The self-made PICK & PRESS INSTRUMENT: an easy route to indirect cementation

7 Dec 2017 - 23884

Indirect composite/ceramic cementation represents an important aspect of treatment with indirect restorations. Surprisingly, while everybody talks about how we should proceed with these kinds of restorations, the most common mistakes are rarely discussed.

Employing the correct cementation technique enables practitioners to avoid many mistakes, such as:
– Time-consuming correction of occlusal interferences
– Incorrect marginal adaptation due to bad sitting of the restoration and resulting greater thickness of cement
– Confusion of the mesial side with distal one, leading to attempts to cement back to front 

– Losing the indirect restoration in the middle of the cementation process, as the restoration can easily slip from the fingers.

The inlay/onlay pick up and silicone press technique is described here, based on the following clinical case:

Fig. 1

The patient attended the dental clinic in order to replace a failed composite restoration in tooth 16. The tooth was root canal filled.

Fig. 2

As the tooth was root canal filled, the cusp coverage was indicated and composite onlay was planned. The cusps were reduced by 1.5-2.0 mm with a diamond bur of appropriate dimension.

Fig. 3

The old composite restoration was removed proximally from both sides, the demineralised tissue was cleaned, and the gingival margin was elevated with composite resin.

Fig. 4

Then the preparation was finished, and an impression taken to be delivered to the laboratory (the composite onlay – dent. techn. Roman Fraczek)

Fig. 5

A rubber dam was placed in order to isolate tooth 16 from neighbouring teeth. Then, tooth 16 was sandblasted with 50 µm aluminium oxide particles and etched with 38% orthophosphoric acid for 20 s.

Fig. 6

The etching agent was then washed meticulously with water spray and delicately air dried.

Fig. 7

And the adhesive system was carefully placed in two layers, air dried and polymerised.

Fig. 8

To facilitate onlay pick up and correct sitting of the restoration, the self-made PICK & PRESS instrument was created from an adhesive applicator stick.

Fig. 9

The polyvinyl siloxane adhesive was applied to the working end of the applicator, then a piece of laboratory silicone was placed on it.

Fig. 10

And before the silicone hardened, it was placed on the composite onlay seating on the cast. In this position it was left for appropriate setting.

Fig. 11

…in order to create the occlusal print of the onlay.

Fig. 12

Now the newly created silicone instrument can serve as a holder for easy inlay/onlay PICK UP & PRESS during the cementation process.

Fig. 13

The inner surface of the indirect restoration was sand-blasted with 50 µm aluminium oxide particles, then covered with silane and adhesive system and again placed into the PICK UP & PRESS INSTRUMENT.
Now the composite cement was placed on the whole inner surface of the indirect restoration.

Fig. 14

The onlay was picked up on the tooth and pressed with PICK & PRESS. 

Fig. 15

The seating onlay only was left for initial removal of the composite cement excess.

Fig. 16

After initial removal of the excess, the PICK & PRESS instrument was adjusted with a scalpel on the two proximal sides.

Fig. 17

In order to hold and press the onlay while allowing the proximal removal of the resin excess with interdental floss. 

Fig. 18

When all visible cement excess was removed, the glycerin gel was placed.

Fig. 19

Correct polymerisation was obtained from all cemented sides of the onlay.

Fig. 20

After removal of the rubber dam, the remaining excess was identified and finally removed with the scalpel no12 and LM Eccesso Instrument (LM dental, Style Italiano).

Fig. 21

Finally, small occlusal adjustments were carried out, in order to remove any premature interferences.

 

Conclusions

The self-made PICK & PRESS INSTRUMENT can be a helpful and economic tool in the cementation process of indirect restorations.

Bibliography

  1. Zarow M , D’Arcangelo C, Felippe LA, Paniz G, Paolone G: EndoProsthodonticsA Guide for Practicing Dentists. 1st edition 2017; Quintessence Int.
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    composite restorations luted with two different procedures: A ten years follow up clinical trial. J Clin Exp Dent. 2015 Feb 1;7(1)
  3. D’Arcangelo C, Zarow M, De Angelis F, Vadini M, Paolantonio M, Giannoni M, D’Amario M. Five-year retrospective clinical study of indirect composite restorations luted with a light-cured composite in posterior teeth. Clin Oral Investig. 2014;18(2):615-24.
  4. Marchetti G: http://styleitaliano.hime.host/composite-inlays-and-onlays/
  5. Marchetti G: http://styleitaliano.hime.host/state-of-the-art-in-posterior-restorative/