Provisional–Temporary Cements

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Provisional–Temporary Cements

Techniques to facilitate placement of provisional restorations

Howard E. Strassler, DMD; and Roseanne J. Morgan, CDA

Provisional or temporary cements play an important role in restorative dentistry.

Recommendations for the use of provisional cements include the temporary cementation of
temporary restorations used to restore tooth preparations for indirect restorations including
crowns, xed partial dentures, inlays and onlays, as well as for temporary cementation of
de nitive restorations of the same types. Provisional cements are also used for the
cementation of implant crowns and xed partial dentures ( xed bridges). There are speci c
techniques to make using a temporary cement easier, and different types of temporary
cements for certain clinical situations.

Techniques for ease of use of temporary cements

Once the provisional restoration has been adapted, nished, and polished, it is ready for
cementation. To facilitate clean-up of the temporary cement, follow two simple tips. First, to
avoid leaving a white streak of set provisional cement around the surfaces and margins of
the restoration and to simplify removal of excess provisional cement, before placing the
cement, lightly paint some petroleum jelly on the outside, polished surfaces of the
provisional restoration using a disposable brush. (Figure 1) For a bridge, place a thicker
portion of petroleum jelly on the tissue surface side (outside) of a pontic and gingival to the
connector of the bridge with a brush. This thicker portion of petrolatum gel will prevent the
temporary cement from getting into these di cult-to-access areas once the cement has
set. Because the gel is there instead of the cement, it will be easier to remove the temporary
cement.

For cement placement into the temporary restoration, either using an automixing tip with a
automixed temporary cement and squeezing it into the temporary (Figure 2) or by mixing
the cement on a pad or dispensing to a pad after automixing, use a disposable brush to
apply the cement to the temporary restoration. In either case, never over ll the inside of the
temporary restoration—only enough to coat the inside. The authors prefer using the brush to
apply the cement to the internal of a crown, bridge, or inlay/onlay temporary because it is
easier to control the amount of temporary cement and where it is applied. The temporary
cement should completely coat all the internal surfaces of the restoration (Figure 3). Do not
overload the restoration with temporary cement (or even a nal cement for a nal
restoration) because it can lead to di culty fully seating the restoration and also to a gross
excess of cement that will need to be removed. Gross cement can easily be removed after
the complete set of the cement with a scaler (Figure 4). In fact, it will easily be removed if
petroleum gel was placed.

One problem when removing provisional cement for crowns, inlays/onlays, and bridge
temporary restorations is removing the cement in the gingival embrasure below the contact
area. Flossing the contact will often not remove the cement: the oss will slide between the
restoration and the cement and the cement will not be pulled out. For those times when the
cement is more di cult to remove from the embrasure space (for teeth with large gingival
embrasures), there is a simple solution. For these cases, tie two to three knots into the end
of a piece of dental oss, then oss the contact area pulling the oss through so the larger
knotted area will pull out the gross set cement (Figure 5). It is critical that all residual
temporary cement be removed. Excess cement remaining in the sulcus can result in
irritation of the periodontium in the sulcus, and in the most extreme cases result in severe
periodontal in ammation with the potential for bone loss. The knotted oss can also be
used to remove the set cement under a pontic area by placing the knotted oss on the
gingival pontic site before cementation. Once the provisional cement has hardened, pull the
oss out.

Choices in Temporary Cements

There are many choices with temporary cements (Table 1). Dentists select cements based
upon their experience with a product, or recommendations that have been made by others,
or through continuing education courses. There are many important factors in the physical
properties and handling of the cement that make a difference.1 These properties include:

1. good retention of the indirect restoration with the provisional cement (good adhesion to
the tooth preparation and restoration)

2. easy to dispense, mix and apply to the restoration

3. easy removal of excess from the external surfaces of the restoration after cementation

4. adequate working time and setting time

5. viscosity and handling properties for ease of placement to restoration to be cemented

and/or tooth preparation

6. easy removal of the indirect restoration from the tooth preparation when cemented with
the provisional cement without damaging the soft tissues, tooth preparation or pulp

7. easy removal of provisional cement from tooth preparation during clean-up from dentin
and enamel, core materials (cast metal, amalgam, composite resin) and implant abutment
materials

8. easy removal of the provisional cement from the internal surfaces of the restoration when
the restoration needs to be recemented

9. no or minimal chemical reaction of the provisional cement to the restorative material in

the restoration restorative material (eg, zinc-oxide eugenol cements can contaminate and
soften acrylic resins)

10. biocompatibility to soft tissues, pulp and tooth structure

11. no interference with adhesion of a nal cement

12. good shelf life

While no one product ful lls all these properties, the choice of a provisional cement should
depend on the clinical circumstance for which it is chosen.

