Clinical Materials Review

Provisional Materials:
Key Components of
Interim Fixed Restorations
Ronald D. Perry, DMD, MS; and Britta Magnuson, DMD

ABSTRACT

Clinicians have many choices of

provisional materials from which
to choose when fabricating
interim fixed restorations. While
traditional materials are still in
use today, temporary materials
are continuously being updated
and improved upon. In addition
to the functional necessities
required of the provisional
material, it must also provide
esthetic value for the patient.
Tliis article provides an overview
of provisional materials,
inchidinji newer his-aeryls that
have helped eliminate some
of the challenges associated
with traditional acrylic
materials. Composite resin
preformed crowns for singleunit provisional applications
are also discussed, along
with CAD/CAM-fahricated
materials. Regardless of the
material selected, a provisional
restoration must maintain and
protect the underlying tooth
structure from ill effects.

rovisional materials are key components in the fabrication of

interimfixedrestorations for the making of various veneers,
crowns, bridges, and other cosmetic procedures.' Temporary'
materials have changed immensely since their early days in
the 1930s- from acrylics and premade crown forms to newer
bis-acryl materials and computer-aided design/computeraided manufacturing (CAD/CAM)-generated restorations.
The dental professional now has many choices of materials from which to choose
and must determine which materialfitsbest for the patient.
Regardless of the material selected, a provisional restoration still must maintain and
protect the underlying tootli structure from ill effects. It must protect the pulp from invasive microorganisms as well as from hot/cold tluMinal chiuiges in the motith. Marginal
adaptation is critical in maintaining a seal around the tt)oth stractiire and protecting
thefinishline for thefinal,permanent restoration.' Proper occlusion as well as the
periodontal elements must be maintained.' '' Food must be able tobe easily swept away
to prevent possible food impaction and maintain soft-tissue health. Interproximal
contacts and emergence profiles must be properly established and maintained to
prevent the shifting of teeth and allow the patient to sustain proper hygiene.'
In addition to all of the functional necessities required of the provisional material, it must also have some element of esthetic value for the patient. This is
especially true for a tooth that is in the anterior aspect of the patients mouth.
Patients want a temporary restoration to look and feel good without the fear of it
falling off prior to the insertion of thefinalrestoration. While traditional materials are still being used in practice today, temporary materials are continuously
being updated and improved upon.
TRADITIONAL OPTIONS

From a historical perspective, acrylic temporaries are the oldest materials still
in use today.- They are divided into two main groups: PMMA (polymethylmethylacrylic) and PEMA (polyethylmethylacrylic). They typically come in a
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Clinical Materials Review

powder/liquid format that necessitates a manual mixing of the

two components, which is usually done in a dappen dish and
delivered into a matrix. The matrix for the acrylic is usually made
from alginate or alginate sub.stitute, silicone matrix, vacuuform
matrix, polyvinyl siloxane material matrix, or polyether matrix.'
Great care must be taken when using these acrylics on the tooth
structure, especially if undercuts are present on the teeth. The
provisional can easily lock into place and become diflicult to
remove, causing it to break or damage the existing tooth structure. Placing a small amount of petroleum jelly or glycerin on
the teeth can help to alleviate this problem.
Both PMMA and PEMA materials can be used for single and
multiple long-span provisionals. Both are low-cost materials
that can be smoothed and polished relatively easily."* PMMA
oflers increased strength' and a stable color over the course of
the couple of weeks that thefinalrestoration is being fabricated.
However, there is a greater exothermic temperature release as
compared to PEMA material.''^ The heat must be dissipated
from the tooth structure to avoid possible pulpal or tissue damage. This can usually be accomplished by carefully removing
the material and using a cool water and air spray during the
polymerization process. Both materials come in a multitude of
shades, depending on the supplying manufacturer. These materials usually need to be relined prior to cementation to create a proper seal around the tooth. During the polymerization
process a distortion of the materials will need to be adjusted in
the patient's mouth. PMMA and PEMA materials both give ofl'
a distinct odor that patients and dental stafl^ often notice. Yet,
they both ofler a cost-effective, adequate option for meeting the
criteria of a proper provisional material.

The fabrication of bis-acryls typically is identical to their acrylic

counten^rts. Amatrix is needed, into which the material is syringed
and then placed on the tooth, removed, trimmed, and polished.
There is less risk of pulpal damage with bis-acryls since these materials typically generate much less heat during the polymerization
process.' Many of the problems associated with traditional acrylics
have been eliminated with the bis-acryl materials, which are easy
to use,flexibleduring insertion and removal, radiopaque, and color
stable.'" These materials are ideal for single-unit and some multipleunit situations. The overall clinical situation of function and occlusion will dictate whether or not bis-acryl is the proper choice.
Preformed acrylic/metal crowns and self-cured bis-acryl materials have led to the evolution of light-cured composite resin
preformed crowns for single-unit provisional applications, namely Protemp Crowns (3M ESPE, www.3MESPE.com). These
crowns come in preformed molar, premolar, and canine shapes
and can easily adapt to select clinical situations. They are convenient for cases of severely broken or missing tooth structure
when fabrication of a matrix is difficult. Made of composite-based
material, these moldable crowns allow the clinician to adapt a flt
around a preparation on the buccal, lingual, and occlusal aspects
prior to setting the material with a light. Enhancing the advantages of composite provisional and preformed crowns, these
newer crowns combine goodfit,wear, and strength with ease
of fabrication and polishability while eliminating the need for
a matrix." There is also the added benefit of improved physical
and chemical properties of the material itself.'-

