Professional Documents
Culture Documents
Techniques"
"For Fixed Prosthodontics"
Before we start:
1- this is an easy lecture so don’t start hitting your head by the walls of your
room saying: it`s a long lecture I will never finish it, or starting pouring streams
of tears on the lecture spoiling it, no, just read it and you will find it very easy.
2- I included the things mentioned in the slides not by Dr with small font
(font 12) as usual so you don’t need to go back to the slides.
• Tissue management
Aims and principles: why would you retract off the gingiva, simply
because you want to create a vertical as well as horizontal
space to push the gum away so there will be access to the finish line
so that the material will be injected in.
Techniques
"Mun: don’t worry just only 17 pages and you will end this easy
lecture"
Simply you push the gum away physically by the body of the cord,
and remember if you don’t want to use any chemical agent as the next
method you should not use it dry but you should immerse it in water
because if you use it alone you will injure the tissues so never
use it alone.
• Chemomechanical methods:
• Surgical methods:
Rotary gingival curettage: using bur we cut some of the inner side of
the gum to create space but this will cause bleeding.
• Combination of these.
• Easy, actually it`s not very easy and its time consuming you
need to put it around the tissue ..etc, that’s why they invented the
cordless techniques.
• Quick
And these are some studies which studied the effect of retraction cord on
the gingiva:
So after these results we can all agree that this technique cause
reversible damage to the tissues, there will be some inflammation but by
the time things go back to normal.
Haemostatic Agents: (Dr said they should be covered more than this)
astringent
Component
Disposable Tips
Technique Principle:
• The strength of the epithelial attachment is 1 N/ mm2
The first expanding PVS material designed for easy and fast
retraction of the sulcus
Disposable tips
The patient bite on them to push the sillicon material in, and
Principle of Work:
Practical implications: This study showed that none of the techniques tested seems to
harm the tissues in the long term; however, clinicians should be aware that Expasyl
use is less friendly to the gingival tissues. Cordless techniques do not require
haemostatic agents to control bleeding.
So by now we ended the first part of the lecture (tissue management) with
all its divisions aims and principles….. tell new cordless techniques which you
can easily read and even if you don’t know the technique you can read it on the
brochure behind it.
previously they said that you should make the taper 6 degrees (this
came from a study done in the fifties by preparing teeth and calculating
the force required to pull the crowns against the path of insertion) and it
remains the ideal degree, but recently they revised this degree and found
that we actually don’t achieve the six degrees at all even
the specialists can`t achieve it, so the average is 18, 16 if it’s
a good preparation, so they revised the study and said that the
study examined the resistant to pull upward but this is not what happen
clinically because clinically the tooth is subjected to
horizontal forces that’s why the resistance form is more
important than the retention form (remember both of them are
important), because there is nothing can pull the tooth upward or
downward (according to Dr), so here after they considered the previous
things they found that the height with the taper with the other
features is the important things in the preparation, so the
recommendations mentioned that 10-20 degrees tapered is
acceptable if you have 3mm minimum height anteriorly
or 4mm minimum height posteriorely because the diameter of
the crown is wide posteriorely, otherwise you should think of other
solutions like guiding grooves boxes crown lengthening posts building up
the tooth core so there are different ways to improve the resistance form.
Now in order to assess the occlusal reduction you could use wax
by making the patient bite on it then you measure the wax by wax gauge
to know the amount that you removed or by the indexes that we talked
about previously.
In the video the tooth was 90% ready and the finish line was still on
the amulgum, so he needed to take it downward to house the amulgum
within the crown.
Always students think that if you do not take much tooth structure then
you are good but this is not true, taking minimal tooth
structure is as bad as taking excessive, because if you prepare
minimal preparation your technician will either make your crown very
big(to get the color as Dr said) to have the enough thickness of metal or
ceramic so the emergence profile will be distorted and it will be
aesthetically ugly also it will cause harmful effects on the
gingival margin, or he will make it as its normal size so the thickness
of the crown will not be enough (especially occlusally he can`t make the
crown big because the crown will be high) and the ceramic will not cover
it or there will be perforation so it will be a failed crown, also if you did
over preparation you will get as bad results, so you should do what is
needed. (here the Dr mentioned example with numbers (I (mun) think they are not accurate and
they are different from book numbers so I think it's better not to memorize them and just get the idea)
about the effect of minimal preparation for metal ceramic crown on
technician work, for you to cast a metal you need minimally 0.3-0.5mm
thickness to cast a metal and at least 1mm for ceramic if it was supported
by metal so you need 1.3-1.5mm (in lec 5 its 1.5-2mm occlusal reduction)preparation
and if you prepare below this, you will get the above results).
