The University of Western Australia logo at the top right, with a yellow and blue horizontal line beneath it. The main text reads "Lecture 5: Temporization" in large blue font, followed by "By Dr Cheryl Fu" in smaller black font. # Learning Outcomes - Biological, mechanical, esthetic principles of temporization - Temporary materials - Custom vs pre-fabricated temporaries - Direct vs indirect vs direct-indirect temporary techniques - Temporary cements Reading: Chapter 15 in Contemporary Fixed Prosthodontics # **Learning Outcomes** - Biological, mechanical, esthetic principles of temporization - Temporary materials - Custom vs pre-fabricated temporaries - Direct vs indirect vs direct-indirect temporary techniques - Temporary cements **Reading:** Chapter 15 in Contemporary Fixed Prosthodontics **Temporization** - Interim restoration/provisional restoration --- **JPD** *THE JOURNAL OF PROSTHETIC DENTISTRY* **THE GLOSSARY OF PROSTHODONTIC TERMS** *Ninth Edition* --- **temporization**: to establish esthetics, occlusal stability, and function for a limited time in preparation for the definitive prosthesis; to verify therapeutic outcome and patient acceptance before the definitive prostheses; syn, PROVISIONALIZATION # **Temporization** - Interim restoration/provisional restoration ## **Definition from The Glossary of Prosthodontic Terms** **temporization**: to establish esthetics, occlusal stability, and function for a limited time in preparation for the definitive prosthesis; to verify therapeutic outcome and patient acceptance before the definitive prostheses; syn, PROVISIONALIZATION **Temporisation** Just like the principles of tooth preparation there are also factors that need to be considered during the fabrication of a temporary restoration **BIOLOGIC** - Protect pulp - Maintain periodontal health - Provide occlusal compatibility - Maintain tooth position - Protect against fracture **MECHANICAL** - Resist functional loads - Resist removal forces - Maintain interabutment alignment **ESTHETIC** - Easily contourable - Color compatibility - Translucency - Color stability **Optimal interim restoration** FIGURE 15-1 ■ Factors to be considered in making an interim restoration. The central area represents the optimum, in which biologic, mechanical, and esthetic requirements are adequately met. Image in Contemporary fixed prosthodontics # **Principles of Temporization** Just like the principles of tooth preparation there are also factors that need to be considered during the fabrication of a temporary restoration. ## **BIOLOGIC** - Protect pulp - Maintain periodontal health - Provide occlusal compatibility - Maintain tooth position - Protect against fracture ## **MECHANICAL** - Resist functional loads - Resist removal forces - Maintain interabutment alignment ## **ESTHETIC** - Easily contourable - Color compatibility - Translucency - Color stability ### **Optimal Interim Restoration** Factors to be considered in making an interim restoration. The central area represents the optimum, in which biologic, mechanical, and esthetic requirements are adequately met. Image in Contemporary fixed prosthodontics # Temporisation ## Biological Factors: - **Protect pulp (if it is still present)** - Removal of tooth structure can lead to sensitivity if the dentin tubules are exposed to the oral environment - **Periodontal health** - A suitably shaped temporary restoration is required to ensure periodontal health. - Appropriate contour shape, and smoothness - Appropriate interproximal contacts - **Occlusal Compatibility and tooth position** - Loss of temporary crown can lead to either supra-eruption of the opposing tooth or tilting of the opposing tooth - **Protect against fracture** - Protect unsupported tooth structure Venn diagram illustrating factors for interim restoration: Biologic, Mechanical, and Esthetic, with central overlap labeled "Optimal interim restoration". # **Detailed Principles of Temporization** ## **Biological Factors** - **Protect pulp (if it is still present)** - Removal of tooth structure can lead to sensitivity if the dentin tubules are exposed to the oral environment - ==For endodontically treated teeth, the focus shifts to preventing bacterial ingress into the canal system.== - **Periodontal health** - A suitably shaped temporary restoration is required to ensure periodontal health. - Appropriate contour shape, and smoothness - Appropriate interproximal contacts - ==**Margins:** Margins must be sealed, smooth, and well-contoured to be cleansable and prevent soft tissue injury. Overhangs and open margins must be avoided.== - ==**Contour:** Over-contoured crowns can trap plaque and make cleaning difficult, while under-contoured crowns can cause gingival injury.