Bridges Intoduction

Bridge:

A prosthesis replacing one or more teeth, that cannot be removed by patient.

WHY REPLACE MISSING TEETH????

Occlusal Improved
Appearance Speech
stability mastication

Periodontal Orthodontic Restoring Psychological

splinting retention OVD benefits

Possible adverse effects of replacing missing teeth.

Failures (90%
Damage to tooth and etention at 10 years, Effects on
Secondary caries Cost
pulp 60-70% retention at periodontium
15 years)

Alternates to bridge

 Precision attachment partial denture

Planning for replacement of missing teeth

1. Patient attitude
2. Age
3. Social fear ( loosing denture in public)
4. Occupation ( wind instrument player, public figures are usually candidates for fixed partial dentures)
5. General health
6. Appearance
7. General dental health and hygiene
8. Number of missing teeth
9. Occlusion ( class II div I)
10. Local dental condition ( condition of adjacent teeth)

Parts of bridges

1. Abutment: is a tooth to which a bridge is attached

2. Retainer: is crown or other restoration that is cemented to abutment
3. Pontic: is an artificial tooth as part of bridge
4. Span: is the space between natural teeth tobe filled by the bridge
5. Connector: joint that connects the retainer to pontics or two retainers to each other. Connectors may
be fixed or allow some movements between the components it join.

• Pier; is an abutment tooth standing between and supporting two pontics.

• Unit: means number of retainer or a pontic. A bridge with two retainer and one pontic is termed as 3 unit
bridge.

Types of bridges

Conventional Minimal Variation:

design Combination
preparation Hybrid design removable
designs
design bridges

Conventional Bridge
1. Fixed-fixed bridge
2. Fixed movable bridge
3. Cantilever bridge
4. Spring cantilever bridge

 Fixed-fixed design

 Rigid connectors at both sides of pontic

  Abutment teeth are rigidly splinted

 Require parallel preparation of abutment

 Fixed-movable design

 Has a rigid connector at distal end of pontic and a movable connector at mesial end

 The movable connector can be separated from bridge hence can be cemented seperately

 Doesn’t require parallelism of abutment preparation.

• Cantilever design

– Provides support or abutment at one end of pontic

– Indicated when adjacent abutment is with good peridontal health and the
other abutment is unrestored tooth.

• Spring cantilever design

– Restricted to replacement of upper anterior teeth only

– Only a single pontic can be supported

– a long thin metal arm connect the retainer and pontic

– Forces applied are absorbed by springiness of the metal arm

– Rarely used now

– Used for preserving anterior adjacent teeth when posterior tooth requires a crown and in patients
with anterior diastemas

• Combination design
 – Suspension of a cantilevered pontic at end of a fixed-fixed bridge.

– Bridge with buccal removable flange.

• Hybrid design

– Combination of minimal preparation and conventional design

– Bridge with one conventional retainer and other minimal preparation retainer.

Minimum preparation design

 Variations of bridges

1. Removable bridges

2. For large span bridges

3. Easier oral hygiene maintenance

4. Made with acrylic facing on metal frame as it is less liable to fracture than porcelain
 Components of bridges
Resin retained bridge replacing maxillary first premolar

• Retainer: is crown or other restoration that is cemented to the abutment

• Classified as major and minor

• Major retainer should be atleast an MOD inlay with full occlusal protection. For anterior teeth they are
usually full coverage crowns

• Minor retainer: do not need full occlusal protection

• Rest seat, partial coverage designs

Factors affecting selection of retainers

Condition of
Conservation
abutment Occlusion Cost
of tooth tissue
tooth
 Pontic:

Surfaces of pontics

Pontics with mucosal contact:

 Without mucosal contact

(a) ridge lap/saddle; (b) modified

ridge lap and (c) ovate pontic.

(a) ridge lap/saddle; (b) modified ridge lap and (c) ovate
pontic.

