My day as a "solo" practitioner.

Your worst fear. Your staff all calls in sick. You will have to work without any assistants and/or assistance! Well, almost--your wife will handle the front desk. At last, I now know why we practiced solo while in dental school. Inevitably this day would come.

My hat is off to my colleagues who practice without an assistant on a daily basis. As one who needs at least one other set of hands, I became the true "solo" practitioner on that day! Once I took a deep breath, gathered my thoughts and reviewed the schedule, I knew this would prove to be a positive experience. With so many new materials, dentistry has become a bit easier when you only have two hands. I will mention specific products I used to make it easier for the reader to prepare an "emergency solo kit" for the day he/she will experience in the inevitable life of a solo practitioner.

Of course, this is the day that every patient will show up for their appointment, on time, or even five minutes early. My first patient was in need of some routine restorative dentistry. While I consider myself to be a fast and efficient operator, the challenge was laid before me. On a first premolar I noticed two darkish areas in the occlusal pits, commonly referred to as "snake eyes." I chose to explore these for decay using the Fissurotomy instrument (SS White). Once I entered into these areas minimal decay was found. Removal of all the decay was confirmed visually with the assistance of Caries Finder (Danville Engineering) and an explorer. To restore these fairly shallow areas I used a single bottle system, iBond (Heraeus Kulzer), followed with a flowable composite called Flowline (Heraeus Kulzer).

This patient also needed a class II (MOD) restoration on a previously restored first molar in the same quadrant. Anesthesia was accomplished for both teeth painlessly, using the N-tralig syringe for intraligamentary anesthesia (Miltex) and Septocaine 4% w/epinephrine 1:100,000 (Septodont). For decay removal I used a 1557 straight, roundended, cross-cut fissure bur (SS White) and confirmed the removal of all the decay and old alloy restoration. I find that using this bur allows for both fast and efficient removal of previously placed alloy material and complete preparation of the cavity to receive the new restoration. The tooth was isolated and a matrix band placed. Contact was assisted with a WedgeWand (Garrison Dental).

For the restorative phase I again relied on iBond, and used Venus (Heraeus Kulzer) for my restoration. To cure the material it was helpful to have a cordless LED light. I used the Radii (SDI) but also own the Kerr L.E. Demetron I and Denmat Allegro lights. Each is terrific and easy to use. Shaping of the occlusal surface was made easy using the "Duck-Head" instrument (Hu-Friedy) and for the final sheen I used a Pogo (Dentsply) polishing disk.

Okay, I'm exhausted just from remembering the day and all that I had to use. Since we don't use tray setups, the real problem was in locating everything I needed. Kudos to my assistants who know where everything is, have it ready, and available for the procedure. The day continued with more restorative treatments and then came the crown. I cringed ... this would be my big test! This time luck was on my side. No, the patient didn't cancel. The patient was very cooperative, could open real wide, and the tooth requiring the crown was a lower first molar.

Again I set out to gather what I needed. However, all the materials I needed were easily assembled due to two key components of our crown and bridge materials. First, I use a "gun rack" (Simple Dental). Hold on, you NRA buffs, this type of rack holds all the automix guns and cartridges that I need for impressions, temporary fabrication and cementation. Credit must be given to my colleague Dr. Scott Perkins, in Houston, for such an ingenious device. Second, I used a crown and bridge Speedpak (Simple Dental). This speed pack has the tips for the automix cartridges, retraction cord, articulating paper, etc., right down to postop instructions. It is a real time saver even with an assistant!

Anesthesia was again performed in the same fashion using the N-tralig and Septocaine 4%. In the short time needed for the anesthesia to work, I took my impression for the temporary using Flexitime Monophase impression material (Heraeus Kulzer) in a rimless quadrant tray. Preparation was accomplished by using a GW 2 and Piranha single patient use burs (SS White). While some may say using single patient burs is costly, they are far more efficient and provide a better result. A final impression was taken with a sideless, quadrant tray (Clinicians Choice), in occlusion ("triple tray technique"), using Flexitime Heavy Tray and Correct Flow (Heraeus Kulzer). No additional syringe was needed for the Correct Flow due to the unique, 3600 swivel tip. The temporary was made with an automix bis-acryl, Luxatemp (Zenith/DMG). After polishing, a high glossy sheen was applied with either Palaseal (Heraeus Kulzer) or Luxaglaze (Zenith/DMG)--don't remember which but both work very well and are light cured. Cementation of the temporary is with an automix, noneugenol cement called TempoCem (Zenith/DMG). By the way, PermaCem is a great "sister" automix product to TempoCem, which I use for final cementation of the finished crown or bridge.

And so the day went on to a welcomed and exhausting conclusion. Would I opt to practice like this everyday? Absolutely not! But it is great to know that when and if I get the calls at home that my staff is ill, and unable to work, I won't hide under the bed and pray for snow!

Dr. Glazer is a Fellow and Past President of the Academy of General Dentistry, and former Assistant Clinical Professor in Dentistry at the Albert Einstein College of Medicine (Bronx, NY). He has been a visiting clinician at several universities around the country. Additionally, he is a Fellow of the American College of Dentists, International College of Dentists, American Society for Dental Aesthetics, the American Academy of Forensic Sciences, and a Diplomate of the American Board of Aesthetic Dentistry. Dr. Glazer is an Attending Dentist at the Englewood Hospital (Englewood, NJ) and is the Deputy Chief Forensic Denial Consultant to the Office of Chief Medical Examiner, City of New York. He is a director of the American Dental Assistants Association Foundation.