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?
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.
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.