Although it may seem like I’m not keeping up with things on the site, I assure you I am. Sort of. You see, even when I’m not writing blog articles, I am still updating the website, fixing code, and lately, working on the School Pages. But I assure you, I did survive my third year of dental school at Midwestern, and it was actually a time of tremendous growth for me and my family. Nearly one year ago, we welcomed our little girl Annabelle into the world, and only a couple of months before that I started in the Midwestern Dental Clinic.
Being a father demands a lot of my time now. Also, clinic keeps me very busy. A typical day for me begins at 6:30 when I wake up. I drop Annabelle off at her daycare, and then get to school around 7:50. We huddle with the suite at 8:00 sharp, and then break off to prepare for our patients at 8:15. We see patients from 8:30 until 11:30. Sometimes we run over, but the school discourages this by deducting professionalism points for every 15 minutes we run over.
Lunch is from noon to 1:00 when we begin our afternoon session. I typically visit Annabelle at daycare to break up her day with some daddy time. We then see patients from 1:00 until 4:30, and the same rules about running over apply here as well. Sometimes running over can’t be helped, especially if you run a full schedule like my partner and I do, but we do usually end on time. That said, we don’t leave for lunch until after noon, and we don’t usually go home until after 5:00.
By the time I pick Annabelle up from daycare and bring her home it is already 6:00 or 6:30. Of course, we have to feed her dinner, give her a bath, and then put her to bed, which usually lasts until around 8:00 or 8:30. We consider this family time and we all listen to music together as we eat and prepare Annabelle for bed.
Snippets from the Midwestern Dental Clinic
I did so many things my third year, I’ve sort of lost track. Below is a list of the procedures I can remember doing with my partner last year. Some of the numbers listed are from a mission trip to Tonga and an implants course in Colombia.
- Over 100 direct restorations
- I’m on the low end of my class, with just 20 crowns last year (10 CAD/CAM), but I am trying to make up for that this year
- A dozen implant placements of my own (Straumann and Bicon) and I assisted my partner with ten more.
- Several Guided Bone Regeneration cases
- Pedicle Tunnel Connective Tissue Graft
- Lots of implant uncoveries
- An Incision & Drainage
- Dozens of surgical and simple extractions with bone grafting
- Removal of zirconia, PFM, and e.max crowns and bridges
- Complete upper and lower removable dentures both final and immediate
- Complete upper and lower implant-supported removable overdentures
- Several RPD cases
- Laser-Assisted Periodontal Therapy / SRP
- Sinus lift from crestal and lateral approaches
- Nitrous sedation on the floor, and IV sedation in OS
- 8 root canals with maxillary and mandibular molars
- Gingival troughing using our Sirona diode laser
- A few sets of bony impacted third molars with an oral surgeon, and a few non-impacted thirds in our suite without a specialist
- Lots of CBCTs with Anatomage workups
The Only Constant is Change
There have been lots of changes this year. So my new partner Chris and I have had to adapt to new workflows that have slowed things down a bit in the Midwestern dental clinic. One big change is the addition of guided surgery for every case we plan. Before we can begin an implants case, we must now plan a surgical guide using our patient’s CBCT and Romexis software to generate a guide that we can 3D print in the clinic. This is an invaluable addition to our skillset, but it definitely takes more time.
First Root Canal
You never forget your first, right? I still remember completing my first root canal. I was nervous because I wanted to be sure that I had memorized the entire protocol from start to finish. If you demonstrate you know what you are doing, the endodontist will frequently let you do the entire case under supervision.
It just so happened, that my first root canal also became my first CAD/CAM crown.
First CAD/CAM Crown
You can see in the above radiograph that the patient had a very deep filling on the side of her tooth. As we were cleaning the canal, we actually saw the filling from inside, meaning the restoration had gone to the pulp. This was likely the reason the patient needed the root canal in the first place. Any time we do a root canal we crown the tooth. So, this was an opportunity for me to do my first CAD/CAM crown case.
You may have noticed that the canine crown is too long compared to her opposite canine but it matches the teeth next to it. We designed the crown based on her existing tooth, which was longer than the contralateral canine.
After wearing the crown around for a few months, the patient decided that she wanted it to match her other canine. We contoured and polished the crown to match the other side better. Unfortunately I don’t have a photo of the final adjustments, but we did achieve a great match in the end!
