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Provisionals in fpd.pptx
- 1. Provisional Restoration infixed dental prosthesis Presented by Dr. Shruti khot II -MDS 1
- 2. Contents Introduction Ideal requirement ofprovisional restoration Functions of provisional restoration Classification Techniques of fabrication of prosthesis Recent advances Cementation of provisional prosthesis Conclusion References 2
- 3. Introduction Provisionalization : - Toestablish esthetics, occlusal stability, and function for a limited time in preparation for the definitive prosthesis; to verify therapeutic outcome and patient acceptance before the definitive prostheses. (GPT - 9 ) 3
- 4. SYNONYMS Provisional restoration, Treatmentrestoration (Temporization), Interim prosthesis, Provisional prosthesis. 4
- 5. Rationale (Modified by Federickand Krug) • Protect pulpal tissue and sedate prepared abutments • Protect teeth from dental caries • Provide comfort and function Evaluate parallelism of abutments • Provide method for immediately replacing missing teeth • Prevent migration of abutments Improve esthetics • Provide an environment conductive to periodontal health • Evaluate and reinforce the patient’s oral home care 5
- 6. • Assist withperiodontal therapy by providing visibility and access to surgical sites when removed. • Aid in developing and evaluating an occlusal scheme before definitive treatment. • Allow evaluation of vertical dimension, phonetics, and masticatory function. • Assist in determining the prognosis of questionable abutments during prosthodontic treatment planning 6 Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: J Prosthet Dent. 2003
- 7. Ideal requirement ofprovisional restoration Biologic Pulp protection Periodontal health Positional stability Prevention of fracture Esthetics Colour compatibility Translucency Colour stability Mechanical Function Loss of retention Removal of reuse 7
- 8. PULP PROTECTION:During tooth preparation the dentinal tubules are exposed. Thus provisional restoration should protect the prepared tooth from oral environment, thereby preventing sensitivity and irritation to pulp. PERIODONTAL HEALTH: It should have good marginal fit, proper contour and smooth surface to prevent accumulation of plaque, facilitate easy plaque removal and maintain periodontal health. 8
- 9. POSITIONAL STABILITY:It should provide a comfortable, stable, and functional occlusal relationship by maintaining interarch and intra-arch stability thereby preventing tooth migration , supraeruption. PREVENTION OF FRACTURE: It should protect the prepared tooth surface from fracture which is commonly seen in partial coverage restoration, in which margin of preparation is close to the occlusal surface of tooth and could be damaged during chewing. 9
- 10. FUNCTIONAL: It shouldpossess good compressive and flexural strength. The strength of material used for fabricating provisional restoration is always much lower than that of the definitive restoration material. The greatest stresses in a provisional restoration occur during chewing.. LOSS OF RETENTION: It should have close adaptation to the prepared tooth surface to prevent displacement and recementation, which will increase patient visits. 10
- 11. Functions of Provisionalrestoration 1. Protect Pulpal tissue and sedate prepared abutments 2. Provide an environment conductive to periodontal health 3. Provide method for immediately replacing missing teeth, prevent migration of abutments and opposing teeth 4. Protects the pulp from thermal and chemical insults after crown preparation and enamel removal. 5. It serves to maintain gingival health and contour while providing for an esthetic and/or functional interim restoration . 6. Protect teeth from dental caries 7. Ensure marginal seal Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6. 11
- 12. Classification of provisionalrestoration Method of fabrication Type of material used Duration of use Technique for fabrication J Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-58 12
- 13. Method of fabrication AdvantagesDisadvantages Custom made • Minimum interference • Wide variety of material can be used • Evaluation of tooth reduction can be done • Additional lab procedure • Time consuming Preformed • Less time consuming • Rarely satisfies the requirement of contours • Generally limited to single tooth restoration 13
- 14. Preform Provisional Restoration Resin Metal Polycarbonatecrown Cellulose acetate Nickel cromium Aluminum Polycarbonate crown Cellulose acetate 14
- 15. Type of materialused Resin based • Cellulose acetate • Polycarbonate • PMMA : chemically activated • Micro- filled composite : BISGMA • Poly-R-methacrylate • UDMA : light cured resin Metal • Aluminum • Nickel- chromium • Tin-silver J Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-58 15
- 16. Materials use forinterim fixed restoration • PMMA Resin • Microfilled composite Resin • Light Polymerised Resin 16
