This document discusses various techniques for fabricating provisional restorations. It begins by defining provisional restorations and outlining their key requirements and purposes. It then describes common provisional luting materials and different types of provisional restorations that can be used. The remainder of the document focuses on detailing specific techniques for fabricating provisional restorations, including direct fabrication techniques, indirect techniques using impressions or templates, and the use of prefabricated crowns. Key steps are outlined for a variety of techniques.

1. PROVISIONAL
RESTORATION IN FIXED
PARTIAL DENTURE
BHUVANESH KUMAR.D.V

2. Hu-friedy -- Gregg 4/5

3. Emergence profile
• The contour of a tooth
or restoration where it
emerges from the
gingiva.
• The contour of an
implant abutment
where it arises from the
implant platform.

4. DOUBLE CORD TECHNIQUE
• Making an impression for single or multiple
abutments
• The finish line is located sufficiently below the
gingival margin
• Reduce the collapse of the gingival tissue
Gingival Displacement for Impression Making in Fixed Prosthodontics Contemporary
Principles, Materials, and Techniques Nadim Z. Baba, DMD, MSDa, *, Charles J. Goodacre,
DDS, MSDb , Rami Jekki, DDSb , John Won, DDS, MSb

5. Contents
Synonyms
Definitions
Requirements for fixed provisional restorations
Provisional luting materials
Types of provisional restorations
Various techniques of fabrication:
 Direct fabrication techniques
 Putty index technique /shell-fabricated provisional
restoration
 Indirect method (alginate impression technique)

6.  Template method
 Technique used in the fabrication of provisionals
using light cured resin.
 Using prefabricated crowns
Provisional treatment for all ceramic veneer
restorations
Removal of provisional restoration
Recementation of provisional restoration
Review of literature
Summary
References

7. SYNONYMS
• Provisional restoration,
• Treatment restoration (Temporization),
• Interim prosthesis,
• Provisional prosthesis.
The word provisional means established for the
time being pending a permanent arrangement

8. Temporary restoration
Unfortunately temporary often conveys the
notion that, requirements are unimportant.
Experience reveals that time and effort spent
fulfilling the requisites of provisional
restoration are well invested.

9. Definition
• A fixed or removable prosthesis
designed to enhance esthetics,
stabilization and function for a limited
period of time after which it is to be
replaced by definitive prosthesis.(GPT-8)

10. Rationale for Provisional trt:
(Fredrick and Krug)
1. Protect pulpal tissue and sedate prepared abutments
2. Protect teeth from dental caries
3. Provide comfort and function
4. Evaluate parallelism of abutments
5. Provide method for immediately replacing missing
teeth
6. Prevent migration of abutments
7. Improve esthetics
J Prosthet Dent 2003;90:474-97

11. 8. Evaluate and reinforce the patient’s oral home
care
9. Provide a matrix for the retention of
periodontal surgical dressings
11. Stabilize mobile teeth during periodontal
therapy and evaluation.
12.Provide anchorage for orthodontic brackets
during tooth movement
J Prosthet Dent 2003;90:474-97

12. 13. Aid in developing and evaluating an
occlusal scheme before definitive
treatment
14. Allow evaluation of vertical dimension,
phonetics, and masticatory function
15. Assist in determining the prognosis of
questionable abutments during
prosthodontic treatment planning
J Prosthet Dent 2003;90:474-97

13. A PROVISIONAL MATERIAL SHOULD SATISFY
FOLLOWING CRITERIA
• Convenient handling: adequate working time, easy
moldability, rapid setting time.
• Bicompatibility: nontoxic, nonallergic,
nonexothermic
• Dimensional stability during solidification .

14. • Ease of contouring and polishing.
• Adequate strength and abrasion resistance.
• Good appearance ,color controllable, colour stable.
• Good patient acceptance, non irritating, odorless.
• Ease of adding to or repairing .
• Chemical compatibility with provisional luting
agents i.e., should establish Mechanical bond for
retention of the prosthesis rather than a chemical
bond

15. BIOLOGIC
Pulp protection
Periodontal health
Occlusal compatibility
Tooth position
Protect against fracture
ESTHETIC
Contourable
Colour stability
Translucent
Texture
MECHANICAL
Resist Functional load
Resist Removal forces
Inter-abutment
alingment
Rosensteil , Land ,Fujimoto – CFP -4TH ED

16. • REQUIREMENTS FOR FIXED PROVISIONAL
RESTORATIONS:
1. Biologic
- Protect pulp

17. - Maintain periodontal health

18. 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

19. -Provide occlusal compatibility

20. 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.

