Premium Cosmetic Dentistry frequently involves the fabrication of cast gold post & cores in addition to cosmetic porcelain crowns (caps). Ideally posts should be custom cast in gold to specifically fit the shape of each tooth and crowns should be made separately for each individual tooth (i.e. teeth should not be connected together) unless absolutely necessary. Custom cast gold posts fit most strongly in a tooth but are much more labor-intensive. Individual crowns provide easier access for cleaning the teeth by the patient. If each tooth is separately made then it can be replaced if it subsequently fails without having to replace an entire "bridge" of teeth. This can be a lot easier for a patient physically, emotionally and financially. But it is a lot more work for a dentist to make lots of little components especially when the fee is the same as if they are all connected together...Premium esthetic dentistry costs more for a reason.
One problem for dentists working with lots of small pieces in the back of the mouth is that they are easy to drop intra-orally. It can be frightening if a patient then chokes and/or swallows the little piece.
Dental labs frequently make a “lingual button” on crowns. This facilitates the removal of a crown from the mouth by a dentist when it is being tried in to check for fit and shade. This lingual button is typically shaped like a pin extending several millimeters towards the tongue. It is made of the same metal that forms the coping of the crown. A dentist can more easily grasp this projection with either fingers and/or an instrument when removing the crown. This lingual button is easily drilled off, extra-orally, before final cementation of the crown.
This author has successfully modified the traditional lingual button into a “Kaitlyn Loop.” This loop, or circle, replaces the pin-shaped projection of the lingual button. This will still function as a projection to facilitate crown removal but additionally will allow dental floss to pass through it. A piece of dental floss that is perhaps 12 inches long can be threaded through the loop with both ends coming out of the mouth. This will provide an extra measure of safety should the dentist drop the crown in the back of the mouth. The dentist need only grab the piece of floss that is extra-oral to retrieve it. This could save many patients, and dentists, the anguish of swallowing a crown.
It is also suggested that dentists and lab technicians consider fabricating the Kaitlyn Loop for cast gold inlays, onlays and post and cores. The technique is the same as above except that when possible the dentist should consider drilling off the loop after cementation. Again, the intention is to try to reduce the likelihood of a dropped prosthesis from being swallowed.
--Dr. Jeffrey Dorfman, Director
The Center for Special Dentistry
NYC
