Alexander Orthodontics 2

Now I have finished two more weeks here in my internship at the Alexanders, it has been a busy two weeks though. My third week I was able to practice on tipodont how to do ligatures, omega loops, place elastics, and how to place the archwires. On the fourth week I was able to start working on patients on the basic appointments like tying rotations, removing archwires, placing new archwires, starting the patients for their bracket placement, trying on bands, adjusting headgears, etc. So as you are able to see busy busy all the time. The opportunity has been great in order to become even more familiar with the whole process the patient goes through while wearing brackets. Also I am able to learn how Dr. Moody motivates each patient so that they wear their appliances, and every patient really enjoys coming here, so we are able to create a very nice atmosphere in the office. 

 

Omega Loops

I had the opportunity to understand the process of sterilizing the instruments, which I think is very important for any dentist to not only understand but acknowledge the importance of it. Crossed contamination has become a rather important issue now a days in the health sciences, so in order to provide quality of treatment for our patients we need to be concerned of their safety as well. 

In this office every stone cast is taken to a special lab, where they are digitized into a 3D computer version of it, where you are able to access the models in the patient's file and compare the initial ones to the final ones. This is a wise way of prevent your storage room from crowding and you are able to be certain these will not break or get lost. 

     

During this two weeks I was able to attend Dr. Wick's study club meeting, where I was able to participate in the discussion of very complicated ortho cases, and it was impressive hearing the orthodontists (including my mom because she came for the meeting) participate and giving their different opinions on how to solve the cases. It was very enriching to hear each doctor express their unique way of solving each case, each of them using the Alexander Discipline to do so. 

Overall I am very excited of what comes next!

Alexander Orthodontics

The transition has been made, from Dallas to Arlington. After saying our goodbyes to Baylor and Dallas I arrived to my new home for the next two months, Arlington TX. Arlington is a small but charming little town, here I am going to be observing in the dental clinic of Dr. Moody Alexander. This orthodontic clinic is the place to go, hands down when you need to go through your bracket phase. It started off with the dental eminence Dr. Wick Alexander, founder of the Alexander Discipline and it was passed down to his great son Dr. Moody Alexander which has continued to keep the high standards the clinic is known for.

The clinic is beautiful, it consists of four main rooms to treat patients: the rainbow room (which is my personal favorite)  its a beautiful room which has chairs of every vibrant color possible, the adult room which consists of a more serious environment, the records room where extraoral and intraoral pictures are taken, and an extra room where impressions and retainer checks take place. Pictures surround the whole area, bulletin boards are created to focus on the latest events the patients have participated in, my favorite one is the smile through generations bulletin board, here they post generation pictures of patients that came here when they were children and have brought their children afterwards, which proves that great service and quality of treatment goes a long way.

rainbow room

                      

We have an early start each morning, and the clinic greets everyone with cheerful music. Once you come in you are greeted by the sweetest secretaries, and guided by efficiency every patient is treated shortly after arriving. The staff is composed by 5 dental assistants which make each appointment very special to each patient, their unique personalities help each patient identify with each one and makes the appointment fun. There is a room dedicated for new patients which has beautiful pictures of their former patients after they finish their treatment, showing off their beautiful smiles, here each new patients receives the options that exist for their problem and the whole explanation of how their treatment will be handled.

  

Treatment Options: Lingual braces, Invisalign, metal and clear braces

Dr. Moody is not only an orthodontist but he dedicates himself to help the children in Ethiopia, by organizing yearly mission trips to Ethiopia where he takes a medical staff with him and provides dental and medical revisions while he is there. Also the community is blessed by all the teams donations, pictures of the mission trip are posted in the office so that patients are aware of what he is doing so if they would want to help they are welcome to.

Here in the Alexander Clinic, they try their best to make the patient's road through braces fun, they host contests every month, they also give tokens based on how good the patient is handling their hygiene so they can win prizes, but my personal favorite idea is that the day their treatment ends they get huge balloons with a bag of goodies filled with gooey candies and chocolates.

