8.0 Provisional Resto, Fluid Control, Impression

Question 1

A good provisional restoration should satisfy the following requirements: (7)

Answer 1

Pulp protection
Positional stability
Occlusal Functiin
Ease of cleaning
Nonimpinging margins
Strength and retention
Esthetics

Question 2

Provisional restorations can be classified according to whether they are (2)

Answer 2

prefabricated or custom made

Question 3

include stock aluminum cylinders (“tin cans”), anatomical metal crown forms, clear celluloid shells, and tooth-colored polycarbonate crown forms. They can be used only for single-tooth restorations.

Answer 3

Prefabricated forms

Question 4

can be fabricated of several different kinds of resins by a variety of methods, direct or indirect.

Answer 4

Custom crowns and fixed partial dentures

Question 5

• preferred over for accuracy.
• Remove directly fabricated resin before polymerization to avoid _____________________.
• ________ shrinks approx. ___ when it polymerizes.
• Without ________, distortion and less than optimal fit result.
• Study shows 70% improvement when fabricated ______.

Answer 5

Indirect
locking into undercuts
Polymethyl methacrylate, 8%
supporting form
indirectly

Question 6

• Several types of resins being used:
  o ________________ - has been in use the longest.
  o _________________ – no longer available

Answer 6

Polymethyl methacrylate
Epimine resin

Question 7

• The requirements for a good provisional restoration are most easily and completely met by a ________________________________.
• There are a variety of techniques for making a mold that provides the appearance of a tooth where needed, physiologic axial contours adjacent to the gingiva, occlusion with opposing teeth, proximal contact, and marginal fit.
• The inner surfaces will be shaped by a _________________________(s).

Answer 7

custom indirect restoration
cast of the preparation

Question 8

• Both elastomeric and alginate ______________ have been used to shape the provisional restoration. It is made on the diagnostic cast, or in the mouth, before the tooth preparation is begun. An elastomeric impression provides ________________, but it is more expensive than alginate.
• A _______ formed from clear thermoplastic resin also can be used for this purpose. It is shaped on a diagnostic cast, using a vacuum forming machine or an impression tray filled with silicone putty.
• The template is filled with resin and applied to the prepared teeth or to a fast-setting plaster cast of the prepared teeth. Templates are very stable, and they can be adapted well enough to be used for checking ________________ or starting _____________.

Answer 8

overimpressions
excellent stability
template
preparation reduction
wax patterns

Question 9

• A ________________________ can be made of autopolymerizing resin in an impression prior to the preparation appointment by alternately dripping monomer and gently blowing polymer with an atomizer. The resulting form is relined after the tooth or teeth are prepared. A second shell can be made from the same impression as a spare. The shell also can be heat processed in a laboratory.
• Although an overimpression is shown for making a ______________ and a clear resin template is shown for making a _____________________, they are interchangeable.

Answer 9

thin shell crown or FPD
provisional crown
provisional fixed partial denture

Question 10

 The __________________ remains a popular technique, because it is always readily available in the dental operatory.
 It is easily adapted to intraoral use in the event that the proposed restoration of a tooth with amalgam is unexpectedly re-planned as a cast restoration.
 what does this pertain to?
 It can be made in the patient’s mouth while waiting for the anesthetic to take effect. However, if the tooth to be restored has any obvious defects, it should be made from the ____________
* Defects such as a ______________, should be filled in on the cast.

• After any defects are filled and smoothed over with red utility wax, the diagnostic cast is immersed in a plaster bowl of water for ___________ (Fig 15- 2). Wetting the cast in this manner will keep the alginate from adhering to it.

