Finishing and Polishing Cast Gold & All Ceramic Restorations Flashcards

1
Q

Steps after waxing up a gold crown
(2)

A

*Send it to the lab for casting it- they use the same technique I have showed
in my investing and casting lecture earlier.
*Lab returns a gold casted crown with sprue.

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2
Q

Patient Try-In (Lab Procedures – Use Typodont)
(3)

A

*(Anesthesia when necessary)
*Remove interim crown; clean with explorer / pumice
*Hypersensitivity

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3
Q

Hypersensitivity –

A

postpone cementation.
*Perfect the interim crown and cement with ZOE (TempBond).

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4
Q

Airway Protection –

A

Throat Pack
Gauze 4X4 / upright position (not more than 45o recline)

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5
Q

Sequence of Clinical Steps- VVV IMP
(7)

A
  1. Proximal contacts
  2. Internal fit
  3. Marginal integrity
  4. (Stability & Retention)
  5. Occlusion
  6. External contours
  7. Surface finish
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6
Q

Patient Try-In: Seating Crown
*Seat crown with finger pressure
*Observe relationship to other teeth and tissues
(2)

A

*Marginal ridges and proximal contacts
*Marginal closure

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7
Q

—- most often prevent crown from seating intraorally.

A

*Proximal contacts

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8
Q

Patient Try-In:
#1. Evaluate and adjust proximal contacts
*Proximal contacts most often prevent crown from seating intraorally.
*Mark with

A

Accufilm; adjust with abrasive wheel
*(Cuttle fine or blue disc; adjust from below and upward)
*Not with a finishing bur or diamond point
*DO THIS FIRST !!!

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9
Q

Craytex Wheel or Fine Sandpaper Disc

A

Grind from inferior border of heavy marking
Burlew Wheel Finish

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10
Q

Proximal Contacts
Objective:
(2)

A

*Adjust to correct size, shape, and tightness.
*Leave very slightly tight to allow for final polish.

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11
Q

Proximal Contacts
Procedure:
(3)

A

*Evaluate contacts visually, with floss, and with shimstock.
*Place articulating film between casting and adjacent tooth, seat crown.
*Selectively adjust region of binding

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12
Q

Selectively adjust region of binding:
(2)

A

*Inferior portion of mark
*Craytex wheel, Burlew wheel, Shofu Brownie polishing discs

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13
Q

Seating the Crown: Proximal Contacts
*Place the crown and check for appropriate proximal contacts using

A

shimstock and then Accufilm.
*Check the location and intensity of the proximal contacts:
*Place shimstock interproximally (should drag through with resistance)

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14
Q

Seating the Crown: Proximal Contacts
*Check the location and intensity of each of the proximal contacts:
*Place Accufilm interproximally to evaluate where the crown should be —
*Use the — disc if slight adjustment is necessary; the (2) may be used if more significant reduction is necessary.

A

adjusted, if necessary.

Blue
separating disc or
diamond disc

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15
Q

Seating the Crown: Internal Fit
*Fit crown to tooth using

A

Blue Fit Checker (any binding areas are more
easily visible than with White Fit Checker).

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16
Q

Internal Surface (intaglio)
Procedure:

A

binocular microscope or loupes
*Identify and remove “positive” contacts
*Fit Checker, disclosing wax
*Burn through – nodules, internal line and point angles
*Selective grinding – #1 round carbide
*Remove slight excess
*Indiscriminate removal is unacceptable
*Repeat steps
*Sandblast and steam clean as final step

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17
Q

Fit crown to tooth using Blue Fit Checker*Clinically, if adjustment is necessary, adjust the preparation using

A

a fine grit
diamond; not the intaglio of the all-ceramic crown.
*Why?

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18
Q

Using Accuflim IV as the fit checker
*Clinically, if adjustment is necessary, adjust the preparation using a fine grit diamond.
Accufilm IV can be used to mark the

A

intaglio of the crown, which will make a
corresponding mark on the prep.
*Is this normal?

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19
Q

Clean the Restoration
*Clean intaglio surface which has been contaminated with Accufilm IV
using
*In addition, the surface can also be cleaned with

A

Q-tips and solvent (rinse thoroughly and dry).
etchant gel and rinsed
thoroughly.

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20
Q

Sprue Removal
*Remove the sprue using the

A

separating disc mounted on the mandrel with the slow-speed handpiece (HP).
*Smooth the roughened surface with the Blue rubber abrasive disc.

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21
Q

Seating the Crown:
Evaluate Complete Seating / Margin Adaptation
*Evaluate the marginal integrity using the

A

cowhorn or perio explorer for
vertical closure, as well as the horizontal contour and extension.

22
Q

A small — can be corrected
by carefully adjusting the casting.

23
Q

Marginal Integrity
*Check for completeness of seating and marginal adaptation.
*Remove any
*Fine grit diamond disc
*Blue course polishing wheel

A

over-extension of ceramic material.