== - **Occlusal Compatibility and tooth position** - Loss of temporary crown can lead to either supra-eruption of the opposing tooth or tilting of the opposing tooth ==or **drifting** of adjacent teeth into the prepared space. This movement can prevent the final crown from seating correctly, requiring significant chairside adjustments or a complete remake.== - **Protect against fracture** - Protect unsupported tooth structure (more for overlays) > [!tip] Patient Instructions > - ==Patients must be informed that the restoration is temporary and held with weak cement.== > - ==Advise them to avoid sticky or hard foods on that side.== > - ==Instruct them on proper flossing: pass the floss through the contact point, then pull it out from the side rather than pulling it back up through the contact, which could dislodge the crown.== # RECAP: Principles of Tooth Preparations ## ABUTMENT TOOTH ### BIOLOGICAL - Principles of tooth preparation - Partial or complete preparation - **Conservation of tooth structure** - **Avoidance of overcontouring** - Supragingival margins - Harmonious occlusion - Protection against tooth fracture ### MECHANICAL - Retention form - Resistance form - Deformation ### AESTHETIC - Minimum display of metal - Maximum thickness of porcelain - Porcelain occlusal surfaces - Subgingival margins **Patient can’t clean this!** Diagram showing three overlapping circles labeled BIOLOGICAL, MECHANICAL, and AESTHETIC, with illustrations of tooth preparations and annotations indicating areas of concern such as "Overcontoured crown" and "Plaque retention". # **RECAP: Principles of Tooth Preparations** ## **ABUTMENT TOOTH** ### **BIOLOGICAL** - Principles of tooth preparation - Partial or complete preparation - **Conservation of tooth structure** - **Avoidance of overcontouring** - Supragingival margins - Harmonious occlusion - Protection against tooth fracture ### **MECHANICAL** - Retention form - Resistance form - Deformation ### **AESTHETIC** - Minimum display of metal - Maximum thickness of porcelain - Porcelain occlusal surfaces - Subgingival margins Patient can’t clean this! Which would you prefer? OR Dental comparison images showing healthy vs. decayed teeth, with labeled close-ups (a, b, c, d) and a University of Western Australia logo. Which would you prefer? OR # Temporisation ## Biological Factors: - **Protect pulp (if it is still present)** - Removal of tooth structure can lead to sensitivity if the dentin tubules are exposed to the oral environment - **Periodontal health** - A suitably shaped temporary restoration is required to ensure periodontal health. - Appropriate contour shape, and smoothness - Appropriate interproximal contacts - **Occlusal Compatibility and tooth position** - Loss of temporary crown can lead to either supra-eruption of the opposing tooth or tilting of the opposing tooth - **Protect against fracture** - Protect unsupported tooth structure (more for overlays) Venn diagram illustrating Biological, Mechanical, and Esthetic factors in temporisation, with overlapping areas indicating optimal interim restoration. # Temporisation Diagram showing proper occlusal and proximal contacts promoting patient comfort and maintaining tooth position, with arrows indicating contact points. **Temporisation** Diagram comparing two dental restorations: one with open margins, overhangs, and over contoured features; the other with sealed, smooth, and well contoured margins. # Temporisation ## Mechanical Factors: - **Resist functional loads** - Chewing/daily function - In complete crown preparation if there is sufficient reduction the temporary material should withstand oral stresses. - Provisional restoration for cracked tooth - **Resist removal forces** - In complete crown preparation, the retentive factors such as parallel preparation - Instruct patient to not chew sticky foods, can continue to floss, but they are to **PULL THE FLOSS THROUGH THE SIDE**, and not back through the contacts. Venn diagram showing overlapping circles labeled BIOLOGIC, MECHANICAL, and ESTHETIC with text inside each circle and a central area labeled "Optimal interim restoration". ## **Mechanical Factors** - **Resist functional loads** - Chewing/daily function - In complete crown preparation if there is sufficient reduction the temporary material should withstand oral stresses. - Provisional restoration for cracked tooth - **Resist removal forces** - In complete crown preparation, the retentive factors such as parallel preparation ==and the luting action of the temporary cement.