Bay View Dental Laboratory

“Are You in a Photography Rut with Your Clinical Photos?”

If you feel stuck with the mediocre results you’re getting every time you have to take photos in the operatory, I’d like to help you get back on the road and begin capturing images that are useful to you, your practice, and your lab.

I’ve been working with cameras for a number of years, and while I certainly don’t consider myself an expert in the field of photography, I do have a certain proficiency with the medium and understand the fundamentals that go into making great images. Over the years, I’ve had the opportunity to study and learn from many professional photographers in various areas of photography. I’ve even managed to land a few paying jobs along the way, and with each of them I’ve grown and improved.

I recently visited a doctor’s office to help them with their clinical photography, as it had quickly become apparent that they needed help in this area. The majority of the photos we received from them were out of focus, had inconsistent color representation, or were shot from odd angles. In some cases it was a combination of all three.

Generally, with a hands-on training session, I’m able to have the doctor and staff up and running in about an hour or so, ready to shoot clinical photos with much improved results. Their understanding of photography is still pretty limited at this point, but they have the necessary knowledge to get the job done. But this situation was a little different than most – they were taking their photos with a camera phone. Although I’ve always said that the best camera to use is the one you have with you, camera phones are not the ideal “camera” to use for clinical photography. Having said that, there are some camera phones that far exceed the ranks of their peers, like the Nokia PureView 808 which has a 41 megapixel camera built in. That’s right – 41 megapixels! Don’t get your wallet ready just yet, chances are it won’t make it to retail stores in the U.S. This is just one more indication of how rapidly technology is advancing, but even this camera phone is not my recommendation for your clinical shots.

Most offices I visit have one of two different types of camera systems – either a DSLR or a point-and-shoot camera. Point-and-shoot cameras are small, relatively inexpensive ($100-$300) and are great for casual photography. Some of the limitations inherent to these types of cameras are the lack of full manual control, small imaging sensors which aren’t capable of producing highly detailed images, and a limited aperture range. Having a broader aperture range allows for greater depth of field (getting all the teeth in focus when shooting at small apertures like f25 or f29). DSLRs, while a bit more expensive, allow the photographer to change out lenses and use a dedicated macro lens for their up-close clinical photography which can give incredibly detailed images. They give the photographer the option of full manual control for creative freedom, the ability to manually focus on a subject, and are much better at balancing color within the camera.

To demonstrate the differences between the two cameras, I took a photo of a patient with each and placed the images side by side for comparison. There are a number of visible differences in the two images. Both cameras were set to Auto White Balance (AWB) and the DSLR did a really nice job of balancing the colors. The point-and shoot, on the other hand, didn’t do so well – the colors are too warm and the image has a slight yellow color cast to it. There’s quite a contrast in the amount of detail in the two images as well.

At 100% magnification you can see the difference between the two cameras and the subtleties of tooth #9 are apparent in the image produced by the DSLR. This patient has fairly monochromatic teeth – imagine if you had a patient with a lot of characterization in their teeth and you were trying to communicate this to the lab – how do you think a point-and-shoot camera would fare? Another difference that jumps out is the distortion apparent in the image from the point-and-shoot. The patient’s mouth appears more convex than it actually is. This is called barrel distortion and is attributed to the cameras lens.

So now that you’ve seen a few of the differences between the two systems, I’m sure you’ll agree that DSLRs provide a much more robust system and superior image quality. They’re my recommendation for all your clinical photography needs and are excellent for your “glamour” shots as well. Look for future photography related articles and feel free to post a comment or make a suggestion if you have a specific topic you would like me to cover.

Author: Harold Yates

Rubber Dam Placement Made Easy

“Rubber Dam Placement Made Easy”

By: Contemporary Product Solutions

When asking Dental Assistants how many of them use rubber dams in their practice, it’s shocking to see the show of hands. Studies show that only 15% of dental offices use rubber dams for adhesive procedures. Excuses come up such as; it takes too long to place, we just use cotton rolls, and retractors get the same results. With so many new and innovative dams introduced, dam placement takes minutes. Why take chances?

WHY USE A RUBBER DAM

1.Visibility is much better due to the contrast of colors of the dam and the teeth being prepared.
2. Creates dry and non-contaminated field from saliva and other debris during all bonded procedures.
3. Improves access during dental procedures by retracting the lip, cheek, and tongue from the field of operation.
4. Protects the patient from swallowing any debris such as the removal of amalgam, old porcelain, and composite.
5. Increases the efficiency, productivity and reduces the time required for treatment.
6. Adds comfort for the patient and dentist
7. Infection Control

WHEN USING A RUBBER DAM IS CONTRAINDICATED

1. Tooth may be too short to hold a clamp.
2. Tooth may not fully erupted and there is not enough tooth to clamp to
3. Patients that may not be able to swallow

Things To Consider When Selecting A Rubber Dam

SIZE

Dental Dam material is available in pre-cut squares of 6×6 and 5×5 inches. The 6×6 is used for posterior applications. The 5×5 squares are for anterior application and primary detention.

