Use of a Customized Rigid Clear Matrix

for Fabricating Provisional Veneers

ARIEL J. R A I G R O D S K I , D M D *
AVISHAI S A D A N , D M D t
A R T U R O J . M E N D E Z , D D S , MSc*

ABSTRACT: The fabrication of provisional veneers is time consuming, and may be unpredictable,
especially in cases of multiple veneer preparations; however, functional and esthetic provisional
veneers, may be used as diagnostic adjuncts for the fabrication of the definitive restoration. This
article presents, in a step-by-step procedure, the use of a customized rigid clear matrix with light-
cured composite resin as a fast alternative for the fabrication of functional and esthetic provi-
sional composite resin veneers.
CLINICAL SIGNIFICANCE: The use of a customized rigid clear matrix for the fabrication of light-
cured composite resin provisional veneers has the following advantages: the shape and surface
texture produced in the diagnostic wax-up are accurately transferred to the patient’s mouth; the
provisional restoration is fabricated without violation of the soft tissue and the margins of the
preparations; use of the matrix can be repeated when needed; and esthetic and functional provi-
sional veneers can be fabricated relatively quickly.

P orcelain veneers have become

a predictable and successful
restorative treatment modality. 1,2
tooth preparation is mostly in
enameL4 However, as with full-
coverage restorations, provisional
psychological comfort until the
definitive restoration is b ~ n d e d . ~
Moreover, provisional veneers pro-
They are a conservative option for restorations for porcelain veneers tect the prepared teeth from a pos-
treating major morphologic anom- can be used as diagnostic adjuncts sible fracture, prevent tilting when
alies, such as conoid teeth and and as guides for the fabrication of the contact points are broken, and
diastemas; for the rehabilitation of the definitive rest0ration.j To serve prevent the eruption of prepared
compromised anterior teeth, such as a foundation for the definitive mandibular incisors.’
as extended coronal fractures and restoration, the provisional veneer
congenital and acquired malforma- must meet biologic, mechanical, Provisional veneers can be fabri-
tions; and for treating discolored and esthetic requirements.6 Provi- cated with light-cured composite
anterior teeth resistant to vital sional veneers also may be indi- resins or autopolymerized or light-
bleaching.3 cated when a significant amount of cured acrylic resins.6,8-11They can
dentin is exposed after the tooth be fabricated directly in the mouth
Provisional veneers have not been has been prepared.j They may or in the dental laboratory.6 The
widely used in the past because the maintain or enhance the patient’s use of light-cured hybrid composite
procedure is time consuming and esthetics and function and provide resins as a restorative material for

“Senior Resident, Postdoctoral Prosthodontics, tAssistant Professor, Department of Prosthodontics, and

#Professor, Department o f Prosthodontics, Louisiana State University School o f Dentistry, New Orleans,
Louisiana

16 1999
 RAIGRODSKI, SADAN, AND MENDEZ

Figure 1. Preoperative view of the maxillary anterior teeth. Note the

multiple diastemas.

provisional veneers is recommended addition silicone impression that is nique mentioned above, and
because of their mechanical proper- made in a clear stock tray as a describes the use of a customized
ties and esthetic advantages.6T12They matrix for their fabrication." The rigid clear matrix for the fabrica-
can be used to provisionalize single advantages of the technique, as tion of direct composite resin provi-
veneer preparations with the free- described, are the ability to achieve, sional veneers in the two cases.
hand bonding technique.6 However, directly in the mouth, a quick, func-
using this technique for multiple tional, and esthetic result. In addi- CASE 1

units is extremely time consuming. tion, the clear matrix can be reused A patient presented with a chief
in the event of a failure.ll complaint of multiple diastemas
One technique that has been previ- between the right and left maxillary
ously reported, describes the fabri- With a step-by-step procedure, this canines (Figure 1).A preliminary
cation of direct composite resin article reviews a technique employ- impression was made, using an irre-
provisional veneers using a clear ing the same principles as the tech- versible hydrocolloid material, and

Figure 2. The diagnostic wax-up made using denture teeth.

V O L U M E 11, N U M B E R 1 17
 J O U R N A L OF ESTHETIC D E N T I S T R Y

Use of a Customized Rigid Clear Matrix for

Fabricating Provisional Veneers

Figure 3 . The maxillary anterior teeth after crown lengthening of the right
and left maxillary lateral incisors. (Surgery:Hisham Nasv, DDS, and Ana
Margarita Saenz, DDS, LSUSD).

was poured in high strength dental made, and the patient was ready for the mechanical retention of the
stone. A diagnostic wax-up was provisionalization. clear impression material to the
completed (Figure 2). It was decided custom tray.
that an esthetic crown-lengthening With the preliminary cast, a custom
procedure for the right and left tray was made using a clear light- With the clear custom tray, an
maxillary lateral incisors would be cured base-plate material (Triad, impression of the diagnostic wax-
beneficial for achieving a harmo- Dentsply International, York, up, from the maxillary right first
nious gingival level (Figure 3 ) . Also, Pennsylvania), according to the bicuspid to the maxillary left first
it would improve the length-to- manufacturer’s instructions. A sili- bicuspid, was made using a clear
width ratio of these teeth. After a cone spacer was placed on the addition silicone impression material
healing period, the teeth were wax-up to provide adequate space (PolySil TransBite, SciCan Inc.,
prepared for porcelain veneers (Fig- for the impression material. Holes Pittsburgh, Pennsylvania). This
ure 4).Final impressions were were drilled in the tray to enhance impression, which reproduced the

Figure 4. The final preparations of the anterior teeth.

