A TECHNIQUE

Replacing PFM Crowns with BruxZir Crowns

In this blog post, our dental lab technicians will take a look at the technique of replacing old PFM crowns with all ceramic BruxZir crowns. We will also provide links to the various dental crown materials and equipment that we recommend.

BruxZir Crowns-Stomadent Lab Boise Idaho

BruxZir Crown Prep Guide

Replacing PFM Crowns with BruxZir Crowns

BruxZir Crowns-Stomadent Lab Boise Idaho

In this blog post, our dental lab technicians will take a look at the BruxZir crown prep when replacing old PFM crowns with all ceramic BruxZir crowns. We will also provide links to the various dental crown materials and equipment that we recommend.

PFM Crown vs BruxZir: When Would a Patient Switch?

More and more dental practices have been making the switch from PFM to Zirconia dental crowns. Why? When it comes to comparing PFM crowns vs BruxZir crowns, there are many advantages to the newer solid Zirconia BruxZir. Many dentists are attracted to its strength, as demonstrated by the BruxZir hammer test, as well as the versatility in looks, safety, and customizability.

Making the switch from a PFM to BruxZir crown is a multi-step process requiring a number of patient visits.

This BruxZir prep guide breaks it down into three appointments:

Initial Appointment

Preparatory work and providing the patient with a temporary dental crown

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Begin by identifying the correct tooth shade using the Vita shade guide while the tooth is hydrated. You want to avoid choosing a tooth shade on a dehydrated tooth because its color value will ultimately be incorrect.

Have your dental assistant take a photo using a high-quality camera, such as Canon EOS Rebel T7i with a Sigma EM-140 DG Macro Ring Flash and a Sigma 105m F2.8 EX Macro Lens, while you hold the shade tab below the patient’s tooth. Send the photo to the master ceramist along with a diagram of the tooth, identifying any shading differences noted clinically between the tooth and the shade tab.

PLEASE NOTE

The first appointment is devoted to doing preparatory work and providing the patient with a temporary dental crown. Determine the type of high-quality temporary crown you will use. This may involve taking a snap impression prior to removing the existing dental crown in order to accelerate the process of switching PFM crowns with BruxZir crowns.

Apply topical anesthesia to the gingiva. Anesthetize the patient with an appropriate injection of local anesthetic.

The first appointment is devoted to doing preparatory work and providing the patient with a temporary dental crown. Determine the type of high-quality temporary crown you will use. This may involve taking a snap impression prior to removing the existing dental crown in order to accelerate the process of switching PFM crowns with BruxZir crowns.

Apply topical anesthesia to the gingiva. Anesthetize the patient with an appropriate injection of local anesthetic.

Once the patient has profound anesthesia, carefully cut portions of the old PFM crown away to determine the condition of the tooth underneath. Remove any old dental cement.

After the old dental crown has been fully removed, probe around the circumference of the prep to the bone to ensure there is at least 3 mm of soft tissue at all aspects. In some cases, it may be necessary to remove unhealthy gum tissue using a diode laser. With the high-speed handpiece running at an appropriate rpm setting to ensure the pulp is not overheated, refine the crown preparation and its margins. The margins should be smooth and located slightly sub-gingival using a two-cord technique.

At this point, the gingiva will be red and inflamed. A clean, dry environment is required to take an accurate impression and fabricate an accurate BruxZir crown. Do not compromise the case by attempting to take the final impression the same day the original dental crown is removed. Instead, temporize the crown preparation using a quality temporary crown to allow time for the tissue to become healthy once again.

Try the temporary dental crown onto the prep. Gently push the temporary crown to place and remove it several times to ensure that it does not become locked into place. Then, adjust the occlusion. Proceed to shape the dental crown, making sure the embrasures are smooth. You may want to slightly over-trim the embrasures and not worry about the “dreaded black triangle” with the temporary crown. The extra space will allow the patient to cleanse debris from the embrasures using Tooth and Gums Tonic without the need for flossing, ensuring that the gingiva stays healthy.

