TECHNIQUE

68 | APRIL 2006
“Optional
restorative
measures should
never be
implemented
without the
treatment team
being aware of
the expectations
of the patient.”
Provisional restorations serve many purposes in restorative dentistry. High-quality
provisionals provide the dentist, dental technician and patient with a lot of
valuable information at the start of permanent-restoration fabrication. Acrylic
diagnostic provisionals can be easily adjusted and modified until the patient is
satisfied with the esthetic and functional result. Using the esthetic provisional
as a model, the permanent restoration can be initiated with confidence –
without running into unpleasant surprises
1
. Naturally, the fabrication of such
diagnostic provisionals takes additional time, but they determine the treatment
result in phonetics, esthetics and function.
This article describes and illustrates the efficient and economical fabrication of
a provisional from the polymethylmethacrylate material New Outline.
STRATEGIES FOR THE FABRICATION OF
PROVISIONAL RESTORATIONS
Today’s exacting patients demand a high level of
esthetics and function from restorative dentistry.
Optional restorative measures should never be
implemented without the treatment team being
aware of the patient’s expectations and the patient
knowing the limits of restorative dentistry. Both the
dentist and the dental technician should have a
clear idea of what the fnal result will look like before
they initiate irreversible therapy. Study models, wax-
ups and provisional prostheses give the patient an
opportunity to comment on the intended
treatment, adjust to the new situation and accept it
before the permanent treatment phase is initiated
2
.
When setting up the treatment plan, mock-ups,
shell provisionals and adapted provisionals are
Optimized
Laboratory-
Fabricated
Provisionals
Michel Magne, Dr. Pascal Magne, Domenico Cascione, Inge Munck
Esthetic provisional restorations using the sandwich technique
various ways to get an idea of the permanent
restoration’s appearance, while still providing the
patient with an adequate transitional solution
during the treatment phase.
THE MOCK-UP
The mock-up is a duplicate in stable
methylmethacrylate of the diagnostic wax-up (Figs.
1-2). It can be worn by the patient for several days
or weeks and gives a sneak preview, so to speak, of
the final treatment result. It can be fabricated either
indirectly in the laboratory or directly by the clinician
working with the patient. If the patient accepts the
result, the mock-up can serve as a preparatory aid
to the dentist (Figs. 3-4). This technique is used
primarily with adhesive ceramic restorations (Fig. 5).
MagneTech 4/14/06 2:58 PM Page 68
APRIL 2006 | 69
TECHNIQUE
Figs. 1-2. Literally translated, mock-up means “imitation”. It is an acrylic duplicate of the diagnostic wax-up and gives the patient an idea of the
possible result.
Figs. 3-4. The second purpose of the mock-up is to help the dentist with the minimally invasive preparation. It stays in the patient’s mouth, and only
the absolutely necessary quantity of tooth substance is removed for the acrylic.
Fig. 5. This method is especially suitable for the preparation of adhesive
ceramic restorations.
MagneTech 4/14/06 2:58 PM Page 69
TECHNIQUE
70 | APRIL 2006
SHELL PROVISIONAL
The shell provisional is a “first-generation provisional”
among individual esthetic provisionals. It combines
excellent esthetics and function with minimal dental
input for the initial provisional (Figs. 6-8). The
fabrication comprises two phases. In the first phase,
the shell provisional is built up in acrylic layers in the
laboratory and hollowed out from the inside to a
minimum thickness. In the second phase, the
provisional is relined directly in place on the patient
in the dentist’s office to ensure a good fit in situ
and achieve an optimal marginal fit. Here it is
important to use as little material as possible if we
want to keep heat generation to a minimum.
ADAPTED PROVISIONAL
The adapted provisional – also known as a "second-
generation provisional" or long-term provisional –
is the most important step in treatment planning.
It serves several purposes concurrently. One is to
prepare the patient for the possible new situation.
It provides sophisticated esthetics and high
precision and, if necessary, helps condition the soft
tissue (Fig. 9). The adapted provisional builds on
the diagnostic wax-up, which is the starting point
for single crowns, bridges and splinted restorations.
Adapted provisionals are of fundamental importance
for molding the soft tissues around the natural
teeth and implants and for active tissue
regeneration in the vicinity of bridge pontics. In
addition, adapted provisionals help the dentist
prepare the patient for the new situation and
match his or her esthetic expectations to reality.
SANDWICH TECHNIQUE
The sandwich technique, developed by Michel
Magne, is a special technique for the fabrication of
“Adapted
provisionals are
of fundamental
importance for
molding the
soft tissues
around the
natural teeth
and implants”
Figs. 6-8. The shell provisional is esthetic and functional and requires a minimum of dental input.
