**Temporarisation** *Provisional Restorations* Dr. Matsubara Close-up of anterior teeth with provisional restorations, showing natural tooth alignment and gum tissue. # **Temporarisation** *Provisional Restorations* Dr. Matsubara **Temporarisation** Synonyms - Provisional restoration/prosthesis - Interim restoration/prosthesis - Temporary restoration/prosthesis # **Temporarisation** ## **Synonyms** - Provisional restoration/prosthesis - Interim restoration/prosthesis - Temporary restoration/prosthesis > [!info] > In the context of indirect restorations, this refers to temporary crowns. **Temporarisation** **Temporary prosthesis** A fixed or removable dental prosthesis, designed to enhance aesthetics, stabilize and give function for a limited period of time, after which it is to be replaced by a definitive dental prosthesis. Assist determination of the therapeutic effectiveness of a specific treatment plan or the form and function of the definitive prosthesis. *Glossary of Prosthodontic Terms; 9th ed 2005* # **Temporarisation** ## **Temporary prosthesis** A fixed or removable dental prosthesis, designed to enhance aesthetics, stabilize and give function for a limited period of time, after which it is to be replaced by a definitive dental prosthesis. Assist determination of the therapeutic effectiveness of a specific treatment plan or the form and function of the definitive prosthesis. - ==Act as a 'trial' for the final restoration, allowing evaluation of the new shape, form, and bite, especially in cases involving an increase in the patient's vertical dimension.== *Glossary of Prosthodontic Terms; 9th ed 2005* # Temporary Prosthesis ## Objectives of Provisional Restorations - Biological - Mechanical - Aesthetic - Part of adjunctive therapy - Endodontic treatment - Periodontal treatment - Communication with dental laboratory # **Temporary Prosthesis** ## **Objectives of Provisional Restorations** The primary aim of a provisional crown is to fulfill a set of biological, mechanical, and aesthetic requirements during the interim period between tooth preparation and the placement of the final restoration. - Biological - Mechanical - Aesthetic - Part of adjunctive therapy - Endodontic treatment - Periodontal treatment - Communication with dental laboratory # Temporary Prosthesis ## Biological Requirements - Prevent sensitivity - Maintain pulp vitality - Maintain periodontal health - Resolve gingival inflammation - Prevents caries (prolonged application) ## **Biological Requirements** - Prevent sensitivity - Maintain pulp vitality - Maintain periodontal health - Resolve gingival inflammation - Prevents caries (prolonged application) # Temporary Prosthesis ## Biological Requirements ### Pulp Protection - Provisional restoration must seal and insulate the prepared tooth from oral environment - Thermal, bacterial and chemical irritants - Inevitable pulp trauma can become irreversible if adequate provisional restoration cannot be made Dentine tubules Microscopic images of dentine tubules, showing structural details and labeled sections. ### **Pulp Protection** - Provisional restoration must seal and insulate the prepared tooth from oral environment - Thermal, bacterial and chemical irritants > [!warning] > If the provisional is lost, bacteria can infiltrate the exposed tubules, potentially leading to future complications even if the patient does not experience immediate pain. - Inevitable pulp trauma can become irreversible if adequate provisional restoration cannot be made > [!tip] Use of Desensitizers > - ==Applying a desensitizing agent or a dentin sealing agent can help seal the tubules and improve the bond of the final restoration.== > - ==**Caution:** Routine use is not recommended for all cases. In situations with deep preparations, a desensitizer might mask underlying sensitivity that could become a problem after the final crown is cemented. The final cementation process (e.g., etching for a resin cement) may remove this protective layer, leading to delayed onset of symptoms.