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.     

The Science of Communicating the Art of Esthetic Dentistry. Part II: Diagnostic Provisional Restorations

Provisional restorations fulfill many functions in restorative dentistry. Quality provisional restorations can provide the clinician, the patient, and the laboratory technician much valuable information prior to fabrication of the definitive restoration. Such diagnostic provisional restorations fabricated with acrylic resin are easily adjusted and modified until both esthetic and functional results are approved by the patient. Once this approval has been obtained, the definitive restorations can be fabricated with confidence, using the esthetic form of the provisional restorations as a blueprint.
CLINICAL SIGNIFICANCE
Routine use of provisional restorations for esthetic diagnostic purposes can prevent the destructive cycle of failure and frustration frequently experienced when performing elective esthetic restorative dentistry.     

The science of communicating the art of esthetic dentistry. Part II: Diagnostic provisional restorations

Provisional restorations fulfill many functions in restorative dentistry. Quality provisional restorations can provide the clinician, the patient, and the laboratory technician much valuable information prior to fabrication of the definitive restoration. Such diagnostic provisional restorations fabricated with acrylic resin are easily adjusted and modified until both esthetic and functional results are approved by the patient. Once this approval has been obtained, the definitive restorations can be fabricated with confidence, using the esthetic form of the provisional restorations as a blueprint.     

Predictable Repair of Provisional Restorations

The importance of provisional restorations is often downplayed, as they are thought of by some as only "temporaries." As a result, a less-than-ideal provisional is sometimes fabricated, in part because of the additional chair time required to make provisional modifications when using traditional techniques. Additionally, in many dental practices, these provisional restorations are often fabricated by auxillary personnel who may not be as well trained in the fabrication process. Because provisionals play an important role in achieving the desired final functional and esthetic result, a high-quality provisional restoration is essential to fabricating a successful definitive restoration. This article describes a method for efficiently and predictably repairing both methacrylate and bis-acryl provisional restorations using flowable composite resin. By use of this relatively simple technique, provisional restorations can now be modified or repaired in a timely and productive manner to yield an exceptional result.

CLINICAL SIGNIFICANCE

Successful execution of esthetic and restorative dentistry requires attention to detail in every aspect of the case. Fabrication of high-quality provisional restorations can, at times, be challenging and time consuming. The techniques for optimizing resin provisional restorations as described in this paper are pragmatic and will enhance the delivery of dental treatment.     

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.     

Digital Custom Impression Technique to Record Emergence Profile and Fabrication of an Esthetic Implant Supported Restoration

One of the challenges in esthetic implant supported restorations is to replicate the emergence profile of soft tissue contours created by provisional restorations. Various analog techniques have been used to achieve the most esthetic and natural emergence profile in final restorations. The evolution of digital dentistry has made dentistry easier and efficient albeit with a learning curve. The technique described here uses digital technology to describe a complete digital workflow from the provisional stage to the final restoration.     

An indirect technique for assuring simplicity and marginal integrity of provisional restorations during full mouth rehabilitation

Full mouth rehabilitation with fixed prosthodontics can be a time- and labor-intensive process. The use of provisional restorations allows the treating clinician to determine the functional and esthetic requirements of the definitive prostheses. However, in the case of full mouth rehabilitation, the individual preparation of provisional restorations for multiple teeth may complicate the provisional phase and increase the treatment time. This article describes a method to simplify the indirect fabrication of provisional restorations for full mouth reconstruction. Provisional restorations may be easily achieved by splinting the provisional restorations in sextants, trimming them according to red pencil marks around the prepared margins as guidelines, and fitting them in the laboratory, utilizing a second set of solid casts for the prepared teeth.     

前牙全瓷美学修复中值得注意的事项

本文介绍了前牙美学修复中的主要注意事项,包括美学修复前的准备,标准化的基牙预备,美学修复中 过渡性修复体的制作,全瓷材料的选择,全瓷美学修复体的粘接以及如何预防瓷折、瓷裂的发生等方面的内容;同时,对前牙美学修复中常见的临床问题进行了总结和回顾。     

Reinforced heat-processed acrylic resin provisional restorations

A technique has been described for the fabrication of strong, esthetic, and periodontally considerable provisional restorations. The technique involves cast nonprecious metal frameworks and heat-processed acrylic resin.     

Fixed and removable provisional options for patients undergoing implant treatment

The provisional phase of treatment can be the most challenging aspect of implant dentistry. The techniques available today include removable, tooth-supported, and implant-retained provisional restorations. The selection of the type of provisional prosthesis should be based on esthetic demands, functional requirements, duration, and ease of fabrication. This article includes a review of 118 articles from peer-reviewed journals published in English from January 1986 to February 2007. This review was performed using MEDLINE. The indications, advantages, and disadvantages of the various provisional restorations are discussed.     

Use of polyethylene ribbon to create a provisional fixed partial denture after immediate implant placement: a clinical report

Provisional restorations are generally necessary to restore lost function and esthetics during the implant integration period. This article describes the fabrication of an esthetic, economic, and conservative bonded provisional fixed partial denture for a patient restored with implants. A reinforcing polyethylene ribbon was used to bond the natural lateral incisors to the adjacent teeth. An acceptable esthetic outcome was obtained, and the result was satisfactory to the patient.     

The modification of interim cylinders for the fabrication of cement-retained implant-supported provisional restorations

This article describes a technique for modification of metal interim cylinders and their use in the fabrication of cementable implant-supported provisional restorations. This chairside technique allows for direct provisionalization of single or multiple implants during or after second-stage surgery, especially when there is a high esthetic demand.     

