provisionals

[KOM]

We've been using Protemp for provisional material and I've been having some trouble achieving consistent retention especially for bridge preps. I'd like to know a little bit more about placing temporaries out in practice.

In the lab, some classmates have been light curing extra material directly to the tooth to seal off the margins, but then can't get the damn thing off. How much retention do you actually want on these little buggers?

On the typodont, I've had them on so loose that when you invert the typodont it falls right off and I've also had them on so tight that when trying to pry them off with a hand instrument it will pull the typodont tooth out.

Any tips/suggestions on achieving nice margins and adequate retention (and how much retention those out in practice finds works best) would be greatly appreciated.

A little background info...we fill a putty matrix and place that on the typodont. I know timing is crucial, but I still don't seem to be able to get consistent retentive features...be it for a bridge or single tooth prep.

Any input would be appreciated.

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[DentalBoardsDDS]

From what I understand these things are preformed temporary crowns. In my school we used Duralay inside a martrix to make it custom fit to the tooth. Then we ground the crown into occlusion. Basically it looked like crap but had decent margins and enough retention to last a few weeks with TempBond.

I just saw the training video and it looks interesting. Here's the link maybe it'll help you. Remember also that in pre-clinic things are very different then in the mouth. You don't have saliva so things will stick. Maybe try using vasaline. The temporary should come off easy until you cement it in. If it doesn't you'll have a hard time getting it off when the patient comes back and the cement has set.
http://solutions.3m.com/wps/portal/3M/en_US/protemp-crown/Protemp_Crown/Training_Resources/


Now in the real world there are many ways to make a good temporary crown/bridge. I personally use a material called Luxatemp, it's a Bisacrylic (much like composite). I have a preformed tray, the material sets in the mouth in 3 minutes and a have a perfect shiny, aesthetically pleasing temporary. Really impresses the patients. It's really expensive stuff. But I jut refuse to work without it. So like everyone told me when I was in dental school, just do what you need to get by but in the real world things are different.

 

[apple1012]

i'm curious as well....in preclinic we use acrylic, and it takes almost 15-20 minutes to properly polymerize and harden, problem is you have to continuously lift it up and down so that it doesnt bind the undercuts, i cant imagine it being like this in real life
ive heard that in the real world, diagnostic casts are sent to the labs, and lab made provisionals are made to fit, they even send you stents to show where the margin should be cut off at, then you prep and cement that temp on that day.

 

[aphistis]

We've been using Protemp for provisional material and I've been having some trouble achieving consistent retention especially for bridge preps. I'd like to know a little bit more about placing temporaries out in practice.

In the lab, some classmates have been light curing extra material directly to the tooth to seal off the margins, but then can't get the damn thing off. How much retention do you actually want on these little buggers?

On the typodont, I've had them on so loose that when you invert the typodont it falls right off and I've also had them on so tight that when trying to pry them off with a hand instrument it will pull the typodont tooth out.

Any tips/suggestions on achieving nice margins and adequate retention (and how much retention those out in practice finds works best) would be greatly appreciated.

A little background info...we fill a putty matrix and place that on the typodont. I know timing is crucial, but I still don't seem to be able to get consistent retentive features...be it for a bridge or single tooth prep.

Any input would be appreciated.

I use Protemp for most of my provisionals. For single units, I make a matrix from a checkbite tray and bite registration material while I'm waiting for anesthesia (it's just like making a PVS putty mold, but it's even easier and takes one minute as opposed to five or more). Prep & impress. Moisten prep with saliva, place Protemp in matrix, seat on prep and tell pt to bite together. Remove after exactly one minute, trim & polish, cement. Normally takes 10-15 minutes including chitchat time. Like DentalBoardDDS said, it's a more expensive way to make a temporary, but to me the headache reduction is more than worth it.

For bridges, yeah, just send models and let the lab make it--but you should be telling the lab where to place the finish line, not the other way around.

As for retention, you want it retentive enough to stay in place until delivery, but you have to be able to remove it then. Provisional retention is a balancing act, and unpredictable to boot. Don't lose too much sleep over it, though; you'll get the hang of it with time.

 

[Darya]

using saliva as lubricant seems to solve some of the problems. Here is what I used to do in pre-clinic: I used my own saliva as lubricant .... just spit in a cup and use a Qtip/brush to apply it on your prep. I know it sounds gross ... but hey you'll be working with patient's saliva in the clinic, why not work with your own to begin with . I bet it's cleaner than your patient's

Good luck!