This document discusses provisional restorations, including definitions, requirements, types, and techniques for fabrication. A provisional restoration is a temporary restoration used during dental treatment to enhance esthetics, stabilization, and function until being replaced by a definitive prosthesis. Requirements for provisional restorations include adequate fit, occlusion, contacts, esthetics, contours, and strength. Types of provisionals include custom temporaries made directly or indirectly, as well as prefabricated shells. Fabrication techniques covered are direct, indirect, templates, and shell methods.

1. PROVISIONAL
RESTORATION IN FIXED
PARTIAL DENTURE
Dr. ROHIT FERNANDEZ

2. WHY GIVE ONE ???

3. SYNONYMS
Provisional restoration, Treatment restoration
(Temporization), Interim prosthesis, Provisional
prosthesis.
The word provisional means established for
the time being pending a permanent arrangement . This
type of a restoration has also been known for many
years as temporary restoration . Unfortunately
temporary often convey the notion that requirement are
unimportant . Experience reveal that time effort
expended fulfilling the requisites of provisional
restoration are well invested.

4. Definition
A fixed or removal prosthesis designed to
enhance esthetics stabilization and function for a
limited period of time after a which it is to be
replaced by definitive prosthesis.(GPT-7 1999) .

5. A PROVISIONAL MATERIAL SHOULD SATISFY
FOLLOWING CRITERIA
Convenient handling: adequate working time, easily
moldability, rapid setting time
Bicompatibility: nontoxic, nonallergic, nonexothermic
Dimensional stability during solidification
Ease of contouring and polishing
Adequate strength and abrasion strength
Good appearance, translucent, color controllable, color
stable
Good patient acceptance, on irritating ,odorless
Ease of adding to or repairing
Chemical compatibility with provisional luting agent

6. Requirements of a Provisional Restoration:
1. Fit: a temporary crown must
fit closely at the finish line of the
preparation. This will help prevent
tooth sensitivity and promote
health of the surrounding gingiva.
In the picture at right, the
provisional restoration will be
worn for an extended period of
time while the tissues heal from
periodontal surgery. Note that the
margins of the temporary fit
closely to the finish line of the
preparation.

7. This provisional has
overextended margins that
have caused gingival
irritation. This inflammation
will progress during the time
that the provisional is worn
and could result in necrotic
tissues or bone destruction
around the tooth

8. 2. Occlusion: The
provisional restoration should
establish or maintain adequate
occlusal contacts. Without occlusal
contacts, the prepared tooth may
extrude. This will make the
permanent restoration too high in
occlusion and further adjustment of
the final restoration may result in an
occlusal surface that is too thin or
that is perforated.
Occlusal contacts on the provisional
must not be too high. This will
cause occlusal disharmony and may
result in tooth sensitivity.

9. 3. Proximal contacts:
The provisional must establish
or maintain adequate proximal
contacts to prevent movement
of the prepared tooth in a
lateral direction. Without
proximal contacts, the tooth
may drift. This will result in a
permanent restoration that will
not fit due to excessive of
deficient proximal contacts.
Proximal contacts must be
present also to prevent food
impaction in those areas.

10. 4.Adequate
esthetics:
The temporary must have
adequate contours, color,
translucency and texture. This is
especially important in anterior
teeth. Because acrylic tends to
darken and discolor over an
extended period of time, a
different provisional restorative
material may need to be selected
if the temporary is to be worn for
a long period.
A smooth polished surface is
important for esthetics as well as
plaque removal

11. 5. Proper contours: A
provisional must have
proper contours for
esthetics and for gingival
health. The emergence
profile must be the same
as the original tooth to
facilitate plaque removal.
Embrasure areas must be
contoured to allow for the
interdental papilla.
In a fixed partial denture,
the pontic must be
contoured so that it is as
self cleansing as possible.

12. The photo at right
shows an improperly
contoured fixed
partial denture. There
is not enough
embrasure space. The
dental papilla are
impinged upon and
signs of gingival
inflammation are
present.

13. At left is an
example of tissue
damage that can
occur from
overcontoured or
overextended
margins on a
provisional

14. 6. Strength: The
strength of most
provisional materials is
far less than gold alloy.
Provisionals must be of
adequate thickness to
withstand occlusal forces
without cracking. In a
fixed partial denture, the
connector area may need
to be slightly enlarged to
prevent breakage.

