Provisonal Restoration

PROVISIONAL RESTORATION

IN FIXED PARTIAL DENTURE

Dr. Victory Ahanthem

Provisional Restoration in FPD - 95Provisional Restoration in FPD - 95 11

CONTENTCONTENT IntroductionIntroduction Definition Definition Ideal requirements of provisional restorationsIdeal requirements of provisional restorations Types of provisional restorations Types of provisional restorations Provisional restorations fabricated using direct techniqueProvisional restorations fabricated using direct technique Provisional restoration fabricated using indirect techniqueProvisional restoration fabricated using indirect technique Provisional restoration fabricated using indirect-direct techniqueProvisional restoration fabricated using indirect-direct technique LimitationsLimitations Recent material used for the provisional restorationsRecent material used for the provisional restorations ConclusionConclusion ReferencesReferences


INTRODUCTION

The word provisional means established for the time being, until a permanent arrangement can be made

It is important that the prepared tooth or teeth be protected and that patient be kept comfortable while a cast restoration is being fabricated

By successful management of this phase of the treatment, the dentist can gain the patients confidence and favourable influence for the ultimate success of the final restoration.

If the provisional restoration is not up to the mark, it may lead to unnecessary repairs as well as need to treat gingival inflammation and it can further prolong the treatment schedule.


SYNONYMS

Provisional restoration,Treatment restoration (Temporization), Interim prosthesis, Provisional prosthesis.

Definition A fixed or removal prosthesis designed to enhance esthetics stabilization and function for a limited period of time after which it is to be replaced by definitive prosthesis.( GPT- 8 )


A PROVISIONAL MATERIAL SHOULD SATISFY FOLLOWING CRITERIA

Convenient handling: adequate working time,easily moldability, rapid setting time.

Bicompatibility: nontoxic, nonallergic, non exothermic

Dimensional stable during solidification .

Ease of contouring and polishing .

Adequate strength and abrasion strength.

Good appearance,transclucent,colour stable.


Good patient acceptance , non irritating , odorless.Good patient acceptance , non irritating , odorless.

Ease of adding to or reparing .Ease of adding to or reparing .

Compatibility with provisional luting agent.Compatibility with provisional luting agent.


REQUIREMENTSREQUIREMENTS


BIOLOGICAL BIOLOGICAL REQUIREMENTSREQUIREMENTS


Pulp ProtectionPulp Protection A provisional restoration must seal A provisional restoration must seal

and insulate the prepared tooth surface and insulate the prepared tooth surface from the oral environment to prevent from the oral environment to prevent sensitivity and irritation to the pulp.sensitivity and irritation to the pulp.

Because of the sectioning of dentinal Because of the sectioning of dentinal tubules, a certain degree of pulp tubules, a certain degree of pulp trauma is enevitable during tooth trauma is enevitable during tooth preparationpreparation


Periodontal HealthPeriodontal Health To facilitate plaque removal, a provisional restoration must have To facilitate plaque removal, a provisional restoration must have

good mariginal fit , proper contour , and a smooth surfacegood mariginal fit , proper contour , and a smooth surface

If the provisional restoration is inadequate and plaque control is If the provisional restoration is inadequate and plaque control is impaired, gingival health will deteriorateimpaired, gingival health will deteriorate


Marginal adaptation of provisional restorations is a critical property of Marginal adaptation of provisional restorations is a critical property of these treatments. these treatments.

Interim materials and their marginal fit was compare in the light of the Interim materials and their marginal fit was compare in the light of the potential disrupting factors . potential disrupting factors .

All these materials fail in moderate or long-term durations under oral All these materials fail in moderate or long-term durations under oral stresses and water sorption, and should be rapidly replaced by permanent stresses and water sorption, and should be rapidly replaced by permanent restorations before damaging teeth and adjacent tissuesrestorations before damaging teeth and adjacent tissues


Occlusal Compatibility and Tooth PositionOcclusal Compatibility and Tooth Position

The provisional restoration should establish or maintain proper The provisional restoration should establish or maintain proper contacts with adjacent and opposing teethcontacts with adjacent and opposing teeth

Inadequate contacts allow supraeruption and horizontal movement.Inadequate contacts allow supraeruption and horizontal movement.