- 17. Types Commercially available Advantages Disadvantages Polymethyl methacrylate Jet (Lang), Alike (GC America), Temporary Bridge Resin (Dentsply/Caulk) , Neopar (SDS/Kerr), and Duralay (Reliance) low cost, good wear resistance, good esthetics, high polishability, good color stability w exothermic reaction, high degree of shrinkage (about 8%) objectionable odor, short working time, hard to repair and radiolucent Bis-Acryl Composites Protemp,coolte mp,Luxatemp shrink less, give off less heat during setting, and can be polished at chair side. Greater cost than acrylic Viscosity cannot be altered More brittle than acrylate 17
- 18. Polymethyl methacrylate resins PolyR Methacrylate Micro filled composite resin with automix delivery system Photo polymerized polymethyl methacrylate 18
- 19. Ideal properties ofmaterials use for interim restoration • Conventional handling – Adequate working time,easy molding, rappid setting time. • Biocompatibility – Non toxic, Non allergic, Non exothermic. • Dimensional stability during solidification. • Ease of contouring and polishing. • Adequate strength and abrasion resistance • Ease of repairing • Chemical compatible with interim luting agents. 19
- 20. Basic clinical armamentarium •Gloves • Mask • Mouth mirror • Periodontal probe • Saliva ejaculator • Cotton rolls • Petrolatum • Autoplymerizing resin • Dropper • Dappen dishes • Cement spatula • Straight slow speed hand piece • Carborondum disc with mandrels • Tungsten carbide burs • Fine garnet paper disc (7/8- Inch diameter) • Muslin wheels • Robinson bristle brush 20
- 21. Direct technique Indirect technique Indirect direct technique Regish KM,Sharma D, Prithviraj DR. technique of fabrication of provisional restoration: An overview. International journal of dentistry. 2011;2011:1-5. 21
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- 25. Post and coreinterim restoration Wire is marked so that bend is made correct level 180 degree or greater bend in the wire is made to resist displacement Wire is inserted into post place Filled external surface form is seated Completed interim post and crown restoration 30
- 26. cooltemp Perfect tempLuxatemp Tuff temp Protemp 31
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- 28. Temp Tabs ThermoplasticMatrix Wafers Matrix for fabrication of provisionals Quick Bite Registration Temp Tabs® Natural and True Blue flexible multiuse thermoplastic matrix tabs 33 Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6.
- 29. PROTEMP CROWN Adapting protemp crownto the buccal margins Light cure buccal surface for 3 seconds Margins are trimmed Protemp crown is cemented 34 Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6.
- 30. LUXATEMP Trimming and polishingkit Luxatemp provisional restorative material Prepared teeth Impression making Putty index Finished and polished restoration Luxatemp poured into putty index Provisional restoration in place Mirazi B. Temporary restoration : the key to success. British dental journal. 2019;226(10):761-68. 35
- 31. TUFF-TEMP PLUS CAD-CAM PMMAProvisionals Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6. 36
- 32. Cementation of Provisionalrestoration • IDEAL PROPERTIES OF CEMENT: • Ability to seal against leakage of oral fluid. • Strength consist with intentional removal. • Low solubility. • Chemical compatibility with provisional polymer. Ease of eliminating excess. • Adequate working time and short setting time. • CEMENTS USED: • Zinc oxide eugenol. • Reinforced zinc oxide eugenol. • Non- eugenol cements. • Zinc phosphate, Zinc polycarboxylate, and Glass ionomer cements are not used because their comparatively high strength makes intentional removal difficult. 37
- 33. • Eugenol basedcements provide sedative effects that reduce dentin hypersensitivity and 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. • This can interfere with the acrylic resin polymerization and hardening process. 38 Lui JL, Setcos JC. Phillips RW. Temporary restorations: a review. Oper Dent 1986;11:103- 10
- 34. Removal of excess cement Removalof excess cement Removing interproximal excess cement Application of Vaseline Placement of luting agent Cementation of provisional restoration 39
- 35. Removal, Repair, Re-cementationof provisional restoration Removal of provisional restoration Repair of provisional restoration using bead brush technique Rosenstiel, Land, Fujimoto. Contemporary Fixed Prosthodontics, 4th edition. 40
- 36. Limitation of provisionalrestoration • Lack of inherent strength • Poor marginal adaptation • Color stability • Poor wear properties • Detectable odour emission • Inadequate bonding characteristics • Poor tissue response to irritation J Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-58 41
- 37. INFLUENCE OF MATERIALPROPERTIES ON TREATMENT OUTCOME • Marginal accuracy • Colour stability • Gingival response • Pulpal response 42 Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: report of the Committee on Research in Fixed Prosthodontics of the Academy of Fixed Prosthodontics. J Prosthet Dent. 2003 Nov;90(5):474-97.
