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Dr. Prakash Nidawani
Professor,
Department of Prosthodontics,
Navodaya Dental College.
Temporary Before Permanent – Provisional
Restoration & Cementation
DEFINITION
A fixed or removal 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 – 9)
SYNONYMS
Temporization
Interim prosthesis
Provisional prosthesis
[provisional – established for time being]
Dr. Nidawani
Rationale for provisional treatment
(Fredrick and Krug)
1.Provide method for immediately replacing missing teeth.
2.Protect prepared abutments from thermal, chemical, mechanical
and bacterial insults.
3.Protect soft tissues –gingiva, tongue, lips & cheek.
4.Provide comfort function and Improve esthetics.
5.Prevent migration of abutments.
6.Evaluate and reinforce the patient’s oral home care
Dr.Nidawani
7. Provide a matrix for the retention of periodontal surgical dressings.
8. Stabilize mobile teeth during periodontal therapy and evaluation.
9. Provide anchorage for orthodontic brackets during tooth movement
10. Aids in developing and evaluating an occlusal scheme before
definitive treatment.
11. Allow evaluation of vertical dimension, phonetics & masticatory
function.
12. Assist in determining the prognosis of questionable abutments
during prosthodontic treatment planning.
J Prosthet Dent 2003;90:474-97
Dr.Nidawani
DESIRABLE PROPERTIES
• Biocompatibility
• Pleasing esthetics
• Dimensional stability
• Ease of fabrication
• Fracture resistance
• Non porous
• Contourable
Dr.Nidawani
IDEAL REQUIREMENTS OF PROVISIONAL
RESTORATION
THREE BASICREQUIREMENTS:
Biologic requirements
Mechanical
requirements
Esthetic
requirements
Dr.Nidawani
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
Maintain inter
abtment alignment
Rosensteil , Land ,Fujimoto– CFP -4TH ED
Dr.Nidawani
BIOLOGIC REQUIREMENTS
PULP PROTECTION:
Dentinal tubules exposed – during tooth preparation.
Provisional restoration – should protect the prepared tooth from oral
environment, thereby preventing sensitivity and irritation to pulp.
PERIODONTALHEALTH:
It should have good marginal fit, proper contour & smooth surface to
prevent accumulation of food debris & facilitate easy plaque removal.
Dr.Nidawani
POSITIONALSTABILITY:
It should provide comfortable & stable functional occlusal relationship
by maintaining interarch and intra- arch stability thereby preventing
tooth migration and supra eruption.
PREVENTIONOF FRACTURE:
It should protect the prepared tooth surface from fracture.
In partial coverage restoration, in which margin of preparation is close
to occlusal surface of tooth can be damaged during mastication.
Dr.Nidawani
MECHANICAL REQUIREMENTS
FUNCTIONAL:
It should possess good compressive & flexural
strength.
The greatest stresses in provisional restoration
occurs during chewing.
RETENTION:
It should have close adaptation to the prepared
tooth surface to prevent displacement & recementation.
RESISTS REMOVALFORCES
Be strong enough for repeated removal and recementation.
Dr.Nidawani
ESTHETIC REQUIREMENTS
It should match the size, colour, shape and texture of the
restored tooth especially in anterior region.
Colour stability is also important if the provisional restoration
are to function for a prolonged period.
Serves as a guide to achieve esthetics to the final restoration.
Dr.Nidawani
AL
RESTOTATI
ON
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
TECHNIQUE OF
FABRICATION
DIRECT TECHNIQUE
IN-DIRECT
TECHNIQUE
IN-DIRECT -- DIRECT
TECHNIQUE
CAD – CAM
TECHNIQUE Dr.Nidawani
TYPES OF
PROVISIONAL
RESTORATIONS
I.DEPENDING ON METHODOF FABRICATION:
1.CUSTOMTEMPORARIES :
Made with a matrix derived from original tooth or a
modified diagnostic cast or by cad/cam.
Advantage:
•Minimal interference.
• Wide variety of materials can be used.
• Helpful in evaluating the adequacy of tooth reduction.
Disadvantage:
• Additional lab procedure involved.
• Time consuming.
Dr.Nidawani
2- PREFABRICATED TEMPORARIES
These are preformed crowns that may be modified to fit a
prepared tooth.
In most cases these requires relining with an acrylic material.
Advantage:
- Less time consuming.
Disadvantage:
- Rarely satisfies the requirement of contours.
- It has to customize with self-cure resin.
- Generally limited to single tooth restoration
IOSR Journal of Dental & Medical Sciences vol18(4) 2019
Dr.Nidawani
II. DEPENDINGUPON THE TYPE OF MATERIAL USED
A) Resin based Provisional Restoration
- Cellulose acetate
- Polycarbonate
- Polymethyl methacrylate: chemically activated resin.
- Poly-R-methacrylate: R group could be ethyl or isobutyl form of resin.
- Micro-filled Composite: BISGMA
- Urethane di-methyl acrylate: light-cured resins
B) Metal Provisional Restoration
- Aluminum
- Nickel – Chromium
- Tin –Silver
IOSR Journal of Dental & Medical Sciences 2019 vol18(4)
Dr.Nidawani
ACRYLIC RESINS : (Methyl methacrylate, Ethyl methacrylate or Vinyl
methacrylate) - SNAP, DPI, Trantemp, Biolon, Bosworth TrimII.
One of the oldest material available as powder & liquid.
Advantages :
• Good wear resistance & available in many shades.
• Capable of high polish & less expensive.
Disadvantages :
• Significant amount of heat given off by exothermic reaction.
• High degree of shrinkage (about 8%).
• Pungent odor.
Dr.Nidawani
Donovan TE, Hurst RG & Campagni WV. Physical properties of
acrylic resin polymerized by four different techniques. J. Prosthet.
Dent. 1987;54:194-97 determined autopolymerizing polymethyl
methacrylate resin specimens polymerized with pressure
demonstrate increase transverse strength and less porosity.
Polymerization under water have no effect on physical properties.
T. Nigel Town, M.Aet al Provisional Restorations : An Overviewof
material used. Journal of Advanced clinical & ResearchInsights
2016;3:212-14.
In cases of full mouth rehabilitation cases and cases involving
more than 5 unit bridges, Heat cure PMMA are more superior in
prolonged use temporary with better physical and mechanical
properties Dr.Nidawani
BIS – ACRYL MATERIALS (20 years old)
 Bis-acrylics are multi functional dimethacrylate materials capable
of cross-linking.
 Can be categorized into two groups: UDMA and bisphenol A-
glycidyl methacrylate (Bis-GMA).
 Less heat generation and shrinkage ,water sorption, minimal
odour.
