Professional Documents
Culture Documents
Clinical Simulation
Laboratory,
Norwich 2015
Why are we all here?
• Confirm / Update our Knowledge
• Clinically Apply our Knowledge
• Accept Incompetency
• Work towards Proficiency
• Learn to be Competent
• Learn to be Proficient
• Exposure to new clinical skills
‘Phantom Head’ dentistry
• It has taught me what I am going to do before I do it
• It allows you to execute practical skills until you can
predictably achieve a satisfactory result
• It taught me the importance of reflective learning and to be
self-aware of my limitations – so I can improve them
• It also taught me to look at criticism positively – and realise
that a ‘nicey / nicey’ approach to teaching (and life) doesn’t
work in the long run
Rules of the Day
LEM DBC
Simulation Environment
• In practice you will rarely be preparing virgin teeth
• The teeth will be heavily restored, broken down or worn
• You may be replacing failed ‘fixed’ restorations
• In practice you are dealing with the quirks of a patient
• You are also dealing with the strengths and weaknesses
of your trainer in your foundation year
Does anyone know what these three anterior tooth
preparations are for and why they are different?
DBC
LEM
WPFM
What do we want you all to do well today?
• Margins
• Taper
• Matching reduction to tooth
anatomy
• Matching reduction to
proposed material of
restoration
• Producing an overall circular
preparation shape
• Hold and control your hand-
piece properly
• Know the dimensions of your
burs – and why you are using
them
Learning outcomes
1.3 mm
1.5mm
Tapered Broad Chamfer
&
Silicone putty
Burs
Plastic Teeth
Sharp pencil
Plastic Teeth – we have lots to practice on – this is a
good place to make mistakes
PB 2015
Basic things
• Handpiece control – smooth cutting
• Holding the handpiece right – ‘parallelism’ control
• Using two hands for extra control when needed
• Bur selection
• Knowing bur size
PB 2015
We will not ask you to do
anything that we cannot
PB 2015
Tools for the day:
Silicone putty
Burs
Plastic Teeth
Sharp Pencil
Objectivise undercut assessment – should be able to
see the 4 points at each of the line angles with mirror
– this means no undercut(s) present
WPFM Preparation
Preparation Specifications:
The ‘Wings’
• If you need a 1.2 – 1.5mm shoulder labially (for metal
and ceramic)
• If you need a 0.5mm palatal chamfer (for metal only)
• Then you will end up with interdental ‘Wings’ where
the different dimensions of the margins meet
Knowledge
PB 2015
Knowledge
PB 2015
DBCC WPFM
Common errors displayed with WPFM Today:
Axial Height
Minimum 2mm Ferrule
Knowledge
Remember
Retention - the direction of the path of insertion
(occlusal direction)
Resistance form any other lateral direction
A function of:
Taper
Surface area/bulk of preparation
Surface roughness Jorgensen 1955
Knowledge
INDIRECT
DBC PJC
COMPOSITE
Aesthetic restorations
looking good comes at a
biological price
DBC prep = 63% off tooth
PFM prep = 72% off tooth
PFM prep 20% > FGC prep
PFM prep x5 > Porcelain veneer
(feathered) x3 > Porcelain veneer
(butt joint)
Edelhoff & Sorensen (2002). Tooth structure removal associated with various preparation designs for anterior teeth. J Prosthet Dent; 87: 503-9
Edelhoff & Sorensen (2002). Tooth structure removal associated with various preparation designs for posterior teeth. Int J Periodontics Restorative Dent; 22:
241–249
Dentine Resin-Bonded Ceramic Crown
Preparation
360o Heavy Veneer Preparation – but no undercuts can be allowed
DRBCC Preparation
No
Undercuts
PB
Convergence Taper
15 - 20o
Occlusal
Reduction
1.0 mm
Heavy
Axial Reduction Chamfer
0.5 - 0.7mm PB
E-max