- Email: [email protected]
A fast and efficient method for cast core provisional restoration of anterior teeth
A fast and efficient method for cast core provisional restoration of anterior teeth T i m J. D y l i n a , D D S , a a n d D e b r a R u t h e r f o r d , R D A a
Merced, Calif. A broken maxillary anterior tooth is an emergency to most patients regardless of the cause. This article describes a direct method for making a cast core provisional restoration for anterior teeth or premolars and has the advantages of (1) producing an esthetic, stable, temporary restoration in less than 30 minutes and (2) a grateful patient. It has the slight disadvantage that the dentist must develop a touch for the setting time and properties of the acrylic resin. This procedure may also be used before cast core fabrication to overcome esthetic concerns of the patient. PROCEDURE Temporary restoration may be the only procedure on the initial visit. The tooth must be cleaned and prepared to its final state to avoid repetition of the process at the appointment for cast core fabrication. 1. Make a cast core preparation one half to two thirds of the length of the tooth vertically (5 mm from the apex) 1 and one third of the diameter of the root horizontally. 2 Use a warm endodontic plugger and no chemical solvents for gutta-percha removal, a (If the tooth is vital, extirpation of the pulp will be necessary before this step.) 2. Draw a No. 3 Peeso reamer (Union Broach, New York, N. Y.) from the apical to the incisal surface that conforms to the anatomy of the root form with slight telescoping to prevent undercuts (Fig. 1). 3. Clean the canal preparation with 4% hydrogen peroxide followed by Maxiclens soap (Henry Schein, Port Washington, N.Y.), dry thoroughly and coat internally and occlusally with petroleum jelly (Vaseline, Cheseborough Ponds USA, Greenwich, Conn.). 4. Measure the mesial-to-distal width of the missing tooth space with a Boley gauge and obtain the appropriate 3M Ion crown form (Dental Products, 3M Corp., St. Paul, Minn.) to fit the area tightly (Fig. 2). Trim the crown on the mesial and distal surface so that contacts are sufficient to hold the crown form in place with no other support, and trim the gingival edge of the crown form to permit seating so the proper incisal height is unimpeded. 5. Make a loop or bend a piece of 0.036 inch Elgiloy orthodontic wire (Elgiloy Elgin, Ill.) and cut it 2 mm short of the anticipated crown and core height. Place the wire
aPrivate Practice. J PROSTHETDENT1995;74"319-20. Copyright 9 1995 by The Editorial Council of THE JOURNALOF PROSTHETICDENTISTRY. 0022-3913/95/$3.00 + 0. 10/4165374
SEPTEMBER 1995
Fig. 1. Canal preparation at one third diameter of root surface.
Fig. 2. Crown form fitted tightly to enhance retention.
in the prepared canal and place the crown form in the ideal position to ensure full seating. Remove the crown form and wire (Fig. 3). 6. Place Alike monomer (Coe Laboratories, Inc., GC America Inc., Chicago, Ill.) in crown form, fill a centrix syringe with the appropriate acrylic resin shade, and syringe it into the preparation and crown form. Place orthodontic wire in the canal with cotton pliers and seat the filled crown over it (Fig. 3). 7. Remove excess marginal acrylic resin with an interproximal carver (Hugh Friedy, Chicago, Ill.) and start a light pumping action after 30 seconds. View laterally to verify that the acrylic resin is not separating between the crown and core. If it is, let the acrylic resin harden 15 additional seconds and then continue the pumping
THE JOURNAL O F PROSTHETIC DENTISTRY
319
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 3. Syringe tip placement of acrylic resin to ensure maximal core length.
action. When it stabilizes into a single unit, continue pumping slowly up and down until final setting occurs (approximately 2 minutes). The longer the acrylic resin is pumped, the better the final fit. 8. Place the crown and post in a pressure pot with warm water for 5 minutes. Trim with a bur to ideal margination and emergence form. Check and adjust occlusion on the crown in centric relation and all excursive movements to ensure ideal occlusion. An 8 tim thick shim stock (Almore Int., Portland, Ore.) should pull through with light resistance in centric occlusion. 9. Cement with a noneugenol temporary cement of choice (Fig. 4).
