Question regarding temporary cementation of Zirconia crown

[Nan]

I went to my dentist to try-in my new monolithic Zirconia crown (Katana STML) and the bite seems ok to me, and the dentist says he's pleased with it.
But it was hard for me to determine if it felt 100% right as there was some pressure up in the gum part, which distracted me.
So the dentist recommended to cement the Zirconia temporarily in order for me to assess how I felt over a few days.
My questions are;
1. Is an assessment stage normally suggested/recommended? Is there any reason to avoid doing that?
2. Would temporary cement ruin/harm my Zirconia crown in any way?
3. How should the crown be cleaned from the temporary cement - can it be done chairside or should it be sent back to the lab for sandblasting, etc?

All opinions would be very much appreciated.
TIA

 

[MattKW]

Well, you can try temporary cementation, but it might be very difficult to remove at the end of the trial. I once made the mistake of temporarily cementing a bridge - it took 3 years for the damn thing to come loose again! The temporary cement won't damage the zirc in any way, and simple chairside cleaning should be enough. To truly bond zirc is really quite difficult, and I doubt any dentists truly do it. A well-fitting crown needs only a little cementation.

 

[Nan]

Well, you can try temporary cementation, but it might be very difficult to remove at the end of the trial. I once made the mistake of temporarily cementing a bridge - it took 3 years for the damn thing to come loose again! The temporary cement won't damage the zirc in any way, and simple chairside cleaning should be enough. To truly bond zirc is really quite difficult, and I doubt any dentists truly do it. A well-fitting crown needs only a little cementation.

Thanks Doc.
Meaning, the temporary cement with Zirconia won't work as it works with a temporary acrylic crown?
(I've been wearing a temp crown for about a month and the dentist removed it pretty easily. Why is it different with Zirc?)
It is a single crown for an endo treated first maxillary molar.

 

[MattKW]

Thanks Doc.
Meaning, the temporary cement with Zirconia won't work as it works with a temporary acrylic crown?
(I've been wearing a temp crown for about a month and the dentist removed it pretty easily. Why is it different with Zirc?)
It is a single crown for an endo treated first maxillary molar.

Normally a plastic temp crown doesn't fit as well, and it flexes more, so that makes it easier to pull off. If you have a tooth that has been prepared with minimal taper, i.e. near-parallel walls, then putting on a well-fitting permanent crown using temp cement can make them really hard to get off. Plus, there's the risk of damaging the permanent crown when you try to dislodge it. But if it went OK for you, then that's fine.

 

[Busybee]

It really is down to the skill of the dentist. Some dentists are good at letting you try in crowns others find it hard to mix the cement to the right consistency without making it rock solid. I am not sure why but it's very much a personal thing as to how dentists deal with their temps or try ins. I think it's a good idea to try crowns in over night. It won't give you the exact feel of the final result because perm cement is more robust and but will give you a good idea compared with not trying it in. If the crown is well made it won't need much temp cement to stay on overnight.

 

[MattKW]

It's hard to mix the cement to the "right" consistency. usually this mean adding some Vaseline to " weaken" the bonding. I don't understand why you think it is a good thing to try in crowns overnight. Apart from the bridge I mentioned earlier (the colour was questionable), I have never let a patient "try-in" a crown or bridge overnight. It's fraught with the danger of not being able to remove the crown at a later appointment without damage. Only once in 36 years of practice have I had to remove a crown after permanently cementing it. If you have a good lab, and do good treatment, and don't cement in iffy crowns, then why the need to temporarily cement crowns? A crown that is " well made" doesn't need temporary cementation.

 

[Busybee]

I'm guessing aesthetic cosmetics aren't your thing MattKW. It's very important to some people when having aesthetic work on the front teeth.

It's fine to just cement anything in if a patient doesn't care a jot for the way the teeth will look or feel. I'm sure loads of people aren't that bothered, But a lot of good cosmetic dentists used to do this to avoid having to drill off if there was a problem later. These days a lot of cosmetic practices go for creating high spec temporaries that are meant to replicate the final result. But it's not the same thing. It's ok for veneers but with crowns it's better to try in the real thing.

I'm sure you've seen people posting here who are unhappy with the shape or length of just one crowned tooth or maybe feel that the teeth stick out too much. This helps avoid such situations. Because the last thing you want to do is replace one tooth when you have porcelain to match on each side.

It seems very easy for some dentists and a bit palaver for those dentists I deem to make a meal of every piece of work. There are different styles of working and some dentists can achieve a great outcome by just doing things simply and quickly. Those are dentists that I really rate. Those dentists will let you try in overnight and know how to get the temp cement just right and have great technicians that they communicate well with. They also tend to know exactly what to do with the minimum fuss. They also don't tend to make mistakes. Confident and capable dentists do all this.

 

[MattKW]

The topic here was a zirc crown, and that's likely to be posterior, so aesthetics don't come into it. I rarely have aesthetic issues with anterior crowns due to digital photography and a good lab. Patients with challenging requirements are best asked to go to the lab in person. Another issue is if the patient takes home a real crown that is temporarily glued in, and it falls out and is damaged or lost, who pays the bill? Much safer and sensible to have the patient with family attend a fitting session at my surgery. I can only be confident and capable when the treatment is under my control.

 

[Busybee]

"Control" is the key word here. The dentist in question in the OP has given the patient some control over the outcome. An important part of change management is allowing stakeholders to feel that they have some control over changes. That facilitates acceptance. Having major dental reconstruction can be life changing (in a good or bad way). In this case it's just one tooth, it may be a back tooth, but the dentist in the OP must have found that trying in works in the past with patients who express concerns on try-in in the chair. The patient appears sensitive to changes and anxious about getting things right. So while most don't need this safety net, some patients do. This is the dentist putting the patient in the driving seat.

Yes there are risks, but there are risks of costs either way.

The OP's question was whether the crown is going to be perfect after trying in. Most dentists are pretty good at clearing out temp cement from a restoration chair-side. After all they have to clean it pretty well from the prepared tooth.

It's great to send patients to the lab by the way.