Restoring Teeth with Implants

I had a post a while back about implants and want to follow up on that. I have a couple implant cases and wanted to share the process of restoring the implant.  As I've explained to patients at school and friends, a dental implant is basically the "root portion" of the tooth. The titanium implant is placed, and allowed to integrate with surrounding bone. Once the implant is deemed integrated and stable, then we can restore it with a crown. At UB as pre-doctoral students, we do not do immediate loading cases, but this is possible in some cases.

After 3-6 months, once the implant has osseo-integrated (bone has grown into the threads of the implant) we can begin the restorative phase. 

I. Data Gathering/ Treatment Planning

This case involves a patient who is seeking implant restoration of tooth #5. No significant medical history. 

Dx cast occlusal 

Dx casts lateral

Dx wax up #5 occlusal

Dx wax up #5 lateral

The process began with diagnostic impressions and treatment planning. There was adequate interocclusal and mesio-distal space for implant restoration. A 4.2mm Straumann Narrow Collar (NC) SLA Implant was selected for placement by the surgeon. A surgical guide made from TRIAD material and a radioopaque cylinder was fabricated to assist the surgeon in placing the implant with the correct angulation. This is important because implants must be at least 1.5mm from adjacent teeth and if implants are placed next to each other there should be at least 3 mm of bone between them.The patient returned for a try-in appointment where one periapical radiograph was taken to ensure correct angulation with regard to adjacent teeth roots, and to ensure the guide fit passively and completely. 

TRIAD surgical guide

Next, the surgeon scheduled the patient for implant placement. A full thickness flap technique was utilized and the guide was used for initial osteotomy.  The implant was placed without complication. The patient was then allowed to heal for 4 months. Upon follow up with the surgeon, the implant appeared to have integrated with bone well, and I was notified that restorative phase of treatmnt could begin.

The patient was appointed for a closed tray implant impression. Prior to the appointment an impression post, cap and analog were secured from Straumann. A custom tray was also fabricated for the impression making. 

II. Soft Tissue Model Fabrication

Straumann Implant components

TRIAD Custom Tray

At the impression making appointment, the patients vitals were taken, and the procedure was explained to the patient. The healing cap was removed from the implant, gingiva was healed very well. The impression post was then inserted and screwed into the implant so that the arrows on the post were oriented bucco-lingually. The patient was given a cotton roll to bite on posterior to site #5 to prevent damage to opposing teeth from the impression post. A periapical radiograph was taken to ensure complete seating of the impression post. Once complete seating was confirmed, the yellow impression cap was placed onto the impression post, and the impression was made using Aquasil Light and Medium Bodied Polyvinyl Siloxane impression materials. 

Closed Tray fixture level impression 

The impression was inspected and decided to be adequate. The impression post and cap come out with the impression. The post is unscrewed, and in it's place the implant analog is screwed into the impression.

This impression was used as a soft tissue model. In the lab, separator was applied on the impression material around the implant analog. Gingifast was then applied around the implant to simulate the gingiva and help us plan how we will develop emergence profile in the gingiva. Separator was then applied on the Gingifast after 2-5 minutes once the material cures. Separator is applied twice because we do not want the gingifast sticking to the impression, or to the stone. The impression was then poured using Jade Stone. 

Creating soft tissue cast

Soft tissue cast

III. Provisional Abutment/Crown Fabrication 

This soft tissue cast will now be used to select our provisional abutment, fabricate a custom abutment  if necessary and a provisional crown. Provisionals will help us develop the gingival emergence profile before the definitive crown is cemented. 

The next step was to secure a provisional abutment from Straumann. The components arrived in about a week.

Provisional abutment and screw

Soft tissue cast, provisional abutment & Straumann screwdriver

The implant analog was unscrewed from the cast and we were left with a cast replicating what is present in the mouth. We can now see the gingival height and shape we will be working with. We've learned a number of times that an implant is not a tooth. It's actually nothing like a tooth. It is ankylosed, lacking a periodontal ligament, and emerges from the gingiva in a circular shape. With this procedure we are hoping to achieve a more tooth-like gingival architecture surrounding the eventual crown. The provisional abutment here is screwed into place. And any undercuts on the mesial and distal of site #5 have been blocked out with wax.

