- Cementation/CIMOE cassette
- High speed handpiece
- Slow speed handpiece
- Straight nose cone attachment (for slow speed handpiece)
- Final restoration
- Appropriate bonding agent and cement
- Fit checker and red pen
- Gauze 2x2
- Articulating paper or green wax
- Shim stock (optional)
- Fine diamond bur (optional)
- Polishing kit (porcelain or gold)
- Anesthetize the patient if necessary. Remember, when dentin is exposed, it will be sensitive to air and cold water. The patient can decide to not use anesthetic so that they can feel whether their bite is normal, but they must be informed that they might have sensitivity during the procedure.
- Use the CIMOE (Contacts, Internal, Margins, Occlusion, Esthetics) technique to seat your crown. Don't adjust contacts with high speed coarse diamonds because you may over adjust. Also check the restorations on proximal teeth for bur marks in contacts areas from previous preparation. Polish these areas prior to contact adjustment of the new crown.
- Make sure to place gauze in the patient’s throat to prevent the patient from swallowing the crown as you take it in and out of the mouth.
- Once the crown seats fully, repeatedly and the occlusion is not heavy and has been adjusted to IDEAL, you are ready to cement. (It is very hard to adjust later in the mouth.)
- Discuss with an instructor which cement should be used. Please see section on cements.
- Place the cement into your crown in a fairly thin layer (do not fill completely) so that all surfaces are covered. Seat the crown on the tooth, and while maintaining pressure on it, check the margins and occlusion to make sure they are the same as when you seated it before.
- Do not have patient bite on a cotton roll. Too often they will bite unevenly and unseat your crown.
- Hold crown in place for duration of cement setting.
- After cement sets, clean away excess, making sure to clear interproximal areas.
- Check contacts and occlusion again.
- Give your patient post-op instructions. Let them know that the cement will not reach maximum strength for 48 hours, so the patient should not chew anything sticky or hard for the next few days. Let them know that their bite may change in the next few days since they are no longer anesthetized, and that if it continues, they need to come back for an adjustment.
C: Contacts (proximal)
- Most common reason for an open margin is a tight contact
- Floss can be used to check contact tightness, position, and shape of contact
- If floss passes very easily - may be open
- If floss shreds, breaks - too tight
- Use articulating paper cut in thin strips or shimstock to check interproximally
- Adjust the proximal contacts using a fine diamond and/or finishing wheel in a slow speed handpiece (5000 rpm). Polish these with the porcelain polishing kit at 5000 rpm.
I: Internal Fit
M: Marginal Adaptation