My first real extraction turned out to be a 7-year old girl at a charity event. I say real, because my first extractions were root tips that were flapping in the breeze. This little girl was so scared of the dentist that she refused to open her mouth for us to even take an x-ray. It took us a lot of time to build her trust and get her to allow us to work inside her mouth.
Sadly, we ended up having to extract one of her teeth. This was not only my first real extraction, it was also the hardest.
I still think back and hope that I didn’t scar that little girl for life!
This one started as a root canal, but we realized the tooth had a vertical root fracture once we got into the pulp chamber. So, the endodontist had me extract the tooth, and the patient wanted an implant so we placed a bone graft that same day. Here is a photo of the offending tooth post-extraction:
I worked everything up in Anatomage as you can see below.
There is a lot of paperwork and planning that goes into placing implants here at Midwestern. As I mentioned earlier, this year we have even more due to the surgical guides. But there is no better way to be sure that your implant will be placed safely than to plan everything diligently with the best tools available. The end result looks something like this:
We are just now restoring this patient’s implant with a crown which I hope to share in a later post!
In Colombia I placed many Bicon implants as part of the Cartagena Bicon surgical course with two of my colleagues from Midwestern. We placed around 10 implants each, did some sinus bumps from a crestal approach, atraumatic extractions, bone grafting, and restored 5-6 implants each. The cool thing about this course was doing everything freehand. The scary thing about the course was doing everything with just a PA.
First Removable Partial Denture
The first patient I made an Removable Partial Denture (RPD) for is in her mid-90s and sweet as you would expect from a grandmother her age. She is always happy and ready to go, which is the perfect patient for your first removable prosthetic!
When she first came to us, she had an old RPD that no longer fit her. The old RPD was thirty or forty years old, and she wanted one that would fit again. Obviously her previous dentist and lab did a wonderful job to make her an RPD that lasted as long as hers had, so we had to try our best to live up to the same standard.
You can see a comparison of the before and after. Our patient left very happy with her new RPD. There are many small things I would do differently if I could do it all again, but that’s the point of learning. Overall though, I think we achieved a very nice result for her.
First Full Mouth Extractions
We had a patient in her mid-40s whose teeth were being held in almost entirely by orthodontic wire. Her dentist was helping her limp along for years because she didn’t have the finances to afford dentures. By the time she found the Midwestern Dental Clinic, her teeth were so mobile that many of them could be plucked out with fingers alone.
Fortunately for her, our dentures are very inexpensive, and so we were able to get started on immediate dentures after extracting all of her back teeth. I hate taking out that many teeth at once. As a dental student, we are taught to save teeth whenever possible, so plucking them all out is not at all what we want to do if we can avoid it. But, I’m glad we will be able to give this patient her smile back.
First Implant-Supported Denture Case
This case took us all year. I don’t have the finished photos with me, but I will try to remember to upload them at a later date. This patient was completely edentulous and hated her removable dentures. She was willing to spend the money to have eight implants and then an implant-supported overdenture for her upper and lower arches. Here at Midwestern we use Bicon’s TRINIA system for our overdentures. It makes for a beautiful and resilient prosthesis.
It took a lot of preparation, planning, and appointments to deliver our patient’s TRINIA. I am very proud that my partner and I managed to deliver an implant-supported overdenture to one of our patients last year.
Onward and Upward
Chris and I have new goals for ourselves this year. We are both really trying to get faster with CAD/CAM dentistry. We are also using CAD for almost everything in an effort to eliminate impressions.
For example, we now use CAD/CAM for our implant impressions to fabricate implant crowns. We are also using it for both e.max and zirconia since we can now mill both in our own lab. As I mentioned earlier, we are using CAD/CAM to design and 3D-print surgical guides. Finally, we are going to use CAD/CAM for future denture cases so we can get used to planning and fabricating digital dentures.
Here is an example of what Chris and I did during our first week in the clinic. He did one crown and I did the other, though I don’t remember who did which crown.
We are also moving ahead with many implant crowns this year, about a dozen or so if I remember right. Below is an implant crown next to a crown we did recently.
We are also making heavy use of the Sirona Diode Laser in our suite. I think we have used it about fifteen times between the two of us already this year.
Of course we are also planning to place more implants this year and get more surgical experience as well, but Chris and I are really focused on increasing our speed, efficiency, and quality with bread and butter dentistry to start the year. Also, we have a couple of orthodontic cases in the works for this year which I am happy about. Later this year we have a lot of complex and fun stuff planned so stay tuned!