THE JOURNAL OF PROSTHETIC DENTISTRY GALINDO, SOLTYS, AND GRASER

698 VOLUME 79 NUMBER 6THE JOURNAL OF PROSTHETIC DENTISTRY

Extensive prosthodontic treatment often requiresfabrication of long-term provisional restorations. Fixedprovisional restorations are also indicated for partiallyedentulous patients undergoing implant therapy whenteeth adjacent to the edentulous area are restored withcomplete crowns. In these cases, fixed provisional res-torations prevent loading of submerged implants or tis-sue grafts during the healing phase, which is likely tooccur with transitional removable partial dentures.

Provisional restorations are indicated to protect thedental pulp, protect periodontal tissues, prevent toothmovement, aid in positional stability, and allow propermastication and esthetics.1,2 In many instances, provi-sional restorations are also helpful as a guide for con-struction of the final restoration. Esthetics and appear-ance are evaluated by dentist and patient during thisphase.3

Autopolymerizing acrylic resin is usually the bioma-terial in provisional restorations. However, when long-term provisional fixed restorations replace several teeth,the strength and stability of the prosthesis is critical.

Heat-processed acrylic resin has greater strength, wearresistance, color stability, and resistance to fracture thanautopolymerizing resins.4 However, in long-span eden-tulous situations, fractures may still occur.

Provisional restorations may be reinforced with vari-ous materials to avoid fracture. Tylman5 described fab-rication of acrylic fixed partial dentures (FPDs) sup-ported by an internal metal framework with ferrule-typeretainers cast in hard gold alloy. Youdelis and Faucher6

reported a technique that used stainless steel wire to re-inforce autopolymerizing acrylic resin provisional res-torations. Binkley and Irvin7 described heat-processed

aResident, Department of Prosthodontics.bClinical Assistant Professor, Department of Prosthodontics.cProfessor and Postgraduate Program Director, Department of Pros-

thodontics.

Long-term reinforced fixed provisional restorations

Daniel Galindo, DDS,a James L. Soltys, DDS,b and Gerald N. Graser, DDS, MSc

University of Rochester Eastman Dental Center, Rochester, N.Y.

Extensive prosthodontic treatment often requires fabrication of long-term provisional restorations.Numerous materials and techniques have been described for prolonged insertion of interim restora-tions. This article describes a procedure for fabrication of long-term reinforced heat-processedprovisional restorations based on a diagnostic wax-up. Reinforced heat-processed provisionalrestorations reduced flexure, which minimizes progressive loss of cement and diminished thepossibility of recurrent decay. Occlusal stability and vertical dimension were maintained because ofgreater wear resistance. Occlusion, tooth contours, and pontic design developed in the provisionalrestoration were duplicated in the definitive restoration. The use of a matrix from a diagnostic wax-up facilitated fabrication of the prosthesis, and made the procedure less time-consuming and morepredictable. (J Prosthet Dent 1998;79:698-701.)

provisional restorations reinforced with a 16- or 18-gauge cast metal framework. Hazelton and Brudvik8

suggested reinforcement of autopolymerized provisionalrestorations with stainless steel orthodontic band mate-rial.

This article describes a procedure for fabricating re-inforced, heat-processed, acrylic resin provisional resto-rations based on a diagnostic wax-up. A base metal frame-work with complete copings was waxed on a stone castof the actual tooth preparations. The framework was thenopaqued and incorporated in the final wax-up. The wax-up was fabricated by using a silicone matrix of a diag-nostic wax-up or cast and injected base plate wax. Afterthe occlusion and contours were established, the struc-ture was processed.

PROCEDURE

1. Formulate a diagnostic wax-up on casts mountedwith a semiadjustable articulator. Establish tooth

Fig. 1. Pretreatment of patient. Bone augmentation has beenperformed in maxillary left quadrant before implant place-ment. Healing is progressing.

DENTAL TECHNOLOGY Kenneth D. Rudd

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contour and occlusion according to clinical situa-tions (Figs. 1 and 2).

2. Make a full arch impression of the prepared teethwith reversible or irreversible hydrocolloid. Recorda face-bow transfer and centric relation. Select theappropriate shade and cast the impression using typeIV dental stone.

