Lec.:10 Crown&bridge ‫ثناء غني السعيدي‬.

‫د‬

Provisional (interim, temporary)

Restoration
It is a fixed prosthesis designed to be temporarily cemented to the prepared
teeth to restore both esthetic & function for a certain period of time (from
taking final impression till the final restoration is ready for cementation).

Requirements of provisional restoration

A-BIOLOGICAL REQUIRMENTS:

1. Pulpal protection.
-An interim fixed restoration must be fabricated of a
material that will prevent the conduction of temperature
extremes.
- The margins of restoration should be adapted well
enough to prevent leakage of the oral environment.
Leakage may cause irreversible pulpitis and root canal treatment.

2. Periodontal Health
To facilitate plaque removal, an interim
restoration must have good marginal fit,
proper contours and smooth surfaces finish.

In this mesiodistal section, an over

contoured connector impinge on the gingiva.
Pressure ischemia and poor access for plaque
removal promote gingivitis.
3. Positional stability.
The interim restoration should maintain proper contacts with adjacent and
opposing teeth, otherwise super eruption of the opposing teeth or shifting of
the prepared teeth leads to difficult insertion & adjustment during
cementation.

4. Prevention of tooth fracture.

It should protect the prepared tooth surface from
fracture(enamel fracture) which is commonly seen in
partial coverage restoration, in which margin of
restoration is close to the occlusal surface of the
tooth and could be damaged during chewing.
Such as ¾ crown, inlay and onlay.

5. Ease of cleaning.
The restoration must be made of a material and contour that will permit the
patient to keep it clean during the time it is worn.

B-MECHANICAL REQUIRMENTS

1. Occlusal function.
Good compressive & flexural strength of
provisional restoration withstand the
masticatory force.

As a trial to increase the strength of

restoration, increasing the connector
occlusogingival height away from the
gingiva.

2
 2. Retention & stability:
Close adaptation of interim restoration to the prepared tooth surface to
prevent displacement and decementation.

C.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 used for prolonged
period.
 It also serves as a guide to achieve aesthetics to the final restoration.

Ideal properties of provisional material:

1. Adequate strength and wear resistance.

2. Biocompatible.

3. Good dimensional stability.

4. Easy to contour and polish.

5. Odourless and non-irritating.

6. Chemically compatible with luting cement.

7. Esthetically acceptable.

8. Adequate working and setting time.

9. Easy to repair.

The ideal provisional material has not yet been developed. Dimensional
change during solidification causes marginal discrepancy especially when
direct technique is used.

In addition the resin currently used is exothermic and not entirely

biocompatible.

The provisional restoration can be made from several kind of material such as
metal, acrylic resin and composite, the selection of is depend on several
factor such as:
3
 Location.
 Period of time.
 Biting force.

Materials used in the construction of provisional restoration:

1. Poly methyl methacrylate (PPM): powder & liquid

-It is used with indirect technique.

- Polymerization shrinkage, exothermic setting reaction.

-good esthetic (varying shade) , polishing.

2. Polyethyl methacrylate (PEM): powder & liquid

-it is used for both direct/indirect technique.

-less polymerization shrinkage& less polymerization heat.

3. Poly(R, methacrylate)

The R, represented an alkyl group larger than methyl ( isobutyl).

It has less polymerization shrinkage & less irritation to soft tissue.

4. Vinyl ethyl methacrylate:

It is a recent material having the same characteristics of polyethyl

methacrylate.

Most acrylic resin products are available in auto mix syringe to simplify its
application.

5. dual cure composite provisional mat.

Bis-acrylic resin similar to Bis-GMA resins.

-it is used in both direct /indirect technique (low curing heat).

-minimal polymerization shrinkage.

-Good marginal fitness.

-esthetic (shade), polishing.

4
 Bis-acryl composites are available as auto-cure system& dual-cure
systems. It is good mat. For directly fabricated long span provisional
bridge.

Reinforcement of provisional restoration

 Fiber-reinforced (polyethelene fibers, glass fibers).
 Heat-processed acrylic resin.
 Metal casting.

Indications for Fiber-reinforced Provisional restorations

1. A long-span posterior bridge.
2. Prolonged treatment time.
3. Patient’s inability to avoid excessive forces on the prosthesis.
4. Above-average masticatory muscle strength.
5. History of frequent breakage.

Classification of provisional restoration

1. Prefabricated (Performed):

-Metal crown

• Aluminium.

• Tin-silver.

• nickel-chromium.

• Stainless steel.

-Plastic crown

(Cellulose acetate, Polycarbonate,

Acrylic temporary crown).

5
 2. Customized:

Direct technique
Indirect technique
Indirect-direct technique.
Digital Interim Fixed Restorations.

1. Metal crown
Clinical procedure

1. Select the proper size by the measuring gauge and shape of the temporary
crown according to the prepared tooth.(A slightly larger or smaller shell can
be deformed with contouring pliers)

2. Trim the cervical margin of temporary crown using scissor to conform the
gingival margin of the preparation (finishing line).

3. Wipe the tooth surface by petroleum jell. The adjusted shell is filled with
interim resin such as PEM and seated.

4. The final position is determined by the patient’s closing into maximum

intercuspation. Adjust the occlusion by articulating paper. Excess resin is
immediately removed.

6
2.polycarbonate crown:
Clinical Procedure

1. Measure the mesiodistal width of the crown space

with dividers and select a shell that is of the same
or slightly larger width.

