Very Dental Student: How to Prep a Crown with Zach and Kevin

[00:00:01] This is a production of the Very Dental Podcast Network.

[00:00:09] It's time for a Very Dental Podcast just for students and new dentists. Welcome to the Very Dental Student Podcast. And now here's your host, Mohamed Aboubasha.

[00:00:20] Hello, everybody. Welcome to another episode of the Very Dental Student Podcast. I'm your host, Mohamed Aboubasha. And I'm back at it again with Kevin and Zach. Kevin and Zach, how are you guys doing?

[00:00:30] Great. I'm in my 35th year of dental school.

[00:00:36] Yeah.

[00:00:38] Good. Chiefs are 10 and 1 as of the day we were recording this podcast. How are the Browns? What's the Browns record?

[00:00:44] We won last week. We beat the Steelers.

[00:00:46] You did?

[00:00:46] And that is a big game.

[00:00:47] Fun game in snow.

[00:00:49] Yeah, it's snowball.

[00:00:50] I think we're playing the Browns the next week of this. Not this weekend, but the next week. Yeah.

[00:00:57] I'm pretty sure we're in Cleveland.

[00:00:58] Oh, excellent.

[00:00:59] Yeah, you should go check out the game. Watch a real team play.

[00:01:03] Not going to do that.

[00:01:06] I'll maybe watch on TV.

[00:01:07] Okay.

[00:01:08] Will Taylor Swift be here? Because Travis Kelsey is from Cleveland, you know.

[00:01:12] He wouldn't go to that area. I'm sorry, Kevin.

[00:01:15] Yeah, probably not.

[00:01:16] Yeah.

[00:01:17] Yeah.

[00:01:17] Yeah.

[00:01:18] Yeah.

[00:01:19] Well, I actually do have something to contribute football wise. OU beat ranked number seven, Alabama over the weekend.

[00:01:26] I watched that.

[00:01:27] I love that.

[00:01:29] And the Ohio State University trounced Indiana. I don't know why anyone thought that was going to be any different. But anyway, how's school going, Mo?

[00:01:38] It's going pretty good. As of right now, when we're recording, we just started our Thanksgiving break.

[00:01:43] Excellent.

[00:01:44] So, I mean, it's calmed down the semesters. It's the calm before finals. So, not much going on right now.

[00:01:54] Well, you know, dental school is fun for everyone. I thought we'd do a little bit about our least favorite. What we should do is least favorite dental school instructor and then favorite on the next ones.

[00:02:06] So, we'll do it. We'll do it backwards. So, not least favorite. Well, whatever. Horrible dental school instructor stories. That would be.

[00:02:17] So, Zach, you go first.

[00:02:19] I had this dude, Dr. Johnson. We called him Weenie J when we were in school because this guy, I can tell why he was in school. He could not commit to an answer and like just was the softest dude when it came to like anything.

[00:02:41] It was like, hey, Dr. Johnson, I'm going to do an endo on a pre-moral this morning. Ooh, you better get an endo consult on that one or like, all right, hey, let me sign in with you. Let's go on this crown prep on number four.

[00:02:56] Ooh, I don't know. We might need a PROS consult on that. It was like, oh my God, what are we doing here? Like, I feel confident doing this. You're telling me you don't?

[00:03:06] Oh, the guy drove me bonkers. Like, it was really hard to get anywhere with him when he was the guy on the floor that day.

[00:03:14] That's crazy.

[00:03:15] Tough.

[00:03:17] Yeah. I can't imagine that kind of experience. It must have been pretty, pretty difficult.

[00:03:23] So I was, it was after a while when I knew it was going to happen, I just did it more for the lapse of like, I bet this is going to, this is going to go awesome today.

[00:03:33] Let's see. Let's see if he'll, uh, greenlight this, this clues will composite here today.

[00:03:39] I don't know. We might need a restorative console on that one.

[00:03:45] Um, I'm a little taken aback because I just looked up this guy figuring he had to be dead.

[00:03:51] Oh, well, he's probably definitely listening, Kevin, for sure.

[00:03:54] But this has to be his son because it's a junior.

[00:04:02] Um, anyway, I won't mention his name, but anyway, this guy, like everyone hated him.

[00:04:09] Like right from the beginning and he just came off like a hard ass right from the beginning.

[00:04:13] He was one of these guys, like first lecture he gave, like, look to your right, look to your left.

[00:04:17] One of those people are going to like, why are you doing that?

[00:04:21] And he just, uh, had this persona of being this hard guy and really harsh grader.

[00:04:28] And I'm just like thinking like, how, what, what is going on in your psyche that you have to get off on, you know, terrorizing dental students.

[00:04:41] It's just, it's anyway, um, in the clinic, he was also, you know, a really hard grader.

[00:04:50] And, uh, we had this rule where things had to be paid for before they were done.

[00:04:57] And I had this sweet old lady, I believe it was before Thanksgiving, break a tooth or something.

[00:05:04] And you know how slow you are in dental school.

[00:05:07] I just wanted to get this thing done for her.

[00:05:09] So I did it.

[00:05:10] And by the time we got down to the cashier, it was closed.

[00:05:14] So, um, he gave me a zero for that experience.

[00:05:20] And I went home and I was like, this isn't fair.

