Very Clinical Takeover: Al's Crown Prep Hacks

Dr. Alan Mead steps in for Zach and Kevin in this "Very Clinical Takeover" episode to share his efficient and refined workflow for single-tooth crown preparations. Alan emphasizes that his streamlined, digital-centric process makes single crowns a quick, straightforward, and profitable procedure in his general practice.

The core of the episode is his detailed Crown Prep Workflow and Hacks, which prioritizes patient comfort and efficiency.

• Profound Anesthesia: Mead's first step is always to achieve profound anesthesia, utilizing inferior alveolar nerve blocks for lower molars and buccal infiltrations (usually with Septocaine) for other teeth. He heavily relies on the  Septodont Paroject pdl syringe for supplemental tissue anesthesia around the entire tooth, often using it to avoid packing cord.

• Pre-Op Digital Scan: He scans the arch using his Medit i700 before prepping the tooth. This pre-op scan is used to register the final prep scan, ensuring a stable and accurate bite registration, which he praises as a massive efficiency improvement over traditional PVS impressions.

• Prep Sequence: His prep sequence is intentionally designed for efficiency:

  1. Break Interproximal Contacts First: He uses a Microcopy 0512C inverted pear bur for gross contact breaking, followed by a Microcopy 33140.10vf ("skinny") fine-tipped diamond for careful separation at the gingival.

  2. Occlusal Reduction: He uses the Microcopy 2137C which large, barrel-shaped coarse bur in an electric handpiece for quick, proper occlusal reduction.

  3. Core Build-up: After removing any old restoration or decay, he prefers Cosmecore from Cosmedent for build-ups, sometimes blocking out with Fuji IX from GC. He utilizes an old-school metal matrix band with Bioclear Diamond Wedges for isolation during the build-up.

• Margin Refinement and Tissue Management: He finishes margins under high magnification (microscope) and prefers a very fine diamond bur (Microcopy 3116.8vf) instead of traditional polishing cups for a smooth finish. Mead emphasizes smoothing the adjacent teeth with a Sof-Lex disc to ensure the lab can create an ideal, broad interproximal contact.

• Retraction: Mead overwhelmingly prefers Traxodent from Premier in the unit dose syringe tips for quick and clean tissue retraction, stating it generally works better for digital scanning than retraction cord.

• Temporization: While his assistant fabricates the temporary using a pre-made matrix, Mead remotes into his computer to mark the margins on the digital scan. He uses Clinician's Choice Template Ultra Quick Matrix Material and Mirror Image temporary material from Cosmedent, which he quickly refines with a Sof-Lex disc. He cements the temp with Dentotemp by Itena provisional cement for its strong retention.

Alan encourages listeners to critique his "bread and butter dentistry" workflow on the Very Clinical or Very Dental Facebook groups, as he believes an efficient crown prep is a key to a successful general practice.

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Some links from the show:

• See above :-)

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