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PROVISIONAL
RESTORATIONS RESTORATIONS
Provisional crown or fixed partial denture is a
restoration applied to the prepared tooth
temporarily to protect it and to keep the
patient comfortable during fabrication of the
permanent restoration. It influences the
ultimate success of the final restoration. The ultimate success of the final restoration. The
word provisional means established for the
time being, pending a permanent
arrangement (temporary)
Functions of provisional restoration : -
- Protection
- Positional stability
- Esthetics - Esthetics
- Mastication
-Protection :-
The provisional restoration protects the pulp, the periodontium
and the prepared tooth.
It protects the pulp from thermal and chemical irritation
caused by foods, drinks and dental plaque.
It protects the peridontiumfrom injury by food impaction due
to loss of contact and gingival recession due to loss of to loss of contact and gingival recession due to loss of
normal buccal and lingual contours.
Protects the integrity of the prepared tooth from fracture or
abrasion due to chewing of hard food on unprotected
preparation margins. This is particularly true with partial
coverage designs in which the margin of the preparation is
close to the occlusal surface and could be damaged during
chewing.
-Positional stability: -
To maintain the tooth position and prevent
mesial, distal drift or over eruption which will
change the relation with the surrounding
teeth. teeth.
To maintain the gingival tissue contour,
prevent gingival hyperplasia or gingival
recession.
-Mastication:
To maintain the function of the prepared teeth
and enables the patient to use them in
mastication satisfactorily.

-Esthetic:-
To restore and maintain esthetic especially in
the visible edentulous areas.
Ideal requirements:-
An optimum provisional restoration must
satisfy many interrelated factors which can be
classified as biological, mechanical and
esthetic requirements esthetic requirements
I -Biological requirements :-
- Pulp Protection
- Periodontal health
-Tooth position.
-Tooth Protection against fracture. -Tooth Protection against fracture.
PROVISIONAL RESTORATIONS
REQUIREMENTS
Biological
PULPAL PROTECTION
Thermal changes or
agression agression
Microleakage
POSITIONAL STABILITY
Extrusion or lateral drifting
OCCLUSAL FUNCTION
Patient comfort
Muskuloskeletal stability
PROVISIONAL RESTORATIONS PROVISIONAL RESTORATIONS
REQUIREMENTS
CLEANSABLE
Maintain gingival
health
MARGINAL INTEGRITY MARGINAL INTEGRITY
Not impinging gingival
tissue
Tissue proliferation
Recession
Hemorrhage
Vertical or Horizontal
overhanging margin
II- Mechanical requirements :
-The restoration should be strong enough to
withstand occlusal forces without fracture.
-It should be retentive to avoid displacement
- Easy removal for reuse without being - Easy removal for reuse without being
damaged
III- Esthetic requirements :
The restorations especially those for anterior
teeth should have
-Natural tooth color and contour.
-Natural translucency -Natural translucency
-Colour stability
Materials and procedures :-
Ideal requirements of Provisional restoration materials:
-Ease of handling, adequate working time, easy moldability
and rapid setting time.
-Biocompatibility non toxic, non allergic, non exothermic.
-Dimensional stability during solidification. -Dimensional stability during solidification.
-Ease of contouring and polishing.
-Adequate strength and abrasion resistance.
-Good appearance, color control and color stable.
-Ease of adding to repair or correct.
-Chemical compatibility with provisional luting cements.
Available materials: -
The materials can be divided into four resin groups
. Polymethyl methacrylate ( Jet , Duralay )
. Poly (ethyl, vinyl or isopropyl) methacrylate.
(Unifast L.c, Trim, Snap) (Unifast L.c, Trim, Snap)
. Microfilled composite resin (Protemp).
. Light cured microfilled urethane
dimethacrylate (Triade)
The light cured materials have two
advantages:-
-The ingredients are mixed by the manufacture
so show little porosity. so show little porosity.
-Working time is unlimited.
Single provisional crown may be
custom made or preformed
Resin Cellulose acetate
Polycarbonate
Metal Aluminum (anatomic)
Aluminum shell
Tin silver (anatomic)
Nickel chromium (anatomic)
These preformed crown forms are
commercially available; they can not satisfy
the requirement of a provisional restoration,
so they must be lined with autopolymerizing so they must be lined with autopolymerizing
resin. They are available in a variety of tooth
types and sizes.
