It’s funny how in this crazy running world full of technological gadgets I find very often so trivial mistakes in the workflow of vertical prep affecting the clinical outcome . Mistakes that most of the people doesn’t care enough .
On this short article i wanna focus just on one detail : cement and its drawbacks.
During a prosthetic workflow we usually use cement in two phases : 1) after the finishing of a provisional crown with , generally , a provisional cement like temp bond 2) in the final cementation with the final crown.
About the first point it’s a quite common experience to remove the provisional crown and find some temp bond stuck in the sulcus. The problem we have to face is that the excess of temp bond in the sulcus is one of the biggest factors affecting the correct healing of the soft tissues. During a vertical preparation we easily work in the space of the junctional epithelium and we need this to heal properly in order to give to our technician the correct biologic space where to decide the area of closure of the final crown .
The temp bond stuck in the sulcus stops a correct healing and keeps the tissue inflamed . This mix is the perfect recipe for bleeding , troubles in putting cords or other devices of retraction , more discomfort for the patient in the handling of the procedure and , eventually , an overextended impression recording a part that should be covered by the junctional epithelium. The average technician in these cases will tend to put the margin of the crown in the most apical part of the impression manifacturing a crown that’s too deep in the soft tissue with an high risk of inflammation and bleeding over time .
Point 2 : similarly to what happens with temp bond it’s very easy to leave excess of cement after delivery of the final crown …the main problem is that you don’t recognize this properly cause you don’t remove the final crown like you do with the provisional one . Definitive cement is also harder than the provisional one so the risk of leaving excesses is even higher . Even in this case this excess may lead , over time , to some bleeding and inflammation . When using some self adhesive cement the removal may be even more problematic if not impossible especially inter proximally.
It’s interesting to read papers about our ability to remove excess cement in the subgingival area showing two interesting things : the first is that we easily leave excesses already 1 mm subgingivally, and we do a disaster when going already at 2 mm , the second interesting is that xrays are not reliable enough . When we see excesses of cement on xray this means we have left “huge excesses” , but when we don’t see excesses in xray this doesn’t mean 100% that the cementation has been clean but that , probably , we have left small excesses somewhere .
It seems a paradox how a so overlooked detail may affect a prosthetic workflow but this is the reality , how many of these small details are still hidden in your work ?
If you wanna learn more on vertiprep there is the last seat available , due to a cancellation , on November 2024