== - Instruct patient to not chew sticky foods, can continue to floss, but they are to **PULL THE FLOSS THROUGH THE SIDE**, and not back through the contacts. # Temporisation ## Aesthetic Factors: - **Anterior teeth** - Accurate shade matching - Appropriate shape - **Complex treatment plans** - May use long term interim restorations to let patient “try out” the proposed treatment - Especially important for large changes to the incisal edges or palatal contour (s, f, th, etc sounds) Venn diagram showing three overlapping circles labeled "BIOLOGIC", "MECHANICAL", and "ESTHETIC", with a central area labeled "Optimal interim restoration". The diagram illustrates factors to be considered in making an interim restoration, with the central area representing the optimum where biologic, mechanical, and esthetic requirements are adequately met. ## **Aesthetic Factors** - **Anterior teeth** - Accurate shade matching ==(e.g., using different shades of Luxatemp like A2 or A3) and selecting appropriately colored cements.== - Appropriate shape - ==The shape should be lifelike. This can be achieved by using a putty key of the original tooth (if it was well-shaped) or a diagnostic wax-up.== - **Complex treatment plans** - May use long term interim restorations to let patient “try out” the proposed treatment - Especially important for large changes to the incisal edges or palatal contour (s, f, th, etc sounds) > [!info] Purpose of Long-Term Interim Restorations > - ==**Purpose:** They allow the patient to **Complex treatment plans** But, not done in 1 step. Many many steps in between: Song MY, Park JM, Park EJ. Full mouth rehabilitation of the patient with severely worn dentition: a case report. Figure showing before and after dental restoration with provisional restorations placed after trial period of removable occlusal overlay splint. ### **Complex Treatment Plans** But, not done in 1 step. Many many steps in between: Song MY, Park JM, Park EJ. Full mouth rehabilitation of the patient with severely worn dentition: a case report. **Alternative reasons for long term temporaries: Cracked teeth** - **Numerous proposed management strategies:** - Single vs multi-staged - Direct vs indirect - Cuspal coverage? - **One of potential treatments: Full crown** - However preferable to start with crack investigation and restoration with composite core prior to crown. Otherwise potential unwanted stress concentration. - Thus we are now in “multi-staged treatment” - How long do we wait: ranges from 1 week to 6 months. - Extracoronal splinting via orthodontic bands, or temporary crowns - Tooth with uncertain prognosis: is it worth it? ### **Alternative Reasons for Long-Term Temporaries: Cracked Teeth** > [!note] > ==A provisional restoration can be placed on a cracked tooth as an immediate measure to hold it together and protect it, especially when there isn't enough time for a full crown preparation appointment.== - **Numerous proposed management strategies:** - Single vs multi-staged - Direct vs indirect - Cuspal coverage? - **One of potential treatments: Full crown** - However preferable to start with crack investigation and restoration with composite core prior to crown. Otherwise potential unwanted stress concentration. - Thus we are now in “multi-staged treatment” - How long do we wait: ranges from 1 week to 6 months. - Extracoronal splinting via orthodontic bands, or temporary crowns - Tooth with uncertain prognosis: is it worth it? **Temporary Materials** Selection of temporary restoration material depends on several factors: - Anticipated load - Prosthesis design - Span length - Duration of provisional restoration # **Temporary Materials** Selection of temporary restoration material depends on several factors: - Anticipated load - Prosthesis design - Span length - Duration of provisional restoration # Temporary Materials ## Ideal Properties - Adequate strength - Abrasion resistant - Biocompatible - Non-irritant - Dimensional Stability - Ease of contouring and polishing - Good aesthetics - Convenient handling - Working time - Setting time - Application - Easily modifiable ## **Ideal Properties** - Adequate strength - Abrasion resistant - Biocompatible - Non-irritant - Dimensional Stability - Ease of contouring and polishing - Good aesthetics - Convenient handling - Working time - Setting time - Application - Easily modifiable # Temporary Materials Custom and prefabricated Direct vs indirect Choices for custom temporary restorations: - Polymethyl Methacrylate (PMMA) - Polyethyl Methacrylate (PEMA) - Bisacryl Composite Resin - Light-Cured Composite Resin ## **Material Categories and Types** - Custom and prefabricated - Direct vs indirect ### **Choices for Custom Temporary Restorations** - ==**Direct:** Fabricated entirely in the patient's mouth.== - ==**Indirect:** Fabricated in a dental lab on a cast.