The Most Important Treatment Tool
There are very few things a clinician can do that will maximize successful results like using well-designed provisionals. Provisionals are not merely placeholders for the permanent restorations to come, they are one of the most important diagnostic and treatment tools that are available.
According to Terry E. Donovan, DDS, and George C. Cho, DDS, of J Can Dent Associates, "... the restorative dentist must clearly understand the esthetic expectations of the patient, and the patient must understand the inherent limitations of any type of restorative therapy. One often neglected modality at the clinicians' disposal to aid in the communication between the dentist and patient is the provisional restoration." Issue: 1999:65:272-5
At Burbank Dental Lab we get clinician feedback from hundreds of doctors about thousands of cases. There is no question that for restorative and cosmetic cases when provisionals are placed for a trial period of sufficient time to get clinical feedback from the patient, a high success rate of the final restorations is easily attained.
Provisionals offer an esthetic and functional prototype for the final restorations, allowing you and the patient to evaluate these aspects:
- Occlusal accuracy
- Muscle and joint comfort
- Minimize interferences that cause damage to the restorations
Esthetic & Phonetic Aspects
- Is the patient happy with the smile design?
- Do the proportions, midline, cant, tooth position, and length, work in the smile?
- Are the phonetics hampered in any way?
Advantages to Lab-Processed DuraTemps Provisionals
1. Protects and shapes tissue
One of the most important clinical concerns while a case is temporized is preserving the health of, and preparing the shape of, the tissue. Proper gingival contouring of provisionals is, therefore, the critical foundation for success. Lab-processed DuraTemps® are the best way to be assured of superior design and finish to protect and shape your patient's tissue. The highly glazed finish also ensures good tissue health.
2. Saves you valuable chair time
Creating properly contoured and esthetic provisionals takes a significant amount of time from auxiliary and spends valuable chair time. DuraTemps® technicians do all of the design and finish work so that you have quick clean-up and minimal chair time to reline.
3. Eliminates surprises in the final seating of ceramics
DuraTemps® design team members build in your specific requirements, minimizing disappointed patients at the placement of final restorations. Your starting point with placement of DuraTemps® will give you immediate feedback from your patients, allowing you to alter design if needed and get final approval before even beginning the ceramics. Simply take an impression of the adjusted DuraTemps® in place, and send it with your final prepped impressions. Burbank Dental Lab's Smiles By Design® technicians will use the model of the temps as a design template for the final ceramic restorations.
Lab Processed vs. Direct Provisionals
When is it advantageous to use lab-processed provisionals, and when is the direct technique the best solution?
For anterior veneer cases, direct is the popular choice for many clinicians. The preferred method seems to be:
- Using a putty impression with a PVS wash, taken of a quality wax-up.
- Then curing a bis-acryl in the mouth using the putty matrix. These typically are not cemented, but rely on material shrinkage and under-cuts to hold them in place.
- Clean-up is done in the mouth without removal of the provisionals.
Once a case gets more complicated, involving restorations beyond the anterior or including full crowns in the treatment, indirect lab-processed provisionals become the standard.
Advantageous Traits of Lab-Processed DuraTemps®
- Proper gingival contour
- No staining due to smooth glazed surface
- Accurate fit
- Patient's testing of VDO
- Approximate shade
- Desired texture and shapes
- Stronger than chairside temps - can have additional strengtheners added, such as wire, metal mesh, fiber mesh.
- Properly proportioned
- Occlusal and functional design
It is essential to make all of the smile design decisions with the patient before wax-up or provisional fabrication. Spending this time on the first records collection appointment gives you and the technicians the tools required to create provisionals that will be your working template for the final ceramics.
Chairside Procedures for Seating Lab-Fabricated Provisionals
Your DuraTemps® provisionals are typically fabricated from pre-op models. The prescribed teeth are reduced 1 mm on all surfaces of the model in the lab. The tissue sites will also be shaped for your prescribed results. This reduction allows you to seat and reline easily in the mouth after preparation. DuraTemps are methyl methacrylate-based and require a cold cure acrylic or bis-acryl to reline.
DuraTemps® Seating Directions
1. Prepare teeth, pack cord, and control bleeding.
2. Try in DuraTemps® to ensure the path of insertion and sufficient reduction.
3. Clean DuraTemps® and brush monomer on the inside of temps.
4. Paint exterior of DuraTemps® with petroleum jelly, avoiding 1 mm away from margins, this will prevent the reline material from sticking to the DuraTemps® surface.
5. Mix acrylic and fill provisional abutments 3/4 full. Wait until acrylic has a slightly dull gloss, then seat in position in the mouth (figure 3).
6. Test acrylic for stiff rubbery texture and remove. Do not allow to cure in mouth fully. Move the temps off of the preps while curing (figure 4).
7. Clean away flash and finish margins. Use soft rubber wheels, or fine acrylic carbide, then polish marginal areas with a fine flower of pumice (figures 5 and 6).
8. Use the temporary cement of your choice (we recommend non-eugenol material if you are bonding final restorations).
9. If needed, you may re-glaze DuraTemps® surface with Palaseal® or Luxaglaze®, or a similar light-cured glaze.
DuraTemps® are laboratory-fabricated provisional restorations that are much more durable and esthetic than traditional chair-side fabricated provisionals, even rivaling the finished restorations. DuraTemps® will save you valuable chair-time by streamlining your provisional process and will deliver your patients a prototype smile at the prep appointment. Provisionals can be fabricated for single crowns and multi-units including splinted full-arch bridges. When altering VDO, DuraTemps® are excellent to establish a predetermined ideal vertical prior to prepping any teeth. DuraTemps® are very advantageous for immediate extraction cases, allowing you to create the ideal pontic site shaping.
DuraTemps® can be fabricated from either the pre-operative or prepped models. Many of our clinicians use DuraTemps® as a diagnostic outline for the final restorations. You and your patient can pre-approve the length, contours, and shade after seating the DuraTemps®. Once you and the patient are satisfied with the provisional’s design modifications, take an impression of the DuraTemps® in place and send it to the lab along with the final prepped impressions. The lab will then use the model of the DuraTemps® in place to use as a guideline for the final restorations.
DuraTemps® increase your profitability by reducing the time you and your staff will spend chair-side fabricating traditional provisionals. DuraTemps® allow you and your team to free up more chair-time and be more productive.
DuraTemps® come backed with a six-month warranty against breakage.
- No preparation required; DuraTemps® can be fabricated from either the pre-operative or prepped models.
- DuraTemps® are stronger and more durable than chairside temps.
Indications for use:
- Indicated for provisional crowns and splinted bridges
- Metal substructures recommended for spans greater than three units
- Immediate smile designs
- Restoring lost vertical dimension
- Creating ideal ovate pontics sites
No preparation is needed.
- Try-In the DuraTemps® to verify passive seating and estimate that the occlusion and vertical are correct.
- Clean restorations with water and dry after try-in.
- Reline with a cold cure acrylic. It is important to block out any undercut in the preps before relining.
- Trim excess acrylics from margins.
- Polish restorations with pumice and acrylic polishing paste, and then use a light cured glaze such as Palaseal.
- Cement using a non-eugenol temporary cement.
In-Lab Turnaround Time
Lab turnaround time is five (5) working days, with expedited delivery available on request.
• D2932 Crown - Prefabricated Resin