Provisional restorations / orthodontic practice

PROVISIONAL
RESTORATIONS
1
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

CONTENTS
• Introduction
• Definition
• History
• Requirements
• Rationale / Functions
• Classification
• Materials
• Techniques
• Influence of material properties on treatment
outcome 2www.indiandentalacademy.com

• Provisionalization in implant dentistry
• Trouble shooting in provisionalization
• Limitations of provisional restorations
• Recent advances in provisionalization
• Conclusion
• References
3www.indiandentalacademy.com

INTRODUCTION
• PROVISIONAL-----
“ESTABLISHED FOR TIME BEING,PENDING A PERMANENT
ARRANGEMENT.”
• Synonyms:- INTERIM; TRANSITIONAL; TEMPORARY;
TREATMENT RESTORATIONS.
• FOUNDATION FOR SUCCESS OF FINAL RESTORATION.

DEFINITION
• “A fixed or removable prosthesis,
designed to protect, enhance esthetics,
stabilization and/or function for a limited
period of time, after which it is to be
replaced by a definitive prosthesis. ”

HISTORY
• Since 1930s
• 1937 ---- Heat cured acrylic resin
• 1947 ---- Auto polymerizing acrylic resin
• 1952 ---- Brotman introduced prefabricated aluminum or
celluloid crown form
• 1959 ---- Amsterdam et al suggested use of copper
band splint or thin flexible metal wire for internal
reinforcement
• 1960s ---- Vinyl poly-ethyl methacrylate (Snap and Trim)7www.indiandentalacademy.com

HISTORY
• 1969 ---- Ethyl imine derivatives (
Suctan)
• 1972 ---- Gerald J described a technique for a modified
“shell” type temporary acrylic resin fixed partial denture.
• 1973 ---- Charles et al described the use of polycarbonate
resin
• 1980 ---- Composite (Protemp, Visio Gem and Triad)
• 1983 ---- Weiner described technique that use silicone putty
impression material in provisional restoration fabrication.

HISTORY
• 1984 ---- Morton et al ---- visible light-cured microfilled
composite resin
• 1986 ---- Kinsel described use of an acrylic resin denture
tooth for construction of interim restoration.
• 1987 onwards ---- Concept of provisionalization applied and
implemented in implant dentistry.

REQUIREMENTS
1. Pulpal protection
2. Periodontal
health
3. Occlusal
compatibility &
tooth position
4. Prevention of
enamel #
1. Resist functional
loads
2. Resist removal
forces
3. Maintain
interabutment
alignment
Restore
1.Tooth contour
2.Color
3.Translucency
4.Texture

FUNCTIONS
1. Comfort/Tooth vitality: Essential to cover freshly cut
dentine and prevent sensitivity, plaque buildup, and
subsequent caries and pulp pathology. It also sedate
prepared abutments.
2. Occlusion and Positional Stability: To prevent
unwanted tooth movement.
3. Function
4. Gingival Health and Contour: To facilitate oral hygiene
and prevent gingival overgrowth.
5. Aesthetics
6. Diagnosis: To assess the effect of aesthetic and
occlusal changes.

FUNCTIONS
1). Callipers may be used to test the thickness of a provisional restoration
to ensure sufficient tooth preparation to accommodate the proposed
restorative material
2). A provisional restoration may be used to provide a coronal build up for
isolation purposes during endodontic treatment.
3). Long-term provisional restoration may also be advisable to assess teeth
of dubious prognosis.

FUNCTIONS
4). A provisional restoration may find a use as a matrix for core build
ups in grossly broken down teeth, by removing the coronal surface
to allow placement of restorative material.
5). Proposed changes to the shape of anterior teeth are best tried
out with provisional restorations to ensure patient acceptance, and,
approval from friends and family.
6). A patient’s tolerance to changes in anterior guidance or
increased occlusal vertical dimension is best tried out with
provisional restorations.

FUNCTIONS
7). Long-term wear of properly fitting and contoured provisional
restorations allows the health of the gingival margin to improve
and its position to stabilize before impressions are recorded for
definitive restorations.
8). Altered function can be assessed (fine mouth movements and
lip/tooth contact required for speech production or sound
generation in the case of a musical instrument.)

CLASSIFICATION

DEPENDING ON THE METHOD OF
FABRICATION
•CUSTOM MADE PROVISIONAL
RESTORATION
• PREFABRICATED PROVISIONAL
RESTORATION

CUSTOM MADE
PROVISIONALS
• To reproduce the original
contours of the tooth
ADVANTAGES
• Minimum interference
• A wide variety of
materials can be used
• Helpful in evaluating the
adequacy of tooth
reduction
DISADVANTAGES
• Time consuming
• Additional lab procedures
involved
PREFABRICATED MADE
PROVISIONALS
• Commercially available
• Available in various
sizes and materials
• Require alteration and
modification before
cementation
• ADVANTAGES
• Less time consuming
• DISADVANTAGES
• Rarely satisfies
requirements of contour
• Generally limited to a
single tooth restoration. 17www.indiandentalacademy.com

DEPENDING ON THE MATERIALDEPENDING ON THE MATERIAL
AVAILABLE IN PREFORMED CROWNSAVAILABLE IN PREFORMED CROWNS
• Polycarbonate
• Cellulose acetate
• Aluminium and tin-silver
• Nickel-chromium

