Treating cracked tooth syndrome on premolars with the One Visit Crown (OVC)

Posted by Dr Terry Wong on 4 February 2019 3:26:41 PM
Dr Terry Wong
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Before and after 150dpi

The patient presented with cracked tooth syndrome on a lower premolar. The One Visit Crown (OVC) was chosen based on its competitive price and good aesthetics.

This case study depicts a slightly different technique used by Dr Terry Wong, whereby the uncured material on the buccal side is shaped with OptraSculpt Pads (Ivoclar Vivadent) prior to curing. Dr Wong prefers to do as much of the shaping as possible prior to the final cure to reduce the time needed for finishing and polishing afterwards.

The images relate to the following steps:

01 pre-op 03 checking occlusal spacing with replica 04 replica should not be obstructed

01 Pre-operative - cracked tooth syndrome.

02 The replica was positioned over the prep to check there was sufficient occlusal distance.

03 When the patient bites down there should be enough room that the replica is not obstructed from moving. 

     
05 Placing McDonald Matrix Band 06 Tightening Mcdonald Matrix Band with Hex Stick 07 Placing StretchWedges and pulling tight
04 A finger was used to secure the McDonald Matrix Band during placement over the prepped tooth.  05 The McDonald Matrix Band was tightened with the Hex Stick. 06 The Stretch Wedges were placed and pulled tight. They were also pushed in further from the lingual side. Wooden wedges can also be used.
     
08 Burnishing contacts 09 10
07 The contact points were burnished. 08 Etch. 09 Bond.
     
11 12 shaping excess material into cone shape 13 Placing OVC into matrix band
10 Flowable added. 11 Excess material was pressed into a dome shape between the fingers. 12 The OVC was pressed into the McDonald Matrix Band and aligned with the fissures on the adjacent teeth.
     
14 spot curing to secure 15 removing excess material from lingual side 16 curing lingual side
13 The Spot Curing Tool was used to spot cure from the top (3 seconds) to secure the positioning of the OVC. 14 Excess material was removed from the lingual aspect. 15 The lingual aspect was light cured.
     
17 Loosening McDonald Matrix Band 18 Cutting off the tightening mechanism for access 19 polishing uncured composite with pads
16 The McDonald Matrix Band was loosened. 17 Then the buccal side of the band was removed to provide access.  18 OptraSculpt Pads (Ivoclar Vivadent) were used to sculpt the uncured OVC material on the buccal side prior to curing. 
     
20 Light cure from buccal side 21 light cure from top 22 remove rest of band
19 The OVC was cured from buccal aspect. 20 Then cured from the top.  21 The rest of the band was removed.
     
23 cut stretchwedges and pull out to remove 24 Finishing 25 polishing
22 Followed by the Stretch Wedges which were cut with scissors and then pulled through from the lingual side. 23 Finishing and polishing was completed using a full range of discs from coarse, medium to fine. Dr Wong used Soflex XT series (3M ESPE). 24 To get the final polish, Dr Wong used EVE Diacomp Plus Twist in beige for high luster. 
     
26 finished OVC from top 27 finished OVC from buccal  
25 Shot of the final restoration. 26 Another shot of the final OVC from the buccal aspect.  

What do you think of Dr Terry Wong's technique? Leave your comments below. 

Tags: Clinical Case Study, Clinical Tips, Cracked Tooth Syndrome, Premolar