Fitting & Adjusting Castings 2023.pdf

4/19/2023 Lecture Topics FITTING & ADJUSTING CASTINGS: FIXED RESTORATIONS Marjan Moghadam, DDS, MA [email protected] • Single Unit Crowns – All metal – Metal-ceramic restoration – All-ceramic restoration • Fixed Partial Dentures • Survey Crowns Single Unit Restorations ~~ All Types ~~ • Se...

4/19/2023 Lecture Topics FITTING & ADJUSTING CASTINGS: FIXED RESTORATIONS Marjan Moghadam, DDS, MA [email protected] • Single Unit Crowns – All metal – Metal-ceramic restoration – All-ceramic restoration • Fixed Partial Dentures • Survey Crowns Single Unit Restorations ~~ All Types ~~ • Sequence of treatment: Single Unit Crowns Single Unit Restorations ~~ All Types ~~ • Sequence of treatment: – Prepare tooth – Fabricate provisional restoration – Substructure (or cast crown) is made – Ceramic applied (if not a full cast crown) – TRY-IN & FINAL INSERTION – Prepare tooth – Fabricate provisional restoration – Substructure (or cast crown) is made – Ceramic applied (if not a full cast crown) – Try-in & final insertion Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: – On the die 1 4/19/2023 Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: – On the die – Solid Cast – On the die – In the mouth •Remove provisional restoration •Clean all debris Courtesy of Synergy Dental Lab Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: CONTACT – Contact – Internal fit – Occlusion – Esthetics Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: CONTACT – Dental floss Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: CONTACT – Dental floss – Polish ceramic or metal after adjustments 2 4/19/2023 Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: INTERNAL FIT – Christensen article – Subgingival: up to 120 μ accepted – Supragingival: as little as 26μ rejected Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: INTERNAL FIT – “Experienced restorative dentists were not able to evaluate consistently the marginal opening of gingival areas by explorer or roentgenogram” Christensen, G. Marginal fit of gold inlay castings. JPD 1966; 16(2) 297 Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: INTERNAL FIT Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: INTERNAL FIT – Disclosing agent **Cannot rely on sight and feel alone** Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: INTERNAL FIT •Occlude spray – NOT recommended for fixed restoraitons Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: INTERNAL FIT – Disclosing agent •Occlude spray •Pressure spot indicator 3 4/19/2023 Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: INTERNAL FIT – Disclosing agent •Occlude spray •Pressure spot indicator – Radiograph Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: OCCLUSION – Articulating paper •Can be up to 200μ •Accufilm brand is about 20μ – Patient can detect as little as 10μ – Seat patient upright as well Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: ESTHETICS – Check incisal edge position – Check tooth length, contours & line angles Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: OCCLUSION – Articulating paper •Can be up to 200μ – do not use this!! •Accufilm brand is about 20μ – Patient can detect as little as 10μ Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: OCCLUSION – Articulating paper •Can be up to 200μ •Accufilm brand is about 20μ – Patient can detect as little as 10μ – Seat patient upright as well – Polish ceramic or metal after adjustments Single Unit Restorations ~~ All Types ~~ • Sequence of fitting: ESTHETICS – Check incisal edge position – Check tooth length – Check shade – Polish ceramic after adjustments 4 4/19/2023 Single Unit Restorations ~~ All Ceramic ~~ • Special consideration: – Do not adjust the internal surface of ceramic restorations – Crack propagation (zirconia) – Leads to failure of the restoration – Adjust the tooth instead Fixed Partial Denture ~~ All Types ~~ • Sequence of treatment: – Prepare teeth – Fabricate provisional restoration – Framework (metal or ceramic) is made – Try-in clinically •Fits well OR •Does not fit and requires soldering procedure – Ceramic applied – Try-in & final insertion Fixed Partial Denture ~~ FRAMEWORK ~~ • Sequence of fitting: – On the dies – In the mouth •Remove provisional restoration •Clean all debris Fixed Partial Dentures Fixed Partial Denture ~~ All Types ~~ • Sequence of treatment: – Prepare teeth – Fabricate provisional restoration – Framework (metal or ceramic) is made – Try-in clinically •Fits well OR •Does not fit and requires soldering procedure – Ceramic applied – Try-in & final insertion Fixed Partial Denture ~~ FRAMEWORK ~~ • Sequence of fitting: – Contact (if applicable) – Passive fit – Internal fit – Occlusal clearance – Pontic design 5 4/19/2023 Fixed Partial Denture ~~ With Ceramic ~~ • Sequence of fitting: Fixed Partial Denture ~~ With Ceramic ~~ • Sequence of fitting: – Passive fit – Contacts – Pontic design – Passive fit – Contacts – Pontic design Fixed Partial Denture ~~ With Ceramic ~~ • Sequence of fitting: – Passive fit – Contacts – Pontic design – Internal fit (verify) – Occlusion – Polish after adjustments Survey Crowns Survey Crowns Survey Crowns • For use with removable partial denture Pictures courtesy of Dr. Edward Golden 6 4/19/2023 Survey Crowns Survey Crowns Survey Crowns Survey Crowns Survey Crowns Survey Crowns 7 4/19/2023 Survey Crowns Survey Crowns Survey Crowns Survey Crowns Survey Crowns References • Chiche, GJ. Esthetics of Anterior Fixed Prosthodontics • Christensen, G. Marginal fit of gold inlay castings. JPD 1966; 16(2) 297 • Rosenstiel, SF. Contemporary Fixed Prosthodontics, 4th Ed. • Shillingburg, HT. Fundamentals of Fixed Prosthodontics, 3rd Ed. • www.platinummetalsreview.com 8