Fixed Prosthodontics: Clinical Protocol from A to Z with Prof. Todor Uzunov

Description of Module 2:

"Prepare like a professional for full-coverage crowns" is a hands-on course dedicated to the most important clinical step in fixed prosthetic dentistry: tooth preparation. The goal is for participants to master a predictable and controlled technique that provides correct geometry, sufficient reduction, optimal retention/resistance and, above all, a clearly defined preparation margin – for both horizontal and vertical preparation concepts. Module 2 builds on the initial protocols and turns the plan into precise clinical execution with a focus on details, aiming to avoid adjustments, compromises and complications.

Objectives of Module 2:

The objective of Module 2 is for participants to adopt a predictable and precise protocol for preparation of full and partial crowns. The focus is on control of reduction, creation of a clearly defined horizontal or vertical preparation margin and conservative management of the gingival tissues through the use of magnification.

Skills participants will acquire from Module 2:

• Refinement of the clinical preparation technique for full and partial crowns through clear logic and a standardized protocol.
• Mastery of control over reduction and preparation geometry, tailored to the material and the clinical situation.
• Creation of a clearly defined preparation margin – horizontal (chamfer/shoulder) and vertical (vertical finish line/BOPT), with emphasis on precision and repeatability.
• Use of magnification (loupes/microscope) as a key instrument for quality and detail.
• Development of skills for conservative management of the gingival tissues, ensuring good visibility, control and biological tolerance.

Demonstrations that will be included in Module 2:

• Vertical finish line (Vertical finish line / BOPT): demonstration - preparation of a molar for a full-coverage crown.
• Horizontal finish line (Chamfer/shoulder): demonstration - preparation of a central incisor for a full-coverage crown.

Registration and organization of workplaces

Fundamentals of professional preparation biomechanical logic: geometry, retention/resistance reduction according to the material and the clinical situation, criteria for quality preparation.

Coffee break

Preparation margin – horizontal vs vertical concept, indications and contraindications, most common clinical errors.

Обяд

Horizontal margin (Chamfer/shoulder): preparation of a central incisor for a full-coverage crown

Horizontal boundary (Chamfer/shoulder)

Coffee break

Vertical margin (Vertical finish line / BOPT): molar preparation for a full-coverage crown

Vertical boundary (Vertical finish line/ BOPT)

Summary of the day and questions

Objectives of Module 3:

Module 3 is focused on one of the most critical stages in fixed prosthodontics – the accurate and reproducible recording of the clinical situation, which is the basis for perfect marginal fit, contacts and occlusion. Module 3 combines analog and digital techniques and trains participants how to choose the correct approach according to the clinical case, as well as how to avoid errors that lead to deformations, inaccuracies and a compromised final result.

Skills participants will acquire from Module 3:

• Selection and application of the appropriate clinical recording technique according to the case – analog impression or digital scan.
• Creation of an accurate and stable analog impression (VPS/polyether) with control over deformations and critical defects.
• Performing precise intraoral scanning (IOS) with the correct protocol for bite registration, margins, contact zones and control of artifacts.
• Professional management of retraction, moisture and bleeding using atraumatic techniques, appropriate cords and hemostatic agents.
• Assessment of the quality of an impression/scan by criteria for accuracy and decision-making when the record is acceptable and when it needs repetition.
• Preparation of reliable information for the laboratory – file/impression + occlusion registration, to achieve better fit and fewer adjustments.

Demonstrations that will be included in Module 3:

• Demonstrations of impression taking for a single full-coverage crown with a horizontal preparation margin using: analog impression (VPS) – one-step and two-step technique; digital scanning (IOS) – margin and occlusion protocol.
• Demonstrations of impression taking for a single full-coverage crown with a vertical preparation margin using: analog impression (VPS) – one-step and two-step technique; digital scanning (IOS) – margin and occlusion protocol.
• Demonstration of retraction and bleeding control as a decisive factor for a subgingival preparation margin - single- and double-cord technique.

Registration and organization of workplaces

Analog and digital impressions in fixed prosthetic dental medicine – criteria and selection of material, trays and technique, analog impression vs digital scan – when each is more suitable, criteria for accuracy and acceptability, most common causes of inaccuracies and repeats.

Coffee break

Retraction, hemostasis, moisture control - means, materials, techniques for subgingival margins, single- and double-cord technique

Lunch

Analog impression (VPS/polyether) – step-by-step protocol, choice of tray and adhesive, technique (one-stage/two-stage)

Analog impression (VPS/polyether) with one-step/two-step technique

Coffee break

Intraoral scanning (IOS) of horizontal and vertical preparation margins

Impression/scan + retraction and field control retraction and hemostasis per protocol performing an analog impression (or scan) quality assessment by checklist correction of errors

Summary of the day and questions

Description of Module 4:

Module 4 is dedicated to provisional restorations as a key clinical tool for achieving a predictable functional and aesthetic outcome. In Module 4 the provisional restoration is not viewed as a "temporary solution", but as an active prototype of the final restoration that allows control over shape, occlusion, comfort, emergence profile and soft tissue stability. The main focus is on direct techniques and the Egg Shell approach, as well as on customizing provisional restorations to sculpt and maintain the gingival architecture.

Goals of Module 4:

• To train participants in fabricating functional and aesthetic provisional restorations using direct and Egg Shell techniques.
• To develop skills for controlling shape, emergence profile, contacts and occlusion, with emphasis on comfort and stability.
• To introduce protocols for soft tissue management through customization and tissue shaping with provisional restorations.
• To provide criteria and practical methods for finishing and polishing that ensure biocompatibility and a predictable result.

