CONTENTS 2 Preface 3 Course Schedule 4 Course Survival Tips 6 Inlay Cavity Preparation for Posterior Teeth Richard V. Tucker, DDS 9 Impression Technique 0 Temporaries Laboratory Notes for Cast Gold Restorations Richard V. Tucker, DDS 4 A Technique for Finishing Gold Castings Richard V. Tucker, DDS 6 Conservative Cast Gold Restorations Richard V. Tucker, DDS Dennis M. Miya, DDS 4 All About Pins in Gold Castings Richard D. Tucker, DDS Richard V. Tucker, DDS 44 Cast Gold Clinical Instrument and Supply List Richard V. Tucker, DDS 46 Laboratory Instruments and Supplies Richard V. Tucker, DDS 47 Suppliers 48 Educational Materials 49 Map 50 Rubber Dam Placement Dennis M. Miya, DDS
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StudyClubFormatWhen someone is finished with his preparation or seat, the mentor will ask for permission to an-nouncethattheprocedurehasbeencompleted.Allparticipantsofthegroupcanthenlookatthecompletedprocedure.Youcanlearnalotfromobservingwhatothershavedone.Itisalsoaformofsupportforyourfellowparticipantstotakethetimetolookattheirprocedure.
•InstructionFindtherightteacher.“Whyre-inventthewheel?”Beginwithagoodfoundation.Lookforthosewhothemselveshavehadgreatteachers.Lookforpatientsandempathy.Lookforthosewhointeract,whopraiseatleastasmuchastheycritique.•PracticePracticecanbeusedasaverb.WepracticetogettoCarnegieHall.Forthemaster’sjourney,prac-ticeisnotsomethingyoudobutsomethingyouare.Practiceisthepathuponwhichyoutravel.Apractice(asanoun)canbeanythingyoupracticeonaregularbasisasanintegralpartofyourlife-nottogainsomethingelse,butforitsownsake.•SurrenderThecourageofamasterismeasuredbyhisorherwillingnesstosurrender.Thismeanssurrendertoyourteacherandtothedemandsofyourdiscipline.Perhapsthebestyoucanhopeforonthemas-ter’sjourneyistocultivatethemindandheartofthebeginningateverystagealongtheway.Forthemaster,surrendermeanstherearenoexperts.Thereareonlylearners.•IntentionalityApplyfullconsciousnesstoanactivity,don’tjustgothroughthemotions.•TheEdgeA master is one who not only pursues the refinements of a skill; he eventually pushes the edge of the envelope.
Thestepsrequiredintheplacementofacastgoldrestorationareasfollows:diagnosis,toothpreparation, impressions, models, wax up, investing, casting, cementation and finishing. A flaw in any of these steps or lack of attention to the finest detail would result in failure or an unsatisfactory result. Thesinglestepwhichcontributestoalargenumberoffailures,andthatwhichrequiresaspecialeffortfromtheoperatingdentististhecavitypreparation..Awellpreparedcavitynotonlymeetsthestandardcriteriaofasatisfactoryoutlineform,resistanceform,retentionformandtheotherrequirementsestablishedyearsagobyG.V.Black,italsomustbesmoothandpreciseinbothitsinternalandexternalform.Itisthisprecise,smooth,properlytaperedcavitywithsharpmarginsandinternalanglesthatmakeitpossibletocarryouteachoftheotherstepswithprecision2. Considerthesestepsmentionedaboveinrelationtothecavitypreparation.Theproperdiagnosisandtreatmentplanisoflittlevalueifthetreatmentisnotadequatelycarriedoutwhilepreparingthetooth.Thepreparationshouldencompassthatwhichwasconsideredwhenitwasdeterminedthatthecastgoldrestorationwasindicated.Itinvolvesocclusalcoverage,estheticconsiderationsandpreven-tiveconcepts. Agoodimpressionismoreeasilyobtainedifthecavityissmoothandsharp,andwithoutthissharpness it is difficult to evaluate the impression. The models are enhanced also by the fine definition ofagoodcavityandfewerfragileareasresult.Asatisfactorywaxpatternismoreeasilyobtainedfromthe model of a smooth cavity preparation with a proper taper and well defined margins. As a result the casting, which can be no better than the wax pattern, is likely to have fewer flaws and discrepancies thanifthepreparationofthetoothwereroughandirregular. Thelastconsiderationwouldbethataproperlyextendedcavitywithsharpsmoothmarginsmake it possible to finish the restoration on the tooth and to produce a more perfectly adapted gold inlay. Dr.GeorgeEllsperman, an outstanding teacher and critic of operative dentistry,invariablyspeaks of his concern with cavity detail, cavity design and fine margins3.Consideringtheimportanceascribedtothecavitypreparation,whichisthethemeofthispaper,ashortdiscussionofthesometimesmundanesubjectofcavityinstrumentationwillbepresented.ThefollowingstepsinprocedurewillinvolvetheposteriorClassIIcavity.
�.Therubberdamshouldbeplacedtogivevisibility,tissueretraction,andforeaseof operation.Whenitisapparentthatsomeprocedurecanbedonebetterwiththedamremoved,suchasdiscingofamarginonthedistalsurfaceofthemostposteriortooth,thenthepreparationshouldbecompletedas nearly as possible before removing the dam for final completion.
2.Thetoothopenedwithahighspeeddiamondstonetheneithera#56carbideburforabicuspidtoothora#57carbideburforamolarwouldbesubstituted.Careisusedtoavoidovercutting.Theflat occlusal and gingival walls are placed at the same time as establishing the axial wall and the oc-clusalpulpalwall.Theroughedoutcavo-surfacemarginiscutatthesametime.Allofthisisdonewhilemaintainingaslighttaperawayfortheocclusalsurface.
(�5-8-�4)isthenplacedontheedgeoftheocclusalwallandwithtwoorthreeslicestowardthegin-gival,theaxialwallisplaned.Thechiselmeetstheproximalwallstoestablishthebucco-axialandthelinguo-axiallineangles.Thebucco-gingivalandlinguo-gingivallineanglesarecoincidentallyformed by the chisel chopping to the gingival wall. The 42S chisel also should smooth any flaws or discrepanciesontheocclusalwallandgingivalwallwhileitisinhand.Thesameprocedureisusedonthemesialareasofthetoothwiththeoffanglechisel#43S(�5-�0-�6)andortheenamelhatchet#15 or #16. On both the mesial and distal areas of the tooth, the proximal walls should be planed first sotheeffectofgougingthelineangleswiththeedgeofthechiselwouldberemovedastheaxialwallisplanedalongthisangle.
