Root Canal Theraphy

Basic steps to do Root Canal Treatment:

EWL RADIOGRAPH

1) Caries removal

2) Canal access

3) Pulp extirpate


4) Straight line access; deroofing etc


5) Cleaning & Shaping; coronal flaring and canal preparation

- IAF at least #15

CWL RADIOGRAPH

- MAF increase #size by 3, CWL/ same length as IAF; apical enlargement
- FAF increase #size by 5, decrease by 1mm each length; step back make tapered root
- Irrigate and recapitulate (using #15, +1mm of CWL) each steps


6) MGP = FAF size/ 3 times bigger then MGP; feel tug back sensation

MGP RADIOGRAPH

7) Obturation
- Add accessories GP
- Lateral compaction!
- Cut GP
- Vertical compaction!

POST RADIOGRAPH


8) Filing/ final restoration

P/s: all above are general procedures to perform RCT, each cases in the clinic have different approaches; based on health of patient, condition of tooth, etc. So all these steps are not concluded. Please refer to your current supervisor.

Last Surgery Clinic

Hello everyone!

Today, I am very thankful to Dr Ayuni because willingly to share her patient with me. Yay!The clinic went very smooth. We had extracted 3 teeth in total with kindly assisted by Dr Fatimah, our senior doctor, Dr Syarfa and Dr Abdullah.

Haul for today was upper right and left first premolar and upper right 3rd molar. Yay! 

P/s: Upper first premolar is the king of fracture!

My magical wand.

In the meanwhile, the requirements given from Dental Department are really unrealistically a lot and stressful in this semester. They have given us a bunch of requirements to do but gave us minimum amount of time to finish. They even cut one clinic to shorten this semester. What effect the most is me and my friends who have to struggle to complete some requirements by having extra clinic.

However, on the positive side, we are going to end the semester earlier and longer.Yay! I have planned to fly to Malaysia real soon! Not only that, we also have the chance to Raya in Malaysia!

I am so blessed and thankful to God as I already bought the ticket last week and did make a bold move by extending the date. It was really worth it and money saving!

15 hours transit in Abu Dhabi! Surely need a while ride to Dubai? Hmm.

Last clinic for oral surgery this semester! Have a nice holiday Dr Ala! Thanks for teaching us unconditionally and with full dedication. Not to forget, to Mr. Mustafa for being such a cooperative patient!

Hope to write more. Till then, bye!

In love with Prosthodontics

Today was our second recall after we did delivery last 2 weeks. It was well fabricated of upper partial denture (PD) and lower complete denture (CD) by Miss Reem. We did not find hard on the first and second visit with our cooperative patient, Mr Hasan because the steps for taking impression and casting were the same as we did last semester on CD patient.

I did the upper PD while my partner did the lower CD. I must say that my case on upper RPD was quiet easy because first, its upper teeth that we were doing, and second its acrylic base denture with additional clasp. When we were doing denture, we have to focus on the upper teeth apperance and it must have certain visibility (2mm) to add aesthetic when smiling.

In the other hand, my partner had some difficulties with the lower teeth setting. Once the upper wax rim had setup good on upper, only then we can adjust the lower teeth. He had to reduce some occlusal wax rim on the third visit as some tooth had supra-errupted on the upper. Then, on the delivery day, he had to make some adjustment on the denture because of over extended flanges, widening the freni opening, and reduce thickness of the denture. Perhaps, we had over put the impression material on lower during second visit that made the flanges over thickness that final result was quiet unsatisfied. Or maybe, just because the lab technician over put the acrylic base plate that made it so bulky?

4th visit; try in denture. Excellent work from the lab!

However, not to point other faults, we need to be more concern each visit especially on the second impression visit because it is ultimate working procedure that can give figure of the final result. Slight changes will make different on the denture that will be produced.

5th visit; delivery day! The polishing effect was out standing and the patient satiesfied with its look.

After 2nd Recall today, we hope today is the last recall. We gave alot explanation and motivation to Mr Hasan; to wear it more frequent so that he get use with the denture under, since this is the first time he wearing denture.

