SECTIONEDITORS
FIXED PROSTHODONTICS OPERATIVE DENTISTRY
DAVID E. BEAUDREAU SAMUEL E. GUYER WILLIAM LEFKOWITZ
Accurate acrylic resin temporary restorations David A. Kaiser, D.D.S., M.S.D.* Wilford Hall USAF Medical Center, Lackland AFB, Texas
A temporary restoration must be well adapted to the tooth and biologically acceptable or pulpal damage and periodontal injury may result. This is especially true when long periods of treatment are expected during periodontal therapy. The purpose of this article is to redescribe and present clinical applications of a technique for making temporary restorations using autopolymerizing acrylic resin? INDICATIONS This technique produces well adapted and esthetic temporary restorations, and there are several indications for its use: (1) Diagnostic. Prior to making the final restoration it may be advisable to determine the prognosis of the pulps and the periodontium of the prepared teeth. Homecare procedures can also be tested especially around selected pontic forms. The dentist can evaluate the occlusal scheme (axial loading and lateral function) prior to the completion of the final restorations. (2) Protective. Cut dentin and the associated pulp are protected from salivary, thermal, and chemical irritants. The gingiva is also protected when restorations are properly formed. (3) Restorative. Replacements of teeth, especially immediate anterior replacements, are feasible with this technique. (4) Stabilization or provisional splinting. Stabilization is of great importance in the treatment of periodontally weakened teeth. Amsterdam 2 described this type of temporary restoration as a provisional splint; he suggested that it will stabilize these weakened teeth and that it can be removed to provide access during periodontal surgery.
Read before the American Prosthodontic Society, Chicago, Ill. The views expressed herein are those of the author and do not necessarily reflect the views of the United States Air Force or the Department of Defense. *Lieutenant Colonel, USAF (DG).
158
FEBRUARY1978 VOLUME39
NUMBER2
Fig. 1. The pretreatment diagnostic cast.
Fig. 2. The diagnostic wax-up cast.
TECHNIQUE Fig. 1 depicts a preoperative diagnostic cast. The cast is modified by waxing-in the missing teeth to represent optimal form and function (Fig. 2). At this stage the desired occlusal and esthetic forms may be determined. Patient acceptance may be verified before the final preparations are started. The waxed diagnostic cast is duplicated using irreversible hydrocolloid. A resin shell is adapted over the duplicated cast using a vacuum adaptor* which has a heating element for softening a clear sheet of acetate (Fig. 3). Since the thickness of the sheet is 0.02 inch the vacuum pump will draw the softened sheet over the *Omnident Corp., Harrisburg, Pa.
0022-3913/78/0239-0158500.40/09 1978The C. V. MosbyCo.
ACCURATE ACRYLIC RESIN TEMPORARY RESTORATIONS
Fig. 4. The cast with the adapted shell in the vacuum adapter.
Fig. 3. The vacuum adapter used to form the shell. cast and form a shell, which is removed with a separating disk (Fig. 4). Note the contact with soft tissue that helps in the orientation of the shell in the mouth, When the teeth are prepared the shell is inserted and used as a template to determine if sufficient tooth structure has been removed for the desired esthetic result as developed in t h e diagnostic wax-up cast (Fig. 5). A tooth-colored autopolymerizing resin is mixed and poured into the acetate shell. The resin is allowed to reach the doughy state (dull surface) before insertion over the prepared and lubricated teeth. The resin is intermittently irrigated with water until it sets. The restoration is then removed from the mouth; the outer shell m a y also be removed. The finishing of the restoration is started by marking the depth of the gingival sulcus with a pencil (Fig. 6). This is not the margin of the preparation but it provides a guide for finishing. When this is accomplished the restoration is brought to the mouth, the margins are evaluated, and the occlusion
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 5. The shell is placed over the prepared teeth and used as a preparation guide. is corrected. Then the temporary restoration is polished. CLINICAL EXAMPLE A patient had maxillary lateral incisors in labioversion (Fig 7). T h e y were mobile and periodontally hopeless. The treatment plan included replacement of the incisors with a fixed partial denture. Diagnostic casts were obtained and a diagnostic wax-up was completed. The cast was duplicated in artificial stone and the shell was fabricated using the vacuum adaptor and acetate sheet described earlier. The abutment teeth were then prepared. After the lateral incisors were extracted the shell was inserted to check t h e amount of tooth reduction. Bleeding from the socket m a y be controlled with a dry foil* or with gauze packs. In order to allow the resin to flow to the margins of the preparations the gingivae had to be displaced (Fig. 8). *Burlew dry foil, J. F. Jelenko & Co., New York, N. Y.
