The Journal of the American Dental Association
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J Am Dent Assoc, Vol 133, No 10, 1381-1382.
© 2002 American Dental Association
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CLINICAL DIRECTIONS

A safe and convenient technique for the cementation of fixed partial dentures



ANDREW YOUNGBLOOD, D.M.D.

Patients’ safety is a major consideration in dentistry, as is clinicians’ convenience. Several authors have written in the literature about the risks of aspirating objects into the respiratory system or swallowing objects during dental treatment, and they have offered protocols and recommendations to prevent and treat such occurrances.1–4

Jacobi and Shellingburg2 reported that any patient can swallow or aspirate foreign objects, particularly elderly patients and patients who are under the effect of narcotics, sedation or nitrous oxide. Such accidents are possible in any patient position during treatment. Foreign objects aspirated or swallowed have included fixed partial dentures, endodontic instruments, crowns, rubber dam clamps and removable partial dentures.

Feit4 has stated that the immediate consequences of an aspirated restoration include the possibility of complete or partial airway obstruction, respiratory distress, pneumothorax or hemorrhage. Fischman1 has reported that no matter how careful the dental practitioner might be, there is the potential for objects to fall into the posterior portion of the pharynx during dental treatment. In most cases, swallowed material will enter the esophagus or be expelled through coughing.

The technique may help clinicians safely insert temporary and permanent fixed partial dentures.

The technique I describe in this article may help clinicians safely insert temporary and permanent fixed partial dentures, aid in the removal of excess luting agent after insertion and facilitate oral hygiene instruction.

THE TECHNIQUE
Cut a length of dental floss for each pontic space in the prosthesis or each embrasure space in which there is no pontic. Knot the center portion of each piece of floss. Loop each piece of floss around the prosthesis and hold the floss (FigureGo) securely in the palm of one hand while pinching it with the fingers of that hand. In this way, the floss can act as a handle, allowing the operator to have firmer and safer control over the prosthesis.



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  		Figure. A length of dental floss with a knot tied in it looped around an acrylic temporary fixed partial denture. The brush shows how lubricant can be applied to the prosthesis.

 
With a small brush, apply lubricant to the external surfaces of the prosthesis, including surfaces that make contact with tissue. In my clinical practice, I use petroleum jelly, but any bio-compatible lubricant of your choice also will work. Carefully place an uncontaminated gloved finger over the margins while applying the lubricant to prevent it from getting into the internal aspect of the prosthesis, which will interfere with marginal integrity and cause failure after insertion.

Place the luting agent of your choice into the prosthesis. While firmly holding onto the prosthesis with the floss as a handle, insert it. Follow your protocol for having the patient bite the prosthesis into its seated position, leaving the floss hanging out of the patient’s mouth. Let the luting agent set fully.

Then use the instrument of your choice to remove the excess luting agent. The lubricant applied previously will facilitate this, especially when placing acrylic temporary restorations. Note, however, that high-strength luting agents may lock mechanically into retentive areas and be difficult to remove.

Use the pieces of floss already in the embrasure or pontic areas to thoroughly clean away residual cement. This step will obviate the need for you to thread floss through the embrasure spaces, which may be blocked by the luting agent after cementation. Using a mirror, show the patient the oral hygiene technique to use with the new prosthesis. Pull the knot in the floss back and forth under the prosthesis to provide additional cleaning force; however, exercise care near delicate gingival tissue.

CONCLUSION
This technique may help preserve the patient’s safety by giving the clinician more secure control of a fixed prosthesis during insertion, which may prevent an aspiration event. The technique also may provide convenience to clinicians by allowing for rapid and easy postinsertion cement removal and facilitating a patient-education experience as part of oral hygiene instruction.

DO YOU HAVE A TIP TO SHARE?
Do you have a time- or work-saving clinical technique to share with your colleagues? Submit it to JADA’s Clinical Directions department. A Clinical Directions item should be a maximum of two double-spaced typed pages and should include no more than one figure or illustration. Submit five copies of your manuscript and of each illustration to Clinical Directions, JADA, 211 E. Chicago Ave., Chicago, Ill. 60611.

FOOTNOTES

Dr. Youngblood is an associate professor, departments of Community Health and Diagnostic Sciences, University of Medicine and Dentistry of New Jersey, Newark, and is the director, University Dental Center at Haddon Heights, Haddon Heights, N.J. Address reprint requests to Dr. Youngblood at University Dental Center at Haddon Heights, New Jersey Dental School, 506 White Horse Pike East, Haddon Heights, N.J. 08035.

REFERENCES

  1. Fischman SL. Prevention, management, and documentation of swallowed dental objects. JADA 1985;111(3):464–5.

  2. Jacobi R, Shellingburg HT Jr. A method to prevent swallowing or aspiration of cast restorations. J Prosthet Dent 1981;46(6):642–5.[Medline]

  3. Harvey W, Johnson L, Scavuzzo F. A method to prevent patients from accidentally ingesting dental devices. J Prosthet Dent 1988;60(2):143–4.[Medline]

  4. Feit DB. Using a removal loop to prevent aspiration of indirect restorations. JADA 2001;132(5):667–9.





This Article
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