3. Make two matrices of the waxed teeth with use oflaboratory putty (Sil-Tech, Williams Ivoclar NorthAmerica, Inc., Amherst, N.Y.), and include adjacentteeth to index the matrix. The first matrix is sec-tioned and is used to evaluate space available foracrylic resin around the framework. On the secondmatrix, make 2 mm wide access holes with a roundbur preserving the occlusal anatomy.

4. Apply die spacer (Zahn Die Spacer, Zahn DentalCompany Inc., Port Washington, N.Y.) over theabutments of the working cast, 2 mm coronal tothe finish line.

5. Wax copings over abutments and connect them with

10-gauge sprue wax (Kerr Manufacturing Co.,Emeryville, Calif.). Extension of copings is 2 mmcoronal to finish line because the margin will becovered entirely with acrylic resin in case modifica-tions of the preparation are needed (Fig. 3). Checkspace for acrylic resin around the waxed frameworkwith the first matrix and adjust.

6. Add Rêten large beads (Lang Dental ManufacturingCo., Chicago, Ill.) to the waxed framework (Fig. 4).

7. Cast the framework using a base metal alloy andseat the casting.

8. Apply Biolon liquid opaquer (Dentsply Trubyte,York, Pa.) to the framework (Fig. 5).

9. Place the second matrix over the cast and seal theedges of the matrix with utility wax strips (HygienicCorporation, Akron, Ohio) (Fig. 6).

10. Heat baseplate wax (Neo Wax, Dentsply Trubyte,York, Pa.) until it melts and inject wax through theholes of the matrix with the use of a glass eye drop-per previously warmed. Wax flows until the avail-able space is full. Allow wax to cool for 5 to 10minutes.

Fig. 2. Diagnostic wax-up. Patient will receive three-unit im-plant-supported FPD in maxillary left quadrant.

Fig. 3. Wax copings end 2 mm coronal to finish line becausemargin will be covered entirely with acrylic resin in case modi-fications of preparation are needed.

Fig. 4. Wax copings and pattern made with 10-gauge spruewax. Large beads were glued to waxed framework.

Fig. 5. Cast metal framework was opaqued with liquid opaquer.

THE JOURNAL OF PROSTHETIC DENTISTRY GALINDO, SOLTYS, AND GRASER

700 VOLUME 79 NUMBER 6

11. Remove matrix and check for completeness of thewax-up and occlusion. Make adjustments in con-tours and occlusion (Fig. 7). Size of embrasurespaces was predicted with the initial diagnostic wax-up.

12. Invest wax-up on the cast in a denture flask.13. Boil out the wax and secure position of framework

on the cast. Pack dentin colored acrylic resin (Biolon,Dentsply Trubyte) covering framework. Close theflasks and trial pack.

14. Open flasks, remove excess, and cut back dentin-colored resin in incisal and cervical aspects. Placeincisal and cervical colored resin. Staining can beadded at this stage using the Kayon synthetic resinsdenture stain kit (Kay See Dental ManufacturingCo., Kansas City, Mo.). Close the flasks and heatprocess.

15. Finish and polish provisional restoration (Fig. 8).

Fig. 9. Restoration cemented with temporary luting cement(mirror image).

Fig. 6. Second matrix was placed on working cast with metalframework and edges sealed with utility wax.

Fig. 7. Wax was injected through holes with glass eye drop-per. Wax was directed through remaining holes indicating thatspace is now full. After wax has hardened, remove matrix andcheck completeness of wax-up, tooth contours, and occlu-sion.

Fig. 8. Final restoration after processing, finishing, and polish-ing.

16. Seat the restorations intraorally. If necessary, relinemargins with autopolymerizing resin; allow to cure,then refine margins and repolish restorations.

17. Cement provisional restoration with an interim lut-ing agent (Fig. 9).

DISCUSSION

Heat-processed provisional restorations with metalreinforcement based on a diagnostic wax-up as a guideoffered several advantages compared with other tech-niques, including predictable contours, stable occlusion,esthetics, patient acceptance, strength, and durability.

