Friday, July 31, 2015

Some days, I feel so very inadequate and underachieving.

I'm 31.  I'm very single.  I've dedicated myself to just getting very good at one very specific skillset--dentistry.  I like to think that I'm pretty good, but I'm only human.  I've found a few people who are better than me...some phenomenally so (Basta, Misch, I'm looking at you guys).

Meanwhile, there are people outside doing cool things like building a treehouse in Hawaii or organizing 1000 people to play a rock concert

Anyways, been recently obsessed with more efficient storage and tiny houses.
My dental office is pretty and fancy looking, but ergonomically it's not that great.
I plan to make some cabinetry over the next year.

Ideally, I want to create a system to minimize the time to transition.
I want it pretty.  I want it minimalist.  I want it flexible.

My belief is that a better setup will lead to better work, and better outcomes for my patients.


Thursday, June 25, 2015

Website up

We've been working on this the last 2 months or so, but Monday we launched our website.

It's been 6 months.  There have been substantial improvements: new chairs, new team mates, digital imaging and X-rays, and better tools.

It's been grueling and mentally draining.

The first two months was survival.  I'd found problems in the practice that jeopardized patient safety and privacy.  Billing was wrong.  Accountability was missing.  Core equipment was missing or broken.

Through all this, God provided just barely enough to pay the bills.  No surplus.  No deficit. 

As mom says, like mana from heaven.

Wednesday, June 10, 2015

A very patient patient--going to the extreme to deliver my very best dentistry--ie: the crown seat from hell.

I have to thank my patient Larry for allowing me to indulge in my vanity.

Some time ago, there was a problem with his previous crown.  It was leaking.
He told me, "just do what you think is right, doc."

I told him gold was king.  He let me do it.  We took the impression with hydrocolloid...twice.
Retention slots were drilled in the second time to improve longevity on a very short, worn out tooth.

Then, I spent 8 hours waxing his crown...attempt 1 was useless since we needed a new impression and retention slots.  After another 8 hours, the second attempt at waxing his crown was a fail (wax cracked during storage).  After yet another 4 hours, the margin broke mentor told me to use a different wax.  And after another 2 hours, we had a wax pattern...we casted the crown in JCB gold from Jenson industries--about $700 worth of gold (including the button).

It was a fail.  The sprue was too short.  There was a bubble right in the middle of the crown.

After another 4 hours of waxing, I presented another wax pattern to my mentor...which was deemed "not tooth shaped."  He rewaxed my crown in under 20 minutes.  We resprued, and recasted the crown.

Today, I spent 2 and a half hours to cement a crown.
I'd repolished the mesial contact to a perfect, wide contact.
The crown would only seat in one direction, with a 2-5 degree tolerance of seating.
Also, this is tooth 15...the last tooth in the mouth.
Lastly, the crown would be almost impossible to remove once seated...even without cement.

Translation....good God this is hard!

5 attempts later, we finally have the thing perfectly seated.
The calibrated, single dose glass ionomer cement would set before I could fully seat this thing.
The margins were burnished and polished flush to the tooth.
The occlusion was adjusted to have 3 point contacts on each teeth.

This is the very best dentistry that I can humanly do...but I wonder at the cost (to me).

Anyways, I owe Larry a debt of gratitude for his patience and understanding.