Crown Preparation and Cementation Note

Clinician Specialty: Dentist **Chief Complaint** Patient presented with a fractured upper right second premolar (tooth 15), reported 3 days ago after biting on something hard. Experiencing mild sensitivity to cold. **History of Presenting Complaints** Patient reports a sudden, sharp pain 3 days prior while eating. The pain subsided quickly but returned with cold exposure. No spontaneous pain or swelling. Tooth 15 has a large, old amalgam restoration that appears compromised. No history of trauma. **Pre-Procedure Discussion** Risk Discussion: Discussed potential risks of crown preparation including post-operative sensitivity, potential need for future root canal therapy due to pulp irritation, and, in rare cases, fracture during preparation or cementation, leading to extraction. Patient acknowledged understanding and consented to the procedure. Cold Test: Tooth 15 responded positively to cold, but the sensation lingered for approximately 10 seconds, indicating reversible pulpitis. Tender to Percussion: Negative. Radiographic Findings: Periapical radiograph of tooth 15 revealed a large, deep amalgam restoration extending close to the pulp chamber, with no evidence of periapical radiolucency. No significant bone loss noted. **Procedure** Anaesthesia: Administered 1.8ml of 2% Lidocaine with 1:100,000 Epinephrine via buccal and palatal infiltration around tooth 15. Achieved profound anaesthesia. Tooth Preparation: Tooth 15 was prepared for a full-coverage ceramic crown, ensuring adequate reduction (1.5mm occlusal, 1.0mm axial) and a smooth chamfer margin supra-gingivally. Caries removal was performed, and a minor build-up with composite was placed to establish ideal form. Gingival Retraction: Ultrapak #00 cord was placed around tooth 15 to ensure clear margin visibility for scanning. Scans/Impressions: Digital intraoral scan performed using iTero Element 5D scanner. Scanned maxillary and mandibular arches, followed by a bite registration scan to capture occlusal relationship. Design and Milling: Crown designed using CEREC software. Design parameters reviewed and approved. Crown was milled in-house using a CEREC MC XL milling unit. Material: IPS e.max CAD lithium disilicate. Try-in: Intra-oral assessment revealed excellent marginal fit, good interproximal contacts, and ideal occlusal relationship. Patient reported comfortable fit. Radiographic Verification: A post-cementation radiograph confirmed excellent marginal adaptation and complete seating of the crown. Cementation: Crown cemented with Ivoclar Vivadent SpeedCEM Plus resin cement after try-in paste confirmation and proper isolation. Final Check: Occlusal adjustments made with a fine diamond bur, ensuring harmonious occlusion in centric and eccentric movements. Crown polished to a high shine. Floss passed through contacts freely. Outcome: Patient expressed satisfaction with the fit, feel, and aesthetic appearance of the new crown. No immediate post-operative sensitivity reported. **Shade Selection** A2 Vita Shade Guide selected for optimal aesthetic match. **Additional Diagnoses/Notes** Observation of incipient caries on tooth 16 mesial surface. Discussed with patient; recommended monitoring. **Prognosis** Good prognosis for tooth 15, given the successful crown placement and healthy surrounding tissues. Expected long-term success of the restoration is high, provided good oral hygiene is maintained. **Review Date/Follow-Up** Patient advised to return for routine check-up and hygienist appointment on 1 November 2025. **Other Notes** Patient provided with post-operative instructions for crown care, including avoiding hard and sticky foods for the initial 24 hours, and maintaining diligent brushing and flossing. Advised to contact the clinic if any prolonged sensitivity or discomfort arises.