BUJOD Mathur et al

REVIEW ARTICLE
Provisional Restorative Materials In Fixed Prosthodontics: A Comprehensive Review
Authors: Somil Mathur*, Alkesh Shah**, Rakesh Makwana***, Mina Shah****, Alaap Shah*****, Nidhi Jathal******

ABSTRACT
The need for accurate provisional restorations has led to the introduction of a multitude of materials for the
same, with considerable variation in physical, chemical and biologic properties. Polymethylmethacrylate-
based materials have long dominated the arena of provisional restorative materials, but the advent of newer
resin based materials with superior handling characteristics has broadened the spectrum of temporization.
While the choice of a particular material, or technique rests solely with the clinician, and varies as per patient
needs; an insight has been provided here, dissecting the merits and demerits of each material, with the sole
aim of affording a better understanding and improving clinical performance.
Key words: provisional restorations, temporaries, resins.

INTRODUCTION BASIC REQUIREMENTS OF PROVISIONAL

Prosthodontic treatment is often incomplete
without accurate provisional or interim
restorations. The need for provisional restorations
has its roots in esthetic, diagnostic and physiologic
factors. Often, provisional restorations are
imperative in decision-makingregarding final
RESTORATIONS
A provisional prosthesis is defined as “a fixed or
removable prosthesis, designed to enhance
esthetics, stabilization or function for a limited
period of time, after which it is to be replaced by a
definitive prosthesis”.
[1]

treatment modalities and serve as constant guide

posts to both the doctor and patient.
A plethora of materials has been in use for interim
restorations, with research aimed at combining
strength and esthetics in the search for the ideal
provisional restorative material. As newer
materials enter the clinical arena, a thorough
understanding of each is imperative to maximize the
benefits in any given restorative scenario. A basic
review of the materials used for provisional
restorations is thus presented, with the aim of
enabling the doctor with a clear view of how
different materials can be used in conjunction with
their individual merits and demerits, paving the
p a t h t o wa rd s b e t t e r p ra c t i c e s i n f i xe d
prosthodontics.
Address for Corresspondence:
Dr Somil Mathur
Prof & HOD
Department of Prosthodontics & Crown & Bridgework,
Faculty of Dental Science,
Dharamsinh Desai University,
Nadiad
*Prof & Head, **, ***,**** Reader, *****Sr. Lecturer, ******P.G. Student
Department of Prosthodontics & Crown & Bridgework, Faculty of Dental Science, Dharamsinh Desai University, Nadiad
An acceptable prosthodontic treatment modality
requires the prepared teeth to be protected and
stabilized by a provisional restoration that closely
resembles the form and function of the definitive
[2]
restoration. A provisional fixed restoration
provides a template for defining tooth contour,
esthetics, proximal contacts, all the parameters of
occlusion, and most importantly, evaluation of the
potential consequences of an alteration in the
vertical dimension of occlusion. [3]
The terms provisional, interim or transitional are
frequently used inter changeably in literature. The
clinical, biological and physical requirements of
provisional restorations should essentially be the
same as those for a definitive restoration, except for
the longevity and color, thus bringing in the
difference of materials from which the two are
fabricated. [4]
The presence of any prosthesis intraorally
necessitates certain parameters to be followed.
Thus, the requirements of a provisional restoration

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BUJOD
can be divided into biologic and biomechanical
requirements.
BIOLOGIC REQUIREMENTS
The exposure of dentinal tubules following tooth
reduction necessitates pulpal protection. To this
end, the marginal integrity of the provisional
restoration shields the pulp from bacterial, chemical
and thermal insults. For teeth subjected to
endodontic therapy, a well-made provisional
restoration helps prevent coronal microleakage,
thus protecting the root canal system. [5]
Maintenance of periodontal health is a requisite of
any prosthesis, whether provisional or definitive.
Ensuring that gingival contours do not impinge on
marginal tissues is an important determinant of a
healthy periodontiumalong with proper emergence
profiles.