== Dentine tubules # Temporary Prosthesis ## Biological Requirements ### Pulp Protection - Used to assess questionable pulpal vitality before completing definitive restorations - Ideal when dealing with teeth with “cracked cusps” - Good anchorage for rubber dam clamps ### **Pulp Protection** - Used to assess questionable pulpal vitality before completing definitive restorations - Ideal when dealing with teeth with “cracked cusps” > [!example] Diagnostic Use in Cracked Tooth Syndrome > - ==**Symptoms:** Patients with cracked tooth syndrome often present with sharp pain on biting and release, without visible decay. The pain is caused by the movement of dentinal fluid as the crack flexes under occlusal load.== > - ==**Provisional as a Diagnostic Tool:** A full-coverage provisional crown is placed to splint the cracked cusp, preventing it from flexing. The patient is monitored for several weeks. If the symptoms resolve, it indicates that a permanent crown will likely solve the problem.== > - ==**Alternative Management:** An orthodontic or metal band can be placed around the tooth with a GIC (Glass Ionomer Cement) filling inside. This also holds the cusps together, simulating the effect of a crown. If this resolves the pain, a permanent crown is the indicated final treatment.== > - ==**Prognosis:** If the crack is too deep or has already led to irreversible pulpitis, further treatment like root canal therapy or extraction may be necessary. Endodontists often need to trace the extent of the crack to ensure a proper seal can be achieved before beginning root canal treatment.== - Good anchorage for rubber dam clamps # Temporary Prosthesis ## Biological Requirements ### Maintain Periodontal Health - Provisional restoration must facilitate plaque control by: - Good marginal fit - Proper contour - Smooth surface - Provisional restoration can be used to promote healing of soft tissues and allows resolution of gingival inflammation - If the existing restoration preclude proper plaque control, then a well made provisional restoration could help to restore gingival health ### **Maintain Periodontal Health** - Provisional restoration must facilitate plaque control by: - Good marginal fit - Proper contour - Smooth surface - ==**Avoid Overextensions:** Overextended or poorly fitting margins act as plaque traps, leading to gingival inflammation, bleeding, and potential decay.== - Provisional restoration can be used to promote healing of soft tissues and allows resolution of gingival inflammation - If the existing restoration preclude proper plaque control, then a well made provisional restoration could help to restore gingival health > [!info] Foundation for Final Restoration > Healthy gingiva is crucial for taking an accurate final impression and for the successful cementation of the permanent crown. # Temporary Prosthesis ## Biological Requirements Maintain Periodontal Health Diagram comparing two dental restorations: one with "Open margins, Overhangs, Overcontoured" and the other with "Sealed margin, Smooth margin, Well-contoured" # Temporary Prosthesis ## Provisional restoration - periodontal tissues to stay or become healthy. Two images showing anterior teeth, one with a provisional restoration and the other showing a more refined temporary prosthesis. GRACIS et al. 2001 - Provisional restoration - periodontal tissues to stay or become healthy. # Temporary Prosthesis ## Biological Requirements **Maintain Periodontal Health** ► Possible implications on - Adequate tissue management and definitive impressions - Possible recession and aesthetic dissatisfaction ► Monitor healing after crown lengthening surgery - Possible implications on - Adequate tissue management and definitive impressions - Possible recession and aesthetic dissatisfaction - Monitor healing after crown lengthening surgery # Temporary Prosthesis ## Mechanical Requirements - Maintain tooth position (occlusal stability) - Protection against fracture - Resist functional load - Resist removal forces (retention and resistance) ## **Mechanical Requirements** - Maintain tooth position (occlusal stability) - Protection against fracture - Resist functional load - Resist removal forces (retention and resistance) # Temporary Prosthesis ## Mechanical Requirements ### Occlusal stability ➤ Preserve intra-arch relationship: - Provisional restoration should establish and maintain proper contacts with adjacent teeth - Prevents movement or drifting - Significant implication on bridge fit ### **Occlusal stability** - Preserve intra-arch relationship: - Provisional restoration should establish and maintain proper contacts with adjacent teeth - Prevents movement or drifting - Significant implication on bridge fit # Temporary Prosthesis ## Mechanical Requirements ### Occlusal stability - Preserve inter-arch relationship: - Establish and maintain proper contacts with the opposing dentition - Prevents extrusion - Observes the effects of occlusion before the definitive restoration Diagrams illustrating occlusal relationships and tooth alignment. ### **Occlusal stability** - Preserve inter-arch relationship: - Establish and maintain proper contacts with the opposing dentition - Prevents extrusion - Observes the effects of occlusion before the definitive restoration > [!warning] Clinical Considerations > - ==While tooth movement may be minimal in a periodontally stable patient, it is a significant risk for patients who have recently undergone orthodontic treatment. In these cases, the periodontal ligament is not yet fully stabilized, and teeth can move quickly if not held in place by a well-fitting provisional with tight contacts.== > - ==Any tooth movement between the impression and insertion appointments can prevent the final crown from seating correctly.== # Temporary Prosthesis ## Mechanical Requirements ### Protection Against Fracture - Protection of weakened tooth structure after preparation - Protection of core restoration - Protection of preparation features - Even small fracture will increase chair side time and, in extensive cases, might require remake Clinical image showing a prepared tooth with a temporary prosthesis and a line drawing of a temporary crown. ### **Protection Against Fracture** - Protection of weakened tooth structure after preparation - Protection of core restoration - Protection of preparation features - Even small fracture will increase chair side time and, in extensive cases, might require remake # Temporary Prosthesis ## Mechanical Requirements ### Resist Functional Load - Provisional restoration should be strong enough to resist functional load: - Preparation reduction - Provisional restoration adjustment - Material selection - Should preserve intercuspal contacts to maintain tooth position - Occlusal interferences must be removed ### **Resist Functional Load** - Provisional restoration should be strong enough to resist functional load: - Preparation reduction - Provisional restoration adjustment - Material selection - Should preserve intercuspal contacts to maintain tooth position - Occlusal interferences must be removed # Temporary Prosthesis ## Mechanical Requirements ### Resist Removal Forces - Retention and resistance forms of the preparation - Fit of provisional restoration - Cementation material ### **Resist Removal Forces** - Retention and resistance forms of the preparation - Fit of provisional restoration - Cementation material # Temporary Prosthesis ## Aesthetic Requirements - Colour compatibility - Translucency - Colour stability **Depends on:** - Material - Morphology - Choose material that is close to final shade - Choose material carefully if long term provisional restoration is required ## **Aesthetic Requirements** - Colour compatibility - Translucency - Colour stability **Depends on:** - Material - Morphology - Choose material that is close to final shade - Choose material carefully if long term provisional restoration is required # Temporary Prosthesis ## Aesthetic Requirements ► After major alterations - Clinician and patient can assess tooth form, gingival contours, shade requirements and effects on phonetics prior to final definitive restorations - Once approved, an impression of the provisional restorations allows the technician to build new crowns to the same shape - Alteration of the palatal surfaces or the incisal tips of the upper anterior teeth can cause problems in forming ‘S’, ‘F’, ‘V’ & ‘Th’ sounds - After major alterations - Clinician and patient can assess tooth form, gingival contours, shade requirements and effects on phonetics prior to final definitive restorations - Once approved, an impression of the provisional