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32 Prep + Interim Appointment

 

🦷 Crown Preparation & Interim Appointment

This appointment includes:

  • Tooth preparation for full coverage crown
  • Fabrication and cementation of a provisional crown


📚 1. Background Overview

 

 Preparation Phase


I. Principles of Tooth Preparation

  • Biologic: Maintain oral tissue health
  • Mechanical: Ensure integrity and durability of the restoration
  • Esthetic: Meet patient’s appearance expectations

II. Preparation Guidelines by Restoration Type

🔹 Full Cast Crown

  • Occlusal reduction: 1.5 mm (functional), 1.0mm (non-functional)
  • Axial reduction: 0.5-1.0 mm

🔹 Ceramo-Metal Crown

  • Incisal clearance: 2.0 mm
  • Porcelain: 1.5 mm
  • Metal: 1.0 mm
  • Functional Cusp: 1.5-2.0 mm
  • Non-functional cusp: 1.0mm-1.5mm

🔹 All-Ceramic Crown

  • Incisal: 1.5-2.0 mm
  • Axial: 1.2–1.5 mm
  • Finish line: 1.0 mm
  • Occlusal reduction: 2.0mm (Functional), 1.5mm (non-functional)

🔹 Monolithic Zirconia

  • Occlusal Reduction: 1.0 to 1.5 mm  (functional) 1.0mm (nonfunctional)  
  • Gingival Chamfer: 0.5 mm reduction. 
  • Axial: 0.8 to 1.0 mm. 
  • Marginal Design: 0.8 mm chamfer. 
  • Incisal Reduction (anterior): 1.8 to 2.0 mm. 
  • 0.8mm is minimal thickness


III. Preparation Sequence

  1. Occlusal/Incisal Reduction
    • Use depth grooves
    • Add functional bevel
  2. Axial Reduction
    • Buccal-lingual and mesial-distal
    • Two-plane reduction
  3. Finish Line Design
    • Chamfer or shoulder
  4. Secondary Retention
    • Grooves or boxes if needed

IV. Retention & Resistance (R&R)

  • Minimum Height:
    • Premolars: 3 mm
    • Molars: 4 mm
  • Convergence Angle:
    • Ideal: 10–20°
    • Resistance decreases with increased taper
  • Enhancing R&R:
    • Increase height (restorative or crown lengthening)
    • Add grooves or boxes

V. Biologic Width

  • Maintain ~2.04 mm (CT + JE)
  • Avoid subgingival margins deeper than ½ sulcus depth
  • Crown Lengthening as needed

 Interim Phase

 


I. Interim Restoration – Definition

A temporary prosthesis used to evaluate esthetics, function, and stability before final restoration.


II. Requirements

  • Protect prepared teeth
  • Maintain periodontal health
  • Preserve occlusal stability
  • Restore function and esthetics

III. Types of Interim Restorations

  • Prefabricated: Polycarbonate, aluminum, stainless steel
  • Custom Molded: Vacuum-formed, silicone, alginate
  • Digital: Milled from scans

IV. Materials

Acrylics Bis-Acryl Composites
Low cost, easy to repair Better esthetics, less shrinkage
High shrinkage, odor More brittle, higher cost

Protemp Instructions

Interim Crown Fabrication with PMMA.ppt


V. Fabrication Techniques

  • Direct: Chairside, fast but risk of irritation
  • Indirect: Lab-based, safer and more accurate
  • Indirect-Direct: Combines both for optimal fit and comfort
  • Digital: CAD/CAM workflow for long-term provisionals


VI. Cementation

  1. Apply petroleum jelly externally
  2. Dry teeth, isolate
  3. Seat interim, allow cement to set
  4. Remove excess, floss contacts, give OHI

VII. Special Scenarios

  • Endodontically Treated Teeth: Use prefabricated crowns with post support
  • Digital Workflow: Ideal for full-arch or long-term provisionals

🧰 2. Armamentarium

Category Items
Anesthesia 2% lidocaine with 1:100,000 epinephrine, topical benzocaine
Isolation Cotton rolls, dry angles, suction tips, Isovac (with permission)
Prep Instruments High-speed handpiece, diamond burs (BUR Help: PROS-Disposable burs list-color coding-Aug 2022)
Provisional Protemp, Luxatemp, bis-acryl syringe, curing light, Flo-It, temporary cement
Occlusion AccuFilm, Shimstock + Floss for Proximal Contacts


🧾 3.  Codes + Business Office

Code Description
D2391–D2394 Composite restorations (if placed prior to prep)
D2950 Core build-up (if needed)
S2001

S2005

Tooth Preparation

Provisional Fabrication

NOTE

Ensure the patient has communicated with business office and DOWN PAYMENT + Pre-Auth completed prior to irreversible work (AKA PREPARING THE TOOTH)

🦷 Clinical Steps

Tooth Preparation

  1. Seat Patient, Review CC/HH, BP.

FACULTY CHECK

  1. Review radiographs, diagnosis, and occlusion
  2. Anesthetize tooth using topical + IANB or infiltration
  3. Remove any existing restorations, caries, or defect
  4. Place core build-up if indicated (D2950)
  5. Perform crown prep: (See resources in “background” for steps)
    • Occlusal reduction
    • Functional cusp bevel
    • Axial reduction
    • Finish line

 Provisional Crown Fabrication

  1. Ensure fit of matrix
  2. Fill matrix with temporary material (PMMA or ProTemp)

 

PROTEMP

PMMA

Steps

 

  1. Extrude material into matrix (keep tip inserted to avoid bubbles)
  2. Allow material to set 3 minutes intraorally
  3. Use Flowable Composite to correct deficiencies
  1. Dispense 15 drops of monomer
  2. Add PMMA powder + mix
  3. Follow through 4 stages:
    • Sticky: load into matrix
    • Doughy: put matrix into mouth
    • Rubbery: lift facially + lingually every 30 seconds to prevent locking
    • Stiff: remove

4. Use Bead Brush technique to refine margins + proximal contacts

REVIEW PPT ON PMMA 

  • Trim provisional
  • Check margins, proximal contacts, and occlusion
  • Chairside and laboratory polish of provisional
  • Isolate + dry preparation
  • Cement with temporary cement
    • Patient bites on cotton roll for 3-5 minutes
  • Provide patient with instructions for care


📝  Sample Clinical Note Template

Procedure: Crown prep and impression – Tooth #____
Anesthesia: 20% benzocaine topical, IANB with 2.4 cc 2% lidocaine w/ 1:100k epi
Prep: Removed existing restoration and refined prep. Core build-up placed with composite (D2950). Crown prep completed for full coverage (all-zirconia).
Provisional: Protemp provisional fabricated using stent and relined with Flo-It. Adjusted contacts and occlusion with AccuFilm. Cemented with Temp-Grip.
Shade: A2 selected with patient

Instructions: Patient advised to avoid sticky foods, floss facial only.
NV: Crown delivery scheduled for __________.
Faculty: Dr. ______ Assistant: ______ Op #: _____

 

CODES: S2001, S2005 (+ Core build up as needed)

 

 

 

 

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License

D3 Prosthodontics Clerkship Clinic Manual Copyright © by Rachel Kellogg; Marnie Vonderhaar; and ICON Support Team. All Rights Reserved.