A highly polished plaque resistant surface enables
maintenance of gingival and periodontal health.
Recession of the marginal gingiva has been
attributed to over extended and over contoured
margins. [6] The interdental papilla form and its
maintenance is a key determinant of pleasing
esthetic contours. Thus, appropriate emergence
profiles and proximal contours of provisional
restorations are highly essential, as they not only
maintain tissue forms, but also enable efficient
plaque control by the patient. Appropriate pontic
forms in provisional fixed partial dentures are
essential in maintaining the health and contours of
gingival tissues in the edentulous areas.
The need for an esthetically pleasing restoration is
not restricted to definitive prosthesis alone. A
pleasing finish along with freedom of appropriate
shade selection, and stability of color for a
provisional restoration are important, asthese
restorations may sometimes be required to be
functional for extended periods of time. The
demand for pleasing esthetics is higher for anterior
[7]
provisional compared to the posteriors.
Though the incidence of allergic reactions to the
components of the materials used for provisional
restorations is low, the free monomer content of
methacrylates in particular has been known to be an
MAHARAJA KRISHNAKUMARSINHJI BHAVNAGAR UNIVERSITY
allergen. For a material to be used successfully intra
orally, it is required to be a non-irritant and non
allergenic.
BIOMECHANICAL REQUIREMENTS
Certain prosthodontic treatments require long-
termprovisionals. In these situations, regular
follow-ups are mandatory to assess the health of the
tissues. The provisional restoration is required to
have sufficient strength, durability and hardness to
effectively combat masticatory forces without
fracture or displacement. [8]
An important requisite of a provisional restoration
is the maintenance of the position of the prepared
teeth. Optimum proximal and occlusal contacts are
essential in maintaining stable inter and intra arch
relationships, which prevent drifting and supra
eruption.
A mandatory feature of an interim restoration is the
ability to maintain the interabutment relationship
recorded during the final impression procedure,
until placement of the definitive prosthesis. Interim
restorations placed in the anterior region should
maintain the appropriate protrusive and lateral
guidance.
Long-term provisional restorations may be
required to be removed to assess the health of the
tissues, and recemented later. An important
requisite of the material used is the ease of removal
and recementation, without distortion or damage to
the restoration.
The ease of fabrication of a provisional restorative
material is important in determining its clinical
success. Ease of relining and repair, with a relatively
short setting reaction are important requirements
along with a relatively low cost, which ensures
comfort for both the doctor and patient. [9]
M AT E R I A L S U S E D F O R P R O V I S I O N A L
RESTORATIONS
Interim restorations are generally fabricated using
two techniques:
1. custom fabrication
2. fabrication with preformed materials.
Vol. 3 Issue-3 September 2013 50
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Both of these procedures can be accomplished with
direct clinical, indirect laboratory, or direct/indirect
[2]
combination techniques. While indirect
techniques may involve laboratory costs, and
increased time for fabrication, custom fabrication
has been known to be the best choice for provisional
[10]
restoration fabrication.
The chemistry of conversion of a material from a
plastic to a solid elastic mass, alongwith the
chemical composition forms the basis of
classification of materials available for provisional
restorations:
1. Chemically activated autopolymerizing
acrylic resins
2. Heat activated acrylic resins
3. Light activated acrylic resins
4. Dual light and chemically activated acryic
resins
5. Alloys
These materials differ with regards to method of
polymerization, filler, composition, and monomer
type. [3]
Acrylic resins are the most common materials used
for custom provisional fixed restorations.
[11,12]
The different types of acrylic resins used are – [10,13]
1. Po ly m e t hyl m e t h a c r yl a te , h e re a f te r
addressed to as (PMMA)
2. Polyethyl methacrylate, hereafter addressed
to as (PEMA)
3. Polyvinylethyl methacrylate, hereafter
addressed to as (PVEMA).
