Basics of Indirect Restorations Part 2 – The Crown Fit – PS007

Protrusive Dental Podcast

What makes us reject crowns and send them back to the technician? What are the standards/guidelines to consider before accepting and luting indirect restorations?

Join us as we explore the key factors that determine the quality of a crown. From the initial lab communication to the final occlusal checks, we cover it all. This episode is packed with essential tips that are perfect for dental students and professionals alike.

https://youtu.be/ftafglxcBbM

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Need to Read it? Check out the Full Episode Transcript below!

Highlights of the episode:

• 1:33 Emma Hutchison: Student Life and OSCEs
• 06:44 Handling Lab Work and Fitting Crowns
• 14:15 Crown Rejections
• 18:12 Understanding Occlusal Tolerance
• 20:09 The Importance of Occlusal Precision
• 22:24 Building a Strong Dentist-Lab Technician Relationship
• 24:17 Tips for Dental Students
• 27:46 Microbiology in Dentistry

Don’t miss the special notes on Microbial Ecology and Infection Transmission available exclusively in the Protrusive Guidance app! (Join the free Students Section)

This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD for Dentists waiting for you on the Protrusive App!

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If you love this episode, be sure to recap PS006 – Basics of Indirect Restorations Part 1 – Decision Making

Click below for full episode transcript:

Jaz's Introduction: Welcome to Part Two of Indirect Restorations for Dental Students, but it's actually suitable for all dentists. But the person who's asking all the questions is our Protrusive Student, Emma Hutchison. Students are so curious and so great at asking questions. I want to make sure that we tailor these more basic episodes to what actually students, young dentists, and those returned to dentistry actually need.

Jaz’s Introduction:
In part one of this series, we covered what are the different types of crowns that we might go through. In part one of the series, we discussed direct versus indirect, and when we are choosing indirect, which materials can we opt for? Especially focusing on all ceramic restorations, which from my time, were not done that much.

As a student, we did PFMs, and it sounds like PFMs are still being done in dent schools. Let me tell you, PFMs are not done that much in the real world. So that’s why we focus a lot on all ceramics. We also discussed on crowns versus onlays. That was in part one. In today’s part two, we’re talking about the clinical details.

When you get the crown back, how you assess if this is a good crown or a bad crown? When should you reject? What are the different parameters that we tick off? And how can we avoid? Mistakes from happening so you never have to reject lab work. I’ll give you a clue involves communicating with your lab technicians, so, so important.

Another interesting thing we discuss is what about if you try in a crown and it’s completely shy of the bite. So it’s not proud. It’s not popping the patient open. It’s not like eyes too big It’s actually completely shy of the bite. Should we reject that? Should we accept it? What is the standard of care? So we covered this real world scenario and so much more in this episode. So I hope you enjoy. Please do comment below and give us a like, if you like what we do. I’ll catch you in the outro.

Main Episode:
Emma Hutchison, welcome back again to the Podcast Student Version. Just give us an update in terms of what’s been happening in your world. Are things getting a little bit heated academically? Are you feeling the strain? Are you feeling the pressure?

[Emma]
Yeah, I’m really starting to sort. At the moment we’re in sort of the end of February when we’re recording this and I’m just becoming a bit more aware. Exams probably end of April, start of May time. So it’s in the back of my mind definitely. So really starting to keep on track of everything, keep up to date. So yeah.

It’s at this point in the year where it can really just make or break you, the workload and things and just trying to keep on top of it and try your best not to be overwhelmed, which is so much easier said than done. But it’s just, especially things like OSCEs as well. I think that’s quite a, it’s a different level of-

[Jaz] Describe what OSCEs are to an international dent student Maybe it doesn’t know what an OSCE is or maybe it’s caught something else in their country What’s an OSCE

[Emma]
Yeah. So your OSCEs are like your, what does it stand for again?

[Jaz]
Objective Structured Clinical Examination.

[Emma]
Yeah, that’s the one. So you go in this big room and there’s maybe, I think we have 12, 10, 12 stations. We’ve got six minutes per station. You go around and it’s very much about your clinical knowledge, your hands on work, your ability to communicate, they get actors in, like proper actors that they hire and things that they pay. And they’re very good. Yeah, very realistic patient scenarios and it’s all about communication and less about how you do.

In written exams and more about how you are as a person and how you are clinically. So it’s a whole different type of stress that I had never, ever, never felt before. And it’s a hard one to get used to, but it’s definitely something that you can learn a skill that you can learn how to manage as it was.

