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Dental Tribune United Kingdom Edition

WhenIwastrain- ing at university, every stage of a proce- dure was supervised, step by tedious step. The “idiot sheets” (as our restorative dentistry profes- sor called them) foreachmaterial were available to be referred to and followed religiously. De- viating from those instructions was not an option. A few years into practice, it begins to be difficult recalling what was said about which particular materials. You know that you were told what was compatible with what, and what was not. When a sales rep- resentative turns up with something won- derful and new and better, a little alarm rings in your head, cautioning you that what the representative is telling you is contrary to what you were taught. But no, the representative quite confidently as- sures you that the research says, the stud- ies show and the in vitro trials prove. And most importantly, the new product is faster.Yes,faster,muchfaster.Youcansave a whole 30 seconds per procedure. You do nothavetowaitforthenextstep:thisdoes two steps in one or even three, if you want to be really good. And faster is better. At this point, you begin to regret your failing recall of material science. How am I supposed to evaluate which material is best, when each of the glossy brochures shows that they are all better than each other? The truth of the matter is, of course, that virtually all of the mainstream products out there are fit for purpose. What makes any material good, bad or indifferent is how the clinician uses it, including skill, time, effort and the amount of care. Even the best of products is going to be rubbish in the hands of someone who uses it badly. “Lithium disilicate crowns are useless,” I was told by a dentist recently. “Every one I have placed has fractured.” With twice as many years of clinical experience as me, thisdentistwaspreparingforthismaterial exactly as he would for a porcelain-fused- to-metal (PFM) crown, using a coarse dia- mond fissure bur. The same internal an- gles, same margins, same lack of surface finish, same flat occlusal surface on the preparation that he had always had, and cementing the final product with glass ionomer. This had served him well for PFM crowns, but this new material was letting him down. What was his conclusion? The material was to blame. Progress was a bad thing. He was going to stick with what he knew worked, full coverage PFM crowns for everyone, and disregard progress. Maybeweallhaveabitofthatinus.Allof the exact details of every process can be lost in the day-to-day stresses of the work- load:thatlittle step being skippedjustthis once, then once again, and then another step gone the next time. It is the normali- sationofdeviance:peoplebecomingsoac- customed to deviating a little from proce- durethat“theydon’tconsideritasdeviant, despite the fact that they far exceed their ownrulesforelementarysafety”.Justskip- ping thatlittle step this time,notperform- ing the process exactly to the manufac- turer’s instructions, finding a way that is convenient, and assuming no responsibil- ity for the results of the deviance. When somethinggoeswrong,whenarestoration fails,whenapatientisinpain,itisthefault of the material, or the patient, or the labo- ratory or the nurse. The next time you are placing or ce- mentingorlayering,stopandaskyourself: am I being a deviant? Refer to your idiot sheetandtakethetimetorecallthecorrect process step by step. And deviate back to normality. 3Dental Tribune United Kingdom Edition | 9/2014 OPINION Hemostasis by mechanical action Practical Quick-acting BDTA 2014 Stand F16 London Expo 9 - 11 October 2014 The end to bleeding Dental materials: Are we all deviants? DrThomas O’Connor,London “Maybe we all have a bit of that in us.”

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