DEPENDING ON THE TYPE OF MATERIAL USEDDEPENDING ON THE TYPE OF MATERIAL USED
• Resin based provisional restoration
Cellulose acetate
Polycarbonate resin
Poly-methyl methacrylate
Poly-ethyl methacrylate
Microfilled composite
Urethane dimethacrylate
 Bis -acryl composite
• Metal provisional restoration
Aluminium
Nickel-chromium
Tin-silver

• SHORT TERM ---- for few days (upto 2 weeks)
( e.g. ---- Polycarbonate or aluminum crowns )
• MEDIUM TERM ---- for few weeks ( > 2 weeks)
( e.g. ---- resin based provisionals)
• LONG TERM ---- for months
( e.g. ---- mostly cast metal crowns)

Indications
1.Long span posterior FPDs.
2.Patient undergoing implant therapy.
3.Extensive periodontal treatment.
4.Orthodontic stabilization.
5.Evaluation of change in VDO.

 DIRECT TECHNIQUE
 INDIRECT TECHNIQUE
 DIRECT-INDIRECT TECHNIQUE

 CHAIR- SIDE FABRICATED
 LABORATORY FABRICATED

MATERIALS &
TECHNIQUES

MOLD CAVITY
• Created by two correlated parts:-
1.Forming the external contour of crown or
FDP ---- External surface form (ESF)
Custom made Prefabricated
2. Forming the prepared tooth surfaces and
edentulous ridge area ---- Tissue surface
form ( TSF)
Direct technique Indirect technique25www.indiandentalacademy.com

MATERIALS

IDEAL PROPERTIES
 Convenient handling – adequate working time, easy
moldability, rapid setting time
 Biocompatibility-nontoxic, nonallergenic, nonexothermic
 Dimensional stability during solidification
 Ease of contouring and polishing
 Adequate strength and abrasion resistance
 Good appearance – translucent, color controllable, color
stable 27www.indiandentalacademy.com

IDEAL PROPERTIES
 Good patient acceptance- nonirritating, odorless
 Ease of adding to or repairing
 Chemical compatibility with provisional luting agents.

TYPES
• Pre-formed crowns (made of plastic or metal),
• Self cured resins
• Light cured resins or
• Composites resins
• Heat cured acrylic resin
• Cast metal.
• Fiber reinforced composite resins

Pre-formed crowns
• Also known as proprietary shells
• Come in a series of sizes
• Usually need considerable adjustment marginally,
proximally and occlusally
• Plastic shells ---- polycarbonate or acrylic
• Metal shell ---- aluminium, stainless steel or nickel
chromium
• Both can be relined with self cured resin to improve their
fit.

Polycarbonate resin crowns
• Possesses a number of superior
properties relative to Polymethyl
methacrylate materials
• Crowns combine microglass ﬁbers
with a polycarbonate plastic
material.
• High impact strength,
• High abrasion resistance,
• High hardness, and
• A good bond with methyl-
methacrylate resin
• B- crowns, molar B- crowns 31www.indiandentalacademy.com

Preformed metal crowns
Aluminum shells
• Provide quick tooth adaptation due to
the softness and ductility
• Rapid wear that results in perforation in
function and/or extrusion of teeth.
• An unpleasant taste
Iso-Form Crowns (3M Dental Products)
• Manufactured with high-purity tin-silver
and tin-bismuth alloys.
• Reasonable ductility and can be
contoured quickly
• Occlusal table is reinforced so they are
more resistant to wear related failure. 32www.indiandentalacademy.com

Preformed metal crowns
• For longer-term use, nickel-
chrome and stainless steel
crowns are available but
• May be more difficult to adapt
to a prepared tooth.
• Gold anodized crowns

Self or light cured resins
• Poly-methyl methacrylate
• Poly-ethyl methacrylate
• Bis- acryl composite
• Urethane dimethacrylate (light cured)
• Restorative composit resins

Poly- methyl methacrylate
ADVANTAGES
• Strong
• High wear resistance,
• Easy to add
• Has good aesthetics, which is
maintained over longer periods.
• A good material for indirect
provisional restorations.
( Vita K&B Acrylics), Alike, Trim plus

Poly- methyl methacrylate
3 main disadvantages :-
i) Polymerization shrinkage which can affect fit
ii) Polymerization exothermic which can damage pulp
iii)Free monomer may cause pulp and gingival damage
Plant et al ---- “ The intrapulpal temperature rise
associated with the polymerization of methyl methacrylate
materials could be up to 5 times that associated with the
normal consumption of thermally hot liquid.”
Br Dent J 1974;137:233-8. 36www.indiandentalacademy.com

Poly- ethyl methacrylate
• Suitable for intra-oral use as it shrinks less and is less
exothermic than poly-methyl methacrylate.
• Strength, wear resistance, aesthetics and color stability
are not as good.
• Presentations with only light and dark shades (e.g. Trim).
• Some presentations with a good color range (e.g. Trim II)
• Highest value of fracture resistance
( Snap, Trim)

• Produce less heat and shrinkage
• Better marginal fit.
• Despite being reasonably strong
but brittle
• Aesthetically reasonable
• More color stable than poly-ethyl
methacrylate materials and are
therefore better suited for use as
long-term provisionals.
• Come in multiple shades,
• Can be added to with a flowable composite (margins, contacts,
occlusion)
Bis-acryl comPosites