 Faster setting time, better mechanical properties – so fabricated
more efficiently with greater predictability.
Dr.Nidawani
VISIBLE LIGHT CURED RESINS: (setson command )
 Based on UDMA (urethane di-methacrylate).
 Has good mechanical properties & color stability.
 Available in variety of shades.
 Marginal fit is good as there is less
polymerization shrinkage.
 Operator has the advantage over control
of the working time as it is light cured.
 Expensive and stains overtime.
Dr.Nidawani
Luxatemp®, (DMG America, www.dmgamerica.com)
high filled self and light cured, glass filler of 44wt%
Luxatemp Fluorescence ; Aimed at achieving superior esthetic.
Luxatemp Ultra ; which incorporates proprietary nano technology
to provide increased flexural strength.
Luxatemp Solar ; a light-cured material.
Comp strength 250 Mpa - making it an ideal choice for long-span
temporary bridges.
LuxaFlow™for-repair & reline.
Luxa glaze varnish that provides a surface glaze for provisionals.
Dr.Nidawani
Protemp™(3M ESPE, www.3MESPE.com)2,3,4, line of bis-acryl
provisional material with “a new generation of sophisticated
nanotechnology fillers”.
Protemp Plus - highly fracture-resistant material in five shades
with high gloss without polishing.
3M ESPE Filtek™ Supreme Ultra Flowable reline & repair material
Sheen - using an alcohol gauze to wipe the provisional restoration
with ethanol
Dr.Nidawani
Astudillo-Rubio D, Delgado-Gaete A, Bellot-Arcı ´s C, Montiel-
Company JM, PascualMoscardo ´ A, Almerich-Silla JM .Mechanical
properties of provisional dentalmaterials: A systematic reviewand
meta-analysis. PLoSONE .2018;13(2): e0193162
Dimethacrylate based (Bis - acrylics) provisionals presented better
mechanical behavior than monomethacrylate for flexural strength
and hardness. Fracture toughness showed no significant differences.
Within the monomethacrylate (acrylics) group, polymethyl
methacrylate showed greater flexural strength than polyethyl
methacrylate.
Dr.Nidawani
Protemp line is the Protemp Crown Temporization Material.
Preformed, malleable composite temporary crowns with nine
preformed sizes, custom fit for single-unit crowns that provide
remarkable strength - with compressive strength of 395.6 MPa
Integrity®Multi-Cure, (DENTSPLY Caulk) is reported by the
manufacturer to deliver durable results due to wear resistance
and strength properties (compressive strength of 386 MPa to 394
MPa) light-cured for 20 second
Inspire™ (Clinician’s Choice, www.clinicianschoice.com) lowest
exothermic reactions, coming in at 53°
Dr.Nidawani
Perfectemp 10 (DenMat, www.denmat.com); Elastic modulus is
reported at 3500 MPa, flexural strength 120 MPa, less than
3.4%.volumetric shrinkage. The Structur® (VOCO America, Inc.,
www.voco.com)
Structur3 ; Nanofilled material with high fracture resistance and
compressive strength (more then 500 MPa), wipe and go
technology
Structur Premium; 1:1 cartridge mix , fast setting Bis-acryl
provisional material with ceramic-like esthetics, high fracture
resistance ideal for long-span bridges, a brilliant gloss, natural
fluorescence, .
Dr.Nidawani
Visalys® Temp; (Kettenbach, www.kettenbach.us) high
fracture-resistant material (impact strength 12.5 KJ/mm²,
flexural strength 132 MPa), can be precisely trimmed with
minimal dust and has a high luster.
Tuff-Temp™Plus; (Pulpdent Corp., www.pulpdent.com)
features a synthetic rubber molecule inserted into it to produce
a tough, impact-resistant, dimensionally stable provisional
material that the manufacturer calls a “rubberized urethane”.
Dr.Nidawani
REINFORCEMENT OF PROVISIONAL RESTORATIONS
Reinforcement of the provisional restoration is recommended in long
span/long term,
• Periodontally compromised abutments .
• Restoration of lost vertical dimension.
• Restoring long span bridges.
• Cases with abnormal occlusal forces / habits ,
• Repeated fracture of restoration .
•Acid etched bridges/resin bonded prosthesis.
Dr.Nidawani
Reinforcedprovisionals maintain better occlusal stability, flex less
there by minimizes progressive cement loss and diminished caries
incidence.
Fibers added to heat cured, self cured & light cured materials: nylon
fibers, graphite fibers, carbon fibers, polyester fibers, ultra high
molecular weight polyethylene fibers and glass fibers.
Pre impregnated fibers: polymer monomer mix for ACRYLICS,
bonding agent for BIS-GMA enhance adhesion between fiber &
matrix.
Others: Swage metal sub structure, 16-18 gauge metal cast frame
work ,stainless steel wire ,ortho bands . Dr.Nidawani
Reinforcing fibers :
•Earlier the carbon fibers were used which were unesthetic and
there was no chemical bonding to the resin.
•There were also chances of fraying of the fibers, which were
exposed on the surface.
•Recently, the nylon fibers were introduced in which there was no
chemical bonding with polymers so no significant increase in
strength.
Dr.Nidawani
Polyethylene fibers (Capaccio and Ward, 1973) :
• Very high molecular weight and thus improves
strength (transverse and flexural strength).
•No proper wetting of fibers by polymer - needs conditioning.
Chemical conditioning done by etching, plasma treating, heat treatment
and silanizing the fibers.
Glass fibers(P.K. Vallittu, 1998) :
•Available as woven fibers and unidirectional fibers.
•Reinforcement of pontic and connector (bridge) - unidirectional fibers
Crown – Woven fibers Dr.Nidawani
CAD– CAM MILLED RESIN BLOCKS:
 Superior marginal fit – lowers the risk of bacterial
contamination of the tooth and prevents damage to pulp from
excessive temperature changes.
 Stronger and more accurate (industrial polymerized).
 Good mechanical properties.
 Serves as a solution for long-term/long-span interim prosthesis
where strength and colour stability is required.
 Easy to manipulate.
Dr.Nidawani
Ishita Dureja et al .A comparative evaluation of vertical marginal fit
of provisional crowns fabricated by computeraideddesign/
computer aidedmanufacturing technique & direct (intra oral tech)
& flexural strengthof the materials : An in vitro study. JIPS 2018
 Concluded that Bis –aryl composite resin based
autopolymerizing Protemp™ 4( 101.41 MPa) and CAD/CAM
(94.06 Mpa) provisional materials have comparable flexural
strength. However, the marginal fit of temporary crowns
fabricated by CAD/CAM was found to be superior (34.34 µm) to
the ones fabricated with Protemp™ 4. (63.42 µm).
