What After BDS?

The most frequently asked question after BDS or during internship is What after BDS?  When we join this BDS we have a lot of dreams for this profession. But when we are actually into the profession, we get to know that, there are very few options left for this Dental  graduates. Kosmo Dental Academy the rebrand of Asian Dental Academy has brought some insights about various options for BDS graduates. We mostly focus on something which is really feasible and practical. There are so many options you might have come across through various videos or articles but most of them are impractical or suitable for BDS grad. Non dental options are there but anyone without the BDS also can do that. We are focusing on something which is useful for the profession. And there are  few non dental options are also there but these are having some direct corelation with BDS.

If you are in search of dental courses after bds which are relavent then you are at the right place. Read the article completely to understand various options available. This article has been divided into two parts. 

Part 1 – Focusing on Indian Based Career

Part 2- For International Career

What After BDS

Should You Choose MDS?

After BDS the most prominent and best option is MDS. This is very common thinking in India that after graduation everyone will think of going for post-graduation,  but the ground reality over here is, there are hardly 6000 seats in India for  28000, Then in that also there are 50% of non-clinical seats.

We strongly recommend that please try to avoid nonclinical segment unless you are very much interested in that subject. There is hardly scope for employment and business opportunity.

After coming out of the college, MDS is not giving any immediate extra edge into the practice. You are just gaining subject knowledge. You have to go to certain finishing school international national for advance dental courses then you have to imbibe that kind of education, which is really useful in practice where you can call yourself as a kind of a specialist. After working hard for more than two years, people will recognize you as MDS,

Even for clinical subject there is hardly any scope for employment You may go for consultation that to mostly for Endo, Surgery Ortho. But this is not going to work for long time.

Now my advice over here is anyway you are going out to get advanced knowledge why don’t you do it immediately after BDS. Why to waste 3 years of time and to crack NEET 1 to 3 years. By the time you finish and come, market will be flooded few more clinics.

And also if you don’t get any MDS after 2  to 3 years of commitment your  time is completely wasted. You need to first understand that it is not the course of only three years now, if you try it for two years and then you got the MDS, then it is of five years course. The biggest loss is that, that MCQ knowledge which is no way helpful in your practice if you don’t get MDS.

Dental MDS
Our Advice For BDS Graduates

Best option for any BDS graduate we recommend at Kosmo Denal Academy is Private Practice. This is highly rewarding and sustainable. Yes there is lot of competition. The biggest problem in India is, every one feels getting out of the college and having one degree is enough for practice. One needs to understand that private practice is a business, you are competing with corporates in dental practice. Those days have gone where patient used to come on the doctor’s name. world is all about branding, value added services and USP. Dental business or private practice is learnable skill one should learn it and then start business.  

 Best option if you are going for private practice is going for a short term Dental Courses where you can learn RCT, crown preparation and extractions. Try to go for a Dental Courses where you are handling the patients. There should be good mentor, good infrastructure, and thorough hands on followed by on patient training. After this work for one year in any reputed clinic to understand the business. Once you are thorough with this basic procedures try to opt for any international PG course from the prestigious universities like UCAM Spain, which is most relevant in the market for courses like implantology, Cosmetic dentistry, digital dentistry etc.  International degree with speciality in advanced course is always better than going for MDS.

 Biggest advantage with this is

  • You will not lose your precious time.
  • Lot of money will be saved.
  • You won’t quit your practice.
  • You are trained in what is relevant in the market.
  • You don’t waste time in unnecessary academic things like lecture, seminars, Library thesis, final thesis.
  • You are associated with worlds most prominent personalities.
  • You get to know international market.
  • Lot of value will be added to your CV if you are trying to settle down abroad.

Lot of NRIs prefer international exposure accreditation points.


  • DCI won’t accept theses degrees, but that is for government posts.

Anyway, you are not hoping for any government jobs your target is private practice. This is no the right option for a stundent who is looking for government job.



Para Dental Options

You can be the Best Digital dental technician. Basically, there is lot of revolutionary changes are coming in the technology in Dental Labs. Dental technician with limited knowledge cannot compete it. They have a limited IQ. If you are dental graduate then you learn dental technician work then he can be the person to bridge the gap between technology and work. There is a lot of scope for them in corporate labs, even they can set up there own digital lab.