4.Thegingivalmarginsarebeveledwithdoubleendedmarginaltrimmers#232(�0-95-�9-�6)forthedistal;then#233(�0-80-�0-�6)forthemesialareasofthetooth.Thedoubleendedinstrumentswouldbeusedforeaseofoperation.Themarginaltrimmersshouldbesharpenedtoacuteanglessothebevelonthegingivalmarginswillbelongerthanthatwhichwouldbeproducedwiththemoreflattened marginal trimmers. The gingival bevel should be made smooth and even with the trimmers planingtowardtheproximalwalls.
5.Thereissomedifferenceofopinionregardingtheuseofabevelontheocclusalmargins4.Whenthetoothbeingpreparedisverysound,withocclusalenamelthat hasnotbeenbruisedorcrazed,itmay be justifiedthat just a faint contouring should be done with a medium sand disc. There would be lessconcernoffuturebreakdownoftheocclusalmarginhowever,ifabevelofapproximatelytwentydegreeswereplacedwitha#56carbidebur.Thediscdoesservetopolishtheproximalwallsiftheyhavenotbeenplanedsharpandstraightwithchisels.
6.Whenitisnecessarytocoveracusporcuspswithgolditcanbeaccomplishedeffectively with a #7404 or #7406 twelve fluted bur producing a hollow ground relief and bevel. This finishing bur is used in almost a painting motion to establish a smooth, well defined flowing outline totheextendedcavity5.Thistechniquewouldnotbeusedforcoverageofmaxillarybuccalcuspsasitwoulddisplayanunnecessaryamountofgoldandtheinclinedplanesoftheoccludingteethdonotrequiresuchcoverage.Insuchcasesafterocclusalreductionhasbeendonewiththehollowgrindingbur,onlyasleightdiscingisnecessarytoremovetheacutenessofthemargin.
However,itshouldgivecausetoavoidpolishingwithdiscsthebulkofthreequartercrownorfullcrownpreparations.Ithasbeenshownthatproperlyplacedpinsservewelltoincreasetheretentivequalityofacasting.Ifatoothisdestroyedtotheextentthatretentionshouldbeaproblemtheplace-mentofthepinsisthesimplesolution. In view of the fundamental necessity to prepare a fine cavity to accomplish a satisfactory gold in-lay,itishopedthatthispaperandthetechniquethathasbeendescribedwillbeofsomeassistance.
nique.2.ThemetalCoetrayisusedmostoften.WhenthebackoftheCoetraydoesnotallowthepatienttobiteintocentricocclusioncomfortably,thesmallerwireEmerytrayisused.3. Forgingivalretraction,abulky,non-braidedcord(Gingivi-Pak#3,Surgident)ispre ferred.Thiscordprovidesgoodretractiondepthbelowthepreparationandgoodwidth of the sulcus. The popular braided cord, double pack method where the first chord remainsinthesulcusduringtheimpressiongenerallydoesnotprovidethedepthand widthdesiredforgoodimpressions.Invariablythetissueseemstobleedifbothchords areremoved.A25%aluminumchloridesolution(Hemodent)isusedforhemorrhage control. It seems to be kind to the tissue and leaves no film on the preparation. Ferric sulfate is notrecommendedforahemostaticagentforinlaypreparations.4.Oneortwocordsareplacedaroundthepreparation.Twocordsseemtoworkwell interproximally.Theyshouldbeleftinplaceforabout3–4minutes.Priortotakingthe impression, check the fit of the tray and have the patient practice getting the “feel” of bitingintocentricocclusionwiththetrayinplace.Notetheocclusiononthe contralateralsideasaguidesoyouknowwhenthepatientisbitingintocentric occlusion.5.Lightbodypolyvinylsiloxaneimpressionmaterialisusedfortheentireimpressiontoavoid foldsthatcanoccurattheinterfaceoflightandheavybodymixes.Thepotentialsetinhibitionduetotherubberdamorlatexglovescanbecounteractedbycleaningthepreparationandadjacentteethwithacottonpelletsaturatedwithdilutedhydrogenperoxide,followedby athoroughrinse.Hydrogengasevolutionisaby-productofthepolymerizationofpolyvinyl siloxaneimpressionmaterials.Smallvoidsinthestonemodelwillresultiftheimpressionispouredtoosoon.Modelpourupsshouldbedelayed30minutesto2hoursdependingonthebrandofmaterial.6. Before the impression material is mixed, the operating field should be spray washed and driedandthecordisslowlyremoved.Itischeckedforadequateretractionandthatthereisnohemorrhage.Ifretractionisnotadequateorifthereishemorrhage,repack.Ifitissatisfactory,itmustbemaintaineddryandtheimpressionmaterialismixed.Syringeimpressionmaterialintothepreparation,placethecheckbitetrayandhavethepatientbiteintocentricocclusion.Bepreparedto“assist”thepatientintotheproperjawpositionwithgentlepressureonthechin.Continuetomonitorandsupportthepatientforafewminutestomakesurethatthereisnodistortionintheimpressionduetopatientmovement.7.Checkthesetofthematerialwiththetipofthecottonpliers.Whenthematerialseemstobeset,
3.TheDuraSealacrylicisplacedwiththeliquid/powdermethodusingafairlylargebrush.Buildacrylictocontour,besuretocoverallmarginsofthepreparation.Workquicklybecausethepatientmustbiteandgothroughexcursivemovementswhiletheacrylicisstillfairlysoft.Theacrylic can be molded with moistened finger-tips. No attempt is made to refine the occlusion if it is not grossly excessive. Excess flash can be
removedwithacleoidoraheatedinstrument.4.Multiplepreparationscanbeconnectedwithasinglelayerofacrylic.5. Tell the patient they will not be able to floss.6.Therearemoresophisticatedmethodstotemporizeinlaysandonlaysbutthismethodisveryeasy
�. Rinseandcleanimpressionwithroomtemperaturewater.2. Spraytheimpressionwithsurfactant.3. Pourtheimpressionimmediately.4. Useadiematerialwithminimumexpansion.FujiRock(goldenbrown).5. Weighthediematerialandmeasurethedistilledwatertomanufacturer’s specifications. Proportion of 20 ml water/100 g of stone.6. Lineupthepinssodiescanbewithdrawn.
Articulating�. Pourtheopposingcast.2. Cutkeywayoneachsideofdowelpins.3. Paintarounddowelpinswithseparatingmedium.4. Fitimpressiontoarticulator.5. Pour�/2atatime.6. Removeimpressionfromthecasts.7. Immediatelypouraback-updie.8. Allow the die material to set at least five hours.
