One-on-One An Interview with Dr. Paul Homoly Simply Beautiful A ...

More documents

Recommendations

Info

6. Facially, extend the preparation margin to the coronal aspect of the primary cord. The margin will be about 0.5 mm into the sulcus when the restoration is completed. With a normal crest, never allow facial tooth structure to show coronally to the primary cord (Figure 9). 7. Interproximally, extend the preparation to the free gingival margin, except in low crest situations. Extending the preparation will develop a scallop. Figure 9: Refine facial finish line apical to free gingival margin with Brasseler KS1 super coarse diamond or KS6 medium grit tapered diamond (Brasseler USA, Savannah, GA). 8. Place ferrous subsulfate circumferentially around tooth directly onto the primary cord (Figure 10). 9. Place the secondary cord. Depending on the tissue thickness, use either Ultrapak #1 or #2. When the secondary cord compresses into the primary cord and pushes it into the connective tissue fibers, Sharpey’s fibers may provide some resistance to the cord. Use the largest cord possible to ensure tissue deflection; however, larger cords cause more distortion (Figures 11 and 12). Leave the secondary cord in for at least four minutes. 10. Cleanse with Superoxol. b This is an optional step. 11. Microabrade the preparations with the PrepStar . c 12. Remove the secondary cord only (Figure 13). 13. Place lip retractors d and large dry tips. e Figure 10: Tissue management gel in place (ferrous subsulfate). 14. Block undercuts of any bridgework. 15. Completely dry the preparations. 16. Set timer to seven minutes. 17. Fill the tray with Star VPS Ultra Heavy #80062 c material, then load a syringe with Star VPS Ultra Light #80060 c material. 18. Flow the Star VPS Ultra Light material around the tooth preparations two to three times, then flood the preparation and adjacent occlusal surfaces with the light material. 19. Insert the tray before the timer reaches four minutes and 30 seconds. Remove the impression after the timer has reached zero. Figure 11: Secondary cord in place. 20. Disinfect the impression, read, and package in a laboratory bag. 38 www.chairsidemagazine.com
The keys to impression making with respect to the osseous crest and gingival response are: • Normal crest situations are not generally technique sensitive. The two-cord technique is best. The tissue will be distorted, but it will heal and return to the normal relationship. • Low osseous crests are very sensitive. The thin biotype tissue should be manipulated as little as possible. A small cord should be used with light pressure. The tissue may distort and not predictably return to the original level. Normal crest situations are “ not generally technique sensitive. The two-cord technique is best. The tissue will be distorted, but it will heal and return to the normal relationship. ” • High osseous crests are moderately technique sensitive. Retraction may be limited to one small cord. High crests are most prone to biologic width violations, which lead to chronic long-term inflammation. ■ Discussion The gingival level will not be accurately represented in the stone cast because the retraction cord displaced the gingiva laterally and apically. If preoperative sounding to the osseous crest has been accomplished, it is unnecessary for the gingiva to be accurately represented in the study cast. The osseous crest is critical in determining where the papilla will ultimately be. Now, the dentist can predict where the contact should begin on the restorations. If the above impression technique is followed, the gingiva in a normal crest will be displaced 0.5 mm to 1 mm apically and approximately 0.4 mm laterally. 15 If the preoperative osseous crest was normal, the laboratory technician can begin the contouring of the contact of the crown 1 mm from the interproximal margin of the die. The beginning of the contact will then be located 4 mm from the osseous crest because the interproximal margin of the preparation was located 3 mm from the bone. Predicting that the tissue will return in a normal crest situation enables the technician to place a contact area for an anterior restoration at the correct starting point (Figure 14). At try-in, the papilla may still be distorted from traumatic manipulation. The dentist may now see a black hole even in a normal crest. The papilla will fill into the interdental space if the technician was guided as to where to begin the contact. If the technician is not guided, the embrasure space may be overclosed and the gingival tissue will be compressed. Chronic inflammation and cervical facial fullness will occur. Figure 12: Diagram depicting cord placement into connective tissue attachment and further distorting free gingival margin apically. Figure 13: Removal of the secondary cord shows displaced tissue without bleeding. Clinical Techniques in Prosthodontics39
Page 1: Chairside® A Publication of Glidew
Page 4 and 5: Editor’s Letter Dentists always w
Page 6 and 7: Letters to the Editor “Dear Dr. D
Page 8 and 9: Contributors Michael C. DiTolla, DD
Page 11 and 12: Dr. DiTolla’s CLINICAL TIPS - ART
Page 13: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 16 and 17: 14 www.chairsidemagazine.com
Page 18: If you have seen the marketing prop
Page 21 and 22: Interview with Dr.Paul Homoly - INT
Page 23 and 24: eplacing old crowns on 7 through 10
Page 25 and 26: ing the dentist quoting the fee. Wh
Page 27 and 28: the time, my grandfather, my mom’
Page 29 and 30: Now, when I teach this choice dialo
Page 31 and 32: But I understand Kevin has two boys
Page 33: PH: Right. After a while it just fe
Page 38 and 39: In the normal osseous crest, the
Page 42: Low and high osseous crests can be
Page 45 and 46: tions, it is not possible to assess
Page 47 and 48: smoothed, using a rotary diamond in
Page 49 and 50: completion of the cure. This “two
Page 51 and 52: Creative Uses for Topical Anestheti
Page 53 and 54: ❚❙❘ Abstract Low-level laser
Page 55 and 56: peared to be completely coated with
Page 58 and 59: ■ The Economics of a Dental Websi
Page 60 and 61: Michael DiTolla: Glenn, we know tha
Page 62 and 63: Earth. Now, you don’t have to joi
Page 64: GL: That’s correct. It’s one of
Page 67: Chairside ® Photo Contest a b c d

One-on-One An Interview with Dr. Paul Homoly Simply Beautiful A ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?