Non Dental

>If you have good hummer and tech savvy,  then there is golden opportunity for you in Digital marketing. If you have good language command and if you can write good blogs, you can be the best person to be inducted as content writer for various dental websites. There so many e commerce dental websites where they need to write lot on product description. If one dentist does that work then that will be the best one.  

You can be a good digital marketer – There are so many online classes available to learn these. You can do such marketing for dental websites.

You can opt for MBA marketing 

You can also opt for MBA healthcare management

There are lot of second line medical hospitals. which need such human resource.

In the next blog I will explain you about international options. 

Where to Start ?

Those who are convinced for private practice for them my advice would be join our Asian Institute or Kosmo Dental Academy Mastership course. Which is of 3 months course which is been designed on 3+3+3 strategy

Mastership in Clinical Dentistry

First one is Domain skills – Domain skills are the actual dental skills like rct crown n bridge. anyway that is already he learned I first 2n months but now focus will be in advancement like rubberdam, magnification and working attire.

Second is business skills – We have designed certain guidelines and protocols for clinic management like how to maintain sterilization, cleanliness, receiving the patient, software management, appointment management etc. how to charge the patient, understanding the Capex, Opex calculations, excel sheet preparations.

  • Separate classes Digital marketing for dental clinic
  • How to maintain social media pages , how to add content in that  ETC
  • Third Personality development
  • First impression is the last impression
  • How to impress the patient with your attire, body language, with kind words
  • Time management, personal finance ETC
  • Basically, we try to make him fully compatible to start a Good Clinic.

Courses After BDS AT A Glance

The Art of Predictable Endodontics

Endodontics Tips

Endodontics Made Simple

What Defines A Successful Root Canal Treatment?

Is it perfect white lines on a radiograph? No! Is it control of pain immediately after treatment? No! Is it long term survival of the tooth after the treatment? Probably yes! There is no definite answer to this question as it depends on the perception of the doctor and that of the patient.
Root canal treatment is a long and complex process which involves many steps and a proper protocol to be followed. In order to make the procedure convenient for the patient as well as for ourselves, we end up skipping certain steps which we don’t consider mandatory for the success of the treatment. This is possibly where we go wrong. We all know the basics. We just don’t consider them serious enough. And then we end up wondering why some of our cases fail.
We need to understand what we are doing. We need to realize that if we are failing, why are we failing. This forms the essence of predictable endodontics. Here is a brief checklist of what has to be done in a root canal treatment. Nothing new here. We have learnt this in our curriculum. Just a quick reminder of the steps that should not be skipped or overlooked. A simple predictable way of how a basic root canal treatment has to be done.
Endodontic Tips

1) Pre-Operative Radiographic Assessment:

Before starting any root canal treatment, go through the pre op radiograph thoroughly. This helps in determining your approach of treatment. Observe the following:
  1. Distance between coronal structure and
  2. Distance between caries and
  3. Distance between caries and
  4. Curvatures in
  5. Width of the
  6. Calcifications in
  7. Calcifications in root
  8. Width of the Check for open apex.
  9. Presence of root caries or sub gingival
  10. Presence or absence of periapical abscess/cyst/granuloma.
Endodontic Tips

2) Communication With The Patient:

Once a proper diagnosis and treatment plan is decided, talk to the patient and discuss the following:

  1. Discuss about the prognosis of Be very honest about the chances of its success or survival.
  2. Inform the patient beforehand that in spite of giving local anesthesia, there might be mild to moderate pain or discomfort during the procedure. In such events ask them not to panic, shot or cry. They can raise their left hand to inform the
  3. Tell the patient that there are no guarantees in root canal treatments and sometimes in spite of taking all the efforts, the treatment may fail either in short term or in the long
Endodontic Tips

3) Anaesthetizing The Tooth:

  1. Every root canal treatment has to be started under local anesthesia. Irrespective of whether the tooth is vital or non-vital, symptomatic or asymptomatic, it has to be anaesthetized completely.
  2. Use a topical anesthetic gel or spray at the injection site before inserting the needle to minimize the pain or
  3. Give nerve block and not local infiltration.
  4. The anaesthetic should be deposited as slow as possible. This helps in proper dispersion of anesthesia and is also less traumatic for the
  5. In cases where nerve block is not effective, bend the needle and give intra ligamentry injection around the This is very effective in controlling pain.
  6. If the patient still experiences pain after access opening, intra pulpal deposition of LA can be done. But remember it has to be done under pressure by placing a finger above the