Dr.Nidawani
III. DEPENDING UPON THE TECHNIQUE OF FABRICATION:
a) Provisional Restorations fabricated using direct technique : these are
constructed with a matrix lined with provisional material that is
placed directly on the preparedtooth
b) Provisional Restorations fabricated using indirect technique :
constructed by placing the filled matrix over a model of the prepared
tooth, thus the provisional is constructed out of the patient'smouth
c) Provisional Restorations fabricated using direct – indirect technique
made by forming a temporaryin an indirect manneron mock
preparedmodel and then relined directly in patients mouth.
This method is useful in constructing temporary bridges.
IOSR Journal of Dental & Medical Sciences vol18(4) 2019
Dr.Nidawani
DIRECT VS INDIRECT VS DIRECT INDIRECT
 Direct - faster for routine provisional restorations.
 Indirect can save time with multiple units or complex
fixed partial dentures.
 Indirect-direct provisionals can be fabricated in
advance of the tooth preparation appointment.
Dr.Nidawani
IV. DEPENDING ON DURATIONOF USE:
a) Short term provisional, for use up to 2 weeks
 Indicated after tooth preparation in FPDs.
 Custom made using acrylics or composite based materials.
 Relined polycarbonate or aluminum preformed crowns .
b) Long term provisional, for use from 2 weeks to a few months
 Full mouth rehabilitation.
 In patients undergoing orthodontic, endodontic, periodontic,
implant treatment, in presence of deciduous teeth.
 Benefits vs value decisions in medically compromised elderly .
IOSR Journal of Dental & Medical Sciences vol18(4) 2019
Dr.Nidawani
EXTERNAL SURFACE FORM
The external contour of the crown is known
as External Surface Form (ESF).
There are two categories : Custom
Preformed
CUSTOM
A custom is a negative reproduction of either the patient’s
teeth before preparation or a modified diagnostic cast.
PREFORMED
Various preformed crowns are available commercially.
Dr.Nidawani
INTERNAL SURFACE FORM(ISF)
Prepared tooth surface is known as Internal Surface
Form.
It can be obtained by three methods
1. Direct
2. Indirect
3. Indirect - Direct
Dr.Nidawani
DIRECT
TECHNIQUE
Types Of Templates :
 Putty index made on cast or intra orally
using a tray
 Clear plastic vacuum-formed template
 Combination of thermoplastic & translucent impression
material. Ioannis Konstantinidis; (J Prosthet Dent 2013;109:198-
201)
Dr.Nidawani
Techniques described all of the literature on direct
provisionalrestorations:
 Use of a pre manufactured provisionalsheIl &relining.
 Use of an impression material, or pressure or vacuum formed
translucent matrix&relining.
 Useofthermoplasticmaterialandtranslucentpolyvinylsiloxane-
menosil2(heracusKulzer,Germany)&relining.
 Temporary temporary- Goldstein created immediate interim
direct temporary by using vaccum formed matrix on wax up
stone model and filling it with tooth colored c- silicon(GC Fit
checker)
Dr.Nidawani
DIRECT TECHNIQUE
 Patient’s prepared teeth and the gingival tissues directly provide
the internal surface form.
 Eliminates all intermediate laboratory procedures.
Disadvantage:
 Potential tissue & pulp trauma from exposed dentinal tubules
from the exothermic heat of polymerizing resin.
 Formation of voids.
 Inherently poorer marginal fit.
Therefore, directly formed interim restoration limited for single
crowns, indirect techniques for multiple units.
Dr.Nidawani
RELINED ALUMINIUM SHELLS RELINED POLYCARBOXYLATE CROWN
VACCUM FORMED TEMPLATEPUTTY TEMPLATE
Dr.Nidawani
Acrylic tooth is placed in the area of missing tooth.
Alginate impression or a putty index is made.
Patient’s teeth is prepared & lubricated with petroleum jelly
(including adjacent tooth & gingival margins).
Index or alginate impression is reseated with provisional
restorative material (dough stage).
Remove and reseat followed by finishing, polishing & cementation
Dr.Nidawani
Dr.Nidawani
Alternative Techniques for Direct Technique
Acrylic Resin Block Technique for Direct Provisional Restoration:
 A seldom employed, method.
 It provides a means of fabricating the interim restoration
without the use of diagnostic casts and laboratory processing
costs.
 The technique requires knowledge of dental anatomy, patience
and artistic traits inherent in dentists.
Dr.Nidawani
INDIRECT TECHNIQUE
 Involves fabrication of the interim restoration outside the mouth.
MERITS:
 No contact of free monomer with the prepared teeth or gingiva which
might cause tissue damage & allergic reaction or sensitization.
 Avoids subjecting prepared tooth to heat evolved from polymerizing
resin.
 Superior marginal fit.
 Frees the patient & dentist for considerable amount of time. (fabricated
in lab)
DEMERITS :
 Increased time & number of intermediate steps.
 Inadequacy of assistants or the laboratory facilities.
 Possible damage of diagnostic casts. Dr.Nidawani
PROCEDURE:
Acrylic tooth placed on missing tooth area of diagnostic cast & putty
index is made
Sectional impression made on diagnostic cast
Provisional restorative material is injected into putty index
Fit is checked on the diagnostic cast
Restoration is relined for proper marginal fit
Finishing, Polishing followed by Cementation.
Dr.Nidawani
Dr.Nidawani
DIRECT – INDIRECT
TECHNIQUE
This technique produces
- custom made preformed external surface form of the restoration
- internal tissue surface form is formed by underprepared diagnostic casts.
Advantages:
 Reduced chair time (provisional shell is fabricated before patient’s appointment)
 A smaller amount of acrylic resin will polymerize in contact with the prepared
abutment, resulting in decreased heat generation, chemical exposure, and
polymerization shrinkage compared to the direct technique.
 Contact between resin monomer and soft tissues is reduced and less chances of
allergic reactions.
Disadvantage:
 Potential need of a laboratory phase before tooth preparation
 Adjustments that are frequently needed to seat the shell completely on the
prepared tooth.
Dr.Nidawani
PROCEDURE:
Pontic is placed in the area of missing in diagnostic cast & putty
index is made with suitable material
Acrylic tooth is removed & abutments are prepared on the
diagnostic cast (Preparations should be more conservative than the eventual
tooth preparation and should follow precisely the gingival margins.)
Diagnostic cast is lubricated with suitable separating media &
provisional restorative material is filled into putty index & reseated
Provisional restoration must be paper thin & correctly contoured
Dr.Nidawani
Patient’s teeth is prepared in usual manner.
Preformed restoration is tried in patient’s mouth (If the amount of
tooth reduction is adequate, the provisional restoration will show optimal
marginal fit with no need for adjustment.)
