exceptional veneer temporariesFabricating veneer temporaries can be an entirely different experience than fabricating full crown temporaries. The minimal reduction typically done and fragility of the thin temporaries makes the process sometimes challenging. In fact, many dentists avoided making veneer temporaries because of how frustrating the process was. However, it makes it extremely difficult to communicate critical elements of tooth size, form and color to the patient and the lab unless we temporize.

By necessity the process starts with a diagnostic wax up incorporating the proposed changes in tooth arrangement, incisal edge position, smile line and tooth form. The information for the wax up can be efficiently communicated to the lab with photos that have drawings on them of the desired changes. From the wax up a matrix is formed out of putty, or an alginate impression can be taken of the wax up and poured in stone. On the stone model a clear matrix can be heat pressed from materials such as copyplast, which is very accurate but also easy to remove from the temporary during fabrication.

The fabrication itself can be performed a number of different ways successfully. Many dentists prefer using the shrink-wrap technique, where the temporary is made on the prepped teeth and not removed. This approach is the most efficient but has the challenge of needing to remove any flash from the margins in the mouth with a bur while not damaging the already impressed preparations.

It also is more difficult to fine-tune gingival embrasures since the temporaries aren’t removed after fabrication. Having said that many excellent dentists use this approach. I personally prefer to make an impression of the preps and create a model of either stone or die silicone on which to make my veneer temporaries using the putty or copyplast matrix. This has the advantage of excellent control of all variables including fit, form, embrasures and polish.

Another thing to be aware of throughout the process is shade – especially when you’re dealing with multiple teeth. What I like to do is make the temporaries a shade I’m comfortable with and then have the patient give feedback on the shade of the temporary. This is an excellent way of determining the patient's desires for the shade of the final veneers.

As for materials, many of the autocure temporaries do an excellent job and have reasonable shades to work with, my most commonly used material in that family of materials has been Pro-temp from 3M. The keys to great temporaries are time and attention to detail. Although fabricating veneer temporaries the way I do takes a bit more time and requires you charge your patients a fee for the diagnostic wax up and the provisional or temporary restorations, that has never been an obstacle once the patient realizes why the diagnostic wax up and provisional are a necessity to create the best final result possible. In general, it costs about 30 percent more of the total case cost to deliver exceptional veneer temporaries from a diagnostic wax up with highly esthetic results.

I get asked frequently how you can charge for wax ups and temporaries on PPO or insurance patients. My answer is that PPOs and insurance don’t cover veneers anyway, so these patients know their treatment is an out of pocket expense.

I would also like to comment on a statement I have heard for years, “you shouldn’t make the temporaries too good.” I have always believed quite the opposite. Excellent temporaries not only function as a great communication tool with patients and the lab, they also promote soft tissue health which makes the seating appointment much easier and can be a huge “BRAND” builder for your practice.

I always love it when my patients get comments from others about how great their smile looks, and my patient can say, oh these are just the temporaries. Inevitably the person wants to know the name of the dentist doing the treatment. In fact, I would say that in the 1980s I built a huge reputation in my community as the person to see for Esthetic dentistry because of what people saw in my temporaries.

In conclusion, take a look at the image above from a publication discussing how the removal of temporaries encourages the tissue to bleed.

If you look closely, you’ll notice that this temporary doesn’t have any gingival or facial embrasures and the margins don’t fit properly. If your concept of a temporary is what is portrayed in this image you will undoubtedly struggle with bleeding tissues, and a limited ability to communicate esthetically with the patient and your lab. I would encourage you to do an anterior case doing the very best fitting and looking temporary you can make and see how big a difference it can make in the experience for you, the patient, and the lab.


Comments

Commenter's Profile Image Greg Johnson
November 5th, 2012
Frank, How do you cement the temporaries? This tends to be my biggest frustration with veneer temps. They just come off. Thanks, Greg
Commenter's Profile Image Cody L.
November 6th, 2012
Hi Greg, Thanks for your question. The following is from Dr. Spear: Spot etch around a 2 to 3mm area in the center of each prep, rinse, dry, place Gluma desensitizer for 20 seconds then dry, (note this is not Gluma the dentin bonding agent, but Gluma the desensitizer), air abrade the internal of the temp with 50 micron aluminum oxide so the the cement sticks to the temp, cement with any light cured resin cement or flowable composite. To remove grind through the temp in the area you had etched and lift off. We appreciate you reading the Spear Review and your willingness to participate. Thanks.
Commenter's Profile Image Peter Murchie
November 15th, 2012
Any suggestions for veneer/crown combo temporization. I find this very difficult. Do you make and polish the veneers first, place a separator and then temporize the crowns? Any suggestions would be helpful in these cases. I have not found a good solution to this problem. Thanks!
Commenter's Profile Image Lamy.G
February 22nd, 2013
Dr. Spear Thank you for temp veneers fabrication method, You have made them in one-piece; do you advice we seperate? In case of seperate how can we manage? In addition to soft tissue health I totally agree with "Brand building" patients always "wow, if the temps look like this what will the real ones look like" Thank you Dr.
Commenter's Profile Image Peter
May 4th, 2015
The post will give more knowledge how to process is done. and how practical and easy this technique there might be many speculation but i'm sure after the result they will have that confidence smile they been dreaming.
Commenter's Profile Image Peter L.
February 25th, 2016
What suggestions do you have for provisionalizing patients who grind? Are these patients better off with separated teeth? What steps do you take to ensure they don't "pop-off"?
Commenter's Profile Image Gary D.
February 25th, 2016
Thanks for voicing something that has (and does) perplex many of us who treat patients with worn dentitions. I'd like to address your two questions separately ...... For the first question I am going to make the assumption that this patient's grinding is not secondary to a breathing disorder and is a CNS driven activity that will continue regardless of the design of the occlusion. I was taught many years ago that the best way to evaluate the changes I had made to the occlusion of a patient who grinds is to make individual provisionals. I have to admit that while I tried that with my acrylic (bis-aryl today) provisionals for awhile many years ago I do not do that today. I build an occlusion using a wax-up with broad surface contacts on as many teeth as possible throughout all functional and non-functional movements and then transfer that to composite preliminary restorations or to cemented or bonded provisionals. I always plan a minimum of 3 months with the composite or provisionals. The benefit of composites (these could be milled and bonded on) is that we have accomplished a result that IS the individual "provisionals" method. If composite is not appropriate as a provisional restoration I use traditional bis-aryl provisionals that I usually fabricate directly in the mouth the day of preparation. I cement these with FYNAL if they are full coverage and with resin if they are veneers. (I rarely will NOT use composite if veneers are involved - at the very least on all the veneers) When a full arch is involved, my preferred segmentation is 6 anterior teeth and two posterior segments of 4 teeth. For the second question - that of keeping things from "popping off", my answer is that I might want them to do exactly that. If they pop off in provisionals I can guess that the forces will want to make the final restorations pop off and I can shallow the guidance and decrease the overjet to minimize that. When they are stable I can look at the wear patterns in the provisionals and determine the extent to which this patient will continue to apply the forces that created the situation presented. I want to stress that I am learning that many wear patients have caused the dental destruction as a response to a breathing disorder - they go out there and brux to open their airway. Hope this helps. Sorry for the wordy reply - if you would like to talk about this please connect directly with me at gdewood@speareducation.com THANKS for being part of the SPEAR online community.