Temporization refers to provisional restorations used to establish esthetics, function, and occlusion prior to definitive treatment. Provisional restorations protect the pulp and support periodontal health during treatment. They also allow evaluation of esthetics, occlusion, and patient acceptance of the planned treatment outcome. Common materials for provisional restorations include polymethyl methacrylate resin and various composite resins. Provisionals must meet biological, mechanical, and esthetic requirements and be cemented securely yet removable when treatment is complete.
2. DEFINITION
According to GPT-9
Temporization is 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 prosthesis.
6. RATIONALE
Protect pulpal tissue and sedate prepared abutments
Provide an environment conductive to periodontal
health
Provide method for immediately replacing missing
teeth
Provide comfort and function
Protect teeth from dental caries
Improves esthetics
Evaluate parallelism of abutments
Prevents migration of abutments
J Prosthet Dent 2003;90:474-97
8. MECHANICAL
FUNCTION
Greater stresses likely to occur during mastication.
Strength of poly methyl methacrylate resin is about
1/20th that of metal-ceramic alloy; fracture more
likely.
Partial coverage crown inherently weaker.
9. Displacement
To avoid irritation to the pulp and tooth
movement, a displaced provisional
must be recemented promptly.
Best prevented: proper tooth
preparation and a provisional with a
closely adapted tooth surface
10. ESTHETICS
Color, contour, translucency and texture are key
elements of coronal appearance
Particularly important in anteriors
11. PROPERTIES
Better fit, particularly at the margins
Increased strength
Better wear resistance
Easier to keep clean
Better esthetics and color stability
Greater occlusal reliability and stability
12. TYPES
Based on technique:
Custom fabrication
Fabrication with preformed material
Based on material:
Chemically activated auto polymerising acrlyic resin
Polymethyl methacrylate (PMMA)
Polyethyl methacrylate (PEMA)
Polyvinylethyl methacrylate (PVEMA)
Heat activated acrylic resins
Light activated acrylic resins
Dual light and chemically activated acrylic resins
Alloys
13. POLYMETHYL METHACRYLATE (PMMA)
Most preferred
Various shades available; more color
stable
Greatest strength
Flexural strength is higher than composite
resins
Contraindicated in direct technique
Indicated in INDIRECT TECHNIQUE
Low abrasion resistance; good polishability
14. POLYETHYL METHACRYLATE
(PEMA)
Best suited for DIRECT TECHNIQUE;
less thermal reaction.
Low polymerization shrinkage
Good handling properties
Good properties
Good resistance
16. BIS ACRYL COMPOSITE RESINS
Available as automix delivery system
Low exothermic reactions
Low shrinkage---good marginal fit and good
transverse strength
Expensive
17. Repair or modification of bis acryl restoration with
composite : difficult ; dissimal chemistry
Koumjian & Nimmo demonstrated an 85%
decrease in transverse strength after repair ;
suggesting that the fabrication of a new
provisional restoration is more advantageous
than repair
18. BIS GMA RESIN
Good marginal fit
Low shrinkage
Stronger than bisacryls;
more brittle
More likely to fracture in
long span FPDs
Castleneuvo and Tjan
reported that bis-GMA resin
had a lower rise in
temperature than bis-acryl.
19. Tempspan- dual curing resin; automixing
cartirage
Protemp crown (3M ESPE, St Paul, MN)
: preformed bisGMA provisional crown ;
single unit posterior teeth and canine
Preshaped as adaptable putty needing
marginal trimming, adaptation to the
preparation,light curing, removal,
finishing and cementation.
20. Visible Light Cured Urethane
Dimethacrylate Resins
Poor stain resistance
Urethanedimethacrylate added; resin
requiring visible light and a
camphoroquinine amine photo initiator ;
polymerization
Prestipino has shown that VLC resins are
brittle; poor choice for a high strength
posterior provisional restorations.