Prevention of Enamel FracturePrevention of Enamel Fracture

The provisional restoration must protect the pulpThe provisional restoration must protect the pulp

Fracture of a tooth after the impression phase delays treatment and Fracture of a tooth after the impression phase delays treatment and jeaopadizes restorabilityjeaopadizes restorability


MECHANICAL MECHANICAL REQUIREMENTSREQUIREMENTS


FunctionFunction The greatest stresses in a provisional restoration occur during The greatest stresses in a provisional restoration occur during

chewingchewing Breakage occur more frequently in partial-coverage restorations and Breakage occur more frequently in partial-coverage restorations and

fixed partial denturesfixed partial dentures


DisplacementDisplacement

To avoid irritation to the pulp and tooth movement, a To avoid irritation to the pulp and tooth movement, a displaced provisional restoration must be cementeddisplaced provisional restoration must be cemented

Displacement is best prevented through proper tooth Displacement is best prevented through proper tooth preparation and a provisional with a closely adapted preparation and a provisional with a closely adapted internal surfaceinternal surface


Removal for ReuseRemoval for Reuse

Provisional restorations often need to be reused and Provisional restorations often need to be reused and therefore should not be damaged when removed from therefore should not be damaged when removed from the teeththe teeth

If the cement is sufficiently weak and the provisional If the cement is sufficiently weak and the provisional has been well fabricated, it will not break when has been well fabricated, it will not break when removedremoved


ESTHETIC ESTHETIC REQUIREMENTSREQUIREMENTS


The temporary must have adequate The temporary must have adequate contours, color, translucency and contours, color, translucency and texture.texture.

This is especially important in This is especially important in anterior teeth. Because acrylic tends anterior teeth. Because acrylic tends to darken and discolor over an to darken and discolor over an extended period of time, a different extended period of time, a different provisional restorative material may provisional restorative material may need to be selected if the temporary need to be selected if the temporary is to be worn for a long period. is to be worn for a long period.

A smooth polished surface is A smooth polished surface is important for esthetics as well as important for esthetics as well as plaque removal plaque removal


Crispin and Caputo studied the color stability of provisional Crispin and Caputo studied the color stability of provisional materials. materials.

They found that methyl methacrylate materials exhibited the They found that methyl methacrylate materials exhibited the least darkening, followed by ethyl methacrylate and vinyl-least darkening, followed by ethyl methacrylate and vinyl-ethyl methacrylate materials.ethyl methacrylate materials.

They also reported that increases in surface roughness They also reported that increases in surface roughness induced increases in material darkening and pressure induced increases in material darkening and pressure polymerizing did not influence discoloration relative to air polymerizing did not influence discoloration relative to air polymerizing. polymerizing.


Types of Provisional RestorationTypes of Provisional Restoration Classified based on the following method:-Classified based on the following method:-

Method of fabrication Method of fabrication Custom made provisional restorationCustom made provisional restoration Prefabricated provisional restorationPrefabricated provisional restoration

Types of material usedTypes of material used Resin based provisional restorationResin based provisional restoration Metal provisional restorationMetal provisional restoration


Duration of useDuration of use Short term temporary restorationShort term temporary restoration Long term temporary restorationLong term temporary restoration

Technique for fabricationTechnique for fabrication Provisional restoration fabricated using direct techniqueProvisional restoration fabricated using direct technique Provisional restoration fabricated using indirect techniqueProvisional restoration fabricated using indirect technique Provisional restoration fabricated using indirect-direct techniqueProvisional restoration fabricated using indirect-direct technique


Depending on the method of fabrication:-Depending on the method of fabrication:-

Custom made provisional restorationCustom made provisional restoration

Prefabricated provisional restorationPrefabricated provisional restoration


Custom made provisional restorationCustom made provisional restoration

The restoration is fabricated to reproduce the original contours of The restoration is fabricated to reproduce the original contours of the tooththe tooth

An impression of the tooth is made and a cast is pouredAn impression of the tooth is made and a cast is poured

The tooth on the cast is waxed up, an carved to reproduce the The tooth on the cast is waxed up, an carved to reproduce the original contoursoriginal contours

Putty index was made from the diagnostic wax up.Putty index was made from the diagnostic wax up.


