The provisional fixed partial denture

A discussion of the rationale and requirements of the provisional restoration in fixed prosthetic dentistry has been presented. The importance of this phase of restorative dentistry and a survey of techniques for making interim restorations were gleaned from a review of the literature. A method for the fabrication of a provisional fixed partial denture using an acrylic resin interocclusal record was described and illustrated.     

Provisional restoration for abutment of an existing removable partial denture

The abutment of an existing removable partial denture may require a crown restoration. Fabrication of a provisional restoration to fit the existing clasp assembly requires special consideration. This article presents a simple technique for fabrication of such provisional restorations. An alginate impression is made of the arch with the removable partial denture in place. The abutment tooth is then prepared, providing adequate clearance between the clasp assembly and the tooth preparation. Cold curing acrylic resin of proper shade is mixed and poured in the impression of the abutment tooth. The impression is then seated in the mouth and removed before the acrylic resin is completely polymerized. The provisional restoration is then separated from the partial denture, finished and polished.     

Esthetic potential of single-implant provisional restorations: selection criteria of available alternatives

Provisional implant restorations are essential tools used to optimize the esthetic outcomes for single-tooth implant restorations. This article describes three groups of available alternatives and the specific options within each group including removable prostheses (interim removable partial denture, vacuum-formed appliance), tooth-supported prostheses (bonded extracted or denture teeth, cast metal or fiber-reinforced resin-bonded fixed partial denture [FPD], wire-retained resin-bonded FPD, acrylic resin provisional FPD), and implant-supported fixed prostheses (implant-retained provisional restoration). Advantages and disadvantages as well as fabrication guidelines for each option are provided. The author proposes that the restorative dentist consider eight criteria in selecting the most appropriate type of provisional prosthesis for a specific patient situation including the esthetic potential, patient comfort, treatment time, laboratory cost, occlusal clearance, ease of removal, durability, and ease of modification. The patient's esthetic expectations are critical in determining the most suitable type of provisional restoration. Esthetically pleasing provisional restorations are part of the evolving implant continuum, making implant dentistry more appealing to practicing dentists and potential patients. CLINICAL SIGNIFICANCE: Provisional restorations for single implants have evolved from temporary expedients during osseous and soft tissue integration to critical therapeutic tools used to assess patient expectations, communicate with the laboratory, and optimize definitive implant treatment. The selection of the type of provisional restoration may significantly influence esthetics during the period of implant integration and soft tissue healing. However, it is unlikely that there is a direct correlation between the type of provisional restoration used and the esthetic outcome of the definitive prosthesis.     

Using Silicone Impression Material and Acrylic Resin to Fabricate Remount Casts for Removable Partial Dentures

A technique is described for fabrication of a remount cast for a removable partial denture. This procedure consists of filling the occlusal/incisal third with acrylic resin and injecting polyvinylsiloxane impression material into the irreversible hydrocolloid impression. This technique provides a simple method for making a remount cast and enables the clinician to remove and easily place the partial denture on the cast during occlusal refinement procedures without damage to the removable partial denture or the remount cast.     

Interocclusal wax impressions for use in provisional and associated fixed prosthodontic procedures

A procedure is presented for the construction of a direct provisional acrylic resin restoration by means of an interocclusal wax impression. This technique requires no preparation or laboratory time and quickly results in a restoration that accurately covers all margins of the preparation and restores proper contact, contour, and occlusion. This procedure can also be used for large restorations, immediate fixed partial dentures, final impressions of preparations, provisional crowns to fit existing removable partial dentures, and some office emergencies.     

Fabricating Crowns to Fit Existing Removable Partial Dentures: An Illustration of Two Techniques

The prosthetic treatment of a structurally compromised abutment tooth supporting a removable partial denture may present a variety of restorative modalities. Ideally, a surveyed crown is made for the individual tooth, which is later followed by a new removable partial denture fit to the contours of the crown. Frequently, however, the removable partial denture is clinically acceptable, and remaking the prosthesis is not indicated. In these cases, the crown can be made to fit the existing removable partial denture. Fabricating crowns to fit existing removable partial dentures can be accomplished using a direct method, an indirect method, or combinations of these techniques. Direct techniques traditionally use acrylic resin and inlay wax intraorally to develop a custom pattern that captures the contours of the clasp assembly. Indirect techniques use a pick-up impression to allow the crown pattern to be waxed against the denture framework on a cast in the laboratory. Combination methods use either a direct-indirect or indirect-direct approach. The direct-indirect method develops the preliminary resin pattern directly on the tooth and finalizes the contours in wax on a master cast. The indirect-direct technique initiates a crown pattern on a die and completes it either intraorally or on the die after the intraoral refinements. This article reviews the literature for methods of fabricating surveyed crowns under existing removable partial dentures. Additionally, two cases are presented that illustrate an indirect and combination direct-indirect technique for making the restorations.     

