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Many methods of provisional restoration fabrication are available to practicing dentists. The indirect method has been found to be the most accurate and least time consuming for the author as well as many other clinicians. After a little practice and familiarity with the methods and materials the restorative dentist will realize the benefits for both the dentist and the patient.
The success of a dental prosthesis is judged according to function, comfort, phonetics, and esthetics. The purpose of a treatment is to come as close as possible to replicating the natural state. For anterior fixed partial dentures, the all-ceramic system IPS Empress 2 offers light transmission and reflection comparable to that of natural teeth, provided that the pink esthetics are optimized in the preprosthetic treatment phase. In this case report, a laboratory-made provisional was placed after extraction of an anterior tooth. Six months later, preprosthetic periodontal surgery was carried out to enhance gingival harmony. The design of the post and core, preparation, and cementation are important parameters for the success of all-ceramic restorations.
BACKGROUND: Developments in adhesive dentistry have given the dental profession new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This article illustrates, through a clinical case study, the clinical requirements for restoring esthetic harmony and functional stability to the worn anterior dentition. CASE DESCRIPTION: The author presents the case of a 24-year-old man who sought esthetic dental treatment because he was unhappy with the appearance of his maxillary anterior teeth. The review of his dental history revealed that he ground his teeth at night. The author performed a complete evaluation of the causes of the patient's bruxism and created a diagnostic preview to, among other things, develop the relationship between the condylar and anterior guidance and to establish the esthetic requirements for the final restorations. Treatment included periodontal recontouring, tooth preparation and placement of temporary and then permanent restorations; the patient also was given an occlusal guard to protect the restorations against future bruxing. CLINICAL IMPLICATIONS: Whatever the cause of occlusal instability, it is important that the restorative dentist be able to recognize its signs--such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance.
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Full-dose intramuscular hepatitis B vaccine was given to 42 staff in the dental and renal departments at Wellington Hospital. Immune levels of anti-HBs were obtained in 41 of 42 (98%) staff six months after the first dose of vaccine. In 3 of 38 (8%) staff given three doses of vaccine, anti-HBs levels fell to below the immune range 18 months after the first dose, and a fourth booster dose was given, with subsequent restoration of immune levels of anti-HBs. The commonest side-effect noticed was temporary soreness at the injection site, which occurred in 33% of doses. Two staff experienced positional vertigo after the first and second doses of vaccine, and the third dose was therefore omitted.
The utilization of properly fabricated provisional prosthodontic appliances will permit a higher rate of success of the definitive treatment. This phase of restorative treatment should not be merely considered a temporary treatment but as a template for the ensuing prosthesis. The information that is obtained in this phase of treatment will reduce the problems that may be encountered in the definitive treatment. This article has discussed the function and requirements of both provisional, fixed restorations and transitional removable partial dentures. The methods of fabrication and the materials employed have been enumerated.
The CEREC system offers the dentist a conservative means to esthetically restore posterior teeth in a single patient visit. It uses advanced restorative materials. It does not require traditional impression techniques, temporaries or outside laboratories. Seven-year recalls in Europe and five-year recalls in the United States establish a firm basis for predicting continued clinical success of these restorations. The technology is currently being taught in 13 dental schools in the United States. Four schools are continuing clinical research.
Congenital labiomaxillary clefts result from the absence or incomplete fusion of the maxillary and medial nasal processes with resultant hard and soft tissue defects. Comprehensive treatment of these defects requires the collaborative efforts of surgeons, orthodontists, restorative clinicians, and laboratory technicians. Precise periodontal and orthodontic treatments must be carefully coordinated with the restorative plan to ensure sufficient space and tissue architecture for the definitive restorations. This article describes the multidisciplinary treatment of a cleft lip/palate patient using conservative fixed and removable restorative options to provide aesthetic restoration.
Provisional restorations are an excellent diagnostic instrument, especially in full-arch oral rehabilitations where no normal occluding contacts remain. Esthetics, phonetics, function, parafunction, and dysfunction after evaluation and acceptance through clinical trial with the provisional restorations should be accurately transferred to the final restorations to ensure the same clinical success. This article presents a sequence of clinical procedures that enables a methodical and controlled transfer of the morphology of the provisional restorations to the final ones in full-arch oral rehabilitations.