PROVISIONAL RESTORATIONS
TYPES
PREFABRICATED (crowns)
Aluminum cylinders
Anatomical metal crown forms
Clear celluloid shells
Tooth coloured polycarbonate Tooth coloured polycarbonate
crown forms
CUSTOM (crowns or fixed
partial dentures)
Material (variety of resins)
Technique (direct or indirect)
-Polycarbonate crown:
Suitable for anterior teeth as it is constructed
from a color stable resin, but available in only
one shade, this can be modified to a limited
extent by the shade of the lining resin. They extent by the shade of the lining resin. They
are supplied in incisor, canine and premolar
tooth type.

Steps:-
*Measure the mesiodistal width of the crown using the mold
guide provided with the kit and select the shell having the
same width or slightly larger width, and place it on the
prepared tooth.
*Mark the crown height on the shell which is equal to the
incisocervical height required for the completed crown using a incisocervical height required for the completed crown using a
pencil.
*The excess gingival length is trimmed away with an acrylic bur
following the curvature of the prepared cavosurface margin.
*Try the shortened shell on the prepared tooth and adjust it if
required until it becomes properly positioned without forceful
gingival contact.
*Apply a uniform thin coat of petrolatum to the prepared tooth
and adjacent tissues (or on the fast set plaster cast)
*Mix the auto polymerizing resin with the proper shade, fill the
shell and place it over the prepared tooth using the adjacent
teeth as a guide for complete seating.
*Immediately remove any marginal excess and when the rubbery
stage is of polymerization reached ( after min ) rock the stage is of polymerization reached ( after min ) rock the
crown faciolingually to loosen it then remove it to avoid its
difficult removal if complete polymerization taken place in the
mouth .
*Put it in warm water to polymerize ( min) then adjust the
margins, contour it if required, adjust the occlusion and polish
it to be ready for cementation.
-Cellulose acetate:
* Available for all teeth types and sizes
*Made from thin (.-.) transparent shell.
* Provide mold to form P.R.
*Does not bond chemically or mechanically to the resin.
* The shade depends on the lining resin. * The shade depends on the lining resin.
*After the polymerization the crown is peeled off
*Usually need addition to reestablishing the proximal contact
*Less esthetic than poly carbonate crown
*It is less expensive
Steps
The crown form is selected and adjusted as
polycarbonate crown but the margin can be
cut with scissors.
Fill the crown with resin as described before, Fill the crown with resin as described before,
but there is no bond between then so it should
be removed from the set material and the
contact area need addition after that to get
proper contact.
-Aluminum / crowns and Tin-
silver: -
Suitable for posterior teeth Aluminum crown may be
anatomically shaped or non anatomical shells resembling tin
cans which are the least expensive form, but they require
modification and lining with acrylic resin to achieve
acceptable fit, good occlusal and axial surfaces .They are acceptable fit, good occlusal and axial surfaces .They are
fabricated from soft material, this softening cause rapid wear
of the crown, So used as a temporary coverage for short time
only.
Steps:-
*Measure the mesiodistal width of the crown
space and select a suitable shell.
*Measure the occlusocervical height and trim
the shell cervically using a pair of scissors. the shell cervically using a pair of scissors.
Sharp edges left by the cutting should be
smothered with green stone.
*Put the trimmed shell over the prepared tooth,
if any gingival blanches is observed, the shell
should be trimmed further.
*After marginal adjustment, ask the patient to
occlude, the soft aluminum will deform until
normal intercuspation is reached. Contouring
pliers can be used to make small size
modifications. modifications.
*Apply petroleum to the prepared tooth and
adjacent tissues, mix self cure resin and fill the
shell when it reaches the correct stage.
*Put the shell over the tooth, instruct the patient to
close and immediately remove the marginal excess.
*Remove it from the mouth at the rubber stage (after
min) loosen the crown and remove it. Allow it to
completely polymerize in warm water then finish the
margins, adjust the occlusion and polish it. margins, adjust the occlusion and polish it.
*If the contact area is deficient, resin can be added to
correct it after grinding of metal in the contact area
to allow resin to resin bond.
*Polish, clean and cement the restoration.
-Nickel-chromium crowns: -
Used mainly for deciduous teeth without lining
with resin. They are trimmed and adapted
with contouring pliers and cemented with high
strength cement. They are longer-term strength cement. They are longer-term
provisional restoration due to their hardness.
Custom made provisional single crown:
May be constructed by
Indirect
or or
direct
method using resin material.