21. 2. Mechanical
• - Resist functional
loads
• - Resist removal forces
• - Maintain inter
abutment alignment
• - Maintain tooth
position

22. • 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

23. - Protect against fracture

24. 3. Esthetics
• - Color
compatibility
• - Translucency
• - Color stability

25. • Proper contours
• 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.
• The pontic must be contoured so that it is as self
cleansing as possible.

26. In this improperly contoured fixed partial
denture, There is not enough embrasure
space. The dental papilla are impinged upon
and signs of gingival inflammation are
present.

27. an example of tissue damage that can occur from over-
contoured or over-extended margins on a
provisional and may result in # of the prepared
teeth

28. Provisional luting materials
• Provisional luting agents should possess :
-good mechanical properties,
-low solubility,
-tooth adhesion to resist bacterial and
molecular penetration.
• The most important function of these
materials is to provide an adequate seal
between the provisional restoration and
prepared tooth. This is necessary to prevent
marginal leakage and pulpal irritation.

29. • There are a variety of luting materials used
for interim purposes. The most common
include
(1) calcium hydroxide
(2) zinc-oxide eugenol
(3) non-eugenol materials.

33. • The retentive requirements for provisional
luting materials are that they be:
strong enough to retain a provisional
restoration during the course of treatment but,
allow easy restoration removal when required.
• This paradoxical necessity for good retentive
and sealing quality and easy restoration
retrieval may lead to a compromise in material
behavior, particularly regarding mechanical
properties.

34. 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.

35. 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.

36. • Eugenol interferes with the acrylic resin
polymerization and hardening process .
• Therefore Eugenol-free provisional
luting materials are commercially
available and have gained popularity
due to the absence of resin-softening
characteristics .

37. Types of Provisional
restorations

39. PROVISIONAL
RESTOTATION
METHOD OF
FABRICATION
CUSTOM
MADE
PRE
FABRICATED
POLYCARBONATE
CELLULOSE
ACETATE
ALUMINIUM AND
TIN-SILVER
NICKEL-
CHROMIUM
TYPE OF MATERIAL
USED
RESIN BASED
PROVISIONAL
RESTORATION
METAL BASED
PROVISIONAL
RESTORATION
TECHNIQUE OF
FABRICATION
DIRECT TECHNIQUE
IN-DIRECT
TECHNIQUE
IN-DIRECT -- DIRECT
TECHNIQUE

40. • 1 Custom temporaries –
- those that are made with a
matrix derived from the original
tooth or a modified diagnostic cast.

41.  Direct: these are constructed with a
matrix lined with provisional material that
is placed directly on the prepared tooth
 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.

42.  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.

43. • 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.

44. Direct fabrication.
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.

45. 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.

46. • If the direct technique is employed, seat
the shell on the prepared teeth in the
mouth

47. Direct provisional restorations made particularly of
PMMA and, to a lesser degree, polyethyl methac-
rylate (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, cooling with air-water spray, periodic
removal, and flushing with water will limit
temperature increase to less than 4°C, minimizing
the exothermic risk .

48. Indirect fabrication
to fabricate multiple unit provisional
restorations .
• (1) avoid exposure of 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

49. 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.
Advantages of the indirect technique:
Can be allocated to auxiliary personnel.
Reduces exposure of oral tissues to monomer,
heat, shrinkage, and reduces the volume of
volatile hydrocarbons inhaled by a patient.

50. 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.
Reinforcing the vacuum or pressure formed
matrix allows it to be secured to the cast on
which the provisional shell is polymerized.

51. Indirect method (Alginate impression
technique)

52. • The over-impression 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 .

53. • 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 .

54. • 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 .

55. • 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 .

56. Application of separating medium

57. • Seat the prepared tooth cast into the over impression,
making sure that the teeth on the cast are accurately
aligned with the tooth impressions.

58. • Once the cast has been firmly seated and the excess
resin has been expressed, hold the cast in place with
a large rubber band.

59. • 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.

61. PUTTY INDEX TECHNIQUE /Shell-
Fabricated Provisional Restoration
• DIAGNOSTIC CAST

62. DIAGNOSTIC WAX UP

63. Putty index made from the
diagnostic wax up.

64. Trimmed acrylic shells oriented
in the putty index

65. Auto polymerizing resin filled in the putty
index

66. The index stabilized on the
prepared sectional cast.

68. Finished provisional.

69. TEMPLATE METHOD
• To make a template, place a metal crown form or a
denture tooth in the edentulous space on the
diagnostic cast . 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 .

70. • 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 .