4) Maintaining Aseptic Conditions:

  1. What I have learnt over the years is that the success or failure of any root canal treatment is predominantly decided by the presence or absence of microorganisms. Make sure of the following:
  2. All the operative instruments, files, airotor, burs, endomotor and everything that is being used in the treatment is thoroughly

  3. Isolation of the highest standard.
  4. Saliva and blood contain a large amount of microorganisms and therefore isolation the tooth that is being treated is mandatory. Applying a rubber dam is the best option. In cases where there is no rubber dam, high volume suction with cotton rolls on each side of the tooth can help to a certain extent. Remember- some isolation is better than no isolation.
  5. Rebuilding the missing walls:
  6. This helps in preventing the outer microorganisms to enter in the tooth and also in holding the irrigant in the tooth chamber

5) Access Opening:

Use airotor with LED Improved visualization increases ease and decreases effort.

    1. Removal of caries is mandatory. This eliminates the microorganisms and also increases visibility. Try extending the carious part into the pulp chamber (caries driven access).
    2. In ideal cases or cases where tooth is used as abudtment, always start from the center (law of centrality).
    3. Try to locate the largest and the widest canal For example, palatal canal in maxillary molar and distal canal in mandibular molar.
    4. Based on radiographic assessment, make a slow guided approach with the help of a round bur till a drop in is
    5. Once a drop in is felt, extend it towards other canals without going any further This can be made easy by using a bur with non-cutting tip (endo Z bur).
    6. At any instance when there is difficulty in locating canals, the following methods can be tried:
      • Take a radiograph and analyze how far the cavity is from the pulp
      • Clean the cavity using sodium hypochlorite and then dry it with a cotton This removes the debris and enhances visibility.
      • Take a picture of the access cavity using intra oral camera. This gives us a magnified image of the cavity on the

6) Determining the working length:

For a long time, I relied on my tactile sensation and avoided this step. The logic behind it being that I would verify it with my master cone radiograph just before the obturation. I was negligent here and it took me time to realize that:

  1. Working on a short working length will end up in pulpal tissue and bacteria in the apical portion of tooth. And by the time we realize this in the pre obturation radiograph, we have to repeat the entire bmp from the beginning with the correct working This wastes a lot of time for the operator as well for the patient.
  2. Working on a larger than required working length causes pain to the patient and violates the apex. Continuous filing beyond the canal is the major reason for mid treatment flare

Common methods of determining the working length are:

  1. Taking a radiograph (Ingles method)
  2. Using a good quality apex locator (make sure the canals are dried to avoid any false reading)
  3. Paper points also help in getting an idea about working length. Bleeding or moisture at the end of the paper point indicate going beyond the

7) Cleaning And Shaping Of The Canal:

a)      Initial file:

The ideal initial file is 10k for any case. This file helps to create a glide path.

b)     Pre curving the file:

Pre curving the apical part of the file before placing it in the canals helps us to explore the curvatures and respect the natural anatomy of the tooth.

c)      Hand filing:

Whatever be the file system, hand filing upto minimum 20k helps to loosen up the canal and prevent stress on the root canals and also on the upcoming rotary files.

d)     Orifice opening:

This step is very underestimated. Using an orifice opener to open the coronal 2/3rd of the canal decreases strain on the rotary files. The enlarged orifices appear dark in color and aid in easy location of canals during bio mechanical preparation.

e)      Filing motions:

  1. The rotary files should never be forced apically in the canal. The motion has to be passive. Forceful filing will push the debris in the periapical area causing mid treatment flare
  2. Scrape the walls of the root canals with the
  • All files should be coated with EDTA preparations. This will facilitate smooth movement of the files. When the EDTA comes in contact with the walls of root canals, it causes chelation and helps in removing debris.

f)       Apical diameter:

  1. There is no fixed concept as to what size the apical diameter has to be This depends on various factors.
  2. Never violate the apical This will lead to loss of working length and also open the communication between apex and periapical area.

g)      Golden rule:

If access opening is being done, then BMP has to be done on the same visit. Atleast till a minimum hand filing of 25k. Avoid using formocresol. This will relieve the patient from pain and in most cases it will avoid the necessity of local anaesthesia on the second visit.