Modified soft tissue cast for fixed partial denture: a technique

In process of fabrication of a fixed partial denture, dies are trimmed to expose margins of the preparations. The need for the soft tissue cast is quite evident as the soft tissue emergence profile that surrounds the prepared tooth is destroyed in the process of fabrication. This article describes a modified technique to fabricate the soft tissue cast for the conventional fixed partial denture. The impression made with the polyvinylsiloxane was first poured to prepare the die cast. After retrieval of the cast, the same impression was poured second time with the resin based resilient material to cover the facial and proximal gingival areas. The remaining portion of the impression was poured with the gypsum material. This technique does not require additional clinical appointment, second impression procedure, technique sensitive manipulations with impression, or cumbersome laboratory procedures. The simplicity of this technique facilitates and justifies its routine use in fabrication of the fixed partial denture.     

Use of a flexible cast for fabrication of multiple post-coping overdenture restorations

Direct intraoral fabrication of multiple post-coping restorations for an overdenture in the same arch can be a time-consuming chairside clinical procedure. In addition, accurate intraoral fabrication of resin patterns with intracrevicular margins is not always possible as a result of limited access. This article presents a direct-indirect method that uses an elastic cast for fabrication of multiple post-coping restorations with intracrevicular margins. Custom post patterns are fabricated directly in the root canal with autopolymerizing resin (Duralay). An impression is made of the remaining tooth structure, which also includes the post patterns, and a flexible cast is poured chairside. The cast is available within 6 to 8 minutes of impression making and can be trimmed similar to a stone die. The procedure also provides flexibility that allows separation of the cast from the impression without fracture of the custom post pattern or cast. The fabrication of the post-coping restoration can be completed in the laboratory, or if necessary, completed chairside and verified intraorally, before dismissing the patient.     

A Technique to Simultaneously Fabricate Multiple Custom Impression Posts for Implant‐Supported Restorations in the Esthetic Zone

Peri‐implant transmucosal tissue, an essential element of peri‐implant esthetics, is critical to the success of prostheses in the esthetic zone. The optimal transmucosal tissue profile can be transferred to the master cast with the aid of custom impression posts. In this clinical technique, the initial cast used to fabricate provisional prostheses was conveniently used to aid in the time‐efficient fabrication of multiple custom impression posts simultaneously using self‐cured acrylic resin. This technique also applies to single restorations. In addition, the use of an initial cast as holder makes it easy to transfer custom impression posts to the mouth accurately and efficiently.     

Indirect implant-supported fixed provisional restoration in the esthetic zone: fabrication technique and treatment workflow

Treatment objectives of an implant-supported fixed provisional restoration include shaping/preservation of the gingival soft tissue contour, functional and esthetic substitution of the missing dentition during postsurgical healing, and definitive prosthesis fabrication stages. Fixed provisional restoration can also serve as an esthetic and functional blueprint in the fabrication of the definitive restoration. Despite its common use and important indications, limited information is available on the various aspects of the provisional fabrication and treatment. This article presents a production technique and treatment workflow of a laboratory-fabricated, screw-retained fixed provisional restoration. Provisional restoration is fabricated using layering technique and internal stain characterization. The soft tissue profile of the working cast is modified according to the coronal contour of the diagnostic wax-up. Upon delivery, the provisional contour is reevaluated and modified as necessary. The developed emergence profile of the provisional restoration is transferred to the master cast via customized impression copings. CLINICAL SIGNIFICANCE: Laboratory-fabricated implant-supported provisional restorations allow the esthetic and functional substitution of the missing dentition and the shaping of the soft tissue profile, and can act as a blueprint in the fabrication of definitive restorations.     

A procedure for fitting a fixed partial denture to an existing removable partial denture

An indirect technique for fitting a new cast gold crown or fixed partial denture (FPD) to an existing removable partial denture (RPD) is presented. This method uses an acrylic resin coping made on a definitive cast fit directly to the patient's RPD intraorally, with the new FPD subsequently completed on the cast. The patient does not have to relinquish the RPD for laboratory procedures, although an appointment is required to fit the coping intraorally where contact is made with the RPD.     

Transferring provisional restorations to final master casts

Many principles guide preparation and fitting of provisional restorations. Their importance as a diagnostic tool is considered. Aesthetic, phonetic, functional, parafunctional and dysfunctional factors after evaluation in the provisional restorations have to be transferred to the master cast to incorporate them into the final restoration. A method for transferring morphology of provisional restorations to the master cast through preparation of a wax analogue fixed partial denture is presented. This method is precise, practical, suitable for most rehabilitation cases, and not clinically time-consuming since most stages are carried out in the dental laboratory.     

A technique for restoring abutments for removable partial dentures.

