Reham hamdy abdel fattah

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 Requirements of provesional restoration

 Types according to way of fabrication

 Preformed
 Custom made
 Procedure OF Custom made
 Direct technique
 Indirect technique
 Indirect direct technique
 cementation
 CAD / CAM
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 Interim
crowns or partial fixed dental
prostheses (FDPs) are essential in
prosthodontic therapy.

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 An
optimum interim fixed restoration
must satisfy many interrelated factors
Biologic Requirements
Mechanical Requirements
Esthetic Requirements

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Biologic Requirements

 Pulpal protection
An interim fixed restoration must seal and insulate
the prepared tooth surface from the oral
environment to prevent sensitivity and further
irritation to the pulp.
 Periodontal health
an interim fixed restoration must have good
marginal fit, proper contour, and a smooth
surface,to facilitate plaque removal
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 Aninterim restoration should have good
marginal fit, proper contour, and a smooth
surface finish. The properly contoured
interim restoration. Smoothly continuous
with the external surface of the tooth.

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 Overcontouring. Irregular transition from the
restoration to the root surface and
inadequate marginal adaptation. These
contribute to plaque accumulation and an
unhealthy periodontium.

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 Occlusal compatibility and tooth position
The interim fixed restoration should maintain
proper contacts with adjacent and opposing
teeth.
Inadequate contacts allow supra eruption and
horizontal movement.

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Horizontal movement results in excessive or deficient
proximal contacts

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 Prevention of enamel fracture
The interim fixed restoration should protect teeth
weakened by crown preparation
a small chip of enamel makes the definitive
restoration unsatisfactory and necessitates a
time-consuming remake .

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Mechanical Requirements

 Function
The greatest stresses in an interim fixed
restoration are likely to occur during chewing.
The strength of polymethyl methacrylate resin is
about one-twentieth that of metal-ceramic alloys

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breakage occurs with partial-coverage restorations
and partial FDPs.
Partial-coverage restorations are inherently
weaker because they do not completely encircle
the tooth.

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Fracture site is at the
connector area in partial
FDP
To overcome this ,
connector size must be
increased in the interim
restoration in comparison
with the definitive
restoration
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 Greater strength is achieved by reducing the
depth and sharpness of the embrasures
 they should not be overcontoured near the
gingiva
 Good access for plaque control must have
high priority.

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 Displacement
 Displacement is best prevented through proper
tooth preparation and an interim restoration
with a closely adapted internal surface.

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 Removal for reuse
 if the cement is sufficiently weak and the interim
restoration has been well fabricated, it does not
break upon removal.

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 Although it may not be possible to duplicate
exactly the appearance of an unrestored
natural tooth, the tooth contour, color,
translucency, and texture are essential
attributes.

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 some resins discolor with time intraorally,
and thus color stability governs the selection
of materials when a long period of service is
anticipated

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 The interim restoration is shaped and modified
until its appearance is mutually acceptable to
dentist and patient

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 This process is more efficient when it begins
with diagnostic waxing procedures.
 Involving the patient in decision making
results in greater patient satisfaction

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 Ideal properties
 adequate working time, easy molding, rapid
setting time
 Biocompatibility: nontoxic, nonallergenic,
nonexothermic
 Dimensional stability during solidification
 Ease of contouring and polishing
 Adequate strength and abrasion resistance

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 Ideal properties
 Good appearance: translucent, color
controllable, color stable
 Good acceptability to patient: nonirritating,
odorless
 Ease of adding to or repairing
 Chemical compatibility with interim luting agents

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a wide variety of materials are available to
make satisfactory interim restorations
 It is a helpful principle that all the
procedures have in common the formation of
a mold cavity into which a plastic material is
poured or packed

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 Although there are many variations, molds
used in making interim restorations consist of
an external surface form (ESF) and a tissue
surface form (TSF).
 Direct techniques entail use of the patient’s
mouth directly as the TSF.

