Providing increased treatment options for cuspal coverage restorations

Sam Koh explains how the One Visit Crown can help speed up your cuspal restorations.

When a patient presents with a tooth that requires a full cuspal coverage restoration, we as clinicians, face two options of contrasting time and cost – a direct or indirect restoration.

A direct restoration, a ‘filling’, is made of a material such as resin composite or amalgam. An indirect restoration, a ‘crown’ or ‘onlay’ for instance, is made of a material such as porcelain or metal. Dentistry has continued to evolve in technology and materials over the years. We now have more products and treatment options available to us as clinicians. One Visit Crown (OVC) is an example, providing an innovative, alternate method to tackle full coverage restorations at a lower cost than a traditional crown and completed in a single dental visit.

The treatment option conundrum

Main considerations between the two traditional treatment options mentioned above – chairside time required to complete the restoration and financial cost to the patient

A direct restoration is relatively quick and well-known to patients as a restorative choice. And it is rather economical and effective for a finite period of time. On the other hand, an indirect restoration usually takes a dentist longer to complete chairside. It is done either over two separate appointments if done traditionally via a dental laboratory, or a single visit if done via CAD/CAM technology (eg CEREC). Although the latter reduces the procedure to just a single visit, both indirect options price significantly higher than a direct restoration.

‘Gold-standard’ for full cuspal coverage restorations is the indirect option. However, the challenge we face as dental clinicians is that some, due to the increased time taken or higher treatment fee, may find it a more difficult treatment option to communicate to patients and convince them to accept treatment.

A patient’s perspective

From the patient’s perspective, a lack of time and the financial cost, are the two main reasons Australians avoid or delay their dental visits (Australian Research Centre for Population Oral Health, 2012). The OVC addresses these two factors, allowing the clinician to offer a treatment option completed in a single visit and generally at a lower cost than a traditional indirect restoration.

The OVC consists of a unique 73% zirconia-filled hybrid ceramic material, in both the top, heat-cured layer, as well as the underlying uncured layer, providing a customised, lab-derived overlay option. Treatment is carried out in one appointment, saving valuable chairside time for the operator in comparison to a traditional indirect technique, thus improving both profitability for the clinician, but also a better experience for the patient as they do not have to return for a second visit.

One Visit Crown (OVC) clinical case study

The following case study is of a LR5, exhibiting signs of cracked tooth syndrome (CTS).

One Visit Crown clinical case
Figures 1, 2 and 3

One Visit Crown clinical case

One Visit Crown clinical case

Figures 1, 2 and 3 show the initial presentation of the LR5, with a large existing distal occlusal composite restoration.

Four treatment options offered to the patient:

  1. No treatment (not advised)
  2. A conventional indirect restoration (ie crown or onlay)
  3. One Visit Crown (OVC)
  4. Direct resin composite restoration.

Treatment

After a discussion about treatment, the patient declined a conventional indirect restoration due to cost but did not want ‘just another filling done’ with a direct resin composite restoration. The patient decided instead to go ahead with the OVC.

During the patient’s initial examination appointment we take a customised, lab-made OVC following a PVS bite registration impression. It took a single 30-minute appointment to carry out the entire crown procedure.

The existing restoration’s completely removed. After assessing the prognosis and restorability of the tooth, it’s prepared minimally to receive the OVC. Once occlusion is reduced, a slight bevel is placed in enamel, both buccally and lingually (Figure 4).

One visit crown clinical case
Figure 4

When significant tooth structure remains, the benefit of an OVC procedure over a traditional crown preparation with circumferential reduction of the tooth, is that the OVC procedure recommends minimal reduction to prepare the tooth for an adhesive onlay-type restoration. Minimal tooth reduction when preparing for restorations has been shown to be better for the pulp (Ruiz, 2017). The compression dome concept after preparing a tooth in this manner has been shown to provide a strong coronal structure. It forms a ‘stable peripheral bond in conjunction with a compressive design’ (Milicich, 2017) .

Final result

The OVC roughly in situ shown in Figure 5 – then correctly seated and adapted to the preparation using an occlusal seating guide fabricated and supplied by the lab (Figure 6).

One Visit Crown clinical case
Figure 5
One Visit Crown clinical case
Figure 6

This fabricated guide, unique to each patient, seats the crown onto the tooth preparation and into its ideal position. Following the advent of the customised OVC and seating guide removes the guesswork in crown placement, seating and occlusion. Thus this also decreases the amount of finishing and polishing required.

Once seated, curing of the uncured portion of the OVC and again after the band’s removed (Figure 7).

One Visit Crown clinical case
Figure 7

Figures 8, 9 and 10 show the crown finished and polished to give final results.

One Visit Crown clinical case
Figures 8, 9 and 10

One Visit Crown clinical case

One Visit Crown clinical case

The One Visit Crown (OVC) offers a great alternate treatment option to restore teeth that require full cuspal coverage. Addressing the two main reasons patients avoid dental treatment, it may also help the clinician with patient communication and case acceptance. With a conservative preparation used wherever possible, the One Visit Crown is able to offer the clinician a healthy and strong and aesthetic restorative solution for posterior teeth where full cuspal coverage is indicated.

References

Australian Research Centre for Population Oral Health (2012) The avoidance and delaying of dental visits in Australia Australian Dental Journal 57(2): 243-7

Milicich G (2017) The Compression Dome Concept – The Restorative Implications. Gen Dent 65(5): 55-60

Ruiz JL (2017) Supra-Gingival Minimally Invasive Dentistry: A Healthier Approach to Esthetic Restorations. New York, New York: Wiley-Blackwell

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