Temporisation Flashcards by Rachel Sladden

Luting agent and procedure for metal and metal-ceramic restorations

Procedure: conventional cementation
Zinc phosphate cement
Zinc polycarboxylate cement

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Luting agent and procedure for metal and ceramic endodontic posts

Procedure: conventional cementation
Luting agent:
-glass ionomer cement
-RMGIC
-compomers

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Luting agent for all-ceramic reinforced core ceramics

Procedure: conventional cementation

Luting cement: GIC, RMGICs, compomers

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Luting agent and procedure for resin bonded bridges

Procedure: etching and gritblasting

Luting agent: dark cure resins, adhesive resins

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Luting agent and procedure for precious metal bonding e.g. intra-oral repair

Procedure: tin plating, silica coating, metal primers

Luting agent: dark cure resins, adhesive resins

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Luting agent and procedure for resin-bonded ceramics

Procedure: HF etch and silane

Luting agent: aesthetic dual resins

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Luting agent and procedure for composite restorations, fibre reinforced resin bridges, fibre reinforced endodontic, post

Procedure: resin-to-resin bond

Luting agent: aesthetic dual cure resins, adhesive resins

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Provisional restorations definition

Prosthesis designed to enhance aesthetics, stabilisation and/ or function for limited period of time, after which it is to be replaced by definitive prosthesis

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Temporary vs transitional

Temp has limited and predetermined life-span
Transitional could be considered as something not planned for long-term but should serve, with modifications, for more extensive period of time compared to a temporary solution

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Functions of provisional restorations

Protection
Maintain tooth position
Aesthetics
Diagnosis
Mastication
Facilitate plaque control - cleansable
Assess tooth reduction?
Informed consent
Provide coronal seal between RCT apts
Assess prognosis
Control/ customise emergence profile

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Uses of temporary restorations

Routine indirect resotrations
Replacing indirect restorations
Immediate tooth replacement
Replace tooth after impant placement
Planning aesthetic, occlusal or perio changes prior to definitive restoration placement

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Materials: PMMA

Good for indirect provisionals
Self/ chemical cure - P/L
Good aesthetics, strength , and wear resistance, easy to repair/ augment
Significant exotherm and polymerisation shrinkage, strong smell, free monomer can cause pulpal/ gingival reactions

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Materials

PMMA
PEM (Snap)
Bis-Acryl composite
Direct composite
Pre-formed crowns
CAD-CAM milled composites

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Materials: PEM

Self/ chemical cure: P/L
Lesser exotherm and shrinkage
Poorer aesthetics, strength, wear resistance

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Materials: Bis-Acryl

ProTemp - we use this most of the time
Most commonly self/ chemical cure but can get dual cure
Contains Bis-GMA, TEGDMA (essentially composite)
Good aesthetics, better colour stability, good wear resistance in adequate thickness
Difficult to repair, weak in thin section

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Materials: direct composite

Used mainly for adhesive preparations (veneers, minimal preps) to maintain occlusal contacts/ improve aesthetics where necessary
Placed without bonding agent (spot etch technique)

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Materials: preformed crowns

Aluminium, stainless steel, polycarbonate
Useful is you don’t have a pre-op imp
Difficult to control marginal adaptation
Often require a lot of chairside modification

Materials: CAD-CAM milled composites

Digital dentistry
Intra-oral scans of preparations sent to milling unit (in clinic or technician’s lab)
Composite/PEEK/PMMA milled and fitted
Very accurate provisionals

Temporary luting cements

ZOE (Temp Bond)
Eugenol free ZO cement (Temp Bond NE)
-useful if using resin-based luting cement as eugenol can inhibit polymerisation of uncured resins
Temporary resin cements: translucent for cementing veneers, aesthetic trial
In very rare cases we may use Zinc Polycarboxylate cement to help to retain unretentive provisionals

Techniques

Direct
-preformed crowns
-wth use of matrices
-direct composite placement
-direct syringe
Indirect techniques

Preformed crowns

Come in range of different sizes
Polycarbonate (White) for anterior teeth
Aluminium/ stainless steel mainly used for posterior teeth
Require trimming or crimping around the margins to provide adequate marginal coverage
All can be relined with resin (PMMA/PEM traditionally, but can use Bis-Acryl) to improve fit to prep

