TEMPORARY CROWN RESTORATIONS

Second Edition

Produced by

QUERCUS CORPORATION
2768 Pineridge Road
Castro Valley, CA 94546

Copyright 1979

Department of Health, Education and Welfare

Contract No. 299-74-0016

Updated Version and Module 5

By

LUANN SPAIN, C.D.A.

1991

Revised June 2005

By
Terrie Beckman, CDA,BSEd

Adopted by

Idaho State Board for Vocational Education

650 West State Street
Boise, Idaho

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 TABLE OF CONTENTS

COURSE OBJECTIVES………………………………………………………………………… 5

MODULE 1 – INTRODUCTION TO THE COURSE

INTRODUCTION……………………………………………………………………… 6

BACKGROUND INFORMATION…………………………………………………… 7

TYPES OF TEMPORARY CROWNS…………………………………………….. 10

Anatomical Metal Crowns………………………………………………..

Preformed Plastic Crowns………………………………………………

Custom Resin Crowns……………………………………………………

Finish Lines………………………………………………………………...

Resin Materials…………………………………………………………….

Methyl Methacrylate………………………………………………………

Light-Cure Resin…………………………………………………………..

Ethyl or Vinyl Ethyl Methacrylates……………………………………..

Epimines…………………………………………………………………….

Composites…………………………………………………………………

OCCLUSION…………………………………………………………………………. 14

TEMPORARY CEMENT……………………………………………………….. 15

PLACING TEMPORARY CROWNS…………………………………………….. 15

ASEPTIC TECHNIQUE…………………………………………………………….. 17

MODULE 2 – PLACING A PREFORMED ALUMINUM TEMPORARY CROWN

TEMPORARY CROWNS………………………………………………………….. 19

Overview of Procedure………………………………………………… 20

ARMAMENTARIUM………………………………………………………………. 21

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 PROCEDURE……………………………………………………………………… 22

Preliminary Procedures .................................................................

Crown Placement Procedures ...................................................…

SUMMARY OF PROCEDURE AND CRITERIA ........................................… 28

MODULE 3 - PLACING A PREFORMED PLASTIC TEMPORARY CROWN

PLACING A PREFORMED POLYCARBONATE TEMPORARY

CROWN ………....................................................................................... 30

Overview of Procedure ................................................................ 31

ARMAMENTARIUM ................................................................................... 33

PROCEDURES .......................................................................................… 34

Preliminary Procedures ..............................................................

Crown Placement Procedure ......................................................

SUMMARY OF PROCEDURE AND CRITERIA ........................................ . 43

MODULE 4 - PLACING A CUSTOM PLASTIC TEMPORARY CROWN

PLACING A CUSTOM RESIN TEMPORARY CROWN ............................. 46

Overview of Procedure ................................................................ 47

ARMAMENTARIUM ................................................................................… 48

PROCEDURE ............................................................................................. 49

Preliminary Procedure ..............................................................…

Crown Fabrication and Placement Procedures .........................

SUMMARY OF PROCEDURES AND CRITERIA ...................................... 54

MODULE 5 – ADDITIONAL TECHNIQUES EMPLOWYED FOR FABRICATION OF CUSTOM

TEMPORARY CROWNS………………………………………………………………… 56

STUDY QUESTIONS…………………………………………………………………….. 60

REFERENCES ......................................................................................................... 62

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 FIGURES

1. COMMONLY USED FINISH LINES .............................................………….. 7

3. TOOTH-TO-TOOTH CENTRIC CONTACT...............................................…. 14

4. PATTERN OF OCCLUSAL MARKINGS.....................................................… 14

5. IDEAL PATTERNS OF OCCLUSAL MARKINGS........................................... 14

6. MESIAL VIEW OF TOOTH #18 .................................................................... 14

7. FACIAL VIEW OF TOOTH #18........................................................................ 22

8. LINGUAL VIEW OF TOOTH #18 .................................................................… 22

9. OCCLUSAL VIEW OF TOOTH NUMBER #18 ................................................ 22

13. FACIAL/MESIAL VIEWS OF TOOTH #8…………………………………………. 43

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Objectives

Following completion of lecture and laboratory activities, the student will be able
to :

1. Explain why temporary crown restorations are placed.

2. List and describe the types of temporary crowns, their advantages and
disadvantages.

3. List and explain the types of finish line forms.

4. Describe types of resin materials and their advantages, disadvantages, and

demonstrate proper mixing technique.

5. Describe the procedures of each type of temporary crown.

6. Fabricate a crown from each module according to the stated criteria.

7. Define and explain the importance of correct occlusion.

8. Demonstrate the ability to correctly evaluate each crown placement that

meet and do not meet the criteria for restorations of these preparations.

9. List and describe additional techniques that are employed for fabrication of
custom crowns.

10. Explain the advantages of the updated techniques for custom temporary
crowns.

11. Define the purpose of temporary cement.

12. Explain aseptic techniques as it applies to these modules.

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 Module 1
Introduction to the course

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 TEMPORARY CROWN RESTORATIONS

INTRODUCTION

The Project ACCORDE Temporary Crown Restorations consists of three modules,

“Preformed Metal Crowns,” “Preformed Metal Crowns,” Preformed Plastic Crowns,” and
“Custom Resin Crowns.” For additional reference, the supplemental module “Additional
Techniques Employed for Fabrication of Custom Temporary Crowns” has been included
in the Project Accorde module. It is essential that you read the background information, a
description of procedures and criteria, and review the evaluation form.

The procedure description will provide step-by-step instructions for each

procedure involved in the temporary crown restoration. Procedures outlined in the
modules are designed specifically for the learning situation, with an emphasis on
introducing new concepts and skills. It should be understood that procedures and
techniques may vary with each dental office. Only a limited amount of experience can be
gained in a lab situation, so it is suggested that students seek additional experience in
the dental office.

Evaluation is a vital element of this course and it is the responsibility of both the
student and the instructor. Your ability to evaluate your own work, according to the
criteria, will help you gain an even better understanding of the proper techniques and
procedures. In a dental situation, the quality of your temporary crowns will depend
largely on your ability to self-assess your work. The instructor’s evaluation will guide you
in the application of the accepted criteria and in the development of your skills.

Tests are an important part of the evaluation process. They check your knowledge
of the technical background information and your ability to apply both knowledge and
skill to similar but different temporary crown restorations. Your instruction will test you
on the different temporary crowns, after competence has been gained in all areas.

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 BACKGROUND INFORMATION

When the pathology of a tooth is such that a cavity preparation and amalgam or a
tooth-colored restoration are considered inadequate to restore the tooth to its original
form and function- that is, if the tooth is badly decayed, brittle as a result of endodontic
treatment, losing function, or unaesthetic- one satisfactory restorative method is the
application of a crown. Crowns are also used to cover undamaged teeth when bridge
abutments are required.

From the standpoint of the patient’s oral health, the care and placement of
temporary crowns is essential for the following reasons:

1. TO PREVENT SENSITIVITY IN THE PREPARED TOOTH.

During crown preparation, portions of the teeth’s enamel and dentin are
removed. Dentin contains microscopic tubules that originate in the pulp and
terminate at the dento-enamel junction. As the dentin is prepared, the tubules are
severed and left open, leaving the highly sensitive pulp of the tooth exposed. It is
important not to desiccate the preparation because of the sensitivity that occurs
with the tubules severed. Because the tubules are open, it is necessary to consider
the chemical composition of the material that is placed adjacent to the dentin. If
potentially irritating substances must be used, dentin can be protected by coating
the surface of the preparation with a substance that seals the tubules.

2. TO PROTECT THE DENTIN FROM ORAL FLUIDS.

Oral fluids may cause sensitivity.

3. TO MAINTAIN OCCLUSION.

To prevent supra-eruption of the prepared tooth or the opposing tooth, and

to prevent movement of the prepared tooth or the adjacent teeth.

The contact of the mandibular teeth against the opposing maxillary teeth
during functional and non-functional movement of the mandible is called
occlusion. Occlusion will be discussed in more detail later in this module.

4. TO PREVENT FRACTURING OF THE FINISH LINE OR BREAKDOWN OF THE

PREPARED TOOTH.

Emphasis is given to the finish line of the preparation, commonly

stated as the place where the bur stops. The finish line is a continuous edge that
borders the entire preparation. It is essential that your have a mental image of the
location and contour of a preparation’s finish line in order to contour a temporary
restoration for that tooth. (Shown later are various forms of finish lines.)

5. TO PREVENT CHANGES IN GINGIVAL TISSUE, CAUSED BY INFRINGEMENT OF

THE CROWN MARGIN ON THE FREEE GINGIVA OR BY FOOD IMPACTION.

Since most clinical crown preparations present subgingival finish lines,

crown margin contour is critical to the health of the gingiva. Should the crown
intrude on the gingiva, irritation will result, causing the patient discomfort.
Recession, inflammation, ulceration, and infection of the gingiva are possibilities.

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 Food impaction is likely to occur if the walls of a crown are not properly
contoured to reproduce normal anatomy or its contacts with adjacent teeth are not
adequately established. Firm contacts normally exist between teeth (in the middle
third for posterior teeth and in the incisal third for anterior teeth), which force food
to be broken down into two parts and distributed down the facial and lingual
surfaces of the teeth. If there is no contact, biting pressure forces food between
the teeth and gingiva. The food can cause irritation, which may lead to
inflammation and infection.

6. TO PROVIDE FOR LOST FUNCTION.

A temporary crown may be placed to protect a chipped tooth and to

restore idea occlusion and surface anatomy.

7. TO MAINTAIN AESTHETICS

This is especially important in the anterior permanent teeth.

8. TO RESTORE OR IMPROVE THE CONTOUR OF THE ORIGINAL TOOTH.

An example would be a chipped incisal edge.

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 TYPES OF TEMPORARY CROWNS

Several types of temporary crowns and crown material are available. Those that
are commercially available are: preformed anatomical metal crowns, non-anatomical
metal crowns, preformed polycarbonate crowns. Cellulose crown forms, as well as
synthetic resin the operator can use to fabricate custom resin crowns.

Anatomical Metal Crowns

The term “anatomical” refers to crown forms whose exteriors approximate natural
teeth in facial, lingual, mesial and distal contours, as well as in the contours of the
occlusal surfaces (cusps, ridges, pits, and grooves).

1. The Stainless Steel Crown is used the most durable of the preformed
anatomical crowns, which is used most often in restoring primary teeth.
Such a crown can provide temporary coverage for months or years. The
short comings of the stainless steel crown include its poor aesthetic
quality for placing on an anterior tooth and the difficulty of adapting its
rigid metal margin to the tooth preparation.

2. An “Anodized” Aluminum Crown is used most commonly on premolars

and molars because of their resistance to wear, strength and unaesthetic
appearance. The chief advantage of this crown is its malleability, which
allows for good occlusal adjustment. Tin, silver alloy crowns are the softest
and most ductile crowns commercially available for the temporary
coverage of posterior permanent teeth. The softness of the alloy eases
marginal and occlusal adaptation, as the material will stretch up to 50%. It
can also be contoured and burnished without wrinkling. Softness, however,
is the chief disadvantage of this crown. It can easily wear through during
normal mastication; hence, is recommended for a short time, unless it can
again be re-lined with acrylic resin for added strength.

Preformed Plastic Crowns

These crowns are used as temporary coverage for anterior teeth. The advantage of
these crowns from the patient’s point of view is that they are tooth-colored making them
aesthetically pleasing replacements. From the operator’s view, they can be made to fit the
preparation easily, as it can be shortened by cutting, or lengthened by adding resin.
There are only a limited number of shades.