Clinical Situations

Provisional restorations are important. The provisional restoration protects the tooth by
minimizing extreme changes in temperature due to food and beverages ingested. In
addition, when cemented, it provides a seal against microleakage for the period of time that
the provisional restoration will be in place and reduces sensitivity while the laboratory is
fabricating the crown or inlay/onlay.2,3 The provisional cement plays a key role in keeping
the temporary restoration on the tooth while the patient is waiting for the nal restoration to
return from the dental laboratory.4,5 While the cement helps retain the temporary
restoration, it also has to provide for easy removal of the provisional restoration without
harming the periodontium, tooth preparation, or pulp when the nal restoration is tried-in
and adjusted.

Some practitioners will temporarily cement some nal restorations, usually all metal or
porcelain-metal, to evaluate the restoration’s contours and margins. In the case of a xed
partial denture ( xed bridge) with a pontic, some clinicians prefer to provisionally cement
the restoration rst with a provisional cement to assess the periodontal response of the
restoration and the adaptation of the tissue-borne side of a pontic. In the past, provisional
cements were opaque in color due to the materials being used. Recently more tooth-colored
provisional cements have been introduced to not interfere with the color evaluation of
translucent restoration materials. Examples of color neutral, shaded or translucent
provisional materials include Zone (Dux® Dental, www.duxdental.com, NexTemp™ (Premier
Dental, www.premusa.com), TempBond® Clear (Kerr Corporation, www.kerrdental.com), and
Systemp®.link (Ivoclar Vivadent®, www.ivoclarvivadent.us). In some cases, for a patient
who relates a history of dentinal hypersensitivity after the tooth preparation and provisional
restoration placement, the de nitive restoration may be temporarily cemented with a
provisional cement to assess pulpal health. In these cases, the use of a eugenol-containing
provisional cement may have a sedative affect on the pulp.6 Eugenol-containing provisional
cements with residual eugenol remaining after setting can result in softening of an acrylic
resin—not allowing additional acrylic resin added to a previously made temporary crown or
bridge to set completely.7,8 With the newer eugenol-containing provisional cements, the
amount of unreacted eugenol can be minimized by using the correct mixing proportions
recommended by the manufacturer.4
The practitioner will determine the best temporary cement for any given clinical situation. In
most cases there is not a one-size- ts-all choice in provisional cements. When using a
provisional cement it is critical that the tooth surfaces of the preparation be adequately
cleaned to remove the residual provisional cement. Techniques to remove residual
provisional cements from tooth preparations include scraping the tooth with a hand
instrument (usually a scaler or curet), cleaning the tooth preparation with a prophylaxis cup
with a water–pumice paste slurry, and the use of an intraoral sandblaster. Of the three
methods, the intraoral sandblaster method is the most reliable, followed by a prophylaxis
cup with a water–pumice paste slurry. To be certain the nal cementation is optimized, the
tooth preparation must be clean.9-11

When placing nal restorations for implant-supported prostheses, some practitioners place
the nal restoration with a provisional cement so it can be more easily removed on a regular
basis; or if one or more of the abutments of a xed partial denture come loose, the
prosthesis can be removed and recemented. Once again, the choice of cement depends on
the clinical situation.

Types of Provisional Cements

The earliest provisional cements were made from zinc-oxide powder and eugenol liquid
(ZOE). Today the dental o ce has many choices with provisional–temporary cements.
Because ZOE cements can have negative effects on the acrylic resin and adhesive tooth
cementation with composite resin cements, in recent years a number of manufacturers
have addressed this problem by introducing provisional cements that are eugenol-free.
Some eugenol-free cements do not set as hard as eugenol-containing cements, which can
lead to a temporary crown or bridge becoming uncemented, requiring an additional o ce
visit to recement the temporary.