[Jaz]
Absolutely. Have you done any OSCEs before?

[Emma]
I had one in second year last year and that was my first one because we never had one in first year because of COVID. So yeah.

[Jaz]
Well, when you do the next one, let’s have a top tips for OSCEs based on your experiences and where you could have gone wrong, what could have improved, what went well. It’ll be nice to have a little session on that. And I can chime in and give you some, from what I remember, I actually remember some OSCEs from the past.

I remember one where there was an actor and you have to explain the therapy, periodontal therapy, non surgical periodontal therapy and the advantages and disadvantages and where the students really didn’t do as well as they wanted is because they failed to identify the fact that there’s going to be recession.

Just warning the patient that there’s going to be recession. If there’s been successful, if you’ve been successful, you’re going to get recession. That’s the normal part. And so that’s a lot of students miss that point. So I guess we can do a little session on OSCEs in the future. I think that’d be good.

[Emma]
Yeah, definitely. And I think a lot of times students will trip up just jargon, jargon, jargon, jargon, and it’s such a skill to be able to put that into patient terms, especially something like perio surgery and recession and putting it in layman’s terms so that someone understands what’s going on can be really quite tricky. So that’s a skill definitely that you can work on as well.

[Jaz]
It’s like sometimes trickier when you are a student because like in practice, I hope that I’m not using jargon very much. I don’t think I am, but because it’s just me and the patient, I’m trying to make everything understandable using being jargon free.

But when you’re actually learning the language of dentistry and you’re deep in it and then you’re kind of trying to flex. You’re trying to flex your knowledge and you’re kind of almost trained to use these words. You’re trying to use all these words of bacteria and everything that you’re learning.

But actually, when you go into that OSCE, it’s complete opposite. You don’t want to show off that you know all these terms. You actually want to really, for the want of a better word, dumb it down, basically, for the patient.

[Emma]
Yeah, yeah, absolutely. And we usually have our OSCE as our last exam. So, a few days before you could be writing about the same scenario, but you have to use all of these trigger words and all the words that you’ve been taught over the last year.

And then just to have to switch that off can be really tricky because using your jargon with an actor patient, like they will question you, like, what do you mean by that? What do you mean by that? And you will get marked down if you start to confuse your patient or they don’t understand what’s going on. And then you get flustered and it’s just, yeah, it’s hard to control those sorts of situations sometimes just from a student’s perspective. It’s really tricky.

[Jaz]
It’s all about preparation and practice. So in a group of students, so please be doing that guys, you’ve got OSCEs coming up and just, I think we spoke about this before in a previous episode about mental health and managing the stress.

But something like an app called Balance, a daily five minute meditation, breathing exercises, really, really important. I remember being crippled by fear during exams and whatnot, especially finally, the closer you get. So completely normal, everything you’re going for, all these emotions, all these feelings.

I don’t want to mention about failure and stuff, but it’s just funny. The recurring theme. I found in interviewing brilliant guests and speaking to great dentists that so many of them actually didn’t pass first time round or whatever. I’m not saying that you should be in the forefront of your mind, but even if that what seems like the worst thing ever, like that seems like the worst thing ever, but I’ve met so many great dentists who have to repeat second year or third year and they’re absolutely, Amazing.

So firstly, forget about it, right? But should you be affected by this theme, then you’re going to be still being okay. So that’s the main thing I want to cover there. Emma, let’s dive into the main question, the main theme for today. Because we kind of had to, we were super busy last time, we had to cut it short, but there’s one really important question when it comes to crowns and indirect restorations, onlays, that kind of stuff. A really great question that you had that I think all students, all dentists actually, young dentists especially, will benefit from.

[Emma]
Yeah, so, as a lot of you probably know by now, I’ve been a nurse for a few years now, and I’ve seen so many times, lab work comes back, and for whatever reason, it needs to be sent back, and I think I’m quite lucky that I’ve heard the labs in Glasgow Dental Hospital are very, very good.

I don’t have much experience with them yet, but, all of the clinical staff rave about them, say, oh, you’ll miss this when you’re out in practice, all the rest of it. But I suppose, are there common challenges that you find during the fitting stage specifically? And even more specific than that, I suppose, what warrants lab work having to be sent back to the lab versus, you know yourself, oh, I can fix that chairside where’s that sort of line, I suppose.

