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Fabrication of a single anterior intermediate restoration
SECTION EDITOR
DENTAL T E C H N O L O G Y
DANIEL H. GEHL
Fabrication of a single anterior intermediate restoration Arun Nayyar, B.D.S., D.M.D., M.S.,* and Wallace S. Edwards, D.D.S., M.A.,** Medical College of Georgia, School of Dentistry, Augusta, Ga.
E s t h e t i c s and tissue heahh are two important considerations when anterior teeth are temporized. The patient appreciates an esthetically acceptable temporary crown, and if the gingival contours are properly finished the possibility of tissue recession and need for a subsequent remake are reduced. Acrylic resin-filled celluloid crowns had been the most convenient method of temporization before the introduction of the polycarbonate crown. The advantages of using the polycarbonate crown are that it is eas t, to adapt, it is esthetic, and it saves chair time. Polycarbonate crowns do not replace celluloid crowns in all temporization procedures. When limited space, minimal occlusal clearance, or tooth rotation make the polycarbonate shell difficult to adapt, the celluloid crown is used. We use the ION~" polycarbonatc temporary crown, but this technique is adaptable to an t ' of the commercially available polycarbonate crown systems. The prefabricated crowns are available in several sizes for incisors, canines, and premolars. Mold guides are provided to aid in selecting the proper size (Fig. 1).
~L
,~'
~.,~
~'
t~L" ~ . lID
ii. ~
. 9
g
.91~.
k
Fig.. 1. Mold guides are provided for maxillary and mandibular anterior teeth. Several sizes for incisors, canines, and premolars are available.
Polycarbonate Crown Selection 1. Measure the width of the space for the tooth in the mouth, on a diagnostic cast Or radiograph, or by comparison of the space for the tooth with the teeth on the mold guide (Fig. 2). ADAPTATION 1. Trim 1 or 2 mm from the facial and lingual length of the crown with curved crown and bridge
Fig. 2. The mesio-distal width of the tooth is transferred from a diagnostic cast or radiograph to the appropriate mold guide.
Assisted b)" the Developmental Dental Studies Program, School of Dentistry, Medical College of Georgia, USPH No. 10-17-021000-01. *Assistant Professor, Department of Restorative Dentistry. **Associate Professor, Deparmaent of Restorative Dentistry. "['3M Co., Costa Mesa, Calif.
scissors before trying the shell on the preparation, because the polycarbonate crowns are usually long on these surfaces. 2. Refine tile trimmed crowns wltb mounted stones or 12-fluted burs. The polycarbonate material cuts easily with the high-speed bur and does not clog
574
MAY 1978
VOLUME 39
NUMBER $
0022-3913/78/0539-0574500.40/0 ~ 1978 The C. V. Moshy Co.
SINGLE ANTERIOR INTERMEDIATE RESTORATION
Fig. 3. The polycarbonate material can be trimmed with a 12-fluted bur or curved scissors. Interproximal margins usually do not require trimming9
Fig. 5. The resin-filled crown is aligned with the labial contours of the adjacent teeth; interproximal contact is maintained. ,'~ ""
Ik I
i
'
T
Fig. 4. A properly trimmed crown compliments the gingival contour and has interproximal contact. The incisal length is adjusted later. it as most plastics do. T h e interproximal surfaces do not usually require trimming (Fig. 3). Tile nt, mbered tab on the crown should not be removed until later; it serves as a handle for positioning the crown. 3. T r i m the crown so that when it is seated on tile margins of the preparation there is interproximal contact and it is properly positioned in the labiolingual dimension. At this time do not be concerned with the occlusion or tile incisal length. If the crown margins are trimmed so that the incisal length is correct tile interproximal margins will usually overhang the preparation. Therefore it is better to make the incisal adjustments at a later time (Fig. ,t). RELINE W I T H A U T O P O L Y M E R I Z I N G A C R Y L I C RESIN I. Coat the preparation with cavity varnish. Apply petroleum jelly liberally over tile tooth and
TIlE JOURNAL OF I'ROSTIIETIC DENTISTRY
Fig. 6. The crown is removed by holding the numbered tab.
Fig. 7. A modification for endodontically prepared teeth is to place a plastic or metal post in the canal prior to seating the resin-filled crown.
.575
NAYYARAND EDWARDS
/
Fig. 8. A sharp pencil line helps identify the margins seen in the acrylic resin.
Fig. 10. Incisal reduction and esthetic characterization are completed to harmonize with the adjacent teeth.
