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Beautiful Provisionals Delight Patient and Increase Referrals By: Sameer Puri, DDS

More by this author (4)
One of my patients wanted 12-year-old veneers redone due to decay and poor esthetics. She especially did not like the lower anterior bridge.

I sent the case for a wax-up and reviewed it with the patient. The wax-up served as both a guide for the provisional restorations and allowed my patient to preview her new teeth before the final restorations were fabricated.

Making a beautiful set of provisional restorations, proved to be an exceptional form of marketing for my practice. Pleased with her provisional restorations, she has already referred several friends for esthetic evaluation.

Here is the case sequence:

Photo 1: Pre-op photo of old veneers. Recurrent decay is present as well as an unaesthetic mandibular bridge. Patient would like all restorations replaced for esthetic and functional reasons.
Photo 2: A detailed wax-up is done of the desired outcome of the teeth. Prior to any work being done, the wax-up is reviewed with the patient for approval. Any changes in tooth size, shape and alignment can be made in the wax-up prior to fabrication of the final restorations.
Photo 3: A putty matrix made from Siltec (Ivoclar Vivadent) is relined with a polyvinyl wash material and seated on the wax-up. Siltec is preferred because it’s inexpensive and its stiffness results in a superior provisional restoration.

This matrix gives a very accurate template of the wax-up which will be transferred to the provisional restorations. This way the wax-up serves as a direct guide for the provisional restorations.

Photo 4: The teeth are prepped with an 856T diamond from Axis Dental. Margins are defined with an 856L bur also from Axis Dental. An impression is made using Take One from Kerr. The teeth are then prepared for provisional restorations. We clean them thoroughly with Consepsis (Ultradent) Lightly coat the teeth with glycerin if you want to remove the temps and trim them extraorally. Many times the temps can be locked in and trimmed intraorally.
Photo 5: Fill the previously made Siltec matrix with Luxatemp (Zenith DMG) and seat in the mouth. Leave the bisacryl material in the mouth for 2 minutes and remove.

Remove the matrix, tease the temps off and allow to further cure for 2-3 minutes outside of the mouth. Trim the provisionals using a 392 diamond from Axis Dental and a D911HF-220 diamond disk, also from Axis Dental.

Photo 6: The temps are trimmed and re-cemented with Temp Bond Clear (Kerr). Excess is removed and the patient is sent home with strict oral hygiene instructions. This photo is 6 days post-op. The mandibular arch is next to be treated.
Photo 7 Close-up view of the temps show highly detailed temps with good marginal adaptation and lack of gingival inflammation. Note how healthy the tissue is resulting in a stress free final cementation appointment.
Photo 8: Non-retracted view of smile. Patient is very happy with the look of the temps. Upon review of the photo, the temps do appear slightly long. This problem is easily corrected with the final restorations if desired. If care was not taken with the provisionals, it may have led to an irreversible problem with the final crowns resulting in a remake of the case. The final restorations were made .5mm shorter than the wax-up.
Photo 9: Esthetic try-in done with the maxillary restorations. This is in the bisque bake try-in state. Patient’s chief concern was that she wanted “WHITE” teeth. The restorations were done by Burbank Dental Laboratory and are Empress B-0 Patient was happy with the size, shape and color of teeth.
Photo 10: Retracted view of the esthetic try-in. Teeth need to be glazed and polished and the margins refined. Mandibular teeth are in provisional restorations (Luxatemp). No try-in was done on the mandibular teeth.
Photo 11: Final crowns cemented. Crowns were made from Empress by Burbank Dental Labratory. The final restorations were cemented with Simplicity 1 & 2 (Apex Dental) self-etching bonding agent. Rely X veneer cement (3M) white opaque shade was used to cement the crowns. Photo is 5 days post-op. Note how the discoloration on #10 has been completely masked with the opaque cement.

After Dr. Puri presented this case online at www.dentaltown.com, questions were immediately raised. If you would like to see all of the comments, or perhaps add some of your own, go to the DentalTown’s homepage, click on Today’s Active Cases and sign in (it’s FREE). The case is listed in the Cosmetic category as: socalsam Beautiful Provisionals.
waxtryin
3/5/2003 4:27:22 PM

Any concern about incisal edge length? Spear talks about incisal edge position at 1/2 - 2/3 of the interlip width...just an idea.

socalsam
3/5/2003 5:36:57 PM

I saw the length of the provisionals and thought they might be a bit long, but patient has had a chance to wear the temps for about 4 or 5 days now and she absolutely loves them. I didn’t want to mess with a thing.

xcell
3/5/2003 10:29:08 PM

Do you mount the case and get a face bow, articulator, etc.?

happy2th
4/8/2003 6:21:34 PM

Dang those are white!

socalsam
4/8/2003 8:42:28 PM

Happy2th, to give you an idea of how white the final restorations actually are, the temps are B1 shade Luxatemp. She would have gone whiter if I let her. It’s difficult to make white crowns look good. Burbank Dental Laboratory did a great job.

tagarwalnc
4/10/2003 3:01:48 AM

Sam, great case...I don’t know if the premolar wasn’t seated completely #5 in the try-in photo, but it seems to be bulky and out of sorts a bit.

These photographs would be highly helpful to the lab for communication of shape, contour, and beauty.

mmelkers
4/21/2003 4:55:42 PM

Hey Sam and Burbank, nice finish on the case! I really like the final modifications that were done on the laterals. They look more natural.

jasonteeth
4/21/2003 6:15:51 PM

Great job. Looks like a full mouth case. In the final post-op, it looked like the lowers had been done. Was this full mouth reconstruction?

socalsam
4/22/2003 6:07:04 AM

Jason, we did 16 teeth total, 8 on top and 8 on bottom. Not quite a full mouth but a large case none the less. No changes were made to vertical etc.

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