Next this provisional abutment was etched, to enhance the bond of the PMMA acrylic. 

The abutment was then marked and cut down so that my template could be used to fabricate a provisional crown. 

The access to the screw channel needed to be maintained so that I would be able to retrieve the provisional crown. A hole was made in my vacuum-formed template to accommodate the screwdriver at the correct angulation. The provisional stump was also trimmed further to accommodate my vacuum-formed template of #5

This step was particularly tricky. . The PMMA was then mixed to the "doughy" state and the template filled around the screwdriver. The template-screwdriver apparatus was then brought to the cast and seated and re-seated a number of times as the PMMA set so that the crown would not lock into any undercuts that may have been missed during the block out.  The seating and reseating was done by basically screwing and unscrewing the provisional into the implant analog a number of times gently. 

The provisional eventually self cured and was removed from the vacuum-formed template, trimmed and polished with Acrylustre. The Gingifast was trimmed minimally into an oval shape buccolingually which will allow the provisional to create the emergence profile we are looking for in the mouth. The surface of the provisional contacting gingiva was highly polished to discourage any plaque accumulation.

Occlusion was checked with the opposing cast and we are ready for try in!

ECHM Town Hall

Our project of starting a community dental clinic is coming together, and is set to open to the public in February of 2014. On December 5th our group presented our progress thus far to faculty, students and staff in a Town Hall meeting. We wanted to give everyone an overview of whose involved, what's being planned, the location, population we'll be serving and how it's all going to come together. 

Kara, our project leader kicked off our presentation with introductions, and a summary of how we got involved, and an overview of what we all would be discussing. JoAnna then took it from there, discussing the surrounding area, and the need for a dental home at 1500 Broadway. She presented photos of the area, and elaborated on the fact that this is an underserved area. I discussed the collaborations that will be occurring at the clinic with LakeShore Behavioral, Catholic Health, Erie County and UB School of Public Health. We're hoping to be making many interdepartmental referrals, and seeing a different population pool than at Squire hall, which will be a great experience for students. Richie then engaged the audience with photos of our equipment and the blueprints and architectural renderings of the proposed facility.  Josh discussed when this would all be happening, and our plans for marketing and attracting patients. Since we're in an underserved area, we're expecting a large percentage of emergency-walk ins but we need to be prepared for many scenarios. By participating in the Buffalo Clean Sweep Initiatives, and marketing within the community we hope build some hype in the community prior to opening. Last but definitely not least, Hoda closed out the presentation with a discussion of how this clinic would fit into our schedules, what procedures would be done and our goals of going paperless. We plan to provide a broad range of palliative care procedures at first, however the vision is to become a comprehensive care clinic. More complex cases will be referred to Squire Hall, but simple operative, extractions and other procedures such as those could be performed on site. The logistics of how the rotation will work are being decided. Currently, the thought of having a vertically set up rotation, in which students rotate once a week through the clinic for the semester is gaining popularity as it would provide students with an experience that we do not already have. 

While we have made a great deal of progress, this is still a work in progress and the questions we received were all a great help. We're very excited to gain access to the building in January and begin our move in. If there are any other questions or concerns they can be directly to any of us via our emails. Hope everyone is as excited as we are about this new venture! 

D3: Onwards and Upwards

Officially checked out B28 Preclinical Lab today, marking the end of the second year of dental school! I'd say I'm half a dentist, but it doesn't feel like half way just yet. After Part I of the NBDE, then I'll assume that title. Nonetheless, it was bittersweet handing in the key to my drawers after having spent so much time right there, developing skills that I'll take with me into the clinic and away after graduation. We often see upperclassmen in the lab so it's not so much a "farewell", than a "be back later" kind of deal, but it's a definite change.

We are issued a giant, heavy, white box of supplies, which serve as our new "lab drawers". Back in the day when students had their own chairs in the clinic, the boxes easily be brought to your chair and left there for easy access. These days, I dont think I've seen one person carrying those huge things around. Instead, we've donned "clinic bags" of sorts to bring up whatever supplies we'll need.  I was lucky enough to find a nice black cosmetics box in our attic at home, which fits my supplies perfectly! But like most things in school, people do what works for them. Some like the freedom of having everything on hand. So after unpacking the white box into my clinic bag, the box will sit nicely in the closet, probably until graduation.