 Occlusal surface

 Should resemble natural tooth occlusal surface

 Can be made narrow buccolingually if the pontic is opposed by another bridge, for improving
access for cleaning

 Approximal surface

 Shape depends on the design of bridge

 Smooth contact with adjacent natural teeth and gingival tissue.

 Buccal and lingual surface:

 The buccal surface of wash through design does not resemble the natural tooth shape

 Ridgelap and saddle pontic the buccal surface appears same as natural tooth

 Lingual surface of pontic with ridgelap design is smooth and concave.

Wash through pontic

 designed to provide complete clearance of the tissues

 Despite its name, it can provide a significant challenge for patients as the space can accumulate significant
amounts

 of food debris and plaque

 does not provide an aesthetic replacement for a tooth

 Its use is now largely historical

Ridge lap/saddle pontic

 sits over the alveolar ridge in intimate contact with the mucosa
  provides a realistic emergence profile with good aesthetics.

 The large concavity of the pontic cannot be cleansed by flossing leading to plaque accumulation and
mucosal ulceration

 Now largely obsolete and is not recommended for bridgework.

Inflamed and ulcerated mucosa associated with a

failing bridge with saddle pontic

Modified ridge lap:

 Compatible with aesthetics and mucosal health

 It has a minimal point contact with the labial/buccal mucos and exert no pressure on the mucosa

 Convex surface is readily accessible to cleaning with floss

 Good aesthetics

 Mechanically durable

Modified Ridge Lap Pontic:

In certain circumstances the emergence profile of this design can be less than ideal, leading to aesthetic
shortcomings.

Poor aesthetics produced by a modified ridge lap pontic.

Conical pontic (spheroid bulet)

 Occlusal two thirds of the pontic lies in the appearance zone

 Gingival third is not visible

 Lower incisors, premolars and molars

Ovate Pontic:

 An ovate pontic design can be defined as one which has an increased amount of mucosal contact and applies
light pressure to the underlying mucosa in an attempt to improve aesthetics

 Convex surface to aid the passage of floss

 Excellent aesthetics, especially emergence profile

 Papillae supported and maintained

 Reduce the presence of black triangles

 Mechanically durable.
Connector:

 Fixed connectors

 Cast

 Soldered

 Welding

 Porcelain

 Movable connectors

 Groove in minor retainer must have a good base to allow the seating of the male part of the
connector and allow depression of pontic under occlusal loading

Planning bridges:

• Support:

– Ante’s Law

– the total periodontal membrane area of the abutment teeth must equal or exceed that of the teeth
to be replaced.“

OR, the total root surface area of all the teeth which will support a bridge must equal or exceed
the total root surface area of the teeth being replaced.

• Length of span of bridge

– Any design may be used for a short span of size of premolar or incisor

– Simple cantilever can be used for one or two anterior teeth, provided excessive forces are avoided.

– Spring cantilever are limited to single missing incisor.

– Unilateral posterior cantilever bridges should be limited to one pontic under favourable occlusal
conditions.

Introduction To Crowns

• Crown: An extra coronal restoration that replaces missing tooth structure by surrounding most or all of
remaining tooth structure.

INDICATIONS FOR CROWN

1. Heaviliy restored tooth

2. Trauma
3. Endo treated tooth
4. Tooth wear
5. Malpositioned teeth
6. Diastema
 7. Discoloration
8. Hypoplastic conditions like amelogenesis imperfecta
9. Flourosis
10. To alter occlusion
11. Improve appearance
12. As part of other restoration e.g bridge.
13. Peg shaped lateral

Alternates to crowns:

1. Bleaching

2. Veneers

(COMPOSITE/CERAMIC)

3. Inlays

(GOLD/ PORCELAIN/ COMPOSITE)

