10/06/04 AM- INTRO TO PRECLIN FIXED PROS

ODTP (NPX)
1. medical history review
2. radiographs & interpretation
3. perio evaluation
4. ohi
5. problem listing and charting
6. consultations
7. treatment sequencing and grouping
8. financial arrangements
Recall Pt X
1. determine need for new radiographs
2. medical history uupdate
3. perio screening
4. ohi/review
5. problem list
6. treatment sequence
7. financial arrangements
Steps to take to get final restoration
Phase 1: Study Models
-taken during ODTP and mounted prior to fixed consultation
Phase 2: Provisionalize
-if pt of record, provisional restoration may be placed
-composite resin
Phase 3- Mount Study Models
-2 ways to do it at UOP
1) arbitrary mounting- models centered on articulator anteropost.
And in vertical relation with ave curve of Spee & max centrals
Centered with incisal pin
2) face-bow transfer-relates max model and external auditory meatus
With articulator
Phase 4- Diagnostic Wax-up
To establish contour of desired finished crown
Reasons:
1) to show pt proposed restoration contour
2) to communicate with lab desired contours
3) to help prepare operator for prep appt
4) provide template for splint fabrication
Phase 5- Impression of Diagnostic Was-up
Alginate impression made of waxup and surrounding teeth
Poured in stone
Phase 6- Splint fabrication

Trim model and pressed formed splint fabricated. Used for provisional
Fabrications at prep appt
Fixed Prosthodontics
-also replaces missing teeth w/fixed or cemented prostheses
-requires combo of:
1) pt education
2) prevention of further dental disease
3) sound diagnosis
4) perio therapy
5) operative dentistry
6) occlusion
7) removable prosthesis
8) orthodontics
9) endodontics
10) oral surgery
Principles of Preparations
1) preservation of tooth structurea. restoration must preserve remaining tooth structure
b. whole surfaces must not be sacrificed for conveniency or efficiency
c. may require limited amts of tooth structure be removed to preven
subsequent uncontrolled loss of larger quantities
2) retention and resistance
a. restoration must stay in places
b. rely on geometric configuration of tooth prep
c. interrelated
d. retention- prevents removal of restoration along path of insertion or long
axis of prep
i. internal retention -fillings
ii. external retention crowns
-veneer, sleeve, and box are examples
-some restorations will combine both
-diminishes as taper of opposing walls increases from 0-10 degrees
-perfectly parallel wallscant seat temp, also difficult to prep w/o
placing an undercut
-taper6-10 degrees btwn opposing walls is optimal
-retention is result of axial wall of prep to inner surface of restoration
-the greater the surface area of a prep, the greater the retention
-maximized when there is only one path along which restoration may be
removed
e. resistance- prevents dislodgement of restoration by forces directed in
apical or oblique direction; basic unit is 2 opposing forces

-limiting freedom of displacement from torquing or twisting in a

horizontal plane increases the resistance of restoration
-for restoration to succeed, length must be greater than the opposite side of
restoration enough to interfere with arc of casting pivoting about a point
on the margin
-box walls should not be oblique with axial walls of prep
-should meet at 90 degrees so they are perpendicular to any forces which
would rotate restoration
3) structural durability
a. must have adequate bulk of material to withstand forces of occlusion
b. fxnal cusp bevel is important part of occlusal reduction
c. 1.5 mm on fxnal surfaces (cusps)
d. 1.0 mm on non-fxnal surfaces (cusps)
4) marginal integrity
a. restoration will survive only if margins closely adapted to cavosurface
finish line of prep
b. chamfer has to be shown to exhibit least stress and best finish line for a
veneer metal finish line
**LOOK AT FLOW CHART-CROWN RESTORATION-STEPS TO
SUCCESS**
10/06/04 PM ARTICULATORS AND FACE BOW TRANSFERS
Mandibular movement- 3-D rotational and translational activites that develops during
Periods of growth, integrating dynamic tooth-contact relationships, joint
Dynamics, & coordinated neuromuscular activity
*important to understand mand. Movement to assess location, direction, and area
of tooth contacts
3-axis with one condyle as reference to measure 3-D movement
1) Horizontal axis-open/close
1st 15-18 mm is pure rotation
Occurs in sagittal plane
2) vertical axis- lateral movements
Occurs in horizontal plane
3) sagittal axis- lateral movements
Occurs in frontal plane
2 types of condylar movement
1) rotational movement- 1st stage of opening
a. 1st 15-18 mm from CR (centric relation) position
b. Occurs within inferior cavity of TMJ
c. Can be captured and transferred to fully or semi-adjustable artic. By
utilitizing facebow and CR interocclusal contact
2) translational movement- 2nd stage of opening