1. Polycarbonate Preformed Crowns. These crowns are hollow, tooth-shaped

with walls about 0.3 mm thick. Polycarbonate crowns are usually only
available in two tooth-colored shades. The operator selects the lighter or
darker shade, which ever is closer to the color of the tooth being restored.
The polycarbonate-preformed crowns are more commonly used in practice
than cellulose crowns.

3. Cellulose Crown Forms. This type of crown is a clear, hollow crown form.
The advantage to this particular crown is that the operator is able to be
more selective cellulose crown form is that when the form is removed from
the acrylic resin, the adjacent teeth may be slightly out of contact.
However, the operator is able to choose a larger variety of shapes and
colors with this type of crown.

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Custom Resin Crowns

The custom resin crown is tooth colored and is completely fabricated by the
operator. The fit and external contours of the crown are superior to those of any other
temporary crown, since it is made in an impression of the patient’s mouth. This crown
can be adapted to any tooth and is esthetically pleasing. The disadvantage to this crown
is that some operators feel it takes longer to produce.

The choice of an appropriate temporary crown depends on which tooth is to be

restored, the patient’s concern for aesthetics, and the length of time a temporary
restoration must serve. With this information, you can make the judgement.

Finish Lines

The finish line is a continuous edge that borders the entire preparation commonly
the location where the bur stops. It is essential that you have a mental image of the
location and contour of a preparation’s finish line in order to contour a temporary
restoration for that tooth.

Four common forms of finish lines are:

1. Bevel or slant
2. Chamfer or slope
3. Feather or knife edge ( a shallower slope ), and
4. Shoulder or ledge

FIGURE 1
COMMONLY USED FINISH LINES

Bevel Ledge Chamfer Feather Cuts Ledge

(Knife Edge) (Shoulder)

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 Bevel, chamfer, feather cuts and shoulder (left to right) are used at
preparation finish lines.

When a preparation is cut, the circumference of the tooth either increases

or remains the same, with the finish line always at the greatest circumference. This
shape permits easy placement and removal of a restoration. A chamfer, bevel or
shoulder provide somewhat of a shelf which the restoration can “hug”, thus
achieving a snug fit of the crown’s margin (the gingival edge). The temporary
restoration, when well adapted, protects the finish line from chipping and prevents
marginal leakage of mouth fluids and bacteria, which could cause sensitivity and
decay of the exposed dentin.

Should a preparation narrow towards the finish line, that area would be an
undercut. Such narrowing is an error in preparation that makes placement of the
crown impossible and prevents marginal seal and/or full seating. Since a crown is
fabricated to fit the largest circumference of a preparation, any area gingival to that
largest dimension will not be sealed. Convexities (positive contours) present
similar problems and also tend to prevent marginal seal.

Resin Materials

Resin material is used to line the preformed polycarbonate crown, cellulose

crown form, or as a liner for aluminum temporary crowns. It is also fabricated to
form a custom temporary crown. The commonly used resin is a combination of a
polymer (powder) and a monomer (a liquid). It is important that all of the powder
used be incorporated into the liquid. There is no exact proportion of monomer to
polymer. The more powder there is, the stronger the mix is, but if the mix is too dry
(if it has too much powder), it does not flow and, therefore, does not conform to
the contours of the preparation. If there is too much liquid, the mix runs out of the
crown when it is placed.

While the acrylic resin has some very desirable qualities, it also has some
characteristics that require special attention. Because monomer in its pure form is
toxic to the tooth, it is extremely important that it be thoroughly incorporated into
the mix. When mixed, the polymer and the monomer polymerize (react chemically)
and produce heat, in an exothermic reaction. If large amounts of dentin have been
removed from a tooth during preparation, the tooth is likely to be sensitive the
heat. The gingiva is also heat-sensitive and can become irritated, coat the tissue
with Vaseline.

Five major categories for temporary resin materials are:

1. Methyl Methacrylates
2. Ethyl Methacrylates
3. Vinyl Ethyl Methacrylates
4. Epimines
5. Composites

Methyl Methacrylate -“Jet”

Methyl methacrylate is formed by the mixture of a monomer (liquid) and a polymer

(powder) which polymerizes (chemically bonds) and hardens into a durable plastic.
Various mixing techniques will be explained later.

Methyl methacrylates have an advantage for their excellent color, stability and
wear resistance. If it is important to maintain the vertical dimension or if strength is very

12
important, it is recommended that the temporary crown be fabricated with methyl
methacrylate. Unfortunately, this material tends to generate more heat during the
polymerization which increases the possibility of pulp irritation when it is in contact with
the cavity preparation during fabrication. It will be important to remove the temporary
crown during the polymerization period or to apply air from the air/water syringe during
this process. The other disadvantage is the extensive setting shrinkage because of the
heat that is generated. A common brand name is Jet.

Light-Cure Resin

A new type of methyl methacrylate resin that is not shown on the table is a light-
cure resin. This resin material is not self-curing, meaning it does not cure until it is
exposed to a visible light. (The visible light is the type of light that is used with composite
resin material.) The light-cured resin comes in a monomer and polymer form but because
the resin does not cure without light, it allows the operator time for preparation and
correction before curing. In cases of temporary inlay and onlay with undercuts, removal
of undercuts, removal of undercuts, etc., can be easily performed after extracting the
rubber-like resin from the mouth. This particular resin is of very low shrinkage and
excellent color stability. The other advantage with the light-cured resin is that it will adapt
with the conventional chemical self-cure resin that is of the same methyl methacrylate
base. A common brand name for a light-cure material is Unifast LC.

NOTE: There are light-cure resins that do not come in a monomer or polymer form
but in a putty-like consistency. They have an excellent ease of use. A common
brand name for this typed of light-cure resin is Triad.

Ethyl or Vinyl Ethyl Methacrylates-Trim II, Snap

Ethyl or vinyl ethyl methacrylates have similar clinical properties, except with the
color stability; ethyl methacrylates have been found to be less stable. Their decreased
color stability may or may not be a disadvantage depending on the length of time the
temporary will be in service and its location.

Ethyl and vinyl ethyl methacrylates do generate less heat than the methyl
methacrylates, resulting in a decrease in setting shrinkage. They have an advantage over
methyl methacrylates because they are easier to use and there is less potential damage
to the tissue. Factors that may cause tissue irritation include the intimate contact of free
monomer, the heat generated by the setting reaction, and an allergic reaction. Therefore,
care should be taken to lightly coat tissues with petroleum jelly to prevent these
irritations while the resins are undergoing chemical and thermal reactions.

Epimines-Scutan

Epimines is a combination of base and catalyst, which forms a paste. The epimines
generate little heat during polymerization, which creates the least amount of shrinkage of
any of the resin materials. The disadvantage of this resin is its poor color stability and
wear resistance. Epimine resins do not react with zinc oxide eugenol (ZOE) cement.
Therefore, the operator can remove the old ZOE cement from the internal aspect of the
temporary crown and re-cement it without experiencing the usual soft, rubbery condition
noted when using the methyl or ethyl methacrylates.

Composites-Protemp, Integrity

Another type of material that is not listed on the table is bis-acryl composite. A
common brand is Protemp. This material comes in tow-tube form: one of catalyst and one
of base. They have high strength, very low heat and shrinkage. The disadvantage with

13
bis-acryl composite is that it does not have a putty stage and is fairly expensive. Because
bis-acryl is a composite resin it will adhere to other composite restorations. For example,
composite restorative material can be used to cover voids when the crown does not meet
the finish line.

NOTE: Resins can cause tissue irritation (i.e. contact with monomer, heat generated or
allergic reactions) so tissue should be coated with vasoline.

OCCLUSION

The contact of the mandibular teeth against the opposing maxillary teeth during
functional and non-functional movement of the mandible is called occlusion. The static
position of the bite is called centric occlusion.

In the normal adult dentition, the supporting cusps maintain centric stop contacts
with opposing fossae and/or ridges and thus maintain the occlusal vertical dimension of
the face. In order to maintain a stable centric occlusion, the forces applied to these
centric stops should be directed down the long axes of the teeth.

The lingual cusps of the maxillary molars and premolars are supporting cusps that
create centric stop contact with the opposing mandibular fossae and/or ridges. The facial
buccal cusps of the mandibular molars and premolars are also supporting cusps that
contact opposing maxillary fossae and/or ridges.

The maxillary facial buccal cusps have no centric contact. They are positioned with
facial horizontal overlap relative to the mandibular facial buccal cusps, and they serve to
keep the patient’s cheek off the occlusal table.

The mandibular lingual cusps also have no centric contact. They are positioned
with lingual horizontal overlap relative to the maxillary lingual cusps, and they serve to
keep the patient’s tongue off the occlusal table.

From a facial view of the dentoform’s occlusion, you will notice the posterior teeth
have a tooth-to-two-teeth centric contact (Figure 3). That is, each posterior mandibular
tooth contacts two opposing maxillary teeth, and each posterior maxillary tooth contacts
two opposing maxillary teeth. Though there are other theories of occlusion and you will
find unlimited variations on patients, this occlusal pattern is described in this course
because manikins or dentoforms are typically manufactured with this scheme.

It is expected that the student will have some background in occlusion before
beginning the course; therefore, only a functional explanation of occlusal checks is
given.

A marking on every tooth except the crown restoration indicates that the
restoration is in infra-occlusion, or below the occlusal plane of the adjacent teeth. This
could initiate supra-eruption (extrusion beyond the occlusal plane of the adjacent teeth)
by the opposing teeth, an irreversible process. The appearance of a marking on the
crown alone indicates the crown is in supraocclusion (beyond the occlusal plane of the
adjacent teeth) which may cause opposing teeth to intrude into their sockets, thereby
weakening and sensitizing them. Another destructive process that can be instigated by
improper occlusion is the movement (drift) of teeth that can result when occlusal forces
are not directed along the long axis of the teeth. From the operator’s point of view, it is
important for the temporary crown restorations to maintain a stable occlusal relationship
because a prepared tooth without occlusal contact may erupt or shift position within a
few days. If this occurs, the permanent crown will be in supraocclusion (too high) or
impossible to seat, necessitating the fabrication of another permanent crown. Because of

14
these possibilities, great attention is given to checking and restoring proper occlusion
during temporary crown placement.

Blue marks on the slopes of cusps or on marginal ridges indicate destructive

forces and are unacceptable. IF they occur, continue articulating until you achieve an
acceptable occlusion. Since teeth in dentoforms are difficult to maneuver and to maintain
in ideal occlusal relationships, it will only be necessary to have one of the four centric
marks at the same intensity as produced on the unprepared tooth, in order to fulfill the
occlusal requirement when the crown has been placed. (Acceptable occlusion in a
dentoform is shown in Figure 4).

FIGURE 3 - TOOTH-TO-TWO TEETH CENTRIC CONTACT

Tooth-to-two-teeth centric contact of posterior teeth.

FIGURE 4 - PATTERN OF OCCLUSAL FIGURE 5 – IDEAL PATTERNS

MARKINGS OF OCCLUSAL MARKINGS

Model teeth showing a patter of occlusal Model teeth showing the ideal
markings acceptable in dentforms. patterns of occlusal
markings.

15
 TEMPORARY CEMENT

Temporary cement is used to hold the restoration in place. It fills the space
between the crown and the preparation, thus supporting the occlusal contours, filling and
sealing the margin/finish line area.

