LABORATORY LEARNING EXPERIENCE SUPPLEMENTAL INSTRUCTIONAL GUIDE Laboratory Session #1 PROCEDURE: Complete a full gold crown (FGC) or what

is also called a full veneer crown preparation in typodont on tooth #30 IN PREPARATION FOR LAB EXPERIENCE: 1) Student should be familiar with all reading assignments in Fundamentals of Tooth Preparation (FTP) and Fundamentals of Fixed Prosthodontics (FFP) on FGC preparation 2) Student should be familiar with all lecture PDF slides on FGC preparation techniques 3) Student should have viewed all the self-instructional video tutorial on Full Veneer Crown preparation provided on the Fixed Web Site paying close attention to techniques used in each aspect of the preparations features 4) Student should be familiar with the large scale 3-D rotational full veneer crown preparation model image, being able to visualize and identify all the preparation features of the prepared tooth 5) Student should be familiar with the taper guide available on the Fixed Web Site in PDF format for printing off a copy for use in analyzing taper of the students FGC preparation 6) Student should be familiar with the operation and maintenance of the dental unit located at their assigned laboratory bench and operation and maintenance of “Boomer” dental head. (See operation manual in pre-course readings) LEARNING OBJECTIVES: 1) Student should be able to identify all features of a FGC preparation 2) Student should be able to identify the function and purpose for each feature on the FGC preparation 3) Student should be able to identify the proper sequence of instrumentation required to prepare FGC preparation 4) Student should be able to critically evaluate for the presence or absence of adequate clinical features in FGC preparation 5) Student should be able to critically evaluate if a FGC is clinically acceptable or not clinically acceptable 6) Student should be capable of critically evaluating the taper of a FGC preparation LABORATORY PLAN: Each student will locate tooth #30 on their typodont. Each student will place typodont into “Boomer’s” head on their dental unit at their assigned seat in laboratory.

Each student will fill water bottle from distilled water tap in “wet” laboratory Each student will sequentially prepare the features of a FGC preparation after viewing a demonstration of each that features preparation in a video, with each instructor providing feedback on the students’ progress. Each student will complete the video assisted FGC preparation on tooth #30 in class and have it evaluated by their bay instructor. Each student will empty waste water bottle and clean the simulator head and their work area before leaving the laboratory. Each student will start and complete another FGC preparation on tooth #30 out of class to be graded at the next laboratory session. ARMAMENTARIUM REQUIRED: High speed hand piece Slow speed motor with contra-angle standard hand piece bur attachment head(HP) Fixed Prosthodontic (FPD) Bur and Diamond Kit Fixed Prosthodontic diamonds and carbide burs placed into FPD Kit (Match the numbers and pictures of diamonds and carbide burs printed on kit) Intra-oral mouth mirror Periodontal probe A 1.0 mm & a 1.5 mm wide hand chisel Polyvinylsiloxane putty material (PVS) Textbook FTP Viade models PURPOSE: This laboratory learning experience is designed to give the student a jump start into preparing teeth for FGC restorations in blue clinic. The emphasis on this course is on developing the students’ preparation skills. The self-intructional video tutorial with narration are available to the student 24/7 for enhancing the students learning of preparation technique. The clinician that demonstrates the FGC preparation in the self-instructional video features a recent graduate from OUCOD and was participating in the Advanced Education in General Dentistry (AEGD) residency. The student clinician prepared this FGC preparation just exactly as we expect each student to do in this course, in “Boomer” with the same typodont that you have. There was no tooth preparation done outside of “Boomer” for the video demonstration. The video was done to give students the opportunity to observe this preparation technique, so all aspects of the preparation can be seen as if from the perfect vantage point. The preparation time used for the preparation is exactly the time required to do the preparation to an acceptable level by a student, and should be your goal to achieve the same outcome by the end of this course. CLINICAL CORRELATION: For the rest of your dental career as a dentist you will have to prepare teeth for prosthodontic restorations. The time required to develop these skills to an

acceptable level will vary quite a lot between students. Some have very strong hand skills, while others require considerable effort and repeated preparations to achieve an acceptable level of hand skill. So do not feel like you are being picked on if the instructor feels like you need to prepare another tooth, or several teeth until you understand the technique to be able to accomplish the preparation without assistance. Spending time after class and in the lab preparing teeth is the norm and not the exception in this class. Practice produces a better preparation and one that is eventually done faster at an acceptable level. Unfortunately, to complete this course, you must develop a minimal acceptable level of preparation skills to promote to FPD II course. So learning these skills whatever it takes is essential. The student must prepare the preparations with their hands and brain, and no one else can do that for the student to pass this course. It is totally up to the student to put the time and effort into preparation technique success. Because this course is so compressed the student will not be able to prepare only the preparations done during the lab session, where an instructor gives feedback. You will be required to do preparations between class sessions, and then have them graded by your instructor during the next lab session. Instructors will give you feedback on your preparations so you can gain knowledge of the areas to improve. Use all this feedback to refine your preparation technique. I encourage all students to use the self-instructional video tutorials as your personal instructor to walk you through each step of the preparation as you practice and prepare extra teeth. Try to copy, or model what is demonstrated in the video. Remember rarely if ever does one prep get you to being at a highly skilled level of preparation ability. The course director, assistant course director, or any of the clinical instructors will be glad to critique your extra preparations during their office hours, but you need to ask the Fixed Secretary for these scheduled office hours. SUPPLEMENTAL INSTRUCTIONS FOR TODAY IN LABORATORY: Prepare a matrix of your unprepared tooth #30 using PVS (Reprosil Putty) by making a cylindrical segment of material that can be laid over the arch from #28 – 31 area. Make sure the two parts of the putty are mixed thoroughly until a homogenous purple color is obtained without streaks. This index can be sectioned from mesial to distal along the central groove and used to compare the amount of reduction that has been accomplished. A second index can be made and sectioned from facial to lingual at the mesio-buccal cusp and at the distalbuccal cusp to make two segments that can be used to determine how much reduction has been done in the central groove and at the functional cusp and lingual cusp areas. Remember to look at the already existent space that is present between cusp tips and central fossa of the opposing teeth before preparing tooth #30. If there is no contact present then you will have to reduce only enough space to get to the desired reduction. If you reduce the amount needed from the index to ideal depth on the tooth being prepared without considering space that was present, you may find that you have over reduced the tooth.