159
KAISER
Fig. 6. The acrylic resin margin is marked and the finishing is begun.
Fig. 9. The margins are perfected by adding a bead of acrylic resin.
Fig. 7. The appearance of the teeth before treatment.
Fig. 10. The final acrylic resin temporary restorations.
Fig, 8. The preparations are completed and gingival displacement is accomplished. T h e retraction cord was removed a n d lubricant was applied with a brush to the preparations a n d the gingivae. T h e lubricant allows easy removal of the setting resin and protects the pulp and gingivae? T h e shell was filled with resin that was allowed to reach the d o u g h y stage after the shell was placed
160
over the teeth. T h e contact of the shell with soft tissues helps to properly orient the shell. After approximately 1 minute the shell a n d resin were loosened but not removed. W a t e r was sprayed u n d e r the restoration to remove free m o n o m e r , lubricate the teeth, and cool the setting resin. In addition the undercut areas of adjacent teeth were wiped away. T h e restoration was b r o u g h t halfway out and flooded with water at 10 to 15 second intervals during the setting of the resin. It is only partially removed to prevent internal folding of the soft resin margins. After the final set of the acrylic resin the restoration was removed and inspected and the acetate outer shell was removed. If a fold or void occurs in the resin it m a y be easily repaired by a d d i n g a bead of unset resin to the defect area while the restoration is in place (Fig. 9). If the preparation is to be modified at a later time the restoration could also be altered in this manner. T h e t e m p o r a r y restoration was then finished a n d polished (Fig. 10).
FEBRUARY1978 VOLUME39
NUMBER2
ACCURATEACRYLICRESIN TEMPORARY RESTORATIONS
CEMENTATION A zinc oxide/eugenol temporary cement is preferred. After the cement has been mixed a small drop i s picked up with a brush and placed in the occlusal or incisal area of the restoration. By this method excessive amounts of cement are avoided and the time required for cement removal is diminished. The brush is easily cleaned with a solvent such as orange oil. Lubricant applied on the outer aspect of the restoration will also decrease the time required for removing cement. SUMMARY A technique for making temporary restorations has been described. The temporary restoration is
ARTICLES TO APPEAR
IN FUTURE
diagnostic, teeth.
protective,
and
stabilizes
prepared
REFERENCES 1. Sortera, A. J.: A direct technique for fabricating acrylic resin temporary crowns using the Omnivac. J PROSTHETDENT 29:577, 1973~ 2. Amsterdam, M.: Provisional splinting--Principles and technics. Dent Clin North Am, March, 1959, pp 72-99. 3. "Suarez, G. L., Stanley, H. R., and Gilmore, H. W.: Hist0pathologic response of the human dental pulp to restorative resins. J Am Dent Assoc 80:793, 1970.
Reprint requests to: DR. DAVIDA. KAISER 2822 DEER LEDGE SAN ANTONIO,TEXAS78230
ISSUES
C o m p a r i s o n o f fluid resin and heat-curing methods in processing dimensional
changes Freeman Hardy, D.D.S., M.S.
A n e v a l u a t i o n o f facial prostheses R. M. Jani, B.D.S., M.D.S., and N. G. Schaaf, D.D.S.
In v i t r o a s s e s s m e n t o f m a r g i n a l l e a k a g e o f six enamel s e a l a n t s (~ivind Ekman Jensen, Gand.Odont., and Stanley L. Handelman, D.M.D.
Prosthodontic treatment for Pierre Robin syndrome J o h n R. Kelly, D.D,S., Herbert W. Sorenson, D.D.S., and Erwin G. Turner, D.M.D.
M i c r o l e a k a g e and enamel f i n i s h Satish C. Khera, B.D.S., D.D.S., M.S., and Kai Chiu Chan, D . D . S , M.S.
D u a l - p a t h design for removable partial dentures Gordon E. King, D.D.S.
Accurate acrylic resin temporary restorations David A. Kaiser, D.D.S., M.S.D.
R a d i o g r a p h i c e v a l u a t i o n o f porosities in removable partial denture castings Arthur J. Lewis, B.Sc., M.D.Sc.