15. Types of provisional restorations:
Many different types of procedures are used to
construct provisional. Provisional construction can
be categorized into two main methods:
1 - Custom temporaries - those that are made
with a matrix derived from the original tooth or a
modified diagnostic cast. Custom temporaries can
be constructed in three different manners:
Direct: these are constructed with a matrix
lined with provisional material that is placed
directly on the prepared tooth

16. Indirect: these are constructed by placing the
filled matrix over a model of the prepared tooth,
thus the provisional is constructed out of the
patient's mouth.
Indirect-Direct: these are made by forming a
temporary in an indirect manner and then relining
this directly in the patients mouth. This method is
useful when constructing temporary bridges
because most of the work can be done in the
laboratory.
2- Prefabricated temporaries - these are
preformed crowns that can be purchased and may be
modified to fit a prepared tooth. In most cases these
require relining with an acrylic material.

17. Direct fabrication. For select patients, a denture
tooth secured in position and orthodontic wire may be a
suitable provisional restoration for a missing
mandibular incisor. For urgent situations, in the absence
of any matrix or opportunity to create a matrix, a
provisional restoration can be fabricated by adapting a
block of freshly mixed acrylic resin directly to a tooth.
After the acrylic resin block has polymerized, the tooth
contours can be carved with acrylic resin burs of choice
and the restorative margins perfected intraorally.Most
patients, however, require a more conventional
approach. Fabricating provisional restorations directly
on teeth using the "direct method" is suitable for single
units and up to 4-unit fixed partial denture provisional
restorations,

18. Three techniques encompass virtually all of the literature
on direct provisional restorations: (1) use of a pre
manufactured provisional sheIl (2) use of an impression
material ,or pressure or vacuum formed translucent
matrix and (3) use of a custom, prefabricated acrylic
resin shell. Direct provisional restorations made
particularly of PMMA and, to a lesser degree, polyethyl
methacrylate (PEMA) must be cooled if the material is
allowed to polymerize completely on a tooth;
polymethyl methacrylate can increase pulpal
temperatures as much as 7°C. Cooling the material
during polymerization by its removal at initial
polymerization and allowing complete polymerization to
be completed while it is off the tooth,

19. cooling with air-water spray, periodic removal, and
flushing with water and use of a "heat sink" matrix
material such as alginate will limit temperature
increases to less than 4°C, minimizing the exothermic
risk .
Indirect fabrication. The indirect method
has been indicated to fabricate multiple unit
provisional restorations to (1) avoid exposure of a
patient to adverse properties of provisional acrylic
resins; (2) optimize the properties of provisional
acrylic resins; (3) allow the use of materials that are
difficult to polymerize intraorally; (4) make significant
contour or occlusal changes; and (5) provide for the
fabrication of hybrid provisional restorations.

20. Indirect techniques generally use either approximate
tooth preparations made on a duplicate cast or a cast of
the actual tooth preparations made after the clinical
procedure has been accomplished. One advantage of
the indirect technique is that it can be allocated to
auxiliary personnel. Fabricating a provisional
restoration wholly or in part using an indirect method
reduces exposure of oral tissues to monomer, heat,
shrinkage, and reduces the volume of volatile
hydrocarbons inhaled by a patient. Creating an indirect
acrylic resin shell of an unprepared tooth that is later
relined intraorally is one method of reducing patient
exposure.

21. It has been reported that provisional restorations
fabricated indirectly have superior margins to those
from direct techniques because the acrylic resin
polymerizes in an undisturbed manner. Polymerizing
autopolymerizing acrylic resin under heat and pressure
improves the physical properties of the material.
Reinforcing the vacuum or pressure formed matrix
allows it to be secured to the cast on which the
provisional shell is polymerized.

22. Indirect method (Alginate impression technique)
The overimpression frequently is made in the
patient's mouth while waiting for the anesthetic to
take effect. However, if the tooth to be restored has
any obvious defects, the overimpression should be
made from the diagnostic cast .
When the alginate has set, the overimpression is
removed from the diagnostic cast and checked for
completeness. Thin flashes of impression material
that replicate the gingival crevice are removed to
insure that there will be no impediments to the
complete seating of the cast into the overimpression
later .

24. The impression is wrapped in a wet paper towel and
placed in a zip lock plastic bag for later use.
When the tooth preparation is completed, another
quadrant impression is made in alginate. This
impression is poured up with a thin mix of quick-
setting plaster .
Mix tooth-colored acrylic resin in a dappen dish
with a cement spatula. Place the resin in the over
impression so that it completely fills the crown area
of the tooth for which the provisional restoration is
being made .

27. Seat the prepared tooth cast into the over impression,
making sure that the teeth on the cast are accurately
aligned with the tooth impressions.
Once the cast has been firmly seated and the
excess resin has been expressed, hold the cast in place
with a large rubber band.