4. Pin retained amalgam onlay

5. Composite restoration

CLASSIFICATION OF CROWNS

1. Based on crown design

2. Based on material of crown

3. Based on indications of crown

4. Based on fabrication techniques

Based on Crown design

1. Full veneer crown

2. Partial veneer crowns
(i) Three fourth crown
(ii) Seven eighth crown

Based on Material of crown

1. Metal crown
2. Porcelain jacket crown
3. Metal ceramic crown
4. Acrylic jacket crown
5. Acrylic faced cast metal crown
6. Composite faced metal crown
Cast metal crown with cemented
porcelain facing

Based on indications of crown

1. Crowns for vital teeth

2. Crown for non vital teeth
3. Anterior crowns
4. Posterior crowns

Based on fabrication techniques

Preformed crowns

( metal, acrylic, poly carboxylate)

Lab/custom made

CAD CAM

( computer assisted designing and computer assisted manufacturing)

Anterior vital teeth crowns:

Full veneer crowns;

1. Porcelain jacket crown

2. Metal ceramic crown
3. Cast metal crown with cemented porcelain facing
4. Cast metal crown with acrylic or composite facing
5. Acrylic jacket crown

Partial veneer crown

1. Three quarter crown.

Anterior non vital teeth crowns:

1. Crown with core of composite or GIC

2. Separate post , separate core and separate crown

3. One piece post and core and separate crown

4. One piece post crown

5. Other crowns ( pin retained core with crown)

Porcelain jacket crown:

Advantages

1. Appearance
2. Color Stability
3. Resistance to plaque accumulation
Disadvantages

1. Marginal fit
2. Brittleness
3. Removal of tooth tissue
4. Expensive

Metal ceramic crown:

Advantages

1. Strength
2. Minimum palatal reduction
3. Adaptability (auxiliary retention can be added to preparation)
 4. Solder ability
5. Cost
Disadvantages

1. Appearance
2. Destruction of tooth structure

Posterior crowns

Cast metal crowns:

Cast alloys for crowns

1. High noble (60%noble with at least 40%gold)

2. Noble (atleast 25% noble metal)
3. Base metal (less than 25% noble metal)

Advantages

1. Minimal tooth preparation

2. Less cost
3. Convenient for providing rest seats, guide planes, reciprocal edges and undercuts for P.D (surveyed
crowns)
4. Solderability

Disadvantages

1. Appearance
Metal ceramic crowns:

Indications

2. Esthetics
3. Extensive tooth destruction
4. Need for superior retention

Contraindications

1. Active caries or periodontal disease

2. Young patients with large pulp chamber

Advantages

1. Appearance
2. Superior marginal fit
3. Can accommodate rest seat for RPD

Disadvantages

1. More tooth tissue removal

2. Short clinical crowns
3. Difficulty in preparation of pin retained amalgam cores

Posterior partial crowns:

• Indications

1. Intact buccal /lingual tooth surface with moderate tooth structure loss
2. As retainer for bridge
• Contraindications

1. Short clinical crown height

2. Retainer of long span bridge
3. Rarely suitable for endodontically treated teeth.
4. Active caries and periodontal disease
5. Malposed teeth

Posterior partial crowns:

• Advantages

1. Conservation of tooth tissue

2. Better esthetic
3. Pulp vitality test possible
4. Easy seating and cementation of restoration

• Disadvantages

1. Less retention than full veneer crown

2. Some metal display of the restoration
 Planning & Designing for crown
Treatment planning:

History & examination of:

1. The patient
2. Mouth in general
3. Individual tooth
Important decision to make:
1. Restoration of tooth vs extraction
2. Plan for direct or indirect restoration
3. Any preparatory treatment if needed
Detailed planning of crown:
1. Appearance
2. Remaining structure of tooth
3. Choice of crown
4. Design of preparation

Phases of treatment

1. First appointment

I. Agreement with patient on treatment plan

II. Agreement with patient and lab regarding fee
2. First clinical stage of crown preparation

3. Laboratory stage

4. Second clinical stage (crown cementation)

5. Maintenance ( follow up and review

History & examination:

The patient:

