provisional restoration in fixed partial dentures.pptx

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1. PROVISIONAL RESTORATION IN FIXED PARTIAL DENTURES

2. CONTENTS Introduction Definition of provisional restorations. Requirements of provisional restoration. Classification of provisional restoration. Fabrication Techniques. Provisional Cements Provisional restorations in laminates and Implant dentistry Limitations of provisional restorations Recent advances in provisionalization Conclusion References.

3. INTRODUCTION The word provisional means established for the time being, pending a permanent arrangement. INTERIM PROSTHESIS - A fixed or removable dental prosthesis, designed to enhance esthetics , stabilization and/or function for a limited period of time, after which it is to be replaced by a definitive dental prosthesis. - GPT 9 Synonyms : PROVISIONAL; TRANSITIONAL; TEMPORARY; TREATMENT RESTORATIONS

4. BIOLOGIC Pulpal protection Periodontal health Occlusal compatibility & tooth position Prevention of enamel fracture. 4 REQUIREMENTS OF PROVISIONAL MATERIALS

5. MECHANICAL Greater stresses in an interim restoration occur during chewing. To reduce the risk of failure, connector size must be increased in comparison with the definitive restoration.

6. ESTHETIC Aesthetic concern: incisors, canines and premolars. Used as a guide for optimum esthetics in definitive restoration. It is shaped and modified until its appearance is mutually acceptable to the dentist and the patient.

7. CLASSIFICATION Method of Fabrication Prefabricated/ Preformed. Custom made. Technique involved in fabrication Direct technique. Indirect technique. Indirect - Direct technique Location of fabrication Chair-side fabricated. Laboratory fabricated. 4. Duration of use Short term : for few days - 2 weeks. Eg - Polycarbonate, aluminium crowns. Medium term : for 2 weeks > few weeks. Eg - resin based provisionals . Long term : for months. Eg - mostly cast metal crowns.

8. 5. Type of material used: Metal provisional restoration Aluminium Nickel-chromium Tin-silver Resin based provisional restoration Cellulose acetate Polycarbonate resin Poly-methyl methacrylate Poly-ethyl methacrylate Microfilled composite Urethane dimethacrylate Bis -acryl composite

9. Method of Fabrication Prefabricated/ Preformed. Custom made. 9

10. Tooth-shaped shells of various materials. Most crown forms need some modification, eg:axial recontouring , occlusal adjustment, relining. They can be cemented directly onto the prepared teeth. Available in various tooth sizes and shapes. Prefabricated/ Preformed crowns ADVANTAGES DISADVANTAGES Less time consuming. Rarely satisfies the requirement of contours. Available in various sizes. Limited to single tooth restoration

11. POLYCARBONATE CROWNS: First described by Charles et al in 1973. Most natural appearance Advantages: Esthetics Readily available Save chair-side time

12. CELLULOSE ACETATE: Thin [0.2 – 0.3 mm] transparent material. Available in all tooth types and range of sizes. Do not chemically or mechanically bond to the inside surface so after polymerisation the shell is peeled off. The disadvantages are : • They merely act as a matrix and so must be removed after their relining material has set. • When the cellulose crown form is removed, the thickness of the crown get reduced (by about 0.2 mm). This may lead to instability in the occlusion and movement of adjacent teeth.

13. METAL Due to their appearance, they are used in the posterior region of the mouth. Various types of metal crown are available: aluminium, stainless steel, tin-silver and nickel-chromium alloy crowns. Aluminium crown forms These have been used for many years as the material is easy to manipulate, and it is malleable and ductile. Aluminium crown forms can corrode with time as saliva can react with them. There is also a risk that if they are placed adjacent to a freshly packed amalgam or gold restoration, a galvanic cell may be established.

14. Stainless steel crown forms: 1. These crown forms are much less malleable and ductile than the aluminium crown forms, thus they are harder wearing and are less likely to deform under load. 2. They are usually not refined but trimmed using crown shears until their fit approximates to the prepared tooth and luted using a glass ionomer or polycarboxylate cement. 3. The success rate is very high and these crowns are useful to maintain the space that may be lost when a deciduous tooth is lost prematurely.

15. Tin silver alloy crowns: These are available for posterior teeth. The alloy is very soft and the margin of the crown can be flexed prior to seating. These produce a close marginal fit after the shell is trimmed with a bur. These should also be lined with acrylic resin to provide good internal adaptation and retention.