71. • As the resin sheet is heated to the proper
temperature, it will droop or sag about 1.0 inch in
the frame. The cast should be in position in the
center of the perforated stage of the vacuum
forming machine. Turn on the vacuum.

72. • 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 .

73. SHEET IS CUT TO REMOVE THE TEMPLATE FROM
THE DIAGNOSTIC CAST

74. VACCUM NOT PRESENT

75. Place the softened sheet over the cast.

76. Forcefully seat the tray of silicone putty
over the coping material

77. • 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.

78. Try on the template to verify its fit .

79. • Coat the cast with separating medium and allow it to
dry. Mix the acrylic resin in a dappen dish. 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 .

80. 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 .

81. • Remove the saddle configuration that was created by
the crown form in the edentulous space .

82. • Technique used in the fabrication of provisionals
using light cured resin.

83. .

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

87. Template is filled with light
cured resin.

90. PREFABRICATED CROWNS

91. • Polycarbonate Crowns:

92. • 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.

93. MOLD SELECTION FOR
TEMPORARY POLYCARBONATE
CROWNS

94. SIZING IT UP

95. IMPROVING FIT WITH RESIN

96. Cemented temporary in
place

97. Ion Crown Formers: These are shells made of
cellulose acetate and are available in all
tooth forms.

98. 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 necessitates the further addition of
acrylic in the areas of the proximal contacts.

99. Tin Silver: Tin
Silver
preformed
crowns are
available for
posterior
teeth.

100. This alloy is very soft and the margin of the
crown can be flexed prior to seating.
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.

101. Aluminum Shell Crowns:
Similar to the tin silver,
aluminum shell crowns
are available in the
anatomic form -that
requires extensive
occlusal contouring.
Adjusting results in
perforation of the
aluminum into the layer
of acrylic beneath

102. Provisional treatment for all ceramic
veneer restorations

103. Provisional veneers are indicated when:
esthetics and intelligible speech are important;
dentin is exposed;
proximal contacts are broken;
maxillary teeth are inverted lingually and the
veneer surface affects occlusion;
the preparation margin invades the gingival sulcus;
the final veneer is dependent on patient approval of
form, color, contour, and position.

104. Provisional restorations allow patients to have a
trial period for making notes about esthetics
so that their desires can be taken into
account with the definitive veneer.
Preparations for porcelain veneers may not
have mechanical retentive features and thus
one concern regarding a provisional
restoration is tooth attachment while avoiding
irreversible contamination or alteration of the
luting surface of a prepared tooth.

105. Elledge advocated placing 2 small dimples
on opposing surfaces of the preparation
to provide mechanical retention for the
provisional veneer that is luted with a
cement of the clinician's choice.
Elledge DA, Hart JK, Schorr BL. A
provisional restoration technique for
laminate veneer preparations. J
Prosthet Dent 1989;62:139-42

106. One method that avoids excess cement while
sealing the margin area is the "peripheral
seal technique" that uses a 3-second etch of
the preparation periphery and then bonding a
provisional restoration primarily at the etched
periphery.
Similarly, a colored luting resin may facilitate
removal of excess resin and reduce
contamination of a tooth surface.

107. A variety of methods for fabrication of veneer
provisional restorations have been reported
and are not unlike the methods advocated
for conventional provisional restorations
including,
a removable hand formed visible light-
polymerized material provisional,
polycarbonate provisional crowns,
acrylic resin shells,
splinting together adjacent provisional
veneers.

108. Methods for improving or customizing colors
also include coloring provisional luting
cements and coloring a provisional
restoration with porcelain stains and visible
light-polymerized acrylic resin.
Custom color guides for provisional
restorations have also been recommended.

109. REMOVAL OF PROVISIONAL RESTORATION

110.  The provisional is removed when the patient returns
for the definitive restoration or for continued
preparation.
 Risk of damage to the prepared tooth can be
minimized if removal forces are directed parallel to
the long axis of the preparation.
 The Backhans or hemostatic forceps are effective.
 Slight buccolingual rocking motion will help break
the cement seal.

111. 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.

112. LITERATURE REVIEW

113. In an in vitro study of surface contamination
associated with provisional bonding,
 a surface treatment left
the cleanest tooth structure
a non eugenol provisional cement left: significant
but removable residue;
a dual polymerizing resin cement left tenacious
residue that could only be removed with a bur .
Mojon P et al,A comparison of methods for
removing provisional cement, Int J
Prosthodont 5:78, 1992

114. A study was done on the Colour stability of
provisional materials. This study evaluated the in
vitro discoloration of seven resins over a 9 week
period. Resin specimens were prepared and placed
in the facial flange of maxillary complete dentures
and the lingual flange of a mandibular complete
dentures.
Patients were given tooth brushes and tooth paste
and told not to use any chemical agents for cleaning
the dentures. Observations were made at 1, 5 and 9
weeks,
Jack Koumi Jian et al 'Colour stability of
provisional materials in view jpd 1998

115. • All materials tested were acceptable from the
standpoint of colour stability for short term
(5 weeks or less) provisional restorations.
• Therefore, the dentist using provisional
restorations for a short period of time may
consider other properties of the materials,
such as resistance of fracture, marginal
accuracy, rate of fabrication and cost.