During cementation it is imperative to remove all debris, to rinse and dry (not to
desiccate causing sensitivity to exposed dentinal tubules) the preparation, and to isolate
the area with cotton rolls to prevent contamination by saliva. Depending on the
consistency of the cement mix, cement creates pressure as it dries, occasionally forcing
the crown in an occlusal direction. This can be detected by a post-cementation occclusal
check. Minor occlusal prematurities (high contacts) can generally be adjusted with the
crown in the patient’s mouth. Gross malocclusion (deviation from acceptable contact) will
also tend to lift the crown from the preparation finish line; adjustment necessitates
removal and re-cementation of the crown. Holding the teeth firmly together in centric
occlusion during cementation should prevent most of these problems.

PLACING TEMPORARY CROWNS

Although the placement of each type of temporary crown is different, there are
some conditions that must be met in order for a temporary restoration to be satisfactory:

(1) The margin of the crown must fit snugly against the finish line of the preparation and
(2) must be sealed so that no oral fluids seep into the prepared area. (3)The contacts with
adjacent teeth and (4) the occlusal pattern that exists before the tooth is prepared must
be replicated not only when the finished crown is placed, but also while the temporary
crown is in service (5)The facial and lingual contours must be similar to original and
adjacent teeth and (6) surfaces should be smooth.

Many criteria for accomplishing the tasks that are described are stated in terms of
a range of acceptable adjustment. A small degree of error in some areas will not distort
the fit of the restoration or disturb the patient. The allowable errors for any temporary
crown are:

1. The crown margin may be up to 0.5 mm short of (occlusal to) the

preparation finish line. Marginal error away from the gingiva will not cause
gingival irritation, whereas 0.5 mm toward the gingiva would be
unacceptable. Up to 0.5 mm distance between the crown margin and the
preparation finish line can be filled with cement without distorting fit or
seal. This area is also protected by the gingiva since the finish line is
normally apical to the gingival crest.

2. Assuming ideal gingiva, the facial and lingual surfaces of a crown may be
slightly over-contoured without disturbing healthy tissue. Gross
convexities, however, would create areas where food and bacteria could
lodge.

3. Under-contouring in the gingival third on the interproximal surfaces is

preferable to over-contouring, as it will not produce gingival pressure and
irritation.

In an instructional setting, the student strives to produce a temporary crown that is

“perfect”; however, in a clinical situation, temporary crowns frequently do not fit
“perfectly” because the time to achieve perfection is too great, the crown is only
temporary and the patient’s oral health is not jeopardized.

16
 ASEPTIC TECHNIQUE

Prevention of disease transmission by careful attention to aseptic technique

before, during and after temporary restoration is required, as it is for all intra-oral
procedures. Infection control guidelines for dental offices that have been published by
the Center for Disease Control should be followed. Personal protection and barrier
protection measures should be followed (e.g., gloves, mask, protective eye wear and lab
coat). Cross-contamination should be avoided. Do not touch instruments, areas which
have not been sterilized or disinfected. Practice proper hand washing techniques,
properly clean, sanitize disinfect or sterilize all instruments and equipment.

The patient treatment area should be clean, orderly and as sanitary as possible
before, during and after use. The laboratory area used for clinical practice should also
be kept as clean and orderly as possible. You are encouraged to be conservative with
your dental materials, to keep mixtures of alginate, acrylic resins, and cements in small
areas on the mixing pad and in the mixing bowl, to produce the best mix; and to perform
all cutting, trimming, contouring, and finishing outside the mouth, clear of the
dentoform, as you would with a patient. An efficient technique will result from having
developed habits such as these.

17
 Module 2
Placing a preformed aluminum temporary crown

18
 MODULE 2

PLACING A PERFORMED ALUMINUM

TEMPORARY CROWN

Module 2 details the procedure for placing a temporary aluminum anatomical

crown on the mandibular left second molar (#18). This crown on the mandibular left
second molar posterior teeth that have been prepared for full crowns. The chief
advantage of the temporary aluminum crown is its malleability, which allows for good
occlusal adjustment. Such aluminum crowns are used only on molars and premolars,
where aesthetics is not a primary consideration.

Temporary aluminum crowns are thin-walled (slightly less than 0.5 mm) tooth-
shaped shells, commercially produced to conform ideal tooth anatomy. They are
available in a range of sizes sufficient to cover most preparations. Although there is no
sizing convention among manufacturers, preformed metal temporary crowns typically
are produced for both molars and premolars and differ in size and occlusal anatomy.
The aluminum crown is short and easily shaped so the idealized occlusal anatomy can
be partially shaped into occlusion by the opposing teeth. Because these crowns are so
soft, they must be handled gently.

Overview of Procedure

The first step in preparing a tooth for a temporary crown is to check occlusion,
determining where the normal centric marks appear on the teeth. The dentiform should
exhibit occlusal markings on every tooth except the incisors. The identical pattern of
markings, with the same intensity as noted before preparation, should be replicated after
placement of the temporary crowns.

After the tooth has been prepared, an impression is made and a cast is made and
sent to the laboratory, where the crown is fabricated.

The mesio-distal space of the tooth to be restored is the primary dimension to be

considered in selecting the crown. Because natural teeth vary in size and shape, it is
unlikely that any preformed crown will ever fit a tooth without adjustment. When the
best-fitting crown has been selected, it is then cut to the appropriate length, the edges
crimped (bent upwardly) with hand instruments until proper tit is achieved. The rough
edges of the crown are smoothed, and when proper occlusion is re-established, the
crown is cemented over the preparation.

This temporary restoration procedure requires that you first study the contour of
the unprepared tooth, certain features of which must be duplicated on the aluminum
shell. Next, you should have an understanding of the slope of the chamfered enamel to
the finish line of the prepared tooth, to help visualize the trimming and contouring
required for the crown to fit snugly. To protect the prepared tooth, the ideal preparation
is shaped to ensure good marginal seal when the crown margin is trimmed and crimped
to hug the finish line of the preparation. Finally, attention the occlusal plane and centric
contacts will help replicate pre-preparation occlusion, which is to preserve tooth
alignment and to ensure patient comfort.

19
 Figure 6 shows the mesial view of the proximal surface of tooth #18.
Figure 7 shows the facial view of tooth #18 unprepared (a) and prepared with
crown (b).

Figure 8 shows the lingual view of the unprepared tooth and the crown.

Figure 9 illustrates the occlusal view of the unprepared tooth; the broken line
indicates the finish line.

FIGURE 6 MESIAL VIEW OF TOOTH #18

FIGURE 7 FACIAL VIEW OF TOOTH #18

Mesial view of proximal surface of unprepared tooth #18 (a); prepared tooth with broken
line indicating crown (b).

FIGURE 8 LINGUAL VIEW OF TOOTH #18

Facial view of unprepared tooth #18 (a); prepared tooth and crown (b).

FIGURE 9 OCCLUSAL VIEW OF TOOTH #18

20
Lingual view of prepared tooth with crown. Occlusal view of prepared tooth #18.

21
 ARMAMENTARIUM

1. PPE
2. Typodont with prepared tooth
3. articulating paper
4. millimeter rule
5. assortment of preformed anatomical aluminum alloy crowns for tooth
6. dental mirror
7. curved crown and bridge scissors
8. explorer
9. contouring pliers
10. dental floss
11. T-ball, flat-tail burnisher or belling pliers
12. sandpaper disc (fine, medium garnet)
13. mandrels
14. pumice—impregnated rubber wheel
15. cotton rolls
16. lubricant (petroleum jelly or cocoa butter)
17. mixing pad and spatula
18. handpiece, contra-angle-latch type

22
 PROCEDURES

Preliminary Procedures

1. CHECK TO BE SURE YOU HAVE ALL THE SUPPLIES LISTED IN THE

ARMAMENTARIUM.

2. CHECK THE OCCLUSION of the unprepared tooth on dentoform. Place blue

articulating paper between the left maxillary and mandibular arches, and
gently tap the teeth together in centric occlusion. There must be at least
one occlusal mark on each tooth in both arches. This occlusal pattern must
be replicated with the temporary crown.

3. PLACE THE PREPARED TOOTH IN THE DENTIFORM. Retain the

unprepared tooth with its occlusal markings for future reference.

4. VISUALLY AND TACTUALLY LOCATE THE FINISH LINE of the preparation

with the explorer and the mirror.

Crown Placement Procedures

1. MEASURE MESIO-DISTAL SPACE AT THE CONTACT AREA AND SELECT

HE CROWN.

Retract the cheek with the dental mirror, and use a millimeter ruler to
measure the width of the mesio-distal space from the contact area of the
left third molar #17, to the contact area of #19 molar in the middle third of
the tooth. Select a crown whose width is equal to or greater than the
measurement. It is better to select a crown that is slightly larger than the
space, rather than too small, because the crown can be trimmed and
shaped to fit. A crown that fits the mesio-distal space, is long enough
occluso-gingivally and can be modified to fit snugly at the finish line.

Criterion

a. Procedure completed

2. TRY THE CROWN, AND CHECK ITS FIT

Orient the crown, and , using finger pressure, gently push it over the
preparation until it is seated. The crown can be adjusted to approximate the
contours of the unprepared tooth and to re-establish occlusal and proximal
contacts if the following relationships are observed:

a. The crown fits the mesio-distal space.

b. The facial and lingual contours of the crown should be in the same
plane as those of the adjacent teeth. Use direct and indirect (mirror)
vision to sight along the quadrant mesio-distally to make sure that
the crown is not rotated or tilted on the preparation.

23
 c. The crown should encompass the finish line of the preparation. If
the crown is so long that it cannot be seated but it nevertheless
meets the mesio-distal and facio-lingual size and contour criteria, it
can probably be shortened to fit. If the crown margin is short of the
finish line, it is too short, and another crown must be selected. Try
crown forms until one meets the criteria.

d. The occlusal surface of the crown should be at or slightly above the

occlusal plane of the adjacent teeth. Hold the mirror at the facial to
view the occlusal plane additional guide to proper seating, by
comparing their level to those of the adjacent molars.

Criteria

a. The crown fits the mesio-distal space.

b. The facial and lingual contours of the crown are in the same planes
as those of the adjacent teeth.

c. The crown margin meets or extends gingival to the preparation

finish line.

d. The occlusal surface and the marginal ridges of the crown are in a
plane with, or within in 0.5 mm occlusal to the occlusal surface and
the marginal ridges of the adjacent molars.

This is the first criteria stage of crown placement. It requires you to

determine size and contour criteria visually. Be aware of minute
shifts in the position of the crown and how they affect alignment
with the adjacent teeth.

3. SCRIBE A TRIM L9INE ON THE CROWN THAT FOLLOWS THE FINISH LINE
CONTOUR.

The crown length usually needs adjustment. If the occlusal surface of the
crown is above the occlusal plane of the adjacent teeth and the crown margin
extends gingivally beyond the preparation finish line, the crown margin can be
trimmed slightly to lower the occlusal surface. Study the contour of the
preparation finish line with the dental mirror. With the crown fully seated on the
preparation exactly. The level and contour of the preparation will be your guides
for trimming the crown margin.

There are two methods of determining the trim line. Both are indirect and
require you to visualize a reference point while scribing the trim line on the facial
and lingual surfaces of the crown with an explorer. In one method hold the crown
on the preparation, covering the preparation finish line, scribe a corresponding
trim line along the marginal portion of the crown with an explorer. You may want to
use the dental mirror to stabilize the crown while scribing. By the other method,
hold the crown just above the preparation finish line so that its contour can be
copied on the facial and lingual surfaces of the crown as you visualize the amount
of trimming that is necessary. The contours of occluso-gingival height. Since this
may require several attempts, it is advisable to trim only a small amount at a time
thereby avoiding over-trimming.