Some eugenol-free provisional cements have been formulated to address problems

identi ed with past cements.12,13 There was a need for a more rigid provisional cement to
improve retention of the restoration and facilitate clean-up of the provisional cement from
the preparation and restoration. A clinician may use a different provisional cement for
certain circumstances to achieve easier removal of the restoration at a later time, compared
to the need for a more rigid provisional cement that will allow for better retention on a
crown preparation that is not retentive due to its occlusogingival height or the presence of
excess taper to the axial walls of the crown preparation.12,13 TempoSIL
(Coltène/Whaledent, www.coltane.com) achieves both goals. It has a unique formulation as
an addition-cured silicone-based zinc oxide temporary cement with a silane agent for
improved adhesion and marginal integrity. This formula produces a rm, yet elastic
temporary cement that can be easily peeled off the tooth preparation (either natural tooth,
core of restorative material, or implant abutment) and removed from the internal surfaces of
both provisional and nal restorations. Other provisional cements, UltraTemp (Ultradent
Products, www.ultradent.com) and Hy-Bond® Polycarboxylate Temporary Cement (Shofu,
www.shofu.com), use a polycarboxylate formulation and are eugenol-free. UltraTemp
addresses the need for greater rigidity for restoration retention and is available in two
different formulas (regular and rigid set), while Hy-Bond has one formula for a more rigid
set. TempSpan® CMT (Pentron Clinical, www.pentron.com) and NexTemp (Premier Dental)
are two resin-based formulations that provide for translucent color, greater rigidity, and a
two-stage gel setting reaction for easy removal of excess. TempSpan CMT also has the
additives of sodium uoride, potassium nitrate, and calcium phosphate for a reported
decrease in postoperative sensitivity.

Convenience Packaging

In the past, many temporary cements were packaged in paste squeeze tubes. There are
problems associated with dispensing of material and maintenance of these tubes. Excess
cement extrudes from the tube, making the outside of the tube making the tube sticky and
di cult to clean due to the oily consistency of the pastes. Convenience packaging has
made the use of provisional cements easier with more consistent dispensing. For those
times when a ZOE provisional cement is desired, Embonte and Embonte 2 (Dux Dental)
afford convenient and easy-to-use packaging. Embonte is provided in unit dose packaging,
which allows the chairside assistant to dispense the right amount of both base and catalyst
paste for a single unit provisional crown cementation without any excess and waste.
Embonte2 uses the same ZOE formulation and is dispensed in a dual-cartridge auto-
aspirating syringe that eliminates the waste of conventional squeeze tubes with its patented
auto aspirating feature.

If convenience packaging is desired with a eugenol-free provisional cement, there are a

number of good choices with the advantages for ease of use. What could be more
convenient than a moisture sensitive and self-setting single paste available in a unit dose?
Eugenol-free NoMIX® Temporary Cement (Centrix, www.centrixdental.com) is a single-paste
no-mix moisture-activated temporary cement. When the practitioner is ready to cement the
restoration, the interior of the restoration is wetted with water before the cement is
dispensed. Initial set for clean-up is 5 minutes with complete setting in 15 minutes. This
extended working time allows for use with single units and multiple units. Also, this
temporary cement is packaged in unit dose so that patients can take it with them to
recement their own provisional restoration.

Many of the newest provisional cements are available in a double-barreled automixing

syringe or in the case of TempoCem® NE (Zenith DMG, www.dmg-america.com), a double
barreled cartridge that is dispensed through gun-type applicator similar to those used with
bis-acryl provisional composite resins. Automixing dual-tube provisional cements allows the
chairside assistant to dispense the right amount for a single unit or multiple units directly
into the provisional restoration. (Figure 2). It also means that each mix is consistent
because the catalyst and base paste will always be dispensed through the mixing tip in the
optimal volume ratio and mixed in a consistent fashion through the automix tip. It also
minimizes waste and eliminates the clean-up of a cement spatula and mixing pad.14 Some
of the products that are available in this automix double-barreled syringe are Temp
Advantage® (GC America, www.gcamerica.com), TempSpan CMT (Pentron Clinical), Zone
(Dux Dental), Systemp.Cem (Ivoclar), and TempoSIL (Coltène/Whaledent), among others.

