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  2. 2. A DVANCED ESTHETICS & I NTERDISCIPLINARY D ENTISTRY Education Series Table of Contents CREATING 1 EXCELLENT Chapter 1: Introduction FULL CROWN 2 Chapter 2: Construction TEMPORARIES: 6 Chapter 3: Trimming & Shaping 9 Materials, Techniques Chapter 4: Refining the Anatomy and Utilization 10 Chapter 5: Frank M. Spear, DDS, MSD Staining & Seattle Institute for Advanced Dental Education Glazing 11 Chapter 6: Polishing 12 Chapter 7: Cementation/ Removal Creating Excellent Full Crown Temporaries: Materials, Techniques and Utilization was produced by See Back Cover for AEGIS Publications, LLC, PO Box 1079, Washington Crossing, PA 18977-1079 on behalf of Frank Spear, DDS, MSD. Copyright © 2006 Frank Spear, Seattle Institute for Advanced Dental Education. Author Contact All rights reserved. No part of this publication may be reproduced in any form without written Information permission from Frank Spear. Printed in the USA. and Product & WARNING: Reading any chapter or section of Creating Excellent Full Crown Temporaries: Materials, Trademark Information Techniques and Utilization does not necessarily qualify you to integrate new techniques or procedures into your practice. AEGIS Publications, LLC, Dr. Frank Spear, and the Seattle Institute for Advanced Dental Education expect readers to rely on their judgment regarding their clinical expertise and recommend further education when necessary before trying to implement any new procedure. The views and opinions expressed in this publication and its chapters are those of the author and do not necessarily reflect the views or opinions of the editors, the editorial board, or the publisher. As a matter of policy, the editors, the editorial board, and any university affiliate do not endorse any products, medical techniques, or diagnoses, and publication of any material herein should not be construed as such an endorsement.
  3. 3. CHAPTER Introduction F abricating full crown temporaries is something every dentist does routinely during their week. For the most part, it is a pretty effortless task. The objective is to create 1 a temporary that fits well, one with the correct occlusion and contacts. However, difficulties arise when creating temporaries for anterior teeth because this area requires more attention. For Table 1.1 COMMONLY USED TEMPORARY MATERIALS anterior teeth, temporaries become the blueprint for the final restoration in terms • Integrity™ of occlusal guidance, smile line, tooth • Luxatemp® Automix Plus position, and tooth color. Additionally, • Protemp™ 3 Garant™ Temporization Material anterior temporaries do things that a routine posterior temporary can’t do, and they can help build your practice by bolstering your patients’ confidence. Therefore, it is critical that anterior temporaries be truly exceptional. Today, a variety of self-cured composite temporary materials are used for full crown anterior and posterior temporaries (Table 1.1). The manner in which they are used is similar. However, the material itself is not as significant to the appearance and function of the resulting temporaries as the amount of time and attention to detail that goes into creating them (Figure 1.1). Additionally, well-made and accurate temporaries not only look good, but also con- 1.1 View of full crown temporaries in tribute to gingival health while the patient is wearing them (Figure 1.2). If poor tissue the patient’s mouth. response is evident upon removal of a temporary, it’s the result of an inaccurately fitting temporary that did not promote hygiene, lacked the necessary gingival and facial embrasures, and was most likely created too quickly. Therefore, it’s important to allow sufficient time to properly contour and finish temporary restorations, and the fee for this work and the related process should be accounted for in the restorative fee schedule presented to the patient. For example, if you are going to create a set of anterior temporaries that will be the template for the case, those temporaries should add roughly 30% to the overall cost of the treatment. This will enable you to spend the time necessary to refine their occlusion, properly contour them, and develop their esthetics into something the patient can be proud of 1.2 Removing provisional restorations (Figure 1.3). often elicits tissue bleeding, complicating the adhesive phase of the restorative process. 1.3 View of highly esthetic, completely finished anterior full crown temporary restorations. Advanced Esthetics & Interdisciplinary Dentistry Education Series Creating Excellent Full Crown Temporaries 1