CONTOURING AND POLISHING
9 Fig. 9. A diagram iliustrates the untrimmed acryli c resin reline. The broken line visualizes the portion that needs to be trimmed to achieve proper contour. adjacent soft tissue. This procedure provides (1) a barrier to the penetration of excessive free monomer and (2) simplified removal of the crown. 2. Mix the acrylic resin and fill the crown. When tile resin is in the doughy stage position the crown over the preparation. 3. Align the shell with the labial contours of the adjacent teeth and maintain tiffs position with finger pressure (Fig. 5). Do not allow tile patient to close the jaws, since this will tip the crown labially. 4. Compress tile acrylic resin that has expressed into the gingival region with an instrument. A large excess remaining in the undercut interproximal space may be a problem during removal. 5. Remove the relined shell straight off the tooth without rocking it aftcr the acrylic resin exhibits memory or rebound. Tile n u m b e r tab is a convenient handle (Fig. 6). 6. Set the crown aside to allow complete polymerization of the resin. 7. For an endodontically treated tooth, a plastic or metal post is inserted into the canal prior to seating the resin-filled polycarbonate crown (Fig. 7). 576
1. Mark the cavosurface margins seen in the acrylic resin with a sharp pencil (Fig. 8). This pencil line is an impression of the margin of the preparation , and identifying it aids in tile contouring procedure. 2. Remove tile bulk of acrylic resin and polycarbonate crown with an acrylic resin trimmer or heatless stone. In some instances the crown may have to be trimmed 9 millimeters to obtain the desired tooth contour (Fig. 9). 3. T r y the crown back on tile tooth to verify complete seating and marginal fit. 4. Mark the desired inc.:sal lcngth With a pencil (Fig. 10) and evaluate the occlusion before removing the crown. 5. Adjust tile lingual and incisal surfaces until the patient can function in the. intercuspal (centric occlusion) and eccentric positions without interference from tl]e new temporary crown. 6. conaplete any morphologic alterations on tile crown that may further characterize its appearance and enhance esthetics. 7. Smooth the rough surfaces with sandpaper disks and burlew wheel. 8. Polish tile crown with wet pumice and a rag wheel followed by a high-lustre polish. 9. Scrub the restoration with soap and water using a hand brush. Tile crown is now ready for cementation. CEMENTATION 1. Apply a light coat of petroleum jelly to the external surface of tile crown to help remove tile e x c e s s cenlent. 2. Mix T e m p Bond cement,* fill tile polycar-
*Kerr Mfg. Co., Romulus, ,Mich. M A Y 1978
V O L U M E 39
NUMBER S
SINGLE ANTERIOR INTERMEDIATE RESTORATION
3. Remove the cement from the crown margins with an explorer and clean the interproximal spaces with dental floss. 4. Rinse the treatment site w i t h water and recheck the occlusion before dismissing the patient (Fig. 11). 5. When the patient returns for the final restoraiion the temporary crown m a y be easily removed with a towel clamp. SUMMARY
Fig. 11. Occlusal adjustments are made and the crown is polished prior to cementation. Reevaluate the occlusion before dismissing the patient. bonate crown, and seat it on the tooth. The preferred cementing medium is one that does not contain free eugenol. T o verify that the crown is completely seated instruct the patient to close the teeth in centric occlusion. T h e cement sets in about 2 minutes.
ARTICLES
TO APPEAR
IN FUTURE
A technique of modifying a polycarbonate shell crown with an acrylic resin reline has been presented. T h e advantage in using this procedure is that it results in a satisfactory treatment restoration that is functionally and csthetically acceptable to the patient. Rrprint requests to: DR. ARU,~ NAYYAR ~[EDICAL COLLEGE OF GEORGIA SCIIOOL OF DENTISTRY
AUGUSTA)GA. 30901
ISSUES
X-linked hypohidrotic ectodermal dysplasia'An unusual prosthetic problem G. J. Nortje, B.Ch.D., A. (3. Farman, B.D.S., G. J. Thomas, B.D.S., H.Dip.Dent., and G. J. j. ~,Vatermeyer, B.D.S.
Construction of orbital prostheses using the silicone pattern technique K. Oral, D.D.S., M.S.D., Ph.D., I. Zini, and M. A. Aramany, D.M.D., M.S.
