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Clinical Case
Griptab use during shade matching and bonding
        of an anterior, all-ceramic crown
               By Graeme Milicich




                                   US: 1-800-811-3949               UK:    0800-311-2097
                                   CA: 1-866-316-9007               NZ:    0800-TRIODENT
                                   INT: +64-7-549-5612              AU:    1-800-350-421
  If you have a great new product idea or wish to contact us for more information on our great
  products, go to www.triodent.com/product-information-request.
Griptab use during shade matching and bonding of an anterior,
all-ceramic crown By Graeme Milicich, BDS


Successful shade matching of a single anterior crown is
one of the most challenging aspects of anterior cosmetic
                                                                    1
dentistry. All-ceramic crowns provide the opportunity to
be able 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
                                                                    A new 21-year-old female patient presented with a central incisor
bonding resin has been loaded into the crown. The presence
                                                                    that had previously had an incisal 1/3 fracture restored with a bonded
of Silane tends to make the glazed surface of a porcelain
                                                                    composite (Fig 1). She had suffered another blow to the tooth and
restoration very slippery, and it is easy to lose manual control
                                                                    the restoration and all the palatal enamel had been lost. The palatal
of the restoration during this phase of bonding.
                                                                    fracture was sub-gingival and down to the bone in one area.
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
                                                                    2
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.




                                                                    The tooth was prepared for an E4D CAD/CAM crown and the sub-
                                                                    gingival margin was exposed (fig 2) using a Waterlase MD, and
                                                                    the bone in the region of the fracture was lowered (Fig 3 & 4) to
                                                                    re-establish biological width using a closed flap approach.




                                  US: 1-800-811-3949               UK:     0800-311-2097
                                  CA: 1-866-316-9007               NZ:     0800-TRIODENT
                                  INT: +64-7-549-5612              AU:     1-800-350-421
 If you have a great new product idea or wish to contact us for more information on our great
 products, go to www.triodent.com/product-information-request.                                                          Case Study      2
Griptab use during shade matching and bonding of an anterior,
all-ceramic crown By Graeme Milicich, BDS


3                                                                  4




5                                                                  6




                                                                   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).




                                 US: 1-800-811-3949               UK:    0800-311-2097
                                 CA: 1-866-316-9007               NZ:    0800-TRIODENT
                                 INT: +64-7-549-5612              AU:    1-800-350-421
If you have a great new product idea or wish to contact us for more information on our great
products, go to www.triodent.com/product-information-request.                                                      Case Study     3
Griptab use during shade matching and bonding of an anterior,
all-ceramic crown By Graeme Milicich, BDS



7                                                                   8




The milled restoration was then contoured to create the surface     Prior to trying in the crown, a Griptab was bonded to the incisal
micro anatomy and stained and glazed (Fig 7).                       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
9                                                                   interfere with the selection of the correct shade of bonding resin
                                                                    cement (Fig 8).




                                                                    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),
                                                                    allowing the assistant to load the crown with the selected bonding
                                                                    resin and hand the crown over without the risk of it being dropped
                                                                    or excess cement getting on the outside of the crown, which makes
                                                                    them slippery and hard to handle safely.




                                   US: 1-800-811-3949              UK:    0800-311-2097
                                   CA: 1-866-316-9007              NZ:    0800-TRIODENT
                                   INT: +64-7-549-5612             AU:    1-800-350-421
 If you have a great new product idea or wish to contact us for more information on our great
 products, go to www.triodent.com/product-information-request.                                                       Case Study      4
Griptab use during shade matching and bonding of an anterior,
all-ceramic crown By Graeme Milicich, BDS


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 can then be 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.


10                                                                      11




Immediately post-cementation (Fig 10), the adjacent teeth were          A couple of minutes of rehydration began to reduce the intensity of
slightly desiccated, which highlighted the white spots in the enamel.   the enamel white spots on the adjacent teeth (Fig 11).

                                                                        To ensure accurate shade matching in cases like this, it
                                                                        pays to take initial images right at the beginning of the initial
                                                                        appointment before the adjacent teeth have a chance to
                                                                        begin drying out and changing the apparent color.




                                    US: 1-800-811-3949                  UK:   0800-311-2097
                                    CA: 1-866-316-9007                  NZ:   0800-TRIODENT
                                    INT: +64-7-549-5612                 AU:   1-800-350-421
 If you have a great new product idea or wish to contact us for more information on our great
 products, go to www.triodent.com/product-information-request.                                                            Case Study      5

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Anterior Crown by Dr Graeme Milicich

  • 1. Clinical Case Griptab use during shade matching and bonding of an anterior, all-ceramic crown By Graeme Milicich US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request.
  • 2. Griptab use during shade matching and bonding of an anterior, all-ceramic crown By Graeme Milicich, BDS Successful shade matching of a single anterior crown is one of the most challenging aspects of anterior cosmetic 1 dentistry. All-ceramic crowns provide the opportunity to be able 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 A new 21-year-old female patient presented with a central incisor bonding resin has been loaded into the crown. The presence that had previously had an incisal 1/3 fracture restored with a bonded of Silane tends to make the glazed surface of a porcelain composite (Fig 1). She had suffered another blow to the tooth and restoration very slippery, and it is easy to lose manual control the restoration and all the palatal enamel had been lost. The palatal of the restoration during this phase of bonding. fracture was sub-gingival and down to the bone in one area. 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 2 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. The tooth was prepared for an E4D CAD/CAM crown and the sub- gingival margin was exposed (fig 2) using a Waterlase MD, and the bone in the region of the fracture was lowered (Fig 3 & 4) to re-establish biological width using a closed flap approach. US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request. Case Study 2
  • 3. Griptab use during shade matching and bonding of an anterior, all-ceramic crown By Graeme Milicich, BDS 3 4 5 6 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). US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request. Case Study 3
  • 4. Griptab use during shade matching and bonding of an anterior, all-ceramic crown By Graeme Milicich, BDS 7 8 The milled restoration was then contoured to create the surface Prior to trying in the crown, a Griptab was bonded to the incisal micro anatomy and stained and glazed (Fig 7). 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 9 interfere with the selection of the correct shade of bonding resin cement (Fig 8). 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), allowing the assistant to load the crown with the selected bonding resin and hand the crown over without the risk of it being dropped or excess cement getting on the outside of the crown, which makes them slippery and hard to handle safely. US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request. Case Study 4
  • 5. Griptab use during shade matching and bonding of an anterior, all-ceramic crown By Graeme Milicich, BDS 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 can then be 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. 10 11 Immediately post-cementation (Fig 10), the adjacent teeth were A couple of minutes of rehydration began to reduce the intensity of slightly desiccated, which highlighted the white spots in the enamel. the enamel white spots on the adjacent teeth (Fig 11). To ensure accurate shade matching in cases like this, it pays to take initial images right at the beginning of the initial appointment before the adjacent teeth have a chance to begin drying out and changing the apparent color. US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request. Case Study 5