Chapter 2 Temporary Protection

TEMPORARY (PROVISIONAL) RESTORATIONS

It is the restoration, which is placed between the time of teeth

preparation and placement of the final restoration. It provides protective
coverage of prepared teeth while permanent restorations are being made.

Functions of Temporary Restorations:

Tooth fracture in unprotected margin

1. Pulp and tooth protection:

Against extreme temperatures and salivary leakage. Preservetion of Tooth
Integrity: It must also protect the reduced tooth from fracture Ex
unprotected margins may fracture.

2. Positional stability :

Maintain neighboring teeth position and prevent them from drifting or

supraeruption. Failure to do this might hinder final restoration seating.

3. Easy Plaque removal:

Restoration material must be smooth. Contour
must allow easy access to cleaning to promote
gingival health.

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4. Margins and contours:

Irregular rough margins lead to plaque accumulation

Properly adapted margins, provide proper contour, contact and fit as leakage
can cause irreversible pulp damage. Smooth margins with adequate extensions
are desired to promote gingival health especially in case of temporaries in long
service. Ischemia caused by pressure maybe detected by tissue blanching, if
not corrected gingivitis and necrosis may occur.

5. Restore Occlusal function:

Proper occlusal & proximal contacts with opposing and neighboring teeth
should be maintained. Normal function provides mastication, comfort and
prevents teeth migration.
! Supereruption " detected as premature contact.
! Horizontal movement " excessive or deficient proximal contact.

6. Provide Adequate Strength and Retention:

Are mandatory to fulfill its function till final delivery. Broken temporaries
allow tooth movement. Also, at times temporaries have to be reused in case of
final restoration delay due to imperfections by the laboratory or patient
unavailability. Connectors of F.P.D. should have adequate bulk to improve
strength.

7. Esthetics:

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Very important in anterior teeth. It also builds patient’s confidence and helps
him visualize the definitive restoration.
8. Diagnostic Data:
The temporaries provide the patient with trial prosthesis to test, adapt and
visualize the final prosthesis ex tooth form & arrangement,
# Lip & cheek support.
# Speech is related to air passage & prosthesis thickness.
# Adaptation to a new vertical dimension in case of attrition or wear.
# The response of abutments to additional forces of occlusion during
mastication.
# Periodontal and soft tissue response.

Requirements of Ideal Temporary Restorations:

1. Should provide adequate margins.
2. Should establish proper occlusal & proximal contact.
3. Should provide adequate esthetics.
4. Should establish correct contours and embrasures to promote
periodontal health.

5. Should have minimal contact with the ridge, passive pressure and
possess a design which promotes hygiene.

6. Should be easily constructed and removed by the dentist.

Types of Temporary Restorations:

A. Intracoronal Restorations:
Zinc Oxide & Eugenol maybe used as a provisional between visits till final
delivery ex. Inlay preparation.

B. Extracoronal restorations:

1. Ready made: Only used for single restorations.

a. Metal:
# Bands: Aluminum shell or cylinders.

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# Anatomic metal forms (Aluminum or tin silver) provided as

premolars and molars. Adaptation is improved by occluding force.
# Nickel-chromium anatomic crowns " mostly used for primary
teeth.

b. Non-metal:
# Clear-celluloid shells.
# Polycarbonate crown forms provided as maxillary and mandibular
anteriors and premolars.

2. Custom Made:
Used for single crowns or fixed partial dentures.
A crown form (mold) is essential.
The form of the teeth before reduction is used to reproduce the external
form of the mold while their shape after reduction forms the internal form
of the mold.

All procedures have in common the formation of a mold cavity into which
a resin is packed.
! Impressions are made in a quadrant tray with irreversible
hydrocolloid or silicone rubber to reproduce the external surface
form of the teeth before preparation .
! Templates made from thermoplastic sheets maybe heated and
adapted to a cast.

