Clinic Manual Single Unit Crown

Manual for Clinical Fixed Prosthodontics
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Single Unit Crown
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New York University, College of Dentistry
Department of Prosthodontics
Marjan Moghadam, DDS, MA

Igor Chikunov, DDS
Gianny Montenegro, DDS Candidate 2014
TABLE OF CONTENTS
Procedure #1: Preliminary Impressions
Procedure #2: Articulation of Diagnostic Casts
Procedure #3: Diagnostic Wax Up
Procedure #4: Preparation for Provisional Restoration
Procedure #5: Tooth Preparation and Caries Removal
Procedure #6: Fabrication of Provisional Restoration for the Prepared Tooth
Procedure #7: Tissue Management & Definitive Impression
Procedure #8: Interocclusal Records
Procedure #9: Try-in, Cementation and Patient Instructions
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Clinical Procedure #1: Preliminary Impressions

Purpose:
To make an impression of teeth and edentulous areas in order to fabricate diagnostic casts for
the purpose of diagnosis and treatment planning prior to prosthodontic procedures
Armamentarium:

NYU Fixed Prosthodontics Instrument Kit

Rubber mixing bowl (Whaledent)
Mixing spatula (Moyco, USA)
Alginate impression material (Jeltrate, Caulk, USA)
Water & powder measuring cups (Caulk, USA)
Tray adhesive (Dentsply, Caulk, USA)
Maxillary & mandibular perforated impression trays (GC America, USA)
Rope wax (Heraeus Kulzer, USA)
THIS MANUAL, THE MATERIALS AND MODELS USED ARE BASED ON

THE PRACTICE AND TEACHING METHODS AT
NEW YORK UNIVERSITY, COLLEGE OF DENTISTRY
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Procedure: Making Preliminary Alginate Impressions

Try the impression tray in the patients mouth
Modify the impression tray by adding wax as needed to the periphery of the tray and try it in
the patients mouth for comfort and proper extension
Apply adhesive to impression tray
Mix the alginate in the proper powder-to-water ratio, load the tray and take the impression
Once the impression material has completely set, remove it from the mouth and examine it for
details and accuracy
Retake the impression as needed if any inaccuracies are visible
Trim any overhanging alginate on the borders of the tray with a knife
Wrap the impression with a wet paper towel until ready to be poured
The impression should be poured as soon as possible after dismissing the patient
Figure 1 below depicts acceptable alignate impressions
Figure 1
Procedure: Pouring the Impression
Add small increments of stone to the last tooth in one quadrant of the impression while it is on
the vibrating machine, then move forward to fill the entire impression
Do NOT invert the impression to form a base
Add a base (10-15 mm or at least inch thick) after initial set of the stone (about 15 minutes)
Once the stone is completely set, separate the cast from the impression and trim on the model
trimming machine
Groom the cast by removing any bubbles and artifacts on the cast
Figures 2 & 3 below depict acceptable diagnostic casts
Figures 2 & 3
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Chart entry:
Make a complete and appropriate chart entry detailing the days procedure, including an update of the medical history and other examinations
Sample chart entry:
Reviewed medical history - no significant changes; Intra-oral exam and extra-oral exam
- within normal limits
Patient presents to clinic at [insert time] for preliminary alginate impressions
Maxillary and mandibular prelimiary impressions made with alginate impression material for fabrication of diagnostic casts
Next visit - interocclusal records or complete treatment plan (as appopriate)
Recommended Teaching/Discussion Points:

Discuss the importance of making pre-treatment records
Discuss the properties of alginate impression material and factors affecting its setting
time
Discuss critical errors such as
Voids/air bubbles in critical areas
Voids in the vestibular areas
Discuss whether interocclusal records are needed for mounting of diagnostic casts
or if the casts can be hand articulated
References:
Rosentiel S.F., Land, M.F., Fujimoto, J. Contemporary Fixed Prosthodontics. 4th Edition, Mosby 2006.
Shillingburg, H.T. Fundamentals of Fixed Prosthodontics. 3rd Edition, Quintessence
Publishing 1997.
Civjan, S., E. F. Huget, et al. (1972). Surface characteristics of alginate impressions.
J Prosthet Dent 28(4): 373-8.
Rudd, K. D., R. M. Morrow, et al. (1969). Accurate casts. J Prosthet Dent 21(5): 54554.
Rudd, K. D., R. M. Morrow, et al. (1969). Accurate alginate impressions. J Prosthet
Dent 22(3): 294-300.
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Clinical Procedure #2: Articulation of Diagnostic Casts