- 38. 43 • Barghi andSimmons • Indicated that autopolymerizing acrylic resin provisional restorations routinely did not have adequate marginal adaptation. • The accuracy could be significantly improved by relining the restoration after the initial polymerization. Barghi N, Simmons EW Jr. The marginal integrity of the temporary acrylic resin crown. J Prosthet Dent 1976;36:274-7 Crispin et al evaluated marginal accuracy with direct and indirect techniques. They reported that indirect fabrication provided significant improvements in marginal fit relative to direct methods.
- 39. 44 • Crispin BJ, CaputoAA. Color stability of temporary restorative materials. J Prosthet Dent 1979;42:27-33. Yannikakis SA, Zissis AJ, Polyzois GL, Caroni C. Color stability of provisional resin restorative materials. J Prosthet Dent Crispin and Caputo • Studied the colour stability of provisional materials. They found that methyl methacrylate materials exhibited the least darkening, followed by ethyl methacrylate • Yannikakis et al • Immersed provisional materials in various staining solutions for up to 1 month. They reported that all materials showed perceptible color changes after 1 week. After 1 month, the methyl methacrylate materials exhibited the best color stability than bis-acryl materials .
- 40. 45 Donaldson D. Theetiology of gingival recession associated with temporary crowns. J Periodontol 1974;45:468-71 • Indicated that the occurrence of gingival recession before provisional treatment was directly linked to further recession observed after the completion of definitive prosthodontic treatment. • He also found a direct relation between the degree of pressure applied by a provisional restoration and gingival recession. An anatomically contoured provisional restoration caused less recession than did a non atomically contoured one
- 41. CLINICAL CONSIDERATION FORPROVISIONAL TREATMENT ENVOLVING NATURAL TEETH • Occlusal diagnostic and treatment • Esthetics phonetics diagnosis • Periodontal treatment • Provisional fixed prosthesis fabrication • - Adaption on prepared tooth • -cavosurface adaptation • - form – cervical concavities and proper emergence properties 46
- 42. CLINICAL CONSIDERATION FORPROVISIONAL TREATMENT INVOLVING DENTAL IMPLANTS Treatment protocol Clinical conditions No interim prosthesis required Esthetics not a concern to a patient Implants placed in posterior region Removable interim prosthesis Before first-stage surgery; eliminated after first-stage surgery with implant supported provisional Before or just after first stage surgery, maintained until completion of definitive treatment Fixed interim prosthesis Resin bonded using clinical crown of extracted tooth or denture tooth • Resin bonded pontic prosthesis Fixed implant retained provisional placed after second-stage surgery/no removable prosthesis Provisional placed at or shortly after first stage surgery implant retained Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: J Prosthet Dent. 2003
- 43. conclusion • Provisional restorationsare usually planned for short-term use and then discarded. • They should provide pleasing esthetics, adequate support, and good protection for teeth. • They should be selected carefully for clinical applications preserving periodontal health. • Proper planning is needed to ensure the most suitable provisional is used, especially when multiple teeth are to be prepared. Therefore dentists should be familiar with the techniques and range of materials available. 48
- 44. Take home points •Provisional restoration is given for a period of time until permanent arrangement can be made. • Ideal requirements – Biologic,Mechanical,esthetics • Techniques for fabrication of provisional restoration – • Direct technique , indirect technique, direct indirect technique • Recent advances – protemp crown , tuff temp plus,temp tabs, CAD CAM PMMA provisionals 49
- 45. References • Rosenstiel, Land,Fujimoto. Contemporary Fixed Prosthodontics, 4th edition. • Regish KM, Sharma D, Prithviraj DR. technique of fabrication of provisional restoration: An overview. International journal of dentistry. 2011;2011:1-5. • Raghvan R, Shajahan PA, Kunjumon N. Provisionals in dentistry- from past to recent advances. IJDMSR. 2018;2(6):1-6. • Barghi N, Simmons EW Jr. The marginal integrity of the temporary acrylic resin crown. J Prosthet Dent 1976;36:274-7 • Donaldson D. The etiology of gingival recession associated with temporary crowns. J Periodontol 1974;45:468-71 • Gandhimathi. Recent advances in provisional restorations. IOSR Journal of dental and medical sciences.2019;18(4):55-5 • 8Crispin BJ, Caputo AA. Color stability of temporary restorative materials. J Prosthet Dent 1979;42:27- 33. • Yannikakis SA, Zissis AJ, Polyzois GL, Caroni C. Color stability of provisional resin restorative materials. J Prosthet Dent 1998;80:533-9. • Burns DR, Beck DA, Nelson SK;. A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: J Prosthet Dent. 2003 50