Packing the mold may be done:

a- Direct: Intraorally on prepared teeth (Technique sensitive).
b- Indirect: on a cast made after preparation.
Advantages:
# More accurate.
# Marginal fit may be improved by indirect technique.
# Pulp is protected from heat produced during resin polymerization
and chemical irritation from the free monomer on freshly cut dentine.
# Less chairside time as personel may do it.
# Any teeth imperfections may be modified on the cast.
c-Combination Indirect Direct Technique:

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Ideal Requirements of Provisional Materials:

1. Easy to use-rapid setting.
2. Biocompatible, non-toxic, non-exothermic.
3. Dimensional stability during setting.
4. Ease of contour, and polish.
5. Adequate strength and abrasion resistance.
6. Good esthetics and color.
7. Easy to repair.
8. Chemically compatible with temporary cements.

Resins used for temporary restorations:

! Polymethyl methacrylate: Ex: (Cr + Br resin):
$shrinkage $heat, % abrasion.
! Polyethylmethacrylate: Ex: (Snap):
% shrinkage + % heat + % strength.
! Polyvinylmethacrylate: Ex: (Trim):
% heat, % strength.
! Bisacryl composite Ex: (protemp II):
%heat, $ strength, % shrink, % hardness.
! Urethane dimethacrylate: Ex :(Triad)
$ strength- $ hardness- % Marginal fit, Expensive.
Each resin has its own advantages and disadvantages.

Techniques For Custom Provisionals:

a. An impression is made intraorally (direct) or from a modified
diagnostic cast (indirect), before the preparation is made.
b. A template (of clear thermoplastic resin) is shaped on the diagnostic
cast "
# Using a vacuum forming machine.
# Manually using silicone putty.

Manual Vacuum forming machine

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The template is filled with resin and applied:

# To the prepared teeth " intraorally.( direct)
# Cast of the prepared teeth " indirect.
C. Combination Indirect Direct Technique:
A thin shell crown or fixed P.D. maybe made before the preparation using
resin in the laboratory after minimal abutment reduction. This shell is later
relined after the teeth preparation for better more intimate adaptation.

Steps of Fabrication:
A. An impression (alginate or putty) is made intraorally before the
preparation. However, if the teeth have to be restored then the impression
may be made from a cast after restoring the defect. The impression is
covered with a wet paper towel (alginate) for later use after reduction. The
impression is used as a mold to reproduce the form of the teeth as they
were before reduction. It must extends one tooth beyond the abutments.

A. Direct Technique:
1. The impression is filled with resin and replaced in the mouth over the
prepared abutments i.e. the patient’s teeth and gingival tissues provide
the internal form of the mold.

Note:
1. Care to avoid pulpal damage of vital teeth as a result of exothermic
reaction during resin setting.

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2. The resin has to be pulled in and out from the teeth (pumping action)
to avoid its blocking in undercuts.
3. Margins of provisionals made indirectly on casts are much better, as
stone restricts shrinkage and distortion.

Disadvantages:
a. Pulp trauma.
b. Poor marginal fit.

B.Indirect Technique:
Resin is adapted on a cast of the prepared teeth.
1. When the preparation is finished another alginate impression is taken
and poured in quick set plaster. There should be at least one tooth on
either side of the prepared tooth.
2. The cast is coated with separating medium. The impression is filled with
resin and the cast seated into it without using excessive force.
3. The impression-plaster cast assembly is placed in a hot water bath for 5
minutes before it is disassembled.
4. Separate the resin restoration, trim the excess with acrylic burs or coarse
carborundum discs " finishing.
5. Smoothen the restoration with fine sand paper adjust the occlusion then
polish the restoration.
6. A temporary cement (ZnO-E) is used to cement the restoration.

C. Template - Fabricated Temporary F.P. Denture:

The external teeth form before reduction maybe recorded using a
thermoplastic sheet.Thermoplastic sheets maybe heated and adapted to a
stone model using a vacuform machine or manually.
Reduced abutments are better provided with temporary bridges in stead of
individual crowns for better esthetics and patient adaptation to restoring the
edentulous space.

Fabrication:
1. A crown form or denture tooth is placed in
the edentulous space on the diagnostic cast.

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All undercuts are blocked.

