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