Inside Dental Assisting
A New Outlook on Provisional Trimming
Hollie A. Bryant, DA II
Every day dental assistants are asked to find the right instruments to complete a particular procedure. As many of you know, this can be a challenge. For example, when searching for the right burs and polishers to use on a four-unit bridge, the dental assistant needs the right cutting and polishing discs to open the interproximal contacts, making it esthetically pleasing and comfortable for the patient. In many cases, there’s little time to finish the work before the dentist arrives to review it. There is considerable pressure to make sure this bridge is more than satisfactory—it must be perfect.
Time is wasted searching for the proper rotary instruments and gathering the materials to buff the provisional. This process is frustrating, because sometimes you cannot find the necessary instruments, and this might compromise your work. Next, you need to assess if you have the correct materials, which of them to use, and when to use them. After all this second guessing, there is little time remaining to complete the task.
To simplify this process, KOMET USA (http://www.komet-usa.com) recently introduced the Complete Esthetic Provisional Kit LD0156 (Figure 1), designed specifically to make the dental assistant’s work on provisionals much faster and easier.
The kit’s bulk-trimming carbide is used to remove a majority of the material on provisionals (Figure 2). The acrylic cutter is used for deepening the central fosse and/ or secondary anatomy (Figure 3). The kit also contains a mandrel to be used with flexible discs on facial surfaces of the anterior provisionals. Most often dental assistants will use flexible discs that come in a variety of grits, ensuring a detailed anatomical tooth (Figure 4). Several dental companies have flexible discs, including the Composite Polishing Discs from KOMET USA and Sof-Lex™ from 3M ESPE (http://www.3mespe.com). The flame-shaped carbide was designed for pits and fissures, and even for adding few quick pit stains (Figure 5).
The embrasures must be opened, which can be a difficult task for dental assistants. This procedure ensures that optimal dental health is being achieved during the interim. Many times, assistants are so focused on making the provisional esthetically pleasing that proper fitting is forgotten.
If dentists were asked what was the most important aspect of a provisional, they most likely would say fit and function. If the fit is poor, then the provisional will come off and valuable time will be lost both by the practice and patient. Contacts must hold the adjacent teeth in place. Marginal integrity is also important to maintain dental health.
With a properly fitting provisional, postoperative sensitivity is minimal. Ideal tissue health is at its best with smooth, fitting provisional margins; however, a provisional’s function is also very important. If an assistant chooses to remove the occlusial contacts on the provisionals, then the opposing tooth is allowed to erupt, causing the final restoration to be askew.
Learning occlusal anatomy is a key factor in fabricating provisionals and using the Complete Esthetic Provisional Kit. One tip is to find an excellent anatomy reference guide (Figure 6). Place it in the laboratory beside the handpiece so that it can be used when trimming provisionals.
Finishing Up All Trimming
Take the red-ringed carbide and run it across all working surfaces, as this assures a smooth surface with minimal scratches. A large diamond disc is used when trimming a round house motion with pontic teeth.
There are three choices. The yellow buffer will strike up a shine. Run the white coarse grit wheel across the margins, ensuring that there are no rough edges that could compromise healthy tissue. The felt polisher provides an excellent final result because no glaze polish is required (Figure 7).
Take the bur and trim a small line inside the provisional prior to cementing. This will allow the necessary room for the cement, and the provisional will not need any final adjustment post-cementation (Figure 8 and Figure 9).
When the provisional is trimmed and excess cement removed, the patient can be released. This process allows for complete confidence when trimming a provisional.
Clearly, the steps are not complex. This new kit provides everything needed to trim and polish a great provisional. The time in the laboratory using this kit is approximately 7 minutes because everything is within reach. Not having to search for the appropriate burs and polishers, the dental assistant gains valuable time that can be spent with the patient.
The author would like to thank Productivity Training Corporation of Morgan Hill, CA for permission to use its anatomy reference guide in this article.
About the Author
Hollie A. Bryant, DA II
Editorial Board Member, Inside Dental Assisting
Office Manager, The Durham Smile