a. movement of condyle down articular eminence while mand. Open to

its max limit
b. occurs w/in superior cavity of TMJ
c. captured and transferred to fully or semi-adjustable artic. By utilizing
protrusive interocclusal contact
What determines movement pattern of mandible?
1) TMJ guidance
a. Determines condylar guidance
b. Influences movement of posterior portion of mand.
c. Fixed factor: pathology and trauma can alter
2) Anterior guidance
a. Determined by ant. Teeth
b. Influences movement of anterior portion of mandible
c. Variable factor-pathology, trauma, and dental procedures can alter
Facebow
caliper like device used to record relationship of max jaw to TMJ and to orient
casts on articulator to relationship of opening axis of TMJ
Technique
o Bite fork positioned in midline of face and secured with bite registration
material
o Transfer assembly is attached to bite fork by hand tightening toggle
o Remaining tightening bar should be loose and hanging below bite fork
o w/nose stabilizer retracted, ear assembly in position and held by pt
o w/facebow held parallel to floor, the nose piece is advanced and tightened
into position
o bite fork assembly is attached to face bow assembly by toggle screw
o bite fork assembly tightened with all components facing to pts left
Articulator
Definition
mechanical device that simulates movements of mand.
Represents TMJ and jaw members, max and mand casts may be attached to sim.
Jaw movements
Instrument used to fabricate fixed (and removable) restoration that is in harmony
with those movements
Purpose
Relate mand cast to max cast
Articulator acts as pt in absence of pt
Mounting of dental casts for diagnosis, treatment planning, and pt presentation
Fabrication of occlusal surfaces for dental restoration
Arrangement of artificial teeth for complete and removable partial dentures

Advantages
mounted casts allows to better visualize occlusion, esp lingual
pt coop. not factor
decrease chair time
some procedures can be handled by assistants
pts saliva, tongue, and cheeks not factors
-varies widely in accuracy with which they reproduce movements of mandible
-distance btwn teeth and axis of rotation on small instrument is considerably shorter than
it is in skull resulting in loss of accuracy
-intercondylar distance in shorter
-as mand moves up and down in retruded position, cusp tip of mand tooth moves along
an Arc in sagittal plane, with center for that rotation located at transverse
horizontal axis, which passes thru the condyles
-if location of axis of rotation relative to cusp tip differs markedly from pt to articulator
the radius of arc of closure of cusp tip may be different producing an error which
can affect placement of morphologic features ie cusps, ridges, and grooves on
occlusal surface
Classification
1) Non adjustable articulators
a. Set intercondular distance of approx 110 mm and condylar guide
inclination of 20-30 degrees
b. Inexpensive
c. Mouning is fast and easy
d. Capable of only hinge movement
e. Shofu Handy IIM, Hanau-Mate, Balance
f. Short distance btwn axis of rotation and teeth
2) Semi-adjustable
a. Condylar guide inclinations adjustable to protrusive and/or lateral
interocclusal records
b. Can accept face bow transfer
c. Adjustable anterior guide tables
d. Mod. Priceds
e. Transfer of mounted casts to another articulator of same style
f. More time consuming than non adj
g. Enables operator to change dimensions and settings to closely match pt
h. Whip Mix (2240 or 8340), Denar Mark II, Hanau Modular
i. Allows for closer approximation of anatomic distance btwn axis of
rotation and teeth
3) Fully adjustable
a. Ability to reproduce pts condylar paths most accurate
b. Can reproduce all condylar border movements including protrusivelateral paths