== - ==**Direct-Indirect:** A combination where a shell is made in the lab and then relined in the mouth.== - Polymethyl Methacrylate (PMMA) - Polyethyl Methacrylate (PEMA) - Bisacryl Composite Resin - Light-Cured Composite Resin # Direct vs Indirect fabrication ## Direct Fabrication - Eliminates the need of an alginate impression and cast (not entirely...) - However technique sensitive - PMMA is not suitable due to exothermic reaction and polymerization shrinkage - Can be subdivided into “custom” or “preformed” method. ## Indirect Fabrication - More accurate ## Direct-indirect Fabrication - A shell is formed using the indirect method which is relined chairside to fit the preparation. - Reduces chairside time - Less heat generation # **Fabrication Techniques** ## **Direct Fabrication** - Eliminates the need of an alginate impression and cast (not entirely...) - However technique sensitive - PMMA is not suitable due to exothermic reaction and polymerization shrinkage - Can be subdivided into “custom” or “preformed” method. - **Advantages** - ==Can be completed in a single visit.== - ==Eliminates the need for a separate impression of the prepared tooth for the lab.== - **Disadvantages** - ==Technique-sensitive.== - ==Potential for pulpal irritation from exothermic heat and monomer release with certain materials (like PMMA).== - ==Fit can be compromised due to polymerization shrinkage.== ## **Indirect Fabrication** - More accurate ## **Direct-Indirect Fabrication** - A shell is formed using the indirect method which is relined chairside to fit the preparation. - Reduces chairside time - Less heat generation **Direct: Preformed** - A premade mould which must be relined to fit on the prepared tooth. - Available forms: - Polycarbonate - Cellulose acetate - Aluminum - Tin-silver - Nickle-chromium ## **Direct Fabrication: Preformed Method** - A premade mould which must be relined to fit on the prepared tooth. - **Available forms:** - Polycarbonate - Cellulose acetate - Aluminum - Tin-silver - Nickle-chromium **Polycarbonate** - Colour stable restoration, but only available in 1 shade (can be modified using the lining material) - Forms part of the provisional restoration - Bonds to PEMA - Procedure - Select correct crown form based on morphology and mesial-distal width - Adjust height until passively fitting - Lubricate tooth with petroleum jelly to protect from monomers and prevent bonding of the acrylic to the tooth. - Mix PEMA and apply to crown when PEMA loses its gloss - Fit crown on tooth, and immediately remove the excess from the margins - Once the material is in rubbery phase (2 minutes) remove and reseat the crown to prevent thermal irritation and ensure the crown can be removed later - After 5 minutes when material is fully set, the material can be adjusted and cemented with temporary cement - Check occlusion ### **Polycarbonate Crowns** - Colour stable restoration, but only available in 1 shade (can be modified using the lining material) - Forms part of the provisional restoration - Bonds to PEMA - **Procedure** - Select correct crown form based on morphology and mesial-distal width - Adjust height until passively fitting - Lubricate tooth with petroleum jelly to protect from monomers and prevent bonding of the acrylic to the tooth. - Mix PEMA and apply to crown when PEMA loses its gloss - Fit crown on tooth, and immediately remove the excess from the margins - Once the material is in rubbery phase (2 minutes) remove and reseat the crown to prevent thermal irritation and ensure the crown can be removed later ==. This repeated removal and reseating also prevents the crown from locking into any undercuts.== - After 5 minutes when material is fully set, the material can be adjusted and cemented with temporary cement - Check occlusion **Acetate strip crowns** - Does not bond to acrylic - Only used to provide shape to the provisional restoration (the crown form needs to be removed) Acetate strip crowns and their application in dental procedures ### **Acetate Strip Crowns** - Does not bond to acrylic - Only used to provide shape to the provisional restoration (the crown form needs to be removed) - **Procedure** - ==Trim and adapt the clear form to the tooth.== - ==A small vent hole can be poked in an accessible area (e.g., incisal edge) to allow excess material and air to escape.== - ==Fill the form with composite resin and seat it on the tooth.== - ==Light-cure the composite.== - ==Remove the acetate form by cutting or prying it off.== - ==Finish and polish the composite temporary.