116. PERIOD AUTHO
R
STUDY INFERENCE
April
2015
Takuya
Mino et
al
The aim of this article was to investigate the
accuracy in the reproducibility of full-arch
implant provisional restorations to final
restorations between a 3D Scan/CAD/CAM
technique and the conventional method.
Scan/CAD/CAM
method enables a
more precise and
accurate transfer of
provisional
restorations to final
restorations
compared to the
conventional
method.
Dec
2007
Ralf
Buerger
s
The purpose of this in vitro study was to
compare 10 commonly used provisional fixed
prosthodontic materials (2 acrylic polymethyl
methacrylates, 2 improved methacrylates,
and 6 bisacrylate composite resins), based on
their susceptibility to adhere to Streptococcus
mutans, and examine the influence of surface
roughness and hydrophobicity.
Bisacrylate
composite resins
and acrylic
polymethyl
methacrylates had
significantly lower
adhesion potentials
than improved
methacrylates.

117. PERIOD AUTHOR STUDY INFERENCE
March
2015
Tritala
Vaidyanatha
n et al
Evaluate the short to
medium term stability of
temporization materials
{Acrylic resins (poly(methyl)
and poly(ethyl)
methacrylate) and bis-acryl
composite resins } under
controlled loading to study
their stress relaxation
behavior
The results showed that PMMA and
composite resins were superior in
their ability to maintain constant
strain without excessive dissipation
of applied stress than PEMA resin.
Dec
2015
Sqn Ldr K.S.
Naveen et al
Evaluated the effect of
silanation of the various
types of glass fibre
impregnation on the flexural
strength of resin interim
restorations.
Flexural strength of the reinforced
PMMA interim fixed dental
prosthesis was significantly higher
(P < 0.0001) when compared to the
unreinforced PMMA interim fixed
dental prosthesis. The use of silane
treated unidirectional glass fibres is
an effective method of reinforcing
interim fixed restorations made of
PMMA resins.

118. • USING THE LAMINAR IMPRESSION TECHNIQUE FOR
PROVISIONAL RESTORATIONS
• DOUGLAS E. McMASTER, D.D.S.

119. • Protemp™ Crowns (3M ESPE)
• • A Bis-GMA light-cured
composite
• • Come in single units,
• • Adaptable,
• • Have a single shade only,
• • Have good wear resistance
• • Good polishability,
• • But because of their single
shade are somewhat limited
unless one is prepared to
custom stain

120. • Luxatemp Ultra
• • Incorporating proprietary
nano technology
• • Luxatemp Ultra surpasses
all leading provisional
materials in flexural strength
• • The key to provisional
stability and long-term
durability, especially with
multi-unit temporaries.
• • Luxatemp Ultra delivers
improved initial hardness
and superior break
resistance

121. • VISIBLE LIGHT CURED RESINS
• Many clear composites,
glazes, or lighter composite
shades may not use a
camphorquinone
photocatalyst because it
imparts a yellowish or orange
hue,
• • Here it is critical to use a
broad-spectrum light like the
VALO™ (Ultradent Products)
or bluephase® 20i (Ivoclar
Vivadent) that cures all photo-
initiators and composites

122. • Cling 2 provisional
cement
• • A resin-optimized non-
eugenol temporary
cement with a unique
polycarboxylate resin
• • This optimizes
adhesion,
• • Soothes the tooth,
• • Bacteriostatic, and
• • Provides an excellent
seal to promote tissue
health

123. • How to take care of undercuts??
• • OraSeal® Putty or OraSeal®
Caulking (Ultradent Products)
• • A cellulose material that sticks
to wet teeth,
• • Easily placed into the
undercuts, and can be simply
shaped with a plastic instrument
to eliminate the undercut.
• • This makes removal of the
temporary much more
predictable. & can be removed
with a plastic instrument and
water after the temporary is

124. SUMMARY
• 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 or in
laboratory from any of several commercially
available materials and by a number of practical
methods.
• The success of fixed prosthodontics often depends
on the care with which the provisional is designed
and fabricated.

125. Thank u