[00:05:23] I helped this lady out.

[00:05:25] This sweet old lady.

[00:05:27] So I stood on it all night long.

[00:05:29] And in the morning I went to school, I went right to his office and I told him off, which is like totally not my character, um, to his face.

[00:05:38] And, um, you know, he, I had the grading slip in my hand somehow.

[00:05:42] I don't remember how I got ahold of that, but like I told him off and he grabbed it out of my hand, changed my grade, gave it back to me.

[00:05:51] And I felt like I won the day.

[00:05:53] And that was a lesson where I was like, bullies are bullies because it, you know, you got to push back on the bully and they, they cave.

[00:06:04] That was lesson learned.

[00:06:05] Nice.

[00:06:06] Well played, Kevin.

[00:06:07] Glad it had a little bit of a happy ending to it.

[00:06:10] Yeah.

[00:06:10] Yeah.

[00:06:10] For sure.

[00:06:11] Well, I, I have all amazing instructors, so I don't have a single, a single instructor that I could possibly contribute to this conversation with, but you have a friend that does though.

[00:06:22] Right.

[00:06:22] I have a story.

[00:06:24] It's not a, it's not a horrible instruction story or a horrible instructor story.

[00:06:28] It's more of just like a crazy story.

[00:06:30] So you guys might know, might've heard of Dr. Schillenberg.

[00:06:35] Yeah.

[00:06:36] He's, he was a faculty for most of our faculty.

[00:06:39] So the faculty that went to OU, they all had him.

[00:06:44] And the story goes that basically towards the end of his days, he had like narcolepsy and he would come over and like help students and like doze off with a handpiece drilling in his hand.

[00:06:57] Oh my God.

[00:06:58] That's a, that's just a fun story.

[00:07:00] I actually also had an instructor with narcolepsy.

[00:07:03] No, no, no joke.

[00:07:05] And I did too.

[00:07:07] No way.

[00:07:08] For real.

[00:07:08] It was, um.

[00:07:09] That was one of the reasons he quit practicing.

[00:07:11] He was like too tired.

[00:07:12] Yeah.

[00:07:12] This guy wasn't a dentist.

[00:07:14] It was like, um, biochem or something like that.

[00:07:17] No, no.

[00:07:17] This was a dentist.

[00:07:18] This was one of my clinic guys.

[00:07:19] He was good.

[00:07:20] Good instructor when he was awake.

[00:07:23] Yeah.

[00:07:23] That's wild.

[00:07:25] Crazy.

[00:07:27] Surely that should be like an instant.

[00:07:30] You don't have a license anymore.

[00:07:31] I don't know.

[00:07:33] Yeah.

[00:07:33] I think that's why he was at the school.

[00:07:35] Yeah.

[00:07:35] I mean, so, I mean, like I said, he was, he was, he was great.

[00:07:39] Is it?

[00:07:39] It was great to sign in with as long as he wasn't, um, either sleeping, which definitely happened more than once.

[00:07:45] And it was like, Hey, I need my prep check.

[00:07:46] And he was like, minors.

[00:07:49] I think he got it.

[00:07:49] Like, or, or he was checking his stocks.

[00:07:53] Cause like, man.

[00:07:54] Oh, that happened a lot too.

[00:07:56] Like we were, we were, uh, I was there during like a stock boom, like the, the tech stock boom of the late nineties.

[00:08:04] And, you know, of course it just, it just kind of happened that it, you know, you could check stocks on the net and man, those guys were always, I mean, E-Trade was always on the background computer.

[00:08:16] So yeah, that's a, there's an instructor story.

[00:08:19] We're way off the rails now.

[00:08:21] Yeah.

[00:08:22] Well, I didn't plan it this way, but good thing we mentioned Dr. Schillenberg.

[00:08:26] Cause the topic for today is.

[00:08:27] Oh, nice segue.

[00:08:29] Whoa.

[00:08:29] That's good.

[00:08:31] I don't believe, I don't believe you didn't plan that.

[00:08:34] Yeah.

[00:08:35] I did not plan it actually, but, um, yeah.

[00:08:38] Only I know, I guess there's no proof.

[00:08:40] Yeah.

[00:08:41] So, uh, where do you guys want to start with, uh, talking through crowns?

[00:08:45] First of all, how many crowns have you done?

[00:08:49] So how many have I done?

[00:08:50] I've prepped eight.

[00:08:52] And how many?

[00:08:53] Nice.

[00:08:54] I've delivered six of them.

[00:08:57] Okay.

[00:08:58] That's, that's really good.

[00:08:59] What, what is your requirement?

[00:09:01] Have you already, is that like, is that all you need to do to graduate?

[00:09:04] To be honest with you?

[00:09:04] Like, I feel like.

[00:09:05] Yeah.

[00:09:05] Like I could probably do, I, if I delivered my last two that I've already prepped, did

[00:09:14] one more, did one more single crown and then one bridge, then I would have my requirement.

[00:09:20] So I'm pretty close.

[00:09:21] And you're doing this all with one carpe anesthetic for, for all eight, all eight patients, right?

[00:09:26] Well, to start.

[00:09:27] Okay.

[00:09:27] Okay.

[00:09:28] Right, right, right.

