Provisional/Temporary crown difficulties!

Darya

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    Does anyone have experience making provisional crowns using Integrity. It takes me too long to patch the margings with flowable composite and was wondering if anyone has any tips.

    Has anyone tried blocking the embrassure space with ortho wax? Any tips?

    Thanks
     

    armorshell

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      Clinical or pre-clinical? One of the things that helped me most refining my margins as cleanly as I can. Have a well defined, smooth margin of appropriate depth and you won't have to do much more than pop the flash off with an instrument and shine it up/adjust occlusion.

      Also, having well-adapted putties with a good amount of bulk helps me as well.
       
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      UKdent

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        If you are in student clinic where time isn't money you can impress the quad of your prep in alginate then pour it up in a quick setting stone like mounting stone. Then refine your margins on that. Helps when it is hard to see the margins.
         

        DrJeff

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          Easiest way, take the time to get a GREAT matrix to put the integrity into. It doesn't matter if you use an alginate, or PVS or even a prefabricated plastic suck down, the better the "template" you put the integrity into the easier and cleaner the margins you'll have to work on(And integrity is all that I've used as a temporary material for the last 6 or 7 years so I'm pretty familiar with it's properties;):D)

          Also, if you're having problems "reading" your margins in the integrity with respect where to trim/finish to, then really take a look at your prep before trimming, so you mentally know EXACTLY what that finish line looks like before you start trimming. This is where having a consistant, smooth finish line 360 degrees around the tooth makes a HUGE difference. Practice, practice, practice, you'll get it.

          BTW, if you need to add to the margins, a little bonding agent and some flowable composite is all that I use and it works very well.
           

          aphistis

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            Easiest way, take the time to get a GREAT matrix to put the integrity into. It doesn't matter if you use an alginate, or PVS or even a prefabricated plastic suck down, the better the "template" you put the integrity into the easier and cleaner the margins you'll have to work on(And integrity is all that I've used as a temporary material for the last 6 or 7 years so I'm pretty familiar with it's properties;):D)

            Also, if you're having problems "reading" your margins in the integrity with respect where to trim/finish to, then really take a look at your prep before trimming, so you mentally know EXACTLY what that finish line looks like before you start trimming. This is where having a consistant, smooth finish line 360 degrees around the tooth makes a HUGE difference. Practice, practice, practice, you'll get it.

            BTW, if you need to add to the margins, a little bonding agent and some flowable composite is all that I use and it works very well.
            +1 to getting a good matrix. It's the difference between a beautiful 5-minute temporary and an ugly 30-minute temporary.
             

            dheav005

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              just place the integrity tip into the deepest part of the matrix and backfill slowly, always keeping the tip in the material. you want to make sure the bisacryl flows over all the inclines, rather than globbing from cusp depth to cusp depth. if you place material in the matrix and on the prep, you risk trapping air bubbles.
               

              SeaBass

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                For removing flash, try a course disc in a slow speed. I don't know why they never showed us that in school but I find I have way more control and less chance of gouging the margin. I usually go over the marginal flash with a disk until their is a very small fin which will just flick off with a spoon if needed.

                I remember really struggling with provisionals in pre-clinic, like everything, it seems easier on real teeth. Integrity shrinks so one thing you could try is removing the provisional after a couple minutes, quickly adjusting the embrasures (ie removing undercuts at the contact to ensure easy removal) and replacing the provisional on the plastic tooth until final set. It's been a while but I remember that suggestion from an instructor when some had issues with open margins, the idea being less tendency toward shrinkage from the margin.

                I think students, being conscientious, have an initial tendency toward being conservative with preps. With overly conservative axial/marginal reduction you will likely have more difficulty with fractures and marginal integrity.

                Hope that helps.
                 

                ProstHoney

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                  I found that to deal with the shrinkage it was best to remove the temp before it had fully set. Then I would reseat it in the matrix until it had fully polymerized and remove the gross flash with a diamond bur. It is essential to lightly relieve the internal axial walls of the temp at this point with a diamond bur oriented along the long axis of the prep. Then it can be reseated on the prep and the margins verified without the concern of the temp locking on or fracturing. I cannot agree more with the necessity of a good matrix and careful reading of the margins during refinement.
                   

                  Darya

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                    I use plastic suck down matrix, fill in the matrix and place it on the tooth and after 2 min, I remove the matrix (provisional remains on the tooth) and start carving the embrasures with a proximal carver, but it never seems to work! 80% of the time the prov. gets locked up and I end up breaking it while removing it.

                    In the clinic, I've seen people take off the matrix and the provisional together and I just don't know how they do it! Mine always stays on!!! Any tips?

                    OHSU 2010
                     

                    SeaBass

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                      I use plastic suck down matrix, fill in the matrix and place it on the tooth and after 2 min, I remove the matrix (provisional remains on the tooth) and start carving the embrasures with a proximal carver, but it never seems to work! 80% of the time the prov. gets locked up and I end up breaking it while removing it.

                      In the clinic, I've seen people take off the matrix and the provisional together and I just don't know how they do it! Mine always stays on!!! Any tips?

                      OHSU 2010

                      If their provisional is coming off in the matrix on a plastic tooth I'm willing to bet they have a fair bit of taper-might not always be a good sign if you are shooting for an ideal prep. I used to have problems with breaking my provisional as well in prelab. I think it was because I was trying so hard not to over-reduce and over taper that I was under reducing and undertapering, this results in a thin provisional requiring more force and manipulation to remove..a recipe for breakage. Try a few preps pushing the upper limit of the allowable axial/marginal reduction and taper and you might find you have a stronger/bulkier provisional that also removes easier. Are you lubricating the prep at all first?
                       

                      SeaBass

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                        I'm using natural teeth and margin seperator as lubricant.

                        How are you trying to remove it and how much time are you spending 'carving' it before trying to remove it? I'm not sure what you mean by carving the embrasures.

                        In the mouth (where it may set a little faster) I remove the matrix after about 1.5 minutes, use explorer to remove flash from the adjacent teeth and run the explorer apical to the margin around the tooth to remove all the excess along the gingiva (~30 sec tops). There will be excess material in the gingival embrasure and I initially leave it and use as a purchase to pull the temp off (your instrument may dig into the material here but you will be trimming this region afterward anyways and won't be touching your margins this way). I take a stronger instrument (eg. scaler) and pull coronally at the gingival embrasures going back and forth from Mesial to Distal contacts (sometimes switching from buccal to lingual as well). The material should be soft enough still such that the excess in the gingival embrasure can flex past the contact (leave it too long to harden and this can become an undercut).
                        After I'm past the undercut there is no rush, I take some hemostats and gently wiggle the provisional off..you want to apply only light pressure with the hemostats so if it doesn't wiggle of with ease you may need to go back with the scaler and continue teasing it from M&D below the contacts a bit more.

                        So try removing the stent a little earlier, the Integrity will still be setting while you are removing flash from the adjacent teeth and gingival region. You might be waiting too long before trying to remove it.
                         
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