by Nelson Gendusa, DDSDirector of Research

When a tooth abutting a partial denturerequires crowning, the dentist traditionallypicks up the prosthesis in a full-arch transferimpression and sends it to the laboratory.This allows the technician to use the claspsas a guide when creating the crown contour.

For most patients, going dentureless(even for a few days) is unpleasant.Without the prosthesis, mastication may bedifficult. If the RPD includes anteriorteeth, the patient may spend the periodbetween appointments hiding from theworld in mortified seclusion.

The following technique uses a Blu-Mousse Super-Fast index to register theclasp-tooth-relationship. This allows thetechnician or dentist to create an accuratetemplate of the clasp. As a result, thepatient never has to surrender the pros-thesis.

Incidentally, we didn’t dream up thistechnique ourselves. It was contributed byDr. Allen L. Weiner (Medfield, MA) whoalso sent the clinical photos (#8-12).* Thelaboratory procedures were performed at

* Incidentally, we filled in some of the missing illus-trations (#1-7) using a typodont. As a result, the caseswitches from mandibular to maxillary mid-treatment.

the Myron J. Dickermanlab (Sharon, MA).

PART 1: How tomake a clasp/toothindex using Blu-Mousse® Super-Fastmaterial.

1. Prepare the toothfor a crown as usual andtake the working impres-sion using whatever tech-nique and materials youprefer.

2. Insert the RPD inthe mouth and assure thatit is properly positioned(Figure 1).

3. Inject Blu-MousseSuper-Fast over the preparation. Continueexpressing material the until the clasps andocclusal rests are completely covered(Figure 2). Because Blu-Mousse has thefluffy consistency of whipped-cream, itwill not flow. Therefore, there is no need touse a confining tray.

4. 30 seconds later remove the RPD withthe Blu-Mousse blob attached (Figure 3).(Notice the impression of the preparation.)

5. Using a blade, carefully trim away the

Blu-Mousse until the outer surfaces of theclasps and rests are exposed (Figure 4).Cut away any additional material that pre-vents the Blu-Mousse index from beingremoved (Figure 5).

6. Remove the index from the partialdenture by pushing it in an apical direction(Figures 6 & 7)

Temporize the preparation, and send thepatient home wearing the partial denture.

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How to fabricate a new crownthat fits an existing RPD ...

without forcing the patient tosurrender the partial.

Since resin template provides an accurate clasp reproduction, the ceramistcan create the proper crown contour without using the RPD as a guide. Thepatient doesn’t have to function even a single day without the prosthesis.

Figure 1 Figure 2 Figure 3

s p e c i a l r e p o r t # 4 6 1

PART 2: How to create a clasp-template using pattern resin

1. Pour the working model and separatethe dies as usual.

2. Seat the Blu-Mousseindex onto the prepara-

tion. Using a Neelon technique (also called“brush-dip” or “salt-and-pepper” tech-nique), flow conventional pattern resin intothe impressions of the clasps on the surfaceof the Blu-Mousse index.

After the impression of the clasps hasbeen filled, extend the resin outward

in order to give the template enoughbulk to withstand handling. (Note:

The only part of the templatethat must precisely recreate

the clasp and rest is theinternal surface ... wherethe clasp metal facescrown.)

3. Continue building thepattern resin outward untilthe template sits securelyon the model on either side

of the index (Figure 8).

4. After the resin has set, carefullyremove the template from the Blu-Mousse.(To avoid damaging the resin, it may benecessary to cut the Blu-Mousse index intopieces.)

5. Replace the template onto the model.(Figure 9)

6. Use the resin template as a contour-guide during crown fabrication. (Figures10 & 11)

7. When the patient presents for crowncementation, the new crown fits the RPDwith few (if any) adjustments ... eventhough the technician never saw theactual partial denture! ❑

Figure 4 Figure 5 Figure 6

Figure 7 Figure 8 Figure 9

Figure 10 Figure 11 Figure 12

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By Michael Fitterling, DDSJoplin, MO

In some practices the provisionalrestoration doesn’t get the respect itdeserves. Granted, elaborate provisionaltechniques can require substantial chair-time ... and chairtime costs money. AndI admit it’s tempting to scrimp on arestoration with a functional life of just acouple of weeks.

But if you scrimp on your provisionalcrowns, both you and your patient maypay the price later. A poorly-fitting tem-porary restoration may leak ... causingsensitivity (or worse, pulpal complica-tions!) Two weeks of improper contactsand poor occlusion is plenty of time forteeth to drift or supererupt ... requiringextensive adjustments to the final restora-tion. If the contour is inaccurate or themargins overbulked, the patient maypresent at the cementation appointmentwith puffy, bleeding gingiva.