Fig. 9. The long-term provisional restoration is complex in fabrication,
esthetically pleasing, and highly stable; its marginal fit is excellent –
and it shapes the soft tissue for the treatment steps to follow.
6 7
8
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APRIL 2006 | 71
TECHNIQUE
“The relative
strength of the
dentin and
enamel material
is of crucial
importance for
the final
result.”
adapted provisional restorations. It is first and
foremost based on the exact reproduction of the
natural tooth and the imitation of nature by using
several layers of acrylic. This technique can be used
for all types of diagnostic provisionals but it is
especially suited to the adapted provisional. This
technique involves preparing the soft tissue area
on the master model around the prepared dies
and, if necessary, under bridge elements to match
the shape of the wax-up. The next step involves
preparation of a silicone key from the diagnostic
wax-up (prefabricated wax facets may be used to
save money and time). We recommend extending
the key to include two further adjacent teeth to
ensure secure repositioning.
With the matrix created, the dentin is pressed onto
the prefabricated insulated master model (Fig. 11).
Curing is performed in a pressure vessel for 10
minutes at 2 to 4 bar and 40°C. The combination
of pressure and water has a positive effect on the
behavior of the material. It increases its lateral
stability and reduces porosity. Following
polymerization, the dentin material is cut back
(Fig. 12). This serves to imitate the actual form of
the dentin in the natural tooth and makes room for
the enamel. Due to the reduction of the dentin layer,
the otherwise intense opacity is reduced, making it
possible to create the impression of a natural incisal
edge later. Here we recommend reducing the
thickness of the dentin layer only and never
decreasing the tooth length (Fig. 13). The relative
strength of the dentin and enamel material is of
crucial importance for the final result.
In the next step, we conditioned the surface of the
reduced dentin with aluminum oxide (5 µm) and
treated it with Skin Primer. This ensured that the
Fig. 10. When making a provisional restoration using the sandwich
technique, a wax-up of high functional and esthetic quality is the
first step.
Fig. 11. First, the provisional is completely invested in dentin material.
Fig. 12a-12b. When cured, the dentin material is cut back to the desired dentin core, making room for effect and enamel materials.
MagneTech 4/14/06 2:58 PM Page 71
TECHNIQUE
72 | APRIL 2006
surface was absolutely clean and grease-free and
that the next layer of material will bond well. We
recommend using light-curing composites and a
variety of stains to reproduce the various attributes
of the natural teeth and to optimize the impact of
internal effects and mamelons (Fig. 14). The effect
of the dentin core can be reinforced by enhancing
shade intensity, shade brightness and translucence,
as desired, using carefully positioned stains. For
example, the cervical area with its saturated and
gingivally influenced shade may be appropriately
customized using yellow-red stains. To adjust the
translucence in the incisal area, white and blue may
be used. This shade characterization should be
implemented both on the labial/buccal and the
palatal/lingual tooth surface to reproduce the
situation as naturally as possible and to adapt it to
the reference teeth (Fig. 15).
If the individual shade characterizations are light-
cured, we recommend that the surface be wetted
with a thin layer of bonding liquid to ensure good
bonding of the enamel materials. Using the various
enamel materials in the New Outline kit (light,
medium, dark and transparent) and different mixing
ratios it is possible to customize the translucence,
transparency and shade of the incisal portion of
the provisional restoration very successfully. Correctly
mixing powder and liquid is particularly important
in the case of enamels. It ensures the highest
quality material and prevents occurrence of
microporosities. The enamel material is pressed
over the dentin layer and internal characterization,
and it is again pressure-cured. The procedure is a
repetition of the dentin-pressing process, and the
same silicone key may be re-used after it has been
carefully checked.
Fig. 13. To obtain a very natural reconstruction, we recommend reducing
only the thickness of the dentin layer.
Fig. 14. Light-curing composites and stains are particularly suited to
reproducing the desired effects.
Fig. 15. Shade characterization should not be neglected palatally.
“The effect of the
dentin core can
be reinforced by
enhancing shade
intensity, shade
brightness and
translucence, as
desired, using
carefully
positioned
stains.”
MagneTech 4/14/06 2:58 PM Page 72
APRIL 2006 | 73
TECHNIQUE
Figs. 16-21. The result is very satisfactory: the provisional restoration is as natural-looking and individual as a living tooth.
16 17
18 19
20 21
MagneTech 4/14/06 2:58 PM Page 73
TECHNIQUE
74 | APRIL 2006
Figs. 24-28. ... produce different translucence and transparency effects through different mixing ratios.
