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Learning from real life

Nov. 1, 2006
I gave a two-day hands-on veneer course recently at my office in St. Louis.

I gave a two-day hands-on veneer course recently at my office in St. Louis. I normally teach these courses at the Center for Advanced Dental Education at St. Louis University. I had some cancellations, which made the class small. So at the suggestion of my secretary, Genna, we scheduled the course at my office.

This veneer course is usually taught with models and typodonts. Since it was going to be a small group, Genna suggested I add an “over-the-shoulder” preparation segment to the course. It had been a long time since I had prepped teeth with other dentists looking over my shoulder.

Karen, a former dental assistant who left assisting to go to dental hygiene school, was working for a young dentist near my office. She told me about the dentist’s wife, Tracy, who had dark tetracycline-stained upper and lower teeth. Tracy rarely smiled and really wanted to do something to improve the color of her teeth. That same afternoon, I did an oral exam and realized this would be an excellent case to illustrate a number of things for the dentists taking the course. Four bicuspids had been removed for orthodontics and the spaces were closed.

Tracy and I decided that I would prep eight teeth on the upper arch and eight teeth on the lower arch. We discussed shade, and she finally decided on Ivoclar bleach shade 020. Then, Tracy told me she was a dental phobic and a gagger, and I began to wonder what I was getting into! However, her husband told me that she was really a good patient.

We took impressions and images on a Monday afternoon, and the course was scheduled for Friday. I sent the models to David Block at Aesthetic Porcelain Studios for a wax-up. The wax-up arrived on Thursday and I completed wax-up impressions so I could make provisionals that would look almost like the finished case. Karen came over to assist me and handle the treatment room setup.

Randy Donahoo of Magna Vu Systems had come by earlier in the week to make some adjustments to my Magna Vu camera system. This is a great system that allows a dentist to prep magnified teeth while looking at a monitor. For the hands-on course, I was able to project the patient’s teeth onto a large screen so the class could see exactly what I was doing.

I prepped the upper arch first, and everything seemed to be going well. But then I had to take three impressions to get one I liked. I cannot remember the last time I took more than one! Finally, I was ready to make the provisionals, which is usually a 15-minute procedure. The material did not set up on the first try, then I did not seat the impression all the way, and I broke it while removing it. Then I had to make a new impression on the wax-up. I did not like the way the next one looked. Finally, on the fourth try, I was successful.

Needless to say, I was very embarrassed, but the class was really excited about how I handled what they called a “real-life situation.” Since these are the types of problems they have in their offices, they learned more from my mistakes than if everything had gone smoothly. It demonstrated how everyone works together to overcome difficult problems. Tracy handled the whole situation nicely and turned out to be a terrific patient. We let her go home, and I prepped the lower arch a few days later. We made a DVD for the class so that they could see the lowers prepped and the case seated.

The next Friday, I was in the Detroit airport waiting for a plane when my phone rang. It was David Block, calling to tell me what a great job I had done prepping Tracy’s teeth. I had used my new three-quarter crown veneer prep to open spaces on all the teeth so David would have enough room to do his magic. David really made my day, and I know I will be calling him after seating Tracy’s veneers to tell him what a great job he did creating her finished case. I hope you have developed a lab relationship like mine! David and I really work well together because we respect each other.

Joe Blaes, DDS, Editor - e-mail: [email protected]
Toll-free phone number: (866) 274-4500

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