24
Q

Adjustment of long, thick margin
*Remove excess with
*Polish with fine rubber disc
*View from inside / outside casting as you go

A

Burlew wheel

25
Margin Evaluation and Adaptation A small ledge of enamel is generally unacceptable -
increases the risk of recurrent caries (and sensitivity).
26
An --- margin requires making a new casting.
open
27
Open Margin??? (3)
1. Heavy proximal contact: 2. Internal binding due to distortion or undercut: 3. Casting with open margin must be re-made
28
1. Heavy proximal contact:
Re-check it
29
2. Internal binding due to distortion or undercut: (4)
*Sandblast the internal surface *Disclose with Fit-checker, aerosol, or disclosing wax Adjust minimally with #330 or green stone *Stay away from margin *Avoid eliminating grooves (unless causing undercut)
30
3. Casting with open margin must be re-made (1)
*Determine cause and correct it first.
31
Marginal Adaptation Procedure:
binocular microscope and/or loupes “Negative” defect – i.e., short or open margin *One or two-way catch *Remake *Additional visit for new impression, .... “Positive” defect - i.e., overextension *One-way catch *Stone or rubber wheel – slow speed handpiece *Steady hands *If margin damaged – remake
32
Gold Margin Finishing (fully seated casting) *Burnishing “softened” metal (type III or softer)
*Margin must fit. *Surface is drawn or moved by rubbing w/ steel point *Marginal improvement: 30 - 80 microns *Subgingival (most FGC’s): burnish on die *Supragingival: burnish & finish (white stone) on tooth *No finishing on typodontteeth
33
Occlusal Surface Procedure:
*Mylar articulating film *Mark occlusal contacts *Shimstock *Evaluate the precision *Iwanson gauge *Prevent perforation *Maintain bulk of restoration *Adjust premature contacts *Green stone, white stone, brownie point *Maintain anatomy of cusp or ridge
34
Occlusal Adjustment (fully seated casting) 1. Check adjacent teeth without crown in place. 2. Check occlusion with crown in place. *Use --- to determine if the crown is in hyper- occlusion or infra-occlusion.
shimstock
35
Occlusal Adjustment *Locate contacts without crown in place
*Mylar articulating film *Shimstock *Visual check amount of “opening” of adjacent teeth *Use adjacent marginal ridges as guides *MIP then lateral excursions
36
Occlusal Adjustment*When complete seating has been verified, mark the occlusal contacts with Accufilm, and slight adjustments can be made with the fine
grit football diamond (low high-speed / water) and/or the blue diamond abrasive point (slow-speed / contra-angle).
37
Always check the --- of the occlusal surface before adjustment.
thickness
38
Anatomy can be accentuated with a --- or diamond (low speed / water), if necessary.
#½ round bur
39
Adjust heavy occlusal markings(triangular ridges / fossae / marginal ridges) speed
SLOW-SPEED ONLY
40
1) Evaluate centric occlusal contact
*Close and squeeze; mandible may deviate *Shift to the buccal (toward side of restoration) *Lingual inclines mn buccal cusps / mx lingual cusps *Shift to the lingual (medial) *B inclines mn lingual cusps / L inclines mx lingual cusps *B inclines mn buccal cusps / L inclines mx buccal cusps
41
2) Check / adjust lateral excursive contact
*“Working side” prematurity *B inclines mn lingual cusps / L inclines mx lingual cusps *“Group function” contact on working side *“Non-working side” prematurity *L inclines mn buccal cusps / L inclines mx lingual cusps
42
3) Check and adjust protrusive contact *Maxillary: *Mandibular:
distal inclines mesial inclines
43
6. External Contours
*Physiologic / esthetic contours *Cervical areas – proper emergence profile *Proper cusp angulation / contours *Edge-edge occlusion: cheek biting *Over-contour / long
44
Pre-Cementation Finishing and Polishing *Polish with
rubber abrasive points and discs. *Brownie – Greenie – Super Greenie *Avoid over-polishing occlusal contacts / proximal contacts *Straight handpiece / slow speed
45
Final Polish with Rouge *Polish with rouge (Robinson brush / Chamois wheel)
*ABSOLUTELY NOT INTRAORALLY ON TEETH!! *Clean with Polishing Compound Remover *No remnant of polishing abrasive *Prevents cement adhesion → de-bonding
46
Pre-Cementation Finishing and Polishing
*Re-check the occlusal contacts *Re-check the proximal contact and contours *Restoration must be CLEAN*Free of polishing compound, residue (internal), moisture or saliva contamination *READY TO CEMENT!
47
Pre-cement-Polish the Restoration After using the blue coarse polishers on the axial and occlusal surface for adjustment and shaping / finishing; use the
pink medium disc and point to polish the axial and occlusal surfaces, respectively.
48
Pre-cement-Polish the Restoration *After using the pink medium polishers, use the gray fine disc and points to further polish the *The final polish can be obtained using diamond polishing paste and a felt wheel. Alternatively, the clinical single use Ceramodot and disposable bristle brush can be used.
axial and occlusal surfaces.
49
Evaluation *Surface Topography (Intaglio) (2) *Tooth preparation is ---; *Ready for cementation (bonding)
*Smooth, no laminations or voids *Snug, passive fit; clean CLEAN
50
Whatever type of crown it is- regardless of the material the steps in finishing and polishing remain the same except the
burs/ armamentarium changes depending on the type/ material of the restoration.