TEMPORIZATION

- Dr. Poly Sonowal

II MDS

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CONTENTS
■ DEFINITION
■ RATIONALE
■ PROPERTIES
■ IDEAL REQUIREMENTS
■ TYPES
■ TECHNIQUES
■ PROVISIONAL LUTING CEMENTS
■ REMOVAL OF PROVISIONAL RESTORATION
■ LIMITATIONS
■ CONCLUSION
■ REFERENCES

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DEFINITION

■ A fixed or removal prosthesis designed to enhance

esthetics, stabilization and function for a limited
period after which it is to be replaced by definitive
prosthesis.

SYNONYMS
■ Temporization
■ Interim prosthesis
■ Provisional prosthesis
■ [provisional - established for time being] which it
is to be replaced by definitive prosthesis.

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RATIONALE FOR PROVISIONAL
TREATMENT
Protect prepared
Provide method for abutments from Protect soft tissues -
immediately replacing thermal, chemical, gingiva, tongue, lips &
missing teeth. mechanical and cheek.
bacterial insults.

Provide comfort Evaluate and reinforce

Prevent migration of
function and Improve the patient's oral home
abutments.
esthetics. care

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DESIRABLE PROPERTIES

• Biocompatibility
• Pleasing esthetics
• Dimensional
stability
• Ease of fabrication
• Fracture
resistance
• Nonporous
• Contourable

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IDEAL REQUIREMENTS OF PROVISIONAL
RESTORATION

■ THREE BASIC REQUIREMENTS :

Biologic Mechanical Aesthetic

requirements requirements requirements

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 MECHANICAL ESTHETIC
BIOLOGIC

Pulp protection Resist Functional load Contourable

Periodontal health Color stability
Occlusal compatibility Resist Removal forces
Maintain inter-abutment Translucent
Tooth position
alignment Texture
Protect against fracture

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9
TYPES OF PROVISIONAL
RESTORATIONS

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I. DEPENDING ON METHOD OF FABRICATION:

1. CUSTOM TEMPORARIES :

Made with a matrix derived from original tooth or a modified diagnostic cast or by
cad/cam.

Advantage:

•Minimal interference.
•Wide variety of materials can be used.
•Helpful in evaluating the adequacy of tooth reduction

Disadvantage:

•Additional lab procedure involved.

•Time consuming.

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2. PREFABRICATED TEMPORARIES:

These are preformed crowns that may be modified to fit a prepared tooth.
In most cases these requires relining with an acrylic material.

Advantage:

- Less time consuming.

Disadvantage:

•Rarely satisfies the requirement of contours.

•It must customize with self-cure resin.
•Generally limited to single tooth restoration

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II. DEPENDING UPON THE TYPE OF MATERIAL USED

A) Resin based Provisional Restoration

• Cellulose acetate
• Polycarbonate
• Polymethyl methacrylate: chemically activated resin.
• Poly-R-methacrylate: R group could be ethyl or isobutyl form of resin.
• Micro-filled Composite: BISGMA
• Urethane di-methyl acrylate: light-cured resins

B) Metal Provisional Restoration

• Aluminum
• Nickel - Chromium
• Tin - Silver

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ACRYLIC RESINS: (Methyl methacrylate, Ethyl methacrylate or Vinyl
methacrylate) - SNAP, DPI, Trantemp, Biolon, Bosworth Trim 11.

One of the oldest material available as powder & liquid.

Advantages :

• Good wear resistance & available in many shades.

• Capable of high polish & less expensive.

Disadvantages :

• Significant amount of heat given off by exothermic reaction.

• High degree of shrinkage (about 8%).
• Pungent odour.

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 DPI TOOTH COLOURED SELF CURE RESIN
FEATURES :
• Close reproduction to natural tooth
• Self Cure
• Available in variety of shades (A-J)

DESCRIPTION:
• A fine acrylic material in a wide range of shades for crown and bridge work.

ADVANTAGES:
• Used for precise crown and bridge work.
• Close reproduction to natural tooth
• Leads to improved mechanical, physical, and biocompatibility properties.