2. A thermoplastic resin sheet is placed in the frame of a vacuum forming
machine and heated. The frame holding the sheet is lowered and adapted
to the cast.

3. The resin sheet may also be placed in a wire frame and heated over a
bunsen flame to soften it before positioning it on the diagnostic cast.
Adaptation of the resin sheet is secured by placing silicone putty in
a tray and seating it over the heated softened sheet.

Manual Technique

4. After 1 minute remove the tray..

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The template is trimmed to extend at least 1 tooth on either side of the

abutments. The template is filled with resin and placed over the prepared
abutments directly in the mouth or indirectly on a cast of the prepared
abutments made of fast setting resin.

Packing the mold may be done:

A. Direct: Intraorally on prepared teeth (Technique sensitive).

" Care to avoid pulpal damage of vital teeth as a result of exothermic
reaction during resin setting.
" The resin has to be pulled in and out from the teeth (pumping action)
to avoid its blocking in undercuts.

Disadvantages:
" Pulp trauma.
" Poor marginal fit.

B. Indirect: on a cast made after preparation.

1. More accurate.
2. Marginal fit may be improved by indirect technique.
3. Pulp is protected from heat produced during resin polymerization and
chemical irritation from the free monomer on freshly cut dentine.
4. Less chairside time as personnel may do it.
5. Any teeth imperfections may be modified on the cast.

C.-Combination Indirect Direct Technique

A thin shell crown or fixed P.D. maybe made before the preparation using
resin in the laboratory after minimal abutment reduction. This shell is later
relined after the teeth preparation for better more intimate adaptation.

The template is filled with resin and placed over the prepared abutments
directly in the mouth or indirectly on a cast of the prepared abutments made
of fast setting resin.

Technique:
1. An impression is made from a diagnostic cast.

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2. Monomer is applied to it followed by enough polymer to render the

impression surface dull. The process is repeated to allow enough
material to reach all the margins and axial surfaces of the abutments
(self cure resin).
3. Remove the shell, trim the flash and open the gingival embrasures.
4. Another method of making the shell is to make a minimal reduction of
the abutments and fabricate a resin shell F.P.D. in the laboratory using
heat cured resin, which is relined after termination of the reduction
either directly or indirectly.

Bis acrylic Composite:

May be used to produce temporary restorations on a plaster cast or directly.
Very little heat is produced therefore the pulp is less affected, and shrinkage is
controlled.

Impressions: May be made of:

# Alginate.
# Putty polyvinyl siloxane.
1. Which is stable and maybe used without a tray.
2. Difficult to distort.
3. May be used more than once.
Disadvantage:
1. Expensive.
2. More chairside time.

Techniques For Prefabricated Temporary Restorations:

Certain situations may arise in which custom temporary restorations
may be unavailable for use. Ready made crowns must be relined with
autopolymerizing resin. Crown forms need modifications ex. axial
recontouring, occlusal adjustments in addition to relining.

Indications:
Patients showing up with prepared teeth.
Emergency visits with fractured teeth.

Ready made:
a. Preformed polycarbonate crowns may be used " anterior restorations.

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b. Cellulose Acetate crown form.

c. Preformed anatomic metal crowns " posterior restorations.

a. Anterior Polycarbonate Crowns:

Appropriate size crowns are chosen and relined with resin to provide
retention, Recontouring may be required to correct morphology and
contour. The occlusion is adjusted. The shade maybe modified by lining
resin. Unlined resins should not be used.

Method:
1. After completion of tooth reduction polycarbonate crown of suitable
mesiodistal size is chosen.

2. Relining may be done directly intraorally or indirectly. In case of

intraoral relining do not use Pmma to avoid pulp trauma from heat of
polymerization.

Relining:
# Crown form is filled with resin and seated intraorally or on the cast
# After resin setting the excess is trimmed. Finish and polish the crown.
# Cement the crown with temporary cement and remove any excess from
the margins and gingival crevice after setting.

B. Cellulose Acetate/Celluloid Crown Former:

1. It is a thin (0.2 to 0.3 mm) transparent
material available in all shapes and range of sizes.

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