METHYL METHACRYLATE
F i r s t i n t ro d u c e d a ro u n d 1 9 4 0 , [ 1 4 ] a u to
polymerizingpolymethyl methacrylate has been the
most preferred material for fabricating interim
[15,16]
provisional restorations.
It is available as a powder and liquid formulation,
the liquid predominantly consisting of methyl
methacrylate and the powder being a polymer with
dibutyl or diethyl pthallate. Various shades are
available, including a clear material useful for
MAHARAJA KRISHNAKUMARSINHJI BHAVNAGAR UNIVERSITY
Mathur et al
fabrication of surgical stents and orthodontic
retainers. [17]
Polymethyl methacrylate has been shown to exhibit
the greatest strength of the methacrylate resins, [18,19]
and also a higher flexural strength than composite
[20]
resins. The fracture toughness and resistance to
crack propagation has been shown to be the highest
for polymethyl methacrylate, followed by bis GMA
resins and polyethyl methacrylate. [21]
The fabrication of provisional crowns and
bridgeworks through a direct technique generates
heat by the exothermic setting reaction of self-
curing resins, which may injure the dental pulp. [22]
The mechanisms of injury include protoplasm
coagulation, expansion of the liquid in the dentinal
tubules and the pulp with increased outward flow
from the tubules, vascular injuries and tissue
necrosis. [23] The temperature increase during
polymerization of polymethyl methacrylate is
significantly higher than poly vinyl ethyl
methacrylate, Visible light cured urethane
dimethacrylate and bis acryl resins. Peak
temperature is defined as the highest temperature
recorded during polymerization.
[24]
Vallittu
d e m o n s t ra te d t h a t p e a k p o ly m e r i z a t i o n
temperature increase has been associated with the
volume of acrylic resin, and that the temperatures
[23]
could go as high as 82 degrees Celsius.
Stanley reported that when external heat was
applied to intact teeth, a 10oF (5.6oC) rise in the
temperature of the pulp caused 15% of the pulps
tested to lose vitality, a 20oF (11.2oC) rise in the
temperature caused 60% of the pulps to lose vitality,
and a 30oF (16.8oC) rise in the temperature caused
[25]
irreversible pulpal necrosis in 100 % of the pulps.
[26]
In vitro studies by Tjan et al tested the
temperature rise in the pulp chamber induced by
self-curing resins during direct fabrication of
provisional restorations. The results showed the
possibility of thermal damage to the dental pulp and
odontoblasts during setting. Plant et al, in a study
found that the intra pulpal temperature rise
associated with the polymerization of methyl
methacrylate materials could be upto five times that
associated with the normal consumption of
Vol. 3 Issue-3 September 2013 51
BUJOD
thermally hot liquids[27]Literature thus indicates
that the use of PMMA in fabricating provisional
restorations should be discouraged when the direct
technique is used. When provisional restorations
are made using the indirect technique, polymethyl
methacrylate is the most preferred material owing
[15]
to its superior physical properties.
This material has been found to be more color stable
than polyethyl methacrylate and poly vinyl ethyl
methacrylate. [28]Though this material has good
polishability, but a low abrasion resistance, it shows
wear of the material over time. [29] Some of the
commercially available PMMA materials include
Alike (GC America, Alsip, Ill), Jet (Lang Dental,
Wheeling, Ill), and Trim Plus (Harry J. Bosworth,
Skokie, Ill).
REINFORCEMENT
The strength and serviceability of any acrylic resin,
especially in long span interim restorations is
determined by the material's resistance to crack
propagation.{21} Crack propagation and fracture
failure may occur with these materials because of
inadequate transverse strength, impact strength or
fatigue resistance.{30}
Various reinforcing techniques have been advocated
to enhance the mechanical properties of acrylic
resins. Attempts have been made to strengthen
acrylic resin materials by reinforcement with either
chemical modification with grafted copolymers and
stronger cross linkage or by inclusion of various
organic and inorganic reinforcing fibers. {30}
Materials used for fiber reinforcement have
included metal, glass, carbon graphite,{31}
sapphire, Kevlar (Du Pont, Wilmington,Del),{32}
polyester and rigid polyethylene.{30} Most of these
materials have had little or no success in increasing
resin strength.
