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OONTINUING EDUCATION 2

PROVISIONAL MATERIALS

Fixed Prosthodontics Provisional


Materials: Making the Right Selection
Howard E. Strassler, DMD
LEARNING OBJECTIVES

Ahstract: Clinicians have many choices when selecting an appropriate material


for interim restorations for hoth single crowns and multi-units. Interim restorations serve as a diagnostic as well as hiologic and hiomechanical component

list materials that can be


used for fixed prosthodontics provisional
restorations
=

offixedprosthodontics treatment; in the anterior, they are also important in


evaluating the esthetics for the definitive restoration. Factors to be considered when choosing provisional materials are physical properties, handling
characteristics, patient response to the appearance of the interim restoration,
durability of the restoration, and the cost of the material. Practitioners should,

explain the functions


of fixed prosthodontics
provisional restorations
discuss the benefits of
the various provisional
materials available

therefore, base their choice on the clinical needs for each situation.

aterials and techniques used for the fabrication of provisional (temporary) restorations
for fixed prosthodontics have been evolving.
For single crowns, clinicians have many choices
when deciding what type of provisional crown
they want to fabricate. The earliest provisional restorations for
single crowns, made from both metal and plastics, were prefabricated and preformed by the manufacturer. They came in a variety of
sizes and shapes, which could be selected based on the given clinical
situation.' As part of this evolution, directly manipulated acrylic
resins and, later, composite resins were developed for routine use
for both single-unit and multiple-unit restorations.^
Provisional restorations are a critical component of fixed prosthodontic treatment, biologically and bioniechanically.^ These restorations are also referred to as temporary or interim, or treatment
restorations. Because these restorations are fabricated to mimic
the definitive restoration that vrill eventually be placed, they are
also diagnostic in nature with regards to shape, size, contour, and
esthetic appearance. Definitive crown and fixed partial denture
(FPD) restorations are usually a multiple-dental-visit procedure
which requires that the interim restoration mimic the planned final
restoration independent of the restorative material(s) used for that
restoration. A primai-y goal during delivery and cementation of
the definitive restoration is minimal adjustment during insertion.
By fabricating a durable, smooth, well-adapted, and well-fitting
provisional restoration, chairtime duringfinalrestoration insertion can be optimized.
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January 2013

The Purpose of Provisional Restorations


Provisional crown and FPD restorations play several key roles during the treatment process for the health of the tooth, periodontium,
and pulp. They protect the underlying tooth preparation and pulp
while the definitive restoration is being fabricated by the laboratoiy.
This pulpal protection promotes pulpal healing after the trauma of
tooth preparation. Also, a well-adapted and contoured provisional
crown assures the return to health of any traumatized soft tissues
during crown preparation and impression making by allovdng patients to maintain their oral health in the area of the restoration
(Figure 1).^ To allow for the maintenance of periodontal health
for both natural teeth and implants, materi als used for provisional
restorations need to be smooth and not plaque-retentive.^''
Temporaiy restorations are trial restorations to help determine
the desired shape, size, contours, lengths, occlusion, esthetics, and
speech during the fabrication of the definitive restoration.^** They are
also diagnostic in that they provide critical information for the evaluation of adequate axial and occlusal clearance and reduction of the
tooth preparation for thefinalrestoration.-* The clinician can make an
impression of the provisional to provide guidance in the fabrication
of the definitive restoration. Provisional restorations also can provide
important diagnostic information on occlusal relationships and tooth
positions and changes desired. These provisional materials must
be durable for the time required untilfinalrestoration fabrication.
Also, once cemented for vital teeth, these restorations must pro-vide
thermal protection and seal the preparation, protecting the dentin
from bacterial invasion and dentinal sensitivity.
Volume 34, Number 1

Once in place, provisional restorations must be easy to remove


without damaging the existing tooth preparation. Provisional restorations help maintain positional stability of the tooth preparations occlusally and proximally.^''^ " Poorly adjusted provisional
restorations can lead to tooth movement and shifting that can
have a negative impact on the placement of the final restoration.
Preparation/tooth movement will very likely necessitate additional
chairtime to make any necessary adjustment of proximal contacts
as well as occlusal adjustment during try-in before cementation
of the definitive restoration returned by the dental laboratory. Eor
EPDs, tooth movement can lead to changes in the path of insertion
between abutments.
For clinicians, the fabrication of temporary restorations for a single
crown requires proficiency with a variety of materials and techniques
that can be used to make well-adapted and functional provisionals.
There are many choices, including preformed/prefabricated metal
crowns, polycarbonate crowns, celluloid crowns, composite resin
crowns, acrylic resin for custom provisionals, bis-acryl or bis- GMA
automix composite resin materials, and composite resin for custom
fabrication.-'-'"'-'^ For multi-unit FPDs, the clinician has the choice of
acrylic resins, bis-acryl, bis- GMA, or rubberized-urethane automix
composite materials, or laboratory-fabricated resin shells.

