C L IN IC A L R E PO R T S

R

e p a ir

te c h n iq u e

f o r

f r a c t u r e d

a n t e r io r

fa c in g s

H o w a r d B ru g g e rs , D D S , M A E d m u n d E. J e a n s o n n e , D D S L o u is G r u s h

A procedure for the repair of anterior facings, using a system of bonding porcelain to pure platinum coated with tin oxide, provides strength and maintains the contour and appearance of the original restoration.

fo ils ,7 a new typ e o f p o rce la in fused-to-m etal cro w n has been de­ ve lo p ed .8 These crow ns have an esthetic appearance and dem on­ strate h ig h strength.9 U sing th is system, a technique fo r re p a ir o f fractures on a n te rio r u n its o f fix e d prostheses has been devel­ oped (Fig 1).

Preparation

w

ith alm ost u n ive rsa l accep­ tance o f p o rcelain fused to m etal as the standard fo r fix e d restorations, fra c tu rin g o f in d iv id u a l u n its has become a serious dental p roblem . V arious techniques fo r re p a ir have been advanced as alternatives to the expensive and tim e-co n su m in g p ro ­ cedure o f remakes. These can be classified in tw o groups: those u sin g pla stics1-3 and those u sin g porce­ la in .2,46 The p rim a ry advantages o f using plastics fo r re p a ir are use o f less tim e and lo w e r cost. Disadvantages in ­ clude lo w strength, poor w e aring qu alities, and poor esthetic appear­ ance due to lack o f tra n slu ce n cy or shade-m atching o f the re m a in in g un its, or both. R epair techniques th a t use porce­ la in are advantageous because o f the esthetic q u a litie s o f p o rce la in to m atch the re m a in in g p o rce la in un its. G enerally, this has to be ac­ com p lish ed by o v e rb u ild in g and overcon tourin g to a llo w fo r the extra laye r o f m etal to w h ic h the po rce la in is bonded or cemented. W ith the developm ent o f a system fo r fusing po rcela in to th in p la tin u m

Fig 1 ■A nterior unit on fixed prosthesis be­ fore repair.

A l l r e m a in in g fa c ia l in c is a l a n d lin g u a l p o r c e la in is r e m o v e d w it h u s e o f a fine d ia m o n d u n d e r w a te r sp ra y . A s h o u ld e r is created o n th e l in g u a l a sp e c t if o n e is n o t present. C a re m u s t be e x e rc ise d in t e r p r o x im a lly to a v o id c h ip p in g the a d ­ jacent p o rc e la in . T h e m e ta l o n the fa c ia l s h o u ld e r m u s t be r e m o v e d ( F ig 2).

Fig 2 ■M etal on facial shoulder of anterior unit is rem oved before repair.

T h e p r e p a ra t io n is n o w e x a m in e d to v e r if y that a 1 -m m sp a c e is a v a ila b le to p r o p e r ly c o n t o u r the repair. If ne ce ssa ry, m etal c a n be re m o v e d in the in c is a l t h ird o f the c o p in g s o that the n e c e s sa ry sp ac e is a c h ie v e d . T h e m e ta l is th e n s m o o t h e d w it h fin e sto n e s to facilitate d e v e lo p m e n t o f a s m o o t h die.

Impressions A

m o d ifie d

im p r e s s io n

tra y

is

con­

stru cte d ( F ig 3). T h is d e s ig n w i l l s u p p o r t are as o f th e p re p a ra tio n , b u t it w i l l p re ­ v e n t e n tra p m e n t o f im p r e s s io n m ate ria l

Fig 3 ■M odified im pression tray.

a r o u n d p o n t ic s a n d la rg e e m b ra s u re s that c o u ld

c a u se

d is t o r tio n

upon

rem o v a l.

A fte r the im p r e s s io n is c h e c k e d for a c c u ­ racy, it is s ilv e rp la t e d ( F ig 4).

jo in t o n th e lin g u a l aspect. T h e t in n e r ’s jo in t s h o u l d be p la c e d m e s ia lly o r d is t a lly to the ce nte r o f th e die. A 1- to 2 -m m s k ir t is left o n th e fa c ia l a n d lin g u a l a s­

Forming platinum foils

pects. P r o x im a lly , th e fo il c o v e rs the e n ­ To

fo rm

th e

in n e r

fo il,

c o n s tr u c t

a

0 .0 2 5 -m m p la t in u m fo il w it h a t in n e r ’s

tire

co n n e cto r

area.

T h is

fo il

is

not

tin p la te d . T o fo rm the o u te r foil, re m o v e

JADA, Vol. 98, June 1979 ■947

C L IN IC A L R E P O R T S

Summary A tech n iq u e fo r re p a irin g the an­ te rio r re g io n w ith use o f a lu m i­ nous p o rce la in -b o n d e d -to -p la tin u m fo il has been described. T h is tech­ n iq u e produces a strong replacem ent and m a in ta in s the esthetic appear­ ance o f the o rig in a l prosthesis.

Fig 4 ■Im pression tray has been checked for accuracy and is silverplated. the first f o il fr o m th e d ie a n d c o n stru c t a n o th e r foil. T h e t in n e r ’s join t s h o u ld be c o n s tru c t e d o n th e lin g u a l aspect o p p o ­ site the jo in t in the first foil. T h i s fo il s h o u ld

be

t rim m e d

ju st

sh o rt

o f the

a x io g in g iv a l lin e a n g le o n the fa c ia l a n d lin g u a l a sp e c ts a n d s h o u l d just c o v e r the c o n n e c t o r area lik e th e first foil. T h e o u te r fo il is n o w t in p la te d w ith u s e o f the M c L e a n - S c e d t e c h n iq u e .7 B rie fly ,

th e

M c L e a n -S c e d

t w in

fo il

te c h n iq u e is a m e th o d o f d e p o s it in g tin (sulfate) o n th e outer, p u r e p la t in u m fo il b y e le c tro p la t in g the p la t in u m w it h 0.2 to 2.0 /u. o f t in be fore f ir in g o n th e p o rc e ­ la in .

