a

Dental Crown Explained | Anterior Crown Preparation

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what is up guys welcome back to the

channel

it's a beautiful Sunday afternoon here

in San Diego and the purpose of today's

video is to look at things I consider

when designing an anterior crown this is

gonna be a little bit different than my

other videos because I'm gonna keep it

super long format so that you'll be able

to scrub through the footage from the

beginning of the crown preparation all

the way to the impression I think that

provides the most value for those of you

out there that are trying to perfect

their crown preparation designs also I'm

gonna be focusing on how to create

really crispy sharp well-defined margins

how to make your crown preparation very

smooth and how to work efficiently so

that your patient is very happy at the

end of the day my philosophy is that if

you spend a little extra time perfecting

your crown preparation then your

assistant will do a better job with

their temporary crown the laboratory

will do a better job fabricating the

porcelain crown and ultimately when you

cement the crown you'll have really

flush smooth margins that hopefully last

a very long time for the patient so

let's jump right into the video as I was

talking we already started the facial

reduction as well as working a little

bit on the margins of the tooth I like

to combine both of these steps together

because it helps me really perfect that

crispy margin that we're trying to

achieve by the end of the crown

preparation design we also need to have

a discussion about why we chose to do an

anterior crown versus an anterior veneer

when we're weighing our options about

whether to do a veneer or a crown I like

to consider the most important factor

for a veneer which is the amount of

enamel left over after preparing the

tooth as you can see this patient

already has a large buckle composite

that takes up a little bit less than 1/2

of the facial surface of the tooth the

bond strength to that composite resin

versus the bond strength

- pure enamel is much less so ideally we

want to have a lot of enamel on the

facial surface of the tooth for a veneer

to be even more successful and have

strong bonding capabilities also when

you're considering designing a veneer

you have to think about what color

change you're doing if you're trying to

go from a very dark color to a lighter

color veneer meaning if the tooth is

already very dark to begin with then you

have to design the veneer a little bit

more aggressively so after talking about

this with our patient we gave him both

options and he decided that the best

option would be an anterior crown

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now you can notice here that I take a

slow speed round bur that runs on a

slower rpm I start teasing away the

cavity a little bit at a time and I make

sure that I have hard sound to structure

and that all the cavity is completely

removed at this point I like to place a

chord and in typically a place as large

of a chord as possible in this

particular video I believe it's a number

2 chord that wraps around the entire

gums and I place a chord now because of

two reasons number one as I place the

chord the gingiva around the tooth

pushes out of the way and you'd be

surprised how much to structure you'll

see and you're able to prep once you

move that tissue out of the way

sometimes you can get two or even three

millimeters of extra length to the tooth

for added retention this really helps

with teeth that have short clinical

crown links to begin with like the

second molars in the back of the mouth

where you want a little bit of that

Maxiell wall height for added retention

of course if you're bonding your crown

to the tooth you don't need that

retention but I'm still a believer of

mechanical retention to support the

tooth and in order to have a stable

crown for as long as possible I would

mention that some people prefer to pack

two cords meaning a double-0 cord and

then a another chord on top of that to

move the gums out of the way for a

better impression and I actually do

agree with that in this particular case

I only packed one cord and it was enough

for me to achieve a really nice

impression which you'll see at the end

but if you decide to go the other route

you can do that as well now some

dentists do like to use the cavity

preparation as part of the crown design

and I see no fault in that

in this particular case I wanted to fill

the cavity with composite resin so as

you can see here I use I use I believe

clear fill SC protect placed a primer

dried it out place my bonding aid

dried it out pure and then I placed a

little bit of flowable composite to fill

in that void in the tooth is that

absolutely necessary I don't think so

but I wanted to really clean design for

the video so here it is so notice how

I'm really taking my time with this

crown preparation I'm trying not to Nick

the tissue at all because I don't want a

bloody mess and I'm making sure

everything is really smooth

if the crown preparation is entirely

smooth then the dental laboratory has an

easier time fabricating that porcelain

crown and during the cementation

appointment it just slips right in and

you have nice contacts when you have

sharp edges to your crown preparation

that's when dentists and lab technicians

run into problems so I definitely

encourage you to take your time to

smooth and everything out and really

polish the restoration to make it look

as nice as possible so I want to make a

few notes about the final impression I'm

carrying the light body and my assistant

is carrying the heavy body of course we

check the occlusal clearance we try and

the Train them out a couple times to

make sure the patient is biting down in

the right way you'd be surprised how

many times a patient when they're out

there's open this long forget how to

bite on their back teeth and that's not

their fault that's something that you

have to remind them to have have them

bite in the right occlusion when you

have a core packed in there as long as I

have it packed in there it can dry out

and you don't want to lift the court up

when it's dry because when it's really

dry it can tear the tissue and when it

tears the tissue guess what you have a

lot of bleeding and then you have to

control the bleeding with either

astringent

or you have to repack another cord so

make sure to moist in the cord a bit and

then slowly tease it away you can

evaluate if you have any bleeding sites

places stringent in as necessary to dry

it up the best way you can

and then you're gonna use that light

body to go around the tooth in a very

slow manner I like to start the margin

and I slowly work my way to the top and

then you place the tray and have them

bite down

typically the setting time we wait about

five minutes take it out and then your

assistant will finish the provisional

crown so that's all I recorded for you

guys today I hope this helps any of you

out there that are trying to learn

different techniques about crown

preparation design if you have any

questions or comments leave it down

below please like subscribe support the

channel and you know one note I'm

thinking about doing a series a ten part

video series where my wife and I go into

how to design a practice we're in the

process right now of expanding our

office into a new space we've made

decisions about whether to lease or buy

and a lot of other business decisions

that please let me know if that's

something you're interested and

listening to and we'll get to work

making a video series on that thank you

so much for tuning in I hope you enjoyed

it and I'll see you for the next one

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