An impression of the prepared tooth is made and a cast is pouredAn impression of the prepared tooth is made and a cast is poured

Auto polymerizing resin filled in the putty index and placed it on Auto polymerizing resin filled in the putty index and placed it on the prepared tooth castthe prepared tooth cast

The index stabilized on the prepared sectional cast.The index stabilized on the prepared sectional cast.

After the material set , it was trimmed ,finished and cemented After the material set , it was trimmed ,finished and cemented provisional.provisional.

..


DIAGNOSTIC CASTSDIAGNOSTIC CASTS


Diagnostic wax-up doneDiagnostic wax-up done


Putty index made from the Putty index made from the diagnostic wax up.diagnostic wax up.


Auto polymerizing resin filled in Auto polymerizing resin filled in the putty indexthe putty index


The index stabilized on the The index stabilized on the prepared sectional cast.prepared sectional cast.



Trimmed ,Finished and cemented Trimmed ,Finished and cemented provisionals.provisionals.


AdvantagesAdvantages

Minimum interferenceMinimum interference A wide variety of materials can be usedA wide variety of materials can be used Helpful in evaluating the adequacy of tooth reductionHelpful in evaluating the adequacy of tooth reduction

DisadvantagesDisadvantages

Additional lab procedure involvedAdditional lab procedure involved Time consumingTime consuming


TEMPLATE METHOD•To make a template, a metal crown form or a denture tooth was placed in the edentulous space on the diagnostic cast.

•All of the embrasures should be filled with putty to eliminate undercuts during adaptation of the resin template.

•To facilitate removal of the template, a thin strand of putty was placed around the periphery of the cast and on the lingual surface of the cast, apical to the teeth .

•A large acrylic bur was used to cut a hole through the middle of the cast (midpalatal or midlingual).

•A 5 x 5-inch sheet of 0.020-inch-thick resin was placed in the frame of the vacuum forming machine .• •After turning on the heating element of the machine , it was swing into position over the plastic sheet .



• As the resin sheet is heated to the proper temperature, it will droop or sag about 1.0 inch in the frame.

• The cast should be in position in the center of the perforated stage of the vacuum forming machine and the vacuum was turned on.

• Grasping the handles on the frame that holds the heated material, forcefully the frame was lower over the perforated stage .

• Turning off the heating element and was swing it off to the side.

• After approximately 30 seconds, turn off the vacuum and release the resin sheet from the holding frame .


Template fabrication without using vacuum forming Template fabrication without using vacuum forming machinemachine




Preformed Provisional RestorationPreformed Provisional Restoration

Preformed crowns are commercially available prefabricated crownsPreformed crowns are commercially available prefabricated crowns

Available in various sizesAvailable in various sizes

The operator can choose the size and the material that would best The operator can choose the size and the material that would best suit the patient and place it as a provisional restorationsuit the patient and place it as a provisional restoration

Before cementation these crowns are slightly altered and modified to Before cementation these crowns are slightly altered and modified to fit the tooth fit the tooth


AdvantageAdvantage

Less time consumingLess time consuming

DisadavantagesDisadavantages

Rarely satisfies the requirements of contour because it has to Rarely satisfies the requirements of contour because it has to be customized with self cure resinbe customized with self cure resin

Limited to single tooth restorationLimited to single tooth restoration


Material available in preformed crownsMaterial available in preformed crowns PolycarbonatePolycarbonate