Fig. 22. The New Outline Materials System. Fig. 23. The high value, mid value, and low value enamel materials ...
Then any excess is removed, shaping is touched up
and finished, and the surface structure is
incorporated and mechanically polished to complete
the process. Stains may be mixed with a light-cured
glaze (Skin Glaze) and applied to the surface to make
fine adjustments to match the characteristics of the
reference teeth and the oral situation. At this point,
the provisional restoration should harmonize
perfectly in the mouth of the patient. Fabrication
of a provisional restoration using the sandwich
technique is very economical, and it only takes a few
steps to reconstruct a natural-looking appearance
(Figs. 16-21).
MATERIALS
New Outline is a complete materials system (Fig. 22)
featuring creative design options and simple
handling. It consists of two opaque dentin materials,
11 dentin materials in the A, B, C and D shade hues
of the Vita shade guide, three enamel materials and
one transparency material. To supplement the system,
a white dentin material is available. In selecting the
dentin materials, one must pay particular attention
to the correct matching of shade hue, brightness
and saturation. New Outline may be used both for
the indirect technique (fabrication in the laboratory)
and the direct technique in the dentist’s office. Based
on different mixing ratios, the enamel materials –
high, mid, low and transparent values – produce
different shades with translucence and transparency
effects. Universal enamel material (medium
brightness), for example, is created from a mixture
of 50 percent high value, 25 percent low value and
25 percent transparent (Figs. 22-28). Skin Primer is
a bonding agent. It is three times as concentrated
as the monomer liquid and produces a permanent
“Fabrication of
a provisional
restoration using
the sandwich
technique is very
economical, and
it only takes a
few steps to
reconstruct a
natural-looking
appearance.”
24 25
MagneTech 4/14/06 2:59 PM Page 74
APRIL 2006 | 75
TECHNIQUE
bond with another layer of the same material.
Bonding Liquid is 10 times as concentrated as the
monomer liquid and produces a permanent bond
with any resin, enabling the user to extend the form
or reline an existing provisional restoration. Skin
Glaze is an oligomeric urethane-polyacrylate-
methylmethacrylate with a photo initiator as an
additional component. For the final surface
characterization, stains may be added to this glaze
liquid. If the provisional restoration has a metal
framework, it too can be concealed using a light-
curing opaquer supplied with the system.
ADVANTAGES OF THE SANDWICH TECHNIQUE
One advantage of the sandwich technique in
fabricating long-term provisional restorations is the
highly esthetic result, which is maintained throughout
the treatment period. Machine polishing can be
used to achieve extremely good surface homogeneity,
which in turn results in excellent tissue compatibility.
Using internally achieved effects, the shade
impression remains stable, which is an important
factor especially if the provisional restoration is in
the esthetic zone and will be worn over an extended
period of time
3
. Another advantage is clearly the fact
that this technique enables a dental technician to
learn in a hands-on way how to make natural-looking
crowns using PMMA and a simple technique.
Experienced dental technicians can give free reign
to their personal creativity. However, the sandwich
technique requires not only precise knowledge of
the dental anatomy but also intuition, sensitivity
and a keen sense of the natural model
4
.
ADVANTAGES OF POLYMETHYLMETHARCRYLATE (PMMA)
Clinical experience has shown that the materials
best suited for provisional restorations are
characterized first and foremost by flexibility and
elasticity. This is where the PMMA reveals its true
value. If a material is too rigid, it cannot absorb
force effects and consequenctly will tend to be
brittle and to fracture. Several studies have also
shown that some PMMA-based resins have fewer
tendencies to discolor than other materials used
for provisionals, such as bis-acrylate. A review of the
pertinent literature shows that this is not a property
of the material category, but of the specific
material itself
5-9
.
ADVANTAGES OF NEW OUTLINE
In the long experience the authors have with New
Outline, provisional restorations may be worn for up
to one year without losing their esthetic properties
or undergoing appreciable discoloration. There are
also several financial, practical and technical aspects
that support the use of this material. New Outline
is a very homogeneous and compact PMMA material
of high density. The surface therefore exhibits
excellent soft tissue compatibility and is also highly
resistant to abrasion following mechanical polishing
or the application of Skin Glaze. The stable shade
intensity of the various dentin and incisor materials
available makes it possible to create an optical
impression of high quality.
CONCLUSION
Provisional restorations are a key milestone along
the way to a comprehensive esthetic treatment
solution. In particular, they provide indispensible
diagnostic information, make a significant
contribution to the conditioning of the affected
soft tissue, and contribute to the patient’s comfort
and ease during the treatment period of the
treatment. A correct treatment approach is critical
to the result
10
.