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 an ideal interim material has not been
developed.
 A major problem still to be solved is
dimensional change during solidification
 shrink and cause marginal
discrepancy,especially when the direct
technique is used
 Exothermic reaction of resin

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 Poly(methyl methacrylate)
 Poly(R¢ methacrylate)*

 Microfilled composite
 Light-cured

 No material being superior in all categories.

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 various preformed “crowns” are available
commercially
 Most crown forms need some modification
(internal relief, axial recontouring, occlusal
adjustment) in addition to the lining
procedure

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 include polycarbonate, cellulose acetate,
aluminum, tin-silver, and nickel-chromium.
 available in a variety of tooth types and sizes

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 Polycarbonate
 has the most natural appearance of
all the preformed materials
 available in only a single shade, this
can be modified to a limited extent
by the shade of the lining resin.
 Polycarbonate ESFs are supplied in
incisor, canine, and premolar tooth
types.
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 Cellulose acetate
 is a thin (0.2- to 0.3-mm) transparent material
available in all tooth types and a range of sizes
 Shades are entirely dependent on the
autopolymerizing resin
 after polymerization, the shell is peeled off and
discarded to prevent staining at the interface.
 has the disadvantage of necessitating the
addition of resin to reestablish proximal
contacts.
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 Aluminum and tin-silver
 are suitable for posterior teeth.
 crown forms have anatomically
shaped occlusal and axial
surfaces
 The least expensive forms are
cylindrical shells resembling a tin
can, require modification to
achieve acceptable occlusal and
axial surfaces.
 the crown has a constricted
cervical contour.
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 This is a greater risk if adaptation is carried out
directly by having the patient forcefully occlude
on the crown shell.
 This highly ductile alloy allows the crown
margins to be stretched to fit the tooth closely
,only where feather edge margins are used.
 For other margin designs, cervical enlargement should
be performed indirectly on a swaging block, which
should be supplied with the crown kit

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 Nickel-chromium
 are used primarily for children
with extensively damaged
primary teeth.
 they are not lined with resin
but are trimmed, adapted with
contouring pliers, and luted
with a high-strength cement.
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 Nickel-chromium
 They may be applied to secondary teeth
but are more suitable for primary teeth,
where longevity is less critical.
 Nickel-chromium alloy is very hard and
thus can be used for longer-term interim
restorations

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 Preformed crowns are generally limited to
use as single restorations, because it is not
feasible to use them as pontics for partial
FDPs

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 indirect
 direct.
 A third category, indirect-direct, is the
sequential application of these.

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 The interim restorations are fabricated
outside the mouth.
 Advantages
1. There is no contact of free monomer with
the prepared tooth or gingiva
2. The procedure avoids subjecting a prepared
tooth to the heat evolved from
polymerizing resin.
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3- The marginal fit of indirectly constructed
restoration is better due to its complete
polymerization undisturbed on the stone
cast.
4-The indirect technique reduced the chair
time

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 The study cast is constructed from alginate
impression before preparation.
 If the tooth or teeth to be restored has any
obvious defect, it should be corrected on the
study cast with waxing up

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 Indirect
technique: ESF, an alginate
impression; TSF, a quick-set plaster cast.

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 Fill
all the embrasures with wax or putty to
eliminate undercuts.
 Construct the rubber base index for the
tooth to be prepared or the index may be
constructed from the patient mouth

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 Indirect
technique: ESF,
a silicone putty
impression

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 Upon completion of the
preparations, make
alginate impression for
them and pour it in fast-
setting plaster.
 Coat the cast with
separating medium.

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 Mix the temporary acrylic resin in a dappen
dish and put some on the protected areas of
the cast, such as interproximal spaces and in
grooves and boxes.
 As the resin begins to lose its surface gloss
and become slightly dull, fill the index, place
it over the cast.

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 Put them in pressure pot if available or
warm water to accelerate polymerization
(hot water causes boiling of the monomer
porosity).
 The restoration is then removed from the
cast, if it is not easily removed from the
cast; break the cast with a heavy laboratory
knife.
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 The interim restoration is then finished using
acrylic burs, sand paper discs with different
grits.
 Finally the restoration is polished with
pumice, rag wheel and rubber cups to be
ready for cementation.