Temporary restoration is relined to perfect the internal fit.
Finishing, polishing and cementation.
Dr.Nidawani
Dr.Nidawani
Provisional restoration for post & core restorations
 If custom made post and core is to be used, it can be instantly
built and temporary crown be fabricated on it.
 For cast posts, following measures may be taken.
(a) A ball pin/wooden wedge placed into the post space and an
alginate over impression made that would pick up the ball pin
and then the restoration fabricated on the cast.
(b) In an alternative technique, a ball pin may be placed into
the post space and the restoration fabricated intra orally using
acrylic resin block technique.
 A tooth trimmed in the form of a labial veneer can also be used to
serve the purpose.
Dr.Nidawani
IMPLANT SUPPORTEDPROVISIONAL RESTORATIONS :
Provisional prosthesis designs for dental implant patients
can vary widely, ranging from a removable acrylic resin
complete/partial denture relined with soft liner to an implant
supported fixed prosthesis. Several different potential designs that
promote esthetics, convenience, the loading of implants, tissue
contour control, material strength, and interim prosthesis
durability.
Dr.Nidawani
Provisional fixed prosthodontic treatment options for an
implant patient that may vary depending on the following:
• The number, position, or location of the implants.
• The number of natural teeth remaining in a treatment arch.
• Opposing occlusion.
• Whether teeth adjacent to the implant site(s) can serve as
abutment teeth for a provisional restoration.
• The desired protocol for provisional treatment at either first or
second stage surgery.
Dr.Nidawani
PROVISIONAL LUTING MATERIALS:
 Provisional luting agents should possess :
- good mechanical properties.
- low solubility.
- tooth adhesion to resist bacterial & molecular
penetration.
 Provide an adequate seal & Sedative effects that reduces dentin
hypersensitivity.
 Strong enough to retain a provisional restoration during the
course of treatment but, allow easy restoration removal when
required.
Dr.Nidawani
 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.
 Zinc phosphate, Zinc polycarboxylate & GIC – not used.
Because of their comparatively high strength which makes
intentional removal difficult.
Dr.Nidawani
Zinc Oxide Eugenol Cement :
It is one of the most commonly used cost effective temporary
luting cement. Because of eugenol it provides an obtundent effect
and anti microbial effect. It has adequate strength. Ease of removal
0f restoration.
Disadvantages:
Eugenol – interfere with polymerization of resin.
Dr.Nidawani
 Free radical production necessary for polymerization of
methacrylate materials can be significantly hampered by the
presence of eugenol, this interference with the acrylic /resin
polymerization and hardening process and softens restoration.
 Eugenol interferes with polymerization of resin cements that are
used to fix final restoration.
 Eugenol used in cementation of temporary restoration can
penetrate into dentine and might affect adhesion of resin
cements.
Dr.Nidawani
 Therefore eugenol free provisional luting materials containing
essential oils are commercially available and have gained
popularity.
Dr.Nidawani
Cement Remnants andTheir Effect on PermanentLuting:
Elisite Karunki et al (2000) gave a method to enhance the bond
strength of the permanent cements following the removal of the
temporary restoration. After removal of cements, the tooth preparation
was conditioned with 38% phosphoric acid and 10% NaOCI. Bond
strength was better after conditioning with H3PO4 and NaOCI.
Micro leakage and Temporary Cements :
Palao B et al (1998) conducted a study to check the micro leakage
and die penetration between tooth preparation and the cement and
reported that the micro leakage was seen in all cements. Less in Ca
(OH)2 and zinc phosphate cement and more for zinc oxide and non-
eugenol cement.
Dr.Nidawani
Dr.Nidawani
Dr.Nidawani
REMOVALOF PROVISIONAL
RESTORATION
 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.
 Holding luke warm water in mouth softens luting cement.
 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.
Dr.Nidawani
LIMITATIONS OF TEMPORIZATION :
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.
Dr.Nidawani
v) Detectable Odour Emission: - This is undeniable despite the
dentists close attention to sufficient embrasure spaces. Resins
are porous.
vi) Inadequate Bonding Characteristics: - Few types of cement
currently secure an adequate interface relationship with resins.
Eugenol – bearing sedative cements are notorious for
incompatibility with methyl methacrylate resins.
vii) Poor Tissue Response to Irritation: - Mild or moderate tissue
irritations is always present.
IOSR Journal of Dental & Medical Sciences 2019 vol18(4)
Dr.Nidawani
CONCLUSION :
Successful temporary restorations are pillars for
successful final restorations.
Dr.Nidawani
REFERENCES:
 STEPHENF ROSENSTIEL. Contemporary Fixed Prosthodontics.
 HERBERT T SHILLINGBERG. Fundamentals of Fixed Prosthodontics.
 TYLAMAN. Theory and practice of Crown and Bridge Prosthodontics.
 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
Dr.Nidawani
Astudillo-Rubio et al.Mechanical properties of provisional dentalmaterials:
A systematic reviewand meta-analysis. PLoS ONE .2018;13(2): e0193162
Ishita Dureja et al .A comparative evaluation of vertical marginal fit of
provisional crowns fabricatedby computer aideddesign/ computer aided
manufacturing technique & direct (intra oral tech)& flexural strength of the
materials : An in vitro study. JIPS 2018
K.M.Regish, Deeksha Sharma & D.R.Prithviraj. Techniques of Fabricationof
Provisional Restoration: An Overview. International Journal of Dentistry
Volume 2011
Limitations of temporization - IOSR Journal of Dental & Medical Sciences
2019 vol18(4)
 Baldissara P Comin G, Martone F, Scotti R. Comparative study of the marginal
microleakage of six cements in fixedprovisional crowns. J Prosthet Dent
1998;80:417-22.
Dr.Nidawani
QUESTIONS ASKED
RGUHS
1. Luting agents in provisional restoration (Sep 2007)
2. Temporization & its importance (Sep 2007)
3. Provisional Restoration (May 2010, July 2016)
4. Explain the methods of Temporization (Nov 2011)
5. Temporization in FPD (May 2014, May 2019)
6. Rationale for Provisional Restorations (Nov 2016)
Dr.Nidawani
OTHER UNIVERSITIES
1. Techniques of fabrication of provisional restoration (oct
2019)
2. Discuss provisionalization in FPD (2013)
3. Provisional restorations (June 2016, 2017)
4. Utility & Scope of temporization in Fixed Prosthodontics
(2017)
5. Write a note on temporization (2005)
Dr.Nidawani
TEMPORIZATION IN PROSTHODONTICS
TEMPORIZATION IN PROSTHODONTICS

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TEMPORIZATION IN PROSTHODONTICS

  • 1.
