Quick and Easy Single Tooth Provisionals
When I first began making provisionals in dental school, we often took an alginate prior to preparing a tooth for an indirect restoration, especially if there was no missing part of the tooth.
When I got out of school, I started using a pre-operative alginate, poured it in Snap Stone and fabricated a silicone matrix. I prepared the tooth and made a quick post preparation alginate, which was handed off to another assistant, who poured it up and made the temporary indirectly while my other assistant placed retraction cord and a final impression was made.
As newer provisional materials are available to be used directly in the mouth, my technique has adapted. I was resistant to making the change at first but now I realize it’s faster, more predictable and requires little to no adjustments.
Now my assistant takes an inexpensive triple tray and loads it with an alginate alternative (AlgiNot) and has the patient close for approximately one minute and then we remove and trim any excess with a #12 Bard Parker blade. At the end of the preparation, we load in a Bis-Acryl (Venus II, Exacta Temp, etc.) and have the patient close back into the pre-operative matrix. We wait for approximately one minute and remove. This will often produce a temporary that has little to no flash, and has great occlusal and proximal contacts.
While the material finishes setting, we place cord and take a final impression. The provisional requires little to no adjustments and is easy for assistants to master in short period of time. On top of that, we can keep the pre-operative triple tray handy until the final restoration is seated, just in case the patient loses the provisional. At times, we have even sent it with our patients that are traveling out of town.
The next time you make a provisional you might want to try something different.
Sweet. Seems like I’m already a step ahead for a change!
Really? I discovered this technique on my own while a senior dental student in 1999. I’ve shared this with many dentists since. I’ve used this religiously and my assistants love it. It’s almost impossible to NOT make a perfect temp this way!! Glad you were finally able to catch on…
This is a great technique used it for 30 years- in a triple tray and last 25 with 30- 60 second bite material. I prefer Luxatemp for the temp material
The use of a fast setting PVS such as Splash with putty wash can make the accuracy even greater
A triple tray for the provisional construction and a full tray that is relined for the master impression for incredible accuracy
Thanks for the tip! Being a dental student, it’s always refreshing to learn about the quicker, more efficient ways to do dentistry, despite how obvious it may seem to dentists practicing for years and years. Good stuff!
I tried this technique a couple of years ago (making the temp before the impression), but then backed off on it when I read something about residue from composite temporary materials (Integrity, etc) interfering with the set of VPS impression materials…. comments/ideas about this?
Rusty
I have used this technique for a few years at least and have had no problem with the problem you described. I use Aquasil PVS on a regular basis. A quick search on Pubmed for PVS and resin inhibitiin did not show any immediate research showing otherwise. Any thoughts on where you saw the article? Thanks for the note. Hope this helps.
The air inhibited layer of resins will inhibit the setting of PVS. You likely haven’t had a problem because it has been adequately cleaned off prior to impression. Lee Ann Brady wrote about this on her blog: http://leeannbrady.com/restorative-dentistry/removing-the-air-inhibited-layer. Here’s from the 3M site: http://multimedia.3m.com/mws/mediawebserver?66666UuZjcFSLXTtn8TyLXs6EVuQEcuZgVs6EVs6E666666–
Here’s one PUBMED article, it deals with immediate dentin sealing, but the same issue would exist with bisacryl: http://www.ncbi.nlm.nih.gov/pubmed/19853171
Jonathan
Thanks for sharing those links and clarifying that. As a side note: other than rinsing my preps, I have had no issues with my impressions, so I would be curious to see a study showing different temporary materials and doing no rinse, rinsing with water only, etc. along with different impression materials (i.e. 3M, Dentsply…). But in the meantime, taking the impression prior to the temp or cleaning the prep seems the safest thing to do. Thanks again for sharing and clarifying things. Jeff
If you make your provisionals before the restoration impression, be very careful to find all the little clear bits of provisional material that hide out on the adjacent teeth. Including them in your final impression will make the models inaccurate. Any wonder how I know this?