“The sandwich
technique
requires not
only precise
knowledge of
the dental
anatomy but
also intuition,
sensitivity and
a keen sense of
the natural
model.”
26 27
MagneTech 4/14/06 2:59 PM Page 75
TECHNIQUE
76 | APRIL 2006
In every treatment, the main focus is ultimately on
the formulation of the correct diagnosis and
subsequent treatment approach, and this is where
provisional restorations play a crucial role.
In terms of length, form, tooth position, wearing
comfort and phonetic aspects, the permanent
restoration should simply be a copy of the
provisional restoration that the patient has
determined to be acceptable.
PMMA is one of the materials best suited for
provisional restorations. It exhibits high durability
because of its elasticity. Its homogeneity ensures
good tissue compatibility, and its optical quality
guarantees good adaptation to intraoral conditions.
The material and its application have a number of
advantages and are well suited as the first step in
the approximation of an optimum treatment
result, and to the preparation of the patient for the
new situation. The recipe for success lies in the
combination of a sophisticated technique with a
superb material. In the opinion of the authors and
based on various studies, there is no material better
suited for the fabrication of provisional restorations
than polymethylmethacrylate at this time.
REFERENCES
1. Derbaian, K., Marzola, R., Donovan, T.E.,
Arcidiacono, A. “The science of communication
in the art of esthetic dentistry. Part II: Diagnostic
provisional restorations.” J. Esthet. Dent., 2000,
Vol. 12, pp. 238-247.
2. Donovan, T.E., Cho, G.C. “Diagnostic provisional
restorations in restorative dentistry: The blueprint
for success.” J. Can. Dent. Assoc, 1999, Vol. 65,
pp. 272-275.
3. Haselton, D.R., Diaz-Arnold, A.M., Dawson, D.V.
“Color stability of provisional crown and fixed
partial denture resins.” J. Prosthet. Dent, 2005,
Vol. 93, pp. 70-75.
4. Magne, P., Belser, U. “Novel porcelain laminate
preparation approach driven by a diagnostic
mock-up.” J. Esthet. Restor. Dent., 2004, Vol. 16,
pp. 7-16.
5. Khokhar, Z.A., Razzoog, M.E., Yaman, P. “Color
stability of restorative resins.” Quintessence Int.
1991, Vol. 22, pp. 733-737.
6. Doray, P.G., Li, D., Powers, J.M. “Color stability of
provisional restorative materials after accelerating
aging.” J. Prosthondont. 2001, Vol. 10, pp. 212-216.
7. Doray, P.G., Wang, X., Powers, J.M., Burgess, J.O.
“Accelerated aging affects color stability of
provisional restorative materials.” J. Prosthodont.
1997, Vol. 6, pp. 183-188.
8. Crispin, B.J., Caputo, A.A. “Color stability of
temporary restorative materials.” J. Prosthet. Dent.
1979, Vol. 42, pp. 27-33.
9. Yannikakis, S.A., Zissis, A.J., Polyzois, G.L., Caroni,
C. “Color stability of provisional resin restorative
materials.” J. Prosthet. Dent. 1998, Vol. 80,
pp. 533-539.
10. Magne, P., Magne, M., Belser, U. “The diagnostic
template: a key element to the comprehensive
esthetic treatment concept.” Int. J. Periodontics
Restorative Dent. 1996, Vol. 16, pp. 560-569.
PRODUCT LIST
Indication
Acrylic for provisionals
Wax facets, prefabricated
Name
New Outline
Form Up
Manufacturer/Distributor
Microstar
Schuler Dental
“PMMA is one of
the materials
best suited for
provisional
restorations. “
28
1
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MagneTech 4/14/06 2:59 PM Page 76
TECHNIQUE
Bio
Michel Magne, CDT, has been a dental technician since 1979, specializing in fixed restorations with an emphasis
on ceramics and esthetics. From 1985 to 1991, he was chief ceramicist of two laboratories and specialized in
implant-supported restorations and complex oral rehabilitations. From 1992 to 2004, he owned and managed a
dental laboratory. In January 2005, he was appointed associate professor of clinicial dentistry and director of the
center of dental technology of the University of Southern California, where he teaches courses in esthetics and
function for postgraduate students. He has authored and co-authored various articles on cosmetic dentistry and is a
frequent speaker at international events. He is a technical consultant for the companies Straumann and Zhermack.