restorations can be fabricated with either of these two subclasses


of resin during prosthodontic treatment using similar techniques.^

Acrylic Resin Provisional Materials

Aciylic resin is a very well-accepted restorative material for provisional restorations. While there are other acrylics, the two most commonly
used are self-curing (autopolymerizing or cold cure) polymethylmetliacrylate (PMMA) and polyethylmethaerylate (PEMA).'-'2 Although
these materials are tooth-colored and relatively inexpensive, they are
difficult to manipulate and have poor physical properties.'"
With acrylic resin, the fabrication of the provisional restoration
usually requires mixing a powder and liquid together to form a paste,
which is placed in either a premade shell, a template, or carrier that
is placed over the tooth preparation. For these materials, it can be
difficult to time the setting and working stages of the polymerization
reaction of acrylics because of the inaccurate method of dispensing and mixing the polymer powder and liquid monomer. Acrylic
resins have an unpleasant odor while setting.'''*"' Wlien the aci-ylic
resin reaches a rubbery consistency, the carrier is removed with the
acrylic resin from the tooth preparation so that the resin can achieve
complete pol}Tnerization and hardening. Some clinicians re-seat
the restoration on the preparation while the acrylic resin is setting
by taking the temporary on and off the preparation to control the
Preformed Single-Unit Crowns
fitting of the restoration.
Preformed stock crowns refer to interim restorations that are comOther difficulties with acrylic resins include relatively high volumercially available through a variety of manufacturers as kits. These metric polymerization shrinkage and the generation of heat during
kits typically contain either anterior-premolar shells, posterior polymerization. Care must be taken to avoid pulpal and gingival
crown shells, or both. The sizes and shapes have been determined damage by removing the aciylic resin before excessive heat of poby the manufacturers to fulfill many clinical situations relating to lymerization occurs."'-'^ Although hot water will accelerate the set
different tooth dimensions, including facial-lingual and mesial- of the reshi, the hot water and heat of polymerization of the resin wiD
distal, and occlusal- (or incisai-) heights.
cause the resin to shrink and distort at a gTeater rate.'^ Room temTofitthese crowns, measurements should be made of the mesial- perature water will equalize the heat of polymerization of the aciylic
distal relationship within the arch of the tooth preparation, and the resin and minimize shrinkage."'"'' Also, aciylic resins on rai-e occacorrect size then selected. These stock crowns usually fit poorly at sions can cause allergic hypersensitivity."*-^" These resins have a high
the gingival margins and require adjustments for length and then coefficient of thermal expansion, low strength, and poor abrasion
relining with polymeric resins. After the resin has polymerized, the resistance to wear.'*'" For the short time period that these resins will
crowns can be shaped and contoured with disks or burs.
be used, they are dimensionally stable and stain resistant.'''^''^^ If used
These preformed crowns can be made from alumij-ium, stainless for extended periods of time, these resins will show significant wear
steel, nickel-chromiimi, polycarin occlusal function, are suscepbonate, polymethylmethacrylate
tible to breakage, have poor fit,
(PMMA), and coi-i-iposite resins.
and can discolor over time.^^'^*
Preformed crowns are generally
Many clinicians prefer acrylic
used for single-tooth restorations
resins for more complex cases,
and, at times, in an emergency sitespecially multi-unit, multi-ponuation when there is no time for
tic clinical situations in which
planningfor use of a custom-fabrilong-term durability is required,
cated, resin-based restoration.''""
as they have the ability to reline
marginal areas and repair fracPolymeric Resins
tures.''^'^-^'' For long-span FPDs
The most commonly used profabricated with acrylic resins,
visional restorative materials
an increase in flexural strength
are polymeric resins. Polymeric
and resistance to breakage can
resins can be divided into two
be attained through the use of
subclasses: acrylic resin and Fig l. Well-adapted and anatomically contoured provisional restoration fiber reinforcement embedded
composite resin. Provisional maintaining periodontal health.
in the provisional material.^
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January 2013