DYLINA AND RUTHERFORD
Fig. 4. Completed temporary crown.
REFERENCES 1. Sorenson JA, Martinoff JT. Clinically significant factors in dowel design. J PROSTHET DENT 1984;52:28-35. 2. Tilk M, Lommel T, Gerstein H. A study of mandibular and maxillary root widths to determine dowel size. J Endodont 1979;5'.79-82. 3. Mattison GD, Delivanis PD, Thacker RW. The effect of immediate post preparation on the apical seal. J PROSTHET DENT 1984;51:785-9.
Reprint requests to: DR. TIM J. DYLINA 1132 OLIVEWOODDR. MERCED, CA 95348
A d h e s i v e r e s t o r a t i o n s w i t h a m a l g a m : G u i d e l i n e s for t h e clinician. Gwinnett AJ, Baratieri LN, Monteiro S Jr., Ritter AV. Quintessence Int 1994;25:687-95. P u r p o s e . This article presents a literature review of the development of the adhesive amalgam restoration and guidelines for its use as a restorative material. Restorations with adhesive amalgam combines the best properties of dental amalgam with the principles of tooth structure preservation and marginal seal inherent in adhesive restorative materials. The results of early clinical use and laboratory testing are encouraging. In spite of the lack of long-term longitudinal data, this bonded amalgam technique may become routine in the future. This system needs confirmation by independent clinical research to become a valid restorative technique. The authors describe the clinical applications (indications), advantages, and limitations (disadvantages) of the bonded amalgam restoration. The technique is presented clearly in a step-by-step fashion by use of superb clinical photographs. The authors conclude that preservation of tooth structure, low placement costs, and reduced chair time will Continue to make amalgam the material of choice for many patients. This technique, when perfected, will overcome some of the shortcomings of amalgam as it is currently used. 82 references.--RP Renner
320
VOLUME 74 NUMBER 3
Merced, Calif. A broken maxillary anterior tooth is an emergency to most patients regardless of the cause. This article describes a direct method for making a cast core provisional restoration for anterior teeth or premolars and has the advantages of (1) producing an esthetic, stable, temporary restoration in less than 30 minutes and (2) a grateful patient. It has the slight disadvantage that the dentist must develop a touch for the setting time and properties of the acrylic resin. This procedure may also be used before cast core fabrication to overcome esthetic concerns of the patient. PROCEDURE Temporary restoration may be the only procedure on the initial visit. The tooth must be cleaned and prepared to its final state to avoid repetition of the process at the appointment for cast core fabrication. 1. Make a cast core preparation one half to two thirds of the length of the tooth vertically (5 mm from the apex) 1 and one third of the diameter of the root horizontally. 2 Use a warm endodontic plugger and no chemical solvents for gutta-percha removal, a (If the tooth is vital, extirpation of the pulp will be necessary before this step.) 2. Draw a No. 3 Peeso reamer (Union Broach, New York, N. Y.) from the apical to the incisal surface that conforms to the anatomy of the root form with slight telescoping to prevent undercuts (Fig. 1). 3. Clean the canal preparation with 4% hydrogen peroxide followed by Maxiclens soap (Henry Schein, Port Washington, N.Y.), dry thoroughly and coat internally and occlusally with petroleum jelly (Vaseline, Cheseborough Ponds USA, Greenwich, Conn.). 4. Measure the mesial-to-distal width of the missing tooth space with a Boley gauge and obtain the appropriate 3M Ion crown form (Dental Products, 3M Corp., St. Paul, Minn.) to fit the area tightly (Fig. 2). Trim the crown on the mesial and distal surface so that contacts are sufficient to hold the crown form in place with no other support, and trim the gingival edge of the crown form to permit seating so the proper incisal height is unimpeded. 5. Make a loop or bend a piece of 0.036 inch Elgiloy orthodontic wire (Elgiloy Elgin, Ill.) and cut it 2 mm short of the anticipated crown and core height. Place the wire
aPrivate Practice. J PROSTHETDENT1995;74"319-20. Copyright 9 1995 by The Editorial Council of THE JOURNALOF PROSTHETICDENTISTRY. 0022-3913/95/$3.00 + 0. 10/4165374
SEPTEMBER 1995
Fig. 1. Canal preparation at one third diameter of root surface.
