Provisionals in fpd.pptx

Provisional Restoration in fixed dental
prosthesis
Presented by
Dr. Shruti khot
II -MDS
1
Contents
Introduction
Ideal requirement of provisional restoration
Functions of provisional restoration
Classification
Techniques of fabrication of prosthesis
Recent advances
Cementation of provisional prosthesis
Conclusion
References
2
Introduction
Provisionalization : -
To establish esthetics, occlusal stability, and function for a limited time in
preparation for the definitive prosthesis; to verify therapeutic outcome and patient
acceptance before the definitive prostheses.
(GPT - 9 )
3
SYNONYMS
Provisional restoration,
 Treatment restoration (Temporization),
 Interim prosthesis,
 Provisional prosthesis.
4
Rationale
(Modified by Federick and Krug)
• Protect pulpal tissue and sedate prepared abutments
• Protect teeth from dental caries
• Provide comfort and function Evaluate parallelism of abutments
• Provide method for immediately replacing missing teeth
• Prevent migration of abutments Improve esthetics
• Provide an environment conductive to periodontal health
• Evaluate and reinforce the patient’s oral home care
5
• Assist with periodontal therapy by providing visibility and access to
surgical sites when removed.
• Aid in developing and evaluating an occlusal scheme before definitive
treatment.
• Allow evaluation of vertical dimension, phonetics, and masticatory
function.
• Assist in determining the prognosis of questionable abutments during
prosthodontic treatment planning
6
Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional
fixed prosthodontic treatment: J Prosthet Dent. 2003
Ideal requirement of provisional restoration
Biologic
Pulp protection
Periodontal health
Positional stability
Prevention of
fracture
Esthetics
Colour
compatibility
Translucency
Colour stability
Mechanical
Function
Loss of retention
Removal of
reuse
7
 PULP PROTECTION: During tooth preparation
the dentinal tubules are exposed. Thus
provisional restoration should protect the
prepared tooth from oral environment, thereby
preventing sensitivity and irritation to pulp.
 PERIODONTAL HEALTH: It should have good
marginal fit, proper contour and smooth
surface to prevent accumulation of plaque,
facilitate easy plaque removal and maintain
periodontal health.
8
 POSITIONAL STABILITY: It should
provide a comfortable, stable, and
functional occlusal relationship by
maintaining interarch and intra-arch
stability thereby preventing tooth
migration , supraeruption.
 PREVENTION OF FRACTURE: It should
protect the prepared tooth surface
from fracture which is commonly seen
in partial coverage restoration, in
which margin of preparation is close
to the occlusal surface of tooth and
could be damaged during chewing.
9
FUNCTIONAL: It should possess good
compressive and flexural strength.
The strength of material used for
fabricating provisional restoration is
always much lower than that of the
definitive restoration material. The
greatest stresses in a provisional
restoration occur during chewing..
 LOSS OF RETENTION: It should have
close adaptation to the prepared tooth
surface to prevent displacement and
recementation, which will increase
patient visits.
10
Functions of Provisional restoration
1. Protect Pulpal tissue and sedate prepared abutments
2. Provide an environment conductive to periodontal health
3. Provide method for immediately replacing missing teeth, prevent migration of
abutments and opposing teeth
4. Protects the pulp from thermal and chemical insults after crown preparation and
enamel removal.
5. It serves to maintain gingival health and contour while providing for an esthetic
and/or functional interim restoration .
6. Protect teeth from dental caries
7. Ensure marginal seal
Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6.
