Creating the Easy and Efficient Temporary

By Lori Trost, DMD

A 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, 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

Figure 2

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 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 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.

Figure 3

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 tray. This could potentially “rock” the tray and cause a misfitting temporary. After the allotted time, the tray/model was removed from the mouth with the temporary remaining inside the template. The tray was placed on the counter with the intaglio surface of the model facing upright. A LED curing light (SmartLite Focus, Dentsply Sirona) was placed over the intaglio surface and activated for 20 seconds to complete the polymerization of the temporary material. (figure 5)

Figure 4

Figure 5

Next, care was taken to remove the newly formed temporary from its model. Notice the lack of voids or bubbles. Because this material is composite-based, if an area needs to be filled in or added to, flowable composite can be used. (figure 6) As you can see, minimal flash resulted from the fabrication process that could easily be peeled away. Also, due to the nature of the composite chemistry, a 2 x 2 dry gauze was used to wipe off the oxygen-inhibited layer.

Figure 6

An acrylic bur was used to trim around the margin and finish the exterior surface. The temporary was tried in to verify occlusion, contacts, and marginal coverage. Few adjustments were necessary. Again, due to the composite-based material selection, flowable resin could be relied upon to fill in an area because of compatible chemistry and light-cured. Prior to these materials, methacrylate-based provisional materials consisted of a powder and liquid mixture that were inconsistent, created a thermoplastic reaction that set off heat into the tooth yielding sensitivity, and ultimately resulting in shrinkage that potentially caused temporaries to “lock on” to the newly prepared tooth.

A cup-shaped composite polisher (Enhance, Dentsply Sirona) with a latch grip on a slow-speed handpiece was selected to polish all the surfaces of the temporary using a light touch. The polishability of the temporary is critical to creating a luster that is biocompatible, smooth to the tongue, and cleansable for the patient.

The provisional was ready to be temporarily cemented. Considerations for temporary cements focus on either a resin-based or eugenol based chemistry. Some temporary cements even offer antimicrobials such as chlorhexidine in their ingredient listing. Relating to the esthetics of the case, temporary cements are also available in clear or translucent options for anterior teeth as well as more opaque cements for posterior teeth.

Regardless, a temporary cement must primarily function to soothe the tooth, work in tandem to keep the provisional seated, possess a low film thickness, and provide an easy clean-up upon initial placement and then upon provisional removal for the cementation of the final restoration. A resin-based temporary cement (TempGrip, Dentsply Sirona) was syringed into the provisional as a thin layer coating the intaglio surface. The provisional was seated over the preparation firmly using finger pressure. A cotton roll was placed over the occlusal table of the quadrant to allow the patient to close and rest for two minutes while the temporary cement set. This temporary cement offers an easy peel-away clean-up that the author finds very favorable and unique. The provisional was flossed and occlusion re-verified. (figure 7)

Figure 7

And finally, the patient was given home care instructions to follow until the final restoration was delivered.

Conclusion

Ultimately, the temporary fabrication process is realized by what works best in the clinician’s hands and what materials are most helpful. By selecting materials that not only provide durability but also efficiency, dental professionals can become more confident in predictable outcomes for the delivery of a much anticipated functional temporary.

About the Author

Dr. Lori Trost has extensive private practice experience that focuses on restorativedentistry, digital workflow solutions, business management and team building.She has been awarded the ADA’s Shils Foundation Award and named a “Top 25”Woman in Dentistry and a Leader in Continuing Education by Dentistry Today.