COMPENDIUM

23

CONTINUING EDUCATION 2 | PROVISIONAL MATERIALS

Bis-acryls and rubberized-urethane composites have a pastepaste


formulation that undergoes a three-stage polymerizaIn recent years, composite resin provisional materials have been
tion
reaction.
The first phase begins as a free-flowing paste that
introduced. These materials were developed to overcome some of
adapts
to
the
tooth
preparation and then becomes elastic within
the deficiencies of acrylic resin for interim crown restorations. The
60
to
75
seconds.
The second phase, which takes place over
chemistry of these provisional composite resins is either bis-acryl,
the
next
4
minutes,
is a cross-linking polymerization reaction
bis-GMA, or rubberized-urethane resins. Their setting reactions
that
enables
the
polymer
to reach a high compressive strength.
can be light-cure, self-cure (autocure), or dual-cure.
The
final
phase
of
polymerization
allows the resin to reach its
These composite resin provisional materials are easy to use;
final
hardness
within
5
minutes
after
initial mixing so that the
they dispense with a double-barrel tube configuration where the
restoration
can
be
adjusted
and
polished
before cementation.
catalyst and base pastes are mixed in automixing tips. They are used
Use
of
composite
resin
provisional
materials
requires less time
with techniques similar to those used for acrylic resins (Figure 2
than
using
acrylic
resin.through Figure 6). These materials have improved physical propIt has been reported that the composite resins used for provisionerties and provide for a more predictable, easier fabrication of a
al
restorations
have advantages over other resin-based provisional
provisional crown restoration."'''"'^^''^'*'-' One problem with bismaterials.^
*'
=
'
2
'
^*-2'-2''^^-^'^' These advantages include the following:
acrylics is their brittle nature and potential for color changes.'--'"'"
Rubberized-urethane resins have been introduced that have demonstrated increased fiexural strength when compared to tradi- Because it is afilledcomposite resin, it is harder, more resistant
to dietary solvents, and more resistant to occlusal wear than
tional bis-aci-yl composites.--^- For FPDs, thefiexuralstrength of
unfilled acrylic resin
composites can be increased significantly through the use of fiber
Quick and easy to use; rapid setting capability enables it to be
reinforcement materials embedded in the restoration.-"-'^
removed from the mouth after 75 to 90 seconds with less chance
Composite provisional materials typically have significantly less
of causing thermal damage to the pulp and gingival tissues
shrinkage than acrylic resin due to the presence of radiopaque glass
fillers. The addition offillersto the resin also improves the fit of Flexible, making insertion and removal easier
the provisional restoration to the tooth preparation and improves Minimal polymerization shrinkage and minimal heat of polymerization
the wear characteristics of the restoration in occlusal function.^*-'*

Composite Resin Pwvisionai Materiais

Fig 2. Crov^/n preparations for implant abutment maxillary right central incisor and natural tooth left central ncisor. Water-soluble lubricant painted on
preparation surfaces as a release agent for rubberized-urethane resin provisionai material. Fig 3. Polyvinyl siloxane (PVS) template removed after 90
seconds. The provisional resin has a putty-like consistency and has remained in the template. Fig 4. For improved adaptation of the facial margins
of the provisionai a flowable light-cure resin is placed. Fig 5. Light-cure of resin for 10 seconds with a high-intensity LED curing light. Fig 6. Provisional
restoration after cementation. (Dentistry by Robert Lowe, DDS, Charlotte, NC)

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COMPENDIUM

January 2013

Volume 34, Number 1

CONTINUING EDUCATION 2 I PROVISIONAL MATERIALS

Radiopaque
Easily repairable with aflowablecomposite
Excellent color stability and stain resistance
Little odor when mixed
Minimal polishing required when used with a resin glaze

Conclusion
Provisional or interim restorations are a key element offixedprosthodontic treatment, both biologically and biomechanically.^ These
restorations provide an important diagnostic function while in place,
and they are critical in evaluating the physiologic position of the final
restoration. In the esthetic zone, they are important in evaluating the
esthetics for the definitive restoration. One can view the provisional
restoration as ablueprint for the design of the definitive prosthesis.'
With many choices of materials available to use as interim restorations, it is important for clinicians to make their selection based
upon the clinical needs for each situation. As part of these considerations, clinicians must understand and factor in the physical
properties, handling characteristics, patient response to the appearance of the interim restoration, durability of the restoration,
and the material cost in deciding which material to use. No one
material meets all the requirements for provisional restorations.
Selection of provisional materials should be made based upon a
case-by-casc evaluation for any given patient.
ABOUT THE AUTHOR

Howard E. Strassler, DMD


Professor, Director of Operative Dentistry, Department ofEndodontics,
Prosthodontics, and Operative Dentistry, University of Maryland Denial School
Baltimore, Maryland

