Provisional restorations/ orthodontic practice

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Provisional restorations/ orthodontic practice

  1. 1. PROVISIONAL RESTORATIONS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. 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 www.indiandentalacademy.com
  3. 3. 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. www.indiandentalacademy.com
  4. 4. www.indiandentalacademy.com
  5. 5. Synonyms Interim prosthesis / provisional prosthesis / temporary restoration / transitional restoration / treatment restoration / intermediate restoration. www.indiandentalacademy.com
  6. 6. 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 www.indiandentalacademy.com
  7. 7. MECHANICAL ESTHETIC BIOLOGICAL FUNCTIONS www.indiandentalacademy.com
  8. 8. 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. www.indiandentalacademy.com
  9. 9. Pulpal protection The restoration must prevent •Extreme temperatures. •Insulate and prevent sensitivity. •Microbiological infection. •Chemical, mechanical injuries. •Adverse pulp effect. www.indiandentalacademy.com
  10. 10. Periodontal Health www.indiandentalacademy.com
  11. 11. Occlusal compatibility www.indiandentalacademy.com
  12. 12. Maintain tooth position www.indiandentalacademy.com
  13. 13. Protect against fracture www.indiandentalacademy.com
  14. 14. MECHANICAL FUNCTIONMECHANICAL FUNCTION Resist functional loads.Resist functional loads. Resist removal of forces.Resist removal of forces. Maintain interabutment alignment.Maintain interabutment alignment. www.indiandentalacademy.com
  15. 15. - 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. www.indiandentalacademy.com
  16. 16. Overcontouring of embrassure area www.indiandentalacademy.com
  17. 17. Displacement. Removal for reuse. www.indiandentalacademy.com
  18. 18. ESTHETIC FUNCTIONESTHETIC FUNCTION Contour.Contour. Color compatibility.Color compatibility. Translucency.Translucency. Color stability.Color stability. www.indiandentalacademy.com
  19. 19. contour Diagnostic wax up Duplicate the cast www.indiandentalacademy.com
  20. 20. color Custom shade guide Resin coloring tints. Provisional stain kit. www.indiandentalacademy.com
  21. 21. 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. www.indiandentalacademy.com
  22. 22. 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. www.indiandentalacademy.com
  23. 23. EXTENDED FUNCTION Splinting of teeth. Psychological benefit. To check altered vertical dimension. Protect the teeth during other treatment. www.indiandentalacademy.com
  24. 24. CLASSIFICATION methods of fabrication types of materials used duration of use technique for fabrication www.indiandentalacademy.com
  25. 25. 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 www.indiandentalacademy.com
  26. 26. 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 www.indiandentalacademy.com
  27. 27. MATERIALS AVAILABLEMATERIALS AVAILABLE Poly methyl methacrylate Poly-R methacrylate Epimines. Microfilled composite; BISGMA. Bis acrly composite VLC urethane dimethacrylate. Aluminium Tin-silver Ni-Cr www.indiandentalacademy.com
  28. 28. 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. www.indiandentalacademy.com
  29. 29. 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. www.indiandentalacademy.com
  30. 30. 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
  31. 31. FABRICATING THE MATRIX OR EXTERNAL SURFACE FORM Custom made matrix. 1. irreversible hydrocolloid. 2. putty/silicone impression 3. vacuum adapted thermoplastic sheet 4. wax. www.indiandentalacademy.com
  32. 32. Pre formed matrix 1. Polycarbonate 2. Cellulose acetate crowns 3. Aluminum and tin - silver shells 4. nickel-chromium; www.indiandentalacademy.com
  33. 33. Polycarbonate crowns Available for incisors, canines, premolars Single shade, can be adjusted by relining materials www.indiandentalacademy.com
  34. 34. 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. www.indiandentalacademy.com
  35. 35. 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
  36. 36. 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. www.indiandentalacademy.com
