Clinical tip: Helping patients through the economic downturn -- intraoral repair of fractured porcelain or PFM crowns

By Dan E. Fischer, DDS

The recent economic downturn has made it necessary for clinicians to rethink some of the options presented to patients when faced with a dental emergency. This is especially true when lifelong patients suddenly find themselves out of work and in need of dental care.

One of the best services a clinician can provide for patients is the intraoral repair of fractured porcelain or porcelain-fused-to-metal (PFM) crowns. With the high-quality bonding and composite products available today, the end result is an esthetic and functional repair that is feasible, low-risk, cost-effective — not to mention an appreciative patient. With the hope of an economic turnaround, it is important to hold on to these patients. By helping these patients through the difficult times with cost-saving options, their trust and loyalty will be back in the office in the ”good times.”

Ultradent Porcelain Repair Kit

Surface preparation

1. Isolate adjacent tissues and restorations with Etch Arrest acid-neutralizing barrier. Leave Etch Arrest in place for duration of etching.
2. Use a diamond or #14 high-speed round bur or microabrasion unit to abrade metal surface and fractured porcelain.

Etch and silanate

1. Apply Porcelain Etch by slowly expressing an even coat onto prepared porcelain and/or metal for 1.5 to 2 minutes. Suction then thoroughly rinse and dry surface.
   
   WARNING: Do not use Porcelain Etch to etch exposed enamel or dentin surfaces.
   
   
2. Apply Ultra-Etch 35% phosphoric acid for 5 seconds. Suction then thoroughly rinse and dry surface.
3. Porcelain will have a frosted appearance. Repeat if necessary.
4. Apply silane to fractured porcelain and allow it to evaporate for 1 minute. After 1 minute, air dry if needed.

Bonding

1. Apply a puddle coat of Peak LC Bond Resin — gently agitate for 10 seconds.
2. Dry/thin 10 seconds. Prep should appear shiny.
3. Light-cure for 10 to 20 seconds.

Restore

1. Apply a thin coat of PermaFlo Dentin Opaquer over metal. Light-cure.
2. Complete restoration with Vit-l-escence or Amelogen Plus.

Author bio
Dan E. Fischer, DDS, is the founder and chief executive officer of Ultradent Products, Inc., a private family company that has become a leader in dental innovation. He lectures internationally on new concepts and technologies in dentistry for the 21st century, and how to maximize these concepts to reach more socioeconomic groups. Dr. Fischer received the Lifetime Achievement Award from the American Academy of Cosmetic Dentistry in 2005, the Alumni of the Year award from Loma Linda University in 1994, and the Utah Academy of General Dentistry Dentist of the Year award in 1995. Dr. Fischer maintains a part-time private dental practice.