From time to time we can help our patients extend the lifespan of an indirect restoration. Today was one of those days. On a lower left first molar all ceramic crown a patient presented with a marginal discrepancy on the buccal. The gap had begun to pick up stain and a very minor amount of decay. Fortunately for the patient the lesion did not extend under the all ceramic material and was confined to the buccal and did not go past the MB line angle so was easy to access. Based on the clinical situation I shared with the patient the ultimate need to replace the restoration and the option for :extending” it’s lifespan a short amount by repairing the margin.
I had the distinct pleasure to day of replacing a crown. It was made that much more delightful because I did the old crown and it was an eMax lithium Disilicate that I bonded to place. How to remove this new material is a common conversation. The material is challenging to remove for all the same reasons we love it. Strong, chip resistant,crack resistant and bondable. Fortunately for me during the Chicago Midwinter meeting I had a meeting with Larry Rose of Brasseler USA and this exact conversation came up. There are new lines of burs being developed for adjusting and removing this material.
When I graduated from dental school in 1988 most teeth that received indirect restorations also got a buildup. The buildup, in those days usually amalgam, replaced the parts of the tooth that had been lost to decay internally. This accomplished several goals, it allowed the indirect preparation to have retention form and resistance form. It also allowed for a uniform thickness of metal in the indirect restoration, which was important during the firing cycles of veneering porcelain on PFM’s.
With the holiday weekend for Thanksgiving starting tomorrow I thought it was perfect timing to share a trick I just learned recently from a dear friend. One of the things that I know is likely to happen over a long weekend or holiday is a few emergency phone calls from patients new and old. A handful of these may be due to a permanent or temporary crown coming loose. Over the years that I have been in practice I have tried suggesting a variety of ways my patients can manage this on their own. In my experience the temporary cements that they sell over the counter in drugstores are difficult for patients to use, and normally result in a mess for both the patient and I. Somewhere once I heard to have them use Vaseline as a temp cement, and I have had poor results with this approach. Other things I have heard is to use toothpaste which I never personally recommended as I was worried that it would cause sensitivity against the dentin.