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One day dentistry in Nepal: Root filling followed by crown within 4/5 hours.

One fine evening when I was walking along the curb of Kings way with senior dentist Dr Niranjan Sharma he shared me his interest, “Dinesh, I feel like starting a crown milling machine.” 
I said, “Seriously? inside your clinic? for your patients only?” 
He said, “Yes!” And, told me the convincing calculation as well. And, listed me benefits of installing inhouse milling machine as well. 

After quite a hiatus, when I met him he was already about to go to Germany to observe and order his machine with the help of Nepali local dental suppliers. 

His philosophy was patient is the God and if they get the best service available, they will automatically patronize your project. And, his idea was , on the other hand, life becomes very easy, whole process of prosthesis is single handed or at least under the direct supervision of one person bypassing lot of hassles: Making impression, sending it to the lab, waiting for the lab, then sometimes you have to adjust yourself or send again back to the lab. So, he said, “ I think this would be a good idea to start your own milling machine inside a dental clinic.” 

After couple of months preparation he installed his plant inside his clinic.
And I again asked him, How are you feeling?  He replied, “A little bit pressure but It feels very cool.” And I said, “What is pressure about and what is cool feeling?” He said, “Pressure means this is new experience, sometimes it takes one more hour than expected  but at the end of the day patients wear their ornament fabricated and finished right in front of them within couple of hours’ hard work by their dentist. They see their partner in chewing or smiling for the next decades been milled in their presence. You feel more satisfied, by being at least an iota part of a modern day dentistry in Nepal even if this has already been just a cup of tea in the west.”

Remembering another senior most dentist of Nepal Dr Chhetry, mentor of many established Nepali dentists including myself, recounting his experience with me that there was a time Nepal did not have dental labs for fabricating fixed prosthesis for teeth. There was no option but to send impression to India. Sometimes color was to be compromised and sometimes altered size and shape. But, this stride ( a single day dental crown)  is something worth mentioning in this part of the world. 

When a patient is in a rush and needs Root canal done followed by crown or  table top (to protect that teeth from being split) same day, this can be helpful.  
In that case, RCT is done within couple of hours. As that RCT is done, a space in the head region of tooth is made ( by whittling down) for the crown to come. Then that prepared tooth is scanned by the scanner, that scanned information goes to the milling chamber. A block of required size, shade and quality is put in the slot. After an hour or so´s cutting time, a crown gets ready. After final finish and polish, patient wears this and can start biting ( just like natural molars) or dazzles people around ( just like natural pearly whites)  after that glue sets well; may be in a couple of hours’ time.

So simple, eh! 
As mentioned above, it is new in Nepal. People´s affordability, our economy and dental-health-a-less-priority are the reasons these things are taking time to be part of our dentistry in Nepal. 

Hope many dentists in Nepal in  near future will start their single day dental prosthesis (especially for crowns and veneers) and this kind of thing will be partner in practice for  new and adventurous up and coming dentists who are rising up by the day.

It saves a lot of things: your time, your manpower hassles and not losing details while transferring your impression: somebody carries it to the lab and lab makes and prepares a cast, and that cast is a replica of your work. There are a lot of minute details that can be lost, a lot of things will be missed. So, if you do it within your premises in front of you, you can play well, because all things are being done single handedly that is always better than the one which passes via multiple hands, which is done by chain of multiple steps. This is one benefit. Patients´ time saving would be another benefit. When patient have hassle free dental experience, they will be all the more motivated to go to the dental office. 

Dental Blocks used after making immediate but long lasting crowns
Dental crown milling machine.
Intra-oral scanner that transfers minute details to milling machine.
Raw materials: Block needed for crown making.

Finally, I asked Dr Niranjan Sharma, what are the difficult thing you feel to run a milling missing within your practice? 

“ Blocks, bro!, blocks!!” he says. 

“ Block of Money to spend in the first place?”  asked. 

“Nope! Money is secondary thing that is all paid by quality patients who deserve the service. But, blocks which are used to make crowns are not available locally. And, no  suppliers are doing this as well.” 

“So?” I asked. 

“ I manage from my friends, families and connections in the US. But, yes!, serving people with challenges every day is also fun!” He quips.    

By Dr Dinesh Karki, Dentist in Kathmandu. Curator of DentistNepal and DentaltreeNepal.

Details of the intraoral study while scanning the teeth to be crowned.

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