STATEMENT OF PROBLEM: Provisional crowns traditionally have been associated with problems such as poor occlusion, contour, fit, and finish. Fabrication procedures should be uncomplicated and predictable within a realistic time frame. PURPOSE: The purpose of this study was to compare the quality of provisional restorations fabricated by dental students from 2 different materials (bis-acryl composite resin and PMMA) and identify the advantages and disadvantages associated with each material. MATERIAL AND METHODS: This study evaluated the occlusion, contour, marginal adaptation, and finish of 222 provisional crowns fabricated by 2 groups (A and B) of dental students. One bis-acryl composite resin material (Integrity) and 2 PMMA resins (C&B Resin and Snap) were evaluated. RESULTS: For group A, Integrity was statistically superior (P<.05) to C&B Resin in all 4 categories for anterior provisional crowns. For posterior provisional crowns, Integrity proved superior in the categories of contour and marginal adaptation, but no significant differences were established for occlusion and finish. For group B, Integrity was statistically superior to Snap in the categories of occlusion, contour, and marginal adaptation, whereas there was no statistical difference in finish. When all 4 categories were analyzed, Integrity was found to be statistically superior. CONCLUSION: Bis-acryl composite resin (Integrity) was significantly superior to PMMA (C&B Resin and Snap) as a provisional restorative material.
One primary objective for implant therapy is the achievement of an aesthetic result, and this is significantly dependent upon the condition of the peri-implant soft tissue and the implant emergence profile. The requisite for the configuration of the definitive crown is formulated by the provisional restoration, which transfers the position of the implant and the peri-implant soft tissue to the model utilized in the fabrication process. This article demonstrates the use of a provisionalization stage to precisely replicate the peri-implant tissue in the definitive restoration.
Due to remodeling of the edentulous ridge following tooth extraction, clinicians and dental technicians face a variety of challenges when attempting to deliver an aesthetic fixed partial denture for the anterior maxilla. An implant-supported, screw-retained fixed partial denture provisional restoration can be utilized in order to manipulate the pontic site with predictable success. This technique can create the illusion of pontics emerging from the soft tissue, creating a natural-looking effect for seating of the definitive restoration.
Replication of desirable design features of an existing implant prosthesis is often appropriate in the construction of a replacement that produces the same spatial relationship to the supporting dental implants. An adaptation of a laboratory copy technique used in conventional complete denture prosthodontics is described. A silicone putty mold that enables the creation of the corresponding fit surface, polished surface, and arch form is used for making a transitional or a definitive complete or partial fixed implant prosthesis. Variations using a basic replication technique are appropriate in clinical practice for refabricating a prosthesis of a preferred design. The procedure is suitable for both acrylic resin-metal or metal ceramic restorations.
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STATEMENT OF PROBLEM: Placement of small diameter implants often provides a solution to space problems in implant restoration. Analysis of the success of this type of implant restoration has not been clearly determined. PURPOSE: This 5-year retrospective study presents results from 52 mini-implants for single-tooth restorations placed in 44 patients from 1992 to 1994. MATERIAL AND METHODS: Dental records of 44 patients with 52 mini-implants placed during 1992-94 were reviewed. The implants were all placed by the same surgeon and the single-tooth custom screwed posts with cemented crowns were positioned on the implants by the same prosthodontist. RESULTS: The results achieved by the mini-implant rehabilitation were similar to those reported for standard single-tooth implant restoration. Total implant survival rate was 94.2%. Two implants were lost at second stage surgery, and another was lost after temporary loading. CONCLUSION: The results suggest that single-tooth mini-implant restoration can be a successful treatment alternative to solve both functional and esthetic problems. They may represent the preferred choice in cases where space problems limit the use of standard or wide diameter implants.
Implant-supported provisional restorations serve several valuable functions. In the anterior region, they are beneficial in determining the best restorative design, ultimately allowing for the most appropriate definitive prosthesis. They also provide a template around which soft tissue contours may be evaluated and manipulated. In areas where bone quality is compromised and implant success is suspect, whether it be anteriorly or more likely posteriorly, implant-supported provisional restorations may be used to "test" the osseointegration prior to fabricating and placing the definitive restorations.
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Esthetic outcomes are related more to soft tissue volume and adaptation than to implant components. A preoperative understanding of the influence and inter-relationship of bone volume, soft tissue volume and contours, attainable augmentation goals, and the achievable realistic restorative results is important. This article shows the application of routine components in methods to solve routine commonly encountered clinical problems, including matching a missing central incisor to the adjacent dentition and soft tissue, esthetic provisionalization for the hopeless anterior tooth after extraction, and elective replacement of an upper denture with a fixed implant restoration without the use of bone grafting.