Prosthodontics

TOMA 2008; 36 : 249 - 252

A technique to fabricate custom provisional fixed partial dentures combining PMMA and light-polymerizing PEMA materials.
K. STAMOULIS1, D. TORTOPIDIS12 Department of Fixed Prosthodontics and Implant Prosthetics, Dental School, Aristotle University of Thessaloniki, Greece

Summary
Among different techniques for a custom provisional xed partial denture construction, the indirect-direct one is a well-established method. It can be completed in the dental ofce, reducing the overhead cost of producing xed prostheses. During the rst (indirect) phase of this technique, a PMMA (methyl methacrylate) material is used for a shell to be fabricated extraorally. A reline procedure that takes place intraorally is the second (direct) phase necessary to complete the provisional bridge construction. A PR'MA (R' = ethyl, vinyl, isobutyl) material is used for relining. A modication of the above technique is proposed using a light-polymerizing PEMA (or ethyl methacrylate) material instead of an autopolymerizing PEMA material. This material exhibits partial setting from a chemical reaction but depends on light for complete setting. Following nal curing, it then behaves with the same physical properties as other materials in its class, minimizing the danger for tooth vitality and the risk of locking the restoration in place.

Introtuction The basic requirements of a provisional restoration (PR) are good marginal adaptation, physiologic contours and embrasures, a polished plaque-resistant surface, and strength and durability, and it must be amenable to routine daily home care 1 . Biologic, esthetic and mechanical factors have to be appropriately considered when a PR is made. A high quality custom provisional fixed partial denture is usually necessary to fulfill all above requirements. Making adequate PR for fixed prosthodontic tooth preparations requires significant time and effort. The three factors that are crucial for achieving a quality PR are time, the use of the proper materials and the proper technique. Several materials and different techniques are available today for a PR to be constructed, depending on special clinical demands, the clinicians skill and patients standards. The indirect-direct technique is a wellestablished method for provisional xed partial denture construction 2,3. The combination of PMMA (poly methyl methacrylates) and PR'MA (R' = ethyl, vinyl, isobutyl) materials has been proposed to complete the PR 2,3. This article suggests a modification of the above technique using a light-polymerizing PEMA (poly ethyl
Presented as a poster presentation at the 25th Panhellenic Congress, Larissa, October 2005. Received on 30th Sept., 2007. Accepted on 18th Feb., 2008. 1 Associate Professor 2 Lecturer

methacrylate) material instead of an autopolymerizing PEMA material. Using this technique, the marginal area of the PR is easily, accurately and safely contoured intraorally. Technique The indirect-direct technique can be used effectively in daily practice for the in-ofce construction of short or long-span provisional fixed bridges. A shell from a PMMA material is constructed extraorally (indirect technique) and is subsequently relined intraorally (direct technique). The procedure is presented in Table 1.
TABLE I

Clinikal and laboratory stages of the progedure

CLINICAL STAGE I impression 1 (preliminary) 1 production _ cast

LABORATORY STAGE cast 1 transformation impression 2 (from cast 1 transformed) _ cast 2 production martrix fabrication onto cast 2 preparations on cast 1 PMMA shell fabrication onto cast 1 using the martix CLINICAL STAGE II tooth preparations completed PR fabrication using the PMMA shell and PEMA reline

250

Stamoulis, Tortopidis

This type of PR is made in the following manner. 1. A preliminary impression is taken for the diagnostic cast (cast 1) fabrication (Fig. 1). 2. The diagnostic cast containing the teeth to be restored is waxed up to the desired morphology, including correct pontic form for the teeth to be replaced. 3. An impression (impression 2) is made of the waxedup diagnostic cast and poured in fast-setting stone (cast 2) (Fig. 2). 4. A "suck-down" template is made of the cast 2 (Fig. 2) or an impression can be taken alternatively. It is used as a matrix to produce the desired external morphology of the PR. 5. The cast 1 is altered by trimming the abutment teeth to simulate tooth preparations 0.75 to 1 millimeter deep, but shallower than the expected depth of the actual tooth preparations (Fig. 3). 6. The previously made template of the cast 2 is lled with a PMMA material (Jet, Lang Dental Manufacturing, Wheeling, Ill., USA) (Fig. 4) and inserted over the lubricated, trimmed cast 1 (Fig. 5). A shade matching adjacent teeth can be selected. 7. The PMMA material is allowed to set and the shell

produced is trimmed and polished (Fig. 6). 8. After tooth preparations have been completed intraorally, a light-curing PEMA material (Unifast LC, GC Europe NV, Leuven, Belgium) (Fig. 7) is used to reline the existing PMMA shell. A shade similar to the selected PMMA can be chosen. Powder is added to liquid in a mixing cup and quick mixing for

Fig 3. Slight tooth preparations onto the diagnostic cast for the shell construction.

