provisional restoration

1. TEMPORIZATION IN
CROWN AND BRIDGE
WORK
AISHA J. AHMAD

2. OUTLINE
•Introduction
•Rationale
•Ideal requirements
 Biologic
 Mechanical
 Esthetic
•Classifications
•Cementation of provisional restoration
•Removal of provisional restoration
•Limitations of provisional restoration
•References
•Conclusion

3. •Provisional crown or fixed partial denture is essential to
prosthodontic therapy.
•Prepared crown / abutment teeth must be restored
temporarily while the final prosthesis is being fabricated
in order to provide protection to pulp, periodontium,
positional stability, mastication, & esthetics.
INTRODUCTION

5. DEFINITION
S
• TEMPORIZATION: A fixed or removable designed to
enhanced esthetics, stabilization and function for a
limited period of time after which it is to be replaced by
definitive prosthesis.(GPT-9)
• CROWN; An artificial replacement that restores
missing tooth structure by surrounding part or all of the
remaining structure with a material such as cast metal,
porcelain, or a combination of materials such as metal
and porcelain (GPT8).

6. • Fixed partial denture
(FPD) or fixed dental
prosthesis: A dental
prosthesis that is luted,
screwed or mechanically
attached or otherwise
securely retained to natural
teeth, tooth roots and/or
dental implant abutments
that furnish the primary
support for the dental
prosthesis.
• They are commonly referred
to as bridges and cannot be
removed by the patient.

7. RATIONALE
(Fredrick and Krug)
1.Provide method for immediately replacing
missing teeth.
2.Protect prepared abutments from thermal,
chemical, mechanical and bacterial insults.
3.Provide comfort function and Improve esthetics.
4.Prevent migration of abutments.

8. 5. Stabilize mobile teeth during periodontal therapy and
evaluation.
6. Provide anchorage for orthodontic brackets during
tooth movement
7. Allow evaluation of vertical dimension, phonetics &
masticatory function.
8. Assist in determining the prognosis of questionable
abutments during prosthodontic treatment planning

9. IDEAL
REQUIREMENTS OF
PROVISIONAL
RESTORATION

10. PROVISIONAL RESTORATION
BIOLOGIC REQUIREMENTS
MECHANICAL REQUIREMENTS
ESTHETIC REQUIREMENTS

11. BIOLOGIC REQUIREMENTS
Provisional restoration
should
protect the pulp
maintain periodontal
health
Positional stability
Protect against fracture

12. MECHANICAL
REQUIREMENTS
Mechanical requirements of provisional
restoration should include;
Function
Retension
Removal for use

13. ESTHETIC REQUIREMENTS
Provisional restoration should
Match the shape,size, colour,and
texture of the restored tooth
especially in the anterior region.
 serve as a guide to achieve
aesthetics to the final restoration

14. TYPE OF PROVISIONAL RESTORATION
BASED ON..
METHOD OF FABRICATION
MATERIALS AVAILABLE IN PREFORMED CROWNS
TYPE OF MATERIAL USED
DURATION OF USE
TECHNIQUE FOR FABRICATION

15. METHOD OF FABRICATION
•Custom made provisional restoration
•Preformed provisional restoration

16. PREFORMED PROVISIONAL
RESTORATION
•These are commercially available prefabricated
crowns
•Available in various sizes
•Operator chooses the best one that suits the
patient
•Before cementation, these crowns are slightly
altered and modified to fit the tooth

17. Prefabricated crown:
Several types of prefabricated crown are available
commercially, however this type is rarely satisfy the
requirements of good provisional restoration, most
preformed crowns need some modifications like
internal relief, axial recontouring & occlusal adjustment
before cementation.
Prefabricated crowns are generally limited to use as
single restoration more than for bridges, there are
several types:

18. • Polycarbonate crown
•Cellulose Acetate
•Aluminum,Tin,Silver crown
•Nickel Chronium crown

19. • INDICATION;
Single tooth restorations
Advantages;
Less technique sensitive to fabricate
Requires less chairside time
Disadvantages;
Cannot be used for fixed partial dentures
Most types need some modification to fit the
preparation

20. CUSTOM-MADE
•Advantages;
Most versatile,can be used for any clinical
situation
Better fit
Disadvantage;
Requires more time

21. BASED ON DURATION OF USE
•Short Term Temporary Restoration;
used when prosthesis is to be used for
maximum of two weeks
•Indicated in fixed partial dentures.
•They are either custom made resins or available
as preformed crowns
•Long Term Temporary Restoration;
•made of cast metals.
•Maybe used for months
Indicated for Healing after periodontal surgery.
•prolonged treatment plan.