THICKNESS

The thickness gauge of a dental dam can vary from thin to heavy. Thin is used for endodontic, medium is the most popular for easy placement, and heavy is used for tight contact and areas that need for stronger support.

COLOR

Dental Dams come in a wide variety of colors. The most common colors are grey, blue, pink, purple, green, white, and yellow. They can also come scented or unscented, flavored or unflavored. Most dentists prefer the darker shades for contrast.

DAM NAPKINS

A dam napkin can be placed between the dental dam and the patients face. This helps to absorb moisture and increase comfort for the patient.

DAM FRAMES

A dental frame is necessary to stabilize and stretch the dam tightly over the teeth. Frames come in plastic as well as metal. Both can be cold or heat sterilized.

LUBRICANTS

Lubricants such as topical such as Ultradents, or KY jelly, can be placed on the underside of the dental dam for easier placement over the teeth and through the interproximal areas.

DAM PUNCH

The dental dam hole punch is used to create holes in the dental dam needed to expose the teeth that are to be isolated. The working end of the punch is used to puncture the dam for the correct hole sizes.
Size 5- The largest size is an anterior tooth
Size 4- The next size smaller is for molars
Size 3- For bicuspids and canines
Size 2- For maxillary anteriors and incisiors
Size 1- The smallest size, for Mandibular Anterior Incisiors

DAM TEMPLATES

Sometimes it is hard to know where to cut the holes on the rubber dam. This is where a dam template is handy. The dam template and stamp inkpad allow the assistant the exactly where to place the holes if the teeth are out of the arch form.

DAM FORCEPS

Dental Forceps are used to place and remove the dental dam clamp. The beaks of the forceps fit into the holes on the jaws of the clamp. The handles have a spring action that allows the forceps when squeezed to open up and fit over the tooth. When the handles are released, the clamp is let go.

DAM CLAMPS

A dental dam clamp is used to stabilize the dental dam. The dam clamp holds the dental dam secure on the end nearest the tooth that is being treated. Clamps can be ligated for security and safety of the patient from swallowing if the clamp becomes dislodged during treatment.

SELECTION OF CLAMPS

Anterior Tooth: Double Bowed Clamp
Pre-Molar: Small, Flat-Jawed Clamp
Mandibular Molar: Flat Jawed Clamp
Maxillary Molar: Curved Jaw Clamp
Partially Erupted: Sub-Gingival Designed Clamp

Placement Of The Traditional Rubber Dam

The dental dam and supplies are ready for use
Determine the operating field.
Mark and punch the hole positions.
Select the correct clamp and ligate.
For Posterior Isolation, Always go one tooth distal to the tooth (teeth) being treated and extend to the midline. Anterior Isolation include pre-molar to pre-molar.
Position the clamp over the tooth with the lingual jaws of the clamp first, then the facial jaws. During the placement, you may need to keep your finger on the clamp to keep the clamp from coming off before it is properly seated on the tooth.
Stretch the Dental Dam that has been punched over the anchor tooth.
The ligature (floss) should be exposed and easy to grasp if needed.
Position the frame over the dam and slightly pulling the dam to catch on the prongs of the frame.
Fit the last whole of the dam over the last tooth to be exposed at the opposite end of the tooth that is anchored.
Using your index fingers stretch the dam over the clamp. For more difficult interproximal contacts, use a waxed floss such as Glide by Proctor and Gamble. The lingual end of the floss is looped over and inserted into the contact, while caring down more dam with it. Remove floss by pulling both ends buccally without disturbing the dam.
Using a black spoon, available from HuFriedy, tuck the edges of the dental dam into the gingival sulcus.
If the patient is having problems breathing, cut a small u shape just under the nose so the nasal passage is not blocked, and the patient can breathe easy.
Placement of the rubber dam should not be an option. With today’s new systems practice and placement makes perfect.
Contemporary Product Solutions provides an expertise in clinical and laboratory evaluation of dental products and equipment from the total team perspective. Their mission is to provide the dental profession with clinically relevant information to all areas of the dental practice. Product review will provide unbiased, up-to-date, evidence-based information on equipment, materials, protocols of treatment, and long term performance. Each evaluation includes a step-by-step tech spec of each product, a clinical overview, a technique video, and an overall rating.

