Preoperative Treatment Procedure:

  1. Take preoperative elastomeric impressions of the arches. Construct maxillary and mandibular study models. Take a bite registration and mount the casts.
    2.
  2. Send both casts to the laboratory. A thoroughly detailed laboratory prescription denoting which teeth are to be crowned, extracted and/or bridged; selected shade and interocclusal registration should accompany the case. A diagnostic wax-up or analyses of required modification can also be included.
    3.
  3. Technician will duplicate the master model and use the duplicate cast to formulate the provisional restoration(s). The original cast serves as a continuing reference for tooth contours, anatomy, texture and gingival architecture.
    4.
  4. The duplicate model will be adjusted by the dental technician to agree with the prescription. Preparation of the crowns and hollowing of the appropriate denture teeth is performed in a controlled manner to allow ample room for easy seating with cold cure acrylic.
    5.

Chairside Adjustments and Modifications:

  1. Ensure coverage of tooth preparations and proper embrasures are established. This will eliminate black spaces and encourage gingival health. Use a sandpaper disk to open embrasures that need to be extended and to trim off excess acrylic from facial and lingual aspects. An acrylic bur will quickly shave off larger amounts of excess acrylic.
    2.
  2. Try in provisionals periodically to check gingival embrasure extensions and to make occlusal adjustments.
    3.

Relining Technique:

  1. Prior to tooth preparation, review the extent of tooth reduction on the duplicate cast to identify the incisal, lingual, facial, mesial and distal aspects along with the extent of gingival reduction. Final tooth preparation must be accomplished within these dimensions to ensure proper fit of provisionals.
    2.
  2. Anesthetize area.
    3.
  3. Prepare the teeth and remove any failing restorations or carious tooth structure.
    4.
  4. Restore missing tooth structure with an appropriate dentin adhesive and composite (or cast metal post and core, if indicated).
    5.
  5. Fully seat the provisional over the crown preparations. If incomplete seating occurs, use contact spray fit-checker or rock the provisional at one end and then the other to identify the tooth that is binding. Reduce that tooth or adjust areas of impingement inside denture tooth with an acrylic round bur. Check the contacts with dental floss or articulating paper. When seated properly, check occlusion by having the patient bite with the restoration in place.
    6.
  6. Isolate the teeth and retract the soft tissue with a cord. Apply a separating medium to the surfaces of all prepared teeth (including the embrasure areas) to prevent cold cure acrylic from adhering.
    7.
  7. Using a round bur at low speed, carefully abrade all internal areas of the provisional and a 1 to 2 mm surface rim along the external margin of any deficient marginal area.
    8.
  8. Lightly coat all surfaces of the provisional to be relined with monomer. Thoroughly mix the selected shade of acrylic to a medium consistency and fill the provisional with enough acrylic resin to allow complete seating.
    9.
  9. Wait until the resin sheen has disappeared (i.e., no free monomer on the surface), then seat the provisional over the lubricated preparations.
    10.
  10. Remove the provisional when the acrylic resin is rubbery ( 50% set) and quickly trim away excess reline material with sharp scissors or composite instrument. Re-seat provisional. Remove the provisional just prior to complete set and let final polymerization take place. Moving the provisional on and off the preparations will prevent possible engagement of undercuts on prepared or adjacent teeth that could lock the restoration in place.
    11.
  11. Place provisional back on prepared teeth. Re-contour, shape, finish and polish margins. Focus on the emergence profile, seamless marginal interfacing, concave proximal contours, periodontal access for oral hygiene and a high surface polish for plaque resistance.
    12.
  12. Reinsert the provisional and reline any inadequate area, taking care to lightly abrade the surface for optimal adhesion.
    13.
  13. Check the occlusion and adjust if necessary. Make final esthetic modifications in contour, length, embrasure definition and incisal silhouette. If any external area has become rough, reseal with light-cured composite resin sealant and polish the surface.
    14.

Return to NaturalTemps™ product page