Provisional restorations / orthodontics courses

11
PROVISIONALPROVISIONAL
RESTORATIONSRESTORATIONS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

22
A fixed or removableA fixed or removable
prosthesesdesigned toprosthesesdesigned to
enhanceenhance estheticsesthetics,,
stabilizationstabilization andand /or function/or function
for alimited period of time,for alimited period of time,
after which it isto bereplacedafter which it isto bereplaced
by adefinitiverestorationby adefinitiverestoration..

33
MECHANICAL ESTHETIC
BIOLOGICAL
FUNCTIONSFUNCTIONS

www.indiandentalacademy.comwww.indiandentalacademy.com 44

55
BIOLOGICALBIOLOGICAL
Pulpal protection.Pulpal protection.
Maintain periodontal health.Maintain periodontal health.
ProvideocclusalProvideocclusal
compatibility.compatibility.
Maintain tooth position.Maintain tooth position.
Protect against fracture.Protect against fracture.www.indiandentalacademy.comwww.indiandentalacademy.com

66
Pulpal protectionPulpal protection
Therestoration must
befabricated of a
material that will
prevent.
•Conduction of
extremetemperatures.
•Microbiological
infection.
•Chemical, mechanical
injuries.www.indiandentalacademy.comwww.indiandentalacademy.com

77
Periodontal HealthPeriodontal Health
•Extent of margins.
•Contour.

88
Occlusal compatibilityOcclusal compatibility
Proper
occlusal and
proximal
contacts
promote
patient
comfort and
maintain
tooth
position.www.indiandentalacademy.comwww.indiandentalacademy.com

99
Maintain tooth positionMaintain tooth position
Prevent migration and extrusion of
theprepared abutment.www.indiandentalacademy.comwww.indiandentalacademy.com

1010
Protect against fractureProtect against fracture

1111
MECHANICALMECHANICAL
Resist functional loads.Resist functional loads.
Resist removal of forces.Resist removal of forces.
Maintain interabutmentMaintain interabutment
alignment.alignment.

1212
ESTHETICESTHETIC
Easily contourable.Easily contourable.
 Color compatibility.Color compatibility.
 Translucency.Translucency.
 Color stability.Color stability.

1313
Typesof provisional restorationsTypesof provisional restorations
 PrefabricatedPrefabricated
MetalMetal
Anatomic metal crown formsAnatomic metal crown forms
Tin – silverTin – silver
Nickel chromiumNickel chromium
Stock aluminum cylindersStock aluminum cylinders
ResinResin
CelluloseacetateCelluloseacetate
Tooth colored poly carbonateTooth colored poly carbonate
crown formscrown forms
 Custom madeCustom made

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MaterialsMaterialsIDEAL PROPERTIESIDEAL PROPERTIES
1. Convenient handling
2. Bio compatibility
3. Dimensional stability
4. Easeof contouring and polishing
5. Adequatestrength and abrasion
resistance
6. Good appearance
7. Good patient acceptance
8. Easeof adding or repairingwww.indiandentalacademy.comwww.indiandentalacademy.com

1515
MATERIALSMATERIALS
AVAILABLEAVAILABLEPolymethyl methacrylate.Polymethyl methacrylate.
Polyethyl methacrylate.Polyethyl methacrylate.
Polyvinyl ethyl methyl methacrylate.Polyvinyl ethyl methyl methacrylate.
Bisacryl composite.Bisacryl composite.
VLC urethanedimethacrylate.VLC urethanedimethacrylate.
Aluminum.Aluminum.
Tin-silver.Tin-silver.
NiCr.NiCr.

1616
TECHNIQUESTECHNIQUES
DIRECTDIRECT
Provisional restoration isdoneProvisional restoration isdone
on theactual prepared teeth in theon theactual prepared teeth in the
mouth.mouth.
INDIRECTINDIRECT
Provisional restoration isProvisional restoration is
fabricated outsidethemouth on thefabricated outsidethemouth on the
cast madeof quick setting plaster.cast madeof quick setting plaster.www.indiandentalacademy.comwww.indiandentalacademy.com

1717
DIRECT vsINDIRECTDIRECT vsINDIRECT
TECHNIQUESTECHNIQUES
DirectDirect
1.1. IntermediateIntermediate
stepsof indirectstepsof indirect
techniquearetechniqueare
eliminated.eliminated.
2.2. Convenient whenConvenient when
assistant trainingassistant training
and laboratoryand laboratory
facilitiesarefacilitiesare
inadequate.inadequate.
IndirectIndirect
1.1. No contact of freemonomerNo contact of freemonomer
with theprepared tooth orwith theprepared tooth or
gingiva, causing damagetogingiva, causing damageto
thetissue.thetissue.
2.2. Better marginal fit.Better marginal fit.
3.3. Lesschair sidework.Lesschair sidework.