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 The patient’s prepared teeth and gingival
tissues directly provide the TSF,
 the direct technique has significant
disadvantages:
1. tissue trauma from the polymerizing resin
2. poor marginal fit.

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 Shortening proximal projections
of the impression material
facilitates complete reseating of
the ESF.
 excess impression material
palatally and facially has been
trimmed away with a sharp knife
for complete reseating of the
ESF.
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A custom ESF can be
produced from
thermoplastic sheets,
which are heated and
adapted to a stone cast
with vacum or air pressure
while the material is still
pliable

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 Thisproduces a
transparent form with thin
walls, which makes it
advantageous in the direct
technique because of its
minimum interference with
the occlusion.

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 Theresulting mold forms a shell that is lined
with additional resin after tooth preparation.
This last step is the direct component of the
procedure.

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 Itis filled with resin, placed
in the mouth, and fully
seated as the patient closes
into maximum intercuspation.

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 The material is a poor dissipater of the heat
released during resin polymerization .
 so care must be taken to remove it from the
mouth before injury can occur

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 Directtechnique: ESF, a
baseplate wax impression;
TSF, the patient.

 Directtechnique: ESF, a
vacuum-formed acetate
sheet; TSF, the patient.

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 Directtechnique: ESF, a
polycarbonate preformed
shell; TSF, the patient.

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 Thethinness and transparency of these
external surface forms (ESFs) allow their use
directly as tooth-reduction guides both in
and out of the mouth.

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 the indirect component
produces a “custom-
made preformed ESF”
external surface form”
 In most cases the
practitioner uses a
custom ESF with an
underprepared
diagnostic cast as the
TSF.
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 Chairside time is reduced.
 Less heat is generated in the mouth.

 Contact between the resin monomer and soft

tissues is minimized compared to the direct
procedure and there is a reduced risk of
allergic reaction

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 ESF “external surface
form” can be prepared
using silicon material or
vacuum-formed
polypropylene sheet.
 Prepare the abutment
teeth on accurately
mounted diagnostic casts.
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 Thediagnostic preparation
should be more conservative
than the eventual tooth
preparation and should have
supragingival margins.

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 Apply resin into the ESF and complete the
interim restoration
 Seat the newly completed interim
restoration (called now custom pre-formed
ESF) on cast and refine occlusion by
articulator.
 Finish and clean then send it to dentist.

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 After tooth preparation, try-in the custom pre-
formed ESF.
 To make the TSF, fill the interim with resin and seat
it over prepared teeth.

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 Confirmthe marginal fit and
occlusion, refinish and polish,
then cement the restoration.

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 issimilar to that for making custom single
crowns.
 the interim restorations are more easily
distorted during handling because of the
conservative tooth preparations that
interrupt the continuity of the axial walls.

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 better results can be expected with the
indirect procedure.
 When the polymerized resin is trimmed to
the margin, it is advisable to leave an excess
of resin at the occlusal cavosurface margin
 This helps prevent fracture of enamel

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 Select the most appropriate resin shade
 apply a thin coat of petrolatum to the
prepared tooth surface.
 Using a plastic instrument wetted with
alcohol, form the preselected light-cured
resin.
 Light-cure the resin and remove it from the
tooth surface.
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 cleanthe petrolatum from the prepared
tooth enamel, and apply the etchant gel to
three 1-mm diameter areas to form an
equilateral triangle, with two of the corners
at the mesioincisal and distoincisal line
angles and the third centered more
cervically . for 20 seconds, rinse completely
with water, and dry.

