SECTION

EDITORS

ion of anterior restoration Alexander

provisional

fixed

partial

dentures

J. Sze, DDSa

University of California Administration Hospital,

at San Francisco, Palo Alto, Calif.

School

of Dentistry,

San Francisco;

and Veterans

Using the provisional restoration as a testing ground to increase the predictability of a final restoration is well understood. With the resolution of issues through a well-developed provisional restoration comes the challenge of duplicating its eontours in the final prosthesis. A method is described using elastomer impression putty and a molten wax technique by which the contours of a provisional anterior fixed partial denture can be duplicated. The described method is particularly useful when the replication of a specific irregular tooth arrangement is mandated. (J

PROSTHETDEWT~~~~;~~:~~O-~.)

t is well known that the use of provisional restorations can greatly influence the predictability of the final restoration.le4 Tooth position in anterior restorations is of particular importance to esthetics, phonetics, lip support, lip closure path, the envelope of function, and the neutral zone.* Gingival aspects of anterior pontics in fixed partial dentures (FPDs) must also be considered with respect to phonetics and the capacity for cleansing. A provisional restoration may be refined to a degree that the only difference between it and the final restoration is the materials used in construction.4 The problem then be-

aAssistant Clinical tistry, University ant, Restorative 1011137283

Professor, Department of Restorative Denof California at San Francisco; and ConsultDentistry, Veterans Administration Hospital.

Fig. 1. Provisional

220

FDD.

Fig. 2. Mounted

study casts of provisional

Fig. 3. Custom incisal guide table developed sional FPD.

AUGUST

1992

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FPD.

from provi-

St3

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DUPLICATION

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DENTURES

6 Fig. 4. Putty index of labial surface of provisional (trimmed at incisal edges of restoration).

FPD

Fig.

6. Molten

wax pour of provisional

Fig. 7. Pontic area of molten working cast by labial index. Fig.

5. Putty

impression

of entire provisional

JOURNAL

OF

PROSTHETIC

DENTISTRY

to master

FPD.

comes how the contours of a well-developed provisional prosthesis can be accurately and predictably replicated in the final restoration. Indeed, it is frustrating to have developed a beautifully functioning and esthetically pleasing provisional restoration only to have the laboratory produce a less than desirable final result. Proper communication between the restorative clinician and the laboratory technician is essential if the fabrication of an optimal restoration is to be achieved. The concept of using an index to define the boundaries of a prosthesis has been well known in prosthodontics for years6 The use of tongue, lip, and cheek matrices has been described in the construction of neuromuscular complete dentures.7,s The use of addition silicone putty indexes to define incisal edge position and labial contours has been described for fixed restorations.5,g The use of indexes also has been described in the construction of porcelain-to-

THE

wax pour related

PPD.

metal restorations to retrofit existing removable partial dentures.rO, I1 The purpose of this article is to describe how elastomer impression putty may be used to duplicate the contours of an anterior provisional FPD, particularly in the pontic areas. The technique to be described is especially useful when a specific irregular tooth arrangement is to be replicated.

TECHNIQUE 1. After the provisional restoration (Fig. 1) has been developed and tested orally and a decision has been made to finalize the prosthesis, mounted articulated casts are made (Fig. 2). 2. A custom incisal guide table is fabricated to preserve the occlusal guidance scheme developed in the provisional restoration (Fig. 3). Note that the incisal edge position also can be captured in the custom incisal guide table (seen as a. secondary “plateau”) and can be

221

Fig. 8. Cutback in wax frame. Adequate lain is verified by labial index.

Fig. 9. Labial tion.

Fig.

space for porce-

index provides guide for porcelain

applicaFig. 12. Comparison (labial view).

4.

5.

6.

7.

Fig. 10. Soft tissue model allows physiologic contours for periodontal

creation of opt,imal maintenance. 8.

used to functionally cross-check incisal edge position with the fully waxed FPD. 3. A putty impression index (addition silicone or polyvinyl siloxane) is made of the labial surfaces of the provisional FPD (Fig. 4). 222

11. Final prosthesis.

9.

of provisional

and final prostheses

At the time of final margination and impressions, another putty impression is made of the entire provisional FPD (Fig. 5). This impression may also be obtained from a study cast of the provisional FPD. The master working cast and dies are prepared in the usual manner. Copings are waxed on the abutments only. Molten wax is poured into the pontic areas of the putty impression of the entire provisional FPD, allowed to cool, and then removed (Fig. 6). The molten wax pour of the pontics is adapted to the labial putty index of the provisional FPD, and the entire assembly is related to the master working cast (Fig. 7). Note that the tissue side of the wax pontics has been relieved so as not to touch the cast. The molten wax pour of the pontics is joined to the previously waxed copings. The wax frame may now be cut back using the labial putty index as a guide to ensure adequate room for porcelain (Fig. 8). The frame is cast and tried in the mouth. AUGUST