I recommend that you work on tooth #30 from the side of the patient and facing the patient (or in your case the typodont), while seated at the 8:00 position. You will have better visibility of the field being prepared from this vantage point. Before you start preparation of the tooth look at the overlap of the mesial facial cusp of the upper tooth that opposes tooth #31 in the buccal groove of #31, and the facial cusp of the upper second bicuspid that contacts tooth #29. Mark a line with a pencil at each of these points where the cusp overlaps the lower opposing tooth. Connect a line between these two lines across the facial cusp of #30. This line should be very close to where the terminus of the functional cusp bevel is to end on the buccal surface of tooth #30. We will play the self-instructional video tutorial as a demonstration on a particular portion of the preparation, or feature. The student will then prepare that particular part of the preparation, or feature. Each bay instructor will then evaluate their students’ progress on each part of the preparation, or feature. Don’t be surprised if you don’t complete all the preparation, or feature in that time allotted. Don’t be too timid in preparing the tooth, this is an opportunity to learn, and this is not a graded preparation. This laboratory experience is to get you over the jitters of having to actually use a hand piece applied to a tooth. This also allows the student to understand much more from the self-instructional video tutorial after they have put a diamond to a tooth. There is a wealth of information in these videos. I cannot stress enough to watch and listen closely; you will learn a lot from these videos if you really spend time with them. Once you have begun to prepare the chamfer finish line on the facial surface remember that it is cut with the diamond held in the long axis of the tooth (this is the same as the root axis of the tooth). The chamfer finish line is cut into the tooth in small increments until the depth of one-half the torpedo diamond’s depth is achieved. There is only a very slight tilt of the bur toward the lingual. This tilt allows the taper of the bur of only 1.5 -1.8 degrees of taper that will not provide the amount of taper that is needed. We don’t want more than 16 degrees of taper maximum (8 degrees facial and 8 degrees lingual). Once the facial is prepared the bur is carried to the lingual surface in the same long axis as was done on the facial. Hold the bur against the facial as a guide for tip of the diamond, without over tipping to the facial. Then this same reduction is done slowly until one-half the depth of the torpedo diamond has been achieved with several sequential passes of the diamond. When you have completed the facial and lingual axial reduction, the student will see that there is an island of tooth structure between the adjoining teeth that is still in contact. Follow the exact sequence of diamonds that is described and demonstrated in the FGC preparation sequence for interproximal reductions in the self-instructional video tutorial. Use the needle diamond in three distinct passes using a sawing motion of the diamond as it is moved through the remaining island of tooth structure in the contact area. Leave only a sliver of tooth still in contact between the adjacent tooth and the tooth being prepared.

When your diamond passes through completely the sliver will be unsupported and will be gone. Now drop down, and keeping the needle diamond vertical as it passes through the contact area about one-half the distance to the the gingival col, or about 1.0 mm from the col. You will in the process continue to remove tooth structure from between the teeth on the tooth being prepared. Now the final pass at the gingival level keeping the diamond still vertical and moving more toward the tooth being prepared lower to the finish line that is now approximately 0.7 to 0.8 mm above the gingival col. After this bur is passed through the teeth they should be separated enough gingivally to allow the flame diamond to pass without hitting the adjacent tooth. If you try to put the torpedo diamond in now you will note that it won’t fit and will cause the bur to have to be held higher away from the gingival areas and to keep it from hitting the adjacent tooth. The torpedo diamond would have to be tipped away from the adjacent tooth to allow it to pass through. This will cause over tapering of the axial wall. With the flame diamond held vertical pass it through just a little above 0.5 mm above the gingival col. Intentionally take a slight bit more tooth away as the diamond ends half its depth into the tooth. The tip of this diamond extends slightly above the point where we want to end the final prep at 0.5 mm. After the flame diamond has been passed through there will be formed the start of a chamfer margin made on the tooth being prepared. Now the torpedo diamond can be passed through and held vertically without needing to tip the diamond to avoid hitting the adjacent tooth at this point about 0.5 mm above the col. A 0.5 mm mechanical lead pencil lead can be used to measure the height of the chamfer finish line to make sure that it is not under-extended (too occlusal), or over-extended (too close) to the gingival tissues. The student can also use Dr. Goodacre’s taper guide that is available in the clinical aids section of the Fixed Web Site and can be printed to paper. If you hold your prep up to this, with the preparation removed from your typodont it is easy to assess the taper of your preparation. With one eye closed the student can have a rough idea of how much taper your preparation has in degrees. We want to keep the taper a preparation between 8 – 12 degrees, but no more than 16 degrees maximum. A pencil point taper is greater than 25 degrees, and would fail on a self-assessment evaluation. Too little taper, is an undercut, and will also fail on a self-assessment evaluation. This lab session will be 3 hours following the FGC lecture.

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