Almost always I remove a patient’s temporary crown (bridge). I’ve been humbled once or twice when I can’t get it off (undercuts, permanent cement, etc).
In these cases, I go through the temp and based on my #cbct , plan accordingly.
And, of course, the words of my #prosthodontics professor in dental school ring through my ears: “don’t touch my walls” meaning do not touch the crown-prepped walls. Why is this important?
Sometimes, the RD has already taken the final impression!
But, sometimes, removing the temp is also not possible: take onlays, for instance. They can be pretty tricky to remove and even harder to re-temporize especially since MOST endodontists only have temporary (not that strong) cements on hand.
With this crownlay, I knew re-temping would be tricky, so I decided to access through it, esp since there was enough CEJ/structure for my RD clamp to avoid pushing the temp off. I saw something curious on the B wall from within the chamber, but nothing stuck *internally.*
Ultimately, towards the end of the procedure, the procedural vibrations had ultimately wiggled off the temp – on the buccal wall, carious dentin was visible. It stuck externally, but was only discolored through internally, and no “stick” internally.
I called the RD; they explained that they were planning to go back in to do the endo and at that time remove the decay themselves, but in the planning, the pt became more symptomatic and was referred to me with no mention of the caries/being removed in their original plan.
If I had one stepped it and NOT removed the temp crownlay, I seal my GP/pulpal floor so I wouldn’t have been concerned about contamination as I’m sure when/if I had completed the endo and returned the pt, the RD would have reprepped the patient and removed all caries.
A few pearls in here:
1) Never hesitate to pick up the phone to communicate with your specialists, and vice versa
2) As specialists, try to avoid altering crown-prepped walls – not just because the final impression may have been taken, but also because the temp crown will not fit as well when walls are altered. THE EXCEPTION to this being – always remove all caries.
