Clinical Update

Vol. 24, No. 3

Naval Postgraduate Dental School National Naval Dental Center Bethesda, Maryland

March 2002

Provisional restorations Lieutenant Commander (sel) Gerald W. Tr ula, !C, "#N$, and Ca%tain #cott & #'nnott, !C, "#N
Purpose The %ur%ose o( this clinical u%date is to assist the clinician )ith the materials and techni*ues needed (or the (a+rication o( (i,ed %rosthetic restorations. Introduction -re%ared teeth must +e %rotected and the %atient e%t com(orta+le durin. (a+rication o( the de(initi/e0(inal restoration. 1' utili2in. success(ul methods and com%ati+le materials, the clinician can .ain the %atient3s con(idence and (a/ora+l' in(luence the ultimate success o( the (inal restoration. & hi.h *ualit' %ro/isional restoration should satis(' the (ollo)in. re*uirements (4, 2, 3, 4)5 1. Pulpal protection 5 The restoration should +e (a+ricated (rom a material that )ill %re/ent the conduction o( e,treme thermal chan.es. 2. Positional stability 5 The tooth should not +e allo)ed to dri(t or e,trude in an' direction. 3. Occlusal function 5 The tooth should +e a+le to (unction under all occlusal loads. This loadin. )ill %re/ent mi.ration and )ill aid in %atient com(ort. 4. Cleansability 5 The restoration must +e made o( a material and ha/e %ro%er contours that )ill %ermit the %atient to ee% it clean durin. the treatment %eriod. 6. Non-impinging margins5 The mar.ins o( the %ro/isional restoration should +e harmonious )ith the .in.i/al tissue and contours. 7ll8ada%ted %ro/isional restorations can contri+ute to .in.i/al %roli(eration, recession, or hemorrha.e durin. im%ression ma in. or deli/er'. 6. Strength an retention 5 The restoration material must )ithstand the (orces o( mastication )ithout (racturin. or loosenin.. !. "sthetics 5 7n all cases, the restoration must %ro/ide an acce%ta+le esthetic result. The esthetic com%onent o( the restoration desi.n )ill allo) the %atient to test the desi.n o( the (inal %rosthesis (or (orm and (unction. 7t )ill con(irm the esthetics o( the dia.nostic )a,8u% and )ill con(irm the incisal len.th and %osition o( teeth )ith re.ard to %honetics. #. $ab communication 5 The %ro/isional restoration can +e used as a tool to communicate (orm, (unction and the restoration3s dimensions to the la+orator'. 7t )ill allo) the la+orator' to (a+ricate a (inal restoration that re(lects the dimensions o( the %ro/isional restoration that has +een %re8 a%%ro/ed +' +oth the %atient and the clinician. Prefabricated vs. Custom Restorations -re(a+ricated (orms include co%%er +ands, stoc aluminum c'linders, anatomic metal cro)n (orms, clear celluloid shells, and tooth8colored %ol'car+onate cro)n (orms. These %re(a+ricated (orms can onl' +e used (or sin.le8tooth > restorations. Custom cro)ns and (i,ed %artial dentures can +e (a+ricated (rom a /ariet' o( resins and +' a /ariet' o( methods. The methods include direct (a+rication, indirect (a+rication or a com+ination indirect8direct (a+rication techni*ue (4, 2, 3). Direct vs. Indirect Techniques -ro/isional restorations can +e classi(ied +' the method used (or ada%tin. the restoration to the teeth. %he irect techni&ue' 9a+rication is done on the %re%ared tooth in the mouth. & clear matri, (a+ricated (rom a dia.nostic )a,8u% made %rior to the treatment a%%ointment can +e used to (orm the %ro/isional restoration and is use(ul as a reduction .uide durin. tooth %re%aration. &uto%ol'meri2in., tooth8colored, acr'lic is mi,ed and %laced in the matri, )hile in the :dou.h': %hase. The matri, is %laced onto the teeth, *uic l' remo/ed and e,cess material remo/ed or additional material added i( needed. When the matri, is reseated it should +e li+erall' cooled )ith )ater durin. the %ol'meri2ation (e,othermic) sta.e. &(ter %ol'meri2ation, the matri, can +e remo/ed, the acr'lic cro)n trimmed and the occlusion (inali2ed. "sin. a %aint8on techni*ue )ith the same resin, the mar.ins can +e (inali2ed and smoothed usin. a ;ollen+ac or Woodson instrument. The restoration can then +e remo/ed and %olished )ith %umice %rior to cementation. &lternati/el', a matri, made (rom a %reo%erati/e im%ression or a manu(actured cro)n (orm can +e used. This same a%%roach is use(ul )ith li.ht cured acr'lic resins and o+/iates the need (or )ater coolant. $e.ardless o( the acr'lic used, care must +e ta en to a/oid loc in. the cured acr'lic into undercuts. ;eat .eneration and (ree monomer contact )ith the tooth ma' ha/e lon.8term %ul%al im%lications (2). %he in irect techni&ue' The indirect techni*ue is %re(erred o/er the direct techni*ue (or its accurac'. &n irre/ersi+le h'drocolloid im%ression is made o( the %re%ared tooth and %oured )ith a *uic settin. %laster. The resultant cast is lu+ricated and the acr'lic %ro/isional restoration (a+ricated much li e the direct techni*ue e,ce%t the resin is allo)ed to (ull' %ol'meri2e on the cast. &dditionall', the %h'sical %ro%erties o( the resin can +e im%ro/ed +' curin. in a )ater (illed %ressure /essel. With all %hases o( construction com%leted e,traorall', no heat is .enerated on the %re%ared tooth. The distortion associated )ith remo/al durin. %ol'meri2ation, )hich occurs usin. the direct8techni*ue, is eliminated. The mar.inal (it o( %ol'(meth'l methacr'late) %ro/isional restorations are im%ro/ed +' nearl' <0= +' (a+ricatin. them indirectl' (6). & (urther ad/anta.e o( the

