This is just a quick tip that can speed up your crown prep appointments.
Most crown preps involve teeth that already have large amalgams. Personally, I take out all old restorative materials, clean up the tooth, and do a build-up. I don’t like leaving behind or covering up old amalgam. And, I’m always amazed at how much decay I find hiding under those old amalgams, not to mention the old Dycal “cottage cheese” sludge.
I like an “ideal” crown prep form in terms of retention and resistance form. Remember those terms from dental school? Some of what we learned still applies today.
But, many of us are still doing the steps in the same order as we were taught in dental school. We were taught to first take out all the old amalgam. Clean up any decay or other “schmutz.” Then slap a matrix band on and build-up with composite. THEN start the crown prep. Sure… this works just fine. But, have you ever gotten done with the crown prep and found that there was very little build-up left or sometimes NONE?? Aaaargh! I spent all that time building it up, only to have little to none left after the prep???
Here’s a different approach. Prep the tooth FIRST! That is… do the “rough” crown prep, first. By that, I mean don’t take out the old amalgam. Just prep the tooth as if it was a crown prep on a virgin tooth. Do the occlusal and axial reduction first. Oh… and if you want it to go quickly, try doing it with a “metal cutting” bur like Brasseler’s H34L bur.
When you’re done, you’ll have what I call a “rough” prep. And, you may find that almost all the old amalgam is already gone.
If there is any old restorative material left, now is the time to remove it and clean up the “schmutz.”
Once you’re down to clean dentin, you may find that all you need to do is a little “block out” with composite. The point is that you will likely be able to free-hand a bit of composite for the build-up. And, it won’t take nearly as long as the dental school method.
Once you’ve done your build-up or block-out, you can then use your typical diamonds to refine your crown prep. Presto! Done! Ready for impression!
Efficiency while not sacrificing quality… even better… INCREASING quality and lowering stress is the Dental Warrior way!