PACKAGING:
• Single pack contains 10g of DPI Self-Cure Tooth moulding powder

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 The DPI Selfcure Tooth Moulding Powder does
not follow the Vita shade system

DPI SHADES
The DPI Selfcure Tooth Moulding Powder offers
shades from A to F in self-cure TMP, with Shade
A being the lightest and subsequent shades
becoming darker.

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BIS - ACRYL MATERIALS (20 years old)

• Bis-acrylics are multi-functional dimethacrylate materials capable of

cross-linking.

• Can be categorized into two groups: UDMA and bisphenol A-glycidyl

methacrylate (Bis-GMA).

• Less heat generation and shrinkage ,water sorption, minimal odour.

• Faster setting time, better mechanical properties - so fabricated more

efficiently with greater predictability.

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VISIBLE LIGHT CURED RESINS: (sets on command)

• Based on UDMA (urethane di-methacrylate).

• Has good mechanical properties & colour stability.

• Available in variety of shades.

• Marginal fit is good as there is less polymerization shrinkage.

• Operator has the advantage over control of the working time as it is light cured.

• Expensive and stains overtime.

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 REVOTEK®
LC
• A new light-cured, single-component, sculptable composite
resin for temporary inlays, onlays, crowns, veneers and bridges.

• Each REVOTEK® LC Putty Stick contains enough material to

fabricate approximately 30 average size crowns.

• The Introductory Set contains: one putty stick of REVOTEK®

LC, one lightproof storage case and one GC plastic spatula (No.
2)

https://www.gc.dental/america/products/operatory/temporary-restorative-systems/revotek-lc#product-contact-form 19
Why choose REVOTEK® LC ?

• Single-component composite resin

• Ideal consistency

• Light-cured

• MMA-free

• Light-proof storage

• Simple cementation

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CAD - CAM MILLED RESIN BLOCKS:

• Superior marginal fit - lowers the risk of bacterial contamination of the

tooth and prevents damage to pulp from excessive temperature changes.

• Stronger and more accurate (industrial polymerized).

• Good mechanical properties.

• Serves as a solution for long-term/Long-span interim prosthesis where

strength and colour stability is required.

• Easy to manipulate.

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III. DEPENDING UPON THE TECHNIQUE OF FABRICATION:

1. Provisional Restorations fabricated using direct technique : these are

constructed with a matrix lined with provisional material that is placed
directly on the prepared tooth

2. Provisional Restorations fabricated using indirect technique: constructed

by placing the filled matrix over a model of the prepared tooth, thus the
provisional is constructed out of the patient's mouth

3. Provisional Restorations fabricated using direct - indirect technique made

by forming a temporary in an indirect manner on mock prepared model
and then relined directly in patient's mouth.
This method is useful in constructing temporary bridges.

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 Direct - faster for routine provisional restorations.
DIRECT
VS
INDIRECT Indirect can save time with multiple units or
VS complex fixed partial dentures.

DIRECT
INDIRECT Indirect-direct provisionals can be fabricated in
advance of the tooth preparation appointment.

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IV. DEPENDING ON DURATION OF USE:

a. Short term provisional, for use up to 2 weeks

• Indicated after tooth preparation in FPDs.

• Custom made using acrylics or composite based materials.

• Relined polycarbonate or aluminium preformed crowns

b. Long term provisional, for use from 2 weeks to a few months

• Full mouth rehabilitation.

• In patients undergoing orthodontic, endodontic, periodontic, implant treatment, in presence of

deciduous teeth.

• Benefits vs value decisions in medically compromised elderly.

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EXTERNAL SURFACE FORM

The external contour of the crown is known as External Surface Form

(ESF).
There are two categories : Custom
Preformed

CUSTOM

A custom is a negative reproduction of either the patient’s teeth before

preparation or a modified diagnostic cast.

PREFORMED

Various preformed crowns are available commercially.

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INTERNAL SURFACE FORM (1SF)

Prepared tooth surface is known as Internal Surface

Form.

It can be obtained by three methods :

1. Direct
2. Indirect
3. Indirect - Direct

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 DIRECT
TECHNIQUE

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 Patient's prepared teeth and the gingival tissues directly provide the internal surface
form.
 Eliminates all intermediate laboratory procedures.
Disadvantage:
• Potential tissue & pulp trauma from exposed dentinal tubules from the exothermic
heat of polymerizing resin.
• Formation of voids.
• Inherently poorer marginal fit.

