Provisional restorations/ orthodontic practice

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

CONTENTS
Introduction
Synonyms
Definition
Functions
Classification of provisional restorations
Provisional restorative materials
Steps in fabrication of the provisional restoration
Provisional restoration in different clinical conditions
Cementation
Removal of provisional restorations
Conclusion
Bibliography

INTRODUCTION
It is important that the prepared tooth or teeth be
protected and that the patient be kept comfortable,
while a cast restorations being fabricated. By successful
management of this phase of the treatment, the dentist
can gain the patients confidence and favorably
influence the ultimate success of the final restoration.
During the time between the preparation of the tooth
and the placement of the final restoration, the tooth is
protected by a provisional restoration.

Synonyms
Interim prosthesis / provisional prosthesis / temporary
restoration / transitional restoration / treatment
restoration / intermediate restoration.

DEFINITIONDEFINITION
A fixed or removable prosthesis designed to enhance
esthetics, stabilization and /or function for a limited
period of time, after which it is to be replaced by a
definitive restoration

MECHANICAL ESTHETIC
BIOLOGICAL
FUNCTIONS

BIOLOGICAL FUNCTIONBIOLOGICAL FUNCTION
Pulpal protection.Pulpal protection.
Maintain periodontal health.Maintain periodontal health.
Provide occlusal compatibility.Provide occlusal compatibility.
Maintain tooth position.Maintain tooth position.
Protect against fracture.Protect against fracture.

Pulpal protection
The restoration must prevent
•Extreme temperatures.
•Insulate and prevent sensitivity.
•Microbiological infection.
•Chemical, mechanical injuries.
•Adverse pulp effect.

Periodontal Health

Occlusal compatibility

Maintain tooth position

Protect against fracture

MECHANICAL FUNCTIONMECHANICAL FUNCTION
Resist functional loads.Resist functional loads.
Resist removal of forces.Resist removal of forces.
Maintain interabutment alignment.Maintain interabutment alignment.

- Strength of resin is about
1/20th
of the metal ceramic
alloy.
- Fracture more often in partial
coverage and FPD than in full
coverage crown.
- Increase thickness of
connector
- - High strength provisional
restorations needed.

Overcontouring of embrassure
area

Displacement.
Removal for reuse.

ESTHETIC FUNCTIONESTHETIC FUNCTION
Contour.Contour.
Color compatibility.Color compatibility.
Translucency.Translucency.
Color stability.Color stability.

contour
Diagnostic wax up
Duplicate the cast

color
Custom shade guide
Resin coloring tints.
Provisional stain kit.

Translucency
Determined by type and amount of enamel present
Two resins – one colored to match body and one to
match the enamel of the tooth.
Otherwise clear resin powder with body powder.

Texture
Important in maxillary anterior teeth.
Developmental lobes – wax pattern.
Grooves – waxing wire.
Developmental defect – on restoration just before
finishing.
Imbrication lines – coarse diamond rotary instrument in
slow speed.

EXTENDED FUNCTION
Splinting of teeth.
Psychological benefit.
To check altered vertical dimension.
Protect the teeth during other treatment.

CLASSIFICATION
methods of fabrication
types of materials used
duration of use
technique for fabrication

Types of provisional restorations
Prefabricated
Metal
Anatomic metal crown forms
Tin – silver
Nickel chromium
Stock aluminum cylinders
Resin
Cellulose acetate
poly carbonate crown forms
Custom made

PROVISIONAL RESTORATIVEPROVISIONAL RESTORATIVE
MATERIALSMATERIALS
IDEAL PROPERTIESIDEAL PROPERTIES
Convenient handling
Bio compatibility
Dimensional stability
Ease of contouring and polishing
Adequate strength and abrasion resistance
Good appearance
Good patient acceptance
Ease of adding or repairing
Chemical compatibility

MATERIALS AVAILABLEMATERIALS AVAILABLE
Poly methyl methacrylate
Poly-R methacrylate
Epimines.
Microfilled composite; BISGMA.
Bis acrly composite
VLC urethane dimethacrylate.
Aluminium
Tin-silver
Ni-Cr

LIMITATIONS OF PROVISIONALLIMITATIONS OF PROVISIONAL
RESTORATIONSRESTORATIONS
Lack of inherent strength.Lack of inherent strength.
Poor marginal adaptation.Poor marginal adaptation.
Color instability.Color instability.
Poor wear properties.Poor wear properties.
Odor emission.Odor emission.
Inadequate bonding characteristics.Inadequate bonding characteristics.
Poor tissue response to irritation.Poor tissue response to irritation.
Arduous cement removal.Arduous cement removal.
Time expenditure for fabrication can be prohibitive.Time expenditure for fabrication can be prohibitive.