• Have good abrasion resistance especially when a glaze
is applied, (Glisten™; PermaSeal, BisCover™ LV,
Bisco, DuraFinish™, Parkell; G-COAT™ Plus, Lasting
Touch)
• Available both as
 Self cure (Bisjet, integrity, luxatemp , Temptation etc)
 Dual cure material (Isotemp, luxatemp solar),
• Repair material ---- (Luxaflow)
DISADVANTAGES
• Fewer shades
• Porous
• Stain easily
• Brittle
• Expensive
• Decreasing hardness
• Left with unpolymerized surface layer

Young et al ---- Compared Bis-acryl and Polymethyl
methacrylate materials in terms of occlusion, contour,
marginal fidelity, and finish.
“For both anterior and posterior teeth, they found the Bis-
acryl materials significantly superior to PMMA in all
categories”
Luthardt et al ---- Compared the clinical performance of
autopolymerizing, dual-polymerizing, and visible light-
polymerizing bis-acryl materials.
“The light- and dual-polymerizing materials did not offer a
clinical benefit relative to autopolymerizing.”
J Prosthet Dent 2001;85:129-32.
J Prosthet Dent 2000;83:32-9. 40www.indiandentalacademy.com

visiBle light cured resins
• Based on urethane
dimethacrylate e.g.
Provipont D.C, Kristall etc.
• Have good mechanical
properties
• Operator has some control
over the material’s working
time.
• More shades are available
than Bis acryl composite
and the colour is relatively
stable.
• No residual monomer
DISADVANTAGES:--
Prone to staining.
Marginal fit can be poor,
Relatively expensive

 Haddix ---- Indicated that VLC materials could produce
provisional restorations with quality similar to heat-
polymerized, laboratory-processed restorations, but with
less time and expense.
 Dual-polymerizing composite materials generally
incorporate both chemically polymerized Bis-acryl and
light-polymerized urethane dimethacrylate resins in
variable product-speciﬁc combinations.

cast metal
• Alloys used include nickel chromium, silver and scrap
gold.
• Copings can be cast with external retention beads for
acrylic or composite.
• In less aesthetically critical areas of the mouth, metal
may be used on its own.
• Very durable, but rarely used unless provisional
restorations have to last a long time.

PHYSICAL PROPERTIES PMMA EMMA BIS-GMA VLC-
COMPOSIT
E
Minimal temperature
change during
polymerization ++ +++ ++++ +
Surface hardness
Marginal fit +++ ++ ++++ +
Wear resistance
Transverse strength ++++ No values -
Too rubbery
++++ ++++
Transverse repair strength
Surface roughness &
polishability +++ ++++ + + ++
Color stability
Stain resistance +++ ++++ + +
+++ + ++ ++++
+ +++ ++++ ++++
++++ + ++ ++++
++ + +++ ++++

Provisional cements
• Usually cemented with soft cement.
• Traditionally, a creamy mix of zinc oxide eugenol was
used.
• Most dentists prefer proprietary materials such as Temp
Bond Comes with a modifier, which is used to soften the
cement, to ease removal of the provisional restoration
from more retentive preparations.
• Cling2®
; TempBond®
; TempoSIL; TempCEM NE, ZONE,
and UltraTemp,

Provisional cements
• Temp Bond NE is a non-eugenol cement which may be
used for patients with eugenol allergy or where there is
concern over the possible plasticizing effect of residual
eugenol on resin cements and dentine bonding agents.

techniques

Provisional restorations — techniques
• As a rule of thumb,
“The time taken to temporise a tooth should be similar to
the time taken to prepare it.”
1. Shells (proprietary or custom)
2. Matrices (either formed directly in the mouth or indirectly
on a cast)
3. Direct syringing
48
British Dental Journal 2002; 192:619–630

difference Between a shell & matrix
SHELL
Incorporated within the
restoration ---
plastic / metal
MATRIX
Just used to make a
provisional restoration

ProPrietary shells
Prefabricated Custom- made
Plastic Metal Beaded Mill crowns
acrylic

ProPrietary Plastic shells
• Crown with correct M-D width is chosen and placed on
the tooth preparation.
• Cervical margins are trimmed to give reasonable seating
and adaptation
• Preparation coated with petroleum jelly and the crown,
containing a suitable resin, is reseated

ProPrietary Plastic shells
• Proximal excess is removed
• Crown removed and replaced several times to prevent
resin setting in undercuts
• Crown is adjusted and polished using steel or tungsten
carbide burs and Soflex discs.

ANTERIOR POLYCARBONATE CROWN

ProPrietary metal shells
• Aluminium crowns ----
 Only suitable for short-term use as they are soft resulting
in wear and deformation
 Can produce galvanic reactions in association with
amalgam restorations.
 Fit is usually poor unless considerable time is spent
trimming and crimping the margins followed by relining
with a resin
• Stainless steel or nickel chromium crowns
 May occasionally be used on molar teeth opposed by flat
cusps where heavy occlusal loading would quickly wear
or break a resin crown.

#ed cusp of max. molar
Conventional crown
preparation done
M-D tooth diameter measured Cervical end expansion 56www.indiandentalacademy.com

Crown tried over preparation and cervical excess trimmed
Crown finished polished and axially contoured 57www.indiandentalacademy.com

custom shells
• For multiple tooth preparations.
• Relining and careful marginal trimming are necessary
prior to fitting.
• Two types – ‘beaded acrylic’ or ‘Mill Crowns’.
• Both offer advantage of being able to use the superior
properties of poly-methyl methacrylate, whilst avoiding
pulpal damage by constructing the shell out of the
mouth.

