New Dentists Stuck on Hard Clinical Cases
Newly graduated dentists are struggling with unexpected complexities in patient cases, ranging from difficult extractions and root canals to challenging restorations and implant placement. They are encountering issues with technique, equipment limitations, and a lack of experience in dealing with unusual anatomical variations and older, potentially problematic, dental work. This leads to frustration and a need for guidance and support.
SOURCES (60)
“I’ve had a dr ask me why I always find bone or debris in trays and no one else does. I’m like maybe no one else is looking! 🤷🏼♂️”
“Hello everyone, I’m 2 years out of school and today I encountered a situation for the first time that made me a bit nervous about how I’ve been placing posts. The patient had an endodontically treated upper first premolar break off. The clinical exam and bitewing shows that there’s still enough ferrule left so I opted to do a post and core buildup with a crown on top. I placed the post in the lingual Canal and cemented it using RelyX Unicem, then I proceeded to build up the core and prep the cro”
“The implant is tapered pro conical.I am freaking out a bit.Should i call the patient back and torque it to 20ncm or leave it as is? submitted by /u/Old_Butterfly9649 [link] [comments]”
“I had this one today and I am still thinking "what the shit?". New patient exam today. Has upper and lower fixed acrylic on a titanium bar that is falling apart. I treatment plan a new fixed upper and lower and the guy asks me how much it would cost to have a second set made but "reverse them". Turns out reverse them means he wants the same design but an extra set but the maxillary arch made to fit the lower implants and the mandibular arch made to fit the upper inplants. Wha”
“I'm an associate and the current group I work for is heavy on sedation dentistry. What sedation courses have y'all taken and how have they been? Docs and Colorado surgical institute are both extremely expensive. submitted by /u/Banal-name [link] [comments]”
“5 visits. Filling removal, pre-endo build up, removal of the most old material, removal of the rest under the microscope, root filling. Between the previous and the last visit a patient had Calcipast in the root canal for almost 3 weeks. submitted by /u/D0ctorLogan [link] [comments]”
“Happy Friday. Completed this case today. Glad to save a tooth. Cement was removed after x ray. submitted by /u/Used-Bullfrog-1923 [link] [comments]”
“Any advice for getting a good visual on posterior mandible Class 2s while you all prep? These have always been a sticking point for me. The bur and head of the handpiece obscure my direct vision. Water spray and lack of space make the mirror useless. I end up positioning my bur, cutting blind for a second, getting my mirror back in position to see the prep, then cutting blind again, back and forth ad Infinitum. There must be a more efficient approach. Would love to hear some thoughts! subm”
“I'm following a pacient that has an implant to replace an 46 (FDI) that needs a new crown, but I've been testing impression copings for months with no success. The patient was given the information by the clinic that did the original work that the implant is a Nobel Speedy Groovy RP, but I've tried every impression coping and they don't fit properly. I've checked every possible source of interference, tested multiple positions and it just won't fit. The best fit I had was”
“When doing composites I aim for a seamless transition from tooth to composite where I cant feel any interruption when probing the margin. However with crowns, there always is a slight catch no matter how accurate the scan or smooth the prep is. Is this catch inevitable? And what is considered a within normal limit margin catch? submitted by /u/Mr9to5guy [link] [comments]”
“Hello, ım a prostodontist and finishing residency in 4 months. I m looking for online courses focus on implant surgery and surgical extraction. Any recommendations? Thanks for advices submitted by /u/DexterMorganI [link] [comments]”
“Sharing another recent case and would appreciate some constructive feedback from fellow dentists. The patient travelled from Germany and stayed for six days. The active treatment was completed over five days, followed by a final clinical review and occlusal check on the sixth day. He presented with generalized tooth discoloration, mild anterior crowding, irregular tooth morphology and an overall lack of smile harmony. His main request was a brighter and more balanced smile, while preserving as m”
“I've been thinking about something for a while, and I'd really like to hear how other dentists approach it. One of my biggest principles has always been avoiding irreversible treatment on healthy tooth structure when the only indication is esthetics. When patients come in asking for veneers, aggressive bonding, or other cosmetic procedures on otherwise healthy teeth, I usually spend a long time explaining why I don't think removing healthy enamel is a good idea. So far, I've neve”
“CC: Pt experiencing hot sensitivity on 27. 27 cold WNL, percussion -ve, palpation -ve, probing WNL 28 seems to be resorbing the distal root on 27. How would you approach this case? I have the option to coordinate with OS and endo: Extract 28 and endo 27 with a guarded prognosis? Or Extract 27 and extrude 28? submitted by /u/pattycakepolka [link] [comments]”
“Was that for a first root canal, or a retreatment of an existing one? I called this place to see if they could fix a botched job done by someone else. But in the end I've decided to just have the tooth extracted.”
