Dr. Howard Jay Kirschner

The adage “Try before you buy” is very applicable to dentistry, especially with crown and bridge restorations. I find that after insertion of a crown or fixed bridge with Waterpik Opotow Trial Cement, 100% of my patients report their restorations seat, and are more comfortable after a few days or a week.

The occlusion, which at first may seem high, settles in and is self-adjusted. Tight crowns fit comfortably with good contact points after a few days with the restoration. However, I find these outcomes only when using Opotow Trial Cement, a nonsetting adhesive with a rubbery consistency.

Inserting a fixed prosthesis with rubbery trial cement gives patients an opportunity to be certain they are comfortable and satisfied with the prosthesis before final cementation. In doing this you give the patient an opportunity to complain about any aspect of the restoration. Once they return for final cementation, and say they are happy, you have fulfilled your obligation to allow the patient to try the prosthesis before final cementation.

Often a crown does not fully seat when first inserted, and the dentist reduces the occlusal. This is wrong unless you gave the lab an inaccurate bite. It’s better to take a new bite and return the case to the lab.

Designed to provide temporary adhesion during try in of bridges, splints, and porcelain-fused-to-metal crowns and bridges, Opotow Trial Cement is a nonhardening material that can easily be removed after the try in is completed. The temporary material kit includes accelerator, base, mixing pad, and tube key. The material is suited for use with temporary restorations from veneers to multiunit bridges.

I realize temporary cementation with Opotow Trial Cement involves an additional visit; it is well worth the extra time. You don’t want a patient to return with a complaint after permanent cementation.

This approach works because the rubbery consistency of the cement allows for easy, nontraumatic removal prior to final placement. Comparatively, regular temporary cement will harden. You must have faith in your lab, and confidence in your bite. The slight tooth movement during the time between the impression and insertion often is responsible for any difficulty in seating the restoration, and that will correct with trial cementation.

It is easier to remove a prosthesis seated with a rubbery trial cement than a prosthesis without any cement at all. There is no point to using a hard setting temporary cement, as that will not permit crown movement. It is best to use a rubbery cement that allows the prosthesis to seat in function. When you remove the prosthesis prior to permanent cementation, Opotow Trial Cement usually peels cleanly out of the crown.

A word of caution: It is best to use a thin viscosity permanent cement that will permit full seating of the prosthesis. Also, watch your setting time. The permanent cement is thinner than the trial cement, so the prosthesis will actually feel even more comfortable to the patient after permanent cementation.

Allowing a patient to wear a fixed prosthesis for a period of time before final cementation offers benefits from a patient/dentist relationship, as well as a legal relationship. The prosthesis will be more comfortable if you let the case fully seat for a few days in function. Tell the patient to bite on it, chew on it, and use it (but avoid chewing gum or sticky foods). Wearing the prosthesis for a few days also helps detect unseen defects prior to permanent placement.

The patients will be very appreciative if you tell them they will have an opportunity to wear the prosthesis before final cementation. A fixed prosthesis might not seat for 1 or more of several reasons, such as bad fit due to a poor impression, bad bite impression, tight contacts from excessive contact reduction, or too thick cement from being either improperly dispensed or mixed, or set too quickly. Such a crown is not fully seated, and will have open margins filled with cement that could be a future source of decay and gum recession.

If you were careful with your bite and impression technique, you should hardly ever have to adjust the occlusion. Our 21st-century impression and bite materials, along with excellent laboratory techniques, should make occlusal adjustments a memory from the 20th century.

“Try before you buy” is ever more pertinent when inserting crowns and fixed bridges. It lets the patient try the new prosthesis before permanent cementation. Doubting patients will become your biggest fans.

Articles

Why one clinician uses Opotow Trial Cement from Waterpik to let every crown and bridge patient test the restoration’s fit before permanent placement.

Closer Look: Let Your Patients Try Before They Buy

I found paradise in the form of QuickShot Instant Film Digitizer. This system really is bliss for dentists who elect to not use digital x-rays. This x-ray copy machine allows analog x-ray films to be digitized and sent by computer, just like digital x-ray images.

Jim Jacobson invented the QuickShot Instant Film Digitizer, and each machine is carefully assembled in Spokane, Washington. Jacobson is an inventor, but he isn’t into marketing, so I only found out about this machineby accident on the internet.

The system has proved to besimple enough when I added it to my practice. Installation was easy and required nothing more than connecting to an available port on my office computer and installing the supplied software.

Designed to capture high-resolution digital images from film x-rays, the QuickShot enables practices using film x-rays to access the advantages of digital radiography. Said to be easy to set up and featuring a simple practice management software connection, the QuickShot makes it simple for any practice to use x-ray images for on screen patient presentation, electronic claims submission, referrals to other providers, and easier archiving of patient records.

In a short time, it has become an integral part of our everyday computer use. We truly use the scanner and software all day. The system offers plenty of flexibility because it can interface with your existing practice management operations or as a stand-alone unit. You can organize your x-rays into folders with each patient’s name for future access, making it simple to find what you’re looking for whenever you need it. With digital x-ray images, nothing can get lost. You can even enlarge just a portion of an x-ray and print it.