BEADED ACRYLIC SHELL
• Formed within an impression
taken of the teeth prior to
preparation or of a diagnostic
wax up.
• A thin shell of poly-methyl
methacrylate is constructed by
alternately placing small
amounts of methyl methacrylate
monomer followed by polymer,
• Once set, it is trimmed and then
relined in the mouth

MILL CROWNS
• A pre-preparation matrix is fabricated
• First cut minimal crown preparations on a stone cast.
• A pre-preparation matrix is then filled with poly-methyl
methacrylate and placed over the preparations.
• The trimmed and adjusted provisional crowns are again
relined in the mouth.

matrices
• Matrices closely duplicate the external form of satisfactory
existing teeth, or, if changes are required, a diagnostic
wax up.
3 main types of matrix:
 Impression
 Vacuum formed thermoplastic
 Proprietary celluloid

ProPrietary celluloid matrix
• Can be used if only a single provisional crown is to be
formed using light cured resin.
• After tooth preparation, a thin smear of petroleum jelly is
placed over the reduced tooth and adjacent teeth.
• The matrix is blown dry and the mixed resin is syringed
into the deepest part of the appropriate tooth recess.
• After reseating, the matrix is left until the resin reaches a
rubbery stage on light curing
• It is removed and interproximal excess removed
• Crowns are trimmed, polished and cemented 63www.indiandentalacademy.com

imPression matrices
ALGINATE
• Best at absorbing the
resin exotherm
ELASTOMER
• Reusable,
• Can be stored in case they are
required again.
• Ease of handling
• long-term stability.
• Flexible
• Good flow
• Affinity, Aquasil, TempSpan
clear matrix, Star VPS clearbite
• QUICK, EASY AND INEXPENSIVE,
• DIRECT OR INDIRECT
Int J Prosthodont 1990;3:
299-304.

Utility wax placed in defect Overimpression made
Thin edges of gingival margin
trimmed away
Alginate impression of
prepared teeth
Overimpression fabricated provisional crown

Untrimmed plaster cast Trimmed cast Cast with overimpression
Separating media applied Acrylic mixing Pouring of material into
impression

Plaster cast secured
with impression
Crown removed from
cast cast
Plaster removed from
inside
Extra resin removed and smoothened with
sand paper disc
Intraoral occlusal
adjustment done

Overimpression fabricated
Bis-acryl composite crown
Putty overimpression made Gingival margins trimmed
Putty index loaded with mixed Bis-acryl68www.indiandentalacademy.com

Vacuum formed matrices
• Made of clear vinyl sheet produced on a stone duplicate
of the waxed up cast.
• Flexible and can distort when seated, especially if there
are few or no adjacent teeth to aid location
• Indispensable for moulding light cured resins.

Template fabricated provisional crown
Denture tooth placed Putty adapted around
the arch
Thermoplastic sheet
adapted
Excess removed with
scalpel
Alternative method of adapting 70www.indiandentalacademy.com

Sheet adapted over cast Putty mold forcefully seated
Silicon putty removed Excess trimmed

Template can be
reinforced with putty
Template filled with resin & seated over cast
Putty index placed
Light polymerizing unit

direct syringing
• When no shell temporary can be found to fit and, no
matrix is available
• Poly-ethyl methacrylate materials are best as they can
be mixed to sufficient viscosity not to slump but are still
capable of being syringed.---- ‘Shear thinning’
• Start at the finish line and spiral the material up the axial
walls.

indirect proVisionals
ADVANTAGES
• Materials which are stronger and more durable can be
used e.g. heat cured acrylic or self cured acrylic cured in
a hydroflask.
• If aesthetic or occlusal changes are to be made these
can be developed on an articulator.
• Can certainly save clinical time, especially with multiple
restorations and most particularly where there is to be an
increase in vertical dimension ( Bruxers).
• No direct contact of tissues with monomer.
• No thermal injury to tissues and pulp.

• Crispin et al ---- Evaluated marginal accuracy with
direct and indirect techniques.
• They reported that indirect fabrication provided
significant improvements in marginal fit relative to direct
methods when methyl and vinyl ethyl methacrylate
resins are used. They demonstrated that the marginal fit
of Polymethyl methacrylate restorations could be
improved by up to 70% with an indirect technique.

Lubrication
• Never use a petroleum jelly lubricant on the teeth,
petroleum-based products are almost impossible to
remove.
• The remnants can lead to premature loss of the
temporary, and can affect final bond or cementation
strength.
• If the dental assistant wants to use a lubricant, a water-
soluble lubricant is recommended.
Contemporary Dental Assisting.
2007;Nov/Dec:34-39. 76www.indiandentalacademy.com

PROVISIONAL RESTORATION OF ADHESIVE
PREPARATIONS
• Lack of conventional retention provided by most adhesive
preparations results in temporary cements being ineffective.
1. No temporary coverage ---- e.g. with veneer preparations
involving minimal dentine exposure and not removing
intercuspal or proximal contacts.
2. A simple coat of zinc phosphate cement to protect exposed
dentine e.g. in tooth preparations which are not aesthetically
critical and where the occlusion is either not involved.
3. Composite resin bonded to a spot etched on the preparation
e.g. veneer preparations

4. Composite resin bonded to the opposing tooth to
maintain occlusal contact and prevent over-eruption
5. Conventional provisional restorations cemented with
either a non-eugenol temporary cement or a hard
cement such as zinc carboxylate.
Effective only in the short -term.