Answer 10

alginate over-impression
OVER-IMPRESSION FABRICATED PROVISIONAL CROWN
diagnostic cast
missing cusp (arrow)
5 minutes

Question 11

• When the alginate has set, the over- impression is removed from the diagnostic cast and checked for _________
• Trim off all excess alginate. _________________ that replicate the _____________ are removed to insure that there will be no impediments to the complete seating of the cast into the over-impression later. The impression is wrapped in a wet paper towel and placed in a ziplock plastic bag for later use.
• This impression is poured up with a thin mix of _________
• Excess material should be trimmed off on a model trimmer when the plaster has set. The trimmed cast should have at least ___________ on either side of the prepared tooth, if possible. Areas of the cast that duplicate the soft tissues should be ________ as much as possible

Answer 11

completeness
Thin flashes of impression material
gingival crevice
quick-setting
one tooth
reduced

Question 12

• Check the occlusal surfaces and gingival crevices for any __________ that will prevent complete seating. Then ___ the trimmed quick-set plaster cast in the over- impression to make sure that it seats completely
• Coat the prepared tooth and adjacent areas of the cast liberally with a _________________________________. Allow the material to dry before mixing the ________________. Drying can be accelerated by the use of an air syringe.
• Mix tooth-colored acrylic resin in a ____________ with a cement spatula
• Use 12 drops of monomer for each tooth being restored. Place the _____ in the over- impression so that it completely fills the crown area of the tooth for which the provisional restoration is being made
• _____ the cast into the over-impression, making sure that the teeth on the cast are accurately aligned with the tooth impressions. The force used to seat the cast into the alginate impression is critical. ___________ can overseat the cast and __________ can torque the cast, either of which will affect the restoration.

Answer 12

plaster nodules; try
“tin foil substitute” separating medium
acrylic resin
dappen dish
resin
Seat
Excessive force
uneven force

Question 13

• Once the cast has been firmly seated and the excess resin has been expressed, hold the cast in place with a ____________
• It is important that the cast be oriented securely in an upright position so that the _____ between the cast and the impression that is filled with the resin forming the provisional restoration will not be distorted
• If the cast is _________________ by the rubber band, the cast may be forced through the soft resin in some areas, resulting in a provisional restoration that may be thin in those areas and thicker than desirable in others
• If the cast is seated with too much force, or if the rubber band is wrapped around the assembly too many times, the cast may be forced through the resin occlusally, resulting in a provisional restoration with an occlusal surface that is too ____
• Place the over-impression plaster cast assembly in a plaster bowl full of hot tap water for approximately 5 minutes, or into a pressure pot if one is available. Allowing a poly(methyl methacrylate) provisional restoration to polymerize in a pressure pot under 20 psi will decrease _____ and increase the ___________ of the restoration by ____.

Answer 13

large rubber band
space
torqued to one side
thin
porosity; transverse strength; 28%

Question 14

• When the resin has polymerized, remove the rubber band to disassemble the quick-set plaster cast from the over-impression. If the restoration is not easily removed from the cast, break the tooth off the plaster cast with a heavy-bladed laboratory knife
• Use the sharp end of a thin-bladed knife or some other small, pointed instrument to remove any plaster that remains in the pro- visional restoration. ______________ is one of the advantages of using the weak, quick-set plaster.
• ___________________ are used to trim the excess resin from the provisional restoration
• Before attempting to seat the restoration on the tooth, be sure to remove all resin extending beyond the preparation _____________ into undercut areas. Smooth the axial sur- faces near the margins of the restoration with a fine sand paper disc

Answer 14

Ease of removal
Acrylic burs or coarse Moore discs
finish line

Question 15

• Seat the provisional restoration on the tooth in the mouth. Check the occlusion with _______________
• Remove the restoration from the tooth and adjust the occlusal __________ with a non-dentate bur
• When the occlusion has been adjusted, polish the restoration first with _____ and then polishing compound on a muslin rag wheel. Besides making the provisional restoration easier to clean and more comfortable for the patient, ________________ are much less likely to discolor.
• Use a temporary cement of moderate strength. After the zinc oxide-eugenol cement has been mixed to a thick, creamy consistency, an amount of ______ equal to 5% to 10% of the cement volume is incorporated to slightly reduce the strength of the cement. This will facilitate removal of the provisional restoration at a subsequent appointment. If the preparation is short or otherwise lacking in retention, the petrolatum should not be added.
• _____ will accelerate the hardening of zinc- oxide eugenol cement while setting. Coating the outside of the restoration with a thin film of petrolatum prior to cementation will aid in the removal of excess cement. After the cement has hardened, all excess must be removed from the gingival crevice. Use an ____ in accessible areas and dental floss inter-proximally

Answer 15

thin articulating paper
prematurities
pumice
polished material
petrolatum
Moisture
explorer

Question 16

 If FPD is to be made for a patient, the provisional restoration should also be in the form of a FPD rather than individual crowns.
 It is cosmetically better in the _______ region.
 Even in the posterior region, a provisional FPD will better _____ the teeth and will afford the patient the opportunity to become accustomed to having a tooth in the _____________ again.

