INTERIM FIXED RESTORATIONS

Dr. Muhammad Nasir Saleem

 REQUIREMENTS

BIOLOGICAL MECHANICAL
•Protect pulp
•Maintain periodontal •Resist functional load
health •Resist removal forces
•Provide occlusal •Maintain interabutment
compatibility alignment
•Maintain tooth position
•Protect against fracture

ESTHETICS
•Easily contourable
•Color compatibility
•Translucency
•Color stability
BIOLOGICAL REQUIREMENTS
 PULP PROTECTION
Pulp
protection

Periodontal
• Seal against oral fluids
health

Occlusal
compatibility • Protection against
already stressed pulp
Tooth
position
maintenance

Prevention
against
fracture
 PERIODONTAL HEALTH
Pulp
protection
• Marginal fit
Periodontal
• Contour
health
• Smooth surface
Occlusal
compatibility • Inflamed gingival tissues
compromise impressioning
Tooth
position
• Blanching of gingival tissues
maintenance

Prevention
against
fracture
 Occlusal compatibility and
tooth position
Pulp
protection

Periodontal
• Proper contacts with
health
adjacent and opposing
Occlusal teeth
compatibility

Tooth • Movement of teeth in

position
maintenance horizontal or vertical
direction compromises
Prevention the final restoration
against
fracture
 Prevention of enamel fracture
Pulp
protection

Periodontal
health
• Protecting the weakened tooth
Occlusal
compatibility
• Special consideration in partial
Tooth
position
coverage designs
maintenance

Prevention
against
fracture
MECHANICAL REQUIREMENTS
 FUNCTION
• Fracture due to material

Function • More common in partial

coverage

• Common fracture site:

Displacement connectors

• Large vs over contoured

connectors
Removal for
reuse • Cast metal or heat
processed resin interims:
possible solutions
 Displacement

Function
• Displacement should
be avoided by lining
the interims

Displacement • Temporary cements

shouldn’t be subjected
to high stress

Removal for • In case of displacement

reuse
prompt recementation
reccomended
 Removal for reuse

Function
• Removal without
damage for reuse

Displacement
• Cement should be
weak and interim
restoration material
Removal for strong
reuse
Esthetic requirements
 Esthetic requirements
• Colour
• Shape
• Form
• Translucency
• Guide for the permanent
• Phonetics and function
• Duplication
Types of provisional restorations
 Types of provisional restorations
Prefabicated
Metal
Anatomic crown froms
Tin silver
Ni Cr
Stock aluminium
cylinders
Resin
Cellulose accetate
Tooth colored
polycarbonate

Custom made
 Materials
IDEAL PROPERTIES
• Convenient handling
• Biocompatibility
• Dimensional stability
• Ease of contouring
• Adequate strength and abrasion resistance
• Good appearance
• Good patient acceptance
• Ease of adding and repairing
• Chemical compatibility
 Available materials
• Polymethyl methacrylate
• Polyethyl methacrylate
• Polyvinyl ethyl methyl methacrylate
• Bis acryl composite
• VLC urethane dimethacrylate
• Aluminium
• Tin silver
• Ni Cr
 TECHNIQUES
DIRECT
• Provisional restoration is done on actual
prepared teeth in the mouth

INDIRECT
• Provisional restoration is fabricated outside
the mouth on the cast made of quick setting
plaster.
DIRECT INDIRECT
1. Intermediate steps of 1. No contact of free
indirect technique are monomer to the
eliminated gingiva, causing
2. Convenient when damage to the tissue.
assistant training and 2. Better marginal fit
laboratory facilities are 3. Less chair side work
inadequate.
 Provisional restoration
POLYCARBONATE CROWNS
DIRECT TECHNIQUE
1. Select an appropriate
sized or slightly larger
crowns form, and trim
the shell to the
appropriate size. Try the
shell in the prepared
mouth.
2. Apply a uniformly thin
coat of petroleum on
the prepared tooth and
surrounding tissues
3. Mix the auto-
polymerizing resin and fill
the shell, place the shell
over the tooth and align it
4. Eliminate any marginal
excess
5. When the polymerization
reaches rubbery stage,
remove the crown and
place it in warm water
6. After the resin had set, the margins are
marked, the flash is eliminated, axial surfaces
are shaped and occlusion is checked
7. Finally, polish and cementation is done
 INDIRECT PROCEDURES
1. When the preparation has been completed,
make an impression of the prepared mouth
and pour the cast with quick setting plaster
2. Select appropriate sized or slightly larger
crown form and trim the shell to the
appropriate size
3. Paint the cast of the prepared tooth and the
surrounding area with the separating media
4. Fill the crown with resin, seat it on the plaster
cast firmly and place it in a bowl of warm
water to accelerate polymerization
5. When the resin is set, remove the provisional
crown from the cast, trim the excess and
recontour the axial surfaces if necessary. Then
check the occlusion and adjust it
6. Finally polish and cement the restoration
 Aluminum Crown Forms
• They are useful in restoring a single posterior
tooth
PROCEDURE
1. The mesiodistal width of the toorh is
measured and appropriate size of the crown
is selected
2. The occluso-cervical height is measured and
the crown is trimed so that it extends 1mm
apical to the gingival margin
3. Crown is placed on the prepared tooth and
the margins are trimmed wherever the gingiva
blanches
4. Instruct the patient to close with moderate
force
5. Apply petroleum jelly to the prepared tooth
surface and the adjacent tissues. Mix the
auto-polymerizing resin and fill the crown and
immediately place the crown over the tooth
6. When the polymerization reached rubbery
stage, remove the crown and place it in warm
water
7. After the resin has set, the margins are
marked, flash is eliminated, axial surfaces are
shaped and the occlusion is checked and
adjusted
8. Acrylic is added in the deficient parts if any
9. Finally polish and cement the restoration
 Techniques for custom provisional
restorations
OVER IMPRESSION FABRICATED PROVISIONAL
RESTORATION:
An over impression is made on the diagnostic
cast or in the mouth before the tooth
preparation had begun
Alginate and elastomeric impression materials
can be used
An over impression is frequently made from the
patients’ mouth
• If tooth to restore has
obvious defects the
over impression can be
made from diagnostic
casts as well
• Utility wax on defect
• Over impression from
diagnostic cast
1. Impression is made after tooth
prep
2. Quick setting plaster poured
into the impression
3. The cast is retrieved and
trimmed after the plaster has
set.
4. The trimmed cast should have
atleast one tooth on either
side of the prepared tooth
5. Try the plaster cast into the
over-impression
6. Paint the surface of the
prepared tooth and
surrounding area on the cast
with separating media
7. Mix the autopolymerizing
resin and place it over the
impression
8. Seat the cast in the
impression. Hold it firmly
with a rubber band
9. After the resin had set the
margins are marked, flash is
eliminated, axial surfaces are
shaped, occlusion is checked
and adjusted

10. Finally polish and cement

Indirect direct technique
Template Fabricated Provisional
Restoration
Provisional for post and core
 CEMENTATION
IDEAL PROPERTIES OF LUTING AGENTS
• Ability to seal against the oral fluids
• Strength consistent with intentional removal
• Low Solubility
• Blandness or obtudency
• Chemical compatibility with the polymer
• Easy to dispense and mix
• Ease of eliminating excess
• Adequate working and setting time
• Compatibility with definitive luting agent