Dr. Pascal Magne completed his postgraduate studies in prosthetics and surgical dentistry at the University of
Geneva, where he had already been teaching, in 1997. As the recipient of several scholarships, Dr. Magne was
able to spend two years at the University of Minnesota conducting research in the areas of biomaterials and
biomechanics. In 2002, he returned to Geneva and he was awarded his doctorate. From 1999 to 2004, Dr.
Magne lectured in Geneva. In February 2004, he was appointed tenured associate professor at USC, where he
teaches Esthetic Dentistry. He is the author of the textbook Bonded Porcelain Restaurations, has authored
numerous articles on esthetic and adhesive dentistry and is an internationally renowned speaker.
Domenico Cascione has been a dental technician since 1985 and a laboratory owner since 1986.
His areas of specialization are metal, implantology and ceramic restorations. Since 1990, he has
been a consultant for Metalor Technologies Italy. Since 2005, he has consulted for Zhermack
SpA, Italy. He has been working at USC, with Dr. Pascal Magne and Michel Magne since January 2005.
Inge Munck has been a dental technician since 1987. She specializes in the areas of fixed
restorations and continues her studies of practice and theory. As a dental technician, she
works in the areas of all-ceramics and pressed ceramics. Munck has been working at USC
with Dr. Pascal Magne and Michel Magne since January 2005.
Contact Information
Michel Magne
mmagne@usc.edu
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Figs. Fig. It is an acrylic duplicate of the diagnostic wax-up and gives the patient an idea of the possible result. and only the absolutely necessary quantity of tooth substance is removed for the acrylic.MagneTech 4/14/06 2:58 PM Page 69 TECHNIQUE Figs. APRIL 2006 | 69 . mock-up means “imitation”. The second purpose of the mock-up is to help the dentist with the minimally invasive preparation. This method is especially suitable for the preparation of adhesive ceramic restorations. 1-2. It stays in the patient’s mouth. Literally translated. 3-4. 5.

“Adapted provisionals are of fundamental importance for molding the soft tissues around the natural teeth and implants” SHELL PROVISIONAL The shell provisional is a “first-generation provisional” among individual esthetic provisionals. One is to prepare the patient for the possible new situation. and highly stable. bridges and splinted restorations. In addition. The long-term provisional restoration is complex in fabrication. The adapted provisional builds on the diagnostic wax-up.MagneTech 4/14/06 2:58 PM Page 70 TECHNIQUE 6 7 Figs. Here it is important to use as little material as possible if we want to keep heat generation to a minimum. which is the starting point for single crowns. The shell provisional is esthetic and functional and requires a minimum of dental input. In the second phase. adapted provisionals help the dentist prepare the patient for the new situation and match his or her esthetic expectations to reality. helps condition the soft tissue (Fig. if necessary. It combines excellent esthetics and function with minimal dental input for the initial provisional (Figs. 9). The fabrication comprises two phases. SANDWICH TECHNIQUE The sandwich technique. the shell provisional is built up in acrylic layers in the laboratory and hollowed out from the inside to a minimum thickness. In the first phase. 6-8). Adapted provisionals are of fundamental importance for molding the soft tissues around the natural teeth and implants and for active tissue regeneration in the vicinity of bridge pontics. 9. ADAPTED PROVISIONAL The adapted provisional – also known as a "secondgeneration provisional" or long-term provisional – is the most important step in treatment planning. developed by Michel Magne. is a special technique for the fabrication of 70 | APRIL 2006 . the provisional is relined directly in place on the patient in the dentist’s office to ensure a good fit in situ and achieve an optimal marginal fit. It serves several purposes concurrently. 8 Fig. esthetically pleasing. its marginal fit is excellent – and it shapes the soft tissue for the treatment steps to follow. It provides sophisticated esthetics and high precision and. 6-8.