  4. 4. CHAPTER 2 Construction T he fabrication of all full crown temporaries requires a matrix into which the tem- porary material will be placed and which will enable you to control the overall contour and shape of the temporaries (Figure 2.1). One pressure formed material that can be used for creating the matrix is Copyplast, which is highly detailed and flexible. Creating the matrix involves several steps (Table 2.1). First, make a model of the patient’s preoperative condition. If you or the patient don’t like something about the teeth (e.g., shape, length, contour), then mock up the model using composite. If more extensive changes are required (e.g., adding several millimeters to the incisal edges or opening up the vertical dimension), a diagnostic wax-up is preferred. Then, duplicate 2.1 View of a Copyplast matrix. that mock-up or wax-up using an alginate impression material. Finally, press the 1.5 mm Copyplast material onto that duplicate model using a pressure former (Mini Star). Table 2.1 MATRIX CONSTRUCTION Anterior full crown temporaries can be constructed directly in the mouth follow- • Make a mock-up or wax-up of the patient's teeth ing tooth preparation and final impression taking, or using an indirect technique. • Duplicate the model Regardless, always make your temporaries • Create the 1.5 mm Copyplast pressure formed matrix after pulling the retraction cord for taking the final impression (Figure 2.2). In order to produce a properly fitting full crown temporary, you must capture the margin with acrylic just as you would capture it with silicone or polyether. Therefore, pull the retraction cords, then your impressions. If those margins aren’t visible, repack the teeth (Figure 2.3) and take another impression. Direct in-the-mouth Technique 1. Load the matrix with the temporary material, seat it into place (Figure 2.4), and let it cure. 2. Because all self-cure composite temporary materials may, at one time or another, 2.2 View of the retraction achieved for be subject to air bubbles, carefully inspect the temporaries upon removal from the impression taking for a patient with mouth and removal of the matrix. missing teeth. 2.3 In the same case, the cord is repacked 2.4 In the same case, view of the matrix to promote better visibility of the loaded with temporary material for margins in the final impression. the creation of direct temporary restorations. 2 Creating Excellent Full Crown Temporaries Advanced Esthetics & Interdisciplinary Dentistry Education Series
  5. 5. Chapter 2: Construction 3. Add just a touch of flowable composite to the area affected by the air bubble and light-cure it (Figure 2.5). 4. Trim and finish the temporaries and seat them with your cement of choice (Figure 2.6). 5. If the temporaries do not fit ideally, relining of the margins may be necessary using flowable composite. To accomplish this, air abrade the internal aspects of the temporaries, apply a single-bottle adhesive (Adper™ Single Bond Plus), and inject the flowable composite around the preparations. Then, seat the temporaries over the flowable composite and light cure for five seconds. Indirect Technique 2.5 Flowable composite is added to Alternatively, full crown temporaries can be constructed indirectly, which allows the area containing an air bubble. total control of their shape and form because they are created on a model. Additionally, the indirect technique enables you to actually prepare the teeth, make the impression, and delegate temporary fabrication to someone in the office trained to make them. The following steps demonstrate the technique for making indirect temporaries using a die silicone model. 1. Once the teeth have been prepared, make an alginate or polyether impression of the preparations for use in creating the die silicone model (Figure 2.7). Note: you should not use a polyvinyl siloxane impression material when working with the die sil- icone; the two materials will stick together. 2. At your workstation, place the tip on the syringe of the flowable addition-reaction 2.6 View of the direct in-the-mouth die silicone (Mach-2®) and inject the die silicone into the impression by placing temporaries after placement in the syringe tip straight down in the base of the impression, loading it just up to the mouth. the free gingival margin (Figure 2.8). 3. Proceed to the other side of the impression, and inject the die silicone into it in a sim- ilar manner. Within a matter of minutes, you have a silicone model. 4. Add a base to the model using bite registration paste (Futar®). Inject the paste over the silicone and across the palate in order to create a flat base on the model (Figure 2.9). Apply sufficient bite registration paste so that the model can be inverted and placed on a plastic plate to harden. Note: this flat base will prevent the model from warping when making the temporaries. 2.7 View of the impression used for 2.8 View of the die silicone being 2.9 View of the bite registration making the model. injected into the impression. paste being injected to create the base plate. Advanced Esthetics & Interdisciplinary Dentistry Education Series Creating Excellent Full Crown Temporaries 3