Before I ended up my post today, I am so thankful Allah had given us a chance to do goods. Thanks to Dr Anas, my supervisor because he had helped me and my partner Dr Abdullah Anas alot through out the each visit. Next person to remember is Miss Reem because she did a good lab work and very dedicated on finishining it on time. Last but not least, everyone in the clinic who had help us whenever we asked for help. May Allah blessed us each day.

Hope to write mote. Till the, bye!

Complete/Partial Removable Denture Procedure

Acrylic CD/RPD simple flow:

1st visit in Clinic:

• History taking amd examination.
• CD: Primary impression using compund cake on metal tray
• RPD: Primary impression using Alginate impression material on stock tray

1st lab work:

• Casting diagnostic cast/ primary cast
• Fabricate custom/special tray with spacer; on non-stress bearing tissues

2nd visit in Clinic:

• Border moulding on special tray lower > upper
• CD: Secondary impression using ZOE/ Monophase silicone (if theres gingival undercut)
• RPD: Silicone Putty on sadle area & Secondary impresion using Highly Precision Alginate

2nd lab work:

• Casting master cast/ secondary cast
• Fabricate acrylic base with occlusal rim wax

3rd visit in Clinic:

• CD: Check wax rim; VDO,VDR,FWS, Centric Relation
• Intraoral check: esthetic, phonetic, occlusal plane, occlusion 
• Post dam (spoon shaped, butterfy shaped)
• Bite registration
• Tooth shade seletion

3rd lab work:

• Articulator check: fit, VDO
• CD: Balance Occlusion
• Tooth setting with wax

4th visit in Clinic:

• Try in base plate with setup teeth; check all features as 3rd visit

4th lab work:

• Fabricate denture
• Finishing & polishing

5th visit in Clinic:

• Delivery and do at least 2 recall

Side notes:

EXTRA ORAL EXAMINATON:

• TMJ examination (12 points):

1. tenderness
2. clicking
3. popping/crepitus
4. deviation
5. displacement
6. 
   

• Muscle (classified into 2):

1. opening:
• lateral pterygoid
• mylohyoid
• geniohyoid
• digestric
2. closing

• temporalis
• messeter
• medial pterygoid
• Lymph nodes
• CHECK SYSTEMATICALLY - so not miss an area!

INTRA ORAL EXAMINATION:

• Ridge Class (Atwood's Classification):

I : Pre extraction
II : Post extraction
III : high well rounded ridge
IV : knife edge shaped ridge
V : low weel rounded ridge
VI : depressed bone level

• Hard palate class (horizontal):

I : U shaped ; the most favourable for retention & stability
II : V shaped ; not favourable, slight movement will break the seal/ loss of retention, assosiated with tappered arch
III :  Flat/ Shallow vault

• Soft palate class (anterior-posterior):

I : almost horizontal curving
II : 45° angle from hard palate
III : 70° angle from hard palate

• Frenal Attachment:

I : sulcus/low attachment

II : midway between sulcus & crest of the ridge

III : crestal/ near crestal (high) attachment

• Tongue size:

(Mallampati Classification: rough estimate tongue size to the oral cavity)

DEFINATION:

• Centric Relation: 
• most retruded position of mandible to maxilla
• when the condyle in the most anterior & superior position in glenoid fossa
• Centric Occlusion:
• the occlusion of teeth when jaw in centric relation
• may/ may not coincide the maximum intercuspal position
• Balanced Occlusion:
• bilateral, simulteneous, anterior and posterior occlusal contact of teeth in centric & eccentric position
• Curve of spee:
• anterio-posterior curve
• Curve of Wilson:
• medio-lateral curve
• Maximum Intercuspal Position:
• complete intercuspatation of opposing teeth independent of condylar position
• best fit of teeth regardless of condylar position

Feel like sharing; Congenital Syphilis

It was my first time doing tooth extraction. Last semester, I had no chance to experience holding a forcep. Luckily today, a patient came into the clinic with refference letter from Intensive Theraphy Unit (ITU) seeking extraction for her teeth due to heavily carious and necrotic (non-vital) teeth.