Emtiaz and Tarnow,{33} Davidoff,{32}Caputi et
al{34} have described various methods of adding
metal reinforcing structures to acrylic resin
provisional restorations in the form of castings, spot
welded stainless steel matrix bands and precut
stainless steel mesh. Youdelis and Faucher{35}
used stainless steel wire material adapted around
abutment teeth, removed, welded and fitted inside
MAHARAJA KRISHNAKUMARSINHJI BHAVNAGAR UNIVERSITY
a c r yl i c re s i n s h e l l c ro w n s to re i n fo rc e
autopolymerizing acrylic resin materials. Similarly,
Greenburg{36} recommends ultra thin stainless
steel bands. Chee et al{37} studied the effect of
chilled monomer on the working time of
autopolymerizing acrylic resins, and found that the
working time and setting time increased by up to 4
times when chilled monomer was used, but the
transverse strength for the materials was decreased
by 17%.
The effectiveness of these strengthening
mechanisms varies, with the main requirement
being adequate bond formation between the
reinforcing materials and the parent resin. If the
bond is not adequate, the filler may act as an
inclusion body weakening the prosthesis, and also
act as a wick attracting oral bacteria.
POLYETHYL METHACRYLATE
Ethyl methacrylate, a self curing material available
as a powder liquid formulation was introduced in
the 1960 s with the aim of overcoming the
disadvantages of polymethyl methacrylate.{33}
The liquid consists of predominantly ethyl
methacrylate whereas the powder is predominantly
a polymer and benzoyl peroxide.{17} It is a better-
suited material for direct interim prosthesis
fabrication, due to a lower exothermic setting
reaction, deeming it kinder to the pulp when large
volumes are being cured intra orally.{2} PEMA
exhibits a low polymerization shrinkage compared
to PMMA.{2},{31} Good polishability and good stain
resistance account for a good esthetic appeal.{38} It
also has a less pungent odor, making it clinically
friendly.{39} Ease of use is afforded by good
handling characteristics.{40} However, the surface
hardness, fracture toughness and transverse
strength of poly ethyl methacrylate is lower than
polymethyl methacrylate, questioning the function
in high stress areas. The wear resistance and color
stability are inferior to the newer materials, thus
making it a poor choice for long-termprovisionals.
{41}Splintline (Lang Dental, Wheeling, Ill) utilizes
PEMA as the main component.
VINYL ETHYL METHACRYLATE
Vinyl ethyl and butyl methacrylate are chemically
Vol. 3 Issue-3 September 2013 52
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similar materials, falling in the same broad category,
and displaying comparable clinical behavior to poly
ethyl methacrylate.{42} Available as a powder –
liquid formulation, PVEMA is an autopolymerizing
material also available in various tooth colors.
Though the color stability has not been known to be
as good as PMMA, it exhibits a lower exothermic
reaction while setting, making it friendlier to the
pulp.{22} Lack of transverse strength compared to
PMMA ensures that it is not used as frequently as the
latter.Due to inferior physical properties compared
to the other materials available for provisional
restorations, literature does not support abundant
use of PVEMA in a clinical setting. Some
commercially available PVEMA materials include
Snap (Parkell, Farmington, NY), Trim (Harry J.
Bosworth, Skokie, Ill), Trim II (Harry J. Bosworth,
Skokie, Ill).