11
Classification of provisional restoration
Method of
fabrication
Type of material
used
Duration of use
Technique for
fabrication
J Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-58 12
Method of fabrication
Advantages Disadvantages
Custom made • Minimum interference
• Wide variety of material can
be used
• Evaluation of tooth reduction
can be done
• Additional lab procedure
• Time consuming
Preformed • Less time consuming • Rarely satisfies the
requirement of contours
• Generally limited to single
tooth restoration
13
Preform Provisional Restoration
Resin
Metal
Polycarbonate crown Cellulose acetate
Nickel cromium Aluminum
Polycarbonate crown Cellulose acetate
14
Type of material used
Resin based • Cellulose acetate
• Polycarbonate
• PMMA : chemically activated
• Micro- filled composite : BISGMA
• Poly-R-methacrylate
• UDMA : light cured resin
Metal • Aluminum
• Nickel- chromium
• Tin-silver
J Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-58 15
Materials use for interim fixed restoration
• PMMA Resin
• Microfilled composite Resin
• Light Polymerised Resin
16
Types Commercially
available
Advantages Disadvantages
Poly methyl
methacrylate
Jet (Lang), Alike
(GC America),
Temporary
Bridge Resin
(Dentsply/Caulk)
, Neopar
(SDS/Kerr),
and Duralay
(Reliance)
low cost, good wear
resistance, good esthetics,
high
polishability, good color
stability w
exothermic reaction, high
degree of shrinkage (about
8%) objectionable odor, short
working time, hard to
repair and radiolucent
Bis-Acryl
Composites
Protemp,coolte
mp,Luxatemp
shrink less, give off less heat
during setting, and can be
polished at chair side.
Greater cost than acrylic
Viscosity cannot be altered
More brittle than acrylate
17
Polymethyl methacrylate resins
Poly R Methacrylate Micro filled composite resin
with automix delivery system
Photo polymerized polymethyl
methacrylate 18
Ideal properties of materials use for interim
restoration
• Conventional handling – Adequate working time,easy molding, rappid
setting time.
• Biocompatibility – Non toxic, Non allergic, Non exothermic.
• Dimensional stability during solidification.
• Ease of contouring and polishing.
• Adequate strength and abrasion resistance
• Ease of repairing
• Chemical compatible with interim luting agents.
19
Basic clinical armamentarium
• Gloves
• Mask
• Mouth mirror
• Periodontal probe
• Saliva ejaculator
• Cotton rolls
• Petrolatum
• Autoplymerizing resin
• Dropper
• Dappen dishes
• Cement spatula
• Straight slow speed hand piece
• Carborondum disc with mandrels
• Tungsten carbide burs
• Fine garnet paper disc (7/8- Inch
diameter)
• Muslin wheels
• Robinson bristle brush
20
Direct
technique
Indirect
technique
Indirect direct
technique
Regish KM, Sharma D, Prithviraj DR. technique of fabrication of provisional restoration: An overview. International journal of dentistry. 2011;2011:1-5.
21
22
23
24
Post and core interim restoration
Wire is marked so that bend is
made correct level
180 degree or greater bend in the wire is made to
resist displacement
Wire is inserted into post place
Filled external surface form is
seated
Completed interim post
and crown restoration
30
cooltemp Perfect temp Luxatemp
Tuff temp Protemp
31
Recent Advances
32
Temp Tabs Thermoplastic Matrix Wafers
Matrix for fabrication of
provisionals Quick Bite Registration
Temp Tabs® Natural and True Blue flexible multiuse
thermoplastic matrix tabs
33
Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR.
2018;2(6):1-6.
PROTEMP CROWN
Adapting protemp
crown to the buccal
margins
Light cure buccal
surface for 3 seconds
Margins are trimmed
Protemp crown is
cemented
34
Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR.
2018;2(6):1-6.
LUXATEMP
Trimming and polishing kit
Luxatemp provisional restorative material
Prepared teeth Impression making Putty index
Finished and polished restoration Luxatemp poured into putty index
Provisional restoration in place
Mirazi B. Temporary restoration : the key to success. British dental journal. 2019;226(10):761-68. 35
TUFF-TEMP PLUS
CAD-CAM PMMA Provisionals
Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR.
2018;2(6):1-6.
36
Cementation of Provisional restoration
• IDEAL PROPERTIES OF CEMENT:
• Ability to seal against leakage of oral fluid.
• Strength consist with intentional removal.