  6. 6. Chapter 2: Construction 5. Once the model base (i.e., bite registration paste) is firm, remove the plastic plate. 6. Now, try the matrix onto the model to ensure complete seating (Figure 2.10). The most common areas of interference occur in the palate or from the labial flange. 7. If the matrix has seated correctly, remove it and begin loading your temporary material fully into it (Figure 2.11). For demonstration purposes, the Protemp 3 Garant Temporization Material in shade A1 is used. 8. Take the fully loaded matrix back to the model, seat it into place, and put it down on the plastic pad, which should be level so that you can press down on it firmly without distorting the model. 2.10 The Copyplast matrix is seated onto 9. Wait a sufficient amount of time for the temporary material to cure. Alternatively, the model. the fully loaded and seated matrix/model can be placed in the Triad® 2000™ Visible Light Curing Unit for two minutes to ensure complete curing. 10. After curing, simply peel the loaded matrix off of the model and then off the temporaries (Figure 2.12). Because the model is silicone, the temporaries will not lock onto it. 11. Prior to trimming, remove excess/bulk temporary material that ran across the silicone model. 12. Additionally, because all of the composite temporary materials produce an oxygen inhibition layer, place the temporaries in alcohol for five to 10 seconds. 2.11 The matrix is loaded with the Alternative Stone Model Technique for Ovate Pontics temporary material. The indirect technique can also be completed using a stone model. The advantage of using a stone model compared to the silicone model is that it is much easier to carve stone. This is important when making full crown temporaries that require an ovate pontic (Figure 2.13). In such cases, simply make a second impression, but instead of using the die silicone alone, use a combination of 50% die silicone and 50% Whip Mix mounting stone to create the model. This will enable you to use a bur to carve the ideal ovate pontic site into the model in the area of the missing tooth. After making the model, simply mark it in pencil to show where/how the correct ovate pontic form should be (Figure 2.14). Then, use your bur to carve the correct form 2.12 The matrix is peeled from the hard- into the model prior to loading and seating your matrix with the temporary material. ened temporaries, which are now ready to be trimmed. 2.13 View of a patient requiring a remake 2.14 The stone model is marked with of her anterior bridge. pencil to identify where it should be carved for placement of the ovate pontic. 4 Creating Excellent Full Crown Temporaries Advanced Esthetics & Interdisciplinary Dentistry Education Series
  7. 7. Chapter 2: Construction Once the indirect temporary is complete (i.e., after completing the other steps out- lined in this manual), it will serve as the template for augmenting the gingival tissue. Simply spray occlude spray on the bottom of the pontic and place in the mouth to mark exactly where on the ridge modifications should be made. Then, contour the ridge using a laser or electrosurgery unit until the temporary seats completely. Bridge Reinforcement For bridge temporaries, reinforcement is sometimes necessary, and many products are available for this purpose, including GlasSpan flexible ceramic ropes and tapes. The ropes, in particular, are small and provide cylindrical fiber reinforcement; they are 2.15 View of a patient missing his incisors available in small, medium and large sizes. who will be wearing the temporary 1. To reinforce a bridge temporary for which the pontic area requires additional for a prolonged period of time. strength (Figure 2.15), create your model and your matrix, as described previously. 2. With this case as an example, place the medium sized GlasSpan rope on the model of the prepared teeth, beginning with one cuspid, and tack it into place with flowable composite (Figure 2.16). 3. Then, move the GlasSpan over to the next tooth and tack it with flowable compos- ite. Continue along all preparations for the temporary bridge restoration. 