Rotary & Handpiece Source - April/May 2012 - (Page 24)

techniques article PROVISIONAL TRIMMING & POLISHING TECHNIQUES FREE 1 FOR THE CHAIRSIDE ASSISTANT CEU COURSE By Shannon Pace Brinker, CDA CDD • CPS Magazine CREDIT! O ne of the most important steps in successfully creating beautiful restorations is finishing and polishing. Proper finishing and polishing techniques will increase esthetic results and build confidence with the patient. Poor finishing and polishing techniques can lead to staining, plaque retention, and gingival irritation. Unfortunately, the proper sequence of polishing steps necessary to achieve beautiful esthetic results is often overlooked.The purpose of this article is to describe clinical techniques that will help achieve maximum esthetics and biological success when contouring, finishing, and polishing esthetic provisionals. PROVISIONALS Restorative procedures have changed dramatically in the past several years. These restorations are no longer regarded as temporary restorations, but rather as provisional restorations with distinct functions and purposes. Provisional restorations have become a vital diagnostic and assessment tool to evaluate function color, shape, contour, occlusion, periodontal response, implant healing, and overall esthetics. An accurate fit and margination is essential to ensure and maintain pulpal and gingival health. MATERIAL SELECTION Talking to patients about the steps used during the restorative phase and giving reassurance that the provisional restorations are a blueprint for our final restorations will aid in their understanding of the process to come. We will need their help in the shade selection and functional aspect in this stage of the restoration. Choosing a provisional material that blends with the natural shade of the teeth is easy; choosing a material that mimics natural tooth structure, polishes well, and has the appearance of translucency and vitality and performs with strength and outstanding elastic modulus is essential for a successful restoration. INDIRECT ANTERIOR PROVISIONAL FABRICATION (Figure 1) Before fabricating the provisional, always lubricate the teeth with a separating medium such as Lubricoat (Dux Dental) to make sure your core buildups will not be removed with the provisional. As you load the putty matrix with your provisional material (Luxatemp, DMG America) toward the facial, make sure that you do not lift the tip of the material until you are sure you have filled the tooth indentions entirely (Figure 1). By not lifting the tip, it will help minimize voids and bubbles. Place on the preparations and wait for material to set according to the directions of the manufacturer. After the material is set, remove the putty matrix. The provisional should still be in the matrix when it is removed. Gently remove the provisional out of the matrix. (Figure 2) ANTERIOR PROVISIONAL TRIMMING First, mark your margins with a sharp #2 pencil. This will keep you from wiping them out. Start by using a large 557 Carbide (AxisDental) to eliminate excess at the margin that was marked with the pencil. Be very careful when trimming your provisionals since they can be fragile (Figure 2). Ultrathin Safe-Sided Diamond Disc–Whether you are using a diamond disc or sand paper disc, put it in only enough to engage. This will give you a much greater radius in which to turn. Use palm thumb grasps (Figure 3), not a pin grasp to keep for better control of the handpiece. A fulcrum is needed to do fine or delicate movements with these instruments. The provisional is fabricated in one piece splinted together to look like single units. By using the safe-sided diamond disc (Figure 4) for trimming embrasures, the provisional will achieve the look of a single unit. Be careful when defining the depth of the facial embrasures or you may break them. Develop gingival embrasures while carving the margin at an angle. Lingual margins can be a little more difficult to discern. (Figure 3) ANATOMY (Figure 4) There is a saying in our business, “Don’t make the provisionals look too good the patient won’t come back!” I tell dental assistants—you want the patient to be overwhelmed with joy and amazement. Provisionals are plastic and they don’t last forever. It is very important to have accurate diagnostic information provided to the laboratory. The lines of the teeth should follow the patient’s natural root morphology and give the proper contour of the anterior facial surface of the tooth. This will develop a nice curvature and avoid a flat surface from top to bottom. Emergence Profile–Anterior teeth have 3 contours from the side view. • The first angle is from the exit of the periodontium to the height of contour—about 1mm. • The second angle is from the height of contour to the junction of the middle and incisal one-third. • The third angle is from the junction of the middle and incisal one-third to the incisal edge. (Figure 5) Step 1–Safe-Sided Diamond Disc: By looking papilla area of the provisional, you can line up the disc with the interproximal area. That is where the teeth can be divided. Allow the disc to drop straight down (Figure 5) until the point of that papilla is contacted. Gingival embrasures are opened up to avoid papillary trauma and promote better hygiene. Gingival and Incisal embrasures are needed to simulate the look of single units. By looking at the central incisors, you can visualize the mesial proximal line angle and the distal proximal line angle. Step 2–Sand paper: Use the sand paper disc on the inside surface. Angle the mandrel to follow the contour toward the cervical to see these surface line angles. (Figure 6) Step 3–557 Fissure: Use 557 fissure (Axis Dental) (Figure 6) for the facial surface, remembering that there are three planes. Using the pen grasp, create three lobes (vertical, mesial central, distal). Note: teeth are not one flat surface. The incisal plane is simulated to separate into three lobes by taking the 557 into these lobes and rounding at the same time. Step 4–Final Polish: Several techniques can be used to give your provisional a final polish. A dry muslin bur or a prophy angle with Preppies pumice (Whipmix) is well suited for this. 24 Fax Your Order: 1.800.732.7023 24 Hours

Table of Contents for the Digital Edition of Rotary & Handpiece Source - April/May 2012

Rotary & Handpiece Source - April/May 2012
Table of Contents
Bien Air
Dental Assistant CE Course
Dentsply Professional
Henry Schein Brand Diamonds
Henry Schein Brand Handpieces
Henry Schein Financial Services
J. Morita

Rotary & Handpiece Source - April/May 2012