restorations allows the technician to build new crowns to the same shape - Alteration of the palatal surfaces or the incisal tips of the upper anterior teeth can cause problems in forming ‘S’, ‘F’, ‘V’ & ‘Th’ sounds **Temporary Prosthesis** **Aesthetic Requirements** - Initial - Temporarisation - Final Good communication with dental laboratory Donovan and Cho; 2001 - Initial - Temporarisation - Final Good communication with dental laboratory Donovan and Cho; 2001 # Temporary Prosthesis **MATERIALS** Selection depends on: - Anticipated load - Prosthesis design - Span length - Duration of provisional restoration # **MATERIALS** **Selection depends on:** - Anticipated load - Prosthesis design - Span length - Duration of provisional restoration # Temporary Prosthesis **MATERIALS** - Polymethyl Methacrylate (PMMA) - Polyethyl Methacrylate (PEMA) - Bisacryl Composite Resin - Light-Cured Composite Resin Metal Reinforcement with base metal alloy - Polymethyl Methacrylate (PMMA) - Polyethyl Methacrylate (PEMA) - Bisacryl Composite Resin - Light-Cured Composite Resin Metal Reinforcement with base metal alloy # Temporary Prosthesis ## MATERIALS ### Ideal Properties - Adequate strength - Abrasion resistance - Biocompatible - Non-irritant - Dimensional stability - Ease of contouring and polishing - Good appearance - Convenient handling - Working time - Setting time - Application - Easily modifiable ## **Ideal Properties** - Adequate strength - Abrasion resistance - Biocompatible - Non-irritant - Dimensional stability - Ease of contouring and polishing - Good appearance - Convenient handling - Working time - Setting time - Application - Easily modifiable # Temporary Prosthesis **MATERIALS** **PMMA** ## Advantages - High strength - Colour stability - Can be characterized - Easily smoothed and polished - Easily repaired - Low cost ## Disadvantages - Highly exothermic: can be traumatic to the pulp - Significant polymerization shrinkage - Monomer release - Unpleasant odour ## **PMMA** ### **Advantages** - High strength - Colour stability - Can be characterized - Easily smoothed and polished - Easily repaired - Low cost ### **Disadvantages** - Highly exothermic: can be traumatic to the pulp - Significant polymerization shrinkage - Monomer release - Unpleasant odour # Temporary Prosthesis ## MATERIALS **PMMA** ### Indications - Should not be used directly in the mouth - Laboratory construction (indirect method) - Shell construction in the laboratory then can be relined by PEMA intraorally (indirect-direct method) - Suitable for long-span provisional restoration **Examples:** Jet, Polyvicron ### **Indications** - Should not be used directly in the mouth - Laboratory construction (indirect method) - Shell construction in the laboratory then can be relined by PEMA intraorally (indirect-direct method) - Suitable for long-span provisional restoration **Examples:** Jet, Polyvicron # Temporary Prosthesis ## MATERIALS **PEMA** ### Advantages - Less exothermic reaction than PMMA (but higher than Bisacryl composite) - Moderate strength - Can be smoothed and polished - Can be characterized - Easily repaired - Low cost ### Disadvantages - Weaker than PMMA - Discoloration - Unpleasant odour - Susceptible for polymerization shrinkage ## **PEMA** ### **Advantages** - Less exothermic reaction than PMMA (but higher than Bisacryl composite) - Moderate strength - Can be smoothed and polished - Can be characterized - Easily repaired - Low cost ### **Disadvantages** - Weaker than PMMA - Discoloration - Unpleasant odour - Susceptible for polymerization shrinkage # Temporary Prosthesis **MATERIALS** PEMA **Indications** - Single crowns (direct method) - Short span bridge - Short term provisional restoration (2-3 weeks) - Relining pre-formed or laboratory made shell **Examples:** Trim, Snap ### **Indications** - Single crowns (direct method) - Short span bridge - Short term provisional restoration (2-3 weeks) - Relining pre-formed or laboratory made shell **Examples:** Trim, Snap # Temporary Prosthesis ## MATERIALS ### Bisacryl Composite Resin **Advantages** - Low exotherm - Minimal polymerization shrinkage - Ease of application (Cartridge system) - Can be smoothed and polished - Can be characterized **Disadvantages** - Brittle - Difficult to repair - Does not bond to polycarbonate crown - High cost ## **Bisacryl Composite Resin** ### **Advantages** - Low exotherm - Minimal polymerization shrinkage - Ease of application (Cartridge system) - Can be smoothed and polished - Can be characterized ### **Disadvantages** - Brittle - Difficult to repair - Does not bond to polycarbonate crown - High cost # Temporary Prosthesis ## MATERIALS **Bisacryl Composite Resin** ### Indications - Single crowns (direct method) - Ideal for intraoral application with matrix or template - Short span bridge ### Examples: Protemp (3M), Luxatemp (DMG), Structor (Voco), Integrity (Dentsply) ### **Indications** - Single crowns (direct method) - Ideal for intraoral application with matrix or template - Short span bridge ### **Examples:** Protemp (3M), Luxatemp (DMG), Structor (Voco), Integrity (Dentsply) # Temporary Prosthesis **MATERIALS** **Light-Cured Composite Resin** ## Advantages - Controlled setting (light-cured) - Highly aesthetic - Can be characterized - Easily polished and smoothed ## Disadvantages - Brittle - Transparent template is necessary or freehand application - Can be time consuming - High cost ## **Light-Cured Composite Resin** ### **Advantages** - Controlled setting (light-cured) - Highly aesthetic - Can be characterized - Easily polished and smoothed ### **Disadvantages** - Brittle - Transparent template is necessary or freehand application - Can be time consuming - High cost # Temporary Prosthesis ## MATERIALS ### Light-Cured Composite Resin **Indications** - Single unit restoration (direct method) - Inlays, onlays and veneers - Repairing open margins of Bisacryl composite crowns - For laboratory application (indirect method) - Overlaying metal reinforcement **Example:** Symphony (Flowable composites) Bohnenkamp et al. 2004 ### **Indications** - Single unit restoration (direct method) - Inlays, onlays and veneers - Repairing open margins of Bisacryl composite crowns - For laboratory application (indirect method) - Overlaying metal reinforcement **Example:** Symphony (Flowable composites) Bohnenkamp et al. 2004 # Temporary Prosthesis ## FABRICATION TECHNIQUES - **Direct (chairside)** - Preformed - Custom - **Indirect (laboratory)** - **Indirect-Direct (laboratory and chairside)** # **FABRICATION TECHNIQUES** - **Direct (chairside)** - Preformed - Custom - **Indirect (laboratory)** - **Indirect-Direct (laboratory and chairside)** # Temporary Prosthesis ## FABRICATION TECHNIQUES ### Direct: Preformed - Based on preformed mould (not a complete restoration) - Must be relined with an acrylic material - Used for single unit restoration - Available moulds: - Polycarbonate - Cellulose acetate - Aluminum - Tin-silver - Nickel-chromium ## **Direct: Preformed** - Based on preformed mould (not a complete restoration) - Must be relined with an acrylic material - Used for single unit restoration - Available moulds: - Polycarbonate - Cellulose acetate - Aluminum - Tin-silver - Nickel-chromium # Temporary Prosthesis ## FABRICATION TECHNIQUES **Direct: Preformed** **Polycarbonate crowns** - Part of the provisional restoration - Bond to PEMA - Colour stable. Only one shade ### **Polycarbonate crowns** - Part of the provisional restoration - Bond to PEMA - Colour stable. Only one shade # Temporary Prosthesis ## FABRICATION TECHNIQUES **Polycarbonate crowns** **Direct: Preformed** 1) Select the correct crown  - Morphology  - Mesiodistal width 2) Adjust the height accordingly until passively fitting  - Green stone  - Soflex discs ### **Polycarbonate crowns** 1. Select the correct crown - Morphology - Mesiodistal width 2. Adjust the height accordingly until passively fitting - Green stone - Soflex discs # Temporary Prosthesis ## FABRICATION TECHNIQUES **Polycarbonate crowns** **Direct: Preformed** 3) Lubricate the prepared tooth with thin petroleum coat  - Protection from monomer  - Avoid bonding of the acrylic to the tooth 4) Mix PEMA 5) When the mixed PEMA loses its gloss, place it in the shell 6) Fit the crown on the prepared tooth and align it adequately ### **Polycarbonate crowns** 3. Lubricate the prepared tooth with thin petroleum coat - Protection from monomer - Avoid bonding of