Building a 3-unit Splint that Preserves Existing Crowns

By Dr. Martin B. Goldstein

FROM the ARCHIVES

eres an interesting adhesive case that appeared last year in the Journal of Prosthetic Dentistry. Dr. Hiroshi Shimizu of Baylor College of Dentistry kindly sent us his photos and consented to expand on the technique for our readers. The second bi was in trouble. A simple crown wouldnt be enough. The tooth required periodontal splinting to reduce its mobility.

Fig. 9 Fig. 4

The obvious treatment would be a 3-unit bridge from #21 to #19. But the proximal teeth were already crowned ... and both the teeth and their restorations appeared to be in fine shape. It seemed a shame to pull out two perfectly good crowns, only to replace them with two new abutment crowns.

4.) Then a post -preparation about 1mm deep was cut in both rests using a flat-end tapered diamond. (Incidentally, it doesnt really matter whether the diamond penetrates the crown. C&B-MetaBond will bond the restoration to metal, enamel and dentin.)

Fig. 9: After it was cemented using C&BMetaBond and MTL-V primer, the casting splinted the teeth together converting the crowns to a 3-unit splint.

Fig. 5

9.) The metal surfaces to be bonded were primed with MTL-V primer and allowed to dry. 10. The prepared surfaces on the two crowns in the mouth were air-abraded. (Note: When blasting in the mouth, never direct the air jet down the sulcus.) 11. Green Activator was applied to the exposed tooth structure where the diamond had penetrated through the metal. This would allow the C&B-MetaBond to create a hybrid-layer seal within the teeth and protect the pulp. After 30 seconds the teeth were rinsed thoroughly, and dried. 12. To improve the bond to the two crowns in the mouth, MTL-V primer was applied to the metal surfaces to be bonded. 13. The new crown was cemented with C&B-MetaBond...and the excess cement cleaned up.
Note: Though C&B-MetaBond adheres
to all alloys, the quality of the bond is inversely related to the nobility of the alloy. For example, its shear bond strength to a non-precious casting is greater than 3000psi. Thats a very stable bond that resists degradation over time. Its bond to a noble palladium/gold casting, however, is much lower ... only 1000psi. And unlike non-precious, if the noble metal is exposed to moisture, the bond may slowly degrade. Traditionally, labs have boosted the quality of the bond to noble metal by tin-plating or heat-treating the alloy. MTL-V primer eliminates the need for these special treatments. Once a noble alloy has been primed with MTL-V Primer, C&B-MetaBond will chemically bond to it as if it were a base metal.
1 Shimizu H, Takahashi Y. Fixed splinting device to be used without removing adjacent existing cast restorations. J Prosthet. Dent. 82:231-2, Aug 99 It is with the kind permission of the Journal of Prosthetic 1 Dentistry that this article appears here.

So instead, it was decided to use a combination of mechanical and chemical retention to graft the new crown and existing crown into a single unified splint.

5.) Finally, shallow 1/2mm vertical grooves were cut at the buccal and lingual extremes of the guide planes using a tapered diamond.
Fig. 6 Fig. 7

Here how it was done ...

Fig. 1

1) The second premolar was prepared for the crown as usual.

Fig. 6 and 7: The preparations, a bit hard to see in the intraoral photograph (left) are much clearer on the laboratorys working model (right).

6.) The impression was taken. In this particular case, the authors used hydrocolloid, but use whatever material works best in your hands. 7.) The crown with its abutting attachments was waxed, cast in precious metal, and polished.
Fig. 8

Fig. 2

2.) Using a tapered round-end diamond, the proximal walls of the crowns on #21 and 19 were reduced. This created opposing guide-planes ending in a gingival shelf.

Fig. 3 Fig. 8: The complete casting.

3.) Substantial occlusal rests were cut in both crowns using a flat-end tapered diamond (approximately 2x2 by 1mm deep.)

8.) The interior surfaces of the casting were blasted using 50 micron aluminum oxide.

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