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Optimizing patient care and efficiency for the dental office has never been more important. Here, we’ll discuss current workflow challenges in the fabrication and delivery of single-unit crowns, common areas of inefficiency and the financial implications. We’ll also look at ways to address these challenges, create more positive experiences and grow your practice.  

Current workflow challenges faced by dentists

 

Workflow challenges can significantly impact outcomes and the efficiency of the dental office, with up to 82% of dentists stating that their single-unit crown procedures are impacted by inefficiencies.1 The causes range from poor preparations to inadequate tissue management, poor impressions, fractured or lost provisionals, and cementation issues when delivering the definitive crown.  

In addition, an estimated 27% of crown procedures are replacements of existing crowns,2 in part due to biological and structural failures. Marginal leakage and secondary caries, for example, may occur due to poor marginal fit of a crown, or failure to remove excess cement during crown cementation.3,4 Other biological issues that can lead to replacement of a failed restoration include irreversible pulpitis and fracture of the tooth.   

Reasons for structural failures include:

 

  • Using a crown material with insufficient strength for the clinical situation
  • Insufficient clearance created while preparing the tooth or, when further occlusal reduction is not possible, failing to use a material that could be milled with a reduced wall thickness
  • Selecting the incorrect cement or technique for the case (e.g., failure to use an adhesive technique or to condition the inner surface (intaglio) of CAD/CAM block materials). 

Common areas of inefficiency in the Single-Unit Crown Workflow

 

Common sources of inefficiency in the single-unit crown workflow include impression taking and the delivery of provisional restorations.

The number one source of inefficiency is excess trimming and adjusting of the final crown, which an accurate final impression and well-fitting provisional can help to avoid.1 Accurate impressions require good soft tissue management, yet poor hemostasis is a problem that more than half of dentists report2 and obtaining adequate hemostasis is regarded as the #1 challenge in final impression procedures.1,5 In examining more than 1100 impressions from 3 large and 1 small dental laboratories, evaluators detected errors in 86% of them – more than half were critical errors affecting the finish line, such as impression voids, preparation margins obscured by soft tissue, or blood over the finish lines.5  

Final impressions are not the only contributor to inefficiency in the single-unit crown workflow. Let’s now explore the efficiency challenges for provisionals:

  • 1 in 3 offices report spending ‘too much time’ fabricating provisionals1
  • 97% of clinicians say they ‘often’ need to repair or replace provisionals1
    • 75% of issues were attributed to the preliminary impression
    • Other causes include selecting the wrong tray or using a weak provisional material.  

Dentsply Sirona Single-Unit Crown Workflow Solution

 

Here at Dentsply Sirona, we want to support you with a single-unit crown workflow solution that will improve efficiency each step of the way. 

Our Final Impression Solution includes Dentsply Sirona’s Aquasil® Ultra+ Smart Wetting Impression Material formulated to help you optimize the accuracy of your conventional final impressions. This VPS material offers leading intraoral performance for both hydrophilicity and tear strength, adding an extra layer of confidence in challenging intraoral environments. Alternatively, digital impressions are fast, accurate and improve communication with the patient and the lab with Dentsply Sirona’s intraoral scanner CEREC Primescan®.

Our Provisional Solution includes Dentsply Sirona’s Algin-X Ultra, an alginate alternative that delivers predictable accuracy with dimensional stability. Our Integrity® Multi•Cure Temporary Crown & Bridge Material delivers strength where and when you need it, with on-demand light curing to allow for immediate and precise trimming. It also finishes smoothly to help maintain tissue health. Cementation of the provisional is simplified with Dentsply Sirona’s Integrity® TempGrip® Temporary Crown & Bridge Cement which is moisture tolerant, and provides for sufficient retention of the provisional yet stays in the provisional during removal, making clean-up easy. 

Our CAD/CAM Restorative solution includes CEREC MTL® Zirconia, a multi-transitional layer zirconia that offers high strength (>850 MPa) and excellent esthetics. CEREC Tessera is also available, an advanced lithium disilicate that also offers excellent strength and esthetics for CAD/CAM restorations, whether in the laboratory or chairside. The Chairside Solution with CEREC Primemill® and CEREC SpeedFire® is designed for speed, accuracy and convenience, enabling the practice team to create and fit a restoration in just one patient visit.

Lastly, Dentsply Sirona’s Crown Cementation Solution offers efficient, and reliable cementation with easy clean-up. Calibra® Ceram is an adhesive resin cement formulated for maximum strength, making it ideal for glass ceramics like CEREC Tessera blocks. Simplified, reliable cementation is designed in, and when used with Dentsply Sirona’s Prime&Bond active® adhesive, no primer is needed, and excellent strength is obtained. Dentsply Sirona’s Calibra® Universal cement is ideal for zirconia like CEREC MTL Zirconia blocks. This cement combines esthetic shading with a self-etching adhesive. It is the simple choice for successful results and no need for additional etchant or adhesive.

 

Here at Dentsply Sirona, we are here to support you with our entire online dental academy complete with webinars, how-to videos, and real-world examples on how to create streamlined solutions with efficient procedures and even greater patient satisfaction. Contact us now and let’s get started!


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References

  1. Internal data on file. For more information, contact consumables-internal-data@dentsplysirona.com
  2. 2015 The Key Group Omnibus Dental Survey, Quarter 3. For more information, contact consumables-internal-data@dentsplysirona.com.
  3. Morphology and Bacterial Colonisation of Tooth/Ceramic Restoration Interface and Different Excess Removal Techniques. J Dent 2012;40:742-749.
  4. Mitchell CA, Pintado MR, Geary L, Douglas WH, Retention of adhesive cement on the tooth surface after crown cementation. J Prosthet Dent 1999;81:668-667.
  5. Rau CT, Olafsson VG, Delgado AJ, Ritter AV, Donovan T. The quality of fixed prosthodontic impressions. An assessment of crown and bridge impressions received at commercial laboratories. JADA 2017. Doi: http://dx.doi.org/10.1016/j.adaj.2017.04.038