18 1999
 RAIGRODSKI, SADAN, AND MENDEZ

Figure 5. The fit of the rigid custom clear matrix is verified Figure 6. The fit o f the rigid custom clear matrix is verified
on the preliminary cast. in the mouth. Note the margins of the matrix are short of the
margins of the preparations and the open embrasures.

shape and the surface texture of the fit of the matrix was verified in the The adjacent teeth and the palatal
diagnostic wax-up, was used at a patient’s mouth, using the palatal nonprepared aspect of the prepared
later stage as a rigid custom clear aspect of the teeth to be prepared teeth were lubricated with petro-
matrix for the direct fabrication of and the two first bicuspids in the leum gel to facilitate the removal
the provisional veneers. matrix as an index. It was also veri- of excess light-cured composite
fied that the gingival margins of the resin. The prepared teeth were spot-
The matrix was trimmed, ensuring tray were short of the margins of etched with 37% phosphoric acid
that its labial margins were short of the prepared teeth and that the gin- for 15 seconds (Figure 7), and rinsed
the gingival margins of the teeth on gival embrasures of the tray were for 60 seconds with water. A hybrid
the cast and that its gingival embra- open enough to allow removal of light-cured composite material
sures would be open enough for excess composite resin prior to its (Z100,3M Dental Products, St. Paul,
easy removal of the composite resin curing (Figure 6 ) . Minnesota) was injected into the
prior to its curing (Figure 5). The matrix. The matrix was seated in

Figure 7. The prepared teeth are spot-etched.

V O L U M E 11, NUMBER 1 19
 JOURNAL OF ESTHETIC DENTISTRY

Use of a Customized Rigid Clear Matrix for

Fabricating Provisional Veneers

Figure 8. The customized rigid clear matrix seated in the Figure 9. The excess composite resin is removed with an
patient’s mouth. Note the excess composite resin covering the explorer, causing minimum trauma to the soft tissue.
labial soft tissue.

the patient’s mouth with pressure resin was gently removed with an ite resin, which might jeopardize
applied, using the first bicuspids as explorer from the labial aspect of the margins of the preparation and
an index to ensure a perfect seat the matrix, with care taken not to traumatize the soft tissue. Healthy
(Figure 8). The rigidity of the cus- traumatize the free gingival margin soft tissue is essential for successful
tom tray ensured that the pressure and the papillae (Figure 9). Over- bonding of the definitive veneers.
applied on the matrix did not cause hanging margins in the provisional
the loss of the shape and the surface restoration would impinge on the After all the excess had been
texture of the matrix and that they soft tissue, which might result in removed, the composite resin was
would be reproduced in the com- plaque accumulation, inflammation, light-cured through the labial
posite resin provisional restoration. or recession. Meticulous perfor- aspect of the matrix. The matrix
mance of this procedure eliminates was removed from the patient’s
The palatal aspect of the matrix the need to use finishing burs to mouth, and with a free-hand bond-
was light-cured. Excess composite remove excess light-cured compos- ing technique, additional composite

Figure 10. The provisional veneers shown 2 months after insertion. Note
the excellent gingival health.

20 1999
 RAIGRODSKI, SADAN, AND MENDEZ

Figure 1 1. Preoperative view of the right and left lateral Figure 12. The diagnostic wax-up for the right and left lat-
maxillary incisors. era1 incisors.

resin was added to the cervical treatment options for enhancing his right and left lateral incisors were
areas of the preparations 0.5 mm dental esthetics. The options were prepared for porcelain veneers and
short of the margins. These areas presented to the patient, and it was provisionalized, using a customized
were polished and blended with the decided to restore the right and left rigid clear matrix and light-cured
rest of the restoration (Figure 10). lateral maxillary incisors with porce- hybrid composite resin, as described
lain veneers (Figure 11).A prelimi- in the previous case (Figure 13).
CASE 2 nary impression was made, using
In the course of restoring the maxil- an irreversible hydrocolloid impres- CONCLUSION

lary right central incisor with a full- sion material, and was poured in As with full-coverage restorations,
coverage restoration and the maxil- high strength dental stone. A diag- provisional veneers are part of the
lary left central incisor with an nostic wax-up was used for the fab- diagnostic phase for the fabrication
implant-supported prosthesis, the rication of the customized rigid clear of the definitive restoration and
patient requested information about matrix (Figure 12).The maxillary serve to communicate information

Figure 13. Left, The right and left maxillary incisors prepared for porcelain veneers. Right, The provisional veneers 1 month
after insertion. (Implant placement and additional surgical procedures for the left maxillary central incisor: Michael S. Block,
DMD, LSUSD).

VOLUME 1 1 , NUMBER 1 21
 JOURNAL OF ESTHETIC DENTISTRY

Use of a Customized Rigid Clear Matrix for

Fabricating Provisional Veneers

to the dental laboratory. The tech- customized rigid clear matrix with 7. Feinman RA. Mandibular laminate Orovi-
sionalization. Quintessence Int 1985;
nique presented in this article light-cured hybrid composite resin 20:771-773.
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veneer preparations. J Esthet Dent 1993;
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22 1999