  • 2. Dr. Prakash Nidawani Professor, Department of Prosthodontics, Navodaya Dental College. Temporary Before Permanent – Provisional Restoration & Cementation
  • 3. DEFINITION A fixed or removal 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 – 9) SYNONYMS Temporization Interim prosthesis Provisional prosthesis [provisional – established for time being] Dr. Nidawani
  • 4. Rationale for provisional treatment (Fredrick and Krug) 1.Provide method for immediately replacing missing teeth. 2.Protect prepared abutments from thermal, chemical, mechanical and bacterial insults. 3.Protect soft tissues –gingiva, tongue, lips & cheek. 4.Provide comfort function and Improve esthetics. 5.Prevent migration of abutments. 6.Evaluate and reinforce the patient’s oral home care Dr.Nidawani
  • 5. 7. Provide a matrix for the retention of periodontal surgical dressings. 8. Stabilize mobile teeth during periodontal therapy and evaluation. 9. Provide anchorage for orthodontic brackets during tooth movement 10. Aids in developing and evaluating an occlusal scheme before definitive treatment. 11. Allow evaluation of vertical dimension, phonetics & masticatory function. 12. Assist in determining the prognosis of questionable abutments during prosthodontic treatment planning. J Prosthet Dent 2003;90:474-97 Dr.Nidawani
  • 6. DESIRABLE PROPERTIES • Biocompatibility • Pleasing esthetics • Dimensional stability • Ease of fabrication • Fracture resistance • Non porous • Contourable Dr.Nidawani
  • 7. IDEAL REQUIREMENTS OF PROVISIONAL RESTORATION THREE BASICREQUIREMENTS: Biologic requirements Mechanical requirements Esthetic requirements Dr.Nidawani
  • 8. 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 Maintain inter abtment alignment Rosensteil , Land ,Fujimoto– CFP -4TH ED Dr.Nidawani
  • 9. BIOLOGIC REQUIREMENTS PULP PROTECTION: Dentinal tubules exposed – during tooth preparation. Provisional restoration – should protect the prepared tooth from oral environment, thereby preventing sensitivity and irritation to pulp. PERIODONTALHEALTH: It should have good marginal fit, proper contour & smooth surface to prevent accumulation of food debris & facilitate easy plaque removal. Dr.Nidawani
  • 10. POSITIONALSTABILITY: It should provide comfortable & stable functional occlusal relationship by maintaining interarch and intra- arch stability thereby preventing tooth migration and supra eruption. PREVENTIONOF FRACTURE: It should protect the prepared tooth surface from fracture. In partial coverage restoration, in which margin of preparation is close to occlusal surface of tooth can be damaged during mastication. Dr.Nidawani
  • 11. MECHANICAL REQUIREMENTS FUNCTIONAL: It should possess good compressive & flexural strength. The greatest stresses in provisional restoration occurs during chewing. RETENTION: It should have close adaptation to the prepared tooth surface to prevent displacement & recementation. RESISTS REMOVALFORCES Be strong enough for repeated removal and recementation. Dr.Nidawani
  • 12. ESTHETIC REQUIREMENTS It should match the size, colour, shape and texture of the restored tooth especially in anterior region. Colour stability is also important if the provisional restoration are to function for a prolonged period. Serves as a guide to achieve esthetics to the final restoration. Dr.Nidawani
  • 13. AL RESTOTATI ON 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 TECHNIQUE OF FABRICATION DIRECT TECHNIQUE IN-DIRECT TECHNIQUE IN-DIRECT -- DIRECT TECHNIQUE CAD – CAM TECHNIQUE Dr.Nidawani
  • 15. I.DEPENDING ON METHODOF FABRICATION: 1.CUSTOMTEMPORARIES : Made with a matrix derived from original tooth or a modified diagnostic cast or by cad/cam. Advantage: •Minimal interference. • Wide variety of materials can be used. • Helpful in evaluating the adequacy of tooth reduction. Disadvantage: • Additional lab procedure involved. • Time consuming. Dr.Nidawani
  • 16. 2- PREFABRICATED TEMPORARIES These are preformed crowns that may be modified to fit a prepared tooth. In most cases these requires relining with an acrylic material. Advantage: - Less time consuming. Disadvantage: - Rarely satisfies the requirement of contours. - It has to customize with self-cure resin. - Generally limited to single tooth restoration IOSR Journal of Dental & Medical Sciences vol18(4) 2019 Dr.Nidawani
  • 17. II. DEPENDINGUPON THE TYPE OF MATERIAL USED A) Resin based Provisional Restoration - Cellulose acetate - Polycarbonate - Polymethyl methacrylate: chemically activated resin. - Poly-R-methacrylate: R group could be ethyl or isobutyl form of resin. - Micro-filled Composite: BISGMA - Urethane di-methyl acrylate: light-cured resins B) Metal Provisional Restoration - Aluminum - Nickel – Chromium - Tin –Silver IOSR Journal of Dental & Medical Sciences 2019 vol18(4) Dr.Nidawani
  • 18. ACRYLIC RESINS : (Methyl methacrylate, Ethyl methacrylate or Vinyl methacrylate) - SNAP, DPI, Trantemp, Biolon, Bosworth TrimII. One of the oldest material available as powder & liquid. Advantages : • Good wear resistance & available in many shades. • Capable of high polish & less expensive. Disadvantages : • Significant amount of heat given off by exothermic reaction. • High degree of shrinkage (about 8%). • Pungent odor. Dr.Nidawani
  • 19. Donovan TE, Hurst RG & Campagni WV. Physical properties of acrylic resin polymerized by four different techniques. J. Prosthet. Dent. 1987;54:194-97 determined autopolymerizing polymethyl methacrylate resin specimens polymerized with pressure demonstrate increase transverse strength and less porosity. Polymerization under water have no effect on physical properties. T. Nigel Town, M.Aet al Provisional Restorations : An Overviewof material used. Journal of Advanced clinical & ResearchInsights 2016;3:212-14. In cases of full mouth rehabilitation cases and cases involving more than 5 unit bridges, Heat cure PMMA are more superior in prolonged use temporary with better physical and mechanical properties Dr.Nidawani
  • 20. BIS – ACRYL MATERIALS (20 years old)  Bis-acrylics are multi functional dimethacrylate materials capable of cross-linking.  Can be categorized into two groups: UDMA and bisphenol A- glycidyl methacrylate (Bis-GMA).  Less heat generation and shrinkage ,water sorption, minimal odour.  Faster setting time, better mechanical properties – so fabricated more efficiently with greater predictability. Dr.Nidawani
  • 21. VISIBLE LIGHT CURED RESINS: (setson command )  Based on UDMA (urethane di-methacrylate).  Has good mechanical properties & color stability.  Available in variety of shades.  Marginal fit is good as there is less polymerization shrinkage.  Operator has the advantage over control of the working time as it is light cured.  Expensive and stains overtime. Dr.Nidawani