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 Mixthe autopolymerizing unfilled resin and
place a small amount on the three etched
areas. Immediately place the veneer on the
tooth and hold it in place until the resin is
set

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 ideal properties
 Seal against leakage of oral fluid
 Strength consistent with intentional removal
 Low solubility
 Blandness or obtundent quality
 Chemical compatibility with the interim polymer
 Convenience of dispensing and mixing
 Ease of eliminating excess
 Adequate working time and short setting time

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 zinc oxide–eugenol cements appear to be the
most satisfactory
 A good compromise would be reinforced ZOE;
another might be eugenolfree zinc oxide,
which has slightly greater strength than
cements containing eugenol
 non-eugenol cements are recommended for
the interim restoration because of the
adverse effect of eugenol on bond strength.
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the digital workflow offers various advantages
such as a fast-manufacturing process and the
opportunity to duplicate the restoration in
case of loss or failure.
Moreover, modifications of the temporary
FDPs in therapy sequences are simple to
perform

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 are commonly divided into three groups:
1. CAD/CAM polymers on the basis of
polymethyl methacrylate (PMMA) resins with
low inorganic filler contents
2. highly filled CAD/CAM resin-based
composites (RBCs) based on dimethacrylates
(DMA)
3. resin-filled hybrid ceramics based on
“polymer infiltrated ceramic network” (PICN)
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 Fabrication of milled IFDPs was initiated by scanning the
typodont casts by an intraoral scanner (Trios 3Shape Dental
Software, 3Shape A/S, Copenhagen, Denmark) to create a
standard tessellation language (STL) file.
 Designing of 3-unit IFDP was done using CAM designing
software (3Shape Dental Software, 3Shape A/S,
Copenhagen, Denmark).
 The designed STL file was sent to the integrated milling
machine (PM7, Ivoclar, Vivadent, Schaan, Liechtenstein) to
fabricate IFDPs from millable blocks
 Minor adjustments were done through removal of samples
from the supporting struts

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 The same designed STL file mentioned before
was sent to two different 3D-printers;
Nextdent printer (based on SLA technology)
and ASIGA printer (based on DLP technology).
Both printers fabricated the same dimensions
of 3-unit IFDPs from two different 3D-printed
composite resins (SLA ND and DLP AS resins)
at 90-degree building orientation and 50 µm
layer thickness

74
 Tahayeri A, et al. 3D printed versus conventionally cured provisional
crown and bridge dental materials. Dent Mater (2017),
https://doi.org/10.1016/j.dental.2017.10.003 75
 our results suggest that the commercially
available 3D printable restorative dental material
and 3D printing system used in this study allow for
sufficient mechanical properties for intraoral use
of provisional restorations, despite the limited 3D
printing accuracy.

 Tahayeri A, et al. 3D printed versus conventionally cured provisional crown and bridge dental materials. Dent Mater
(2017), https://doi.org/10.1016/j.dental. 2017. 10.003

76
Son, K.; Lee, J.-H.; Lee, K.-B. Comparison of Intaglio Surface Trueness of Interim
Dental Crowns Fabricated with SLA 3D Printing, DLP 3D Printing, and Milling
Technologies. Healthcare 2021, 9, 983.
77
Son, K.; Lee, J.-H.; Lee, K.-B. Comparison of Intaglio Surface Trueness of
Interim Dental Crowns Fabricated with SLA 3D Printing, DLP 3D Printing, and
Milling Technologies. Healthcare 2021, 9, 983.
78
The 3D printing and milling technologies used in
this study showed clinically acceptable intaglio
surface trueness
 The milling technology showed inferior trueness
in the reproduction of angle region than occlusal
region.
 interim crowns fabricated with 3D printing
technologies (SLA and DLP) can reproduce more
uniform and superior intaglio surface trueness
than milling technology
: Son, K.; Lee, J.-H.; Lee, K.-B. Comparison of Intaglio Surface Trueness of Interim
Dental Crowns Fabricated with SLA 3D Printing, DLP 3D Printing, and Milling
Technologies. Healthcare 2021, 9, 983
79
Hensel, F.; Koenig, A.; Doerfler, H.-M.; Fuchs, F.; Rosentritt, M.; Hahnel, S. CAD/CAM
Resin-Based Composites for Use in Long-Term Temporary Fixed Dental
Prostheses. Polymers 2021, 13, 3469.
80
 Only DMA-based CAD/CAM RBCs with a high
filler content should be used for the
fabrication of long-term temporary FDPs that
are in clinical service for more than six
months.