REFERENCES
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Land MF, Fujimoto J, eds. Contemporary Fixed Prosthodontics. 4th ed.
St. Louis, MO: Mosby Elsevier; 2006:466-504.
2. Strassler HE, Lowe RA. Chairside resin-based provisional restorative materials for fixed prosthodontics. Compend Contin Educ Dent. 2O11;32(9):1O-2O.
3.GrattonDG,AquilinoSA. Interim restorations.DeniC//nA/orf/)/\m.2004;48(2):
487-497.
4. Strassler HE, Anolik C, Frey C. High-strength, aesthetic provisional
restorations using a bis-acryl composite. Dent Today. 2OO7;26(ll):128-133.
5. Maalhagh-Fard A, Wagner WC, Pink FE, Neme AM. Evaluation of surface
finish and polish of eight provisional restorative materials using acrylic bur
and abrasive disk with and without pumice. Oper Dent. 2003;28(6):734-739.
6. Buergers R, Rosentritt M, Handel G. Bacterial adhesion of Streptococcus mutans to provisional fixed prosthodontic material. J Prosthet Dent.
2007;98(6):461-469.
7. Davidi MR Beyth N, Weiss El, et al. Effect of liquid polish on in vitro biofilm accumulation on provisional restorations? Part 2. Quintessence Int. 2008;39(l):45-49.
8. Vahidi F The provisional restoration. Dent Clin North Am. 1987;31(3):363-381.
9. Strassler HE. Provisional crown and bridge resin materials: an update.
Maryland State Dental Association Journal. 1998;41(1):11-12.
10. Perry RD, Magnuson B. Provisional materials: key components of
interim fixed restorations. Compend Contin Educ Dent. 2012;330):59-62.
11. Zinner ID, Trachtenberg DI, Miller Rd. Provisional restorations in fixed
partial prosthodontics. Dent Clin North Am. 1989:33(3):355-377
12. Lui JL, Setcos JC, Phillips RW. Temporary restorations: a review. Oper
Dent. 1986:11(3):103-110.

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COMPENDIUM

January 2013

13. Jones T, Karim N, Winters E, et al. A new temporary preformed


curable crown material: mechanical properties [abstract]. J Dent Res.
2007;87(spec iss A). Abstract 130.
14. Powers JM. Composite restorative materials. In: Powers JM, Sakaguchi
RL, eds. Craig's Restorative Dental Materials. 12th ed. St Louis, MO: Mosby
Elsevier; 2006:513-543.
15. Powers JM. Mechanical properties. In: Powers JM, Sakaguchi RL, eds. Craig's
Restorative Dental Materials. 12th ed. St Louis, MO: Mosby Elsevier; 2006:51-96.
16. Driscoll CF, Woolsey G, Ferguson WM. Comparison of exothermic
release during polymerization of four materials used to fabricate interim
restorations. J Prosthet Dent. 1991;65(4):504-506.
17. Altintas SH, Yondem I, Tak O, Usumez A. Temperature rise during
polymerization of three different provisional materials. Clin Oral Investig.
2OO8;12(3):283-286.
18. Giunta J, Zablotsky N. Allergic stomatitis caused by self-polymerizing
resin. Oral Surg Oral Med Oral Pathol. 1976;41(5):631-637
19. Stugis TE, Fink JN. Hypersensitivity to acrylic resin. J Prosthet Dent.
1969;22(4):425-428.
20. Kanerva L, Estlander T, Jolanki R. Allergy caused by acrylics: past,
present and prevention. Curr ProbI Dermatol. 1996;25:86-96.
21. Givens EJ Jr, Neiva G, Yaman P, Dennison JB. Marginal adaptation and
color stability of four provisional materials. J Prosthodont. 2008;17(2):97-101.
22. Koumjian JH, Firtell DN, Nimmo A. Color stability of provisional materials in vWo. J Prosthet Dent. 1991;65(6):740-742.
23. Sham AS, Chu FC, Chai J, Chow TW. Color stability of provisional prosthodontic materials. J Prosthet Dent. 2004;9K5):447-452.
24. Young HM, Smith CT, Morton d. Comparative in vitro evaluation of
two provisional restorative materials. JProsf/)efDenf.2OOl;85(2):129-132.
25. Lodding DW. Long-term esthetic provisional restorations in dentistry.
Curr Opin Cosmet Dent. 1997;4:16-21.
26. Emtiaz S, Tarnow DP. Processed acrylic resin provisional restoration
with lingual cast metal framework. JPrasfftetDenf. 1998;79(4):484-488.
27. Saygili G, Sahmali SM, Demirel F. The effect of glass fibers and aramid
fibers on the fracture resistance of provisional restorative materials. Oper
Dent. 2003;28(l):80-85.
28. Hamza TA, Rosenstiel SF, Elhosary MM, Ibraheem RM. The effect
of fiber reinforcement on the fracture toughness and flexural strength
of provisional restorative resms. J Prosthet Dent. 2004;91(3):258-264.
29. Yap AU, Mah MK, Lye CP, Loh PL. Influence of dietary simulating
solvents on the hardness of provisional restorative materials. Dent Mater.
2004;20(4):370-376.
30. Yilmaz A, Baydas S. Fracture resistance of various temporary crown
materials. J Contemp Dent Pract. 2007;8(l):44-51.
31. Rutkunas V, Sabaliasuskas V, Mizutani H. Effects of different food colorants and polishing techniques on color stability of provisional prosthetic
materials. Dent Mater J. 2010;29(2):167-176.
32. Levine E, Hack G, Prymas S. Using biomaterial investigative skills to
assist in the clinical decision making process [abstract]. J Dent Educ.
2011;75(2):190-256. Abstract 117.
33. Karbhari VM, Strassler H. Effect of fiber architecture on flexural characteristics and fracture of fiber-reinforced dental composites. Dent Mater.
2007;23(8):960-968.
34. Powers JM. Resin composite restorative materials. In: Powers JM,
Sakaguchi RL, eds. Craig's Restorative Dental Materials. 12th ed. St Louis,
MO: Mosby Elsevier; 2006:189-212.
35. Akova T, Ozkomur A, Uysal H. Effect of food-stimulating liquids on the
mechanical properties of provisional restorative materials. Dent Mater.
2OO6;12(l);n3O-1134.
36. Yilmaz A, Baydas S. Fracture resistance of various temporary crown
materials. J Contemp Dent Pract. 2007;8(l):44-51.
37. Bohnenkamp DM, Garcia LT. Repair of bis-acryl provisional restorations
using flowable composite resin. J Prosthet Dent. 2OO4;92(5);5OO-5O2.
38. Hagge MS, Lindemuth JS, Jones AG. Shear bond strength of bis-acryl
composite provisional material repaired with flowable composite. J Esthet
RestorDent 2002;14(l):47-52.

