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restorative > provisional EC restorations (3rd year) > Flashcards

provisional EC restorations (3rd year) Flashcards

1
Q

clinical stages for indirect restorations

A

preparation
temporisation
impressions and registration
cementation

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2
Q

when are they provided?

A

between the tooth prep and fit of an indirect restoration

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3
Q

what do they have a role in the immediate and long-term health of?

A

tooth
supporting structures e.g. PDL
definitive restoration

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4
Q

what characteristics should the provisional restore?

A 
aesthetics
function
sensitivity
coronal seal of RCT tooth
destabilised occlusion
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5
Q

how should they fit?

A

good marginal fit
well-contoured - no overhangs
cleansable and maintainable by pt

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6
Q

consequences of a poorly fitting and contoured provisional

A

pt unable to clean - caries, gingival inflammation
poor moisture control
gingival overgrowth

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7
Q

uses of provisionals

A 
establish/maintain aesthetics
prevent sensitivity
cleansable
maintain gingival health and contour
prevent micro leakage - preserve vitality
confirm adequate prep
IC and EC design characteristics - occlusal stability
 - no OVD changes (unless required)
 - prevent drifting/tilting of prepared teeth
preseve/improve fct
 - mastication/speech
isolation for RCT
matrix for core build-up
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8
Q

ideal properties of provisional materials

A 
non-irritant
low temp rise during setting
 - high will cause expansion
dimensionally stable
adequate working and setting time
adequate strength and wear resistance
 - if too strong hard to remove
good aesthetics
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9
Q

types

A 
custom formed
 - preferable
 - can be technically demanding
preformed
 - standard shapes and sizes
 - adjust at chairside
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10
Q

custom resin provisional crowns material

A

chemically cured bis-acrylic composite resin (acrylic/composite hybrid)
e.g. Protemp Plus, Integrity Temp-Grip

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11
Q

custom resin provisional crowns fit advantages

A

fits tooth prep internally (inner surface hugs tooth prep)

reproduces contact points and occlusion externally

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12
Q

when should custom resin provisional crowns be made and why?

A

before impressions for definitive

check prep ok - undercuts, sufficient reduction

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13
Q

what can you use to check for sufficient prep reduction?

A

Svensen gauge

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14
Q

custom resin provisional crowns - what impression?

A

sectional - full arch unnecessary and difficult to reseat

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15
Q

custom resin provisional crowns - impression materials

A

addition cured silicone putty e.g. president
alginate
softened modelling wax

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16
Q

custom resin provisional crowns - addition cured silicone putty for impression pros and cons

A

can disinfect and keep - can be reused if pt loses provisional
resistant to tearing

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17
Q

custom resin provisional crowns - alginate for impression pros and cons

A

cheaper

cannot be reused/kept

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18
Q

custom resin provisional crowns - softened modelling wax pros and cons

A 
easy to adjust and smooth
cheap
unsuitable for deep undercuts 
distorts
cannot be reused
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19
Q

custom resin provisional crowns - alternative to impression

A

custom vacuum formed plastic mould (stent)

made on study model and/or diagnostic wax up

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20
Q

custom resin method

A

sectional impression
prep tooth
syringe bis-acrylic composite resin onto mixing pad
syringe into sectional
relocate impression in mouth
- fully seated
- click over bulbosity of remaining tooth
remove before complete polymerisation (about 1.5mins)
- rubbery
- fully polymerised hard to remove from undercuts
remove completely
remove flash and ledges - high speed/soft flex discs
confirm tooth prep - Svensen gauge
check marginal fit and occlusion in situ - adjust if required (ideally outside mouth)
check aesthetics
cement

21
Q

syringe bis-acrylic composite resin onto mixing pad - why?

A

ensure mixed

monitor setting

22
Q

custom resin method - when remove set provisional what may happen?