Now, with the QuickShot in use to digitize my x-ray films, I can electronically send cases for insurance authorizations and approvals. The ability to include digital versions of x-rays helps provide a faster turnaround time. Also, I no longer need to use a 2 film x-ray packet to duplicate my images, which means cost savings for my practice. Additionally, I never lose copies of the x-rays I have to send to insurance carriers that no longer return any x-rays.

QuickShot has already standardized workflow in my practice. My assistant, Carolina, places the analog film on the screen at the back edge to keep it straight, and she presses a few buttons. Almost instantly, the x-ray image is saved into our files and ready to attach for electronic processing.

To me, this is heaven.I resisted going into digital x-rays. Now this machine gives me all the benefits of digital x-rays without the expense and trouble.

You can also use QuickShot for scanning other types of images for more than just documentation and claims. If you need to duplicate an image of almost anything, you can place a picture, photo, or model on the screen and print an accurate copy on your printer.

This machine is not only the fulfillment of my dream but has saved me a lot of money compared with the cost to integrate a full digital x-ray system into my practice. I am still learning all the wonderful things I can do with this machine, and I’m excited about finding new applications in my practice.

A wonderful thing about X-Ray Support is that they care. They are always just a phone call away to help. QuickShot is not available through any supply dealer, only directly from the manufacturer.

Based on my experience with the system, I can confidently say QuickShot is not only an excellent addition to my team’s armamentarium, but it is also just plain fun to use.

How the QuickShot Instant Film Digitizer from X-Ray Support brought the benefits of digital imaging to one dental practice.

A Simple Path From Analog to Digital Imaging

How can there be “secret” dental impression trays? I began my quest of discovery when my laboratory lost my favorite COE impression tray. I called GC America, Inc., for a catalog and discovered a treasure trove that had not been part of my dental school kit and that I’d never seen in any convention display or heard any lecturer mention.

These metal denture impression trays originally were made by COE Laboratories. There are two kinds of full and partial denture trays: trays with perforations, for use with alginate impression materials, and solid, nonperforated trays for use with solid impression materials, such as red compound or fast-set impression plaster No. 2.

The COE line of impression trays are available in many shapes, sizes, and types. The metal trays include aluminum, nickel-plated, and stainless steel trays, which are available in perforated and solid for rigidity. The line also features disposable Triple Function Check-Bite trays and disposable Triple Function Sideless trays.

The trays are inserted into the mouth, and the facial muscles are manipulated for border molding. The impression is poured up with regular lab plaster. A base plate is fabricated from the resulting model, and this is used for the final denture impression. A well-fitted denture impression tray will lead to a well-fitted base plate and final denture impression.

The catalog shows all the standard trays, plus several pages of trays that were unknown to me. Here are five of them, listed with numbers for better understanding and quick reference:

No. 3. McGowan-Winkler perforated immediate (depressed)

No. 4. McGowan-Winkler complete denture (perforated and solid)

Sheldon Winkler, DDS, designed a partial denture tray, which allows for a step down in the No. 3 tray for the remaining anterior teeth and the depressed posterior alveolar ridge. This is a 2-level impression No. 3 tray, so the edentulous posterior tray is closer to the ridge and extends deeper on the lingual mylohyoid region. This is brilliant and logical. These trays are the McGowan-Winkler perforated immediate trays for immediate and partial dentures.

The No. 1 Depressed Anterior perforated trays are for immediate and partial dentures, but have a buccal flange that is longer for wider ridge impressions, along with the 2-step depression for residual anterior teeth. The No. 3 McGowan-Winkler perforated immediate denture set of trays consists of upper and lower trays, which have a depression for the remaining anterior teeth to be extracted. The trays have two planes: the first is for the remaining anterior teeth, and the other is a step down for the posterior edentulous resorbed ridge area. These trays allow for an excellent impression of the depressed resorbed posterior ridge and the residual anterior teeth to be extracted.

COE also offers a regular partial denture impression tray in an extra long perforated version (No. 2) for the unique case of a longer-than-usual upper or lower jaw. These trays are not available with the depressed anterior.

The No. 5 STO-K trays are for full denture impressions. They are available as perforated and solid and come in three shapes to match a patient’s jaw: square, tapered, and ovoid. Each shape is available in many sizes, and the entire set, upper and lower, consists of 23 trays.

The STO-K perforated and metal lower full denture trays have a unique and very significant lingual extension into the mylohyoid region, essential for a good impression of the mylohyoid for mandibular denture retention. This impression permits a lingual flange, which is critical for denture retention. They do not have the unique button, or as much anatomical design as the McGowan-Winkler perforated immediate tray.

Such a varied tray selection lets you match the tray as closely to your patient’s anatomy as possible. It is necessary to have a complete set of trays in every size and mold (shape) to properly fit every mouth. These trays will solve a multitude of partial and full denture impression problems, because you can select a tray that best fits your patient.

A good denture starts with a good impression. A good impression starts with a good tray. A partial denture tray cannot serve as a substitute for a full denture tray. The use of some of these lesser known, but highly effective trays can make all the difference in a patient’s success with dentures.

Denture impression trays from GC America should be your next purchase—here’s why. 