Therefore, directly formed interim restoration limited for single crowns, indirect
techniques for multiple units.

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Acrylic tooth is placed in the area of missing tooth.

Alginate impression or a putty index is made.

Patient's teeth is prepared & lubricated with petroleum jelly

(including adjacent tooth & gingival margins).

Index or alginate impression is reseated with provisional

restorative material (dough stage).

Remove and reseat followed by finishing, polishing & cementation

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 INDIRECT
TECHNIQUE

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 Involves fabrication of the interim restoration outside the mouth.

MERITS:

• No contact of free monomer with the prepared teeth or gingiva which might cause tissue
damage & allergic reaction or sensitization.

• Avoids subjecting prepared tooth to heat evolved from polymerizing resin.

• Superior marginal fit.

• Frees the patient & dentist for considerable amount of time. (fabricated in lab)

DEMERITS :

• Increased time & number of intermediate steps.

• Inadequacy of assistants or the laboratory facilities.

• Possible damage of diagnostic casts

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PROCEDURE:

Acrylic tooth placed on missing tooth area of diagnostic cast & putty index is made

Sectional impression made on diagnostic cast

Provisional restorative material is injected into putty index

Fit is checked on the diagnostic cast

Restoration is relined for proper marginal fit

Finishing, Polishing followed by Cementation.

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35
DIRECT – INDIRECT
TECHNIQUE

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This technique produces
• custom made preformed external surface form of the restoration
• internal tissue surface form is formed by underprepared diagnostic casts.

Advantages:
• Reduced chair time (provisional shell is fabricated before patient's appointment)
• A smaller amount of acrylic resin will polymerize in contact with the prepared abutment, resulting
in decreased heat generation, chemical exposure, and polymerization shrinkage compared to the
direct technique.
• Contact between resin monomer and soft tissues is reduced and less chances of allergic reactions.

Disadvantages:
• Potential need of a laboratory phase before tooth preparation
• Adjustments that are frequently needed to seat the shell completely on the prepared tooth.

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PROCEDURE:

Pontic is placed in the area of missing in diagnostic cast & putty index is made with suitable material

Acrylic tooth is removed & abutments are prepared on the diagnostic cast (Preparations should be more
conservative than the eventual tooth preparation and should follow precisely the gingival margins)

Diagnostic cast is lubricated with suitable separating media & provisional restorative material is filled
into putty index & reseated

Provisional restoration must be paper thin & correctly contoured

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 Patient's teeth is prepared in usual manner.

Preformed restoration is tried in patient's mouth (If the amount of tooth reduction is adequate, the
provisional restoration will show optimal marginal fit with no need for adjustment.)

Temporary restoration is relined to perfect the internal fit.

Finishing, polishing and cementation.

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40
Provisional restoration for post & core restorations

• If custom made post and core is to be used, it can be instantly built, and temporary crown be
fabricated on it.

• For cast posts, following measures may be taken:

• A ball pin/wooden wedge placed into the post space and an alginate over impression made
that would pick up the ball pin and then the restoration fabricated on the cast.

• In an alternative technique, a ball pin may be placed into the post space and the restoration
fabricated intra orally using acrylic resin block technique.

• A tooth trimmed in the form of a labial veneer can also be used to serve the purpose.

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 IMPLANT SUPPORTED
PROVISIONAL
RESTORATIONS:
Provisional prosthesis designs for dental implant
patients can vary widely, ranging from a removable
acrylic resin complete/partial denture relined with
soft liner to an implant supported fixed prosthesis.

Several different potential designs that promote

esthetics, convenience, the loading of implants,
tissue contour control, material strength, and interim
prosthesis durability.

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 Provisional fixed
prosthodontic treatment
options for an implant
patient that may vary
depending on the following:

Whether teeth
adjacent to the The desired protocol
The number of
The number, Opposing implant site(s) can for provisional
natural teeth
position, or location occlusion. serve as abutment treatment at either
remaining in a
of the implants. teeth for a first or second stage
treatment arch.
provisional surgery.
restoration.