1. Patient attitude and informed consent

2. Patient full understanding of treatment plan and its alternatives
3. Patient’s motivation for treatment
4. Realistic expectation……. Unrealistic expectations are met with disappointments and lack of trust
Age

1. No upper or lower age limit

2. Main limiting factors
3. Size of pulp
4. Degree of eruption
5. Cooperation of patient
6. Oral hygiene maintenance
Gender

Social history

1. Profession of patient
2. Habits
3. Patients social commitments and availability for treament.
Cost

Medical status

1. Inability to lie (dental chair)

2. Neuro muscular disorders.

Considering whole mouth:

1. Oral hygeine
2. Condition of remaining teeth
i. Missing teeth and already existing denture
ii. Recession
iii. Assessment of occlusion
3. The value of tooth

4.Appearance of tooth
I. Angulation
II. Shape
III. Discoloration
5.Condition of the tooth :
I. periodontium & pulp
II. Restorability of the tooth
III. Occlusion

Periodontium
1. Presence of periodontal disease
2. Calculus deposition
3. Furcation involvement
4. Mobility,malposition
5. Frenal attachment

Assess need for corrective periodontal surgery:

1. crown lengthening
2. Flap surgeries

Endodontic status
• Always assess pulp vitality status in teeth not treated endodontically
• Assess need for endodontic therapy prior to crown preparation
▫ Elective endodontics
I. Risk of pulpal exposure
II. Teeth that cant be restored without support from pulp chamber
• Periapical pathosis
• Replace root canal fillings that were exposed to oral environment, inadequate root filling with periapical
radiolucency
• Endodontics through a crown can lead to
1. Weakening of metal porcelain bond
2. Chipping of porcelain
3. Perforations
4. Over cutting of tooth structure
5. Disrupt cement lute
I. microleakage
II. Loss of crown
6. Cutting through glaze decreases strength of porcelain.
Restorative status of tooth
1. Plan for conservation of tooth structure
2. Special consideration to root treated teeth
I. Conservative access cavity
II. Plan for ferrule
3. Assess need for post.
4. Status of present restoration
I. Caries
II. Margins
III. bulk

Restorability of tooth
1. Assess for
▫ Tooth length
▫ Need of internal features for retention
2. Plan so that margins extend 1-2 mm on sound tooth for ferrule effect against
fracture Planning margins
3. Provide necessary cuspal coverage according to restoration

OCCLUSION
• Check ICP
For reproducibility of contacts on teeth to be restored
• Check RCP
To establish interferences
• Check teeth relation in protrusion and lateral excursion Conservation of tooth
To assess type of guidance and interferences structure

Occlusal guidance
Failure to conform to type of occlusal guidance leads to
1. Decementation of crown
2. Fracture of tooth
3. Fracture of restoration Group function
4. Accelerated local wear ccclusion
5. Tooth mobility
6. TMJ dysfunction
 Canine guided occlusion

• Nature of opposing contact

• Can dictate choice of

crown material

Occlusion

1. Location and angulation of tooth

 Assess for orthodontic treatment for:
 Extrusion
 Up righting of tilted teeth
 Mesialization or distalization of tooth or sectioned tooth
segment.
2. Assess need for change in OVD

Diagnostic waxup

1. A technique traditionally favoured by many clinicians is the use

of articulated study models and the diagnostic wax-up
2. It involves a lab technician adding wax to an articulated model of the patient’s dentition
3. It allows the clinician to visualize the original dentition, restoration design, occlusal scheme and
possible aesthetic outcomes.
Records for planning occlusion of crown

1. Hand held cast study

2. Inter occlusal record
 Helps in assessing ICP, Crown height ,space available for the restorative material

3. Articulated casts
 Simple hinge articulators
  Semiadjustable articulators

Principles of tooth preparation

Principles of tooth preparation

Biologic consideration

1.Prevention of damage
2.Conservation of tooth structure
3.Effects on future dental health
4.Margin placement
6.Margin adaptation
7.Margin geometry