== **Metal Crowns** - Available in molar and premolar forms - More suited for children - Very strong - Easily adjusted - Luted with cement - Will form part of the final provisional restoration - Procedure: - Selected the correct crown based of morphology and mesiodistal width - Adjust mesiodistal width with pliers - Can adjust the height using scissors or pliers ### **Metal Crowns** - Available in molar and premolar forms - More suited for children - Very strong - Easily adjusted - Luted with cement - Will form part of the final provisional restoration - **Procedure:** - Selected the correct crown based of morphology and mesiodistal width - Adjust mesiodistal width with pliers - Can adjust the height using scissors or pliers - ==The crown can be lined with PEMA or cemented directly with temporary cement if the fit is adequate.== **Direct (custom)** - Requires a mold - Silicon or Clear thermoplastic material - Mold can be constructed intra-orally with silicon, or can be done on a cast of the teeth. (Allows wax up to change the morphology of the existing tooth) - **Advantages** - Easy to apply - Can be done in same visit - Can incorporate wax up modifications - Cheapest - **Disadvantages** - Inferior mechanical properties - Optimal fit is compromised - More clinical time ## **Direct Fabrication: Custom Method** - Requires a mold - Silicon or Clear thermoplastic material - Mold can be constructed intra-orally with silicon, or can be done on a cast of the teeth. (Allows wax up to change the morphology of the existing tooth) - **Advantages** - Easy to apply - Can be done in same visit - Can incorporate wax up modifications - Cheapest - **Disadvantages** - Inferior mechanical properties - Optimal fit is compromised - ==Fit is compromised as there is no dedicated space for cement.== - More clinical time **Indirect** - **Advantages** - Superior mechanical properties - Patient not exposed to uncured monomers (allergies) - No heat from polymerizing resins - Better fit (we are removing the luxatemp provisional restorations when semi-set) - Better finish and polish - Less clinical time - Incorporates wax-up modifications - Possibility of metal reinforcement - **Disadvantages** - Time consuming (lab turn around time) - Additional cost - More suitable for extensive restorations (long term temporaries) ## **Indirect Fabrication** - **Advantages** - Superior mechanical properties - Patient not exposed to uncured monomers (allergies) - No heat from polymerizing resins - Better fit (we are removing the luxatemp provisional restorations when semi-set) - Better finish and polish - Less clinical time - Incorporates wax-up modifications - Possibility of metal reinforcement - ==Allows the use of materials not suitable for direct intraoral use (e.g., heat-cured PMMA).== - **Disadvantages** - Time consuming (lab turn around time) - Additional cost - More suitable for extensive restorations (long term temporaries) **Indirect-Direct** - **Advantages** - Superior mechanical properties - Better finish and polish - Incorporates wax-up modifications - **Disadvantages** - Additional laboratory cost - More time consuming than indirect technique (shells likely need some sort of adjustment) ## **Indirect-Direct Fabrication** - **Advantages** - Superior mechanical properties - Better finish and polish - Incorporates wax-up modifications - **Disadvantages** - Additional laboratory cost - More time consuming than indirect technique (shells likely need some sort of adjustment) **Indirect-Direct** **Indirect** - Stone model is conservatively prepared in the laboratory with supragingival margins - Provisional restoration is constructed in the laboratory with the aid of template **Direct** - Provisional restoration is tried in the mouth and adjusted accordingly - Relined with suitable material Figure showing two dental models labeled 'a' and 'b', illustrating provisional restorations. ### **Indirect-Direct Procedure Overview** #### **Indirect** - Stone model is conservatively prepared in the laboratory with supragingival margins - Provisional restoration is constructed in the laboratory with the aid of template ==. The tooth on the model is under-prepared by the lab technician, meaning the shell will be slightly larger than the final preparation.== #### **Direct** - Provisional restoration is tried in the mouth and adjusted accordingly - Relined with suitable material > [!info] > ==The internal surface of the shell is relined with a suitable material (e.g., PEMA) and seated on the actual tooth preparation. After setting, the relined provisional is trimmed, polished, and cemented.