Your crown doesnt fit!

[desertfox384]

Working with a doc for a few months now. Have had 3 crowns not fit in the mouth at all. Not tight contacts or anything of that sort, he says it just doesnt fit the prep. Fits the model perfectly, and fits the solid model perfectly.

Today he had 2 e.max crowns for the same patient that did not fit at delivery. Each crown had its own impression, both uppers but on opposite sides. Initial inspection looks like the impression and model is fine, no noticeable chips or anything. He took a few new impressions so I'll pour them up tomorrow and do some comparing.
Have never had this happen with any other of my docs, but 3 from him in 2-3 months.

I have read before that when using triple trays sometimes it will cause poor fits, but I cant remember the specifics of the article. He always uses the plastic triple trays.
Any ideas? popcorn

 

[TheLabGuy]

What type of impression material? What type of technique (one or two step)? Can you upload a picture of the prep?

 

[DMC]

Patient needs to bite into the middle of the tray.

If he/she hits the wall(s),the plastic may bend, and then un-bend when removed from mouth leaving a sh1t impression.

 

[DMC]

Troubleshooting Guide*: 3M ESPE Dental Products US

http://multimedia.3m.com/mws/mediaw...cuZgVs6EVs6E666666--&fn=imp_trouble_guide.pdf

Download the impression guide! ( I have family and accounts in Cary and go there all the time! Nice place. You go to Baba Gannouj Bistro? God I love that place!)

Scott

 

[charles007]

Triple tray are widely known for remakes......and I haven't seen one in years. Picked up new account and now dealing with triple trays

Rob and others, please educate me on triple trays. What works, what doesn't, good materials-trays to use.. How to spot a remake in the making..
Thanks

 

[user name]

The Doctor HAS to use enough (substanial) impression material so that it will retain its shape and not allow the distorted trampoline of a tray to flex back to flat. More risk of distortions if the patient bites all the way down to centric...Kind of defeats some of the intended purpose of the short-cut. Otherwise, cut the small piece that connects the labial/lingual sides of the tray.

 

[TheLabGuy]

Good advice User name....
-Impression materials have a lot to do with triple trays. Too much viscosity (high durameter) and any slight undercut will cause a distortion. So your Dentists that are using Impregum (high durameter) for inlays are asking for a distortion, better to use something like Aquasil that isn't so rigid. The two step techniques or as some call the H&H is never a good idea. You really want one harmonious homogenous technique while taking triple trays (a.k.a. H&S technique). Plastic versus metal triple trays really relates more to a bite being off than a distortion. When it comes to a distorted impression, it's a two-step technique, undercut preps, or the assistants/Doc didn't allow enough time for the impression material to set up. I've had probably half a dozen cases in the last 5 years where all it was is that the assistant was shaving 30 secs or minute here on the set up time and the material wasn't set up enough and when they removed the impression it pulled/distorted. That would be the first place I asked about, then impression material especially if there is undercut preps, then the technique. I do have a couple clients that do have to use metal trays, the ladies get a wrong bite all the time if they use plastic. Hope that helps.

 

[desertfox384]

Taking a look at the 2 old impressions and 2 new ones.. patient bit inot the wall of 3 of them. Im guessing that is the problem.
So that will cause the tray to spread and then snap back once removed causing the material to distort?

 

[desertfox384]

Scott,

Never been to Baba Ghannouj but just saw a coupon in a flyer for them tonight in the mail, will keep it in mind. Cary is great, I love living here.

 

[doug]

Taking a look at the 2 old impressions and 2 new ones.. patient bit inot the wall of 3 of them. Im guessing that is the problem.
So that will cause the tray to spread and then snap back once removed causing the material to distort?

Just so you understand, it's still your fault that they didn't fit. How many times do I have to say that the docs are mentally lazy.

 

[desertfox384]

Old Impression (I should have caught this)



New Impression. Same Story






Sorry its rotated.

 

[desertfox384]

Just so you understand, it's still your fault that they didn't fit. How many times do I have to say that the docs are mentally lazy.

Of course it is Doug, when is it not. They will be remade at my loss and hopefully my eyes will be more careful, but he needs to reimpress.

 

[TROJAN HORSE]

THE IMPRESSION IS DISTORTED, LOOK AT THE SIDE WALLS WHERE THE TRAY IS EXPOSED, ASK THE DOC TO USE INDEPENDENT TRAYS. BEFORE TRIPLE TRAYS WHERE INVENTED WE NEVER HAD THESE PROBLEMS. CHARGE HIM FOR THE REMAKE, THAT WILL GET HIS ATTENTION. GOOD LUCK.

 

[aabregini]

yes You have to charge him for remake it was his fault , 2 nd impression was distorted at the buccal , or send him a case and make him trim the die so he can evaluate his mistake.Good luck.

 

[Bobby Orr ceramics]

This is classic Triple Tray death as soon as it came out of the mouth. If the doc is deadset on using these trays..... give him 1 simple solution: When taking the impression Dr, you need to intentionally open the bite. You don't rely on this impression for bite registration. Give him a piece of pink baseplate wax about 1cm wide X 4 teeth long. Place it over the opposite quadrant. He instructs the patient to close into the impression until the opposite teeth touch into the pink wax. Patient must not clench. When the Triple Tray is poured up Max and Mand , there will be no rebound from the plastic. This technique works wonders for this impression. Good Luck !!! Don't charge the Dr. for the remake.....you'll lose 'em forever. Work with them, not against them. It's cheaper than marketing for a new client.....School of Hard Knocks lesson. Orr4

 

[paulg100]

Tell him to use rigid trays!

If the guy doesn't understand this he shouldn't be practicing dentistry, these things are COMPLETE waste of time.

 

[DMC]

New Impression looks like instant re-make to me?

Bummer.

 

[Toast]

Had a doc who used the same trays with the same problems. With the help of this article Ask Dr. Christensen - Dental Economics and a switch to sideless triple trays everything drops right in.

 

[paulg100]

ill keep a link to that article might, might come in use when clients who use these dont wanna listen about whats causing all their variables.

(i havnt had the time to read it fully yet, but it has to conclude that these trays are prone to distortion right?)

 

[charles007]

Thanks everyone, please keep this thread going and keep the pictures coming. Pictures are worth a thousand words......

Charles