e25

Simplified Protocol for Relining Provisional

Prosthesis on Natural Abutments:
A Technical Note

Fabio Galli, MD, DDS1 The clinician needs to address and

Matteo Deflorian, DDS2 solve a series of biologic, biome-
Tiziano Testori, MD, DDS, FICD3,4 chanical, and esthetic diagnostic is-
sues before proceeding to the final
prosthetic rehabilitation of one or
more teeth. The design of the provi-
This article describes a simplified technique for relining provisional prostheses sional restoration is first established
on natural abutments that can be applied to this specific type of tooth by a diagnostic wax-up. The clinician
preparation with feather-edge finish line. Starting from a diagnostic wax- can use it to assess a number of ba-
up, a provisional fixed restoration is constructed, containing all the correct
sic esthetic decisions, such as shape,
structural information. This includes the controlled depth of the prosthetic
margin into the gingival sulcus, the emergence profile, and the area from color, position, and morphology of
the emergence profile to the gingival third. Chair time is saved during the the incisal edges, length/width ra-
clinical procedures because the finishing and polishing steps are shortened, tio of teeth, and placement of the
and the resulting provisional restoration is precise and highly biocompatible. prosthetic margin.1 From a biologic
This technique allows for a simple and quick relining and finishing procedure and esthetic point of view, the po-
and for the delivery of an esthetic and biocompatible provisional restoration.
sitioning of the prosthetic margin
Int J Periodontics Restorative Dent 2018;38:e25–e28. doi: 10.11607/prd.3338
appears to be a fundamental issue.
The biologic width of the gingival
tissue includes the sulcular epithe-
lium, the epithelial attachment, and
the connective attachment.2 This
anatomical structure was defined as
supracrestal gingival tissue since it
extends from the gingival margin to
the alveolar ridge.3
Section of Implantology and Oral Rehabilitation (Head of Section of Implant Prosthesis),
1

Dental Clinic, Department of Biomedical, Surgical and Dental Sciences, Institute for This tissue has a high variability
Scientific Clinical Research and Treatment (IRCCS), Galeazzi Institute, Milan, Italy. in thickness and width relative to the
2Section of Implantology and Oral Rehabilitation , Dental Clinic, Department of Biomedical,
relationship of the width of the alve-
Surgical and Dental Sciences, Institute for Scientific Clinical Research and Treatment (IRCCS),
olar process to the size of the teeth
Galeazzi Institute, Milan, Italy.
3Head of Section of Implantology and Oral Rehabilitation , Dental Clinic, Department of and it is referred to as the biotype.4
Biomedical, Surgical and Dental Sciences, Institute for Scientific Clinical Research and The biologic width evaluation
Treatment (IRCCS), Galeazzi Institute, Milan, Italy. of periodontally healthy teeth is de-
4Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine,

University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA.

fined as the average apicocoronal
extension of the supracrestal gingi-
Correspondence to: Dr Tiziano Testori, IRCCS Istituto Ortopedico Galeazzi, val tissue that can range between 2
Via R. Galeazzi 4, Milan, 20161, Italy. Fax: + 39 02 50319960.
and 6 mm.5 These results are con-
Email: Tiziano.Testori@unimi.it
sistent with a clinical survey of 400
©2018 by Quintessence Publishing Co Inc. teeth: the conventionally recognized

Volume 38, Number 2, 2018

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e26
Fig 1 Abutment preparations on the dental
stone model.
3 mm of supercrestal gingival tis-
sue is only present in 46.8% of pa-
tients.6 Even if according to some
studies the sulcus area should be
avoided,7–10 the intrasulcular posi-
tioning of prosthetic crown mar-
gins presents esthetic advantages.
Furthermore, there are two clinical
situations in which supragingival po-
sitioning of the prosthetic margins
is not feasible: the need to add me-
chanical retention and the need to
reprepare an abutment with subgin-
gival margins11,12 without violating
the biologic width.
For these reasons, it is neces-
sary to position the prosthetic mar-
gins subgingivally for satisfactory
esthetic results after periodontal
health has been established.
One feature of the vertical prep-
aration is that it allows selection of
the prosthetic finish line within the
gingival sulcus if the prosthodontist
carefully prepares the intrasulcular
position of the clinical crown, re-
specting the epithelial and connec-
tive tissue attachment.
The International Journal of Periodontics & Restorative Dentistry
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NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
Fig 2 Gingival sulcus replica preparation
based on the periodontal charting.
The goal of the present article
is to describe a protocol that short-
ens chair time and simplifies the
provisional restoration finishing and
polishing procedures. Topics such
as emergence profile, resistance
and retention, finish line types, fin-
ish line location, occlusal aspects,
and materials are beyond the scope
of this study.
Technical Note
Laboratory Phase
The design of the provisional resto-
ration is established by a diagnostic
wax-up. Teeth are prepared on the
dental stone model using diamond
burs (859 104 018, Komet) (Fig 1).
After the occlusal reduction,
the axial walls are prepared ex-
tending into the intrasulcular area.
The intrasulcular extension varies
from case to case, depending on
the probing depth (Fig 2). Using
the abutment long axis as a refer-
Fig 3 Enlargement of the gingival sulcus
replica to create space for the provisional
restoration.
ence, the dental technician inclines
the bur facially with an angle that
ranges from 30 to 50 degrees to
prepare the sulcus area. If the pa-
tient presents a thin biotype, the
bur inclination toward the facial
is around 30 degrees; in cases of
thick biotype, the bur facial inclina-
tion can be up to 50 degrees. This
step creates the space needed for
the emergence profile that would
otherwise interfere with the stone
replica of the gingival margin
(Fig 3).
After preparation of the stone
abutments, a transparent vacuum
shell is prepared to highlight the dif-
ferences between the stone model
and the intraoral preparation. The
transparent disk used for this vacu-
um shell is 1 mm in thickness (Byte
Plane Morbido, Effegi Brega).
Using the diagnostic wax-up,
the dental technician fabricates an
acrylic resin provisional restoration
extended inside the sulcus (Vertys
Templus Dentin, Vertys Templus
Enamel, and Vertys Artist, Verty-