THE JOURNAL OF PROSTHETIC DENTISTRY
161
FIXED PROSTHODONTICS OPERATIVE DENTISTRY
DAVID E. BEAUDREAU SAMUEL E. GUYER WILLIAM LEFKOWITZ
Accurate acrylic resin temporary restorations David A. Kaiser, D.D.S., M.S.D.* Wilford Hall USAF Medical Center, Lackland AFB, Texas
A temporary restoration must be well adapted to the tooth and biologically acceptable or pulpal damage and periodontal injury may result. This is especially true when long periods of treatment are expected during periodontal therapy. The purpose of this article is to redescribe and present clinical applications of a technique for making temporary restorations using autopolymerizing acrylic resin? INDICATIONS This technique produces well adapted and esthetic temporary restorations, and there are several indications for its use: (1) Diagnostic. Prior to making the final restoration it may be advisable to determine the prognosis of the pulps and the periodontium of the prepared teeth. Homecare procedures can also be tested especially around selected pontic forms. The dentist can evaluate the occlusal scheme (axial loading and lateral function) prior to the completion of the final restorations. (2) Protective. Cut dentin and the associated pulp are protected from salivary, thermal, and chemical irritants. The gingiva is also protected when restorations are properly formed. (3) Restorative. Replacements of teeth, especially immediate anterior replacements, are feasible with this technique. (4) Stabilization or provisional splinting. Stabilization is of great importance in the treatment of periodontally weakened teeth. Amsterdam 2 described this type of temporary restoration as a provisional splint; he suggested that it will stabilize these weakened teeth and that it can be removed to provide access during periodontal surgery.
Read before the American Prosthodontic Society, Chicago, Ill. The views expressed herein are those of the author and do not necessarily reflect the views of the United States Air Force or the Department of Defense. *Lieutenant Colonel, USAF (DG).
158
FEBRUARY1978 VOLUME39
NUMBER2
Fig. 1. The pretreatment diagnostic cast.
Fig. 2. The diagnostic wax-up cast.
TECHNIQUE Fig. 1 depicts a preoperative diagnostic cast. The cast is modified by waxing-in the missing teeth to represent optimal form and function (Fig. 2). At this stage the desired occlusal and esthetic forms may be determined. Patient acceptance may be verified before the final preparations are started. The waxed diagnostic cast is duplicated using irreversible hydrocolloid. A resin shell is adapted over the duplicated cast using a vacuum adaptor* which has a heating element for softening a clear sheet of acetate (Fig. 3). Since the thickness of the sheet is 0.02 inch the vacuum pump will draw the softened sheet over the *Omnident Corp., Harrisburg, Pa.
0022-3913/78/0239-0158500.40/09 1978The C. V. MosbyCo.
ACCURATE ACRYLIC RESIN TEMPORARY RESTORATIONS
Fig. 4. The cast with the adapted shell in the vacuum adapter.
Fig. 3. The vacuum adapter used to form the shell. cast and form a shell, which is removed with a separating disk (Fig. 4). Note the contact with soft tissue that helps in the orientation of the shell in the mouth, When the teeth are prepared the shell is inserted and used as a template to determine if sufficient tooth structure has been removed for the desired esthetic result as developed in t h e diagnostic wax-up cast (Fig. 5). A tooth-colored autopolymerizing resin is mixed and poured into the acetate shell. The resin is allowed to reach the doughy state (dull surface) before insertion over the prepared and lubricated teeth. The resin is intermittently irrigated with water until it sets. The restoration is then removed from the mouth; the outer shell m a y also be removed. The finishing of the restoration is started by marking the depth of the gingival sulcus with a pencil (Fig. 6). This is not the margin of the preparation but it provides a guide for finishing. When this is accomplished the restoration is brought to the mouth, the margins are evaluated, and the occlusion
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 5. The shell is placed over the prepared teeth and used as a preparation guide. is corrected. Then the temporary restoration is polished. CLINICAL EXAMPLE A patient had maxillary lateral incisors in labioversion (Fig 7). T h e y were mobile and periodontally hopeless. The treatment plan included replacement of the incisors with a fixed partial denture. Diagnostic casts were obtained and a diagnostic wax-up was completed. The cast was duplicated in artificial stone and the shell was fabricated using the vacuum adaptor and acetate sheet described earlier. The abutment teeth were then prepared. After the lateral incisors were extracted the shell was inserted to check t h e amount of tooth reduction. Bleeding from the socket m a y be controlled with a dry foil* or with gauze packs. In order to allow the resin to flow to the margins of the preparations the gingivae had to be displaced (Fig. 8). *Burlew dry foil, J. F. Jelenko & Co., New York, N. Y.