• Low solubility.
• Chemical compatibility with provisional polymer. Ease of eliminating excess.
• Adequate working time and short setting time.
• CEMENTS USED:
• Zinc oxide eugenol.
• Reinforced zinc oxide eugenol.
• Non- eugenol cements.
• Zinc phosphate, Zinc polycarboxylate, and Glass ionomer cements are not used
because their comparatively high strength makes intentional removal difficult.
37
• Eugenol based cements provide sedative effects that reduce dentin
hypersensitivity and possess antibacterial properties.
• Unfortunately, free radical production necessary for polymerization
of methacrylate materials can be significantly hampered by the
presence of eugenol found in eugenol based provisional luting
materials.
• This can interfere with the acrylic resin polymerization and hardening
process.
38
Lui JL, Setcos JC. Phillips RW. Temporary restorations: a review. Oper Dent 1986;11:103-
10
Removal of excess
cement
Removal of excess
cement
Removing
interproximal excess
cement
Application of Vaseline Placement of luting
agent
Cementation of provisional restoration
39
Removal, Repair, Re-cementation of
provisional restoration
Removal of provisional restoration
Repair of provisional restoration using bead brush technique
Rosenstiel, Land, Fujimoto. Contemporary Fixed Prosthodontics, 4th edition.
40
Limitation of provisional restoration
• Lack of inherent strength
• Poor marginal adaptation
• Color stability
• Poor wear properties
• Detectable odour emission
• Inadequate bonding characteristics
• Poor tissue response to irritation
J Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical
sciences.2019;18(4):55-58
41
INFLUENCE OF MATERIAL PROPERTIES ON
TREATMENT OUTCOME
• Marginal accuracy
• Colour stability
• Gingival response
• Pulpal response
42
Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed
prosthodontic treatment: report of the Committee on Research in Fixed Prosthodontics of the Academy of Fixed
Prosthodontics. J Prosthet Dent. 2003 Nov;90(5):474-97.
43
• Barghi and Simmons
• Indicated that autopolymerizing
acrylic resin provisional restorations
routinely did not have adequate
marginal adaptation.
• The accuracy could be significantly
improved by relining the restoration
after the initial polymerization.
Barghi N, Simmons EW Jr. The marginal integrity of the temporary acrylic resin crown. J Prosthet Dent 1976;36:274-7
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.
44
•
Crispin BJ, Caputo AA. Color stability of temporary restorative materials. J Prosthet Dent 1979;42:27-33.
Yannikakis SA, Zissis AJ, Polyzois GL, Caroni C. Color stability of provisional resin restorative materials. J Prosthet Dent
Crispin and Caputo
• Studied the colour
stability of provisional
materials. They found
that methyl
methacrylate materials
exhibited the least
darkening, followed by
ethyl methacrylate
• Yannikakis et al
• Immersed provisional materials in
various staining solutions for up to
1 month. They reported that all
materials showed perceptible
color changes after 1 week. After
1 month, the methyl methacrylate
materials exhibited the best color
stability than bis-acryl materials .
45
Donaldson D. The etiology of gingival recession associated with temporary crowns. J Periodontol 1974;45:468-71
• Indicated that the occurrence
of gingival recession before
provisional treatment was
directly linked to further
recession observed after the
completion of definitive
prosthodontic treatment.