Because as much as I’ve seen it, lab works needs to be sent back. It’s never really been explained to me, it’s never had to be, it’s not my job at that point. So that’s just an interesting one for me as well, just, where you sort of, what’s going on in your head when you, something’s just not quite right.

[Jaz]
Okay. Excellent question. Let’s tackle it a bit by bit. So when the lab work comes back, let’s say to, so they can make it very specific. It’s an upper first molar crown. Let’s say it’s an all ceramic crown about a traditional shoulder, one millimeter all the way around. And the reason we did this crown was it as a root filled molar.

And then you prepared it and then you took some impressions or a scan to lab, labs and you got this lovely tooth colored crown that you’re going to fit. So first thing to do actually is to check it on the model. When you check it on the model, what you’re looking for is, are there any major gaps or voids?

So where the crown meets the actual prep on the dye model, if you’re seeing gaps and voids, you’ve got to assess what’s going on. Is it perhaps that you’re not able to seat the crown all the way on the model? And maybe the issue is not. That’s an open contact. The issue is that it’s not fully seated because the contacts, mesial and distal, are too proud and they’re not allowing you to seat the crown all the way. Does that make sense?

[Emma]
Yeah, yeah.

[Jaz]
So the crown is too tight. It’s not able to go in because the adjacent teeth are not letting it slip through. So that’s the first thing to check. So you want to check with floss on the model, see how it is. And if the contacts are tight, we’re going to talk about how to adjust that in a moment. But let’s assume that there is a degree of an open contact. Well, firstly, before we take a step back, I was always taught, always check that this is the correct lab work for the correct patient.

[Emma]
Yes.

[Jaz]
Sounds silly. I know, but you’d be amazed. Okay. So make sure it’s the correct patient. And correct thing was done, correct tooth, et cetera, all that kind of stuff. And then you’re going to do quality control on the model. If you notice that the contacts are fine, you’re flossing them okay, but there seems to be an open contact, that’s a real red flag right there. Really, it should be nice and sealed. So at that point, you’ve got to think, okay, what is my threshold?

Because, you know what, sometimes the lab are doing their best they can with what you’ve sent them. Sometimes you’ve sent a preparation and there’s been an undercut or there’s been an issue that the lab had to overcome. For example, another issue could be the path of insertion of the crown was very awkward.

Because we’ve got some like rotated and twisted teeth, the lab had to really find out how to insert this crown. Because that path of insertion, it creates an undercut in one area and therefore, now you have to accept the slight open contact in one place. Now, if it’s a straightforward crown and nothing should be wrong, it really should be perfect, then fine.

But if maybe you’ve got to re evaluate your prep and think, hmm, at that point, you’ve got to pick up the phone and maybe take a photo, pick up the phone and say, hmm, I’m noticing this. Did you guys struggle? And then you’d be amazed that sometimes you get some feedback that actually, you know what, Emma, we really struggled with this prep.

Let us know how it goes and what it looks like. We had a look. We noticed this issue as well, but we think it’s within limits. So if you see a huge, void that your probe can go in. Okay. Then that’s no good. But if it’s a small, tiny little gap, that cement will fill in and it’s pretty much good 90 percent all the way around, then you might want to then take this to the next stage, which is, okay, let’s try it in clinically.

[Emma]
Okay. Yeah.

[Jaz]
So if it’s a huge void, then that’s a cause of concern. You need to pick up, take a photo, send that photo to the lab, pick up the phone and have a chat with them. If it’s a small one, then maybe still talk to lab, I know it’s a small void, have a look at the photo and, have a chat with them anyway, but then be willing to go through a try in because it might have been a tricky one for the lab to make.

At the try in, you’re going to take off the temporary. So I like to use like these artery forceps or mosquitoes, squeeze the temporary and wiggle it off. You want to clean the the actual prep now because what you don’t want is excess temporary cement Stopping your crown from seating. And then when you do the try in again, you’re checking the same things again are you able to seat the crown all the way or is a tight contact hanging you up?

So the way I check this clinically is Just check with floss. I’ll get my nurse to hold the crown. Okay. With her finger. My nurse, a female, so her, but it could be a male nurse. So the crown is now held in place with finger. I will floss myself and just check. Is there a nice click? We don’t want open contacts and we don’t want something that’s so tight that the floss is tearing. Now, when you were nursing, how involved were you in the crown fit appointment?