Hensel, F.; Koenig, A.; Doerfler, H.-M.; Fuchs, F.; Rosentritt, M.; Hahnel, S. CAD/CAM Resin-
Based Composites for Use in Long-Term Temporary Fixed Dental
Prostheses. Polymers 2021, 13, 3469.

81
 Ellakany, P.; Fouda, S.M.; Mahrous, A.A.; AlGhamdi, M.A.; Aly, N.M. Influence of CAD/CAM
Milling and 3D-Printing Fabrication Methods on the Mechanical Properties of 3-Unit Interim
Fixed Dental Prosthesis after ThermoMechanical Aging Process. Polymers 2022, 14, 4103.
82
 Interimfixed dental prosthesis (IFDP) is
subjected to intraoral thermal changes and
occlusal loads that, in the long-term, might
cause its distortion

Ellakany, P.; Fouda, S.M.; Mahrous, A.A.; AlGhamdi, M.A.; Aly, N.M.
Influence of CAD/CAM Milling and 3D-Printing Fabrication Methods on the
Mechanical Properties of 3-Unit Interim Fixed Dental Prosthesis after
ThermoMechanical Aging Process. Polymers 2022, 14, 4103.
83
 Auto-polymerized polymethyl methacrylate
(PMMA) is the most common material used in
construction of IFDPs It is a readily available,
inexpensive, and easy to use material
 Computer-aided design and computer-aided
manufacturing (CAD/CAM) technology is
increasingly used in dentistry, widely used in
the fabrication of IFDPs
84
 Themost widely used 3D-printing
technologies in the fabrication of 3D-printed
dental prostheses are stereolithography (SLA)
and digital light projection (DLP).
 The main differences between both 3D-
printing technologies are the materials used
and technique of building layers to create a
3D-object.
85
 all tested materials are suitable for clinical
application following a thermal mechanical
aging process with greater privilege to the
milled and SLA ND-printed IFDPs due to their
significantly higher fracture resistance when
compared to the other tested materials
Ellakany, P.; Fouda, S.M.; Mahrous, A.A.; AlGhamdi, M.A.; Aly, N.M. Influence of
CAD/CAM Milling and 3D-Printing Fabrication Methods on the Mechanical Properties of
3-Unit Interim Fixed Dental Prosthesis after ThermoMechanical Aging Process.
Polymers 2022, 14, 4103.

86
Henderson JY, Korioth TVP, Tantbirojn D, Versluis A. Failure load of milled, 3D-printed, and
conventional chairside-dispensed interim 3-unit fixed dental prostheses. J Prosthet Dent.
2022 Feb;127(2):275.e1-275.e7. doi: 10.1016/j.prosdent.2021.11.005. Epub 2021 Dec 10.
PMID: 34895902. 87
 The purpose of this in vitro study was to
compare the strength of computer-aided
design and computer-aided manufacturing
(CAD-CAM) milled polymethylmethacrylate
(PMMA) or 3-dimensionally (3D) printed bis-
acryl interim fixed dental prostheses with a
traditional chairside-dispensed
autopolymerizing bis-acryl prosthesis

88
Henderson JY, Korioth TVP, Tantbirojn D, Versluis A. Failure load of milled, 3D-printed,
and conventional chairside-dispensed interim 3-unit fixed dental prostheses. J Prosthet
Dent. 2022 Feb;127(2):275.e1-275.e7. doi: 10.1016/j.prosdent.2021.11.005. Epub 2021
Dec 10. PMID: 34895902.
89
Henderson JY, Korioth TVP, Tantbirojn D, Versluis A. Failure load of milled, 3D-printed, and
conventional chairside-dispensed interim 3-unit fixed dental prostheses. J Prosthet Dent.
2022 Feb;127(2):275.e1-275.e7. doi: 10.1016/j.prosdent.2021.11.005. Epub 2021 Dec 10.
PMID: 34895902.
90
  Regardless of loading rate, interim fixed dental
prostheses from milled PMMA had the highest
initial strength 1 day after storage. Thirty days
of exposure to humidity, however, reduced the
strength of the CAD-CAM-manufactured interim
prostheses, whereas the traditional chairside
prostheses retained their strength.