24
 Criterion
a. Trim line scribed along the marginal area of the crown.

4. ADJUST THE LENGTH OF THE CROWN.

Remove the crown from the preparation, and use the curved crown and
bridge scissors to trim the crown margin to the scribed line. Begin trimming at a line
angle (the junction of two horizontal adjacent tooth surfaces, such as mesial and facial),
making sure that the curve of the blades follows the curve to be trimmed. Trim the
interproximal areas of the crown with the same contours as the interproximal area of the
preparation finish line. Use care not to cut the margin too short. Any sharp curve left after
cutting must be blended into a smooth line.

The crown is held high as a trim line replicating the reparation finish line is scribed on it.
Then the crown is trimmed, replace it on the preparation and inspect the
margin of the crown to see how it conforms to the finish line. Check this by
holding the explorer firmly against the finish line and then following along its
contour. The crown margin should coincide with the finish line. Check that the
marginal ridges of the crown are at or within 0.5 mm occlusal to the marginal
ridges of the adjacent molars.

Criteria

a. Crown is trimmed so that its margin meets and conforms to the contours of
the preparation finish line.

b. Crown margin is free of sharp edges.

c. Occlusal plane of crown is at or 0.5 mm occlusal to that of the adjacent

teeth.

5. REDUCE THE CIRCUMFERENCE OF THE CROWN MARGIN.

When a crown fits the mesio-distal space, it will probably not fit the
gingival margin of the preparation. To reduce the circumference of the crown
margin, use a pair contouring pliers to crimp (bend inward) the edges of crown.
While the crimping reduces the marginal circumference, the action of the pliers
tends to distend the crown walls immediately occlusal to the margin. Besides
reducing the circumference of the crown with crimping, the length of the crown is
also reduced.
Use the contouring pliers to crimp inwardly and evenly around the gingival
third of the crown until the crown fits snugly against the margin of the preparation.
Work in small increments in order to maintain the general contour of the crown
walls.

Check the marginal adaptation of the crown by placing it over the

preparation and with a finger on the occlusal surface move the crown in a facio-
lingual direction, noting where additional crimping is needed. Use the explorer tip
in a gingivo-occlusal direction to determine where there is space between the
crown and the preparation. You will notice only a slight catching as the explorer tip
moves from enamel to aluminum if the margin is well-fitted. If the explorer catches
in a space under the crown, more crimping is required. Interproximal areas of the

25
 crown margin are particularly difficult to check and need careful attention.
Continue to crimp and check the crown on the preparation until the crown fits
firmly against the finish line of the preparation. When the marginal circumference
of the crown is sufficiently reduced, a slight clicking sound is produced when it
contacts the preparation margin. Caution: There is also a clicking sound when the
crown is too long and snaps over the margin.

Criteria

a. Crown margin conforms to the contour of the preparation finish line.

b. Crown walls show no convexities or distensions.

6. SMOOTH THE EDGES OF THE CROWN.

Use the straight handpiece and a sandpaper disc with short, light strokes
to smooth any rough edges on the crown margin. Clean all debris from the crown.

Criterion

a. Crown margin is a smooth curve free of sharp edges and debris.

7. DEVELOP THE CROWN’S OCCLUSAL ANATOMY.

Seat the crown on the preparation, and close the mandible into centric
occlusion with slight pressure. The opposing teeth should impress and shape the
occlusal surface of the crown. Take care to exert only slight force, as excessive
pressure will be filled with cement so the final occlusal features can be safely
developed with slightly more pressure.

Criterion

a. Preliminary occlusal anatomy of the crown is impressed on the crown.

8. CHECK OCCLUSION.

Clean and dry preparation, and use the air jet to dry all other teeth.

Place articulating paper between the arches, and tap the teeth into centric occlusion.
Examine the teeth in the quadrant for margins; at least one point of contact should be
present on each tooth. Compare with pre-preparation markings. If there are more and/or
darker marks on the crown than were perceived at the pre-preparation check, or if only
the maxillary teeth and the temporary crown show marks from the articulating paper, the
crown is in supraocclusion (too high). To reduce the heights of the crown, trim, re-crimp,
smooth the margin, clean the crown, and check the occlusion again. If no marks register
on the crown, it is in infra-occlusion (too low), and you must fit a new crown.

Criterion

a. Pre-preparation occlusion is replicated, and all the teeth, including the

crown, produce at least one occlusal contact mark of the same intensity as
they did in the pre-preparation check.

26
9. CHECK CONTACT

Check for proximal contacts by passing a length of dental floss through

both the mesial and the distal contact areas. The floss should meet some
resistance, but should snap through the contact areas. Remove floss through the
embrasure, so as not to dislodge the crown.

If there is no contact, remove the crown. Place the crown on a paper pad
for cushioning, and with the ball end of the T-ball burnisher, impress an ovoid
shape on the inner facial surface. The burnishing will stretch the aluminum
outward, to produce a convexity and establish contact. Replace the crown, and
recheck.

If a contact is too tight, use contouring pliers to bend and flatten the
contact area. If the marginal area is deformed during this process, some re-
crimping may be necessary.

Criterion

a. The crown has a smooth margin and is free of debris.

10. SMOOTH CROWN

When you are satisfied that the crown meets all criteria related to margin,
contacts, and occlusion, use a rubber wheel impregnated with pumice in the
handpiece to smooth the margin. Polish off any written identification on the crown,
taking care not to deform any contours. Use the air jet to clean the crown of debris.

Criterion

a. The crown has a smooth margin and is free of debris.

11. CEMENT TEMPORARY CROWN ON PREPARATION

Lubricate the exterior of the crown with petroleum jelly so excess cement
will be easier to remove. Rinse and air dry the preparation but do not desiccate the
tooth. When working with a patient, it is necessary to place a cotton roll between
the cheek and the preparation and another between the tongue and the
preparation, to keep the tooth dry (cement will not adhere if the preparation is too
moist).

Prepare a mix of temporary cement according to the manufacturer’s

directions. When the cement is of uniform consistency and flows slowly from the
end of the spatula coat all internal surfaces of the crown. Add additional cement so
that the crown is from one-third to one-half full.

Place the crown in its predetermined position on the preparation; use the
marginal ridges of the adjacent teeth as a guide for proper seating then use an
explorer to check that the crown is seated. Gently bring the mandible into
occlusion and maintain centric occlusal contact until the cement sets. This contact
will further shape the occlusal surface of the crown. Avoid excess pressure, as it
can produce infra-occlusion.

27
 The cement is set when the tip of the explorer does not penetrate its
surface. After the cement has set, use an explorer to carefully remove all excess
cement from interproximal areas and the gingival margin. Since small chips of
cement can easily get embedded in the gingival sulcus, remove the excess cement
in the largest pieces possible. Floss the contact areas to remove any cement chips
in the proximal areas, adding a knot to the floss will help. Remember to remove the
floss laterally not up through the contact.

Remove the cotton rolls, and thoroughly rinse and dry the restoration area.

Criteria

a. Crown contacts with the adjacent: mesially, distally.

b. Facial and lingual surfaces are in the same plane as the adjacent teeth.

c. Crown margins:
-Ranges from the preparation finish line to 0.5 mm occlusally of the finish
line.
-Fits snugly against the finish line.

d. Excess cement removed from interproximal and gingival areas.

12. MAKE FINAL CHECK FOR OCCLUSION

Place articulating paper between the teeth, and perform a post-cementation

check of the occlusion of the entire arch. Should the crown be in infra-occlusion, it
will be necessary either to remove it and re-contour its occlusal surface or to adapt
a new crown form.

Criteria

a. There is at least one centric mark on the crown that is of the same intensity
as those on the adjacent teeth.

b. There is at least one centric mark on each tooth.

28
 SUMMARY OF PROCEDURES AND CRITERIA

Procedures Criteria

1. Measure mesio-distal space a. Procedure complete.

at the contact area, and
select the crown.

2. Try the crown, and check a. The crown fits the mesio-
its fit. distal space.
b. Facial and lingual contours
of the crown are in the
adjacent teeth.
c. Crown extends gingivally
form preparation finish line.
d. The occlusal surface and
the marginal ridges of the
crown are in a plane with,
or within 0.5 mm occlusal
to, the occlusal surface
and the marginal ridges
of the adjacent molars.

3. Scribe a trim line on the a. Trim line scribed along the

crown that follows the marginal area of the crown
finish line contour.

4. Adjust the length of crown. a. Crown is trimmed so that

its margin meets and
conforms to the contours
of the preparation finish
line.
b. Crown margin is free of
sharp edges.
c. Occlusal plane of crown
is at or 0.5 mm occlusal
to that of the adjacent teeth.

5. Reduce the circumference a. Crown margin is crimped to

of the crown margin. hug the preparation finish
line.
b. Crown walls show no
convexities or distensions.

6. Smooth the edge of the crown. a. Crown margin is a smooth

curve free of sharp edges
and debris.

7. Develop the crown’s a. Preliminary occlusal

occlusal anatomy anatomy of the crown is

impressed.

29
8. Check occlusion. a. Pre-prepared occlusion is
replicated, and all the
teeth, including the crown,
produce at least one
occlusal contact mark of
the same intensity as they
did in the pre-preparation
check.

9. Check contacts. a. Interproximal contacts are

established between the
crown and the adjacent
teeth.

10. Smooth crown. a. Crown has a smooth margin

and is free of debris.

11. Cement temporary crown on a. Crown contacts with the

preparation. Adjacent teeth: distally,
mesially.
b. Facial and lingual surfaces
are in the same plane as
the adjacent teeth.
c. Crown margin:
-Ranges from the
preparation finish line
to 0.5 mm occlusally
of the finish line.
-Fits snugly against the
finish line.
d. Excess cement removed from
Interproximal and gingival
areas.

12. Make final check for a. There is at least one

occlusion. centric mark on the crown
that is the same intensity
as those on the adjacent
teeth.
b. There is at least one
centric mark on each tooth.

30
 Module 3
Placing a preformed plastic temporary crown

31
 MODULE 3

PLACING A PREFORMED POLYCARBONATE

TEMPORARY CROWN

The crown used in this module is polycarbonate (a form of synthetic resin). This
material is widely used for temporary crowns for several reasons: it is strong yet flexible
enough to contour easily; it bonds chemically to a self-curing acrylic resin material used
to fill the shell. Although plastic crowns do not bend and draw as metal crowns do, they
have almost perfect bonding properties. Any area of a plastic crown, including the incisal
edge, can be extended by adding layers of acrylic and smooth them.

Plastic crowns are commercially produced to conform to standard surface

contours of teeth and are available in a range of sizes sufficient to cover most
preparations. Although the manufacturers have no sizing convention, the sizes of most
polycarbonate crowns vary by increments of approximately 0.5 mm mesio-distally. Incisal
crowns, when fitted to preparations mesio-distally, are generally too wide facio-lingually.

In this module the maxillary right permanent central incisor (#8) is to be

temporarily restored with a preformed polycarbonate temporary crown. The tooth has
been prepared for a permanent porcelain-fused-to-metal crown. Figure 13 presents facial
and mesial views of the unprepared tooth and the prepared tooth with a crown.

incisor (#8) is to be temporarily restored with a preformed polycarbonate temporary

crown. The tooth has been prepared for a permanent porcelain-fused-to-metal crown.
Figure 13 presents facial and mesial views of the unprepared tooth and the prepared tooth
with a crown.

Overview of Procedure

The procedure for temporarily restoring this tooth with a preformed plastic crown
begins and ends with occlusion checks. After occlusion is checked, a preformed plastic
crown that will cover the prepared tooth and contact the adjacent teeth is selected. The
size of the crown is determined by measuring the space between the mesial and distal
contacts of the tooth with a Boley gauge.

