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PROVISIONAL RESTORATIONS

IN
FIXED PARTIAL DENTURES.

REJI P G
III MDS

INTRODUCTION

Provisional restorations are protype on which


functional, occlusal & esthetic adjustments are
made to optimize the definitive prosthesis.

They enhance the prognosis of the definitive


restoration as well as assist in the preparation
of the oral cavity for the definitive restoration.

DEFINITION

Provisional:- means establish for a time being.

A fixed or removable prosthesis, designed to enhance


esthetics, stabilization &/or function for a limited period of
time, after which it is to be replaced by a definitive
prosthesis(GPT-8).

Synonyms

Provisional

Transitional

Interim

Term temporary : controversial & inappropriate

(As provisional restorations serve many


functions and temporary treatment may be
interpreted as of lesser importance)
Rosenstiel, Contemporary fixed prosthodontics. 3rd edition.

FUNCTIONS

Comfort.

Occlusion and positional stability

Function

Gingival health and contour

Aesthetics

REQUIREMENTS

BIOLOGIC

MECHANICAL

ESTHETIC

BIOLOGIC REQUIREMENTS

PULP PROTECTION:
It must seal and insulate the prepared tooth surface.

Margin (well adapted)

prevent saliva leakage

BIOLOGIC REQUIREMENTS

PERIODONTAL HEALTH

To facilitate plaque removal a provisional


restoration must have:
- Good marginal fit,
- Proper contour and
- A smooth surface.

Gingival tissue impingement


Ischemia
Localized inflammation or necrosis

BIOLOGIC REQUIREMENTS

c) OCCLUSAL COMPATIBILITY AND


TOOTH POSITION

It should establish or maintain proper contacts with


adjacent and opposing teeth.

Inadequate contacts :

Supra eruption

Horizontal Movements.

proper proximal contact

Horizontal migration

BIOLOGIC REQUIREMENTS

d) PREVENTION OF ENAMEL
FRACTURE
The provisional restoration should protect crown

preparation margins.
In partial coverage designs fracture may occur.

2)MECHANICAL REQUIREMENTS
Greater stresses occur during chewing.

To reduce the risk of failure

connector size must be increased compared to definitive restorati

3)ESTHETIC REQUIREMENTS
Esthetic concern: incisors, canines and premolars

Used as a guide

optimum esthetics in definitive

restoration.

It is shaped and modified until its


appearance is mutually acceptable
to the dentist and the patient.

CLASSIFICATION
1. Mode of Fabrication
:

Prefabricated.

Custom made.

2. Technique involved in fabrication:


.

Direct technique.

Indirect technique.

Indirect - Direct technique

3. Duration of use:

. Short Term
. Long Term

Type of materials used for provisional


restorations

Resin based
Provisional
Restoration

Metal
Provisional
Restoration

Mode of fabrication: (Preformed)


Available as prefabricated crowns in various sizes

ADVANTAGES

DISADVANTAGE
Rarely satisfies the

Less time consuming.

requirement of

Available in various

contours.

sizes

It has to customize
with self-cure resin.
Limited to single tooth
restoration

POLYCARBONATE CROWN

First described by Charles et al in 1973

Most natural appearance

Supplied in incisor, canine and premolar tooth

Advantages:

Esthetics

Readily available

Save chair-side time

CELLULOSE ACETATE

Thin [0.2 0.3 mm] transparent material.

Available in all tooth types and range of sizes.

Does not chemically or mechanically bond to the


inside surface

so after polymerization the shell is peeled off.

METAL

Metallic crowns include


the crowns made from:
Aluminium,
Tin-silver,
Nickel-chromium.

CUSTOM FABRICATED MATERIALS

A negative reproduction of patients teeth before


preparation
or a modified diagnostic cast is obtained.

Materials

1. Chemically activated acrylic resin.


2. Heat activated acrylic resin
3. Light activated acrylic resin.
4.Dual light and chemically activated acrylic resin

MODE OF FABRICATION- (CUSTOM


MADE)
ADVANTAGES

Minimum interference

Helpful in evaluating the adequacy of tooth


reduction.

DISADVANTAGES

Additional lab procedure involved.

Time consuming.

METHACRYLATE RESINS

Poly methyl methacrylate first appeared around 1940.

Is extremely stable but absorb water by a process of


imbibition.

Plant et al found- Intrapulpal


temperature rise is 5 times that
associated with the normal
consumption of thermally hot liquid.

ADVANTAGES
DISADVANTAGES
Durability

Exothermic heat.

Color

stability and esthetics

Polymerization shrinkage

Good

marginal adaptation

Poor wear resistance

Capable

of high polish

Pulpal irritation associated


with excess free monomer

Relatively

inexpensive

Strong odour

COMPOSITES:

Composite provisional materials are chemically combination


of 2 or more types of material.

