Awareness among Dental students on different Techniques available for Temporisation in FPD-A Survey

 

Prasanna Guru E, Vinothkumar Sengottaiyan

 

Abstract:

To assess the awareness among dental students on different techniques available for temporisation in FPD. Materials and methods: The survey will be conducted based on a questionnaire which will be distributed to final year dental students, interns and PGs of Saveetha Dental College. Background: Fabrication of provisional restorations or temporisation is an important procedure in fixed prosthodontics. Provisional restorations must satisfy the requirements of pulpal protection, positional stability, occlusal function, ability to be cleansed, margin accuracy, wear resistance, strength, and esthetics. Although any technique can be used to fabricate a provisional restoration, the choice of technique will be based on the ease, predictability and availability of materials required to accomplish the required characteristics. This is possible only when an individual has adequate knowledge about pros and cons of different techniques. Purpose: The purpose of this study is to assess and compare the awareness of dental students on different techniques available for temporisation in FPD.

 

 

INTRODUCTION:

Fabrication of provisional restorations is an important procedure in fixed prosthodontics. Provisional restorations must satisfy the requirements of pulpal protection, positional stability, occlusal function, ability to be cleansed, margin accuracy, wear resistance, strength, and esthetics. Provisional restorations in fixed prosthodontic rehabilitation are important treatment procedures, particularly if the restorations are expected to function for extended periods of time or when additional therapy is required before completion of the rehabilitation. Interim procedures also must be efficiently performed, because they are done while the patient is in the operatory and during the same appointment that the teeth are prepared. Costly chair side time must not be wasted, but the dentist must produce an acceptable restoration. Failure to do so results in the eventual loss of more time than was initially thought saved. A well-made provisional fixed partial denture should provide a preview of the future prosthesis and enhance the health of the abutments and periodontium. The theories and techniques of fabrication for numerous types of provisional restorations abound in the dental literature. As new materials are introduced, associated techniques are reported, and thus, there is even more variety. It is helpful principle that all the procedures have in common the formation of a mold cavity into which a plastic material is poured or packed. Provisional restorations may be made directly on prepared teeth with the use of a matrix or indirectly by making an impression of the prepared teeth. A combination indirect-direct technique is also possible which has evolved as a sequential application of these that involves fabrication of a preformed shell that is relined intraorally.

 

According to the Glossary of Prosthodontic Terms, “provisional or interim prosthesis or restoration is a fixed or removable dental or maxillofacial prosthesis designed to enhance esthetics, stabilization and/or function for a limited period of time, after which it is to be replaced by a definitive dental or maxillofacial prosthesis.”[1] The importance of providing interim treatment with provisional restorations becomes critical in cases of full mouth reconstruction, in which multiple teeth are prepared. In these situations, provisional restorations will typically be used for relatively long periods of time (6–12 weeks) to monitor patient comfort and satisfaction and to allow for any necessary adjustments.[2] The interim treatment focuses on protecting pulpal and periodontal health, promoting maxilla-mandibular relationships.[3] Provisional material selection should be based on how their mechanical, physical, and handling properties fulfill specific requirements for any clinical case. Other factors to be considered are biocompatibility and complications from intraoral use, such as chemical injury from the presence of monomer residue and thermal injury from an exothermic polymerization reaction. The most common materials used for custom interim-fixed restorations are several types of acrylic resins such as (1) polymethyl methacrylate methacrylate (PMMA) resin, (2) polyethyl (PEMA) resin, (3) polyvinyl methacrylate resin, (4) bis-acryl composite resin, and (5) visible dimethacrylates.4 light-cured Fabrication guided tissue healing in order to achieve an acceptable emergence profile, evaluating hygiene procedures, preventing migration of the abutments, providing adequate occlusal scheme, and evaluating of provisional restorations is an important procedure in fixed prosthodontics. Provisional restorations must satisfy the requirements of pulpal protection, positional stability, occlusal function, ability to be cleansed margin accuracy, wear resistance, strength, and esthetics. They serve the critical function of providing a template for the final restorations once they have been evaluated intraorally. A well-made provisional fixed partial denture should provide a preview of the future prosthesis and enhance the health of the abutments and periodontium. The theories and techniques of fabrication for numerous types of provisional restorations abound in the dental literature. Provisional restorations may be made directly on prepared teeth with the use of a matrix or indirectly by making an impression of the prepared teeth. A combination indirect-direct technique is also possible which has evolved as a sequential application of these that involves fabrication of a preformed shell that is relined intraorally. Composite provisional materials encompass a fairly variable category by virtue of the fact that they are chemically comprised of a combination of 2 or more types of materials. Most of these materials use bisacryl resin, a hydrophobic material that is similar to bis-GMA. Composites are available as autopolymerized, dualpolymerized and visible light polymerized. Bis-acryl provisional materials are resin composites and represent an improvement over the acrylics because they shrink less, give off less heat during setting, excellent esthetics, minimal odour and can be polished at chair-side. Preformed provisional crowns or matrices usually consist of tooth-shaped shells of plastic, cellulose acetate or metal. They are commonly relined with acrylic resin to provide a more custom fit before cementation, but the plastic and metal crown shells can also be cemented directly onto prepared teeth. Polycarbonate resin is commonly used for preformed crowns. Polycarbonate resin is the commonly used for preformed crowns. These crowns combine microglass fibres with a polycarbonate plastic material.[5]