the acrylic to the tooth 4. Mix PEMA 5. When the mixed PEMA loses its gloss, place it in the shell 6. Fit the crown on the prepared tooth and align it adequately # Temporary Prosthesis ## FABRICATION TECHNIQUES **Polycarbonate crowns** **Direct: Preformed** 7) Immediately eliminate marginal excess material before the rubbery stage 8) After the rubbery stage (about 2 minutes) remove and reseat the crown  - Facilitate removal  - Minimize thermal irritation 9) After full setting (5 minutes), the excessive material can be adjusted 10) Adjust the occlusion ### **Polycarbonate crowns** 7. Immediately eliminate marginal excess material before the rubbery stage 8. After the rubbery stage (about 2 minutes) remove and reseat the crown - Facilitate removal - Minimize thermal irritation 9. After full setting (5 minutes), the excessive material can be adjusted 10. Adjust the occlusion # Temporary Prosthesis ## FABRICATION TECHNIQUES ### Direct: Preformed **Acetate strip crowns** - Determine the tooth morphology - Does not bond to acrylic - Should be removed after setting ### **Acetate strip crowns** - Determine the tooth morphology - Does not bond to acrylic - Should be removed after setting # Temporary Prosthesis ## FABRICATION TECHNIQUES **Direct: Preformed** ### Acetate strip crowns - Determine the tooth morphology - Does not bond to acrylic - Should be removed after setting # Temporary Prosthesis ## FABRICATION TECHNIQUES ### Direct: Preformed **Metal crowns** - Molar and premolar - Easily adjustable - Occlusal surface - Contact area - Part of the provisional restoration - Bond to PEMA ### **Metal crowns** - Molar and premolar - Easily adjustable - Occlusal surface - Contact area - Part of the provisional restoration - Bond to PEMA Images showing steps in adjusting and fitting preformed metal crowns for temporary prosthesis # Temporary Prosthesis ## FABRICATION TECHNIQUES ### Direct: Custom - Requires a mould - Can be: - Silicone - Clear thermoplastic material - Can be used with any provisional material ## **Direct: Custom** - Requires a mould - Can be: - Silicone - Clear thermoplastic material - Can be used with any provisional material # Temporary Prosthesis ## FABRICATION TECHNIQUES ### Direct: Custom > Construct the mould with one of the following techniques: > - Intraorally (silicone) > - Extraorally: on diagnostic cast or wax-up > (silicone, thermoplastic template) Images showing examples of temporary prosthesis fabrication techniques including intraoral silicone mould, extraoral diagnostic cast, and thermoplastic template. > Construct the mould with one of the following techniques: > - Intraorally (silicone) > - Extraorally: on diagnostic cast or wax-up > (silicone, thermoplastic template) # Temporary Prosthesis **FABRICATION TECHNIQUES** **Direct: Custom** Images of temporary dental prostheses and related tools # Temporary Prosthesis ## FABRICATION TECHNIQUES **Direct: Custom** - Lubricate the prepared - Acrylic PEMA Bisacryl - Apply the material to the mould - Seat the mould - Lubricate the prepared - Acrylic PEMA Bisacryl - Apply the material to the mould - Seat the mould # Temporary Prosthesis ## FABRICATION TECHNIQUES **Direct: Custom** - Trim the excess - Polishing - Trim the excess - Polishing **Temporary Prosthesis** **FABRICATION TECHNIQUES** *Direct: Custom* Two images showing a dental model with a custom temporary prosthesis in place, demonstrating the fit and contour of the temporary crown on adjacent teeth. **Temporary Prosthesis** **FABRICATION TECHNIQUES** **Direct: Custom** **Advantages** - Easy to apply - Applied in the same visit - Incorporates wax-up modifications - Cheapest **Disadvantages** - Inferior mechanical properties - Optimal fit is compromised - More overall clinical time ### **Advantages** - Easy to apply - Applied in the same visit - Incorporates wax-up modifications - Cheapest ### **Disadvantages** - Inferior mechanical properties - Optimal fit is compromised - More overall clinical time # Temporary Prosthesis ## FABRICATION TECHNIQUES **Indirect** - Impression of the prepared teeth - Elastomeric - Laboratory construction of the provisional restoration - With the aid of template - In pressure pot ## **Indirect** - Impression of