Message in a Bottle Mailbag: Metal-ion crowns, PermaSeal and sensitivity, holiday parties

The "Message in a Bottle Mailbag" is a monthly feature of the e-newsletter, Pearls for Your Practice: The Product Navigator. Each month, Editorial Director Joshua Austin, DDS, FAGD, answers reader-submitted questions to help you navigate your dental and hygiene product decisions (and more!). This month, he learns of a new approach to using metal-ion crowns, offers his take on sensitivity and PermaSeal, and shares what he did for his staff holiday party.

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QUESTION:
Dr. Samuel wrote: You made some good suggestions in your article about making a temporary crown from nothing. I agree with your comments about metal-ion crowns. But I use them every time I am in the position you described. Here's how: Finish your prep, then select the most appropriate metal-ion crown. Insert the metal-ion crown (with no cement, etc.) on the prep. Take a quick impression of it using the material of your choice. I use a polyvinyl siloxane (PVS) bite registration so I can keep it until I deliver the crown. Remove the metal-ion crown from the impression and use the impression to make a temporary as you would if you had the matrix from the start. The result is quick and esthetic with no extra appreciable cost. You can even sterilize the metal-ion crown to use as a tooth form again later.

ANSWER:
Thank you so much for writing in, Dr. Samuel. This is a great idea that works perfectly well, and in my opinion, it’s the only reasonable use for a metal-ion crown. Aside from the fact that they are metal and patients generally hate the esthetics, the worst thing about metal-ion crowns, in my opinion, is that the margins can end up with very sharp overhangs that irritate the gingiva. Your idea eliminates that problem. With the bisphenol-A glycidyl methacrylate (bis-GMA) temp made from the outline that the metal-ion crown gave us, you can trim and polish the margins to a smooth, flush surface. I also like the idea of sterilizing them and reusing them. I might order a small kit to have some around for just this purpose. Thank you!

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QUESTION:
Dr. Kathleen F. asked: Does the additional etching with PermaSeal cause sensitivity?

ANSWER:
Thanks for writing in. You could get some sensitivity if you etch dentin. If you are just dealing with enamel, there will be no sensitivity. This would mainly come into play for Class V restorations. With those, I recommend limiting the etch to the restoration surface and not extending down the root. That would mitigate the risk of sensitivity. Great question!

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QUESTION: Jim from Pennsylvania asked: What did you do for your staff holiday party?

ANSWER:
Thanks for your question, Jim! Holiday parties are always a tough deal. It is impossible to please everyone and for some reason, staff love to complain about the holiday party. I am not sure why that is. We are under no obligation to have one. We do it for them as a “thank you” for their hard work for us. They are expensive and a headache to plan, but people love to complain about them as if they are some kind of birthright. I’ve done all kinds of different parties—from a restaurant to my house. Once, I even cancelled one on the day of the party when my staff members weren’t getting along and were creating drama among themselves.

This year, we decided to involve everyone’s families. I rented out a movie theater, and we had a private showing of the movie Elf. Everyone brought their spouses and kids. The theatre, Alamo Drafthouse, serves food, so they catered the event. They did an interactive “quote-along,” so the whole thing was interactive. Everyone seemed to have a good time, and they appreciated that we were all able to meet each others’ families. I think it was a good party. Next year, we will probably go back to an adults-only party with lots of wine and whatnot, but this year, it was nice to do something more family-oriented. Hope your holiday party was great this year!


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