               


Here infection control is very important as well, every unit is perfectly cleaned after each patient and the all the instruments go through a sterilizing procedure. So far these weeks have been highly productive and a lot of fun!

Seventh and Eighth Week: Endodontics and General Dentistry

Seventh Week 
The seventh week in Baylor we were transferred to Endodontics. We were able to observe root canal treatments in several patients. As mentioned in a previous post, here in Baylor the students are able to use rotary instruments to work and GuttaCore to obturate.

In the first appointment, X Rays are evaluated and the tooth receives vitality tests, in order to decide if a root canal is necessary. After careful evaluation of the options available for the patient,  a treatment plan is developed. If the best option is a root canal, the cleaning of the canal may start in that same day.

This is the cassette for root canal treatment

After reaching the access point, the student takes the estimated working length with a  #10 file and takes an X Ray to verify. After the canal length is checked, the cleaning of the canal may begin. Here they used a low speed rotary instrument to clean the canal, which allows the cleaning of the root canal to be more dynamic and precise. This shortens the appointment tremendously, which makes it more comfortable for the patient and the clinician. Every root canal is done in a two appointment manner. After thoroughly cleaning the root canal if the patient had an abscess or a periapical lesion the canal is filled with a calcium hydroxide paste, which will help to avoid contamination and help the healing process to be faster. If there is no lesion the canal is left  alone and a cotton ball is placed and the preparation is filled with a temporary material calledTI CORE which is a mix between titanium and composite.

Materials needed for the root canal 

This is what the TI CORE mix looks like it has a very fast setting time
so the students have to be quick

 

In the second appointment the TI CORE is removed and the canal is cleaned once again just to verify there is nothing there and  irrigated with sodium chloride to ensure the canal is ready to obdurate. Before placing the GUTTACORE they place a paste in the apex to avoid any guttapercha going beyond the working length. Then they select the GUTTACORE file number to obdurate with, which is the same number as the last file they used to clean the root canal. After inserting the GUTTACORE they break of the tip and condense the material to ensure the whole area is covered. Which leads to the last step which is to build up the tooth for a crown prep or to seal it with vitreous ionomer.

This is where the GUTTACORE is placed

GUTTACORE instructions

The last day we were able to attend to the graduate Endo program, where they have highly specialized equipment for root canals. Here everything they do is through a microscope, so they are able to be very careful and exact. The image is then transmitted to a screen in front of the patient so they are able to see the procedure, and so that the assistant is able to be prepared with the material the resident is going to need.

Grad Endo Department 

Eighth Week

In our final week we attended General Dentistry, we were able to observe procedures similar to those described in the first week in Baylor. At the end of the eighth week we went to say good bye to all of the doctors we had met and thank everyone for helping us and for being so welcoming.

This truly was a wonderful and enriching experience which we were able to learn and increase our dental knowledge. Baylor has a great dental program, and their installations have the latest  technology in dentistry in order to create a great environment for their students to learn.

Sixth Week: Pediatrics

Our sixth week started in the Pediatric Department, the whole place was decorated in order to make the child's visit a little more enjoyable. The pediatric residents were able to receive children from 6 months to 18 years old. While we were in the clinic we were able to observe cleanings, crown preparations and the placing of sealants and composite obturations. We were able to observe how the doctors try to mold the patient's conduct with the techniques that Dra. Aida showed us in her classes. After the patient's conduct was evaluated, the doctors in charge decided if the patient would need an administration of nitrous oxide during the long appointments (extractions, crown preparations and placing of obturations).

The waiting area in the Clinic

Pediatric protection for X Rays 

We were able to observe a crown preparation in a patient that was around 8 years old. Here their protocol is a little different than they way we do it in Monterrey. They started off with nitrous oxide at 70%  and his pressure was carefully taken every 30 minutes, in order to ensure that he was doing ok. Here the crown preps are done with a rubber dam on the patient where they carefully evaluated the dimensions and how the crown is going to fit. After the crown is placed and adjusted they cement it and check the occlusion and margins. When the appointment is over the nitrous oxide starts to be reverted, by increasing the concentration of oxygen.