Answer 16

anterior
stabilize
edentulous space

Question 16

 If FPD is to be made for a patient, the provisional restoration should also be in the form of a FPD rather than individual crowns.
 It is cosmetically better in the _______ region.
 Even in the posterior region, a provisional FPD will better _____ the teeth and will afford the patient the opportunity to become accustomed to having a tooth in the _____________ again.
 what does this pertain to?

Answer 16

anterior
stabilize
edentulous space
TEMPLATE-FABRICATED PROVISIONAL FPD

Question 17

• To make a template, place a __________ or a _______________ in the edentulous space on the diagnostic cast. All of the embrasures should be filled with putty to eliminate undercuts during adaptation of the resin template.
• To facilitate removal of the template, a _________________ can be placed around the periphery of the cast and on the lingual surface of the cast, apical to the teeth
• what does the thin strand of putty pertain to?
• Use a large acrylic bur to cut a hole through the middle of the cast (mid-palatal or mid- lingual). Place a 5 x 5-inch sheet of 0.020-inch- thick resin (____________________________ or transparent Temporary Splint Material) in the frame of the vacuum forming machine with the shiny surface down. If temporary splint material is used, both sides will be _____. Turn on the heating element of the machine and swing it into position over the plastic sheet.
• As the resin sheet is heated to the proper temperature, it will __________ about 1.0 inch in the frame. If you are using coping material, it will lose its cloudy appearance and become completely clear. The cast should be in position in the center of the perforated stage of the vacuum forming machine. Turn on the vacuum.
• Grasping the handles on the frame that holds the heated coping material, forcefully _____ the frame over the perforated stage

Answer 17

metal crown form or a denture tooth
thin strand of putty
rope of Mor-Tight
translucent Coping Material; transparent Temporary Splint Material
shiny
droop or sag
lower

Question 18

• Turn off the heating element and swing it off to the side. After approximately 30 seconds, turn off the vacuum and release the resin sheet from the holding frame. After removing the ______ from the frame, use a laboratory knife with a sharp no. 25 blade to cut through the resin.
• If a vacuum forming machine is not available, it is still possible to fabricate a template for a provisional restoration. Fill a quadrant impression tray with a soft silicone putty available in most variety or toy stores. Cut a sheet of coping material in half and insert it, shiny side down, into a wire frame bent from a coat hanger. Heat the resin sheet over a ________ flame until it sags and becomes clear, which usually occurs in about _______
• Place the softened sheet over the cast
• Forcefully ____ the tray of silicone putty over the coping material
• To accelerate cooling, blow compressed air on the plastic sheet and the impression tray. After about a minute, snap the tray off the cast. If the silicone putty sticks to the resin sheet, the putty can be easily removed by pulling it off in quick jerks. Rapid separation causes the silicone putty to exhibit brittleness that will result in easy removal. Replace the putty in its original container for later reuse. Separate the _____ from the diagnostic cast.
• Trim the template, however it was fabricated, with a pair of scissors. It should extend at least one tooth on either side of the prepared teeth. Save those portions not needed for possible later use.

Answer 18

resin sheet
Bunsen burner
10 seconds
seat
template

Question 19

• Upon completion of the preparations, make an ______________ of them and pour it in fast-setting plaster. The plaster cast will include replicas of soft tissue and teeth that are not needed
• Trim the cast so that it includes only one tooth on either side of the prepared teeth. ____ on the template to verify its fit
• Coat the cast with _________________ and allow it to dry. Mix the acrylic resin in a dappen dish and place some on protected areas of the cast, such as ______________ and in _____ and ____
• As the resin begins to lose its surface gloss and becomes slightly dull, fill the area for which the _______________________ is being made. Place some extra bulk in the portion that will serve as the ____.

