provisional restoration fixed partial denture

PROVISIONAL RESTORATION IN
FIXED PARTIAL DENTURES
Guided By:
Dr. Shailendra Kumar Sahu
Dr. Anurag Dani
Dr. P Muralidhar Reddy
Dr. Manupreet Kaur Rangi
Dr. Poonam Deshmukh
Dr. Prashant Kothari

CONTENTS
• Introduction
• Definition of provisional restorations.
• Requirements of provisional restoration.
• Classification of provisional restoration.
• Fabrication Techniques.
• Provisional Cements
• Provisional restorations in laminates and Implant dentistry
• Limitations of provisional restorations
• Recent advances in provisionalization
• Conclusion
• References.

INTRODUCTION
• The word provisional means established for the time being, pending a permanent
arrangement.
INTERIM PROSTHESIS - A fixed or removable dental prosthesis, designed to enhance
esthetics, stabilization and/or function for a limited period of time, after which it is to be
replaced by a definitive dental prosthesis. - GPT 9
Synonyms : PROVISIONAL; TRANSITIONAL; TEMPORARY; TREATMENT
RESTORATIONS

BIOLOGIC
1.Pulpal protection
2.Periodontal health
3.Occlusal
compatibility & tooth
position
4.Prevention of enamel
fracture.
4
REQUIREMENTS OF PROVISIONAL MATERIALS

MECHANICAL
Greater stresses in an interim restoration occur during chewing.
To reduce the risk of failure, connector size must be increased in comparison with the
definitive restoration.

ESTHETIC
Aesthetic concern: incisors,
canines and premolars.
Used as a guide for optimum
esthetics in definitive restoration.
It is shaped and modified until
its appearance is mutually
acceptable to the dentist and the
patient.

CLASSIFICATION
1. Method of Fabrication
Prefabricated/ Preformed.
Custom made.
2. Technique involved in fabrication
Direct technique.
Indirect technique.
Indirect - Direct technique
3. Location of fabrication
Chair-side fabricated.
Laboratory fabricated.
4. Duration of use
Short term : for few days - 2 weeks.
Eg - Polycarbonate, aluminium crowns.
Medium term : for 2 weeks > few weeks.
Eg - resin based provisionals.
Long term : for months.
Eg - mostly cast metal crowns.

5. Type of material used:
Metal provisional restoration
Aluminium
Nickel-chromium
Tin-silver
Resin based provisional restoration
Cellulose acetate
Polycarbonate resin
Poly-methyl methacrylate
Poly-ethyl methacrylate
Microfilled composite
Urethane dimethacrylate
Bis -acryl composite

Method of Fabrication
Prefabricated/ Preformed.
Custom made.

Tooth-shaped shells of various materials.
Most crown forms need some modification, eg:axial recontouring, occlusal adjustment, relining.
They can be cemented directly onto the prepared teeth.
Available in various tooth sizes and shapes.
Prefabricated/ Preformed crowns
ADVANTAGES DISADVANTAGES
• Less time
consuming.
•
• Rarely satisfies the
requirement of contours.
•
• Available in
various sizes.
• Limited to single tooth
restoration

POLYCARBONATE CROWNS:
First described by Charles et al in 1973.
Most natural appearance
Advantages:
1. Esthetics
2. Readily available
3. Save chair-side time

CELLULOSE ACETATE:
Thin [0.2 – 0.3 mm] transparent material.
Available in all tooth types and range of sizes.
Do not chemically or mechanically bond to the inside surface so after polymerisation the
shell is peeled off.
The disadvantages are :
• They merely act as a matrix and so must be removed after their relining material has set.
• When the cellulose crown form is removed, the thickness of the crown get reduced (by
about 0.2 mm). This may lead to instability in the occlusion and movement of adjacent teeth.

METAL
Due to their appearance, they are used in the posterior region of the mouth.
Various types of metal crown are available: aluminium, stainless steel, tin-silver and
nickel-chromium alloy crowns.
Aluminium crown forms
1. These have been used for many years as the material is easy to manipulate, and it
is malleable and ductile.
2. Aluminium crown forms can corrode with time as saliva can react with them.
3. There is also a risk that if they are placed adjacent to a freshly packed amalgam
or gold restoration, a galvanic cell may be established.

Stainless steel crown forms:
1. These crown forms are much less malleable and ductile than the
aluminium crown forms, thus they are harder wearing and are less likely to
deform under load.
2. They are usually not refined but trimmed using crown shears until their
fit approximates to the prepared tooth and luted using a glass ionomer or
polycarboxylate cement.
3. The success rate is very high and these crowns are useful to maintain
the space that may be lost when a deciduous tooth is lost prematurely.