[00:09:29] I tell you what, I'm going to, I'm going to push you, Mo.

[00:09:31] I want to know, why don't you walk me through how you did one of those crowns and then Kevin

[00:09:36] and I will tell you how you were wrong about that.

[00:09:40] Well.

[00:09:41] Like a real dental school instructor.

[00:09:42] Yes.

[00:09:43] Yeah.

[00:09:44] I'd love, yeah.

[00:09:45] I'd love that.

[00:09:45] Oh, leave it apart.

[00:09:47] So.

[00:09:47] You need to remove 1.5 microns off the distal.

[00:09:57] So, okay.

[00:09:58] So crown, we've already determined that the tooth needs a crown and we're sitting down to do

[00:10:02] it basically is where we're at, right?

[00:10:04] Right.

[00:10:04] Yes.

[00:10:05] And so I would start by getting the patient numb.

[00:10:12] Allegedly.

[00:10:14] Allegedly.

[00:10:15] And then while, while the anesthesia is working, I'd get my blue bite.

[00:10:21] We use like basically a little triple tray for that.

[00:10:24] Get blue bite.

[00:10:26] And that's for your temp?

[00:10:27] That's what you're going to use?

[00:10:28] That's for the temp.

[00:10:29] Yes.

[00:10:29] All right.

[00:10:29] Great.

[00:10:29] And then once the patient's numb, then we get started.

[00:10:36] I do, I like depth cuts on the, so I take a 330 to the full depth.

[00:10:41] And I do basically like all the, all the fissures with it.

[00:10:46] And then I also go out the cusps, the sides of the cusps.

[00:10:49] Um, and then we have a little pancake burr.

[00:10:53] I don't know.

[00:10:54] That's definitely not what it's actually called, but use that for occlusal reduction.

[00:10:59] And then, uh, we have like a, we have 1.2 millimeter and 1.4 millimeter straight, uh, round ended diamonds that we use for axial reduction.

[00:11:12] Yep.

[00:11:12] So, um, uh, I try to keep everything super gingival unless it needs to go sub gingival based on like the buildup or whatever or decay.

[00:11:25] So try to keep everything super gingival for sure, because it's just so much easier to scan.

[00:11:29] And then, but if we do have to go sub gingival, then I'll pack cord and use that when I'm refining and stuff.

[00:11:38] Have you had to do any buildups at the same time as your prep or does the buildup have to be done in advance?

[00:11:43] Does all the carries control have to happen before you can have that appointment?

[00:11:48] So it depends.

[00:11:49] So I have had a couple, uh, buildups same day as the prep.

[00:11:53] Okay.

[00:11:54] But that has happened a few times.

[00:11:55] Um, if the patient has a lot of operative on their treatment plan, then they want us to do all the operative before we do fixed.

[00:12:04] Okay.

[00:12:05] But if they only need like, if they only need like two crowns and both of those teeth also need buildups, then we can just do buildups with the prep or something, you know?

[00:12:15] So.

[00:12:15] And then after you do your, your tissue control, what it, what, what's, what's, how does it go from there?

[00:12:21] Uh, so then we have the prime scan, uh, that we're using for.

[00:12:25] How many prime scans are in the school?

[00:12:27] In the, in the operating room?

[00:12:31] I think we have like 10 total.

[00:12:33] Okay.

[00:12:34] I might be wrong on that, but it's not an issue to get a prime scan.

[00:12:37] Okay.

[00:12:38] Um, if you have a crown prep, you get one, like, uh, it's not hard to get.

[00:12:43] So yeah.

[00:12:44] Once I'm done with the prep and I have tissue control, uh, no bleeding, nothing, then I can just use the prime scan.

[00:12:52] And, um, that we use that for full gold and for all ceramics.

[00:12:56] I haven't done an MCR yet, but if we did MCR, we'd have to do what's our PVS or no PFM.

[00:13:05] Oh, okay.

[00:13:06] Yeah.

[00:13:07] Okay.

[00:13:08] PFM metal ceramic restoration.

[00:13:11] Yeah.

[00:13:12] So then we would have to, if we did one of those, we would have to use PVS.

[00:13:16] Okay.

[00:13:16] Why?

[00:13:19] I'm not sure.

[00:13:20] Probably a lab thing, right?

[00:13:20] You have to send it to a different lab thing or something.

[00:13:23] Yeah.

[00:13:23] That's weird.

[00:13:24] So then, then, uh, okay.

[00:13:26] So now you're done with your prime scan, but now what do you do?

[00:13:28] So then we make our temporary, we use integrity.

[00:13:33] No.

[00:13:33] Kevin has integrity also.

[00:13:35] Yeah.

[00:13:35] Just a little bit.

[00:13:37] Yeah.

[00:13:38] Less and less every day.

[00:13:39] That's what, that's what we use for our temps.

[00:13:42] Um, so, I mean, yeah, we put that into the, load that up into the blue bite, seed it, let

[00:13:49] it, let it about 80% harden and then pull it off.

[00:13:55] Um, let it fully harden, then adjust it, make it look nice.

[00:13:59] And then cement that with temp cement.

[00:14:03] How many checks do you have to get along the way to, to get from, you know, point A to

[00:14:08] point B?