“Important Updates from the 2012 Chicago Mid-Winter Meeting”

This year we attended several meetings in Chicago including The American Equilibration Society, American Prosthodontic Society, The American Academy of Fixed Prosthodontics, and The American Academy of Restorative Dentistry. Several themes were repeated which I have highlighted here along with a couple of exciting new products.

SLEEP DENTISTRY/ OBSTRUCTIVE SLEEP APNEA

Obstructive Sleep Apnea was a topic of significant discussion from many speakers this year. It appears to play a much more significant role in dentistry than we ever realized, with some now reporting a connection between OSA and bite related issues. The team of Robbins and Rouse in Texas has emerged as leaders in the field of Sleep Medicine in Dentistry. We are already working on having Dr. Jeff Rouse here next year to update all our customers on the importance of the condition and proper protocol for diagnosis and treatment of OSA. Bay View Dental Lab plans to host the program at the Mid-Atlantic Centerin the fall of 2013 (date to be announced).

FULL CONTOUR IPS E.MAX STILL #1 AND GROWING

Materials were discussed by many, and lithium disilicate (IPS e.max) continues to be recognized as a leading material for restorative dentistry. More and more studies confirmed what we have been experiencing – it is a very robust material. Some studies were reporting no drop-off in strength at 1.2mm of occlusal clearance. While we still recommend full contour zirconia on second molars when occlusal clearance is less than 1.5mm, we continue to see e.max as our first choice restoration for posteriors overall. I am continuing to work with these restorations personally every day and can attest first hand to the strength, impeccable fit, excellent esthetics, and all around versatility of e.max as a restorative material. Coinciding with the rising popularity of e.max was the release of a new material from 3M called RelyX Ultimate Adhesive Resin Cement. RelyX Ultimate has reduced the number of components while maximizing the bond strength. It is a significant improvement in adhesive dentistry.

ATLANTIS PATIENT SPECIFIC CAD/CAM IMPLANT ABUTMENTS

The trend in implant dentistry continues away from cemented restorations, and back toward screw-retained restorations. Research shows that some of the reason for this edging away from cemented implant restorations is irretrievability when something goes wrong and the number one cause of implant failure – cement in the sulcus. One option for avoiding these situations is to go with screw-retained crowns. Of course, these restorations require a much more precise placement of the implant and tend to be quite a bit more costly. Another highly successful option is to simply use a patient-specific CAD/CAM abutment with proper contouring and support of the tissue around theimplant abutment. The patient-specific CAD/CAM abutment has been our recommendation for several years now. We’ve found that the Atlantis Gold Hue option, with a full-contour e.max crown, provides exceptional results. The total bill for this restoration, including implant model, parts, custom abutment, and crown is still just $595.00. We recommend usingCeramir, a new generation of cements created for the specific demands of implant dentistry.

These specific topics are among many that will be discussed at Dr. Bob Faulkner’s course “Current Concepts in Implant Dentistry: Diagnosis and Treatment Planning” here at Bay View Dental Laboratory on November 8-10, 2012. Contact Kim at 757-222-9843 for more information or to register.

Atlantis Gold Hue Implant Abutments

The popularity of gold hue CAD/CAM implant abutments soared last year, and it is now our first choice for implant cases. Previously, we had used gold hue only sparingly, but with so many zirconia abutments breaking, we have backed off zirconia in favor of the more the predictable results of Atlantis Titanium Gold Hue. The warm gold color of the abutment has a reflective property you don’t get from darker colored or silver abutments. The reflective properties create a beautiful aesthetic when combined with an all-ceramic restoration. The abutments are stronger, have a beautiful gold color and cost less than zirconia, making it the best option for all three considerations. IPS e.max is our first choice for restorative materials over these gold-hue abutments. We use low translucency e.max with micro-layering on anteriors, and full contour high translucency IPS e.max on posteriors.

Special pricing from Atlantis has also allowed us to pass along savings and offer a very special pricing combination on posterior implant cases with the implant model, abutment, and crown for just $595.00 complete. They’re the perfect combination of strength, esthetics, and affordability. On top of that, these restorations are usually turned around in just two weeks.

Dr. Bob Faulkner, DDS

To learn more about the many benefits of Atlantis CAD/CAM gold hue abutments, join us for a special 1 & ½ day program with Dr Bob Faulkner, DDS on March 9 & 10 for our “Treatment Planning Implant Dentistry” Workshop. This hands-on program will include a review on current concepts in implant dentistry from Dr Faulkner. Participants are asked to bring a case for treatment planning. Everyone attending will also receive a voucher for a FREE Atlantis CAD/CAM Gold Hue abutment, compliments of Atlantis and Bay View Dental Lab. A $470.00 value, FREE just for attending the program.