Tin silver alloy crowns:
1. These are available for posterior teeth.
2. The alloy is very soft and the margin of the crown can be flexed prior to seating.
3. These produce a close marginal fit after the shell is trimmed with a bur.
4. These should also be lined with acrylic resin to provide good internal adaptation and
retention.

Nickel chromium alloy:
1. Used in children with extensively damaged primary teeth
2. They cannot be altered with resin
3. These crowns can be easily recontoured using pliers.
4. Indicated as long term temporaries.

CUSTOM MADE CROWNS
Custom fabrication represents one of the best choices for
provisional restorative treatment.
The technique allows for intimate contact between a
provisional restoration and prepared tooth.
Tissue surface form
Direct & Indirect forms, a 3rd category indirect-direct
results from the sequential application of these two forms

Technique involved in Fabrication.
• Direct technique.
• Indirect technique.
• Indirect - Direct technique

DIRECT TECHNIQUE
The prepared teeth and tissues directly provide the tissue
form for the provisional restoration.
Techniques available are:
1. Shells (proprietary or custom)
2. Matrices ( formed directly in mouth or indirectly on
cast)
3. Direct syringing.

DIRECT TECHNIQUE.
• The patient’s prepared teeth & the gingival tissues directly provide the TSF, so the
intermediate steps of the indirect technique are eliminated
• Disadvantages such as potential tissue trauma & inherently poor marginal fit.
• Therefore the routine use of directly formed provisional restorations not
recommended when indirect techniques are feasible.

Regish.k.m et al, Techniques of Fabrication of Provisional Restoration: An Overview, International Journal of
Dentistry,Volume 2011 (2011), Article ID 134659
Advantage :
- Less time consuming as the intermediate steps of
indirect technique are eliminated.
Disadvantages :
- Potential tissue trauma from the polymerizing
resin, and
- Inherently poor marginal fit.

INDIRECT TECHNIQUE
Impression of the prepared teeth is poured in quick-setting gypsum :
1. Avoid exposure of patient to adverse properties of resins.
2. Optimise the properties of resins.
3. Ease of making significant changes in contours or occlusal changes.

• Regish.k.m et al, Techniques of Fabrication of Provisional Restoration: An Overview, International Journal of
Advantages:
1. No contact of monomer
with the prepared tooth
or gingiva.
2. Avoids subjecting a
prepared tooth from the
heat created from
polymerization.
3. Marginal fit is better.
4. Comfortable to the
patient.

INDIRECT - DIRECT TECHNIQUE
Regish.k.m et al, Techniques of Fabrication of Provisional Restoration: An Overview, International Journal of
Advantage:
1. Chair side time is reduced.
2. Less heat generated in
mouth.
3. Contact between the resin
monomer and soft tissue is
minimised.

TEMPLATE FABRICATED PROVISIONAL FIXED
PARTIAL DENTURE
When a fixed partial denture made for a patient the provisional restoration
should be in the form of a fixed partial dentuare rather than individual crowns.
In the anterior region it will provide better cosmetic result & even in the
posterior region the provisional fixed partial denture will better stabilize the
teeth & the patient gets accustomed to having a tooth in the edentulous space
again.

provisional restoration fixed partial denture

TEMPLATE FABRICATED VLC CURED PROVISIONAL
RESTORATION

MATERIALS
• The most common materials used for custom interim-fixed restorations are several types of acrylic
resins such as:
• Polymethyl Methacrylate (PMMA) Resin, (Duralay)
• Polyethyl Methacrylate (PEMA) Resin, (Slintine)
• Polyvinyl Methacrylate Resin, (Trim)
• Bis-acryl Composite Resin(Protemp 4)
• Vinyl Ethyl Methacrylate (Snap)
• Butyl Methacrylate(Temp Plus)
• Visible Light-cured Urethane Dimethacrylates.(Revotech LC)

PRESENTLYAVAILABLE PROVISIONAL LUTING CEMENTS
• Polycarboxylate temporary luting cements:
Low postoperative sensitivity
Adequate retention
Easy cleanup
Ex. Cling 2(Clinician’s Choice), Hy-Bond(Shofu dental)

ZOE TEMPORARY LUTING CEMENTS: (Commonly Used)
• Sedative on sensitive teeth
• Excellent antibacterial effect
• Ex. RelyX TempE (3M
ESPE), Temp Bond(Kerr),
Flow Temp(Premier Dental
Products), Hy- Bond
ZOE(Shofu Dental)

