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Continuing Dental Education

P R O V I S I O N A L I Z AT I O N T E C H N I Q U E S

Creating Veneer
Provisionals
Using Silicone
Matrices and
Models
Lee Ann Brady, DMD

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Provisionals Using
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Creating Veneer Provisionals Using
Silicone Matrices and Models
Lee Ann Brady, DMD
ABSTRACT
Veneer provisionals are
essential components of
esthetic treatments that serve
several functional, esthetic,
and treatment planning roles.
While dentists can select
from several techniques for
creating veneer provisionals in
the practice, whether directly
or indirectly, the nuances
of the specific techniques
used affect accuracy, ease of
placement and cementation,
and predictable function.
This article reviews three
specific provisionalization
techniques and the materials
and armamentarium that could
be selected for use during the
process, including silicone
matrices and silicone models.
LEARNING OBJECTIVES
• Discuss the differences
between indirect and direct
veneer provisionalization
techniques.
• Describe matrix and model
materials that can be
used in different veneer
provisionalization techniques.
• Explain matrix, model,
and provisional material
characteristics that affect
different veneer provisional
techniques.
VOLUME 3 • NUMBER 68
PEER-REVIEWED
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P
rovisional restorations are an essential component of es-
thetic veneer treatments that are beneficial for patients
and dentists alike. Enabling patients to maintain esthetics,
speech, and function in anticipation of the definitive restorations,
provisionals protect preparations from caries risk, sensitivity, and
plaque1; help maintain and/or shape the gingival architecture that
will frame the restorations2,3; and serve as a diagnostic blueprint
of the final restorations for assessing esthetic and functional as-
pects (eg, incisal edge position, alignment, width-to-height ratio,
color).4,5 They also serve as a 3-dimensional and visual basis for
communication among the patient, dentist, and laboratory regard-
ing changes required for the definitive veneers.
Although provisional veneer restorations may be fabricated in
a laboratory, dentists can create functional and esthetic provision-
als in the practice either indirectly extraorally, or directly in the
mouth.6 Indirect techniques can produce precise temporaries in
an efficient manner, while direct techniques enable creation of
quick and esthetic veneer provisionals that are cost-effective.6,7
However, the manner in which each type of veneer provisional
is produced—and the materials and armamentarium used during
the process—impact its accuracy, ease of placement, and func-
tionality, as well as patient comfort during the provisionalization
appointment.5 For example, among the materials used for creat-
ing direct and indirect chairside provisionals are the provisional
material itself (eg, bis-acrylic), the provisional matrix and the
material(s) used to make it (eg, Copyplast/Biocryl [Great Lakes
Orthodontics, www.greatlakesortho.com], vacuum-formed tem-
plate; silicone), and model materials (eg, silicone, stone). Likewise,
the nuances of the specific techniques employed to create the
veneer provisionals affect their accuracy, ease of placement and
cementation, and predictable function.
BIS-ACRYL COMPOSITE RESIN
The introduction of bis-acrylic resins for temporary restorations
has provided dentists with improvements over previously available
provisional materials (eg, methacrylates) in terms of handling,
CDEWORLD.COM 3
 improved compressive and tensile strength,
less water sorption, and less shrinkage for a
good marginal fit.8-10 Dispensed from automix
tip syringes or cartridges, bis-acryl provisional
materials are easy to manipulate, provide reliable
mixtures without air incorporated into them, and
are typically more comfortable for patients.8-12
Although they demonstrate abrasion resistance,
bis-acryls are more brittle than their predeces-
sors. 9,12 Because of their improved esthetics,
bis-acryls are suitable for anterior provisional
restorations.5,8
MATRIX MATERIALS
The basis for creating in-office provisional res-
torations is a matrix, which essentially shapes
the provisional material into the desired form of
the temporary restoration. The materials for use
in creating a matrix include impression materials
(eg, polyvinyl siloxane with a tray), silicone (eg,
a putty-putty impression material or Sil-Tech®
laboratory silicone [Ivoclar Vivadent, www.ivo-
clarvivadent.com]), and vacuum-formed material
(eg, Copyplast or Biocryl, processed in a tradi-
tional vacuform machine such as miniSTAR®
or Biostar® [Great Lakes Orthodontics]). Each
serves a different purpose depending upon the