Fig. 2. Crown form fitted tightly to enhance retention.
in the prepared canal and place the crown form in the ideal position to ensure full seating. Remove the crown form and wire (Fig. 3). 6. Place Alike monomer (Coe Laboratories, Inc., GC America Inc., Chicago, Ill.) in crown form, fill a centrix syringe with the appropriate acrylic resin shade, and syringe it into the preparation and crown form. Place orthodontic wire in the canal with cotton pliers and seat the filled crown over it (Fig. 3). 7. Remove excess marginal acrylic resin with an interproximal carver (Hugh Friedy, Chicago, Ill.) and start a light pumping action after 30 seconds. View laterally to verify that the acrylic resin is not separating between the crown and core. If it is, let the acrylic resin harden 15 additional seconds and then continue the pumping
THE JOURNAL O F PROSTHETIC DENTISTRY
319
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 3. Syringe tip placement of acrylic resin to ensure maximal core length.
action. When it stabilizes into a single unit, continue pumping slowly up and down until final setting occurs (approximately 2 minutes). The longer the acrylic resin is pumped, the better the final fit. 8. Place the crown and post in a pressure pot with warm water for 5 minutes. Trim with a bur to ideal margination and emergence form. Check and adjust occlusion on the crown in centric relation and all excursive movements to ensure ideal occlusion. An 8 tim thick shim stock (Almore Int., Portland, Ore.) should pull through with light resistance in centric occlusion. 9. Cement with a noneugenol temporary cement of choice (Fig. 4).
DYLINA AND RUTHERFORD
Fig. 4. Completed temporary crown.
REFERENCES 1. Sorenson JA, Martinoff JT. Clinically significant factors in dowel design. J PROSTHET DENT 1984;52:28-35. 2. Tilk M, Lommel T, Gerstein H. A study of mandibular and maxillary root widths to determine dowel size. J Endodont 1979;5'.79-82. 3. Mattison GD, Delivanis PD, Thacker RW. The effect of immediate post preparation on the apical seal. J PROSTHET DENT 1984;51:785-9.
Reprint requests to: DR. TIM J. DYLINA 1132 OLIVEWOODDR. MERCED, CA 95348
A d h e s i v e r e s t o r a t i o n s w i t h a m a l g a m : G u i d e l i n e s for t h e clinician. Gwinnett AJ, Baratieri LN, Monteiro S Jr., Ritter AV. Quintessence Int 1994;25:687-95. P u r p o s e . This article presents a literature review of the development of the adhesive amalgam restoration and guidelines for its use as a restorative material. Restorations with adhesive amalgam combines the best properties of dental amalgam with the principles of tooth structure preservation and marginal seal inherent in adhesive restorative materials. The results of early clinical use and laboratory testing are encouraging. In spite of the lack of long-term longitudinal data, this bonded amalgam technique may become routine in the future. This system needs confirmation by independent clinical research to become a valid restorative technique. The authors describe the clinical applications (indications), advantages, and limitations (disadvantages) of the bonded amalgam restoration. The technique is presented clearly in a step-by-step fashion by use of superb clinical photographs. The authors conclude that preservation of tooth structure, low placement costs, and reduced chair time will Continue to make amalgam the material of choice for many patients. This technique, when perfected, will overcome some of the shortcomings of amalgam as it is currently used. 82 references.--RP Renner
320
VOLUME 74 NUMBER 3