Purpose:
To articulate the maxillary and mandibular diagnostic casts on an articulator for the purposes of
diagnosis and treatment planning prior to starting prosthodontic procedures
Armamentarium:

Plastic mixing bowl

Mixing spatula
Panadent articulator, magnetic mounting plates, adjustable mounting platform
Plaster or Snap stone (Whip Mix Corp., USA)
Pink base-plate wax (Corning, USA)
Blazer torch (Blazer Products, USA)
Triad light cure record base material (Dentsply International)

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Procedure: Articulation of diagnostic casts that can be hand articulated

Use the adjustable mounting platform (Figure 1) or a face bow to attach the maxillary cast on
the upper member of the articulator
Figure 1
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Procedure: Articulation of casts that cannot be hand articulated

If the casts cannot be hand-articulated, fabricate a record base with occlusal rims (Figure 2 &
3) to make an interocclusal record
Adjust the height of the wax occlusal rim to the vertical dimension of occlusion established by
the existing dentition
Make the interocclusal record (in maximum intercuspation or centric relation as appropriate) in
the patients mouth (Figure 4 & 5)
Use this record to articulate the mandibular diagnostic cast (Figures 6 & 7)
Figure 2 & 3
Figures 4 & 5
Figures 6 & 7
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Once you have completed the treatment plan with your faculty, discuss treatment options with
the patient and finalize the treatment plan
Obtain informed consent from patient
Finalize the treatment sequence
Chart entry:
Sample chart entry:
Patient presents to clinic at [insert time] for completion of treatment plan. Interocclusal
records made utilizing occlusal rims (Triad record base material and baseplate wax) for
mounting of diagnostic casts
Treatment plan discussed and finalized with patient, informed consent obtained
Next visit - begin fabrication of crown for teeth #6 & 7

Discuss the importance of appropriately articulated diagnostic casts, specifically in
diagnosing:
The need for pre-prosthetic surgery
Extrusion or tilting of teeth
Assessment of the occlusal scheme, plane of occlusion and horizontal/vertical
overlap of teeth
Discuss the difference between maximum intercuspation & centric relation records
Discuss development of the patients treatment plan using the diagnostic casts as well
as radiographs
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References:
Publishing 1997.
Rhoads, J.E., Rudd, K.D., Morrow, R.M., Dental Laboratory Procedures, Fixed Partial
Dentures. 2nd Edition, Mosby 1986.
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Procedure #3: Diagnostic Wax Up

Purpose:
To create final contours of the proposed restoration in wax in order to:
Aid in treatment planning
Assess the esthetic outcome of treatment
Facilitate fabrication of provisional restorations
Verify adequate space for final restoration
Facilitate communication with the laboratory technologist and the patient
Armamentarium:

Blazer torch (Blazer Products, USA)

#7 Wax spatula (Miltex, USA)
PKT carvers (Hu-Friedy)
Esthetic wax (Cendres Metaux, Switzerland)

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Procedure:
Complete a diagnostic wax up of the tooth form being restored on your mounted diagnostic
cast (Figures 1 & 2)
Be sure to consider the anatomy of the opposing dentition as well as concepts of esthetics,
form and function
Figure 1: Diagnostic wax up of teeth #6 & 7
Figure 2: Anterior artificial tooth arrangement for verification of esthetics
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Discuss the importance of the diagnostic wax-up as a tool for diagnosis and treatment
planning
Discuss the importance of the diagnostic wax-up as a tool for communication with the
laboratory technologist
Discuss the importance of the diagnostic wax-up as a tool for communication with the
patient
Discuss the importance of the diagnostic wax-up as a tool for fabrication of provisional
restorations
Discuss waxing techniques
References:
Publishing 1997.
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Procedure #4: Preparation for Provisional Restoration

