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Porcelain inlays between anterior teeth without separation
PORCELAIN
INLAYS BETWEEN ANTERIOR WITHOUT SEPARATION
TEETH
T. GREGG, D.D.S.
GEORGE
Pittsburgh,
Pa.
NE OF MY PROBLEMS has been to place porcelain inlays between the anterior teeth without much tedious work and inconvenience to my patient. For that reason, I have placed fillings about which I was not happy. I have overcome this problem by a technique which requires the minimum of tooth separation. No special skill is required, and those who do not do their own porcelain work can produce accurate dies for a laboratory. Ninety-eight per cent of the cases do not require separation, and five-thousandth of an inch of separation is sufficient (about the thickness of writing paper), if it is necessary.
0
THE
EQUIPMENT
1. A rubber dam punch. 2. A springy matrix metal* 0.005 inch thick, with enough elasticity to restore its original form if bent. 3. One of the rubber base impression materials. 4. Coe-flex liquid. 5. Tissue tint CAVITY
PREPARATIONS
Porcelain inlays can be used in four types of cavities: labial, proximal, proximal-labial combination, and incisal corners (Fig 1) . Proximal cavities should be prepared as nearly box-shaped as possible, with the opening slightly wider than the base so the impression can be withdrawn. Incisal corners can have a substantial lock on the lingual surface for retention. IMPRESSIONS
All impressions are withdrawn labially or lingually, i.e., at right angles to the long axis of the tooth. To make an impression of a cavity between any of the six anterior teeth, shape a piece of the 0.005 inch metal, about f/z inch long and slightly (1.0 mm.) wider than the cavity (Fig. 2). Presented as a table clinic before the American Academy Ill., Feb. 4, 1956. Received for publication June 1, 1956. *William Dixon, Inc. 32 Kinney St., Newark, N. J. *Obtained from J. M. Ney Company. 250
of Restorative
Dentistry,
Chicago,
Volume 7 Number 2
PORCELAIN
INLAYS
BETWEEN
ANTERIOR
251
TEETH
With the rubber dam punch, punch three or four small holes in the metal so that, when the metal strip is placed between the teeth opposite the cavity, the holes will be about its center. The object of the holes is to secure the impression material firmly to the metal strip, by flowing through the holes. This makes it possible to remove the impression. To further secure the impression material to the metal strip, paint on the cavity side of the metal with a thin film of Coe-flex. It should be thinned so the film will be quite thin. The impression procedure is quite simple. Some half-inch squares of the thin tin are prepared in advance, to prevent the impression material from sticking to the finger while it is being forced to place. Lubricate the cavity with a 10 per cent solution of Aerosol. This will reduce surface tension and prevent bubbles in the impression.
PROXlMOLABIAL Fig. I.-Various
PROXIMAL types of cavities
Fig. 2.-Thin
INCISAL CORNER
LABIAL
which may be restored by porcelain
steel is perforated
inlays.
to act as a tray.
The perforated metal strip should be flat so it will be easy to slip between the teeth, and so it can be withdrawn without being bent or distorted. Place the metal strip in position between the teeth (Fig. 3). Mix sufficient rubber impression material (Permlastic), and with a suitable plastic instrument tease the Permlastic into the cavity. Be careful not to disturb the perforated metal strip. Add extra impression material against the metal strip. Place a square of the thin tin on the excess material, and press gently against the tin square with the index finger until the impression material rolls 1.0 mm. over the margin of the cavity on the side opposite that from which the impression is to be withdrawn. For example, if the impression is to be taken out on the lingual side, press the material so it will just roll over the margin on the labial side.
J. l’ros. l)en.
252
March.
1957
The impression material sets in about four minutes. Setting can be hastened by heating a wet pellet of cotton placed on the square of tin with a large ball burnisher. When the impression material loses its stickiness, the impression can be gently withdrawn. When the cavity is large, and opens from lingual to labial, such as an incisal corner, dry the laxial surface, and paint it with a sticky cavity lining (gum mastic dissolved in chloroform). Then cover the surface with 24 gauge Kerr soft blue wax. Cut the wax away from the cavity margin about 1.0 mm. The wax will prevent the overflow of the excess on the cavity margin. For developing the contact area of an incisal corner restoration with an adjoining tooth, make an impression of both teeth with the rubber impression material. No fitting in the mouth will be required and the fit will be surprisingly accurate. The proximal labial cavity (Fig. 1) requires the use of a metal strip between the teeth, and one shaped to fit the curvature of the labial surface and rounded so it will pass beneath the gum margin (Fig. 4).
