Februari 22, 2017
step 1 is always to put a throat pack in andprotect the airway to make sure nothing falls back into the lungs or stomach ... just kindof snake it back and forth into the oropharynx, so that it's completely full. that way anythingfalls back there, it's very easy for us to just pick it up. always prophy [prophylaxis] first, that wayyou are treatment planning off of clean teeth. it makes it much easier to detect decay andnot miss anything. alright, so, we're going to prep a cheng crown on tooth number h. the first step i do [is] occlusal reduction. and then i go interproximal.
a good rule of thumb that i do is the cuttingedge of the burr, i usually put that at the reduced occlusal height table, and that'show far i know to go subgingival. and basically you just have to adjust your reduction depending on where the decay is and how extensive that decay is. there's still a little bit here,but i'll address that in a second, and then what i do is bevel the lingual, and as younotice, the shapes of the crown are similar to a natural tooth, and have that lingualbevel. i go through to make sure there are no sharp angles anywhere. i'll just touchup that one spot that has a little extra decay. then you do your pulpotomy or your pulpectomyaccess ... kind of straight in.
open that up. size 80 file. and the pulp just comes right out. just go in a couple more times to make sureit's nice and clean. formocresol point. and you let that sit for a little bit. now i use vitapex which is an injectable filling material, which is nice because you can putit to the apex and as you squeeze you retract, and you get a nice perfect fill every time,but because this washes away a little bit
easier than regular zoe, i like to cap itoff ... gives it a little more sturdiness. and them i’m just going to prep the toothnext to it, and then we can fit those crowns. the same thing in the front ... occlusal reduction, and depending on the decay, it's usually a millimeter and a half to two millimeters,and you do interproximals. again, the height of the cutting burr ... iput the top of it at the occlusal height of the reduced plane there and that's usuallymy guide to know how deep to go. as you can see, as you take away more tooth structure,it becomes more uniform in color and that
kind of just denotes that you're getting toa healthy layer of tooth and no longer have decay, which is what you want. you want solidtooth structure, and then you bevel the lingual again. then i just make sure there's no sharpangles anywhere. come in, do your pulpotomy access. see, the pulp tissue comes right out. make sure the inside is nice and clean. while we're waiting, i'll finish prepping the facial tooth b. vitapex again... in the center. directing until you see it come out and retract, and then cap it off. what i like about the vitapex is that it'sbactericidal, so it also helps decrease the
bacteria count within the internal root structure. now, tooth d. same thing. occlusal reduction. interproximal reduction. i can see there's an old composite filling on here. bevel the lingual, round off any sharp edges. okay, we can try on some crowns. let's try a right lateral ... let's go 4. just for fun, can i see a 3? i like the way this fits, but i just want to... check. okay, so we're going to go with the 3’s.
that's nice. those 3’s more closely resemble the original shape and size of the teeth. as you notice, they got some pretty decent gapping everywhere. you want to try to reproduce as closely the original size, which you can do pretty easily. and that fits pretty nicely. so we can cement those. so that's how you do two lateral incisors and one canine. as you can see, it turns out pretty good. extremely stable and durable. in my opinion, one of the nicest restorations you can do. so what we'll do is we'll cement these. go around and remove any excess cement. as you can see,
it fits perfectly. gingiva, as long as the patient keeps it clean, will heal extremely nicely within a day or two. and that's it. and that's the exact sound you want to hear. a nice snap into place means no adjustment needed. pop it off. crown size is set. take out the formo pellet. you can mix cement. ok the crowns fit. cemented. perfect shape and size. occlusal reduction.
again, interproximal. if there's any decay or [inaudible], then we'll buffer the lingual surface. can i see an upper right d4? make sure it's seated all the way. check for excess cement. and that's all, she wrote.
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