159
KAISER
Fig. 6. The acrylic resin margin is marked and the finishing is begun.
Fig. 9. The margins are perfected by adding a bead of acrylic resin.
Fig. 7. The appearance of the teeth before treatment.
Fig. 10. The final acrylic resin temporary restorations.
Fig, 8. The preparations are completed and gingival displacement is accomplished. T h e retraction cord was removed a n d lubricant was applied with a brush to the preparations a n d the gingivae. T h e lubricant allows easy removal of the setting resin and protects the pulp and gingivae? T h e shell was filled with resin that was allowed to reach the d o u g h y stage after the shell was placed
160
over the teeth. T h e contact of the shell with soft tissues helps to properly orient the shell. After approximately 1 minute the shell a n d resin were loosened but not removed. W a t e r was sprayed u n d e r the restoration to remove free m o n o m e r , lubricate the teeth, and cool the setting resin. In addition the undercut areas of adjacent teeth were wiped away. T h e restoration was b r o u g h t halfway out and flooded with water at 10 to 15 second intervals during the setting of the resin. It is only partially removed to prevent internal folding of the soft resin margins. After the final set of the acrylic resin the restoration was removed and inspected and the acetate outer shell was removed. If a fold or void occurs in the resin it m a y be easily repaired by a d d i n g a bead of unset resin to the defect area while the restoration is in place (Fig. 9). If the preparation is to be modified at a later time the restoration could also be altered in this manner. T h e t e m p o r a r y restoration was then finished a n d polished (Fig. 10).
FEBRUARY1978 VOLUME39
NUMBER2
ACCURATEACRYLICRESIN TEMPORARY RESTORATIONS
CEMENTATION A zinc oxide/eugenol temporary cement is preferred. After the cement has been mixed a small drop i s picked up with a brush and placed in the occlusal or incisal area of the restoration. By this method excessive amounts of cement are avoided and the time required for cement removal is diminished. The brush is easily cleaned with a solvent such as orange oil. Lubricant applied on the outer aspect of the restoration will also decrease the time required for removing cement. SUMMARY A technique for making temporary restorations has been described. The temporary restoration is
ARTICLES TO APPEAR
IN FUTURE
diagnostic, teeth.
protective,
and
stabilizes
prepared
REFERENCES 1. Sortera, A. J.: A direct technique for fabricating acrylic resin temporary crowns using the Omnivac. J PROSTHETDENT 29:577, 1973~ 2. Amsterdam, M.: Provisional splinting--Principles and technics. Dent Clin North Am, March, 1959, pp 72-99. 3. "Suarez, G. L., Stanley, H. R., and Gilmore, H. W.: Hist0pathologic response of the human dental pulp to restorative resins. J Am Dent Assoc 80:793, 1970.
Reprint requests to: DR. DAVIDA. KAISER 2822 DEER LEDGE SAN ANTONIO,TEXAS78230
ISSUES
C o m p a r i s o n o f fluid resin and heat-curing methods in processing dimensional
changes Freeman Hardy, D.D.S., M.S.
A n e v a l u a t i o n o f facial prostheses R. M. Jani, B.D.S., M.D.S., and N. G. Schaaf, D.D.S.
In v i t r o a s s e s s m e n t o f m a r g i n a l l e a k a g e o f six enamel s e a l a n t s (~ivind Ekman Jensen, Gand.Odont., and Stanley L. Handelman, D.M.D.
Prosthodontic treatment for Pierre Robin syndrome J o h n R. Kelly, D.D,S., Herbert W. Sorenson, D.D.S., and Erwin G. Turner, D.M.D.
M i c r o l e a k a g e and enamel f i n i s h Satish C. Khera, B.D.S., D.D.S., M.S., and Kai Chiu Chan, D . D . S , M.S.
D u a l - p a t h design for removable partial dentures Gordon E. King, D.D.S.
Accurate acrylic resin temporary restorations David A. Kaiser, D.D.S., M.S.D.
R a d i o g r a p h i c e v a l u a t i o n o f porosities in removable partial denture castings Arthur J. Lewis, B.Sc., M.D.Sc.
THE JOURNAL OF PROSTHETIC DENTISTRY
161