As the plastic shell is placed over the tooth, it will be immediately obvious that the
internal form of the crown does not approximately that of the preparation. The crown must
be in place, marked and trimmed until the crown margin conforms to the contour of the
finish line of the preparation. An acrylic resin is then mixed and placed in the crown, which
is subsequently seated on the preparation. The viscous resin fills the spaces between the
prepared tooth and the crown and as the acrylic resin hardens, the contours of the pre-
prepared tooth are replicated. With the crown in place, occlusion is checked; then extra
resin removed the margin of the crown trimmed, the incisal length adjusted, and contacts
established. Finally, the crown is cemented in place and a last occlusion check is made.

Success in placing this crown depends on careful trimming and contouring of the
polycarbonate crown shell and the acrylic resin.

32
 FIGURE 13
FACIAL/MESIAL VIEWS OF TOOTH #8

Facial (at top) and mesial view of tooth #8,

unprepared and prepared.

33
 ARMAMENTARIUM

1. PPE
2. articulating paper and holder
3. typodont with prepared tooth
4. assortment of preformed polycarbonate temporary crowns for tooth
5. explorer
6. dental mirror
7. round bur (#6 or #8)
8. flame-shaped acrylic bur
9. green stone
10. sharpened soft lead pencil (#1)
11. curved crown and bridge scissors
12. cotton rolls
13. lubricant (petroleum jelly or cocoa butter)
14. dappen dishes
15. acrylic resin kit
16. spatula (#7)
17. gauze pads (2” x 2”)
18. excavator
19. boley gauge or micrometer caliper
20. unwaxed dental floss
21. mandrels (Moore’s)
22. coarse garnet disc (3/4”)
23. fine cuttle disc (3/4”)
24. fine pumice (optional)
25. buffing wheel (optional)
26. temporary cement kit
27. mixing pad double-ended plastic instrument
28. low speed straight and contra angle handpiece

34
 PROCEDURES

Preliminary Procedure

Before the temporary plastic crown placement procedure is begun on a patient, the
anterior maxillary quadrant should be thoroughly cleaned to remove plaque and debris,
the occlusion the quadrant should be checked, and maxillary right central incisor #8
should be prepared for ultimate placement of the porcelain-fused-to-metal permanent full
crown.

1. Check the Armamentarium to be sure you have all the necessary supplies and
equipment.

2. Remove the unprepared tooth from the dentoform after checking occlusion, and
set it aside for later reference. Note whether the tooth was in occlusion.

3. Place the prepared tooth in the dentoform.

Crown Placement Procedure

1. MEASURE THE MESIO-DISTAL SPACE BETWEEN THE CONTACT AREAS, AND

SELECT THE CROWN.

With a micrometer caliper (or boley gauge), measure the space between the
mesial and the distal contact areas of the tooth #8 at the level of the incisal third of
the adjacent teeth. From the selection of sample crowns, choose a crown that is
the same size or wider than the space. (A wider crown ensures an adequate lining
of acrylic all around the preparation).

To facilitate placing on and removing the crown from the preparation,

maintain the tab on the incisal edge.

a. Procedure completed.

2. TRY THE CROWN FOR FIT, AND ADJUST THE BINDING.

Gently press the crown over the prepared tooth; keep the facial surface in
the same plane as those of the adjacent teeth. There should be enough clearance
between the preparation and the crown to allow the crown margins to reach the
finish line of the preparation. Almost any crown will need adjustment to fit;
following are some of the common problems and solutions.

a. If the crown fits mesio-distally, but is too tight internally preventing the
crown from meeting the preparation finish line, use a round bur in a
straight handpiece at low speed to adjust the interior of the crown. You
may need to place and remove the crown several times to determine the
exact point of binding; take care to place the crown in exactly the same
position each time you place it on the preparation.

35
 b. If the crown should bind at the preparation’s finish line, increase the
marginal diameter with an acrylic bur. Determine with an explorer the exact
place of binding, usually in an interproximal area.

c. If the proximal surfaces of the crown bind on the adjacent teeth, but a
smaller preformed crown is too narrow to make contact, remove a small
amount of plastic from the contact areas with an acrylic bur in the straight
handpiece. Should you accidentally perforate the plastic crown, you can
correct it later by adding acrylic.

d. When the crown has been adjusted to fit mesio-distally, there usually
remains several other adjustments to be made. Typically the crown extends
gingivally over the finish line, is longer at the incisal edge than the adjacent
tooth and is too wide facio-lingually at the finish line. Don’t expect a perfect
fit too soon; these adjustments will be made later in the procedure.

Criteria

a. Crown fits the mesio-distal space of the tooth to be restored.

b. Crown fits over preparation without binding.

c. Crown contacts adjacent teeth.

3. ADJUST GINGIVAL LENGTH OF MARGIN AND MARGINAL CONTOUR OF CROWN.

In this step, the margin of the crown will be grossly trimmed; final fitting
will take place after the crown has been lined. The crown margin should be just
gingival to the finish line so that the acrylic lining will be able to flow freely,
extruding all around the margin and thus reproducing the finish line of the
preparation.

Study the contour and location of the finish line, place the crown over the
preparation and with a sharpened soft lead pencil mark the finish line. Remove the
crown and with the curved crown and bridge scissors, begin trimming the gingival
margin of the crown at the facial. Cutting carefully toward the proximal, trim only a
small amount of plastic at a time, results if large pieces are cut. Place the crown on
the tooth occasionally to check how closely the margin conforms to the finish line.

This same procedure can be achieved with the acrylic bur in the straight
handpiece, holding the handpiece in a palm grasp. Assume a thumb-to-thumb
finger rest; trim, thin, and smooth the crown margin until it is smooth and of
uniform thickness. When the crown is in place over the preparation, the
preparation finish line should be just visible where the crown margin meets the
prepared tooth. Use the mouth mirror to view the lingual marginal area. Replace
the crown on the tooth occasionally to check how closely the margin conforms to
the finish line.

It is important to seat the crown in the same position each time you try it on
the preparation. The adjacent central incisal edge and facial surface can serve as
guides for this. When you line the crown up on any one plane, you should sight
from two vantage points 90 apart; for example, view the facial plane from the
incisal edge and from the distal side.

36
 Criteria

a. Crown margin fits over preparation.

b. Crown margin approximates the finish line contour and extends slightly
gingival to the finish line.

c. Crown margin is smooth and of uniform thickness.

d. Major areas that will need re-contouring are noted.

4. CLEAN AND DRY THE PREPARATION AND CROWN, ISOLATE THE AREA, AND
LUBRICATE THE PREPARATION AND THE ADJACENT TEETH.

Clean and dry the preparation with water and a flow of air. Clean all debris
from the crown, and dry the crown with air pressure. Since moisture will interfere
with acrylic polymerization, place a cotton roll between the lip and the gingiva. To
prevent the acrylic from adhering to the preparation, the adjacent teeth and the
gingiva, coat a cotton roll with some petroleum jelly and lubricate the areas.
Remember that the lubricant will contaminate the acrylic resin during
polymerization so that it will not bound properly with any additional acrylic resin
you might wish to add later.

Criterion

a. Procedure completed.

5. FILL THE CROWN WITH ACRYLIC RESIN, AND SEAT IT ON THE PREPARATION.

Seat the crown on the preparation in the exact position for which the
margin has been trimmed, and not its alignment. Once it is fully seated, hold the
facial surface of the crown flush with that of the adjacent central incisor for correct
positioning. This position will have to be duplicated when the crown is filled with
acrylic resin.

For the placement of the crown, it is assumed that a larger quantity of

acrylic resin will be needed. Follow the manufacturer’s directions exactly. Place a
few drops of monomer in a dappen dish and add polymer; mix the monomer and
polymer with a spatula or tap on the counter to incorporate thoroughly and to
eliminate air entrapment. When the resin mix has a creamy consistency, use a
spatula to apply a thick coat to the interior of the crown. Begin at the incisal depth
of the crown, filling carefully so bubbles do not form. Coat the walls thoroughly,
filling the crown until there is only a shallow concave surface of acrylic resin at the
marginal end of the crown. Avoid overfilling the crown.

When the acrylic resin loses its highlights and surface shine (after about
one minute), seat the crown on the prepared tooth, taking care not to rotate it from
its correct position. Hold the facial and incisal surface stable with your forefinger
on the crown and the adjacent central incisor for 2or 3 minutes. Be especially
careful to guard against mesial and distal rotation.

The acrylic resin will fill the space between the crown and the preparation
and the excess will flow gingivally covering the finish line.

37
 If only a small amount is needed to fill a void or to extend a contact area,
the bead-brush or the brush-flow technique is recommended. For this, you line up
three dappen dishes, shallow end up. Place a drop or two of monomer in each of
the first and second dishes (one of these is for rinsing the brush) and a little
polymer in the third dish. Dip the brush in the monomer; then touch it to the
powder, to form a bead on the tip of the brush. Brush the bead onto the crown
where it is needed, and smooth it in place with the brush. Rinse the brush in the
rinsing dish of monomer, and wipe it on a piece of gauze before dipping it into the
clean monomer and then into the polymer again, to form another bead; and apply it
as before.

Criteria

a. Polymer and monomer are mixed thoroughly to a cream consistency.

b. Crown interior is almost completely filled wit acrylic resin, which forms a
shallow concave surface at the marginal end of the crown.

c. Crown fully seated on the preparation, with its facial surface flush with that
of the adjacent central incisor.

d. Resin has extruded over the finish line.

6. REMOVE CROWN AND TRIM AWAY EXCESS ACRYLIC RESIN.

Excess acrylic resin must be removed from the crown before it is

completely hard to prevent the crown from binding interproximally. If the acrylic
resin hardens before trimming, the crown or the tooth may break when you attempt
to remove the crown. Use the explorer to check the consistency of the excess
resin at the margins. When the resin has become doughy (when it does not run
and has little stretch to it), remove the crown from the tooth. Using the crown and
bridge scissors, trim away the excess acrylic resin.

Criterion

a. Margin is free of gross excess resin.

7. RESEAT CROWN WHILE POLYMERIZAION IS COMPLETED.

Immediately reseat the crown. Stabilize the crown with your finger. Test the
marginal acrylic resin with the explorer. At this point, you may want to take the
crown on and off the preparation a few times. When the explorer cannot indent the
acrylic resin, polymerization is complete.

Remove the crown. Should this be difficult, use a piece of gauze to get a
purchase on the crown. If the crown still does not unseat, gently pry around the
margin with an excavator. If needed, use Backus towel clamps to pull the crown
off.

Use a magnifying glass to examine the internal surfaces of the crown and
the marginal area. The preparation and the finish line should be replicated; acrylic
resin should be free of large voids. If 95% of the finish line is not successfully
replicated, fit a new crown; small voids can be filled.

38
 Replace the crown over the preparation. It should fit snugly, and it should
resist if you try to move it with your finger.

Criteria

a. Acrylic resin liner has polymerized; it is hard.

b. The preparation and at least 95% of the finish line is impressed in the
acrylic resin.

c. Acrylic resin liner is free of large voids.

d. Crown fits preparation snugly without binding.

8. TRIM CROWN MARGIN.

Remove the crown. Locate the impressed finish line of the preparation on
the interior of the crown; mark it with a sharpened, soft lead pencil. The pencil line
indicates the impressed finished line of the preparation. Use an acrylic bur to trim
the resin that extends gingival of the finish line. Short intermittent strokes of the
bur will reduce softening and tearing of the resin. As you trim the margin, clean
away the debris and place it occasionally on the preparation until the margin
conforms to the finish line.