LINGUAL Fig. 3.-The
perforated
steel plate in position
for making
an impression
Fig. 4.-The
perforated
steel plate and the labial steel plate in position of a Class IV cavity.
of a proximal
for making
cavity.
an impression
With the perforated metal strip in place between the teeth, fill the cavity with rubber impression material, add some of the material to the metal shaped to fit the labial surface, and pass it beneath the gum margin. Then place the tin square in position and press it to place. Hold it in position for about one minute, then fit a short piece of copper wire to the angle formed by the two pieces of metal, and with sticky wax place the wire in the angle. The wire prevents distortion when the impression is withdrawn.
Volume Xumber
7 2
PORCELAIN
INLAYS
BETWEEN
ANTERIOR
TEETH
253
To make impressions of Class V cavities (Fig. 1) at the gum line, shape the perforated metal to the curvature of the labial surface of the tooth so it will pass beneath the gum margin. Lubricate the cavity, blow away the excess moisture, and fill the cavity with rubber impression material. Place some of the material on the metal, and slide it beneath the gum margin. Place a tin square over the perforated metal and press it to place. If the gingivae interfere, the gingival crevice can he packed with Sensitex on cotton to make space for the metal. The Sensitex should be neutralized with bicarbonate of soda. It is important to groove the cavity after the impression is made, and to do the same to the filling. In this manner, a lock is created which will help to prevent dislodgment of the filling. DIES
AND
MATRICES
The impressions should he filled with a model cement.* Any thin he re-enforced so as to prevent their crumbling during the swaging of matrix. When the cement model is invested in modeling compound which in a metal cup for swaging, the platinum is gently shaped to the cavity wood points, then forced to place in the swager. Illustrations are by Dorothy Sterling. 844
OLIVER PITTSBURGH
*Caulk’s
BUILDING
Model
22, PA. Cement
of‘ Posterior
Di-Cem.
edges should the platinum is contained with orange-
INLAYS BETWEEN ANTERIOR WITHOUT SEPARATION
TEETH
T. GREGG, D.D.S.
GEORGE
Pittsburgh,
Pa.
NE OF MY PROBLEMS has been to place porcelain inlays between the anterior teeth without much tedious work and inconvenience to my patient. For that reason, I have placed fillings about which I was not happy. I have overcome this problem by a technique which requires the minimum of tooth separation. No special skill is required, and those who do not do their own porcelain work can produce accurate dies for a laboratory. Ninety-eight per cent of the cases do not require separation, and five-thousandth of an inch of separation is sufficient (about the thickness of writing paper), if it is necessary.
0
THE
EQUIPMENT
1. A rubber dam punch. 2. A springy matrix metal* 0.005 inch thick, with enough elasticity to restore its original form if bent. 3. One of the rubber base impression materials. 4. Coe-flex liquid. 5. Tissue tint CAVITY
PREPARATIONS
Porcelain inlays can be used in four types of cavities: labial, proximal, proximal-labial combination, and incisal corners (Fig 1) . Proximal cavities should be prepared as nearly box-shaped as possible, with the opening slightly wider than the base so the impression can be withdrawn. Incisal corners can have a substantial lock on the lingual surface for retention. IMPRESSIONS
All impressions are withdrawn labially or lingually, i.e., at right angles to the long axis of the tooth. To make an impression of a cavity between any of the six anterior teeth, shape a piece of the 0.005 inch metal, about f/z inch long and slightly (1.0 mm.) wider than the cavity (Fig. 2). Presented as a table clinic before the American Academy Ill., Feb. 4, 1956. Received for publication June 1, 1956. *William Dixon, Inc. 32 Kinney St., Newark, N. J. *Obtained from J. M. Ney Company. 250
of Restorative
Dentistry,
Chicago,
Volume 7 Number 2
PORCELAIN
INLAYS
BETWEEN
ANTERIOR
251
TEETH
With the rubber dam punch, punch three or four small holes in the metal so that, when the metal strip is placed between the teeth opposite the cavity, the holes will be about its center. The object of the holes is to secure the impression material firmly to the metal strip, by flowing through the holes. This makes it possible to remove the impression. To further secure the impression material to the metal strip, paint on the cavity side of the metal with a thin film of Coe-flex. It should be thinned so the film will be quite thin. The impression procedure is quite simple. Some half-inch squares of the thin tin are prepared in advance, to prevent the impression material from sticking to the finger while it is being forced to place. Lubricate the cavity with a 10 per cent solution of Aerosol. This will reduce surface tension and prevent bubbles in the impression.
