r/Dentistry • u/Reddit2025man • 1d ago
Dental Professional Crown preps
Anyone ever crown prep with caries and old restoration in place, then remove old restoration and caries and add composite to gaps and then refine after??
I normally remove all caries and restoration first, fill gaps and then then crown prep but it’s quite slow.
Curious what everyone else thinks
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u/stefan_urquelle-DMD 1d ago
I did it your way my first year out and it was indeed slow.
Now I do the first way you described. Much faster.
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u/Least-Assumption4357 1d ago
Right, and rarely is a buildup actually needed
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u/stefan_urquelle-DMD 1d ago
Lol I did not say that. I do a bu 95% of the time
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u/Least-Assumption4357 1d ago
I know you didn’t, that’s why I added it. Because it’s not. It’s a money grab if doing anything other than gold.
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u/stefan_urquelle-DMD 1d ago
Lol. Wtf. How does that make sense.
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u/Daneosaurus General Dentist 1d ago
He works for delta, who now requires I X-ray all CBU.
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u/Least-Assumption4357 1d ago
I don’t but I understand how so many are offended when it hits their pocket. I am not scared to have a contrarian opinion backed by decades of private practice and faculty at a major US dental school. I will continue to treat my patients ethically from both a clinical and financial viewpoint, even at the detriment of my “production”
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u/stefan_urquelle-DMD 1d ago
Lol faculty at US major dental school is a joke. That works only on scared dental students. A buildup has absolutely nothing to do with material.
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u/Least-Assumption4357 1d ago
Disagree. Having an ideal thickness of gold will likely save the patient money vs build up, and potentially allow better burnishing of the margin.
If you’d care to post any justification of your stances I’d be happy to engage in a spirited debate.
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u/stefan_urquelle-DMD 1d ago
Ok I don't understand how your brain works.
Core buildups allow us to get ideal, even thickness of restorative material be idealizing the prep.
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u/cschiff89 1d ago edited 1d ago
I reduce occlusion first, then excavate caries and place my core. I don't want to waste core material by placing it in places that will be prepped away but I find that I end up doing double work if I prep first and then have to go back and reprep to clean up all the excess core material that ends up being wasted anyway.
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u/justnachoweek 1d ago
This is what I do as well. Also I can still get a band on the tooth if needed or the walls are still present enough to place the core.
But as soon as that buccal/lingual/Interproximal is removed it’s a lot harder to get isolation to place core material so I do that part of the crown prep after core is placed
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u/Papalazarou79 General Dentist 1d ago
Depends on the size of the old filling. But mainly prep, fill, adjust.
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u/DissentingDentist 1d ago
My order is Occlusal reduction, open contacts, remove old material, buildup then prep.
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u/ToothacheDr 1d ago
Do it the first way you describe: gross crown prep, remove defective restoration/caries, build-up, refine prep. Sometimes the old undermined restoration will literally fall out while you’re prepping. Sometimes you’ll realize you don’t actually need a build-up. A lot of times your build-up will be significantly smaller. All of these scenarios save you and the patient time.
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u/DentistDortmund 14h ago
Depends if I want my build up under rubberdam and great bonding conditions (+maybe endo even). Then I prep after, but no real anatomy in the build up.
If it doesn’t require heavy resto before I just prep and do the resto inbetween but usually a little more time consuming to apply rubber dam.
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u/Dufresne85 1d ago
For me it depends on a lot of things including, perhaps most importantly, what I want to do that day.
If it's a heavily broken down tooth I remove everything first so I can evaluate what exactly I'm getting in to.
If it's a physical break with no obvious signs of decay I'll usually prep the tooth first and then remove remaining restorative material or decay and evaluate.
A lot of the time the remaining restorative material flies out during the prep. And if you completely rebuild the tooth before prepping the tooth you're just going to be removing a bunch of material you just placed, which seems pretty wasteful to me.