I- Custom made indirect
provisional restoration :
In this technique the provisional is constructed
outside the mouth so it has the following advantages
over the direct technique:
-There is no contact of free monomer with the -There is no contact of free monomer with the
prepared tooth or gingiva, which might cause tissue
damage, allergic reaction or sensitization.
-The prepared tooth is not subjected to heat created
from the exothermic reaction of resin which might
cause irreversible pulp damage.
The marginal fit of indirectly constructed provisional
is better due to its complete polymerization
undisturbed on the stone cast, while the direct
construction necessitate the removal of the
restoration from the mouth while it is in the rubber
stage before complete polymerization to avoid its
locking into the undercuts. Polymerization outside locking into the undercuts. Polymerization outside
the mouth without a supporting form will result in
distortion and improper fit..
-The indirect technique reduced the chair time and can
be carried out by a well trained assistant; this
minimizes the disturuption in the office schedule and
earns the patients appreciation.
Steps:
*The study cast is constructed from alginate impression before
preparation.
*If the tooth or teeth to be restored has any obvious defect, it
should be corrected on the study cast with red utility wax.
* Fill all the embrasures with wax or putty to eliminate
undercuts.
*Construct the rubber base index for the tooth to be prepared or *Construct the rubber base index for the tooth to be prepared or
the index may be constructed from the patient mouth if the
tooth or teeth are intact.
*Upon completion of the preparations, make alginate
impression for them and pour it in fast-setting plaster.
* After setting, trim the cast so that it includes only one tooth
on either side of the prepared tooth.
*Try-in the index to verify its fit on the fast setting stone cast,
coat the cast with separating medium.
* Mix the temporary acrylic resin in a dappen dish and put some
on the protected areas of the cast, such as interproximal
spaces and in grooves and boxes.
*As the resin begins to lose its surface gloss and become slightly
dull, fill the index, place it over the cast and wrap rubber dull, fill the index, place it over the cast and wrap rubber
bands around them, taking care of proper alignment.
*Excessive force can over seat the cast resulting in provisional
restoration with thin occlusal surface. Also uneven force can
torque the cast to any side resulting in deficient provisional
restoration.
Put them in pressure pot if available or warm water to
accelerate polymerization (hot water causes boiling
of the monomer porosity).
*The restoration is then removed from the cast, if it is
not easily removed from the cast; break the cast with
a heavy laboratory knife.
*The provisional restoration is then finished using
acrylic burs, sand paper discs with different grits.
Finally the restoration is polished with pumice, rag
wheel and rubber cups to be ready for cementation.
II- Custom made direct provisional
restoration :
The rubber index filled with the acrylic resin is seated on
the prepared teeth directly in the patients mouth, so
this technique has significant disadvantages as:
*potential tissue trauma from the big amount of
polymerizing resin (pulp, gingiva)
*Poor marginal fit.
Therefore, the routine use of directly formed
provisional restoration is not recommended
FABRICATING PUTTY MATRIX
FABRICATING PROVISIONAL
FABRICATING PROVISIONAL
FABRICATING PROVISIONAL
FABRICATING PROVISIONAL
FABRICATING PROVISIONAL
FABRICATING PROVISIONAL
FABRICATING PROVISIONAL
FABRICATING PROVISIONAL
FABRICATING PROVISIONAL
Cementation :
The primary function of provisional luting
agent is to provide a seal, preventing marginal
leakage and pulp irritation. The luting agent
should not provide retention and resistance should not provide retention and resistance
against occlusal and lateral forces because it is
of low strength
Ideal properties of provisional
luting agent.
- Provide seal against leakage and oral fluid.
- Of adequate strength.
- Low solubility.
- Chemical compatibility with provisional polymer.
-Ease of manipulation. -Ease of manipulation.
- Adequate working time and short setting time.
- Compatibility with definitive luting agent and has an
obtunding effect on the pulp.
- Ease of removal of excess.
Procedures :-
Lubricate the external surface of the restoration with
petrolatum to facilitate removal of excess cement.
Mix the two pasts and apply a small quantity just
occlusal to the cavosurface margins avoid filling the
crown with cement because it will provide hydraulic crown with cement because it will provide hydraulic
pressure and will force excess material in the sulcus.
Seat the restoration and allow the cement to set
them remove the excess from the gingival crevice
with an explorer and from interproximal spaces by
dental floss.
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