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Using Removable Partial Denture Framework as Matrix for Pin-Retained Restoration
J A D )A C L I N I C A L
T E C H N I Q U E S
Using removable partial denture framework as matrix for pin-retained restoration E. F. W right, D D S, MAGD
This article describes a quick and easy tech nique fo r restoring a broken-down abutment tooth fo r a well-fitting removable partial den ture xvith a pin-retained amalgam restoration.
p in -re ta in e d am alg am re s to ra tio n is a n e x c e lle n t r e s to r a tio n f o r a b ro k e n -d o w n to o th . C o m p a re d w ith c r o w n s , th e y r e q u i r e o n ly o n e a p p o in tm e n t, a re e c o n o m ic a l, a n d c o n serve to o th stru c tu re .' Serviceability o f this ty p e o f r e s to r a t io n c o m p a r e s fa v o ra b ly w ith a single crow n acco rd in g to longevity
A
Fig 1 ■ D efective restoration in ab u tm en t to o th o f
stu d ies by R o b b in s a n d o th e rs2 a n d W alton a n d o th e rs.^ M a ry n iu k a n d o th e r s 4 also d e te rm in e d th a t am alg am re sto ra tio n s d o n o t n e e d to b e re p la c e d j u s t b e c a u se o f m arg in al d efects, u n le ss th e se d efects a re very large. W h en a bro k en -d o w n to o th is th e a b u t m e n t fo r a se rv ice a b le re m o v a b le p a rtia l d e n tu r e , it is d if fc u lt f o r a p in - re ta in e d am a lg a m to p ro p e rly fit th e in te rn a l su r faces o f th e p a rtia l d e n tu r e . T h is a rtic le describ es a m e th o d I have used fo r 8 years to o b ta in e x c e lle n t p in -re ta in e d am alg am resto ratio n s. T h e te c h n iq u e involves c o n d e n sin g th e
Fig 2 ■ A dequate clearance fo r the condenser.
am alg am re sto ra tio n w ith th e p a rtial d e n t u r e s e a t e d , e n a b l i n g t h e d e n t i s t to achieve th e p ro p e r c o n to u rs w ith th e p a r tial d e n tu re , th e p ro p e r a d a p ta tio n to th e p a rtia l d e n tu r e , a n d p r o p e r re st seats fo r th e su p p o rt o f th e p artia l d e n tu re .
Technique T h e c lin ic ia n b e g in s by e v a lu a tin g th e r e m o v a b le p a r tia l d e n t u r e to e n s u r e a g o o d fit a n d o b serv in g its p a th o f in sertio n a n d re m o v a l (F ig 1). R e m o v in g th e o ld r e s to r a tio n , c a rie s , a n d u n s u p p o r te d e n a m e l allows th e clinician to use th e con-
Fig 3 ■ Amalgam condensed.
a well fitting p artial d enture.
JADA, Vol. 121, N o v em b er 1990 ■ 635
C L I N I C A L
T E C H N I Q U E
Fig 4 ■ Excess am algam rem oved.
