provisional restorations
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Provisional Restorations
Wael Al-Omari. BDS, MDentSci, PhD
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Functions of Provisional Restorations
Comfort/tooth vitality Occlusion and positional stability
Function Gingival health and contour
Aesthetics Diagnosis Other practical uses
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Assessment of Aesthetic ChangesAssess appearance of
intended restorations Make directly or use a
matrix made from the wax-up.
Ensure patient’s acceptance Record the temporary
crowns and instruct technician to copy their form ad shape into the final restoration
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Provisional crown can be used to assess axial and
occlusal reduction
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Occlusal Changes Prevent unwanted tooth movement by
maintaining occlusal and interproximal contacts
Evaluate patient’s tolerance to change in anterior guidance or increased occlusal vertical dimension:
Cement temporary crowns made from diagnostic wax up and review for aesthetics, guidance, drifting, mobility, decementation, and comfort
Copy the provisional crowns guidance by a custom guidance table, to transfer to definitive restorations.
It is recommended to assess tolerance to change in vertical dimension by a reversible method such as splint.
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Periodontal Changes Allow for resolution of
inflammation Improve gingival healing and
stabilization of gingival margin position
Used after surgical crown lengthening during the healing period before definitive preparation and impression
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Preoperative Polycarbonate provisional crown
cemented
Gingival healing after 2 months
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Change in Tooth Shape
Accurately copy a satisfactory and successful provisional restoration to:1. Avoid minor or major changes in
tooth shape.2. Avoid disrupting fine mouth
movements and lip/tooth contact3. Avoid incorporating wide cervical
embrasure to prevent air leakage
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Provisional Restorations Materials Preformed crowns Plastic shells: polycarbonate or acrylic. Used for anterior and premolar teeth. Metal Shells: aluminum, stainless steel or nickel chromium. Self or light cured resins
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Aluminum provisional crown
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Self or light cured resins
Polymethyl methacrylate Polyethyl methacrylate (Snap, Trim) Bis acryl composite (Protemp) Urethane dimethacrylate (light cured). Restorative composite
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A- Polymethyl methacrylateB- Bis-acryl composite
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Cast Metal Nickel chromium, silver and scrap gold. Durable Can be made with external retention beads to retain acrylic or composite Rarely used
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Provisional Cements Creamy mix of zinc oxide eugenol
Most practitioners use proprietary cements such as Temp Bond Available with modifier to soften the cement Non-eugenol Tem Bond is available and used to:1. Cement temporary restorations for
preparations for definitive adhesive restorations (eg All ceramic, veneers) to avoid interference with bonding of resin cements.
If eugenol containing cement used, eugenol residues should be removed with pumice and water
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Provisional Cement (Temp Bond)
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Direct Provisional Restorations Techniques
Proprietary Shells Plastic Shells: Polycarbonate relined with resin, trimmed, polished and cemented. Metal shells: 1. Aluminum shells: relined with resin
(short term). Soft and galvanize with opposing amalgam
2. Stainless steel and nickel chromium: used with bruxist patients.
Custom shells: beaded acrylic and Mill crowns
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Matrices for Provisional Restorations
Impressions: Alginate: absorbs resin exotherm Elastomers: reusableAdvantages: simple, quick, inexpensive. Vacuum formed thermoplastic: clear vinyl sheet on stone duplicate of the wax up. used only in presence of number of adjacent locating teeth could be used with light cured resins. Proprietary celluloid crown form
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A- Alginate impression as a matrixB- Provisionals with an excess material
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A preoperative silicone sectional
impression
The resin material in injected into the
impression
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Techniques Direct Syringing: polyethyl methacrylate. Indirect Provisionals: Used for long term provisionals. Strong heat cured materials can be used Aesthetics and occlusion made on articulated wax up. Indicated or multiple restorations and for an increased vertical dimension. Alginate impression of the preparations, cast in fast set stone, and fabricate provisionals.
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A- Stone duplicate of the wax upB- Vacuum formed matrix
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A- preparation
B-Excess film of material attached to provisional crown
C-Trimming the excess
D- Cemented provisional crown
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Provisionals of Adhesive Restorations
No temporary coverage Simple coat of zinc phosphate cement Composite resin bonded to a spot etched on the preparation Composite bonded to opposing tooth
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Problem Solving Insufficient bulk of material: Inadequate reduction, or make it bulkier by relieving the matrix (impression). Gross occlusal errors, air blows and voids: trim away suspected areas (interpoximal), an educe hydrostatic pressure by cutting escape vent. Locking in of provisional restorations: material engaging the adjacent tooth proximal undercut. Marginal discrepancy: polymerization shrinkage, distortion on removal, reline with resin around the margins
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The inside of the alginate is trimmed to increase the
thickness of the provisional
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Problem Solving Multiple crowns: joined restorations prevent drifting, gingival embrasures should be opened to access brushing. Premature decementation: Ensure harmony with occlusion, use stronger cement Partial denture abutment: fabricate with the denture fully seated. Eugenol containing cements: do not use if the underlying core is composite. Removing temporary cement: use modifier. Removal of excess cement: apply petroleum jelly to outside of the restorations
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Pre-operative view
Linked temporary Crowns made at chairside using
preoperative clear thermoplastic matrix