22. •The following techniques are used for fabrication:
1. Direct technique – restorations are fabricated
intraorally
2. Indirect technique – restorations are fabricated
extra-orally on a cast
3. Direct–indirect technique – restorations are
fabricated using a combination of intraoral and
extraoral procedures
TECHNIQUES OF FABRICATION

24. •Direct technique
•Restoration is fabricated intraorally directly in the
patient’s mouth.
•Merits
• Less time and reduced cost as there is no need for a
cast
Demerits
• Can only used for single-unit restorations or short-
span bridges and patient cooperation is required.
• Exothermic heat may cause pulpal irritation and
there may be offensive odour.
• May be difficult to remove the provisional
restoration if attention is not given to setting
characteristics.

25. Direct technique: Preformed (polycarbonate)
•Steps in Fabrication
(A) Mesiodistal and incisocervical measurements
made with the help of a divider.
(B) Appropriate size of crown is selected from the
assorted kit.
(C) Selected crown is tried in the patient’s mouth.
(D) Excess portion is marked on the cervical
portion.

27. (E) Excess is trimmed carefully at the cervical
and never at the incisal portion.
(F) The trimmed crown is filled with
autopolymerizing acrylic and seated on the
prepared tooth.
(G) The polymerized crown is trimmed,
finished, polished and cemented with
provisional cement.

29. •Indirect technique
• Restoration is fabricated extraorally on a cast.
• Preferred method for making provisionals for FPDs.
Advantage
• Patient is not affected by material properties like
odour and exothermic heat.
Disadvantages
• Takes more time as impressions are made after tooth
preparation
Increased cost.

30. (A) Appropriate size of nickel–chromium crown
is selected.
(B) Excess height is removed from the gingival
margin.
(C) Gingival margin is smoothened.
(D) Contouring axial surfaces with pliers.
(E) Occlusion is checked with articulating paper.
(F) Crown filled with provisional cement is
seated.
(G) Excess cement is removed from the crevice
with an explorer.
(H) Cemented crown.

33. Indirect technique: Custom-made
Provisionals using vacuum-formed template
•(A) Diagnostic cast with missing mandibular
anterior teeth.
•(B) Teeth arranged.
•(C) Cast placed in machine and thermoformed sheet
heated and allowed to sag.
•(D) Cast with artificial teeth vacuum formed.
•(E) Tooth preparation done.
•(F) Plaster cast following tooth preparation.

34. •(G) Template placed on cast to check fit.
•(H) Template seated on cast filled with the
provisional material in the area of the restoration.
•(I) Template removed from cast after polymerization.
•(J) Provisional restoration trimmed and fitted on cast
– buccal view.
• (K) Final provisional cemented in mouth.

38. •Direct–indirect technique
•This technique combines the merits of the indirect and
direct techniques.
•A shell (anatomic form) of the provisional restoration is
fabricated indirectly on a cast with the material used for
the restoration, before tooth preparation.
•The shell is relined with the same material intraorally
after tooth preparation to ensure accurate fit.

39. (A) Intraoral picture showing missing first premolar, first molar and fractured anterior FPD
requiring replacement. (B) On the diagnostic cast, edentulous areas are restored and
wax corrections are done.
(C) Putty index fabricated. (D) Tooth prepared minimally in the stone model

40. (E) Preparation completed on stone model.
(F) Autopolymerizing acrylic resin is poured into the putty index.
(G) Putty index secured onto cast using rubber bands.
(H) Indirect provisional restoration trimmed and fitted on the cas

41. I. Abutment teeth prepared in the patient’s mouth.
(J) After tooth preparation in the patient’s mouth acrylic resin is
added to retainers in the indirect provisional.
(K) Stabilized using finger pressure in the patient’s mouth and allowed to partially set.
(L) Relined provisional after removal from mouth.