Use LuxaGlaze to give the temporary crown a sealed surface and avoid tissue irritation. Also, be sure to coat the inside of the temporary crown with LuxaTemp Ultra. Avoid using an excessive quantity of dental cement, and have the patient bite together to achieve proper fit. Carefully remove excess cement from the margins without trimming against the tissue. Reappoint the patient for the next portion of the restorative dental procedure.

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Second Appointment

TWO WEEKS LATER

Taking Impressions

Begin the second appointment by applying topical anesthesia to the gingiva. Anesthetize the patient with an appropriate injection of local anesthetic.

Using a pair of forceps, carefully remove the temporary dental crowns, along with the temporary cement. Clean up the surrounding epithelial tissue using ViscoStat Clear silica to quickly stop any minor bleeding and ensure that the patient has stain-free teeth. Avoid the formation of coagulated blood and hemostatic residue attached to the preparation. ViscoStat Clear is a wonderful product to use for anterior teeth because it prevents discolored gingiva. A diode laser may be used to stop any additional bleeding from the tissue.

Even though a temporary crown is a step in the right direction, the tissue will not heal completely until a permanent BruxZir crown with smooth surfaces is seated. Using one strand of Ultrapak E double zero cord, floss the cord into place around the tooth. Pack the cord without leaving any hanging tags. Leave the cord in place for the entire procedure to guarantee no bleeding. The cord provides the vertical retraction necessary to see the crown preparation margins.

Apply topical anesthesia to the gingiva. Anesthetize the patient with an appropriate injection of local anesthetic.

Using a pair of forceps, carefully remove the temporary dental crowns. Remove temporary dental cement. Clean up the surrounding epithelial tissue using ViscoStat Clear silica to quickly stop any minor bleeding and ensure the patient has stain-free teeth. Avoid the formation of coagulated blood and hemostatic residue attached to the preparation. ViscoStat Clear is a wonderful product to use for anterior teeth because it prevents discolored gingiva. A diode laser may be used to stop any additional bleeding from the tissue.

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Even though a temporary crown is a step in the right direction, the tissue will not heal completely until a permanent dental crown with smooth surfaces is seated. Using one strand of Ultrapak E double zero cord, floss the cord into place around the tooth. Pack the cord without leaving any hanging tags. Leave the cord in place for the entire procedure to guarantee no bleeding. The cord provides the vertical retraction necessary to see the crown preparation margins.

Now, pack a second Ultrapak E cord around the tooth. As soon as the cord overlaps, cut it leaving a little hanging tag. The two retraction cords together help to better visualize the margin. Leave the cords in place for 8 to 10 minutes. Using an 856 O25F bur with the cords in place, smooth the margins to remove any irregularities. Typically, the more reduction below the gingiva you give the ceramist, the more aesthetic the permanent dental crown will be.

Insert Roeko Anatomic Comprecap over the crown prep and have the patient close down to control any residual bleeding and remove moisture. Remove the Comprecap and the two strands of retraction cord, exposing a wide open sulcus. Quickly fill the space with light-body polyvinyl impression material dispensed from a syringe followed by an impression tray loaded with polyvinyl impression material or take a digital impression as an alternative. Obtain a bite registration. Re-cement the temporary dental crowns with LuxaTemp Ultra and reappoint the patient for delivery of the final BruxZir crown.

Third Appointment

TWO WEEKS LATER

BruxZir Crown Cementation

At this point, the gingiva has had more time to heal and should look pink and healthy. Remove the temporary dental crown and all of the temporary cement. Dry the crown preparation. Try on the BruxZir crowns, making sure the shade matches. Check the margins, contacts, embrasures, and occlusion. If the dental crown is not seating correctly or needs additional adjustments, return the crown to your dental lab. Cement the BruxZir crown using a resin-modified glass ionomer cement and clean up the area.

BruxZir dental crowns are porcelain-free and made of solid Zirconia, which is an extremely strong material that won’t chip on the incisal edges and is metal-free. At StomaDent, we offer Zirconia crowns and e.max crowns. Both are great aesthetic choices for anterior tooth restorations. Download the report below to learn more, or contact Stomadent Dental Laboratory to get started!