teeth to be provisionalized, their location in the
mouth, and the provisionalization technique to
be used.
Vacuum-formed Matrix
It is important to note that the respective benefits
of vacuum-formed matrix materials can also
present challenges. For example, the more rigid
the matrix material is (eg, Biocryl), the more ac-
curate the provisional restoration will be because
the material will precisely copy the desired size,
shape, surface texture, and morphology from the
enhanced waxup model. Yet, the more rigid the
matrix is, the harder it can be to remove from the
bis-acryl provisional once the material has set.
Likewise, the more flexible the matrix mate-
rial is (eg, Copyplast), the easier it will be to peel,
4 CDEWORLD.COM
stretch, and pull from the bis-acryl provisional
material, which is ideal for fragile veneer pro-
visionals. However, due to the matrix material’s
flexibility, the provisionals may be less accurate,
resulting in the need for more chairtime to trim
and shape the provisionals.
To overcome this dilemma, both matrices can
be used simultaneously. An alginate impression
of the waxup can be made and a stone model
poured. The stone model is then placed in a
miniSTAR or vacuform machine along with
Copyplast material, and a flexible matrix made.
Upon removal, the matrix is trimmed with scis-
sors to the proper size and shape, then returned
to the model. The model and matrix are placed
in the vacuform machine, this time with a rigid
Biocryl material that will be suctioned over the
top. Once cooled, the flexible Copyplast matrix
can be peeled from the rigid Biocryl matrix, and
the latter trimmed with a slow-speed handpiece
and disc.
Note that leaving the full palatal form on
the rigid Biocryl matrix while only covering
the occlusal table and facial incisal edge of the
tooth form will enable its use as a carrier for
the flexible Copyplast matrix. Therefore, the
Biocryl matrix is trimmed above the incisal to
the gingival margins on the lingual and buccal
surfaces. The matrices can then be nested to-
gether (Figure 1), the provisional material loaded
into the Copyplast, and the rigid matrix used to
prevent overseating and bending in the mouth.
Once the provisional material is set, the ma-
trix complex can be removed from the mouth
and the matrix layers separated. Unlike Biocryl,
Copyplast is bendable, so it can be flexed buc-
cal and lingual and removed from the bis-acryl
provisional easily, without distorting it.
Silicone (Putty-Putty) Matrix
A silicone matrix can be made using a putty-put-
ty silicone that is part of an impression system.
DECEMBER 2016
 1 2
Fig 1. To overcome the challenges associated with flexible matrix and rigid matrix materials, the two types can be used simultaneously,
nested together, to enable easy removal of the matrix from the provisional material while preventing distortion. Fig 2. View of silicone matrix.
Putty-putty silicones include a base and catalyst,
or two separate putties that must be measured
precisely and mixed thoroughly.
Using a model of the patient’s teeth (ie, wax-
up), the entire arch (ie, all the way back to the
second molars) is covered with the putty-putty
silicone as evenly and as thick as possible (ie,
minimum of 3 mm to 4 mm) to ensure it will be
rigid to prevent flexing or distorting the matrix
once it is seated; additionally, a flat occlusal
table is desirable. It is not necessary to extend the
putty-putty silicone past the free gingival margin
or down onto the base of the model.
To ensure the utmost accuracy, a two-stage
matrix may be desired. Once the putty-putty sili-
cone matrix is completely set, excess is trimmed
using a Bard-Parker, and the matrix is removed
from the model (Figure 2). The silicone matrix
is then completely filled (ie, second molar to sec-
ond molar) with a light-body impression material
from the same impression system, after which
the matrix is seated back over the model of the
waxup and allowed to completely set. Once the
light-body is completely set, it is removed from
the model, and excess material is trimmed using
a Bard-Parker or blade (Figure 3).
VOLUME 3 • NUMBER 68
Although visualizing the silicone matrix’s
exact position can be difficult, cutting a small
notch or “V” in between the maxillary central
incisors can indicate the midline’s location
(Figure 4). This facilitates seating the matrix
in the proper place in the mouth. Additionally,
removing any impression of the tissue behind
the second molar will also help the matrix seat
completely in the mouth.
DIRECT TECHNIQUE
Unlike anterior teeth that are treatment-planned
for veneers, posterior teeth can be easily provi-
sionalized using a direct technique (Figure 5). A
direct technique requires taking a preoperative
impression (eg, triple tray or alginate) and using
the preoperative size and shape of the tooth for the
provisional restoration. The provisional is essen-