8) Irrigation:

Never compromise on irrigation. Copious irrigation should be done after each filing.

a)      Choice Of Irrigant:

  1. After experimenting with a lot of irrigants, I have realized that no irrigant is as good as sodium hypochlorite. NaOCl has tissue dissolving properties and also has a mild anti-bacterial effect. A great endodontist once said,” Doing RCT without sodium hypochlorite is like trying to cut vegetables with a



If a rubber dam is applied, then full concentration NaOCl (>6%) should be used.

In cases without rubber dam, 3% NaOCl should be used with cotton rolls on each side on the tooth and a high volume suction placed close to the tooth. The cotton rolls should be removed immediately after irrigation to avoid prolonged contact of hypo with the soft tissues.

  1. Chlorhexidine irrigant (2%) can be used in infected cases as it has strong anti- microbial

  • In calcified canals and blocked chambers, EDTA irrigant (17%) will help in chelation and make our work

  1. Saline is a good irrigant to wash out the debris. It is mild and non-toxic but it does not have any anti-microbial effect. It can be used as an adjunct with other irrigants.

a)      Method Of Irrigation

  1. Insert the irrigation needle 4-5mm away from the apex. The needle should never bind to the walls of the

  2. Irrigation should never be forced into the canal. The deposition of irrigant has to be slow and

  • Use side vent needles. Irrigation with side vent needles prevents the flow of irrigants beyond the

  1. Avoid using NaOCl, EDTA or CHX in the same tooth. This will cause a reaction and end up in formation of

  2. Let the irrigants stay in the canal for some Studies have shown that NaOCl requires at least 20 minutes to dissolve pulp tissue.

  3. Activation of irrigants can enhance the treatment success to a great extent. This helps in facilitating the flow of irrigants to all those places where our files cannot reach

9) Obturating The Canals:

a)      Drying the canals with paper points:

This is yet another step which is very underestimated and skipped by many practitioners. Drying the canals is mandatory to achieve good bonding of obturating material and canals.

b)     Common obturation techniques:

There are various obturation techniques and using any one of them would be fine. Honestly speaking, if the canals are cleaned well and dried properly, the technique of obturation does not have much impact on the success and failure of tooth.

I.             Single cone technique:

This technique works fine for molars and upper premolars. Make sure the single cone fits tightly in the canal, especially at the apical third and is well coated with sealer.

Palatal canal in maxillary molars and distal canal in mandibular molars have to be cross checked and if needed lateral gutta percha cones should be compacted.

II.             Lateral compaction technique:

Ideal technique for anterior teeth and lower premolars with single canals. Try to achieve three dimensional obturation with fluid tight seal (no lateral spaces).

III.             Down pack and back fill technique:

Another great and easy technique which can be used in all teeth. However, it requires specific obturating armamentarium which is not available in all dental set ups.

c)      Sealing the gutta percha:

It is very important to seal the gutta percha exactly at the orifice of canals. Make sure there is no remanant gutta percha in the coronal cavity as it may affect the placement of permanent restoration.

It is best to seal one canal at a time and not altogether.

d)     Cleaning the cavity after irrigation:

Clean the cavity with either saline or isopropyl alcohol and dry it properly with cotton pellet. Any contamination in the cavity with affect the permanent restoration.

e)      Sealer puff:

Not desirable. Neither harmful.

It may cause temporary post-operative pain which can be controlled by medications. It is important to understand the difference between sealer puff, sealer extrusion and over filling.

f)       Under and over obturation:

As long as the bio mechanical preparation is done properly and the canals are clean and sterile, a little short or a little over obturation is fine and wont effect the outcome of the treatment.

Anything in excess is not acceptable and if it happens then the obturation should be repeated.

10) Mandatory radiographs in RCT:

  1. Pre-op radiograph
  2. Working length radiograph
  3. Mater cone radiograph
  4. Pot-op radiograph

11) Communication With The Patient After The Treatment:

The following instructions should be given to the patient after the treatment:

  1. Post- operative tenderness e. pain on mastication is common in root canal treated teeth for a few days (3-7 days). This is normal and can be controlled by medication.
  2. Avoid biting on anything hard: Ask the patients to avoid hard foods such as bones, nuts, guava etc. as these may fracture the treated tooth. Patients have to be very careful at least till they get a crown.
  3. Ask the patients to come back for follow up evaluation of the treated teeth every 3 This is particularly very important in cases with periapical lesions.

