Indirect and Direct Restorative Protocols - Caulk

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››“The B4 Surface Optimizer helps me work faster by adapting each surface and readying the tissues for precise impression capture.” David Parker, DDS Private practice, Smithtown, NY. Figure 3. The cord is removed immediately prior to taking the impression, with caution exercised to avoid tearing the cord or damaging the soft tissues, which will cause sulcular bleeding and obscure marginal detail in the resulting impression. Figure 4. Use of the B4 ® Pre-impression Surface Optimizer (DENTSPLY Caulk, Milford, DE) coats the hard and soft tissue surfaces to allow the syringed wash material to pass more easily over and around the surfaces to be impressed. Table. Achieving Predictable Tissue Retraction: Treatment Rationale Method Rationale Considerations Cords n Enhanced degree of mechanical displacement n Available with or without a hemostatic agent n Available in a variety of types and thicknessesto accommodate a range of procedures n Care must be taken to avoid soft tissue trauma n Often requires the use of local anesthesia n The ability to absorb hemostatic agents must be taken into account during cord selection Pastes n Completely atraumatic to soft tissue n Local anesthesia is not required n Expeditious application may be advantageous in multi-abutment situations n Vigorous rinsing is required for removal n Does not work well in narrow or shallow sulci n Does not provide the same degree of displacement as the cord technique Insertion and removal of the retraction cord should be performed with great care to avoid inflicting trauma to the soft tissue and ensure optimal patient comfort (Figure 3). Use of a pre-impression surface optimizer (B4®, DENTSPLY Caulk, Milford, DE) will further ensure predictable marginal accuracy and precise data capture by coating the hard and soft tissues and allowing the wash material to better flow over and around them for improved accuracy (Figure 4). The highly wettable Aquasil Ultra Smart Wetting® Impression Material (DENTSPLY Caulk, Milford, DE) is designed to aid the clinician in maintaining adequate moisture control during the process. When using this hydrophilic material, the preparation area should be moist, but pooled liquid should first be removed with an evacuator to avoid the creation of an excessively moist field. When conducted accordingly, an impression material can thus flow subgingivally and capture the details of the tooth and ensure proper integration with the periodontal tissues. In fixed prosthodontic care, where the smallest subtleties have a considerable impact on the outcome of treatment, proper tissue management and tissue retraction are critical. n 10
››Principles & Practices Accurate Impression Making: Material Selection and Clinical Considerations ››Abstract: Correct impression capture is paramount to overall restorative success. Clinicians are constantly challenged to provide clear margins free from tears and voids in order to allow multiple pours and accurate reproduction of the intraoral environment within the laboratory. Communication is enhanced by the use of predictable materials that optimize this data transfer while creating a simplified, systematic approach designed for success. The impression remains the technician’s most valuable tool when developing an indirect restoration. Properly fitting restorations can only be fabricated if the dental laboratory is provided with a precise replica of the existing intraoral condition. Impression making, therefore, can be considered the most critical technique required for data transfer. A predictable execution of this procedure is subsequently required to ensure that the first impression captured is as accurate and clear as possible (Figure 1; Table). As a precursor to the impression procedure, use of B4® Pre-Impression Surface Optimizer (DENTSPLY Caulk, Milford, DE) can equalize the surface tension of multiple substrates (eg, tooth, gingiva, implant), thereby allowing the impression material to achieve the desired flowability and detail. Voids and bubbles will be minimized for a more practicable impression, improving model surface details. A durable material such as Aquasil Ultra Smart Wetting® Impression Material (DENTSPLY Caulk, Milford, DE) should then be selected to avoid tears, distortions, pulls, or drags in the impression itself. Its ability to adapt to tooth structures and the below the sulcus enables the practitioner to capture the details of the intraoral environment. Use of Aquasil Ultra Smart Wetting® Impression Material, with its favorable viscosities and working time, ensures that the clinician is able to maintain and capture well-defined margins during the impression procedure (Figures 2 and 3). It can also be delivered via 50 mL cartridge, the digit® targeted delivery system (DENTSPLY Caulk, Milford, DE), or DECA 380 mL dynamic mixing machine cartridge (DENTSPLY Caulk, Milford, DE) according to the preference of the clinician. Once the impression is made to the clinician’s satisfaction, it must demonstrate Figure 1. Aquasil Ultra Smart Wetting ® Impression Material (DENTSPLY Caulk, Milford, DE) can be used for all indirect restorative procedures. Figure 2. The dual-cord technique provides gingival retraction and hemostasis at the treatment site during impression making. 11
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Indirect and Direct Restorative Protocols - Caulk

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