Little did I know, during the presentation case to the Dr Hamed, he asked about the clinical sign of the patient of 5th decade age. At first, my assistant and I were startled a few seconds because we had a few double checked with all the extraoral and intraoral examination. It was really unnoticeable until he pointed out about the shape of the incisor teeth! It was peg-shaped incisor teeth! Then we promptly asked the patient to open her mouth and found a multiple poorly developed molar. From the clinical features, we suspected that the patient has Congenital Syphilis.

I feel like sharing some information about the disease and hope these kind of clinical features would not be missed in future.

Other clinical finding that should be found in such patient would be:

-poorly developed maxilla/ Bulldog face

-Bullous eruptions

-Rhagades (fissures, cracks, or linear lesion in skin; angle of mouth & nose)

-Hutchinson triad; 8th nerve deafness, Hutchinson incisor, and interstitial keratisis.

-Du Bois sign (shortness of little finger)

-Higaoumenakis sign (unilateral enlargement sternoclavicular of clavicle)

Hutchinson Incisor -Wiki- 

Mulberry Molar -Wiki-

Barely notice the Mulberry shaped of permenant first molar in my patient:(

My surgical tools.

Alhamdulillah, exodontia went smooth without any complication. Insya Allah, I will be more aware in future and not neglect even a small abnormality structure in the mouth.

Hope to write more. Till then, bye!

9 Places to Visit in Kuala Terengganu

Hello everyone! Welcome to Terengganu!

On January, 22 last week, my family and I had a short vacation in Kuala Terengganu. We spent about 3 days there and had time to visit some interesting places and attractions.

After 4 hours of driving, we arrived at Pahang-Terengganu Border Gate and need to continue driving about plus one hour to reach our destination.

We stayed at Arked Mara infront of Dataran Shahbandar and the shores; which cost us only RM30 per night (the fee is conditionally for Mara Employee).

Hereby, I have listed some attractive places to stop by for activities or sightseeing, once you are in Kuala Terengganu.

1) Crystal Mosque

Welcoming and tranquil places to visit for a mosque. You can perform any solah in it yet solah Jumaat is exceptional because the mosque is built on the riverbank of an island which has no permenant resident. So, most of the time the mosque is filled by tourist and those who stay for the purpose of Iktikaf.

Appealing view of the mosque from the river cruise.

Alhamdulillah, we had chance to perform solah Zohor in it after the tiring tour in TTI (Taman Tamadun Islam).

Full view of the Masjid.

2) Islamic Heritage Park + TTI River Ride (RM 35 for adult, RM 22 for children/ old folks) located near Crystal Mosque.

Islamic Heritage Park/ TTI (Taman Tamadun Islam) is one of the famous historical attraction in Kuala Terengganu presented with 22 remarkable monuments that was replicated from 21 different countries from all over the world across Asian, European, and Africant continents. It was such an unforgetable experience to see and learn how mosque was first build in other Muslim country.

 Some photos from TTI.

While enjoying view from the banks of river.

TTI Water Mill.

Embah (Grandma) and my mum!

My life. My soul. My parents.

My little brother and background of Qubah As Sakhrah (Masjid Al Aqsa).

After done touring throughout the park, we took a river ride along the island starting from TTI jetty to 17 mini destination including Haji Siah Island, Api Island, Pulau Duyung (Mermaid Island), Central Market, Warisan Island, Pelabuhan Ikan and Pengkalan Keropok. We were given a brief explaination about each destination and short tips to shop in Kuala Terengganu.

While waiting to depart. Infront of TTI Jetty.

First time on a river cruise.

Behind us is Masjid Kristal!

3) Payang Market + Breakfast and Lunch

Here, you can find malay traditional market that offers hundrend of cheap stuff such as clothes, jewelery, foodcourt, and traditional food. Plus, you can also find stuff that signify Terengganu like keropok lekor, batik, serunding, dodol, and egg turtles. You can actually do bargain and that is the ultimate reason I love shopping here. Haha.

Breakfast with Nasi Dagang.

4) Chinatown

What I love about Chinatown is its lively night, hipster-style coffee shop, and surely because of the beautiful art streets drawn along the road.

Relatively narrow street for cars to move.

A must take photo spot!

"No need to Rantau Abang anymore" -Citizen-

You almost feel like you could fly without a plane. Haha.

The sun too bright.