A

stay on tooth - ease off with instrument beneath contact points, otherwise sets in undercuts
be removed in imp - leave to set

23
Q

cementing custom resin crown

A

temp luting cement e.g. TempBond NE - non-eugenol temp cement material
trim away excess - let it set then you can just peel excess off
- margins
- interdentally - floss

24
Q

using provisionals for wear cases- establishing occlusion and aesthetics

A 
loss of original tooth form e.g. wear
 - reestablish tooth shape
 - pilot occlusion and aesthetics using provisionals
guidance (anterior/incisal)
 - produce on crowns
 - diagnostic wax up, study models
 - require Facebow
25
Q

using provisionals for wear cases - once guidance and aesthetics satisfactory

A

lab - duplicate waxed-up cast, construct vacuum formed stent
next pt visit - prepare teeth, use mould to produce custom formed provisional restoration to new occlusion and appearance
pt trial
- wear until happy with form and fct
- adjust/alter - trim with bur, add composite

26
Q

using provisionals for wear cases - guidance created on provisionals

A

can be transferred to definitives
custom formed incisal guidance table
- imps of provisionals in situ and opposing teeth
- mount casts on semi-adjustable
- unset acrylic on incisal table
- reproduce lateral and protrusive movements
- light cure and give to lab - custom incisal guidance table - copy of occlusal scheme that you want followed when constructing restoration

27
Q

using provisionals for wear cases - impressions of tooth preps (for definitives)

A

master cast mounted on articulator
technician constructs definitives
- guided by custom-formed incisal table
- simultaneous contact between restorations/opposing teeth and incisal pin/guidance table

28
Q

diagnostic wax up

A 
satisfy pts aesthetic demands
high aesthetic demand cases
 - alter provisionals
 - minor changes chairside
 - major - replace provisionals
once satisfactory make impression for technician
29
Q

establishing gingival contours

A

use provisionals to achieve satisfactory emergence profile for definitives
- illusion tooth comes out from gum

30
Q

bone level dental implant

A

metal finishes at bone

used for anterior teeth - can mould gingiva

31
Q

gingival level implant

A

ends at gingiva
easier to clean
used for posterior teeth

32
Q

preformed provisional crowns variations

A

tooth coloured
- polycarbonate
- clear plastic crown forms filled with composite
metal - Al/SS

33
Q

problems with preformed crowns

A

unlikely to fit accurately

large bank of crowns needed

34
Q

when are preformed crowns useful?

A

situations where no impression taken prior to tooth prep or damage e.g. trauma cases

35
Q

polycarbonate crowns

A

tooth coloured shells
don’t really fit round tooth - fill inner surface with acrylic
tooth morphology
- anteriors and premolars - sublined with acrylic e.g. trim

36
Q

polycarbonate crowns method

A 
select shell slightly larger than prep
trim back until
 - correct prep dimension
 - sits fully over tooth prep
 - not bedding into gingivae
 - pink stone in straight handpiece
fill shell - trim/protemp
seat over tooth
allow polymerisation
remove
check fit
trim if necessary
cement with temp luting cement
cut off tag
37
Q

what if polycarbonate crowns are overbuilt?

A

blanching of gingivae occurs

38
Q

clear plastic crowns

A 
select and trim until fit - scissors
pierce hole at cusp tip/canine tip/incisal angle so air can escape - no bubbles
fill with bis-acrylic composite resin
seat over tooth
allow setting
remove from tooth
remove plastic crown form
check margins and occlusion - adjust
cement with temp cement
39
Q

metal preformed crowns

A

used for posterior teeth
Al or SS
any ledges/sharp margins - soft tissue trauma
difficult to adjust - some provided with crimping device to help mould margins

40
Q

using old crown as provisional

A

if replacing, can use/modify original crown for temp
may need partially sectioned/relined
preserve original crown as much as possible

41
Q

removing old crown

A

WAMkey
safe relax/ anthrogyr
sliding hammer

42
Q

preformed malleable composite crowns

A

e.g. protemp crown temporisation material

soft - easily mouldable to tooth

43
Q

preformed malleable composite crowns method

A

moulded over tooth to desired shape
partially light cured 2-3s, otherwise difficult to remove
remove then cure completely outside of mouth
check fit
adjust if necessary
cement

44
Q

why is temporisation of veneers difficult?

A

relying on chemical retention rather than mechanical

45
Q

temporisation for veneers

A

spot bonded, no etch

often don’t need temp as prep should be within enamel and pt can cope with aesthetics for short time

46
Q

indirect provisionals

A 
lab made (usually acrylic)
low shrinkage IO
more accurate
high strength
time and cost
used long term
examples of materials - composite, acrylic, meta
47
Q

provisional replacement of missing teeth

A

conventional bridgework temporisation - diagnostic wax up of replacement
acrylic RPD
Essex retainer with pontic
edentulous space and only provisional crowns on prepared teeth

48
Q

advice to pt

A

pt to maintain good OH
- caution with floss as may pull out provisional
otherwise gingival inflammation
- GCF
- bleeding
- poor moisture control for definitive imps
inadequate cement lute placement

restorative (12 decks)

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