High occlusion resolution help.

[Travis]

I need some ideas on how to help eliminate occlusal adjusting in the mouth. I need ideas from both dentists and technicians.

We had the same problem awhile back. He used a blue mousse triple tray pre invasion and a second wash afterward. We concluded that the second wash was creating a high spot everywhere. The second wash was (the prep). He started using Ivoclar Virtual heavy/light fast set polyvinyl to fix this. It seemed to have fixed this problem up until now. He has been doing a lot of chairside adjustments and a case I just received back were he had given me 1.5mm of room he hit the metal. I put the crown back on the model and I can see 1mm clearance around the opposing. I keep all my metal in the occlusion .5mm

I use a very thin marking paper to take out the bite slightly. This seems to work for the other doctors.

What is the trick for these triple trays?

[magushnik]

probably the framework or coping isnt seated all the way, try a small hole on the occlusial for the dr to check if it is seated all the way down. that might help you to see what the problem is. so many things that could be causing this. maybe his impressions are just crap. try working with a full arch. i hate blue mousse triple trays!!!

[Travis]

That was my first question were they seated correctly. Putting a hole throough the metal on the occlusal surface is a great idea. He says that the margins are sealed even with an x-ray they look fine.

I am getting a chamfer/bevel prep.

I ditch my dies under 10x microscope so is it possible I am over extending the margin?

The problem with triple trays are that I cant adjust the bite any. The triple tray is only allowing me to stamp the crown. In my case I take it .1-.3mm out of occlusion.

With a full arch once mounted I can detect any high spots with film paper and adjust it accordingly, you cant do this when you have 3 or 4 teeth opposing it.

[magushnik]

sealed is not the issue, they can be sealed and still not be all the way down if the margin is overextended. taking it out of occlusion is not the answer, try articulating by hand travis, i had this same problem with one account and we found that hand articulation worked wonders. i think in this case there is overextention. either way you do great work, you will figure it out!!!

[TheLabGuy]

Travis, your problem is not the tray or the stone. Your Doctor is trying a technique called H & H. To read more about this technique go here http://www.patrioticthunder.com/HHHS.pdf For the record, I've found very few dentists who can accurately do a H & H technique. What you need to do is have the Dentist do the H & S technique (one-step) technique. Any Dentist that does a "two-step" impression technique is doing a disservive to you and the patient, never works. Your problems result from this

"The most common complaint is that the crowns don’t go down all the way. During the impression, it is very important to have the patient bite hard so that you see a tint of the blue material showing through the SnoWhite material on the occlusal surface of the impression. Also, every lab has their own technique for die spacing. It must be brought to their attention that this technique requires more
die spacing (approximately 40 microns) than other materials especially at the line angles."

I've worked with this technique for about 10 years now, the H&S really works well with 90 second blue mouse with 90 second velvet yellow or sno-white.......the key is though, to make sure they do it at the same time, you shouldn't see a wash line. Hope this helps and if you have any questions about it, send them my way and please print out the link and send the last page to your doctor, it will save you a migraine.

[magushnik]

great info Rob, you're a lifesaver!!!

[Travis]

I wish I knew this two years ago when this was the problem.

I think I know what caused this problem. Two or three months ago I changed my sp metal from sparton plus back to disign.59. I had to go back to silver metal because the cost for metal is getting too high. I never changed the water liquid ratio but the copings seemed to fit the dye. I did 6 copings today and I added to the liqid ratio to have more expansion.

He does do a one step impression. Those two step impressions gave us so many problems in the beginning.

[TheLabGuy]

No problem Travis, as for your liquid/powder ratio, that really could be the problem. Magushink had a great suggestion about boring a hole in the top (like a root canal) while the patient is in the chair, to see if the crown is seated all the way, great idea.

Now i'm wondering, you mentioned you use silver in your metal, have you ever noticed a green tint in some of your crowns, possibly when you fire at a lower temperature, like for instance when you do an add on? Just curious, I don't use any silver in any metal's except for Captek (specified ovens for that), is why i'm wondering?

[Travis]

I have a second oven I use for degassing. I purge the ovens once a month. I dont think I have had any greening problem.

How do you not use any silver metals? Sparton plus has 78.8 Pd 2.0 Au and last time I bought it was 450.00 an once. The d.sign 59 right now is 350.00.

I think most labs are trying to get away from metal.

I am paying dale 70.00 for captek.

[TheLabGuy]

We use Argenco metals, they offer silver/silver-free metals for everything from high-noble to noble, to base metal. 70.00 for a captek coping is a legit price for a coping, especially how gold prices are these days. It's almost to the point where it's cheaper to get an all-ceramic crown than it is a pfm-high noble crown. Which, when it comes to full cast high noble crown, it is cheaper.

P.S. Have you thought about doing your own captek copings? Do you do enough of them to cover the 5,000 - 6,000 introductory price? Just curious.

[Travis]

I talked to the doctor today about the high occlusion and I may have convinced him to go all ceramic for every case. I told him I could give him the same price that I charge for a pfm including metal costs for a posterior all ceramic stained and glazed. The anterior would have a different fee and would include having a full porc build up.

My new account for three months now gives me between 6-12 captek crowns a week.
I dont think I have the time to learn and the time to make each coping. I would never be able to do this many units if I had to do the metal work this new account gives me.

I didnt think it was that expensive to setup.

[labdude]

You have time you waste sleeping, don't you Travis???

[TheLabGuy]

Sleep, what's that? Actually Travis, I was thinking about that price after I posted it, but if you include the airfare, hotel, travel expenses to a regional place to be taught the Captek from a Captek representative, then include the designated oven, and the initial materials, my price may be correct. However, if you already have the oven, then knock 2,500 off the price. When I did it, I didn't have a designated oven at the time. Either way, if you're doing 6-12 a week, then you're probably correct in not having the time to do it. One technician would spend a full day doing 12 units. Just a thought though, and hey, if your wife is bored, not a bad idea there either.

Just a tip I'll share with you......Buy a swedger from Captek, sometimes when you fire the porcelain on a captek crown, the porcelain will pull the margin up or lift the captek away from the margin. If you have a swedger you can go ahead and build/stack/finish your porcelain like you normally do, but before you glaze, swedge it. This will correct that margin imperfection (it will crack the porcelain), glazing will heal any fractures in the porcelain. Captek won't suggest this, but I've had to do it from time to time, and something I showed Captek which surprised them. Hope that helps.

[labdude]

The poor guy. I could be a real bad ass, as usual, and point out the obvious.
Notice all the high scores going under his GLARINGLY missing avatar???
He doesn't have time for much that guy, what with those high scores to maintain.