indirect techni*ue is that much o( the )or can +e dele.ated to au,iliar' %ersonnel. %he in irect- irect techni&ue 5 This techni*ue incor%orates the ad/anta.es o( the %rior t)o techni*ues. The %redominant %ortion o( the %ro/isional restoration is (a+ricated e,traorall', minimi2in. the e,othermic e,%osure to the tooth. The %ro/isional restoration is then tried in and an' mar.inal errors corrected intraorall' usin. an auto%ol'meri2in. acr'lic resin %rior to cementation. Resins for Provisional Restorations

There are se/eral t'%es o( resins that can +e used (or ma in. custom %ro/isional restorations. -ol'(meth'l methacr'late) has +een in use the lon.est. -ol'(eth'l methacr'late), %ol'(/in'leth'l methacr'late), +is8acr'l com%osite resin, and /isi+le li.ht8cured (VLC) urethane dimethacr'late ha/e come into common usa.e in recent 'ears. ?%imine resin (#cutan), )hich (or a decade also )as used (or this %ur%ose, is no lon.er a/aila+le. No one resin is su%erior in all res%ects and the restorati/e dentist must assess the ad/anta.es and disad/anta.es o( each in selectin. a resin to use (3, >, <, @).

Table 1 Characteristics of Resins used for Provisional Restorations (3) T'%e -ol'(meth'l Methacr'late) -ol'(eth'l Methacr'late) 1rand &li e CrA1r $esin !urala' Bet #na% Manu(acturer GC &merica L! Caul $eliance !ental Lan. !ental -ar ell 1iomaterials &d/anta.es Good mar.inal (it Good trans/erse stren.th Good %olisha+ilit' !ura+ilit' Good %olisha+ilit' Minimal e,othermic heat increase Good stain resistance Lo) shrin a.e Good mar.inal (it Lo) e,othermic heat increase Good a+rasion resistance Good trans/erse stren.th Lo) shrin a.e ;i.h sur(ace hardness Good trans/erse stren.th Good a+rasion resistance Controlla+le )or in. time Color sta+ilit' !isad/anta.es ;i.h e,othermic heat increase Lo) a+rasion resistance 9ree monomerC To,ic to %ul% ;i.h shrin a.e Lo) sur(ace hardness $educed trans/erse stren.th Lo) (racture tou.hness Not as dura+le Lo) sur(ace hardness Less stain resistance Limited shades Limited %olisha+ilit' 1rittle -oor mar.inal (it Less stain resistance Limited shades ?,%ensi/e 1rittle

1is8acr'l Com%osite

-ro8Tem%

?s%e8-remier

VLC urethane dimethacr'late

Triad

!ents%l' Dor

References 4 $osenstiel #9, Land M9 and 9uEimoto B. Contem%orar' 9i,ed -rosthodontics. 3rd ed. #t. Louis5 Mos+', 7nc.C200453@08 44>. 2. Weintrau+ G#, Finner 7!. -ro/isional $estorations. !ent Clin North &m 4G@G BulC33(3)53438636. 3. #hillin+ur. ;T, Br., ;o+o #, Whitsett L!, Baco+i $, 1rac ett #?. 9undamentals o( 9i,ed -rosthodontics. 3 rd ed. Chica.o5 Huintessence -u+lishin. Co.C4GG<522686<. 4. -hilli%s $W. # inner3s #cience o( !ental Materials, G th ed. -hiladel%hia5W1 #aundersC4GG454@@8G2. 6. ;unter $N. Construction o( accurate acr'lic resin %ro/isional restorations. B -rosthet !ent 4G@3 IctC60(4)56208 4. >. Christensen GB. -ro/isional restorations (or (i,ed %rosthodontics. B &m !ent &ssoc 4GG> 9e+C42<(2)524G862. <. Cris%in 1B, Watson B9, Ca%uto &&. The mar.inal accurac' o( treatment restorations5 & com%arati/e anal'sis. B -rosthet !ent 4G@0 #e%C44(3)52@38G0.

@. Mouldin. M1, Te%lits ' -?. 7ntra%ul%al tem%erature durin. direct (a+rication o( %ro/isional restorations. 7nt B -rosthodont 4GG0 Ma'8BunC3(3)52GG8304. Lieutenant Commander Tr ula is a third8'ear resident in the -ros8thodontics !e%artment. Ca%tain #'nnott is the Chairman o( the -rosthodontics !e%artment at the Na/al -ost.raduate !ental #chool. Note5 The mention o( an' +rand names in this Clinical (p ate does not im%l' recommendation or endorsement +' the !e%artment o( the Na/', !e%artment o( !e(ense, or the "# Go/ernment. The o%inions and assertions contained in this article are the %ri/ate ones o( the authors and are not to +e construed as o((icial or re(lectin. the /ie)s o( the !e%artment o( the Na/'.

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