the prepared teeth - Elastomeric - Laboratory construction of the provisional restoration - With the aid of template - In pressure pot **Temporary Prosthesis** **FABRICATION TECHNIQUES** **Indirect** **Advantages** - Superior mechanical properties - Better fit - Better finish and polish - Less clinical time - Incorporates wax-up modifications - Possibility of metal reinforcement **Disadvantages** - Time consuming (additional clinical appointment) - Additional cost - More suitable for extensive restorations ### **Advantages** - Superior mechanical properties - Better fit - Better finish and polish - Less clinical time - Incorporates wax-up modifications - Possibility of metal reinforcement ### **Disadvantages** - Time consuming (additional clinical appointment) - Additional cost - More suitable for extensive restorations **Temporary Prosthesis** **FABRICATION TECHNIQUES** **Indirect** **Metal reinforced provisional restorations** - Long term temporary restorations - Extensive areas ### **Metal reinforced provisional restorations** - Long term temporary restorations - Extensive areas # Temporary Prosthesis ## FABRICATION TECHNIQUES ### Indirect - Direct **Indirect** - Stone model is conservatively prepared in the laboratory - 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 Two labeled images (a and b) showing a dental model with a temporary prosthesis, illustrating fabrication techniques. ## **Indirect - Direct** ### **Indirect** - Stone model is conservatively prepared in the laboratory - 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 # Temporary Prosthesis ## FABRICATION TECHNIQUES **Indirect - Direct** ### Advantages - Superior mechanical properties - Better finish and polish - Incorporates wax-up modifications ### Disadvantages - Additional laboratory cost - More time consuming than indirect technique - Suitable for bridge provisional restoration ### **Advantages** - Superior mechanical properties - Better finish and polish - Incorporates wax-up modifications ### **Disadvantages** - Additional laboratory cost - More time consuming than indirect technique - Suitable for bridge provisional restoration **Temporary Prosthesis** **FABRICATION TECHNIQUES** Indirect - Direct CAD-CAM Milled temporary crown 3D printed temporary crown ### **CAD-CAM** # Temporary Prosthesis ## TEMPORARY CEMENTS ### Objectives - Provide adequate seal - Retain provisional restoration - Minimal solubility - Adequate handling and mixing - Adequate working and setting time - Cleansable - Compatible - Pulp and gingiva - Tooth structure, core restoration and provisional restoration material - 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 - Compatible - Pulp and gingiva - Tooth structure, core restoration and provisional restoration material - Allows for restoration removal # Temporary Prosthesis ## TEMPORARY CEMENTS **Examples** - **Zinc-oxide eugenol cement** (Tempbond) - **Eugenol free cement** - **Polycarboxylate cement** (harder cement) - **Tempbond clear** (Aesthetic option) ## **Examples** - **Zinc-oxide eugenol cement** (Tempbond) - **Eugenol free cement** - **Polycarboxylate cement** (harder cement) - **Tempbond clear** (Aesthetic option) # Temporary Prosthesis ## TEMPORARY CEMENTS - Zinc-oxide eugenol is the most commonly used cement - Strength can be minimised by the addition of petroleum gel - High strength cements should be avoided since restoration removal can damage either the restoration or prepared tooth. **Indications:** - Lack of retention in tooth preparation - Long span or long-term use of provisional restoration - Parafunctional activities - Zinc-oxide eugenol is the most commonly used cement - Strength can be minimised by the addition of petroleum gel - High strength cements should be avoided since restoration removal can damage either the restoration or prepared tooth. **Indications:** - Lack of retention in tooth preparation - Long span or long-term use of provisional restoration - Parafunctional activities # Temporary Prosthesis ## TEMPORARY CEMENTS - Free eugenol acts as a plasticiser of methacrylate resin - Possible effects on: - Resin provisional restoration, composite core - Bond strength of resin cements - Some studies have shown that