[Emma]
Not very, no, not really. I would mix the cement. And that’s about it. There’s a few practices I’ve worked in where I would be the one to put the cement in the crown whilst the clinician is holding it. But that’s about it, really. That’s about it.

[Jaz]
Okay, so the biggest mistake, I remember fitting a crown when I was like one or two years qualified, and the cement escape, I wasn’t quick enough in removing the cement. And then now the patient was left with a blocked contact because the cement kind of went in that zone and the floss wouldn’t go through.

And so the biggest takeaway I had at that, this was actually in hospital, I was a DCT, and the biggest learning I had there is that when you’re doing a crown, when you’re cementing a crown, it’s not a one person procedure, it’s a teamwork procedure. And then really the nurse should be heavily involved. And so the way we do it is, once I put the cement in, once I’ve put the crown on, and I’ve got the patient, let’s say, bite on a cotton roll to fully seat it all the way.

At that point, it’s not like I’m doing everything myself. At this point, either the nurse is flossing or I’m flossing and one of us is holding the crown. Typically, the nurse is holding the crown with her finger and I’m going to floss basically. So that is much easier and better than me trying to hold it and then floss it at the same time or just floss it and then the crown could be shaking, could not be stable, for example.

So, in that case, we’re going to check how it’s flossing so remember we’re still at try-in stage. We’re checking how it’s flossing and if it’s flossing well, great. Now under magnification and lighting, I’m going to check the buccal. I’m going to check the palatal. I’m going to check my probe. Okay. And then interproximally, sometimes if you just really get the right angle, you can see interproximally.

Sometimes you can use a probe to suppress the papilla. And blow some air and really see that mesial and distal margin. If it’s looking sealed all the way, happy day. So you’ve got a nice concept that flosses and you’ve got a good seal all the way around. If you have a doubt or if you see an open contact, reassess the contacts, make sure the contacts are good.

But now if you see an open area where there’s a void, at that point, you got to decide, okay, is it within a threshold? Is it for the reasons that we talked about earlier? Or really does this need to be rejected? I reject probably for this kind of a reason. One in thirty crowns. What’s been your experience from nursing? How often have you seen a crown being rejected?

[Emma]
Mmm, I don’t even know that I could put a number on it, Jaz. Not hugely common though. Probably quite similar to your own experience. Yeah, quite similar maybe.

[Jaz]
Yeah. So it’s only because I’m quite strict my quality control. So if I say something like that, I mean, you could at this point take a bite wing radiograph, right? And see, okay, how’s it look on a bite wing? Sometimes it’s very obvious on a bite wing as well that it’s open. So if you have a doubt, you could take a bite wing at this stage. You really want the margins sealed all the way. So assuming now the contact’s good and it’s sealed all the way. What are the other reasons why it could get rejected?

Okay, for an upper first molar, aesthetics, you’d be amazed. Okay, so usually you shouldn’t, aesthetics shouldn’t be that important, but some patients, for some patients it is. Yeah. And so you could show the patient a mirror, but even before you show the patient a mirror, you got to look at it. And decide, okay, we want for a white crown for a reason, because obviously it’s got to be tooth colored.

And if you think it looks good, if you, as your, the clinician feels like it looks good and you are proud enough to cement it, great. That’s a great sign. If you think something’s not right and this looks really bad, then don’t be the guy who shows the patient a mirror and the patient goes, yeah, yeah, it’s fine.

Because that could really bite you in the backside one day. The patient comes back saying, Oh, I smiled really big. And actually it’s a bit yellow. You don’t have a leg to stand on because you notice, yeah, actually this looks really out of place. Right. So you yourself have to be happy with it.

Once you’re happy with it, you show the patient what you don’t want to say is what do you think? Because then what you’re doing is you’re opening yourself up to criticism. Well, actually this and that is okay. Hey, look how nicely it matches the adjacent teeth. I’m quite happy with this. Just checking.

I just want to show you before I glue it in. Oh, okay. All right. Thank you so much. Okay. That’s good. So aesthetics could be a reason that it gets rejected. Very rare in this type of situation, basically. The other one is now occlusion. When the occlusion is proud, you can adjust it, right? If it’s like massively proud, like huge and you’re running short time, then you may wish to record a bite restoration.

Send the crown back and get the lab to adjust the occlusion in, very rarely you have to do that basically. Okay. The more significant issue is the other way whereby it’s completely shy of the bite. Like it’s massively shy. So there’s no bite on it at all. And so you might be thinking, okay, is that really important, Jaz?

