Dental crown and dental bridge final fitting
During this appointment, the practitioner checks all the important details about a definitive restoration (crown or bridge) : insertion, shade, shape, position, bite and makes the necessary adjustments.
If a porcelain restoration is designed, at the conclusion of the appointment, the restoration is sent back to the dental laboratory where the last layer of porcelain is fused (the glaze).
The glaze is a thin layer that ensures the final gloss of the reconstruction but does not influence the size and shape of the artificial teeth. To some extent, it may influence the shade.
All the important aspects must be verified during this appointment :
The perfect insertion of the restoration on the abutment teeth
The insertion must be smooth, unimpeded and the restoration must fit onto all abutment teeth simultaneously. The restoration should have a good grip on the abutment teeth to increase the stability. The crowns must slightly extend bellow the gumline and reach the end of the preparation.
If the prosthesis can be removed to easily from the teeth, the dental crowns are "too loose" and the reconstruction lacks the necessary stability. If it removes too hard, it is possible that a small obstacle prevents the correct insertion. It has to be eliminated before the next step.
The shape, size and position of the artificial teeth
Generally, the artificial teeth are shaped based on the other remaining teeth. What does this mean ?
First, artificial teeth should not have a disproportionate size and they must follow the normal line of the dental arch. If one or more artificial teeth are well inside or outside this line it will create a disagreeable appearance.
a dental crown shaped in accordance
with the line of the dental arch
It is generally advisable that an artificial tooth should resemble his homologous tooth. It is extremely unsightly to execute, for example, a crown on a left premolar that has a totally different shape and size to the right premolar.
In some clinical situations, additional impressions, photos or videos (with the patient's teeth-look before preparation) are sent to the dental laboratory. They will give the dental technician more information on how to shape the artificial teeth. At this stage, the artificial teeth are compared with the additional samples to verify if they were adequately shaped.
If small adjustments are required, they can be performed at the dental office. If large adjustments are needed, the restoration must be sent to the dental laboratory.
The shade is the first element that stands out when looking at a dental restoration (especially if the shade is mismatched). Consequently, any small discrepancy may jeopardize the entire aesthetic results.
Of course, the shade is even more important when the restoration is in a visible area and aesthetic demands are higher.
Dental ceramics or porcelain has the advantage of a rich range of shades that can mimic the smallest details on the surface of teeth. Different areas of the same tooth may benefit from different shades, special effects and characterization can be added, all in order to give artificial teeth a close to natural appearance.
the dental crown has a lighter shade then the adjacent teeth
the dental crown shade selection is perfect
The best results are achieved when the ceramic restoration is "not noticed". It is not desirable to select very white shades, although many patients prefer this.
In some situations, the dental technician can also take part at this operation. The shade can be changed to some extent, during the application of the last layer of porcelain ("the glaze").
A dental restoration must perfectly fit the patient static and dynamic occlusion (or bite). This is a vital element, as a dysfunctional environment created by a misadjusted dental restoration can lead to occlusal trauma that can produce various symptoms from toothaches to muscle fatigues or headaches.
For the static occlusion, the patient closes the dental arches in the correct bite while the dynamic occlusion is checked during various movements of the mandible.
The articulating paper is the tool used to highlight occlusal contacts by marking areas on teeth or restorations where contacts are made during biting or other movements of the jaw.
Articulating paper is manufactured as "books" of many leaves, which are torn out and used when required. Normally, each leave has 2 different colors, one for each side.
The bite adjustment procedure is done by placing a strip of articulating paper between the teeth while the desired mandibular movements are performed. The areas where restorations need occlusal adjustments appear as colored points or lines.
Adjustments are made with diamond or tungsten carbide burs and the bite is rechecked until the reconstruction perfectly fits.
After all procedures are performed, the dental restoration should perfectly fit, both aesthetically and functionally. If a porcelain restoration was designed, it is sent back to the dental lab for "glazing" and the temporary crowns are re-cemented on the abutment teeth.
Last review and update: November 2020