making room for effect and enamel materials. This serves to imitate the actual form of the dentin in the natural tooth and makes room for the enamel. 12). Following polymerization. 10. making it possible to create the impression of a natural incisal edge later. This technique involves preparing the soft tissue area on the master model around the prepared dies and. The combination of pressure and water has a positive effect on the behavior of the material. Due to the reduction of the dentin layer. a wax-up of high functional and esthetic quality is the first step. When making a provisional restoration using the sandwich technique. In the next step. Fig. 11.” APRIL 2006 | 71 . When cured. The next step involves preparation of a silicone key from the diagnostic wax-up (prefabricated wax facets may be used to save money and time). First. Fig. the provisional is completely invested in dentin material. It is first and foremost based on the exact reproduction of the natural tooth and the imitation of nature by using several layers of acrylic. This ensured that the “The relative strength of the dentin and enamel material is of crucial importance for the final result. 13). we conditioned the surface of the reduced dentin with aluminum oxide (5 µm) and treated it with Skin Primer. adapted provisional restorations.MagneTech 4/14/06 2:58 PM Page 71 TECHNIQUE Fig. under bridge elements to match the shape of the wax-up. This technique can be used for all types of diagnostic provisionals but it is especially suited to the adapted provisional. if necessary. It increases its lateral stability and reduces porosity. Curing is performed in a pressure vessel for 10 minutes at 2 to 4 bar and 40°C. 11). the dentin material is cut back (Fig. Here we recommend reducing the thickness of the dentin layer only and never decreasing the tooth length (Fig. the dentin is pressed onto the prefabricated insulated master model (Fig. the dentin material is cut back to the desired dentin core. The relative strength of the dentin and enamel material is of crucial importance for the final result. the otherwise intense opacity is reduced. With the matrix created. We recommend extending the key to include two further adjacent teeth to ensure secure repositioning. 12a-12b.

Using the various enamel materials in the New Outline kit (light. and the same silicone key may be re-used after it has been carefully checked. using carefully positioned stains. The enamel material is pressed over the dentin layer and internal characterization. Correctly mixing powder and liquid is particularly important in the case of enamels. shade brightness and translucence. shade brightness and translucence. The procedure is a repetition of the dentin-pressing process. Fig. dark and transparent) and different mixing ratios it is possible to customize the translucence. using carefully positioned stains. Light-curing composites and stains are particularly suited to reproducing the desired effects. We recommend using light-curing composites and a variety of stains to reproduce the various attributes of the natural teeth and to optimize the impact of internal effects and mamelons (Fig. we recommend that the surface be wetted with a thin layer of bonding liquid to ensure good bonding of the enamel materials. This shade characterization should be implemented both on the labial/buccal and the palatal/lingual tooth surface to reproduce the situation as naturally as possible and to adapt it to the reference teeth (Fig. Shade characterization should not be neglected palatally.” 72 | APRIL 2006 surface was absolutely clean and grease-free and that the next layer of material will bond well. 15. we recommend reducing only the thickness of the dentin layer. Fig. 14). medium. . 13. as desired. The effect of the dentin core can be reinforced by enhancing shade intensity. as desired. For example. 14. “The effect of the dentin core can be reinforced by enhancing shade intensity. the cervical area with its saturated and gingivally influenced shade may be appropriately customized using yellow-red stains. To obtain a very natural reconstruction. 15). To adjust the translucence in the incisal area. If the individual shade characterizations are lightcured. It ensures the highest quality material and prevents occurrence of microporosities. transparency and shade of the incisal portion of the provisional restoration very successfully. white and blue may be used. and it is again pressure-cured.MagneTech 4/14/06 2:58 PM Page 72 TECHNIQUE Fig.

MagneTech 4/14/06 2:58 PM Page 73 TECHNIQUE 16 17 Figs. 18 19 20 21 APRIL 2006 | 73 . The result is very satisfactory: the provisional restoration is as natural-looking and individual as a living tooth. 16-21.

is created from a mixture of 50 percent high value.” 74 | APRIL 2006 Then any excess is removed. New Outline may be used both for the indirect technique (fabrication in the laboratory) and the direct technique in the dentist’s office. low and transparent values – produce different shades with translucence and transparency effects. B. Universal enamel material (medium brightness). 23. .. 11 dentin materials in the A. Based on different mixing ratios. 24-28. mid value. and the surface structure is incorporated and mechanically polished to complete the process.MagneTech 4/14/06 2:59 PM Page 74 TECHNIQUE Fig. To supplement the system. and low value enamel materials . At this point. shaping is touched up and finished. Fabrication of a provisional restoration using the sandwich technique is very economical.. three enamel materials and one transparency material. produce different translucence and transparency effects through different mixing ratios. The high value. 22. In selecting the dentin materials. Stains may be mixed with a light-cured glaze (Skin Glaze) and applied to the surface to make fine adjustments to match the characteristics of the reference teeth and the oral situation. the provisional restoration should harmonize perfectly in the mouth of the patient. 22-28). 25 percent low value and 25 percent transparent (Figs. It is three times as concentrated as the monomer liquid and produces a permanent . 16-21). one must pay particular attention to the correct matching of shade hue. and it only takes a few steps to reconstruct a natural-looking appearance. mid. Fig. for example. “Fabrication of a provisional restoration using the sandwich technique is very economical. MATERIALS New Outline is a complete materials system (Fig. the enamel materials – high. 24 25 Figs.. a white dentin material is available. C and D shade hues of the Vita shade guide. 22) featuring creative design options and simple handling. Skin Primer is a bonding agent. and it only takes a few steps to reconstruct a natural-looking appearance (Figs. The New Outline Materials System. It consists of two opaque dentin materials. brightness and saturation..

