Fixed Prosthodontics Burleson CH.

15 - PROVISIONAL RESTORATIONS During the time between the preparation of the tooth and the placement of the final restoration, the tooth is protected by a provisional restoration or commonly called a temporary restoration. A good provisional restoration should satisfy the following requirements: 1. pulpal protection - restoration should prevent the conduction of temperature extremes 2. positional stability - should not allow the tooth to shift or extrude in any way 3. occlusal function - aids patient comfort, prevents tooth migration, and prevents neuromuscular imbalance 4. easily cleaned - proper material and contour will allow proper hygiene 5. nonimpinging margins - or else inflammation will result 6. strength and retention - must not break or come off the tooth 7. esthetics - anterior teeth and premolars require good cosmetic results I. TYPES OF PROVISIONAL RESTORATIONS A. Prefabricated vs. Custom - prefabricated forms can be used only for single-tooth restorations - for fixed partial dentures, provisional restorations can be fabricated of several different kinds of resins and methods B. Direct vs. Indirect Techniques - the direct technique is done on the actual prepared teeth in the mouth - the indirect technique is accomplished outside of the mouth on a cast made of quick-set plaster - the indirect technique is preferred over the direct technique for its accuracy and pulpal protection - since polymethyl methacrylate shrinks 8% when it polymerizes, it is desirable to keep it on an indirect cast - indirect technique protects the pulp from pulpal irritation or acute pulpal inflammation II. RESINS FOR PROVISIONAL RESTORATIONS - there are several resins used to make custom provisional restorations - polymethyl methacrylate has been used the longest - polyethyl methacrylate, polyvinylethyl methacrylate, bis-acryl composite resin, and visible light-cured (VLC) urethane dimethacrylate have also come into common usage in recent years II. TECHNIQUES FOR CUSTOM PROVISIONAL RESTORATIONS - there are a variety of techniques for making a mold to form the outer surface of a custom provisional restoration - both elastomeric and alginate overimpressions have been used to shape the provisional restoration - an overimpression is made on the diagnostic cast, or in the mouth, before the tooth preparation is begun - template formed from clear thermoplastic resin can also be used for this purpose; shaped using a cast & vacuum A. Overimpression-Fabricated Provisional Crown - alginate impression is popular because it is readily available in the dental operatory - for later use, these impressions must be stored in a ziplock plastic bag, wrapped in a wet paper towel - the tooth is prepared and another quadrant impression is taken in alginate; this is poured up in quick-set plaster - the quadrant cast is trimmed and soft tissue areas are reduced as much as possible - prepared tooth and adjacent areas on the quadrant cast are coated int alcote - tin foil substitute separating medium - 12 drops of monomer are used for each tooth being restored; mix tooth acrylic resin: dappen dish w/ cement spatula - seat the cast into the overimpression making sure the teeth are evenly aligned in the impression - excessive force - can overseat the cast; while uneven force - can torque the case - hold the cast in place with a large rubber band and place the assembly in a plaster bowl of hot tap water for 5 minutes - place the assembly into a pressure pot if one is available; keep the pressure under 20psi - break the plaster cast off the provisional restoration - acrylic burs or coase Moore discs are used to trim excess resin from the provisional restoration - smooth the axial surfaces near the margins with a fine sandpaper disc

Fixed Prosthodontics Burleson B. Provisional Cementation - seat the provisional restoration and check the occlusion - polish the restoration with pumice and then polishing compound on a muslin rag wheel - undercontour the crown if it will be placed under an existing removable partial denture; does not touch clasp/rests - the restoration should be cemented with temporary cement of moderate strength (zinc oxide-eugenol cement) - 5-10% petrolatum is incorporated to slightly reduce the strength of the cement - it is not necessary to keep ZOE cement dry while cementing; in fact, moisture will accelerate the hardening C. Template-Fabricated FPD - FPD provisional restorations should be in the form of a FPD rather than individual crowns - this provides better cosmetic results in the anterior region and better strength in the posterior region - to make a template, use a metal crown form or denture tooth in the space for the pontic of the FPD - place a 5 by 5 inch sheet of 0.020-inch thick resin in the fram of the vacuum forming machine, shiny side down - after approximately 30 sec. after pulling the hot sheet over the cast, turn off the vacuum and release the sheet - trim the template: it should extend at least one tooth on either side of the prepared teeth - after tooth preparation, take an alginate impression of the prepared quadrant and pour a quick-set plaster cast - trim the quadrant cast and place alcote separating agent on the prepared abutment teeth and adjacent areas - mix the acrylic resin (12 drops of monomer per tooth) and place the resin-filled template over the quadrant cast - hold in place with rubber band, do not place the rubber band over the abutment teeth - place the cast in hot water or pressure pot (20psi) for 5 minutes - before removing the provional restoration from the cast, add resin to any voids or thin spots and place back in water - placing the unpolymerized resin back into water will prevent monomer evaporation and prevent a frosted surface - remove and trim the proximal embrasures to premit proper emergence profile

Table 15-1 Characteristics of Resins used for Provisional Restorations 1. polymethyl methacrylate - has good marginal fit, transverse strength, polishability, and durability - disadvantages: high exothermic heat increase, low abrasion resistance, free monomer toxic to pulp, shinkage - brands: Jet (Lang dental), Duralay (Reliance Dental) 2. polyethyl methacrylate - good polishability, low exothermic heat increase, good strain resistance, low shrinkage - disadvantages: surface hardness, durability, fracture toughness - brands: Snap (Parkell biomaterals) 3. polyvinylethyl methacrylate - good polishability, low exothermic heat release, good abrasion, strain, flexible - disadvantages: surface hardness, esthetics, fracture toughness - brands: Trim (Harry Bosworth) 4. bis-acryl composite - good marginal fit, low exothermic heat increase, good abrasion, transverse, low shrinkage - disadvantages: surface hardness, limited shade selection, limited polishability, brittle - brands: Protemp (ESPE-Premier) 5. VLC urethane dimethacrylate - high surface hardness, good transverse, abrasion, working time, color stability - disadvantages: marginal fit, less strain resistance, limited shade selection, expensive, brittle - brands: Triad (Dentsply York)