Everyday Success with Provisionals
The patient was a 53-year-old female who presented to our office with a broken laminate restoration on tooth No. 9. Prior to removal of the laminate a double bite impression of the tooth was made using an alginate substitute, Silginate (Kettenbach). Using a double bite tray has 2 main advantages. Not only is a template made of the tooth to be prepared, but also the bite relationship is recorded simultaneously, and it prevents the provisional material from escaping to the occlusal surface, significantly reducing adjustment time.
Due to insufficient remaining enamel following the laminate removal, a cemented full-coverage restoration was deemed to be the best option instead of restoring the tooth with another laminate. Once the patient was anesthetized and the porcelain laminate was removed, the tooth was prepared for an IPS e.max all-ceramic crown (Ivoclar Vivadent). Prior to packing retraction cord, the Silginate impression in the No. 9 area was filled with Venus Temp 2 (Heraeus Kulzer) and seated in the mouth.
The provisional material can be removed in about one minute, and the material is still pliable enough that it will not engage any undercuts. The Silginate impression containing the provisional was set aside so that the material can achieve complete polymerization. The impression material was then expressed around the prepared tooth and the impression tray seated. While waiting for the impression material to set, the trimming on the provisional was started. There was a void on the incisal (as is frequently the case when making provisionals).
Rather than redo the provisional, a small amount of Venus Bulk Fill Flowable (Heraeus Kulzer) was added to the defect and light-cured. It is imperative that any repairs be done before the polishing and finishing of the provisional in the affected area, since the oxygen-inhibited layer on the surface of the provisional will allow the composite repair to adhere to the surface. Once the repair is completed, the provisional restoration was trimmed using fine and ultrafine diamond burs to trim the margin and the interproximal areas.
The provisional was then placed in the mouth, and using Sof-Lex discs (3M ESPE), the incisal portion was adjusted and the basic contours were formed. If the initial impression for the provisional is clean and accurate, very little time has to be spent finishing the provisional restoration, so it pays dividends to spend the time to make a good initial impression.
The finished provisional exhibits a natural luster that not only feels normal against the patient?s lips, but also will reduce plaque adhesion, leading to greater gingival health at the time of the cementation of the definitive restoration. After the prep was cleaned with chlorhexidine, the provisional was cemented with Dycal (DENTSPLY Caulk).