c. Recording condylar paths: pantographic tracings and stereographics

d. Intercondylar distance completely adjustable
e. TMJ articulartor, Denar D5A
Arcon Vs. Non-Arcon
Arcon articulators-condylar on lower member, fossae on upper member
Mostly used in fixed
Non- arcon- condylar on upper member, fossae on lower member
Used in removable
When to use what type of articulators
Finger and Purcell: reports the level of dentistry at which they want to work
determines the choice of articulators
Ramfjord and Ash: reports selection of artic. Dependent on size and complexity
of treatment
-single restorations: simple non adj. artic.
-multiple restorations and fixed partial dentures: semi adj artic
-full mouth reconstruction: fully adj art
**OUR ARTICULATOR IS WHIP-MIX 4640**
-upper member pin release
-posterior guidance settings
Horizontal condylar guidance setting approximates slope of articular eminence
Medial wall setting approx the lateral shift
10/13/04 AM/PM- DIAGNOSTIC WAX-UP-CUSTOM INCISAL TABLE
Duplicate impression- alginate impression of diagnostic wax up cast
Duplicate cast of diagnostic wax up for constructing splint
To make splint-include 2 teeth to each side of tooth to be crowned
Creating Incisal Table
-table should mimic incisal guidance
1) Pin adjustment-pin is raised 2mm off table and locked
2) Glycine paper placed btwn casts to protect from abrasion
3) Anterior protrusive guidance-max member of artic moved posteriorly, mimicking
protrusive movement
4) Right lateral movement-max member move to left to simulate right lat. Movement
5) Left lateral movement-max member of articulator move to right
Made from DURLAY
Remember to moisten plastic table with monomer prior to placing mixed durlay.
Produces better final bond
Trim anterior wall of incisal table
Trimming instruments- stone, carbide acrylic bur (watermelon), fastcut stone

10/20/04 AM- CUSTOM INCISAL TABLES & #9 PFM PREP

Stock tray vs custom tray
Stock
Not exact
Needs putty material
Resusable
Low cost per use
Easy to use
Less accurate

Custom (we use composite resin TRIAD system)

Made on pts cast
only wash material
individual use
med. Cost per use
labor intensive
more accurate

-wash material goes around prep itself

-need to perforate custom tray
-impression material can delaminate
Cast prep for custom tray
Draw outline for base plate wax (like the one we use for bite registration)- 6 mm from
CEJ
nd
Draw 2 outline for tray material 8-10 mm in from edge of cast
Heat base plate was over Bunsen burner to a soft pliable state- remember to put Vaseline
On first, then wax
Put vaseline on top wax
Remove wax over second molars and central incisors for occlusal stops
Tray Fabrication
Mold and trim tray to 2nd outline
Add handle
Place in TRIAD machine and cure for 2 min
After initial set, remove tray from cast
Remove wax from interior of tray
Recure for additional 2 min
Total cure time is 4 min
Use 8 round bur to make perforations-allows impression material to flow thru
#9 PFM Prep
Indications for Anterior Crowns
1. esthetics (ant. Teeth)
2. extensive tooth destruction
3. endo treated teeth
4. as abutment for FPD

contraindications for anterior crowns

pts with active caries
pts with untreated or active perio disease
young pts with large pulp chambers
Types of ant. Crown restorations
PFM with metal or porcelain occlusal surface
all ceramic restoration
pressed ceramic (empress, OPC)
milled ceramic (procera, cerac)
traditional PJC
gold
stainless steel
-all require diff amts of tooth reduction
1.
2.
3.
4.

FVC (full veneer crown)- most conservative

Procera
PFM
All Ceramic- least conservative

-chords push tissue away to prevent hemorrhage for better impression

-single unit crown most difficult restoration and should be undertake w/caution
Empress Crown
-pattern burned out to allow wax to escape
-molten glass (porcelain) is pressed under high temp and pressure into investment
Material (not cast)
(molten glass similar to refrigerated honey~ consistency)
-traditional porcelain may be added to provide life-like appearance
Putty Matrix (Pre-operative Index)
1. used as a gauge to measure tooth reduction during crown prep
2. fabricated with Extrude XP impression material
3. Can be sectioned to allow multiple views of your prep
Putty Matrix Fabrication
1. avoid contamination use color coded scoops
2. dispense one scoop putty base and one scoop putty catalyst
3. knead together-mixing time is 30 sec
4. material should cover all surfaces of #6-11 and extend down to buccal and palatal
surfaces of typodont
5. allow material to set- 10 min
6. cut into sections

