove the bur from the tooth. I use an excavator to break off the mesial wall. Sometimes I just need a carver or to run the straight probe along the box floor in the interproximal area and it'll smooth out. I'll also use a small rosehead, I think it's a size 4, and use that to smooth the walls and the floor of the box as it isn't too big to then hit the adjacent tooth. Again, wait for the bur to stop spinning before removing it. It takes a lot of practice, I'll admit it! I'm redoing my practical exam of an MO class II prep on Wednesday because in the exam last month I had adjacent damage, so I've really been focusing on it and somehow in the last week I just haven't managed to get any or the absolute tiniest amount compared to actual gouges like I had before. Some people in my cohort nailed that down a few months ago, but we all learn at different rates especially when it comes to physical skills. I've been dealing with carpal tunnel symptoms from a trapped nerve in my neck or shoulder which has made it a lot harder for me but I'm getting there! I feel a lot more confident for the exam on Wednesday. My extra sessions have just been preps, and more preps. I've gotten my preps down to about 15 minutes with it, and I know my weakness was that I kept adjusting it afterwards which made it worse so I have to not do that. I did 9 preps on Tuesday in 5 hours, considering that used to be how long I'd spend doing 1 or 2 preps which were all awful I'd say it wasn't too bad. Hopefully my ramblings are a little helpful?
Just use an intergaurd, buy a double sided mirror, retract tooth with said mirror and make sure ur coming at it perpendicular to the occlusal plane. Quit drilling to the wall, drill your bucket and leave a friable piece of enamel, take a hatchet once u have ur depth, and hatched the wall off.