• He also found a direct relation
between the degree of
pressure applied by a
provisional restoration and
gingival recession. An
anatomically contoured
provisional restoration caused
less recession than did a non
atomically contoured one
CLINICAL CONSIDERATION FOR PROVISIONAL
TREATMENT ENVOLVING NATURAL TEETH
• Occlusal diagnostic and treatment
• Esthetics phonetics diagnosis
• Periodontal treatment
• Provisional fixed prosthesis fabrication
• - Adaption on prepared tooth
• -cavosurface adaptation
• - form – cervical concavities and proper emergence properties
46
CLINICAL CONSIDERATION FOR PROVISIONAL
TREATMENT INVOLVING DENTAL IMPLANTS
Treatment protocol Clinical conditions
No interim prosthesis required Esthetics not a concern to a patient Implants placed in posterior
region
Removable interim prosthesis Before first-stage surgery; eliminated
after first-stage surgery with implant
supported provisional
Before or just after first stage
surgery, maintained until
completion of definitive
treatment
Fixed interim prosthesis Resin bonded using clinical crown of
extracted tooth or denture tooth
• Resin bonded pontic prosthesis
Fixed implant retained provisional
placed after second-stage
surgery/no removable prosthesis
Provisional placed at or shortly after
first stage surgery implant retained
Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed
prosthodontic treatment: J Prosthet Dent. 2003
conclusion
• Provisional restorations are usually planned for short-term use and
then discarded.
• They should provide pleasing esthetics, adequate support, and good
protection for teeth.
• They should be selected carefully for clinical applications preserving
periodontal health.
• Proper planning is needed to ensure the most suitable provisional is
used, especially when multiple teeth are to be prepared. Therefore
dentists should be familiar with the techniques and range of materials
available.
48
Take home points
• Provisional restoration is given for a period of time until permanent
arrangement can be made.
• Ideal requirements – Biologic,Mechanical,esthetics
• Techniques for fabrication of provisional restoration –
• Direct technique , indirect technique, direct indirect technique
• Recent advances – protemp crown , tuff temp plus,temp tabs, CAD
CAM PMMA provisionals
49
References
• Rosenstiel, Land, Fujimoto. Contemporary Fixed Prosthodontics, 4th edition.
• Regish KM, Sharma D, Prithviraj DR. technique of fabrication of provisional restoration: An overview.
International journal of dentistry. 2011;2011:1-5.
• Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR.
2018;2(6):1-6.
• Barghi N, Simmons EW Jr. The marginal integrity of the temporary acrylic resin crown. J Prosthet Dent
1976;36:274-7
• Donaldson D. The etiology of gingival recession associated with temporary crowns. J Periodontol
1974;45:468-71
• Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical
sciences.2019;18(4):55-5
• 8Crispin BJ, Caputo AA. Color stability of temporary restorative materials. J Prosthet Dent 1979;42:27-
33.
• Yannikakis SA, Zissis AJ, Polyzois GL, Caroni C. Color stability of provisional resin restorative materials. J
Prosthet Dent 1998;80:533-9.
• Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed
prosthodontic treatment: J Prosthet Dent. 2003
50
THANK YOU
51
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Provisionals in fpd.pptx

  • 1. Provisional Restoration in fixed dental prosthesis Presented by Dr. Shruti khot II -MDS 1
  • 2. Contents Introduction Ideal requirement of provisional restoration Functions of provisional restoration Classification Techniques of fabrication of prosthesis Recent advances Cementation of provisional prosthesis Conclusion References 2
  • 3. Introduction Provisionalization : - To establish esthetics, occlusal stability, and function for a limited time in preparation for the definitive prosthesis; to verify therapeutic outcome and patient acceptance before the definitive prostheses. (GPT - 9 ) 3
  • 4. SYNONYMS Provisional restoration,  Treatment restoration (Temporization),  Interim prosthesis,  Provisional prosthesis. 4
  • 5. Rationale (Modified by Federick and Krug) • Protect pulpal tissue and sedate prepared abutments • Protect teeth from dental caries • Provide comfort and function Evaluate parallelism of abutments • Provide method for immediately replacing missing teeth • Prevent migration of abutments Improve esthetics • Provide an environment conductive to periodontal health • Evaluate and reinforce the patient’s oral home care 5