tially made directly over the tooth in the patient’s
mouth, and the technique works well for single-
and multiple-unit full-coverage restorations.
To create a direct provisional, an impression
of the tooth over a silicone matrix (Figure 2)
is loaded with the bis-acryl provisional mate-
rial and seated in the mouth. Using a timer, the
provisional material is allowed to set to a gel
phase, which takes approximately 30 seconds,
CDEWORLD.COM 5
 depending upon the brand of material. At the gel
phase, the matrix is removed from the mouth
and, if performed properly, the provisional will
remain completely inside the matrix, without
pulling or sticking. After placing the matrix on a
countertop, the provisional material is allowed to
reach its full set time—between approximately
2.5 and 5 minutes—after which it can be re-
moved from the matrix. Finishing, polishing,
and cementation can then be completed.
INDIRECT VENEER PROVISIONALS
As previously discussed, the setting time of
bis-acryl provisional material requires that it
be removed from the mouth when it is in a gel
phase. Ideally, the matrix is removed from the
mouth with the gel-state provisional material
inside it, such that the provisionals can then be
allowed to reach their full setting.
However, veneer provisionals present two
challenges. First, because teeth are conserva-
tively prepared for veneer restorations, the bis-
acryl material in the gel phase can easily pull
and tear upon removal, leaving the provisionals
prone to damage. Second, although bis-acryl
does demonstrate less shrinkage than other
provisional materials, it still does undergo po-
lymerization shrinkage; when not on the veneer
preparations, the material distorts enough that
reseating is difficult.
The development of indirect techniques for
creating single-unit provisional restorations for
multiple preparations enables dentists to over-
come both of these challenges: early removal and
shrinkage.13 Because veneer provisionals must
replicate the definitive restorations as closely as
possible, the ability to create multiple adjacent
provisionals individually, with their own con-
tours and profiles, facilitates more predictable
outcomes for patients.13 Additionally, working
indirectly also provides the advantage of allow-
ing the patient to rest and avoid tasting bis-acyl
in their mouth.
6 CDEWORLD.COM
To create indirect veneer provisionals, a final
impression is taken, after which an alginate im-
pression is taken of the final preparations. This
alginate impression is used to fabricate a silicone
model (eg, Mach-2® die silicone and bite registra-
tion silicone; Blu-Mousse® vinyl polysiloxane
[Parkell, www.parkell.com]) of the preparations.
The flexibility and smooth surface of the silicone
model offer advantages over stone, including a
rapid set. Additionally, when working with rigid
bis-acryl materials, a similarly rigid die or stack
stone model may add to the complexity of repeat-
edly removing and placing the provisionals on
and off the model without breaking them or chip-
ping a margin; the silicone model material is flex-
ible, and no die spacer or lubricant is necessary.
A silicone model is made by first injecting
the silicone die material (Mach-2) down into the
alginate impression and up over the free gingival
margin (Figure 6). To create the base, the bite
registration paste (Blu-Mousse) is injected along
the die material in a horseshoe shape, but up past
the vestibular extension of the impression, after
which it can be flipped over. When working with
a silicone model, all work must take place on a
flat surface to avoid applying pressure that can
cause bending, flexing, and distortion. Once the
bite registration is set (between 45 seconds to
1 minute), the alginate impression and silicone
model can be separated (Figure 7).
The indirect veneer provisionals are then created
by first injecting bis-acryl provisional material into
a matrix of the waxup (either silicone or Copyplast),
and then seating the matrix onto the silicone model
on a countertop (Figure 8). The material should be
allowed to completely set for approximately 2.5 to
5 minutes, after which the matrix can be separated
from the provisionals, which should remain on the
model (Figure 9). The provisionals can be trimmed
and all margins checked against the model, and any
necessary repairs can be made. Polishing can also
be completed with the provisionals on the model
to avoid breakage.
DECEMBER 2016
 The veneer provisionals can then be tried in, the preparation, approximately 2 mm to 3 mm in
after which the preparations can be spot-etched diameter (Figure 10). After rinsing thoroughly,
for 25 seconds midway on the labial surface, be- the preparations are air-dried. Flowable compos-
tween the mesial, distal, cervical, and incisal of ite in the same shade as the bis-acryl is applied to

