Dentaltown July 2017 - 64

Continued from p. 62
intercuspation. After breaking through
the contacts with a thin tapered diamond,
the supragingival portion of the crown
is completed using the workhorse of my
burs, Premier's Two Striper 724.10C. This
thick, fl at-end tapered diamond enables
speedy bulk reduction, and prepares an
extremely smooth, easily readable shoulder
in preparation for the bevel.
Beveling is important to the success
of the crown. In my hands, the bevel adds
1-1.5mm of additional tooth structure to
provide strength and additional surface area
for retention. It also seals off the tooth from
bacterial ingress. In addition, the action of
creating the bevel reduces the circumferential
width of the tooth in the critical cervical
area, thereby decreasing the emergence
profile of the crown.
For anterior teeth and premolars, a
needle-shaped 860/010 diamond is placed
under the sulcus and angulated toward the
prepped tooth. Its cutting motion is used
circumferentially around the neck of the tooth,
always angulated coronally. For molars, a wider
needle-shaped diamond 860/016 is used. I
then carefully inspect for tissue attachment
Fig. 10

Fig. 11

Fig. 12

to the bevel region. Any tissue left adhering
will negatively affect my impression and is
removed with a periodontal curette.
In this case, a crown-lengthening procedure was required to avoid biologic width
invasion. I have performed closed-tissue
crown-lengthening procedures for years
with great success. It is simple to take a
Brasseler USA 957, 958 or 959 FG End
Cut bur and quickly eliminate interfering
osseous structures (Fig. 10).
Subgingival preparation is traumatic to
the gingiva, and a fair amount of bleeding
can be expected. It is critical to control the
heme before impressions are taken. Ultradent's Astringent, an aqueous 15.5 percent
ferric sulfate solution, is vigorously rubbed
circumferentially in the sulcular region
until bleeding has slowed. The astringent
is washed away and the second part of my
tissue management protocol is used.
Premier's Traxodent is applied directly
into the sulcus, and a compressive Premier
Retraction Cap is fitted over the tooth. The
cotton cap guides the Traxodent into the
sulcus, completes the hemostatic cascade
began by the astringent and then retracts the
gingiva by turning into a claylike material
after it dehydrates.
Astringent and Traxodent are two of
my "can't live without them" products. Two
minutes later, after I have washed away the
Traxodent, I am looking at a tooth that is
fluid-free, with wide open sulcular regions
(Fig. 11), ready for Impregum Monophase
to be injected around it. Impressions such as
the one featured in Fig. 12 are commonplace
after following these steps for hemostasis
and retraction.

Conclusion

Fig. 13

64

JULY 2017 // dentaltown.com

Fig. 14

Some years ago, I placed a quote I read
in a dental journal on my office pegboard.
"A crown and bridge impression is merely a
reflection of the dentist's integrity. Nothing
more, nothing less." I have reflected on this
quote often during my career. This article
reflects the present-day care that I provide
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