Provisionals Part 2

When creating multiple unit anterior provisionals, you need to account for ...

anatomy/occlusion

contacts

contours

margins

finish and polish

In regards to anatomy/occlusion, you need to ___

avoid interferences

Contacts need to be ___

closed

With which provisional material may you see effects of distortion, as well as exothermic release?

acrylic

When maximizing esthetics, you should minimize use of ___

add-on technique

What is the #1 patient complaint when it comes to provisionals?

occlusion

In regards to occlusion, you want to have the same occlusal marks ...

with and without the provisional in

You also want to avoid "___" when provisional(s) are placed in

rocking

You want to evaluate ___ and ___ movements

centric

lateral

Centric

up and down (vertical)

Lateral

right and left (horizontal)

Before the appointment, you want to prepare ___ and ___

diagnostic casts

matrix fabrication

You want a provisional to be both ___ and ___

functional

esthetic

Which provisionals are 'allowed' to be functional, but unaesthetic?

happens fairly often with posteriors

What is generally the dentist's priority?

function

What is generally the patient's priority?

esthetics

Is it a problem if a provisional looks pretty but has an open margin?

yes!

nonfunctional, even though it is esthetic

No cement being found in a provisional means it has been dislodged, which means that ___ of the provisional has taken place

rocking

T/F: sometimes, the only way to fix prosthetics is to crown adjacent teeth

true

to provide extra retention/to hold the tooth in

ex: if patient fractured a canine (#6) and had it extracted, you may need to put a crown on top of #s 4,5,7, as well as an acrylic provisional in place of #6

for esthetics, you may even extend to crowning #8

What is the name of the clear shell that is used for anterior multiple unit provisionals?

Omnivac

Omnivac shells are made on ___

modified diagnostic casts

T/F: omnivac shells are more detailed than overimpressions

false

not as detailed

T/F: the omnivac shell can flex during seating, causing bulky contours

true

You should seat Omnivac shell into the mouth to gauge if you ___

reduced enough

How do you prepare teeth for crowning?

abutments

How do you make abutments, using an Omnivac shell?

pour acrylic into shell

place cotton pellets to confine the acrylic within the teeth areas that need them and remove them before placing the shell intraorally

You should ___ at the margins and contact points of provisionals

remove gross excess

___ should be modified in and out of the mouth, since it is exothermic

Acrylic

(don't let it fully set before it has been fully modified)

For composite, you can modify until you ___

spot cure

___ can be used to carve excess and reduce embrasure areas

Pointed acrylic burs

___ burs can also be used to accomplish these means

Pointed diamond

Embrasure designs on/of provisionals can be developed using a ___

disc (interproximally)

What is the name of a disc that you can use?

Horico

What is the body of the provisional, that wraps around the tooth structure, called?

pontic

What are the connectors between provisional teeth called?

bridges

When designing embrasures, you want to avoid ___

over-cutting

Over-cutting has a ___ effect on strength and may convey poor ___

weakening

esthetics

You don't want to break bridges nor make them too small, since these connectors establish proper ___

embrasures & contacts

You want to avoid ___ when creating embrasures/contacts

dark triangles

Contacts ___ as you move proximal

go down on the tooth

You want to carve enough gingival embrasure for ___

gingival health

Occlusal embrasure is needed for (esthetics/function)

both!

___ (error) is common if provisionals are created in direct fashion

Distortion at marginal seal

Provisional Reline Technique

a dental procedure used to adapt or "fit" a temporary restoration (such as a crown, bridge, or denture) snugly to the patient's gums and prepared teeth

it ensures a precise seal to prevent sensitivity, promote gum healing, and verify the fit before the final restoration is permanently placed

Does the provisional reline technique involve temporary cement?

yes

You want even contact (if possible) on all anterior teeth during ___ movement

protrusive

___ technique can be used for multiple unit bridges

Eggshell

Explain the eggshell technique:

Summary of this method:

Turn patient—with a missing tooth—current mouth into two stone models... wax up a tooth on one of the stone models and turn this wax up into stone... you now have a stone model with all teeth in it, as well as one with a missing tooth

Go back to original stone model with missing tooth...on this model, you will prepare the two adjacent teeth as abutments

On the stone model with the tooth filled in, you put Omnivac retainer on... this gives you the shape that you will need

You take this Omnivac to the other stone model with the missing tooth and adjacent abutments... you then pour acrylic into the Omnivac and set it on this stone model

After a few minutes of setting, you will an acrylic designed to fit directly into the patient's mouth

In patient's mouth, you prepare the same abutments and then place this INDIRECT provisional in

May need some modifications (ex: reline) before officially temp cementing it in

When you prepare the abutment teeth on the original diagnostic model, it is important to ___ the abutment teeth

underprepare

Demonstrate:

If you need about 2mm in real life, do about 1mm in model

The paint-on technique should largely be avoided, as we have already discussed. What may using this technique produce?

an unaesthetic, frosty appearance

Lab processed shell provisionals can also be employed... these are ___, but ___

very esthetic

expensive

Lab processed shell provisionals may be difficult to ___, as well

re-line

___ are sometimes extended beyond where you may originally think they will be in order to garner more retention/resistance/esthetics

Bridges

for instance, a #6-8 bridge may not be able to support itself.. so you extent all the way to 4 and and 10

Esthetic Consideration for Anterior Provisionals: the long axes of the central incisor crowns converge slightly toward the ___

midline

Esthetic Consideration for Anterior Provisionals: the long axes of the crowns of posterior teeth are inclined toward the ___

lingual

Esthetic Consideration for Anterior Provisionals: the long axis of the lateral incisor should tilt ___

distally

Esthetic Consideration for Anterior Provisionals: when viewed from the midline, each tooth is narrower than the tooth mesial to it... by what %?

60%

Esthetic Consideration for Anterior Provisionals: incisal edges of lateral incisors are slightly off the plane of ___

occlusion

Esthetic Consideration for Anterior Provisionals: contacts are progressively closer to the gingiva the more ___ you go from the midline, toothwise

distal

Esthetic Consideration for Anterior Provisionals: incisal embrasures become progressively ___ from central to lateral to canine

larger

Esthetic Consideration for Anterior Provisionals: incisal embrasures become ___ with age and wear

smaller

Esthetic Consideration for Anterior Provisionals: narrowing TLAs makes the tooth look ___

longer

Esthetic Consideration for Anterior Provisionals: widening TLAs makes the tooth look ___

smaller

Esthetic Consideration for Anterior Provisionals: you may need to change ___, as well, in order to bolster symmetry with remaining natural teeth

height of contour