[00:14:10] So unless you really need help with something, um, like once you start the prep, you don't

[00:14:17] need them to check until you're done with the prep.

[00:14:20] To scan it.

[00:14:21] Okay.

[00:14:21] Yeah.

[00:14:22] Until you're done scanning.

[00:14:23] So, but I mean, in most cases they come look at the scan and they give you things to

[00:14:31] fix.

[00:14:31] Yeah.

[00:14:32] And you go back, you go back.

[00:14:34] Then you have to scan again, scan again.

[00:14:36] And I would say that most people end up temporizing and bringing the patient back for refinement

[00:14:45] and scan at a second point.

[00:14:47] Because they run out of time.

[00:14:48] Yeah.

[00:14:49] Okay.

[00:14:49] Um, I'm curious as a CEREC owner and trying to store data, what happens with the scan when

[00:14:56] you're done?

[00:14:57] So we go into the connect software.

[00:15:00] Which doesn't exist anymore or is being, is phased out.

[00:15:04] Like, go ahead.

[00:15:05] I don't know if, I don't know what they're going to do if it gets completely phased out,

[00:15:10] but we send it basically to the lab.

[00:15:12] Through connect.

[00:15:13] Through connect.

[00:15:15] And then, uh.

[00:15:16] Does anyone ever lose their data?

[00:15:19] I haven't heard of anything like that.

[00:15:21] I think the lab, once the lab gets it, they just, I don't know what happened.

[00:15:26] Does the school have a lab on site or do you, are you using an external lab or do you not

[00:15:30] know?

[00:15:31] So we have like a, we're using external labs, but we have like a lab office that handles

[00:15:38] all the lab scripts and is like quality control basically.

[00:15:42] Got it.

[00:15:42] But also just, I'm curious, like, is your name on the administration?

[00:15:48] Like, how do they know it's your patient and your crown and all that?

[00:15:52] Yeah.

[00:15:53] Yeah.

[00:15:53] We put in our name.

[00:15:55] Um, we put in our name as the dentist name and then our faculty also adds their license,

[00:16:04] their name and license number to the lab script.

[00:16:08] So it has my name on it and my faculty's name on it and the patient's name.

[00:16:13] And then somehow it comes back to you.

[00:16:15] Yeah.

[00:16:16] When it gets back to the school, it goes into the office, the, the dental support lab,

[00:16:21] and then they email me telling me to come pick up my case.

[00:16:25] Okay.

[00:16:26] Interesting.

[00:16:27] Yeah.

[00:16:27] All right.

[00:16:28] Kevin, Kevin, in like 30 seconds, can you describe how you did a crown dental school?

[00:16:33] Because like what Mo's saying is light years.

[00:16:37] Yeah.

[00:16:38] More patient friendly than what I had the opportunity to do in school.

[00:16:42] Yeah.

[00:16:42] I mean, we had, when you mentioned the buildups, we had to do, we called them RUCs, restorative

[00:16:49] under crowns.

[00:16:50] We had to do these giant amalgam buildups first.

[00:16:53] That was one appointment.

[00:16:55] Right.

[00:16:55] At a different day.

[00:16:56] At a different day.

[00:16:57] Correct.

[00:16:57] Which like totally like messed me up for a long time because, you know, composite bonding

[00:17:05] was existed, but I didn't realize you could do that all in one visit.

[00:17:11] Right.

[00:17:11] For, for a while.

[00:17:12] But anyway, we had to do that.

[00:17:14] And then, um, as Mo was talking, I can't remember how we made our temporaries.

[00:17:20] I knew, I know we used jet acrylic.

[00:17:23] We had to take some pre-op alginate or something.

[00:17:25] I don't know.

[00:17:26] Maybe pre-op alginate.

[00:17:27] I don't know.

[00:17:28] We had to take a pre-op alginate.

[00:17:30] So that was an appointment.

[00:17:31] Yeah.

[00:17:31] Pour that up.

[00:17:32] Yes.

[00:17:32] And make a custom tray.

[00:17:34] Yes.

[00:17:34] Yes.

[00:17:35] Yes.

[00:17:35] With, with, you know, uh, for a single unit, full mouth, custom tray.

[00:17:40] Then, then you, you either made some kind of a, I don't know if you made a little suck

[00:17:44] down split or make a cutty.

[00:17:45] Oh yes.

[00:17:45] It was, it was a suck down.

[00:17:47] Yeah.

[00:17:47] It was one of those two technologies and you had to have all that all ready to go before

[00:17:52] the patient came in the door.

[00:17:54] And a custom tray for a single crown.

[00:17:57] Yes.

[00:17:57] And then we used rubber base.

[00:18:00] Okay.

[00:18:00] That was the only impression material you had was rubber base.

[00:18:02] And so.

[00:18:03] And I remember, I vividly remember, um, during the board exam, walking past another operatory

[00:18:10] and seeing someone use PBS, like in a syringe gun, which I, that was like brand new to me.

[00:18:16] I'm like, wow, that's so cool.

[00:18:18] But I had tubes of rubber base that you would squirt out, like base and catalyst.

[00:18:23] And you had a.

[00:18:23] Oh, the worst.

[00:18:24] With a spatula.