Prevention of damage

1. To adjacent teeth
2. To soft tissue
3. Pulp ( temperature, dessication, chemicals, bacteria)
Conservation of tooth structure

1. Partial coverage vs full coverage design

2. Minimum taper between axial wall
3. Occlusal reduction following anatomical planes
4. Attempt to retain tooth structure surrounding pulpal tissue
Effects on future dental health

Adequate axial reduction to provide sufficient space for good axial

contours of crown and avoiding over contoured crowns and over
hanging margins

Margin placement

1. Supragingival margins are advantageous as it

2. Avoids soft tissue trauma
3. Easily kept free of plaque
4. Easier impressions
5. Easy evaluation on recall visit

Margin adaptation

1. Smooth margins of crown preparation are desirable as it ensure adaptation of crown margin
to tooth structure and decreases the chances of dissolution of luting.

Margin geometry

1. Ease of preparation without unsupported enamel

2. Easy identification on impression
3. Distinct boundry for wax margin finish
4. Sufficient bulk of crown material at margin to avoind
distortion
5. Conservation of tooth structure
Crown Margins

a)Shoulder(90)

b) Deep chamfer (130-160),

c) Beveled shoulder,

d) Knife edge (180) ,

e) Chamfer (130-160

MECHANICAL CONSIDERATION

RETENTION FORM

1. Geometry of tooth preparation

2. Roughness of fitting surface of restoration
3. Luting agent
RESISTANCE FORM

1. Magnitude and direction of the dislodging force

2. Geometry of tooth preparation

Retention form

1. Geometry of tooth preparation

2. Avoid over convergence or making undercuts in preparation
3. Slight convergence is desirable
4. Taper is the angle of axial wall with the long axis of tooth. ideal is 6 degrees
5. Convergence angle is the combination of two opposing taper of axial wall
6. Minimal axial height required for adequate retention is 3 mm
Taper of preparation

1. Creation of preparation with 2 degrees of axial inclination

by use of diamond rotary cutting instrument with 2 degrees
of axial inclination held parallel to planned line of draw
2. For correct convergence check the taper of preparation with one eye to minimize
discrepancy

Retention form

 Roughness of surface being cemented (crown)

1. Roughness of internal surface of crown increases the retention by increasing surface area

2. Can be achieved by sandblasting the internal surface of crown or use of acid etching.

 Type of luting agent

1. Adhesive cements give more retention

RESISTANCE FORM

 Magnitude and direction of the dislodging force

 Geometry of tooth preparation

1. Magnitude and direction of the dislodging forces

 Sticky food like candies

 Parafunctional habits like bruxism, pipe smoking

2. Geometery of the tooth preparation

 prevent rotation of crown on preparation
 Axial wall taper, preparation diameter and height of preparation
 Acceptable taper 5-22 degrees
 Ideal height should be at least 3.5 to 4mm
ESTHETIC CONSIDERATOINS

1. Adequate bulk of porcelain

2. All ceramic crown
 Minimal thickness of 1 to 1.2 is necessary for esthetics

3. Metal ceramic crown

 Min. labial reduction of 1.5 mm
 Incisal reduction of2mm for translucency
 Subgingival margin placement
 CROWN PREPARATION

Before crown preparation

1. Study casts and opposing casts

2. Photographs
3. Wax ups
4. Shade selection
 To identify difficulty in shade
 Better shade selection at beginning due to less fatigue
 Match shade in natural light and artificial light (tungsten filament and florescent)

Shade selection

1. Hue is the color itself ( red, green)

2. Chroma is the amount of color (concentration, intensity)
3. Value is the darkness or lightness (brightness, amount of white or black)
4. Shade guide are grouped as A,B,C,D on basis or hue (light brown, yellow,
blue/grey and pinkish respectively)
5. First select hue by assessing all teeth
6. Assess the opposing , contralateral and adjacent teeth. Select
7. chroma
8. Assess shade of body, incisal edge and neck part of tooth
9. Assess for any characterization like staining or cracks
Clinical steps of crown preparation