v e n tio n a l p in - re ta in e d a m a lg a m re s to ra tiv e t e c h n i q u e 5-7 ( o n e o f W h a l e d e n t ’s T h r e a d - M a te - S y s te m [T M S ] p in s w as r e t a in e d in th is e x a m p le ) a n d to p la c e pins as n e e d e d fo r th e p in -re ta in e d am al gam .5-7 T h e rem ovab le p a rtia l d e n tu r e is seated to e n su re a d e q u a te clea ra n c e fo r th e c o n d e n s e r to fit b etw een th e pins, to o th an d th e p a r tia l d e n t u r e fr a m e w o rk (F ig 2 ). O n e o r m o re o f th e pin s m ay n e e d to be s h o r te n e d o r a d d itio n a l to o th s tru c tu r e m ay n e e d to be re m o v e d fo r c o n d e n s e r accessibility. W h en th e p artial d e n tu r e is in place, th e a m a lg a m is c o n d e n s e d . T h r o u g h o u t th e c o n d e n s in g p h a se , se a tin g p re ssu re m u st b e m a in ta in e d o n th e p a rtia l d e n tu r e to avoid its m o v em en t. If it m oves, th e n th e a m a l g a m f r a c t u r e s ( t h i s is s i m i la r to m o v in g th e m a trix r e t a in e r d u r in g c o n d e n sa tio n ). If th e p artial d e n tu r e d o es n o t have lin g u a l p la tin g a n d th e r e is in su ffi c ie n t to o th s tr u c tu r e to re sist c o n d e n s a tio n fo rc e s , e x tr a m a trix in g m ay b e n e e d e d . D u rin g c o n d e n s a tio n , th e c lin i cian te n d s to pro v id e in a d e q u a te c o n d e n sation to th e gingival p o rtio n o f th e cavity p re p a ra tio n b ecau se it is n o t tightly sealed by a m a trix b a n d . A lso, in a d e q u a te c o n d e n s a tio n o c c u rs in th e a r e a u n d e r th e rest seat because c o n d e n sa tio n forces te n d to d islodge th e p a rtia l d e n tu re . A d eq u ate c o n d e n sa tio n is essential to avoid porosity
6 36 ■ JADA, Vol. 121, N o v em b er 1990
Fig 5 ■ Amalgam resto ratio n with partial d e n tu re
Fig 6 ■ O cclusion ad ju sted an d re sto ra tio n bur-
rem oved.
nished.
a n d p rovide th e re q u ire d stre n g th fo r this re sto ra tio n (Fig 3). T h e su rfaces th a t can be re a c h e d w ith o u t r e m o v in g t h e p a r t i a l d e n t u r e a r e c a rv ed . By u sin g a n e x p lo re r a ro u n d th e e d g e s o f th e p a rtia l d e n tu r e fra m e w o rk , th e clin ician e n su re s th a t n o excess am al g a m c o v e rs th e p a r tia l d e n tu r e . E x cess a m alg am im p airs th e rem oval o f th e p a r tial d e n tu re a n d possibly lead s to fra c tu re o f p a rt o f th e re sto ra tio n (Fig 4). T h is te c h n iq u e re q u ire s p la c e m e n t o f th e c o n d e n s e r o n th e occlusal p o rtio n o f th e re sto ra tio n fo r s u p p o rt w hile th e p a r tial d e n tu r e is slowly re m o v e d (Fig 5 ). A t this p o in t, th e clinician rem oves th e excess a m a lg a m a n d c a rv e s th e r e s to r a t io n to p ro p e r c o n to u r, allow ing easy re p la c e m e n t o f th e p a rtia l d e n tu re . T h e p artial d e n tu re slides freely o n to th e new re sto ra tio n . For f in a l im p r o v e m e n ts , t h e c li n ic i a n c a n a d ju s t t h e o c c lu s io n a n d b u r n i s h th e re sto ra tio n (Fig 6).
Summary A q u ic k a n d easy m e th o d c a n r e s to r e a b ro k e n -d o w n p a r tia l d e n tu r e a b u tm e n t w ith a p in -reta in e d a m alg am re sto ra tio n . It h a s a h ig h d e g re e o f p a tie n t a c c e p ta n c e as o n ly o n e a p p o in tm e n t is re q u ire d , elim i n a tin g th e n e e d fo r th e p a tie n t to leave a p a rtia l d e n tu r e f o r a d a p ta tio n to a wax p a tte rn . T h e cost can b e m in im al.
T h is te c h n iq u e can b e u sed fo r Class II r e s to r a tio n s ; h o w ev e r, th e p r a c t i t i o n e r m u s t e n s u re su ffic ie n t c le a ra n c e fo r th e c o n d e n se r to pass b etw een th e to o th an d th e p a rtia l d e n tu r e , so all a re a s c a n be p ro p erly c o n d e n sed . -------------------------JA O A \ -------------------------T h e o p in io n s e x p re s s e d in th is a rtic le a r e th o s e o f th e a u th o r a n d a r e n o t to b e c o n s tr u e d as o fficial o r as r e fle c tin g th e views o f th e U n ite d S ta te s A ir F o rc e o r th e D e p a r tm e n t o f D efen se. L t. C o l. W r ig h t is th e B ase D e n ta l S u r g e o n a t 6 4 F T W H o s p ita l/S G D , R e e se A FB , T X 7 9 4 8 9 -5 3 0 0 . A d d ress re q u e sts f o r re p r in ts to th e a u th o r.