Criteria

a. Crown margin meets preparation finish line exactly.

b. Crown is clean of debris.

9. ADJUST OCCLUSION, INCISAL LENGTH, FACIAL AND LINGUAL CONTOURS AND

FACIO-LINGUAL WIDTH OF CROWN.

Gross occlusal adjustment is necessary at this time. For this step, fist dry
the prepared area, the crown, the adjacent maxillary teeth, and the opposing
mandibular teeth. (Articulating paper will not mark a wet surface.) Seat the crown,
place blue articulating paper between the maxillary and the mandibular incisors,
and gently tap the teeth together. If the mark on the crown is heavier than the mark
on the unprepared tooth (as it is likely to be), the lingual surface of the crown is
too thick. Thin that area at the blue mark using the acrylic bur in the straight
handpiece at low speed. After using the bur, us gauze to wipe all traces of blue
from the teeth. Check occlusion again, and repeat the procedure until the crown
occlusion replicates the occlusion of the unprepared tooth.

To check the incisal length of the crown, be sure the crown is fully seated,
and compare the location of its incisal length of the crown, be sure the crown is
fully seated, and compare the location of its incisal edge with that of the adjacent
central incisor. Use a sharpened, soft lead pencil to draw a line from mesial to
distal across the facial surface of the crown, indicating where to trim. Remove the
crown from the preparation, and break off the tab. Use the acrylic bur at low speed
to trim the areas that require reduction. In some areas it may be necessary to trim
away the plastic shell entirely and contour the underlying acrylic resin. Reseat the
crown frequently to reassess the contours.

39
 Use the mirror to compare the facial contour of the crown with that of the
other central incisor. Hold the mirror to the distal of the lateral as you sight across
the central incisors. Use a pencil to shade any area that needs reduction or
addition.

In the majority of clinical situations, the finish line is sub gingival and the
contour is critical because over-contouring in the area can cause gingival irritation
and patient discomfort. Take time to examine the marginal area on the lingual
surface carefully with the mirror and explorer. Check for any overhang that catches
the explorer, and use various sighting techniques to compare the overall contour
of the crown with that of the adjacent central incisor. Again, use a pencil to shade
any areas that need adjustment.

Compare the facio-lingual width of the incisal edge of the crown with that
of the other central after you have adjusted the incisal length. Shortening a crown
increases the width of the incisal length. Shortening a crown increases the width
of the incisal edge enough that facial and lingual contouring may be necessary to
reduce that dimension on the crown.

Criteria

a. Crown occlusion replicates the occlusion of the unprepared tooth.

b. Tab is removed.

c. Needed contouring is adjusted.

d. Crown is the same length gingivo-incisally as tooth #9.

10. REFINE INCISAL, FACIAL AND LINGUAL CONTOURS, FACIO-LINGUAL WIDTH,

AND INTERPROXIMAL AREAS.

If an area of the crown is under-contoured, acrylic resin may be added to

the area by the bead-brush technique.

Last, inspect the crown for overall contour, and compare it to the adjacent
central incisor. Check the interproximal contours in the gingival half, and
remember that the patient’s comfort and aesthetics depend upon your ability to
reproduce the original, unprepared tooth.

Criteria

a. Crown margin exactly meets the preparation finish line.

b. Crown contour resembles that of tooth #9 facially, lingually, incisally, and

interproximally in the gingival half.

11. CHECK AND ADJUST THE CONTACTS OF THE CROWN WITH THE ADJACENT
TEETH.

Check the mesial and distal contacts of the crown with the adjacent teeth
by using dental floss. If the floss encounters some resistance incisally but snaps

40
 through, the contact is well established. When no contact exists, use the bead-
brush technique to add acrylic resin to the incisal third of the crown on the
proximal surface. Allow the resin to become doughy, and then seat the crown till
the acrylic hardens, to establish the contact. Next, remove the crown, and smooth
any pits or bumps with the acrylic bur. Should the contacts be so tight that the
floss cannot pass through, use the acrylic bur to trim the incisal third. Replace the
crown, and check that both contacts have been adequately established.

Criterion

a. Mesial and distal contacts re-established.

12. REFINE THE CONTOUR, AND POLISH CROWN SURFACES.

While holding the crown in your hand, use the coarse garnet disc or acrylic
bur in the handpiece with the thumb-to-thumb rest, to finish and refine the contour;
exclude centric stops, crown margin, and interproximal contacts. Light pressure
and intermittent strokes will minimize the generation of heat. Coat a fine cuttle disc
with petroleum jelly, place it in the handpiece , and polish the crown until it is free
of pits and rough areas or you may refine the crown surfaces on the late with a
buffing wheel and a thin slurry of fine pumice.

Criterion

a. All surfaces, except centric stops, margin, and interproximal contacts, are
smooth and polished.

13. FINAL CHECK OF MARGINAL FIT, INTERPROXIMAL CONTACTS, AND

OCCLUSION.

Rinse and dry the crown with the water and air spray, to clean away all
debris. Reseat the crown, and check with the explorer that its margin meets the
preparation finish line. The explorer should catch only slightly when moved in a
gingivo-incisal direction along the junction of the margin and the finish line.

Use dental floss to check again for the presence of interproximal contacts.
Then recheck the occlusion. The occlusion marks (if any) should replicate those
noted before the procedure was begun. Remove the crown.

Criteria

a. Crown margin exactly meets and fits the preparation finish line.

b. Mesial and distal contacts re-established.

c. Crown occlusion replicates the occlusion of the unprepared tooth.

14. CLEAN, DRY AND ISOLATE PREPARED TOOTH, AND LUBRICATE CROWN.

41
 Isolate the anterior maxillary area with a cotton roll between the lip and the
gingival. With a cotton roll lubricate the exterior surfaces of the crown with a light
coating of petroleum jelly or cocoa butter, to prevent excess cement form adhering
to the crown. Caution: no lubricant should contact the surfaces to be cemented.

Criteria

a. Preparation is isolated with cotton rolls.

b. Crown exterior is lubricated.

15. CEMENT THE CROWN ON THE PREPARATION.

Prepare a mix of temporary cement according to the manufacturer’s

directions. When the mixture is of uniform consistency, use a plastic instrument to
coat the internal surfaces of the crown evenly with only a thin layer of cement. Dry
the preparation with light air or a dry gauze. Place the crown on the preparation,
and check the margin with the explorer to see whether it is properly seated. Insert
a cotton roll between the maxillary and the mandibular incisors, and bring the teeth
together, holding them with moderate pressure for about 3 minutes until the
cement sets. (You can remove the extruded cement with the explorer after it dries
to the point where the tip of the explorer does not penetrate its surface).

Criteria

a. Temporary cement is mixed to uniform consistency.

b. Interior of crown is coated with a thin layer of cement.

c. Dry the preparation with light air pressure or with a dry gauze.

d. Crown is fully seated on the preparation and hold in place by a cotton roll
between maxillary and mandibular incisors until the cement is set.

16. CLEAN AND DRY THE CROWN AND ADJACENT TEETH.

Remove excess cement from the interproximal areas, the margins, and the
sulcus with the explorer and an excavator; the cement can cause considerable
irritation. Use dental floss to free the contact areas of cement. A knot added to
restored tooth with gauze, remove the cotton roll, and wash and dry the entire area
with the air/water spray.

Criterion

a. Restored tooth and surrounding area are free of excess cement and are clean
and dry.

19. FINAL CHECK OF OCCLUSION AND MARGIN.

Check the occlusion with blue articulating paper. Check the marginal seal
with the explorer. Should incisal prematurities appear, trim and polish with the fine
discs, and then check again.

42
Criteria

a. Occlusion of the restored tooth replicated that of the unprepared tooth.

b. Crown margin is sealed.

43
 SUMMARY OF PROCEDURES AND CRITERIA

Procedure Crieria

1. Measure the mesio-distal a. Procedure completed.

Space between the contact
Areas, and select the crown.

2. Try the crown for fit, and a. Crown fits the mesio-
distal space of the tooth
to be restored.
b. Crown fits over preparation
without binding.
c. Crown contacts adjacent
teeth.

3. Adjust gingival length and a. Crown margin fits over

marginal contour of crown. preparation.
b. Crown margin approximates
the finish line contour
and extends slightly
gingival to the finish line.
c. Crown margin is smooth and
of uniform thickness.
d. Major areas that will need
re-contouring are noted.

4. Clean and dry preparation a. Procedure completed.

and crown, isolate the area,
lubricate the preparation and
adjacent teeth.

5. Fill the crown with acrylic a. Polymer and monomer is

resin and seat it on the incorporated thoroughly to
preparation. a creamy consistency
eliminating air entrapment.
b. Crown interior is almost
completely filled with
acrylic resin, which forms
a shallow, concave surface
at the marginal end of the
crown.
c. Crown is fully seated on
the preparation with its
facial surface flush with
that of adjacent central
incisor.
d. Resin has extruded over the
finish line.

44
6. Remove crown, and trim away a. Margin is free of gross
excess acrylic resin. resin.

7. Reseat crown, and complete a. Acrylic resin liner is set.

Polymerization. b. Interior of the crown
replicates the preparation
and at least 95% of the
finish line is reverse.
c. Acrylic resin liner is
free of large voids.
d. Crown fits preparation
snugly without binding.

8. Trim crown margin. a. Crown margin meets

preparation finish line
exactly.
b. Crown is clean of debris.

9. Adjust occlusion, incisal a. Crown occlusion replicates

length, facial and lingual the occlusion of the unpre-
contours, facio-lingual pared tooth.
Width of crown. b. Tab is removed.
c. Needed contouring is
adjusted.
d. Crown is the same length
gingivo-incisally as tooth
#9.

10. Adjust incisal length, a. Crown margin exactly meets

facial and lingual the preparation finish
contours, facio-lingual line.
Width, and interproximal b. Crown contour resembles
areas. that of tooth #9 facially,
lingually, incisally,
interproximally in the
gingival half.

11. Check and adjust the contacts a. Mesial and distal contacts
of the crown with the re-established.
adjacent teeth.

12. Refine the contour, and a. All crown surfaces, except

polish crown surfaces. Centric stops, margin and
interproximal contacts,
are smooth and polished.

13. Final check of marginal fit, a. Crown margin exactly meets

interproximal contacts, and and fits the preparation
occlusion. finish line.
b. Mesial and distal contacts
re-established.
c. Crown occlusion replicates
the occlusion of the
unprepared tooth.

45
14. Isolate the prepared tooth, a. Preparation is isolated
and lubricate crown with cotton rolls.
b. Crown exterior is
lubricated.

15. Cement the crown on the a. Temporary crown is mixed

preparation. to uniform consistency.
b. Interior of crown is
coated with a thin layer
of cement.
c. Dry the preparation with
light air pressure or with
a dry gauze.
d. Crown is fully seated on
preparation and held in
place by a cotton roll
between maxillary and
mandibular incisors until
cement is set.

16. Clean and dry the crown a. Restored tooth and

and the adjacent teeth. surrounding area are free
of excess cement and are
clean and dry.

17. Final check of occlusion a. Occlusion of the restored

and margin. tooth replicates that of he
unprepared tooth.
b. Crown margin is sealed.

46
 Module 4
Placing a custom plastic temporary crown

47
 MODULE 4

PLACING A CUSTOM RESIN TEMPORARY CROWN

This particular crown can be fabricated for a posterior or anterior tooth. A custom
resin crown can be made for a full coverage, ¾ crown, inlay or onlay preparation without
a great deal of involvement. It has a superior occlusal and gingival fit because it is
molded from an impression of the patient’s tooth. The crown’s tooth-like appearance is
an additional advantage. The crown’s tooth-like appearance is an additional advantage.
Construction of this crown may take longer to learn initially; once the contouring
technique is mastered, it can be quick and easy.

