The provisionul fixed partial denture

David R. Federick, D.M.D., M.Sc.D.*

University of California at Los Angeles, School of Dentistry, Los Angeles, Calif.

lh e importance of the provisional (treatment) restoration among the procedures

required for successful completion of a fixed partial denture is often overlooked.
Perhaps the inaccurate assignment of the term “temporary” to the interim resto-
ration has generated the misconception that eventual placement of the permanent
restoration will immediately and miraculously remedy the detrimental effects of a
poorly conceived and fabricated transitional restoration.
A well-made provisional fixed partial denture should provide a preview of the
future prosthesis and enhance the health of the abutments and periodontium.l-t The
theories and techniques of fabrication for numerous types of provisional restorations
abound in the dental literature. Techniques from the fabrication of single-tooth pro-
visional coverage to demanding multiunit provisional acrylic resin splints are pre-
sented in depth in many texts and journals.

LITERATURE REVIEW
Perhaps the most empirical treatment restoration for full coverage is the prefabri-
cated aluminum or celluloid crown form.“-I1 Talkov” and Adams’” described a
technique for attaching individual celluloid crown forms together to obtain a splint-
ing effect. Fritts and Thayerl’ suggested that preformed crowns are seldom mor-
phologically correct and usually require alteration to make them esthetically accepta-
ble and protective.
A popular method for fabricating provisional fixed partial dentures and splints
is the acrylic resin restoration made either directly over the prepared abutments*ls I23
In-~” or indirectly, utilizing a diagnostic cast.“. 111,w ?‘: Some dentists regard the use
of an elastic material, as a medium for curing the acrylic resin, as inadequate and
recommend the use of the Omnivac VT to secure an acetate stent over the diagnostic
cast.“-“x The superior properties of polycarbonate resin have convinced some dentists
to substitute it as the matrix material in lieu of polymethyl methacrylate2Qg 30
Precious and semiprecious metal castings may be employed as provisional resto-

*Assistant Professor, Department of Restorative Dentistry.

tOmnivac V, Omnidental Corporation, Harrisburg, Pa.

520
Volume 34
Numhrr 5 Provisional fixed partial denture 521

rations when a long period of time is anticipated between preparation of the abut-
ments and delivery of the permanent restorations.llt 31 The most convenient and
time-saving method for providing a provisional restoration when multiple units are
involved is to have an acrylic resin “shell” splint ready for relining intraorally at the
time of abutment preparation. The shell may be made with autopolymerizing acrylic
resin?” ‘X2-31or heat-cured resin.359 36 Gold collars may be incorporated in the splints
to provide a stronger and possibly more accurate gingival margin than is obtainable
with acrylic resin alone.“’

RATIONALE FOR THE PROVISIONAL RESTORATION

For patients requiring periodontal therapy in conjunction with fixed restorative
dentistry, the interim of provisional coverage is critical.2, 22 Prichard38 recognized
that a provisional splint may be worn for long periods of time while questionable
teeth and supporting structures are evaluated for inclusion in the final prosthesis.
With regard to its significance in both periodontal prostheses and rehabilitation,
the purposes for the provisional (treatment) restoration are as follows: (1) to protect
pulp and sedate prepared abutments, (2) to evaluate parallelism of abutments,
(3) to immediately replace missing teeth, (4) to prevent migration of abutments,
(5) to improve esthetics, (6) to provide an environment conducive to periodontal
health, (7) to evaluate and reinforce the patient’s oral home care, (8) to aid peri-
odontal therapy by providing visibility and access to surgical sites when removed,
(9) to provide a matrix for the retention of periodontal surgical dressings, ( 10) to
stabilize mobile teeth during periodontal therapy and subsequent repair, ( 11) to an-
chor orthodontic brackets during minor tooth movement, (12) to aid in developing
and evaluating an occlusal scheme before the final prosthesis is made, ( 13) to allow
evaluation of vertical dimension, phonetics, and masticatory function, and (14) to
aid in determining the prognosis of questionable abutments in the over-all restorative
treatment plan.

