MY SEQUENCE OF STEPS IN EVALUATING YOUR FIXED RESTORATION PRIOR TO CEMENTATION
As a dental student, I remember that prior to inserting a crown, I have to check for several things. I have to check for the margin, the fit, the occlusion the contacts, the contour, the shade and more. I thought these are common knowledge.
But then, when I was in my prosthodontic residency, one of my mentors, Dr. Hussein Zaki, asked me what is the best sequence you should be checking them in? I paused and I didn’t know the answer. He said certain things should be checked first because they can affect the accuracy of the other things. You don’t want to be checking for occlusion when the crown has a defective margin. That is a waste of your effort when it has to be redone or corrected first. And my mentor was right. You want to be checking these things systemically and logically so you don’t end up wasting your valuable chairside time.
So I am sharing with you the order of things I always go through with all my fixed restorations.
My sequence is as below:
1/Proximal contacts:I always start with checking the contacts. If the contacts are tight, then whatever you check can be off…. your occlusion may be off and your margin may appear open. So I always make sure the contacts are adjusted so they are just right before checking anything else. If the contact is loose, inadequate, or missing, then it has to be sent back for adjustment.
2/Fit (retention and resistance) Once the contacts are properly adjusted, then I will assume that the fixed restoration is not being held up by tight contacts, then I want to make sure the intaglio surface is adequate; adequate in the sense that it is adapting to the tooth preparation properly. There is no rocking; no nodules that are preventing the proper seating of the restoration. The intaglio surface fits intimately around the preparation so there is proper retention and resistance
3/Margin: Once I feel confident that the restoration is properly seated and not being held up by tight contacts or improper fitting from the intaglio surface, then I will check my margin to ensure it is adequate.
4/Occlusion (centric and excursive): If the fixed restoration is properly seated and the margin is closed, then I go on to check the occlusion in both the centric position and excursive movements. For simple cases, the occlusal relation should be to conform to the existing occlusal scheme, in both centric and excursive movement.
5/Contour:I always check contour after I check occlusion, especially for my anterior cases. Sometimes I get these pretty looking porcelain crowns where the lingual incisal edge may interfere with occlusion….or the posterior buccal cusp is too long causing occlusal interference. I want to be sure that the contour respects the patient’s occlusal scheme. Part of these surfaces may affect the aesthetic outcome of the case. So I don’t want my patient to see these restorations until I know that they conform to the patient’s occlusal scheme.
6/Shade: Lastly, once everything is considered acceptable, then I will check the shade with patient’s input.
Once all these items are checked off and approved, then I will proceed with the cementation steps.
I hope you find this sequence makes sense. Please comment if you have a better system of checking your fixed restorations. Thanks for reading!