W it h

o x id a tio n ,

t h is p r o d u c e s a

c h e m ic a l b o n d b e tw e e n the p la t in u m , tin, a n d c o re p o r c e la in in the f in is h e d c ro w n . T h e o u te r f o il th at h a s be e n t in p la te d a n d o x id iz e d is re p la c e d o v e r the u n ­ p la te d in n e r p la t in u m fo il a n d is b u r ­ n is h e d a c c u ra te ly to place. T h e o x id iz e d f o il s h o u ld be c o v e re d w it h c e llo p h a n e w h e n th e t w o f o ils are b u r n is h e d

Fig 5 ■After trial fitting in m outh and after occlusion is checked, replacem ent crow n is cem ented.

to ­

ge th e r s o th at d a m a g e to the o x id iz e d su rfa c e is p re v e n te d .

m m . A s e c o n d fir in g is n e c e s sa ry to fill in th e se areas after the p la t in u m h a s b e e n r e b u r n is h e d to the die. T h i s a s s u re s a c lo s e a d a p ta tio n , e s p e c ia lly in th e c o n ­ n e c to r area. T h e fo ils are re m o v e d fro m th e d ie a n d n o r m a l f ir in g p r o c e d u r e s are fo llo w e d . T h e first fir in g is a c c o m p lis h e d u n d e r v a c u u m fr o m 8 5 0 C to 1,1 0 0 C. A fte r the first fir in g is co m p le te d , the fo ils are re b u rn is h e d , a g a in p ro te c tin g th e o x id iz e d fo il w it h ce llo p h a n e . T h e d it c h e d

areas are fille d

in

w it h

core

p o r c e la in a n d s o m e e xtra p o r c e la in is a d d e d o n the lin g u a l a sp e c t fo r a d d e d stre n gth . It is a ir fire d at 1,1 0 0 C fo r fiv e m in u te s.

Building the replacement crown

Finishing the crown

A ft e r the t w o c o p in g s h a v e b e e n b u r ­

A fte r g l a z in g is co m p le te d , the in n e r fo il is s tr ip p e d a n d the c e rv ic a l m a r g in is

n is h e d

fin is h e d w it h th e u s e o f a fin e ru b b e r a b ra ­

together,

c o re

p o r c e la in

is

a p p lie d . T h e w e t p o r c e la in is d it c h e d at the are as o f th e fa c ia l a n d lin g u a l c e rv ic a l

sive . T h e in n e r fo il w i l l be v is ib le a n d s h o u l d e x te n d o v e r the c o n n e c t o r area.

m a r g in s to p re v e n t th e p la t in u m fro m

A fte r a tria l fittin g in the m o u t h a n d

b e in g lifte d w h e n it s h r in k s d u r in g fir­

c h e c k in g th e o c c lu s io n , the re p la c e m e n t

in g . C o re p o r c e la in is a ls o re m o v e d i n the

c r o w n is c e m e n te d ( F ig 5).

c o n n e c t o r area fr o m th e o u te r 0.75 to 1.0

948 ■JADA, Vol. 98, June 1979

Dr. Bruggers is a professor of fixed prosthodontics and is assistant dean for curriculum and student affairs at Louisiana State U niver­ sity School of Dentistry. Dr. Jeansonne, former dean of Louisiana State University School of D entistry and Loyola University School of Den­ tistry, is a professor of fixed prosthodontics at Louisiana State University School of Dentistry. Mr. Grush is an associate at Louisiana State University School of Dentistry. A ddress re­ quests for reprints to Dr. Bruggers, Louisiana State University M edical Center, School of Dentistry, 1100 Florida Ave, New Orleans, La 70119. 1. W einberg, L.A. Atlas of crown and bridge prosthodontics. St. Louis, C. V. Mosby Co., 1965, pp 260-264. 2. Courtade, G.L., and Tim m erm ans, J.J. Pins in restorative dentistry. St. Louis, C. V. Mosby Co., 1971, pp 287-296. 3. Aspes, T., and M cllwain, J.E., Jr. Restora­ tive technic to repair pontics. Dent Surv 49:24-27, 1973. 4. W elsh, S.L., and Schwab, J.T. Repair technique for porcelain-fused-to-metal restora­ tions. J Prosthet Dent 38(l):61-65, 1977. 5. Johnston, J.F.; Dykema, R.W.; and Cun­ ningham , D.M. The use and construction of gold crowns w ith a fused porcelain veneer—a progress report. J Prosthet Dent 6(6) :811-821, 1956. 6 . Bakland, L.K. Replacing porcelain ven­ eers in the m outh. Quintessence Int 3(8):45-49, 1972. 7. McLean, J.W., and Seed, I.R. The bonded alum ina crown. The bonding of platinum to alum inous dental porcelain using tin oxide coatings. Aust Dent J 21(2):119, 1976. 8 . McLean, J.W., and others. A new metalceram ic crown. J Prosthet Dent 40(3):273-287, 1978. 9. Seed, I.R.; McLean, J.W.; and Hotz, P. The strengthening of alum inous porcelain w ith bonded platinum foils. J Dent Res 56(9):10671069, 1977.

Repair technique for fractured anterior facings.

C L IN IC A L R E PO R T S R e p a ir te c h n iq u e f o r f r a c t u r e d a n t e r io r fa c in g s H o w a r d B ru g g e rs , D D S , M...
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