28. It is important that the cast be oriented securely in
an upright position so that the space between the
cast and the impression that is filled with the resin
forming the provisional restoration will not be
distorted.
If the cast is torque to one side by the rubber band,
the cast may be forced through the soft tissue in
some areas resulting in a provisional restoration that
may be thin in those areas and thicker than desirable
in others. The force used to seal the cast into the
alginate impression is critical.

31. DIAGNOSTIC CASTS
PUTTY INDEX TECHNIQUE

32. Diagnostic wax-up done

33. Putty index made from the
diagnostic wax up.

34. Trimmed acrylic shells oriented in the
putty index

35. Auto polymerizing resin filled in
the putty index

36. The index stabilized on the
prepared sectional cast.

38. Finished and cemented
provisionals.

39. 2TEMPLATE METHOD
To make a template, place a metal crown form or a
denture tooth in the edentulous space on the
diagnostic cast . All of the embrasures should be
filled with putty to eliminate undercuts during
adaptation of the resin template.
To facilitate removal of the template, a thin strand of
putty can be placed around the periphery of the cast
and on the lingual surface of the cast, apical to the
teeth . Use a large acrylic bur to cut a hole through the
middle of the cast (midpalatal or midlingual). Place a
5 x 5-inch sheet of 0.020-inch-thick resin . Turn on the
heating element of the machine and swing it into
position over the plastic sheet .

41. As the resin sheet is heated to the proper temperature,
it will droop or sag about 1.0 inch in the frame. If you
are using coping material, it will lose its cloudy
appearance and become completely clear. The cast
should be in position in the center of the perforated
stage of the vacuum forming machine. Turn on the
vacuum.
Grasping the handles on the frame that holds the
heated coping material, forcefully lower the frame over
the perforated stage . Turn off the heating element and
swing it off to the side. After approximately 30
seconds, turn off the vacuum and release the resin
sheet from the holding frame . if a vacuum forming
machine is not available, it is still possible to fabricate
a template for a provisional restoration.

42. Place the softened sheet over the cast. Forcefully seat the
tray of silicone putty over the coping material . To
accelerate cooling, blow compressed air on the plastic
sheet and the impression tray. After about a minute, snap
the tray off the cast . If the silicone putty sticks to the
resin sheet, the putty can be easily removed by pulling it
off in quick jerks. Rapid separation causes the silicone
putty to exhibit brittleness that will result in easy
removal. Replace the putty in its original container for
later re use. Separate the template from the diagnostic
cast.

44. Upon completion of the preparations, make an
alginate impression of them and pour it in fast-setting
plaster. Trim the cast so that it includes only one tooth
on either side of the prepared teeth. Try on the template
to verify its fit .
Coat the cast with separating medium and allow it to
dry. Mix the acrylic resin in a dappen dish and place
some on protected areas of the cast, such as
interproximal spaces and in grooves and boxes. As the
resin begins to lose its surface gloss and becomes
slightly dull, fill the area for which the provisional
fixed partial denture is being made . Place some extra
bulk in the portion that will serve as the pontic.

46. Wrap rubber bands around the template and cast,
being careful not to place them over the abutment
preparations, lest they cause the template to
collapse in that area . Place the cast in a pressure
pot if one is available. Otherwise, place it in warm
(not hot) tap water to hasten polymerization.
Remove the fixed partial denture from the cast. Do
not.hesitate to break the cast if necessary. Trim off
the excess acrylic resin. Use discs to trim the axial
surfaces down to the margins. Remove the saddle
configuration that was created by the crown form in
the edentulous space . The pontic should have the
same general shape that the pontic on the permanent
prosthesis has.

48. Shell-Fabricated Provisional Restoration
A thin shell crown or fixed partial denture can be
made from any of the acrylic resins, and then that
shell can be relined indirectly on a quick-set plaster
cast. It also can be relined directly in the mouth. If
the reline is done directly, a methacrylate other than
poly(methyl) should be used. This technique can
save chair time because the restoration is partially
fabricated prior to the preparation appointment Care
must be taken not to make the shell too thick. If too
thick, the shell will not seat completely over the
prepared teeth and it will need to be trimmed
internally.

49. This can be time-consuming and defects any advantage
gained by making it before the preparation appointment .
An overimpression is made from a diagnostic
wax-up before the preparation appointment. Trim off thin
flashes of impression material created by the gingival
crevice to produce an extra bulk of resin near the margins.
Use a plastic squeeze bottle with a fine tip to deposit one
drop of monomer on the facial and one drop on the
lingual surface of the overimpression. Keep the monomer
near the gingival portion of the impression to prevent
excess from accumulating in the incisal or occlusal area.
Extend the coverage by the resin to one tooth imprint on
either side of the teeth being restored.

