An Array of Options Available For Crown and Bridge Placement

Innovations in restoration are offering clinicians an array of options for treating their patients, according to a speaker at the Updates in Contemporary Dentistry Meeting, held here.
Robert A. Lowe, DDS, noted that clinicians have a number of options for placing crowns and bridges, and highlighted a few products that are in the pipeline or have recently launched that he said have worked well for him.
Discussing preparation technique, Dr. Lowe said typically after a topical and local anesthetic is applied, he will use a high-speed handpiece, like those from KaVo Dental, to prepare the tooth following anatomic planes, and carefully refining the gingival margins. Prior to making the provisional restorations, he paints the preps with Wink, from Pulpdent Corporation. “I always paint the preps and areas surrounding the prep with Wink, particularly if there is any composite buildups present,” he said, adding it provides easy release of provisional materials and prevents distortion caused by torque.
For impression materials, Dr. Lowe said he likes unidose delivery of light-bodied impression materials, such as Aquasil’s Ultra Targeted Delivery System, which features an automatic mixing system that makes it easier to dispense. “I’ve always been a big fan of unidose delivery,” he said.
When it comes to cement choices, Dr. Lowe said he considers solubility, dispensing, mixing, and set times.
Dr. Lowe noted that resin cements require pretreatment of the tooth surface with phosphoric acid and a dentin-bonding agent. He noted that self-etching resin cements require no pretreatment of the tooth surface, and appear to have many advantages, but the bond strengths of self-etching resin cements are not typically as high as those for resin cements using total-etch.
He noted that “feldspathic porcelain restorative materials, such as porcelain veneers, requires total etch treatment of dentin and placement of a dentin adhesive prior to application of resin cement.”
 
An Array of Choices
Dr. Lowe said he has been working with a new crown and bridge material that is set to launch at the American Dental Association Meeting in October, Dentsply’s Integrity Multicure. Dr. Lowe said the manufacturer reports this product will offer an improved option with flexural strength, and up to 30% faster curing times over the current version of Integrity.
For help in tissue management, Dr. Lowe said a good choice is Premier Dental’s Traxodent, a Hemodent Paste Retraction System that provides predictable hemostasis and soft-tissue management. He also noted that Traxodent is great for dealing with the “red lubricant (blood),” providing excellent hemostasis during impression making and cementation of restorations.
Summarizing his presentation, Dr. Lowe noted that it is important for clinicians to understand a predictable rationale for cementation of crowns and bridges, either conventionally or with total etch, and encouraged the clinicians in attendance to look for creative options for restorative cases.