ZONE TEMPORARY LUTING CEMENTS
• Replace eugenol with various types
of Carboxylic acids.
• Compatible with permanent resin
cements.
• Greater retention than ZOE
cements.
• No Sedative effect on pulp.
• Ex. Rely X Temp NE(3M ESPE),
Temp Bond NE (Kerr), Freegenol,
Nogenol and Temp Adavantage(GC
America), Ultratemp(Ultradent
Products)

RESIN TEMPORARY LUTING CEMENTS:
• High Strengh
• Excellent retention
• Better esthetics
• Easy Cleanup
• Ex. Systemp.Link(Ivoclar Vivadent),
Temp Bond Clear(Kerr), ImProve (Noble
Biocare)

Maya zalkind, DMD," and nira hochman, DDS , laminate veneer provisional restorations: A clinical report, The Journal of Prosthetic
Dentistry, February, Volume 77 Number2 1997,

W. DAN SNEED, DMD, MAT, MHS JAMES S. KNIGHT, DDS , Simple Technique to Fabricate Provisional Restorations for Porcelain Veneers , J
Esthet Restor Dent 13:115-119, 2001

W. DAN SNEED, DMD, MAT, MHS JAMES S. KNIGHT, DDS , Simple Technique to Fabricate Provisional Restorations for Porcelain Veneers , J Esthet Restor
Dent 13:115-119, 2001

Celin Arce, DDS, MS, FACP, Predictable techniques for single provisional ,dentaleconomics..com

Provisional Restorations For Implants
• Challenging roadblocks to implant treatment is the patient’s
perception of the temporization.
Partially Edentulous sites Fully Edentulous sites
1) Fixed prosthesis
Ex. Existing FPD, Acrylic Provisional
or resin bonded bridge
Complete dentures
2) Removable prosthesis(i.e stayplate,
flippers)
Ex. Essix appliance, Snap on Smile

Fabrication of In - Office resin- bonded bridge

Removable
Provisional Prosthesis
Fixed prosthesis and
Resin bonded ridge

Fabrication of Essix Appliance

Recent Advances In Provisonal Restorations
Tuff-Tem plus
Protemp Crowns
RohitRaghavan, Shajahan P A, NeenaKunjumon, Provisionals In Dentistry – From Past To Recent Advances , International Journal Dental and Medical
Sciences Research ,Volume 2, Issue 6 (June- 2018), PP 01-06

Temp Tab Thermoplastic
Matrix Wafers
CAD-CAMPMMA
Provisionals

Limitations of provisional restorations
1. Lack of inherent strength-Provisional restorations fracture in long span bridges
2. Poor marginal adaptation- This inherent deficiency is difficult to improve upon.
provisional restorations infers adequate margins at its best
3. Color instability- this is apparent when the provisional restorations are placed for
longer duration.
4. Poor wear properties- teeth will drift or torque if heavy occlusal forces are used.
5. Detectable odor emission- this is undeniable as the resins are porous.
6. Inadequate bonding characteristics-eugenol cements are incompatible with methyl
methacrylate resins
• The three factors that are responsible for achieving quality provisional restorations are
time, proper materials and technique

CONCLUSION
• Although interim restorations are usually intented for short term use
& then discarded, they can be made to provide pleasing esthetics,
adequate support & good protection for teeth while maintaining
periodontal health.
• They may be made in dental office by number of practical methods
from several commercially available materials.
• The success of Fixed prosthodontics often depends on the care with
which the interim restoration is designed & fabricated.

REFERENCES
 Phillip’s Science of dental materials. Eleventh edition
 Rosenstiel, Contemporary fixed prosthodontics. 4th edition.
 Shillingburg, Fundamentals of fixed prosthodontics. 3rd edition.
 Regish.k.m et al, Techniques of Fabrication of Provisional Restoration: An Overview, International Journal of
 Maya zalkind, DMD," and nira hochman, DDS , laminate veneer provisional restorations: A clinical report, The
Journal of Prosthetic Dentistry, February, Volume 77 Number2 1997
 W. DAN SNEED, DMD, MAT, MHS JAMES S. KNIGHT, DDS , Simple Technique to Fabricate Provisional
Restorations for Porcelain Veneers , J Esthet Restor Dent 13:115-119, 2001
 Celin Arce, DDS, MS, FACP, Predictable techniques for single provisional ,dentaleconomics..com
 RohitRaghavan, Shajahan PA, NeenaKunjumon, Provisionals In Dentistry – From Past To Recent Advances ,
International Journal Dental and Medical Sciences Research ,Volume 2, Issue 6 (June- 2018), PP 01-06

provisional restoration fixed partial denture

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