3 4

5 6

7 8
Fig 3. Two-stage silicone matrix after removal from the waxup model. Fig 4. Cutting a small notch or “V” in between the maxillary central
incisors can indicate the midline’s location. Fig 5. Posterior teeth can be easily provisionalized using a direct technique that requires taking
a preoperative impression and using the preoperative size and shape of the tooth for the provisional restoration. Fig 6. A silicone model was
made by injecting the silicone die material down into the alginate impression and up over the free gingival margin. Fig 7. View of silicone
model. Fig 8. The matrix loaded with bis-acryl provisional material was seated on the silicone model.

VOLUME 3 • NUMBER 68 CDEWORLD.COM 7


9
10
11
Fig 9. After the bis-acryl material was allowed to set, the matrix
was separated from the provisionals on the model. Fig 10. The
preparations were spot-etched for 25 seconds. Fig 11. View of
the indirectly made provisional veneers following placement using
flowable composite.
the air-abraded surface of the provisionals, after
which they can be seated onto the preparations.
Excess composite is removed, and the provision-
als are thoroughly cured (Figure 11).
SHRINK-WRAP VENEER PROVISIONALS USING
A SILICONE PROVISIONAL MATRIX
The shrink-wrap technique enables dentists
to place bis-acryl provisionals directly in the
mouth and have them reach a full set so they
are intentionally locked in place, after which all
8 CDEWORLD.COM
trimming and shaping can be completed intra-
orally. Therefore, it is essential that the potential
for any excess material be reduced to avoid dam-
aging the preparations and/or the provisionals.14
Once the teeth have been prepared and all
final impressions have been taken (Figure 12), a
stone model is made of the waxup for use in fab-
ricating a silicone matrix (Figure 13). However,
before the matrix is created, a cleoid-discoid
carver (Figure 14) is used to scribe a 0.5 mm to 1
mm deep channel around the gingival margins of
all the teeth that will be provisionalized (Figure
15).14 For veneer restorations, only the labial
surface should be scribed; full-coverage restora-
tions require scribing on the lingual side, also.
Then, the same cleoid-discoid carver is used to
remove the top 0.5 mm to 1 mm of the gingival
tissue beyond the previously scribed channel.
Finally, as much of the stone in the interproximal
embrasures on both the buccal and lingual sides
of the model is carved out as possible, with care
taken to avoid creating a connection between the
buccal and lingual (ie, some stone should be left
in the center of the embrasure areas).
Once the model is trimmed, a two-stage sili-
cone matrix is made, and excess silicone material
is trimmed, with care taken to not remove the
silicone that adapted into the channel that was
created (Figure 16). The silicone and the light-
body impression material that flowed into the
channel cut into the model, against the tooth
forms where the gingiva and embrasure were
trimmed away, will place pressure against the
prepared teeth when forming the provisional.
This will dramatically improve adaptation and
reduce the amount of excess material that must
be trimmed once seated intraorally.14
The preparations can then be spot-etched,
thoroughly rinsed, and dried. The matrix is then
filled with bis-acryl provisional material, fully
seated in the mouth, and allowed to set for the full
amount of time required. Once the provisional
DECEMBER 2016
material has fully set, the matrix is removed,
after which any excess can be trimmed and the
provisionals finished and polished (Figure 17).
CONCLUSION
Today, dentists have options when it comes to
creating predictable provisionals: a direct tech-
nique, which is ideal for single-unit posterior
restorations; an indirect technique, where an al-
ginate impression of the preparations, a silicone
model, and a silicone or vacuform matrix are
used to make veneer provisionals extraorally;

12 13

14 15

16 17
Fig 12. View of the veneer preparations prior to impression-taking. Fig 13. By putting the tip of the instrument right at the free gingival margin
on the model, a trench can be created around every tooth prepared for a veneer. Fig 14. Cleoid-discoid carver. Fig 15. The cleoid-discoid
carver is also used to carve slightly deeper interproximally, taking care to not punch all the way through to the lingual. Fig 16. Close-up view
of the two-stage silicone matrix that captured the details of the carved model. Fig 17. View of the shrink-wrapped veneer provisionals after
placement.

