Prepping and Temp. for Gold Crown- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

This is a nice, simple 3/4 gold prep with a little glitch. We're hiring 2 new hygienists now so we're all a bit stressed out. One of my world class assistants forgot to make a blue bite template for the temporary, so we reverted to the 1970's for this procedure.
On all lower 2nd molars and most upper 2nd molars, because of their proximity to the joint, I do only gold or monolithic zirconia. No more PFM on those to avoid the unpredictable but inevitable porcelain fracture. I'm fortunate enough to practice in a "high dental IQ/high median income" area, so I do get the opportunity to do these restorations frequently.

Thomas W. Mitchell, DDS, FAGD
#31 with a fractured and missing ML cusp.
Thomas W. Mitchell, DDS, FAGD
This is the basic prep. In reality there's no need for a buildup.
Thomas W. Mitchell, DDS, FAGD
But I did bond some Titan Flowable with Surpass 1,2,3 to replace the missing cusp. Perhaps for no other reason than to reduce the amount of gold in the restoration.
Thomas W. Mitchell, DDS, FAGD
This is the basic prep finished. The dam always helps me go quickly, especially here since her tongue is very curious.
Thomas W. Mitchell, DDS, FAGD
And after packing my first cord, 00 silk suture, the prep is finished
Thomas W. Mitchell, DDS, FAGD
2nd cord packed and waiting a few minutes to take the impression.
Thomas W. Mitchell, DDS, FAGD
The final impression in 3M Imprint Quick Medium Body and Heavy Body in a check bite tray.
Thomas W. Mitchell, DDS, FAGD
Then my assistant goes "oops"! She forgot to take the blue bite template impression for our temp. So we head back to the lab to find the decades old box of aluminum shell crowns. These are Ion crowns by 3M.
Thomas W. Mitchell, DDS, FAGD
We have a mess of them to sort thru.
Thomas W. Mitchell, DDS, FAGD
And find one that fits over the prep
Thomas W. Mitchell, DDS, FAGD
We're going to trim it, fill it with Voco Structure to line the internal, then trim again.
Thomas W. Mitchell, DDS, FAGD
Then smooth off the edges, adjust the occlusion
Thomas W. Mitchell, DDS, FAGD
And seat it with TBNE. Obviously I'm not into wasting time polishing this thing. It covers and protects all the margins. It is over-extended on the buccal for better retention.

Conclusion: 

We recovered nicely from the "glitch". I think some practices are continuing to use aluminum shells as their primary temp crown. We've used either methyl methacrylate (Jet) or Bis GMA for many years. If relined and properly trimmed, then aluminum shells can be every bit as effective as a custom temp. But if they're not you'll see tissue damage and have a difficult time keeping them in place. The whole procedure took 50 minutes start to finish.

Case by: 

Thomas W. Mitchell, DDS, FAGD