Single-visit hollow obturators for edentulous patients Stephen M. l)arel, D.D.S., and Henry LaFuente TIlE J O U R N A L OF PROSTIIETIC DENTISTRY
577
DENTAL T E C H N O L O G Y
DANIEL H. GEHL
Fabrication of a single anterior intermediate restoration Arun Nayyar, B.D.S., D.M.D., M.S.,* and Wallace S. Edwards, D.D.S., M.A.,** Medical College of Georgia, School of Dentistry, Augusta, Ga.
E s t h e t i c s and tissue heahh are two important considerations when anterior teeth are temporized. The patient appreciates an esthetically acceptable temporary crown, and if the gingival contours are properly finished the possibility of tissue recession and need for a subsequent remake are reduced. Acrylic resin-filled celluloid crowns had been the most convenient method of temporization before the introduction of the polycarbonate crown. The advantages of using the polycarbonate crown are that it is eas t, to adapt, it is esthetic, and it saves chair time. Polycarbonate crowns do not replace celluloid crowns in all temporization procedures. When limited space, minimal occlusal clearance, or tooth rotation make the polycarbonate shell difficult to adapt, the celluloid crown is used. We use the ION~" polycarbonatc temporary crown, but this technique is adaptable to an t ' of the commercially available polycarbonate crown systems. The prefabricated crowns are available in several sizes for incisors, canines, and premolars. Mold guides are provided to aid in selecting the proper size (Fig. 1).
~L
,~'
~.,~
~'
t~L" ~ . lID
ii. ~
. 9
g
.91~.
k
Fig.. 1. Mold guides are provided for maxillary and mandibular anterior teeth. Several sizes for incisors, canines, and premolars are available.
Polycarbonate Crown Selection 1. Measure the width of the space for the tooth in the mouth, on a diagnostic cast Or radiograph, or by comparison of the space for the tooth with the teeth on the mold guide (Fig. 2). ADAPTATION 1. Trim 1 or 2 mm from the facial and lingual length of the crown with curved crown and bridge
Fig. 2. The mesio-distal width of the tooth is transferred from a diagnostic cast or radiograph to the appropriate mold guide.
Assisted b)" the Developmental Dental Studies Program, School of Dentistry, Medical College of Georgia, USPH No. 10-17-021000-01. *Assistant Professor, Department of Restorative Dentistry. **Associate Professor, Deparmaent of Restorative Dentistry. "['3M Co., Costa Mesa, Calif.
scissors before trying the shell on the preparation, because the polycarbonate crowns are usually long on these surfaces. 2. Refine tile trimmed crowns wltb mounted stones or 12-fluted burs. The polycarbonate material cuts easily with the high-speed bur and does not clog
574
MAY 1978
VOLUME 39
NUMBER $
0022-3913/78/0539-0574500.40/0 ~ 1978 The C. V. Moshy Co.
SINGLE ANTERIOR INTERMEDIATE RESTORATION
Fig. 3. The polycarbonate material can be trimmed with a 12-fluted bur or curved scissors. Interproximal margins usually do not require trimming9
Fig. 5. The resin-filled crown is aligned with the labial contours of the adjacent teeth; interproximal contact is maintained. ,'~ ""
Ik I
i
'
T
Fig. 4. A properly trimmed crown compliments the gingival contour and has interproximal contact. The incisal length is adjusted later. it as most plastics do. T h e interproximal surfaces do not usually require trimming (Fig. 3). Tile nt, mbered tab on the crown should not be removed until later; it serves as a handle for positioning the crown. 3. T r i m the crown so that when it is seated on tile margins of the preparation there is interproximal contact and it is properly positioned in the labiolingual dimension. At this time do not be concerned with the occlusion or tile incisal length. If the crown margins are trimmed so that the incisal length is correct tile interproximal margins will usually overhang the preparation. Therefore it is better to make the incisal adjustments at a later time (Fig. ,t). RELINE W I T H A U T O P O L Y M E R I Z I N G A C R Y L I C RESIN I. Coat the preparation with cavity varnish. Apply petroleum jelly liberally over tile tooth and
TIlE JOURNAL OF I'ROSTIIETIC DENTISTRY
Fig. 6. The crown is removed by holding the numbered tab.
Fig. 7. A modification for endodontically prepared teeth is to place a plastic or metal post in the canal prior to seating the resin-filled crown.
.575
NAYYARAND EDWARDS
/
Fig. 8. A sharp pencil line helps identify the margins seen in the acrylic resin.
Fig. 10. Incisal reduction and esthetic characterization are completed to harmonize with the adjacent teeth.