Layers of PFM
-cast metal substructure: 0.3-0.5 mm thick (waxed and cast)
-Veneered porcelain: 0.8-1 mm thick (adequate thickness for esthetics)
Opaque layer-mask out underlying metal structure
-if occlusion is such that contact will be in metal rather than porcelain, less tooth structure
Is required to be removed
-different layers in PFM crown: metal, opaque, body, incisal
-overall thickness 1.2-1.3 mm on porcelain veneered areas
#9 Criteria
2 mm incisal reduction
1.2-1.3 mm facial reduction
Each wall tapered 3-5 degrees
Facial shoulder 0.5 mm above gumline
o Margins have to meet tooth structure; have to be sealed
o Overcontour- if too round in cervical 1/3 recession
Lingual chamfer 0.5 mm above gum line
o Lingual margin subgingivally when? To gain lingual height
STEP 1- Depth cuts
1. 847 or 856 but
2. depth of 1 mm
3. place 2-3 depth cuts on incisal (1.5 mm depth cut) and cervical facial planes
STEP 2- Labial (Facial) Reduction
1. remove remaining tooth structure btwn depth cuts creating shoulder 1.0 mm
above gum line
2. final prep will have margin 0.5 mm subgingival
STEP 3- Incisal Reduction
using 847 or 856, perform incisal reduction by removing islands of remaining tooth
structure
STEP 4- Axial Reduction of Proximal
1. 878.012 then 878.016, reduce proximal surface parallel to long axis of tooth
2. walls of prep should each have 3-5 degrees taper
3. shoulder carried past (lingual) to contact areas
STEP 5- Axial Reduction of Lingual Surface
1. width of lingual chamfer is width of 878.016
2. maintain height of 3 mm on lingual wall
3. use football shaped diamond to reduce lingual fossa
4. lingual clearance from opposing lower tooth should be 1mm (metal contact)
STEP 6- Finishing
1. finish shoulder with 839.012 end cutting bur
2. use bur to slope shoulder to 120 degrees from axial wall
3. blend shoulder to chamfer lingual to contact point using 878.016 bur

EVALUATION OF PREP
o 2mm incisal reduction
o 1.5 lingual clearance (minimal)
o 120 degrees shoulder
o Chamfer located 0.5 mm supragingivally
o Shoulder 1.2-1.3 mm
o No undercuts
10/27/04- AM PROVISIONAL RESTORATIONS
Why Produce Aesthetic Provisionals?
1. create and reinforce confidence in your abilities
2. huge practice builder
3. allows pt to adjust to new oral conditions
4. very rewarding
5. can alert you to problem pts
6. good lab communication tool
Provisional restorations serve to
1. restore fxn
2. build practice
3. determine adequate prep reduction
4. protect tooth from harsh environment
5. hold tooth position firmly in dental arch
6. provide sedative effect for hypersensitive teeth
Review of objectives
1. reproduce occlusal fxns
2. provide stability to correct tooth position
3. reproduce desired contour
4. provide certain degree of acceptable aesthetics
types of provisions restorations
1. removable
a. flipper
2. fixed
a. polycarbonate
b. acrylic (methyl or ethyl)
c. bis-acrylic (composite)
d. lab processed
e. stainless steel crown
traditional methods of provisionalization
1. polycarbonate shell
2. methyl or ethyl methacrylate in impression

3.
4.
5.
6.
7.
8.
9.

methyl or ethyl methacrylate in press form splint

lab processed shell
stainless steel crown
bis-acrylic resin (composite resin in automix gun) in impression
bis-acrylic resin in press form splint
temp crown matrix buttons
composite resin (for repairs)

polycarbonate techniques
1. reline with acrylic resin
2. reline with composite resin
3. reline with bis-acrylic resin
4. adjust and cement
polycarbonate shell
advantages
1. great for emergency situations
2. good initial shape and polish
3. available in many sizes and shades (can purchase clear version)
4. relatively fast process
disadvantages
1. require large on hand stock to ensure fit
2. can require fair amount of recontouring
3. initial cost quite high
4. can stain quickly in marginal area
methyl or ethyl methacrylate in impression
advantages
1. inexpensive
2. can be repaired
3. available in several shades
4. predictable results
disadvantages
1. requires pre-op model or diagnostic wax-up
2. exothermic and time intensive
3. susceptible to stain and color change
4. not very aesthetic
5. approx 7% shrinkage (potential of locking on tooth)
methyl or ethyl methacrylate in press formed splint
adv
1. inexpensive
2. can be repaired
3. available in many shades
4. predictable results
disadv

1.
2.
3.
4.
5.

requires pre-op model or diagnostic wax-up

exothermic and time intensive
susceptible to stain and color change
less detail than previous technique
approx. 7% setting shrinkage

lab processed shell

adv
1. hard/fracture resistant
2. great for long term provisionals
3. available in many shades
4. great aesthetics
disadv
1. requires pre-op model and diagnostic wax up
2. time intensive or lab fee involved
3. must have fall back plan if they dont fit
4. reline required
5. cant be used for veneer provisionals
stainless steel crown
adv
1. inexpensive
2. wear resistant
3. available in many sizes
4. ensure pt satisfaction in final product
disadv
1. horrible aesthetic
2. often tissue irritant
3. must be relined
4. require fair amount of adjustment
bis-acrylic resin in impression (putty matrix)
adv
1. great aesthetics
2. can be repaired and modified
3. availablein many shades
4. predictable results
5. many applications
6. little temperature change
a. temperature characteristic of bis acrylic resin- under 5 degrees of temp
change
b. other products
i. jet=12
ii. snap=21
iii. pro temp=6

iv. estimated that prolonged exposure to temp increase of 7 degrees

may cause pulpitis
disadv
1.
2.
3.
4.
5.

