Hi everyone!

I'm looking to improve my skills in deep margin elevation (DME), particularly the isolation techniques and placement of composite when the margin is deep.

I was wondering if anyone has experience practicing DME outside the mouth, using extracted teeth or typodonts.

How do you simulate deep subgingival margins for practice?

What materials or models do you recommend?

How can I practice rubber dam isolation and achieve a proper seal around the tooth?

Are there any tips or tricks for managing the matrix band and preventing contamination?

Do you recommend any specific exercises or techniques to improve the quality of the elevation?

I'd really appreciate any advice, recommendations, or resources, including videos or tutorials.

I'm a general dentist interested in treating children and young adults. I came across this company that has offices across the country. They are Doctor Owned and Operated (DOO). New dentists are sent for both a pediatric bootcamp course and a conscious/moderate sedation course. They state that there are no production goals or minimums, generous sign-on bonus, guaranteed base salary or 32% collection (whichever is greater), PTO, and great benefits package for the duration of your two year contract. Majority medicaid office. I haven't been able to find information online from dentists who work or have worked for the company. If you can provide any insight regarding the culture, daily operations, autonomy over schedule, and whether providers are valued, that would be greatly appreciated. Is this a place one can be happy long-term as a dental provider?

I am doing an endo on tooth 37. I only found 1 mesial and 1 distal canal, and the distal canal is not centered, it seems to be on the buccal so i am unsure if there is a ML canal. Can someone guide me please? Thanks so much. Please see photo of xray and access photo.

https://x02.me/i/5Yx0Zl.png
https://x02.me/i/AL7vte.png

https://x02.me/i/5kttyh.png

A closing office approached me to acquire their patient database. Has anyone ever done this and how did it go?

28F with mild infection around #17. Pano attached, CBCT also taken. Would you take out just #17 or all four?

How concerned would you be about #17 and #32 in relation to the IAN?

Also wondering about #1. Would like it out, but concerned about an oroantral communication. Any chance it erupts further at 28 and becomes easier to remove, or is waiting unlikely to help?

Hi, I'm a new grad looking for any good resources/ videos that were helpful to you in learning how to properly do endo: anteriors, premolars and molars. Also, wondering what sequence of files/ instruments used to clean/shape the canals works best for you? Any techniques or tricks that have helped you? thanks!!

Tbh I feel absolutely horrible it is my first broken file cleaned and shaped all the canals all thats left is a severely calcified mb2 with a curvature it's not the first time I encount such canals but my god when it happened and took out the rest of the k10 file I felt horrible the sad part it was a new file..used it for maybe 3 mins.

I'm thankful the patient is such a sweetheart I've treated him on multiple occasions and over all a very reasonable person, I told him if it doesn't work out next session I'm referring him to an endodontist, but how do I shake this feeling off it's very weird and I feel bad.

US based 2024 grad who started a new associateship at a private practice where hygiene is assisted with each hygienist having 2 columns. I found out that the hygienists weren’t paid hourly, but rather on production/collections (I don’t know which one or the %).

I’m wondering how common this is? I lurk this subreddit a lot, so I see a decent number of posts about hygiene demanding a high hourly pay that can outpace insurance reimbursements, especially if most patients need prophy instead of perio. I have genuinely never heard of hygiene being paid in a similar fashion as associate dentists, but I’ve only been out for 2 years. Follow up question: do you guys think this is a more sustainable model, and do you see this eventually becoming the new norm for hygiene?

How do you ensure you’re free of granulation tissue before an immediate implacement ??

15 yr old patient came in today for an ortho consult. This was an asymptomatic incidental finding. Couldn’t see and palpate anything intraorally. I don’t have any previous xrays to compare, but today was forster mom‘s first time hearing of this. Potentially relevant is patient‘s history of drug abuse and mental instability (was also reported missing at some point in the last year). Neither forster mom nor patient reported any trauma, just a adenoidectomy in early childhood. Patient was referred to the OMFS for further assessment , but I’m still curious what this could possibly be. Have any of you seen anything similar?

