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BDS3 CLINICAL Optech > Provisional Extra-coronal restorations > Flashcards

Provisional Extra-coronal restorations Flashcards

1
Q

Why should the provisional restoration be of high quality

A

otherwise failures occur

this leads to problems

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2
Q

What does the provisional play a role in the immediate and long term health of

A

the tooth
the supporting structures
the definitive restoration

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3
Q

What are the clinical stages of an indirect restoration

A

preparation
temporisation
impressions and registration
cementation

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4
Q

Why is provisional so important in terms of tooth preparation

A

tooth prep compromises aesthetics in smile line

degrades tooth function - occlusal reduction and destabilizes occlusion

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5
Q

What does occlusal and interproximal reduction do to the tooth

A

render a vital tooth sensitive as there is exposed dentine

compromise coronal seal of RCT’d teeth

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6
Q

What are features that a provisional should have

A

good marginal fit
be well contoured so there’s no overhangs
cleanable and maintainable by px

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7
Q

What does a poorly fitting and contoured provisional result in

A

px unable to clean resulting in caries and gingival inflammation

poor moisture control

gingival overgrowth

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8
Q

What must a provisional restoration do

A

establish and or maintain dental aesthetics mimicking either the original tooth or the definitive restoration

prevent sensitivity

allow ‘optimum home care’

prevent micro leakage/bacterial leakage

confirm that tooth prep is adequate

intra and extra coronal design characteristics

preserve or improve function

isolation for RCT

matrix for core build up

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9
Q

What are desirable characteristics of a provisional material

A

non irritant to pulp and periodontal tissues

low temp rise during setting

dimensional stability

adequate working tiem

adequate setting time

adequate strength and wear resistance

good aesthetics

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10
Q

What are the types of provisional restorations

A

custom formed

preformed

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11
Q

What is a custom formed provisional restoration

A

bespoke to individual situations
preferable
can be technically demanding

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12
Q

What is a performed provisional restoration

A

standard shapes and sizes

adjust to fit chair side

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13
Q

What material are custom resin provisionals made from

A

chemically cured bis acrylic composite resin

e.g protemp

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14
Q

How is custom resin provisional crowns customizable

A

fits tooth prep internally

reproduces contact points and occlusion externally

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15
Q

Why do we make them before the impression for the definitive restoration is taken

A

to help check that the tooth prep is satisfactory
check for udnercuts
check there’s sufficient reduction

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16
Q

What can we use to check there’s sufficient reduction

A

svensen gauge

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17
Q

Why are sectional impressions better for custom resin provisional crowns

A

a full arch one is unnecessary and difficult to reseat

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18
Q

What materials can you use for the sectional impression

A

additional cured silicone putty
alginate
softened modelling wax

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19
Q

What are the advantages of additional cured silicone putty

A

can be disinfected and kept by px or clinician

can be reused

resistant to tearing

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20
Q

What are the advantages and disadvantages of alginate

A

cheaper

cannot be reused or kept

21
Q

What are the advantages and disadvantages of softened modeling wax

A 
easy to adjust and smooth
cheap
unsuitable for deep undercuts
distorts
cannot be reused
22
Q

What is the method for a custom resin provisional crown

A
  1. sectional impression
  2. prepare tooth for chosen resotration
  3. syringe bis-acrylic composite resin onto bracket table or mixing pad
  4. syringe material onto sectional impression of tooth that has been prepared
  5. relocate impression in the mouth (ensure fully seated and click over bulbosity of remaining teeth)
  6. remove before complete polymerization
  7. remove completely
  8. remove flash and ledges
  9. confirm tooth prep using svensen guage
  10. chem marginal fit and occlusion in situ
  11. check aesthetics
  12. cement using temp luting cement
23
Q

If there is loss of original tooth form such as in wear cases what should be done

A

re establish tooth shape

pilot occlusion and aesthetics using provisional restorations

24
Q

What should be done for guidance (anterior/incisaL

A

produce on crowns
diagnostic wax up
articulated study models
face bow reg required

25
Q

Once the guidance and aesthetics are satisfactory are done what should be done

A

lab should duplicate the waxed up cast and construct a vacuum formed mould/stent//template

the next patient visit prepare the tooth and use the mould to produce a custom formed provisional restoration to thew new occlusion and appearance

26
Q

What is the patient trial

A

they wear until happy with form and function
then you can adjust and alter and trim with a bur or add composite

once satifaoctry make an impression for the technician

27
Q

How can provisionals help establish gingival contours

A

use provisional restorations to achieve satisfactory emergence profile for definitive restoration

28
Q

What are the variations in provisional crowns

A

can be tooth colored or metal

29
Q

What are the tooth colored preformed crowns

A

polycarbonate

clear plastic crown forms that are filled with composite

30
Q

What are problems with preformed provisional crowns

A

unlikely to fit accurately - cervically, occlusally, interdentally

large bank of crowns needed to accommodate variation between px and this is costly

31
Q

When are preformed provisional crowns useful

A

for situations where no impression is present prior to tooth prep or damage

e.g trauma

32
Q

What is the method for preformed provisional crowns

A
  1. select shell slightly larger than prep
  2. trim back
  3. fill shell
  4. seat over tooth
  5. allow polymerization
  6. remove
  7. check fit
  8. trim/tidy if necessary
  9. cement
  10. cut off tag
33
Q

With the preformed provisional crowns where do you trim back to

A

correct preparation dimension
seats fully over tooth preparation
not bedding into gingival

34
Q

What are the advantages of clear plastic crowns

A

thin

easy to trim

35
Q

What is the method for clear plastic crowns

A
  1. select and trim until fit
  2. pierce hole at cusp tip/canine tip/incisal angle
  3. fill with bis-acrylic composite resin
  4. seat over tooth
  5. allow setting
  6. remove from tooth
  7. remove plastic crown form
  8. check margins and occlusion
  9. cement with temporary cement
36
Q

What are metal preformed crowns used for

A

used for posterior teeth

37
Q

What are the materials for metal preformed crowns

A

aluminum

stainless steel

38
Q

What are issues with the preformed metal crowns

A

ledges and sharp margins can cause soft tissue trauma

difficult to adjust, some provided with crimping device to help mould margins

39
Q

If you are replacing an old crown what can you do

A

can use/modify original crown for temp

may need partially sectioned/reclined and preserve original crown as much as possible

40
Q

What are the preformed malleable composite crowns

A

soft

easily moldable to tooth prep

41
Q

What is the method for composite provisional restorations

A 
moulded over tooth to desired shape
partially lite cured
remove then completely cure outside of mouth
check fit
adjust if necessayr
cement
42
Q

What are composite provisional restorations

A

they used in veneer cases

spot bonded

43
Q

What are indirect provisional restorations

A

lab made

44
Q

What are the advantages and disadvantages of indirect provisional restorations

A 
Adv
low shirnkage intra orally
more accurate
high strength
used long term

disadv
time and cost consuming

45
Q

What are examples of indirect provisional restorations

A

composite
acrylic
meta

46
Q

What are provisional replacement of missing teeth

A

conventional bridge work temporization (diagnostic wax up)
acrylic removable partial denture
essix retainer with pontic
edentulous space and only provisional crowns on prepared teeth

resin bonded bridges and implants

47
Q

What advice should be given to the px

A

brushing 2-3 x daily
interdentally cleaning 1-2x daily
caution with floss as may pull out the restoration

48
Q

If patient doesn’t follow advice what can happen

A

increased GCF, bleeding, poor moisture control for definitive impressions
inadequate cement lute placement

BDS3 CLINICAL Optech (4 decks)

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