eugenol-containing temporary cements can reduce bond strength of resin cements, but there are other in vitro studies showing no difference Al Wazzan et al 2005; Chiluke et al 2017 - Free eugenol acts as a plasticiser of methacrylate resin - Possible effects on: - Resin provisional restoration, composite core - Bond strength of resin cements - Some studies have shown that eugenol-containing temporary cements can reduce bond strength of resin cements, but there are other in vitro studies showing no difference Al Wazzan et al 2005; Chiluke et al 2017 # Temporary Prosthesis ## 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: a temporary crown with cement, cement application on a tooth, and removal of excess cement with an explorer. ## **Cementation Process** 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 Photo of the Golden Gate Bridge with "Thank you" text in the bottom left corner [[M4 Temporization.pdf#page=1|M4 Temporization, p.1]] [[M4 Temporization.pdf#page=2|M4 Temporization, p.2]] [[M4 Temporization.pdf#page=3|M4 Temporization, p.3]] [[M4 Temporization.pdf#page=4|M4 Temporization, p.4]] [[M4 Temporization.pdf#page=5|M4 Temporization, p.5]] [[M4 Temporization.pdf#page=6|M4 Temporization, p.6]] [[M4 Temporization.pdf#page=7|M4 Temporization, p.7]] [[M4 Temporization.pdf#page=8|M4 Temporization, p.8]] [[M4 Temporization.pdf#page=9|M4 Temporization, p.9]] [[M4 Temporization.pdf#page=10|M4 Temporization, p.10]] [[M4 Temporization.pdf#page=11|M4 Temporization, p.11]] [[M4 Temporization.pdf#page=12|M4 Temporization, p.12]] [[M4 Temporization.pdf#page=13|M4 Temporization, p.13]] [[M4 Temporization.pdf#page=14|M4 Temporization, p.14]] [[M4 Temporization.pdf#page=15|M4 Temporization, p.15]] [[M4 Temporization.pdf#page=16|M4 Temporization, p.16]] [[M4 Temporization.pdf#page=17|M4 Temporization, p.17]] [[M4 Temporization.pdf#page=18|M4 Temporization, p.18]] [[M4 Temporization.pdf#page=19|M4 Temporization, p.19]] [[M4 Temporization.pdf#page=20|M4 Temporization, p.20]] [[M4 Temporization.pdf#page=21|M4 Temporization, p.21]] [[M4 Temporization.pdf#page=22|M4 Temporization, p.22]] [[M4 Temporization.pdf#page=23|M4 Temporization, p.23]] [[M4 Temporization.pdf#page=24|M4 Temporization, p.24]] [[M4 Temporization.pdf#page=25|M4 Temporization, p.25]] [[M4 Temporization.pdf#page=26|M4 Temporization, p.26]] [[M4 Temporization.pdf#page=27|M4 Temporization, p.27]] [[M4 Temporization.pdf#page=28|M4 Temporization, p.28]] [[M4 Temporization.pdf#page=29|M4 Temporization, p.29]] [[M4 Temporization.pdf#page=30|M4 Temporization, p.30]] [[M4 Temporization.pdf#page=31|M4 Temporization, p.31]] [[M4 Temporization.pdf#page=32|M4 Temporization, p.32]] [[M4 Temporization.pdf#page=33|M4 Temporization, p.33]] [[M4 Temporization.pdf#page=34|M4 Temporization, p.34]] [[M4 Temporization.pdf#page=35|M4 Temporization, p.35]] [[M4 Temporization.pdf#page=36|M4 Temporization, p.36]] [[M4 Temporization.pdf#page=37|M4 Temporization, p.37]] [[M4 Temporization.pdf#page=38|M4 Temporization, p.38]] [[M4 Temporization.pdf#page=39|M4 Temporization, p.39]] [[M4 Temporization.pdf#page=40|M4 Temporization, p.40]] [[M4 Temporization.pdf#page=41|M4 Temporization, p.41]] [[M4 Temporization.pdf#page=42|M4 Temporization, p.42]] [[M4 Temporization.pdf#page=43|M4 Temporization, p.43]] [[M4 Temporization.pdf#page=44|M4 Temporization, p.44]] [[M4 Temporization.pdf#page=45|M4 Temporization, p.45]] [[M4 Temporization.pdf#page=46|M4 Temporization, p.46]] [[M4 Temporization.pdf#page=47|M4 Temporization, p.47]] [[M4 Temporization.pdf#page=48|M4 Temporization, p.48]] [[M4 Temporization.pdf#page=49|M4 Temporization, p.49]] [[M4 Temporization.pdf#page=50|M4 Temporization, p.50]] [[M4 Temporization.pdf#page=51|M4 Temporization, p.51]] [[M4 Temporization.pdf#page=52|M4 Temporization, p.52]] [[M4 Temporization.pdf#page=53|M4 Temporization, p.53]] [[M4 Temporization.pdf#page=54|M4 Temporization, p.54]] [[M4 Temporization.pdf#page=55|M4 Temporization, p.55]] [[M4 Temporization.pdf#page=56|M4 Temporization, p.56]] [[M4 Temporization.pdf#page=57|M4 Temporization, p.57]] [[M4 Temporization.pdf#page=58|M4 Temporization, p.58]] [[M4 Temporization.pdf#page=59|M4 Temporization, p.59]] [[M4 Temporization.pdf#page=60|M4 Temporization, p.60]]