Inside Dental Assisting

July/Aug 2012, Volume 8, Issue 4

Published by AEGIS Communications

Provisional–Temporary
Cements
Techniques to facilitate placement of provisional restorations
Howard E. Strassler, DMD; and Roseanne J. Morgan, CDA
Provisional or temporary cements play an important role in
restorative dentistry. Recommendations for the use of
provisional cements include the temporary cementation of
temporary restorations used to restore tooth preparations for
indirect restorations including crowns, fixed partial dentures,
inlays and onlays, as well as for temporary cementation of
definitive restorations of the same types. Provisional cements
are also used for the cementation of implant crowns and fixed
partial dentures (fixed bridges). There are specific techniques to
make using a temporary cement easier, and different types of
temporary cements for certain clinical situations.
Techniques for ease of use of temporary
cements
Once the provisional restoration has been adapted, finished, and
polished, it is ready for cementation. To facilitate clean-up of
the temporary cement, follow two simple tips. First, to avoid
leaving a white streak of set provisional cement around the
surfaces and margins of the restoration and to simplify removal
of excess provisional cement, before placing the cement, lightly
paint some petroleum jelly on the outside, polished surfaces of
the provisional restoration using a disposable brush. (Figure 1)
For a bridge, place a thicker portion of petroleum jelly on the
tissue surface side (outside) of a pontic and gingival to the
connector of the bridge with a brush. This thicker portion of
petrolatum gel will prevent the temporary cement from getting
into these difficult-to-access areas once the cement has set.
Because the gel is there instead of the cement, it will be easier to
remove the temporary cement.
For cement placement into the temporary restoration, either
using an automixing tip with a automixed temporary cement and
squeezing it into the temporary (Figure 2) or by mixing the
cement on a pad or dispensing to a pad after automixing, use a
disposable brush to apply the cement to the temporary
restoration. In either case, never overfill the inside of the
temporary restoration—only enough to coat the inside. The
authors prefer using the brush to apply the cement to the internal
of a crown, bridge, or inlay/onlay temporary because it is easier
to control the amount of temporary cement and where it is
applied. The temporary cement should completely coat all the
internal surfaces of the restoration (Figure 3). Do not overload
the restoration with temporary cement (or even a final cement
for a final restoration) because it can lead to difficulty fully
seating the restoration and also to a gross excess of cement that
will need to be removed. Gross cement can easily be removed
after the complete set of the cement with a scaler (Figure 4). In
fact, it will easily be removed if petroleum gel was placed.
One problem when removing provisional cement for crowns,
inlays/onlays, and bridge temporary restorations is removing the
cement in the gingival embrasure below the contact area.
Flossing the contact will often not remove the cement: the floss
will slide between the restoration and the cement and the cement
will not be pulled out. For those times when the cement is more
difficult to remove from the embrasure space (for teeth with
large gingival embrasures), there is a simple solution. For these
cases, tie two to three knots into the end of a piece of dental
floss, then floss the contact area pulling the floss through so the
larger knotted area will pull out the gross set cement (Figure 5).
It is critical that all residual temporary cement be removed.
Excess cement remaining in the sulcus can result in irritation of
the periodontium in the sulcus, and in the most extreme cases
result in severe periodontal inflammation with the potential for
bone loss. The knotted floss can also be used to remove the set
cement under a pontic area by placing the knotted floss on the
gingival pontic site before cementation. Once the provisional
cement has hardened, pull the floss out.
Choices in Temporary Cements
There are many choices with temporary cements (Table 1).
Dentists select cements based upon their experience with a
product, or recommendations that have been made by others, or
through continuing education courses. There are many important
factors in the physical properties and handling of the cement that
make a difference.1 These properties include:
1. good retention of the indirect restoration with the provisional
cement (good adhesion to the tooth preparation and restoration)
2. easy to dispense, mix and apply to the restoration
3. easy removal of excess from the external surfaces of the
restoration after cementation
4. adequate working time and setting time
5. viscosity and handling properties for ease of placement to
restoration to be cemented and/or tooth preparation
6. easy removal of the indirect restoration from the tooth
preparation when cemented with the provisional cement without
damaging the soft tissues, tooth preparation or pulp
7. easy removal of provisional cement from tooth preparation
during clean-up from dentin and enamel, core materials (cast
metal, amalgam, composite resin) and implant abutment
materials
8. easy removal of the provisional cement from the internal
surfaces of the restoration when the restoration needs to be
recemented
9. no or minimal chemical reaction of the provisional cement to
the restorative material in the restoration restorative material
(eg, zinc-oxide eugenol cements can contaminate and soften
acrylic resins)
10. biocompatibility to soft tissues, pulp and tooth structure
11. no interference with adhesion of a final cement
12. good shelf life
While no one product fulfills all these properties, the choice of a
provisional cement should depend on the clinical circumstance
for which it is chosen.