Uses Bis-acryl resin hydrophobic material similar to Bis-GM

Bisacryl Composite
less heat and shrinkage during polymerization
a better marginal fit.

ADVANTAGES
DISADVANTAGES
Good surface hardness
Easy to use

Expensive
Brittle

Low exothermic reaction Alterations and repair difficult


Low polymerization shrinkage
Good marginal adaptation

Good wear resistance


Minimal pulpal irritation

Poor stain resistance


Less polishability
Poor handling characteristics

Poor color stability

VISIBLE LIGHT POLYMERIZED RESIN:

Introduced in the1980s.

Require the addition of urethane dimethacrylate

Visible light energy and a camphoroquinone /amine


photo initiator.

Filler such as micro fine silica is used.

ADVANTAGES
DISADVANTAGES

Low temperature change

Poor marginal fit

Good color stability

Brittle

Good surface hardness

Poor stain resistance

Good wear resistance

Limited shades present

Good transverse strength

Relatively expensive

CLINICALLY RELEVANT PHYSICAL PROPERTIES

1.
.

STRENGTH AND RIGIDITY:

Poly methyl methacrylate

greatest

strength.
.

Bis acrylic resins

highest modulus of

elasticity.
.

Flexural strength: PMMA resin >composite


resins.

REINFORCEMENT:

Materials used:

Metal, Glass, Carbon graphite,


Sapphire, Polyester and Rigid polyethylene.

Baldissara et al :solid carbon epoxy framework .


flexure,

retention and

structural integrity.

EXOTHERMIC REACTION:

Chemicals may coagulate or dissolve cell


protoplasm.

PMMA has the highest temperature rise during


setting.

Visible Light Cured urethane dimethacrylate


exhibits less polymerization temperature than
other resins

COLOR STABILITY:

Discoloration can produce serious esthetic


complication.

Porosity and poor surface quality :- unesthetic


appearance.

Yannikakis et al - After 1 month use, methyl


methacrylate materials exhibited best color stability
and composite the worst.

PROCEDURES
The mold cavity is created by two correlated parts:

The external contour of crown or fixed partial


denture:- External surface form (ESF)

The other form the prepared tooth surface and


(when present) the edentulous ridge contact area:Tissue surface form (TSF)

DIRECT TECHNIQUE
The prepared teeth and tissues directly provide the tissue
form.

Techniques available are:

1.

Shells (proprietary or custom)

2.

Matrices ( formed directly in mouth or indirectly on cast)

3.

Direct syringing

MATRICES:
There are three main types of matrices :
1.

Impression :reusable(elastomers).

2.

Vacuum formed thermoplastic : clear

3.

Proprietary celluloid : single provisional crown

CUSTOM SHELLS:

Beaded acrylic shell


Mill Crowns

DIRECT SYRINGING

Polyethylmethacrylate materials are best.

This material undergoes decrease in viscosity at


high rates of shear, as when passed through a
syringe nozzle.

DIRECT TECHNIQUE

Advantage : less time consuming as the


intermediate
steps of indirect technique are eliminated.

Disadvantages :
- Potential tissue trauma from the polymerizing
resin, and
- Inherently poor marginal fit.

Indirect Procedure
Impression of the prepared teeth is poured in quick-setting
gypsum :

Avoid exposure of patient to adverse properties of resins

Optimize the properties of resins

Make significant contour or occlusal changes

Provide scope for the fabrication of hybrid provisional


restorations.

INDIRECT TECHNIQUE

Advantages:

1.

No contact of monomer with the prepared tooth or


gingiva.

2.

Avoids subjecting a prepared tooth from the heat


created from polymerization.

3.

Marginal fit is better .

4.

Comfortable to the patient

INDIRECT-DIRECT TECHNIQUE
Indirect component produces a custom-madepreformed ESF.

Custom ESF is obtained from unprepared diagnostic


cast.

The mold is lined with resin after tooth preparation .


This last step is the direct component of the
procedure

2
CUSTOM INDIRECT-DIRECT
PROVISIONAL FPD
3

4
5

Advantage:

Chair side time is reduced.

Less heat generated in mouth.

Contact between the resin monomer and soft


tissue is minimized.

to summarize..

Interim restorations provide the clinician with valuable


diagnostic information.

They act as a functional and esthetic try-in and serve


as a blue-print for the design of the definitive
prosthesis.

A prosthdontist must never rationalize that acrylic resin


provisional restoration is only temporary, a mindset
than can easily lead to failure of treatment goals

REFERENCES

Phillips Science of dental materials. Eleventh edition

Rosenstiel, Contemporary fixed prosthodontics. 3 rd


edition.

Shillingburg, Fundamentals of fixed prosthodontics. 3 rd


edition. Journal of Prosthetic Dentistry;1984;51;192

Journal of Prosthetic Dentistry;1989;61;266

Journal of Prosthetic Dentistry;1989;62;622

Dental Clinics of North America; 2004;48;487

Thank you.

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