1. S tu rd e v a n t CM , B a rto n RE, S ockw ell CL, S trick la n d W D . T h e a r t a n d s c ie n c e o f o p e ra tiv e d e n tistry . St. Louis: M osby; 1985:374-6. 2. R o b b in s JW , S u m m itt JB . L o n g e v ity o f c o m p le x a m a lg a m re s to ra tio n s . O p e r D e n t 1988;13:54-7. 3. W a lto n J N , G a r d n e r FW, A g a r J R . A su rv e y o f cro w n a n d fix e d p a rtia l d e n tu r e failu res: L e n g th o f s er v ic e a n d r e a s o n s f o r r e p l a c e m e n t . J P r o s t h e t D e n t 1986;56:416-21. 4. M a r y n iu k G A, B r u n s o n W D . W h e n to r e p la c e fau lty -m arg in a m a lg a m re s to ra tio n s : a p ilo t study. G en D e n t 1989;37:463-7. 5. L a m b e rt RL, R o b in so n FB, L in d e m u th JS . C o ro n a l r e i n f o r c e m e n t w ith c r o s s - s p lin te d p in - a m a lg a m re s to ra tio n s . J P ro s th e t D e n t 1985;54:346-9. 6. R o b b in s JW , B u rg ess J O , S u m m itt JB . R e te n tio n a n d re sista n c e fe a tu re s fo r c o m p le x a m a lg a m re s to ra tio n s. JA D A 1989;118:437-42. 7. M o n d elli J , Is h ik iria m a A, P e r e ir a J C , e t al. C rosss p lin tin g a w e a k e n e d to o t h w ith a h o r iz o n ta l p in : a new m e th o d . J P ro sth e t D e n t 1987;57:442-5.
T E C H N I Q U E S
Using removable partial denture framework as matrix for pin-retained restoration E. F. W right, D D S, MAGD
This article describes a quick and easy tech nique fo r restoring a broken-down abutment tooth fo r a well-fitting removable partial den ture xvith a pin-retained amalgam restoration.
p in -re ta in e d am alg am re s to ra tio n is a n e x c e lle n t r e s to r a tio n f o r a b ro k e n -d o w n to o th . C o m p a re d w ith c r o w n s , th e y r e q u i r e o n ly o n e a p p o in tm e n t, a re e c o n o m ic a l, a n d c o n serve to o th stru c tu re .' Serviceability o f this ty p e o f r e s to r a t io n c o m p a r e s fa v o ra b ly w ith a single crow n acco rd in g to longevity
A
Fig 1 ■ D efective restoration in ab u tm en t to o th o f
stu d ies by R o b b in s a n d o th e rs2 a n d W alton a n d o th e rs.^ M a ry n iu k a n d o th e r s 4 also d e te rm in e d th a t am alg am re sto ra tio n s d o n o t n e e d to b e re p la c e d j u s t b e c a u se o f m arg in al d efects, u n le ss th e se d efects a re very large. W h en a bro k en -d o w n to o th is th e a b u t m e n t fo r a se rv ice a b le re m o v a b le p a rtia l d e n tu r e , it is d if fc u lt f o r a p in - re ta in e d am a lg a m to p ro p e rly fit th e in te rn a l su r faces o f th e p a rtia l d e n tu r e . T h is a rtic le describ es a m e th o d I have used fo r 8 years to o b ta in e x c e lle n t p in -re ta in e d am alg am resto ratio n s. T h e te c h n iq u e involves c o n d e n sin g th e
Fig 2 ■ A dequate clearance fo r the condenser.
am alg am re sto ra tio n w ith th e p a rtial d e n t u r e s e a t e d , e n a b l i n g t h e d e n t i s t to achieve th e p ro p e r c o n to u rs w ith th e p a r tial d e n tu re , th e p ro p e r a d a p ta tio n to th e p a rtia l d e n tu r e , a n d p r o p e r re st seats fo r th e su p p o rt o f th e p artia l d e n tu re .