51. When the teeth have been prepared, make a
quadrant alginate impression and pour it with a thin
mix of quicksetting plaster. Trim off excess plaster
on a model trimmer. Save one tooth on either side of
the prepared tooth, if possible. Remove areas of the
cast that duplicate soft tissues.
Try the shell gently on the cast to make sure it
seats completely without binding. If it does bind,
relieve the inner surfaces of the shells until the
restoration seats completely and passively. Liberally
coat the tooth preparations on the cast with
separating medium and make sure it is dry before
mixing the acrylic resin.

53. Monomer and polymer can be added directly to the
shell and mixed there. The resin also can be mixed in
a dappen dish and then transferred to the shell,
completeIy filling each tooth. Seat the shell onto the
prepared teeth on the cast. Wrap a rubber band
around the shell and cast, and place them in a plaster
bowl full of hot tap water for approximately 5
minutes, preferably in a pressure pot. The use of a
pressure pot will significantly increase the strength
of the restoration .

54. If the direct technique
is employed, seat the shell
on the prepared teeth in the
mouth
A matrix can be made in
many different ways. Most
are from sheets of plastic
that are heated and formed
over the diagnostic cast.
Then the matrix is filled with
acrylic resin and placed over
the prepared teeth in the
patient's mouth.

55. Technique used in the fabrication
of provisionals using light cured
resin.
DIAGNOSTIC WAX UP
& IMPRESSION.

58. Resin placed on the finish line for
better adaptation.

59. Template is filled with light cured
resin.

62. PREFABRICATED
CROWN
Polycarbonate Crowns:
These are available in
incisors, canines and
bicuspids. There is a range
of sizes for each tooth
form.It should be relined
with acrylic in order to
provide a good internal fit.
After lining with acrylic, they may be trimmed to
provide a good marginal adaptation and further adjusted
into proper occlusion.

63. MOLD SELECTION FOR
TEMPORARY POLYCARBONATE
CROWNS

64. SIZING IT UP

65. IMPROVING FIT WITH RESIN

66. Cemented temporary in place

67. Ion Crown Formers: These are
shells made of cellulose acetate
and are available in all tooth
forms. These shells come in
various sizes for each tooth form
and are lined with acrylic resin.
After the acrylic resin has
polymerized, the cellulose shell
is peeled away from the crown.
This usually necessitated the
further addition of acrylic in the
areas of the proximal contacts.

68. Tin Silver: Tin Silver
preformed crowns are
available for posterior
teeth. This alloy is very
soft and the margin of the
crown can be flexed prior
to seating with a swaging
block. This produces a
close marginal fit after the
shell is trimmed with a bur.
These should also be lined
with acrylic resin to
provide good internal
adaptation and retention of
the temporary.

69. Aluminum Shell Crowns:
Similar to the tin silver,
aluminum shell crowns are
available in the anatomic form as
shown here, or in a cylindrical
form that requires extensive
occlusal contouring. Adjusting
occlusion on an aluminum crown
lined with acrylic sometimes
results in perforation of the
aluminum into the layer of
acrylic beneath it as shown here

70. REMOVAL OF PROVISIONAL
RESTORATION
The provisional is removed when the patient returns
for the definitive restoration or for continued
preparation. The prepared tooth or foundation must
be avoided. Risk of this can be minimized if removal
forces are directed parallel to the long axis of the
preparation. The Backhans or hemostatic forceps are
effective for obtaining purchase on a single unit.A
slightl buccolingual rocking motion will help break
the cement seal. Damage can occur when a FPD is
being removed. If one abutment retainer suddenly
breaks loose, the other abutment can be supported to
severe leverage.

71. Care must be exercised to remove the prosthesis alongthe
path of withdrawl. Sometimes it is helpful to loop dental
floss under the connector at each end of the FPD,
providing a more even force distribution for removal.
RECEMENTATION OF PROVISIONAL
RESTORATION
If provisional is to be recemented clean out the bulk
of cement with aspoon excavator then place the
provisional in a cement dissolving solution in an ultrasonic
cleaner. Line it with a fresh mix of resin if necessary
(as when a toothpreparation has been modified, eg).
The internal surface is relieved slightly and painted
with monomerto ensure good bonding of the new lining.

72. SUMMARY
Although provisional restorations are usually
intended for shortterm 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 or in laboratory from
any of several commercially available materials and
by a number of practical methods. The success of
fixed prosthodontics is often depends on the care with
which the provisional is designed and fabricated.

73. THANK YOU