PROXlMOLABIAL Fig. I.-Various
PROXIMAL types of cavities
Fig. 2.-Thin
INCISAL CORNER
LABIAL
which may be restored by porcelain
steel is perforated
inlays.
to act as a tray.
The perforated metal strip should be flat so it will be easy to slip between the teeth, and so it can be withdrawn without being bent or distorted. Place the metal strip in position between the teeth (Fig. 3). Mix sufficient rubber impression material (Permlastic), and with a suitable plastic instrument tease the Permlastic into the cavity. Be careful not to disturb the perforated metal strip. Add extra impression material against the metal strip. Place a square of the thin tin on the excess material, and press gently against the tin square with the index finger until the impression material rolls 1.0 mm. over the margin of the cavity on the side opposite that from which the impression is to be withdrawn. For example, if the impression is to be taken out on the lingual side, press the material so it will just roll over the margin on the labial side.
J. l’ros. l)en.
252
March.
1957
The impression material sets in about four minutes. Setting can be hastened by heating a wet pellet of cotton placed on the square of tin with a large ball burnisher. When the impression material loses its stickiness, the impression can be gently withdrawn. When the cavity is large, and opens from lingual to labial, such as an incisal corner, dry the laxial surface, and paint it with a sticky cavity lining (gum mastic dissolved in chloroform). Then cover the surface with 24 gauge Kerr soft blue wax. Cut the wax away from the cavity margin about 1.0 mm. The wax will prevent the overflow of the excess on the cavity margin. For developing the contact area of an incisal corner restoration with an adjoining tooth, make an impression of both teeth with the rubber impression material. No fitting in the mouth will be required and the fit will be surprisingly accurate. The proximal labial cavity (Fig. 1) requires the use of a metal strip between the teeth, and one shaped to fit the curvature of the labial surface and rounded so it will pass beneath the gum margin (Fig. 4).
LINGUAL Fig. 3.-The
perforated
steel plate in position
for making
an impression
Fig. 4.-The
perforated
steel plate and the labial steel plate in position of a Class IV cavity.
of a proximal
for making
cavity.
an impression
With the perforated metal strip in place between the teeth, fill the cavity with rubber impression material, add some of the material to the metal shaped to fit the labial surface, and pass it beneath the gum margin. Then place the tin square in position and press it to place. Hold it in position for about one minute, then fit a short piece of copper wire to the angle formed by the two pieces of metal, and with sticky wax place the wire in the angle. The wire prevents distortion when the impression is withdrawn.
Volume Xumber
7 2
PORCELAIN
INLAYS
BETWEEN
ANTERIOR
TEETH
253
To make impressions of Class V cavities (Fig. 1) at the gum line, shape the perforated metal to the curvature of the labial surface of the tooth so it will pass beneath the gum margin. Lubricate the cavity, blow away the excess moisture, and fill the cavity with rubber impression material. Place some of the material on the metal, and slide it beneath the gum margin. Place a tin square over the perforated metal and press it to place. If the gingivae interfere, the gingival crevice can he packed with Sensitex on cotton to make space for the metal. The Sensitex should be neutralized with bicarbonate of soda. It is important to groove the cavity after the impression is made, and to do the same to the filling. In this manner, a lock is created which will help to prevent dislodgment of the filling. DIES
AND
MATRICES
The impressions should he filled with a model cement.* Any thin he re-enforced so as to prevent their crumbling during the swaging of matrix. When the cement model is invested in modeling compound which in a metal cup for swaging, the platinum is gently shaped to the cavity wood points, then forced to place in the swager. Illustrations are by Dorothy Sterling. 844
OLIVER PITTSBURGH
*Caulk’s
BUILDING
Model
22, PA. Cement
of‘ Posterior
Di-Cem.
edges should the platinum is contained with orange-