• Standard poly-carbonate
crown by placing a piece
of paper clip or other stiff
wire into the canal and
placing the resin-filled
crown over that.
POST-AND CORE
PROVISIONAL
RESTORATIONS

influence of material
properties on treatment
outcome

1. Marginal accuracy
• Assists in protecting the pulp from thermal, bacterial,
and chemical insults.
• Autopolymerizing acrylic resin provisional restorations –
lack of adequate marginal adaptation, can be improved
with relining.
• Barghi and Simmons ---- because of hydraulic
pressure, 80% of restorations did not fully reseat after
the reline procedure.
• Improved marginal accuracy of PMMA ---- when a
shoulder ﬁnish line was used as compared with a
chamfer marginal design. ( not applicable to Bis-acryl)
• Light-polymerized materials better marginal accuracy
relative to autopolymerizing PMMA resin.

Koumjian and Holmes ----
Examined a variety of resinous provisional materials and
reported that they “All demonstrated continued
polymerization shrinkage after storage in air for 1 week.
When stored in water for 1week, water absorption
compensated for polymerization shrinkage in all of the
materials except for polyvinylethyl methacrylate and Bis-
acryl materials.

2. Color stability ---- Discoloration of provisional
materials can produce serious esthetic complications.
• Modern provisional materials use stabilizers that
decrease chemically induced color changes .
 Absorption & adsorption of liquids ( coffee, tea)
 Porosity and surface roughness
 Oral hygiene habits,
Crispin and Caputo ---- Found that methyl
methacrylate materials exhibited the least darkening,
followed by ethyl methacrylate and vinyl-ethyl
methacrylate materials.
Yannikakis et al ---- Bis –acryl worst color stability

3. Gingival response
 Donaldson ----
(1)Presence of a provisional restoration lead to at least
some recession at about 80% of the free gingival
margin sites evaluated;
(2)Degree of recession was time dependant;
(3) Placement of the deﬁnitive treatment commonly lead
to gingival recovery;
(4) 10% of subjects demonstrated recession in excess of
1mm; and
(5) In the presence of gingival recession, only one third
of subjects demonstrated complete gingival recovery.
(6) Direct relation between the degree of pressure
applied by a provisional restoration and gingival
recession.
J Periodontol 1973;44:691-6. 84www.indiandentalacademy.com

4. Pulpal response
• Dental pulp inﬂammation can be caused by either thermal
or chemical insult resulting from materials used to produce
direct provisional restorations
• Tjan et al
 use of air and water coolants
 use of matrix material that can dissipate heat rapidly
(Alginate)
• Moulding and Teplitsky ---- “Temperature rise was
• Greatest with Polymethyl-methacrylate and vacuum
adapted templates.
• Least with Bis-acryl and relined resin shells.
• Intermediate temperature increases were recorded with
polyethylmethacrylate materials and either irreversible
hydrocolloid or polyvinylsiloxane impression materials
J Dent1979;7:22-4.
J Prosthet Dent 1989; 62:622-6.

5. Hypersensitivity
• Rare
• “ Autopolymerizing methacrylate materials have greater
potential for producing allergic contact stomatitis than
similar heat-polymerized materials.
• The residual monomer in the material has been
implicated as the causative factor ”
• Indirect material processing methods are recommended
• Unpolymerized monomer can be substantially removed
by placing an autopolymerized provisional restoration in
a pressure pot with warm water for 20 minutes
Oral Surg Oral Med Oral Pathol1976;41:631-7.

reinforcement of
proVisional restorations

Why to reinforce ??????
• Most resin materials brittle
• Repairing & replacing provisionals – concern for both
dentist and patients ---- additional cost and time
associated
• Failure often occurs suddenly and probably as a result of
a crack propagating from a surface ﬂaw. (because of
inadequate transverse strength, impact strength, or
fatigue resistance.)

1. Covey et al ---- Found that “oven heat treatments at
120°C for 7 minutes could significantly increase the
tensile strength for both chemical and light-polymerized
composite materials.”
2. Heat-polymerization of acrylic resin materials
3. Metal castings and swaged metal substructures in
combination with resin materials.
4. Chemical modification with grafted co-polymers and
stronger cross linkage
5. Inclusion of various organic and inorganic reinforcing
fibers (metal, glass, carbon graphite, sapphire, Kevlar,
polyester, and rigid polyethylene.(Most of these
materials have had little or no success in increasing
resin strength.)

• Powell et al compared Kevlar 49 polyaramid fiber with
stainless steel wire , found that wire configuration produced
a superior stiffness and toughness.
• Zuccari et al reported that when admixed zirconium oxide
powders were added to unfilled methylmethacrylate resin,
the resultant composite material exhibited significant
improvements in the modulus of elasticity, transverse
strength, toughness, and hardness
• Chee et al ---- Chilled monomer reduces transverse
strength of autopolymerizing acrylic resin by 17%
Int J Prosthodont 1994;7:81-9.
Biomed Mater Eng 1997;7:327-43.