DIGITIZED FABRICATION

Esthetic demands have given rise to the digitization and CAD/

CAM-aided fabrication of materials and restorations, taking denNEWER MATERIALS
tistry to a new dimension. Precision-milled acrylate polymerNewer bis-acryl materials have helped to eliminate some of the
filled contoured single- and multiple-unit provisional restorations
challenges associated with traditional acrylic materials. Bowen
are now available that ofl"er increased strength andfitalong with
developed bisphenol A glycidyl methacrylate (Bis- GMA) in the a customizable solution for even the most demandingof patients.
1960s,'' a material that has been the backbone for most composite
One drawback is that this is not a direct chairside procedure. A
resins used today. This paved the way for bis-acryl materials,
scan must be sent to a laboratory, and the provisional is fabricated
which are self-cured composites. Available in a wide variety of
prior to the procedure. An increased cost is associated with this
shades, including the more popular bleach shades, bis-acryls
service, which typically must be passed on to the consumer.
come in a convenient syringe applicator and have a low exoOne product that integrates the dentist with the dental technithermic reaction,' ^ decreased shrinkage,^ and a less odorous
cian is Tel io (Ivoclar Vivadent, www.ivoclarvivadent.com), a syssmell. A disadvantage of bis-acryls is that they ^ ^ ^ ^ ^ ^ ^ 1 ^ ^ ^ ^ ^ ^ ^ ^ tem of compatible materials for temporary rescan break relatively easily when placed in areas
torations. Dental CAD/CAM users are able to
of increased stress'; however, since they are a
combine a chairside product (Telio CS)a selfcomposite-based material they are fairly easy
curing provisional material-with Telio CAD
to repair with either the same material, tradiRELATED CONTENT:
acrylate polymer blocks and Telio Lab materiLearn more about temporization
tional composite, orfiowablematerials.'" Bisals.'' This combination of materials (chairside
materials at
acryls also typically cost more than traditional
and laboratory) allows for easier fabrication of
dentalaegis.com/go/ccedS
acrylic materials."
inlays, onlays, veneers, and crowns, eliminating
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Volume 33, Number 1

Clinical Materials Review

some of the challenges associated with other provisional techniques such as polymerization shrinkage, impression errors, mixing errors, and overall clean-up. The acrylate polymer blocks can
be used for long-term provisional up to a year in difficult crown
and bridge cases. This system also combines improved physical
properties ofthe material. The collaboration between dentists
and dental technicians across all phases of treatment is the first
step in achieving aflawlessprovisional andfinalrestoration.

should be based on each unique clinical case. A well-made provisional restoration can not only help avoid inconvenience and
annoyance issues such as a patient returning for a broken or lost
temporaiy but can save on chairside insertion ofthe final restoration. Healthy tissue and the overall health ofthe gingiva and
teeth enable easier insertion and clean-up.
A thorough understanding of the materials available to clinicians and the clinical situation at hand will allow for a successful
end-product.

CONCLUSION
ABOUT THE AUTHORS

The provisional restoration is one ofthe most important steps in

fabricating afixedprosthodontic restoration, allowing both the
dentist and patient to evaluate functional and esthetic concerns
prior to thefinalinsert. It is a test drive of sorts ofthe biological
and physical characteristics.
There are many materials available for interim restorations,
and it is vital that the clinician chooses the material that most
closely matches the clinical needs ofthe patient. No one material
fits all of the needs of the patient or dentist. Material selection

Articulating and Occlusion

products for,
rocedure.
Since 1953. .....:. :.,; .p^^.^i.^eo m iiiuiiuiuuuuiiy miH.Mmill - ,
occlusion test materials designed to represent occtusal proportions on the
masticatory surfaces as true to nature as possible. As one ofthe the world's
leading manufacturers in this domain, we offer an extensive range of
different
articulating
papers
and
articulating test-films in different shapes,
sizes and colors. Achieving
visible !
markings on surfaces such as gold, mefal 1
alloys and ceramics, ond especially on
moist occlusal surfaces is our first priority.

Bouichh Arlkuloli
Ailkuloliiw Popers, I K . 12 Mwpliy Drive, Unit 4 Noslnio, NH 03062
i: 1-888 6-8aUStH Phone: 1 (603) 883-21S5 foui 1 1603)883-0606

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Ronald D. Perry, DMD, MS

Director and Clinical Professor, Gavel Centerfor Restorative Dental Researeh,
Tufts University Sehool of Dental Medicine, Boston, Massachusetts

Britta Magnuson, DMD

Instruetor, Tufts University School of Dental Medicine, Boston, Massachusetts

REFERENCES

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13. Telio CS and Telio-CAD: Instructions for Use. Amherst, NY: Ivoclar
Vivadent Technical: March 2010.
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