We obviously want to keep things isolated... sorry...
I normally finish with the margin so I start off on the occlusal surface
and begin working my way down the axial surfaces of the prep and the very last thing I try to
touch will be_____ Now we'll get the restoration we'll apply in this space our resin adhesive resin
cement from 3M which is the relaxed ultimate how does it feel right now very good feels very good
so one of the important steps when it comes to bonding bruxer is to decontaminate the restoration
after you've tried it in so when you try the crown in on the patient it becomes contaminated with the
patient's saliva so those salivary phosphates could certainly inhibit bonding whether you put
the correct zirconia primer bonding agents that saliva's blocking those sites so one of the best
ways to decontaminate the internal surface of the restoration is to use a sandblaster or in
this case we're using a chairside micro etcher within this vial we have 50 Micron aluminum oxide
and this will help not only remove those salivary phosphates so that we have a clean surface to bond
to it will also roughen the internal surface so that we have extra surface area for the zirconia
primer and then subsequent resin cement to bond to so after we've fried it in we've confirmed
the fit it has become contaminated now we're using this Danville chairside micro etcher
and I'm applying this to the entire internal surface this is a bruxer now Crown which was
military side so we have our decontaminated brux or crown now we're going to follow it up with a
zirconia primer so in this case because I'm using a universal bonding agent the bonding
agent also contains some methacrylate and light sensitive monomers within it so I make sure that
I have my orange filter on and here I apply it to the entire intaglial surface because
we certainly want that mdp primer to come into contact with the entire restoration
including the margins of the restoration so something that we do is we'll use a suction
to remove some of the excess bonding agent on the restoration and also with oil and water
free air we're gonna lightly apply some air to this to continue thinning out this bonding agent
and the resulting layer will certainly be the bonding agent but within this Universal bonding
agent Scotch Bond Universal there is the mdp primer which is critical for our bonding to
zirconium so anytime we're cementing particularly if we're bonding following adhesive Dentistry
we really want to make sure we isolate the area really well we do have an ISO dry it's a suction
device it's a retraction device also to help keep the tongue and cheek out of the way and
it will suction any excess fluids so a nice way to combat that and has been proven to reduce the
risk of post-operative sensitivity is to apply a desensitizing agent on the preparation in this
case I use gluma the gluma is a gluteraldehyde and Hema solution the combination of that again has
been shown to greatly reduce the risk of post-op sensitivity it also has a nice antimicrobial
action as well to help clean the preparation I lightly scrub that into the preparation and
helps the prep just absorb the solution in I let it sit for about one to two minutes
leave it on and we actually don't want to rinse it off I just leave it onto the preparation if
after the one or two minutes have elapsed if I see a lot of excess of the desensitizing
agent then we'll block dry it with a cotton pellet or aspirate the excess with the suction
to bond this Restoration in we're going to use 3m's relaxed ultimate which is their adhesive
resin cement so the adhesive resin cement does require an additional application of a bonding
agent onto the preparations so using Scotch Bond Universal we're going to apply a thin
coat of the bonding agent I normally finish with the margin so I start off on the occlusal surface
and begin working my way down the axial surfaces of the prep and the very last thing I try to touch
will be the margin because you may potentially contaminate the micro Brush by touching some
of the surrounding soft tissue especially if there's heme or saliva or purvicular fluid in
those areas that just helps for me minimize the risk of contamination so we've now filled the
restoration with our adhesive resin cement now we make sure we apply that down with good pressure
we've now seated our Restoration in with the relaxed ultimate adhesive resin cement and then
with our resin cement we will pack here for a couple of seconds on each side it's about two
to three seconds I would error on the side of less time at first especially if you're maybe new to a
resin cement you don't want to cure for too long okay we'll do the same thing on the Buckle there
we finish off with the removal after we've secured everything in place we've light cured and now I
can feel more comfortable removing any areas of excess cement so using a scaler along the
Buckle and certainly all of the margins just to make sure that all of the margins and proximal
surfaces are free of any excess cement so now that the restoration is secured into place but
we do want to check all these aspects again so go ahead and bite down together tap tap and
bite your heart together all right and open how does it feel right now very good feels very good