Reflecting on D2, I'd say was way more fun than D1. Tons of lab work, but also a lot of dentistry. Constantly cramming just became a way of life. There's quizzes in every class, which keep you on your feet. At first I definitely remember feeling overwhelmed by the 5 or 6 casts we had to have poured, impressions and wax-ups that were due, and preparation for tests and quizzes, but all was well. Looking back on individual courses:

Endodontics I
Endo was awesome. Probably one of my favorite courses so far. The class is divided up into groups of about 8, and assigned different instructors who grade projects and teach technique. You can of course ask any professor for their opinion, but asking the one whose grading you is usually most wise. But preclinical endo is great. Dr. Pantera plays Pandora, or the occasional movie and we go at it on our extracted teeth. The projects are on different teeth each week, and the lecture part of the course correlates really well. Although I feel like I've learned a lot, I can see clinical endodontics being quite challenging. Visualization in posterior teeth, or even anteriors may be a challenge, since they are fixed, rather than in our hand. The only improvement I could think of is having a typodont where mounted teeth could be placed, to simulate clinical endodontics. Working with extracted teeth was a great experience though, to teach the complexity of the root canal system, how instruments feel cutting actual tooth structure, and tons of other things.

Ethics and Law

Awesome class, and I hope we get more of this because it's really important. Dr. Gary and Dr. Maggio are really passionate about the subject, and it doesn't hurt that Dr. Gary is also a lawyer AND a dentist. The class touches on a lot of subjects that will definitely arise in practice, and teaches the ethical and legal obligations to dentist. We also covered a bit of social media, which gave me some guidelines for this blog.  I personally thought quizzes and the class was overall fair, although like any ethics class, there are subjective areas that will encourage more discussion than probably was intended. Aside being amazingly relevant to dentistry, I liked the information the class taught about how the clinic at the school runs, and Dr. Maggio's survey results about successful students in clinic, and patient interaction. Simple things like communicating clearly, being more accommodating and courtesy can help dentistry run much smoothly and improve the patient experience a ton.

Indirect II

Indirect was a challenge for me at first. This class really showed me how important attention to detail is, and the professors drive that home over and over. Cheers to everyone for getting through the infamous 3-unit bridge project. Luckily, the competency was a #30CCC rather than a #18-20 FDP prep. But the bridge definitely got it's fair share of attention. I think I must have waxed, broken and rewaxed it 5 times, and casted it twice. We're not required to cast our own, but I'd suggest it for anyone with any interest in the casting process. We had a lecture from Dr. Conny about lab work and dental school which gave me some basis for constantly being in B28 second year. Dr. Conny is an incredible prosthodontist who has done his own lab work for many years in private practice and stressed the importance of dental students understanding the process lab technicians go through to fabricate restorations and dentures. Dentists these days are placing more indirect restorations thanks to CEREC and increased demand for more esthetic, tooth like solutions, yet, dental students are doing less lab work. He presented examples of dental lab work authorizations with outrageous requests, clearly showing that the dentist did not understand the process which must be followed to fabricate the crown/bridge/denture/etc. So if you're a dental student drowning in lab work thinking, "This is pointless, I'm not going to be a lab tech", know as a future dentist, you'll be a customer, and a supervisor of a dental lab one day. And supervising something you've never done before, might be quite difficult.

Removable II

Went through partial dentures this semester. Now those mysterious tooth replacing apparatuses in patients mouth's make a lot more sense. I can see removable being really tricky, but amazingly rewarding when things come together. Lecturers were again great, and Buffalo has really helpful prosthodontists that are really passionate. For my own future reference the process for removable includes: Primary impressions, secondary impressions, pouring of a diagnostic cast, surveying, determining the need for survey crowns, preparing guide planes, heights of contour modifications and rest seats, then taking an impression for the master cast. If a survey crown is indicated, we've learned its better to make your modifications before taking the impression of the crown prep, so that the lab can fabricate the crown according to the modifications. The specs of the crown should also be clearly communicated on the work authorization.  Some upperclassmen mentioned they hadn't had the survey crown experience so I'm really glad we had the opportunity to work on one. Survey crowns are crowns that are made to fit the partial denture framework. They're usually indicated on teeth that are excessively tilted, or that may require a crown due to caries or other pathology.