4. Once the reinforcing rope is in place, cut off the excess. However, to keep the rope from fraying, paint it with dentin adhesive precisely where you plan to cut it and light cure it. Then, cut through the cured rope. 5. Now, mould the rope to the preparations, bearing in mind that the loaded matrix must still be able to fit properly on the model. Additional flowable composite can be used to ensure that the rope does not flex or distort when the loaded matrix is placed (Figure 2.17). 6. Load your matrix with the desired temporary material and seat onto the matrix, as described previously, and continue the construction process as outlined (Figure 2.18 and 2.19). Note: this type of bridge temporary can easily last for between six and 12 months. 2.16 The GlasSpan rope is placed on the 2.17 More flowable composite was added preparations on the model and to the GlasSpan rope to make it tacked into place with flowable bulkier and less likely to flex. composite. 2.18 The matrix is loaded with 2.19 View of the patient with the temporary material and seated completed reinforced temporary onto the reinforced model. bridge in place. Advanced Esthetics & Interdisciplinary Dentistry Education Series Creating Excellent Full Crown Temporaries 5
  8. 8. CHAPTER 3 Trimming & Shaping W hen trimming and shaping temporaries, a useful tool for the dental office is a workstation equipped with an electric handpiece, vacuum system, compressed air, and a curing light/curing unit (Figure 3.1). Additionally, the workstation may be equipped with sterilized burs for trimming and shaping that are contained in the Seattle Institute for Advanced Dental Education Provisional Kit (Figure 3.2). To begin trimming full crown temporaries, ensure that all margins are clearly visi- ble by highlighting them using a red pencil (Figure 3.3). This will help prevent over- trimming and under-trimming the margins, as well as leaving an overhang. 1. Once the margins have been marked, begin trimming the full crown temporary at 3.1 View of a lab station equipped with the buccal and lingual margin using a flame shaped acrylic bur. This bur is appro- an electric handpiece, vacuum priate for full crown temporaries based on the bulk of the temporary material. system, compressed air, and curing 2. Move the bur inward and across the buccal and then the lingual surfaces (Figure 3.4). light/unit. 3. Run the bur up to the marked red line on the facial surface, partially into the interproximal embrasure. Trim the entire facial and lingual aspects of the tempo- raries in this manner. 4. Once the basic buccal and lingual aspects have been trimmed to the margin, begin trimming the interproximal region. Correcting Marginal Concavities 1. If you notice a slight concavity on the surface of the temporaries, the matrix may have been too tight on the model. To recontour the temporary, ensure that all of the basic buccal and lingual margins fit correctly by trying the temporaries back 3.2 View of assorted Brasseler burs con- tained in the Seattle Institute for on the silicone model. Advanced Dental Education 2. If there is a concavity to be filled, handle the margins as if the temporaries need to Provisional Kit. be relined (Figure 3.5). 3. Prepare the temporary by air abrading it with 50 µm aluminum oxide and then painting a single-bottle adhesive (Adper Single Bond Plus) onto the facial surface. 4. Once the adhesive has been placed, use flowable composite to outline the margin around the facial aspects of each preparation and then seat the temporary on the silicone model (Figure 3.6). 3.3 View of all margins clearly high- lighted using a red pencil. 3.4 View showing movement of the bur 3.5 View showing how to handle the 3.6 Demonstration of how to use flow- inward and across the buccal and margins if a concavity must be able composite to outline the mar- then the lingual surfaces. filled. gin around the facial aspects of each temporary. 6 Creating Excellent Full Crown Temporaries Advanced Esthetics & Interdisciplinary Dentistry Education Series
  9. 9. Chapter 3: Trimming & Shaping 5. To fill in the concavity, paint the concavity to its shape using just the tip of the flowable material. 6. In order to avoid much more trimming, use the adhesive brush to wipe down the facial aspect to “feather out” the composite (Figure 3.7), then light-cure it for 30 sec- onds. Ideally, the temporary can be placed in the Triad curing unit for 30 seconds. 7. To remove the oxygen inhibiting layer, place the temporary in alcohol. 8. After removing it from the alcohol, dry the temporary and mark the margins again with red pencil. If the margins were relined correctly, there should be an extension of acrylic beyond the margin of the preparation (Figure 3.8). 3.7 View showing how to use the adhe- sive brush to wipe down the facial 9. Now, using the pointed and shaped acrylic bur, continue refining the facial mar- aspect to “feather out” the composite. gin to the marked line. Note: because the concavity has been filled in, the contour appears more esthetic. 