Provisionals made from matrices

Pre-op imp in silicone or alginate taken of teeth before prep
-alginate: cheap, dissipates exotherm better
-silicone: more expensive, reusable - can give it to pt
Can also take an imp of wax-up of tooth or
use an Essix retainer/suck-down matrix
If seated carefully, normally require minimal adjustments
Coat tooth with vaseline - allow you to remove it easily particularly if composites on core!
Bis-Acryl (such as ProTemp) placed into impression and
then seated onto prep, remove at rubbery stage, before it
can lock into undercuts.
Adjust margins and finish/polish

Direct composite placement

Spot-etch technique
Melleable composites
These often used in adhesive preps where there is minimal tooth reduction (veneer preps, gold onlay preps, resin-bonded bridge preps that require temporatisation

Direct syringe

Last resort if matrix does not fit or you don’t have access to preformed crown
Material placed around tooth, starting at margins
PMMA/ PEM easier than Bis-Acryl as they tend to slump
less

Indirect provisionals

Can be made before crown prep apt by taking imps for study models Some initial reduction can be done on model and provisionals made, relined chairside to fir your preps May start with direct provisionals until indirect are made (long-term, complex cases)

When don't I need a provisional?

Preps in enamel on non-occluding surfaces Quick lab turnover time Use of CAD-CAM in-office milled restorations

Problem solving: always breaking?

Very minimal preps (such as FGC), relieve inside of pre-op imp to increase bulk of provisional material, then trim back chair-side

Problem solving: marginal gaps?

Reline/ repair provisional, ensure adequate adaption of pre-op imp, place silicone arounds necks of teeth and in tray Can also use light-bodied silicone on tooth and putty in tray to improve accuracy

Problem solving: occlusion wrong?

Ensure imp fully seated when making provisionals

Problem solving: can't remove your provisional?

Ensure you have enough vaseline on tooth and remove the provisional in timely fashion (rubbery stage) to prevent hardened material locking in undercuts

Problem solving: can I join adjacent provisionals?

Yes but the embrasure | area MUST be cleared and OHI demonstrated (interdental brush fit)

Problem solving: Having difficulty removing previisonal at fit apt?

You can add vaseline to your temporary cement to facilitate removal

So, what's the point?

Provisionals important, they have variety of functions, rangingin from protecting tooth to testing new occlusal schemes and aesthetics Should take similar time to temporise tooth as it does to prepare it Bis-Acryl (ProTemp and similar) is usual 'go-to' temp material and is used for the majority of cases, however in specific situations, some of the other techniques are invaluable

Diagnostic uses of temporary restorations

Aesthetic trials Occlusal trial Periodontal changes -->diagnostic wax ups invaluable in these cases

Aesthetic trials

Confirm tooth shape/ dimensions before definitive crown fabrication Easier to reshape and trim provisional restorations

Occlusal trials

Confirm patient’s ability to tolerate new occlusion prior to lab making definitive restorations

Periodontal changes

Used to replace overhanging restorations causing inflammation/recession or after crown lengthening surgery. Kept in place until periodontal tissues have stabilised

Disadvantage of preformed crowns

Difficult to assess margin adaptation interproximally, may need considerable adjustments

Preformed crowns - stainless steel/ aluminium

Choose suitable size. Trim and crimp margins to improve seating. Option to reline with PMMA/PEM/Bis-Acryl to improve fit. Check occlusion. Cement into place. Remove excess

Preformed crowns - polycarbonate (Directa)

``` Choose suitable size Trim margins to improve seating Shape to improve appearance Reline with PMMA/PEM/Bis-Acryl to improve fit. Trim excess Check occlusion Cement into place Remove excess ```

Direct composite placement: spot-etch technique

Use of phosphoric acid etch at one spot in the centre of the tooth (rinse/dry) and then directly applying a bulk of composite without the use of a bonding agent -means it is fairly easy to remove the composite with a probe when required

Direct composite placement: malleable composites

easier handling allows them to be moulded over the tooth and then light cured