I was working on a tissue management CE course last week and it triggered me to share a few thoughts. Certainly, tissue management is one of the most important subjects in operative dentistry. In my early days at school, I loved full mouth reconstruction. This caused me to become engaged in the research of better ways to achieve predictable tissue management. I realized then that poor impressions can lead to ill-fitting crown margins and that this ultimately leads to crowns and bridges prematurely failing. In contemporary adhesive dentistry, there are even times where we need to prepare and seal/bond margins subgingivally. Even when taking extra care, some soft tissue might be cut. Historically, we've used chemical mechanical packs against the cut tissues to move them away from the margins and to stop bleeding at the same time. I discovered that trying to do both of these simultaneously can be challenging and unpredictable. I began studying the problem in 1973 when I was a young dental student at Loma Linda. I later studied the status quo of impressions in commercial labs and came to realize the vast majority of the impressions did not show all of the margin. When our crowns etc don't fit, it is most always the fault of our incomplete impressions, not the fault of laboratory technicians.

A specific case comes to mind where a patient with a Class III skeletal deformity received surgical correction. The surgeon chose to remove the lower first molars and close the space surgically. Prior to this, two different dentists had placed crowns on the two lower molars. The same technician had made the crowns for the molar crown albeit placed a couple of years apart. I still have pictures of the two extracted teeth with the crowns in place. One crown is significantly shy of the margin, while the other fits nicely. The same technician constructed both crowns. How do we know this? The patient is/was sister to the technician. I was once again reminded of the critical need to adequately displace tissue and to obtain quality hemostasis prior to impression making. Quality tissue management, be it the direct or the indirect procedure, is paramount!

Thank you,
Dan

Last week, Ultradent hosted a group of bright young men and women from various backgrounds and specialties for a full day of training related to public speaking, photography and PowerPoint presentations. The meeting stemmed from a idea of Tufts University’s Dr. Gerard Kugel. He recognized the need to provide education on the “basics” for new speakers. The group of individuals we hosted last week consisted of under-represented sects of the population which are coincidentally under-represented on the current lecture circuit. As a company, Ultradent will always support the concept of education and visibility for those who faced with any disadvantage. The first day of the conference was managed by Dr. Gary Genard, President of Public Speaking International (www.publicspeakinginternational.com). We often assume that public speaking is a natural component of education but this is rarely the case. I’ve found that it is an art like any other that must be mastered through continual practice. Dr. Genard has decided to specialize in the dental industry with tips and techniques on everything from case presentations to lectures in front of an audience. The second presenter was Dr. Greg Lutke who specializes in photography and PowerPoint. Dr. Gregory Lutke graduated from Baylor College of Dentistry in 1985 and maintains a private practice in Plano, Texas. He is the Founder and CEO of Dallas Dental Solutions (www.dental-solutions.com), a digital hands-on facility where attendees experience hands-on courses on digital communication technology as it relates to dentistry. Attendees of Dr. Lutke’s course learn how to communicate complex multi-disciplinary cases to patients in a simple and easy to understand format. The end result is also a transformation to a digital office. Dr. Kugel and I joined forces the last day to offer suggestions for getting into the lecture circuit. Collectively, we’ve found that opportunities result from participation in study clubs, tradeshows and publishing to name a few. We both share the same advice for success - the importance of staying honest and having a desire to give back and share the information with others. Overall, this was an exciting time spent with potential future “voices” of dentistry. For sure we must pay attention to the future. My daughter Dr Jessop is a gifted and wonderful dentist. It is enjoyable to see how she grows with each lecture she gives. And, I must say that it is fun to co-present with her. The youth in dentistry bring a new and fresh dimension but women also do. Fun stuff!!