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Provisional restoration

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Provisional restoration in Prosthodontics

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Provisional restoration

  1. 1. PROVISIONAL RESTORATION OR TEMPORIZATION Under the guidance of: Dept. Of Prosthodontics and Crown and Bridge NORTH BENGAL DENTAL COLLEGE AND HOSPITAL
  2. 2. • DEFINITION: A fixed or removal prosthesis designed to enhance esthetics stabilization and function for a limited period of time after which it is to be replaced by definitive prosthesis.( GPT- 8 ) • SYNNONYMS: Temporization, interim prosthesis, provisional prosthesis.
  3. 3. Why provisional restoration needed??? • Provisional restoration is given for a period of time until a permanent arrangement can be made. • To protect the prepared tooth and kept patient comfortable. • By successful treatment with provisional restoration dentist can get the patient confidence which is an influencing factor for success in the final restoration.
  4. 4. IDEAL REQUIREMENTS OF PROVISIONAL RESTORATION Three basic requirements : • Biologic requirements  Pulp protection  Periodontal health  Positional stability  Prevention of fracture • Mechanical requirements  Function  Loss of retention  Removal of reuse • Esthetic requirements  Colour compatibility  Translucency  Colour stability
  5. 5. BIOLOGIC REQUIRMENTS  PULP PROTECTION:  During tooth preparation the dentinal tubules are exposed.  Thus provisional restoration should protect the prepared tooth from oral environment, thereby preventing sensitivity and irritation to pulp.  PERIODONTAL HEALTH: It should have good marginal fit,proper contour and smooth surface to prevent accumulation of plaque,facilitate easy plaque removal and maintain periodontal health.
  6. 6. BIOLOGIC REQUIRMENTS  POSITIONAL STABILITY: It should provide a comfortable, stable, and functional occlusal relationship by maintaining interarch and intra-arch stability thereby preventing tooth migration , supraeruption.  PREVENTION OF FRACTURE: It should protect the prepared tooth surface from fracture which is commonly seen in partial coverage restoration, in which margin of preparation is close to the occlusal surface of tooth and could be damaged during chewing.
  7. 7. MECHANICAL REQUIREMENT  FUNCTIONAL: It should possess good compressive and flexural strength. The strength of material used for fabricating provisional restoration is always much lower than that of the definitive restoration material. The greatest stresses in a provisional restoration occur during chewing.  LOSS OF RETENTION: It should have close adaptation to the prepared tooth surface to prevent displacement and recementation, which will increase patient visits.
  8. 8. MECHANICAL REQUIREMENT  REMOVAL OF REUSE: Provisional restoration may need to be removed and recemented often. If they are well fabricated with adequate thickness and cemented with weak cement Can be removed without breakage. ESTHETIC REQUIREMENT It should match the shape, size, colour, and texture of the restored tooth especially in the anterior region. Colour stability is also important if the provisional are to function for a prolonged period. It also serves as a guide to achieve aesthetics to the final restoration.
  9. 9. CLASSIFICATION  Provisional restorations are classified on the following basis:  According to method of fabrication:  Preformed  Custom made  According to material used:  Resin :  Preformed (Polycarbonate, Cellulose acetate)  Custom made (Acrylics, Bis-acryl composites)  Metals:  Preformed (Aluminium, Tin silver, Nickel chromium)  Custom made (Cast metal alloy)  According to duration of use:  Short term.  Long term.  According to technique of fabrication:  Direct technique.  Indirect technique.
  10. 10. PROVISIONAL RESTORATION MATERIAL  IDEAL REQUIRMENTS OF PROVISIONAL RETORATIVE MATERIAL:  Adequate strength and wear resistance.  Biocompatible.  Good dimentional stability.  Easy to contour and polish.  Odourless and non-irritating.  Chemically compatible with luting cement.  Esthetically acceptable.  Adequate working and setting time.  Easy to repair.
