Daniel S. Kim, DDS, FAGD
Any athlete can tell you how important it is to give 100% of your effort from start to finish. After all, few races are won by runners who slow to a relaxed walk just before the finish line, and baseball players cannot just call it a day after playing well for six innings.
This same idea is just as critical for us as dental practitioners. For us, the final steps of many procedures are integral to the long-term health and viability of the work we have done for our patients. This has a direct effect on the health and viability of our practices; patients rarely recommend or return to dentists who have provided them with short-lived restorations.
This is, perhaps, most readily seen when seating crowns. Even a perfectly made crown can fail within two years if it is not seated properly. In developing ContacEZ, and through my own clinical research and the feedback of my colleagues, I have established a system of three key steps that should be taken during the interproximal finishing of every crown: adjusting the proximal contact, removing trapped cement debris, and polishing to remove surface roughness.
Proximal contact adjustment
Although rarely covered in the literature or in dental school curricula, proximal contact adjustment is important to seating crowns successfully. Leaving proximal contacts unadjusted when seating a crown can be catastrophic for the restoration and for the patient's oral health. The pressure the crown creates can cause a wide variety of complications, and seating the crown completely might be impossible, leaving open margins exposed to bacterial accumulation.
For patients, the constant feeling of pressure from tight contacts on a newly crowned tooth is more than physically uncomfortable. For many, it is also a reminder that the crown is synthetic. Taken together, these issues lead to dissatisfaction with the procedure and, possibly, its provider.
Snapping dental floss through the contacts has long been used to check the strength of proximal contacts, but twisting and warping often make this inaccurate. Instead, I recommend using a single-handed diamond strip to adjust contacts directly in the mouth (figure 1). The material strength of the stainless steel strips improves consistency, and adjustments can be performed in the mouth to ensure comfortable and complete marginal seating with every patient.
Figure 1: A single-handed diamond strip is used to adjust proximal contacts directly in the mouth.