Let's talk about how to cement a bridge every single time in 30 minutes or less. Now, cementing a bridge is a little bit different than a single-unit crown because you have three teeth involved in the occlusion, you have interproximal contacts. You have a lot of issues.
Preps need to be perfect before you start
So number one, make sure your preps are perfect. If it needs build-up or crown lengthening, get it done. Nothing under the tissue that's too deep, that's going to cause bleeding. If the preps are irregular, it doesn't give a smooth surface for the coping to go over it.
Make sure when you get done with the preps, in addition to rounding the sharp line angles, polish it with a rubber wheel. Make it smooth.
Make sure you get a full arch impression, upper and lower. I know we can do some things with triple trays, but I also know that I want to cement my bridges in 30 minutes or less every single time.
Communicate with the lab
Next step. Communicate clearly with your technician. Make sure he knows exactly what you want. Make sure:
- There's good interproximal contacts
- There's a solid model. All that guesswork is taken away
- Your temporary is perfect
- You have good occlusal stops and it conforms to the tissues
- There's no bleeding
- Your patient can clean under it
- There's an occlusal contact
- The bridge stays on
So if it's a really retentive temporary, I almost always use polycarboxylate cement because I don't want it coming off. If it does, everything has a chance to go astray.
Do a coping try in
Most important tip, and I don't want you to forget this, and I don't want you to skip this step. Do a coping try-in.
I know we're digital. I know everything's better. But I also know how important a coping try-in is. We learned it in dental school.
Why is it important? Let me remind you. When you have a coping try-in, number one, You check the framework. You're making sure the marginal integrity's going to be perfect without all the porcelain. You're not having to deal with any interproximal adjustments at this time because the coping doesn't have an interproximal contact. So you know for sure the margins are good.
Now, if it comes back from the lab and for some reason it doesn't go on, like it did at the coping try-in stage, you know where to adjust. It's almost always interproximal or under the pontics.
Verify the lab's work
The other reason I do a coping try-in is I'm trying really hard to get the bite right. I've got a face-bow done. We've taken a wax record, but I like to check it from my lab. So I put the coping in. I take a little sectional piece of Denar wax. Lay it on the coping. Have them bite down. Pop it off. Chill it. Have them bite again. Drop it on the articulator and check my articulator mounting so that it's perfect.
If it's not perfect, I can remount it right then at the coping try-in stage and then the technician can get my bite perfect. Now, my bridge is coming back. I know that the coping fits. I know the margins are good. If there's any adjustments, very minor.
It is an extra step, but how many times have you sat there with a bridge and you're not really sure if you need to drill underneath it or you need to adjust interproximal. Why is an occlusion high? If I have an issue, it's so surprising.
30 minutes or less to cement your bridge if you follow these steps. Hope it helps.
Learn more about ensuring stability in the Dawson Core Curriculum.