Answer 19

alginate impression
Try
Alcote separating medium
interproximal spaces; grooves; boxes
provisional fixed partial denture
pontic

Question 20

• Wrap ________ around the template and cast, being careful not to place them over the ____ preparations, lest they cause the template to collapse in that area
• Place the cast in a pressure pot if one is available. Otherwise, place it in ____ (not hot) tap water to hasten polymerization. Hot water causes the monomer to boil, increasing ______. Wait for about 5 minutes. Pry off the template and save it in case it is needed again.
• Before removing the provisional restoration from the cast, add resin to any voids or thin spots and place the cast back in warm water. Do not replace the _____ for this correction. Placing the unpolymerized resin back into water will prevent evaporation of monomer and the formation of a _____________ surface.
• Remove the _____________ from the cast. Do not hesitate to break the cast if necessary. Trim off the excess acrylic resin. Use discs to trim the axial surfaces down to the margins. The pontic should be trimmed with discs and burs to open up the ___________

Answer 20

rubber bands; abutment
warm; porosity
template; granulated, “frosted”
fixed partial denture
proximal embrasures

Question 21

• Remove the _____ configuration that was created by the crown form in the edentulous space. The pontic should have the same general shape that the pontic on the permanent prosthesis will have. This will insure that the patient will be comfortable and satisfied with the pontic form before the completed fixed partial denture is inserted.
• Fabricate a template on the diagnostic cast. If the restoration is to be a fixed partial denture, set a metal crown form or denture tooth in ________ in the edentulous space. If a diagnostic ______ has been made, soak the cast for 5 minutes and duplicate it with an alginate impression. Pour the impression in quick-set plaster.
• Produce a template from a resin sheet on the __________________. Trim the template and replace it on the cast. Mix a scoop of silicone impression putty with accelerator (Citricon, Kerr Manufacturing Co) and mold it around the template on the cast (Fig 15-42). This is needed to reinforce the unsupported template and prevent _________ by the highly viscous resin later.
• Make an _________ of the prepared abutment teeth and pour a cast of quick-set plaster. Coat the cast with a layer of _____________ (MRA, Dentsply International), which is part of the resin system. Then place some of the Triad resin around the finish lines of the abutment preparations. Lay a strand of ____ inside the clear template. ____________ can be placed in the incisal or occlusal portion of the template first to enhance esthetics.

Answer 21

saddle
Mor-Tight putty; wax-up
vacuum forming machine
displacement
alginate impression
model release agent
resin
“Enamel” resin

Question 22

• Use firm _______ to seat the loaded template on the quick-set plaster cast of the prepared abutments
• Compress the silicone putty index over the template insure ___________ of the template and an ______________ of resin in the provisional restoration. In an alternative technique, the template can be seated into the silicone putty index before the resin is loaded into the template. Remove the putty index from the cast, leaving the resin and template in position on the cast.
• Place the cast in the _____________ to polymerize the resin in the template for _____. Carefully remove the template and then the provisional restoration from the cast. Paint all surfaces of the restoration with ___________________ (ABC, Dentsply International). Place the provisional restoration back in the curing unit, tissue side up, for an additional 6 minutes. Retrieve the restoration from the curing unit and remove all of the ABC with a brush and water.
• Trim as much excess material as possible with a pair of curved scissors. Finish trimming the axial surfaces to the margins with ___. Open the _______ around the pontic with discs and burs. Be sure to remove the _____ form produced by the template. Polish the restoration with ______ and a _________ polishing material.
• what technique does this pertain to?

Answer 22

pressure
complete seating; even thickness
Triad curing unit
4 minutes
air barrier coating material
discs
embrasures
saddle
pumice; high- shine
TEMPLATE-FABRICATED PROVISIONAL FPD TECHNIQUE

Question 23

 A _________ or fixed partial denture made from any of the acrylic resins, and then that shell can be relined indirectly on a quick- set plaster cast. It also can be relined directly in the mouth. If the ______ is done _______, a methacrylate other than poly(methyl) should be used. This technique can save chair _____ because the restoration is partially fabricated prior to the preparation appointment.

 Care must be taken not to make the shell too ____. If it is, the shell will not seat completely over the prepared teeth and it will need to be trimmed internally. This can be time-consuming and defeats any advantage gained by making it before the preparation appointment.
* what does this pertain to?

