RMDC SPEAKER
Creating the Easy and Efficient Temporary By Lori Trost, DMD
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well-made temporary lends itself as the blueprint to the final dental restoration and its long-term success. Regardless if you utilize digital impression scanning or take traditional impressions, maintaining the restorative space during the temporary phase is critical for dimensional accuracy. And, given a recent ADA survey that 48% of any dental practice production directly reflects indirect procedures, temporary fabrication quickly becomes a significantly valued procedure. Often though, temporaries become an arch nemesis of the practice. They come off or break and need to be remade and then recemented. For a busy dental practice, this interruption in the schedule leads to frustration, miscommunication and appointment delays. Effectively, the inefficiency of a single unit crown procedure can manifest in many ways. Implementing a temporary fabrication protocol that can be performed predictably and efficiently has benefits not only for the patient but for the practice. Patients want their temporary to “stay on,” look good and not be sensitive. Dental professionals desire to work with a temporary material that is easy, strong and esthetic, protects the pulp, maintains the periodontal health, yet, is easy to remove. And each of these features must be respected. Whether fabricating a single or multiple unit provisional, specific material properties offer advantages that can significantly reduce the temporary-making anxiety. From the initial model or template of the tooth to be restored, to the actual provisional material and temporary cement choice, each selection should provide a benefit. Case Study A patient presented with a large MOD amalgam on tooth #29 that had recurrent decay. A crown was treatment planned to properly restore the tooth for function and support. Before the tooth was prepared, a model or template was made using a polyvinylsiloxane hybrid impression material (AlginX Ultra, Dentsply Sirona). The PVS material was syringed into an aluminum quadrant tray (TempTray,
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Clinician’s Choice) and positioned and held steady over the tooth for three minutes. (figure 1) This PVS hybrid impression material offers two weeks of dimensional stability, therefore it can be stored and re-used if necessary in case the temporary needs to be remade. (figure 2)
figure 1
The crown prep and digital intraoral scan were completed. A dual cure composite-based material, shade A2 (Integrity Multicure, Dentsply Sirona) was syringed into the initial model/ template. (figure 3) The selection figure 2 of a dual cure temporary material affords the clinician the benefit from a self or auto-cure mode that can be complimented and finalized by light curing to expedite the polymerization process. Not only is this a time savings feature, but also provides a fully cured temporary that can be immediately finished and polished. The syringe tip was figure 3 placed at the base or occlusal table of the model, carefully dispensing the material to fill the preparation site to 2/3 full. No swirling occurred during the dispensing. This technique minimizes voids and air bubbles that can often form during the fabrication process. The filled model was positioned over the prep and held in the patient’s mouth for 90 seconds. (figure 4) The patient was instructed not to bite down on the