Waxing�. Brushonwaxseparatorsparingly.(NeyDieLube)2. Paintopposingandadjacentteethwithdielube.3. Apply wax (Yeti grey) evenly, flowing into all line and point angles.4. Flowwaxwithsweepingmotionovertheentiresurfaceofthediebeforeallowingitto
hardeninordertoavoidlinesandvoidsinthepattern.5. Buildwaxtoexcess.6. Establishcontacts.7. Meltocclusionwithhotspatulaandclosearticulatortoregisterbite.8. Carve and finish the wax pattern immediately after the wax is built up.9. Avoidscrapingthediemarginswithcarvinginstruments.�0.Avoidreapplyingwaxoveraoncecarvedmargin.��.Besurewaxiscoolbeforeremovingwaxpattern(mayrefrigerate).�2.Avoidrepeatedremovalofwaxpattern.
Casting�. Castwithin20minutes.2. Use air and gas flame ( no oxygen).3. Do not over heat gold. Dust with flux, cast as soon as the gold rolls together.4. Kerrbrokenarmcastingmachineisgood.5. UseaTypeIIgoldwithBrinellhardnessof95-��0withapproximately80%goldalloy.6. Letgoldcoolinringbeforebreakingout.7. Brushcastingcleanandplaceinanultrasoniccleaner.Donottouchinsidewithaninstru-
perature,andtimeoffurnacetemperaturebuild-up.4. Adjustcontactsandbite.5. Adjustcontactwithrubberwheel.6. Finish casting with #.5 round bur over all occlusal fissures.7. UseRobertson#��standardstiffbristlebrushwithTripolioverocclusalalsoendbrush
mandrelsthathavebeensharpened.8. All other surfaces are finished with discs in the following order: medium garnet, fine sand
and fine cuttle.9. Robertsonsoftbristlebrushwithrougeovertheocclusal.�0.FeltwheelonmandrelwithTripoli.��.Chamoiswheelonmandrelwithrouge.DonotletTripoligetonchamois.�2.Washpolishoffcastingwithhotwaterandallpurposecleaner. (Mayuseultrasonic).�3.*Note:Whilewaxing,removeasmuchbulkfromtheinsideaspossiblewithasharp
cleoidordiscoidinstrument.�4.*Note: Do not finish on the die, and avoid finishing the margins.
Afterallproceduresnecessarytoproduceagoldinlay,onlay,orothertypeofcastinghavebeencompleted with care and understanding; the last step, the finishing of the gold if done properly will make the difference between a serviceable restoration and that of a fine, beautiful case. The procedures described below are predicated on the fact that the casting fits the tooth cavity, because without a good casting no finishing technique will produce a fine case, nor even a serviceable restoration. The initial procedure of finishing involves the laboratory, as it is here that the difficult access areas on the occlusal portion of the restoration are refined and polished; and the final contours are placed onthecastingToavoiddestructionofthedetailedanatomyinthecasting,thefollowingproceduresaresuggested.Allaccessiblesurfaces,exceptcontactareasandmarginsaresmoothedwith�/2inchgarnet medium, and 1/2 inch sand fine discs in that order. Then 1/2 inch cuttle fine discs are used over allsurfacesofthecasting,includingmarginsandinterproximalcontactpoints.. All pits and fissures are smoothed lightly with a No. 3 carbide bur, contacts corrected, occlusion corrected,thenallocclusalanatomyispolishedwithaNo.��standardstiffbrushwheelandtripoli.Ifneededtheendbrushmandrelmaybeusedwithtripoliinthedeepareasofthecasting.Finallytheno.��softbrushwheelisusedwithahighpolishingcompoundoverallsurfacesofthecasting. Since the restoration is finished except for the margins before cementation, the dentist confines hiseffortsintheoperatorytothemarginsonly. Followingtheadministrationofananestheticandproperisolationwiththerubberdam,thecavityiscleanedandthencavityvarnishisappliedtothedentinwalls,usingcarenottoapplyitonthemargins.Therestorationis“tried”toinsurepropercontact.Itisnotnecessarytodrivetherestorationtoplacepriortocementation.Usuallyitcanbeleftahalfmillimeterfrombeingcompletelyseated,wecanbesureofproperexpansionofthecasting,doanynecessaryadjustmentofthecontactpoint,andavoid the difficult task of removing a hard seating casting that could damage the tooth or the restoration. Aslowsettingmixofzincphosphatecementshouldbemadeonacoolglassslab.Thisisaccomplishedbyslowintroductionofthepowdertotheliquidandpowderwouldbeaddedonlytothepointthatitwoulddropfreelyfromthespatula.Thisisimportantasthecastingwouldnothavebeenfinished on the tooth prior to this time and the margins should be smoothed with the most coarse of the threediscs,priortothehardeningofthecement. The interior surfaces of the casting are first covered with cement which would also be applied tothecavityinthetooth.Afterhavingplacedthecastinginthetoothitwouldbeseatedhardbyapply-ingconsiderablepressureonanorangewoodstickwhilebeinggentlymallotted.Thecastingshouldbeheldwithpressureforashortperiodoftimetoallowreleaseofhydraulicpressure,whichcouldcausethecastingtolift. Withaslowlyrotatingmandrelinastraighthandpiece,amediumgritgarnetdiscshouldberolledoverthemarginsfromthecastingtowardthetoothsurface,creatingasingleplanebetweenthegoldandthetooth.Thisalsoaccomplishesaslightburnishingofthegoldatthemargin. Allmarginsofthegoldcanbeoperatedwiththestraighthandpieceexceptthemesio-lingualmarginandthegingivalmarginsofallposteriorteethinboththemandibleandthemax-illa,withsomeunusualexception.Afterallothermarginshavebeensmoothedwiththistypedisconthestraighthandpiece,thecontra-anglewouldbeusedtosmooththemesio-lingualaspect.Thisisaccomplishedwiththegritsideofthedisc“in”facingthehandpiece.Finishingtothispointshouldbedonebeforethecementhashardened.