requires pre-op model or diagnostic wax-up

expensive
can lock on if not careful
relatively brittle material
more time required

bis acrylic resin in press formed splint

adv
1. good aesthetics
2. can be repaired and modified-cheap and transparentcan see where it is being
seated
3. available in many shades
4. predictable results
5. many applications
disadv
1. requires pre-op model or diagnostic wax-up
2. expensive
3. can lock on if not careful
4. relatively brittle material
temporary crown matrix buttons (1/2 size of wheat thin)
adv
1. no prep time involved
2. minimal occlusal and axial contouring required
3. relatively user friendly
4. predicatble results
5. inexpensive
disadv
1. if tooth damaged, must be built up first
2. provisional can lock into matrix
3. inflexible-can lock in to undercut potential
4. tricky for use with multiple units (best for single unit)
composite resin
adv
1. great aesthetics
2. can be repaired and modified
3. available in many shades
4. can establish a high polish
disadv
1. limited applications
2. expensive
3. time intensive

4. can de-bond or leak

6 most aesthetic provisional technique
1.
2.
3.
4.
5.
6.

lab fabricated provisional

bis-acrylic resin (composite) in a putty matrix
bis acrylic resin (composite) in a press form splint
composite resin
polycarbonate shell
methyl or ethyl methacrylate in press formed splint

UOP Technique 1- Bis acrylic Resin in Putty Matrix

STEP 1- obtain quality set of diagnostic casts and stick-bite measurement with a notation
of any midline deficiency
STEP 2- pour diagnostic impressions in dental stone and mount
STEP 3- complete diagnostic wax-up
Suggested material- inlay wax (blue)
STEP 4- fabricate putty matrix of diagnostic wax up using a base and catalyst system or
Hand mixed addition rxn silicone
-determine whether you will:
1. make removable provisionals
2. cement in provisionals
3. bond prov.
4. lock-in prov
STEP 5-(following preps) load putty matrix w/biscrylic resin and seat with 45 sec
Remove after 1 min over prep
Set aside to cure for 6 min (air inhibited layer can be removed with ethyl alcohol)
STEP 6- trim provisional and adjust occlusion.
Use acrylic provisional kit to
1. trim margins
2. open gingival embrasures
3. polish surface of provisional
Brasseler discs: 911HP-220, 933-220
Stains, tints, and opaquers available to provide surface stain and characterization
Glazing media available to apply short term luster to surface of provisional
Restorations
-lightly air dry prior to bonding agent placement
-removable of air inhibited layer
-bis acrylic resin is composite resin
UOP Technique 2- Methyl Methacrylate in Press Formed Splint

1.
2.
3.
4.
5.
6.
7.
8.
9.

press formed splint

prepped tooth
bosworths trim kit
glass dappen dish
cement spatula
explorer
Vaseline
acrylic finishing kit
low speed

STEP 1- Confirm Accurate Fit of splint

STEP 2- Creating escape holes for trapped air
STEP 3- Lubrication of typodont
Vaseline prevents acrylic from sticking
STEP 4- Mixing the acrylic
1. dispense monomer (liquid) in cup or dappend dish (10-12) drops
2. always add powder to liquid while tapping cup on bench top
3. cont. adding powder until you see dry powder not being absorbed at top of dish
4. count slowly to 10 and tap off excess powder from dish
STEP 5- Loading the splint
Runny acrylic more shrinkage, more brittle
STEP 6- seating the loaded splint
STEP 7-examine provisional for accuracy
Armamentarium for finishing and polishing
1. watermelon bur
2. acrylic burs (fastcut)
3. Robinsons bristle brush
4. all purpose adjustment polishing kit (green, black, and yellow polishers)
5. pumice mixed with water/ragwheel
6. bendick/ragwheel
7. buffalo handpiece
want acrylic to passively fit
Lithuanian Rule of Reverse Alphabetical Order for colors
Zalia= green
Yuoda= black
Geltona= yellow
All Purpose Adjustment Polishing KitWheels used to finish flat surfaces- ie lingual
Points- finish concave surfaces
Final polishing- pumice and bendick