Cellulose AcetateCellulose Acetate

Aluminium Aluminium

Tin – silverTin – silver

Nickel -ChromiumNickel -Chromium


PolycarbonatePolycarbonate

Has the most natural appearanceHas the most natural appearance

Available in single shadeAvailable in single shade

Available for incisor , canine and Available for incisor , canine and premolar teethpremolar teeth

Polycarbonate crown forms are Polycarbonate crown forms are more tolerable, selected to more tolerable, selected to establish contact areasestablish contact areas


MOLD SELECTION FOR MOLD SELECTION FOR TEMPORARY POLYCARBONATE TEMPORARY POLYCARBONATE

CROWNSCROWNS


SIZING IT UPSIZING IT UP


IMPROVING FIT WITH RESINIMPROVING FIT WITH RESIN


Cemented temporary in placeCemented temporary in place


Cellulose AcetateCellulose Acetate

Cellulose acetate crown form consists of Cellulose acetate crown form consists of thin, soft, and transparent material. thin, soft, and transparent material.

Sizes and shape can be selected from a Sizes and shape can be selected from a mold guide. mold guide.

The crown form is trimmed and festooned The crown form is trimmed and festooned to fit the preparation without to fit the preparation without impingement on the soft tissue.impingement on the soft tissue.

Available in all tooth typesAvailable in all tooth types


Aluminium Aluminium

Materials are suitable for posterior teethMaterials are suitable for posterior teeth

They have anatomical shaped occlusal and They have anatomical shaped occlusal and axial surfacesaxial surfaces

Care must be taken during try in verification Care must be taken during try in verification to avoid fracture of their delicate marginsto avoid fracture of their delicate margins

As it is highly ductile , it allows easy As it is highly ductile , it allows easy contouringcontouring


Tin Silver: Tin Silver preformed crowns are

available for posterior teeth.

This alloy is very soft and the margin of

the crown can be flexed prior to seating with a swaging block.

This produces a close marginal fit after the shell is trimmed with a bur.

These should also be lined with acrylic resin to provide good internal adaptation and retention of the temporary.


Nickel -ChromiumNickel -Chromium Used in children with extensively Used in children with extensively

damaged primary teethdamaged primary teeth

They cannot be altered with resinThey cannot be altered with resin

These crowns can be easily These crowns can be easily recontoured using pleirsrecontoured using pleirs

Indicated for long term temporariesIndicated for long term temporaries


Depending on the Types of Material UsedDepending on the Types of Material Used

Resin based provisional restorationResin based provisional restoration

Cellulose acetateCellulose acetate PolycarbonatePolycarbonate Poly methyl methacrylatePoly methyl methacrylate Poly-R methacrylatePoly-R methacrylate Microfilled compositeMicrofilled composite Urethane dimethacrylateUrethane dimethacrylate

Metal provisional restorationMetal provisional restoration AluminiumAluminium Nickel- ChromiumNickel- Chromium Tin- SilverTin- Silver


Materials • Material used to fabricate provisional restorations can be classified as acrylics or resin composites. •Subcategories are based on method of polymerization (e.g., chemically activated, light activated, dual activated).

Acrylics• These materials have been used to make provisional restorations since the 1930s and usually consist of a powder and liquid.• •They are the most commonly used materials today for both single-unit and multiple-unit restorations.

•Advantages : low cost, esthetics, and versatility.


Disadvantages

• They produce acceptable short-term (i.e., three months) provisional restoration but tend to discolor over time.

• Objectionable odor

• Significant shrinkage and heat generation during setting, and messiness during mixing.

The three types of acrylics are polymethyl methacrylates,poly-R’ methacrylates(where R’ represents either ethyl,vinyl,or isobutyl groups), and epimines.


1 . Polymethyl MethacrylatesPolymethyl Methacrylates

Advantages •low cost •good wear resistance•good esthetics •high polishability •good color stability .

