{"id":561,"date":"2012-05-07T16:43:52","date_gmt":"2012-05-07T21:43:52","guid":{"rendered":"http:\/\/allisonwatts.com\/blog\/?p=561"},"modified":"2020-12-24T16:01:31","modified_gmt":"2020-12-24T22:01:31","slug":"excellent-cementation-full-mouth-rehabilitation","status":"publish","type":"post","link":"https:\/\/allisonwatts.com\/excellent-cementation-full-mouth-rehabilitation\/","title":{"rendered":"Excellent Cementation – Full Mouth Rehabilitation"},"content":{"rendered":"

\"\"<\/a><\/h1>\n

Excellent Cementation<\/span><\/span><\/h1>\n

by Allison Watts, DDS
\n\t<\/span><\/em><\/span><\/h1>\n

 <\/p>\n

Cementation of Temporary Restorations<\/strong><\/span><\/span><\/p>\n

When we’ve made the temporaries beautiful (stained and polished) and well-fitting and have the occlusion adjusted properly and the interproximal embrasures open enough for floss-treading, we are ready to cement our temporaries.  <\/span><\/span><\/p>\n

We ream out a little space for cement in the intaglio<\/strong> (inside (I just love the word intaglio)) and place a piece of floss in each gingival embrasure prior to cementation.  The assistant dries the provisionals well while I dry and isolate the teeth.  She mixes durelon for the posteriors and anterior crowns that are thick enough to not show through.  <\/span><\/span>Generally for anteriors we use Calibra base, because it is clear. <\/strong>  <\/span><\/span><\/em><\/p>\n

So for the durelon, just mix until nice and creamy <\/strong>and put a thin coat in all the way to the margin.  Seat temporaries and clean immediately with a microbrush or cotton pellet with vaseline on it.  When the cement is just setting, use the floss that is threaded in the interproximals to floss up in those gingival embrasures.  Clean remaining cement with a scaler or explorer.<\/span><\/span><\/p>\n

For anterior temporary restorations needing to be cemented with something clear, we use calibra (base only).  It stays better than tempbond clear and doesn’t leak as much.  The procedure is as follows:<\/span><\/span><\/p>\n

    \n
  1. Place floss on the embrasures (doesn’t work as well for veneers)<\/li>\n
  2. Place bond on the tooth and the inside of the restoration.  Do not etch and prime unless it’s just spot etching!<\/span><\/span><\/li>\n
  3. Cure or don’t cure… I don’t cure.<\/li>\n
  4. Assistant places calibra on the inside of the restoration and we seat it to place, cleaning the cement as much as possible while wet. <\/li>\n
  5. Tack the cement by waving the light around for a few seconds.<\/li>\n
  6. Clean the cement while in the gel stage, including flossing.<\/li>\n
  7. Continue to clean cement as necessary.<\/li>\n
  8. Final cure.<\/li>\n
  9. Check occlusion again.<\/li>\n<\/ol>\n

    Cementation of Permanent Restorations<\/strong><\/span><\/span><\/p>\n

    When the restorations have been tried in one at a time and as a group, and all the margins and contacts are good,<\/strong> I will check the occlusion lightly.  We like to radiograph them to make sure the margin is closed.  I will look to see if I like them and then we have the patient approve them.  We scrub the teeth with pumice and peroxide to clean any cement residue and bacterial film off the tooth.  If any cord needs to be packed, make sure it is tucked in well under the finish line.  Then prepare the restorations for cementation.  <\/span><\/span><\/p>\n

    We use tray table paper with the tooth numbers written on it—22, 23, 24, 25, 26, 27 and place the restorations just above their number (leave a little space between the numbers).  Generally, I like to seat two at a time.  I’ve tried all different ways and this is definitely personal choice, but for me, I feel I have better control when I cement two at a time…<\/span><\/span><\/p>\n

    Here’s my choice when cementing.<\/strong><\/em>  If the restoration is a PFG or emax crown with plenty of retention, I will cement, usually using rely-x.  If the crown doesn’t have a lot of retention, I’ll bond it in place or use panavia.  Also, if I want to make the restoration whiter (like when the tooth underneath is a tad dark), I may cement.  Hopefully the lab and I have already taken that into account and have created a restoration that will block out the dark color.   Most anterior teeth get bonded with calibra, whether they are emax or whatever (although if for some reason I used PFG’s, I’d probably still cement.  Veneers get bonded every time—with 3m veneer cement.<\/em><\/span><\/span><\/p>\n

    Cementation of non-bonded restorations:  <\/strong>If it’s a PFG, we sandblast the metal intaglio of the crown and silinate the porcelain margin (I generally use a 180 degree porcelain shoulder margin).  If it’s emax or any porcelain, we don’t sandblast it.  Rinse and dry the inside of the crown.  Once the assistant has the crowns we are cementing ready, I will isolate the teeth and rinse and dry.  <\/span><\/span><\/p>\n

    Let’s use the lower anteriors as an example.<\/em> <\/strong> When the centrals have been cleaned and are ready to put in place, I place the two laterals on their respective teeth with no cement to keep cement from getting on the preps.  The assistant mixes the rely-x (it is quite technique-sensitive) and places it in the inside of the crowns and hands them to me one at a time, telling me which tooth it is if I haven’t told her which one I prefer first ready to cement.  I put it to place, then she hands me the other and I put it to place and quickly begin to clean cement with a microbrush.  Once the cement is setting, I remove the laterals and clean the cement.  Then we try in the lateral and canine on one side to make sure the interproximal contacts are still good.  We go through the cementation process on the lateral and canine the same way on each side, one side at a time.<\/span><\/span><\/p>\n

