It seems to be one of those more common challenges we see in our office. A patient already has a night guard, but there is a tooth under the night guard that needs treatment. You don’t want to necessarily have to make a new one with a whole new charge to the patient, but there is no way you can get that thing to fit the same. If it is a little filling, it may not be so hard to modify the guard to get things to fit. An entire crown is a different story. Even if you are using a correlation/copy mode with in-office CAD/CAM software, there is little chance you won’t have to do some adjustments. Adjust too much, and that tooth is floating in the guard. Adjust too little, and that tooth becomes bite sensitive from too much pressure.
This week, we had this exact thing happen to us. I thought I adjusted it enough, but the patient came back saying that her new crown felt great, but hurt by morning when she was wearing her night guard. We popped it in, and it looked like it was seating all the way. How would we tell where that pressure point was coming from? I remembered back in school when we had this material from GC call “Fit Checker”. We would mix it up, place it under a crown we were attempting to seat, and then any pressure points would show up on the coping. I haven’t needed that material for years since everything these days sits down just fine.
Instead, I injected a quick-set bite registration material called MegaBite from DenMat into the area of the new crown on the guard. While it was still in a very viscous phase, we seated the guard into place, and waited the 15 seconds or so that it took to set up the material. We made sure the guard was dry so that the material would stick to the guard instead of locking onto the tooth. After removing it, I could see a pressure point that was still keeping the guard from sitting down all the way. The patient immediately noticed a difference in the way the guard felt after doing that small, targeted adjustment.
I feel like I would have messed around with this thing for a long time before accidentally finding that spot. Hopefully this little tip helps someone out there. If you have your own little fix for a common problem, drop a comment below!