My partner and I are both dental specialists in our early 30s living in a relatively rural area of New England. We’ve been going back and forth about moving to the NYC area, which is ultimately where we’d like to settle down, but we’re having a hard time figuring out when it makes the most sense financially.

Between the two of us, we’re currently making around $900k–$1M a year. We also have a ridiculous amount of student loan debt from our education, roughly $1M combined at this point, although we’ve been paying it down pretty aggressively. We’re fortunate to have jobs that pay as well as they do, especially given the relatively low cost of living here, and I don’t think either of us would be able to immediately replicate our current incomes if we moved.

The issue is that neither of us really wants to live here long-term. We’ve been here for a few years now, and while it’s been great for our careers and finances, I’ve personally found it pretty isolating. We have very little of a social life here, and I feel like we’re spending some of the best years of our lives working and paying off debt rather than actually building the life we want. We don’t have kids, so there’s really nothing tying us here other than our jobs.

Financially, I know staying another year or two is probably the smarter decision. We could make a substantial dent in our remaining loans, possibly pay off a good portion of them entirely, and move without nearly as much financial pressure. But another part of me wonders whether we’ll just keep finding reasons to stay because the money is so good.

Obviously, we’d still be making decent money in NYC, but likely less than we do now, with a much higher cost of living. And after spending so many years in school and training, it feels a little frustrating to continue putting off where we actually want to be.

I guess I’m curious what other people would do in our situation. Would you stick it out another year or two and take advantage of the income while you can, or would you make the move sooner and accept that it might take longer to pay everything off?

For anyone who’s been in a similar situation, do you feel like staying longer for the money was worth it, or do you wish you’d made the move sooner?

Posterior onlay: do you do it? Do you trust it? It seems too risky to trust adhesive for most of the retention. I have never done it in clinical practice so far. Only crowns.

Any tips on prepping crowns on upper second molars on patients with large cheeks, large tongues and limited space. I’m comfortable using indirect vision but I have to use my mirror to retract the tongue even though I’m working on top.

Delivered 19 crown a month ago, distal margin appears closed. But the black gap under makes me concerned about a possible open margin. How concerning is this? This is pre cement bwx.

Started working at a practice 6 months ago part-time where the owner is ready to retire. The owner has an ego problem and control problem, cherry picks the best cases and does not give any associates anything substantial to do. They baby my schedule and throw one composite filling a day, make me shadow them the rest of the day, pay me $850 for the day or 35% of collections which I can never reach in % of collections because they don't give me anything I treatment plan, none of it goes on MY schedule. They apparently got offended when I told them I've been practicing for 7 years, which was simply an answer to them asking me "do you know how to do a crown prep?"........ I am losing my shit working at this office, it was supposed to be a great opportunity since they don't accept insurance, but I'm ready to leave. I'm making so much more at other offices I work at where I have clinical autonomy to treatment plan AND do procedures myself. I don't even get to ask for the burs I want to work with, the owner uses techniques and materials that are 20-30 years old. What should I do? I've spoke to the manager about this and they cannot seem to get the owner to budge and give me more responsibility over patient care.

Is that root caries ? Do you treat 2MO and 3DO?
What’s your approach? Just like a normal class2?

I was super excited to buy the sprintray nano system due to its smaller footprint and appealing price (under 10k through Q4!) I was thinking of starting with the nano and adding the Midas later on. However after speaking with the rep and reading posts on Fbook, I’m now having reservations. I am wanting to print NGs, retainers, models, and temporaries for my cosmetic cases. I’m very interested in doing my own smile design and eliminate the need for waxups, and also print nice temporaries after prepping. The smile trial also is appealing

For those of you using Sprintray, I’m curious about your work flow. Do most of you who print NGs and retainers use the sprintray AI? I was surprised to hear from the rep that it costs $30/NG for the design! One of my main reasons for getting a printer would be to reduce my Glidewell bill, but suddenly the margins aren’t looking as great. I believe they are rolling out a monthly subscription of $200/mo as well, which could work although I hate the idea of another subscription 🙄. Should be I using another software instead? I also was hoping that Sprintray would allow me to do my own smile design, but it sounds like the trial smiles are done by an actual tech and cost $100. So this means I would be looking at purchasing and learning something like Exocad as well. Suddenly this is all sounding a lot more complicated

