Griptab Crown Clinical Case Study by Graeme Milicich
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Griptab use during shade matching and bonding of an anterior, all-ceramic crown Griptab Crown Case by Graeme Milicich, BDS
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Griptab is a must for dentists, dental assistants and lab technicians - anyone handling crowns, inlays, onlays and veneers.Think of the value of a handle to a cup. Triodent has applied that same principle to indirect restorations. By adhering Griptab to the restoration, you have a reliable grip and total mastery of the placement process, especially when using Triodent Pin-Tweezers for extra maneuverability, although small hemostats will do.
Transcript of Griptab Crown Clinical Case Study by Graeme Milicich
Griptab use during shade matching and bonding of an anterior, all-ceramic crown
Griptab Crown Case by Graeme Milicich, BDS
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US: 1-800-811-3949CA: 1-866-316-9007INT: +64-7-549-5612
UK: 0800-311-2097NZ: 0800-TRIODENTAU: 1-800-350-421
Griptab use during shade matching and bonding of an anterior, all-ceramic crown Graeme Milicich, BDS
Successful shade matching of a single anterior crown is one of the most challenging aspects of anterior cosmetic dentistry. All-ceramic crowns provide the opportunity to subtly manage the final aesthetics by using various shades of resin cements. During the try-in process, the glycerol-based try-in pastes tend to make the crown slippery and difficult to manipulate. By attaching a Griptab to the incisal region of the crown, manipulative control of the restoration is regained, making assessment of the final shade easier for the clinician. The placement of the Griptab on the incisal edge of the restoration does not affect the cervical 2/3 of the crown where color change can be altered with the use of various resin shades.
The Griptab can be used during the HF etching and silanation phases of bonding and allows for easy transfer of the restoration between the assistant and the dentist once the bonding resin has been loaded into the crown. The presence of Silane tends to make the glazed surface of a porcelain restoration very slippery, and it is easy to lose manual control of the restoration during this phase of bonding.
The light-cured adhesive used to bond the Griptab onto the restoration is not affected by the presence of Silane, as long as the surface of the new crown is cleaned with alcohol prior to bonding the Griptab in place. If contamination is present on the surface, it can affect the Griptab adhesive bond and Silane can then track under the adhesive and cause premature release of the Griptab.
A 21-year-old female patient presented with a central incisor that had previously had an incisal 1/3 fracture restored with a bonded composite (Fig 1). She had suffered another blow to the tooth and the restoration and all the palatal enamel had been lost. The palatal fracture was sub-gingival and down to the bone in one area.
The tooth was prepared for an E4D CAD/CAM crown and the sub-gingival margin was exposed (Fig 2) using a Waterlase MD. The bone in the region of the fracture was lowered (Fig 3 & 4) to re-establish biological width using a closed flap approach.
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US: 1-800-811-3949CA: 1-866-316-9007INT: +64-7-549-5612
UK: 0800-311-2097NZ: 0800-TRIODENTAU: 1-800-350-421
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An impression was taken and the patient released with a temporary crown. A model was poured and scanned into the E4D design center and a crown was designed and milled using an A1 IPS Empress multi-block (Fig 5 & 6).
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Griptab use during shade matching and bonding of an anterior, all-ceramic crown Graeme Milicich, BDS
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US: 1-800-811-3949CA: 1-866-316-9007INT: +64-7-549-5612
UK: 0800-311-2097NZ: 0800-TRIODENTAU: 1-800-350-421
The milled restoration was then contoured to create the surface micro anatomy, stained and glazed.
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Prior to trying in the crown, a Griptab was bonded to the incisal region of the labial surface. This was then used to control the crown while a correct shade of Variolink Veneer bonding resin was chosen using the try-in pastes. The position of the Griptab did not interfere with the selection of the correct shade of bonding resin cement.
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Once the correct shade had been selected, the Griptab was re-engaged with pin-tweezers and the crown removed from the tooth. The try-in paste was rinsed out prior to HF etching and silanation.
The Pin-Tweezers provide secure control during this phase (Fig 9). They allow the assistant to load the crown with the selected bonding resin and hand the crown over without the risk of it being dropped. They also prevent excess cement getting on the outside of the crown, which can make it slippery and hard to handle safely.
Once the crown was placed, the Pin-Tweezers were released and the cement was tacked through the labial surface to initially secure the crown prior to removing excess unset resin from the margins. The Griptab was removed from the crown by sliding a flat-bladed metal instrument, like a Wards Wax Carver, under the adhesive. The cement was then fully light-cured and any remnants of resin removed from the crown with a No 11 scalpel.
Case study demonstrating Griptab use during shade matching and bonding of an anterior, all-ceramic crown
Griptab Case by Graeme Milicich, BDS
Griptab use during shade matching and bonding of an anterior, all-ceramic crown Graeme Milicich, BDS
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US: 1-800-811-3949CA: 1-866-316-9007INT: +64-7-549-5612
UK: 0800-311-2097NZ: 0800-TRIODENTAU: 1-800-350-421
A couple of minutes of rehydration began to reduce the intensity of the enamel white spots on the adjacent teeth (Fig 11).
To ensure accurate shade matching in cases like this, it pays to take images right at the beginning of the initial appointment before the adjacent teeth begin to dry out and their apparent color changes.
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Immediately post-cementation (Fig 10), the adjacent teeth were slightly desiccated, which highlighted the white spots in the enamel.
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Griptab use during shade matching and bonding of an anterior, all-ceramic crown Graeme Milicich, BDS