[00:18:24] We had a different denture.

[00:18:25] Oh, so bad.

[00:18:26] It was bad.

[00:18:27] Nine minutes set or something ridiculous.

[00:18:29] It was gross.

[00:18:30] You know?

[00:18:31] So there was a, there was a different section of our dental school where like, I don't know

[00:18:35] if they had a more progressive instructor over there, but it, you know, integrity was one

[00:18:39] of the first visit roles to the market and they had access to that.

[00:18:43] I had to use jet.

[00:18:44] I had to use jet.

[00:18:45] And I saw them messing around some triple tray stuff.

[00:18:49] Whereas, you know, that was, that was, uh, below the standard of care over in my section.

[00:18:54] Triple tape trays were forbidden.

[00:18:56] Yes.

[00:18:57] And, um, I.

[00:18:58] Even for temps.

[00:18:58] Even for temps.

[00:18:59] I vividly remember in practice, like, so that's what I learned how to do, right?

[00:19:07] Like make a custom tray.

[00:19:08] So I actually practiced, practiced like that for a year or two till I was like, this is crazy.

[00:19:15] And, um, I remember the first time I used, maybe not the first time, one of the first

[00:19:20] times I used a triple tray where I thought I was like the devil.

[00:19:23] I was cheating and that crown fit better than all the other crowns.

[00:19:28] And I realized like, I'm taking this impression in occlusion.

[00:19:33] You know what I mean?

[00:19:34] Like, I don't know why they were so anti-triple tray.

[00:19:36] I think I do know why because they were flimsy.

[00:19:40] Those first ones were flimsy plastic.

[00:19:42] And I, I got ahold of some sort of Temrex metal kind.

[00:19:46] Yeah.

[00:19:46] The metal ones are good.

[00:19:47] Yes.

[00:19:48] Uh-huh.

[00:19:48] I like a nice stiff tray.

[00:19:50] Oh yeah.

[00:19:50] Put that in someone's mouth.

[00:19:52] And, uh, so I like, all of a sudden I started getting these crowns back from the lab that

[00:20:00] fit great using this technique that I was told was bad.

[00:20:05] Yeah.

[00:20:06] Kevin, when I switched to triple trays a couple of years after I got out of school, my dad

[00:20:10] thought I was doing garbage.

[00:20:12] Yeah.

[00:20:12] Garbage dentistry compared to his custom tray stuff.

[00:20:17] And, but lo and behold, shockingly the crowns fit rather well.

[00:20:21] Yeah.

[00:20:22] And I got better impressions because the pressure from the slump.

[00:20:27] People liked them better too.

[00:20:28] A lot better.

[00:20:30] Yeah.

[00:20:31] I became quite a triple tray master after a while.

[00:20:34] I mean, it was pretty, do you remember the laminar impression technique?

[00:20:39] You know what that was?

[00:20:40] Were you talking about like the H and H type of thing?

[00:20:42] It wasn't quite H and H.

[00:20:44] You would, you would, uh, take a pre-op triple tray and then you drill holes on the museum distal

[00:20:52] of where the prep was.

[00:20:53] And then you took the triple tray with a heavy body and then you'd seat the, um, triple tray

[00:21:01] with a heavy body in it and squirt light body into the holes that you made.

[00:21:06] It would come out the other hole and you get this really nice impression.

[00:21:10] I did that for a while.

[00:21:12] And then, yeah.

[00:21:13] Yeah.

[00:21:14] Anyway.

[00:21:16] Times have changed.

[00:21:16] Well, so fast forwarding to, uh, 2024, Kevin.

[00:21:20] Yes.

[00:21:21] Tell us how you do, how you do it now.

[00:21:24] All right.

[00:21:25] So now I, um, I get to use more than one carpal anesthetic.

[00:21:31] That's a nice start.

[00:21:32] Oftentimes it's not me giving the anesthetic.

[00:21:35] It's a hygienist.

[00:21:36] Even better.

[00:21:37] Yeah.

[00:21:37] And then, um, I have, uh, Afta or an assistant take my pre-op scans for me and I do take a

[00:21:46] blue moose bite in case something happens like the electricity goes out or I can't mill it

[00:21:54] out of Emax, my, uh, my crown.

[00:21:58] Then, uh, because I'm a weirdo, I, uh, prepare almost all my crowns with rubber dam on.

[00:22:05] I just find it goes faster and easier for me.

[00:22:09] Um, I usually pack a cord or two, uh, I take the rubber dam off and pack the cord.

[00:22:18] I scan that and assistant designs it.

[00:22:21] We mill it.

[00:22:22] They stain and glaze it.

[00:22:23] And then we cement it on in about an hour and 45 minutes out the door.

[00:22:29] Pretty speedy.

[00:22:30] Yeah.

[00:22:31] Sounds amazing.

[00:22:32] Yeah.

[00:22:33] Pretty speedy.

[00:22:34] Yeah.

[00:22:35] Compared to about nine hours process at the school.

[00:22:39] Yeah.

[00:22:39] It really was that.

[00:22:41] That's not even, that's not hardly an exaggeration with the way I had to do it.

[00:22:44] But it was worse for Zach and I.

