3, 2, 1, Contact – Dental Restoration

By Joey Shaw

Three tips will ensure dentists and technicians will get the perfect contact the first time.

Contacts have always been one of my key areas of interest during my 26 years as a technician. In part, this is due to my strong desire to reduce the number of adjustments the dentist must make at the final seating. If the dentist or the technician do not properly establish the contacts, patients may experience food impaction, periodontal disease, and other complications.

In the ideal arch, each tooth is in firm contact with its neighbors. This helps the arch withstand occlusal force. In the traditional human arch, the collective action of one tooth supporting another helps stabilize the arch. When the collective action is compromised, the patient may experience tangential loading. The result is a reduced chewing force and a negative effect on the alveolar process and the surrounding gingiva. Clearly, contacts play a critical role in successful restorations.

There are a number of daily contact challenges I encounter when I work on single or multiple restorations. Out of these challenges I have identified three primary areas that I believe all dentists should consider to ensure a successful prognosis: use quality materials, pay attention to the line-of-draw, and communicate your preferences to the laboratory. Following is my count down to successful contacts.

Three: Communicate with the Laboratory

Stephen Covey has said, “Begin with the end in mind.” Similarly, you should begin by telling your technician what you want to see as the end product. An accurate description of your preferred contacts or the current condition of the contacts you have is essential information for the technician. The technician should be able to go to great lengths with this information by ensuring consistent, ideal contacts. Dentists should describe every detail of their preferences, including the size and scope. The size or scope of the preferred contacts is an essential detail needed to create customized, specific standards. This detail alone can ensure a more consistent fit.

The same rule of communication applies to the technician. After the technician fabricates the crown or bridge to fit the working model, he or she should make a final check against an uncut solid model to ensure the best contact(s) possible. He or she should also make sure that the restoration is ultimately what the dentist prefers.

Two: Pay Attention to Reduction, Angles, and Line-of-Draw

Dentists often do not consider proper reduction, line angles, and draw, and consequently, they rarely pass these measurements on to the lab. Simply evaluating the contacts before taking the impression aids technicians in a successful fabrication. Dentists should make sure they especially pay attention to the following two situations. The first occurs when a tooth that has a mesial or distal tilt is adjacent to the tooth being restored. The second occurs when a prepped tooth has a significant mesial or distal tilt. The latter situation may not only compromise the contact area, but it now may affect the draw as well.

At this point in the fabrication process there are only two options: the technician can send the case back to the doctor for evaluation, or he can adjust and mark the contact area with the dentist’s permission. Unfortunately, the latter is an easier option for the dentist and it may resolve the problem, but it requires a higher level of technical skill from the technician. If the doctor over-adjusts, the restoration will need to be sent back to the lab. It also requires extra time from the dentist to adjust the restoration during insertion.

A broken-down contact area is just as challenging. Whether the broken area is a failed filling or a fractured, old restoration, technicians can be more successful in matching the contact area if dentists will evaluate and repair the contact at the prep appointment. There may be times this is not an option because of future treatment plans, finances, or other obstacles the technician may not be aware of. In these instances just providing that information will help the technician adjust the contacts to fit the dentist’s desired objective.

One: Use Quality Materials

Both dentists and technicians need to realize that every material used beginning with the time the tooth is prepped through the entire fabrication process has expanding and contracting characteristics. This includes provisional materials, cements, impression materials, stones, investments, alloys and, of course, ceramics. When technicians and dentists strictly adhere to the numerous technical procedures involved with these materials, contacts will more likely support the forces required.

Both technicians and clinicians should make getting optimal contacts every time a priority. Paying close attention to the three key elements of using quality materials, paying attention to the line-of-draw, and communicating with the laboratory are fundamental. Contacts need not be a guessing game. They can be a predictable and precise technique for dentists, technicians, and patients. ■

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Joey Shaw, CDT is the team leader of the Ceramic department at Arrowhead Dental Laboratory. He has 20 years of dental laboratory management experience, and has worked closely with world-renowned technicians such as Matt Roberts, Dr. Ed McLaeron, and Uwe Bromale.