Volume 34, Number 1

CONTINUING EDUCATION 2

Fixed Prosthodontics Provisional Materials: Making the Right Selection


Howard E. Strassler, DMD
This article provides 2 houfs of CE credit from AEGIS Publications, LLC. Record your answers on the enclosed Answer Form or submit them on a
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1.

A primary goal during delivery and cementation of the definitive


A.
B.
C.
D.

restoration is:
A. minimal adjustment during insertion.
B. a weli-defined occlusal esthetic design.
C. complete exposure of all margins on the tooth.
D. no evidence of gingival abrasion.
2.

3.

Composite provisional materials typically have significantly less


shrinkage than acrylic resin due to the presence of:
A. silver halide crystals.
B. nanoparticles.
C. silane coupling.
D. radlopaque glass fillers.

8.

Bis-acryls and rubberized-urethane composites have a paste-paste


formulation that undergoes what type of polymerization reaction?

Poorly adjusted provisional restorations can lead to:


A. tooth movement and shifting.
B. occluded salivary ducts.
C. crepitus.
D. bilateral TMJ symptoms.
Stock preformed single-unit crowns usually fit poorly at the
gingival margins and require:
A. fabrication with either acrylic or composite resin.
B. adjustments for length.
C. no relining with polymeric resins.
D. all of the above

5.

With acrylic resin, the fabrication of the provisional restoration


usually requires:
A. light-curing.
B. fabrication In a laboratory setting.
C. mixing a powder and liquid together to form a paste.
D. indirect application to the prepared tooth model.

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28

7.
Temporary restorations are:
A. not practical.
B. usually designed with only esthetics in mind.
C. trial restorations.
D. only important if meant to last more than 2 months before
the final restoration is delivered.

4.

COMPENDIUM

January 2013

bis-acryl.
bIs-GMA.
rubberized-urethane resins.
all of the above

A.
B.
C.
D.
9.

a three-stage
a conditional addition phase
a phase reactive
a delayed phase shift

Composite resins used for provisional restorations have which


of the following advantages over other resin-based provisional
materials?
A. flexible, making insertion and removal easier
B. minimal polymerization shrinkage and minimal heat of polymerization
C. easily repairable with a flowable composite resin
D. all of the above

10. Selection of provisional materials should be made based upon:


A. the brand of composite material.
B. a case-by-case evaluation for any given patient.
C. the type of final restoration planned.
D. the opposing arch occlusion and composition.

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COURSES ARE ALSO AVAILABLE ONLINE AT CCED.CDEWORLD.COM.

30

COMPENDIUM

January 2013

Volume 34, Number 1

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