Speedy Success with Spee-Dee Build-Up
Spee-Dee Build-Up (Pulpdent Corporation, Watertown, MA) is a dual-cure, fluoride-releasing resin that contains no bisphenol A and is extremely versatile. It is ideal in the type of case described here because it is highly radiopaque, is self-etching to dentin, and is self-adhesive. It will actually bond to the tooth structure without any additional adhesive agents, although bonding agents can be used if desired. This author has also found that when contouring Spee-Dee Build-Up using an air-driven or electric handpiece, the resistance of the material to the cutting bur perfectly mimics dentin. It cuts smoothly and evenly without ditching, chattering, or clogging up the bur, and the author finds that it actually does cut like dentin.
A 44-year-old woman presented for a routine continuing care appointment. Clinical examination revealed a “catch” at the mesial margin of an existing all-ceramic crown on her maxillary left lateral incisor (Figure 1). The marginal defect could be seen radiographically (Figure 2), and although the crown had only been in place for 7 years, the author recommended that it be replaced.
On a subsequent visit, the patient was anesthetized, and the old ceramic crown was removed. The radiograph indicated that the underlying tooth structure was cylindrical, and this was confirmed once the crown was removed. The tooth also had a composite restoration that had some marginal deficiency and needed to be replaced (Figure 3).
The decay on the margin was removed, and to create a more retentive design, the tooth was prepared so that it was slightly less cylindrical. During preparation, the old composite debonded (Figure 4). In these situations, rather than cut further into the tooth, the author prefers to rebuild the crown preparation and preserve as much healthy tooth structure as possible. This is consistent with his conservative approach and philosophy of minimal intervention. He decided to use Spee-Dee Build-Up multi-purpose core and tooth build-up resin (Figure 5).
Spee-Dee Build-Up is moisture tolerant. The directions state that it should be placed on the slightly moist tooth (ceramic, metal, and cured composite should be dry). It can be light-cured in 20 seconds, and under a restoration at mouth temperature, it self-cures in about 3 minutes. In this case, without etching or using a bonding agent, the tooth was rebuilt with Spee-Dee Build-Up and light-cured for 20 seconds. The tooth was prepared so that it was slightly less round and less tapered to maximize retention and minimize the rotational forces once the crown was placed (Figure 6). Then impressions were made and a provisional crown was placed. When the patient returned 10 days later, the interior of the crown was etched for 1 minute with porcelain etch gel from Pulpdent and cemented to place with Embrace WetBond Resin Cement (Pulpdent Corporation), medium viscosity, which the author prefers for crowns (Figure 7).
Spee-Dee Build-Up multi-purpose core and tooth build-up resin was ideal not only in this case, but it is also ideal for core build-ups with or without a post, for repairing a broken tooth (eg, lost or/ fractured cusps), to patch up divots and defects in crown preparations, and even to repair chipped crowns and bridges. It flows easily from the automix syringe, has a 360Þ swivel tip, and is ideal for those situations when there is an immediate need to restore an exposed margin with minimal but accessible decay.
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About the Author
Howard S. Glazer, DDS, FAGD