Long-term reinforced fixed provisional restorations

Extensive prosthodontic treatment often requires fabrication of long-term provisional restorations. Numerous materials and techniques have been described for prolonged insertion of interim restorations. This article describes a procedure for fabrication of long-term reinforced heat-processed provisional restorations based on a diagnostic wax-up. Reinforced heat-processed provisional restorations reduced flexure, which minimizes progressive loss of cement and diminished the possibility of recurrent decay. Occlusal stability and vertical dimension were maintained because of greater wear resistance. Occlusion, tooth contours, and pontic design developed in the provisional restoration were duplicated in the definitive restoration. The use of a matrix from a diagnostic wax-up facilitated fabrication of the prosthesis, and made the procedure less time-consuming and more predictable. (J Prosthet Dent 1998;79:698-701.)     

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.     

The effect of cooling techniques on intrapulpal temperature during direct fabrication of provisional restorations.

In vitro measurements were made of the heat transferred to the pulp chamber during the direct fabrication of extracoronal provisional restorations. The temperature was monitored for the following four groups: (1) control--the provisional restoration was left on the tooth with no coolant used; (2) removal--the provisional restoration was removed upon initial resin polymerization; (3) in situ--the provisional restoration was left in place and cooled with an air/water spray; and (4) on/off--the provisional restoration was repeatedly removed and replaced upon initial polymerization while using an air/water spray. The intrapulpal temperature rises were as follows: control 7.08 degrees C, removal 2.39 degrees C, in situ 2.36 degrees C, and on/off 3.12 degrees C. The temperature rise for all cooling techniques was significantly lower than that of the control. No significant differences were found between the three cooling techniques.     

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.     

Direct technique for the fabrication of a visible light-curing resin provisional restoration

A properly fabricated provisional restoration will, among other things, provide acceptable esthetics. Although many materials have been used for provisional restorations, when esthetics is of primary concern, the choice is limited to tooth-colored resin materials. Recently, a tooth-colored, light-activated urethane dimethacrylate resin has been developed. This material has been reported to be useful for many prosthetic applications, including the indirect fabrication of provisional restorations. This paper presents a technique for the direct fabrication of single-unit provisional restorations using this material. The physical properties of this resin and the advantages and disadvantages of the technique are also discussed.     

CEREC陶瓷修复体的临床应用

在临床修复中，传统的瓷嵌体等修复体的制作，至少需要二次就诊时间。随着光学扫描方法和计算机辅助制作嵌体技术的应用，省去了目前操作的印模、灌模、蜡型等技术。CEREC系统运用光学印模方法以及CAD-CAM技术，将一预成陶瓷块铣磨成修复体，使牙科医生能在牙体预备后即制作一个色泽自然的陶瓷修复体，并即时粘固于预备牙上，这不仅提高了工作效率，更重要的是提高了修复体的质量。该系统不仅可以制作嵌体和高嵌体，而且还可制作各种贴面。本文的目的是介绍和描述CEREC系统制作修复体的方法步骤，并就临床应用中的有关问题加以探讨。     

Implant Digital Impression in the Esthetic Area

The aim of this report is to describe two standardized protocols for digital impression when implant support rehabilitation is used in the esthetic area. The two techniques were used to transfer all provisional crown parameters to definitive restorations in different clinical scenarios. In the direct technique, an impression (STL1) is made of the provisional restorations attached to the implants, with surrounding gingival tissue. The second scan (STL2) captures the sulcular aspect of the peri‐implant soft tissue immediately after removal of the provisional restoration. The last impression (STL3) of the complete arch is made with a standardized scanbody attached to the implant to capture the 3D location of the implant. The direct technique is indicated when the peri‐implant soft tissues are stable upon removal of the provisional restoration. The indirect technique is used when the gingival tissue collapses rapidly after the removal of the provisional crown. The impressions of the provisional restoration and the position of the implant are similar to those obtained with the direct technique, and the shape of the peri‐implant tissue is extrapolated from the negative shape obtained from making the digital impression when the provisional restoration is taken out of the mouth. Finally, in both techniques the 3 scans are superimposed to obtain a file, which contains the details of the peri‐implant soft tissue. The direct and indirect digital techniques allowed realization of a predictable definitive restoration in the esthetic zone in different clinical scenarios, reducing the duration of clinical procedures.     