16. Nickel chromium alloy: Used in children with extensively damaged primary teeth They cannot be altered with resin These crowns can be easily recontoured using pliers. Indicated as long term temporaries.

17. CUSTOM MADE CROWNS Custom fabrication represents one of the best choices for provisional restorative treatment. The technique allows for intimate contact between a provisional restoration and prepared tooth. Tissue surface form Direct & Indirect forms, a 3 rd category indirect-direct results from the sequential application of these two forms

18. Technique involved in Fabrication. Direct technique. Indirect technique. Indirect - Direct technique

19. DIRECT TECHNIQUE The prepared teeth and tissues directly provide the tissue form for the provisional restoration. Techniques available are: Shells (proprietary or custom) Matrices ( formed directly in mouth or indirectly on cast) Direct syringing.

20. DIRECT TECHNIQUE. The patient’s prepared teeth & the gingival tissues directly provide the TSF, so the intermediate steps of the indirect technique are eliminated Disadvantages such as potential tissue trauma & inherently poor marginal fit. Therefore the routine use of directly formed provisional restorations not recommended when indirect techniques are feasible.

21. Regish.k.m et al, Techniques of Fabrication of Provisional Restoration: An Overview, International Journal of Dentistry, Volume 2011 (2011), Article ID 134659 Advantage : - Less time consuming as the intermediate steps of indirect technique are eliminated. Disadvantages : - Potential tissue trauma from the polymerizing resin, and - Inherently poor marginal fit.

22. INDIRECT TECHNIQUE Impression of the prepared teeth is poured in quick-setting gypsum : Avoid exposure of patient to adverse properties of resins. Optimise the properties of resins. Ease of making significant changes in contours or occlusal changes.

23. Regish.k.m et al, Techniques of Fabrication of Provisional Restoration: An Overview, International Journal of Dentistry, Volume 2011 (2011), Article ID 134659 Advantages: No contact of monomer with the prepared tooth or gingiva. Avoids subjecting a prepared tooth from the heat created from polymerization. Marginal fit is better. Comfortable to the patient.

24. INDIRECT - DIRECT TECHNIQUE Regish.k.m et al, Techniques of Fabrication of Provisional Restoration: An Overview, International Journal of Dentistry, Volume 2011 (2011), Article ID 134659 Advantage: Chair side time is reduced. Less heat generated in mouth. Contact between the resin monomer and soft tissue is minimised.

25. TEMPLATE FABRICATED PROVISIONAL FIXED PARTIAL DENTURE When a fixed partial denture made for a patient the provisional restoration should be in the form of a fixed partial dentuare rather than individual crowns. In the anterior region it will provide better cosmetic result & even in the posterior region the provisional fixed partial denture will better stabilize the teeth & the patient gets accustomed to having a tooth in the edentulous space again.

26. TEMPLATE FABRICATED VLC CURED PROVISIONAL RESTORATION

27. MATERIALS The most common materials used for custom interim-fixed restorations are several types of acrylic resins such as: Polymethyl Methacrylate (PMMA) Resin, ( Duralay ) Polyethyl Methacrylate (PEMA) Resin, ( Slintine ) Polyvinyl Methacrylate Resin, (Trim) Bis -acryl Composite Resin( Protemp 4) Vinyl Ethyl Methacrylate (Snap) Butyl Methacrylate ( Temp Plus) Visible Light-cured Urethane Dimethacrylates .( Revotech LC)

28. PRESENTLY AVAILABLE PROVISIONAL LUTING CEMENTS Polycarboxylate temporary luting cements : Low postoperative sensitivity Adequate retention Easy cleanup Ex. Cling 2(Clinician’s Choice), Hy -Bond( Shofu dental)

29. ZOE TEMPORARY LUTING CEMENTS : (Commonly Used) Sedative on sensitive teeth Excellent antibacterial effect Ex. RelyX TempE (3M ESPE), Temp Bond(Kerr), Flow Temp(Premier Dental Products), Hy - Bond ZOE( Shofu Dental)

30. ZONE TEMPORARY LUTING CEMENTS Replace eugenol with various types of Carboxylic acids. Compatible with permanent resin cements. Greater retention than ZOE cements. No Sedative effect on pulp. Ex. Rely X Temp NE(3M ESPE), Temp Bond NE (Kerr), Freegenol , Nogenol and Temp Adavantage (GC America), Ultratemp ( Ultradent Products)