VOLUME 3 • NUMBER 68 CDEWORLD.COM 9

 and the shrink-wrap technique, which employs
a two-stage silicone matrix and a stone model
carved specifically using a cleoid-discoid to
create an intimate fit against the preparations.
Considering that veneer provisional restorations
are an essential component of esthetic treat-
ments, it behooves dentists to understand the
nuances of the specific techniques for each type
of veneer provisional—and the materials and
armamentarium used during the process—to
ensure accuracy, ease of placement, and predict-
able function.
REFERENCES
1. Fondriest JF. Using provisional restorations to improve
results in complex aesthetic restorative cases. Pract Proced
Aesthet Dent. 2006;18(4):217-223.
2. Milnar FJ. Altering tooth inclination and overall esthet-
ics with direct composite veneers, gingival contouring, and
enamelplasty. Inside Dentistry. 2006;2(1):46-49.
3. Morley J, Eubank J. Macroesthetic elements of smile design.
J Am Dent Assoc. 2001;132(1):39-45.
4. Bruce WE. The missing link: on the edge of aesthetics and
function. Picture Perfect Aesthetics: The AACD Monograph.
Vol II. Mawah, NJ: Montage Media Corporation; 2005:57-60.
5. Gratton DG, Aquilino SA. Interim restorations. Dent Clin
North Am. 2004;48(2):vii,487-497.
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6. Schwedhelm ER. Direct technique for the fabrication
of acrylic provisional restorations. J Contemp Dent Pract.
2006;7(1):157-173.
7. Young CW. A simple and predictable direct technique
for esthetic provisional veneers. J Calif Dent Assoc.
2004;32(2):178-183.
8. Comisi JC. Provisional materials: advances lead to ex-
tensive options for clinicians. Compend Contin Educ Dent.
2015;36(1):54-59.
9. Kurtzman GM. Crown and bridge temporization. Part 1:
provisional materials. Inside Dentistry. 2008;4(8):72-80.
10. Gegauff AG, Holloway JA. Interim fixed restorations.
In: Rosenstiel SF, Land MF, Fujimoto J, eds. Contemporary
Fixed Prosthodontics. 4th ed. St. Louis, MO: Mosby Elsevier;
2006:466-504.
11. Lieu C, Nguyen TM, Payant L. In vitro comparison of
peak polymerization temperatures of 5 provisional restoration
resins. J Can Dent Assoc. 2001;67(1):36-39.
12. Strassler HE, Anolik C, Frey C. High-strength, aesthetic
provisional restorations using a bis-acryl composite. Dent
Today. 2007;26(11):128,130-133.
13. Hansen PA, Sigler E, Husemann RH. Making multiple
predictable single-unit provisional restorations using an indi-
rect technique. J Prosthet Dent. 2009;102(4):260-263.
14. Snyder T. Bead line veneer provisional restorations. Pract
Proced Aesthet Dent. 2009;21(3):E1-E7.
DECEMBER 2016
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Creating Veneer Provisionals Using Silicone

Matrices and Models
Lee Ann Brady, DMD

1. An
 essential component of esthetic veneer 6. W
 ith a more flexible matrix material, the
treatments, provisional restorations: provisionals may be:
A. protect preparations from caries risk. A. harder to peel from the bis-acryl material.
B. help maintain and/or shape the gingival architecture. B. more difficult to stretch.
C. serve as a diagnostic blueprint of the final C. less accurate.
restorations. D. more precise.
D. All of the above
7. When
 using a putty-putty matrix, the patient’s entire
2. Direct
 techniques enable creation of quick and arch is covered with the putty-putty silicone as
esthetic veneer provisionals that: evenly and as thick as possible to ensure:
A. are cost-effective. A. the two putties are mixed thoroughly.
B. will likely be inaccurate. B. ample flexibility in the matrix.
C. need no finishing or polishing. C. the silicone extends past the free gingival margin.
D. are only suitable for anterior teeth. D. proper rigidity to prevent distorting the matrix.

3. Dispensed
 from automix tip syringes or cartridges, 8. In
 which technique is the provisional essentially
bis-acryl provisional materials are: made directly over the tooth in the patient’s mouth?
A. easy to manipulate. A. Direct technique
B. difficult to handle. B. Indirect technique
C. uncomfortable for patients. C. Shrink-wrap technique
D. not suitable for anterior restorations. D. Putty-putty technique

4. T
 he basis for creating in-office provisional 9. With
 the development of indirect techniques,
restorations is: being able to create multiple adjacent provisionals
A. a waxup model. individually with their own contours and profiles:
B. a matrix. A. leads to material tearing upon removal.
C. an alginate impression. B. accelerates polymerization shrinkage.
D. a proper dispensing unit. C. facilitates more predictable outcomes for patients.
D. typically increases patient discomfort.
5. Although
 a rigid matrix material may provide a
more accurate provisional restoration: 10. The shrink-wrap technique enables dentists to
A. the provisionals will require more chairtime for place bis-acryl provisionals directly in the mouth
trimming and shaping. and have them:
B. the matrix can be harder to remove once the material A. trimmed and shaped extraorally.
has set. B. scribed using a Bard-Parker instrument.
C. the matrix prevents the provisional material from fully C. reach a partial set before cementing them in.
curing. D. reach a full set so they are intentionally locked in
D. All of the above place.

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