Clinical Examination

Step 1: Clinical Exam

![[F8 Try in#1.0 Phase 1 Assessment and Treatment Planning]]

[[F8 Try in#Treatment planning[ 4][ 5]]]

Individual Tooth Assessment

Restorability
long term prognosis

[[F8 Try in#Treatment planning[ 4][ 5]]]

Dentition and Patient Assessment

[!important] Control phase MUST BE COMPLETED FIRST

Complex cases need to be considered, especially if the patient requires complex rehabilitation or increased the OVD
Patient management
- Have to make sure their expectations are managed
- Can they tolerate the procedure?

![[F8 Try in#Patient communication]]

[[F8 Try in#Why does a tooth need a crown?|Why does a tooth Need a crown?]]

Extensive destruction of tooth structure
Failure of direct restorations
Enahnced retention
Control of external contour
- i.e. survey Crowns act as an abutment for a removable parital dneture clas
Destruction of tooth structure
Aesthetics
Plaque control/moisture control

Step 1.5 : Before patient arrives

Decide on material of choice
Approval of treatment planning
Wax up of tooth if any modifications required for existing tooth + Putty key

Materials

![[F6 Soft Tissue Impressions#Impression Materials[ 40]]

Putty Key :

PVS Putty

Clinical

PVS Dual Body

[[F4 Digital Impressions]]

Permanent Crowns

Temporary Crowns

![[Temporary Crown Materials Summary]]

Temporary Cements

![[Temporary Cements]]

![[Types of Dental Crowns and Their Indications]]

![[Types of Dental Cements]]

Permanent Cements, Brands and Indications

I. Permanent Cements (Luting and Adhesive Agents)

The permanent cements are generally classified by their composition and bonding mechanism (water-based luting agents vs. resin-based adhesive cements).

Brand Name	General Type/Mechanism	Application Context/Composition
Panavia (specifically Panavia F 2.0)	Resin Cement (Molecular Adhesion)	Contains the 10-methacryloyloxydecylhydrogen-phosphate (MDP) monomer which facilitates chemical bonding to metal oxides (like zirconia) and to calcium in tooth structure. Used for zirconia, metal crowns, and PFM crowns.
Variolink Esthetic (LC or Dual Cure)	Adhesive Resin Cement	Requires etching and bonding steps. Often used for glassy ceramic crowns (such as Lithium Disilicate/IPS e.max).
Rely X Unicem 2 Automix	Dual Curing, Self-Adhesive Resin Cement	This cement does not require a separate etching and bonding step. It achieves demineralization via acidic monomers.
Multilink Automix	Adhesive Cement	Listed as an option for cementing Lithium Disilicate crowns.
SpeedCEM Plus	Self-adhesive Cement	Listed as a product used for cementing Zirconium Oxide crowns.
Vivaglass CEM	Conventional Cement	Listed as a product used for cementing Zirconium Oxide crowns.
Fleck	Zinc Phosphate Cement (Luting)	A classic luting cement. Zinc phosphate has high solubility but generally works based on mechanical friction.

Cements used for provisional restorations are typically classified as temporary cements.

Brand Name	General Type/Purpose	Key Consideration
Tempbond	Zinc-oxide eugenol cement	The most commonly used temporary cement. The eugenol component may inhibit the polymerization of permanent resin cements.
Tempbond clear	Temporary Cement (Aesthetic Option)	An aesthetic choice among temporary cements.
(Not specified brand)	Eugenol Free Cement	Used when the final restoration will be bonded with a resin cement, thus avoiding inhibition of polymerization.
(Not specified brand)	Polycarboxylate Cement	Described as a “harder cement” for temporary use.

III. Ancillary Materials (Cleaners and Primers)

These agents are used to condition or clean the tooth or restoration surface immediately before permanent cementation, often specified by brand name in protocols for adhesive cements:

Brand Name	Type/Purpose	Role
Ivoclean	Fitting surface cleanser / Universal cleaning paste	Used to remove contamination (saliva, blood, try-in paste) from the internal surface of ceramic (glassy or zirconia) crowns after try-in.
Katana Cleaner	Fitting surface cleanser / Universal cleaning paste	A practical and effective method for chairside decontamination of zirconia.
Monobond Plus	Silane Coupling Agent / Conditioner	Applied to etched glassy ceramics (like Lithium Disilicate) to create a chemical bridge between the inorganic ceramic surface and the organic resin cement.
Alloy Primer	Primer	Used for metal crowns/PFM crowns in the Panavia cementation protocol.
Liquid Strip	Glycerin Gel	Applied around margins during final curing of resin cements to prevent the formation of the sticky oxygen inhibition layer.

Step 2 Primary Impressions

Use PVS Putty, Alginate for a dental cast if you need to for occlusion

1. Confirm Treatment and Anesthetize

2. Pre-operative Records:

take a new opposing model or putty key if any changes have occured

[[F8 Try in#Shade selection[ 14]|3.Shade Selection]]

![[F8 Try in#VITA plan classic]]

![[F8 Try in#Vitapan 3D-Master]]

Trios 3D shade selection

Step 3 [[F8 Try in#Preparation stage[ 10][ 11][ 12]|Preparation Stage]]

4. Tooth Preparation

Prepare the tooth according to the material guidelines

![[M2 PFM Prep#PFM Partial coverage with ceramic]]

5. Check Preparation

Ensure sufficient occlusal Clearance and no undercuts

6. Provisional Restoration

[[F6 Soft Tissue Impressions|7. Impression]]

8. Temporization

Step 4 : Try in Procedure

Systematic Approach

1. Evaluation of the crown on the die

Aims:

Detection of fabricatoin errors
Save Critical chair time
Anticipation of problems before clinical appointment
Consider good lighting and magnification
In case of problems, consult with the dental laboratory

B. Assess the Internal Surface

Casting problems: Air bubbles
Casting nodules or blebs
Ideal, the casting should touch the die at the margins only

C. Overall fit and resistance

loosenenss
Excessive gap
Proximal contact areas

D. Marginal Fit

open margins
Overhangs or underextensions

E. External Surface and Occlusion

2. Seating the crown on the prepared Tooth

--> [[F8 Try in]]Insert appointment

A. Proximal contacts

B. Internal Fit

C. Marginal Fit

3. Assessment of the seated Crown

Check:

Stability
Contour
Occlusion
Aesthetics

A. Assess the Die and opposing model

Poor pouring
Overtrimming
Fracture
Scratches
Wear