Fig 4 Vacuum shell and fit checker paste to
facilitate the abutment preparation and the
provisional restoration placement.
Fig 7 (left) Interim restoration finishing
procedure. The facial profile, highlighted
in red, is minimally recontoured because it
was already defined during the analysis and
fabrication phase.
Fig 8 (right) Provisional restoration
finishing procedure: the blue line highlights
the intrasulcular portion of the interim
restoration most involved during this phase.
system). This provisional restoration
contains all the information (con-
trolled depth of the prosthetic
margin into the gingival sulcus,
emergence profile, area from the
emergence profile to the gingival
third, gingival scalloping, interdental
spaces). The dental technician fabri-
cates an occlusal index to correctly
position the provisional restoration
during the relining procedure.
Clinical Phase
The clinician prepares the abut-
ments following the stone model.
Using a transparent vacuum shell
and a colored fit-checker paste
(Xantopren L Blue, Heraeus Kulzer),
it is easy to highlight differences be-
tween the stone and natural abut-
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Fig 5 Hard acrylic resin index to maintain
the provisional restoration’s correct position
during the relining procedure.
ments and to correct them (Fig 4).
Before relining the provisional resto-
ration, waxed dental floss is placed
in the interdental spaces to give a
limit to the relining acrylic resin. Au-
topolymerizing acrylic resin is used
to fill the small gap between the
tooth and the fitting surface of the
provisional restoration.
The provisional restoration is
placed intraorally together with
the occlusal index for better po-
sitional precision (Vertys Surgical,
Vertysystem) (Fig 5).
Before full polymerization, ex-
cess facial, interproximal, lingual,
and palatal resin is removed with a
thin probe. This allows preservation
of the provisional prostheses sur-
face characterizations, emergence
profile, and polished surfaces as
fabricated by the dental technician.
e27
Fig 6 With flowable composite resin, the
emergence profile is harmonized with the
more apical portion of the relining acrylic
resin.
The finishing procedure will be
minimal at this point.
After full polymerization, the
provisional restoration is removed
from the mouth and the internal fin-
ish line is highlighted with a pencil.
Any remaining space is filled with
acrylic or composite resin (Fig 6).
The provisional restoration is fin-
ished and polished. The emergence
profile, the gingival scalloping, and
the interdental spaces usually need
little finishing. Especially on the fa-
cial surface, the clinician only needs
to finish the small portion of the pro-
visional restoration corresponding
to the intrasulcular margin, without
removing, carving, or modeling the
excess resin that usually expands to
the middle third of the crowns (Figs
7 and 8). Final glaze is accomplished
by the application of a light-cured
Volume 38, Number 2, 2018
e28
Fig 9 Provisional restorations after
cementation.
nanofilled varnish that seals all the
porosities of the polished surfaces
(Optiglaze, GC). The provisional res-
toration is cemented (RelyX Temp
NE, 3M ESPE) and the occlusion
checked (Occlusionspapier 40 µm,
Bausch; Shimstock 8µm, Coltene)
(Fig 9). The final zirconia-ceramic
prosthesis is placed, and the patient
is followed up for 3 years (Fig 10).
Conclusions
The described relining technique
for periodontally healthy natural
abutments has different clinical ad-
vantages. It saves chair time dur-
ing the clinical procedures, since
the finishing and polishing steps
are shortened due to the small
amount of excess relining material
to be trimmed away; it promotes
tissue integration of the provisional
restoration due to the controlled
depth of the prosthetic margin into
the gingival sulcus and the correct
emergence profile; and it presents
tissue biocompatibility, since the fi-
nal glaze is accomplished in the lab-
oratory and the relining technique
does not interfere with the polished
surface of the provisional prosthesis.
The International Journal of Periodontics & Restorative Dentistry
© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
Fig 10 Final zirconia-ceramic prosthesis at
3 years follow-up.
Acknowledgments 8. Silness J. Periodontal conditions in
patients treated with dental bridges.
J Periodontal Res 1970;5:60–68.
The authors thank Vito Minutolo, CDT, LAB 9. Silness J. Periodontal conditions in pa-
Monza Dental Work, Italy, for the prosthetic tients treated with dental bridges. 2.
work. The authors reported no conflicts of The influence of full and partial crowns
on plaque accumulation, development
interest related to this study.
of gingivitis and pocket formation.
J Periodontal Res 1970;5:219–224.
10. Silness J. Periodontal conditions in pa-
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