10. Remember that putting tremendous effort and time into ensuring that the tem- poraries fit well contributes to the condition that the gingival tissue will be in when seating the definitive restorations. If the temporaries fit properly and the margins are well contoured, there is less likelihood of experiencing inflamed gin- giva when the final restorations are seated. Resume Interproximal & Embrasure Contouring 1. Once the buccal and lingual surfaces have been finished, continuing trimming 3.8 View of the extension of acrylic that would appear beyond the margin of and shaping interproximally. For posterior temporaries, use either a flexible disc the preparation if the margins were or a double-sided stiff and coarse diamond disc. For anterior temporaries, the very realigned correctly. flexible, ultra thin and double-sided 9 11 H disc is preferred. 2. Begin trimming the gingival embrasures by holding the disc so that it is parallel to the root of the temporary (Figure 3.9), beginning first with the lateral and then the central. 3. Turn the temporaries around to trim the embrasures from the lingual aspects of the lateral and then the central. Note: throughout the process, a fairly slow speed is used; working in this manner creates the emergence profile against the root of the temporary. 4. Be sure that the midline of the two central incisor temporaries is correct. Examine where the two roots of the centrals are and make a little notch between them to 3.9 View showing how to hold the disc identify the midline’s location. Lean the disc against one central and then against parallel to the root of the temporary the other central (Figure 3.10). when beginning to trim the gingival embrasures. 3.10 View demonstrating how to notch between the two centrals and lean the disc against one central and then the other to create the proper midline. Advanced Esthetics & Interdisciplinary Dentistry Education Series Creating Excellent Full Crown Temporaries 7
  10. 10. Chapter 3: Trimming & Shaping Incisal Edge Adjustments 1. Place the temporaries back on the model and ensure that the incisal plane is cor- rect (Figure 3.11). Any incisal edge adjustments should be made at this time, prior to further finishing. 2. Use a gray ceramic pre-polishing wheel to adjust the incisal edges by creating a very flat edge on it. Use a coarse double-sided, very stiff diamond disc for support. 3. Use this pre-polishing wheel to create a flatter incisal edge, if desired, or impart other desired incisal contours. 3.11 Illustration showing proper incisal 4. After the incisal edges have been properly adjusted, define the incisal embrasures edge plane. (i.e., make them large or small, depending on the characteristics desired in the temporaries) and connect them to the previously carved cervical embrasures. The 9 11 H disc can be used for this purpose, working on the model (Figure 3.12). 5. To refine the facial embrasures, hold the temporary in your hands and, using the 9 11 H disc, begin at the cervical and work up into the insisal embrasure. 6. Next, turn the temporary around to complete the mesial of the lateral by pulling the disc to create a curved surface (Figure 3.13). 7. Continue with the other side, using the bending action of the disc to create the curved form of the embrasure and the line angle of the tooth. Proceed with the distal aspect of the central and finally, the midline. 3.12 View showing how to use the 8. Drag the disc along the mesial line angle of each temporary to provide some con- 9 11 H disc when working on the tour in those areas to complete the trimming process (Figure 3.14). model to properly define the incisal embrasure. 3.13 Demonstration of how to complete the trimming of the mesial aspect of the lateral by pulling the disc to create a curved surface. 3.14 View of the completely trimmed and shaped temporaries. 8 Creating Excellent Full Crown Temporaries Advanced Esthetics & Interdisciplinary Dentistry Education Series