12) Documentation of cases:

  1. All the data of the case should be kept with the doctor and stored permanently. This includes:
    1. Patient details
    2. Medical history of the patient
    3. Chief complaint of the patient
    4. Advised treatment plan
    5. Treatment done
    6. All the radiographs
      This briefly sums up our journey of predictable endodontics. Most of us have learnt all these points from our graduation days. The whole idea of this article is to gain a quick reminder of what we are supposed to do and to realize where we are probably going wrong. A small checklist for those who wish to have a safe and successful root canal treatment.

10 Tips to maintain Dental Handpiece

Here You Go...


  • Lubricate handpiece regularly
  • Lubricate with regular airspray provided by the manufacturer
  • Lubricate after work
  • Clean it before you start in the Patient Mouth
  •  After lubrication keep it upside down on the chair or stand


  • After lubrication keep it upside down on the chair or stand


  • Adjust the air filter regulator of the chair at 40
  • It should within 30- 40, more than 40 will spoil the bearings of the handpiece


  • Use the Chuck Lightly or
  • If it is pressable secure it firmly
  • Don’t over tighten the Bur
  • use only quarter turn to secure the Bur
  • Use clean burs only
  • Discard the bur if it is not going smoothly into the handpiece


  • Colored marking indicates position of the bur it should be placed exactly near to the marking


  • Clean your burs using Aluminium oxide stone chips
  • After cleaning of the bur run it on the stone with plenty of water spray


  • Use only sharp Burs
  • Discard the Burs after 5 or 6 Teeth of crown preparation
  • Use Burs cautiously during access cavity preparation of the posteriors there are chances of maximum torque and Dualplane forces.


  • Don’t Remove the metal highpoints with airotor handpiece


  • Clear the water channel regularly with Wire provided by the manufacturer or Orthodontic Ligature Wire.
  • Don’t use handpiece without Water it will block water channel


  • Water spray should fall on the tip of the Bur



Hey guys, today I am going to share with you a super material. which is going to change the future of Dentistry.

  • It is a supernatural wonder material,  which is stronger than any material known in the universe.
  • It is lighter than paper but stronger than a diamond.
  • It is 200 times stronger than steel. Its tensile strength is 130 Gigapascals yet it is very thin like an atom. 1 gm material is enough to cover an entire stadium.
  • If somehow we can make an elephant stand on a pencil and try to break this sheet with it, It will not tear or break.You may be wondering!!!! What is this materiel? This is Graphene.   It is a unique single thin layer of graphite which is of 2 Dimensional hexagonal structure . It was invented in 2004 by Prof Abdre Geim and Prof Koysta Novoselov. Who got nobel prize for the same in 2010. Graphene is an allotrope of carbon, In 2 Dimensional Honeycomb like structure.

    How it is useful for the dental industry. 

  • Graphenano dental has come up with a biopolymer of graphene in CAD CAM millable disc form called as G-CAM Disc. Graphene is a nanotrophic form of carbon, which allows to cover the monomer particle with its precursor thus resulting in a very dense biocompatible high flexural strength bio-material with mechanical, biological and chemical supermaterial properties. The polymerisation of PMMA trigers the exothermic chemical reaction. This chemical reaction is improved by graphene due to its excellent heat conductive property and resulting complete polymerisation with a very stable compact material with the elimination of all the negative properties of acrylic like coefficient of absorption of liquid and strength. This graphene polymer has very high flexural strength, high esthetics, high superficial abrasion resistance. This is what every dentist was looking for any prosthesis.
  • This is one of the game changer in Implant Dentistry, as it has high flexural strength so the impact forces on the underlying implant is very less.
  • Graphene superstructure will act as a shock absorber thus leading to prevention of high impact force on the implant body.
  • As it is highly aesthetic we can fabricate entire prosthesis in a single framework.
  • There are also other materials which has got flexibility and strength in the prosthesesis but they can’t stand by themselves so you can make only a framework out of that and you need high precision, high end equipment and materials to make an implant prosthesis. where as GCAM can be milled in any dry or wet milling machine. And you can just add glaze or composite layering on it to get the right shade of the teeth and gingival color.

