Darin O'Bryan, D.D.S. The preparation of a multiple unit case should be predictable and efficient. The best way to insure this is by having a systematic approach to the preparations. For this purpose I utilize two things. First is the anterior design preparation kit from Bob Winter and the second is the plastic vacuform stent that I will be using for the temporaries.
The depth reduction burs for the anterior design kit has various sizes based on if you are doing lower anterior, upper anterior or cuspid/bicuspid preparations and also incisal depth reduction burs. This allows for uniform reduction in an efficient manner.
First I make depth cuts in the incisal and occlusal surfaces of all teeth. The depth depends on how much length I am adding. If more than 2mm then I won’t reduce the incisal edges much at all. This is where the vacuform stent comes into play with this I can judge how much reduction I am going to need prior to starting.
Once adequate reduction is verified I then use the facial reductions burs to give adequate material thickness to my final restorations. The depth cuts are then removed with a chamfer or modified shoulder bur. The lingual are prepared as need for the final restorative outcome. In this case the cingulums were left intact as to not compromise the strength of the tooth.
I don’t finalize the preparations. This initial preparation is to allow for the overlay of the wax up in resin. About 90% of the preparation is done at this time and all 8 teeth were prepared to this state in less than 45 minutes from the start of the appointment. By doing the initial preparations this way it allows for minimal preparation once the wax up has been transferred, adjusted and okayed by the patient.