Oral Sciences II

Learned some valuable knowledge here and Oral Sci was really well run. Not really much to say about this course, except that brute memorization only goes so far. Dr. Cho really emphasizes understanding the material, for your own benefit as well as that it's on the board exam. So the three hours on Monday afternoons spent in a basement other than Squire's, was well spent. The coolest things I thought came out of Oral Sci was learning about the science behind periodontal treatments like  PDGF, and the experiments our own faculty went through to develop advances in their field.

So that's about it for D2. D3 starts full swing on Monday with a full day of clinic! #letsdoit

Friday Afternoon Endo

When I see the "C" for Clincal Rotation on our Integrated Dental Practice schedule I'm never sure how to feel. The last clinical rotation I had was spent talking to a fourth year friend for a few hours about impressions, casts, dentures, patients and dental school in general. All very, very useful stuff, but while in clinic it'd be great to do something clinical which is exactly what I got this time around

I had the privilege of working with an awesome third year, named Joy whose name perfectly fits her personality. Our patient was an elderly woman in need of RCT on tooth #11. She had many other dental problems, however the canal in this tooth had been previously treated and needed to be completed. Joy began with a few anesthetic injections before removing the IRM (temporary filling -Immediate Restorative Material), while I manned the suction. Once cleared she then cleaned the canal with the slow-speed and filed and shaped it with different files. Despite some trouble we ran into with excess saliva, and placing the rubber dam, the patient was amazingly patient and understanding. Looking back, I think that situation was exactly what Dr. Goldberg in Orofacial Neurobiology was talking about. Our patients will react to our demeanor and attitude. While competence is vital, compassion and empathy for our patients is also critical.

Once we had a clear canal, the next step involved cleaning the canal with a bleach solution, measuring the correct gutta percha length and filling. While the bleach rinse was fairly painless, measuring the correct length of gutta percha can be tedious. Once measured the apex could then be filled and checked via radiograph to ensure that the apex really was filled. I familiarized myself with the digital radiography program and developer the clinic uses and some protocols for the x-ray room which was nice. Once the apex was filled we could then fill the remainder of the canal then finish it off with more IRM since this patient would need another appointment to crown off the  tooth since so much of it was lost to decay. 

This was the first appointment I got to assist in entirety at UB's clinic and I can say I completely understand  how 3 hour appointments can fly by, how amazingly helpful the professors and assistants are and how great our patients can be. Next week we've got an Orofacial Neurobiology Midterm on Tuesday and Microbiology on Thursday. Group presentations for Community Dentistry are also coming up fast. On a more fun note, I've been keeping up with the weekly Capoeria classes and it feels like I'm getting the hang of it. There's also a couple of bike rides for Diabetes and Cancer that I'm  getting excited for. Never a dull moment! 

Post Spring Break

It's been a week since we got back from Spring Break and it seems like Spring just decided to descend on Buffalo. We've had basically 4 days of consecutive 80 degree weather which is uncharacteristic of Buffalo for this time of the year. It's supposed to cool down a bit, but before it does, some classmates and I have been taking full advantage of the weather. Being super bogged down in work all the time, its hard to find time to explore the other campus at UB North, however we got to the other day which was great. It almost makes you feel like UB South is the somewhat neglected campus.

Aside from the fabulous weather, there has been work. Third Micro Test was challenging, different from the past though since the material was divided up between a bunch of professors. And questions from the longest lecture (81 slides on Staphylococcus) were left off. Thankfully I saved that lecture for last :). Physiology is the next exam coming up next Wednesday, where we'll be evaluated on our knowledge of the lungs and respiratory system. The book work continues...

Integrated dental practice though has proven to be an awesome experience. On Monday we took our first alginate impressions on one another, and poured up casts. Our overseeing faculty had sympathy on us since they realized how long this would take, and our group had one hour less than the other groups would have, since we lost an hour to lecture. Even with that sympathy, and the added stress of the Microbiology exam the next day, the process took hours. Taking impressions is probably something we'll do many, many times in our careers, and we've probably seen dentists do flawlessly, without hesitation. Learning the procedure on the other hand is another story. First you need to measure out the powder, and water. They both then need to be combined and mixed throughly in a mixing bowl with a spatula, and within that same minute that it is mixed the impression material must be placed in a tray, and into the patient's mouth properly. Spend too much time mixing and your material polymerizes and you'll have to start all over. Spend too little time mixing and the material won't set correctly and you risk gagging your patient with dripping alginate down their throat(which I may have experienced lol). Once the mandibular and maxillary impressions are taken, it is rinsed, sprayed with Cavicide, wrapped in a wet paper towel and stored in a sealed plastic bag.