  11. 11. CHAPTER Refining the Anatomy W hen fabricating full crown temporaries on silicone models, the Protemp 3 Garant Temporization Material shrinks by approximately 3% to 4%. As a result, 4 it will be snug when placed in the mouth. This can be corrected by relining the temporary at some point during the fab- rication process. To do so, select a small acrylic bur and run it lightly inside the temporary, primarily in the marginal region, relining it just enough to provide room for cement and ensure it fits prop- erly (Figure 4.1). 4.1 View of the selected small acrylic 4.2 View illustrating the orientation of To refine the anatomy: bur as it is used to lightly reline the the bur against the temporary in 1. Run a fairly fine fluted acrylic bur inside of the temporary. order to create centrals with a over the facial surface of the tempo- definite flat labial surface. raries to create a relatively smooth surface. 2. When working from wax-ups, the centrals can become very convex. To create centrals with a definite flat labial surface, run the bur in such an orientation so as to impart a flat plane that produces esthetic light refection (Figure 4.2). 4.3 View demonstrating how to hold/ 4.4 View illustrating how the bur tip is 3. Repeat this process on the laterals to place bur tip against temporaries also run on the distal aspect of the ensure that the temporaries are not to create lobes or convexities in the centrals to create a concavity. centrals. too convex, but instead demonstrate a nice flat surface anatomy. 4. To create lobes or convexities that mimic those found in natural teeth, use the round tip of an acrylic bur. Run the bur tip vertically on the mesial aspect of both centrals to create a concavity in that location (Figure 4.3). 5. Run a bit of the bur tip on the distal aspect of the centrals, also, to create a con- cavity (Figure 4.4). 6. Next, run the bur on the mesial aspect of the laterals. 7. To blend the concavities and impart texture into the temporaries, run the 4.5 View showing how to run the rounded edge of the bur horizon- rounded edge of the bur horizontally to the concavities that were just completed tally to the previously created in order to create striations in the surface (Figure 4.5). Note: some of this texturiza- concavities for blending. tion will be filled when staining the temporaries; if too much texture has been created, realize that some will be lost during the final staining, glazing, and polishing process. 8. Now, check the cervical embrasures. Do they need to be opened or not? Pay particular attention to whether the embrasure is closed relative to the papilla. If it is closed relative to the papilla, it will hold the papilla in that position once the temporary is cemented. 9. To open gingival embrasures, use a 9 11 H ultra thin disc and open them approx- imately .5 mm to provide space to the papilla (Figure 4.6). 10. Verify that interproximal space has been created by trying the temporaries on the 4.6 View demonstrating the orientation model. Floss should pass easily through the cervical embrasures. and angle of the 9 11 H ultra thin disc when opening the gingival embrasures. Advanced Esthetics & Interdisciplinary Dentistry Education Series Creating Excellent Full Crown Temporaries 9
  12. 12. CHAPTER 5 Staining & Glazing A fter refining the anatomy, colorant and glaze is applied to the full crown tempo- raries. For demonstration purposes, orange and blue porcelain stains—and a light-cured denture sealant (Palaseal)—are used. 1. Apply a very thin wash of Palaseal to coat the temporaries. 2. Then, begin to add color. For these temporaries, orange is applied cervically and interproximally on each (Figure 5.1). The surface texture, concavities, and convexi- ties that were created using the round end of the bur should be visible. 3. Use only a small amount of color; it does not take much to effectively change the 5.1 Color is first applied cervically and shade of the temporary. For example, these temporaries were fabricated from interproximally on all of the temporaries. shade A1 of the Protemp 3 Garant Temporization Material, but the colorant is easily turning them to an A2 or A3 (Figure 5.2). 4. Now, highlight the translucency of the incisal edge. Here, blue is used. Excess can be applied and wiped over with a fresh layer of clear Palaseal for blending (Figure 5.3). 5. Set the colorant with a curing light according to the manufacturer’s instructions. 6. Apply the final glaze layer completely over all temporaries. Do not apply too much glaze because the surface anatomy could be lost. Apply only enough to seal the color (Figure 5.4). 7. Bake the temporaries for two minutes in the Triad curing unit. Note: temporaries 5.2 Image demonstrating how even a fabricated in this manner can routinely function esthetically for six months. small amount of color can change 8. Remove the temporaries from the curing unit and examine before proceeding to the appearance of temporaries from the lathe. Verify fit, color and contours on the model. a shade A1 to a shade A2 or A3. 9. Use the lathe to impart a natural luster, one that isn’t too dull or too shiny, similar to natural teeth (Figure 5.5). 5.3 View demonstrating that excess color to highlight the incisal edge can be wiped over using the clear sealant. 5.4 View illustrating the proper applica- 5.5 View demonstrating the use of a tion of the final glaze layer—just lathe to impart a natural luster to sufficient glaze to seal the color. the temporaries. 10 Creating Excellent Full Crown Temporaries Advanced Esthetics & Interdisciplinary Dentistry Education Series