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PROVISIONAL LUTING MATERIALS:
 Provisional luting agents should possess :
• good mechanical properties.
• low solubility.
• tooth adhesion to resist bacterial & molecular penetration.

 Provide an adequate seal & Sedative effects that reduces dentin

hypersensitivity.

 Strong enough to retain a provisional restoration during the course of

treatment but, allow easy restoration removal when required

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 There are a variety of luting materials used for interim purposes. The most common include:

1. Calcium hydroxide

2. Zinc-oxide eugenol

3. Non-eugenol materials.

Zinc phosphate, Zinc polycarboxylate & GIC - not used.

Because of their comparatively high strength which makes intentional removal difficult.

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Zinc Oxide Eugenol Cement:

It is one of the most used cost-effective temporary luting cement. Because of eugenol it
provides an obtundent effect and anti microbial effect. It has adequate strength. Ease of removal of
restoration.

Disadvantages:

Eugenol - interfere with polymerization of resin.

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Free radical production necessary for polymerization of methacrylate materials can be
significantly hampered by the presence of eugenol, this interference with the acrylic /resin
polymerization and hardening process and softens restoration.

Eugenol interferes with polymerization of resin cements that are used to fix final restoration.

Eugenol used in cementation of temporary restoration can penetrate into dentine and might affect
adhesion of resin cements

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 Therefore, eugenol free provisional luting materials
containing essential oils are commercially available and
have gained popularity.

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REMOVAL OF
PROVISIONAL
RESTORATION

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• The provisional is removed when the patient returns for the
definitive restoration or for continued preparation.

• Risk of damage to the prepared tooth can be minimized if

removal forces are directed parallel to the long axis of the
preparation.

• The Backhans or hemostatic forceps are effective.

• Holding lukewarm water in mouth softens luting cement.

• Sometimes it is helpful to loop dental floss under the connector

at each end of the FPD, providing a more even force
distribution for removal

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LIMITATIONS OF TEMPORIZATION :
1. Lack of Inherent Strength: - fractures in long span coverage in patients with bruxism or a
reduced interocclusal clearance, if the bulk is increased, the patient’s discomfort is evident.

2. Poor Marginal Adaptation

3. Colour Instability: This is apparent when temporary restorations are placed for an inordinate
time.
4. Poor Wear Properties: Teeth will drift or torque if the patient places heavy occlusal stresses
upon the interim coverage.

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5. Detectable Odour Emission: - This is undeniable despite the dentist's
close attention to sufficient embrasure spaces. Resins are porous.

6. Inadequate Bonding Characteristics: - Few types of cement currently

secure an adequate interface relationship with resins. Eugenol - bearing
sedative cements are notorious for incompatibility with methyl
methacrylate resins.

7. Poor Tissue Response to Irritation: - Mild or moderate tissue irritations is

always present.

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 To quantify the temperature changes in the pulp chamber using different provisional
Purpose: restorative materials.

To evaluate the peak temperature time of different materials used.

To compare the intrapulpal temperature changes with a variation in the width of the
finish line.

Piplani A, Sajjan MS, Ramaraju AV, Tanwani T, Sushma G, Ganathipathi G, Jagdish K, Agrawal A. An in-vitro study to compare the temperature rise in the pulp chamber by direct method using three different
provisional restorative materials. The Journal of Indian Prosthodontic Society. 2016 Jan 1;16(1):36-41. 53
 METHODOLOGY
Two intact mandibular molars were selected and designated as Specimen A and B.

Tooth preparation was done to prepare a finish line of 1.2 mm and 1 mm width, respectively.

Three provisional restorative materials were considered, and they were grouped as :
• Group I-Cool temp
• Group II-Protemp-4
• Group Ill-Integrity

A J thermocouple probe was placed into the pulp chamber to determine the rise in temperature.

The temperature was recorded during polymerization at 30-s intervals until the peak temperature was reached.

The same procedure was repeated for fabricating remaining provisional crowns.

A total of 45 provisional crowns were fabricated for each specimen.

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• To standardize the tooth preparation, an airotor straight headpiece (NSK–JAPAN) was mounted
onto the vertical arm of the dental cast surveyor (SaeYang)

• Preparation was done carefully watching the tip of the diamond point to the complete depth. This
resulted in 1.2 mm shoulder on Specimen A and 1 mm shoulder on Specimen B, respectively.