31. RESIN TEMPORARY LUTING CEMENTS: High Strengh Excellent retention Better esthetics Easy Cleanup Ex. Systemp.Link ( Ivoclar Vivadent ), Temp Bond Clear(Kerr), ImProve (Noble Biocare )

32. Maya zalkind , DMD," and nira hochman , DDS , laminate veneer provisional restorations: A clinical report, The Journal of Prosthetic Dentistry, February, Volume 77 Number2 1997,

33. W. DAN SNEED, DMD, MAT, MHS JAMES S. KNIGHT, DDS , Simple Technique to Fabricate Provisional Restorations for Porcelain Veneers , J Esthet Restor Dent 13:115-119, 2001

34. W. DAN SNEED, DMD, MAT, MHS JAMES S. KNIGHT, DDS , Simple Technique to Fabricate Provisional Restorations for Porcelain Veneers , J Esthet Restor Dent 13:115-119, 2001

35. Celin Arce, DDS, MS, FACP, Predictable techniques for single provisional , dentaleconomics ..com

36. Provisional Restorations For Implants Challenging roadblocks to implant treatment is the patient’s perception of the temporization. Partially Edentulous sites Fully Edentulous sites Fixed prosthesis Ex. Existing FPD, Acrylic Provisional or resin bonded bridge Complete dentures 2) Removable prosthesis( i.e stayplate , flippers) Ex. Essix appliance, Snap on Smile

37. Fabrication of In - Office resin- bonded bridge

38. Removable Provisional Prosthesis Fixed prosthesis and Resin bonded ridge

39. Fabrication of Essix Appliance

40. Recent Advances In Provisonal Restorations Tuff-Tem plus Protemp Crowns RohitRaghavan , Shajahan P A, NeenaKunjumon , Provisionals In Dentistry – From Past To Recent Advances , International Journal Dental and Medical Sciences Research ,Volume 2, Issue 6 (June- 2018), PP 01-06

41. Temp Tab Thermoplastic Matrix Wafers CAD-CAMPMMA Provisionals

42. Limitations of provisional restorations Lack of inherent strength -Provisional restorations fracture in long span bridges Poor marginal adaptation - This inherent deficiency is difficult to improve upon. provisional restorations infers adequate margins at its best Color instability - this is apparent when the provisional restorations are placed for longer duration. Poor wear properties - teeth will drift or torque if heavy occlusal forces are used. 5. Detectable odor emission - this is undeniable as the resins are porous. 6. Inadequate bonding characteristics - eugenol cements are incompatible with methyl methacrylate resins The three factors that are responsible for achieving quality provisional restorations are time, proper materials and technique

43. CONCLUSION Although interim restorations are usually intented for short term use & then discarded, they can be made to provide pleasing esthetics, adequate support & good protection for teeth while maintaining periodontal health. They may be made in dental office by number of practical methods from several commercially available materials. The success of Fixed prosthodontics often depends on the care with which the interim restoration is designed & fabricated.

44. REFERENCES Phillip’s Science of dental materials. Eleventh edition Rosenstiel , Contemporary fixed prosthodontics. 4 th edition. Shillingburg , Fundamentals of fixed prosthodontics. 3 rd edition. Regish.k.m et al, Techniques of Fabrication of Provisional Restoration: An Overview, International Journal of Dentistry, Volume 2011 (2011), Article ID 134659 Maya zalkind , DMD," and nira hochman , DDS , laminate veneer provisional restorations: A clinical report, The Journal of Prosthetic Dentistry, February, Volume 77 Number2 1997 W. DAN SNEED, DMD, MAT, MHS JAMES S. KNIGHT, DDS , Simple Technique to Fabricate Provisional Restorations for Porcelain Veneers , J Esthet Restor Dent 13:115-119, 2001 Celin Arce, DDS, MS, FACP, Predictable techniques for single provisional , dentaleconomics ..com RohitRaghavan , Shajahan P A, NeenaKunjumon , Provisionals In Dentistry – From Past To Recent Advances , International Journal Dental and Medical Sciences Research ,Volume 2, Issue 6 (June- 2018), PP 01-06