In this module the fabrication of a custom resin crown for tooth #14, the maxillary
left first molar, is presented.

Overview of Procedure

The procedure begins and ends with checking occlusion. After checking
occlusion, the operator will need to take an alginate impression before the tooth is
prepared. Check the impression for air bubbles or voids in the area of the tooth that will
be prepared for the crown.

After the tooth is prepared, the operator may want to remove proximal tags from
the impression and reseat the impression to check for proper placement over the
prepared tooth. An acrylic resin is then mixed and placed in the alginate over the
impression of the tooth that has been prepared for a crown. The impression, which is
filled with acrylic, is then placed over the prepared tooth. As the acrylic resin
polymerizes over the prepared tooth, it will replicate the contour of the unprepared
tooth. The temporary crown is then gently eased out of the impression and ready for
trimming and contouring to fit the finish line of the prepared tooth. Once the contacts
and occlusion are established, the crown is polished and cemented in place.

48
 ARMAMENTARIUM

1. PPE
2. articulating paper and holder
3. typodont with prepared tooth
4. assorted quadrant impression trays
5. tray adhesive (for plastic trays)
6. utility wax
7. alginate
8. alginate scoop
9. alginate-mixing spatula
10. plastic mixing bowl
11. lab knife (or scalpel)
12. cement mixing spatula
13. spatula (#7)
14. gauze sponges
15. acrylic resin
16. medicine dropper
17. dappen dishes
18. small scissors (or curved crown and bridge scissors)
19. spoon excavator
20. sharp soft pencil (#1) (optional)
21. acrylic bur
22. pumice impreginated rubber wheel
23. assorted discs/mandrel (Moore’s)
24. petroleum jelly
25. dental mirror
26. explorer
27. dental floss
28. cotton rolls
29. temporary-cement kit
30. mixing pad
31. double-ended plastic instrument
32. lathe (optional)
33. rag wheel (optional)
34. fine polishing agents (optional)
35. low speed straight and contra angle handpiece

49
 PROCEDURE

Preliminary Procedure

To prepare for the fabrication of an acrylic resin temporary crown, first

clean the left maxillary quadrant.

1. Check to be sure you have all the supplies listed in the Armamentarium.

2. Check occlusion with the unprepared tooth #14 by placing blue articulating paper
between the left maxillary and the left mandibular arches, and gently tapping the
teeth together in centric occlusion. There must be at least one occlusal mark on
each tooth. (Note: this pattern must be replicated when the temporary crown is
placed.)

3. Take an impression of the maxillary arch before the tooth is prepared for a crown.

4. Place the prepared tooth #14 in the dentoform; retain the unprepared tooth with its
occlusal markings for future reference.

Crown Fabrication and Placement Procedures

1. TAKE AN ALGINATE IMPRESSION OF THE UNPREPARED TOOTH.

Select proper try size. A sectional tray works best since the temporary
crown will be constructed for a single tooth and there is no need to use4 a full arch
tray. There are two types of sectional trays. One type is hard plastic or metal tray
held in place by the operator while the alginate sets. The other type is a disposable
bite tray, which is held in place by the patient occluding on it until the alginate
sets.

Mix the alginate according to manufacturer’s instructions. Inspect the

impression to be sure all details of the prepared tooth are accurately replicated
and the impression is free of large voids and torn areas or potential undercut
bulges. If the impression is acceptable, use a lab knife (or scalpel) to trim large
overhangs of alginate that extend beyond the impression tray and thus might
cause distortion. Remove interproximal tags from the alginate impression with a
sharp instrument or cotton pliers. This allows the impression with a sharp
instrument or cotton pliers. This allows the impression to be reinserted more
easily and gives sufficient bulk to the temporary. Use the air and water spray to
clean the impression. Wrap with a moist paper towel until ready for acrylic resin.

Criteria

a. Impression shows all details of the prepared tooth.

b. Impression is free of large voids, torn areas, and defects.

c. Impression is free of interproximal tags of alginate.

d. Impression is clean and wrapped in moist paper towel.

50
 2. PLACE PREPARED TOOTH IN DENTOFORM

After placing the tooth in the dentoform, reseat the impression to check for
proper placement over the prepared tooth. Coat the preparation and adjacent
tissue with petroleum jelly.

3. FABRICATE THE ACRYLIC RESIN CROWN.

The technique for mixing the acrylic resin can be done directly in the
alginate impression or it may be mixed in a dappen dish and applied to the
impression mold of the area to be temporized. In order to add directly to the
impression, isolate with cotton pellets, then begin by adding a small amount of
polymer then a few drops monomer (liquid) with an eye dropper directly in the
impression mold of the unprepared tooth. (Let the drops fall on the walls of the
preparation in order to prevent bubbles.) Then add sufficient polymer (powder) to
absorb the liquid. Each ingredient is added repeatedly in turn until the tooth mold
is approximately two-thirds full.

In order to use the dappen dish technique, partially fill the dappen dish with
the monomer and then the polymer to absorb the liquid. The operator can add
polymer gradually while tapping the dappen dish on the counter top to help
saturate the monomer and eliminate air bubbles which could weaken the mix.

Regardless of which technique is used to mix the resin, the key elements
are to apply the monomer and polymer repeatedly and to keep the eye dropper of
monomer from touching the mix plus, taking further caution not to over fill the
impression should help you form a solid crown which is not full of bubbles.

The resin in the impression is ready to be placed over the prepared tooth
when it has lost its highlights and surface shine. Hot water can hasten
polymerization. With even pressure, hold the impression in place or have the
patient occlude; if using the disposable bite tray. The operator can hold excess
acrylic resin between the fingers in order to monitor polymerization. The
impression tray should be held very still until polymerization occurs
(approximately 3-5 minutes). The acrylic resin will be slightly rubbery when it is
ready to be removed.

Criteria

a. Acrylic resin is mixed to proper consistency.

b. Impression of tooth is two-thirds full of acrylic resin mix.

c. Impression is seated over prepared tooth and held still for approximately 3-
5 minutes.

d. Acrylic is at the slightly rubbery stage when removed.

4. REMOVE CROW FROM IMPRESSION AND EXAMINE IT

Remove the crown from the impression. Use very gentle movement if the
crown remains on the tooth when the impression is removed. The operator can
ease the crown off of the preparation. Move very quickly at this point to trim
excess bulk. Use curved crown and bridge scissors to trim away excess from the

51
 interproximal, buccal and lingual crown margins. All of the bulk excess should be
trimmed quickly to prevent final set before placing the crown on the tooth. If final
set occurs before placement, the crown may shrink or warp and will not fit
properly.

Inspect the crown for voids. If any voids are present, fill them with acrylic
resin, using the bead-brush technique. The crown should be clean and dry before
each addition of resin. Dip the brush into monomer and then into polymer; paint
the mixture into the void; clean the brush in a second dish of monomer; and wipe
the brush on gauze. Repeat until the void is slightly overfilled.

Criterion

a. Crown replicates the unprepared tooth on its outer surface and the prepared
tooth on its interior surface.

5. REMOVE MARGINAL EXCESS FROM CROWN.

Mark the preparation finish line with soft lead pencil. Trim the marginal
excess to the finish line with acrylic bur and/or assorted discs. If the gingival 1/3 of
the crown has excess bulk where the interproximal tags of the impression were
trimmed, remove excess with the acrylics bur, and clean the crown of debris with
an air spray.

6. CHECK CONTACTS, MARGINAL ADAPTATION, AND CONTOURS OF THE CROWN.

Place the crown on the prepared tooth, and assess its fit. If the crown does
not seat completely, one or both contacts may be too bulky. Acrylic resin may be
removed with the acrylic bur. Reseat the crown and check the contacts with dental
floss. Should the contact areas (in the middle third) be under contoured, add
acrylic resin to the crown with the bead-brush technique. The crown must be clean
and dry for the resin to adhere, and it should be seated when the resin is at the
rubbery stage in order to establish the contacts. Trim the acrylic resin additions
with the acrylic bur, and clean away the debris with an air spray.

Once the crown is fully seated, make sure the margin meets the finish line
and conforms to it. If the crown has an open margin or needs more retention, at
this point you can reline the interior of the crown with resin. Relining is
accomplished by mixing the resin in a dappen dish or adding monomer to the
interior of the crown and slowly adding the polymer. It is important that the
operator seats the crown properly and applies pressure as the acrylic polymerizes.
In the clinical setting, the operator would want the patient to occlude on a cotton
roll or use an index finger to assure even pressure. Acrylic additions should be
smoothed with an acrylic bur or disc. A mouth mirror is used to compare the
buccal and lingual contour of the crown with that of the adjacent teeth. Contour the
crown as necessary. May add resin just to finish lines.

Criteria

a. Mesial and distal contacts re-established.

b. Crown margin is adapted to the finish line.

52
 c. Buccal and lingual contour of crown conforms to that of the adjacent teeth.

d. Crown is free of debris.

7. CHECK OCCLUSION.

The thickness and contour of the occlusal surface of the crown depend on
the pressure that was exerted during polymerization. Check occlusion after
seating the crown on the prepared tooth. Compare the markings on the crown with
those of the unprepared tooth. Remove any prematurities with the acrylic bur.

If the crown is in infra-occlusion, add acrylic resin, using the bead-brush

technique. After applying the acrylic resin, wait a moment for the acrylic resin to
develop a doughy texture; then seat the crown and close the teeth into occlusion
to contour the occlusal surface of the crown.

Criterion

a. Crown’s occlusion replicated that of the unprepared tooth.

8. SMOOTH AND POLISH THE CROWN.

Remove the crown. With a straight handpiece and a pumice-impregnated

rubber wheel, smooth all of its surfaces. Use light, intermittent strokes to keep
from deforming the contours and contacts. For a highly polished surface, you may
use a polishing agent with the rag wheel on a lathe.

Criterion

a. Crown is smooth and shiny.

9. CHECK CROWN BEFORE CEMENTATION.

Reseat the crown. Check its marginal adaptation, contacts, contours, and
occlusion, as before.

Criteria

a. Crown marginal meets, contours to, and fits snugly against preparation
finish line.

b. Crown contacts adjacent teeth.

c. Crown’s contours duplicate those of unprepared tooth #14.

d. Crown’s occlusion replicates the occlusion of unprepared tooth #14.

10. CEMENT THE CROWN.

Remove the crown; rinse and dry the preparation area. Isolate the area
with rolls of cotton. Apply a thin layer of petroleum jelly to the exterior of the

53
 crown, to facilitate the removal of the excess cement. The lubricant should not
contact the interior of the crown; it will prevent adherence.

Mix temporary cement according to the manufacturer’s directions. When it

has a uniform consistency and flows freely, use a plastic instrument to coat the
internal surfaces of the crown with a thin layer of the cement.

Seat the crown on the preparation. Place a cotton roll on the occlusal
surface of the crown, and occlude the teeth. Check with the explorer at the
crown’s margin to see that the crown is fully seated. Hold the teeth in occlusion
until the explorer can no longer penetrate the extruded cement.

When the cement is set, remove the cotton rolls, and use the explorer to
chip away any excess cement. Use dental floss to free the interproximal areas of
cement. A knot can be tied in the floss to aid in interproximal removal of cement.
Rinse and air dry the restoration.

Criteria

a. Preparation is clean, dry and isolated.

b. The exterior of the crown is lubricated.

c. The interior of the crown is coated with a thin layer of temporary cement.

d. Crown’s margin fits snugly at preparation finish line when crown is seated.

e. No excess cement is present.

f. Restoration is clean and dry.