“Patient had ext and bone graft #30 about 4 years ago. Patient had implant placed about 2 years ago. #3 is supra-erupted. submitted by /u/tique_dds [link] [comments]”
“Sharing one of my recent cases here and would genuinely appreciate some feedback from fellow dentists. The patient was mainly unhappy with the discoloration, uneven tooth shapes and overall appearance of her smile. The goal wasn’t to create an ultra-white or overly uniform “Hollywood smile”, but something cleaner, softer and more balanced with her facial features. We focused on improving the tooth proportions, smile line, symmetry and overall harmony while keeping the result as natural as possib”
“Hey y'all, new grad here, been practicing a week lol. I'm gonna be flooding these forums with questions over the next few months just to have some additional guidance from as many opinions on the internet I can find, as well as a few mentors I've got too. So yes this patient had all remaining extractions 8 weeks ago and comes to our office like this. I don't want to make anything that really wont be comfortable for him, but he's got a decent amount of excess gingiva that you”
“Hi everyone, we currently have a new dentist working in our office. He did a root canal (photo linked below) and after taking the PA to check how he did, this is what it looks like. A lot of his PAs have been looking like this recently. What do you think? I’m merely an assistant with 5 years of experience. Is this okay or will bacteria get inside here and end up extracting? What the longevity rating of this tooth? Patient is not getting it crowned. Thanks in advance! submitted by /u/”
“Today I performed a root canal treatment on a mandibular second premolar (#35). The initial working length was 20.5 mm. I instrumented the canal with Zarc rotary files up to a size 30 Blue, and all the files reached working length. After instrumentation, the working length was 20.0 mm, and the electronic apex locator indicated an apical diameter of size 40. I then placed a medium gutta-percha cone with a size 40 tip, and it reached working length without any problem. I also tried an FM cone with”
“I've long been wanting to get into placing hall crowns and finally have a patient that could fit the bill. 7yo squirrely boy with moderate decay on #I on D surface, no pulpal involvement. I tried to place spacers on him at his recall apt but he picked them out of his teeth before he even left the building and mom said he likely would just pick them out again if we placed them back in. I have a mentor who recommended just flattening the D aspect of the SSC and pressing hard to place it but I&”
“Super interesting case. never seen one of these before. Life changing stuff here. submitted by /u/IamTruman [link] [comments]”
“Other than os, ive seen GP dentists doing zygos and ptergoids hardly hear of perios doing those. Any periodontists that do them ? Did you learn to do them during residency? If not what courses? How did you feel about them ? submitted by /u/Zoster619 [link] [comments]”
“wondering how you all work up patients who only come in to get antibiotics. had a patient today who has had a fractured #19 referred to os for ext at every single recall. tooth is previously RCT’d, no PARL, no swelling, no facial asymmetry, etc. basically, no evidence of systemic involvement of infection. but there is some slight purulent exudate on palpation, localized small perio abscess. pt is having 3/10 pain. definitive tx is ext, she’s had the OS consult done numerous times and has never p”
“Patient hadn’t seen a dentist in 10 years. Came complaining of “a swelling in the jaw that won’t go away”. I can’t tell you how satisfying her clean was. Took 2 half an hour visits though. It was like this pretty much everywhere. submitted by /u/joboog [link] [comments]”
“Recent grad here with a question for the endo folks If a pt has an existing crown with what appears to be a cast post, and they may need endo re tx, how does endo access and do the re-tx. Do I need to take off the crown and remove the cast post and then send them? I was never taught to do that in dental school I don’t even know how I would approach the removal of that. I also don’t know how to obviously tell if it’s a cast post or just really radiopaque material submitted by /u/denti”
“I have a patient this afternoon for a split molar I told him needed a crown three months ago. Tooth has a crack through the marginal ridge I could park my car in. It was his first time seeing me and he acted like I was trying to scam him or something. I don’t wish ill on anybody, but I have to admit I derive some sort of satisfaction from people who either don’t value me or doubt my intentions having to wrestle with being wrong. submitted by /u/More_Winner_6965 [link] [comments”
“Struamann Bone level tapered Roxolid SLActive RC. Torqued to 35 Ncm. Implant crown kept rotating when I hand tightened so had to use the lab index guide. Kept rotating at final torque without the guide. submitted by /u/NervousGrapefruit539 [link] [comments]”
