Dental Crown: What is it? & Set up (2 appointments)

                                                                    

                                                                   Dental Crown 👑

Crown is a tooth shaped cap that goes over the tooth (like a helmet or a hat)

When do we place a crown?

We place a crown when the tooth had lost a lot of structure and when we need extra protection.

How many types of crowns we have?

1st Appointment; Crown preparation

*PPE for the patient

*PPE for the dental nurse & the dentist

Instruments/Materials : 

Exam kit: Mirror, Probe, Perio Probe, Tweezers

Flat plastic

Biteblock

Dental floss ( to remove the excess on the mesial and distal)

Syringe, needle and cartridge

Cotton rolls

Suction tips

3 in 1 tip

Crown gauge (gauge for the dental burs) - You do not see this instrument often

      Fast handpiece, Slow handpiece & the burs (see few examples below)

 

 

Procedure

The dentist will numb the area and then they will start preparing the tooth for the crown. They will use the fast handpiece and the slow handpiece to remove any decay and they will shape the tooth. 

When the tooth is ready the dentist will take impressions. The tooth will look like this photo below:

Then, it's time for the impressions. You will need putty, light body, alginate adhesive, impression trays and alginate powder.

Putty and light body you will need for the area that you prepare the tooth for a crown and alginate for the opposite area (to record the bite).

eg. If you prepare the crown for the bottom jaw, then you will take putty impressions for the lower and alginate impressions for the upper.

or some dentists they prefer to use the triple trays where you only need to use putty and light body.

Rinse the impressions, leave them in the impressions box with the sanitiser tablets/powder for 10 minutes, rinse them well, wrap the putty impressions with a dry tissue and the alginate impressions with a wet tissue. Put them in a polybag with the lab docket and ready to send to the technician, normally it takes 15 working days for the crown to be ready.

In the meanwhile, the dentist will place a temporary crown.

- The temporary crown is going to be a material that it will be tooth coloured and it will stay on the tooth till the crown is back. Few examples of temporary crowns:

Readymade temporary crowns that you only have to mix the temporary cement. By using flat plastic or ball burnisher the dentist will fill the inside of the temporary crown with the temporary cement and then when it sets, the dentist will remove the excess with flat plastic or hand scaler. They might ask you to put finger pressure on the temporary crown while they are using floss on the mesial and distal side of the tooth.

The in-house temporary house made, when the dentist before they start the preparation of the tooth will take putty impressions (we do it before so we can have the original shape of the tooth) and then they will dry the tooth, they will fill the putty impressions - where the crown will be - with the temporary crown material and when it sets, they will ask you to prepare the temporary cement and they will use flat plastic or ball burnisher to place the cement inside the temporary crown. When the temporary cement sets, the dentist will use the flat plastic or hand scaler to remove the excess. They might ask you to put finger pressure on the temporary crown while they are using floss on the mesial and distal side of the tooth.

In the end of the appointment, the dentist will use the articulate holder with articulate paper to check the bite and they will adjust it with the fast handpiece and the right bur.

                                                          

 

2nd Appoinment : Crown Fit

The crown will come from the laboratory inside the polybag with the lab docket. Most of the laboratories they disinfect the crowns - check with your practice manager or the head nurse. If they do not, then you have to disinfect them -be extra careful.

Instruments/Materials

*PPE for the patient

*PPE for the dental nurse & the dentist

Mirror, Probe, Perio Probe, Tweezers

Handscaler ( The dentist might use it)

Scaler & scaler tip ( The dentist might use it)

Slow handpiece & burs

Fast handpiece & burs

Dental floss ( to remove the excess on the mesial and distal)

Cotton rolls

Flast plastic

Dental Floss

Artery forceps

Suction tips

3 in 1 tip

Syringe with needle and cartridge

Xylonor gel or spray & cotton pellets 

The dentist will remove the temporary crown by using fast handpiece to cut it in half and flat plastic to remove it. When they remove the temporary crown, they will remove the temporary cement and they will polish the tooth. They will try the new crown to see how it fits, they will use the artery forceps to grip the crown when they want to remove it.

Now... they are many cements that they can use. 

1st Lutting Cement: You will need the luting cement powder, distilled water, scoop, mixing spatula and mixing pad, dental floss.

Hand scaler and Flat plastic to remove the excess.

2st GCem cement: It's a capsule that you can put it on the amalgamator. You will need etch and GCem gun for application, dental floss to remove the excess and light cure with the shield to set the cement.

Hand scaler and Flat plastic to remove the excess.

3rd Rely X : It's in syringe and it stored in the fridge( they are many types - check the instructions) you will you etc and maybe bond - it will say on the instructions, and then they will use dental floss to remove the excess, and light cure with the shield to set the cement.

Hand scaler or Flat plastic to remove the excess.

After they have done the placement, they will need articulate holder with articulate paper to check the bite. They will need fast handpiece and the burs to adjust it.

None of the photos or the links that I used are mine.