- 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)
- Anesthesia may be necessary. Exposed dentin of a vital tooth will react to air, water, friction (instruments or restoration), and acidic materials such as cements. Patients will often express reluctance to have local anesthesia for what seems like a trivial procedure, but you may find that flinching and other reactions to pain will make it difficult for you to successfully place your restoration. It is not true that patients lose their ability to perceive hyper-occlusion if they are anesthetized.
- Follow the steps described in the CIMOE sequence to adjust your crown. Do not use coarse diamond burs to adjust proximal or occlusal contacts as this will leave a surface that is too rough to be smoothed without losing those contacts. It is also a good idea to check the proximal surfaces on adjacent teeth for bur marks from any 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.
- You may have the patient bite on a cotton roll or tongue blade if you are cementing a full metal or PFM crown. Ceramic crowns should not be seated with biting pressure.
- Hold crown in place for duration of cement setting.
- After cement sets, clean away excess, making sure to clear interproximal areas.
- Check proximal 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. Any hyperocclusion or lateral interferences should be apparent within a few days, sometimes accompanied by cold sensitivity. This will require occlusal adjustment. Cold sensitivity should subside within a week.
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 (consider using floss holder.)
- 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