  • 6. • Assist with periodontal therapy by providing visibility and access to surgical sites when removed. • Aid in developing and evaluating an occlusal scheme before definitive treatment. • Allow evaluation of vertical dimension, phonetics, and masticatory function. • Assist in determining the prognosis of questionable abutments during prosthodontic treatment planning 6 Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: J Prosthet Dent. 2003
  • 7. Ideal requirement of provisional restoration Biologic Pulp protection Periodontal health Positional stability Prevention of fracture Esthetics Colour compatibility Translucency Colour stability Mechanical Function Loss of retention Removal of reuse 7
  • 8.  PULP PROTECTION: During tooth preparation the dentinal tubules are exposed. Thus provisional restoration should protect the prepared tooth from oral environment, thereby preventing sensitivity and irritation to pulp.  PERIODONTAL HEALTH: It should have good marginal fit, proper contour and smooth surface to prevent accumulation of plaque, facilitate easy plaque removal and maintain periodontal health. 8
  • 9.  POSITIONAL STABILITY: It should provide a comfortable, stable, and functional occlusal relationship by maintaining interarch and intra-arch stability thereby preventing tooth migration , supraeruption.  PREVENTION OF FRACTURE: It should protect the prepared tooth surface from fracture which is commonly seen in partial coverage restoration, in which margin of preparation is close to the occlusal surface of tooth and could be damaged during chewing. 9
  • 10. FUNCTIONAL: It should possess good compressive and flexural strength. The strength of material used for fabricating provisional restoration is always much lower than that of the definitive restoration material. The greatest stresses in a provisional restoration occur during chewing..  LOSS OF RETENTION: It should have close adaptation to the prepared tooth surface to prevent displacement and recementation, which will increase patient visits. 10
  • 11. Functions of Provisional restoration 1. Protect Pulpal tissue and sedate prepared abutments 2. Provide an environment conductive to periodontal health 3. Provide method for immediately replacing missing teeth, prevent migration of abutments and opposing teeth 4. Protects the pulp from thermal and chemical insults after crown preparation and enamel removal. 5. It serves to maintain gingival health and contour while providing for an esthetic and/or functional interim restoration . 6. Protect teeth from dental caries 7. Ensure marginal seal Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6. 11
  • 12. Classification of provisional restoration Method of fabrication Type of material used Duration of use Technique for fabrication J Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-58 12
  • 13. Method of fabrication Advantages Disadvantages Custom made • Minimum interference • Wide variety of material can be used • Evaluation of tooth reduction can be done • Additional lab procedure • Time consuming Preformed • Less time consuming • Rarely satisfies the requirement of contours • Generally limited to single tooth restoration 13
  • 14. Preform Provisional Restoration Resin Metal Polycarbonate crown Cellulose acetate Nickel cromium Aluminum Polycarbonate crown Cellulose acetate 14
  • 15. Type of material used Resin based • Cellulose acetate • Polycarbonate • PMMA : chemically activated • Micro- filled composite : BISGMA • Poly-R-methacrylate • UDMA : light cured resin Metal • Aluminum • Nickel- chromium • Tin-silver J Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-58 15
  • 16. Materials use for interim fixed restoration • PMMA Resin • Microfilled composite Resin • Light Polymerised Resin 16
  • 17. Types Commercially available Advantages Disadvantages Poly methyl methacrylate Jet (Lang), Alike (GC America), Temporary Bridge Resin (Dentsply/Caulk) , Neopar (SDS/Kerr), and Duralay (Reliance) low cost, good wear resistance, good esthetics, high polishability, good color stability w exothermic reaction, high degree of shrinkage (about 8%) objectionable odor, short working time, hard to repair and radiolucent Bis-Acryl Composites Protemp,coolte mp,Luxatemp shrink less, give off less heat during setting, and can be polished at chair side. Greater cost than acrylic Viscosity cannot be altered More brittle than acrylate 17
  • 18. Polymethyl methacrylate resins Poly R Methacrylate Micro filled composite resin with automix delivery system Photo polymerized polymethyl methacrylate 18