BIS ACRYL COMPOSITE RESINS
Bis acryl resin is a hydrophobic material similar to
bis GMA. The introduction of bis acryl resins was
aimed at overcoming the shortcomings of
methacrylates, and was a foray into two paste
system dispension, available as an automix delivery
system. They are quick and easy to use but are
expensive.{40}
Bis acryl resins have very low exothermic reactions,
making them kinder to the pulp. {43} They also
exhibit a low shrinkage, leading to a good marginal
fit and good transverse strength.{44} The presence
of a thick oxygen inhibited layer on the surface upon
setting makes them less stain resistant compared to
methacrylates.{45} While they do exhibit enhanced
microhardness and resistance to wear over
polymethyl methacrylate,{44},{46} they are more
brittle.{17}
Repair or modification of bis acryl restorations with
composite resin is difficult due to dissimilar
chemistry.{47}Koumjian and Nimmo have
demonstrated an 85% decrease in transverse
strength after repair of a bis acryl material,
suggesting that the fabrication of a new provisional
restoration is more advantageous where repair is
indicated.{48}
In a study comparing the clinical performance of
MAHARAJA KRISHNAKUMARSINHJI BHAVNAGAR UNIVERSITY
Mathur et al
autopolymerizing, dual polymerizing and visible
light polymerizing bis acryl materials, Luthardt et al
concluded that the light and dual polymerizing
materials did not offer a clinical benefit relative to
autopolymerizing materials.{49}Clinically, the only
perceived advantage would be the time available to
mould and modify the resin to the desired contours
before initiation of the setting reaction. While
bisacryls are more expensive compared to
polymethyl methacrylate, their superior esthetics
makes them better suited for anterior temporaries.
Auto polymerized Bis acryl resins are commercially
marketed as Bis Jet (Lang Dental, Wheeling, Ill),
Luxatemp (Zenith/DMG, Englewood, NJ), Protemp
II(ESPE, Plymouth Meeting, Pa). Dual polymerized
bis acryl resins include Iso Temp (3M Dental, St.
Paul, Minn), Luxatemp Solar (Zenith/DMG,
Englewood, NJ).
Bis GMA RESINS
The problems associated with both methacrylates
and bis acryl materials were attempted to be
rectified through the introduction of bisGMA resins.
They provide a good marginal fit, a lower shrinkage,
and low exothermicity. A very thin oxygen inhibited
layer is present on setting, and the polishabilty and
esthetics of bis GMA resins is good. They are
stronger than bisacryls but more brittle compared
to polymethyl methacrylate and are more likely to
fracture in long span fixed partial denture
applications. The similarity of chemistry to
composite resins facilitates ease of repair by use of a
dentin adhesive and light curing.{50}Castleneuvo
and Tjan reported that bis-GMA resin had a lower
rise in temperature than bis acryl composite
resin.{51} The presence of bis-GMA in dual cure
resins, thus is the reason they exhibit low
exothermicity compared to self curing resins.
Tempspan( Pentron clinical Technologies,
Wallingford, CT) is a syringeablebis GMA material,
available in a multitude of shades, demonstrating
long term color stability. It is a dual curing resin,
provided in an automixing cartridge. Using a clear
stent, which could be made from a vacuform sheet,
facilitates light curing.
The Protemp crown (3M ESPE, St paul, MN) is a
Vol. 3 Issue-3 September 2013 53
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preformed bis GMA provisional crown, for single
unit posterior teeth and canines. It is preshaped as
adaptable putty needing marginal trimming,
adaptation to the preparation, light curing, removal,
finishing and cementation. The margins or contour
may be modified using a flowable composite.
Currently, it is only marketed in a single shade,
which is a major disadvantage.
VISIBLE LIGHT CURED URETHANE DIMETH-
ACRYLATE RESINS
Visible light curing materials were introduced in the
1980s.{33}Urethanedimethacrylate is added, which
is a resin requiring visible light and a
camphoroquinone or an amine photo initiator for
polymerization.{52},{53} Fillers like microfine
silica are incorporated to reduce polymerization
shrinkage. The setting reaction does not emanate
residual monomer, unlike methacrylates, causing
decreased tissue toxicity.{54}
Controversial studies exist as far as the temperature
change during setting is concerned.{38} Conflicting
data has been reported regarding the color stability
of visible light curing resins, (hereafter addressed to
as “VLC resins”) used for fabricating provisional
restorations. They demonstrate a good surface
hardness and wear resistance. The transverse
strength also has been shown to be acceptable.