42. ACCORDING TO MATERIALS
USED
1. RESINS;
a) Preformed; polycarbonate, cellulose acetate
b) Custom made; acrylic, bis acryl composite

43. 2)METALS;
a)preformed; Aluminum, Tin-silver, Nickel-
chromium
b)Custom -made; cast metal alloys

44. CEMENTATION OF PROVISIONAL
RESTORATION
•IDEAL PROPERTIES OF CEMENT
•Ability to seal against leakage of oral fluid
•Strenght consist with intentional removal
•Low solubility
•Ease of eliminating excess
•Adequate working and short setting time
CEMENTS USED
•Zinc oxide eugenol
•Reinforced zinc oxide eugenol
•Non eugenol cement

47. •Some of the most commonly used cements with
provisional prostheses are those containing zinc-
oxide and eugenol. They provide:
•sedative effects that reduce dentin hypersensitivity
•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.

48. •Eugenol interferes with the acrylic resin
polymerization and hardening process .
•Therefore Eugenol-free provisional luting materials are
commercially available
•Baldissara et al recommended that interim
restorations be frequently evaluated and used for only
short periods of time.
• Literature reports advise that if provisional treatment
is required over a protracted time period, it is best to
remove and replace the provisional luting agent on a
regular basis.

49. REMOVAL OF PROVISIONAL
•Removed when the patient returns for definitive
restoration
•Risk of damage to the prepared tooth can be
minimized if removal forces are directed parallel
to the long axis of the preparation.
•The hemostatic artery forceps are effective
•Slight buccolingual rocking motion; breaks
cement seal for single unit restoration
•Looping dental floss under the connector at each
end of the connector is useful in case of fixed
partial dentures.

50. LIMITATIONS OF PROVISIONAL
RESTORATION
i) Lack of Inherent Strength: - fractures in long
span coverage in patients with bruxism or a reduced
interocclusal clearance, if the bulk is increased, the
patients discomfort is evident.
ii) Poor Marginal Adaptation:
iii) Colour Instability: -This is apparent when
temporary restorations are placed for an inordinate
time.
iv) Poor Wear Properties: - Teeth will drift or torque
if the patient places heavy occlusal stresses upon
the interim coverage.

51. v) Detectable Odour Emission: - This is undeniable
despite the dentists close attention to sufficient
embrasure spaces. Resins are porous.
Vi) Poor Tissue Response to Irritation: - Mild or
moderate tissue irritations is always present.

52. CONCLUSION
•Successful temporary restorations are pillars for
successful final restorations.
•Fixed prosthodontic treatments can have extended
durations from weeks to months.
•Therefore, provisional restorations play a supportive
role in the continuum of care by improving oral
heath & quality of life .
•So patient sees a progressive improvement from the
beginning to completion of prosthodontic treatment.
•This continuum, in turn, can improve patient
satisfaction, clinician/patient rapport and
confidence leading to predictable success.

53. REFERENCES
• Patras M et al. Management of Provisional
Restorations' Deficiencies: A Literature Review. J
Prosthet Dent 2003;90:474-97
• Stephen F. Rosenstiel, Martin F. Land.
Contemporary Fixed Prosthodontics, 5th Edition
• Koumjian & Nimmo. Evaluation of fracture
resistance of resins used for provisional
restorations. J Prosthet Dent. 1990 Dec;64(6):654-7.
• Rohitraghavan, Shajahan P A,. Provisionals in
Dentistry - From Past To Recent Advances. IJDMSR
2006 Vol2 Issue 6. pp01-06
• Textbook of Prosthodontics, 2e, V Rangarajan and
TV Padmanabhan

54. • Rationale of provisional restoration - J Prosthet Dent
2003;90:474-97.
• Types of provisional restoration - IOSR Journal of Dental
& Medical Sciences 2019 vol18(4)
• Donovan TE, Hurst RG & Campagni WV. Physical
properties of acrylic resin polymerized by four different
techniques. J. Prosthet. Dent. 1987;54:194-97
• T. Nigel Town, M.A et al Provisional Restorations : An
Overview of material used. Journal of Advanced clinical &
Research Insights 2016;3:212-14