�5�5 �5
Thenextprocedurerequireslittletimebecauseitismerelytopolishthegoldandthetoothatthe margins, not reduce them. The 1/2 inch fine sand grit disc would be used with the same handpiece proceduresasdiscussedabovetoaccomplishareductioninthesizeofscratchesleftbythemediumgarnetdiscs. Attention is next given to the gingival margins. The casting should fit accurately, with no excess gold over the margin. A narrow eighteen inch finishing strip, with medium garnet grit, sharpened to allow passage, would be passed interproximally. This is aided, as is the entire finishing of the gingival margins,bytheassistantretractingthetissueastheinterproximalrubberdamisheldup,onboththebuccalandlingualaspects.AlittleVaselinelubricantalsoisanaidtoavoidcatchingtherubberwiththestripasitispassedoverthemargins. Theuseofthestripsmoothesthegingivalgoldandtoothstructuretothesameplane,aswellasthegingivalthirdofthebuccalandlingualcavosurfacemargins,whichcannotbereachedwithdiscs.Usuallytwoorthreeswipesoverthemarginaccomplishesthispurpose,andcareshouldbegiventoavoidoveruseofthestripontherelativelysoftcementum.Itisobservedthatifgoldisinexcess,itseldom can be finished properly to the tooth, since the strip seems to remove tooth structure faster than thegold. After use of the medium garnet strip, a similar fine cuttle strip is use in the same manner. Again only two or three passes with the strip should suffice. This is only to remove fine scratchesandpolishwhereitisnotpossibletouseadisc. If there are inaccessible areas such as in grooves or fissures, a fine white stone may be used in those specific areas of the tooth. A fine cuttle disc is then used to polish all accessible margins in the manner described above. Thisseemstoclosethejointaswellaspolishthesurfaces. Finalpolishingcanbedone,aftertheproperdiscingwithverylittleeffort.Firstaslurryofpumice in a rubber cup on a contra-angle would be used, to be followed by flushing and irrigation. After drying the field of operation, dry tin oxide or similar polishing agent would be lightly used over allaccessiblesurfaces. Itshouldbenotedthataircoolantbeusedduringalldiscingandduringuseofthestrip,aswellaspolishing,toavoidover-heatingthetooth.
Historically,theuseofgoldforrestora-tionsindentistryhasdeclinedwiththedevelop-mentofcompositeandporcelainrestorations.However,conservativecastgoldrestorationscontinuetobethetreatmentofchoicetorestoreposteriorteethanddistalofcuspidsformanyclinicians(Fig�).Theprimaryadvantageofagoldcastingisitspermanence(Fig2).Thistypeofrestorationcanlastalifetime.Acast-goldres-torationmaintainsthebeautyofanaturaltoothinmostcaseswhencavitydesignisthoughtfullyconsidered,andwhencareisgiventoperfectionof the casting and its finishing. Typical cast gold restorationsareshowninFigs3ato3f.Theadvantagesofgoldcastingsare:
5. The cast gold inlay can be finished to beahighlypolishedandsmoothsur-face,whichispleasanttothetongueandcompatiblewiththeoraltissues.Thisalsoismoreplaqueresistantthanamoreroughenedsurface.
•RubberdamPlacementofarubberdamisstandardprocedureforthistechnique.Itallowstheopera-tor to have the best field possible to work in. Theteethareisolated,gingivaltissueisslightlyretractedandsalivaiseliminated.Thetongue,cheekandlipsareeliminatedfromtheoperatingfield. The patient is not concerned about swal-lowinganypreparationdebris.Thequalityandquantityofrestorationsareenhanced.�-3
•RemovepreviousrestorationandcariesTheentireexistingrestorationisexpedi-tiouslyremoved.Careshouldbetakennottoextendtheoutlinebeyondtheexistingrestora-tion.Removeallremainingcaries.Theoperatorshouldnotbeconcernedaboutthepreparationtaperatthisstage.Theremainingtoothstructureisthenevaluatedandtheappropriaterestorationistreatmentplanned.Itishelpfultotransillu-minate with a fiber optic light during the evalu-ationoftheremainingtoothstructure.Someimportanttreatmentplanningconsiderationsare:amountandqualityofremainingtoothstructure,occlusion, significant fracture lines or enamel crazing,parafunctionalhabitsandgolddisplay.
•Calciumhydroxidebase A thin film of calcium hydroxide (Dycal) is placedontheinternalofthepreparationwithasmallcottonpellet.Itactsasaseparatorforeasyremovalofthecompositebuilduppriortocementation.Retentivepitsforretentionofthecompositecanbeplacedwitha#2roundburafterthebaseisset.
•Occlusalpreparation The preparation is cut with a #56 fissure bur for bicuspids and a #57 fissure bur for molars. The occlusal outline and pulpal floor are placed
toadepthof�.5-2mmandauniforminclina-tionofthewallsof3-5degrees(Fig5).Thisresultsinanidealpreparationtaperof6-�0degrees ( Fig 6). The #56 and #57 fissure burs are4mminlengthandcanbeusedtodetermineproperdepth.
•ProximalboxformTheproximalboxformisestablishednextandisblendedwiththeocclusalpreparation.Theboxformiscutwiththesameoveralltaperas the occlusal. The width of the gingival floor isslightlylargerthanthediameterofthe#56burforbicuspidsandthe#57burformolars.Thebuccalandlingualwallsmustbeextendedfarenough(�mm)beyondtheadjacenttoothtofinish the casting. A smaller bur (169L) is some-timesconvenienttoestablishtheproximalwallextensionswithoutdamagingtheadjacenttooth. The proximal walls have a slight flare (~45˚) thateliminateunsupportedenamel
D.GingivalbevelItisasmallbevelthatis.5-.75mmwide.Thebevel should be definitive and smooth but not toowide(Fig.�0).Thereisnoadvantageincut-tingalargebevel.Thebeveliscreatedinthirdstopreventget-tingaswaleinthemiddlewhereitiseasiesttocut.Startbycuttingthebuccalandlingual�/3byplaningtowardtheproximalwall.Thenjointhebuccalandlingualsegmentsbycuttingthemiddle�/3ofthebevellast.Gingivalmargintrimmersthatarepre-sharp-enedbythemanufacturer(Suter)atamoreacuteangle than normal (30˚) are marked “Tucker.” The#232Tuckergingivalmargintrimmerisusedonthedistal.The#233Tuckergingivalmargintrimmerisusedonthemesial.
2�2� 2�
•OcclusalbevelThefunctionoftheocclusalbevelistore-movefragileenamelrodsandanyirregularitiesinthecavosurfacemargin.Itgivestheoperatoran opportunity to prepare a smooth, flowing, estheticallypleasingoutline.Thisbevelshouldbe placed with the same straight fissure bur ( #56 or#57)usedfortherestofthepreparation.Thebevelisplacedwiththeburinclineofonlyafewdegreesmorethantheocclusalwall(Fig��).Wheretheexistingoutlineisalreadyadequate,nobevelisneededsincetherearenounderminedenamelrods(Fig�2).