Answer 23

thin shell crown
thick
reline; directly
time
SHELL-FABRICATED PROVISIONAL RESTORATION

Question 24

• Complete control of the environment of the operative site is essential during restorative dental procedures. For the patient’s _______________, and for the operator’s _____________, saliva, as well as water introduced during instrumentation, must be removed from the mouth
• Control of the oral environment extends to the ______ surrounding the teeth being restored. It must be displaced to make a complete impression and sometimes even to permit completion of the preparation and cementation of the restoration. Occasionally it is necessary to permanently alter the contours of the gingival tissues around the teeth or of the edentulous ridge to insure a better, longer-lasting result for the fixed restoration
• The need for removal of fluids varies depending upon the task being performed. During the preparation of teeth, it is necessary to remove ____________ produced by a handpiece spray and to control the _____ to prevent accidental injury. When an impression is made or a restoration is cemented, there is a much ______________ to be removed, but a much greater degree of _______ is required.
• Several types of attachments can be used with __________ (saliva ejector) or high-volume vacuum outlets to remove fluids. Some combine the functions of fluid removal with ________.

Answer 24

comfort and safety
access and clear visibility
gingiva
large volumes of water
tongue
smaller volume of fluid
dryness
low-volume
isolation

Question 25

• THREE COMMONLY USED VACUUM ATTACHMENTS:
• The ________ is the most effective of all isolation devices utilized in restorative dentistry. Its use is valuable in the removal of old restorations or excavation of caries when _______________ is a possibility. It also provides excellent isolation and access when a _____________ or ____________ is required before a cast restoration can be fabricated. Teeth with old or questionable endodontic treatments should be isolated in this for _______________, _____________, and ______________.

Answer 25

A) Saliva ejector
B) Svedopter
C) High volume vacuum outlet (vacuum tip)

rubber dam
exposure of the pulp
pin-retained amalgam or composite resin core
dowel-core preparation, pattern fabrication, cementation

Question 26

a synthetic anticholinergic medication, is used in its injectable form (Robinul, Baxter) to reduce salivary secretions before surgery.
* Dosage?
* an antihypertensive agent, and it should be used cautiously in patients who are receiving other antihypertensive medication. Its principal side effect, besides a dry mouth, is drowsiness, which is not altogether undesirable in a patient undergoing a lengthy restorative dental appointment.

Answer 26

glycopyrrolate
1-mg tablet of Robinul, taken 30 minutes before
Clonidine hydrochloride

Question 27

• Physically displacing the gingiva was one of the first methods used for ensuring adequate reproduction of the preparation finish line. A copper band or tube can serve as a means of carrying the impression material as well as a mechanism for displacing the gingiva to ensure that the gingival finish line is captured in the impression.
• By combining chemical action with pressure packing, enlargement of the gingival sulcus as well as control of fluids seeping from the walls of the gingival sulcus is more readily accomplished.

Answer 27

Mechanical Technique
CHEMICOMECHANICAL (RETRACTION CORD)

Question 28

• a “troughing” technique, the purpose of which is to produce limited removal of epithelial tissue in the sulcus while a chamfer finish line is being created in tooth structure. The technique, which also has been called “__________,” is used with the subgingival placement of restoration margins. It has been compared with periodontal curettage, but the rationale for its use is decidedly different. Periodontal curettage is used to debride diseased tissue from the sulcus to allow re-epithelialization and healing.
• There are situations in which it may not be feasible or desirable to manage the gingiva with retraction cord alone. Even if the general condition of the gingiva in a mouth is healthy, areas of inflammation and granulation tissue may be encountered around a given tooth. This can be caused by overhangs on previous restorations or by the caries itself. It may have been necessary to place the finish line of the preparation so near the epithelial attachment that it is impossible to retract the gingiva sufficiently to get an adequate impression. In these cases, it may be necessary to use some means other than cord impregnated with chemicals to gain access and stop minor bleeding.
  It has been recommended for enlargement of the gingival sulcus and control of hemorrhage to facilitate impression making

Answer 28

ROTARY CURETTAGE
gingetage
ELECTROSURGERY