Purpose:
To prepare a matrix for fabrication of a provisional restoration prior to tooth preparation in the
patients mouth
Armamentarium:

Vacuum form sheet or PVS matrix material with a non-perforated quadrant tray
Hemostat
Scissors
Knife (Henry Schein, USA)
Disposable, perforated impression tray (GC America)
Polyvinyl siloxane heavy viscosity (Quixx Putty)
Adhesive
Mixing guns
Plastic tip attachment

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Prior to appointment for preparation of the tooth being restored, a matrix must be made for fabrication of the provisional restoration. There are many techniques for creating this matrix. The
following are two methods: utilizing a polyvinyl siloxane putty matrix or a vacuum shell matrix.
Procedure: Utilizing the polyvinyl siloxane matrix (Figure 1)
Duplicate the cast of the wax up of the tooth/teeth being restored by making an alginate impression of the diagnostic cast and wax up
Using the non-perforated quadrant tray with NO adhesive, make an impression of the quadrant
with a heavy body PVS impression material (putty)
Separate the impression when set
Remove the putty impression from the quadrant tray
Use a knife to trim the matrix just created to at least one tooth beyond the abutment tooth being prepared. In the case of a terminal abutment, extend the putty onto the residual alveolar
ridge adjacent to the abutment tooth
Maintain one tooth on either side of the desired restoration to act as positive seats for the matrix; also remove any impression material that is more than 5 mm apical to the clinical crown
Figure 1
Procedure: Utilizing the vacuum form sheet

Duplicate the cast of the wax up of the tooth/teeth being restored

Adapt the thermoplastic sheet to the duplicated cast using the vacuum form machine
Carefully remove the formed sheet from the cast and trim the matrix to the appropriate size
Be sure to maintain at least one tooth on either side of the desired restoration to act as positive seats for the matrix
Trim the occluso-gingival height to no more than 5mm apical to the clinical crown (figure 2)
Figure 2
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Discuss the importance of planning ahead for patient appointments to facilitate
efficient patient interactions and time utilization
Discuss the different methods for fabricating interim restorations
References:
Publishing 1997.
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Clinical Procedure #5: Tooth Preparation and Caries Removal

Purpose:
To remove diseased tooth structure and create adequate space for fabrication of a complete
coverage (crown) restoration
Armamentarium:

Fixed Prosthodontics Instrument Tray

Fixed Prosthodontics diamond bur block
High-speed handpiece (Midwest Dentsply Professional, USA)
Slow-speed handpiece (Brasseler, USA)

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Procedure: Tooth Preparation (Figure 1)

Anesthetize the patient as indicated
Make a note of the tooth shade PRIOR to any dental treatment, as a baseline measure
Prepare the tooth keeping in mind the correct principles of tooth preparation. Pay close attention to the following:
Sequence of tooth preparation: Occlusal reduction, buccal and lingual reduction, formation of the proper finish line
Preservation of an adequate amount of tooth structure for retention of the restoration
If there is an inadequate amount of tooth structure for proper fabrication of a
crown, you must build a core using a resin restoration material
If there is not enough tooth structure for a core buildup, it may be necessary to
perform elective endodontic therapy for the use of a dowel and core
Taper of axial walls
Place boxes or grooves as needed to increase retention
If placing a groove: the groove should begin at the shoulder, be the height of the
buccal axial wall, with the same depth and width as a #700 bur
If placing a box: the box should begin at the shoulder, be a minimum of 2.0mm in
height, the same depth as the #700 bur, and twice its width
Occlusal reduction
To evaluate proper reduction: place the occlusal clearance Flexible Clearance
Tab (green for 1.5 mm, blue for 2.0 mm). Have the patient close and try to remove the guide. The guide should be drawn through with slight resistance, but
still touching the preparation and the opposing tooth
Functional Cusp bevel
Evaluate for and eliminate any undercuts
Finish line: discuss the proper finish line for your restoration with your faculty
If placing a bevel, do so using a FG steel bur #30011
A provisional restoration should be fabricated (see Clinical Procedure #6), prior to making the final impression (see Clinical Procedure #7)
Figure 1
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Chart entry:
Sample chart entry:
Patient presents to clinic at [insert time] for treatment of teeth #6 & 7
Include anesthetic type and dosage if used
Preliminary/final preparation on teeth #6 & 7 performed
Interim restoration fabricated with autopolymerizing acrylic resin and cemented with
(interim cement) [see chapter 6]
Occlusion checked
Instructions given to patient
Next visit finalize preparation/make final impression

