Indirect and Direct Restorative Protocols - Caulk

››“The Midwest metal-cutting burs have made
removal of old crowns a quicker, less stressful
experience, and they efficiently cut through whatever
metal is used to fabricate the restoration.”
Gregori M. Kurtzman, DDS
Private practice, Silver Spring, MD.
Figure 3. Cross-section view of the divergent walls, created with the tapered,
round-end bur (MultiPrep, DENTSPLY Professional, York, PA),
for the cavity preparation.
Figure 4. Straight, flat-end burs can be utilized to finalize the walls and
floor of the preparation. Tapered burs create divergent walls with
rounded internal line angles.
Table. Tracking Individual Bur Usage
It is important to track use on a bur-by-bur basis to reduce
premature disposal or overuse of burs. Overuse may
result in:
■■ Instrument separation;
■■ Excessive heat generation;
■■ Damage to the handpiece; and
■■ Potential patient injury.
Sterilization is also critical using a Cresent® Germicide Tray (DENTSPLY
Rinn, Elgin, IL) and Bur Caddy / Bur Block (DENTSPLY Professional,
York, PA) to safely disinfect bur systems with glutaraldehyde- and
phenol-based disinfectants. These caddies allow burs to be:
■■ Individually sterilized;
■■ Cleansed using a hands-free approach to prevent
contamination;
■■ Kept separate from other burs in the kit; and
■■ Easily restocked following autoclaving.
a bur and torque speed that will remove
the existing restoration without
impinging on the underlying tooth
structures (Figure 2). Copious irrigation
is also paramount to keeping the
bur cool, prolonging its use (Table),
and improving its cutting efficiency. It
also ensures that the clinician can view
the structures being removed, thereby
reducing the potential for excessive
tooth reduction. Once the preexisting
restoration and carious structures have
been removed, it is imperative to create
divergent angles to facilitate retention
of the definitive indirect restoration or
convergent preparation walls to retain
the restoration (Figure 3). Application
of a cross-cut bur should only be implemented
if additional gross reduction
is required for extensive preparation
designs (Figure 4). Once the desired
preparation design has been achieved,
the burs should be cleaned and carefully
returned to the bur kit. n
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