Technique T h e c lin ic ia n b e g in s by e v a lu a tin g th e r e m o v a b le p a r tia l d e n t u r e to e n s u r e a g o o d fit a n d o b serv in g its p a th o f in sertio n a n d re m o v a l (F ig 1). R e m o v in g th e o ld r e s to r a tio n , c a rie s , a n d u n s u p p o r te d e n a m e l allows th e clinician to use th e con-
Fig 3 ■ Amalgam condensed.
a well fitting p artial d enture.
JADA, Vol. 121, N o v em b er 1990 ■ 635
C L I N I C A L
T E C H N I Q U E
Fig 4 ■ Excess am algam rem oved.
v e n tio n a l p in - re ta in e d a m a lg a m re s to ra tiv e t e c h n i q u e 5-7 ( o n e o f W h a l e d e n t ’s T h r e a d - M a te - S y s te m [T M S ] p in s w as r e t a in e d in th is e x a m p le ) a n d to p la c e pins as n e e d e d fo r th e p in -re ta in e d am al gam .5-7 T h e rem ovab le p a rtia l d e n tu r e is seated to e n su re a d e q u a te clea ra n c e fo r th e c o n d e n s e r to fit b etw een th e pins, to o th an d th e p a r tia l d e n t u r e fr a m e w o rk (F ig 2 ). O n e o r m o re o f th e pin s m ay n e e d to be s h o r te n e d o r a d d itio n a l to o th s tru c tu r e m ay n e e d to be re m o v e d fo r c o n d e n s e r accessibility. W h en th e p artial d e n tu r e is in place, th e a m a lg a m is c o n d e n s e d . T h r o u g h o u t th e c o n d e n s in g p h a se , se a tin g p re ssu re m u st b e m a in ta in e d o n th e p a rtia l d e n tu r e to avoid its m o v em en t. If it m oves, th e n th e a m a l g a m f r a c t u r e s ( t h i s is s i m i la r to m o v in g th e m a trix r e t a in e r d u r in g c o n d e n sa tio n ). If th e p artial d e n tu r e d o es n o t have lin g u a l p la tin g a n d th e r e is in su ffi c ie n t to o th s tr u c tu r e to re sist c o n d e n s a tio n fo rc e s , e x tr a m a trix in g m ay b e n e e d e d . D u rin g c o n d e n s a tio n , th e c lin i cian te n d s to pro v id e in a d e q u a te c o n d e n sation to th e gingival p o rtio n o f th e cavity p re p a ra tio n b ecau se it is n o t tightly sealed by a m a trix b a n d . A lso, in a d e q u a te c o n d e n s a tio n o c c u rs in th e a r e a u n d e r th e rest seat because c o n d e n sa tio n forces te n d to d islodge th e p a rtia l d e n tu re . A d eq u ate c o n d e n sa tio n is essential to avoid porosity
6 36 ■ JADA, Vol. 121, N o v em b er 1990
Fig 5 ■ Amalgam resto ratio n with partial d e n tu re
Fig 6 ■ O cclusion ad ju sted an d re sto ra tio n bur-
rem oved.
nished.