Advantage for Dentists:

  • As it is a polymer we can repair anything intraorally it can be shade or shape or occlusal contacts. Even we can reshape the gingival contour in the oral cavity itself. We can also make Full crowns, veneers, Fpds also. G CAM discs are available in monochromatic and polychromatic forms so we can make direct monolithic crowns also. It has high esthetic than that of our Zirconia. The biggest advantage with general practitioners is these crowns are not that costly and clinical workflow is very simple. You can get the Aesthetics of Lithium Di-silicate with just monolithic poly-chromatic crowns.
    Repair is very easy; you can use your normal composites for any repair work no need to send it to the lab.

Advantage For Labs

  • The biggest advantage for Dental lab in comparison with zirconia; this  doesn’t need sintering so you will save lot of time and money Also it doesn’t require high end milling machines, any existing dry or wet machine can serve the purpose also we don’t require any cermist. If you have little knowledge of composite layering or its shading is enough to make g cam crowns. Yes it is new material with all together new fundas so we have train ourselves to get the best out of that. I am very thankful to the almighty that we are the part this change. There are so many advancements coming in this,  please stay with us. Thanks  to Neodental Technologies Pvt Ltd which has brought this product to India. Thank you for your attention. For more details or further clarification contact Kosmo Dental Academy.

Author: Dr M Anil Goud

  • Professor:  Dept of Prosthodontics and Implantology NRDC
  • Director:  Asian Dental academy Hyderabad.
  • Mentor: GPS Digital  Smile  Designing LAS Vegas USA
  • Mentor: German Oral Implontology and Surgery Germany
  • Coordinator: UCAM univrsity Spain.



Maxillary anterior teeth are very important in achieving successful aesthetics. Several factors contribute to this success which includes patient’s healing capabilities, level and condition of existing soft and hard tissues and provisional and final restorations.
  • Tooth extraction is followed by severe bone alterations both in height and width. Such re-modelling can make implant placement a challenging task mainly due to deficient  facial bone. However, it is possible to overcome this challenge by carrying out Socket Shield technique by partial extraction.
  • The following case outlines the technical basis of SST and demonstrates its importance in anterior implant planning.
  • Case Details

    A 46 year old female patient with no medical history, presented with appalling aesthetics.The patient had high smile line and had a history of wearing fixed prosthesis wrt 11, 13 & 21, 23 with midline diastema since 8 years. Clinical examination showed bulky prosthesis with irregular and short margins and severe gingival inflammation.

    On radiographic examination, the central incisors and prosthesis deemed hopeless, so removal of prosthesis along with 11, 21 was suggested . Also, thin buccal cortical bone was evident, so a socket shield technique by partial extraction of 13, 23 was planned.

    Case Planning

    • Patient’s CT was obtained and the planning was done on Blue Sky Bio software. The anticipated site wrt 13 & 23 were viewed in Cross – sectional and Tangential windows . It was observed that there was a very thin buccal plate available wrt 13 &23.
    • A measuring scale was used to define the measurements of the available bone. The length was measured from the crest of the bone to the nasal floor which was around 12mm and the crestal width was around 6 -7mm  in the right canine region.
    • On the left canine region, the length was around 14mm and the crestal width was around 7mm.
    • The final dimensions of the Implants decided were:  wrt 13 (4.2×11.5mm) & wrt 23 (4.2x13mm).
    • The anticipated placement of the Implants in the desired sites were viewed in panoramic window.

