proper mixing of the material. After the temporary
cement has set, use the mirror and explorer to gently
remove all excess cement from the crown and gingival
area. Check the patient's occlusion again and allow
you patient to rinse his/her mouth with water to
remove any debris or loosened excess cement.
A t t h e e n d o f t h i s a p p o i n t m e n t , m a k e
arrangements for future visits before dismissal of the
patient. Be sure to annotate the DD Form 2322 with the
date, time, and step of the next treatment planned. This
information is essential to the dental laboratory for
fabrication of the requested work.
INSERTION OF FIXED PROSTHETICS
The basic steps involved in inserting crowns and
fixed FPDs are the same. Your instrument tray setup
for insertion is the same as shown in figure 8-43. You
will need to include assorted stones and burs for
adjustment of the prosthesis. Usually, local anesthesia
is not required since most patients can tolerate the
minimal discomfort associated with the insertion of the
prosthesis. The basic steps in delivery of the final
prostesis include removal of the temporary, try-in and
adjustment, stain and glaze, and permanent
Removal of the Temporary
The removal of the temporary is usually delegated
to the dental assistant. Do this gently since your patient
usually does not have anesthesia and may experience
some slight sensitivity. Use the following steps when
removing a temporary:
1. Use an instrument, such as a stellite, to loosen
the temporary bond at the margin of the
2. Once removed, clean any debris or retained
temporary cement on the tooth or teeth with a
cotton pellet and cotton forceps.
One of the first steps in the try-in of the prosthesis
is the adjustment of the proximal contacts. Proximal
contacts between adjacent teeth should exist, but be
nonwedging. The proper amount of contact exists
when there is a slight snap of dental floss as the dentist
passes it through the contact areas. The dentist will
check other aspects of the prosthesis as follows:
Ensures the prosthesis is fully seated.
Evaluates the pontic adaptation visually, and
then passes dental floss between the pontic tip and the
tissue ridge to ensure very little, if any, pressure is on the
residual ridge mucosa.
Uses articulating paper to mark any areas of
interference between the prosthesis and the opposing
teeth, and then reduces them with dental stones and burs
in a dental handpiece.
If the prosthesis is completely metal, any surface
roughness resulting in clinical adjustments is
eliminated, and the metal is highly polished before
Stain and Glaze
If the prosthesis involves porcelain, the dentist will
stain and glaze the porcelain to characterize the
porcelain for maximum esthetics. Unstained and
unglazed porcelain is referred to as being in a bisque
bake state. Before the prosthesis can be cemented, it
must be returned to the laboratory to fire the stain and
glazed porcelain. After glazing, the laboratory will
highly polish the exposed metal of the prosthesis. The
prosthesis is now ready for cementation.
Cementing the Prosthesis
The final step in this appointment is the cementing
of the prosthesis. The treatment site must be kept clean
and dry throughout the procedure.
Zinc phosphate (ZnPO4) and glass ionomer
cement have been recognized as excellent permanent
cementing agents for fixed prosthetics. ZnPO4,
however, is highly acidic during the initial setting
stage because of the presence of phosphoric acid.
Therefore, ZnPO4 can be quite irritating to the pulp
tissues if the cementation process is not handled
properly. Some dentist prefer to coat the preparation
with copalite varnish before cementation with ZnPO4.
Other permanent cements such as reinforced Zinc
oxide and Eugenol (ZOE), ethoxybenzoic acid (EBA),
and polycarboxylate (PCA) cements are less irritating
to the pulp tissues, but have not proved to be clinically
superior to glass ionomer as a permanent cement. You
must follow the manufacturer's instructions for
dispensing and mixing the particular cement selected.
To accomplish cementation of FPD, perform
the following steps A through C shown in figure 8-45:
1. Isolate the treatment site with clean, dry cotton
rolls, and gently dry the prepared tooth or teeth with a
gentle blast of warm air or cotton pellet (step A).