Prosthodontips – temporary crowns – not so temporary?

prosthodontips temporary crownsTemporary crowns are more useful than you might think, Zo Ali and Josh Sharpling explain how you can utilise them further.

There is an awful lot to think about once we start talking about temporary crowns.

There are so many options out there for materials, techniques and chairside versus lab made. But the single biggest question is why bother in the first place?

This article aims to outline some common, but also those less frequent indications and uses for provisional restorations.

Why bother with temporary crowns in the first place?

The most common reason for placing a temporary crown is to protect a tooth after preparation before placing the definition restoration (Figure 1).

During this time, the provisional restoration should fulfil some basic requirements:

Provide stability with respect to occlusal and proximal contacts

Provide stability with respect to occlusal and proximal contacts

    • This ensures the tooth’s position in the arch is stable and the definitive restoration will fit without much need for proximal adjustments. It also helps to minimise the occlusal adjustments required upon delivery of the definitive restoration

Insulate the tooth from thermal stimuli

    • Obviously this only applies to vital teeth. Freshly cut dentine is generally extremely sensitive to hot and cold foods. The provisional restoration and cement should function to allow the patient to eat and drink as they would normally

Allow for normal aesthetic and social function

    • Often this is where things start to fall apart for many practitioners. However, the ability to provide a high quality, durable, and highly aesthetic provisional restoration will set you apart from most other clinicians.
temporary crowns
Figure 1: Provisional crowns in place for six months. Some surface stain is now present but otherwise the restorations are intact and periodontium is healthy

Basics done…what else?

Outside of protecting the tooth whilst the definitive crown is made, there are some other scenarios in which a provisional crown is useful:

Endodontic treatment on a tooth with a pre-existing crown

    • Research shows us that the overwhelming majority of these teeth have marginal deficiencies or caries. This is the case regardless of whether these issues are detectable prior to dismantling the old restoration. Hence, to optimise the endodontic outcome, a new crown is indicated to ensure adequate coronal seal
    • Dismantling also allows us to check restorability before committing to expensive endodontic treatment. Otherwise it is possible that the endodontic access cavity actually weakens the last area of remaining dentine ferrule needed to support the crown in the first place

Optimising periodontal condition

    • Especially when dismantling old ill-fitting crowns, the placement of a well marginated provisional allows access for oral hygiene procedures and improvement of the periodontal condition. Whilst there is obvious benefit in this, it also allows us to take impressions or optical scans without any bleeding contaminating the preparation surface resulting in an optimal final restoration
    • A well constructed provisional crown can also help to sculpt the soft tissues to achieve a more ideal final outcome (Figure 2)

      Figure 2: Provisional restorations on maxillary central incisors removed after six months in situ (same case as Figure 1). The periodontal tissues have stabilised and matured in the interim period

Changing aesthetics

    • Most of us have an image in our minds of what we are ‘supposed’ to look like. Any change from this can cause us to become uncomfortable and hyper-aware of ourselves. Well executed, aesthetic provisional restorations allow us, together with our patients, to trial, evaluate and refine aesthetics before committing to the final outcome (Figure 2)
    • Some teeth may also need to provisionalising whilst adjust adjunctive procedures are taking place, eg whitening. You will require a secure but retrievable restoration to allow the whitening to take place and impression taking thereafter

      Figure 3: Before and after replacement of provisional restorations on maxillary central incisors. The definitive restorations (right) are virtually identical in shape to the provisional restorations

Occlusion

    • When reorganising the occlusion, it is generally a good idea to test the new occlusal scheme by incorporating a provisional phase into the treatment plan. This allows us and the patient the opportunity to review things and make adjustments. The modifications can then be reproduced in the definitive restorations. This approach is also useful even if only a few teeth are being treated, but those teeth are important in dynamic occlusion (Figure 3)

Assess restorability

    • Sometimes a previously restored tooth is strategically important within a larger treatment plan. In these instances, it is important to dismantle the existing restoration and place a provisional crown. This allows assessment of the tooth structure remaining. As well as its suitability as a potential abutment tooth

      Figure 4: Laboratory-produced provisional restorations in a full mouth rehabilitation. The previous restorations exhibited poor fit and were frequently dislodging. An extended period of occlusal monitoring was required

Assess preparation

    • After initial preparation, you can make an initial provisional restoration. Once set, you can use an Iwanson gauge to measure the thickness of the provisional restoration to verify adequate reduction

Soft tissue healing

    • Following extraction or implant/periodontal surgery, utilise provisional restorations to replace missing teeth and stabilise teeth during healing. This period can often extend to six months. So it is reasonable to expect that most patients will want and need some sort of a temporary prosthesis in the meantime
    • Additionally, use the provisional restoration to sculpt soft tissues during this healing phase.

In summary, there are numerous indications for the use of provisional restorations.

They are not merely there to stabilise teeth whilst you produce the definitive restorations. Used correctly, they can add a great deal of value to your treatment and are extremely effective in building patient confidence and rapport.


Please keep the questions coming for the Prosthodontips team. You can contact us on Instagram (@sharplingdental and @prostho_zo) and also email ([email protected]).

If there are specific topics you would like us to cover in a column, please let us know.

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