STAGES CORE RESTORATIONS FOUNDATION WORK 09/03/2018. Endodontic treatment. Extractions. Crown lengthening. Implants.

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Randall Shelton
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1 STAGES CORE RESTORATIONS 1. Records, Planning, Case Discussion 2. Initial basic wax up + Chairside temporisation 3. Foundations + Core restorations 4. Prep and Temp refinement 5. Definitive diagnostic wax-up + Lab provisionals (the later the better) 6. Final restorations FOUNDATION WORK Endodontic treatment Implants Crown lengthening Core restorations Don t rely purely on adhesion Extractions 5-Year Follow-up of a Prospective Clinical Study on Various Types of Core Restorations Creugers et al. Int J Prosthodont 2005;18: The type of post and core was not relevant with respect to survival. The amount of remaining dentin height after preparation influenced the longevity of a post-and-core restoration. Cannot be compensated for with dentine bonding 1

2 FAILURE (fibre) FAILURE (cast) Remaining tooth structure CORE RESTORATIONS - anterior < 1/3 rd > 1/3 rd < 2/3 rd Cast post Or extract Composite core with post Or Cast post < 1/3 rd remaining tooth > 2/3 rd Composite core with or w/out post 2

3 CAST POST IMPLANT CAST POST Direct pattern resin post and core fabrication Requirements and Rationale Thin film thickness Extended setting time CEMENTATION cast post Zinc Phosphate MULTIPLE CAST POSTS allows for slow and complete seating of post prior to setting 3

4 DIRECT POSTS (metal or tooth coloured) Hollow out and reline temps Use when adequate coronal tooth structure remaining to support and protect post/core interface > 1/3 rd < 2/3 rd remaining tooth 4

5 > 2/3 rd remaining tooth Emax Technician : S Newbold No need for any post if adequate tooth structure FIBRE POSTS OPTIONS? 1. Cast metal post and core and cemented PFM or Zi crown 2. Tooth coloured direct post and core and adhesively bonded Emax crown Cast post would have caused loss of labial wall 5

6 BM 09/03/2018 WHAT POST? BIOMECHANICAL PRINCIPLES Consider 1 piece cast post Endodontically treated CORE RESTORATIONS - posterior Remaining tooth structure < 1/3 rd > 1/3 rd Nyar core Direct posts and core crown onlay or crown CAST POST AND CORE Vital Direct core buildup (GI, composite, amalgam,) with mechanical and adhesive retention Final restoration margins must be on tooth not core onlay or crown 6

7 BM 09/03/2018 Direct Post + amalgam core Vital Tooth Planned restoration = Crown or Onlay Core? If not amalgam use composite GI or Composite Planned treatment? 17 Vital Tooth Planned restoration = Crown Core? All vital teeth PFM crown = elective endo (future proofing), amalgam core and posts 7

8 16 Vital Tooth Planned restoration = Crown 16, 17 PFM crowns Core? Composite core and PFM crown 14, Vital Planned restoration = Crown Core? PFM or Zi crown = composite core Consider elective endo? (future proofing) 8

impression Decision on final restorations + Prep refinement + Laboratory Provisionals Tooth reduction based on outer form of

9 15 Vital Planned restoration = Crown Core? 14, 15 CT graft PFM or Zi crown = elective endo (future proofing), cast post and core Requirements before proceeding to final impression Decision on final restorations + Prep refinement + Laboratory Provisionals Tooth reduction based on outer form of the temporary restoration Healthy and stable soft tissue Stable occlusion Correct vertical, horizontal and sagittal plane orientation Agreement on aesthetics between all parties (patient, technician, dentist) 9

LABORATORY provisionals LABORATORY provisionals As close to the final restorations as possible - Minimise the jump Most modifications carried out in the initial temporary stage Aesthetics working on

tissue for impression Occlusal precision refinement of occlusal morphology and occlusal scheme Durability laboratory processing with heat and pressure increases durability when provisionals need to

10 LABORATORY provisionals LABORATORY provisionals As close to the final restorations as possible - Minimise the jump Most modifications carried out in the initial temporary stage Aesthetics working on preparations allows more freedom to develop optimal morphology and colour Marginal precision If margins are captured in the impression, technician can develop optimal emergence profile to condition tissue for impression Occlusal precision refinement of occlusal morphology and occlusal scheme Durability laboratory processing with heat and pressure increases durability when provisionals need to be in place for extended periods of time (implant cases, perio sx, etc) Preparation assessment technician input based on preps MARGIN REFINEMENT INFORMATION TXFER reference planes Kois Facebow Alar Tragus line 10

11 CR RECORD IMPRESSIONS for provisionals IMPRESSIONS for provisionals Provisional crowns Tissue health You get out from the tissues what you put into the temporaries 11

12 Definitive wax-up Wax try-in Wax try in (if there s a big jump from temps to finals) Visualise before you Finalise Minimise the Jump 12

13 LABORATORY PROVISIONALS LABORATORY PROVISIONALS CORRECTION OF CANT, IMPROVEMENT OF SHAPE Definitive wax-up 13

14 TISSUE HEALTH emergence profile TISSUE HEALTH and SUPPORT Technician - Salvatore Sgro You get out from the tissues what you put into the temporaries PREP ASSESSMENT technician input PREP ASSESSMENT reduction copings thickness gauge 14

15 Definitive wax up and Provisionals (pmma) Occlusal Precision Marginal and Aesthetic Precision 15

16 PROGRESSION OF TEMPS temps provisionals occlusal progression to precision Technician = S Sgro Progression of temps Initial chairside temps 16

17 Progression of temps modified chairside temps laboratory provisionals Chairside temps Laboratory provisionals Finals Chairside temps Laboratory provisionals Finals 17

PG Cert Contemporary Tooth Preparations and Operative Dentistry

PG Cert Contemporary Tooth Preparations and Operative Dentistry www.dominic-hassall-training.co.uk DAY 1 Rules and tools in smile design/aesthetic planning The aesthetic assessment sheet/check list Facially