1. ADEQUATE
REDUCTION AND SMOOTH PREPS: Depth
cutting burs and clearance tabs are helpful
but you must think anatomically for realistic
contour and esthetic shades! For PFM's it's
important that you have 2mm occlusal reduction
and at least 1.5 mm on the facial for porcelain
esthetics. Smooth your preps to reduce sharp
angles and irregularities (hat cannot be dequately
reproduced in stone.
2. IDEALIZE
ADJACENT PROXIMAL AMD OPPOSING1 OCCLUSAL CONTACTS
BEFORE IMPRESSING: Too many cases
arc compromised by a failure to address these
irregular surfaces. By minimal recontouring
of adjacent proximals you can often dramatically
improve results. Occlusal adjustments (equilibration)
will help lab techs properly mount a case
and minimize occlusal adjustments on crowns
at delivery.
3. CLEAN THE
PREP ADEQUATELY AND DRY IT: If you
used a flowable composite or other resin base,
build-up, or temporary material on the prep,
there is a dispersion layer on the prep surface
that inhibits PVS impression materials. Thoroughly
wash and pumice preps before impressioning
to emove
contaminants.
4. IMPRESSION
TRAYS: Restrict quadrant tray use
to 1 or 2 posterior units when there is a
posterior stop (tray recommended from Clinician's
Choice Quad Tray 1-800-265-3444.) Use full
arch trays when no posterior stops, restoring
canines, or 3 teeth or more. Never let teeth
touch the tray: distortion, rebound, and powdery
inaccurate cusp tips are all the result. Don't
use triple trays for inlays or onlays. When
margins meet mesh, we all lose.
5. FLEXIBLE
TRAYS: Flexible trays will flex buccal-lingually
to accommodate more bulk of material and then
rebound. Die is small, tooth is big. Crown
doesn't fit, margin is open and occlusion
is high.
6. DON'T RELINE
IMPRESSIONS:There is simply no way
to "see" that an impression is completely
reseated in exactly the same position or to
the same degree of closure. Your relined margin
might look great but it's relation to the
occlusal surface of adjacent teeth and to
the prep itself is often inaccurate and undetectable
until seating failure.
7. BITE REGISTRATION:
Use a rigid bite registration material like
Blue Mouse or similar rigid material. Please
don't use clear bite or other rubber like
materials that have a memory or offer resistance
on closing. When doing one or two teeth, take
a bite over the preps only and make sure the
contra-lateral occlusion is unaltered while
taking the bite. %
8. USE MORE
WASH: Nothing improves margins, occlusion,
fit and contacts more than using more wash
(light body). Putty, medium or heavy body
tray materials simply don't have the detail
you need to get accurate dies. Contacts, opposing
teeth and prep detail are all enhanced by
more wash. Again, the result is fewer adjustments.
9. FITTING
CROWNS: If a crown doesn't go to
place immediately, check the die. Impression
materials are far superior to gypsum when
it comes to reproducing sharp detail on incisal
or occlusal edges, axial line angles and other
areas. Careful inspection of the die may reveal
an area where detail is not accurate to the
prep. Brushing these areas with a fine diamond
is quicker and easier than most fit-checker
silicones, markers, etc.
10. CEMENTATION
GETS EASIER: The newest cement from
3M, RelyX Unicem, appears to have won the
hearts and minds of dentists all over the
country. For ease of use, clean up, and reduced
post-op sensitivity, nothing seems to beat
this new material by all accounts of Keller
clients.