Henderson JY, Korioth TVP, Tantbirojn D, Versluis A. Failure load of milled, 3D-printed, and
conventional chairside-dispensed interim 3-unit fixed dental prostheses. J Prosthet Dent. 2022

91
Angwarawong T, Reeponmaha T, Angwaravong O. Influence of thermomechanical aging on
marginal gap of CAD-CAM and conventional interim restorations. J Prosthet Dent. 2020
Nov;124(5):566.e1-566.e6. doi: 10.1016/j.prosdent.2020.03.036. Epub 2020 Jul 3. PMID:
32624223.
92
Angwarawong T, Reeponmaha T, Angwaravong O. Influence of thermomechanical aging on
marginal gap of CAD-CAM and conventional interim restorations. J Prosthet Dent. 2020

93
94
1. The types of materials and the simulated
aging process had a significant effect on the
marginal gap of interim restorations.
Moreover, the interaction of both factors
significantly influenced the marginal gap of
interim restorations.

Angwarawong T, Reeponmaha T, Angwaravong O. Influence of

thermomechanical aging on marginal gap of CAD-CAM and conventional
interim restorations. J Prosthet Dent. 2020

95
2. The Brylic Solid and Freeprint Temp groups
(CADCAM efabricated interim restorations)
exhibited better marginal adaptability than
the Unifast Trad and Protemp 4 groups
(conventionally fabricated restorations),
both before and after artificial aging

Angwarawong T, Reeponmaha T, Angwaravong O. Influence of

thermomechanical aging on marginal gap of CAD-CAM and conventional
interim restorations. J Prosthet Dent. 2020
96
3. All interim restoration groups were
significantly affected by the simulated aging
protocol.
4. The Unifast Trad group had the largest
increase in marginal gap, which was
significantly greater than that of the
Freeprint Temp group.
Angwarawong T, Reeponmaha T, Angwaravong O. Influence of
thermomechanical aging on marginal gap of CAD-CAM and conventional
interim restorations. J Prosthet Dent. 2020
97
 Henderson JY, Korioth TVP, Tantbirojn D, Versluis A. Failure
load of milled, 3D-printed, and conventional chairside-
dispensed interim 3-unit fixed dental prostheses. J
Prosthet Dent. 2022
 Ellakany, P.; Fouda, S.M.; Mahrous, A.A.; AlGhamdi, M.A.;
Aly, N.M. Influence of CAD/CAM Milling and 3D-Printing
Fabrication Methods on the Mechanical Properties of 3-Unit
Interim Fixed Dental Prosthesis after ThermoMechanical
Aging Process. Polymers 2022, 14, 4103.
 Son, K.; Lee, J.-H.; Lee, K.-B. Comparison of Intaglio
Surface Trueness of Interim Dental Crowns Fabricated with
SLA 3D Printing, DLP 3D Printing, and Milling Technologies.
Healthcare 2021, 9, 983.

98
 Hensel, F.; Koenig, A.; Doerfler, H.-M.; Fuchs, F.; Rosentritt,
M.; Hahnel, S. CAD/CAM Resin-Based Composites for Use in
Long-Term Temporary Fixed Dental
Prostheses. Polymers 2021, 13, 3469.
 Angwarawong T, Reeponmaha T, Angwaravong O. Influence
of thermomechanical aging on marginal gap of CAD-CAM
and conventional interim restorations. J Prosthet Dent.
2020
 Tahayeri A, et al. 3D printed versus conventionally
cured provisional crown and bridge dental materials.
Dent Mater (2017),

99
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