Hazelton and Brudvik ---- reported the beneﬁts of
stainless steel orthodontic band material adapted around
abutment teeth, removed, welded, and ﬁtted inside
acrylic resin shell crowns to reinforce autopolymerizing
acrylic resin materials.

proVisionaliZation in
implant dentistry

• A provisional restoration in combination with an implant
retained definitive restoration provides many of the same
benefits derived when treating teeth retained fixed
restorations.
• Implant-retained treatment can require an extended period of
time and provisional treatment can present a challenge.
• Can vary widely, ranging from a removable acrylic resin
complete denture to an implant supported fixed prosthesis
with several different potential designs that promote esthetics,
convenience, the loading of implants, tissue contour control,
material strength, and interim prosthesis durability
• When treating a partially edentulous patient, acceptance of a
removable interim prosthesis may be objectionable. 95www.indiandentalacademy.com

Factors affecting selection of
treatment options
(1) The number, position or location of the implants
(2) The number of natural teeth remaining in a treatment arch
(3) Opposing occlusion
(4) Whether teeth adjacent to the implant site(s) can act as a
abutment teeth for a provisional restoration
(5) Desired protocol for provisional treatment at either first or
second-stage surgery.

• A reduction of micro-movement of an implant due to the
potential stability obtained from adjacent teeth as well as
a rigid implant connection when treating both partially
and completely edentulous patients may lead to
successes when providing provisional treatment at ﬁrst-
stage surgery

Single-tooth, implant provisional treatment
• Depending on the location of an implant, an interim
prosthesis may or may not be necessary.
• Kupeyan and May
• Brånemark healing abutments modified in the laboratory
before the surgical date.
• Acrylic resin copings fabricated to fit the modified healing
abutments
• A provisional crown was fabricated from either a
polycarboxylate material or a polystyrene preformed
provisional shell
• After surgical implant placement, resin coping fitted to
the modified implant healing abutment
• The crown united to the coping with a small amount of
autopolymerizing resin. 98www.indiandentalacademy.com

Single-tooth, implant provisional treatment
• Proussaefs and Lozada.
• Preparatory phase ----
(1)Diagnostic casts;
(2) Diagnostic waxing
(3) Duplication of the diagnostic waxing with an
impression
(4) Generation of a gypsum cast
(5) A vacuum formed matrix

TECHNIQUE
• A light-polymerized acrylic resin template fabricated on
the duplicate cast {used as a surgical guide}
• Implant analogs attached to the surgical guide at
registered locations with acrylic resin
• Diagnostic cast modified to accommodate implant
analogs and were incorporated into the cast with acrylic
resin.
• A “temporary” hexed abutment was placed on the
implant analog and, after verifying the appropriate
occlusal height and position of the abutment with a clear
vacuum formed matrix, a screw-retained provisional was
fabricated with the matrix and autopolymerizing acrylic
resin

Provisional treatment at first-stage surgery:
partially edentulous and edentulous cases
• Horiuchi et al
• Heat-polymerized acrylic resin provisional restorations
were fabricated and reinforced with chromium-cobalt
castings.
• At the time of stage-1 surgery, implants were
immediately loaded and abutments were incorporated
within the provisional restoration using “temporary”
cylinders
 Rigid fixation
 use of a metal-reinforced, passively fitting provisional
restoration 101www.indiandentalacademy.com

• Balshi and Wolfinger
• Four widely distributed implants placed that were
immediately loaded with an interim fixed, implant-
retained prosthesis at first-stage surgery.
• The authors used additional implants in a conventional
manner to provide sufficient support for a definitive fixed
prosthesis, even if all the immediately loaded implants
failed.
• Schnitmann et al.
• Converted a previously fabricated complete denture into
a fixed-retained provisional partial denture by
incorporating gold cylinders in the complete denture with
autopolymerizing acrylic resin.
• Recontoured into a fixed partial denture by removal of
the flanges and reduction of the distal extension 102www.indiandentalacademy.com

• Balshi and Wolfinger
• Described the “conversion prosthesis,” one that at second-stage
surgery was converted from a complete denture to a fixed, interim
prosthesis.
• The technique involved incorporation of modified screw-retained
impression copings within a wire-reinforced complete denture.
Advantages
(1) a fixed prosthesis with improved function, stability, and
distribution of load was provided immediately following second
stage surgery;
(2) the prosthesis protected the mucosa;
(3) it served as a prototype for a definitive prosthesis;
(4) the original vertical dimension of occlusion was preserved;
(5) the provisional restoration aided in obtaining and transferring
interocclusal records;
(6) it assisted long-term patient maintenance and reduced the
number of treatment visits.

• Zinner et al presented RBFPD techniques
• Dumbrigue et al
• Described options for fabrication of provisional
restorations for an ITI solid abutment
 By using an ITI plastic (burn-out) coping,
 Fabrication of an acrylic resin coping on a brass ITI
practice solid abutment,
 With the ITI impression cap where the solid abutment act
as a core,
 Fabrication a provisional restoration with the ITI
cementable Protictiv Cap

• Stefan Holst and Priv-Doz ---- studied The effect of
provisional restoration material type on micromovement
of implants
• Concluded that : “The choice of material used for a
provisional restoration significantly influences the vertical
displacement of implants placed in artificial bone. When
loads are applied to distal cantilevers, load distribution
with metal reinforcement seems more favorable than
with unreinforced acrylic resin.”
J Prosthet Dent 2008;100:173-182

