Provisional Restorations

Contents:

• Role of a provisional
• Maintaining fit, form and function efficiently
• Implications of various challenges
• Alginate alternatives
• Leveraging assistants
• Fabricate a well-fitting provisional

The importance of provisional restoration excellence cannot be underestimated.

Here, we’ll walk through how to make the process efficient, leverage your assistant, and offer practical solutions that enhance results and efficiency.  

Role of a provisional

Fundamentally, the provisional takes the place of missing dental hard tissue. The provisional must fulfil several requirements while waiting for delivery of the final crown:

• Space maintenance – preventing tilting/drifting of adjacent teeth and movement of opposing teeth.
• Function – enabling usual eating and drinking, with the provisional tolerating functional loads.
• Protection – preventing damage to the preparation, including the enamel margins, and protecting exposed dentin in vital teeth against sensitivity.
• Soft tissue – preserving gingival contours and preventing gingival irritation and food impaction associated with gaps. Should crown lengthening be required prior to tooth preparation, a provisional helps to contour the soft tissue during the healing phase.  
• Esthetics – the contour, shade and position should match the dentition, and the gingival contour should look natural. Provisionals are also used to develop peri-implant soft tissue for an esthetic restorative emergence profile for implant-supported crowns.

This method offers efficient delivery of a custom provisional. There’s no need for a separate visit and while stock pre-fabricated provisionals are available, these can fit poorly, offer poor esthetics, and often require time-consuming adjustments.  

Implications of various challenges  

A poorly-fitting/lost provisional can cause inadequate space maintenance and result in the final restoration being too large for the remaining space. Another potential outcome is chipped enamel margins that cause gaps at the margins of definitive restorations. Both are examples of why it is imperative that inadequate provisionals be avoided and lost ones are rapidly replaced.

Errors that can cause loss of the provisional include:

• Poor form and function overall
• A poor-fitting inner surface
• Using a provisional material with insufficient strength
• Poor cement selection  
• Poor technique

Provisional restorations may be ‘temporary’, but a poor fit/lost provisional causes frustration and has a negative impact on practice efficiency, function, esthetics, patient comfort and satisfaction, and ultimately on practice profitability.

Why alginate alternatives are ideal preliminary matrix materials
 

Historically, alginate impressions have been used as preliminary matrix materials.  However, their rough surface means more time spent finishing and polishing a provisional. In addition, since set alginate is not dimensionally stable, it is usually impossible to use the matrix for a second provisional should that be needed.  

Today, alginate alternatives/Vinyl Polysiloxane (VPS) are available and provide a smooth surface when set, improving the surface texture and esthetics of provisionals. The matrix is also dimensionally stable for some time allowing the matrix to be re-used for a second provisional if necessary.

Leveraging assistants to fabricate provisionals
 

Delegating all or some stages of fabricating a provisional to dental assistants leverages their time, freeing the dentist up for other tasks. Depending on the procedures permissible, dental assistants can perform intra-oral fabrication, extra-oral trimming, finishing and polishing, and/or cementation and removal of excess cement. Where permitted, each step delegated to assistants can increase practice efficiency.

With a portfolio of excellent materials for the fabrication of provisionals, we want to support you further with Dentsply Sirona’s entire online Dental Academy complete with webinars, how-to videos, and real-world examples on how to create streamlined solutions with efficient procedures and even greater patient satisfaction.
 

Contact us now and let’s get started!
 

The information provided herein, does not, and is not intended in any way to, constitute legal advice; Instead, all information, content and materials available are for general informational purposes only.