“What do you do when you have a 3 unit bridge that’s only loose on one abutment? I’m always super hesitant to tug on the other tooth if it’s still adequately cemented because I don’t want to damage the underlying prep. I’d also rather not section and remake the bridge if I don’t have to. submitted by /u/DiamondBurInTheRough [link] [comments]”
“You got your mock up done with raised vertical, patient is happy. Now, how do you sequence the prep, impression(digital) and temporization? do you do a side at a time? do you do the full arch but the 2nd molars?? submitted by /u/inquisitorthegreat [link] [comments]”
“oh yeah. Stuff is missed all the time in periop which is nuts to me. I remember things being so militant. I’m talking consents not signed, labs not drawn, sugar not checked, antibiotics not given…”
“I’m quite often seeing this clinical situation but am not sure how best to restore this for the pt. Obviously removing the existing amalgam, but then building a composite core and doing very minimal reduction palatally to preserve as much natural tooth structure as possible for crown? (Accepting that it will be bulky on the palatal side)? Thank you for your advice 🙏 EDIT: did not realise this (even with loupes on clinical exam!) until someone pointed it out but palatally is also composite 😔 &#”
“I have started practising since last 2 months , is the obturation fine and how can i improve myself. Its my first single sitting rc case. Please give you feedback backs submitted by /u/hellodoremon [link] [comments]”
“History : Failed extraction a week ago due to persistent pain even after loading more anaesthetic. During the ext attemp, manages to luxate and could been rotated left and right yet during pull out the crown part broke. It feels like something stuck. Ext couldnt continue bcs pain started to flared up, even the lip feel painful for pt. Loading more anaesthetic didnt work too. I was worried that maybe I poke around the foramen mentale and stopped. A week later, pt didnt have any pain anymore, said”
“I will be taking over an existing practice that has an omniscan and MC XL with the furnace. So it is currently functional, but I am looking to upgrade it as I'm used to the prime scan and primemill. Since I am already accustomed to cerec, the easiest thing to do would be to get a Primescan and go from there, however it isn't cheap and is more of a closed system. I haven't ever seen the workflow for a different scanner and mill so I'm curious to know what scanner and Mill set up p”
“Just curious about opinions on selective caries removal vs complete caries removal and what you would do. I work at an FQHC where I get people coming in with caries very close to the pulp. Most are asymptomatic and test within normal limits to endo testing, but have high chances of pulpal exposure if complete caries removal. I don’t do endo (I just don’t like it), so closest place for some people with their Medicaid insurance end up being around 2 hours away. A lot of the teeth we refer for endo”
“Hi everyone! This my little recall. Fillings and crown (Vertiprep technique). Implant will be later submitted by /u/Tanymoly [link] [comments]”
“Good day all, does anyone have experience with the gIDE dental implants course? I am a new gen dentist with only 1 year of working clinical experience. I’ve grown to have a passion in implants and surgeries but my implant knowledge is close to none and I’m interested to take the course so that I’m able to start my implant journey. I’m unsure if this course is right for someone with zero implant knowledge? Any advice on this is much appreciated. Thanks! submitted by /u/Emergency-Long3”
“I have a patient who wants to close the gap on the bottom. NOT wanting to do ortho. Planned for 4 lower crowns that are wide to fill gap. Im in communication with Lab, here they are showing me what it would look like with 5 crowns. What would you guys do: 4 wide crowns or fill the gap with a tooth? submitted by /u/Pulpal_fiction [link] [comments]”
“Not my case Do you guys believe in treating cases like this by performing root canal treatment, placing fiber posts, and then restoring the teeth with a bridge? Or do you think the prognosis is too poor, making extraction and implant placement the better option? submitted by /u/Odd-Conversation812 [link] [comments]”
“I wanted to tap into the hive mind for any cool prints or things to help us practice dentistry better. submitted by /u/dr_wussy52 [link] [comments]”
“Looking for some advice I’m a foreign-trained dentist about two years out of dental school. I recently completed a residency that makes me eligible for licensure in the state where I’d like to practice. I thought I had everything lined up with a job that would sponsor my work visa, but that fell through at the last minute because they decided not to move forward with sponsorship. My options are: Apply for another residency . The downside is I wouldn’t know where I’d end up until mid-2027, there’”
“New grad here- what else can I do if I can’t get pt’s new PFM bridge #9-11 to match her existing #7,8 PFM crowns, to pts satisfaction. I’ve sent pictures to the lab and informed them about what changes to make but if the pt is still not satisfied what else can I do? Do I change labs? Any advice is appreciated! submitted by /u/Ashamed-Earth-1756 [link] [comments]”