•DiskproximalwallsA�/2inchgarnetdiskisusedtostraightentheproximalwalls.A#42Sor#43Schiselisusedto plane the proximal walls if space is insuffi-cientforthedisk.Thesingleplaneoftheproxi-malwallismaintainedsinceatwoplanewallisnotdesirable.Thediskcanalsobeusedtoblend
Thebevelsontheseinstrumentsarelessacute(45˚) than the ones marked Tucker (30˚)(Fig 17). Theaxialwallisinstrumentednexttoinsurethatitisnotundercutorirregularatthegingivo-axial line angle. The gingival floor must be cut approximately.5mmwiderthanusualtoaccom-modateaninternalbevel
theteethtomorecompletelyinterdigitateastheimpressionregisterstheirpositioninfunction. TheresultingquadrantmodelsmountedfromthecentricocclusionbiteoftheimpressiononasimplehingearticulatorisshowninFig20. Forgingivalretraction,abulky,non-braidedcord(Gingivi-Pak#3,Surgident)ispreferred.Thiscordprovidesgoodretractiondepthbelowthepreparationandgoodwidthofthesulcus.Thepopularbraidedcord,doublepackmethodwhere the first chord remains in the sulcus dur-ingtheimpressiongenerallydoesnotprovidethedepthandwidthdesiredforgoodimpressions.Invariablythetissueseemstobleedifbothchordsareremoved.A25%aluminumchloridesolution(Hemodent)isusedfor
hemorrhagecontrol.Itseemstobekindtothetissue and leaves no film on the preparation.Oneortwocordsareplacedaroundthepreparation.Twocordsseemtoworkwellin-terproximally.Theyshouldbeleftinplaceforabout3–4minutes.Priortotakingtheimpres-sion, check the fit of the tray and have the patient practicegettingthe“feel”ofbitingintocentricocclusionwiththetrayinplace.Notetheoc-clusiononthecontralateralsideasaguidesoyouknowwhenthepatientisbitingintocentricocclusion. Iftheoperatorchoosestouseapolyvinylsiloxaneimpressionmaterial,itisadvisabletouseonlythelightbodymaterialfortheentireim-pressionbecausefoldscanoccurattheinterfaceofthelightandheavybodythatareunacceptableforinlayimpressions.Thepotentialsetinhibi-
tionduetotherubberdamorlatexglovescanbecounteractedbycleaningthepreparationandadjacentteethwithacottonpelletsaturatedwithhydrogenperoxideafterthecordisremoved.Rinsethoroughlybeforetakingtheimpression.Beforetheimpressionmaterialismixed,theoperating field should be spray washed and dried andthecordisslowlyremoved.Itischeckedforadequateretractionandthatthereisnohemor-rhage.Ifretractionisnotadequateorifthereishemorrhage,repack.Ifitissatisfactory,itmustbemaintaineddryandtheimpressionmaterialismixed.Syringeimpressionmaterialintothepreparation,placethecheckbitetrayandhavethepatientbiteintocentricocclusion.Bepre-paredto“assist”thepatientintotheproperjawpositionwithgentlepressureonthechin.Con-tinuetomonitorandsupportthepatientforafewminutestomakesurethatthereisnodistortionintheimpressionduetopatientmovement.
Theacrylicisplacedwiththeliquid/powdermethodusingafairlylargebrush.Buildacrylictocontour,besuretocoverallmarginsofthepreparation.Workquicklysothatthepatientcanbiteandgothroughexcursivemovementswhiletheacrylicisstillfairlysoft(Fig23).Theacrylic can be molded with moistened fingertips. No attempt is made to refine the occlusion unless there is a gross excess of acrylic. Excess flash canberemovedwithacleoidoraheatedinstru-ment.Multiplepreparationscanbeconnectedwithasinglelayerofacrylic.Besuretotellthepatient they will not be able to floss.
Lab Theskillinwhichanoperatorcanprepareteethandseatcastingsisaveryimportantpartofthistechniquebutunlessqualitycastingsarefabricatedinthelaboratory,itisimpossibletocreateconsistentlyexcellentrestorationsforourpatients.Abasicunderstandingofthelaboratoryproceduresisessentialtobeabletocritiquecast-ings and to communicate with your lab if refine-mentsarenecessary.Itisnotwithinthescopeofthischaptertodiscusslabproceduresindetailbutcastingexpansionwillbecoveredbecauseitisanimportantconcepttounderstand. Goldshrinksapproximately2.4%ofits
massasitiscastandgoesfromaliquidtoasolid.�5Ifnothingisdonetocompensateforthis gold shrinkage, inlays will fit loosely with marginalgapsandcrownswillnotseattoplace(Fig24).Thetermexpansionisusedtodescribemethodsusedtocompensateforgoldshrinkage. Is the gold shrinkage clinically significant? Theocclusalinlayin(Fig25)isanexampleofaninlaythatistoosmallforthepreparation
resultinginmarginalgapsthatcannotbeclosedduring finishing. Theinvestmentproceduresarewherethecompensationforgoldshrinkagetakesplace.Themethodstoincreaseexpansionbymanipu-latingtheinvestmentaretodecreasethewaterinthewater/powderratio;increaseoventempera-ture;increasethenumberofringliners;hydro-scopic expansion in water bath (100˚F). Asmanyvariablesaspossibleshouldbeeliminated.Onlywater/powderratioandoventemperatureshouldbevariedtogivemaximumaccuracytoeachtypeofcasting.Itisimportanttorealizethateachtypeofcastinghasitsownrequirementasregardstoexpansion.Itmightbenotedthatthedoubleringlineraccountsforthenecessity of fifty degrees less furnace tempera-ture.Thisallowsthecastingtemperaturetobebelowthatwhichcausesbreakdownoftheinvestment. Dr.RichardV.Tucker’srecommenda-tionsforexpansionwithNovocastinvestmentareshowninFig26.
SeatingCastingsshouldbeseatedwithanesthetic.Thetemporaryisremovedandarubberdamis placed. The fit of the casting is verified on thepreparationandthecontactsareadjustedifnecessary.
goldtowardthetooth.Thegarnetdiskistheworkhorse of the finishing process and usually severaldisksareused.Allmarginscanusuallybe finished with a straight hand piece except themesiallingualarea,whereacontra-angleisusedwiththegritofthedisktowardtheman-drel.Aftercompletionwithgarnetdisks,mostoftheworkwillhavebeendonesothegoldandtooth are merely finished so that the scratches are smaller. The fine sand disks are used next. Thegingivalonethirdofthecastingandgingival margins can be finished with finishing strips. After completion with fine sand disks, a narrow eighteen-inch medium garnet finishing stripthathasbeencuttoapointispassedunderthecontact.Usuallytwoorthreeswipeswiththe strip will adequately finish this area. Care mustbetakennottoovercuttherelativelysoftcementum. A fine cuttle stip should be used next inthesamemanner.