  • 19. Ideal properties of materials use for interim restoration • Conventional handling – Adequate working time,easy molding, rappid setting time. • Biocompatibility – Non toxic, Non allergic, Non exothermic. • Dimensional stability during solidification. • Ease of contouring and polishing. • Adequate strength and abrasion resistance • Ease of repairing • Chemical compatible with interim luting agents. 19
  • 20. Basic clinical armamentarium • Gloves • Mask • Mouth mirror • Periodontal probe • Saliva ejaculator • Cotton rolls • Petrolatum • Autoplymerizing resin • Dropper • Dappen dishes • Cement spatula • Straight slow speed hand piece • Carborondum disc with mandrels • Tungsten carbide burs • Fine garnet paper disc (7/8- Inch diameter) • Muslin wheels • Robinson bristle brush 20
  • 21. Direct technique Indirect technique Indirect direct technique Regish KM, Sharma D, Prithviraj DR. technique of fabrication of provisional restoration: An overview. International journal of dentistry. 2011;2011:1-5. 21
  • 22. 22
  • 23. 23
  • 24. 24
  • 25. Post and core interim restoration Wire is marked so that bend is made correct level 180 degree or greater bend in the wire is made to resist displacement Wire is inserted into post place Filled external surface form is seated Completed interim post and crown restoration 30
  • 26. cooltemp Perfect temp Luxatemp Tuff temp Protemp 31
  • 28. Temp Tabs Thermoplastic Matrix Wafers Matrix for fabrication of provisionals Quick Bite Registration Temp Tabs® Natural and True Blue flexible multiuse thermoplastic matrix tabs 33 Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6.
  • 29. PROTEMP CROWN Adapting protemp crown to the buccal margins Light cure buccal surface for 3 seconds Margins are trimmed Protemp crown is cemented 34 Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6.
  • 30. LUXATEMP Trimming and polishing kit Luxatemp provisional restorative material Prepared teeth Impression making Putty index Finished and polished restoration Luxatemp poured into putty index Provisional restoration in place Mirazi B. Temporary restoration : the key to success. British dental journal. 2019;226(10):761-68. 35
  • 31. TUFF-TEMP PLUS CAD-CAM PMMA Provisionals Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6. 36
  • 32. Cementation of Provisional restoration • IDEAL PROPERTIES OF CEMENT: • Ability to seal against leakage of oral fluid. • Strength consist with intentional removal. • Low solubility. • Chemical compatibility with provisional polymer. Ease of eliminating excess. • Adequate working time and short setting time. • CEMENTS USED: • Zinc oxide eugenol. • Reinforced zinc oxide eugenol. • Non- eugenol cements. • Zinc phosphate, Zinc polycarboxylate, and Glass ionomer cements are not used because their comparatively high strength makes intentional removal difficult. 37
  • 33. • Eugenol based cements provide sedative effects that reduce dentin hypersensitivity and possess antibacterial properties. • Unfortunately, free radical production necessary for polymerization of methacrylate materials can be significantly hampered by the presence of eugenol found in eugenol based provisional luting materials. • This can interfere with the acrylic resin polymerization and hardening process. 38 Lui JL, Setcos JC. Phillips RW. Temporary restorations: a review. Oper Dent 1986;11:103- 10
  • 34. Removal of excess cement Removal of excess cement Removing interproximal excess cement Application of Vaseline Placement of luting agent Cementation of provisional restoration 39
  • 35. Removal, Repair, Re-cementation of provisional restoration Removal of provisional restoration Repair of provisional restoration using bead brush technique Rosenstiel, Land, Fujimoto. Contemporary Fixed Prosthodontics, 4th edition. 40
  • 36. Limitation of provisional restoration • Lack of inherent strength • Poor marginal adaptation • Color stability • Poor wear properties • Detectable odour emission • Inadequate bonding characteristics • Poor tissue response to irritation J Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-58 41
  • 37. INFLUENCE OF MATERIAL PROPERTIES ON TREATMENT OUTCOME • Marginal accuracy • Colour stability • Gingival response • Pulpal response 42 Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: report of the Committee on Research in Fixed Prosthodontics of the Academy of Fixed Prosthodontics. J Prosthet Dent. 2003 Nov;90(5):474-97.