Now we reached our topic in the video, the operator dipped the
retraction cord in haemostatic agent (strengodent as Dr read it)
then he took the excessive by gauze and then he applied it,
and the ways to do that is many, you can use a probe or a plastic
instrument with flat end, also there is some instruments the tip of
it is irregular ( )مخرمةto catch the cord to push it or other things flat
like plastic instruments you could use either ( )كله بيمشيbut you should be
experience in this process.
Make the cord as a loop, the Dr himself found that if you hold the two
ends and you give it a bit of stress ( )شديتو شويthen you push it, it will slip
all inside the tissues, when you push you keep pushing backward means
you started from a point you keep pushing toward the starting point with
the same direction don’t make like this (I don’t know what he meant by this but
the result of making this this is pulling out the cord from the tissues ), then you cut
the excess and you push what remains inside.
And you do roundation for the cusps because these sharp areas
can cause problems to you, any sharp area in the impression may
cause voids and when the technician cast it if we got the impression
maybe he will not pour it properly because it`s very thin, even if all these
things continued good ( )يعني حتى لو زبطت كل المورlater on even on the
crown when he work on these sharp edges he might break them, even if
he continue ( )رد مشاهاthere will be another chance that in the future after
cementation it will be stress areas on the cement, so there is many
advantages to remove the sharp areas.
Finally the operator checked for any sharp edges by probe and by
howly (spelling not sure) instrument he did finishing for the finish line or you
can use tungsten carbide bur, then he cleaned the area and prepared
for the impression, so by now we finished the first step which is the tissue
management and the tooth was ready for impression, now as the finish
line was clear to the operator he had two choices either taking the
impression with the retraction cord in its place, or removing it and do
syringing directly.
Then the operator started with the impression (the Dr didn’t about
what he did but he explained what we use in our clinics) by gun we load
the light body of silicon on the finish line and on the tooth
because its flowable and the heavy body (putty) on the
tray so this is the technique the same concept with different material
(from the material that operator used).
The Dr mentioned a clinical point that when you do syringing with the
gun always keep material in front of and behind the tip of the gun
which means don’t drag the material behind, so you start with bollous of
impression then you keep syringing where there is material in front and in
the back of the tip.
Then the operator continued syringing the light body for all the
occlusal surfaces for all teeth because its more accurate than the heavy
body, so we need the more accurate light body on all the
teeth because the die is not the only thing important, we need
our impression to be accurate on all teeth even those on the other side
because these teeth after pouring the impression will be articulated
against the opposing arch and if the other teeth were not accurate this
means that your mounting will be wrong and the occlusal
surface shape of the crown will be wrong, so don’t be as one
of the students who asked the Dr "I want to make a bridge, can I get
sectional impression?" and of course the answer is no, you should get
full arch impression.
Finally he removed the impression and he inspected the impression,
and here the Dr pointed in the video on the impression and pointed on
depression in it, and that depression is the finish line and the part of
the impression which is coming upward toward us and has
irregularities is the material that entered subgingivally beneath
the finish line.
you understand.
Now one should ask why here the operator removed the
retraction cord while in the previous case he didn’t?
Will this depends on the case, for example if you put the
retraction cord and still the finish line is not clear you
should remove the retraction cord because when you
remove it there will be space so the impression will be better,
but if you put the retraction cord and the finish line
became clear and you are afraid that if you removed the
cord there will be bleeding and you are working on
posterior teeth it will be better to take the impression
without removing it.
"Mun: did you see how this lecture is easy, just 5 pages and you will finish"
Classifications:
According to elasticity:
According to viscosity:
Available materials:
Polysulphide:
Base:
Objectionable odor
Polyether:
Base:
Activator:
Aromatic Sulphonate
Silicone Rubber:
• Condensation Type
• Base:
• Catalyst:
Alkyl silicate.
Comparison of elastomers:
Trays:
Routinely we don’t use custom trays, we use stock trays and
the best tray is the one who covers the teeth and is rigid,
notice for example the silicone, the spacer in it is not that important (we
want spacer if we use heavy body but the light body don’t need much
spacer same as ZOE).
The more important thing is that the tray should be rigid, because if
you want to use heavy body or putty with the red tray which is flexible (look
to the lower picture right)the tray will deflect and the impression will be deflected
You could use custom tray if you have big mouth and you don’t
have stock tray that cover all teeth, but not for the purposes of
thicknesses because silicon is accurate in either thin or thick sections
and at the end there is no dimensional changes.
This was previously important when they were using the condensation
type, because as you lower the amount of material in the impression you
lower the amount of dimensional changes.
Disinfection:
DISINFECTANTS FOR IMPRESSION MATERIALS:
Glutaraldehyde:
- Indicated for all impression materials except
hydrocolloids
Phenols:
- Indicated for polysulfide rubber base only (so you will never
use it because the Dr didn’t ever use polysulfide)
The end
Normal thanks to saleh alqadi for hearing a one word in the record