Gain verifiable CPD with our sales specialists HOW TO GUIDE Indirect Restorative Procedure + + + + = Better Dentistry 1 Tooth Preparation how to guide Indirect restoration Andy Hall Senior Lecturer and Consultant in Restorative Dentistry, University of Dundee Heavily filled, broken down or missing teeth have long been restored using crown and bridgework. These procedures can be some of the most challenging in clinical dentistry. It is of paramount importance that crown and bridge preparations are ideal, impressions are accurate and laboratory work is precise. The use of contemporary, long-lasting cementation materials adds confidence to your work and enhances the care for your patients. Dental practice becomes more efficient, costeffective and patients appreciate the long lasting results. The increased demand for aesthetic dentistry requires dentists to use an ever wider range of dental materials each with different physical and chemical properties. Advances in ceramic restorations means that patients can often have the smiles they see every day in the media. Accommodating these patient desires is often a significant aid to building dental practice. This ‘How to guide’ for indirect restorations, identifies products used in the procedure that will help towards an accurate, predictable and long-lasting result. This guide takes you step-by-step through quality branded products to use in tooth preparation, impression taking, provisional restorations and finally cementation of the permanent restoration. Tooth preparation for indirect restorations must be accomplished in a systematic, efficient and atraumatic manner. Diamond burs are the ‘gold standard’ for carrying out sufficient occlusal reduction, clearing proximal contact points, establishment of preparation margins and ensuring correct preparation taper and surface finish. They are considered safe and effective with a lower risk of tooth tissue fracture. Ash Hi Di® diamond burs use natural diamonds resulting in more efficient cutting, saving time and improving patient comfort. There is a wide range of patterns to chose from ensuring the ideal tooth preparation. 3 Temporary/Provisional Restoration Integrity™ and Integrity™ TempGrip is the provisional crown and bridge solution; provisional bis-acryl composite crown and bridge material (available in 3 shades) and non-drip temporary cement. Temporisation Technique 1. Take matrix impression using Aquasil impression materials. 2. Dispense Integrity™ material into the matrix. Place matrix into the patient’s mouth within 45 seconds. Remove matrix after 2 minutes from start of mix. 3. Allow to self-cure for 7 minutes from start of mix. Remove provisional from impression. 4. Adjust and trim the provisional with a slow speed acrylic bur and/or a high speed diamond bur. 5. Apply a thin, uniform layer of Integrity™ TempGrip™ Cement to the entire internal surface of the Integrity™ material restoration. 6. Seat the restoration with gradual pressure. The cement will self cure in approx. 2-3 minutes. You can also receive 1 hour’s verifiable CPD if you read the guide fully, answer the questions on the back and provide feedback. Objectives Upon completion of this guide, the clinician will be able to do the following: A To understand the steps in tooth preparation B Explore an impression material for impression taking C Learn to make an effective temporary crown D Understand the self-adhesive cementation procedure * Always read the manufacturer’s full directions for use before commencing work. 7. Remove gross excess from marginal areas. Restoration should not be moved or torqued during cleanup. Looks that Last 2 Impression-taking Reality is an independent body of dentists that trial and tests a wide range of dental materials and equipment. They have rated Aquasil Ultra smart wetting material the top rating of 5 stars for 5 years running. Reality spoke about a number of strengths that Aquasil Ultra has, including “one study shows it to have the highest tear strength of any impression material…the mint flavour is a plus for most patients.” Always making a great impression DENTSPLY PolyTrays are available in three colour-coded sizes for an accurate fit, uppers and lowers, and are single use for improved cross infection control Silfix tray adhesive increases the adhesion between a-silicones impression materials and the impression tray surface 7 Aquasil Ultra is available in a range of viscosities and application methods to suit every clinician: 4 Permanent Cementation SmartCem™2 self-adhesive resin cement is strong yet really simple to use, making it ideal for your everyday needs. m Mediu m Mediu 1. Remove the syringe cap, dispense a small amount to get material flowing freely from both ports, and carefully wipe ports clean, avoiding any crosscontamination. Install a mixing tip and gently depress the syringe plunger to start material flow. 4. Floss interproximally and then complete excess removal during the gel phase for easy clean up. 2. Gently apply a thin uniform layer of SmartCem™2 Cement to the entire internal surface of the restoration. For direct intra oral placements, the mixing tip can be bent for improved access. SmartCem™2 offers up to 2 minutes of working time. For indications that SmartCem2 is not suitable, such as veneers and Maryland bridges, we recommend Calibra aesthetic resin cement. Calibra is available in multiple shades, viscosities and aesthetic try-in pastes for a more versatile cementing solution 3. Immediately seat the restoration in the mouth. There is a gel phase with SmartCem™2. It starts after about 1-2 minutes and lasts about 1minute. The gel phase can also be achieved with a curing light applied around the margins for less than 10 seconds and lasts about 45 seconds after the brief light curing. 5. Restoration is stabilised by light curing the margins for 20-40 seconds. For restorations that are not light transmissible (e.g. metallic) final set is achieved by allowing SmartCem™2 to self-cure for approximately 6 minutes from start of mix. You will need a range of hand instruments throughout this procedure, therefore we would recommend the new range of Artio™. Super-light, super-strong and super-sharp. 60 lightweight instruments for restorative and periodontal needs Earn one hour CPD point… To complete the questions, give us your feedback and to receive your CPD certificate, please visit www.dentsply.co.uk. 1. W hat sorts of teeth are suitable for crown preparations? 5. If you were to perform a correction impression technique, which material(s) would you recommend? A Unrestored teeth B Heavily restored and broken down teeth A Aquasil Ultra Monophase C Small teeth B Aquasil Ultra Hard Putty and Aquasil Ultra LV 9. When should you use Calibra instead of SmartCem2? A Maryland bridges C Aquasil Ultra Monophase and Aquasil Ultra XLV D Deciduous teeth B Replacement of all restorations C Clearing proximal contacts B Burs 6. What type of material is Integrity crown and bridge material? D Preparation of subgingival margins 10. Artio is the new range of: A Impression trays D Aquasil Ultra Heavy and Aquasil Ultra XLV 2. Preparation of teeth for crowns usually involves A Endodontic treatment C Restorative and Periodontal instruments D Cements A Bis-acryl resin B Glass ionomer C Compomer D None of the above 7. How long does it take for Integrity TempGrip to self cure? 3. Which burs are seen as the gold standard in preparing a tooth for an indirect restoration? A Steel burs B Tungstan carbide burs C Diamond burs D All of the above 4. Ash Hi Di burs are made from natural diamonds? A True B False B Veneers C All of the above A 1-2 minutes B 2-3 minutes C 3-4 minutes D Over 7 minutes Reader Feedback 8. SmartCem2 can be tack-cured using a curing light to turn the material to a gel for easy removal of excess cement. But for how long should you tack-cure? A Less than 4 seconds B Less than 10 seconds We encourage your comments on this “How to Guide”. Please email any comments or suggestion on how to improve this guide to [email protected] C Less than 20 seconds D More than 10 seconds Other How to Guides available: Earn 1 hour CPD point UKP00191 how to guide Scaling & root planing scaling & root planing Earn 1 hour CPD point how to guide Whitening whitening Earn how to guide For more information, please call our freephone number or email us: [email protected] www.dentsply.co.uk www.dentsply.com hour air polishing For more information on the products detailed in this How to Guide, please call our freephone number or email us: +44 (0)800 072 3313 1 CPD point Air Polishing guide Earn 1 hour CPD point how to guide composite layering techniques Composite Layering Techniques guide