There are numerous approaches toprovisional crown fabrication. (I know.I’ve tried a good many of them.) In myhands, the following technique producesthe most consistent results.

It’s efficient ... so it doesn’t devourmassive amounts of precious chairtime.

It’s extremely accurate. Our restora-tions normally slide into place with littleor no adjustment. The tissue remainshealthy.

And it’s easy. In fact, your assistantcould probably do the entire procedure.

1. This patient (figure 1) required acrown on a maxillary first molar (#14).

2. Because Blu-Mousse sets so formi-dably hard, there is no need for a conven-tional stiff tray.

Prior to preparing the tooth, we cut arectangular piece from a 3 oz plastic cup(figure 2). Then we bend it into the shapeof a tray to carry the Blu-Mousse. Thetray must be large enough to cover thetooth plus the two proximal teeth.

3.) We expressed Blu-Mousse Super-Fast into the carrier (figure 3) ...

4.) and immediately seated it in themouth (figure 4). Before it sets, Blu-Mousse has the light fluffy consistency ofwhipped-cream, so there is no tendencyfor the material to flow out of the tray.

5.) The impression was removed after45 seconds and examined (figure 5).

If the coronal structure of the toothwas damaged (for example, by a cuspfracture or serious decay), we wouldrestore approximate crown contour byremoving Blu-Mousse from the deficient

SUPER-FAST PROVISIONAL RESTORATIONS

Figure 1 Figure 2

Figure 3 Figure 4

Figure 5 Figure 6

Figure 7 Figure 8

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area of the impression using a bur orblade.

6.) After preparing the tooth and takingthe C&B impression as usual, we filledthe mold in the Blu-Mousse impression3/4 full with an autopolymerizing provi-sional crown material (figure 6). Then wereplaced the impression in the mouth, tak-ing care that it was fully seated.

7.) Once the provisional material hadset, we removed the Blu-Mousse impres-sion (figure 7). The restoration maycome off in the impression or (as in this

case) it may remain on the tooth.*

8.) We removed the restoration andinspected it for voids or bubbles. (If anywere found, we would have repairedthem using provisional material.)

The crown was then finished, cementedin place with temporary cement and theocclusion checked (figure 8).

We use this same technique for tempo-rizing multiple crowns, inlays and onlays.It’s also excellent for bridgework. Forexample, on a 3-unit bridge, we use lightcure composite or sticky wax to tack a den-

ture tooth into the pontic position (eitherdirectly in the mouth or on a model). Thenwe take the Blu-Mousse Super-Fastimpression and proceed exactly asdescribed above. ❑

* If you use a heat-generating provisional materi-al, the impression should be removed after severalminutes so the restoration completes curing outsidethe mouth.

As you extrude the Blu-Mousse material directly fromyour cartridge gun into the mouth, it has the light, fluffyconsistency of whipped cream.

It doesn’t slump or run. It sits obediently, right whereyou put it.

And like whipped cream, it offers virtually no resist-ance to closure. So the patient feels nothing between theteeth as you guide the mandible into centric.

Yet just 30 seconds later*, this remarkable materialhas set almost plaster-hard ... creating a distortion-freeregistration that’s tough enough to withstand the rigors ofarticulation. A registration that maintains its accuracyindefinitely.

We created Blu-Mousse primarily for occlusal regis-tration.

But almost from the day we introduced it, creativedentists like Dr. Weiner have been sending us clinical pic-tures of exciting new techniques that were difficult-to-impossible before we introduced our Blu-Mousse “BiteRegistration Material.”

• The Laminar Impression Technique -Dr. Gary Schoenrock (Perrysburg, OH)

• The Preoccluded Registration -Dr. Robert Weller (Brooklyn, NY)

• The Trayless Impression -Dr. Kent Mattison (Snellville, GA)

• The Trayless Injection Impression -Dr. Howard Goldstein (Bethlehem, PA)

• Fast Models for Denture RepairDr. David Winkler (Outrup, Denmark)

• Cosmetic Feature RegistrationDr. Thomas Hughes (Monument, CO)

Classic Blu-Mousse is available in tubes and burst-free cartridges. Super-Fast Blu-Mousse comes in car-tridges only.

* Blu-Mousse Super-Fast material sets in just 30-sec-onds. Blu-Mousse Classic material takes slightlylonger ... 2 minutes.

By the way, Blu-Mousse® also makesa terrific occlusal registration.

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