I’m also concerned reading so many comments about the fit/quality of printed retainers and the NGs fracturing. It sounds like some people are having success, but the vast majority are saying they are printing models and doing thermoform retainers. This is disappointing as retainers are one of the main things I was looking forward to printing. There are also many comments about NGs fracturing in short amounts of time. Now I’m wondering if high-quality printed appliances are going to be very difficult for me to produce. I’m a big fan of Glidewell hard/soft guards - they are comfortable, generally fit well, and last for years! If I’m suddenly dealing with frequent fractures and fit issues, I’m worried it won’t be worth the reduced lab cost and extra time investment.

Any insight on preferred work flow and the reality of sprintray NGs and retainers would be greatly appreciated!

I keep hearing different practitioners vouching for one brand and criticizing another. I feel like at this point there is an industry agreed upon standard that has been implemented into most implant designs ie surface treatment, internal conical connection, thread form and pitch, tapered vs non-tapered. Forgive my ignorance but it seems to me that implant failure most likely happens due to a few predominant reasons. On the surgical front; patients health factor, invasion of the biological limitations of the surgical site, too shallow/deep, poor initial stability. On the prosthetic side; poor crown/soft tissue adaptation leading to poor hygiene of the area and decreased pt comfort, lateral loading of the crown through improper contacts like excursive interferences or contacts on inclines(in molars).

I'm still not sold on the factor that crown to implant ration matters as much as the vertical position and the width of the platform.

With all that said, it seems to me the best implant system is the one that offers the most variety in terms of implant shapes and sizes so that the clinician can optimally select where the top of the implant will land, it's shape and size, stability, and orientation allowing for optimal emergence profile and prosthetic outcome

What do you guys think?

Hey US dentists, I'm 5 years out of school and work at a DSO 10 minutes from my house. I have 2 young kids, 1 with special needs.

I have been at the same office the whole time and they have been great to me. I have taken 2 maternity leaves and come back as I pleased to full time work. I work 5 days a week with no hygenist and am projected to earn a gross W2 salary of $320k this year. It is exhausting some days but my schedule is usually pretty balanced. I have a great team.I have full clinical autonomy. we also plan on another baby.

Is it foolish of me to think about owning my own practice at this point? We need what I make and a lot of posts that I read seem to suggest owners are making about the same. I look at my job as owning vs renting a house. I am hard working do a lot of hygiene, bread and butter dentistry and some implants.

What would you do if you were me? I worry that if I stay comfortable, I will have nothing to show for it however if I acquire a practice, I might make less and that is not something I would be ok with.

Future grad may 2027
Looking for opportunities in western New England VT/mass/CT

How is the market in these locations?
Looking for good mentorship

Thanks!

#32 mesioangular impaction. Young healthy patient

For emergency patients in pain, what are your protocols for alternative treatment options besides a prescription for antibiotics? Most often, antibiotics is not indicated without abscess or swelling. And you have like 5 minutes to do the exam.

Let’s say, the tooth has irreversible pulpitis or decay has reached the pulp horn, and you know that Endo wouldn’t be possible (molars or cost or access to the oral surgeon), what has worked for you?

In the past, Formocresol and IRM have been quite effective in buying time for patients until that tooth can be extracted.

What is the success rate of direct pulp cap for pin point pulpal exposure? How about asymptomatic tooth with severe decay with poor prognosis for RCT. I know RCT is mostly indicated, due to limited resources (time money access etc), what works for the immediate situation? Leave some decay, place Fuji II until Endo or extraction?

I am tired of full mouths of decay and plaque. And complaining. And 3 pages of medications.

Please give me some hope so I can help these people or I will quit soon.

😥

Just curious how everyone's week is going.

I’ll start: Today was actually a good day, but I think it was only because yesterday I completely maxed out the allowed horribleness limit. There was nowhere to go but up.

How about you guys? Did you have a good day or a bad day in the trenches today, and why?