By: Howard Farran DDS, MBA, MAGD
Publisher, Dentaltown Magazine

When preparing a tooth for a final indirect restoration, dentists try so hard not to nick or cut the gingival tissue. Sometimes it is impossible not to nick the tissue. The decay can be subgingival, the old MOD amalgam restoration is often below the tissue, the patient can be less than cooperative, and your hand often does things your mind never told it to do. This is why for years my assistant Jan has always insisted on packing the zero cord, followed by the one cord, before I start to prepare the tooth. Examples of before packing the cord and after packing the cord are provided in figures 1 through 3.

Packing the cord before I prepare the tooth will retract the gingival tissue a millimeter apically and a millimeter horizontally away from the enamel. If this is an emergency patient and you are looking at doing herodontics on a single tooth in a mouth full of gingivitis, the cord can retract two to three millimeters apical and one or two millimeters of gingiva horizontally away from the enamel.

Have you ever noticed during most crown and bridge presentations how perfect the preps look? Have you ever noticed during most crown and bridge courses how perfect the gingiva is and how the gums never ever bleed? Have you ever wondered, during most crown and bridge presentations, “Why is this tooth getting a crown?” It is so easy to have a perfect prep with perfect tissues if the tooth is in near perfect condition! But back in the real world, working on my Wal-Mart, IKEA, Southwest Airlines, Home Depot patients, a crown is usually going to top off a molar root canal on a bombed out tooth! Usually on a patients who are so hot and thirsty they bring their 74-ounce Mountain Dew into the treatment room.

The same goes for a reduction coping. What does a reduction coping mean to you? You might say that it means you did not reduce the occlusal surface enough. To me it means you took your final impression for your indirect restoration BEFORE you made your temporary. This is simply a bad habit. You learn so much about your preparation when making your temps before your final impression. My crown and bridge instructor at the University of Missouri was the best in the country, Dr. Dean A. Elledge DDS. Dr. Dean always said, “Always solve your problems with your temporary!” A reduction coping is just another problem that could have been solved with your temporary if you made it BEFORE you took your final impression.