PDF Version - Glidewell Dental Labs

Figure 32: My assistant has trimmed the BioTemps with a thin,
perforated diamond disc, taking extra care to make sure she
opens the gingival embrasures. If anything, she will intentionally
create black triangles on the temps so the patient can swish Tooth
& Gums Tonic ® (Dental Herb Company; Lancaster, N.H.) through
the spaces. This also avoids blunting the papilla with the temps,
which can lead to real black triangles when we try in the permanent
crowns. I have made that mistake too many times in the past and
have had to drop the prep margins and re-impress.
Figure 33: The BioTemps are now cemented with TempBond ®
(Kerr Corp.; Orange, Calif.) and the temporary cement is cleaned
up with an explorer and Thornton 3-in-1 Floss (Thornton International;
Norwalk, Conn.). The proper overjet and overbite relationship
has been re-established with the BioTemps, and the next two
weeks will give us a good chance to see if the patient has any
issues with this change. My assistant did a good job with the embrasures,
but she over-trimmed the gingival margin on tooth #9. If
I were concerned about gingival overgrowth on the margin, I could
place some flowable composite, but I feel confident it will stay put.
Figure 34: Two weeks later the patient returns, reporting no functional
or phonetic issues with the BioTemps, so we can ask the
dental technician assigned to the case to fabricate the final BruxZir
crowns based on the digital scan of the BioTemps. Thanks to digital
technology, we can now duplicate BioTemps in the contours of
the final restorations by scanning them, storing the digital information
and then using the stored digital file to mill the final crowns to
match. (To request this “scan & save” service, simply note this preference
on your BioTemps prescription.) Things look pretty good
when we remove the BioTemps, and there are just a few spots of
minor gingival irritation. It’s now time to take the final impression.
Figure 35: Not taking the impression during the prep appointment
for large anterior cases was a difficult lesson to learn, but now I
won’t do it any other way. I have had too many cases of crowns
having to be remade because the temps blunted the papilla. The
first thing my assistant does is place a #00 Ultrapak ® cord (Ultradent;
South Jordan, Utah). This cord does not have any hemostatic
agent or epinephrine on it. Its purpose is to create vertical retraction
of the tissue and sit against the inflamed base of the sulcus to
prevent bleeding when I pull the top cord.
32 www.chairsidemagazine.com