Dr. Stuart Ray gives us an insight into what else you can use silicone stents for in everyday practice.
Silicone has often been limited to the material we use for palatal stents, but it is becoming increasingly apparent that it has many other uses.
In the Mini Smile Makeover course, much of the work is based on a mock-up, and we use a palatal stent made of silicone putty. Many people think that this is the only time silicone can be used, butIt has been found in practice that silicone stents can actually work in a number of situations. And I will share them with you.
We are all aware that freehand in composite is a skill that few people possess, so anything you can use to create a more predictable restoration will always be useful. In everyday practice, we don't always need to use a wax-up, and often we don't even have the luxury of a wax-up.
When to use silicone stents
If we find that patients have a restoration that needs to be replaced and it has been successful for many years, then we can assume that the occlusion – which is one of the most important points of a successful restoration – is good and in harmony.
Then, all we have to do is simply take the silicone caulk, we record the palatal surface with the putty (as we would do if it were a model) and then we can use the composite on the stent. We know that we will create a restoration that has the same contour and should then have the same occlusal harmony. And if we copy it, then we should have another very successful restoration.
“Palatine stents are not just for diagnostic wax-ups, they can also be used in combination with freehand reconstruction.”
There are also some situations where you will use a freehand technique and this can then be combined with the use of a silicone stent.
For example → in cases with fractures, the patient has an immediate problem, you can do a freehand reconstruction and you can just use a technique where you use your fingers behind the tooth or Mylar tape. Which you can then refine if you want to make changes. When the patient comes back, you can do the refinement in the mouth, which means you're essentially making a direct mock-up.
Once you are satisfied with the occlusion, you can use the palatal stent again.if you are going to modify the restoration, if you are not satisfied with the shade or if the patient wants something more than an immediate fracture replacement.
5 things to remember
- Palatal stents are not just for diagnostic waxing, they can also be used in combination with a freehand reconstruction.
- It is essential to take into account the color of the putty you use to make the palatal stent. (blue, dark green and even purple).
- It is essential to make sure you take great care when placing the grout.
- Make sure record the entire surface of the tooth you are working on.
- And always remember to make sure you have good crossbow stability and that you are not only working a very small field.
Let's review them in detail.
Palatal surface registration
It is very important that when performing a palatal stent with putty, you take great care to ensure that you record the entire palatal surface, the incident area on the palatal side, but also the entire incisive mass.
depth
When recording incisal edges, you want make sure that the putty is not too thin on the incisal edge. Often when placing the stent, if too much pressure is applied and the putty is thin, then it will deflect and you will end up with an inaccurate record of the model or tooth that you have recorded. You need to make sure that you have the appropriate thickness of the palatal stent; it needs to be sturdy and not deform when you actually place the restoration.
“If you use something that is yellow, it’s very hard to gauge how thick the composite is.”
Color
Another vital factor when making a palatal stent and choosing the material is the color. It sounds ridiculous, but if you use something yellow, it's very difficult to judge how thick the composite is when you put it on the putty, so use something with a bit of contrast, maybe a dark green, blue, or even purple.
Crossbow stability
What we have found that some people do in the course when they do palatal stents is they only register one tooth on either side of the one they are actually working on. What we tend to find in this case is that they lack the stability of the transverse arch, so when the stent is in place it can move. So it is imperative to record at least two or three teeth on either side of the ones you are working on just to make sure the palatal stent remains stable while you work.
Source: enlightensmile.com
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