The importance of fabricating a good temporary?



I teach at a NYU dental school on Thursdays and Fridays and am often wish the students spent a little more time on fabricating and polishing their the temporaries they fabricate for their patients Temporaries that are ill fitting and have poor margins tend to be more likely to come off between visits and to cause gingival inflammation. Also for anterior crowns, a well made temporary can function as a "dress rehearsal" for the permanent one.

Some crown preparations can be done over more than one visit and relining the temporary in order to aide both in the temporary's retention and in achieving good coverage of the margins. Also when margins are covered often patients experience less sensitivity between visit.

Of course there are time when I will accept less than ideal coverage of a preparations margin, but only when I expect to insert a permanent crown in approximately two weeks or less. When a patient goes for a longer time between visits, let's say several months, they are subject to recurrent decay developing along the margins if they are not properly covered or the temporary comes loose. Usually time spent on a good fitting temporary will pay off. This is especially true if the crown will be luted with composite bonded cement, since inflamed gums bleed readily, often just when we don't want them to- when we are luting a permanent restoration. This is an unfortunate circumstance since bleeding can compromise bonding.

Yesterday I reprepped the six anterior teeth and  took a final impression. The patients temporary had been in place for several months and had some cement wash out. When I removed it to get ready for my final impression, her gums were inflamed and made my taking of the final impression more difficult. I was able to get a good impression, but placement of the final margins adjacent to inflamed gingiva can be tricky, since the swelling of the gums may resolve later and cause the margins of the final restoration to be unintentionally exposed.

After I took the impression I relined the temporary so that it would be better adapted to the new final margins I had created. The marginal gingivitis is noticeable around the margins. luckily this patient has a "low lip line" and doesn't show her gums when smiling. Even if she has some unintended recession it won't be a problem. This patient has been having a full arch reconstruction and has been having crowns placed in sections over the last few months. See the occlusal view below.

cracked temporary between centrals
relined and repaired temporary after 
final impression was taken

Posterior crowns completed during prior sessions. 
Pt is bruxer and metal occlusals were chosen for
 posterior crowns. 

Occlusal view of patients worn teeth
 prior to restoration




from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2019/10/the-importance-of-fabricating-good.html - http://lspindelnycdds.blogspot.com/

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