FIXED PROSTHODONTICS

DR. ERWAN SUGIATNO DR HARYO M.DIPOYONO

PUSAT PENGAJIAN SAINS PERGIGIAN UNIVERSITI SAINS MALAYSIA

FINISHING & CEMENTATION

The surface of the casting that is retrieved from investment is too rough for use in the mouth Five preparatory procedures need to be performed on any type of cemented restoration after it has been fabricated in the laboratory : preliminary finishing, try-in and adjustment, pre-cementation polishing, cementation, and postcementation finishing

Preliminary Finishing
To minimize the expenditure of valuable chair time, preliminary adjustment using the die and master cast should be completed on the internal and external surfaces of the restoration prior to the cementation appointment

Armamentarium
1. High-speed handpiece 2. Straight handpiece 3. Separating disc on mandrel 4. No.2F Craytex disc on mandrel 5. 5/8-inch Burlew wheel on mandrel 6. Sulci disc on small-head mandrel 7. No. 0 budfinishing bur 8. No. 330 friction-grip bur 9. Articulating paper 10. Green stone

 Remove any small nodules or bubbles with a no. 330 bur in a high-speed handpiece Use a separating disc to cut the sprues from the casting Use a coarse rubber disc to smooth away the roughness left by the separating disc Use the finer Burlew or Gold Lustre Blue disc in a similar manner after the coarse disc The axial surface should be finished to the margin, the disc should be rotated parallel with the margin, rather than perpendicular to it.

Remove nodules used no. 330 bur Sprue is removed with a separating disc.

Axial surface are smoothed with a Burlew wheel (A). The wheel should be turned parallel with the margin (B).

 Use a no. 0 bud finishing bur to smooth out the grooves on the occlusal surface Smooth the cusp ridges and blend them into the groove on the occlusal surface with a small rubber sulci disc.

Grooves are finished with a small bud finishing bur. Cusp ridges are finished with a small sulci disc.

Try-in and Adjustment

If you are careful and gentle, the try-in procedure can be accomplish on many patients without administering an anesthetic. Cementation should be postponed if the patient reports that the tooth has been hypersensitive under provisional crown. Make sure the provisional restoration is not hyperocclusion and that it covers all prepared tooth surfaces. Recement it for several days.

Adjustment of Proximal Contacts

The proximal contacts of a restoration must be neither too tight nor too light. If they are too tight, they will interfere with correct seating of the restoration, produce discomfort, and make it difficult for the patient to floss. If they are too light, they will allow impaction of strands of food, which is deleterious to the gingiva and annoying to the patient.

 A frequent cause for failure of restoration to seat completely is an overcontoured proximal surface. Hold the restoration firmly in place and test both proximal contacts with waxed floss. If both proximal contacts feel too tight, adjust only the tighter contact first. Care must be taken not to remove too much material from the contact area. If the proximal contact is open or too light, this must be corrected by adding solder before cementation.

Proximal contacts are tested with dental floss.

Marginal Adaptation
After the proximal contacts have been corrected, seat the restoration and examine the margins closely. An acceptable margin is not overextended, underextended, too thick, or open.

Types of defective margins : overextended (A), underextended (B), thick (C), and open (D).

Margin Finishing
Two types of margins need to be considered Subgingival margins can be burnished on the die with a beavertail burnisher or fine stone Supragingival margins of inlays, onlays, and partial veneer crowns can be finished on the tooth.

 A burnisher, such as a dull Spratley knife, can be used to press the margins against the tooth surface The white stone should always rotate from casting to tooth surface, under heavy pressure and at low speed.

All accessible margins are burnished intraorally with a smooth, dull instrument. Margins are finished with a white stone rotating from alloy to tooth.

Occlusal Adjustment
Insert the restoration and see, if the patient can still hold the shim between the same pair of nearby teeth. If not the crown is high in the intercuspal position.
If the patient can hold shim stock on adjacent teeth with the crown out, but not with in it, the crown is too high.

 If the mandible shifts to the side where the restoration is located, the buccal incline of the maxillary lingual cusp or the lingual incline of the mandibular buccal cusp needs adjustment. If the mandible shifts to the side away from the restoration, one of two deflective contacts requires correction, there is a possibility of a heavy contact between the lingual incline of the maxilary buccal cusp and the buccal incline of the mandibular buccal cusp. There may also be excessive contact between the lingual incline of the maxillary lingual cusp and the buccal incline of the mandibular lingual cusp that needs correction.

A premature contact on the buccal incline of the maxillary lingual cusp produces a buccal shift of the mandible. A premature contact on the lingual slope of the maxillary buccal cusp produces a lingual shift of the mandible. A premature contact on the lingual incline of the maxillary lingual cusp produces a lingual shift of the mandible.