  • 38. 43 • Barghi and Simmons • Indicated that autopolymerizing acrylic resin provisional restorations routinely did not have adequate marginal adaptation. • The accuracy could be significantly improved by relining the restoration after the initial polymerization. Barghi N, Simmons EW Jr. The marginal integrity of the temporary acrylic resin crown. J Prosthet Dent 1976;36:274-7 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.
  • 39. 44 • Crispin BJ, Caputo AA. Color stability of temporary restorative materials. J Prosthet Dent 1979;42:27-33. Yannikakis SA, Zissis AJ, Polyzois GL, Caroni C. Color stability of provisional resin restorative materials. J Prosthet Dent Crispin and Caputo • Studied the colour stability of provisional materials. They found that methyl methacrylate materials exhibited the least darkening, followed by ethyl methacrylate • Yannikakis et al • Immersed provisional materials in various staining solutions for up to 1 month. They reported that all materials showed perceptible color changes after 1 week. After 1 month, the methyl methacrylate materials exhibited the best color stability than bis-acryl materials .
  • 40. 45 Donaldson D. The etiology of gingival recession associated with temporary crowns. J Periodontol 1974;45:468-71 • Indicated that the occurrence of gingival recession before provisional treatment was directly linked to further recession observed after the completion of definitive prosthodontic treatment. • He also found a direct relation between the degree of pressure applied by a provisional restoration and gingival recession. An anatomically contoured provisional restoration caused less recession than did a non atomically contoured one
  • 41. CLINICAL CONSIDERATION FOR PROVISIONAL TREATMENT ENVOLVING NATURAL TEETH • Occlusal diagnostic and treatment • Esthetics phonetics diagnosis • Periodontal treatment • Provisional fixed prosthesis fabrication • - Adaption on prepared tooth • -cavosurface adaptation • - form – cervical concavities and proper emergence properties 46
  • 42. CLINICAL CONSIDERATION FOR PROVISIONAL TREATMENT INVOLVING DENTAL IMPLANTS Treatment protocol Clinical conditions No interim prosthesis required Esthetics not a concern to a patient Implants placed in posterior region Removable interim prosthesis Before first-stage surgery; eliminated after first-stage surgery with implant supported provisional Before or just after first stage surgery, maintained until completion of definitive treatment Fixed interim prosthesis Resin bonded using clinical crown of extracted tooth or denture tooth • Resin bonded pontic prosthesis Fixed implant retained provisional placed after second-stage surgery/no removable prosthesis Provisional placed at or shortly after first stage surgery implant retained Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: J Prosthet Dent. 2003
  • 43. conclusion • Provisional restorations are usually planned for short-term use and then discarded. • They should provide pleasing esthetics, adequate support, and good protection for teeth. • They should be selected carefully for clinical applications preserving periodontal health. • Proper planning is needed to ensure the most suitable provisional is used, especially when multiple teeth are to be prepared. Therefore dentists should be familiar with the techniques and range of materials available. 48
  • 44. Take home points • Provisional restoration is given for a period of time until permanent arrangement can be made. • Ideal requirements – Biologic,Mechanical,esthetics • Techniques for fabrication of provisional restoration – • Direct technique , indirect technique, direct indirect technique • Recent advances – protemp crown , tuff temp plus,temp tabs, CAD CAM PMMA provisionals 49
  • 45. References • Rosenstiel, Land, Fujimoto. Contemporary Fixed Prosthodontics, 4th edition. • Regish KM, Sharma D, Prithviraj DR. technique of fabrication of provisional restoration: An overview. International journal of dentistry. 2011;2011:1-5. • Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6. • Barghi N, Simmons EW Jr. The marginal integrity of the temporary acrylic resin crown. J Prosthet Dent 1976;36:274-7 • Donaldson D. The etiology of gingival recession associated with temporary crowns. J Periodontol 1974;45:468-71 • Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-5 • 8Crispin BJ, Caputo AA. Color stability of temporary restorative materials. J Prosthet Dent 1979;42:27- 33. • Yannikakis SA, Zissis AJ, Polyzois GL, Caroni C. Color stability of provisional resin restorative materials. J Prosthet Dent 1998;80:533-9. • Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: J Prosthet Dent. 2003 50