1. Occlusal preparation
2. Buccal preparation
3. Lingual preparation
4. Proximal reduction
5. Gingival margin preparation
6. Finishing of preparation

Occlusal reduction

Incisal Reduction

Grooves are made with 330 carbide bur with 2.0 mm cutting
head length. Followed by 1,2 mm round cylinder bur to
complete the reduction.
Buccal and lingual preparation

Proximal reduction

Cervical Reduction

Ginvival third is removed by fissure bur

(dia1.2mm)and 0.5mm apical to the free
gingival crest. This would create an
internallly rounded shoulder with a lip. The
marginal lip is removed with 1.6mm round
ended bur, leaving a 90° butt joint.

Material

Porcelain jacket crown

Advantages

1. Appearance
2. Stability
3. Cost (less)
4. Resistance to plaque accumulation
Disadvantages

1. Marginal fit
2. Brittleness
3. Removal of tooth tissue

All ceramic/porcelain jacket crown Tooth preparation

Metal ceramic crowns

Indications

1. Esthetics
2. Extensive tooth destruction
3. Need for superior retention
Contraindications

1. Active caries or periodontal disease

2. Young patients with large pulp chamber
Advantages

1. Appearance
2. Superior marginal fit
3. Can accommodate rest seat for RPD
4. Strength
Disadvantages

1. More tooth tissue removal

2. Short clinical crowns
3. Difficulty in preparation of pin retained amalgam cores

Metal ceramic crown Tooth preparation

Cast metal crowns

Cast alloys for crowns

1. High noble (60%noble with atleast 40%gold)

2. Noble (atleast 25% noble metal)
3. Base metal (less than 25%noble metal)
Advantages

1. Minimal tooth preparation

2. Less cost
3. Convenient for providing rest seats, guide planes, reciprocal edges and undercuts for P.D (surveyed
crowns)
4. Solderability
Disadvantages

1. Appearance

Cast metal crown Tooth preparation

Crown and bridge failure

Type of failures
 Biological Mechanical Design failure Esthetic
• Discomfort
• Pressure on soft
tissues
• Loss of retention
• Porcelain fracture
• Distortion of solder
• Abutment design
• Inadequate bridge
design
.at time of
• Periodontal disease joints • Marginal cementation
• Pulpal pathology • Occlusal wear and deficiencies
• Caries
• Tooth fracture
• Movement of teeth
perforation
• Lost facing
• Defect
.delayed
esthetic
failures

Biological

2. Loss of pulp vitality

3. Caries
4. Movement of teeth
 Periodontal comprised teeth
 Relapsing orthodontic treatment
5. Changes in abutment tooth
 Predisposition due to poorly designed, made or maintained restoration

.
Mechanical Failures

 Loss of retention:

 Dissolution of cement

 Generation of high forces with sticky food

 Lose retainer…. Bubbles appear on applying digital pressure on the lose retainer

 Minimal preparation design lose retention more commonly

 Porcelain fracture:

 Failure of metal ceramic joint

 Thinner section of porcelain

 Failure of solder joint

 A flaw in the solder joint

 Failure to bond with the metal structure

 Solder joint not sufficiently large

 Distortion

 Wash through pontic made too thin

 Too much force exertion during bridge removal

 Trauma

 Occlusal wear and perforation:

 Lost facing:

 Failure of porcelain and metal joint

 Acrylic or composite facing

Design failure

 Underprescribed bridges

 Too less number of abutments selected for designed

 Too conservative in selection of retainers

 Over prescribed bridges

too many abutments involved results in destruction of tooth structure and complication of bridge design.
Marginal deficiencies

• Positive ledge

• Negative ledge

• Defect

Gap between tooth and crown. Causes are

• Crown or retainer donot fit prepared tooth at try in

• Crown or retainer fitted at try in but failure to seat the crown fully during cementation