You might be saying, is that really important? Well, on someone who’s got 32 teeth and all the teeth hitting together nicely. One tooth that’s not perfect in the bite is not going to be the end of the world. The patient will likely adapt. There’ll be some overruption and rotation, that kind of stuff.

That’s not ideal, but in that case, the patient’s going to live. It’s all right. But if you’ve got like implants around the arch, which you don’t want loaded in clench, if you’ve got a patient who’s periodically susceptible, maybe they’ve got some mobility, then that kind of patient maybe is kind of important. And so it may be that, you remember we talked about shim stock foil, that eight micron foil.

[Emma]
Yeah.

[Jaz]
It may be that it’s not holding shim. We’ve got to now re figure out, okay, at what’s our threshold level, at what point do we reject and what point do we accept? And, and there’s no hard and fast rule here.

With me, if it’s a patient who’s got generally an okay occlusion, I want the occlusion to be within a hundred microns, within 0.1 millimeters. This is on someone whose occlusion is pretty good. If it’s more than 0.1mm out so for example, I get a hundred micron articulating paper, get the patient to bite together.

There is no smudge, there is no ink. Only when I get the 200 micron paper do I see a mark on it, that really is out of the bite. In that case, you could send it back and take a photo and send a bite register, like this has not met my expectations. Okay, so that happens very rarely.

However, in someone who actually, this is a strategic tooth and it really needs to be in the bite. It needs to be well in the bite. Your threshold might change. It now might be 20 microns basically. If you try when the shim stock is pulling, but when you try with your 25 micron paper, it’s biting.

That’s an okay threshold. It’s going to just do some minor adjustments and it should be okay. So it’s something that we don’t think about and I didn’t think about for many years until after qualifying. So hopefully it’s a nugget in there for someone who might be listening and watching to this. Have you ever thought about that in terms of the occlusal tolerance of a crown fit?

[Emma]
Not really, but what you’re saying is making sense. And I think quite commonly as students, if we see a blue dot, after using your articulating paper, you just want to take it away. No, there’s so much more to it than that.

And I think what has always stuck with me, one of your first episodes I ever sort of made the notes for, was checking the occlusion beforehand. If you have the luxury of being able to do that, then that’s definitely something. Because you don’t just want to take something out of the bite. If you don’t have to, if that’s not the case.

So that’s something that’s always stuck with me. And I think, yeah, as students, we just want to grind all the way until there’s no dots that you can see at all. But that’s just not what you want to do, is it?

[Jaz]
Yeah. That level of precision is not great. And so when you’re a dent student, when sometimes young dentists, some dentists might be watching, listening to this. You might be 20, 30 years qualified. You might be following this philosophy called GABS. Do you know about the GABS occlusal philosophy?

[Emma]
No, I don’t think we do. No.

[Jaz]
GABS is a Grind All Blue Spots philosophy. So there’s no precision there. So I wouldn’t recommend it. And it’s something that we do. And then the patient says, Oh yeah, that feels great. And then obviously it feels great. But actually that you’re not really serving your patient at all. Because every time the patient comes in and they have a new crown restoration, it’s out of the bite.

Most people adapt, but sometimes people don’t adapt very well. For example, if everyone just adapted, everyone’s bite just adapted, you’d never see a patient with an anterior open bite because their teeth would just compensatory erupt, right? That would exist. But some people don’t have that adaptation capacity.

So I would suggest a degree of occlusal quality control. I’m not saying we have to be perfect because no one’s perfect. No one’s going to fit their crown. It’s going to be shim hold every single tooth every time. But to be recognized that patient where it’s absolutely crucial and recognize the patient that, okay, it’s not crucial, but it’s a little bit shy, but it’s not so shy that I can’t sleep at night.

So aesthetics, seal and occlusion, those are the main things basically. In terms of checking the contacts once again, again, I’ve talked about this on a podcast, but in case a student hasn’t seen it, here’s an interesting one. Have you fit a crown yet?

[Emma]
No. Nope. Not yet.

[Jaz]
So this is really, really important. Like when you come, like, so this happened to me as a young dentist, I’m trying to put the crown on and I’ve said, Oh my goodness, there’s a huge open margin here, but it wasn’t an open margin. It’s just because the crown didn’t seat all the way because the contacts were too proud. And at that, at that time I didn’t really know how best to check that.