1818
TECNNIQUE FOR PRE FABRICATEDTECNNIQUE FOR PRE FABRICATED
PROVISIONAL RESTORATIONPROVISIONAL RESTORATION
POLY CARBONATEPOLY CARBONATE
CROWNSCROWNS
DIRECTTECHNIQUEDIRECTTECHNIQUE
1.1. Select aappropriatesizedSelect aappropriatesized
or slightly larger crownor slightly larger crown
form , and trim theshell toform , and trim theshell to
theappropriatesize. Trytheappropriatesize. Try
theshell in thepreparedtheshell in theprepared
mouth.mouth.
2.2. Apply auniformly thinApply auniformly thin
coat of petroleum jelly oncoat of petroleum jelly on
theprepared tooth andtheprepared tooth and
surrounding tissues.surrounding tissues.www.indiandentalacademy.comwww.indiandentalacademy.com

1919
33.. Mix theauto-Mix theauto-
polymerizing resin and fillpolymerizing resin and fill
theshell ,placetheshelltheshell ,placetheshell
over thetooth and align it.over thetooth and align it.
4.4. Eliminateany marginalEliminateany marginal
excess.excess.
5.5. When theWhen the
polymerization reachespolymerization reaches
rubbery stageremovetherubbery stageremovethe
crown and placeit incrown and placeit in
warm water.warm water.

2020
6.6. After theresin had set themarginsareAfter theresin had set themarginsare
marked flash iseliminated ,axial surfacesaremarked flash iseliminated ,axial surfacesare
shaped , occlusion ischecked and adjustedshaped , occlusion ischecked and adjusted
7.7. Finally, polish and cement therestorationFinally, polish and cement therestoration

2121
INDIRECT PROCEDUREINDIRECT PROCEDURE
1.1. When the preparation has beenWhen the preparation has been
completed make an impression of thecompleted make an impression of the
prepared mouth, and pour the cast withprepared mouth, and pour the cast with
quick setting plaster.quick setting plaster.
2.2. Select a appropriate sized or slightlySelect a appropriate sized or slightly
larger crown form , and trim the shell tolarger crown form , and trim the shell to
the appropriate size.the appropriate size.
3.3. Paint the cast of the prepared tooth andPaint the cast of the prepared tooth and
the surrounding area with the separatingthe surrounding area with the separating
media.media. www.indiandentalacademy.comwww.indiandentalacademy.com

2222
4. Fill the crown with resin, and seat it on4. Fill the crown with resin, and seat it on
the plaster cast firmly. place it in athe plaster cast firmly. place it in a
bowl of warm water to acceleratebowl of warm water to accelerate
polymerization.polymerization.
5. When the resin is set, remove the5. When the resin is set, remove the
provisional crown from the cast, trimprovisional crown from the cast, trim
the excess , if necessary recontour thethe excess , if necessary recontour the
axial surfaces ,check the occlusionaxial surfaces ,check the occlusion
and adjust it.and adjust it.
6. Finally, polish and cement the6. Finally, polish and cement the
restoration.restoration. www.indiandentalacademy.comwww.indiandentalacademy.com

2323
ALUMINUM CROWN FORMSALUMINUM CROWN FORMS
TThey areuseful in restoring asingleposteriorhey areuseful in restoring asingleposterior
tooth.tooth.
PROCEDUREPROCEDURE
1.1. TheThe mesiodistal width of themesiodistal width of the tooth ismeasuredtooth ismeasured
and appropriatesizeof thecrown isselected.and appropriatesizeof thecrown isselected.
2.2. Theoccluso-cervical height ismeasured and theTheoccluso-cervical height ismeasured and the
crown istrimmed so that it extends1mm apical tocrown istrimmed so that it extends1mm apical to
thegingival margin.thegingival margin.
3.3. Crown isplaced on theprepared tooth and theCrown isplaced on theprepared tooth and the
marginsaretrimmed wherever thegingivamarginsaretrimmed wherever thegingiva
blanches.blanches.
4.4. Instruct thepatient to closewith amoderateforce.Instruct thepatient to closewith amoderateforce.www.indiandentalacademy.comwww.indiandentalacademy.com