“I had met this pt that want to fix their 11 12. Both had history of several restoration attempt and failed every year it chipped off. During examination I noticed pt had an anterior cross bite, and laid out my concern for the cause of the failure. This one def need root canal + post + crown. But I knew its not going to be easy since usually you'll need to calculate the core prep so it could be manipulated to Class I bite. I washed my hand off it and sent them a merry way to endodontist. I kn”
“Hello everyone, A patient had root canal treatment on this tooth about 6 months ago by another colleague but never returned for the final restoration. Tooth was left open because the TF had fallen out. He presented today with constant pain, especially on biting. The existing root canal treatment appeared radiographically acceptable, but I suspected recurrent caries might have allowed bacterial contamination of the canals. After removing the caries, I considered the possibility of a missed MB2 ca”
“This is a thread to help newbies in dentistry if you have a trick that you learned that helped you a lot throughout your career and wish you knew it earlier feel free to help us out! Thanks in advance submitted by /u/Medpizza12 [link] [comments]”
“Mesial root canals were narrow and the apex of the distal canal (1/5 of it) was around 90° to the tongue side. Cavity destroyed 2 walls out of 4 but I rebuilt them before performing treatment of the root canals. RC themselves took me 2 visits. submitted by /u/D0ctorLogan [link] [comments]”
“The abutments look like ball abutments. But no idea who the implant or abutment manufacturer is. Pt has had these for around 10 years. I’m looking to replace the o rings. submitted by /u/DentalDeity [link] [comments]”
“Recently received a crown case after retreatment with an endodontist. The xray shows the tooth is half filled without any mention of post space preparation. How can I confidently determine whether there is a post space or not when looking at the xray? In my head there are 3 scenarios 1) endo filled full length then cut back whilst prepping for post space 2) endo back filled to where he thought was appropriate then prepared post space 3) endo back filled to where he thought was appropriate and le”
“Hey everyone! Just wanted to share my last case from yesterday—ended the day on a massive high note. The patient was referred to me for endo after the previous dentist just opened the tooth for emergency pain management (pre-endo pic 2). Looking at it initially, I expected a straightforward case with a slight curve. I definitely didn't anticipate this crazy S-shape! Super happy with how it turned out, and feeling pretty proud of this one. File used Dentsply protaper gold. Sx-S2- 10.02-15.02”
“I feel like no matter what CE i take or look at I am completely lost with the TMJ and how to treat pain/issues. Any recommendations that work well for you guys? submitted by /u/jallen263 [link] [comments]”
“Will be seeing a patient today complaining of sensitivity on an existing implant crown. Implant was placed many years ago at another office and patient recently started experiencing sensitivity. I’m still a relatively new grad so don’t have much knowledge on implant crowns. Any thoughts on what could be causing the problem or what tests I should do to make a diagnosis? submitted by /u/Kindly_Armadillo1654 [link] [comments]”
“Patient arrived with chief complaint of “loose bridge.” #2 was a terminal molar and patient arrived with this in a ziplock. Mesial abutment crown was sectioned off and recemented. “I can’t put this back on. There is nothing to put it on.” “Well can you fix it?” “Fix what?” “The bridge, I don’t have any teeth to chew with on my right side anymore.” “You only had 2 teeth holding in an entire section of your mouth and the back one fell completely out. The bridge didn’t break or come off, the entire”
“How do you guys handle mandibular anterior incisal chipping when the patient has a tight bite? When do you go composite vs veneer vs crown? Do you adjust the bite/nightguard first, or restore and monitor? Thank you! submitted by /u/InsectJust6374 [link] [comments]”
“I was exoing the maxillary second molar and the palatal root fractures. I managed to almost get it out with root pick but I saw it get sucked back in. Do you think this PA is in the sinus? submitted by /u/Sea-Bandicoot2823 [link] [comments]”
“I keep pulling but they came back. I assume I’m not pulling deep enough? submitted by /u/CodeFirst1945 [link] [comments]”
“https://preview.redd.it/hagbg76cj2ch1.png?width=1242&format=png&auto=webp&s=1dad8c5fefe0c5f2e6e36597708ac2c317fb7d4e Have this 80 year old patient presenting with a loose two unit cantilever bridge on an unknown implant system. On the radiograph looks like the collar around implant tooth #19 has fractured and the whole thing is hyper mobile and moving. I am tempted to use finger pressure to lift it out but think #18 is still holding on though its loosend. Looking closely the screw in”