However, poor stain resistance affords for
unacceptable esthetics for long-term provisional
restorations. Prestipino has shown that VLC resins
are brittle, making them a poor choice for high
strength posterior provisional restorations. {53}
VLC resins are available in limited shades, and are
more expensive compared to the other materials
used for provisionalization. {55}
In a study, Haddix claimed that visible light cured
materials produce provisional restorations with a
quality similar to heat curing, laboratory fabricated
restorations, but the time and expense involved are
less. {55}
VLC resins are currently marketed in two forms,
which are similar chemically but have different
handling techniques. Revotec LC (GC America,
Alsip, IL) is moldable putty available as a thick rope.
MAHARAJA KRISHNAKUMARSINHJI BHAVNAGAR UNIVERSITY
The use consists of cutting off a desired quantity,
adaptation to the prepared tooth, light curing,
polishing and cementation. It can be used for
temporization of multiple adjacent crown units and
bridgeworks. A good marginal fit, polishability, no
shrinkage upon setting and no exothermicity
account for some of the advantages of Revotec LC.
Flowable and hybrid composites can be used to
repair it, as no oxygen-inhibited layer is present.
This material, currently available in a single shade,
offers good transverse strength and abrasion
resistance. However, bisacryls and bis GMA resins
are superior in so far as esthetics is concerned.
Radica (DentsplyCeramco, York, PA) is a
thermoplastic material packaged in syringes
according to the enamel and dentin shades, which
requires light curing to achieve complete setting. It
affords a very good transverse strength and
abrasion resistance, and can be well suited for long-
term provisionalization. It exhibits a good
polishability and is available in a variety of shades.
A special unit is required to condition the syringes,
and also for light curing. It is thus designated for
indirect provisional restoration fabrication in the
laboratory, but can be accomplished chair side if the
equipment is available.
OUTCOME OF REVIEW
The choice of a material for a provisional restoration
has to be made keeping many factors in mind.
Though PMMA has been shown to have
disadvantages, it is a versatile material, showing
favorable results in most situations. The requisites
of posterior high strength temporary restorations
and treatment scenarios warranting long term
provisionals are most often fulfilled by PMMA.
Adding reinforcing agents and heat curing further
enhances the properties. Bis acryl resins have been
deemed a good choice for anterior temporaries,
satisfactorily fulfilling the esthetic requirements
along with the demonstration of satisfactory
mechanical properties. VLC resins afford ease of
usage, but controversies exist regarding the
accuracy of marginal adaptation and stain
resistance, thus negating their use in situations
demanding superior esthetics and long-term
Vol. 3 Issue-3 September 2013 54
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temporization. While BIS-GMA resins demonstrate
superior physical properties, the prohibitive costs
and limited shade selection restrict their usage.
CRITICAL EVALUATION
This paper attempts to identify a material, which
satisfies all the ideal requirements considering the
huge advancements biomaterial science has made.
Almost all materials, which have been discussed in
great detail in the scientific literature, were
reviewed. In the recent times, bis acryl resins and
heat cure PMMA would be the choice of an astute
clinician to fabricate provisional restorations.
SUMMARY
The importance of accurate, well made provisional
restorations in prosthodontic treatment cannot be
emphasized enough.This article has reviewed the
materials used for fabricating provisional
restorations, with the goal of familiarizing the
contemporary clinician with the physical, chemical,
mechanical and biological properties of each. The
plethora of materials available today requires the
doctor to have an in depth understanding of each in
order to maximize the benefits and fit the
requirements in any given clinical scenario. While
no single material exists that fits all the
requirements, research should be further initiated
towards the quest for the ideal material in terms of
satisfying each need of both the patient and the
doctor.
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