Finecuttledisksareusednexttoremoveanyremainingscratchesandpolishthegold.The key to fine finishing seems to be good use ofcuttledisks.Asdisksbecomeusedandworn,thescratchestheyleavebecomesmaller.Ithasbeensaidthatdiskshavethreelives:new,usedand worn. When gold is finished to a “third life” worncuttledisk,itcanthenbepolishedwithpowders to a mirror-like high finish. This
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Fig 29 Slight reflection at functional margins of gold inlay.Openingandgapformationatfunctionalmarginsofbothporcelaininlays..
oftheenamel/goldcavosurfacemarginholdsupwellunderocclusalstress.Thegoldandtooth wear at a similar rate and the coefficient ofexpansionissimilar.Therefore,preparationcavosurfacemarginscanbeplacedwithouttoomuchconcernfortheopposingocclusion.Thegold margin exhibits only a slight reflection even aftermanyyearsoffunctionwhereasfunctionalmarginsofamalgam,compositeandporcelainwilleventuallyopen(Fig29).
Esthetics Ifconservativegoldrestorationsareproperly designed and finished, gold display can beminimalornonexistent.Atoothcanbefunc-tionallyrestoredforalifetimewhiletheestheticsoftheoriginaltoothcanbemaintained
Fig 31Slightgolddisplayatocclusalof7/8crown#4.
can be accomplished by finishing the casting a sectionatatimewithallthreelivesofthesamecuttledisk.Thelifeofadiskcanbeacceleratedtoamorewornstagebyrotatingitonthemirrorhandle. Difficult access areas might be finished with the smaller 3/8 inch disks. Small finishing dia-mondsfollowedbybrownie,greenieandsupergreenie points work well for grooves and fissures thatarenotaccessiblewithdisks.
Thecastingisthenreadytopolishwithpowders.Caremustbetakenbecausethepow-derscutthetoothandgoldatdifferentratesandcan open up a margin or cause a reflection. This is especially true with flour pumice. Each of the powdersshouldbeusedwithaclean,ribbedrub-bercuponacontra-angle.Aslurryofpumiceisused to give the gold a uniform finish after the disks.�5micronaluminumoxidewithalcoholis used next. The final powder, 1 micron alumi-numoxide,isuseddrywhiletheassistantblowscontinuousairandsuctions. Aftertherubberdamisremoved,theoc-clusionischeckedwitharticulatingpaper.Adjustmentsaremadewithahighspeedgreenstoneandpolishedwithhighspeedbrownieandgreeniepoints. Thelongevityofconservativegoldcastingsislargelyduetoourabilitytocreatecastingsthat fit well and are nicely finished with marginal gapsoflessthan50microns.�7Keenan�8suggeststhat a well finished gold surface accumulates less plaque.
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Fig 33 Magnification.
Magnification The use of magnification for this type of dentistryisveryhelpful.Ourabilitytodeliverqualityrestorationsisenhancedwiththeuseofsome type of magnification. A range of 2 - 3.5 dioptersisrecommended(Fig33).
VARIATIONS OF CAVITY DESIGNInlay vs onlayTherestorationofchoiceforaposteriortoothisaninlaybecauseitpreservesmorefunctionaltooth structure and can be predictably fitted and finished. It is often very esthetic because most of theenamelcanbepreserved.Itistheexperienceoftheauthorsthatcuspfractureofaninlayisrare.Anonlayrestoresthestrengthofatoothbutdestroysmoretoothstructureandthegolddisplaycanbeunesthetic.
OnlayAnonlayisindicatedwhenthereisnotenoughsoundtoothstructureremainingtosupportaninlay.Thebasictechniqueistoalwayscutthemod preparation first and then onlay the cusps as the final step. In questionable situations where the
remainingtoothstructuremightsupportaninlay,generallyitisadvisabletoonlaythetoothsincepredictablelongevityisourgoal.Ifthereissuf-ficient tooth structure, only the weakened portion ofthetoothcanbeonlayed.However,inmostcasesbothbuccalandlingualcuspsareonlayedtodistributetheocclusalforcesoverabroadersurface.Anonlayedtoothcanbestrongerthantheoriginalnon-restoredtooth.Cuspreduc-tionforafunctionalcuspisabout�.5-2mm.Non-functionalcuspscanbereducedless.Theappropriatebevelsareplacedwitha7404bur.Theresultinghollowgrindbevelgivesbulkofgoldatthebevelandprovidesaverynicemarginto wax and finish to. Step-by step procedures for onlaysareshownonFigs33ato33L.
Indication This preparation is a modification of the traditionalonlaypreparationtominimizegolddisplayontheocclusalbuccalmarginofupperbicuspids.Armamentarium1. #56 fissure bur2. Brasseler7404bur3. Finecuttledisk
4. Thebuccalwalliscutfairlystraight acrossandthedistalbuccallineangle isquitesquaretotryandmaintainan actualbuccalwall.Thisresultsina littletriangleorirregularityonthe distal buccal finish line. This is left sincesmoothingthisareawould resultinanundercut.
FullGoldCrownVariationsThevariationsallowthebuccalmargintobekeptwellabovethegingivaforbettertissuehealth.Eachvariationhasafeaturethataddsre-tentionandresistanceformtothepreparationtoallowahighbuccalmargin.Thebuccalmarginis finished like an onlay.
Brasseler7404BurPreparationVariationsThisbulletshapedburproducesaverysmoothhollow ground margin that allows good defini-tionandbulkofgoldatthemargins.�9
The finger-like extension on the buccal of molarsisplacedwhenthereisextensivebreakdownofthelingualcusp.Itallowsthecastingtoengagethestrongerbuccaltoothstructure,reducingthestressonthelingual.
4. Usingthe#233margintrimmerplaceaninternalbevelonthegingivalwall.Slidedownboththelabialandlingualwallsto define the line angles and sharpen the pointangles.
Indication Oftenappropriatewhereacastinghasbeenplacedtorestorethetoothanda smallbuccalorlinguallesionremainsthatcanberestoredseparately. Armamentarium Preparation 1. 55 fissure bur 2.35invertedcone 3.7404bur Condensation �.Powderedgold(EasyGold) 2..5foilcondenser 3..7foilcondenser 4.Goldfoilmallet 5.Goldfoilcarrier 6.Woodbury-Myerholder 7.Goldknife 8.Varneyfootcondenser 9.Cohesivegoldpellets Finishing 1. Disks: medium garnet, fine sand, fine cuttle 2.Cleoid 3.Beavertailburnisher 4.Ribbedrubbercups 5. Polishing powders: #4 flour pumice, 15 and 1 micron aluminum oxide. Preparationsynopsis Asmallcircularpreparationwithaxialretentioncutwitha35inverted oneandasmallocclusalbevelplacedwitha7404bur. Preparationsequence 1. Use a 55 fissure bur to outline the cavity. An ideal depth is 1.5 mm. 2.Usea35invertedconetogivetheaxialwallalittleretention. 3.The7404burisusedtosmooththeoutlineformandplacealittle bevelonthecavosurfacemargin. Foilplacement �.Usea.5or.7condenser.Usethelargestcondenserthatthecavitywill accommodate. The bulk of the restoration is filled with powdered goldbecauseitisquickerandeasier. 2. Anneal the powdered gold over a flame using a foil carrier.
