Provisionals: A Temporary Tool for Final Restorations

THE BENEFITS OF PROVISIONALS

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Meeting a patient’s esthetic expectations is a critical component of ensuring their overall satisfaction. In most instances, patients can be purely driven by esthetics, but as clinicians, managing the functional aspects of a patient’s overall oral health holds an equally critical role in ensuring comfort and longevity. It is vital then that the dentist clearly understands the patient’s expectations and works out any limitations to achieving those expectations. One of the most effective tools in creating an ideal plan is through the use of provisionals.

The Benefits of Provisionals

Provisional restorations can be used to evaluate and preview a desired esthetic outcome and help to uncover any functional limiters. They can help to determine the desired shape and color, as well as assess periodontal response and function. Provisionals are often utilized in large complex cases such as full mouth reconstructions. Still, it is essential to note that, in some instances, they are used to evaluate single units, multiple units, and implants as well. Especially in implant restorations, provisionals play an essential role in tissue management and overall case success.

At the fundamental level, a provisional is useful to provide a holding spot both horizontally and vertically to help prevent tooth movement while waiting for a more permanent restoration. They help to prevent bacteria exposure on the surfaces and tubules by protecting the dentin. Provisionals also help to avoid sensitivity while waiting for the final prosthesis. Provisionals, especially like those fabricated at Burbank Dental Lab (fig 1), offer the following specific goals:

  • To help manage esthetic issues to ensure a patient has a clear idea of the outcome. This includes determining the smile line, embrasures, length, and midline. The patient will have a visual representation of these parameters to help ensure overall satisfaction with the final restorations.
  • To help manage tissue health to reduce the chances of inflammation. While some inflammation can occur even if handled correctly, this resolves once the final restorations are inserted.
  • To allow the clinician to check for speech issues that may result from the new prosthesis. The clinician will check for problems such as articulation, lisps, whistling, etc.
  • To ensure that occlusion has been accurately worked out, especially in cases where the vertical dimension has been altered.
DuraTemp Provisionals by Burbank Dental Lab (Figure 1)

The Ultimate Prototype

The provisional works as a prototype of the final restoration. It is advised, especially in larger cases, to allow the patient several days of wearing the provisional to ensure that they will be satisfied with the final results. When the final restorations have been seated, the doctor and the patient will already have a clear idea of what the final restorations will look like and how they will function.

When a provisional is not provided, the outcome will be a guess and may result in an unsatisfied patient with the possibility of having to make corrections or remakes. This is notably true in cases where changes in the vertical dimension are part of the treatment plan. These types of changes must be tested to determine how the patient will tolerate them. Through wearing a prototype of the final restorations, the vertical dimension, occlusion, and mandibular position can be tested to ensure the patient will be comfortable with the final prosthesis.

Determining the case design begins with understanding the esthetic concerns and desires of the patient. This step is best gained through not only listening to the patient but also through having the patient view smile design photos and perhaps having them look for other pictures of smiles that they find appealing. There are computer imaging services available that can provide a digital mock-up of proposed smile designs as well as other products that offer chairside quick smile mock-ups that get the uncovering process going.

Case Planning Steps

After these preliminary steps are completed, and the initial criteria are gathered, a wax-up is created to determine the possibilities of what the patient’s actual oral situation is, coupled with the desired outcome.

This process should begin the following steps: 

  • 1

    Take accurate impressions and bite registrations.

    These records can be taken utilizing traditional impression techniques or through digital impression capture.

  • 2

    Record the horizontal plane with an instrument such as the Lois Dento-facial analyzer.

    Burbank Dental Lab - Kois Bow instructions

  • 3

    Provide detailed information on the patient's desired results and concerns.

  • 4

    This information is deciphered, and then a visual representation is fabricated in the form of a wax-up.

    The wax-up can either be recreated in wax or digitally.

    Beyond Imaging - Digital Smile

  • 5

    Provisionals are either fabricated in the lab, or a matrix can be sent to use chairside for try-in.

In some cases, these provisionals can be tried in and accepted at the time of delivery, but for more complicated cases, it is recommended to have the patient wear provisionals to determine not only esthetic considerations but comfort and functionality as well. The provisionals are then either approved, or adjustments are made or recorded. Pictures should be taken with the temporaries in place, and a model of the temps should be sent to the lab.

This approved prototype can now be used as a blueprint for the lab.

The Benefits of DuraTemps
DuraTemps Provisionals

Depending on the situation, provisionals can be used either before preparation or after. The critical consideration is to gain this information before the final restorations are fabricated. The actual fabrication of the provisional can either be done chairside using a matrix from the provided wax-up or can be done with lab fabricated temps. There are clear benefits to using lab fabricated provisionals such as DuraTemps by Burbank Dental Lab. These benefits include:

  • The ability to provide proper gingival contours.
  • Eliminates the possibility of staining due to the smooth glazed surface
  • Fits are more accurate
  • These are ideal for a patient’s long term wear and great to test if a new vertical dimension of occlusion was proposed.
  • Provide the patient with an idea of shade selection
  • Overall texture, shape, and proportions are better.
  • Provisionals can be modified to reach patient satisfaction.

With the capability to create a dental prototype that takes into consideration the patient’s esthetic concerns, and a proposed diagnostic outcome, the ability to meet patient expectations is possible. Implementing this step helps to bolster profits by eliminating the need for remakes and improving the patient’s overall satisfaction.

Contact Burbank Dental Lab’s Smile by Design team today for more information.

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