The next step, which is normally done in the same day, is to make the cast out of castone. This involves mixing water, and the stone powder, then filling the impression carefully. Once full the rest of the castone is neatly placed on a paper towel which becomes your base. The impression tray is then placed on top of this and set to dry, which takes about an hour. Once dry you can then remove the stone from the tray, trim the model and be set to go.

The whole process took a couple of days since none of us really wanted to wait around for an hour when there was a 10 lecture exam the next day. This made removing the stone a little more difficult than it should have been, but removing the stone from the alginate in a pool of water made things a little easier.  All in all, a great experience to have! I'd hope to do it again sometime, before having to be evaluated, but I'm not sure if we'll get that opportunity.

Lawnchair Denstistry - Good Neighbors Clinic Outreach

Today began at 6:50AM with an alarm that might induce a heart-attack in someone not as accustomed to vibrating mechanisms under their pillow. 6:50AM isn't a time most dental students see on Saturdays, but I was lucky enough to be selected to volunteer at my first REAL dental outreach!

On Jefferson Ave in downtown Buffalo, the Good Neighbors Clinic provides free dental, optometric, chiropractic and medical services to the area on designated days. Today was a purely dental day. Along with a handful of local area dentists, twelve dental students and staff of the clinic we provided care to upwards of 30 patients in the span of 8 hours! Of the twelve students, first and second years were assigned to assist third and fourth year students who would perform procedures. Upon arriving there at 8AM was already a line of patients waiting outside in the snow.  Much work had to be done to set up operatories with the necessary instruments, personal protective equipment and more. Rooms designated for surgery were equipped with reclinable lawn chairs, forceps, gauze, elevators, syringes, carpules of anesthetic and dental bibs. Once a triage system and front desk were set up we were on our way.

I was assigned to a third year student, who was overseen by a dentist. The three of us were placed in room designated for extractions, where I assisted in the extraction of some three or 4 molars.  I quickly learned that during outreach events, conditions are far from ideal.  Watching my third year (Susie), who is a few inches taller than me, extract upper and lower molars from incredibly uncomfortable positions was amazing.  Even moreso was the fluidity and confidence of Dr. Hattin, the designated oral surgeon of the crew. Upon being presented a case he deemed "very difficult" to all onlookers, he would proceed to remove bone around the tooth with the surgical drill and in minutes the tooth that we had struggled with for much longer would be out - next patient.

Not everyone had this much luck, as I witnessed others with more difficult patients. It was through their experiences I learned that patients may sometimes require anesthesia prior to having x-rays due to sensitivity or anxiety. Nonetheless, even though some extra time was needed, quality care was achieved.

When I wasn't showing patients to their rooms, bibbing them, dabbing blood from teeth, collecting freshly extracted ones from Susie and Tom, or bringing supplies back and forth from the sterilization/x-ray room, I spent most of my time learning about taking and developing Panorex X-rays. A dental hygenist who basically ran that room was a great help to me with this. Today I took one periapical and 3 Panorex X-rays - solo! The procedure for pans was:

- Prep the X- Ray machine with a small plastic wrapper that goes over where the patients teeth contact the machine
- Retrive patient from waiting room,  walk to the X-ray room.
- Explain to them what the X-ray machine does, since pans are not your average x-ray and the machine can be somewhat intimidating and complex
- Have patient remove all jewelry from their head and mouth, and jackets if they may get in the way
- Place the lead apron on the patient and have them step forward into the machine
- Have the patient bite onto the peg, with their chin comfortably seated and forehead forward against the headplate.
- Ensure proper tooth positioning on the biting peg by having the patient smile slightly and observing the peg reach back about to the canine
- Have the patient place their hands on the handles and ensure the machine will not be obstructed by the patient's shoulders when it moves.
- Once you let the patient know to remain completely still, you're set!