  • 22. Luxatemp®, (DMG America, www.dmgamerica.com) high filled self and light cured, glass filler of 44wt% Luxatemp Fluorescence ; Aimed at achieving superior esthetic. Luxatemp Ultra ; which incorporates proprietary nano technology to provide increased flexural strength. Luxatemp Solar ; a light-cured material. Comp strength 250 Mpa - making it an ideal choice for long-span temporary bridges. LuxaFlow™for-repair & reline. Luxa glaze varnish that provides a surface glaze for provisionals. Dr.Nidawani
  • 23. Protemp™(3M ESPE, www.3MESPE.com)2,3,4, line of bis-acryl provisional material with “a new generation of sophisticated nanotechnology fillers”. Protemp Plus - highly fracture-resistant material in five shades with high gloss without polishing. 3M ESPE Filtek™ Supreme Ultra Flowable reline & repair material Sheen - using an alcohol gauze to wipe the provisional restoration with ethanol Dr.Nidawani
  • 24. Astudillo-Rubio D, Delgado-Gaete A, Bellot-Arcı ´s C, Montiel- Company JM, PascualMoscardo ´ A, Almerich-Silla JM .Mechanical properties of provisional dentalmaterials: A systematic reviewand meta-analysis. PLoSONE .2018;13(2): e0193162 Dimethacrylate based (Bis - acrylics) provisionals presented better mechanical behavior than monomethacrylate for flexural strength and hardness. Fracture toughness showed no significant differences. Within the monomethacrylate (acrylics) group, polymethyl methacrylate showed greater flexural strength than polyethyl methacrylate. Dr.Nidawani
  • 25. Protemp line is the Protemp Crown Temporization Material. Preformed, malleable composite temporary crowns with nine preformed sizes, custom fit for single-unit crowns that provide remarkable strength - with compressive strength of 395.6 MPa Integrity®Multi-Cure, (DENTSPLY Caulk) is reported by the manufacturer to deliver durable results due to wear resistance and strength properties (compressive strength of 386 MPa to 394 MPa) light-cured for 20 second Inspire™ (Clinician’s Choice, www.clinicianschoice.com) lowest exothermic reactions, coming in at 53° Dr.Nidawani
  • 26. Perfectemp 10 (DenMat, www.denmat.com); Elastic modulus is reported at 3500 MPa, flexural strength 120 MPa, less than 3.4%.volumetric shrinkage. The Structur® (VOCO America, Inc., www.voco.com) Structur3 ; Nanofilled material with high fracture resistance and compressive strength (more then 500 MPa), wipe and go technology Structur Premium; 1:1 cartridge mix , fast setting Bis-acryl provisional material with ceramic-like esthetics, high fracture resistance ideal for long-span bridges, a brilliant gloss, natural fluorescence, . Dr.Nidawani
  • 27. Visalys® Temp; (Kettenbach, www.kettenbach.us) high fracture-resistant material (impact strength 12.5 KJ/mm², flexural strength 132 MPa), can be precisely trimmed with minimal dust and has a high luster. Tuff-Temp™Plus; (Pulpdent Corp., www.pulpdent.com) features a synthetic rubber molecule inserted into it to produce a tough, impact-resistant, dimensionally stable provisional material that the manufacturer calls a “rubberized urethane”. Dr.Nidawani
  • 28. REINFORCEMENT OF PROVISIONAL RESTORATIONS Reinforcement of the provisional restoration is recommended in long span/long term, • Periodontally compromised abutments . • Restoration of lost vertical dimension. • Restoring long span bridges. • Cases with abnormal occlusal forces / habits , • Repeated fracture of restoration . •Acid etched bridges/resin bonded prosthesis. Dr.Nidawani
  • 29. Reinforcedprovisionals maintain better occlusal stability, flex less there by minimizes progressive cement loss and diminished caries incidence. Fibers added to heat cured, self cured & light cured materials: nylon fibers, graphite fibers, carbon fibers, polyester fibers, ultra high molecular weight polyethylene fibers and glass fibers. Pre impregnated fibers: polymer monomer mix for ACRYLICS, bonding agent for BIS-GMA enhance adhesion between fiber & matrix. Others: Swage metal sub structure, 16-18 gauge metal cast frame work ,stainless steel wire ,ortho bands . Dr.Nidawani
  • 30. Reinforcing fibers : •Earlier the carbon fibers were used which were unesthetic and there was no chemical bonding to the resin. •There were also chances of fraying of the fibers, which were exposed on the surface. •Recently, the nylon fibers were introduced in which there was no chemical bonding with polymers so no significant increase in strength. Dr.Nidawani
  • 31. Polyethylene fibers (Capaccio and Ward, 1973) : • Very high molecular weight and thus improves strength (transverse and flexural strength). •No proper wetting of fibers by polymer - needs conditioning. Chemical conditioning done by etching, plasma treating, heat treatment and silanizing the fibers. Glass fibers(P.K. Vallittu, 1998) : •Available as woven fibers and unidirectional fibers. •Reinforcement of pontic and connector (bridge) - unidirectional fibers Crown – Woven fibers Dr.Nidawani
  • 32. CAD– CAM MILLED RESIN BLOCKS:  Superior marginal fit – lowers the risk of bacterial contamination of the tooth and prevents damage to pulp from excessive temperature changes.  Stronger and more accurate (industrial polymerized).  Good mechanical properties.  Serves as a solution for long-term/long-span interim prosthesis where strength and colour stability is required.  Easy to manipulate. Dr.Nidawani
  • 33. Ishita Dureja et al .A comparative evaluation of vertical marginal fit of provisional crowns fabricated by computeraideddesign/ computer aidedmanufacturing technique & direct (intra oral tech) & flexural strengthof the materials : An in vitro study. JIPS 2018  Concluded that Bis –aryl composite resin based autopolymerizing Protemp™ 4( 101.41 MPa) and CAD/CAM (94.06 Mpa) provisional materials have comparable flexural strength. However, the marginal fit of temporary crowns fabricated by CAD/CAM was found to be superior (34.34 µm) to the ones fabricated with Protemp™ 4. (63.42 µm). Dr.Nidawani
  • 34. III. DEPENDING UPON THE TECHNIQUE OF FABRICATION: a) Provisional Restorations fabricated using direct technique : these are constructed with a matrix lined with provisional material that is placed directly on the preparedtooth b) Provisional Restorations fabricated using indirect technique : constructed by placing the filled matrix over a model of the prepared tooth, thus the provisional is constructed out of the patient'smouth c) Provisional Restorations fabricated using direct – indirect technique made by forming a temporaryin an indirect manneron mock preparedmodel and then relined directly in patients mouth. This method is useful in constructing temporary bridges. IOSR Journal of Dental & Medical Sciences vol18(4) 2019 Dr.Nidawani
  • 35. DIRECT VS INDIRECT VS DIRECT INDIRECT  Direct - faster for routine provisional restorations.  Indirect can save time with multiple units or complex fixed partial dentures.  Indirect-direct provisionals can be fabricated in advance of the tooth preparation appointment. Dr.Nidawani