[00:22:45] And also just to bring it full circle, um, I know we didn't touch on this, but I still,

[00:22:52] I, I prefer to do a full contour crown preps a la Dr. Schillenberg.

[00:23:00] So I, I know you can do a bunch of fancy onlays and stuff with your hair, but it never worked

[00:23:05] out well for me.

[00:23:06] And I had a, a lot of D bonds and just stuff that looked like crap as time went on.

[00:23:11] But, um, Dr. Schillenberg and his, um, narcolepsy, um, has served me well.

[00:23:21] Zach, how do you, how do you do a crown?

[00:23:24] Um, so as someone who does not do an inoffice milling, but does have a scanner, you know,

[00:23:31] a lot of what I do sounded pretty, pretty similar to what Mo is doing actually, which is amazing

[00:23:39] that like they're showing you a, a workable system.

[00:23:43] So like, you know, more or less I'm, I am still also using anesthetic and almost always

[00:23:50] more than one, one carp of anesthetic.

[00:23:52] Um, and then, uh, you know, I, I walk out, the assistant takes the shade preop scan and

[00:23:59] does the blue bite.

[00:24:01] Um, and then I, I come in and, you know, one of the first things I like to do after I do a

[00:24:07] little bit of occlusal reductions, I tried to get my mesial and distal cuts done so that

[00:24:11] I can get that first piece of cord in getting that like, and that's been one of the biggest

[00:24:15] time savers for me.

[00:24:17] Um, and I don't know why I didn't do that from the get go, but it was something I actually

[00:24:22] didn't start doing until about, I don't know, six or seven years ago, just making that

[00:24:25] cut and getting that first double zero or triple zero cord in.

[00:24:30] Then that makes the whole thing go a lot smoother.

[00:24:32] The buildup, if I need to, I've got my, you know, I've got some cords, got some tissue

[00:24:36] under control and it's made it go smoother.

[00:24:38] But from there it's, you know, pack the cord, medit scan, um, you know, use a, use a

[00:24:45] bisacryl and temp bond.

[00:24:47] You know, that's, that's that.

[00:24:50] And Zach's using a medit.

[00:24:51] I do want to go back to the burrs.

[00:24:53] I use a occlusal routing burr.

[00:24:55] That's I think 1.8 millimeters.

[00:24:58] So instead of using the 330 burr, which is fine.

[00:25:01] I mean, you can use that.

[00:25:02] I just like having a routing burr is thicker and takes away more tooth structure.

[00:25:09] And then what you call the pancake, which I will call it that from now on, I call it

[00:25:14] a wheel burr.

[00:25:15] I also would call it the wheel burr.

[00:25:17] And just flatten the occlusal.

[00:25:19] And then I have some disposable, uh, chamfer diamonds.

[00:25:23] Yep.

[00:25:24] Um, so less is more, right?

[00:25:27] So I just want to use the least amount of burrs possible.

[00:25:34] Um, and, um, you know, that's the way I do it.

[00:25:38] Okay.

[00:25:38] I think the, I think where crowns get weird is when, uh, you go from just like your, you

[00:25:49] know, your, your standard prep to like when things start getting weird with like the tooth

[00:25:54] has some weird ab fractions or the decays below the gum line on the facial.

[00:25:59] And you're almost like making almost like a wavy.

[00:26:01] I feel like that's some of the scenarios they didn't run us through in school that made

[00:26:07] like some crowns are just way harder than others.

[00:26:10] I like to tell my associate that not all crowns are created equal.

[00:26:13] Yeah.

[00:26:14] That's, and that's, and so the things that really bog you down are crappy tissue, crappy

[00:26:19] tissue or the patient may have great hygiene and great tissue, but they have a overhang amalgam

[00:26:25] or there's the can or the amalgam or the can or the composite.

[00:26:28] And just in that one area, the tissue's horrible or they broke the tooth and they've been jamming

[00:26:33] food into it for a couple of days before they got to see you.

[00:26:37] And that will just grind the process to a halt.

[00:26:43] It really does.

[00:26:45] It really, that's interesting.

[00:26:46] The 35 minute crown prep appointment and the, you know, the, the full like 60 to 75 minute

[00:26:51] crown prep appointment.

[00:26:53] Yeah.

[00:26:53] For sure.

[00:26:54] I don't think I was well prepared for that.

[00:26:57] And I think that you really can't teach that.

[00:27:01] That's a case by case basis, but you have to have a very quick decision tree to get through

[00:27:07] that fast, you know, efficiently.

[00:27:11] The same thing for chasing cracks, you know, when, when to stop and when, what to do with

[00:27:15] those.

[00:27:16] And there's some, like I said, there's some, there's a whole bunch of like, I feel like

[00:27:21] scenarios with teeth.

[00:27:22] Like there's like the, the crown prep that like Schillenberg puts in his book where it's

[00:27:26] like, you know, you can visual every, we can all, any dental student or dentist can, can

[00:27:29] visualize what they would like a crown prep to look like.

[00:27:32] And then it's like, doesn't always happen.

[00:27:33] Well then, you know, here's this tooth that doesn't want to be prepped that way.

[00:27:37] And oftentimes with the CEREC, I'm leaving the existing restorative in there just so I

[00:27:45] can get to the scan.