Clinical Situations
Provisional restorations are important. The provisional
restoration protects the tooth by minimizing extreme changes in
temperature due to food and beverages ingested. In addition,
when cemented, it provides a seal against microleakage for the
period of time that the provisional restoration will be in place
and reduces sensitivity while the laboratory is fabricating the
crown or inlay/onlay.2,3 The provisional cement plays a key role
in keeping the temporary restoration on the tooth while the
patient is waiting for the final restoration to return from the
dental laboratory.4,5 While the cement helps retain the temporary
restoration, it also has to provide for easy removal of the
provisional restoration without harming the periodontium, tooth
preparation, or pulp when the final restoration is tried-in and
adjusted.
Some practitioners will temporarily cement some final
restorations, usually all metal or porcelain-metal, to evaluate the
restoration’s contours and margins. In the case of a fixed partial
denture (fixed bridge) with a pontic, some clinicians prefer to
provisionally cement the restoration first with a provisional
cement to assess the periodontal response of the restoration and
the adaptation of the tissue-borne side of a pontic. In the past,
provisional cements were opaque in color due to the materials
being used. Recently more tooth-colored provisional cements
have been introduced to not interfere with the color evaluation
of translucent restoration materials. Examples of color neutral,
shaded or translucent provisional materials include Zone (Dux®
Dental, www.duxdental.com, NexTemp™ (Premier Dental,
www.premusa.com), TempBond® Clear (Kerr Corporation,
www.kerrdental.com), and Systemp®.link (Ivoclar Vivadent®,
www.ivoclarvivadent.us). In some cases, for a patient who
relates a history of dentinal hypersensitivity after the tooth
preparation and provisional restoration placement, the definitive
restoration may be temporarily cemented with a provisional
cement to assess pulpal health. In these cases, the use of a
eugenol-containing provisional cement may have a sedative
affect on the pulp.6 Eugenol-containing provisional cements with
residual eugenol remaining after setting can result in softening
of an acrylic resin—not allowing additional acrylic resin added
to a previously made temporary crown or bridge to set
completely.7,8 With the newer eugenol-containing provisional
cements, the amount of unreacted eugenol can be minimized by
using the correct mixing proportions recommended by the
manufacturer.4
The practitioner will determine the best temporary cement for
any given clinical situation. In most cases there is not a one-
size-fits-all choice in provisional cements. When using a
provisional cement it is critical that the tooth surfaces of the
preparation be adequately cleaned to remove the residual
provisional cement. Techniques to remove residual provisional
cements from tooth preparations include scraping the tooth with
a hand instrument (usually a scaler or curet), cleaning the tooth
preparation with a prophylaxis cup with a water–pumice paste
slurry, and the use of an intraoral sandblaster. Of the three
methods, the intraoral sandblaster method is the most reliable,
followed by a prophylaxis cup with a water–pumice paste slurry.
To be certain the final cementation is optimized, the tooth
preparation must be clean.9-11
When placing final restorations for implant-supported
prostheses, some practitioners place the final restoration with a
provisional cement so it can be more easily removed on a
regular basis; or if one or more of the abutments of a fixed
partial denture come loose, the prosthesis can be removed and
recemented. Once again, the choice of cement depends on the
clinical situation.
Types of Provisional Cements
The earliest provisional cements were made from zinc-oxide
powder and eugenol liquid (ZOE). Today the dental office has
many choices with provisional–temporary cements. Because
ZOE cements can have negative effects on the acrylic resin and
adhesive tooth cementation with composite resin cements, in
recent years a number of manufacturers have addressed this
problem by introducing provisional cements that are eugenol-
free. Some eugenol-free cements do not set as hard as eugenol-
containing cements, which can lead to a temporary crown or
bridge becoming uncemented, requiring an additional office
visit to recement the temporary.
