2010 provisional restorations

7/27/2019 2010 Provisional Restorations

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PROVISIONAL

RESTORATIONS


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Definition

A restoration that temporarily occupies theplace of a permanent restoration

Exposed dentin must be protected from

thermal, chemical, mechanical, and bacterial

effects of oral environment

Adjacent tissues must be protected

Position of tooth must be maintained Consider esthetics, function, and patient

comfort


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Procedures Requiring Provisional

Coverage

Pedodontic

Endodontic

Prosthodontic

Criteria for provisional coverage

Maintenance of tooth position to adjacent opposing

teeth

Protection of hard and soft oral structures Establishment of function and esthetics


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Criteria for Provisional Coverage

Maintain prepared tooth position to

adjacent and opposing teeth

Prepared tooth can migrate within a few days

Provisional restoration too high

Occlusal trauma

Will not seat properly

Does not contact adjacent teeth

Gingival irritation from food impaction Should share forces of adjacent and opposing teeth


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Protect Exposed Tooth Surfaces And

Margins

Provisional restorations placed near the

pulp

Must have no adverse chemical effect Must insulate pulp to protect from the

thermal assaults

Margin susceptible to fracture if notsupported

Marginal leakage of oral fluids and bacteria


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PROTECT GINGIVAL TISSUES

Margins must be flushwith preparation

Margin overextended Tissue irritation from

gingival recession

Undercontoured margins Food forced directly onto

gingiva


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Provide Functional Esthetics

Restore ideal anatomy Must be able to:

Chew

Speak

Clean provisional restoration

Esthetics Must look natural

Match shades and customize provisionalmaterials Will enhance patient acceptance


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Properties of Provisional Materials

Strong and durable

Hardness

Tissue compatible

No odor or taste

Esthetics Handling

Easy to apply and contour

Easy to manipulate

Quick setting

Economical

Repairable

Able to seal margins


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Intracoronal Cement Provisionals

Require less provisional coverage

Less extensive emergency care

Place directly into cavity preparation

Carved, contoured, and allowed to set

Check occlusion with articulating paper


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Materials Used for Intracoronal

Temporaries Zinc oxide cement

Eugenol (oil of cloves)

Pallative benefits

Has good marginal seal qualities

Durable and strong

May damage pulp due to exothermic

reaction (zinc phosphate)

Gutta percha

Polycarboxylate cements


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Patient Education

Proper home care Limitations and expectations of coverage

Address patient concerns

Instruct patients not to eat sticky or hard foods

May be an increase in temperature sensitivity

Call office immediately if dislodged

Home care instructions


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Armamentarium

Mouth mirror, explorer, cotton pliers

Matrix retainer & bands Wooden wedges

Cement spatula

Paper mixing pads

Temporary cement

Plastic instrument

Condenser

Cleiod/discoid carver/ hollenback

Articulating paper

Dental floss


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Procedural Steps

1. Clean and dry preparation

2. Examine and make mental note

3. Place pulpal protection

4. Place a matrix band and wedge

5. Prepare mix of temporary cement

to putty-like consistency

6. Use plastic instrument coated with

ZOE powder to pick up a small ball

of mixed ZOE


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Procedural Steps Contd

7. Place material in least accessible

portion

8. Wipe blade of instrument against

margin

9. Use condensor to condense cement

to all walls10. Pack cement firmly to avoid

trapping air

11. Fill proximal box to level of pulpal

wall

12. Place material in increments untiloverfilled

13. Always wipe toward margins


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Procedural Steps Contd

14. Remove excess material around matrix in proximal areas andocclusal margins

15. Remove wedges, retainer, and matrix

16. Slide in facio-occlusal or lingual-occlusal direction

17. Remove proximal and gingival excess

18. Create embrasure

19. Remove excess from occlusal with carver

20. Carve from tooth to filling material

21. Check occlusion

22. Check contacts with dental floss


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Cement Removal

After cementation on patient asked to bite downon cotton roll for initial setting process

Material selected will determine correct time to

remove excess cement from around the margins,interproximal spaces, adjacent areas

If not removed from around gingival margin and

sulcus it will irritate and cause additional

problems


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Procedural Steps

1. Remove cotton rolls after cement completed initial

setting

2. Using explorer examine material to ensure proper

set

3. With a firm fulcrum take edge of explorer and move

in a horizontal movement, pulling excess from tooth

4. With tip of instrument of gingival edge of crown use

overlapping strokes to remove bulk of cement

5. Follow along margin to remove small pieces

6. Pass floss through contact

7. Rinse and dry to evaluate

2010 provisional restorations

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