"Hari ini nak jadi rama-rama lah" -Ibu-

5) Pantai Batu Buruk

We went there during night to taste their street food. Then, Embah, Ibu and me walk by the sea shores embracing the night air while my little brother were enjoying baloon playground nearby with my father.

Keropok lekor and flour fish fry.

Sea breeze so calming.

Long toe and sea sand.

6) Dataran Shahbandar

Our hotel is about 5 minutes from here. Shahbandar Square also provide hallway for rollerblading and if you guys want to try/play, they also do rent equipment for it.

Night market on Friday.

7) I-City Kuala Terengganu

Lights everywhere? Haha.

Literally, 'I love KT' was the only light on that night.

8) Abidin Mosque/ White Mosque/ Big Mosque

The mosque is very beautiful plain white.

9) Kuala Ibai Lagoon + Tengku Tengah Zaharah Mosque

People do not usually swim here because the water wave is stong and unpredictable sinkholes.

But the view is absolute sedative.

Another floating mosque but on centre of lake. Alhamdulillah. My family did stop by here on our route back home. 

You can buy fish pellet infront of the mosque and sow to the lake. OMG, the fish all shouling around us.

That is all from me. I hope the short listed places somehow could help you guys and give you an idea to make plan to visit Kuala Terengganu.

"Ayah, belanjalah selfie satu" -aku disebelah; seat pemandu- uhuks.

Hope to write more. Till then, bye!

Korean Drama- Oh My Venus!

I am not a fan to Korean drama , movie or music. But this time I am really into this Korean drama entitled Oh My Venus who admirably casted by So Ji Sub (as Kim Young Ho) and Shin Min Ah (as Kang Jun Eun). They played the character very well in each scene, counting in the roles of other suppoting character. 

I have started loving this drama since episode one when they begun the serries with a play of a pretty little girl and later, turn her into a fat woman. Back then, she was envied by every girl and desired by every boy in high school as the Daejeon Venus because of her pretty face and killer figure. She came from a poor family, yet was determined to go to law school and become an attorney. 

She has achieved her professional goals and has been in a stable relationship with her high school boyfriend, Im Woo Sik (as Jung Gyu Woon), for 15 years. But she has let herself go over the years and is now overweight and often disregarded and overlooked by society and her coworkers. 

On the plane ride back from a quick business trip to the United States, Jun Eun has an embarrassing run-in with Kim Young Ho and his two sidekicks, Jang Joon Seong (as Sung Hoon) and Kim Ji Woong (as Henry). Kim Young Ho is a personal trainer for Hollywood stars. Eventhough he comes from a wealthy family background, he suffered a devastating injury during his childhood days. 

A lost purse causes Young Ho to reconnect with Jun Eun and witness another personal embarrassment for Joo Eun in the aftermath of being dumped by Woo Sik and finding out that he has been dating her new boss, Oh Soo Jin (Yoo In Young).
As it seems to become a habit for Yeong Ho to bail Joo Eun out of trouble and he also have helped her to reclaim her former looks. Does Jun Eun achieve her goal to become pretty and thin again?

So Ji Sub (as Kim Yeong Ho)

My Fav- Shin Min Ah (as Kang Jun Eun)

 Im Woo Sik (as Jung Gyu Woon)

Oh Soo Jin (as Yoo In Young)

After expressing disbelief that Joo Eun was ever known as Daegu’s Venus, her dimples have comeback swinging and Young Ho just got knocked for a loop.

The story focuses on their journey of searching for love and health. I am fully recommending you guys to watch this highly-rated comedy and romance serial drama. It took me two weeks to finish the total of 16 episodes. It is really worth-time-watching and gives me alot of advices on daily diet and motivation to keep a healthy lifestyle. It inspires me to reduce/ zero sugar, salt and high calories food intake and do routine excercises. 

Fun fact, I just knew that people can actually eat green veggie and fruits for life. Haha. Well, I really did eat green veggies for a week before return to Malaysia and it is actually possible thing to do. 
You know, to started a healty diet is crucial but to maintain it is devastating. So, spirit up and watch it!

I leave you guys a link, click it to watch the whole serries of Oh My Venus! And hopefully you guys will be inspired and lets eat healthy!

Hope to write more. Till then, bye.