And I remember a consultant coming over and then putting on a Miller’s forcep, the articulating paper in between the prep and the adjacent tooth. So in between like really like sausage hands, like trying to get in and then trying to seat the crown on the other hand, it’s very claustrophobic, very messy.

So the better way of doing it is keep the crown in place, get the nurse, put a finger on the crown. So it’s now stable. It’s not going to the patient’s not going to swallow it. You get some articulating paper and you color in your floss, i. e. you pinch the floss with the articulating paper and you drag it.

Now, you’ve got white floss, white floss, and suddenly the floss is red, red, red, and then it’s white again, okay? That red ink on the floss, when you floss that through now, through the crown, it’s going to make a red smudge where it’s too tight. That’s where you adjust. Until you get the perfect flossing and it’s seating all the way.

[Emma]
That’s good. I’ve never seen anyone do that colour in your floss. That’s a good one. Yeah.

[Jaz]
As a nurse, if you’ve seen dentists do the traditional way of checking with their fingers is very claustrophobic. It’s a terrible way of doing it. So this was taught to me by a prosthodontist, Ricky Bopal, and I always credit him for this is the best way to do it.

And actually, when I shared this on Protrusive, everyone who does this like mind blown, like why wasn’t this ever taught to me before? So top tip there. So just to summarise the episode, there will come a time where you need to reject lab work. We talk about dentures another time and all sorts of things, but talk about a single crown, aesthetics is one reason and make sure you’re happy with it. Is the seal not good? And if the seal is not good, then that’s a big fail. If it’s like there was a tricky prep and it’s like a tiny bit, but you can’t get your probe fully in, you then have to put some faith in your cement to help you out here and seal that. And then occlusion, if the occlusion is really, really shy, then that is a problem as well in some patients.

[Emma]
Yeah, that makes sense. I think as well, a huge takeaway for me, you’re always told make friends with your lab technicians and that’s so true and just picking up the phone and talking to them can solve so many, so many issues, just having a chat, getting that feedback as well. They’re not scary, they’re not going to bite you or anything, but communication is a huge one with the labs and keeping them on your side because then they’ll do you a favor when you need it.

[Jaz]
Absolutely. And I would encourage everyone to have a good relationship with their lab. And also, when you qualify and stuff and to maintain that and to ask for feedback, it’s really scary. But if you say, be brutally honest, if you write in your prescription form, be brutally honest about my prep, they will be. And then they will feel comfortable having that relationship with you. And that’s a really great place to be. If you can visit your lab one day as well, it’s a really good thing to do to visit your lab.

Okay. That’s a good thing to do as well. See their workflows and develop a really open relationship with your lab. If you can WhatsApp your lab, voice notes and stuff and discuss cases, that’s something I do works really well. So, I think you’ve summarized that really well, having a really good relationship with your lab.

Now, here’s a really interesting thing, right? Dentists, especially when you’re new to qualified, we see the lab technician as this like guru. This oracle, right? And they’re like, they know so much. And I’m the insufficient one. And oh my God, my prep is not good enough for this guru. Okay. Now, funnily enough, I’m speaking to lab technicians.

They are seeing us as the gurus. Oh my God, it’s the dentist. The dentist knows what they want and I’m just following. And what if I’m not good enough? And so we’re looking at each other as like, you’re the guru. You’re the guru. Basically, actually, we’re both the gurus. We both need to work together.

And we have so much to learn from technicians. And technicians can learn something from us as well, for sure. So, sometimes when I used to write that, okay, I’ve trained my technician to do this type of technique. People were like, Oh, really? You can train a technician? You totally can. And technician can train you as well.

So have that symbiotic relationship. Has anything been left unclear now in terms of when to reject a standard crown? And any questions your student mind could come up with now as you’ve read about this procedure and when you eventually first come to do it?

[Emma]
Not in particular. I think you’ve covered things quite well. Loads of good tips and tricks, especially about the floss. I like that one. I’ll bring that into dental school one day. But no, really, really good tips and tricks. And I think as well just assessing each patient individually. Such a common thing in dentistry. Like, oh, it depends, but it really, really does.

It’s so case dependent and as well when you’re saying about utilizing your nurse. I think being a nurse myself, it makes your work so much more interesting when the dentist will use you to your full capacity. Like, get me to put my finger on there and get me to floss these contacts. Cause I’ve watched too many dentists struggle and it’s just, I’ve got an extra two hands here. If you need them, then they’re yours. And it makes work so much more fun as well.

