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Biomedical subjects

Bruce W Small

Publications and source records attributed to Bruce W Small.

36 records · Page 2Linked to original sources
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Organization and case planning for interdisciplinary esthetic restorative cases.

With the help of knowledgeable specialists, a complex case can be made easier to plan and treat when it is broken down into stages. These cases can be confusing, intimidating, and downright scary at first but if a general dentist demonstrates a little patience and assembles the right team, such cases can become routine.

Adult↗
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The soft side.

For true communication between dentist and patient, a dentist must develop behavioral skills (or "soft" skills) in addition to clinical skills. These skills should be utilized at all times but particularly during a patient's initial visit. Educating the patient is mandatory and the dentist should never offer solutions to problems that the patient cannot see, feel, or understand. If these ideas are kept paramount at all times they will become normal operating procedure and not seem artificial. Caring about the patient and remaining committed to technical excellence will go a long way toward the delivery of quality care.

Communication↗
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Pretreatment wax-ups and provisionals for restorative dentistry.

One of the most important factors in restorative success is the preparation of a case prior to treatment. Case planning, constructing the wax-up and provisional restorations, and understanding the potential problems with a case prior to beginning can only ensure a higher degree of success than would be achieved by not employing these basic restorative steps. Although it is not utilized generally, the wax-up can be of immense value to any restorative dentist for cases of all kinds, ranging from a single tooth to full-mouth reconstruction.

Composite Resins↗
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Occlusal splints.

Explore the source record for details and available documents.

Dental Materials↗
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Occlusal plane analysis using the Broadrick flag.

The determination of the occlusal plane can have a profound effect on the short- and long-term success of a restorative case. The fewer posterior interferences that result from the reconstruction means fewer problems for patients with their teeth, muscles, and temporomandibular joints. Proper utilization of the Broadrick flag on a semi-adjustable articulator will allow the dentist or laboratory technician to easily determine the ideal plane for each case. As mentioned earlier, the use of Monson's theory is only a starting point for the analysis. Patients come in different shapes and sizes and sometimes have mandibular incisors that are not positioned ideally. With a little experience and training, dentists can make the Broadrick flag an integral part of their practice. The Broadrick flag now has been adapted to several articulator systems, including Hanau (all models), Denar, Jensen (Artex--under development), and Kavo (Protar).

Cephalometry↗
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A literature-based overview of the preparation of teeth.

This column has discussed only a few highlights of tooth preparation. Any degree of success is difficult without proper positioning for the operator, patient, and assistant. There are many other aspects to preparation of teeth; these will be discussed in future restorative columns.

Ergonomics↗
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Impression success using the dual arch technique.

Taking an accurate impression and pouring a model that duplicates the clinical situation is the goal of every restorative dentist. The chance of having a restoration that fits the tooth properly increases as more care, skill, and judgment are applied to these early steps in restoration construction. When used as described above with any of the trays mentioned, the dual arch impression technique can be of great value in restorative dentistry.

Dental Arch↗
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Centric relation bite registration.

The bite registration is one of the most important steps in any restorative or occlusal case. Bite registrations are used for study models, provisional restorations, splint construction, and restorative dentistry. The author has tried many methods and materials and has found that the above technique works extremely well, can be repeated easily, and simplifies the mounting of the opposing cast. Other materials (such as polyvinylsiloxane) sometimes are too spongy and do not offer a solid seat for the lower model. The most important thing to remember when using any method is to pay attention to detail at every step. Step one must be completed to the highest level prior to continuing to step two, and so forth. Excellence in restorative dentistry depends on patience and exacting technique.

Centric Relation↗
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Laboratory communication for restorative excellence.

Excellence in restorative dentistry requires teamwork between the patient, dentist, and laboratory technician. This can occur only when there is mutual trust and respect. Many years ago (and in some cases still today), the technician was denigrated and also blamed for the lack of excellence in fit, occlusion, and shade. All of these problems can be avoided by sharing in the diagnosing and planning of a restorative case. Major differences will result when this occurs and all parties will benefit.

Communication↗
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Shade selection for restorative dentistry.

There is no absolute single method that will work all of the time for every patient/dentist situation. Computerized systems offer great hope for the future but visual shade selection with the human eye still is the most predictable method available.

Color Perception↗
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Material choice for restorative dentistry: inlays, onlays, crowns, and bridges.

New materials--specifically the new CAD/CAM zirconia-based systems--are available now for restorative dentistry. When esthetics are not a factor, gold remains the standard, particularly for intracoronal restorations and full posterior coverage. Tooth-colored crowns made with zirconia are new and offer great promise for the future, although more long-term in vivo studies are necessary.

Crowns↗
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The try-in visit for restorative dentistry.

The try-in visit for restorative dentistry is one of many important steps toward excellence. Attention to detail in all parts of this visit outlined above will lead to fewer remakes and more satisfied patients and dentists.

Dental Occlusion↗