Faculty of Dentistry

Fixed Prosthodontics department

Lecture : Provisional Restorations Part -2

Dr : Amr Rizk Date : 27/11/2024

ILOs Intended learning outcomes
1. Classify the different types of provisional restorations
2. Differentiate between the methods of fabrication of
provisional restoration.
3. Know the Advantages and disadvantage of each technique
4. Understand the Cementation protocols & methods of removal
of provisional restorations
Classifications for Provisional restorations

1 According to Duration of use

2 According to the location of tooth

3 According to the fabrication technique

4 According to the material of use

 Classifications for Provisional restorations
• 1) According to duration of use :
• Short term provisional restoration: for few days up to 2 weeks
• Intermediate provisional restoration: more than 2 weeks
• Long term provisional restoration: for months in case of patient undergoing
implant therapy orthodontic stabilization, evaluation & alteration of vertical
dimension.
 2) According to location to the tooth
A. Intra-coronal restorations:
Will be discussed later in “Inlay and Onlay Provisional Technique”

B. Extra-coronal restorations:
1) Ready made “Pre-Fabricated”: -Metal
- Non-metal
2) Custom made
A) EXTRA-CORONAL RESTORATIONS:
1) Ready made “Pre-fabricated”:
for single and multiple units F.P.D

a) Metal crown.
b) Tooth colored (polycarbonate).
c) Clear cellulose acetate crown form.
Pre-fabricated metal crown:
• Select the suitable size: according to the MD width of the Abutment using special divider
gauge.
• cervical extension of the crown shell is cut with curved scissor or cutting stone to follow
F.L.
• Occlusion is adjusted by shaping the metal with ball burnisher.
• Adjustment of occlusal interference by asking the patient to occlude
forcibly must be avoided to prevent any impingement of crown on the
gingiva then cervical margins are smoothed by rubber wheel.

• If poor marginal adaptation or cervical contour, relining the shell by

self cure acrylic resin is required. Courtesy of www.doctorspiller.com

• Excess material is removed polish the margins, and cementation with

temporary cement.
B) Pre-fabricated cellulose acetate crown form
And Poly carbonate Crowns :

1. Select the suitable size according to the MD width.

2.Self-cured A.R is mixed & placed inside the crown &

seated over the prepared tooth.
3. Reseat again to examine & adjust occlusion
then cement with temporary cement.

Protemp
crowns
The celluloid crown form doesn’t bond to the resin , therefore
it is peeled off easily. While, polycarbonate is left.

NB: This will result in loss of proximal contact, therefore

required additional material to be added to these areas. if the
celluloid crown form is left in place it may peel away during
function so, loss of contact will occur.
 Custom made Provisional restoration is better than
ready made…Why?

Because, it produces original tooth morphology &

relation with adjacent & opposing teeth.
 Custom made temporary restoration

• 3) according to fabrication technique:

Direct technique indirect technique IndirectDirect

 I. Direct Technique
• FIRST ➔Make a mould of tooth surface & anatomy before
preparation ….how??

➔ take a putty index directly from the patient's mouth. Or by

forming vacuum formed plastic template, made of the study
cast.
• Mix the desired shade of A.R & place it inside the impression at
abutment then seat the impression on the prepared tooth.

1.Remove the impression in the late polymerization stage why??

because if left until complete polymerization it will be difficult in
removing temporary restoration from undercut area.
2. Remove the excess.

3. Reseat the temporary restoration inside patient's mouth.

 II) Indirect technique for fabrication of custom
made temporary restoration:
In this technique→ resin in adapted on a cast after teeth preparation.

The INDIRECT technique is preferable than DIRECT

technique ?!
→construction of temporary restoration directly on
freshly cut dentin cause THERMAL pulpal irritation;
(heat of polymerization)
CHEMICAL (residual monomer).
Also, the marginal adaptation of restoration on the
Finish line Is BETTER in the INDIRECT technique than
DIRECT ➔ Visibility.
 Finished Temporary restoration

Before After
Recent” InDirect custom made provisionals” are :
Machine fabricated material
• Vita CAD-Temp
• Telio CAD
Ex.VITA CAD-Temp:
▪ Composite blocks for the fabrication of long-term temporary crowns
and bridge up to 2 pontics milled by cerec.

Technique:

The abutment is scanned then designed by the software , milled and

finished then external characterization with composite then final
finishing and polishing.

Advantage: Good Marginal adaptation, polished surface,

biocompatibility and Best color stability.
III] Combination indirect-direct technique:
Temporary bridge can be done in the laboratory on an altered
diagnostic cast prior to clinical tooth preparation.

• On the diagnostic cast, any abutment defects Impression is made for the corrected cast →
is corrected by wax, pontic is established by mold
denture tooth.
Indirect/Direct

a suitable size denture teeth are fixed in the

pontic place using sticky wax.
The upper centrals cannot be preserved.

Vacuum formed matrix is tried intra-orally after tooth

preparation to verify sufficient tooth reduction.
 The amount of clinical teeth preparation is greater than reduction on
the cast ➔ and so is the space between temporary restoration &
prepared teeth.

• Internal adaptation of Temporary restoration RELINING by filling

the bridge by self-curing resin→ seat over the prepared teeth.
• Once impression is taken →wax & denture tooth is removed from the
cast.
• Stone teeth are reduced as preparation & coated with a separating
medium.