  • 36. IV. DEPENDING ON DURATIONOF USE: a) Short term provisional, for use up to 2 weeks  Indicated after tooth preparation in FPDs.  Custom made using acrylics or composite based materials.  Relined polycarbonate or aluminum preformed crowns . b) Long term provisional, for use from 2 weeks to a few months  Full mouth rehabilitation.  In patients undergoing orthodontic, endodontic, periodontic, implant treatment, in presence of deciduous teeth.  Benefits vs value decisions in medically compromised elderly . IOSR Journal of Dental & Medical Sciences vol18(4) 2019 Dr.Nidawani
  • 37. EXTERNAL SURFACE FORM The external contour of the crown is known as External Surface Form (ESF). There are two categories : Custom Preformed CUSTOM A custom is a negative reproduction of either the patient’s teeth before preparation or a modified diagnostic cast. PREFORMED Various preformed crowns are available commercially. Dr.Nidawani
  • 38. INTERNAL SURFACE FORM(ISF) Prepared tooth surface is known as Internal Surface Form. It can be obtained by three methods 1. Direct 2. Indirect 3. Indirect - Direct Dr.Nidawani
  • 40. Types Of Templates :  Putty index made on cast or intra orally using a tray  Clear plastic vacuum-formed template  Combination of thermoplastic & translucent impression material. Ioannis Konstantinidis; (J Prosthet Dent 2013;109:198- 201) Dr.Nidawani
  • 41. Techniques described all of the literature on direct provisionalrestorations:  Use of a pre manufactured provisionalsheIl &relining.  Use of an impression material, or pressure or vacuum formed translucent matrix&relining.  Useofthermoplasticmaterialandtranslucentpolyvinylsiloxane- menosil2(heracusKulzer,Germany)&relining.  Temporary temporary- Goldstein created immediate interim direct temporary by using vaccum formed matrix on wax up stone model and filling it with tooth colored c- silicon(GC Fit checker) Dr.Nidawani
  • 42. DIRECT TECHNIQUE  Patient’s prepared teeth and the gingival tissues directly provide the internal surface form.  Eliminates all intermediate laboratory procedures. Disadvantage:  Potential tissue & pulp trauma from exposed dentinal tubules from the exothermic heat of polymerizing resin.  Formation of voids.  Inherently poorer marginal fit. Therefore, directly formed interim restoration limited for single crowns, indirect techniques for multiple units. Dr.Nidawani
  • 43. RELINED ALUMINIUM SHELLS RELINED POLYCARBOXYLATE CROWN VACCUM FORMED TEMPLATEPUTTY TEMPLATE Dr.Nidawani
  • 44. Acrylic tooth is placed in the area of missing tooth. Alginate impression or a putty index is made. Patient’s teeth is prepared & lubricated with petroleum jelly (including adjacent tooth & gingival margins). Index or alginate impression is reseated with provisional restorative material (dough stage). Remove and reseat followed by finishing, polishing & cementation Dr.Nidawani
  • 46. Alternative Techniques for Direct Technique Acrylic Resin Block Technique for Direct Provisional Restoration:  A seldom employed, method.  It provides a means of fabricating the interim restoration without the use of diagnostic casts and laboratory processing costs.  The technique requires knowledge of dental anatomy, patience and artistic traits inherent in dentists. Dr.Nidawani
  • 48.  Involves fabrication of the interim restoration outside the mouth. MERITS:  No contact of free monomer with the prepared teeth or gingiva which might cause tissue damage & allergic reaction or sensitization.  Avoids subjecting prepared tooth to heat evolved from polymerizing resin.  Superior marginal fit.  Frees the patient & dentist for considerable amount of time. (fabricated in lab) DEMERITS :  Increased time & number of intermediate steps.  Inadequacy of assistants or the laboratory facilities.  Possible damage of diagnostic casts. Dr.Nidawani
  • 49. PROCEDURE: Acrylic tooth placed on missing tooth area of diagnostic cast & putty index is made Sectional impression made on diagnostic cast Provisional restorative material is injected into putty index Fit is checked on the diagnostic cast Restoration is relined for proper marginal fit Finishing, Polishing followed by Cementation. Dr.Nidawani
  • 52. This technique produces - custom made preformed external surface form of the restoration - internal tissue surface form is formed by underprepared diagnostic casts. Advantages:  Reduced chair time (provisional shell is fabricated before patient’s appointment)  A smaller amount of acrylic resin will polymerize in contact with the prepared abutment, resulting in decreased heat generation, chemical exposure, and polymerization shrinkage compared to the direct technique.  Contact between resin monomer and soft tissues is reduced and less chances of allergic reactions. Disadvantage:  Potential need of a laboratory phase before tooth preparation  Adjustments that are frequently needed to seat the shell completely on the prepared tooth. Dr.Nidawani
  • 53. PROCEDURE: Pontic is placed in the area of missing in diagnostic cast & putty index is made with suitable material Acrylic tooth is removed & abutments are prepared on the diagnostic cast (Preparations should be more conservative than the eventual tooth preparation and should follow precisely the gingival margins.) Diagnostic cast is lubricated with suitable separating media & provisional restorative material is filled into putty index & reseated Provisional restoration must be paper thin & correctly contoured Dr.Nidawani
  • 54. Patient’s teeth is prepared in usual manner. Preformed restoration is tried in patient’s mouth (If the amount of tooth reduction is adequate, the provisional restoration will show optimal marginal fit with no need for adjustment.) Temporary restoration is relined to perfect the internal fit. Finishing, polishing and cementation. Dr.Nidawani
  • 56. Provisional restoration for post & core restorations  If custom made post and core is to be used, it can be instantly built and temporary crown be fabricated on it.  For cast posts, following measures may be taken. (a) A ball pin/wooden wedge placed into the post space and an alginate over impression made that would pick up the ball pin and then the restoration fabricated on the cast. (b) In an alternative technique, a ball pin may be placed into the post space and the restoration fabricated intra orally using acrylic resin block technique.  A tooth trimmed in the form of a labial veneer can also be used to serve the purpose. Dr.Nidawani