CONTOURING AND POLISHING
9 Fig. 9. A diagram iliustrates the untrimmed acryli c resin reline. The broken line visualizes the portion that needs to be trimmed to achieve proper contour. adjacent soft tissue. This procedure provides (1) a barrier to the penetration of excessive free monomer and (2) simplified removal of the crown. 2. Mix the acrylic resin and fill the crown. When tile resin is in the doughy stage position the crown over the preparation. 3. Align the shell with the labial contours of the adjacent teeth and maintain tiffs position with finger pressure (Fig. 5). Do not allow tile patient to close the jaws, since this will tip the crown labially. 4. Compress tile acrylic resin that has expressed into the gingival region with an instrument. A large excess remaining in the undercut interproximal space may be a problem during removal. 5. Remove the relined shell straight off the tooth without rocking it aftcr the acrylic resin exhibits memory or rebound. Tile n u m b e r tab is a convenient handle (Fig. 6). 6. Set the crown aside to allow complete polymerization of the resin. 7. For an endodontically treated tooth, a plastic or metal post is inserted into the canal prior to seating the resin-filled polycarbonate crown (Fig. 7). 576
1. Mark the cavosurface margins seen in the acrylic resin with a sharp pencil (Fig. 8). This pencil line is an impression of the margin of the preparation , and identifying it aids in tile contouring procedure. 2. Remove tile bulk of acrylic resin and polycarbonate crown with an acrylic resin trimmer or heatless stone. In some instances the crown may have to be trimmed 9 millimeters to obtain the desired tooth contour (Fig. 9). 3. T r y the crown back on tile tooth to verify complete seating and marginal fit. 4. Mark the desired inc.:sal lcngth With a pencil (Fig. 10) and evaluate the occlusion before removing the crown. 5. Adjust tile lingual and incisal surfaces until the patient can function in the. intercuspal (centric occlusion) and eccentric positions without interference from tl]e new temporary crown. 6. conaplete any morphologic alterations on tile crown that may further characterize its appearance and enhance esthetics. 7. Smooth the rough surfaces with sandpaper disks and burlew wheel. 8. Polish tile crown with wet pumice and a rag wheel followed by a high-lustre polish. 9. Scrub the restoration with soap and water using a hand brush. Tile crown is now ready for cementation. CEMENTATION 1. Apply a light coat of petroleum jelly to the external surface of tile crown to help remove tile e x c e s s cenlent. 2. Mix T e m p Bond cement,* fill tile polycar-
*Kerr Mfg. Co., Romulus, ,Mich. M A Y 1978
V O L U M E 39
NUMBER S
SINGLE ANTERIOR INTERMEDIATE RESTORATION
3. Remove the cement from the crown margins with an explorer and clean the interproximal spaces with dental floss. 4. Rinse the treatment site w i t h water and recheck the occlusion before dismissing the patient (Fig. 11). 5. When the patient returns for the final restoraiion the temporary crown m a y be easily removed with a towel clamp. SUMMARY
Fig. 11. Occlusal adjustments are made and the crown is polished prior to cementation. Reevaluate the occlusion before dismissing the patient. bonate crown, and seat it on the tooth. The preferred cementing medium is one that does not contain free eugenol. T o verify that the crown is completely seated instruct the patient to close the teeth in centric occlusion. T h e cement sets in about 2 minutes.
ARTICLES
TO APPEAR
IN FUTURE
A technique of modifying a polycarbonate shell crown with an acrylic resin reline has been presented. T h e advantage in using this procedure is that it results in a satisfactory treatment restoration that is functionally and csthetically acceptable to the patient. Rrprint requests to: DR. ARU,~ NAYYAR ~[EDICAL COLLEGE OF GEORGIA SCIIOOL OF DENTISTRY
AUGUSTA)GA. 30901
ISSUES
X-linked hypohidrotic ectodermal dysplasia'An unusual prosthetic problem G. J. Nortje, B.Ch.D., A. (3. Farman, B.D.S., G. J. Thomas, B.D.S., H.Dip.Dent., and G. J. j. ~,Vatermeyer, B.D.S.
Construction of orbital prostheses using the silicone pattern technique K. Oral, D.D.S., M.S.D., Ph.D., I. Zini, and M. A. Aramany, D.M.D., M.S.
Single-visit hollow obturators for edentulous patients Stephen M. l)arel, D.D.S., and Henry LaFuente TIlE J O U R N A L OF PROSTIIETIC DENTISTRY
577