2. Mark the crown height (from the incisal edge) with

the dividers and use this measurement as a guide to
trimming the shell to follow the curvature of finishing
line. Green stone or small diameter tungsten carbide
bur be used.

3. For now the occlusion should be ignored, it is

usually better to adjust it after cementation.

4. Apply a uniformly thin coat of petroleum to the

prepared teeth and adjacent gingiva.

5. Mix the interim resin and fill the shell & reset on the
tooth surface.

6. When the rubbery stage of polymerization is

reached (after approximately 2 minutes in the

mouth) remove it from the pt mouth.

7. Place the shell in a cup of warm water (40°C).

8. Replace the crown, and adjust the occlusion as

deemed necessary using articulating paper.

9. Polish, clean, and cement the restoration.

7
 3.Celluloid Temporary Crowns
Clinical procedure

1. Coat the prepared tooth with petroleum or Vaseline to facilitate

removal of the temporary crown.

2. Select the proper size and shape of

the celluloid crown.

3. Make two holes in the corners of

temporary crown to provide an escape
way for the excess material.

4. Cut the gingival margin of the crown

to accommodate that of the prepared
tooth.

5. Fill the celluloid crown with provisional material (acrylic resin or

composite resin) if acrylic is used as a provisional material, the celluloid
crown should be removed at its semi plastic

6. Take the crown out and remove the excess material. Then place it
again on the prepared tooth and check the occlusion, contact with
adjacent teeth, fitness, extension and cemented by non eugenol zinc
oxide cement.

Note: the cement of choice for luting provisional restoration:

-Zinc oxide eugenol or free eugenol zinc oxide cement.

Customized provisional crown:

Indication of customized temporary restoration
1. Coverage of multiple individual crown restorations.

2. Coverage of a single tooth preparation which is usually large or of

special design (when preformed temporary crown is not fit to the tooth).

3. To construct a temporary bridge.

8
 Direct technique(chair side) of customized provisional
restoration
1. Preoperative impressions made with irreversible hydrocolloid or
silicones are convenient (if the patient had removable appliance in the
span area, the denture teeth will serve as pontic teeth in provisional
restoration).

2. After perperation, the tooth is coated with thin coat of Vaseline & mix a
tooth colour PEM or composite provisional resin & put the impression in
the position of the prepared teeth only & reset the impression inside the
patient mouth on the prepared teeth.

3. Remove the tray from the patient mouth before complete setting;
otherwise it won’t be able to remove due to polymerization shrinkage of
acrylic.

4. Separate the set provisional mat. From the impression, finish, polish it.

5. Check the occlusion & margins & cement with non eugenol zinc
cement.

In direct technique customized provisional restoration (on

the primary cast):
1. Make alginate preoperative impression for the case &pour it with quick
setting plaster of Paris.

2. Complete any defect in the abutment using blue inlay wax& place a
denture teeth or wax pontic in the missing tooth area (span area).
9
3. Duplicate the wax up model with another alginate impression &pour it
with stone to get cast similar to that of final FPD.

4. Make a plastic template using a vacuum machine.

5. Prepare the abutment teeth intra orally; make an alginate impression

for the perperation &pour it with quick setting plaster of Paris.

6. Check the plastic template on the plaster model of the prep. coat the
model with separating medium, place some acrylic in the interproximal
area of the cast, fill the template with provisional mat.(PMM,PEM) in the
FPD area only &secure it on the plaster cast with a rubber band.

7. Separate the formed provisional FPD from the cast& template, trim
excess acrylic and widen the pontic embrasures & remove its saddle.

8. Place it intraoral, adjust any binding spot with adjacent teeth & remove
high spot.

9. Polishing, cementation using eugenol free tem. cement.

Advantage of Indirect tech. over Direct technique:

1. There is no contact of free monomer with the prepared tooth or
gingiva.

2. Avoid the effect of polymerization heat on prepared teeth.

3. It has better marginal fitness because complete polymerization occurs

on stone cast (direct technique the crown removes before complete
polym.(it is not rigid).

4. Allow the use of materials that are difficult to polymerize intraorally.

Indirect –direct provisional restoration technique

1. Restoring the edentulous area by denture teeth & wax correction
are done.
2. Fabricating a plastic template or another method (Making a
silicone index for the abutment teeth on the primary cast before
any preperation).

01
 3. Lubricate the cast with separating medium, fill the plastic template
or the silicone index with acrylic provisional resin &secure it on the
cast with rubber band.
4. After complete polymerization, separate the provisional restoration
from the template or the index, finish & polish it.
6. Prepare the abutment in the patient mouth.
7. Try in the provisional restoration, adjust it & reline it with prov.resin
for more retention.
8. cement the pro. Using non eugenol zinc oxide. Cement.

Advantage of Indirect/direct technique:

1. Chair side time is reduced. Most of procedure completed in the lab
before patient visit.

2. It acts as a guide for amount of preperation like the mock up of indirect

veneer restorations.

3. It reflect the esthetic of the final restorations (shape, texture &

contour)

4. Less heat generated, less free monomer contact.

Main disadvantage:

Adjustment is needed to seat the provisional bridge in the patient mouth.

00
 Digital Interim Fixed
Restorations
(CAD/CAM) production of restorations at the
same day of tooth preparation:

Advantages:

1. Good wear resistant.

2. Definitive (final) restoration can be
milled as an exact duplicate of interim.
3. No laboratory work needed.
4. No residual monomer.
5. No polymerization shrinkage.

02