Discuss concepts of taper as related to retention and resistance form

Discuss guidelines for tooth reduction and how to evaluate amount of reduction
Discuss types of finish lines and their appropriate use in the clinical situation
Discuss methods for checking for undercut areas on tooth preparation
Discuss the appropriate use for a bevel on the finish line
References:
Publishing 1997.
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Clinical Procedure #6: Fabrication of Provisional Restoration for the Prepared Tooth
Purpose:
To protect the prepared tooth
Prevent drifting of the prepared tooth during treatment by providing contact areas and centric
receiving areas
Restore function and occlusion
Provide esthetics and restore normal speech
Diagnostic evaluation of tissue acceptance to contours of the restoration and as a blueprint for
the definitive restoration
Armamentarium - need to update this after new pictures:

Fixed Prosthodontics Instrument Kit

Matrix fabricated before preparation appointment (see Chapter 4)
Auto-polymerizing acrylic resin powder and liquid (Duralay - Reliance or Alike - GC America)
Brush
Disposable dappen dish
Knife (Henry Schein, USA)
Petroleum jelly (Kendall, Covidien, USA)
Occlusal marking paper (Parkell)
Interim restoration finishing and polishing bur kit
Straight slow-speed handpiece ((Brasseler, USA)
Interim luting agent (Temp-Bond, Kerr)

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Procedure:
Lubricate the prepared tooth as well as adjacent teeth with petroleum jelly or saliva
Place a small amount of monomer in a disposable mixing cup
Slowly add resin powder to the liquid and mix with cement mixing spatula. Continue adding
powder until the mix begins to lose its shine but is still runny
Pour a small amount of this mix into the appropriate tooth form in your matrix making sure not
to allow the material to flow into the other tooth forms
Place the matrix with the resin on the prepared tooth and fully seat it, check for intimate seating of the matrix on the adjacent teeth
Gently lift and reseat the matrix and provisional restoration from the prepared tooth being careful not to distort the doughy provisional restoration
If the provisional restoration remains on the tooth (figure 1), gently remove and reseat
with an instrument being careful not to distort it
If the provisional restoration remains in the matrix, allow it to polymerize for a longer
period of time before attempting to remove it from the matrix
Be careful NOT TO LOCK THE PROVISIONAL ONTO the prepared tooth or the undercuts of the adjacent teeth
Once the acrylic resin has completely polymerized, remove it from the mouth and trim with
acrylic trimming burs. Check to make sure there are no open margins. If there are, add acrylic
to those deficient areas utilizing the Nealon technique with the powder and liquid monomer
(figure 2)
Once the provisional restoration is fully seated and the margins are all properly closed, check
the occlusion and the contacts and adjust/add as needed
Cement the provisional with an interim cement (such as Temp-Bond)
Remove excess cement
Figure 1
Figure 2
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Chart entry:
Sample chart entry:
Patient presents to clinic at [insert time] for continued treatment of teeth #6 & 7
Include anesthetic type and dosage if used
Preliminary/final preparation on teeth #6 & 7 performed
Interim restoration fabricated with autopolymerizing acrylic resin and cemented with
interim cement
Occlusion checked
Next visit finalize preparation/make final impression as appropriate