Fig 1. The diagnostic cast (cast 1). First upper right premolar will be replaced with a xed partial denture.

Fig 4. The PMMA material used for the shell fabrication.

Fig 2. A template is fabricated from the modied diagnostic cast (cast 2).

Fig 5. The template lled with PMMA and suited over the trimmed diagnostic cast.

A technique to fabricate custom provisional xed partial dentures combining PMMA and light-polymerizing PEMA materials

251

Fig 6. The nished shell outer form of the provisional xed partial denture.

Fig 9. After light-polymerization of PEMA material the accurate t of the provisional xed partial denture is checked.

9. When contouring is completed, the PR is lightpolymerized, trimmed, adjusted occlusally, polished and cemented (Fig. 9). Discussion Many methods of PR fabrication are available to practicing dentists. Custom-made PRs can be fabricated in dental ofce by dentists or assistants. Construction of PRs by laboratory technicians is only necessary in complicated cases. According to the indirect-direct method, a preoperative PMMA shell is made in the dentists personal laboratory and subsequently relined with a PEMA material intraorally, after the tooth preparations have been made. The PMMA material is cost-effective and strong enough for a short or long-span provisional xed partial denture 4. It also has good esthetic appearance and polishability5, but it produces an exothermic reaction and shrinkage during polymerization6,7, so its use is safer extraorally. It is very good as a shell, but the reline has to be secure, so a PEMA material is usually used8. These shells, relined with better-fitting PEMA materials, make well-fitting, strong, and color-stable PRs. PEMA materials can be used with success, but moderate exothermic reaction and color degeneration are objectionable6,9. The light-curing PEMA material that is proposed for relining offers considerable advantages that can make PR production more accurate, and safer for the prepared teeth and gingivae. It is an acrylic based material that can set partially (a result of a chemical reaction), but depends upon light for complete setting. Following nal curing, it then behaves with the same physical properties of other materials in its class (like an acrylic). This material will not set completely until the light is applied, which minimizes the danger for tooth vitality and the risk of locking the restoration in place. Yet, because there is

Fig 7. The light-polymerized PEMA material to be used for the shell relining intraorally.

Fig 8. The shell is lled with PEMA LC and properly contoured by means of a brush.

10-15 seconds is suggested. A brush is used to accurately contour the PR with the reline material (Fig. 8) and additional material can be used with the brush-on technique to ll any void.

252

Stamoulis, Tortopidis

an initial chemical cure occuring it is possible to remove it with minimal distortion. It can then be either cured out of the mouth or placed back on the teeth after removing any excess material from undercuts and finally cured. This can be a tremendous advantage over chemical cure only products. Light-curing permits an increased working time, so there is plenty of time for accurate contouring and excellent t and seal can be achieved. References
1. Bral M. Periodontal considerations for provisional restorations. Provisional Restorations. Dent Clin North Am 1989; 33:457-65. 2. Rosenstiel SF, Lang MF, Fujimoto J. Contemporary Fixed Prosthodontics. 2d ed. CV Mosby Co., St. Louis 1995, pp 342-5. 3. Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of Fixed Prosthodontics. 3d

4. 5.

6.

7.

8. 9.

ed. Quintessence Publishing Co., Chicago 1997, pp 241-3. Vahidi F. The provisional restoration. Dent Clin North Am 1987; 31:363-81. Wang RL, Moore BK, Goodacre CJ, Swartz ML, Andres CJ. A comparison of resins for fabricating provisional xed restorations. Int J Prosthodont 1989; 2:173-84. Driscoll CF, Woolsey G, Ferguson WM. Comparison of exothermic release during polymerization of four materials used to fabricate interim restorations. J Prosthet Dent 1991; 65:504-6. Moulding MB, Teplitsky PE. Intrapulpal temperature during direct fabrication of provisional restorations. Int J Prosthodont 1990; 3:299-304. Christensen GJ. The fastest and best provisional restorations. J Am Dent Assoc 2003; 134:637-639. Lui JL, Setcos JC, Philips RW. Temporary restorations: A review. Oper Dent 1986; 11:103-10.