Jun 152011
 
Decay on a Lower Second Bicuspid

Decay on a Lower Second Bicuspid

Today I had a patient of record come in with a single tooth that had begun to decay and then she fractured the buccal cusp. She and I decided to proceed with a veneerlay restoration, so I prepared an MODB onlay, reducing the buccal cusp.  Then I incorporated a veneer prep down to the crest of tissue on the buccal for esthetic optimization.

With this single tooth prepared my assistant asked me whether we would be taking a triple tray or full arch impression. Fifteen years ago I took most of the final impressions in my practice with triple trays. As my practice began to evolve and I began my journey toward more comprehensive care I started taking more and more full arch impressions with facebow transfers. As Chelly asked me this question I began to ask myself the question why wouldn’t I take this with a triple tray?

Veneerlay Prep on Lower Bicuspid

Veneerlay Prep

Triple trays do several things very well. They are very effective at impressing the preparation, margins and adjacent teeth. In addition they capture the bite at the vertical dimension the restoration will be made at, so the lab can very accurately manage intercuspal position. The missing pieces are about how the teeth function against one another in excursive movements. A triple tray does not give the lab the ability to move the models through all of the movements the mandible can make and adjust the restoration. What it does transfer is the relative cusp height, fossa anatomy and cuspal inclines of the adjacent teeth. A technician that has been trained well, can follow these anatomic features through to the new restoration.

Triple Tray Impression

Triple Tray Impression

So I decided in this case, a single lower bicuspid restoration, where we are replicating the patients existing occlusal scheme, triple tray it is! I’m confident that my technician at The Winter Lab, will have the information to create an exquisite result, and I am prepared to check and finalize the excursive contacts at the seat appointment.

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  8 Responses to “Triple Trays, Yeah or Nay?”

  1. Have used them for ever on single tooth impressions. If I am careful to to have the occlusion and canine guidance correct and included in the impresson , it will be correct on this new one as well.

  2. Lee, can you discuss your decision to restore this type of lesion indirect vs. a direct restoration

    • Hi Bill,

      The patient had decay on the cusp tip, at the gingival margin on the labial, and as it turned out on e we started the prep on the distal as well. The patient and i discussed the option of doing separate composite restorations on the labial and cusp tip. The risk for me in doing the composite is the tooth structure between the two restorations on the labial being undermined, as well as the longevity and retention of the composite on the cusp tip, with the benefit being less removal of tooth structure now. For the veneerlay the risk is more aggressive reduction now, with the benefit to me being the continuity of the restoration, porcelain replacing the cusp tip, and retention form. The patient opted for doing the veneerlay after our discussion. I think either approach would have worked and achieved a nice result.

  3. Thanks Lee. Makes sense. I was not aware or the other areas of decay on the tooth.

  4. Lee, I enjoy reading you blog very much. I missed your energy after you left Pankey, and I never made it to Scottsdale to take courses there. It is nice to get your insights again.
    Thank you!

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