the shade impression remains stable. Machine polishing can be used to achieve extremely good surface homogeneity. which in turn results in excellent tissue compatibility. they provide indispensible diagnostic information. A correct treatment approach is critical to the result10. ADVANTAGES OF THE SANDWICH TECHNIQUE One advantage of the sandwich technique in fabricating long-term provisional restorations is the highly esthetic result. If the provisional restoration has a metal framework. The stable shade intensity of the various dentin and incisor materials available makes it possible to create an optical impression of high quality. but of the specific material itself5-9. Several studies have also shown that some PMMA-based resins have fewer tendencies to discolor than other materials used for provisionals. it cannot absorb force effects and consequenctly will tend to be brittle and to fracture.MagneTech 4/14/06 2:59 PM Page 75 TECHNIQUE 26 27 bond with another layer of the same material. If a material is too rigid. The surface therefore exhibits excellent soft tissue compatibility and is also highly resistant to abrasion following mechanical polishing or the application of Skin Glaze. it too can be concealed using a lightcuring opaquer supplied with the system. CONCLUSION Provisional restorations are a key milestone along the way to a comprehensive esthetic treatment solution. For the final surface characterization. enabling the user to extend the form or reline an existing provisional restoration. Using internally achieved effects. such as bis-acrylate. “The sandwich technique requires not only precise knowledge of the dental anatomy but also intuition. stains may be added to this glaze liquid. ADVANTAGES OF NEW OUTLINE In the long experience the authors have with New Outline. and contribute to the patient’s comfort and ease during the treatment period of the treatment. Another advantage is clearly the fact that this technique enables a dental technician to learn in a hands-on way how to make natural-looking crowns using PMMA and a simple technique. sensitivity and a keen sense of the natural model4. New Outline is a very homogeneous and compact PMMA material of high density. However. There are also several financial. Experienced dental technicians can give free reign to their personal creativity. A review of the pertinent literature shows that this is not a property of the material category. the sandwich technique requires not only precise knowledge of the dental anatomy but also intuition. Bonding Liquid is 10 times as concentrated as the monomer liquid and produces a permanent bond with any resin. make a significant contribution to the conditioning of the affected soft tissue. This is where the PMMA reveals its true value. provisional restorations may be worn for up to one year without losing their esthetic properties or undergoing appreciable discoloration. which is an important factor especially if the provisional restoration is in the esthetic zone and will be worn over an extended period of time3. Skin Glaze is an oligomeric urethane-polyacrylatemethylmethacrylate with a photo initiator as an additional component. sensitivity and a keen sense of the natural model. which is maintained throughout the treatment period. ADVANTAGES OF POLYMETHYLMETHARCRYLATE (PMMA) Clinical experience has shown that the materials best suited for provisional restorations are characterized first and foremost by flexibility and elasticity. In particular. practical and technical aspects that support the use of this material.” APRIL 2006 | 75 .

Doray. 2004.. Donovan. pp. Magne. “Diagnostic provisional restorations in restorative dentistry: The blueprint for success.L. J.” J. Wang. 212-216.” J..M. tooth position.. D. Vol. 6. Dent. Powers. 6. Burgess. 560-569. Doray. Cho. “Color stability of restorative resins. pp. Belser. there is no material better suited for the fabrication of provisional restorations than polymethylmethacrylate at this time. 16. Li. D. Yaman. Esthet. P. Powers. M. 1998.O.. Prosthet. Razzoog. REFERENCES 1.. Crispin.G. Vol. U. pp. 5. Belser. P. C. wearing comfort and phonetic aspects. Magne. 16. Part II: Diagnostic provisional restorations. Prosthondont. the permanent restoration should simply be a copy of the provisional restoration that the patient has determined to be acceptable. The recipe for success lies in the combination of a sophisticated technique with a superb material.M.. 2000. Vol.” J. X. Prosthet. Marzola. Yannikakis. K.. 80.” J.E.” Quintessence Int. 1999. pp. 1979. 9. A. 1991. A.E. 2. 