STEPS IN FABRICATION
Diagnostic wax up on the study models
Fabrication of the matrix / external surface form
Contouring of the tissue surface form
Cementation and evaluation of the restoration.

Diagnostic wax up
It is to be done to change or correcting occlusal
abnormalities.
To restore / alter the V.D.O
To provide a guide for the technician
To seek patient consent
It also helps to fabricate the customized matrix form
The diagnostic wax-up has to be done and all occlusal
interferences should be eliminated and then utilized for
further procedures.www.indiandentalacademy.com

FABRICATING THE MATRIX OR
EXTERNAL SURFACE FORM
Custom made matrix.
1. irreversible hydrocolloid.
2. putty/silicone impression
3. vacuum adapted thermoplastic sheet
4. wax.

Pre formed matrix
1. Polycarbonate
2. Cellulose acetate crowns
3. Aluminum and tin - silver shells
4. nickel-chromium;

Polycarbonate crowns
Available for incisors,
canines, premolars
Single shade, can be adjusted
by relining materials

Cellulose acetate crowns
All tooth shape and different
sizes.
0.2-0.3mm thickness
Shades entirely dependent on
relining resin
Does not bond mechanically
or chemically, peeled off
Reestablish proximal contact.

Aluminum and tin - silver shells
Suitable for posterior
teeth.
Both anatomic and non
anatomic form
Care taken to avoid
fracture of delicate
cavosurface margin by
cervical enlargement of
crowns using swaging
block.
Galvanic shock and
metallic taste
Wear resistance is less,
so no chances of
supraeruption. www.indiandentalacademy.com

Nickel-chromium crowns
Primarily for children’s with
extensively damaged
primary teeth.
Not lined with resin but are
trimmed, adapted with
contouring pliers, and luted
with high strength cement.
Very hard and can be used
for longer term provisional
restorations.
Metallic taste and chances of
nickel sensitivity.

FABRICATION OF TISSUE SURFACE FORM
Indirect techniqueIndirect technique
Direct technique
Indirect-direct technique

DIRECT
Provisional restoration is done on the actual prepared
teeth in the mouth.
when office laboratory facilities are inadequate.
potential tissue trauma from the polymerizing resin and
inherently poorer marginal fit.
difficult to fabricate in case of limited mouth opening,
long span provisional restorations.

INDIRECT
Provisional restoration is fabricated outside the mouth
on the cast made of quick setting plaster.
No contact with free monomer.
Avoids subjecting a prepared tooth to the heat created
from polymerizing resin.
The marginal fit and occlusal morphology of
provisional restorations that have been polymerized
undisturbed on stone casts is significantly better
Less chair side time

DIRECT vs INDIRECT
TECHNIQUES
Direct
1. Intermediate steps of
indirect technique
are eliminated.
2. Convenient when
assistant training
and laboratory
facilities are
inadequate.
Indirect
1. No contact of free monomer
with the prepared tooth or
gingiva, causing damage to
the tissue.
2. Better marginal fit.
3. Less chair side work.

INDIRECT DIRECT TECHNIQUE
matrix is formed (custom or pre fabricated).
diagnostic tooth preparation on the plaster models
(slightly under preparation is made) and these models
are utilized as the tissue surface forms.
The provisionals are fabricated by the indirect
technique; and when the tooth preparation is completed
in the clinic the provisionals are relined with self curing
resin chair side (direct technique)
chair side time is less
The external surface formed will be finished and
polished.
Less thermal and chemical irritation because of
minimal relining resin
The occlusal adjustments are still needed.

