time to pat me on the back, no?

so i know it's late and i have to be up and butt-crack of dawn tomorrow morning (when it will be dark when i wake up, dark when i leave, and dark when i arrive at the office, and that blows goats but what can you do?). but i've had a pretty interesting couple of days in the dental department that i'm kind of stoked about and i just wanted to do a cyber pat on my back for several reasons (to offset the fuck up post from a few weeks ago, as we need to strike a balance.)

- surgical extractions, swore i'd never touch 'em again. but something in me changed, and now i'm not afraid to pick up a handpiece or a scalpel and drill some bone to get the tooth out. i used to shy away from root canal treated teeth or anything that had more than one root and/or 50% bone support. but this past week, i did TWO, read that TWO surgical exo's on RCT teeth with no post-op complications thus far. all by myself, not leaving any root tips behind or calling the OS to bail me out. and i got to place sutures, too, which is cool because i kinda dig sewing a little bit. so i'm kind of excited to introduce this new "skill" i've decided to develop into my practice. my next step is to get really, really awesome at cutting flaps so i can start doing some minor perio surgery. but i'll still leave impacted 8's and the implants to the experts.

- endo time (ameloblast, this one's for you!). so my colleague hates, and i mean despises in all senses of the word, doing root canals of any type and refers most of them to our trusty endo specialist downtown. now, he's awesome, hey, he fixed my tooth (more on that later) but as a specialist he does charge quite a bit more and requires payment upfront, and some patients are strapped for cash and are hence hesitant to seek treatment at specialists offices. that combined with the fact that the office manager is putting gentle pressure on all of us to keep more procedures within our practice and the other fact that my endos are actually halfway decent, has driven her to refer some of her cases to me, which makes me feel pretty darn good. until i got a beast of one on saturday. silly me, she sent me this case weeks ago and i (wrongfully) assuming the case was a slam dunk because she referred it to me, never got around to looking at the radiograph until the patient was actually seated in my chair (around 45 minutes late for an hour and a half appointment, i might add). it was then that i discovered that this #36 had had a pulpotomy completed god knows how long ago, but the IRM was shoved all the way down into the pulp chamber sans cotton, and had made it's way down some of the canals. fuck, how am i going to get this crap out? maybe i should send this out. but wait, it's just IRM. let's back out of my comfort zone and see if i can actually pull this off. very slowly and gently, i worked my way into the chamber, flicked off peices of the nasty, old and hard IRM, got to the pulpal floor without perfing, and with a series of very small gates glidden drills and peaso reamers, was able to successfully locate and instrument all four canals. since he was so late, i was only able to complete the pulpectomy, but i set it up so all i have to do is some light rotary instrumentation and obturation when he comes back. that felt really good!

- two porcelain jacket crowns i prepped two weeks ago on #14, 15 were cemented and looked B-E-A-U-T-I-F-U-L. color was perfect, margins were sealed, everything looked nice. the patient was once in the russian army and had dentistry done with no anesthesia, so he was very pleasantly surprised when i completed all the work without hurting him and he left as one very satisfied customer.

i like it when things go my way. really. and just as i am quick to point out my mistakes, i will never hesitate to pat myself on the back.

hurray for me!