A Temporary Material That Simplifies
Provisionalization is a routine step in crown and bridge treatment, yet all too often, clinicians do not seek out materials that would make the process easier. While numerous provisional materials are available with varying levels of strength, polishability, durability, and shrinkage, many lack the elasticity, “forgiveness,” and speed required for the job.
Access Crown, a bis-acryl composite resin, has a quick initial setting time, low shrinkage upon setting, and an elasticity that prevents it from locking onto the adjacent interproximal spaces during removal. The material has high polishability that prevents gingival irritation and yields higher esthetics. The following case describes its use when converting teeth to be extracted and replaced with a fixed bridge.
An 81-year-old woman presented to an emergency appointment complaining of pain in the upper right premolar area. Her medical history was reviewed and her healthcare aide indicated she had a history of cardiac issues, early-stage dementia, and was currently on several medications, including a blood thinner. The exam noted caries on the buccal, mesial, occlusal, and lingual of the first premolar with a defective occlusal-distal amalgam present. Splinted crowns were noted on the canine and lateral incisor with no mobility, and visible caries was present at the facial cervical of the canine crown (Figure 1). Radiographs were taken and the caries noted on the premolar was deep, leaving the tooth non-restorable. The lateral incisor had prior endodontic treatment and caries had separated it from the splinted crowns with the canine supporting both crowns. The condition of the remaining lateral incisor rendered it non-restorable.
Due to the patient’s medical issues and no other missing teeth on the maxillary arch, the treatment proposed was a fixed bridge on the canine. It would consist of removing the splinted crowns, extracting the remaining tooth of the first premolar and lateral incisors, and then restoring the area with an abutment crown on the canine and pontics at the first premolar and lateral incisors.
Treatment Begins
A preliminary impression was taken of the anterior to the second premolar in a dual-arch tray using a monophase medium body VPS impression material (Access MONOPHASE, Centrix) to be used as a mold for fabrication of the provisional restoration (Figure 2).
After the roots of the first premolar and lateral incisor were extracted (Figure 3), the crown preparation on the canine was refined with a diamond. A composite resin (Access Crown, Centrix) was injected from an automix cartridge into the previously taken preliminary impression at the treatment site (Figure 4). The impression was reinserted intraorally and the patient guided into occlusion in the dual-arch tray.
After 2 minutes, the impression with provisional within was removed from the mouth (Figure 5). The margins of the 3-unit provisional were contoured with a fine flame polisher and the material extending into the extraction sockets modified to form “bullet-shaped” pontics. The provisional was tried in to verify its fit, and occlusion checked and adjusted to eliminate any contacts on the premolar and lateral incisor (Figure 6). The provisional was removed and a final impression taken in a dual-arch tray using NoCord VPS MegaBody material in the tray and NoCord VPS Wash material injected around the margins of the canine abutment.
After the temporary cement set, the provisional was luted (Access Automix, Centrix) and the patient was dismissed to her aide’s care. She returned 1 week later to check healing around the provisional restoration. Gingival tissue had minimal inflammation, and the patient indicated she had no discomfort following the extractions. Occlusion was checked and no adjustments were necessary (Figure 7).
The patient returned at 3 weeks posttreatment and the provisional bridge was removed and residual temporary cement cleaned from the abutment preparation at tooth No. 6. Since the patient was in an anterior crossbite, the PFM bridge was tried in and occlusion checked to verify that there was no contact with the facial of the bridge. A universal resin cement (AbsoLute, Centrix) was placed into the abutment and the bridge was seated. After allowing the resin cement to initially set for 1 minute, excess cement was cleaned at the margins with a scaler. The resin cement was then allowed to complete setting and occlusion was checked (Figure 8). injected from an automix cartridge into the previously taken preliminary impression at the treatment site (Figure 4). The impression was reinserted intraorally and the patient guided into occlusion in the dual-arch tray. After 2 minutes, the impression with provisional within was removed from the mouth (Figure 5). The margins of the 3-unit provisional were contoured with a fine flame polisher and the material extending into the extraction sockets modifi ed to form “bullet-shaped” pontics. The provisional was tried in to verify its fit, and occlusion checked and adjusted to eliminate any contacts on the premolar and lateral incisor (Figure 6). The provisional was removed and a final impression taken in a dual-arch tray using NoCord VPS MegaBody material in the tray and NoCord VPS Wash material injected around the margins of the canine abutment. After the temporary cement set, the provisional was luted (Access Automix, Centrix) and the patient was dismissed to her aide’s care. She returned 1 week later to check healing around the provisional restoration. Gingival tissue had minimal inflammation, and the patient indicated she had no discomfort following the extractions. Occlusion was checked and no adjustments were necessary (Figure 7). The patient returned at 3 weeks posttreatment and the provisional bridge was removed and residual temporary cement cleaned from the abutment preparation at tooth No. 6. Since the patient was in an anterior crossbite, the PFM bridge was tried in and occlusion checked to verify that there was no contact with the facial of the bridge. A universal resin cement (AbsoLute, Centrix) was placed into the abutment and the bridge was seated. After allowing the resin cement to initially set for 1 minute, excess cement was cleaned at the margins with a scaler. The resin cement was then allowed to complete setting and occlusion was checked (Figure 8).
This relatively standard procedure was made easier by 2 unique elements of Access Crown—its short setting time and its ability to be removed and reinserted without distortion. These benefits made the procedure easier for this older patient, as well as for the clinical team. The choice of 7 shades made it easy to closely and esthetically match the patient’s adjacent teeth.
REVEAL CLEAR ALIGNERS
Access Crown is a fast and easy bis-acryl temporary resin composite for provisional crowns and bridges. It sets to an elastic memory state in only 60 seconds and is very easy to remove without distortion. It offers the ideal combination of strength, esthetics, and ease of use, offering more usable material and less waste with smaller, more effi cient SuperMixer mixing nozzles.
Dr. Hamoud graduated from Midwestern University’s College of Dental Medicine in 2015 and currently practices general and cosmetic dentistry at Premiere Family Dental in Burbank, IL.