== **Temporary Materials** Choices for custom temporary restorations: - Polymethyl Methacrylate (PMMA) - Polyethyl Methacrylate (PEMA) - Bisacryl Composite Resin - Light-Cured Composite Resin # **Specific Temporary Materials** **PMMA** **Advantages:** - High strength - Colour stability - Can be characterized - Easily smoothed - Easily repaired - Low cost **Disadvantages:** - Highly exothermic - Significant polymerization shrinkage (21%!) - Monomer release toxic to pulp - Unpleasant odor - Low abrasion resistance Can be used in indirect or direct-indirect method ## **Polymethyl Methacrylate (PMMA)** **Advantages:** - High strength - Colour stability - Can be characterized - Easily smoothed - Easily repaired - Low cost **Disadvantages:** - Highly exothermic - Significant polymerization shrinkage (21%!) - Monomer release toxic to pulp > [!warning] Clinical Consideration > ==The highly exothermic (heat-releasing) reaction makes PMMA unsafe for direct intraoral use, and its high polymerization shrinkage can lead to distortion and poor marginal fit if used directly.== - Unpleasant odor - Low abrasion resistance Can be used in indirect or direct-indirect method **PEMA** **Advantages:** - Easily polished - Minimal exothermic heat increase (compared to PMMA) - Low shrinkage - Can be characterized - Easily repaired - Low cost - Moderate strength **Disadvantages:** - Surface hardness (weaker than PMMA) - Strength - Durability - Fracture toughness - Unpleasant odor Can be used in direct method for single crowns, or in the direct-indirect reline method ## **Polyethyl Methacrylate (PEMA)** **Advantages:** - Easily polished - Minimal exothermic heat increase (compared to PMMA) - Low shrinkage - Can be characterized - Easily repaired - Low cost - Moderate strength **Disadvantages:** - Surface hardness (weaker than PMMA) - Strength - Durability - Fracture toughness - Unpleasant odor Can be used in direct method for single crowns, or in the direct-indirect reline method Series of images showing preparation and seating of a custom dental mould using Acrylic PEMA (Bisacryl) Custom dental impression and crown fitting process **Bisacryl composite resin** **Advantages:** - Low exothermic reaction - Minimal polymerization shrinkage - Ease of application via cartridge system - Can be smoothed or polished - Can be characterized **Disadvantages:** - Brittle - Difficult to repair - Does not bond to polycarbonate crowns - High cost Ideal for direct methods for single crowns ## **Bisacryl Composite Resin** **Example:** Luxatemp. **Advantages:** - Low exothermic reaction - Minimal polymerization shrinkage - Ease of application via cartridge system - Can be smoothed or polished - Can be characterized **Disadvantages:** - Brittle - Difficult to repair - Does not bond to polycarbonate crowns - High cost Ideal for direct methods for single crowns **Light cured composite resin** **Advantages:** - Controlled setting (light cured) - Highly aesthetic - Can be characterized - Easily polished and smoothed **Disadvantages:** - Brittle - Transparent template required for light cure - Can be time consuming - High cost Single unit restorations in the direct method. Can also be used to repair open margins in bisacryl composite crowns. Can also be fabricated in the indirect method ## **Light Cured Composite Resin** **Advantages:** - Controlled setting (light cured) - Highly aesthetic - Can be characterized - Easily polished and smoothed **Disadvantages:** - Brittle - Transparent template required for light cure - Can be time consuming - High cost Single unit restorations in the direct method. Can also be used to repair open margins in bisacryl composite crowns. > [!tip] Clinical Tip for Repair > ==To repair an open margin on a bis-acryl temporary, it is best to first cement the temporary with temporary cement, remove any excess cement from the defect, and then add and cure flowable composite to seal the margin.== Can also be fabricated in the indirect method # Temporary cements - **Objectives:** - Provide adequate seal - Retain provisional restoration - Minimal solubility - Adequate handling and mixing - Adequate working and setting time - Cleansable - Biocompatible with pulp/gingiva - Compatible with restorative materials - Allows for restoration removal # **Temporary Cements** ## **Objectives** - Provide adequate seal - Retain provisional restoration - Minimal solubility - Adequate handling and mixing - Adequate working and setting time - Cleansable - Biocompatible with pulp/gingiva - Compatible with restorative materials - Allows for restoration removal # Temporary cements - **Types:** - Zinc-oxide eugenol cement - Eugenol free cement - Polycarboxylate cement (harder cement) - Tempbond clear (aesthetic) ## **Types** - Zinc-oxide eugenol cement - Eugenol free cement - Polycarboxylate cement (harder cement) - Tempbond clear (aesthetic) # Temporary cements - Zinc-oxide eugenol