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.     

1998 Judson C. Hickey Scientific Writing Award. Use of a flexible cast for the indirect fabrication of provisional restorations.

Efficient fabrication of a clinically acceptable provisional restoration for a fixed partial denture is an important part of treatment success. Fabrication of provisional restorations that uses the indirect technique produces accurate fitting provisional restorations without the chemical and thermal irritation associated with direct fabrication. With a typodont model, an indirect method is presented that uses an elastic cast for fabrication of multiple unit provisional restorations for fixed partial dentures. The cast is available within 6 minutes of impression making, can be trimmed with a sharp scalpel, and provides flexibility that allows easy separation of the acrylic provisional from the cast. The cast can also be used to evaluate the clinical acceptability of the preparations before impression making. This method has also been successfully used for the fabrication of acrylic provisional restorations for onlay preparations.     

Clinical evaluation of a visible light-cured indirect composite for long-term provisionalization

OBJECTIVE: To clinically evaluate a visible light-cured (VLC) resin composite system for long-term provisional and esthetic diagnostic restorations, fabricated using indirect techniques. METHODS: One-hundred and nine teeth were restored in 31 patients. Preoperational impressions were used to create VLC resin composite restorations (Radica) using indirect techniques. Restorations were relined as necessary and placed using various provisional cements at a follow-up appointment, subsequent to preparation of the teeth. Both fabricating laboratory technicians and placing dentists rated the restorations for acceptability in esthetics, marginal fit, occlusion, and functionality in various stages of provisionalization. RESULTS: All restorations (100%) were rated acceptable for esthetics prior to relining. After relining, a majority (93-100%) of restorations were rated acceptable in esthetic and functional criteria. At the placement of the permanent restoration, a majority (96-100%) of restorations were rated acceptable in esthetic and functional criteria. Terms of service ranged from two to seventy-six days. CONCLUSION: In combination with in vitro results, the clinical performance of the Radica VLC system for provisionalization and esthetic diagnostic restorations was judged to be acceptable. The system offers esthetics that are superior to conventional provisional restorations, and should be a valuable option to practitioners considering longer-term provisionalization in complex cases.     

Preservation of soft tissue contours with immediate screw-retained provisional implant crown

When a patient with a missing or failing maxillary anterior tooth desires immediate tooth replacement, fabrication of a provisional restoration can be challenging. Due to individual anatomical variations in tooth shape, size, and supporting soft and hard tissue structures, there are no premanufactured components with an anatomical emergence profile that universally suits all individual situations. This article describes the fabrication of a screw-retained immediate provisional restoration that fulfills anatomic, biologic, and esthetic requirements.     

Use of a customized rigid clear matrix for fabricating provisional veneers.

The fabrication of provisional veneers is time consuming, and may be unpredictable, especially in cases of multiple veneer preparations; however, functional and esthetic provisional veneers, may be used as diagnostic adjuncts for the fabrication of the definitive restoration. This article presents, in a step-by-step procedure, the use of a customized rigid clear matrix with light-cured composite resin as a fast alternative for the fabrication of functional and esthetic provisional composite resin veneers. CLINICAL SIGNIFICANCE: The use of a customized rigid clear matrix for the fabrication of light-cured composite resin provisional veneers has the following advantages: the shape and surface texture produced in the diagnostic wax-up are accurately transferred to the patient's mouth; the provisional restoration is fabricated without violation of the soft tissue and the margins of the preparations; use of the matrix can be repeated when needed; and esthetic and functional provisional veneers can be fabricated relatively quickly.     

A direct technique for fabricating esthetic anterior fixed provisional restorations using polycarbonate veneers

Fabrication of esthetic interim restorations by a chairside technique often challenges the clinician with regard to the required time and skills, as well as meeting the expectations of the patient. Autopolymerizing polymethyl methacrylate resin has been reported to be the most popular material for fabricating provisional restorations. However, this material does not routinely yield esthetic provisional restorations via a chairside technique. This article describes a simple technique to overcome some of the disadvantages of this material by using prefabricated polycarbonate facings backed with autopolymerizing acrylic resin. This technique can be used chairside for fabricating esthetic anterior interim restorations, utilizing the beneficial properties of both materials. It exploits the manufactured smooth-surface finish, superior esthetics, color stability, and durability of polycarbonate facings, as well as the marginal adaptation, strength, and low cost of autopolymerizing acrylic resin.     

Repair of bis-acryl provisional restorations using flowable composite resin

Provisional restorations provide interim coverage for prepared teeth while fixed definitive restorations are fabricated. Several types of autopolymerizing acrylic resins have been used for many years to fabricate provisional restorations. In recent years, bis-acryl resin composite material has gained popularity among clinicians for the direct fabrication of provisional fixed restorations. Occasionally, deficiencies may occur while fabricating a direct provisional restoration and require chairside repair. This article describes an effective procedure for the use of light-polymerized flowable composite resin for the intraoral repair of bis-acryl provisional restorations.     

Use of a Customized Rigid Clear Matrix for Fabricating Provisional Veneers

Abstract: The fabrication of provisional veneers is time consuming, and may be unpredictable, especially in cases of multiple veneer preparations; however, functional and esthetic provisional veneers, may be used as diagnostic adjuncts for the fabrication of the definitive restoration. This article presents, in a step-by-step procedure, the use of a customized rigid clear matrix with light-cured composite resin as a fast alternative for the fabrication of functional and esthetic provisional composite resin veneers.