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• The prepared teeth were evaluated with the index for uniform
reduction.

• The dimensions of finish line and uniformity were confirmed by

observing under a stereomicroscope (Olympus SZX 16).
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• Each Tooth was then embedded in square acrylic
resin block along with thermocouple
• The tooth was placed in a water bath (Dalal tissue
water bath) containing distilled water of 37°C
temperature to equilibrate the tooth temperature
with oral temperature
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 Excess resin material
Thin layer of petroleum
The vacuum‐formed was removed, and the
jelly lubricant was
template filled with tooth was placed
The tooth was allowed applied to the total
mixed resin was immediately in the
to thermally equilibrate. assembly to facilitate
positioned on the water bath of 37°C to
removal of provisional
prepared molar tooth. stimulate oral
crowns.
temperature.

After complete The tooth was cleaned to

The temperature polymerization of the remove any resin residue
and was placed in the Both the specimens
change in the pulp resin material, the
water bath again to were stored in distilled
chamber was recorded template was removed equilibrate to 37°C; same water while not being
during polymerization from the tooth and the procedure was repeated to used.
at 30‐s intervals. provisional crown was fabricate the remaining
retrieved. provisional restorations.

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CONCLUSIO Within the scope of this study, bis‐acryl composite resin proved
to be predictable material for the efficient fabrication of
provisional restorations.
N Cool temp showed the least temperature rise in the pulp
chamber.

The order of rise in peak temperatures in the pulp chamber using

provisional materials using a direct technique would be Cool
temp, Integrity, and Protemp‐4, respectively

Peak temperature was highest for Protemp‐4 followed by

Integrity and Cool temp, respectively

A thinner residual dentin compared to Specimen A resulted in

higher intrapulpal temperature rise.

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 CONCLUSION

• Successful temporary restorations are pillars for successful final

restorations.
• Clinical techniques and indications are reasonably well characterized, but
future research activities will need to focus on technological
advancements to provide improved materials that demonstrate improved
biocompatibility, physical properties, ease of use and esthetically
pleasing appearance to the patients.

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REFERENCES

• STEPHEN F ROSENSTIEL. Contemporary Fixed Prosthodontics.

• HERBERT T SHILLINGBERG. Fundamentals of Fixed Prosthodontics.
• TYLAMAN. Theory and practice of Crown and Bridge Prosthodontics.
• Rationale of provisional restoration - J Prosthet Dent 2003;90:474-97.
• Types of provisional restoration - 10SR Journal of Dental & Medical
Sciences 2019 vol18(4)
• Donovan TE, Hurst RG & Campagni WV. Physical properties of acrylic resin polymerized by four
different techniques. J. Prosthet. Dent.
1987;54:794-97
• T. Nigel Town, M.A et al Provisional Restorations : An Overview of material used. Journal of
Advanced clinical & Research Insights 2016;3:212-1

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• Astudillo-Rubio et al. Mechanical properties of provisional dentalmaterials:
A systematic review and meta-analysis. PLoS ONE .2018;13(2): e0193162

• Ishita Dureja et al A comparative evaluation of vertical marginal fit of provisional crowns fabricated by computer aided
design/ computer aided manufacturing technique & direct (intra oral tech) & flexural strength of the materials : An in vitro
study. JIPS 2018

• K.M.Regish, Deeksha Sharma & D.R. Prithviraj. Techniques of Fabrication of Provisional Restoration: An Overview.
International Journal of Dentistry
Volume 2011

• Limitations of temporization - 10SR Journal of Dental & Medical Sciences

2019 vol18(4)

• Piplani A, Sajjan MS, Ramaraju AV, Tanwani T, Sushma G, Ganathipathi G, Jagdish K, Agrawal A. An in-vitro study to
compare the temperature rise in the pulp chamber by direct method using three different provisional restorative materials.
The Journal of Indian Prosthodontic Society. 2016 Jan 1;16(1):36-41.

• Baldissara P CominG, Martone F, Scotti R. Comparative study of the marginal microleakage of six cements in fixed
provisional crowns. J Prosthet Dent
1998;80:417-22

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