Sunday, February 16, 2014

Published!



I had great expectations for this month's issue of ASDA News and rightfully so! I submitted my first book review for the publication back in December and it's been published! Pretty excited. I really want to do this again. Here's the text:


If there has ever been a time to blaze your own path, take risks, and change the way we think, now is the time. In Linchpin: Are you Indispensable? Seth Godin inspires his readers to pursue their passions wholeheartedly. He asserts that this passion is not simply an option, but a requirement for success in a changing society. The former model of being trained to simply do a job is obsolete. Professionals as well as nonprofessionals are being called to solve unique problems. As dentists, we must not only be manually and intellectually adept, but also serve as team builders, community leaders, and more. The way I see it, the nature of the profession demands that we become linchpins. 

A linchpin is a pin placed through an axle that keeps the wheel in position while it rotates. Godin defines a linchpin as one who successfully combines passion with art. Great organizations and ideas arise from these types of people. Through historical anecdotes of his own life, artists and corporate leaders, Godin illustrates that we are all artists with gifts to share; and to not share them would be a disservice to society.

He describes art as, “the ability to change people with your work, to see things as they are and create stories, images, and interactions that change the marketplace.” We already see this in dentistry today where dentists are challenged to provide care in the face of barriers such as anxiety, or costs.  The innovation and evolution of sedation dentistry has changed the marketplace and brought care to those who may have been emotionally out of our profession's reach before . Moreover, dentists in Michigan are demonstrating linchpin qualities in reaching the underserved. They‘ve created a system where community service can be done in exchange for dental care. Dental related ER visits are down and patients who previously could not afford dental care, now have dental homes.  

All health professionals are required to do the “emotional work” that is one of the tenets of Godin’s linchpin. Godin rejects the idea of scripted courtesies and calls for genuine compassion in our interactions. He explains how JetBlue built their brand not by training attendants to be friendly, but by seeking out individuals with the qualities they wanted and encouraging them to make connections with customers.  “ The act of giving someone a smile, of connecting to a human, of taking initiative, of being surprising, of being creative, of putting on a show…we do for free all our lives.” These “emotional gifts” as Godin puts it, are essential to creating value in our interactions.

Linchpins are those who have conquered the “lizard brain”.  This lizard brain, better known as the amygdala plays a key role in anger, arousal, hunger and fear. Virtually all dental students can relate to the excited anxiety of our first operative procedure. Imagine the fear of failure in starting your own practice. We are wired to resist; but with some effort, we can be rewired. The first step is the decision not to feed your anxiety. Godin explains how simply acknowledging it, but not rationalizing the feeling eventually leads to its dissipation.  Realize anxiety is practicing failure in advance, it doesn’t protect us or help accomplish but rather inhibits progress. Banish procrastination, as this is the lizard brain keeping us stuck. Develop a “posture of challenging the resistance”; good habits can be fashioned just the same as we fall into bad ones. Conquering the resistance comes back to believing in your cause, “When you set down the path to create art...the path is neither short nor easy. That means you must determine if the route is worth the effort. If it’s not, dream bigger.”

Most importantly, Godin reaffirms us that,  “All of these attributes are choices, not talents, and all of them are available to you.” As future health care professionals we have the incredible opportunity to create valuable change in those around us. Linchpin encourages its readers to view your art as a gift; to be generous, bold, and creative. Health care is changing, and “Our passion for contribution and possibility, the passion we’ve drowned out in school and in the corporate world – that’s the only way.”

Sunday, February 9, 2014

Surgical Guide Techniques - Triad & Vacuuform

I was fortunate enough to have an implant case this semester. At UBSDM, we're involved in every aspect of the implant treatment, from it's placement to it's final restoration. As we were taught in pre-clinic, implant treatment involves a team of practitioners and careful planning and communication is essential.

The Surgical Guide is a tool made by the restorative dentist and [hopefully] used by the implant surgeon to place the implant in the location dictated by the restorative dentist. Once placed properly, the restorative dentist can then select an abutment and crown to finish the restoration. The surgical guide is used in treatment planning as well. Once completed, the patient is brought back, the guide tried in and a radiograph (CBCT or PA) is taken to assess the angulation and planned placement of the implant.

At the initial evaluation, we take a medical and dental history, and address any chief complaints. The implant treatment planning starts here, where we take the necessary radiographs to assess bone, alginate impressions, a facebow and bite registration so that we can mount the diagnostic casts.



So this implant is being planned for position #29. 






[Left]So here's the cast of the lower arch. 
[Middle]We first do a diagnostic wax up of the tooth, with proper embrasures and [Right]occlusal contacts. Next, an alginate impression is taken of the cast with the wax up so that we have a template from which to make the vaccuformed surgical guide. 



[Left]Here's the duplicated cast, trimmed and after the vaccumform was made. The hole in the tongue space helps the template better adapt. The template is then removed from the cast somewhat carefully. The cast won't be needed anymore so it shouldn't be concerning if it breaks, but the template should be handled carefully.
[Middle] Here's the trimmed guide after removal from the cast. The area around #29 is trimmed to the gingival margin, however around all other teeth the guide is trimmed to half the occluso-gingival height of the tooth. The guide should seat on the original cast without rocking. 
[Right] Next we need to fill position #29 with a radiopaque material so that when the guide is tried in the patient's mouth, we can assess the angulation of the implant. Barium sulfate is combined with PMMA and the tooth to be restored is filled in.



A hole is then made to accomodate the metal cylinder. The vacuuformed template with PMMA and barium Sulfate is slide onto the cast, and the cylinder is secured into place with super glue. I'll need to get a photo up of the finished thing. But here is a finished TRIAD guide:

 

So with these guides the surgeon can make a pilot hole at an angulation that has been previously evaluated radigraphically. After the implant is placed we'll be going through the impressioning techniques to restore!