The patient can perform oral hygiene procedures easierbecause embrasure spaces may be wider without com-promising strength. If teeth are contoured appropriately,periodontal tissues are healthier.

The framework design included copings adapted overthe prepared abutments, which reduced flexure of theprovisional restorations. This increased retention of therestoration, minimized flexure, progressive loss of ce-ment, and diminished the possibility of recurrent de-

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JUNE 1998 701

cay.5 The marginal area was relined with a minimalamount of autopolymerizing resin that reduced the pos-sibility of thermal damage to the dental pulp.9

Occlusal stability and vertical dimension were main-tained because of greater wear resistance. The occlusiondeveloped in the provisional restoration was duplicatedin the definitive restoration, and tooth contours andpontic design can also be monitored. After the patientand dentist were satisfied, the definitive restoration re-sembled the provisional prosthesis.

In this procedure, the first silicone matrix was used toevaluate available space for acrylic resin. The use of in-cisal, dentin body, and cervical acrylic resin enhancedthe patient’s acceptance of esthetics in the restoration.The final wax-up for the provisional restoration was com-pleted with use of the second silicone matrix. This savedtime during fabrication of the restoration and allowedduplication of the contours and occlusion programmedin the diagnostic wax-up.10

SUMMARY

This article described a procedure for the fabricationof reinforced heat-processed fixed provisional restora-tions with use of a diagnostic wax-up. The increase inrigidity provided by the metal framework incorporatedin the restoration addressed the problem of fracture. Theincidence of fractures have increased when provisionalFPDs were worn for prolonged periods and/or in long-span edentulous areas. The reduction of flexure in thisprovisional prosthesis prevented loss of retention andpossible recurrent decay. The use of a previous diagnos-tic wax-up reduced laboratory time and ensured the suc-cess of the definitive restoration.

Adequate embrasure spaces and tooth contour also

developed in the initial wax-up were accurately dupli-cated in the provisional restoration, leading to healthyperiodontal tissue. Enough space was provided for thebulk of acrylic resin with the use of a silicone matrixindexed on adjacent teeth. This facilitated developmentof esthetics that was used as a guide for fabrication ofthe definitive restoration.

REFERENCES1. Dykema RW, Goodacre CJ, Phillips RW. Johnston’s modern practice in fixed

prosthodontics. 4th ed. St Louis: WB Saunders; 1986. p. 77-90.2. Amsterdam M, Fox L. Provisional splinting—principles and technics. Dent

Clin North Am 1959;1:73-9.3. Rieder CE. The use of provisional restorations to develop and achieve es-

thetic expectations. Int J Periodont Rest Dent 1989;9:123-39.4. Anusavice KJ. Phillips’ science of dental materials. 10th ed. Philadelphia:

WB Saunders; 1996. p. 237-71.5. Tylman SD. Theory and practice of crown and bridge prosthodontics. 5th

ed. St Louis: CV Mosby; 1965. p. 1197-217.6. Youdelis RA, Faucher R. Provisional restorations: an integrated approach to

periodontics and restorative dentistry. Dent Clin North Am 1980;24:285-303.

7. Binkley CJ, Irvin PT. Reinforced heat-processed acrylic resin provisional res-torations. J Prosthet Dent 1987;57:689-93.

8. Hazelton LR, Brudvik JS. A new procedure to reinforce fixed provisionalrestorations. J Prosthet Dent 1995;74:110-3.

9. Tjan AH, Grant BE, Godfrey MF. Temperature rise in the pulp chamberduring fabrication of provisional crown. J Prosthet Dent 1989;62:622-6.

10. Morgan DW, Comella MC, Staffanou RS. A diagnostic wax-up technique. JProsthet Dent 1975;33:169-77.

Reprint requests to:DR. DANIEL GALINDO

DEPARTMENT OF PROSTHODONTICS

UNIVERSITY OF ROCHESTER

EASTMAN DENTAL CENTER

625 ELMWOOD AVE.ROCHESTER, NY 14620

Copyright © 1998 by The Editorial Council of The Journal of Prosthetic Den-tistry.

0022-3913/98/$5.00 + 0. 10/1/89605

New product news

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