A technique was presented to restore a removable partial denture abutment so that the removable denture can continue to be used. The technique uses cold-curing acrylic resin in a rubber base impression form. The technique can be adapted to both direct and indirect procedures.     

Evaluation of interarch space for implant restorations in edentulous patients: A laboratory technique

This article describes a laboratory procedure for the visual evaluation of interarch space and its effect on implant prosthesis design. The method is applicable to patients presenting with completely edentulous arches. Silicone impression material is used to form a resilient cast and an external mold from an existing denture. The denture is duplicated using autopolymerizing acrylic resin. The duplicate denture and resilient cast are mounted on an articulator. Spatial relationships of anatomic landmarks can be evaluated, and a quantitative evaluation of available space can be made. The duplicate denture can also be used as a surgical template to direct implant placement. Reference tables are provided to serve as guidelines in the correlation between available space and minimum space required for various implant-assisted restorations.     

A provisional and new crown to fit into a clasp of an existing removable partial denture

A technique that forms an abutment crown to fit into an existing clasp of a removable partial denture by relining an acrylic resin pattern is described. The outer contour of the pattern is made within an irreversible hydrocolloid impression by use of Duralay autopolymerizing acrylic resin applied with precision dispensers. The pattern is formed before tooth preparation and is made approximately 0.4 mm thick. After tooth preparation, the shell pattern is relined with the same autopolymerizing resin and the existing removable partial denture is fitted over it. The gross pattern is trimmed and the margins refined on a die made from an elastomer impression. The refined pattern is cast and finished, avoiding reduction of the contours established. A second crown is similarly formed in tooth-colored autopolymerizing acrylic resin. It serves as a provisional restoration that allows the patient to wear the removable partial denture while the laboratory procedures are performed.     

Fabrication of a fixed provisional restoration utilizing a light-curing acrylic resin.

The properly fabricated provisional restoration must take into account the following interrelated factors: pulpal protection, periodontal health, occlusion, esthetics, and phonetics. The techniques advocated for construction of a provisional restoration include direct, indirect, and a combination of direct and indirect techniques. Two simple techniques that use light-curing acrylic resin for the fabrication of fixed provisional restorations are presented, and advantages and disadvantages of these techniques are discussed.     

Fabrication of a multi-applicable removable intraoral denture system for rodent research

The objective was to engineer an inexpensive intraoral removable denture system for rodents that can be utilised in numerous oral health research applications. At the forefront is biofilm research related to Candida-associated denture stomatitis. Previously described intraoral devices are primitive and inadequate. The denture system was engineered consisting of a fixed part that is anchored to the posterior palate by orthodontic wires and acrylic resin and a removable part fitted to the anterior palate that is retained by magnets embedded in the fixed part. Both parts are custom fitted to the rodent palate by impression making and cast fabrication. Rats fitted with the intraoral denture system maintained body weight and normal activity with the device maintaining integrity and durability for upwards of 8 weeks. The denture system was used successfully to establish a working model of denture stomatitis. This newly engineered inexpensive intraoral removable denture system for rodents can be utilised in numerous oral health research applications, including denture-associated infections, biofilms and a variety of biomaterial applications. The removable portion is advantageous for longitudinal analyses and charging/discharging of biomaterials.     

Abstracts from the Table Clinic Session of the Annual Session of the American College of Prosthodontists October 28, 2004

Yung-tsung Hsu , DDS MS Assistant Professor   UAB School of Dentistry
For a removable prosthesis, the best way to perform occlusal equilibration is to remount the prosthesis on the articulator. To remount a removable partial denture, a remount cast must be fabricated. Many techniques have been presented in the literature, including fabrication with stone, occlusal registration material, or silicone impression material. This presentation will compare several different techniques for making remount casts for removable partial dentures. A new technique of using the silicone impression material with acrylic resin and dental stone will also be demonstrated.     

Adapting fixed prosthodontics principles to screw-retained restorations

Implant restorations may be visualized clinically using a provisional fixed partial denture and in the laboratory with a fully contoured waxing on the master cast. The benefits of eggshell restorations for provisional restorations are as valid in implant prostheses as in conventional restorations. A technique is presented using the plastic laboratory sleeves to provide reliable anchorage as well as protection and preservation of the abutments. A fully contoured waxing on the master cast predictably determines the most appropriate design for screw-retained restorations. When unfavorable implant placement would create compromised morphology, a retrievable auxiliary substructure is indicated.     

Fabricating custom provisional restorations for the ITI solid abutment system

This article describes a technique for the quick and accurate fabrication of custom acrylic resin provisional restorations for the ITI implant system. Materials and procedures common to fixed prosthodontics are used. The technique should necessitate no more chairtime than the fabrication of custom acrylic provisional restorations for conventional fixed prostheses.