A Direct Provisional Restoration for Decreased Occlusal Wear and Improved Marginal Integrity: A Hybrid Technique

A direct technique for the fabrication of provisional restorations is described. Occluding surfaces of the provisional restoration are veneered with a light-cure composite resin for increased wear resistance and improved occlusal stability. Also described is a method for reestablishing the provisional restoration's margins to achieve optimal tissue health.     

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.     

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.     

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。     

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.     

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.     

Aesthetic replacement of an anterior tooth using the natural tooth as a pontic; an innovative technique

This article presents a novel technique for replacing an anterior tooth. A new modification to the clinical technique of direct fabrication of a resin-bonded bridge was employed, in which the patient’s natural tooth was used as a pontic. Treatment with this modification led to overall improved aesthetics and reduced treatment cost. The natural tooth pontic was stabilized in the extraction socket with a resin-wire splint as a provisional restoration to maintain the gingival architecture while the permanent bridge was being constructed.     

Multiple cast post and cores for severely worn anterior teeth

A technique has been presented to simplify the fabrication of multiple direct post and core patterns. When combined with techniques for indirect provisional restorations, this technique merely requires the fabrication of an additional plastic template to form the direct core patterns.     

Selecting treatment options and sequencing treatment in the replacement of 2 maxillary central incisors with implants: a case report

This article describes treatment provided to replace 2 maxillary central incisors with implant-supported restorations. The site of a missing maxillary central incisor was treated utilizing a bone expansion technique to augment the labial hard and soft-tissue profiles at the time of implant placement. The adjacent central incisor tooth, although destined to be extracted, was retained to serve as an abutment for a fixed provisional restoration until the first implant was deemed to have successfully integrated. At the appointment to uncover this implant, the fractured tooth was extracted and an implant was immediately placed into the socket. The first implant was then used to support the provisional restoration during the healing phase of the second implant. The techniques utilized resulted in optimum soft-tissue contours, allowed the patient to have a comfortable and esthetic provisional restoration, and minimized the number of surgical procedures.     

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.     

Human mineralized bone in extraction sites before implant placement: preliminary results

BACKGROUND: Bone loss after tooth extraction may prevent dental implant placement. Human mineralized bone grafts can be used to restore bone volume and allow for tooth replacement with dental implants. METHODS: The authors grafted 22 sites in 18 patients with human mineralized bone after tooth extraction. They allowed molar sites 16 weeks for graft healing, placed the implants and restored them with a final crown after a four-month integration period. Single-rooted maxillary sites received implants and immediate placement of provisional crowns or underwent a delayed two-stage restoration approach. The authors used radiographs and clinical examinations to evaluate the results. RESULTS: All of the sites were restored successfully with a single-tooth implant restoration. Periapical radiographs indicated that the crestal bone levels were limited to the first thread of the implants or slightly coronal to the first thread of the implant. Clinical evaluation indicated excellent gingival health around the provisional and final restorations, without obvious gingival migration. CONCLUSIONS: The use of human mineralized bone may have significant potential to reconstruct missing bone resulting from tooth extraction and to preserve bone after tooth extraction. In addition, healed bone graft sites seem to be able to support immediate placement of a provisional crown and implant restorations. CLINICAL IMPLICATIONS: Patients who are having teeth extracted may become candidates for implant restorations when the sites are appropriately grafted to preserve and reconstruct bone volume, thus allowing for more options for reconstructing the missing tooth site.     

An accurate chairside technique for fabricating a temporary restoration for ITI single-tooth implant

Current implant restoration techniques depend upon a well-fitting, anatomic provisional restoration--especially at the restoration margin--to promote healthy soft tissue contours, which are necessary for successful final restorations. The ITI implant system presents a particular challenge in this regard because of the configuration of the implant head and shoulder, especially when these are placed subgingivally. A chairside method for obtaining an accurate marginal fit and customized contours in the single-tooth provisional restoration is described and illustrated.