Ashley Mahoney

3/13/17

DH271

For my office visit, I went and observed at Dr. Harpers practice off of Cal
Young road. I observed two procedures, an extraction and an implant
placement. There are two assistants and one hygienist who work in his office.
Shelly was the name of the assistant who I observed. Patients are referred to his
office for NSPT, simple extractions, tissue grafts, gingival flaps, and root
amputations. The hygienist there also performs perio maintenance.

The first procedure was implant placement on #31. The patient had the
extraction in July 2016, and a bone graft was taken at this time as well. Two
weeks prior to the implant placement, the patient had a conebeam radiograph
taken in order to check bone height. After the assistant brought the patient
back into the chair, she explained the procedure and gave the patient 4 500mg
Keflix. The antibiotics are used as a premed for implants, so that the patient
doesnt have to take a whole weeks worth.

The product used was a Nobel implant guide. It consisted of two boxes-
one contained different kinds of drills, and the other was a main station which
hooks up to high speed handpiece. After the doctor double checks the
radiograph (PA that they took that day), he performed an SP below #31 using
cartridge of septocaine. The different drill heads ranged in diameter from
3.5x11.5-5x11.5. The dentist begins with the smaller diameter, and works his way
up slowing widening the opening. After the stent was placed, he used the tissue
punch to mark the head of the implant. The assistant used the HVE to suction
the tissue circle, following by irrigation with a syringe. He used the precision drill
incrementally, until a 5x11.5 incision was achieved. Next, he removed the stent
and used the twist drill to create grooves for the screw implant. The assistant
irrigated once more and placed the Nobel titanium implant into the socket,
followed by a cover screw. The doctor then checks occlusion, and has the
assistant take a pano to check proper placement.

The assistant then provided patient with after care instruction such as
warm saline rinse, ibuprofen, and CHX .12%. In five months they will have the
patient back to check integration and determine if it is ready for a crown. A
follow up appointment a week later was also scheduled to check for infection.
All together, this procedure took about 30 minutes.

The second procedure I observed was a simple extraction of #1. The

patient was rather anxious, so he requested nitrous oxide sedation. After about
five minutes of sedation, the dentist administered a left PSA and left GP using a
cartridge of septocaine. He then used an elevator to check soft tissue and
loosen the tooth. Next he picked up the pliers to remove the tooth, it came out
rather easily I was surprise. He used a Nevi to clean out the socket. The assistant
irrigated, and clotted the blood using forceps and cotton. The dentist then
placed 1 plain gut suture. After titrating him off the nitrous, the assistant
explained follow up care, medications, and scheduled an appointment one
week later to check for infection. This procedure took about 30 minutes as well.
The software that they used at this office was Daisy, with Tigerview for x-
rays. The autonote template was interesting to me because there wasnt really a
template. It looked like an e-email with a couple blank fill in information. The
assistants write all the autnotes for the day. They basically just outlined what the
procedure was, aftercare instructions provided, x-rays taken, ITAC, and any
complications that occurred.

Overall, I was pleasantly surprised by how simple these procedures turned

out to be. Reading about them in a book is very different than actually
experiencing the procedures. It was a smaller office which I liked, and all the
staff seemed to get along very well. To me, it seemed like there was more
variety in the day to day procedures. The assistants always went over home
care at the beginning of the procedure in order to not be rushed and allow the
patient time to answer any questions before the dentist made it in.