  13. 13. CHAPTER Polishing Polishing is the last step necessary to complete the full crown temporaries. 1. Using a completely wet chamois wheel, begin on low speed, polishing the lingual 6 surface first with plenty of pumice mixed with water (Figure 6.1). Note: working at a low speed provides more control. 2. Polish the facial surface of the temporaries on low speed initially, also. 3. Take care not to let the wheel catch the incisal edge. 4. Keep the wheel moving using plenty of wet pumice. Note: the denture sealant that was applied to the stain is durable during the polishing process. 5. Rinse the surface of the temporary with water and examine its appearance (Figure 6.1 View showing a completely wet chamois wheel on low speed with 6.2). plenty of pumice mixed with water. 6. To achieve the desired luster, switch to a dry wheel at low speed and use a small amount of universal polishing paste to bring the temporaries to a very high shine. Polish the labial and lingual aspects of the temporaries in this manner (Figure 6.3). 7. For a higher shine, raise the speed. However, take care not to lose control of the temporaries. 8. Examine the temporaries. They should demonstrate enamel-like luster, as well as the surface anatomy that was originally created. 9. Finally, clean the temporaries using either a brush or ultrasonic prior to cement- ing in the mouth. 6.2 To evaluate the polishing progress, rinse the temporaries with water and examine. 6.3 Illustration of how to use a dry wheel and universal polishing paste to achieve a very high shine in the temporaries. Advanced Esthetics & Interdisciplinary Dentistry Education Series Creating Excellent Full Crown Temporaries 11
  14. 14. CHAPTER 7 Cementation/Removal C ontrary to what most people use these days for cementing full crown temporaries, zinc oxide eugenol cements—such as TempBond® and Fynal®—can be used. The latter, in particular, is a reinforced zinc oxide eugenol cement that is strong and desensitizes the tooth; anesthetic is rarely needed. Questions may arise regarding bonding of the definitive restorations if an eugenol cement has been used for temporary restorations. Eugenol contaminates bonding and interferes with the polymerization of resin if it is free eugenol. However, after one week in the mouth, this author has found that there is no free eugenol left in these cements. 7.1 View of Miltex carbide tipped Regardless, it is prudent practice to always clean preparations after removing the hemostats that can be used for temporaries and before cementing the final restorations. Preparations can be cleaned removing temporaries. with either air abrasion—which requires anesthetizing the patient—or by using pumice and a rubber cup. If the temporaries have been placed using Fynal, this author has found that, when they’re removed, the cement has remained in the temporaries. As a result, cleaning the preparations with pumice—and without the need for anes- thetic—is simplified. Because this temporary cement is strong, questions have been posed about how to successfully remove the temporaries. Carbide tipped hemostats (Miltex, Inc.) that allow you to grab the temporary, squeeze it, and then rock it enable you to simply lift it off (Figure 7.1); only rarely will a temporary need to be sectioned in order to be removed. 12 Creating Excellent Full Crown Temporaries Advanced Esthetics & Interdisciplinary Dentistry Education Series
  15. 15. Notes Advanced Esthetics & Interdisciplinary Dentistry Education Series Creating Excellent Full Crown Temporaries 13
  16. 16. Author Contact Information Frank M. Spear, D.D.S., M.S.D. Seattle Institute for Advanced Dental Education 1-888-575-0370; Outside the United States: 1-206-322-0370 Product & Trademark Information • Carbide tipped hemostats; Miltex, Inc., York, PA • Copyplast; Mini Star; Whip Mix; Great Lakes Orthodontics, Tonowanda, NY • Fynal®; Integrity™; DENTSPLY Caulk, Milford, DE • Futar®; Kettenbach GmbH & Co. KG, Eschenburg, Germany • GlasSpan flexible ceramic ropes; GlasSpan, Inc., Exton, PA • Luxatemp® Automix Plus; Zenith/DMG, Englewood, NJ • Mach-2®; Parkell, Inc., Edgewood, NJ • Palaseal; Heraeus Kulzer, Armonk, NY • Protemp™ 3 Garant™ Temporization Material; Adper™ Single Bond Plus; RelyX™ Luting Cement; 3M™ ESPE™, St. Paul, MN • Seattle Institute for Advanced Dental Education Provisional Kit; Brasseler USA®, Savannah, GA • TempBond®; Kerr, Orange, CA • Triad® 2000™ Visible Light Curing Unit; DENTSPLY International, York, PA