 

These materials have been used to fabricate provisional restorations since the 1930s and usuallyavailable as powder and liquid. They are the most commonly used materials today for both single-unit and multiple-unit restorations. Advantages of this material include low cost, good wear resistance, good esthetics, high polishability, good colour stability whereas it also has certain drawbacks like significant amount of heat given off by exothermic reaction, high degree of shrinkage (about 8%) objectionable odour, short working time, hard to repair and radiolucent.[5]

 

The technique involves fabrication of the interim restoration outside the mouth. Fabrication of provisional restorations using the indirect technique eliminates the problems associated with the direct technique and also has the advantage that it can be partially delegated to auxiliary personnel. Fisher et al. describes the use of an indirect technique for provisional fabrication that uses a fast-setting plaster.[6] The technique has several advantages over the direct procedures. There is no contact of free monomer with the prepared teeth or gingival which might cause tissue damage and an allergic reaction or sensitization. The technique avoids subjecting prepared tooth to the heat evolved from the polymerizing resin[7]. When compared to direct technique, it has fewer demerits. Principal disadvantage of the technique includes increased chair side time and increased number of intermediate steps.The technique produces a custom made preformed external surface form of the restoration but the internal tissue surface form if formed by the underprepared diagnostic casts[8]. This indirect-direct procedure has several advantages. With the combination indirect-direct technique, chair time can be reduced, since the provisional shell is fabricated before the patient’s appointment. Enhanced control over restoration contours minimizes the time required for chair side adjustments. The disadvantage of this procedure is the potential need of a laboratory phase before tooth preparation and the adjustments that are frequently needed to seat the shell completely on the prepared tooth.[4]In the direct technique, patient’s prepared teeth and the gingival tissues directly provide the tissue surface form eliminating This is convenient when assistant training and the office laboratory facilities are inadequate for efficiently producing an indirect restoration. However the direct technique has significant disadvantages like potential tissue trauma from the polymerizing resin and inherently poorer marginal fit.[4]

 

MATERIALS AND METHODS:

The survey will be conducted based on a questionnaire which is distributed to final year dental students, interns and PGs of Saveetha Dental College. The survey consists of 10 questions. The questionnaire was based on awareness of different techniques employed in provisional restoration. The results were analysed based on statistical analysis

 

RESULTS:

 

Figure 1

 

50% of the professionals answered that the temporary restoration was not required to be after fixed prosthesis preparation. 30% was aware about the temporary restoration preceding fixed prosthesis preparation. ( Figure.1)

 

 

Figure 2.

 

Only 20% of the professionals answered that temporisation is to be proceeded including the root canal treated abutment teeth and 60% of the professionals answered that temporisation is not necessarily to be proceded for the root canal treated abutment teeth.( Figure 2)

 

 

Figure 3.

 

Almost 35% of the professionals have answered that they were sure it leads to failure of the temporary restoration and 40% of the professionals answered that the success of the fixed restoration is not interefered by the provisional restoration. (figure 2)

 

Figure 4.

 

20% of the professionals answered that the teeth will not change its position even if temporisation is not done. 60% of the professionals answered that the teeth will change its position if temporisation is not done. ( Figure 4)

 

 

Figure 5.

 

40% of the people answered that methyl methacrylate is not directly used in the oral cavity 35% of the people answered that methyl methacrylate is directly used in the oral cavity (Figure 5)

 

 

Figure 6.

 

45% of the professionals answered that the bisacrylic composites can be directly used in the oral cavity where as 20% of the professionals answered that the this type of composites are not used directly in the oral cavity . (Figure 6)

 

Figure 7.

50% of the professionals answered that the model preparation and wax up in diagnostic cast is essential for the success of the fixed prosthesis where as 30% of the professionals answered that its not necessary for model preparation and wax up in diagnostic cast.

 

 

Figure 8.