REQUIREMENTS FOR THE PROVISIONAL RESTORATION

The fabrication of a physiologically acceptable provisional splint requires atten-
tion to detail and allocation of adequate time with the patient.3” The treatment
restoration must provide an environment conducive to attainment and maintenance
of good gingival health. 2, 15, 24, 25, 37, 40, 41 Donaldson42, 43 studied the problems of
gingival recession caused by the wearing of temporary crowns and found six factors
directly related to incorrect form and contour of acrylic resin crowns having detri-
mental effects on the marginal gingiva.
The basic requirements of a morphologically correct and physiologically com-
patible provisional restoration are: ( 1) good marginal adaptation, (2) retention and
resistance to dislogment during normal masticatory function, (3) strong and durable,
(4) nonirritating, (5) nonporous and dimensionally stable, (6) comfortable, (7)
esthetic, (8) physiologic contours and embrasures, (9) easy to reline and repair,
( 10) physiologic occlusion, ( 11) kind to the supporting structures and tissues, ( 12)
conducive. to routine oral home-care cleaning procedures, (13) highly polished,
plaque-resistant surfaces, and ( 14) easy to remove and recement by the dentist.
 J. Prosthet. Dent.
522 Federick November, 1975

Fig. 1. The maxillary right first premolar and first molar on a Typodont have been prepared
for full crowns.
Fig. 2. The acrylic resin record is in the doughy state over the prepared teeth with the Typo-
dont closed in the centric occlusion position.

Fig. 3. Cusp tips and buccolingual crown width are marked to facilitate carving proper ana-
tomic form.
Fig. 4. A carbide bur is used to delineate marginal form prior to relining.

FABRICATION TECHNIQUE
A useful, though seldom employed, method for making provisional restorations
is the acrylic resin block technique. It provides a means of fabricating the interim
restoration without the use of diagnostic casts and laboratory processing costs. The
technique requires a knowledge of dental anatomy and the patience and artistic
traits inherent in dentists.
The fabrication of a three-unit provisional fixed partial denture by use of the
acrylic resin block method is described and illustrated on a Typodont.
( 1) The maxillary right first premolar and first molar are prepared for complete
crowns (Fig. 1) .
(2) Autopolymerizing acrylic resin of the suitable shade is mixed and allowed
to set to a doughy consistency (the sheen of surface-free monomer has completely
disappeared). After the abutments and surrounding gingiva have been lightly
lubricated with petrolatum, the acrylic resin record is placed over the prepared
abutments, and the patient is guided to closure in the centric occlusion position
(Fig. 2).
 Provisional fixed partial denture 523

Fig. 5. Space is provided in the crowns to accept the reline mix of acrylic resin. A No. 6 round
carbide bur is used to remove approximately 0.5 mm. of acrylic resin.
Fig. 6. The provisional restoration with a reline mix of acrylic resin has been placed over the
abutments.

Fig. 7. The marginal detail is refined with a carbide bur.

Fig. 8. Proper crown contour is achieved with a diamond stone. Note the physiologic contour
of the tissue side of the pontic.

(3) The acrylic resin record is removed and replaced a few times during the
curing process to minimize the effect of the exothermic heat on the abutments. After
polymerization, the occlusal surface of the resin record is analyzed for anatomic
design and may be marked with pencil as to cusp location and buccolingual width
to facilitate carving the crown forms (Fig. 3).
(4) Carbide burs and diamond stones are used to roughly develop contour and
form of the provisional restoration (Fig. 4) .
(5) Since no impression matrix is used to carry the acrylic resin mix over the
prepared teeth, the initial splint must be relined to assure adequate marginal adap-
tation and integrity. The inside of the crowns is relieved with a round carbide bur
to provide space for the relining acrylic resin. The inner surfaces are moistened with
monomer and filled with a fresh mix of acrylic resin. The splint is then replaced
over the prepared abutments while the acrylic resin reline cures. The patient is
again guided to closure in the centric occlusion position (Figs. 5 and 6) .
(6) The provisional restoration is carved to correct occlusal anatomy, crown
contour, and embrasure form with burs, stones, and discs. This must be done with
524 Federick J. Prosthet. Dent.
November, 1975

Fig. 9. A lingual view of the completed acrylic resin provisional restoration.

Fig. 10. The provisional restoration on the Typodont. The darker shade was selected to provide
contrast for photographic purposes.

sufficient care and attention to detail so that it approximates the environment to be

established by the final restoration. The provisional splint must be smooth and highly
polished (Figs. 7 and 8).
(7) The completed provisional restoration is now ready for placement with a
temporary cement. Zinc oxide and eugenol cements should be avoided as they tend
to soften the acrylic resin on contact and may weaken the restoration (Figs. 9 and
IO.).

SUMMARY

A discussion of the rationale and requirements of the provisional restoration in

fixed prosthetic dentistry has been presented. The importance of this phase of resto-
rative dentistry and a survey of techniques for making interim restorations were
gleaned from a review of the literature. A method for the fabrication of a provisional
fixed partial denture using an acrylic resin interocclusal record was described and
illustrated.

References
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Px:ru “5” Provisional fixed partial denture 525

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526 Federick J. Prosthet. Dent.
November, 1975

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SCHOOL OF DF~TISTR~
UNIVERSITY OF CALIFORNIA AT Los ANGELES
THE CENTER FOR THE HEALTH SCIENCES
Los ANGELES, CALIF. 90024