2424
5. Apply petrolatum jelly to theprepared tooth5. Apply petrolatum jelly to theprepared tooth
surfaceand theadjacent tissues. Mix theautosurfaceand theadjacent tissues. Mix theauto
polymerizing resin and fill thecrown, placethepolymerizing resin and fill thecrown, placethe
crown over thetooth.crown over thetooth.
6. When thepolymerization reachesrubbery stage,6. When thepolymerization reachesrubbery stage,
removethecrown and placeit in warm water.removethecrown and placeit in warm water.
7. After theresin had set themarginsaremarked,7. After theresin had set themarginsaremarked,
flash iseliminated, axial surfacesareshaped ,flash iseliminated, axial surfacesareshaped ,
occlusion ischecked and adjusted.occlusion ischecked and adjusted.
8. Acrylic isadded in thedeficient partsif any.8. Acrylic isadded in thedeficient partsif any.
9. Finally, polish and cement therestoration .9. Finally, polish and cement therestoration .

2525
Techniques for custom provisionalTechniques for custom provisional
restorationsrestorations
Over impression fabricated provisionalOver impression fabricated provisional
restorationrestoration
An over impression ismadeon theAn over impression ismadeon the
diagnostic cast or in themouth beforethediagnostic cast or in themouth beforethe
tooth preparation had begun.tooth preparation had begun.
Alginateand elastomeric materialscanAlginateand elastomeric materialscan
beused for over impressions.beused for over impressions.
An over impression frequently ismadeAn over impression frequently ismade
from thepatientsmouth.from thepatientsmouth.

2626
If tooth to berestoredIf tooth to berestored
hasany obvioushasany obvious
defectstheoverdefectstheover
impression can beimpression can be
madefrom themadefrom the
diagnostic cast.diagnostic cast.
Utility wax isplacedUtility wax isplaced
on thedefect.on thedefect.
Over impression isOver impression is
madefrom themadefrom the
diagnostic cast.diagnostic cast.www.indiandentalacademy.comwww.indiandentalacademy.com

2727
When thetooth preparationWhen thetooth preparation
iscompleted impression isiscompleted impression is
made.made.
Quick setting plaster isQuick setting plaster is
poured into theimpression..poured into theimpression..
After theplaster setsthecastAfter theplaster setsthecast
isretrieved and trimmed .isretrieved and trimmed .
Thetrimmed cast shouldThetrimmed cast should
haveat least onetooth onhaveat least onetooth on
either sideof thepreparedeither sideof theprepared
tooth.tooth.
Try theplaster cast into theTry theplaster cast into the
over-impression.over-impression.

2828
Paint thesurfaceof thePaint thesurfaceof the
prepared tooth andprepared tooth and
surrounding areaon thesurrounding areaon the
cast with theseparatingcast with theseparating
media.media.
Mix theautoMix theauto
polymerizing resin andpolymerizing resin and
placeit in theoverplaceit in theover
impression.impression.
Seat thecast in theSeat thecast in the
impression. Hold itimpression. Hold it
firmly with arubberfirmly with arubber
bandband www.indiandentalacademy.comwww.indiandentalacademy.com

2929
•After theresin hadAfter theresin had
set themarginsareset themarginsare
marked, flash ismarked, flash is
eliminated ,axialeliminated ,axial
surfacesareshaped ,surfacesareshaped ,
occlusion ischeckedocclusion ischecked
and adjustedand adjusted
•Finally, polish andFinally, polish and
cement thecement the
restorationrestoration www.indiandentalacademy.comwww.indiandentalacademy.com

3030
Over impression fabricatedOver impression fabricated
provisional restorationsprovisional restorations

3131www.indiandentalacademy.comwww.indiandentalacademy.com

3232
TEMPLATE FABRICATEDTEMPLATE FABRICATED

3535
LIMITATIONSOF PROVISIONALLIMITATIONSOF PROVISIONAL
RESTORATIONSRESTORATIONS
1.1. Lack of inherent strength.Lack of inherent strength.
2.2. Poor marginal adaptation.Poor marginal adaptation.
3.3. Color instability.Color instability.
4.4. Poor wear properties.Poor wear properties.
5.5. Odor emission.Odor emission.
6.6. Inadequatebonding characteristics.Inadequatebonding characteristics.
7.7. Poor tissueresponseto irritation.Poor tissueresponseto irritation.
8.8. Arduouscement removal.Arduouscement removal.
9.9. Timeexpenditurefor fabrication can beTimeexpenditurefor fabrication can be
prohibitive.prohibitive.