Disadvantages•significant amount of heat given off by exothermic reaction•high degree of shrinkage •objectionable odour •short working time •hard to repair


2 Poly-R' Methacrylates (R' = ethyl, vinyl, isobutyl) 2 Poly-R' Methacrylates (R' = ethyl, vinyl, isobutyl) AdvantagesAdvantages •low cost low cost •less heat given off during reaction than polymethyl less heat given off during reaction than polymethyl methacrylates methacrylates •less shrinkage than polymethyl methacrylates less shrinkage than polymethyl methacrylates

DisadvantagesDisadvantages •extended working timeextended working time•less esthetic than other currently-marketed materials less esthetic than other currently-marketed materials •poor wear resistance poor wear resistance •poor color stability poor color stability •objectionable odour objectionable odour •hard to repair hard to repair


3.Epimines •These were the first two-paste acrylics, commercially introduced in 1968 as Scutan (ESPE).

•Although Scutan had relatively low shrinkage and heat production, it was weak and could not be altered or repaired.

•4 . Bis-Acryl Composites • These are resin composites and represent an improvement over the acrylics • •The majority of these products are provided in cartridges for use in an automix dispenser gun.


Based on Duration of UsedBased on Duration of Used

Short term temporary restorationShort term temporary restoration

Long term temporary restorationLong term temporary restoration


These are used when the prosthesis is to be used for a These are used when the prosthesis is to be used for a

maximum of two weeksmaximum of two weeks

Indicated after tooth preparation in fixed partial denturesIndicated after tooth preparation in fixed partial dentures

They are either custom made resins or preformed crownsThey are either custom made resins or preformed crowns

Polycarbonates or aluminium crown are the most Polycarbonates or aluminium crown are the most commonly used commonly used

Short term temporary restoration


Long term temporary restorationsLong term temporary restorations

Usually made of cast metalUsually made of cast metal

Long span posterior fixed partial denturesLong span posterior fixed partial dentures

If the patient is unable to avoid excessive forces on If the patient is unable to avoid excessive forces on the prosthesisthe prosthesis


Depending on the Technique of FabricationDepending on the Technique of Fabrication

Provisional restoration fabricated using direct techniqueProvisional restoration fabricated using direct technique

Provisional restoration fabricated using indirect techniqueProvisional restoration fabricated using indirect technique

Provisional restoration fabricated using indirect- directProvisional restoration fabricated using indirect- direct techniquetechnique


Provisional restoration fabricated using direct technique Provisional restoration fabricated using direct technique




Fabrication of an Acrylic Provisional Restoration Fabrication of an Acrylic Provisional Restoration for a posterior tooth using Indirect Techniquefor a posterior tooth using Indirect Technique





Provisional Restorations Fabricated Provisional Restorations Fabricated using Indirect-Direct Techniqueusing Indirect-Direct Technique

Here a preformed crown is checked for the external fit and finish in the Here a preformed crown is checked for the external fit and finish in the patients’ mouthpatients’ mouth

Later , the tissue surface of the preformed crown is customized for the Later , the tissue surface of the preformed crown is customized for the patient patient

An impression of the prepared tooth surface is made and a cast is pouredAn impression of the prepared tooth surface is made and a cast is poured

The altered preformed crown is then placed on the cast and the tissue The altered preformed crown is then placed on the cast and the tissue surface is contoured using the resinssurface is contoured using the resins

The final restoration is a customized oneThe final restoration is a customized one




LimitationsLimitations

Lack of inherent strengthLack of inherent strength Poor marginal adaptationPoor marginal adaptation Poor colour stabilityPoor colour stability Poor wear propertiesPoor wear properties Detectable odourDetectable odour Inadequate bonding characteristicsInadequate bonding characteristics Poor tissue response often resulting in mild to moderate tissue Poor tissue response often resulting in mild to moderate tissue

irritationirritation Arduous cement removalArduous cement removal


Recent Materials used in Recent Materials used in Provisional RestorationProvisional Restoration


Chemically-Activated Composites

Chemically-activated resin composite provisional

products include Protemp 3 Garant (3M ESPE), Integrity

(Dentsply/Caulk), Temphase (SDS/Kerr), InstaTemp

(Sterngold), and Luxatemp (Zenith/DMG).