• S. Banerji , A. Sethi studied clinical performance of
Rochette bridges used as immediate provisional
restorations for single unit implants.
• Conclusion : “ This type of restoration is an effective
means of immediate temporization for patients
undergoing single tooth implant retained restorations.”
BRITISH DENTAL JOURNAL 2005; 199(12) : 771-75

CAD- CAM,CT Imaging & Immediate
provisionalization
• A working master model of the soft tissue anatomy can
be generated stereolithographically from the computer
data. This model incorporates detail of implant
orientations allowing construction of surgical stent and
temporary immediate load prosthesis.
• CT denture can be seated accurately onto the master
model to provide an index and occlusal guide for tooth
positions during the construction of an accurate
temporary immediate load prosthesis which is built
around known implant positions and axes.
British Dental Journal 2008; 204: 377-381107www.indiandentalacademy.com

LIMITATIONS OF TEMPORIZATION
 Lack of Inherent Strength
 Poor Marginal Adaptation
 Color Instability
 Poor Wear Properties
 Detectable Odor Emission
 Inadequate Bonding Characteristics
 Poor Tissue Response to Irritation
 Arduous Cement Removal
 Time Expenditure for Fabrication Can be Prohibitive

TROUBLE – SHOOTING IN
PROVISIONALIZATION

INSUFFICIENT BULK OF MATERIAL
• Axial walls --- e.g. preparations for gold crowns
• To prevent damage, the provisional should be made
temporarily wider by relieving the appropriate part of the
impression with a large excavator

GROSS OCCLUSAL ERRORS, AIR BLOWS AND
VOIDS
• May occur for two reasons:
1. Fins of interproximal impression material being displaced
and sandwiched between the impression and the
occlusal surface — trim away any suspect areas from
the inside of the impression with a scalpel or scissors
before reseating
2. Hydrostatic pressure built up within the unset resin
during reseating of the impression matrix — consider
cutting escape vents cut from the crown margin to the
periphery of the impression with a large excavator.
3. Avoid voids by syringing material directly onto
preparations. ensuring the tip is always in the resin, to
prevent the incorporation of air. 111www.indiandentalacademy.com

LOCKING IN OF PROVISIONAL RESTORATIONS
• By material engaging the undercuts formed by the
proximal surfaces of adjacent teeth.
------- Cut out a triangular wedge of material from the
gingival embrasure space with a half Hollenbeck
instrument

MARGINAL DISCREPANCIES
• Can occur due to polymerization shrinkage.
--------- flare out the inside of the crown margin with a bur.
This provides a greater bulk of reline material.
• To facilitate seating it is best not to fill the whole crown
with resin, but to confine the reline material to the inner
aspect of the crown margin, thus reducing hydrostatic
pressure.

MULTIPLE CROWNS
• Invariably results in all the restorations being joined
together as material passes through the thin and often
torn interproximal area ----- Splinting teeth has the
advantage of preventing drift in case of poor
interproximal and occlusal contacts.
• Ideally, provisional crowns should be separate, but
separation can result in unwanted gaps between them.
------- One way of overcoming this is to place small
pieces of celluloid strip, roughly 1cm long, between the
teeth to be prepared. Holes punched in their buccal and
lingual portions.

PREMATURE DECEMENTATION
• Can be largely avoided by ensuring harmony with the
occlusion.
EUGENOL CONTAINING TEMPORARY CEMENTS
AND ADHESION
• Eugenol-containing cements should be avoided where it is
intended to cement the definitive restoration to an underlying
composite core

REMOVING TEMPORARY CROWNS
1. when impressions are taken,
2. Certain adjustments are needed,
3. Definitive restorations need cementing.
 To make removal easier, the cement should be applied
in a ring around the inner aspect of the margin.
 Alternatively, the manufacturer’s modifier should be
added to the cement

REMOVAL OF EXCESS CEMENT
• Facilitated by pre-applying petroleum jelly to the outside
of the restorations and placing floss under each
connector of linked crowns before seating

REMOVAL OF PROVISIONAL CEMENT FROM
INTAGLIO SURFACE OF CASTINGS
• Intaglio surfaces of cast restorations may be airborne-
particle abraded using 50-mm aluminum oxide
• Alternative methods ---- steam cleaning, ultrasonic, and
organic solvents. [ alcohol (ethanol),soap, chloroform,
and eucalyptus oil , Solitine ( containing isoparaffin
hydrocarbon oil & lanolin ]

Provisionalization of a tooth with short
crown height
• In these cases, adequate retention can
only be possible with a good grip on the
root surface.
• Copper-band temporary can grip the
root for adequate retention and be
fabricated thin enough to promote
periodontal health.
• Copper has amazing antimicrobial
properties, a factor that also might assist
in preventing recurrent decay.
• A thin, snug-fitting margin whether
copper is readily accepted by the
peridontium. NYSDJ • 2010 : 22-26 119www.indiandentalacademy.com

RECENT ADVANCES IN
PROVISIONALIZATION

Protemp™ Crowns (3M ESPE)
• A Bis-GMA light-cured
composite
• Come in single units,
• Adaptable,
• Have a single shade only,
• Have good wear resistance
• Good polishability,
• But because of their single
shade are somewhat limited
unless one is prepared to
custom stain

Luxatemp Ultra
• Incorporating proprietary nano
technology
• Luxatemp Ultra surpasses all
leading provisional materials
in flexural strength
• The key to provisional
stability and long-term
durability, especially with
multi-unit temporaries.
• Luxatemp Ultra delivers
improved initial hardness and
superior break resistance.