733-737. Caputo... form. “Novel porcelain laminate preparation approach driven by a diagnostic mock-up. Vol. 8.. G. and to the preparation of the patient for the new situation.” J. Polyzois.. pp. 533-539. Caroni. 1996. 10. 22. 1 q1( +LJ 76 | APRIL 2006 . U. Derbaian. R.” J. In terms of length.V. M. pp. Vol.R. P. T. 65. Esthet.MagneTech 4/14/06 2:59 PM Page 76 TECHNIQUE 28 PRODUCT LIST Indication Acrylic for provisionals Wax facets.J.. Khokhar. prefabricated Name New Outline Form Up Manufacturer/Distributor Microstar Schuler Dental “PMMA is one of the materials best suited for provisional restorations. Can. Dent. PMMA is one of the materials best suited for provisional restorations.. pp. 4.. Vol. pp. It exhibits high durability because of its elasticity. 70-75.” J. Dawson. A.M. Donovan. In the opinion of the authors and based on various studies. 2005. pp. “The diagnostic template: a key element to the comprehensive esthetic treatment concept. 183-188..E. Dent.A.. “Color stability of provisional crown and fixed partial denture resins. pp. The material and its application have a number of advantages and are well suited as the first step in the approximation of an optimum treatment result. Z. Vol. Vol.. B. 7. Dent. Prosthodont. S. Its homogeneity ensures good tissue compatibility. 1997. 238-247. J.A. Dent. J..J. “Color stability of provisional restorative materials after accelerating aging.” J. “Color stability of provisional resin restorative materials.” Int.G. T.. P. 272-275. Assoc.C. 42. 2001. “ In every treatment. Prosthet. 10. “Accelerated aging affects color stability of provisional restorative materials.. Periodontics Restorative Dent. Arcidiacono. Haselton. Dent.. A. P. 27-33. Zissis. and its optical quality guarantees good adaptation to intraoral conditions. “The science of communication in the art of esthetic dentistry.A. the main focus is ultimately on the formulation of the correct diagnosis and subsequent treatment approach.. Restor. G. 7-16. and this is where provisional restorations play a crucial role. 93. 12. J. D. 3. “Color stability of temporary restorative materials. Vol. Magne. Diaz-Arnold. Vol.

with Dr. Dr. where he teaches courses in esthetics and function for postgraduate students. he has consulted for Zhermack SpA. Since 1990. From 1985 to 1991. As the recipient of several scholarships.1( RU " q1(:287/. Magne lectured in Geneva.1(E\0LFKHO0DJQHrDKLJKO\HVWKHWLFHDV\WRXVHDFU\OLFIRUWKHIDEULFDWLRQRIWHPSRUDULHVPDWFKLQJWKHQDWXUDOWRRWKFRORU +LJK+RPRJHQHLW\DQG'HQVLW\DUHFKDUDFWHULVWLFVWKDWPDNHLWIDYRUDEOHIRUJLQJLYDOKHDOWK YLVLW ZZZPLFURVWDUGHQWDOFRP IRU WKH DQVZHU _  . he owned and managed a dental laboratory.edu 1(: 287/. In January 2005. Dr. Domenico Cascione has been a dental technician since 1985 and a laboratory owner since 1986. He is a technical consultant for the companies Straumann and Zhermack. he returned to Geneva and he was awarded his doctorate. She specializes in the areas of fixed restorations and continues her studies of practice and theory. Pascal Magne and Michel Magne since January 2005. he was chief ceramicist of two laboratories and specialized in implant-supported restorations and complex oral rehabilitations. From 1992 to 2004. Since 2005. has authored numerous articles on esthetic and adhesive dentistry and is an internationally renowned speaker. In 2002. In February 2004. implantology and ceramic restorations. He has been working at USC. Italy. where he teaches Esthetic Dentistry. specializing in fixed restorations with an emphasis on ceramics and esthetics. From 1999 to 2004. Pascal Magne and Michel Magne since January 2005. Inge Munck has been a dental technician since 1987. Pascal Magne completed his postgraduate studies in prosthetics and surgical dentistry at the University of Geneva. has been a dental technician since 1979. Magne was able to spend two years at the University of Minnesota conducting research in the areas of biomaterials and biomechanics. he has been a consultant for Metalor Technologies Italy. CDT. Munck has been working at USC with Dr. He has authored and co-authored various articles on cosmetic dentistry and is a frequent speaker at international events. he was appointed associate professor of clinicial dentistry and director of the center of dental technology of the University of Southern California. Dr. He is the author of the textbook Bonded Porcelain Restaurations. Contact Information Michel Magne mmagne@usc. in 1997. she works in the areas of all-ceramics and pressed ceramics.MagneTech 4/14/06 2:59 PM Page 77 TECHNIQUE Bio Michel Magne. where he had already been teaching. he was appointed tenured associate professor at USC. His areas of specialization are metal. As a dental technician.

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