Available in limited shades
More expensive
21. Revotec LC (GC America, Alsip, IL) :
moladble putty available as a thick
rope
Used for temporization of multiple
adjacent crown unit and bridgeworks
Flowable and hybrid composites can be
used to repair
However bisacryls and bis GMA resins are
superior in so far as esthetics is concerned
22. PRE FORMED CROWN FORMS
POLYCARBONATE
Made of a polymer with high impact
resistance.
Have sufficient strength
Name implies that it contain multiple
carbonate groups
LIMITATIONS
Often too broad buccolingually so
recontour gingivally
23. CELLULOSE ACETATE
Thin, soft and transparent.
Disadvantages
Act as matrix, must be removed after their
relining material is set.
Refining material lock into undercut, thus
compromising removal of the material from
gingival area.
24. STAINLESS STEEL
Available in various sizes
Less malleable, harder to wear and
less likely to deform under load.
Success rate is high
Usually not refined but trimmed
approx. the size of tooth.
Maintain the space that may be lost
when a deciduous tooth is lost
prematurely
25. ALUMINIUM
Easy to manipulate
Malleable and ductile in nature, easily
bent and trimmed
Corrodes with time
Used as a posterior crown
28. FINISHING AND POLISHING
Finishing : surface smoothness
Polishing: surface luster
For trimming: acrylic laboratory burs and discs
are used
29. DEFICIENCY
Marginal inaccuracy
Dimensional unstablility
Moisture of oral cavity, temperature changes and
occlusal forces affect the fit
Longer span of the prosthesis, greater is surface
distortion
Non integrity of external contour
Correct shaping of external contour is mandatory
Fracture
To strengthen: fibers are used; possesses superior
mechanical, esthetic characterstics
30. REPAIR
Repair of aged restorations is less
structurally effective
Reduced number of free radicals and
has absorbed water from saliva and
other fluids into its surface
35. PROVISIONAL LUTING
MATERIALS
• Provisional luting agents should
possess :
-good mechanical properties,
-low solubility,
-tooth adhesion to resist bacterial and
molecular penetration. • The most
important function of these materials is
to provide an adequate seal between
the provisional restoration and prepared
tooth. This is necessary to prevent
36. There are a variety of luting materials
used for interim purposes.
The most common include
(1) calcium hydroxide
(2) zinc-oxide eugenol
(3) non-eugenol materials.
37.
38.
39.
40. Some of the most commonly used
cements with provisional prostheses are
those containing zinc-oxide and
eugenol. They provide:
sedative effects that reduce dentin
hypersensitivity
possess antibacterial properties.
41. Unfortunately, free radical production
necessary for polymerization of
methacrylate materials can be
significantly hampered by the presence
of eugenol found in eugenol based
provisional luting materials.; Eugenol
interferes with the acrylic resin
polymerization and hardening process .
Therefore Eugenol-free provisional
luting materials are commercially
available
42. Baldissara et al recommended that
interim restorations be frequently
evaluated and used for only short
periods of time. Literature reports
advise that if provisional treatment is
required over a protracted time period,
it is best to remove and replace the
provisional luting agent on a regular
basis.
43. REMOVAL OF PROVISIONAL
Removed when the patient returns
for definitive restoration
Risk of damage to the prepared
tooth can be minimized if removal
forces are directed parallel to the
long axis of the preparation.
The BACKHANS or hemostaic
forcep is effective
Slight buccolingual rocking motion;
breaks cement seal
45. Recent advancements
TEMP TABS THERMOPLASTIC
MATRIX WAFERS
Multiuse matrix
Easily adapted to desired shape
No liberation of heat
46. TUFF TEMP PLUS
Impact resistant rubberized resin
No ploymerization shrinkage
High flexural strength
Eliminates fractures
Marginal fit is perfect
47. CAD CAM PMMA PROVISIONAL
Digitally fabricated from PMMA
Highly precise temporaries
Milled out from dense block and shows
reduced porosity of traditional hand
processed techniques
BIOTEMPS provisional crowns and
bridges are created with CAD/CAM
technology
48. So the perfect provisional …
Super strong
Highly esthetic
Gingival sculpting
Patient fixed
Universal use
Cost
Gentle