  37. 37. FABRICATION OF TISSUE SURFACE FORM Indirect techniqueIndirect technique Direct technique Indirect-direct technique www.indiandentalacademy.com
  38. 38. 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. www.indiandentalacademy.com
  39. 39. 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 www.indiandentalacademy.com
  40. 40. 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. www.indiandentalacademy.com
  41. 41. 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. www.indiandentalacademy.com
  42. 42. PROVISIONAL RESTORATIONSPROVISIONAL RESTORATIONS IN DIFFERENT CLINICALIN DIFFERENT CLINICAL CONDITIONSCONDITIONS www.indiandentalacademy.com
  43. 43. FOR ANTERIOR TEETH: SINGLE CROWN www.indiandentalacademy.com
  44. 44. Direct technique www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46. indirect technique using polycarbonate crowns www.indiandentalacademy.com
  47. 47. www.indiandentalacademy.com
  48. 48. www.indiandentalacademy.com
  49. 49. Direct technique using metal provisional restoration www.indiandentalacademy.com
  50. 50. www.indiandentalacademy.com
  51. 51. Indirect technique for provisional restoration of posterior tooth www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. www.indiandentalacademy.com
  55. 55. www.indiandentalacademy.com
  56. 56. TEMPLATE FABRICATED PROVISIONAL RESTORATION www.indiandentalacademy.com
  57. 57. www.indiandentalacademy.com
  58. 58. www.indiandentalacademy.com
  59. 59. FABRICATION OF PROVISIONAL RESTORATION FOR FIXED PARTIAL DENTURES; www.indiandentalacademy.com
  60. 60. CUSTOM INDIRECT-DIRECT PROVISIONAL FIXED PARTIAL DENTURES www.indiandentalacademy.com
  61. 61. www.indiandentalacademy.com
  62. 62. www.indiandentalacademy.com
  63. 63. www.indiandentalacademy.com
  64. 64. www.indiandentalacademy.com
  65. 65. ONLAY AND PARTIAL VENEER CROWN; INLAY LAMINATE VENEERS www.indiandentalacademy.com
  66. 66. POST AND CORE PROVISIONAL RESTORATIONS DIRECT METHOD INDIRECT METHOD www.indiandentalacademy.com
  67. 67. PROVISIONAL RESTORATION FOR ADHESIVE BRIDGES www.indiandentalacademy.com
  68. 68. PROVISIONAL RESTORATION FOR THE ABUTMENT TOOTH OF THE REMOVABLE PARTIAL DENTURE www.indiandentalacademy.com
  69. 69. CEMENTATIONCEMENTATION Zinc oxide eugenol cement Non-eugenol cements Calcium hydroxide cement www.indiandentalacademy.com
  70. 70. 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. www.indiandentalacademy.com
  71. 71. 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. www.indiandentalacademy.com
  72. 72. 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. www.indiandentalacademy.com
  73. 73. www.indiandentalacademy.com
  74. 74. www.indiandentalacademy.com
  75. 75. www.indiandentalacademy.com
  76. 76. Chairside Provisional Replacement of an Extracted Anterior Tooth Using Fiber-Reinforced Ribbon- Composites and a Natural Tooth (Journal of Prosthodontics 2006) www.indiandentalacademy.com
  77. 77. Sectioned at CEJ. pulp chamber sealed with composite. Grooves placed in midpalatal section. Pontic held in position with composite to prevent movement during procedure. www.indiandentalacademy.com
  78. 78. Required length of ribbon determined using dental floss on diagnostic cast. Acid etching, bonding, curing www.indiandentalacademy.com
  79. 79. 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. www.indiandentalacademy.com
  80. 80. Newer material REVOTEK LC REVOTEK LC www.indiandentalacademy.com
  81. 81. 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. www.indiandentalacademy.com
  82. 82. Direct technique www.indiandentalacademy.com
  83. 83. www.indiandentalacademy.com
  84. 84. For FPD bridges www.indiandentalacademy.com
  85. 85. www.indiandentalacademy.com
  86. 86. Bridge fabrication with stent www.indiandentalacademy.com
  87. 87. www.indiandentalacademy.com
  88. 88. 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. www.indiandentalacademy.com
  89. 89. 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
  90. 90. 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 www.indiandentalacademy.com
  91. 91. www.indiandentalacademy.com

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