• Gap developed after cementation due to dissolution of cement or tooth structure loss due
to abrasion or errosion

Esthetic Failure:

(A) At time of cementation

 Color mismatch

 Poor tooth contour

 marginal roughness & extension

 Metal display in partial coverage

 Improper pontic placement

 Porcelain fracture during cementation

B) Delayed esthetic failures

 Subpontic tissue shrinkage

 Wear

 Gingival recession >

Repairs

 Grinding and polishing

 Repairs by restoring in situ

 Repairs by removing and replacing parts of bridge

Removing crowns and bridges

6. Removal of metal crown

7. Removing porcelain jacket crown
8. Removing metal ceramic crowns
9. Removal of bridges
10. Large spoon excavator
11. scaler crown remover
12. Brass ligature wire
 13. Chesil and hammer
14. Sectioning
15. Richwill crown and bridge removers
16. Crown slitter

Metal crowns:

– Use of heavy duty scaler like mitchel or cumine

– Sliding hammer

• PJC

– Need to be cut off by making vertical groove

• Metal ceramic crown Brass ligature wire

– Vertical groove till cement layer and then sprung open with heavy instrument. Porcelain portion is
removed with diamond burs and Metal part is removed with tugsten carbide bur

sliding hammer crown remover Morrel Crown Remover

Richwill crown and bridge removers

 Impression techniques, temporization and cementation

Before impression

 GINGIVAL RETRACTION

1. Proper horizontal displacement of the tissues at the coronal margins.

2. Vertical displacement of marginal tissues to expose undercuts apical to the finish line.

3. Gingival bleeding must be arrested.

4. Complete dry field.

◦ Not needed for supragingival margins

Methods of retraction

◦ Electrosurgery

◦ Placement of retraction cord (Mechanical)

◦ Retraction cords can be soaked in hemostatic or astringent solution (chemo mechanical)

1. Epinephrine

2. Aluminium chloride

3. Ferrous sulphate

◦ Blasts of air from triple syringe over impression material to flow material into crevices
ELECTROSURGERY

Retraction cords

 Braided cords are preferred than twisted retraction cords

 Available in various thickness

 Should be placed for 2-3mins for sufficient retraction

 Double cord technique

Double cord technique

Impression materials
Impression techniques

 Single stage technique

 Two stage techniques

◦ Unspaced technique

◦ Spaced technique

 Recording putty impression before preparation and light body impression after preparation

 Use of polythene spacer while recording putty impression and final impression with light
body

 Gouging away putty impression around prepared tooth impression and relining impression
with light body impression material.

Interocclusal records

 Polymer material

 Wax interocclusal record

 Zn Oxide eugenol paste record

Temporization

• Difference between provisional crown and

temporary crown

• Temporization is important for

– Protection of prepared dentin

– Maintain appearance

– Prevent tilting,overeruption by maintaining contact points and occlusion

– Maintain ginigival and pulpal health

– Maintain function

Types of temporary crown

 Custom made
◦ Acrylic ( self cured)

 Preformed temporary crown

◦ Polycarbonate

◦ Steel

◦ Aluminium
Before cementation

• Checking of fit of crown and margin on die

• Check for seating of crown

• Check for margin defects ( Negative ledges,

positive ledges or overhang margins).

• Check for fit of inner surface of crown by

disclosing agents (colloidal graphite spray)

• Check for tightness of contact with floss

• Check for retention of crown ( not too tight , no pivoting)

• Check for buccal and lingual contours

• Check for shade matching

• Check and adjust occlusion

Positive Ledge correction

Cementation

 Crown should be cemented quickly

 Firm pressure by dentist or patient by biting on a

cotton roll

 Maintain isolation till the cement is set

 Excess cement is removed by probes on the buccal

and lingual surface. Interproximal surfaces are
cleaned using dental floss while assistant applies
digital pressure on the crown.