Hydraulic and Hydrophobic Impressions

Following the final impression, the preparations were coated with Astro-glide, a water-soluble lubricant. The preoperative impression in Blue Velvet was loaded with Photocore (J. Morita), a highly filled hybrid resin composite used for building cores for full coverage restorations. The loaded preoperative impression was inserted over the prepared teeth and light cured through the occlusal aspect of the Blue Velvet impression (Figure 6). Photocore can be light cured to the an 8-mm depth. After light curing, the provisional was easily removed from the prepared teeth (Figure 7), finished, polished, and provisionally cemented with Durelon (ESPE/ Premier), a polycarboxylate cement (Figure 8).

Figure 6. Photocore in the preoperative 30-Second Blue Velvet impression being light cured through the occlusal aspect.

Figure 7. Photocore provisional.

Figure 8. Provisionally cemented Photocore.

While the patient awaited the insertion of the fixed partial denture, he was comfortable with the provisional fixed partial denture. Applying Liner Bond 2V sealed the dentinal tubules and protected against any adverse stimuli. Using the preoperative Blue Velvet impression as a matrix, a highly accurate provisional was made with all margins covered and sealed. The provisional fixed partial denture also maintained the abutment teeth in their exact positions.

When the patient returned for cementation of the permanent, no injection of local anesthesia was needed. The Liner Bond 2V applied at the initial visit continued to seal the dentinal tubules and protect the pulp from adverse stimuli. The ATD Plus Bridge Remover was used to gently tap out the provisional Photocore bridge. The inlay preparations were debrided of cement and were pumiced clean.

The bridge was fabricated by overlying the edentulous area with the FibreKor resin-impregnated segments and stabilizing them in the proximal boxes and occlusal portions of the onlay cavity preparations. This segment served as the substructure, and the Sculpture material was added over this in layers and under pressure, minimizing the chance of voids or air-inhibited areas. The result was a fixed all-ceramic inlay bridge that was exceptionally strong and aesthetic.

The all-ceramic inlay bridge was cemented with Panavia 21 (J. Morita), a filled resin-composite cement. The undersurface of the pontic was coated with Astroglide, making it easier to remove excess cement following cementation without damaging the undersurface. Next, ED Primer was applied for 1 minute to the onlay cavity preparations and blown dry. The intaglio surfaces of the onlay portion of the fixed partial denture were sandblasted with 50-pm aluminum oxide particles, then washed and dried. The intaglio surfaces of the onlays were etched for 5 seconds with Etching Agent V (37% phosphoric acid), then washed and dried. One drop of Porcelain Activator was mixed with one drop each of the Liner Bond 2V base and catalyst and applied to the intaglio surfaces of the onlays.

The Panavia 21 cement was applied to the intaglio surfaces of the onlays, and the all-ceramic inlay bridge was seated and held in place for 1 minute (Figure 9). Excess cement was removed with a stiff brush and explorer, and a floss threader was inserted under the pontic to remove excess around and under the pontic. The margins of the onlays were covered with Oxyguard to eliminate the air inhibited layer and ensure complete polymerization. After 3 minutes, the Oxyguard was washed off.

After the all-ceramic inlay bridge had been cemented, excess set cement was removed with a scaler or No. 7406 12-fluted finishing bur. The occlusion was checked, requiring minimal adjustment. Occlusion should not be checked until the bridge is permanently cemented (when all margins are bonded to the enamel and supported by cement). An Enhance finishing cup (L.D. Caulk) was used for the final polish (Figure 9).

Figure 9. All-ceramic fixed onlay bridge following finishing and polishing.

Dr. Hoos maintains a private practice with an emphasis on implant and aesthetic restorative dentistry in Stratford, Conn. He received his DMD in 1978 from Tufts University in Boston and is a Fellow in the Academy of General Dentistry and the Academy of Implant Dentistry. He can be reached at (203) 378-9500, fax at (203) 397-3632, or E-mail at jchdmd@worldnet.att.net.

Dr. Kaplowitz is a commander in the US Public Health Service and is senior dental officer at the US Coast Guard YARD in Curtis Bay, Md. He received his DDS from New York University in 1979. He is a diplomate of the Federal Services Board of General Dentistry. He can be reached at E-mail calak@erols.com.

For ordering and/or technical information, call J. Morita USA at 888-JMORITA.

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