Initial kit: the patient is given a toothbrush and paste 

Nitrous Oxide tanks

Setting up for the appointment

           

These kits are equipped with all the material needed to do a sealant 

The patient is also given a pair of sunglasses so that the light
doesn't bother them 

After the appointment every patient gets a little surprise.

Fifth Week: Orthodontics

An appliance we were able to observe in our class
used to treat an open bite in children

Our fifth week began with our rotation in Ortho, Carolina and I were very excited because this is the area in which both of us would like to specialize in the future. The clinic was beautiful, there was music in the background and everything ran smoothly. We were able to attend to the clinic every morning from 9-12, as well as Monday and Wednesday afternoon from 1-5, and the rest of the week we attended Ortho classes with the first year residents in which we were able to discuss subjects such as Cephalometrics, Research Design and Methodology, Contemporary Orthodontic Appliances, Clinical Seminars and Human Cranio Development. Each class consists of 6 residents, which allow the leaders to offer them undivided attention. Classes are very dynamic, because they have computer screens that project the PowerPoint but also allow the teachers or students to draw on top of them allowing the students to understand thoroughly. 

The learning technique used

 

This appliance aids the treatment of a patient with Class III 

The clinic was very organized, every resident has their own chair which contains all of their materials and their computers which contain their patient's appointments and information.

Each student's individual cart where they have their material 

                                   

The way each unit looks like.

Each appointment starts as usual: taking the patients information, initial impressions, intra and extraoral photographs, evaluation of X Rays, evaluation of occlusion and a overall exam of the facial distribution. The patient is also given an initiation packet which includes: a T shirt, a brochure with instructions of how to deal with cleaning brackets, of what food to eat, a new toothbrush and a special rigid floss to make the flossing easier.

          
 

These are some of the instruments used for the first appointment. Here they use flexible trays which allow the resident to open it in order to take the impression in patients that have bigger arches, and they use wax on the borders in order to copy the vestibule area 

This is an alginate mixer which eliminates the possibility of bubbles and helps maintain
a clean bowl making the process of mixing alginate quicker and more effective

After developing a treatment plan the patient comes back to the appointment where his brackets are placed; we were able to see two techniques of bracket placement: Direct technique and Indirect technique. The Indirect technique is faster for the patient and delivers a more exact bracket placement  but requires lab work for the clinician, which in my opinion is the best way to go. The direct technique involves the traditional way of bonding brackets one at a time which makes the appointment a little bit longer. Prior to the placement of brackets a sealant is placed over the buccal surfaces of the teeth which helps protect the teeth from white lesions during the treatment. We were also able to witness a patient treated with Invisalign and the procedure this involves.  

This was the tray required for this appointment 

This was the Direct Technique where the brackets were placed
individually, these were covered because they were pre cemented

This technique was the Indirect Technique where the brackets were already
placed in a custom tray which were then bonded to the teeth all together 

This was another presentation of the brackets for the Direct Technique 

           

                                 This instrument came to be very handy when placing the brackets because it isolated the
cheeks and tongue in order to create a dry environment to provide excellent
bonding results

                            

                             At the end of the appointment the patient was able to choose the color of the
                                           band they wanted

This was the tray needed when a patient came back because
one of the brackets detached. 

 After the treatment is finished the patient comes back to get impressions so that the retainers are made in order to maintain the position their teeth are in.

This is a special alginate used to take impressions of a patient with
braces, due to its  rubbery consistence it enables the clinician
to take the impression without tearing the alginate

Here are some examples of retainers 

After retainers are delivered the patient is able to leave with a beautiful smile. Being able to see how the patient evolves from the first to the last appointment is priceless. That's when you know you have completed your job.