Lucky for me all of my patients were calm, collected and sociable. I loved sharing stories about my own tooth extraction and my first panorex x-ray that I saved in my room for months since it made a nice window decoration. Not sure what they thought of me after that but at least it made them smile.

I also learned to develop films and pans. The pans were a little more involved in that the room needed to be closed, the machine off and lights off. The film is kept in a cartridge which needs to be opened, then the film must be placed in the developer. Chris helped me reload the cartridge and place the unexposed films back in their package before the lights were turned back on.

For a first time assisting and actually serving in a clinic I feel like I learned a ton. The day flew by and before I knew it, it was 3:00PM and we were cleaning up. While technical skills are important and necessary, the most important lessons of the day were those in patient communication, as well as colleague interaction. Providing care is always, always, 100% focused on the patient. In my mind it's a privilege to treat any patient, since they could have gone to anyone else. In this case, these patients needed any care they could get, but I was still gracious to have interacted with them since they could have ended up in other student's operatories. Every effort should be made to create a positive experience for the patient (which reminds me for future outreach events to definitely bring a radio!) Additionally, patients are people and people love to socialize, especially when they're nervous and need to feel more comfortable. I learned more about patient's children in college, struggles with drugs, favorite movies, hometowns and more than about dentistry today and recalling all that would be an accomplishment. The take away is that the patients are what makes it all so rewarding.

One patient's husband who was a minister told me something that stuck with me. When I expressed an interest in his preaching and mentioned the name of the pastor of my church in Binghamton, he recognized the name and shared that he was actually from there. He then told me it sounds like I have a calling on my life and wished me blessings. Despite the conflicts it's caused, I'm happy that faith still brings us closer together.

Spring Semester: The Start of Something New

Been back for a little less than a week, and things are already in full swing. This semester's schedule is MUCH easier than last, since nothing can really compare to the workload of Gross. Here's a look at the start:

Integrated Dental Practice will be added Mondays and Fridays from 1-4PM on the 31st and a couple other changes will happen as well. For now things are totally manageable and it seems like there's a general sense of optimism in the class.  I'm personally a little bummed that we have absolutely no dental lab courses this semester after just starting waxing and using our handpieces last semester. I'm toying with the idea of bringing home my supplies and waxing on occasion since hand skills are vital. Nonetheless, classes are still interesting. 

Next week we have our first outreach trip for Practice, Profession and Community Dentistry. We'll be talking to middle school aged children about oral health and mentoring them later on. Buffalo was apparently the first to implement this type of program into their dental curriculum and since then a few schools have followed. Opportunities such as these are what made Buffalo so appealing. I really hope to take away new perspectives and a deeper comfort with people from this class.

Physiology is nothing spectacular, I'm thinking about it as just another biology class.  Surprisingly, much of the material we are covering in the first unit on action potentials, is material I spent hours on in Autonomous Agents, in my fourth year of Bioengineering.

Neuroanatomy, while another biology class, I find really interesting after the first lecture. The professor appears extremely knowledgable and teaches clearly and emphatically. High hopes for this one. Microbio, another bio class also is great thus far. Great professor, interesting material, also should be good. 

The much feared Occlusion class being one of the few actual dental classes we have this semester has gotten off to a good start. I can definitely see spending a ton of time memorizing definitions. Not sure how a class this important could end up getting only one credit hour. 

Oral Radiology, another important class also potentially could be somewhat time consuming, not only material wise but due to the interest level. I'm hoping we go into so much depth that we really are competent radiograph readers by the end of the semester.

I think the most anticipated class for me this semester will be Integrated dental practice, where we'll be assisting third year students in the clinic. This is another new implementation for Buffalo so hopefully all goes well and it sticks for the future. 

D1 - Week 1.

Tomorrow concludes the first week of year one and all I, and most my classmates are thinking is probably something along the lines of "...what?" I personally feel way more stressed than I should be, mainly because at this point, the work has been laid out, one week's worth that feels more like months worth. I was reflecting a little earlier on the classes we have, and what exactly to study for each so I think outlining them here will help get me a bit more organized:


Dental Biochemistry: Word from upperclassmen and the professor thus far is just study the (1)lectures. I've been recording what I can but I also have a notebook that will come in handy in test preparation.