[00:27:46] And then I will remove that or remove the decay afterwards and just use my cement as

[00:27:51] a buildup, which I know there's probably some people, their heads are exploding right

[00:27:56] now.

[00:27:56] But when your buildup ends up being a very small, we've talked about this before, a

[00:28:03] small little whatever, like I just want to get to the scan.

[00:28:07] The buildup to me is, is not providing any strength at all.

[00:28:11] It's just a space filler.

[00:28:13] Yes.

[00:28:14] There's plenty of buildups like that.

[00:28:15] Yeah.

[00:28:15] Sure.

[00:28:16] And then there's others that aren't, I get that.

[00:28:19] You know, we can't, we can't talk about every scenario, but that's another slowdown

[00:28:24] where you truly do have to do a buildup to, because there's so much decay or broken

[00:28:29] costs or whatever.

[00:28:30] Yeah.

[00:28:31] Sure.

[00:28:31] Absolutely.

[00:28:32] Yeah.

[00:28:33] Um, so the, a question, I guess, what materials are you guys using on your crowns?

[00:28:39] Um, are you milling both zirconia and Emacs?

[00:28:42] Uh, I don't have the capability to, um, mill zirconia, which I think as time has gone on

[00:28:51] is a problem.

[00:28:51] My MCXL is very old and is still running.

[00:28:57] And I just, I'm going to ride that guy till it dies.

[00:29:01] Um, so most of my crowns are Emacs, but if we run into a scenario where I can't get enough

[00:29:06] reduction on a second molar, then I send those out by a DS core, not connect to the lab.

[00:29:12] And those are ones.

[00:29:13] So we're probably making 90% of our crowns in house.

[00:29:17] But if we, I don't try to fight the system anymore.

[00:29:21] I used to try to make everything fit into one small box and then those crowns will last

[00:29:26] for a couple of years and then they break and then you're back in the same boat.

[00:29:29] And, you know, I've got to give someone a free crown.

[00:29:32] So, um, Zach, you doing zirconia?

[00:29:37] Yeah.

[00:29:37] The vast majority of my, my crowns are, are zirconia.

[00:29:41] Um, I would say I, Emacs is pretty much only, you know, almost only veneers.

[00:29:51] It seems like is about the only thing I'm doing with, with Emacs.

[00:29:55] Cause I, I would used to be like, well, if it was an any anterior tooth, I would do Emacs.

[00:29:59] And then it was like, well, it got better with the zirconias to the point where I don't

[00:30:02] need that.

[00:30:03] And anytime I would, I would rather cement than bond all day, every day.

[00:30:08] And some of those teeth, Kevin, I don't even know how you do it.

[00:30:10] That, that bonding works hard.

[00:30:12] That's hard work.

[00:30:12] You know, some of those second molars and stuff.

[00:30:15] You're performing a magic trick inside someone's mouth every day.

[00:30:19] You are for sure.

[00:30:21] It's a magic trick.

[00:30:21] For sure you are.

[00:30:23] I mean, there's some times where I'm like, what the heck am I doing?

[00:30:25] But I think we've got a pretty nailed down pretty good.

[00:30:28] Oh, I know you know what you're doing.

[00:30:29] I'm just saying.

[00:30:30] No, I mean, there's that.

[00:30:31] So the scenario that slows you down is the same scenario, you know, like the tissue's

[00:30:36] crappy and it's going to be crappy, you know, in 30 or 40 minutes after the thing's milled

[00:30:44] and stained and glazed and everything.

[00:30:45] So now you got to deal with that.

[00:30:47] So I'm trying to get smarter about identifying those when I diagnosed the crown to begin with.

[00:30:54] It can't be the same day person, but if it's in hygiene.

[00:30:57] Yes.

[00:30:57] Of like trying to get the paradox script.

[00:31:00] That's an excellent idea.

[00:31:03] Before the prep, because that if they'll do it and you know they have garbage tissue, that'll that will save you a lot of a lot of heartache for sure.

[00:31:12] But it's funny that you said that because several years ago I had our Patterson rep or Serona rep wanted me to give a demo of the prime scan and our mill and everything.

[00:31:26] So I had a couple of dentists come in and watch me do a prep.

[00:31:31] So I cherry picked this one patient, but I was like, you've got to use this rinse.

[00:31:35] Yeah.

[00:31:36] Yeah.

[00:31:37] And it really did help.

[00:31:39] But I wish I would think of that more often.

[00:31:41] I started stocking like little of these little four ounce bottles.

[00:31:44] Yeah, that's fine.

[00:31:45] Chlorhexidine rinse just so I can have something to give to them and be like, hey, will you please start using this like five days before this procedure starts?

[00:31:52] That's fine.

[00:31:53] That's awesome.

[00:31:54] Something that helps for sure.

[00:31:55] Even for a quad evoperative on like a teen that doesn't brush their teeth, it can be helpful.

[00:32:00] Something we've talked about also before, and Mo, this may not really apply to you right now, but it will in the future, is getting ahead of some of these teeth that are going to need a crown.

[00:32:11] So you avoid some of these scenarios.

[00:32:14] I'm not talking about over-treatment or being over-aggressive, but there's some of these scenarios where, let's say you have a large DO on a tooth and there's a crack on the mesial marginal ridge.