    Bonded restorations:<\/strong> As you know, bonded restorations are more technique-sensitive.  Once the restorations fit great and are ready to be bonded, the assistant gets the centrals ready to bond in by etching (you can use phosphoric or hydrofluoric acid)  just to clean them for 5 seconds or so—the lab has already etched them (make sure you know if your lab is etching them for you; if not, you will need to etch them according to the specifications of the material),<\/em> then rinsing and drying them, placing silane, leave it on for 1 minute and then air drying.  <\/span><\/span><\/p>\n

    Once she has the restorations ready, I will isolate the area and place the lateral restorations on the teeth to keep cement from getting on the adjacent tooth.  Now we etch the two central incisors with 37% phosphoric acid (I am pretty sure) for 15-20 seconds, putting it on the enamel first.  Rinse and dry some, leaving the tooth a tiny bit damp, place gluma, then place prime (air dry until all the carrier evaporates (10 or more seconds) and bond (air dry until it is a thin even coat).  My prime and bond are together on the 3m veneer kit, which is light-cure only and I have separate prime and bond (with self-cure activator added) for the calibra (which is dual cure).  I use calibra on crowns and onlays that I’m going to bond and veneer cement on veneers.<\/span><\/span><\/p>\n

    Clean as much as possible off before it hardens. <\/strong> I use a microbrush as soon as I seat it all the way and then have the assistant tack them for a couple of seconds to turn the cement to gel and do the cleaning then.  I use clear matrices when it’s wet to run through the contacts and unwaxed floss in the gel stage along with 12 blades and scalers as needed.<\/span><\/span><\/p>\n

    Hope this helps!<\/strong> Let me know if you have any specific comments or questions or if there’s something you want to hear about.
    \n\t<\/span><\/span><\/em><\/p>\n

     <\/p>\n

    On a slightly different note …<\/strong><\/em> <\/span><\/span><\/span>Thanks for subscribing to and reading my newsletter.  I’ve noticed that most of the dentists on my newsletter list are highly trained (I know a lot of you) and may not get as much out of my articles as those who are not quite as advanced in their career or have not done much complex dentistry, but would like to.  <\/span><\/span><\/span><\/p>\n

    If you got value from what I’m writing and you know other professionals who are considering doing more complex dentistry, would you share my free Practice Guide with them?<\/span><\/span><\/span><\/p>\n

    You can send a simple email like this:<\/span><\/p>\n

    \tTake a minute and check out this free Practice Success Guide from Allison Watts, DDS. I've read it too – really good stuff.<\/span><\/b><\/span><\/span><\/p>\n

    http:\/\/allisonwatts.com\/blog\/dental-practice-success-guide\/<\/strong><\/a><\/span><\/span><\/p>\n


    \n\tFeel free to write whatever you want. My point is that it doesn't have to take a lot of time. <\/p>\n

    \tIn fact, by taking 2 minutes out of your day, you could make a huge difference to the success of another dentist's practice.<\/p>\n

    \tThanks in advance for being generous and I’ll “see you again” soon with my next article!<\/b><\/span><\/span><\/p>\n

    You can find me on facebook <\/a>or via email<\/a> if there is anything I can help YOU with!
    \n\t<\/strong><\/font><\/span><\/span><\/p>\n


    \n\t<\/span><\/span><\/p>\n

    Happy Cementing!<\/strong><\/span><\/span><\/p>\n


    \n\t<\/span><\/span>    \"\"<\/a><\/p>\n

     <\/p>\n

    \"\"<\/a>Allison Watts is a dentist and dental practice owner for 16 years.  She focuses on relationship-based, complex restorative and esthetic dentistry.  She is a personal and professional life coach and clinical mentor.  She is a member of the visiting faculty at the Spear Institute and faculty-in-training at the Pankey Institute.<\/strong><\/span><\/span><\/div>\n

    \n\t<\/span><\/span><\/div>\n

    As the founder and owner of Transformational Practices, she has helped many dentists and team members improve the quality and enjoyment of their practice and life.  She has created many systems and tools for practice and life success, including her newest tool, The Practice Success Guide.  <\/em><\/strong>Request your free copy by visiting TransformationalPractices.com\/<\/a><\/strong><\/span><\/span><\/a><\/strong><\/font>blog<\/a> and begin experiencing the practice and life you dream of!<\/strong><\/span><\/span><\/p>\n

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     <\/p><\/p>\n","protected":false},"excerpt":{"rendered":"

    Excellent Cementation by Allison Watts, DDS   Cementation of Temporary Restorations When we’ve made the temporaries beautiful (stained and polished) and well-fitting and have the occlusion adjusted properly and the interproximal embrasures open enough for floss-treading, we are ready to cement our temporaries.  We ream out a little space for cement in the intaglio (inside […]<\/p>\n","protected":false},"author":1,"featured_media":566,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_cloudinary_featured_overwrite":false,"footnotes":""},"categories":[310,22,25,4,23,24,3],"tags":[215,12,58,140,179,115,16,186,116,110,214,63,56],"yoast_head":"\nExcellent Cementation - Full Mouth Rehabilitation<\/title>\n<meta name=\"description\" content=\"Excellent Cementation Techniques are an integral part of successful full mouth reconstruction. 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