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eachpelletinitiallywithhandpressureandthencondenseusingthe mallet. 4. Fillthecavitytothebevelwithpowderedgoldsothatthereisonly about .5 mm left to fill. 5. The rest of the cavity is now filled with cohesive gold because it is denserandwillhavelessporosity.Thecondensationforceisnow directedtowardtheenamelbevel.Thiswillmakethegoldtighttothe wallsaswellasprotectthefragileenamelduringcondensation. 6. Asthegoldisaddedtobuildupthecontour,excessgoldisremovedbeyondthemarginwith
a gold knife. It can be difficult to remove later and we may lose the relationship of where the marginactuallyexists.
7. Verify if the cavity is filled by using an explorer from gold toward the tooth. If we do not feel an edge of tooth, the cavity is filled.
8. Use a Varney foot condenser to finalize the condensation. It takes out the hills and valleys a bitandsmoothesthegoldtooneplanealittlemore.
Finishing 1. Always blow air when finishing gold with disks because the heat generated can damage the
3. Next use the fine sand disks. Use a cleoid to remove any surplus flecks of gold since the diskswillcontinuetocarrythegoldoverthemargin.
4. Useabeavertailburnishertoburnishandworkhardenthegoldabit. 5. Follow with the fine sand again to remove any irregularities produced as the gold was work
hardened. 6. The last disk is the fine cuttle. It does not require much effort because of the step-by-step
finishing sequence we have used. Polish �. Usingaribbedrubbercup,beginpolishingwith#4pumice.Donotusepumicetoolong
becauseitremovestoothstructureandgoldatdifferentrates. 2. We now use aluminum oxide 15 microns. The final finish is with the 1 micron aluminum
AllAboutPinsinGoldCastingsRichardD.Tucker,DDSRichardV.Tucker,DDS Inlays are so much fun to design and finish, and they are so beautiful. A simple MO, DO, or perhapsanMODgivessuchexceptionalservicetothepatient.However,sometimesthereisinsuf-ficient tooth structure remaining to provide enough retention or resistance form to retain the simple castingwewouldliketoplace.Ratherthanapreparationforamoreextensivecastingrequiringtheremovalofmoreofthepatients’healthytoothstructure,wecangaintheresistanceformand/orretentionneededthroughtheadditionofoneormorecastgoldpinstoourgoldcasting.Thereare4typesofpinsavailabletosatisfyourneedsformoreresistanceformandretention.TheShooshanpin,the700 tapered fissure pin,avariationonthiscalledthe 700 tapered fissure slot,andtheTuckerpin. TheShooshanpintechniquewasdevelopedbyDr.DavidShooshan,anoteddentistinsouthern California. The position of the pin hole is first marked with a #4 round bur to half the depth oftheburhead.Thisformsthe“countersink”aroundthepinholeopeningwhichwillgivethepinmorestrengthwhereitjoinsthecasting.Thepinholeismadetwotothreemillimetersdeepwitha.027inchtwistdrill,usedintheslowspeedcontra-anglehandpiece.Thepositionofthepinholehavingalreadybeendeterminedandmarkedwiththe#4roundbur,theoperatorsimplyplacesthetwistdrillinthecountersinkandalignsitwiththepreparationforproperdraw.Thepinholeisthendrilled, being careful to not move your finger rest until the final depth has been reached. If more than one pin hole is to be made, the positions of all pin holes are first marked with the #4 round bur countersink. The .027 inch twist drill is placed in the first countersink and aligned with the prepara-tion draw, but no pin hole is made. Without changing the finger rest, or the angle of the twist drill, thetwistdrillisnowplacedinthenextcountersinkcheckedforalignment,andadjustedifrequired.Thisprocedureiscontinuedforallthecountersinksuntilacommonpathisdeterminedthatwillac-commodate all pin holes and draw with the preparation. Then without changing the finger rest, each pin hole is drilled. The finger rest and drill function like a surveyor, allowing the operator to place asmanypinholesasrequiredknowingtheywillallbeparallel.Thekeytothistechniqueistonotchange the finger rest until all the pin holes have been made. Theimpressionofthesepinholesiseasilymadebyplacingashortlengthof.025inchnylonbristle with a flat “nailhead” on the end, in each of the pin holes. Theimpression material subse-quentlyinjectedintothepreparationlocksontotheheadsofthebristles,andtheyareallwithdrawninperfectalignmentwhenthesetimpressionisremovedfromthemouth.Theimpressionisin-spectedforcompleteness,withatleast�mmofimpressionmaterialextendingbeyondallmargins,gentlywashedwithroomtemperaturewater,andpouredinalowexpansionstone.Oncethediehasbeenremovedfromtheimpression,an.024inchnylonbristleisinsertedintoeachpinhole.Thissizedifferentialwillallowthepinstoseateasierwhenthecastingisplacedinthetooth,andprovideroom for cement. The wax is flowed around the .024 inch nylon bristles and the wax up is carried to completion.Thenylonbristleswillburnoutcompletely,butmayrequirealongersoaktimeifthefinal burnout temperature is less than 950 Fahrenheit. The advantage of the Shooshan pins is they maybeeasilyplacedinrelativelyrestrictedareas.