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Editor's Notes
- #16 From1937 poly methyl methacrylate was available in granules and molding powders. The popularity of this material increased so fast
- #18 From1937 poly methyl methacrylate was available in granules and molding powders. The popularity of this material increased so fast .By 1946, 95% of the denture bases were fabricated with it. Auto polymerizing acrylic resins provide adequate short term interim prostheses
- #34 Protemp crown is a pre-fabricated composite provisional crown made of light curable methacrylate composite which was introduced as malleable and adjustable Protemp crowns areavailable for molars, bicuspids and canines Appropriate Protempcrown isselected and trimmed according to the gingival contou Applicab;le Matrix for Temporaries(Figure 3b) b. 5 Minute Chairside Night Guards c. Quick Bite Registration (
- #35 Protemp crown is a pre-fabricated composite provisional crown made of light curable methacrylate composite which was introduced as malleable and adjustable.To fabricate a protemp crown simply select the appropriate size and adapt the crown to its oral environment. Appropriate Protempcrown isselected and trimmed according to the gingival contour. Then protemp crown is placed gently on the preparation. Use finger to ensure the crown is in line with adjacent teeth. Ask patient to close mo uth slowly and gently into occlusion. Adapt buccal margin using composite instrument (Figure 2a).Tack cure buccal surface for 3 sec (Figure 2b). Similarly adapt it to the lingual surface and occlusal surface and tack cure for 3 seconds.After tack cure remove protemp crown carefully and put crown back in several times, to ensure fit before final cure. Then fully cure for 60 seconds outside mouth, making all surfaces light cured. Finally the margins are trimmed (Figure 2c) and protemp crown is cemented (Figure 2d)
- #37 Tuff-Temp Plus is an impact resistant rubberized-resin.It doesnot show polymerization shrinkageand holdstightlyto the tooth.Itdisplays very high flexural strength without brittleness. Provisional restorations are digitally fabricated from polymethyl methacrylate (PMMA) and yeilds a highly precise and anatomically detailed result14 . PMMA temporaries (Figure 5) are milled out of a dense block and shows reduced the porosity of traditional hand processed techniques, reducing chair timeand cracking.Axial contours and occlusal anatomy provided from tooth libraries produce additional anatomy that mimics natural teeth14 . BioTemps provisional crowns & bridges are created with CAD/CAM technology.
- #45 Discoloration of provisional materials can produce serious esthetic complications, especially when long-term provisional treatment is required
- #46 Inflammation and recession of the free gingival margin associated with provisional treatment is a common occurrence.81-84
- #47 provisional restorations provide a means of designing, improving, and assessing the occlusion, esthetics, and contours for definitive restorations, as well as to determine their effects on gingival health, phonetics, and patient adaptability before the initiation of the definitive treatment.6,12,112-114 Provisional restorations fit into 2 categories: (1) those that fit within an arch of fundamentally intact teeth that provide reference for their occlusion, contours, and esthetics; 1)Casts of provisional restorations mounted opposite definitive casts transfer contours, clinical crown dimensions, and maxillomandibular relationships from a patient to a dental laboratory for developing occlusal factors, especially anterior guidance, for fixed prosthodontic treatment.2,4 2)Evaluation of the maxillary anterior incisal edges follow the contour of the lower lip, the “smile line,” aion of anteriros 3) Periodontal treatment is commonly part of comprehensive prosthodontic care. These provisional restorations provide a matrix against which the tissue heals, guiding the generation of correct soft tissue architecture.1 4) Provisional restorations should have cervical concavities and proper emergence profile.22 It has been suggested that pontics should be designed for hygiene on the mandibular arch and hygiene and esthetics on the maxillary arch.