HOW TO GUIDE Indirect Restorative Procedure CPD verifiable

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Indirect Restorative Procedure
1 Tooth Preparation
how to guide
Indirect restoration
Andy Hall
Senior Lecturer and Consultant
in Restorative Dentistry,
University of Dundee
Heavily filled, broken down or missing teeth have long
been restored using crown and bridgework. These
procedures can be some of the most challenging in
clinical dentistry. It is of paramount importance that
crown and bridge preparations are ideal, impressions
are accurate and laboratory work is precise. The use of
contemporary, long-lasting cementation materials adds
confidence to your work and enhances the care for your
patients. Dental practice becomes more efficient, costeffective and patients appreciate the long lasting results.
The increased demand for aesthetic dentistry requires
dentists to use an ever wider range of dental materials
each with different physical and chemical properties.
Advances in ceramic restorations means that patients
can often have the smiles they see every day in the
media. Accommodating these patient desires is often
a significant aid to building dental practice.
This ‘How to guide’ for indirect restorations, identifies
products used in the procedure that will help towards
an accurate, predictable and long-lasting result.
This guide takes you step-by-step through quality
branded products to use in tooth preparation,
impression taking, provisional restorations and finally
cementation of the permanent restoration.
Tooth preparation for indirect restorations
must be accomplished in a systematic,
efficient and atraumatic manner. Diamond
burs are the ‘gold standard’ for carrying
out sufficient occlusal reduction, clearing
proximal contact points, establishment of
preparation margins and ensuring correct
preparation taper and surface finish.
They are considered safe and effective with
a lower risk of tooth tissue fracture.
Ash Hi Di® diamond burs use natural
diamonds resulting in more efficient cutting,
saving time and improving patient comfort.
There is a wide range of patterns to chose
from ensuring the ideal tooth preparation.
3 Temporary/Provisional Restoration
Integrity™ and Integrity™ TempGrip is the provisional crown and bridge solution;
provisional bis-acryl composite crown and bridge material (available in 3 shades)
and non-drip temporary cement.
Temporisation Technique
1. Take matrix impression using
Aquasil impression materials.
2. Dispense Integrity™ material into
the matrix. Place matrix into the patient’s
mouth within 45 seconds. Remove matrix
after 2 minutes from start of mix.
3. Allow to self-cure for 7 minutes from
start of mix. Remove provisional from
4. Adjust and trim the provisional with
a slow speed acrylic bur and/or a high
speed diamond bur.
5. Apply a thin, uniform layer of
Integrity™ TempGrip™ Cement
to the entire internal surface of the
Integrity™ material restoration.
6. Seat the restoration with gradual
pressure. The cement will self cure in approx. 2-3 minutes.
You can also receive 1 hour’s verifiable CPD if
you read the guide fully, answer the questions
on the back and provide feedback.
Upon completion of this guide, the clinician will be able to
do the following:
A To understand the steps in tooth preparation
B Explore an impression material for impression taking
C Learn to make an effective temporary crown
D Understand the self-adhesive cementation procedure
* Always read the manufacturer’s full directions for use before commencing work.
7. Remove gross excess from marginal
areas. Restoration should not be
moved or torqued during cleanup.
Looks that Last
2 Impression-taking
Reality is an independent body of dentists
that trial and tests a wide range of dental
materials and equipment. They have rated
Aquasil Ultra smart wetting material the
top rating of 5 stars for 5 years running.
Reality spoke about a number of strengths
that Aquasil Ultra has, including “one study
shows it to have the highest tear strength of
any impression material…the mint flavour is
a plus for most patients.”
Always making a
great impression
PolyTrays are available
in three colour-coded
sizes for an accurate fit,
uppers and lowers,
and are single use
for improved cross
infection control
Silfix tray adhesive
increases the adhesion
between a-silicones
impression materials
and the impression
tray surface
Aquasil Ultra is
available in a range
of viscosities and
application methods
to suit every clinician:
4 Permanent Cementation
SmartCem™2 self-adhesive resin cement is strong yet really simple to use, making it ideal for your everyday needs.
1. Remove the syringe cap, dispense a
small amount to get material flowing
freely from both ports, and carefully
wipe ports clean, avoiding any crosscontamination. Install a mixing tip and
gently depress the syringe plunger to
start material flow.
4. Floss interproximally and then
complete excess removal during the gel
phase for easy clean up.
2. Gently apply a thin uniform layer
of SmartCem™2 Cement to the entire
internal surface of the restoration.
For direct intra oral placements, the
mixing tip can be bent for improved
access. SmartCem™2 offers up to
2 minutes of working time.
For indications that
SmartCem2 is not suitable,
such as veneers and Maryland
bridges, we recommend
Calibra aesthetic resin
cement. Calibra is available
in multiple shades, viscosities
and aesthetic try-in pastes
for a more versatile
cementing solution
3. Immediately seat the restoration in the mouth.
There is a gel phase with SmartCem™2. It starts after
about 1-2 minutes and lasts about 1minute. The gel
phase can also be achieved with a curing light applied
around the margins for less than 10 seconds and lasts
about 45 seconds after the brief light curing.
5. Restoration is stabilised by light curing the
margins for 20-40 seconds. For restorations that
are not light transmissible (e.g. metallic) final set
is achieved by allowing SmartCem™2 to self-cure
for approximately 6 minutes from start of mix.
You will need a range of
hand instruments throughout
this procedure, therefore we
would recommend the new
range of Artio™. Super-light,
super-strong and super-sharp.
60 lightweight instruments
for restorative and
periodontal needs
Earn one hour CPD point…
To complete the questions, give us your feedback and to receive your CPD certificate,
please visit
1. W
hat sorts of teeth are suitable for crown
5. If you were to perform a correction impression
technique, which material(s) would you
A Unrestored teeth
Heavily restored and broken down teeth
A Aquasil Ultra Monophase
Small teeth
B Aquasil Ultra Hard Putty and Aquasil Ultra LV
9. When should you use Calibra instead of
A Maryland bridges
C Aquasil Ultra Monophase and Aquasil Ultra XLV
D Deciduous teeth
Replacement of all restorations
Clearing proximal contacts
B Burs
6. What type of material is Integrity crown and
bridge material?
D Preparation of subgingival margins
10. Artio is the new range of:
A Impression trays
D Aquasil Ultra Heavy and Aquasil Ultra XLV
2. Preparation of teeth for crowns usually involves
A Endodontic treatment
C Restorative and Periodontal instruments
D Cements
A Bis-acryl resin
B Glass ionomer
C Compomer
D None of the above
7. How long does it take for Integrity TempGrip
to self cure?
3. Which burs are seen as the gold standard in
preparing a tooth for an indirect restoration?
A Steel burs
B Tungstan carbide burs
C Diamond burs
D All of the above
4. Ash Hi Di burs are made from natural diamonds?
A True
B False
B Veneers
C All of the above
A 1-2 minutes
B 2-3 minutes
C 3-4 minutes
D Over 7 minutes
Reader Feedback
8. SmartCem2 can be tack-cured using a curing
light to turn the material to a gel for easy removal
of excess cement. But for how long should you
A Less than 4 seconds
B Less than 10 seconds
We encourage your comments
on this “How to Guide”.
Please email any comments
or suggestion on how to
improve this guide to
[email protected]
C Less than 20 seconds D More than 10 seconds
Other How to Guides available:
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& root planing
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