Some eugenol-free provisional cements have been formulated to
address problems identified with past cements.12,13 There was a
need for a more rigid provisional cement to improve retention of
the restoration and facilitate clean-up of the provisional cement
from the preparation and restoration. A clinician may use a
different provisional cement for certain circumstances to achieve
easier removal of the restoration at a later time, compared to the
need for a more rigid provisional cement that will allow for
better retention on a crown preparation that is not retentive due
to its occlusogingival height or the presence of excess taper to
the axial walls of the crown preparation.12,13 TempoSIL
(Coltène/Whaledent, www.coltane.com) achieves both goals. It
has a unique formulation as an addition-cured silicone-based
zinc oxide temporary cement with a silane agent for improved
adhesion and marginal integrity. This formula produces a firm,
yet elastic temporary cement that can be easily peeled off the
tooth preparation (either natural tooth, core of restorative
material, or implant abutment) and removed from the internal
surfaces of both provisional and final restorations. Other
provisional cements, UltraTemp (Ultradent Products,
www.ultradent.com) and Hy-Bond® Polycarboxylate Temporary
Cement (Shofu, www.shofu.com), use a polycarboxylate
formulation and are eugenol-free. UltraTemp addresses the need
for greater rigidity for restoration retention and is available in
two different formulas (regular and rigid set), while Hy-Bond
has one formula for a more rigid set. TempSpan® CMT (Pentron
Clinical, www.pentron.com) and NexTemp (Premier Dental) are
two resin-based formulations that provide for translucent color,
greater rigidity, and a two-stage gel setting reaction for easy
removal of excess. TempSpan CMT also has the additives of
sodium fluoride, potassium nitrate, and calcium phosphate for a
reported decrease in postoperative sensitivity.
Convenience Packaging
In the past, many temporary cements were packaged in paste
squeeze tubes. There are problems associated with dispensing of
material and maintenance of these tubes. Excess cement
extrudes from the tube, making the outside of the tube making
the tube sticky and difficult to clean due to the oily consistency
of the pastes. Convenience packaging has made the use of
provisional cements easier with more consistent dispensing. For
those times when a ZOE provisional cement is desired, Embonte
and Embonte 2 (Dux Dental) afford convenient and easy-to-use
packaging. Embonte is provided in unit dose packaging, which
allows the chairside assistant to dispense the right amount of
both base and catalyst paste for a single unit provisional crown
cementation without any excess and waste. Embonte2 uses the
same ZOE formulation and is dispensed in a dual-cartridge auto-
aspirating syringe that eliminates the waste of conventional
squeeze tubes with its patented auto aspirating feature.
If convenience packaging is desired with a eugenol-free
provisional cement, there are a number of good choices with the
advantages for ease of use. What could be more convenient than
a moisture sensitive and self-setting single paste available in a
unit dose? Eugenol-free NoMIX® Temporary Cement (Centrix,
www.centrixdental.com) is a single-paste no-mix moisture-
activated temporary cement. When the practitioner is ready to
cement the restoration, the interior of the restoration is wetted
with water before the cement is dispensed. Initial set for clean-
up is 5 minutes with complete setting in 15 minutes. This
extended working time allows for use with single units and
multiple units. Also, this temporary cement is packaged in unit
dose so that patients can take it with them to recement their own
provisional restoration.
Many of the newest provisional cements are available in a
double-barreled automixing syringe or in the case of
TempoCem® NE (Zenith DMG, www.dmg-america.com), a
double barreled cartridge that is dispensed through gun-type
applicator similar to those used with bis-acryl provisional
composite resins. Automixing dual-tube provisional cements
allows the chairside assistant to dispense the right amount for a
single unit or multiple units directly into the provisional
restoration. (Figure 2). It also means that each mix is consistent
because the catalyst and base paste will always be dispensed
through the mixing tip in the optimal volume ratio and mixed in
a consistent fashion through the automix tip. It also minimizes
waste and eliminates the clean-up of a cement spatula and
mixing pad.14 Some of the products that are available in this
automix double-barreled syringe are Temp Advantage® (GC
America, www.gcamerica.com), TempSpan CMT (Pentron
Clinical), Zone (Dux Dental), Systemp.Cem (Ivoclar), and
TempoSIL (Coltène/Whaledent), among others.
Conclusion
While there is no one provisional cement that meets all the
requirements of an ideal product, the current generation of
provisional cements offers a number of advantages over what
has been used in the past. If a practitioner is having success with
a provisional cement, there is no reason to make a change.
However, if the practice has expanded the types of restorations
to include all-ceramic and implants, there may be a need for
more than one brand of provisional cements. The advantages of
a more rigid setting provisional cement may be necessary for a
number of clinical situations, including a crown with
compromised retention or a patient with parafunctional habits. If
there are issues with postoperative sensitivity, a provisional
cement containing eugenol or a eugenol-free provisional cement
with additives for desensitizing may solve these problems.
There is no one provisional cement to meet all clinical needs. It
may be necessary to have at least two different provisional
cements to accommodate the dental practice. Whatever product
is used, it is important that the provisional cement be cleaned
thoroughly from the tooth before definitive cementation.
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