VISIBLE LIGHT CURED RESINS
• Many clear composites,
glazes, or lighter composite
shades may not use a
camphorquinone
photocatalyst because it
imparts a yellowish or
orange hue,
• Here it is critical to use a
broad-spectrum light like the
VALO™ (Ultradent
Products) or bluephase®
20i
(Ivoclar Vivadent) that cures
all photo-initiators and
composites 123www.indiandentalacademy.com

Cling 2 provisional cement
• A resin-optimized non-eugenol
temporary cement with a unique
polycarboxylate resin
• This optimizes adhesion,
• Soothes the tooth,
• Bacteriostatic, and
• Provides an excellent seal to
promote tissue health.

MATERIALS FOR MAKING
OVERIMPRESSION
• Polyvinyl substitutes for alginate,
 CounterFIT™ (Clinician’s Choice)
 Position™
 Penta™ Quick (3M ESPE)
 AlgiNot®
(Kerr Corporation)
 StatusBlue®
(DMG America)
 Silgimix™ (Sultan Healthcare) can be used as a matrix
in an impression tray.
• Essentially low-cost polyvinyl siloxanes
• Have good flow,
• Excellent detail reproduction,
• Ability to be re-used because of their long-term stability.125www.indiandentalacademy.com

Trays for making overimpression
• President Tray (Coltene/Whaledent )
• Spacer Trays (GC America).
• The metal TempTray™ (Clinician’s Choice)
 Designed to be a customizable,
 Distortion-free, and
 Disposable temporary tray.
• When used as a posterior matrix tray, the handle that is facing
the retro-molar area is bent over on top of the tray so as not to
impinge on the tissue,
• The anterior is bent at a 45° angle to facilitate insertion,
providing a convenient handle.
• When used anteriorly, the lingual wall is bent slightly toward
the palate and both ends are bent at 45° angles to provide a
handle on both ends.

How to take care of
undercuts??????
• OraSeal®
Putty or OraSeal®
Caulking
(Ultradent Products)
• A cellulose material that sticks to wet teeth,
• Easily placed into the undercuts, and can be
simply shaped with a plastic instrument to
eliminate the undercut.
• This makes removal of the temporary much
more predictable. It does not harden and
can be removed with a plastic instrument
and water after the temporary is fabricated.

CAD-CAM Generated Provisionals
• Can be milled out of the blocks of temporary restorative
materials.
• Telio CAD (Ivoclar Vivadent),
artBloc®Temp (Merz), VITA CAD-Temp®
monoColor (VITA)
• Telio CAD is a block made of
polymethyl methacrylate (PMMA) and is used to mill both
full-contour single-tooth and multiple-unit temporary
restorations using CAD/CAM technology.
• Enables restorations to be milled both in the laboratory
(labside) and the dental practice (chairside).
• Additional layering materials and stains can be used to
enhance the esthetic appearance

CAD-CAM Generated Provisionals
• Alt V, Hannig M, Wostmann B
• STUDY: Fracture strength of temporary fixed partial
dentures: CAD/CAM versus directly fabricated restorations.
• CONCLUSION : CAD/CAM fabricated FPDs exhibit a higher
mechanical strength compared to directly fabricated FPDs,
when manufactured of the same material. Composite based
materials seem to offer clear advantages versus PMMA
based materials and should, therefore, be considered for
CAD/CAM fabricated temporary restorations.
DENTAL MATER 2011 Apr;27(4):339-47.

CONCLUSION
• Quality restorative dentistry needs quality provisional
restorations for predictable results.
• Dentists therefore need to be familiar with the range of
materials and techniques for short term, medium-term
and long-term temporization.
• Forethought and planning are also needed to ensure the
most appropriate provisional is used, especially when
multiple teeth are to be prepared or where occlusal or
aesthetic changes are envisaged.

REFERENCES
• Fundamentals of tooth preparations for cast metal and
porcelain restorations : H. T. Shillinburg
/Jacobi/Brackett
• Contemporary fixed prosthodontics : S F
Rosensteil/M. F. Land /Junhei Fujimoto
• Tylman’s theory and practice of fixed prosthodontics
• J Prosthet Dent 2003;90:474-97
• Br Dent J 1974;137:233-8
• British Dental Journal 2002; 192:619–630
• Int J Prosthodont 1990;3: 299-304
• J Prosthet Dent 1980;44:283-90 131www.indiandentalacademy.com

REFERENCES
• Contemporary Dental Assisting. 2007;Nov/Dec:34-39
• J Prosthet Dent 1998;80:533-9.
• J Periodontology 1973;44:691-6.
• J Prosthet Dent 1989; 62:622-6
• J Dent1979;7:22-4
• Oral Surg Oral Med Oral Pathol1976;41:631-7
• Int J Prosthodont 1994;7:81-9
• Biomed Mater Eng 1997;7:327-43
• J Prosthet Dent 1995;74:110-3 132www.indiandentalacademy.com

REFERENCES
• BDJ 2005; 199(12) : 771-75
• BDJ 2008; 204: 377-381
• J Prosthet Dent 2008;100:173-182
• NYSDJ 2010 : 22-26
• DENTAL MATER 2011 Apr;27(4):339-47
• Internet sources
• Inside Dentistry 2008;4(5)
• Compendium continued dental education

www.indiandentalacademy.com 134

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