  • 57. IMPLANT SUPPORTEDPROVISIONAL RESTORATIONS : Provisional prosthesis designs for dental implant patients can vary widely, ranging from a removable acrylic resin complete/partial denture relined with soft liner to an implant supported fixed prosthesis. Several different potential designs that promote esthetics, convenience, the loading of implants, tissue contour control, material strength, and interim prosthesis durability. Dr.Nidawani
  • 58. Provisional fixed prosthodontic treatment options for an implant patient that may vary depending on the following: • The number, position, or location of the implants. • The number of natural teeth remaining in a treatment arch. • Opposing occlusion. • Whether teeth adjacent to the implant site(s) can serve as abutment teeth for a provisional restoration. • The desired protocol for provisional treatment at either first or second stage surgery. Dr.Nidawani
  • 59. PROVISIONAL LUTING MATERIALS:  Provisional luting agents should possess : - good mechanical properties. - low solubility. - tooth adhesion to resist bacterial & molecular penetration.  Provide an adequate seal & Sedative effects that reduces dentin hypersensitivity.  Strong enough to retain a provisional restoration during the course of treatment but, allow easy restoration removal when required. Dr.Nidawani
  • 60.  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.  Zinc phosphate, Zinc polycarboxylate & GIC – not used. Because of their comparatively high strength which makes intentional removal difficult. Dr.Nidawani
  • 61. Zinc Oxide Eugenol Cement : It is one of the most commonly used cost effective temporary luting cement. Because of eugenol it provides an obtundent effect and anti microbial effect. It has adequate strength. Ease of removal 0f restoration. Disadvantages: Eugenol – interfere with polymerization of resin. Dr.Nidawani
  • 62.  Free radical production necessary for polymerization of methacrylate materials can be significantly hampered by the presence of eugenol, this interference with the acrylic /resin polymerization and hardening process and softens restoration.  Eugenol interferes with polymerization of resin cements that are used to fix final restoration.  Eugenol used in cementation of temporary restoration can penetrate into dentine and might affect adhesion of resin cements. Dr.Nidawani
  • 63.  Therefore eugenol free provisional luting materials containing essential oils are commercially available and have gained popularity. Dr.Nidawani
  • 64. Cement Remnants andTheir Effect on PermanentLuting: Elisite Karunki et al (2000) gave a method to enhance the bond strength of the permanent cements following the removal of the temporary restoration. After removal of cements, the tooth preparation was conditioned with 38% phosphoric acid and 10% NaOCI. Bond strength was better after conditioning with H3PO4 and NaOCI. Micro leakage and Temporary Cements : Palao B et al (1998) conducted a study to check the micro leakage and die penetration between tooth preparation and the cement and reported that the micro leakage was seen in all cements. Less in Ca (OH)2 and zinc phosphate cement and more for zinc oxide and non- eugenol cement. Dr.Nidawani
  • 68.  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.  Holding luke warm water in mouth softens luting cement.  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. Dr.Nidawani
  • 69. LIMITATIONS OF TEMPORIZATION : 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. Dr.Nidawani
  • 70. v) Detectable Odour Emission: - This is undeniable despite the dentists close attention to sufficient embrasure spaces. Resins are porous. vi) Inadequate Bonding Characteristics: - Few types of cement currently secure an adequate interface relationship with resins. Eugenol – bearing sedative cements are notorious for incompatibility with methyl methacrylate resins. vii) Poor Tissue Response to Irritation: - Mild or moderate tissue irritations is always present. IOSR Journal of Dental & Medical Sciences 2019 vol18(4) Dr.Nidawani
  • 71. CONCLUSION : Successful temporary restorations are pillars for successful final restorations. Dr.Nidawani
  • 72. REFERENCES:  STEPHENF ROSENSTIEL. Contemporary Fixed Prosthodontics.  HERBERT T SHILLINGBERG. Fundamentals of Fixed Prosthodontics.  TYLAMAN. Theory and practice of Crown and Bridge Prosthodontics.  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 Dr.Nidawani
  • 73. Astudillo-Rubio et al.Mechanical properties of provisional dentalmaterials: A systematic reviewand meta-analysis. PLoS ONE .2018;13(2): e0193162 Ishita Dureja et al .A comparative evaluation of vertical marginal fit of provisional crowns fabricatedby computer aideddesign/ computer aided manufacturing technique & direct (intra oral tech)& flexural strength of the materials : An in vitro study. JIPS 2018 K.M.Regish, Deeksha Sharma & D.R.Prithviraj. Techniques of Fabricationof Provisional Restoration: An Overview. International Journal of Dentistry Volume 2011 Limitations of temporization - IOSR Journal of Dental & Medical Sciences 2019 vol18(4)  Baldissara P Comin G, Martone F, Scotti R. Comparative study of the marginal microleakage of six cements in fixedprovisional crowns. J Prosthet Dent 1998;80:417-22. Dr.Nidawani
  • 75. RGUHS 1. Luting agents in provisional restoration (Sep 2007) 2. Temporization & its importance (Sep 2007) 3. Provisional Restoration (May 2010, July 2016) 4. Explain the methods of Temporization (Nov 2011) 5. Temporization in FPD (May 2014, May 2019) 6. Rationale for Provisional Restorations (Nov 2016) Dr.Nidawani
  • 76. OTHER UNIVERSITIES 1. Techniques of fabrication of provisional restoration (oct 2019) 2. Discuss provisionalization in FPD (2013) 3. Provisional restorations (June 2016, 2017) 4. Utility & Scope of temporization in Fixed Prosthodontics (2017) 5. Write a note on temporization (2005) Dr.Nidawani

Editor's Notes

  1. lingual aspects of the maxillary incisors to the incisal edges of the mandibular incisors are modified, the patient’s ability to enunciate may change
  2. The desired properties of a provisional material include biocompatibility, pleasing aesthetics, fracture resistance, ease of fabrication, the ability to shape and polish, nonporousness, dimensional stablility, a short setting time, and reparability.
  3. Traditional methyl methacrylate resins are monofunctional, have a low molecular weight, and are linear molecules that exhibit decreased strength and rigidity
  4. This cross‑linkage provides strength and durability to the material.
  5. tack-cure done for 2 to 3 seconds
  6. Fibrs r lighter,more estheticmcohesive
  7. CAD‑Temp, Telio CAD, and artBloc
  8. The use of a vacuum-formed template has the disadvantage of lacking detail relative to the occlusal surfaces and the margins because it is inherently difficult to adjust over the cast with simultaneous. visible light-polymerized (VLP) resin between cast and matrix is recommended to improve matrix accuracy and achieve better formed occlusal surface