Charles J. Goodacre, DDS, MSD Professor of Restorative Dentistry

Loma Linda University School of Dentistry

This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission.

Provisional restorations in fixed prosthodontics

Provisional Restorations •  They are restorations that provide interim protection,

mastication, esthetics, and positional stability while the definitive restoration is being fabricated

•  FUNCTIONS / REQUIREMENTS 1) Protection / Preservation; (prepared tooth from damage; pulp from irritation; cheeks / tongue / lips

from trauma; periodontal health by good fit, contour, & surface smoothness)

2) Mastication; (allow some chewing of food) 3) Positional stability; (tooth; gingiva; lips / cheeks) 4) Esthetics for visible teeth; 5) Provide diagnostic information

Provisional Restoration Resins •  Methyl methacrylate (Jet)

- Reasonably hard; sets somewhat rapidly; reasonable color stability

•  Ethyl methacrylate (Trim) - Not as hard as methyl methacrylate; slower set and more working time; susceptible to discoloration

•  Composite resin (Protemp; Integrity) - Hardest; rapid polymerization; best color stability

Provisional Restoration Resins •  Methyl methacrylate (Jet)

- Reasonably hard; sets somewhat rapidly; reasonable color stability

•  Ethyl methacrylate (Trim) - Not as hard as methyl methacrylate; slower set and more working time; susceptible to discoloration

•  Composite resin (Protemp; Integrity) - Hardest; rapid polymerization; best color stability

Types of Provisional Restorations •  Prefabricated

1) Metal shell / relined metal shell 2) Relined polycarbonate shell

•  Custom-fabricated 1) Template & unfilled resin 2) Template & composite resin 3) Laboratory produced shell 4) Cast metal (long-term service needed)

• “Direct on tooth” versus “Indirect on cast”

Direct versus Indirect

•  Direct is faster for routine provisional restorations

•  Indirect can save time with multiple units or complex fixed partial dentures

•  Indirect provisionals can be fabricated in advance of the tooth preparation appointment

Direct Technique: Types of Templates

•  Putty index made on cast or intraorally using a tray

Direct Technique: Types of Templates

•  Putty index made on cast or intraorally using a tray •  Clear plastic vacuum-formed template

Direct Technique: Types of Templates

•  Putty index made on cast or intraorally using a tray •  Clear plastic vacuum-formed template •  Repair of crown / prosthesis that was removed

DIRECT TECHNIQUES

Relined Aluminum Shells

Relined Polycarbonate Crowns

Putty Template

Putty Template

TEMP TABS® – TRUE BLUE •  Do a Google search “temp tabs dental” •  Heat at 135 degrees Fahrenheit •  Mold over teeth & then blow air for 10 seconds

Vacuum-Formed Template

Crown Removal & Repair

Products Used

•  Carbide bur •  Bonding resin •  Color modifier •  Resin glaze

Brasseler XTREMECUT 330MZ

PermaSeal by Ultradent

Crown Removal & Repair

Provisional Restoration for RCT with Prefabricated P&C

Provisional Restoration for RCT while Custom Cast P&C is being Fabricated

INDIRECT TECHNIQUES •  Prepare tooth / teeth and make impression •  Laboratory then fabricates provisional

restoration(s) while patient waits OR

•  Laboratory fabricates shell provisional restoration before the patient comes for the tooth preparation appointment

Shell Fabrication

Minimal tooth preparations completed on cast; Less reduction than will be achieved clinically

Space between shell and minimal tooth preparations will be filled with resin

Video of Shell Fabricated by Laboratory in Advance of Tooth Preparation

Provisional Cements •  They are typically zinc oxide powder or zinc oxide paste mixed with

eugenol liquid •  Noneugenol formulations are available that do not soften resin (as in

provisional crown). They use carboxylic acids in place of eugenol •  The liquid can be ethoxybenzoic acid, known as ZOEBA, making it

stronger •  TempBond Clear is a translucent cement with Triclosan (an antibacterial &

antifungal agent)

Thank You For Your Kind Attention

Charles J. Goodacre, DDS, MSD Professor of Restorative Dentistry

Loma Linda University School of Dentistry

v Visit ffofr.org for hundreds of additional lectures on Complete Dentures, Fixed Prosthodontics, Implant Dentistry, Removable Partial Dentures, Esthetic Dentistry and Maxillofacial Prosthetics.

v The lectures are free. v Our objective is to create the

best and most comprehensive online programs of instruction in Prosthodontics