[Jaz]
So brilliant, brilliant. So, so important to involve your nurse And you will have a much less like to have that scenario where cement is now blocked the contact, like it happened to me. So that’s a really great point there. There’s one more thing I was going to say, actually. We haven’t really talked about cementing so maybe we will talk about cementing another day, but you’re, you’re right. That getting the nurse involved is another great tip. Oh, here’s my thing. I remembered. Okay. This is really important, Emma, for all students who’ve got to this point and all dentists got to this point.

When you are at dental school, especially, okay. I’m teaching you the shortcuts and the tricks that I’ve learned now because of failure and trial and tribulation and errors and stuff. So you’re able to show, stand on the shoulders of the giants and not have to go through all the mistakes and tears and stuff.

You’re able to really leverage this and you’re in a great, so this is a beautiful thing about dentistry nowadays is that we can pick up these tips, but before we were very isolated. However, you got to be really careful in dental school, right? Because your tutor. wants you do it a certain way.

So my suggestion is learn the way they’re teaching you to do it, learn the way and learn it well. So if they tell you, okay, this is how you check a contact, you get the red paper and they show you this atrocious way of doing it, please do it. Be good at doing this atrocious way. Only then will you appreciate the way I’m showing you, okay. So please, what I don’t want it to do is all these hundreds of students, generation of students now, every time the tutor shows us something, it’s like, nah, Jaz taught me a better way. Let me show you tutor, we don’t want to create that culture. You must be a learner and have some humility and be like, I’m going to do it this way because this is the way I’m taught. But in the back of your mind, it’s like, Hmm, I know another way. And then try it. So please, please don’t be a smart Alec with your tutors guys. And then I’ll get a bad rep with the tutors.

[Emma]
But also as well, like as a student, half of the time, these clinical staff, they can be the ones writing the exam questions and writing the marking schemes. So yeah, definitely listen to what they have to say as well. And I would know lots of clinical staff that I would feel comfortable saying. Oh, that’s interesting. This is another way I’ve heard of doing things. And they’re always so open, new techniques and having these conversations.

[Jaz]
Brilliant.

[Emma]
They like you to be able to do your own research and have your own back about why you want to do things a certain way. But yeah, they’re the ones writing the clinical exams.

[Jaz]
There are some tutors like that, and God bless them. So, but not everyone’s like that. So just be tread carefully. So Emma, what notes have you got as part of the student revision notes that you’re giving away in terms of Emma’s famous notes?

[Emma]
So this month, we’ll go back to first year, and we’re going to do a bit of microbiology. It is quite theory heavy, very examinable, especially in first year. But these things come up time and time again. And as you move on to second year, third year, fourth and fifth year, you just build upon it more and more. And it gets more specific to specific aspects of dentistry. So it’s definitely something that you need to have solidified from your first year going forward. So we’ll do a bit of microbiology.

[Jaz]
Have you got like the microbiology of cariology like caries that kind of stuff?

[Emma]
Yeah, I need to dig out my first year books actually. But yeah-

[Jaz]
Caries process, very important. And then also infections, different bacteria involve anaerobes and that kind of stuff. You’ve got that, right?

[Emma]
Yeah. Well, it will all be in there.

[Jaz] Okay. Every examinable facet of microbiology will be in there. So we look forward to sharing that with all those on Protrusive Guidance in the Student Section. All the instructions about it is on Protrusive Guidance. So Emma, thanks again. And have a lovely week.

[Emma]
Thank you.

Jaz’s Outro:
Well, there we have it, guys. Thank you so much for listening all the way to the end. Hope you found some value from that. Please let me know if you did. The best place to let me know is on Protrusive Guidance.

Our app is on iOS, Android, even the laptop when you hit www. protrusive. app. If you’re a student, you get access to the Protrusive Student notes, including for this episode, and the Protrusive Vault. You just have to email your proof to [e-mail]. The community otherwise is completely free to join.

So if you haven’t joined Protrusive Guidance yet, What are you waiting for? I want to thank Emma, our Protrusive Student, again, and the whole team for this series. That’s Erika, our producer, Gian, behind the scenes of video, Krissel and Nav, who often do the premium notes, a shout out to Rakesh, who’s just qualified as a dentist, God bless him.

Such an exciting time. And of course, our CPD queen, Mari. Please do share this episode if you think someone would benefit from it. I’ll catch you same time, same place next week. Bye for now.