Discuss properties of auto-polymerizing acrylic resin and proper handling of the
material in fabrication of provisional restorations
Discuss different materials available for fabrication of provisional restorations
Discuss different techniques for fabrication of provisional restorations
Discuss direct and indirect techniques of fabrication of provisional restorations
Discuss different interim cements and their proper use in clinical situations
References:
Publishing 1997.
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Clinical Procedure #7: Tissue Management & Definitive Impression

Purpose:
To retract gingival tissues in order to expose entire prepared tooth structure to facilitate accurate impression making
To prepare a negative likeness of the prepared tooth and the surrounding structures in order to
create a master cast for fabrication of a single unit crown
Armamentarium:

Fixed Prosthodontics Instrument Kit

Gingival retraction cord (Ultradent USA)
Disposable dappen dish
Hemostatic agent as needed (Viscostat, Ultradent USA)
Disposable, perforated impression tray (GC America)
Polyvinyl siloxane heavy and medium viscosity (Quixx Putty & Reprosil)
Adhesive
Mixing guns (2)
Plastic tips (2) & fine tip attachment
Shade guide (Vita)
Cord Placement Instrument

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Procedure: Gingival retraction

Anesthetize the patient
Remove the provisional restoration, clean the prepared tooth and eliminate any interim cement
and/or plaque
Measure the gingival pocket depths around the margins of the prepared tooth
If you will be using the double-cord technique, there should be sufficient space to allow for
placement of two cords. If there is not enough space, you should use the single-cord technique
Cut a length of retraction cord long enough to go all around the circumference of the prepared
tooth
Soak the cord in the hemostatic agent
Use the cord placing instrument to place the cord in the sulcus (figure 1):
Begin by tucking one end of the cord in the sulcus
Continue around the rest of the circumference of the sulcus
When you have completed placement of the cord, it should be located just apical to the
finish line of the crown preparation
Single-cord technique
Place your cord in the sulcus and leave a small tail of cord out of the sulcus for retrieval prior
to final impression making
With this technique, you will remove this cord prior to making the final impression
Isolate and dry the prepared tooth using cotton rolls and the saliva ejector
Double-cord technique
Place a smaller (size 0 or 00) cord in the sulcus
Cut off any excess cord and make sure the entire cord is fully submerged subgingivally
Place your second slightly larger cord in the sulcus but leave a small tail of cord out of the
sulcus for retrieval
With this technique, you will only remove the 2nd, larger cord to make your final impression
(remember to remove the smaller cord after the impression is completed successfully)
Figure 1
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Procedure: Final Impression

Apply adhesive to the perforated impression tray

Have a colleague express the heavy body PVS (Quixx Putty) material in the impression tray
At the same time, GENTLY remove the cord from the sulcus
Using the fine tip attachment, inject the medium body PVS (Reprosil) material into the gingival
sulcus which has now been displaced by the cord
To avoid trapping air, be careful not to lift the tip away as you inject the impression material
around the tooth
Once you have placed some of the medium body material into the sulcus, use the air/water
syringe to gently blow the material further into the sulcus and re-inject
Seat the impression tray in the mouth and hold in place for at least 5 minutes until the material
has fully set
Remove the tray and evaluate the impression:
The impression should be remade if there are any air bubbles in the area of the prepared tooth and the margin or if there is evidence of impression material drag (figures 2
& 3)
Disinfect the impression
Inspect pour up of impression for accuracy (figure 4)
Figure 2
Figure 3
Figure 4
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Acceptable Final Impression & Master Casts

Note that the entire finish line is captured and no air bubbles are present
Unacceptable Final Impressions

Unclear
finish line
Cord trapped in
impression
material
Procedure: Shade selection

Select the appropriate shade for the final restoration utilizing a shade selection guide
Discuss and demonstrate the selected shade with the patient for additional input and approval
Be sure to complete any tooth whitening procedures PRIOR to shade selection for final restoration
Consider taking photographs of the patient to send to the laboratory to aid in shade matching
Chart entry:
Sample chart entry:
Include anesthetic type and dosage used
Preparation on teeth #6 & 7 finalized
Final impression made with (name of impression material)
Interim restoration cemented with (temp cement)
Occlusion checked
Shade __ selected
Next visit - interocclusal record or delivery of crown as appropriate
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Laboratory Prescription:
Select the proper work authorization form for pouring the final impression
Indicate that you would like the impression to be poured in DieKeen (green stone)
References:
Publishing 1997.