 

60% of the professionals answered that the putty consistency material is ideal for making impressions for the fabrication of a temporary fixed prosthesis. 20% of the professionals answered that the vaccum formed sheets are used in making impressions for temporary fixed prosthesis

 

 

Figure 9.

 

35% of the professionals answered that the final impressions taken before or after temporisation does not alter in the prosthesis whereas 25% of professionals that temporisation is altered based on the final impression. (Figure 9)

 

 

Figure 10.

 

40% of the professionals answered that CAD CAM processed temporary restoration has longer shelf life where as 20% of the professionals answered that CAD CAM associated temporary restoration shelf life does not last longer.

DISCUSSION:

Various materials are available for the fabrication of provisional restoration but till date none have proven to be the most accurate and stable. Every material had its own merits and demerits that could be attributable to numerous factors. Any interim restoration should fulfil the biologic, mechanical and esthetic requirements. Provisional restorations must not only provide an initial shade match, but also maintain the esthetic appearance over a period of time. Alterations in color of these restorations compromise the acceptability. Color stability gains importance, particularly when the restorations involve esthetic zones and must be worn for extended periods of time. Discoloration of provisional materials may lead to patient dissatisfaction and even additional expense for replacement. This is particularly problematic when provisional restorations are subjected to colorants during lengthy treatments. Hence colour stability, along with mechanical properties is an important criterion in the selection of a provisional restorative material.

 

Koumjian et al. stated that methyl methacrylate resin was less colour stable than bis-acryl composite (Protemp II) in 20 an in vivo study whereas study by Gupta et al showed Revotek LC as the most colour stable material. Staining of these provisional were attributed to adsorption or absorption of colorants by resins. Factors like surface roughness, wear resistance and polishability also influenced the colour stability of these materials. Various methods of fabrication are also described but none can be considered as a universally accepted standard technique. Indirect technique is generally preferred over the direct techniques as it overcomes the potential hazards caused to the tooth during fabrication by the direct technique but routinely, situation dictates the material and the technique of fabrication. Provisionalisation should also be considered during other treatment modalities like various stages of implant supported prosthesis which include provisionalisation prior to implant loading (removable and tooth supported), provisionalisation at first/second stage surgery (implant retained – at first stage surgery - single tooth, implant retained- partially edentulous and dentulous), tooth retained – at or before first stage surgery, implant retained- at second stage surgery, transitional implant provisional restoration, cement or screw retained provisional prosthesis. Provisional restorations also play a significant role in the sequelae of maxillofacial rehabilitation by using interim obturators or feeding plates and interim dentures and also during transformation of an immediate denture to conventional denture prosthesis.

 

CONCLUSION:

One of the most important aspects of dental profession is to provide a predictable outcome to any oral rehabilitation, and the use of the provisional restoration is a critical phase in the treatment. Clinical techniques and indications are reasonably well characterized, but future research activities will need to focus on technological advancements to provide improved materials that demonstrate improved biocompatibility, physical properties, ease of use and esthetically pleasing appearance to the patients.

 

REFERENCES:

1.      Glossary of Prosthodontic Terms 8th ed. J Prosthet Dent 2005; 94:10-92.

2.      Al Jabbari YS, Al-Rasheed A, Smith JW, Iacopino AM. An indirect technique for assuring simplicity and marginal integrity of provisional restorations during full mouth rehabilitation. Saudi Dental Journal 2013; 25:39-42.

3.      Patras M, Naka O, Doukoudakis S, Pissiotis A. Management of Provisional Restorations’ Deficiencies: A Literature Review. Journal of Esthetic and Restorative Dentistry 2011:1-13.

4.      Regish KM, Sharma D, Prithviraj DR. Techniques of Fabrication of Provisional Restoration: An Overview. International Journal of Dentistry 2011; 134659

5.      Prasad KD, Shetty M, Alva H, Prasad AD. Provisional restorations in Prosthodontic rehabilitations-concepts, materials and techniques. Nitte University Journal of Health Science 2012; 2:72-77.

6.      Fisher DW, Shillingburg Jr. HT, Dewhirst RB. “Indirect temporary restorations,” The Journal of the American Dental Association 1971; 82:160-163.

7.      Koumjian JH, Firtell DN, Nimmo A. Color stability of acryilic resins for provisional restorations. Int J Prosthodont1997; 10: 164-168.

8.      Gupta G, Gupta T. Evaluation of the effect of various beverages and food material on the color stability of provisional materials – An in vitro study. J Conserv Dent. 2011 Jul-Sep; 14(3): 287–292.

 

Received on 12.08.2018       Modified on 16.10.2018 Accepted on 20.11.2018      ©A&V Publications All right reserved Research J. Science and Tech. 2019; 11(2):129-134. DOI: 10.5958/2349-2988.2019.00020.2