The functional requirements of provisional fixed restorations including protection, mastication, positional stability, esthetics are discussed in this presentation. The types of provisional restorations available to the clinician (prefabricated, custom fabricated) are described as well as techniques used in their fabrication.

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  • 1. Charles J. Goodacre, DDS, MSD Professor of Restorative Dentistry Loma Linda University School of Dentistry This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission. Provisional restorations in fixed prosthodontics
  • 2. Provisional Restorations •  They are restorations that provide interim protection, mastication, esthetics, and positional stability while the definitive restoration is being fabricated •  FUNCTIONS / REQUIREMENTS 1) Protection / Preservation; (prepared tooth from damage; pulp from irritation; cheeks / tongue / lips from trauma; periodontal health by good fit, contour, & surface smoothness) 2) Mastication; (allow some chewing of food) 3) Positional stability; (tooth; gingiva; lips / cheeks) 4) Esthetics for visible teeth; 5) Provide diagnostic information
  • 3. Provisional Restoration Resins •  Methyl methacrylate (Jet) – Reasonably hard; sets somewhat rapidly; reasonable color stability •  Ethyl methacrylate (Trim) – Not as hard as methyl methacrylate; slower set and more working time; susceptible to discoloration •  Composite resin (Protemp; Integrity) – Hardest; rapid polymerization; best color stability
  • 4. Types of Provisional Restorations •  Prefabricated 1) Metal shell / relined metal shell 2) Relined polycarbonate shell •  Custom-fabricated 1) Template & unfilled resin 2) Template & composite resin 3) Laboratory produced shell 4) Cast metal (long-term service needed) • “Direct on tooth” versus “Indirect on cast”
  • 5. Direct versus Indirect •  Direct is faster for routine provisional restorations •  Indirect can save time with multiple units or complex fixed partial dentures •  Indirect provisionals can be fabricated in advance of the tooth preparation appointment
  • 6. Direct Technique: Types of Templates •  Putty index made on cast or intraorally using a tray •  Clear plastic vacuum-formed template •  Repair of crown / prosthesis that was removed
  • 7. DIRECT TECHNIQUES
  • 8. Relined Aluminum Shells
  • 9. Relined Polycarbonate Crowns
  • 10. Putty Template
  • 11. Putty Template
  • 12. TEMP TABS® – TRUE BLUE •  Do a Google search “temp tabs dental” •  Heat at 135 degrees Fahrenheit •  Mold over teeth & then blow air for 10 seconds
  • 13. Vacuum-Formed Template
  • 14. Crown Removal & Repair
  • 15. Products Used •  Carbide bur •  Bonding resin •  Color modifier •  Resin glaze Brasseler XTREMECUT 330MZ PermaSeal by Ultradent
  • 16. Crown Removal & Repair
  • 17. Provisional Restoration for RCT with Prefabricated P&C
  • 18. Provisional Restoration for RCT while Custom Cast P&C is being Fabricated
  • 19. INDIRECT TECHNIQUES •  Prepare tooth / teeth and make impression •  Laboratory then fabricates provisional restoration(s) while patient waits OR •  Laboratory fabricates shell provisional restoration before the patient comes for the tooth preparation appointment
  • 20. Shell Fabrication
  • 21. Minimal tooth preparations completed on cast; Less reduction than will be achieved clinically Space between shell and minimal tooth preparations will be filled with resin
  • 22. Video of Shell Fabricated by Laboratory in Advance of Tooth Preparation
  • 23. Provisional Cements •  They are typically zinc oxide powder or zinc oxide paste mixed with eugenol liquid •  Noneugenol formulations are available that do not soften resin (as in provisional crown). They use carboxylic acids in place of eugenol •  The liquid can be ethoxybenzoic acid, known as ZOEBA, making it stronger •  TempBond Clear is a translucent cement with Triclosan (an antibacterial & antifungal agent)
  • 24. Thank You For Your Kind Attention Charles J. Goodacre, DDS, MSD Professor of Restorative Dentistry Loma Linda University School of Dentistry
  • 25. v Visit ffofr.org for hundreds of additional lectures on Complete Dentures, Implant Dentistry, Removable Partial Dentures, Esthetic Dentistry and Maxillofacial Prosthetics. v The lectures are free. v Our objective is to create the best and most comprehensive online programs of instruction in Prosthodontics