Available in four shades (A1, A3, B1, B3).

A dispenser syringe of Add On, a low-viscosity light-cured resin, is also included with the product.

Add On is used to correct voids or defective margins of the provisionals.

Provisional restorations made with Protemp 3 Garant are said to be more fracture resistant that those made with other composite products.

3M ESPE also claims that the restorations have excellent marginal adaptation and are fast and easy to polish.

Protemp 3 GarantProtemp 3 Garant


Integrity is available in three shades (A1, A2, A3.).

Two sizes of mixing tips are available: a small size for single-unit temporaries and a larger tip for multiple temporaries and fixed partial dentures.

The product has a snap set and should be used expeditiously; place it in the mouth within 45 seconds and remove it in another 45 seconds.

.



Visible Light-Activated (VLA) CompositesVisible Light-Activated (VLA) Composites

Very few provisional materials are available that are polymerized Very few provisional materials are available that are polymerized solely by exposure to a light curing unit.solely by exposure to a light curing unit.

One is Revotek LC, One is Revotek LC, introduced by GC America in 2002.introduced by GC America in 2002.


Revotek LC is a VLA, single-component, sculptable resin composite. It is supplied in a Putty Stick form in a lightproof plastic tray. To make a provisional restoration, a small portion of the material is cut from

the stick and adapted to the preparation directly in the mouth.

It is then sculpted using hand instruments after which the patient is instructed to occlude into it to establish a functionally-generated occlusal scheme.

The Revotek LC provisional is then light-activated for 10 seconds in the mouth, removed, and given a final 20-second light exposure.

After finishing and polishing, the restoration is cemented with a temporary

cement. Revotek LC is available in only one shade (B2).


Technique used in the fabrication Technique used in the fabrication of provisionals using light cured of provisionals using light cured

resin.resin.

DIAGNOSTIC WAX UP & IMPRESSION.




Resin placed on the finish line for Resin placed on the finish line for better adaptation.better adaptation.


Template is filled with light cured Template is filled with light cured resin.resin.




Dual-Activated Composites

One example is Unifast (GC America), which goes through a chemically-activated, rubbery, setting stage and is then VLA for final set.

Other such products have appeared in the past such as TempCare (3M) and Provipont DC (Ivoclar Vivadent) but have since discontinued.

.


Provisional luting materials Provisional luting agents should possess good mechanical properties, low solubility, and tooth adhesion to resist bacterial and molecular penetration.

The most important function of these materials is to provide an adequate seal between the provisional restoration and prepared tooth. It prevent marginal leakage and pulpal irritation.

The most common include (1) calcium hydroxide; (2) zinc-oxide eugenol; and (3) noneugenol materials.


Removal of Provisional RestorationThe provisional is removed when the patient returns for the definitive restoration or for continued preparation.

Risk can be minimized if removal forces are directed parallel to the long axis of the preparation.

The Backhans or hemostatic forceps are effective for single unit.

A light buccolingual rocking motion will help break the cement seal.

Damage can occur when a FPD is being removed.

It is helpful to loop dental floss under the connector at each end of the FPD, providing a more even force distribution for removalProvisional Restoration in FPD - 95Provisional Restoration in FPD - 95 8989

.Recementation of Provisional Restoration

If provisional is to be recemented , clean out the bulk of cement with a spoon excavator then place the provisional restoration in a cement dissolving solution in an ultrasonic cleaner.

Than line it with a fresh mix of resin if necessary

The internal surface is relieved slightly and painted with monomer to ensure good bonding of the new lining.


CONCLUSION Although provisional restorations are usually intended for short term use and then discarded, they can be made to provide pleasing esthetics, adequate support, and good protection for teeth while maintaining periodontal health.

They may be fabricated in the dental office or in laboratory from any of several commercially available materials and by a number of practical methods.

The success of fixed prosthodontics is often depends on the care with which the provisional is designed and fabricated.



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