cement is most commonly used - High strength cements should be avoided as it can cause damage during the removal of the temporary restoration. - Can be used when there is lack of retention in tooth preparation - Long span restorations - Parafunctional activities - Eugenol may act as a plasticizer of methacrylate resins - Thus could reduce bond strengths of permanent resin cements - Thus can use eugenol free cements ## **Considerations** - Zinc-oxide eugenol cement is most commonly used - High strength cements should be avoided as it can cause damage during the removal of the temporary restoration. - Can be used when there is lack of retention in tooth preparation - Long span restorations - Parafunctional activities - Eugenol may act as a plasticizer of methacrylate resins - Thus could reduce bond strengths of permanent resin cements > [!warning] Eugenol and Resin Cements > ==The eugenol in traditional ZOE cements can act as a plasticizer and **inhibit the polymerization of permanent resin cements**. Therefore, a **eugenol-free** temporary cement should be used if the final restoration will be bonded with a resin cement.== - Thus can use eugenol free cements # Temporary Cements **TEMPORARY CEMENTS** 1) Mix the base and activator 2) Apply a small quantity just short to the margin 3) Seat the crown and hold tightly (or ask patient to bite over a cotton roll) 4) Remove the excess with an explorer and dental floss 5) Make sure no cement is left in the gingival sulcus 6) Occlusion should be checked and adjusted after cementation Three clinical images showing application of temporary cement: mixing cement, applying to crown, and seating crown on tooth. ## **Application Procedure** 1) Mix the base and activator 2) Apply a small quantity just short to the margin ==. A very thin layer should be applied to the internal surfaces of the crown.== 3) Seat the crown and hold tightly (or ask patient to bite over a cotton roll) 4) Remove the excess with an explorer and dental floss ==. This should be done once the cement reaches a rubbery or partially set stage. Pass dental floss through the interproximal contacts *before* the cement fully sets to clear the embrasure spaces.== 5) Make sure no cement is left in the gingival sulcus 6) Occlusion should be checked and adjusted after cementation > [!info] > ==The slight thickness of the cement layer may make the crown slightly high, requiring minor occlusal adjustment.== **Thanks for listening** Any questions? Send me an email or ask me during CSSL **Thanks for listening** Any questions? Send me an email or ask me during CSSL [[F3 Temporization.pdf#page=1|F3 Temporization, p.1]] [[F3 Temporization.pdf#page=2|F3 Temporization, p.2]] [[F3 Temporization.pdf#page=3|F3 Temporization, p.3]] [[F3 Temporization.pdf#page=4|F3 Temporization, p.4]] [[F3 Temporization.pdf#page=5|F3 Temporization, p.5]] [[F3 Temporization.pdf#page=6|F3 Temporization, p.6]] [[F3 Temporization.pdf#page=7|F3 Temporization, p.7]] [[F3 Temporization.pdf#page=8|F3 Temporization, p.8]] [[F3 Temporization.pdf#page=9|F3 Temporization, p.9]] [[F3 Temporization.pdf#page=10|F3 Temporization, p.10]] [[F3 Temporization.pdf#page=11|F3 Temporization, p.11]] [[F3 Temporization.pdf#page=12|F3 Temporization, p.12]] [[F3 Temporization.pdf#page=13|F3 Temporization, p.13]] [[F3 Temporization.pdf#page=14|F3 Temporization, p.14]] [[F3 Temporization.pdf#page=15|F3 Temporization, p.15]] [[F3 Temporization.pdf#page=16|F3 Temporization, p.16]] [[F3 Temporization.pdf#page=17|F3 Temporization, p.17]] [[F3 Temporization.pdf#page=18|F3 Temporization, p.18]] [[F3 Temporization.pdf#page=19|F3 Temporization, p.19]] [[F3 Temporization.pdf#page=20|F3 Temporization, p.20]] [[F3 Temporization.pdf#page=21|F3 Temporization, p.21]] [[F3 Temporization.pdf#page=22|F3 Temporization, p.22]] [[F3 Temporization.pdf#page=23|F3 Temporization, p.23]] [[F3 Temporization.pdf#page=24|F3 Temporization, p.24]] [[F3 Temporization.pdf#page=25|F3 Temporization, p.25]] [[F3 Temporization.pdf#page=26|F3 Temporization, p.26]] [[F3 Temporization.pdf#page=27|F3 Temporization, p.27]] [[F3 Temporization.pdf#page=28|F3 Temporization, p.28]] [[F3 Temporization.pdf#page=29|F3 Temporization, p.29]] [[F3 Temporization.pdf#page=30|F3 Temporization, p.30]] [[F3 Temporization.pdf#page=31|F3 Temporization, p.31]] [[F3 Temporization.pdf#page=32|F3 Temporization, p.32]] [[F3 Temporization.pdf#page=33|F3 Temporization, p.33]] [[F3 Temporization.pdf#page=34|F3 Temporization, p.34]] [[F3 Temporization.pdf#page=35|F3 Temporization, p.35]] [[F3 Temporization.pdf#page=36|F3 Temporization, p.36]] [[F3 Temporization.pdf#page=37|F3 Temporization, p.37]] [[F3 Temporization.pdf#page=38|F3 Temporization, p.38]]