Fill the impression • After resin polymerization →thin

with resin in the walled retainer is obtained.
area of prosthesis
& seat over the
cast.
B) Intra-coronal Temporary restoration:
Inlay and Onlay Provisional Technique
An inlay and onlay is fabricated by “Free-hand Technique”.
This technique requires skill to achieve good marginal adaptation and
proper occlusion.
The small size and intricate margins require precise fabrication and
trimming.
OTHER PROVISIONALS:
1) Provisional Over Implant Technique
To fabricate a provisional over an implant ➔ indirect
technique is preferred .
In case of the immediate loading ➔ the temporary restoration
should be OUT OF OCCLUSION to allow the osteo-integration.

-The material used should act as a Shock absorber.

-Studies should that Composite “Protemp 4” acts as a shock absorber

allowing osteo-integration UNLIKE Acrylic resin that recorded a higher
rate of BONE RESORPTION.

In the Delayed loading, The Temporary restoration is more of an

Esthetic requirement.
Temporary restoration for Endodontically treated teeth:
The type of restoration is determined by the amount of the
remaining tooth structure :

• Sufficient remaining tooth structure to give resistance and

retention form ➔Use ready- made temporary crown.
• Little intact supra-gingival tooth structure ➔
-Retention is gained through root canal via a plastic post of a wire.
2)Provisional restoration for laminate veneers :

• Objectives :

• Mainly for esthetic purpose.

• To avoid staining of prepared teeth.
• In case of proximal wrap around design: it prevents tilting
or mesial drifting. While in Incisal wrap around design it
prevents over eruption of teeth.
• Technique :

• Directly with composite resin after spot etching of the tooth away
from the margin.
Zno/e Should be avoided ?! Why ?
• Eugenol inhibits the polymerization of the resin cement
Technique
 According to materials of use
• Chemically-Activated Composites
• include Protemp 3.

• Visible Light-Activated (VLA) Composites:

Revotek LC is a VLA.
Used with intracoronal provisional restorations

• Dual-Activated Composites
One example is Unifast
Acrylic
Disadvantages
• Acrylics exhibit a strong odor also exothermic setting
reaction which could cause pulpal damage if not carefully
controlled.
• In addition, acrylic undergoes significant shrinkage.
 Acrylics (Poly-R’ methacrylates)
• Advantages:
Low cost
Lower level of heat given off during exothermic reaction, as
compared to methyl methacrylates
Lower shrinkage than methyl methacrylates

Disadvantages:
Less esthetic than some current materials
Poor physical properties

snap (polyethylemethacrylate)
Trim and Trim II (polyvinylmethacrylate)
Temp Plus ( polyisoputylmethacrylate)
 Self-Cured
Temporization
Resin Materials
These systems are generally
considered as improvements over
traditional acrylic materials in the
areas of reduced volumetric
shrinkage, heat generation, taste
and odor and physical properties.
• Advantages: Self-Cured Temporization
Low odor Resin Materials
Minimal heat generation
Very good esthetics
Some systems use auto-mix delivery
Can be repaired using composite

• Disadvantages:
Higher cost than acrylic materials
Different handling characteristics than conventional acrylics
Resins form an oxygen inhibited layer
 Visible Light-Activated (VLA) Composites
Advantages :
• unlimited working time
• easy to use(contour ,sculpt ,and shape
• save time and no oxygen inhibited layer

Revotek
• 1/2 the cost of comparable Bis acrylic composite
• No exothermic heat , no odor , no irritation
• Used to freehand fabricate intracoronal provisional
restorations (inlays, onlays, endocrowns, overlays). Reline
a prefabricated crown or bridge or reconstruct a crown.
 Dual-Activated Composites
• One example is Unifast (GCAmerica), TempCare (3M) which
goes through a chemically-activated,rubbery, setting stage and
is then Light activated curing for final set.
 VITA CAD-Temp:

Composite blocks made from acrylate

polymer

• long-term temporary crowns for

oral rehabilitations and Implants
• Used in bridge up to 2 pontics
VITA CAD-Temp:
Vita CAM blocks are Fiber Free called MRP
(Micro Reinforced Polyacrylic )

Multi Color Blocks

 Telio CAD ( Ivoclar Vivadent):

Is a polymethyl methacrylate blocks

Can be done both in chair side or lab side

Flexural strength

durable shade stability

6 shades are available
PolyMethyl MethAcrylate (PMMA)
Monochromatic
PolyMethyl MethAcrylate (PMMA)
Multi-Layer
Advantages:

1. extremely accurate.

2. increased resilience.

3. They have a smooth, life-like

appearance.

4. They are not liable to

discolouration.

5. They do not wear out.

6. They are extremely unlikely to

break.

7. Allow for long term temporization

Disadvantages:

Expensive

Requires a considerable amount of time to be milled and finished

Advantages :
1 Higher strength
2 Dimensional stability
3 Excellent abrasion resistance. CAD-CAM Temp
4 Lasting color stability and esthetics.
5-Radiopaque
6 superior polishing characteristics
7 No generation of polymerization heat
8 No irritation of the gingiva and the pulp by Residual monomers.
9 No time Consuming (No Mix Error or Removing Excess )
Cementation
Remember that eugenol containing cements can interfere with
the setting of acrylic and prevent bonding of the final
restoration. Cements that are light-cured and dual-cured are
also used.
• Isolate
the area with cotton rolls and keep area dry.
• Mix the cement.
• Coat the inside of the crown with cement.
( Be careful not to overfill the crown. This could result in improper
placement and the need for excessive cement to be removed).
• Request patient to bite down.
 Removal of Provisional restoration
• During removal of the provisional
restoration , fracture of the
prepared teeth should be avoided.
• Its done by:
- Backhaus clamp or hemostatic
forceps
• A slight bucco-lingual rocking
motions helps break the cement
seal.
- Ultrasonic with cement-remover
solution

- Opticlean
❖Rotary instrumentation for fast removal of temp.
cement .
❖40 microns aluminum oxide abrasives