    Case Presentation

    • Following administration of LA, the tooth wrt 13 was sectioned using TF-13 bur at gingival level.  After complete sectioning of the anatomic crown of 13, 11 was extracted using maxillary anterior forceps the FPD along with 11 was extracted in toto.
    • Vertical and crevicular incisions were given to raise a full thickness flap and all the granulation tissue was removed. The tooth was sectioned bucco-palatally using PET (partial extraction theraphy) bur kit . This was intended to preserve the buccal 1/3rd of the root intact and undamaged. After thorough sectioning of the root, x-ray was taken to ensure the right path of the cutting.
    •  The palatal section of root was then carefully removed without traumatizing the buccal root section using Periotome and root forceps. The remaining buccal half of the root section was then shaped properly and reduced to the level of the alveolar crest. Curettage was done of the extraction socket to remove any granulation tissue.
    • Implant placement phase was initiated using a lance drill to engage the palatal aspect of the socket so that the buccal half of root would remain intact. A desired length of 11.5mm was achieved using the lance and pilot drill. Subsequent diameter drills were used to place the desired implant of diameter 4.2mm.
    • For proper flap approximation, the connective tissue was debrided and any remnant granulation tissue was curettaged. 
    • Same procedure was performed for the contralateral side wrt 23. Multi-unit abutments were screwed in for angle verification. 
    • Post-op OPG was taken to verify the implant placement according to the implant planning phase.
    • After the implant placement, a screw-retained temporary prosthesis was fabricated, chairside as per routine protocol for immediate implant placement in the esthetic zone. For this, temporary cylinders were tightened on the MUAs and holes were drilled in the prefabricated RPD at the temporary cylinders site.
    • Rubber dam was placed and a pick-up of the cylinders was done using cold-cure acrylic resin. After polymerisation, the prosthesis was removed and high-points adjustments were done. After finishing and polishing, the screw holes were blocked with Teflon tape and composite was placed and cured.
    • Following fabrication of the interim restoration, a meticulous occlusal check was performed to ensure non-functional loading. Postsurgical instructions included antibiotics and analgesic medication and chlorhexidine 0.12% oral rinse. At 2 weeks, the patient was asked to return for a postoperative evaluation. 


    For any FPD, diagnostic impression with putty is most useful and economical   

    •  It serves as diagnostic impression,
    • Diagnostic Casts made from it,
    • Mock preparations can be done from these casts
    • It can be used for making immediate temporaries
    • Same can be used to make final impression with Light Body


    Do the occlusal/Incisal preparation first

    • This will reduce the tooth bulk a lot, gives more clarity of long axis of the tooth
    • Always do preparation by cutting motion
    • Do not follow wiping or swiping motion for preparation
    • Use new burs for preparation. I can’t explain the details of preparation but if you follow my unique technique of crown preparation, your preparation will be highly predictable , conservative and fast. It needs little Hands on Extracted teeth with 2 ,3 preparations only you will get to know how exactly this cutting motion works. Better join our Fixed Prosthetic Session or Clinical Dentistry Fellowship.


    • Start gingival retraction with temporaries this will facilitate easy insertion of cord
    • Remove temporaries
    • Do final preparation and finishing


    • Take bite if necessary I will explain in detail About in my next Blog


    • Lute temporaries with temporary cement
    • Use noneuzenol cement for all ceramic or zirconia crowns
    • Use Euzenol cement for metal ceramic crowns


    • Shade matching should be done before tooth preparation
    • You can’t get accurate shade from comparing adjacent tooth


    Before going for final impression or gingival retraction

    • Prepare temporaries first
    • Lubricate the prepared teeth with petroleum jelly
    • Cut out excess material from the impression to have smooth re-seating  
    • Prepare vent hole channels along with the cervical margins of the prepared teeth to the outer surface of the impression with a scraper /BP Blade
    • This will let out the excess material out of the impression without creating any undue pressure
    • Add temporary resin or acrylic mix into the diagnostic putty impression into the prepared teeth sockets and place it over the teeth
    • After initial setting when material starts polymerization(increase in the temperature of mix), take out the impression and temporaries
    • Remove excess material
    • Finish And polish it
    • Try these temporaries in patient’s mouth
    • Check seating and high points


    • Now take final impression after few min of cord insertion
    • Take wash impression with light body, with or without cord, no need to add complete arch, just fill prepared teeth impression sockets and insert in patients mouth
    • Wait for 3 min and take out the impression Inspect for any voids, bubbles, irregularities


    • Here we used same putty for diagnostics, temporaries and for final impressions also
    • My sincere request is try using rubber base impressions for FPD’s and give immediate temporaries, may be metal ceramic or all ceramic
    • Alginates are used for diagnostics not for final impression
    • Cost may be higher by 200 Rs. But we are getting temporary along with that
    • We are giving immediate temporaries that’s a great relief for patients.
    • All together patients perception and your work standards will be improved with this.
    • Better join with us in the Fixed prosthetic session at Asian Dental Academy Hyderabad or NRDC Dental College Nanded, your complete perception towards Fixed prosthetics will be changed. We started Clinical Dentistry Fellowship where you will be given 10 cases of Endo, 10 cases of FPD’s and 10 cases of  Restorative and Extractions. We also cover Laminates and Veneers in this.