[00:32:30] Like, I'm not doing an MOD on these teeth.

[00:32:33] I'm just crowning it and getting ahead of it because you're just, I don't believe you're doing a patient service by putting a large composite in any tooth at all.

[00:32:46] So I just got that.

[00:32:48] That's off my menu.

[00:32:50] Like today, there was a patient with a DOL.

[00:32:54] This patient is relatively new to us.

[00:32:57] It was like, it was the second time we saw her and like, it's already breaking down.

[00:33:00] I didn't do it.

[00:33:01] It was done somewhere else.

[00:33:02] Like that tooth needs a crown.

[00:33:05] Yeah.

[00:33:05] Okay.

[00:33:06] Is there a rule of thumb that you have?

[00:33:09] Like the, how wide, like the, the composite gets before it's too big or anything?

[00:33:17] I just stopped doing MODs on adults, adult adults.

[00:33:23] Yeah.

[00:33:23] I'm just, I don't think it's a good, I, I, there's no hard and fast rule.

[00:33:27] And I'm not saying that that's a hundred percent of the time, but I just, I'm, I'm just trying to get ahead of the scenario every time.

[00:33:37] The G I think the general, I mean, what do they teach you, Moe?

[00:33:40] If it's, if it's over, you know, 60% or 6%, it's over two thirds.

[00:33:44] The.

[00:33:44] Yeah.

[00:33:44] That's what they teach us.

[00:33:45] Okay.

[00:33:46] Yeah.

[00:33:47] Which feels really big.

[00:33:48] I don't know, like two thirds of the occlusal table.

[00:33:54] Bucklingually.

[00:33:54] Plus the entire occlusal table mesodustral.

[00:33:58] It does look massive sometimes.

[00:34:00] I don't know.

[00:34:01] Yeah.

[00:34:01] I just.

[00:34:02] You're going to notice when you.

[00:34:03] I'm also not replacing any cusps with composite.

[00:34:06] That.

[00:34:07] That's off the menu.

[00:34:08] And.

[00:34:09] That's something I've recently taken off the menu within the last, you know, few years.

[00:34:14] Yeah.

[00:34:14] That's for sure.

[00:34:15] And, you know, Zach and I have talked, there were these gurus on Dental Town or just magicians, really.

[00:34:21] These really nice looking composites on posterior teeth.

[00:34:25] But then I wonder what, what do theirs even look like five years down the line?

[00:34:29] It's just.

[00:34:30] You know, and if you're listening to this and you're shaking your fist at, at, uh, your car stereo or whatever, like I get it.

[00:34:40] You know, I'm just saying that I think I'm doing, I'm personally doing a better service by crowning this to you.

[00:34:48] Okay.

[00:34:49] Good to know.

[00:34:50] Good to keep in mind.

[00:34:51] Um, what buildup material are they teaching you to use Mo?

[00:34:54] Yeah.

[00:34:55] I did want to go over that real quickly with you.

[00:34:56] So for us, we're using multi-core, uh, which I think is an Ivoclar product.

[00:35:02] Um.

[00:35:02] What's the bonding steps on that?

[00:35:04] Real fast.

[00:35:04] So it comes with, um, we use a regular phosphoric acid etch and then there's TVO desensitizer and then excite is the bonding agent, I think.

[00:35:17] Um, and then, um, put in the multi-core and then, uh, for our, all, almost all of our single units that I've been doing have been Emacs because my, my faculty really likes Emacs over Zircona.

[00:35:33] So I've been doing for the cementations.

[00:35:36] We're using a variable link aesthetic dual cure.

[00:35:40] Okay.

[00:35:41] With, with, uh, phosphoric acid etch?

[00:35:44] And OptiBond.

[00:35:45] Okay.

[00:35:46] All right.

[00:35:47] Okay.

[00:35:48] And we're using the MonoBond etching primer.

[00:35:52] Yeah.

[00:35:54] That's a really expensive way to do all that.

[00:35:57] Just so you, just so you know, that's, that's, that's a school special right there.

[00:36:01] Use up, use up all those materials because that is, that is a lot.

[00:36:05] That is a, that is an inventory you're going to want to tighten up a little bit.

[00:36:10] Yeah.

[00:36:11] Um, yeah, it's interesting.

[00:36:13] The digital, like digital dentistry department, uh, for crowns seems to be, they're the ones that are like all about getting the newest, best stuff available in the clinics, which is.

[00:36:24] That's great.

[00:36:25] That's good.

[00:36:25] Good for the.

[00:36:27] They're the digital dental instructors, robots, cyborgs.

[00:36:32] They're very down to earth.

[00:36:34] Well, thank you to that.

[00:36:35] Amazing people.

[00:36:39] All right.

[00:36:39] Very good.

[00:36:40] All right.

[00:36:41] Well, I think we'll wrap up for this episode and then for, uh, next episode, we'll touch on tissue management, which we kind of touched on in this episode as well.

[00:36:49] Oh, but there's more.

[00:36:50] Yeah.

[00:36:51] There's more.

[00:36:52] All right.

[00:36:52] We'll see you guys next time.

[00:36:53] All right.

[00:36:54] See ya.

[00:36:54] See ya.

[00:36:55] Bye.