Discuss single-cord versus double-cord impression techniques:
The actual techniques and when each one is appropriate
Discuss the use of hemostatic agents:
Which agent is appropriate in which clinical situation
Discuss the importance of an accurate final impression and what errors can arise if air
bubbles are incorporated in the impression or if there is material drag
Discuss final impression materials and their appropriate use in different clinical settings
Polyvinyl siloxane
Polyether
Polysulfide
Irreversible hydrocolloid
Discuss the concepts of hue, value and chroma as related to shade selection
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Clinical Procedure #8: Interocclusal Records

Purpose:
To register the appropriate interocclusal record (centric relation or maximum intercuspation) in
order to properly relate the maxillary and mandibular master casts on the articulator
Armamentarium:

Fixed Prosthodontics instrument kit

Slow-speed handpiece (Brasseler, USA)
Acrylic trimming bur kit
Master cast obtained from laboratory after pour-up
Cast of opposing arch
Occlusal rims as needed
Knife
Hot plate (Buffalo Dental, USA)
Pink baseplate wax or alluwax (Corning Rubber Co, USA)
Autopolymerizing acrylic resin (Red Duralay resin)
Petroleum jelly (Kendall Covidien, USA)

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Procedure:
If hand articulation of maxillary and mandibular casts is possible, and the prepared tooth is
NOT a distal terminal abutment (i.e. not the last tooth in the arch) no interocclusal record is
needed
If the prepared tooth is a distal terminal abutment (i.e. the last tooth in the arch) an interocclusal record made of autopolymerizing acrylic resin (red Duralay) is required as follows:
Lubricate the abutment tooth, as well as the adjacent and opposing teeth with petroleum jelly
Mix red auto-polymerizing acrylic resin powder and monomer until a dull consistency is
achieved the acrylic resin should not stick to lubricated gloves
Create a small doughy block of acrylic resin and place it between the abutment tooth
and opposing tooth
Ask the patient to close into habitual closed position (maximum intercuspation)
Do not cover more than 2/3 of the axial height of prepared tooth with the resin
Continue to take the acrylic block on-and-off the abutment tooth and have the patient
close and open until the block has fully polymerized be sure to monitor the exothermic
reaction and not allow the abutment tooth to become affected by the heat
When the acrylic block has completely polymerized, remove it from the patients mouth
Trim any excess material to reveal the buccal surfaces of your abutment and opposing teeth - the registration should not cover more than 2-3mm of axial walls of prepared
tooth
If the master cast is availabe, place the acrylic record on the master cast and articulate
against the opposing cast to ensure that a stable and accurate record has been made
Procedure:
If hand articulation of the maxillary and mandibular casts is NOT possible, an occlusal rim
should be fabricated for either or both arches in order to facilitate making an interocclusal record as follows:
Fabricate a record base with an occlusal rim on the cast (master cast, opposing cast or
both casts if needed) with Triad material and pink baseplate wax
Adjust the occlusal rim(s) in the mouth to establish the proper plane of occlusion and
vertical dimension
Create V-shaped notches in the occlusal rim(s) in order to facilitate retention of the
interocclusal record
Place soft baseplate wax or Alluwax on the occlusal rim(s)
Place occlusal rim(s) inside the patients mouth and guide the patient into the proper
occlusion (maximum intercuspation or centric relation as appropriate for the clinical situation)
Allow the wax to harden prior to removing the occlusal rims from the patients mouth
Remove rim(s) from the patients mouth
Place the occlusal rim(s) and interocclusal record on the master cast and opposing cast
to ensure that a stable and accurate record has been made
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Interocclusal Records made with resin and record bases
Lab Prescription:

Select the proper work authorization form for fabrication of a crown

Indicate your finish line (chamfer, shoulder, with/without a bevel)
Indicate the type of crown being requested (metal-ceramic or all-ceramic)
Indicate the shade as well as the shade guide system being used
If survey crowns are being requested, indicate rest seats as well as the design of the removable partial denture for the laboratory
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Chart entry:
Sample chart entry:
Interocclusal record made using __
Provisional restoration recemented with interim cement
Next visit - Try-in of final restoration

Discuss the properties and the proper manipulation of autopolymerizing acrylic resin
specifically for the purpose of making an interocclusal record
Discuss the difference between maximum intercuspation and centric relation
Discuss the use of centric relation in restorative dentistry
Discuss instances where the use of a facebow record and custom-made incisal guide
table is required
References:
Publishing 1997.
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Clinical Procedure #9: Try-in, Cementation and Patient Instructions

Purpose:
To evaluate the fit of the restoration and adjust as needed to ensure optimum fit
To instruct patient on home care and sequelae to cementation of the restoration
Armamentarium:

Fixed Prosthodontics instrument kit

FPD Preparation bur block (diamond burs)
Ceramic polishing bur block
High-speed handpiece (Midwest Dentsply Professional, USA)
Low-speed handpiece (Brasseler, USA)
Articulating paper (Accufilm, Parkell)
Dental floss
Caliper (Pearson Dental)
Disclosing agent (Fit Checker, GC America)
Definitive cement (FujiCem, GC America)

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Procedure before patient appointment:

Evaluate the crowns and casts, be sure to examine the internal surfaces. Specifically, look for
any metal bubbles/blebs that should be removed prior to try-in of the crown
Check the contact and marginal fit of the crown on the master cast (figures 1-6).
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Procedure at delivery appointment:

Anesthetize the patient as needed
Remove the provisional restoration and thoroughly clean the prepared tooth including removal
of any excess cement or plaque
Isolate the tooth and try the crown on the prepared tooth
First, check the proximal contact by passing floss between the teeth
If the floss shreds, the contact is too tight and needs to be relieved with a high-speed
handpiece and fine diamond bur
If the floss passes freely through the contact, the contact is too loose and the crown
needs to be sent back to the lab for the addition of ceramic interporximally
If the floss snaps through the contact without shredding, it is correct
Use the caliper to measure the thickness of the crown before making any adjustments
in order to avoid any perforations
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Next check the margins of the crown all margins should be completely sealed and the explorer should not catch on the margins
If the crown is not completely seated and you have determined that the proximal contacts are not preventing the proper seating of the crown, you will have to check the
internal fit of the crown as follows
Apply a disclosing agent (such as Fit Checker) and seat the crown on the tooth
Remove the crown and check for any areas that are binding to the tooth structure. This will show as a rubbed off section in the disclosing agent (figures 7-9)
Relieve the marked area with a handpiece and reseat the crown
Repeat this procedure as needed until the crown is fully seated
Please note that the internal surface of an all-ceramic crown should not be adjusted. Rather, the tooth surface corresponding to the rubbed off area should be
adjusted
Figure 7
Figure 8
Figure 9
Finally, when the crown is completely seated and the proximal contacts are sufficient, check
the occlusion of the crown using thin articulating paper (Accu-Film; figures 10-11)
Adjust any interferences with a high-speed handpiece and a fine diamond bur
Use the caliper to measure the thickness of the crown before making any adjustments
in order to avoid any perforations
Be sure to check the occlusion in excursive movements as well as in maximum intercuspation
Figure 10
Figure11
Polish the porcelain with the low-speed handpiece and the appropriate polishing burs depending on if you are polishing ceramic or metal
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Procedure: Cementation
Select the appropriate definitive luting agent
Be sure that the prepared tooth is clean and all debris has been removed (figure 12)
Use a pumice and water mixture on a contra-angle low-speed handpiece to thoroughly clean
the prepared tooth
Isolate and dry the tooth with cotton rolls
Figure 12
Mix the luting agent in the appropriate manner (per manufacturers instructions)
Apply a small amount of the luting agent inside the crowns making sure to lightly coat the
internal walls. Do not overfill the crown with cement as it will only make clean-up more difficult
(figure 13)
Place the crown on the prepared tooth and firmly press and hold in place (figure 14)
You may wish to pass dental floss between the crown and adjacent teeth, while the luting
agent is setting, in the gingival direction only and pull through DO NOT pull the floss back
through occlusally as it may unseat the crown
When the luting agent has completely set, clean all excess material from the margins and the
contours of the crown and as well as adjacent teeth and interproximally (figure 15)
Verify occlusion (figure 16)
Figure 13
Figure 14
Figure 15
Figure 16
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Procedure: Instructions to the patient and follow-up