    The major reasons for op sensitivity is because of Micro- Leakage: Especially due to  improper bonding and condensation. Most of the clinicians in fact avoid composite fillings due to post op sensitivity phobia. There are lot many advancements evolved  in adhesion mechanism to counteract bonding failure, we need to understand many aspect of composite restorations to avoid these complications. This article will help you construct clarity on the right methods of composite filling:


    • Proper Marginal Seal can be achieved by clear understanding of the complex interplay between polymerization shrinkage and adhesion.
    • The cross-linking of resin monomers into polymers is responsible for an unconstrained shrinkage of 2% to 5%.
    • The uncompensated forces may exceed the bond strength of the tooth-restoration interface, resulting in a gap formation from a loss of adhesion.
    • The shrinkage forces generated by a high modulus material or a high volumetric shrinkage can result in stresses, being transferred in a pulpal direction, resulting in dentinal tubular fluid movement that stimulates the odontoblastic process.
    • This pressure change may be responsible for postoperative sensitivity upon mastication.
    • There are lot factors which can decrease this gap formation and thus Post op sensitivity.


    • Understanding Basics of adhesion principles or Dentin bonding is must to get proper adhesion
    • There are Two concepts of Bonding
    • Total etch (etchant + prime and bond) and self etch (single Bottle, all in one)
    • Total etch should be prefered for cavities or preparations involving only enamel surfaces and Self etch should be used for Dentin preparations, and for deeper restorations Resin modified glass inomers liners should be used.

      Note: The most  important thing is to prepare the tooth surface for Bonding,  creating the moist tooth surface will facilitate good bonding and remember  at any circumstances Dentin should not be dried thoroughly but moderately moist.  


    1. The cavosurface enamel margins of the preparation should be etched for 30 seconds with 37.5% phosphoric.
    2. A self-etch primer should be applied to the dentin for 20 seconds and air-dried for 2 seconds.
    3. A bonding agent was applied to the enamel and dentin surfaces for 20 seconds, lightly air-dried and light-cured.
    4. If it is self etch one, apply the bonding agent for 40 seconds, air dry it by chip blower for 2 seconds
    5. Curing should be done for each surface in the perpendicular direction.


    Before we get on to the procedure, lets know the  major factors that influence polymerization shrinkage:

    • Type of resin,
    • filler content of the composite,
    • Elastic modulus of the material,
    • Curing characteristics,
    • Water sorption,
    • Cavity configuration, and the intensity of the light used to polymerize the composite


    • First three factors are related to the Material which can not be controlled by dentist
    • Rest all are operator dependent.  


    • Intensity of light, the illumination must be in the range of 460-480 nms. I recommned all to please check the curing unit light intensity at least once a year.
    • Time: strictly follow manufacturers instructions,
    • Distance from the curing material,  It should be as near as possible.   For each mm light intensity is reducing drastically. This diagram explains the intensity of light at 0-1mm, 1-2mm, 2-3mm. For the first 1 mm it is 65% and for 3mm it is negligible.


    • The light coming out of the tip is like a stream of water from a hose. The flow is highly acclimated. There fore, light only goes where you point the tip.
    • Unusual features of the cavity preparation design require that you angulate the light from a variety of directions (usually requiring more curing cycles).


    • Avoid bulk filling and bulk curing, follow layering technique to avoid Marginal leakage
    • Use clean instruments
    • Don’t keep any voids in between the layers
    • Give sufficient time after each layer of condensation and each cycle of curing to compensate material to shrink
    • Understand the basic principles of C- Factor

      C-Factor configuration factor is the ratio of the bonded surface to the unbonded or free- surfaces in a tooth preparation. The higher the c factor greater is the potential for bond disruption from polymerization effects.

    • Don’t keep premature occlusal contacts
    • Fully excavate residual tooth decay
    • Polishing should be done after complete adjustments of occlusal contacts
    • Liquid polishers will be more useful to fill the Voids on the surfaces
    • Don’t use bonding agent as polisher
    • These are the few basic things which needs to be understood.
    • Composite restoration is purely artistic job we need to invest lot of time to master this art
    • For any query please write us in comment box
    • If you liked please do forward to your fellow colleague.

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