  11. 11. PROVISIONAL RESTORATION MATERIAL  MATERIALS USED:  Resin :  Acrylics  Polymethyl methacrylate  Ploy-R’ methacrylate  Bis- acryl composites  Chemically activated  Light activated  Dual activated  Metals :  Cast metal alloy Advantage & disadvantage of ploy-r methacrylate Advantage & disadvantage of poly methyl methacrylate Advantage & disadvantage of bis-acryl composites
  12. 12. PRE-FORMED PROVISIONAL RESTORATION Depending on the Types of Material Used:  Resin based provisional restoration  Cellulose acetate  Polycarbonate  Poly methyl methacrylate  Poly-R methacrylate  Microfilled composite  Urethane dimethacrylate  Metal provisional restoration  Aluminium  Nickel- Chromium  Tin- Silver
  13. 13. RESIN: Polycarbonate crowns: They combine microglass fibers with polycarbonate plastic material. It is used as a matrix material around a prepared tooth . It possesses high impact strength, abrasion resistance, and good bond with meth acrylate resin. Best esthetic among all preformed crowns. Available in shape of incisor, canine, and premolars in varying size Cellulose acetate: It is thin, soft, transparent scaffold material. It is available in all tooth shape and different sizes. It does not bond to the relining resin. An approximately size of this crown is selected from a mould guide and filled with autopolymerizing resin of appropriate shade. This is inserted over the lubricated prepared tooth.
  14. 14. METALS:  Aluminium: These are generally limited to posteriors for esthetics reasons. Available as simple shell. They provide good adaptation due to softness and difficulty of the material, but can also promote rapid wear resulting in perforation. They may be relined with resin to obtain better fit and rigidity and then luted to prepared tooth.  Nickel- Chromium: Indicated for use in children with damaged primary teeth. They need not to reline with resin. They are trimmed, contoured, and adapted to the tooth. Strong cements are used for luting.
  15. 15. TECHNIQUES OF FABRICATION DIRECT TECHNIQUE INDIRECT TECHNIQUE DIRECT-INDIRECT TECHNIQUE
  16. 16. DIRECT TECHNIQUE APPLICATION OF SEPARATING MEDIA ON PREPARED TOOTH PUTTY INDEX WITH RPD AND TRIMMED FLANGE REMOVABLE PARTIAL DENTURE IN PLACE PRE OPERATIVE PICTURE RESIN MIXED AND POURED IN THE INDEX MAKING PUTTY INDEX WITH THE RPD ALLOWED TO SET RESIN WITH RPD IN THE INDEX INDEX RESEATED IN THE MOUTH TRIMMED PROVISIONAL PROSTHESIS
  17. 17. INDIRECT TECHNIQUE DIAGNOSTIC CAST WITH MISSING MANDIBULAR INCISORS ARTIFICIAL TEETH ARRANGED CAST WITH ARTIFICIAL TEETH VACUUM FORMED CAST FOLLOWING TOOTH PREPARATION TOOTH PREPARATION DONETEMPLATE PLACED ON CAST TO CHECK FIT TEMPLATE SEATED ON CAST FILLED WITH THE PROVISIONAL RESTORATIVE MATERIAL IN THE AREA OF RESTORATION TEMPLATE REMOVEDFROM CAST AFTER POLYMERIZATION PROVISIONAL RESTORATION TRIMMED AND FITTED ON CAST
  18. 18. DIRECT-INDIRECT TECHNIQUE FINAL DIRECT INDIRECT PROVISIONAL RESTORATION INDIRECT PROVISIONAL RESTORATION TRIMMED AND FIT ON CAST ABUTMENT TEETH PREPARED IN PATIENT MOUTH POLYMERIZING ACRYLIC RESIN POURED INTO PUTTY INDEXPREPARATION COMPLETE IN MODELTOOTHPREPARED MINIMALLY IN THE MODEL PUTTY INDEX FABRICATED ON THE DIAGNOSTIC CAST ,EDENTULOUS AREAS ARE RESTORED AND WAX CORRECTION ARE DONE STABILIZING RESTORATION IN PATIENT MOUTH ACRYLIC RESIN ADDED TO RETAINER IN THE PROVISIONAL RESTORATION PUTTY INDEX SECURED ON THE CAST BY RUBBER BAND
  19. 19. CEMENTATION OF PROVISIONAL RESTORATION  IDEAL PROPERTIES OF CEMENT:  Ability to seal against leakage of oral fluid.  Strength consist with intentional removal.  Low solubility.  Chemical compatibility with provisional polymer.  Ease of eliminating excess.  Adequate working time and short setting time.  CEMENTS USED:  Zinc oxide eugenol.  Reinforced zinc oxide eugenol.  Non- eugenol cements.  Zinc phosphate, Zinc polycarboxylate, and Glass ionomer cements are not used because their comparatively high strength makes intentional removal difficult.
  20. 20. LIMITATIONS OF PROVISIONAL RESTORATION  Lack of adequate strength—fracture of provisional is possible in long span FPDs, patient with bruxism and reduced interocclusal clearence.  Inadequate marginal adaptation.  Poor aesthetic in long term provisional restoration.  Plaque accumulation due to poor surface characteristic.  Compromised bonding characteristics.  Mild to moderate tissue irritation
  21. 21. References: Contemporary fixed prosthodontics- Rosenstiel, Land, Pujimoto Textbook of prosthodontics- V Rangarajan

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