11. CHECK CROWN AFTER CEMENTATION.

Using the mirror and the explorer, check the crown margin for fit and seat.
At least 95% of the margin must meet the finish line. Compare the contours of the
crown with those of the adjacent teeth.

Check contacts, and make a final occlusal check. Should the crown need
re-contouring, use a green stone and then a fine disc.

Criteria

a. At least 95% of the crown margin meets preparation finish line, and entire
margin is sealed with cement.

b. Crown contours are aligned with those of adjacent teeth.

c. Crown contacts adjacent teeth mesially and distally.

d. Crown’s occlusion matches occlusion of unprepared tooth

54
 SUMMARY OF PROCEDURE AND CRITERIA

Procedures Criteria .

1. Take an alginate impression of a. Impression shows all of the

the unprepared tooth details of the prepared tooth.

a. Impression shows all of the

details of the unprepared tooth.
b. Impression is free of large voids,
torn areas, and defects.
c. Impression is free of
interproximal tags and large
overhangs of alginate.

d. Impression is clean and free of

2. Test seating the alginate excess water.
impression on dentoform.
a. The impression of the prepared
tooth seats fully into the
dentoform of the unprepared
tooth. Coat prep and tissue with
3. Fabricate the acrylic resin crown. petroleum jelly.

a. Impression of tooth #14 is two-

thirds full of acrylic resin mix.

b. Impression is fully seated on the

dentoform with even pressure.

c. Impression is held very still

(approximately 3-5 minutes) until
4. Remove crown from impression slightly rubbery.
and examine it.
a. Crown replicates the unprepared
tooth on its outer surfaces and
5. Remove marginal excess from the prepared tooth on its interior.
crown.
a. Crown is trimmed to the
impression margin.

6. Check contacts, marginal b. Crown is free of debris.

adaptation, and contours of the
crown. a. Mesial and distal contacts re-
established.

b. Crown margin is adapted to the

finish line.

c. Buccal and lingual contour of

crown conforms to that of the
adjacent teeth.

55
d. Crown is free of debris.

a. Crown’s occlusion replicates that

of the unprepared tooth.
7. Check occlusion.
a. Crown is smooth and shiny

8. Smooth and polish crown. a. Crown margin meets, contours

to, and fits snugly against
9. Check crown before cementation. preparation finish line.

b. Crown contacts adjacent teeth.

c. Crown contours replicate those

of unprepared tooth #14.

d. Crown occlusion replicates that

of unprepared tooth #14.

a. Preparation is clean, dry and

isolated.
10. Cement the crown.
b. The exterior of the crown is
lubricated.

c. The interior of the crown is

coated with a thin layer of
temporary cement.

d. Crown margin fits snugly at

preparation finish line when
crown is seated.

e. No excess cement is present.

f. Restoration is clean and dry.

a. At least 95% of the crown margin

meets preparation finish line, and
11. Check crown after cementation. entire margin is sealed with
cement.

b. Crown contours are aligned with

those adjacent teeth.

c. Crown contacts adjacent teeth

mesially and distally.

d. Crown occlusion matches the

occlusion of the unprepared
tooth.

56
 Module 5
Additional techniques employed for fabrication of
custom temporary crowns

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 MODULE 5
ADDITIONAL TECHNIQUES EMPLYED FOR FABRICATION OF CUSTOM TEMPOARY
CROWNS

The previous modules have listed the basic objectives and described the technique for
fabrication of a custom acrylic temporary crown. There are a few other techniques that are
employed in some dental practices. This segment of the temporary crown module is
intended to familiarize the student with these techniques: however, actual practice is
recommended prior to attempting them in the clinical setting.

Additional techniques for fabrication of custom temporary crowns which will be

discussed include the following:

1. Wax molding technique

2. Silicone putty impression
3. Intraoral molding technique
4. Vacuum-formed plastic resin tray
5. Temp tab impression
6. Relining of the aluminum temporary crown

Wax Molding Technique

Instead of taking an alginate impression, the operator may use pink baseplate wax for
taking the impression.

1. Cut a piece of 3” x 5” baseplate wax to approximately 3” x 2 ½” and fold it in half

lengthwise. Place the wax in a bowl of hot water to soften. (or place over hot water
facet or flame.

2. Place the wax over the prepared tooth and finger burnish it onto the occlusal
surface and into the interproximal areas. Wax is hardened by cooling with air from
air/water syringe. Once the wax matrix hardens, remove it from the prepared tooth
and trim excess wax.
3.
Use the wax molded impression in the same manner as an alginate impression.
The operator may want to cool the acrylic resin while it is polymerizing with the air
from the air/water syringe.

Some operators prefer the wax molding technique because it is less expensive tha
alginate impressions and trays and it saves time.

Silicone Putty Impression

Another impression material used for custom temporary crowns is silicone putty.
Silicone putty is placed in a sectional tray like the alginate impression material.
Some operators prefer silicone putty impressions because o their versatility for use in a
broad range of techniques. Most manufacturers supply additional curing silicones in
various viscosities. The advantage with the silicone putty is that the final impression is
taken with the putty impression serving as your custom tray.

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Temp Tab Impressions

Temp Tabs are a small disk of plastic used to make a matrix of the unprepared tooth.
Although they are somewhat expensive, they are simple to use and can be reused as
needed.

1. The Temp Tab is heated in hot water until clear.

2. The Tab is molded over the unprepared tooth and
allowed to set.
3. Air may hasten the cooling and set of the Tab.
4. The prepared tooth, adjacent tissue, and Temp Tab with
petroleum jelly.
5. Add acrylic to Tab and seat over prepared tooth.

Intraoral Molding Technique

An impression of the tooth is not necessary when the intraoral molding technique
or “blob” technique is employed. The acrylic resin itself is used to fabricate the
temporary crown without any preliminary impression prior to tooth preparation.

1. Mix the acrylic resin in a dappen dish as described

previously.
2. When the resin has lost its highlights and has a doughy
consistency (like putty), the operator molds the resin
into a rectangular “blob”.
3. The acrylic is molded over the prepared tooth and the
patient occludes in order to establish the impression.
4. Gross excess will be present on the buccal, lingual and
interproximal surfaces. The excess is trimmed in the
mouth with a sharp instrument, or the temporary is
removed from the mouth and crown and bridge scissors
are used for trimming. It is important to proceed quickly
at this point to prevent shrinkage. The final
polymerization should be done in the mouth. The
patient’s tongue can help mold the resin on the lingual
surface.
5. Proceed with trimming and contouring according to
dental anatomy of the particular tooth being restored.
Check the occlusion.
6. Sometimes it is necessary to re-line the first attempt or
to add contact areas of the occlusal surface. This re-
lining is easily accomplished as described in Module 3
and 4.

The advantage of this technique is that it does not require any initial work before
the tooth is prepared. It is preferred by some operators when the patient has broken teeth
and a preliminary impression of the unprepared tooth is impossible. The intraoral
molding technique works well for anterior or posterior teeth. It also has excellent margin
adaptation. This technique is particularly suitable for inlays, onlays and ¾ crowns.

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Vacuum-formed Plastic Resin Tray

A vacuum-formed plastic resin tray is a plastic matrix heated to the shape of the
arch using a vacuum forming system. It can be a full arch matrix or a sectional. It is used
when the dentist is making multiple crowns of several unit brides. In this case, it is very
helpful to have a clear plastic resin sheet vacuum-formed to the study model.

This type of tray enables the operator to have a custom tray made to fit the
patent’s mouth without the distortion that can occur with an alginate impression. This
custom form can be re-used a number of times if needed, unlike alginate impressions.
The disadvantage of the plastic resin tray technique is that it may require two
appointments: one for the study models used to make the tray and one for the crown
preparation. The advantage is the clear tray allows the operator to see if is seated
properly.

Relining Aluminum Shell Crowns

At times, aluminum shell crowns may not have adequate retention or marginal
adaptation. It is possible to reline the shell with acrylic resin. This technique would result
in an aluminum temporary crown which fits better and last longer.
1. Coat prepared tooth with
petroleum jelly.
2. Mix acrylic in dappen dish or
directly in the aluminum shell.
3. Place acrylic in the aluminum
shell, 2/3 full, and allow time for
surface to dull.
4. Place lined shell on prepared
tooth and apply even pressure, or
have the patient bite down.
5. Trim excess acrylic in the mouth
with a sharp instrument.
6. Smooth, polish, and clean crown
before cementing.

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 STUDY QUESTIONS-MODULE 1

1. Why are temporary crowns placed?

2. List the types of temporary crown.
3. What is a finish line?
4. What are the common forms of finish lines?
5. List the major types of resin materials. Give their advantages and disadvantages.
6. Why is it vital that the liquid of the acrylic resin be thoroughly mixed with the powder?
7. Define occlusion and centric occlusion.
8. Why is it important to for temporary crowns maintan stable occlusion?
9. What causes unstable occlusion?
10. During cementation. Why is it imperative not to desiccate the preparation?
11. Why is it important to practice proper asepsis?
12. What function does the temporary cement serve other than adhering the crown to the
preparation?
13. Why is it important that the margin fit well?

STUDY QUESTIONS-MODULE 2

1. List the advantages and disadvantages of temporary aluminum crowns.

2. What measurement is a used first in determining which size crown to use?
3. If the aluminum temporary is short what should be done?
4. What adjustments should be made if the crown is in supra-occlusion? Infra –occlusion?
5. What criteria determine a properly fit temporary aluminum crown?

STUDY QUESTIONS- MODULE 3

1. What techniques are used to adjust the size of a temporary polycarbonate crown at the try in
step?
2. What indicates that a temporary drown is over-contoured on the lingual? On the facial?
3. Why must the crown be removed from the preparation before the acrylic is completely
polymerized?
4. What difference would it make if the crown ere over-contoured at he gingival third?
5. What difference would it make if the incisors were not in occlusion at the preparation check,
but they were after the crown was cemented in place?
6. What is the function of the acrylic resin liner?
7. Why is the prep and adjacent tissue coated with petroleum jelly?

STUDY QUESTIONS-MODULE 4

1. What are the advantages and disadvantages of custom temporary crown?

2. How can you hasten polymerization?
3. When is the resin ready to place over the prepared tooth?
4. What can cause distortion of the occlusion and contours of a custom crown during
polymerization?
5. When can you remove the impression with the acrylic from the prepared tooth?
6. List the criteria for the cemented crown.

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 STUDY QUESTIONS-MODULE 5

1. What are the alternative techniques for fabrication of a custom temporary crown?
2. What are the advantages of each technique?
3. Which technique is considered most versatile? Affordable?
4. Why is it necessary for the operator to reline the aluminum shell if it already fits snuggly to
the finish line?

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 REFERENCES

Baum, Lloyd, McCoy, Richard B. Advanced Restorative Dentistry.

Philadelphia: W.B. Saunders Co., 1984

Castano, Frances, A., Alden, Betsy. Handbook of Expanded Dental Auxiliary Practice.
J.B. Lippincott Co., 1973.

Chasteen, Joseph E. Essentials of Clinical Dental Assisting. The

C.V. Mosby Co., 1989.

Phillips, William J. Elements of Dental Materials. Philadelphia:

W.B. Saunders Co., 1984.

Simon, William J. Clinical Dental Assisting. Harper and Row,

Inc., 1973.

Spohn, Eric E., Halowski, Wendy A., and Berry, Thomas G. Operative Dentistry
Procedures for Dental Auxiliaries. The C. V. Mosby Co., 1981.

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