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The Shooshan pins provide sufficient retention for an extensive inlay such as a large distal lingualinlayonamaxillarycuspid.However,ifthecastingwillrelyentirelyonitspinsforresis-tanceandretention,thenalargerpintypemaybedesirable.Inthiscase,thepinholelocationsaremarked with a #6 round bur countersink. The pin holes are then made with the same constant finger resttechnique,substitutinga169-Lor170-L(depending on size)tapered fissure bur for the twist drill. Theimpressionofthesepinholesismadedirectlywiththeimpressionmaterial,usingtheairventtechnique,asfollows.Thetipofadry27gaugeanestheticneedleisbrokenoffwithasmallplierinsuringthatthelumenremainsopen.Onesuchneedleispreparedforeachpinhole.Theneedlesareplacedtothedepthofthepinholes,andastheimpressionmaterialisforcedalongsidethe needles, the air in the bottom of the pin hole will flow out the hollow needle allowing the impres-sion material to completely fill the pin hole. The needle is then slowly withdrawn as more impres-sionmaterialisinjectedbesideit.Afterallneedleairventshavebeenremoved,theremainderofthepreparationisinjectedwithimpressionmaterialandtheimpressioniscompleted. Duringthewaxup,asize700taperedplasticpin*isplacedintoeachpinhole.Thewaxisthen carefully flowed around the protruding end of each plastic pin and down into the counter sink area.Thistechniquewillgiveamoresubstantialpinforuseinhigherstressapplications. There are times when even the 700 tapered fissure pin is not substantial enough, so a varia-tioncalledthe700 tapered fissure slot isused.Therearevariousapplicationsbutitmightbeusedin a distal occlusal inlay where there is insufficient tooth remaining in the isthmus area to provide agooddovetail.Ratherthancutanapproximalboxintheuntouchedtoothstructureofthemesialsurfacetokeepthecastingfrombeingdisplaceddistally,a�69-Lor�70-L(dependingonsize)burisusedtoplaceaslotinthepulpalwalljustinsidethemesialmarginalridge.Thisslotshouldextendbuccallinguallyabout2-3millimetersdependingonthesizeofthepreparation,andtoadepthof2.5millimeters.Thiswillprovideampleresistanceandretentionformaswellasallowingustoleavethemesialsurfaceofthetoothuntouched.Theslotthusformedisofrelativelylargedimension,andcaneasilybereproducedbyplacingthetipoftheimpressionsyringeinthebottomoftheslotastheimpressionmaterialisinjected,ortheneedletechniquecouldbeused.Afterthedieisrecoveredfrom the impression, trimmed, and lubricated, wax can be flowed directly into the slot with a small instrumentduringthefabricationofthewaxpattern.Thelargercrossectionalareaoftheslotshouldallow the wax pattern to be removed without breakage or distortion of the slot portion. The finished castings provide sufficient strength and retention without involving the remaining good approximal surface. Thefourthpintype,theTuckerpin,wasdevelopedbyDr.RichardV.TuckerinFerndale,Washington. In order to understand its use, one must first visualize a tooth which has suffered a great amount of destruction of the pulpal wall. This great void inside the tooth is filled with compos-itetoprovideabuildupyieldingoptimumdimensiontotheinternalofthecasting.
*Mfg. by N.W. Dental Supply, 590 Clearwater Suite C, Post Falls Idaho 83854 Concept by Dr. Maurice Chechik, Vancouver, British Columbia, Canada
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If the final preparation needs more resistance and retention form, a 7404 bur is used to place apinholetothefulldepthofthecompositebuildup.The7404burwhichismanufacturedwithafairly straight, rather than rounded profile**, works well for making this pin hole. When the impres-sionismade,thesyringeneedleairventtechniquedescribedpreviously,mayberequiredtoavoidtrappinganairbubbleinthedepthofthepinhole.Thepiniswaxeddirectlyonthedieasinthecase of the 700 tapered fissure slot. Before the casting is cemented in the tooth, the entire composite buildup is completely removed. This large internal void is then filled with zinc phosphate cement andthecasting,whichalsoiscoveredontheinternalsurfacewithcement,isseated.Thecementlocksintotheinternalofthetoothandatthesametime,locksaroundthe7404pin.Inthiswayweare able to get additional resistance and retention without sacrificing any additionaltoothstructure.Becauseofitslargesize,theTuckerpinisonlyplacedinthebuildupma-terial,andneverintoothstructure. Thiscompletessomeoptionsforincreasingresistanceandretentionformthroughthein-corporation of pins in our gold castings. A first choice would be the Shooshan pin because of its conservative nature. Secondly, the 700 tapered fissure pin would be chosen if additional strength is required. Thirdly, the 700 tapered fissure slot would be indicated where there are great demands to resist mesial or distal displacement, and finally, the Tucker pin could be used when more resistance and retention form is required and there is a buildup of sufficient volume to contain the pin. Incorporatingthesepintypesinyourcastingswillallowyoutoplacemoreconservativeandlongerlastingcastgoldrestorations.
Richard D. Tucker DDS private practice 1800 C st suite 226 Bellingham WA
Richard V. Tucker DDS private practice PO Box 1146 Ferndale WA
** Mfg. by Midwest Dental Products Corp. 901 W Oakton St., DesPlaines, IL 60018-1884
Models*4simplehingearticulators*straightpins*debubblizer(Delarsurfactant)*smallbrush*dowelpins*mixingbowl*spatula*FugiRockdiestone(goldenbrown)*separatingmedium(NeyDieLube)*coping saw and fine blades*Parkerknife(#25blades)*die relief (Tru-fit,Geo. Taub.)*microfilm (Kerr)
Finishing*PrevoxTripolijewelersrougebristlebrushes(Buffalo#��,stiff&soft)ultrathinJoedandydiscsheatlessstonesdiscmandrels(Moore)mediumgarnetdisc(Moore)sand fine discs (Moore)cuttle fine discs (Moore)feltwheel&chamoiswheel&mandreltoothbrushbunsenburneroralcohollampmatches169 taper fissure bur#.5roundbur(straighthp)
RichardV.TuckerDVDThisDVDcontainsallthreeofDr.Tucker’svideos:The Gold Inlay Basics for gold inlays and onlays that include preparations, impressions and finishing.Variations in Cavity DesignCoversmostofthepreparationsandvariationsthatDr.Tuckerteaches.The LaboratoryLabbasicsandproblemsolving.Amustseefordentists.
IvoreenteethPlastic teeth to practice cutting preparations. Upper and lower first molars and second bicuspids seemtobeanadequateselectionaswellassomeuppercuspids.Orderfrom:
CLAMPSELECTION(Ivoryclampswithwings) Molars 14 standard workhorse clamp because it fits the most teeth. 56distalextendedbowgivesgoodaccessforrestoringsecondmolar. �4ad,8adusefuldistalextensionclampswhenrestoringthesecondmolar. 8aforsmallmolars.�4aforpartiallyeruptedmolars. Bicuspids2,0 Cuspids2
PLACEMENTAneasymethodistotakethedam,frame,andclamptoplaceasoneunit.Pickyourclampandpre-fit to the tooth if necessary. Attach the top of dam to the frame by placing tension between the toptwonibsandthenthebottomportionisattachedwithtensionbetweenthebottomtwonibs.Thisallowsplentyofplayinthedamwheretheclampwillbeattached.Attachtheclamptothedamandframeviathewingsontheclamp.Lookthroughtheholeintheclampandplace.Releasethedam over the wings with cotton pliers or an explorer. Stabilize the dam initially by flossing the front tooth first and then work back to the molars. The dam is tucked around the teeth resulting two layers ofdamaroundeachtooth.Thishelpsretractthetissueandsealthedamtominimizesaliva.Thetechniqueistoinvertthedamwithanexplorerortissuepackerwhilepullinggingivallyonthedam.Eachtoothissimultaneouslydriedwithairtofacilitatetheprocedure.Re-adjustthedamtotheframeasnecessary.