Fabricating Esthetically-Pleasing Temporaries
What’s in Your Tool Box to Maximize Your Clinical Efficiency?
It never fails. On a Friday, with 30 minutes left in the work day, a patient walks in with a broken crown (Figure 1). Ideally, you would have had the patient come in during your emergency time and performed a palliative treatment; however, dentistry—and dental patients—can be unpredictable. One of the values our profession prides itself on is customer service: these days, you can’t have too much of it. At this moment, a good clinical assistant has at hand both experience and a “tool box” of emergency equipment.
Being one step ahead of the dentist helps maximize efficiency. As you reassure the patient that she will not have to be without a crown for the weekend, you fire up the intraoral camera. The patient can see the problem for herself (Figure 2). As you investigate the problem, you realize that the dentist had previously diagnosed this crown for a replacement in the treatment plan, however the patient had been concerned about the costs. After reminding her of the dentist’s recommendation, you have the opportunity to inform her of her financial options that will help make optimal care affordable.
This author always asks permission to take an x-ray so that the dentist can assess the damage and reconfirm the original diagnosis. As the dentist explains and offers help, the patient feels she has some control of the situation and reaffirms her request for optimal care. In this author’s experience, patients do not like to be told what they need, but rather determine what they want for themselves.
Because there isn’t much crown structure to take a preliminary impression for the temporary, you decide to remove what remains of the crown and use a prefabricated temporary. However, to find one that fits and do the adjusting is not time-efficient. The decision is to place composite (non-etched or bonded) as a temporary build-up on the fractured lingual surface to take a preliminary impression (Figure 3).
Place the build-up on the lingual surface of the tooth and light cure. Use a polyvinyl bite registration for the preliminary impression; for maximum efficiency, place the Isolite™ i2 dryfield illuminator (Isolite Systems, Santa Barbara, CA) in the patient’s mouth, while the dentist preps the tooth.
After placing the retraction cord and the final impression, it is time for the provisional temporary. A well-stocked dental assistant “tool box” should contain the CDA PRO-Visional Kit (KOMET USA, Rock Hill, SC): the first provisional bur kit made for assistants by an assistant (Figure 4). It was developed with one focus: to keep it simple.
As an experienced assistant, this author has used some extraordinary provisional tools and attended a number of provisional courses. However, many fellow assistants have expressed the idea that it is not necessary to use a number of instruments to fabricate an esthetically-pleasing temporary. With this in mind, the CDA PRO-Visional Kit was designed to be simple and affordable.
After fabrication of the provisional with the preoperative impression, a “Christmas Tree” acrylic bur is used to trim excess acrylic material (Figure 5). The significance of this tool compared to the traditional pear-shaped bur is better visibility while trimming with the triangular point. If needed, thickness is provided at the base of the bur. Next, there is the option of using a honeycomb/swirl diamond disc, allowing the assistants excellent vision of the temporary’s interproximal space (Figure 6). This tool is also outstanding for performing bridge work. The disc is flexible and durable to allow a feathering technique. The acrylic slow-speed football-shaped bur is designed for minimal occlusal adjusting to the temporary, while keeping its natural anatomy. Then for the last application, the acrylic polisher smoothes any rough edges, and the microfiber polisher adds a high shine (Figure 7).
The provisional is temporarily cemented in place (Figure 8). The patient is given post-care instructions and a travel size tube of denture adhesive for emergencies. With the right set of tools, this emergency was handled efficiently and satisfactorily.
About the Author
Tina Calloway, CDA
Editorial Board Member
Inside Dental Assisting
Greensboro, North Carolina