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Avoiding extraction for an elderly patient with an easy prep solution – Dr Ed Williams

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  Posted by: The Probe      13th April 2019

Dr Ed Williams qualified in 1993 and has worked in general practice, in the prison service and at Cardiff Dental Hospital. He is currently a clinical lecturer, working part-time. Here, he talks about using COLTENE AFFINIS® impression materials on a recent case, treating a long-term patient who, at the remarkable age of 86, was keen to keep her own tooth.

Initial presentation 

My patient, an 86-year-old female, came to see me with a broken tooth that she was desperate to keep (see Fig 1).The patient is a regular and long-standing patient of mine and has an above average set of teeth for her age; she has done extremely well to get to where she is. Her medical history was uneventful, and the radiographs showed that the site was caries free, but not suitable for root treatment. There was no eventful pathology in the sclerotic pulp and the sclerotic canal and the tooth tested non-vital.

Fig: 1

We looked at the possible options and discussed extraction and a denture, but the patient really did not want to lose any of her teeth whatsoever if she could help it and was extremely keen to go down the restorative route. 

Treatment options and preparation

As such, we gave her the option of trying a crown. With minimal surface to hold, we decided to modify the preparation to have a modified Nayyar core central restorative retention area. Compliance was easy to achieve and the patient was happy with the treatment plan that I proposed. 

As for limitations, other than because she is elderly – which meant that I had to watch for normal medical complications – there were no compromises.

Making the impression, delivery and fit 

We prepped the patient there and then. I used COLTENE AFFINIS®impression material in the automix machine.  For this particular case, I used the COLTENE AFFINIS®regular body wash, which is blue in colour (see Fig 2).As with the AFFINIS® light body wash, which I have also used, I find that this product flows extremely well, is non-sticky and very readable. Overall, none of the AFFINIS®materials clog, which is what has happened when using cheaper, poorer quality materials, and I’ve found that they all mix and match together with very good results.

Fig:2

Using the AFFINIS®impression material, I managed to get an accurate and easily readable impression (see Fig 3). I used COLTENE AFFINIS®System 360Putty and COLTENE AFFINIS®regular body wash in a single shot (see Fig 4), temporised, then sent it off to my lovely laboratory (see Fig 5). They constructed a non-precious bonded crown (see Fig 6), to allow us to use adhesive technology to give us extra retention. 

Fig: 3
Fig:4
Fig:5
Fig: 6

Outcome and appraisal 

The fit was uneventful. The restoration fitted perfectly, the margins were as we would expect and occlusion was fine (see Fig 7).And the last I know the crown is still there! 

Fig: 7

My patient was very pleased with the outcome; she was able to keep her tooth and functionality has returned to normal. The process was efficient, and her crown is not painful. I was very happy with the result too; I am always happy if the patient is happy. 

Having trialled COLTENE restorative products at the beginning of the year, they are now exclusive in the practice. I would definitely recommend COLTENE impression materials to other practitioners – I also use COLTENE PRESIDENT®impression trays. Other materials have come and gone and yet I have always come back to COLTENE. 

To find out more visit www.coltene.com, email info.uk@coltene.com

or call 01444 235486


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