a n d p rovide th e re q u ire d stre n g th fo r this re sto ra tio n (Fig 3). T h e su rfaces th a t can be re a c h e d w ith o u t r e m o v in g t h e p a r t i a l d e n t u r e a r e c a rv ed . By u sin g a n e x p lo re r a ro u n d th e e d g e s o f th e p a rtia l d e n tu r e fra m e w o rk , th e clin ician e n su re s th a t n o excess am al g a m c o v e rs th e p a r tia l d e n tu r e . E x cess a m alg am im p airs th e rem oval o f th e p a r tial d e n tu re a n d possibly lead s to fra c tu re o f p a rt o f th e re sto ra tio n (Fig 4). T h is te c h n iq u e re q u ire s p la c e m e n t o f th e c o n d e n s e r o n th e occlusal p o rtio n o f th e re sto ra tio n fo r s u p p o rt w hile th e p a r tial d e n tu r e is slowly re m o v e d (Fig 5 ). A t this p o in t, th e clinician rem oves th e excess a m a lg a m a n d c a rv e s th e r e s to r a t io n to p ro p e r c o n to u r, allow ing easy re p la c e m e n t o f th e p a rtia l d e n tu re . T h e p artial d e n tu re slides freely o n to th e new re sto ra tio n . For f in a l im p r o v e m e n ts , t h e c li n ic i a n c a n a d ju s t t h e o c c lu s io n a n d b u r n i s h th e re sto ra tio n (Fig 6).
Summary A q u ic k a n d easy m e th o d c a n r e s to r e a b ro k e n -d o w n p a r tia l d e n tu r e a b u tm e n t w ith a p in -reta in e d a m alg am re sto ra tio n . It h a s a h ig h d e g re e o f p a tie n t a c c e p ta n c e as o n ly o n e a p p o in tm e n t is re q u ire d , elim i n a tin g th e n e e d fo r th e p a tie n t to leave a p a rtia l d e n tu r e f o r a d a p ta tio n to a wax p a tte rn . T h e cost can b e m in im al.
T h is te c h n iq u e can b e u sed fo r Class II r e s to r a tio n s ; h o w ev e r, th e p r a c t i t i o n e r m u s t e n s u re su ffic ie n t c le a ra n c e fo r th e c o n d e n se r to pass b etw een th e to o th an d th e p a rtia l d e n tu r e , so all a re a s c a n be p ro p erly c o n d e n sed . -------------------------JA O A \ -------------------------T h e o p in io n s e x p re s s e d in th is a rtic le a r e th o s e o f th e a u th o r a n d a r e n o t to b e c o n s tr u e d as o fficial o r as r e fle c tin g th e views o f th e U n ite d S ta te s A ir F o rc e o r th e D e p a r tm e n t o f D efen se. L t. C o l. W r ig h t is th e B ase D e n ta l S u r g e o n a t 6 4 F T W H o s p ita l/S G D , R e e se A FB , T X 7 9 4 8 9 -5 3 0 0 . A d d ress re q u e sts f o r re p r in ts to th e a u th o r.
1. S tu rd e v a n t CM , B a rto n RE, S ockw ell CL, S trick la n d W D . T h e a r t a n d s c ie n c e o f o p e ra tiv e d e n tistry . St. Louis: M osby; 1985:374-6. 2. R o b b in s JW , S u m m itt JB . L o n g e v ity o f c o m p le x a m a lg a m re s to ra tio n s . O p e r D e n t 1988;13:54-7. 3. W a lto n J N , G a r d n e r FW, A g a r J R . A su rv e y o f cro w n a n d fix e d p a rtia l d e n tu r e failu res: L e n g th o f s er v ic e a n d r e a s o n s f o r r e p l a c e m e n t . J P r o s t h e t D e n t 1986;56:416-21. 4. M a r y n iu k G A, B r u n s o n W D . W h e n to r e p la c e fau lty -m arg in a m a lg a m re s to ra tio n s : a p ilo t study. G en D e n t 1989;37:463-7. 5. L a m b e rt RL, R o b in so n FB, L in d e m u th JS . C o ro n a l r e i n f o r c e m e n t w ith c r o s s - s p lin te d p in - a m a lg a m re s to ra tio n s . J P ro s th e t D e n t 1985;54:346-9. 6. R o b b in s JW , B u rg ess J O , S u m m itt JB . R e te n tio n a n d re sista n c e fe a tu re s fo r c o m p le x a m a lg a m re s to ra tio n s. JA D A 1989;118:437-42. 7. M o n d elli J , Is h ik iria m a A, P e r e ir a J C , e t al. C rosss p lin tin g a w e a k e n e d to o t h w ith a h o r iz o n ta l p in : a new m e th o d . J P ro sth e t D e n t 1987;57:442-5.