Faculty Inservice OperFixed Cementation Competency

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Faculty In-serviceOper/FixedCementation
Competency

• February 5, 2005
• R Kahn DDS

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Cementation/Bonding Procedures
Clinical Examinations
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Examination Criteria

• The two indirect restorations to be cemented
  (bonded) may be any extra-coronal restoration.
  The student doing the cementation must have done
  the preparation and the daily evaluation form
  with all signatures must be presented at the time
  of the examination. The tooth must be in
  occlusion and have at least one proximal
  contacting tooth.

Senior Comp Document
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Indirect RestorationDaily Evaluation Form
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Cementation/BondingCompetency Examination

• Should have been evaluated by the student/doctor
  24 hours prior to the patients appointment.
• Areas that need modification should be corrected
  by the student/doctor or returned to the lab for
  correction prior to the patients appointment.

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Surface

• Shade verified with shade guide, photo or
  diagrammatic drawing.

• Internal
• Duplicates details of prep
• Clean

• Surface texture, glaze and polish

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Margins

• Evaluate on
• Fabrication die - red lined
• Unaltered die
• Solid cast

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Occlusion Morphology

• Evaluate occlusal contacts without restoration
  using thin articulating material

• Evaluate occlusal contacts with restoration fully
  seated with thin articulating material

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Occlusion Morphology

• Evaluate occlusal contacts without restoration
  using thin mylar (shim stock) material

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Occlusion Morphology

• Evaluate occlusal contacts with restoration fully
  seated with thin mylar (shim stock) material - at
  least 5 thickness of mylar must hold in area of
  restoration with one thickness on adjacent teeth

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Axial Contours Contacts

• Contact with the adjacent tooth holds or drags 1
  thickness of mylar with the restoration
  completely seated

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Axial Contours Contacts

• The contact is broad enough to prevent food
  impaction
• Restoration is visually in contact with adjacent
  tooth

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Axial Contours Contacts

• Axial contours
• Gingival contour create a flat emergence profile
• Allow for proper oral hygiene
• Compatible with good esthetics
• Gingival embrasures allow for good gingival
  health

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Axial Contours Contacts

• Contours of RPD abutments
• proper rest seats
• guide planes
• Undercuts for retentive clasps

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Cementation/BondingCompetency Examination

• Evaluation and adjustments should be done by the
  student prior to faculty evaluation
• Unacceptable restoration in any category that is
  identified by the student prior to faculty
  evaluation can abort the exam

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Cementation/BondingCompetency Examination

• Unacceptable restoration in any category that is
  identified by the faculty should be evaluated and
  the exam results recorded
• Failure to cement the restoration would result in
  a deduction of 5 points in the After Cementation
  Category and require retaking the exam
• This step must be completed within the 2 hour
  time limit or a grade of 0 is calculated

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Surface

• Restoration is in harmony with patients
  dentition
• Shade
• Contours
• Texture
• Patient has observed and agreed to appearance of
  restoration

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Surface

• Restoration is properly polished

• Internal
• Duplicates details of prep
• Clean
• Air abraded or etched as required
• Area is properly isolated
• Tissue is retracted as needed to expose margins
  and control fluid

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Margins

• Margins are satisfactory
• visually
• tactilely

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Occlusion Morphology

• Evaluate centric excursive contacts with
  articulating material without restoration
• Evaluate holding contacts with mylar without
  restoration

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Occlusion Morphology

• Evaluate centric excursive contacts with
  articulating material with restoration in place
• Contacts should match marks without restoration

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Occlusion Morphology

• With restoration seated mylar should hold evenly
  on the restoration as well as the teeth anterior,
  posterior and contra-laterally (assumption being
  that teeth contacted without restoration)

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Occlusion Morphology

• Occlusal surface of posterior teeth or lingual
  surface of anterior teeth should be properly
  contoured with tooth morphology that is
  compatible with the patients natural dentition

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Axial Contours Contacts

• The contact should be viewed from the facial,
  occlusal and lingual to verify it is visually
  closed and has the correct dimensions
• Contact area should be broad enough to prevent
  food impaction

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Axial Contours Contacts

• Contact area should be firm enough to hold or
  drag, with resistance, one thickness of mylar
  with the restoration fully seated and firmly held
  in position
• Contact area should resist the passage of floss,
  yet be smooth so as not to shred the floss

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Axial Contours Contacts

• Axial contours
• Contours near margins create a flat emergence
  profile
• Contours allow for proper oral hygiene
• Contours are compatible with good esthetics

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• Write, in the appropriate category, any aspects
  of the procedure that could be improved
• Circle appropriate evaluation grade
• R - Meets all requirements
• S - Satisfactory with minor deviation in isolated
  area
• M - Satisfactory with minor deviation in multiple
  areas
• T - Unsatisfactory in any aspect
• V - Extremely unsatisfactory in any aspect or
  multiple T errors

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After Cementation

• Evaluate time to insure procedure was done within
  the 2 hour time limit - 5 point deduction for
  finishing late
• Evaluate restoration is fully seated
• Evaluate for complete cement removal
• Evaluate for tissue trauma
• 1-5 point deduction for error

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Accurate evaluation of a students overall
performance in Oper/Fixed is dependent on
accurate information from the faculty