Conclusion

While there is no one provisional cement that meets all the requirements of an ideal
product, the current generation of provisional cements offers a number of advantages over
what has been used in the past. If a practitioner is having success with a provisional
cement, there is no reason to make a change. However, if the practice has expanded the
types of restorations to include all-ceramic and implants, there may be a need for more than
one brand of provisional cements. The advantages of a more rigid setting provisional
cement may be necessary for a number of clinical situations, including a crown with
compromised retention or a patient with parafunctional habits. If there are issues with
postoperative sensitivity, a provisional cement containing eugenol or a eugenol-free
provisional cement with additives for desensitizing may solve these problems.

There is no one provisional cement to meet all clinical needs. It may be necessary to have at
least two different provisional cements to accommodate the dental practice. Whatever
product is used, it is important that the provisional cement be cleaned thoroughly from the
tooth before de nitive cementation.

References

1. Strassler HE. Provisional cements. Inside Dentistry. January 2008.

http://www.dentalaegis.com/id/2008/01/provisional-cements. Accessed June 28, 2012.
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agents. J Prosthet Dent. 1991;66(6):763-766.

3. Pan YH, Ramp LC, Lin CK, Liu PR. Comparison of 7 luting protocols and their effect on the
retention and marginal leakage of a cement-retained dental implant restoration. Int J Oral
Maxillofac Implants. 2006;21(4):587-592..

4. Geganuff AG, Holloway JA. Provisional restorations. In: Rosensteil SF, Land MF, Fujimoto
J. Contemporary Fixed Prosthodontics. 4th ed. Mosby Elsevier. St. Louis; 2006:466-504.

5. Shillingburg HT Jr. Provisional restorations. In: Shillingburg HT, Hobo S, Whitsett LD, et al.
Fundamentals of Fixed Prosthodontics. 3rd ed. Quintessence Publishing: Chicago;
1997:225-256.

6. Pashley EL, Tao L, Pashley DH. Sealing properties of temporary lling materials. J
Prosthet Dent. 1988;60(3):292-297.

7. Gegauff AG, Rosensteil SF. Effect of provisional luting agents on provisional resin
additions. Quintessence Int. 1987;18(12):841-845.

8. Millstein PL, Nathanson D. Effect of eugenol on cured composite resin. J Prosthet Dent.
1983;50(2):211-215.

9. Fonseca RB, Martins LR, Quagliatto PS, Soares CJ. In uence of provisional cements on
ultimate bond strength of indirect composite restorations to dentin. J Adhes Dent.
2005;7(3):225-230.

10. Grasso CA, Caluori DM, Goldstein GR, Hittelman E. In vivo evaluation of three cleansing
techniques for prepared abutment teeth. J Prosthet Dent. 2002;88(4):437-441.

11. Rosensteil SF. Luting agents and cementation procedures. In: Rosensteil SF, Land MF,
Fujimoto J. Contemporary Fixed Prosthodontics. 4th ed. Mosby Elsevier. St. Louis;
2006:909-927.

12. Sadan A. Clinical considerations in cement selection for provisional restorations—Part I.

Pract Periodontics Aesthet Dent. 2000;12(7): 638.

13. Sadan A. Clinical considerations in cement selection for provisional restorations—Part 2.

Pract Periodontics Aesthet Dent. 2001;13(1):16.
14. Strassler HE, Tomona N, Serio CL. Anterior provisional restorations with a translucent
prefabricated crown form. Contemporary Esthetics and Restorative Practice. 2004;8(9):44-
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About the Authors

Howard E. Strassler, DMD

Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School
Baltimore, Maryland

Roseanna J. Morgan, CDA

Clinic Coordinator
Postgraduate Prosthodontics
University of Maryland Dental School
Baltimore, Maryland