Clinical insights using auto-cure composite resin
(courtesy of, and described by, Stephen Markus, DMD)
When the "shells" come in from NTI, before we stock them, one assistant takes a slow speed, and a large inverted cone, or round bur, and puts about 6 retention notches on the internal aspect of the buccal and lingual.
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The shell is then silanated for a minute, and then Prime and bond one step (so you can bond a self-cure to it) is light cured over the whole interior portion.
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Use a non-filled composite, like Luxatemp, Integrity, or Perfect Temp, or any material you would normally use to make shrink-wrapped temps.
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This saves me a whole lot of time at fabrication, because all my shells are ready to roll.
Looking at the second hand of my watch, I start to load the composite. I pinch the shell between the thumb and forefinger of my left hand while loading.
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At the 35 second mark, from when I started loading, with the patient sitting up, I place and hold the loaded shell in the proper position, making sure that the DE appears to be parallel to the opposing plane of occlusion (not sloped down or up, but allowing protrusion of the mandibular arch in a straight line parallel to the plane). |
At the 90 second mark I take my fingers off the shell and take a Hollenbach carver and trim off the excess beyond the shell. Between 1:45 and 2:00 minutes I remove the shell, noting mentally how retentive it feels.
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Give the patient the informed consent to read and sign, and go back to the lab. I round all corners with the acrylic bur. If I felt the retentiveness was too much, I will take the 4 round, and trim the interproximal struts to lighten the contact. In the future, if the patient ever complains it's gotten loose (which seldom, if ever happens), just add some light cured flowable to the interproximal areas, reseat the NTI and cure right through it.
When I have patients in temporaries, I will take the shell and fill it with Discus' Vanilla Bite until the permanent veneers and crowns are done. Then I will strip the shell, refresh the bonding agent, and proceed as above. This eliminates the possibility of the NTI locking in or snapping the incisal aspect of the tempS.
Hope this helps everyone.
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