Notas do Editor

  1. From1937 poly methyl methacrylate was available in granules and molding powders. The popularity of this material increased so fast
  2. From1937 poly methyl methacrylate was available in granules and molding powders. The popularity of this material increased so fast .By 1946, 95% of the denture bases were fabricated with it. Auto polymerizing acrylic resins provide adequate short term interim prostheses
  3. Protemp crown is a pre-fabricated composite provisional crown made of light curable methacrylate composite which was introduced as malleable and adjustable Protemp crowns areavailable for molars, bicuspids and canines Appropriate Protempcrown isselected and trimmed according to the gingival contou Applicab;le Matrix for Temporaries(Figure 3b) b. 5 Minute Chairside Night Guards c. Quick Bite Registration (
  4. Protemp crown is a pre-fabricated composite provisional crown made of light curable methacrylate composite which was introduced as malleable and adjustable.To fabricate a protemp crown simply select the appropriate size and adapt the crown to its oral environment. Appropriate Protempcrown isselected and trimmed according to the gingival contour. Then protemp crown is placed gently on the preparation. Use finger to ensure the crown is in line with adjacent teeth. Ask patient to close mo uth slowly and gently into occlusion. Adapt buccal margin using composite instrument (Figure 2a).Tack cure buccal surface for 3 sec (Figure 2b). Similarly adapt it to the lingual surface and occlusal surface and tack cure for 3 seconds.After tack cure remove protemp crown carefully and put crown back in several times, to ensure fit before final cure. Then fully cure for 60 seconds outside mouth, making all surfaces light cured. Finally the margins are trimmed (Figure 2c) and protemp crown is cemented (Figure 2d)
  5. Tuff-Temp Plus is an impact resistant rubberized-resin.It doesnot show polymerization shrinkageand holdstightlyto the tooth.Itdisplays very high flexural strength without brittleness. Provisional restorations are digitally fabricated from polymethyl methacrylate (PMMA) and yeilds a highly precise and anatomically detailed result14 . PMMA temporaries (Figure 5) are milled out of a dense block and shows reduced the porosity of traditional hand processed techniques, reducing chair timeand cracking.Axial contours and occlusal anatomy provided from tooth libraries produce additional anatomy that mimics natural teeth14 . BioTemps provisional crowns & bridges are created with CAD/CAM technology.
  6. Discoloration of provisional materials can produce serious esthetic complications, especially when long-term provisional treatment is required
  7. Inflammation and recession of the free gingival margin associated with provisional treatment is a common occurrence.81-84
  8. provisional restorations provide a means of designing, improving, and assessing the occlusion, esthetics, and contours for definitive restorations, as well as to determine their effects on gingival health, phonetics, and patient adaptability before the initiation of the definitive treatment.6,12,112-114 Provisional restorations fit into 2 categories: (1) those that fit within an arch of fundamentally intact teeth that provide reference for their occlusion, contours, and esthetics; 1)Casts of provisional restorations mounted opposite definitive casts transfer contours, clinical crown dimensions, and maxillomandibular relationships from a patient to a dental laboratory for developing occlusal factors, especially anterior guidance, for fixed prosthodontic treatment.2,4 2)Evaluation of the maxillary anterior incisal edges follow the contour of the lower lip, the “smile line,” aion of anteriros 3) Periodontal treatment is commonly part of comprehensive prosthodontic care. These provisional restorations provide a matrix against which the tissue heals, guiding the generation of correct soft tissue architecture.1 4) Provisional restorations should have cervical concavities and proper emergence profile.22 It has been suggested that pontics should be designed for hygiene on the mandibular arch and hygiene and esthetics on the maxillary arch.