Skills participants will acquire from Module 4:

• Fabrication of direct provisional restorations with predictable fit, stability and aesthetics.
• Application of the Egg Shell technique for more precise prototyping and occlusion control.
• Shaping and customizing the emergence profile for optimal management and stabilization of soft tissues.
• Control of occlusion and contacts in provisional restorations to achieve functional comfort and avoid overload.
• Finishing and polishing provisional restorations to a smooth, biocompatible surface with minimal plaque retention.
• Use of the provisional restoration as a prototype for evaluation, adjustments and optimization before the final restoration.

Demonstrations that will be included in Module 4:

• Demonstration: Fabrication of a direct provisional crown for an anterior tooth using a silicone index and bis-acryl polymer.
• Demonstration: Fabrication of a provisional bridge in the distal area using the Egg Shell technique.

Registration and organization of workplaces

The role of the temporary restoration as a prototype aims of the temporary restoration: form, occlusion, comfort, aesthetics transitional profile and management of the soft tissues.

Coffee break

Techniques for making temporary structures - direct techniques and Egg Shell technique.

Lunch

Direct temporary crown on a front tooth

Fabrication of a temporary crown on an anterior tooth using a direct technique

Coffee break

Temporary bridge construction in the distal zone fabricated using the Egg Shell technique

Temporary bridge construction in the distal zone fabricated using the Egg Shell technique

Summary and Questions and Answers

Description of Module 5:

• Module 5 is dedicated to one of the most critical steps in fixed prosthodontics – cementation. This is the moment when all previous work (planning, preparation, impression/scan and provisional restorations) is finally “completed.” The goal of Module 5 is for participants to master predictable and evidence-based protocols for adhesion and cementation that minimize the risk of debonding, microleakage, fractures, gingival inflammation and postoperative sensitivity.
• The focus is on the correct choice of system according to the material and type of restoration, the clinical situation, on the required isolation, and on techniques for controlled removal of cement excess.

Objectives of Module 5:

• To train participants in selecting appropriate cement and adhesive protocol according to the material and the clinical situation.
• To master a standard for reliable isolation and working-field control as the basis for predictable adhesion.
• To develop skills for proper preparation of the tooth and prosthetic surfaces according to the cementation protocol used.
• To master a protocol for removal of cement excess and rules for minimizing postoperative sensitivity.

Skills participants will acquire from Module 5:

• Selection of appropriate cement and adhesive protocol according to the material (glass-ceramic, zirconium dioxide, hybrid ceramic, composite) and the clinical situation.
• Achieving reliable isolation (rubber dam/alternative methods).
• Proper preparation of the tooth surface – cleaning, etching, primer/adhesive, measures for “Immediate Dentin Sealing (IDS)”.
• Proper preparation of the prosthetic surface – silanization, MDP primer, microretention/air abrasion according to the material.
• Controlled cementation and positioning technique with correct polymerization and final occlusal check.
• Careful and safe removal of excess cement.

Demonstrations that will be included in Module 5:

• Demonstration of cementation of a zirconium dioxide full-coverage crown.
• Adhesive cementation of a glass-ceramic full-coverage crown (e.max).

Registration and organization of workplaces

Logic of choice – cement and adhesive according to the material and the case, glass-ceramic vs zirconium dioxide vs composite/hybrid ceramic, adhesive and conventional cementation, clinical indications.

Coffee break

Protocols for conventional and adhesive fixation in prosthetic dental medicine

Lunch

Surface preparation and cementation techniques for glass-ceramics, isolation protocol

Isolation and adhesive cementation of a full lithium disilicate crown

Coffee break

Surface preparation and cementation techniques for a zirconium dioxide crown

Cementation of a full zirconium dioxide crown

Summary of the day and questions

Description of Module 6:

Module 6 is dedicated to functional stability and patient comfort through the correct application of splints and deprogrammers in bruxism and TMD. Module 6 treats bruxism not only as a "parafunction" but as a clinical problem with real consequences: wear, cracks, pain, muscle fatigue, headache, overload of restorations, and occlusal instability.

Objectives of Module 6:

• To provide a clear clinical protocol for diagnosis and management of bruxism.
• To train in the selection and application of deprogrammers and splints according to symptoms, risk, and therapeutic goal.
• To develop skills in registration, design, thickness, and adjustment of splints for predictable comfort and protection.

Skills participants will acquire from Module 6:

• Recognizing clinical signs of bruxism and TMD and determining the therapeutic goal.
• Selection of the appropriate deprogrammer (NTI, Lucia Jig, Kois Deprogrammer, Dawson splint) according to the situation.
• Reliable registration of occlusion/centric relation and preparation for splint fabrication.
• Determining the design and thickness of the splint with functional logic.
• Occlusal adjustment and contact control for stability, comfort, and protection.

Demonstrations that will be included in Module 6:

• Demonstration of deprogramming and registration with Lucia Jig and Leaf Gauge (if used) – quick and repeatable deprogramming.
• Demonstration of deprogramming with NTI splint, Kois Deprogrammer.
• Demonstration of adjustment and balancing of a Michigan-type bruxism splint and Dawson stabilization splint.

Registration and organization of workplaces

Bruxism and TMD – diagnosis, goals and clinical approach indications for deprogramming/splint, risks to teeth and restorations, behavior plan and follow-up.

Coffee break

Techniques for making splints for bruxism and deprogrammers.

Lunch

Adjustment and articulation of a Michigan-type splint for bruxism

Adjustment and articulation of a Michigan-type splint for bruxism

Coffee break

Deprogramming and registration using Lucia Jig / Leaf Gauge, NTI splint, Kois Deprogrammer

Summary of the day and questions