PROVISIONAL RESTORATIONSPROVISIONAL RESTORATIONS
IN DIFFERENT CLINICALIN DIFFERENT CLINICAL
CONDITIONSCONDITIONS

FOR ANTERIOR TEETH: SINGLE
CROWN

Direct technique

indirect technique using
polycarbonate crowns

Direct technique using metal
provisional restoration

Indirect technique for provisional
restoration of posterior tooth

TEMPLATE FABRICATED
PROVISIONAL RESTORATION

FABRICATION OF PROVISIONAL
RESTORATION FOR FIXED
PARTIAL DENTURES;

CUSTOM INDIRECT-DIRECT
PROVISIONAL FIXED PARTIAL
DENTURES

ONLAY AND PARTIAL VENEER
CROWN;
INLAY
LAMINATE VENEERS

POST AND CORE PROVISIONAL
RESTORATIONS
DIRECT METHOD
INDIRECT METHOD

PROVISIONAL RESTORATION FOR
ADHESIVE BRIDGES

PROVISIONAL RESTORATION FOR
THE ABUTMENT TOOTH OF THE
REMOVABLE PARTIAL DENTURE

CEMENTATIONCEMENTATION
Zinc oxide eugenol cement
Non-eugenol cements
Calcium hydroxide cement

IDEAL PRORERTIES OF LUTINGIDEAL PRORERTIES OF LUTING
AGENTAGENT
Ability to seal against the oral fluids.Ability to seal against the oral fluids.
Strength consistent with intentional removal.Strength consistent with intentional removal.
Low solubility.Low solubility.
Blandness or obtundency.Blandness or obtundency.
Chemical compatibility with the polymer.Chemical compatibility with the polymer.
Easy to dispense and mix.Easy to dispense and mix.
Ease of eliminating excess.Ease of eliminating excess.
Adequate working time and short setting time.Adequate working time and short setting time.
Compatibility with definitive luting agent.Compatibility with definitive luting agent.

REMOVAL OF PROVISIONAL
RESTORATION
For single crown slight buccolingual tilt using
Backhaus forcep or hemostat.
For FPD, after breaking the cement seal looping
with floss under the connector at each end.

A Direct Provisional Restoration for
Decreased Occlusal Wear and Improved
Marginal Integrity: A Hybrid Technique
(Jol of Prosthodontics 1994 )
Increased wear resistance and improved occlusal
stability.
Reestablishing provisional margins to achieve optimal
tissue health.

Chairside Provisional Replacement
of an Extracted Anterior Tooth
Using Fiber-Reinforced Ribbon-
Composites and a Natural Tooth
(Journal of Prosthodontics 2006)

Sectioned at CEJ.
pulp chamber sealed
with composite.
Grooves placed in
midpalatal section.
Pontic held in position
with composite to
prevent movement
during procedure.

Required length of
ribbon determined using
dental floss on
diagnostic cast.
Acid etching, bonding,
curing

Composite resin in
place. Ribbon wet with
unfilled resin pressed
into the resin and
polymerized.
Composite resin placed
to prevent movement of
pontic is removed.

Newer material
REVOTEK LC
REVOTEK LC

REVOTEK - LC
Urethane dimethacrylate based
No mixing required
No preoperative impression
No stent, no wax up procedures
Light cured for 10 sec intraorally and 20
sec finally per surface
Minimal occlusal adjustment-functional
registared
Both direct and indirect technique.

For FPD bridges

Bridge fabrication with stent

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 from any of
several commercially available materials and a
number of practical methods. The success of
fixed prosthodontic often depends on the care
with which the provisional is designed and
fabricated.

REFERENCES
Contemporary fixed Prosthodontics - stephen f.
Roseinstiel.
Fundamentals of fixed Prosthodontics - Herbert T.
Shillinberg.
Theory and practice of crown and bridge
Prosthodontics – Tylmann
Contemporary implant dentistry – Misch C.E
A Direct Provisional Restoration for Decreased
Occlusal Wear and Improved Marginal Integrity: A
Hybrid Technique; Journal of Prosthodontics, Vol 3,
(4) 1994:pp 256-260www.indiandentalacademy.com

Laminate veneer provisionals – JPD, 1997: 77; 109-
110.
Long term reinforced provisional FPD – JPD, 1998;
79: 698-701.
A Provisional Fixed Partial Denture That Simulates
Gingival Tissue at the Pontic-site Defect; Journal of
Prosthodontics, Vol 11(1) 2002: pp 46-48.
An Innovative Approach to Chairside Provisional
Replacement of an Extracted Anterior Tooth: Use of
Fiber-Reinforced Ribbon-Composites and a Natural
Tooth; Journal of Prosthodontics, Vol 15,(5)
2006: pp 316-320

Provisional restorations/ orthodontic practice

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