Dental Anatomy: LOVE this class, but I love it way too much considering it's only worth 1.5 credits..which doesn't make sense to me but that's that. I've been reading the text mainly cause it's super cool, but the advice has been to stick to the (1)lectures and I'll start to skim the (2)text. This week we had our first lab - Mounting the typodont, which some completed in a timely and neat manner, while others struggled for hours, in some cases completly disassembling their plastered down mandible and repositioning, rewaxing, and replastering the articulator. I'm hoping to get a photo of mine on here soon :D.

Histology: Not one of my favorites thus far, but definitely necessary. I think with time the course will get more interesting when we actually get a feel for what structures look like more. Main study tools seem to be (1)laboratory slides and (2)lectures. The text may be worth a skim also but from what it seems, pictures will be priceless.

Intro to Profession: Something like a seminar course, grading is P/F. Really awesome so far with lectures from members of organized dentistry, ethics committees and more. Not much to study thus far.

Gross Anatomy: Said to be the killer of first year. My attack plan will include hours spent in the cadaver lab, (1)Rohen's Color Atlas of Anatomy, (2)Grant's Dissector and the (3)UB issued lab manual. Altogether should be a winning combo. But we'll see, having our first dissection tomorrow on the superficial back.

One piece of software I used to study for the DAT that has been coming in handy for memorizing amino acids, dental anatomy vocab and other things is Anki . The program allows you to make flashcards and tests you based on how long it takes you to turn over the card. Easier cards will show up less often than harder ones. It's free and there are some downloadable card sets already on there for dental anatomy and other topics.

So looking at all of this, its definitely a lot, but definitely manageable. One friend of mine said it well, in that most of the stress this week is the hype. That every moment we  feel like we should be doing something, but in reality I've quickly realized that isn't healthy, or sustainable. I've also quickly learned that when people say "all you can do is give your best", that is ideal advice. Its easy to flood your schedule with the workload, let your spirits and health slip, and be a slave to the books. The key is really going to be learning to take a breath and keep the pace.

Cheers! :D

Orientation Week

By no insane stretch of the imagination could I have foreseen the beginnings of dental school being what this week has been.  From the formal and professional welcome breakfast, to open bar parties reminiscent of undergrad, orientation here is said to be the best week of first year.

Today we finally picked up what seems to be the last of our supplies for the first year courses. In what felt like an early Christmas (that we paid for dearly in advance), Henry Schein and Brasseler reps gave out boxes filled with models, instruments, and a ton of other stuff I'm yet to figure out what it is. Getting the scrubs I think was just icing on the cake, but to me felt unreal. Looking back to the interview when I met and spoke with the current 2nd year students, I remember them wearing their anatomy scrubs, and how much I wanted to be in their shoes. Now finally, I am :D.

The coolest thing thus far though had to have been the lecture on IT in Dentistry. A professor whose name totally escapes me talked about all the awesome new technology that's coming up, and things that we'll be working with by our 3rd year. Digital x-rays are a common change, but the use of Cone beam CT scans in dentistry is something that was new to me. Oral surgeons for instance can use them to get much, much better view of where nerves are and how to go about placing implant, or removing third molars for instance. He also presented a video about Invisalign and how the devices are made and all which was crazy cool.

Today was the white coat ceremony and family day picnic which was again unlike anything I could have imagined. Sure, being cloaked in a white coat feels great but it's much more than the act, the feelings and thoughts about the future, and how fortunate I am to be here made me almost teary eyed. I definitely cannot complain and as second year students have said, our lives won't ever be the same. At the picnic I spoke with a few friends' parents and got a lot of insight as to how different all our lives are, and had a ton of fun listening to older dentists' stories of celebrities, quirky patients and tales of dental school in years past.  The entire experience was nothing short of honorable. When people talk about feeling honored, and or an individual or institution having prestige, I always thought of the high-nosed professional, looking down on the world. Buffalo has redefined those words for me today, with emotions of trust, character and wholeheartedly lust for life. Prestige being the characteristic that sets one apart from the crowd and honor being the pride and exaltation that comes with achievement. 

UBSDM C/O 2015 White Coat Ceremony - 08.12.11