3636
CEMENTATIONCEMENTATION
IDEAL PRORERTIESOF LUTING AGENTIDEAL PRORERTIESOF LUTING AGENT
Ability to seal against theoral fluids.Ability to seal against theoral fluids.
Strength consistent with intentional removal.Strength consistent with intentional removal.
Low solubility.Low solubility.
Blandnessor obtundency.Blandnessor obtundency.
Chemical compatibility with thepolymer.Chemical compatibility with thepolymer.
Easy to dispenseand mix.Easy to dispenseand mix.
Easeof eliminating excess.Easeof eliminating excess.
Adequateworking timeand short setting time.Adequateworking timeand short setting time.
Compatibility with definitiveluting agent.Compatibility with definitiveluting agent.www.indiandentalacademy.comwww.indiandentalacademy.com

3737
TECNNIQUE FOR PRE FABRICATTECNNIQUE FOR PRE FABRICAT
POLY CARBONATE CROWNSPOLY CARBONATE CROWNS
Seat crown on
preparation. Mark
gingival contour
using a pencil
remove the crown
and trim 1mm below
the line using crown
scissors , bur or
stone

3838
Cervical
margins
can be
crimped, if
needed
using
crimping
pliers.
Reseat and
check fit.www.indiandentalacademy.comwww.indiandentalacademy.com

3939
Line crown
with
provisional
acrylic or
resin
material to
enhance fit
and extend
wear

4040
Remove
from the
mouth and
trim to finish
line using a
carbide bur .
Smooth and
polish as
required,
using discs
and rubber
wheel

4141
Mix
cement
and fill
crown,
assuring
voids are
not
present
in the
cement.www.indiandentalacademy.comwww.indiandentalacademy.com

4242
Seat crown
and allow
cement to
set. Remove
the excess
cement with
scaler or
explorer.
Floss
interproximal
areas.www.indiandentalacademy.comwww.indiandentalacademy.com

4343
Temporary metal crowns
Crown selection
Determine
the mesio-
distal width.
Select
appropriate
crown.

4444
PressPress
gently togently to
stretchstretch
crown cervixcrown cervix
over finishover finish
line ofline of
preparationpreparation
Trial fitTrial fit
For chamfer preparationFor chamfer preparation

4545
Slightly flare theSlightly flare the
cervix ofcervix of
crown on thecrown on the
stretch block.stretch block.
Do not overDo not over
expand.expand.
For shoulder preparationFor shoulder preparation

4646
SeatSeat
expandedexpanded
crown oncrown on
preparedprepared
shouldershoulder

4747
If gingival
blanching
occurs during
trial fit, trim
crown using
crown
scissors
Crown preparation

4848
Reset in mouthReset in mouth
and haveand have
patientpatient
establishestablish
occlusionocclusion

4949
Use a sharp
explorer to mark
the marginal
contour. Trim
crown back to the
line using a
crown scissors.
Smooth and
polish if desired
using discs and
rubber wheel.
and rubber wheel

5050
Mix cementMix cement
and fill crownand fill crown
assuringassuring
voids are notvoids are not
present inpresent in
the cement.the cement.

5151
Seat theSeat the
crown andcrown and
have thehave the
patient bitpatient bit
intointo
occlusion.occlusion.
Crown cementationCrown cementation

5252
Burnish theBurnish the
cervicalcervical
margin to themargin to the
preparationpreparation
before thebefore the
cement setscement sets
completelycompletely

5353
RemoveRemove
excessexcess
cement withcement with
scaler orscaler or
explorer.explorer.
FlossFloss
interproximalinterproximal
areasareas

www.indiandentalacademy.comwww.indiandentalacademy.com 5454

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