Advise the patient that the definitive restoration has been inserted
Follow up within a week to evaluate if the patient is feeling any discomfort with his/her new
crown you may need to do further adjustments of the occlusion
Advise the patient to clean and care for the crown as s/he would do other teeth with brushing
and flossing
The margins of the crowns, oral hygiene and occlusion should be checked at each recall visit
Chart entry:
Sample chart entry:
Indicate anesthetic type and dosage if used
Crowns for teeth #6 & 7 tried in, contacts and occlusion checked and adjusted appropriately
Crown cemented with definitive luting agent __
Instructions given
Next visit - follow up

Discuss the proper order for crown try-in: contacts, internal fit, occlusion
Discuss the possible consequences of not following this recommended sequence
Discuss importance of verifying proper occlusion
Discuss the need for checking occlusion in all excursive movements as well as maximum intercuspation
Discuss types of luting agents available and the appropriate use of each
Single Unit Crown
36
References:
Publishing 1997.
Single Unit Crown
37

Clinic Manual Single Unit Crown

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Clinic Manual Single Unit Crown

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Manual for Clinical Fixed Prosthodontics

Marjan Moghadam, DDS, MA

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Clinical Procedure #1: Preliminary Impressions

NYU Fixed Prosthodontics Instrument Kit

THIS MANUAL, THE MATERIALS AND MODELS USED ARE BASED ON

Single Unit Crown

Procedure: Making Preliminary Alginate Impressions

Single Unit Crown

Recommended Teaching/Discussion Points:

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Clinical Procedure #2: Articulation of Diagnostic Casts

Plastic mixing bowl

THIS MANUAL, THE MATERIALS AND MODELS USED ARE BASED ON

Single Unit Crown

Procedure: Articulation of diagnostic casts that can be hand articulated

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Procedure: Articulation of casts that cannot be hand articulated

Single Unit Crown

Recommended Teaching/Discussion Points:

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Procedure #3: Diagnostic Wax Up

Blazer torch (Blazer Products, USA)

THIS MANUAL, THE MATERIALS AND MODELS USED ARE BASED ON

Single Unit Crown

Figure 1: Diagnostic wax up of teeth #6 & 7

Figure 2: Anterior artificial tooth arrangement for verification of esthetics

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Recommended Teaching/Discussion Points:

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Procedure #4: Preparation for Provisional Restoration

THIS MANUAL, THE MATERIALS AND MODELS USED ARE BASED ON

Single Unit Crown

Duplicate the cast of the wax up of the tooth/teeth being restored

Single Unit Crown

Recommended Teaching/Discussion Points:

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Clinical Procedure #5: Tooth Preparation and Caries Removal

Fixed Prosthodontics Instrument Tray

THIS MANUAL, THE MATERIALS AND MODELS USED ARE BASED ON

Single Unit Crown

Procedure: Tooth Preparation (Figure 1)

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Recommended Teaching/Discussion Points:

Discuss concepts of taper as related to retention and resistance form

Manual for Clinical Fixed Prosthodontics

Single Unit Crown

Fixed Prosthodontics Instrument Kit

THIS MANUAL, THE MATERIALS AND MODELS USED ARE BASED ON

Single Unit Crown

Single Unit Crown

Recommended Teaching/Discussion Points:

Manual for Clinical Fixed Prosthodontics

Single Unit Crown