1992

VOLUME

68

NUMBER

2

DUPLlCATlON

OF PROVISIONAL

FPD

DENTURES

10. A soft tissue model is fabricated after appropriate try-in procedures for the lmetal frame. The labial putty index is used to verify cutback and as a guide when porcelain is applied (Fig. 9). The soft tissue model provides an excellent replica of gingival contours so that the final restoration may be contoured for proper maintenance of the periodontium (Figs. 10 and 11). 11. A comparison between the provisional and final prostheses is depicted showing the duplication of tooth position and contours (Fig. 12).

SUMMARY A technique using elastomer impression putty to duplicate the tooth arrangement and contours of an anterior provisional FPD in the final prosthesis has been described. This method is particularly useful when a specific irregular tooth arrangement is mandated. Function and form of the well-developed provisional prosthesis may therefore be accurately transferred to the final prosthesis.

3. Youdelis RA, Faucher R. Provisional restorations: an integrated approach to periodontics and restorative dentistry. Dent Clin North Am 1980;24:285. 4. Rosenberg MM, Kay HB, Keough BE, Holt RL. Periodontal and prosthesis management of advanced cases. Chicago: Quintessence Publishing, 198&80-92. 5. Dawson PE. Evaluation, diagnosis, and treatment of occlusal problems. 2nd ed. St Louis: CV Mosby, 1989322, 347-9. 6. Fish EW. Principles of full denture prosthesis. 2nd ed. London: Bale, Sons & Danielson Ltd, 1933:82-5. 7. Schiesser FJ. The neutral zone and polished surface in complete dentures. J PROSTHET DENT 1964;14:856-65. 8. Beresin V, Schiesser F. The neutral zone in complete and partial dentures. 2nd ed. St Louis: CV Mosby, 1978:119-23. 9. Rieder CE. The use of provisional restorations to develop and achieve esthetic expectation. Int J Period Rest Dent 1989;9:136-7. 10. Schenider RL. Adapting ceramometal restorations to existing removable partial dentures. J PROSTHET DENT 1983;49:279-81. 11. Diaz-Arnold AM, Langenwalter EM, Hatch LK. Cast restorations made to existing removable partial dentures. J PROSTHET DENT 1989;61: 414-7.

Reprint

requests to:

DR. ALEXANDER J. SZE 450 SUTTER ST., SUITE 2012 SAN FRANCISCO, CA 94108

REFERENCES I. Amsterdam Dent Clin

M, Fox L. Provisional North Am 1959;Mar:73-99.

splinting-principles

and techniques.

2. Skurow H, Nevins M. The rationale of the preperiodontal provisional biologic trial restoration. Int J Periodont Rest Dent 1988;8:9-29.

Occlusal

discrepancies

Terri 5. I. Tilliss, Royce A. Hatch, University

of Colorado

after

sealant

RDH, MS,a Donna J. Stach, RDH, DDS, MS,e and Gail N. Cross-Poline, Health

Sciences

Center,

School

of Dentistry,

therapy

MEd,b RDH, Denver,

MPHd Colo.

To date there has been no evidence concerning the need for adjusting the occlusion after sealant placement. Thus, this study investigated the occlusal effects of filled and unfilled sealants. For each of 18 subjects a sealant was applied and the occlusion monitored for 1 week. Each participant received a filled and an unfilled sealant for the specified period. With the filled sealant, nearly all subjects experienced a perceptable occlusal change and most were unable to abrade the interferences to a comfort level. These results indicate that the occlusion should be routinely verified and, if necessary, adjusted immediately after placement of a filled sealant. (J PROSTHET DENT 1992;68:223-8.)

Presented before the Second National Dental Hygiene Research Conference, Iowa City, Iowa, and American Association of Dental Research, Chicago, Ill. aAssociate Professor, Department of Dental Hygiene. bAssistant Professor, Department of Dental Hygiene. cAssociate Professor and Chairman, Division of Operative Dentistry and Occlusion. dAssociate Professor and Chairperson, Department of Dental Hygiene. LO/1137622 THE

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OF PROSTHETIC

DENTISTRY

P.

It and fissure sealantsare routinely usedin clinical practice. The method is supportedby a significant body of research, centered around retention, effectiveness in cariesprevention, and economicfactors. Technical considerationshave been describedin literature accompanyingcommercialproducts and in textbooks. However, the application of sealantsin supraclusionand the subsequentneed for adjustment have not always been adequately addressed. 223