Provisional Material Advances and Options
What to consider before you “test drive” today’s newer materials
The provisional or “temporary” crown is an integral part of crown and bridge procedures. Dentistry has progressed dramatically since the workhorse powder and liquid self-cured methacrylate-type materials used decades ago. The evolution of provisional materials to bis-acrylics—complete with auto-mixing, easier handling, improved compressive and tensile strength, better water sorption, and less shrinkage—has led to the creation of chairside provisional restorations that are better than ever. These self- or light-cured materials offer expanded color range possibilities and varying degrees of translucency/opacity.
Bis-acrylics are dimethacrylate materials and can be categorized into two groups: bisphenol A-glycidyl methacrylate (bis-GMA) and urethane dimethacrylate (UDMA).1,2 These materials are multi-functional methacrylate esters that are filled with glass and/or silica particles. They are very easy to manipulate with their availability in auto-mix cartridges, and they bring a good level of comfort to the patient because they produce minimal odor, heat, and shrinkage during the curing process.3,4
There are a number of provisional materials that are in widespread use today, and this article will examine several options.
Material Choices
Luxatemp® products (DMG America, www.dmg-america.com) consist of a family of self- and light-cured composite provisional materials that have a glass filler content of 44 wt %, with a working time of 45 seconds and setting time of 2 to 3 minutes, and complete cure of 6 to 7 minutes. The product is methyl methacrylate- and peroxide-free. The manufacturer instructions for use for the product states that with its self-curing materials “the setting reaction has to be monitored intraorally (eg, with a scaler) as the temperature in the mouth has a significant influence on the setting time and the temporary can be removed only during the elastic phase.” This is a very important concept for all self-curing provisional materials.
Several product variations in the Luxatemp line include Luxatemp Fluorescence (aimed at achieving superior esthetics), Luxatemp Ultra (incorporates proprietary nano technology to provide increased flexural strength), and Luxatemp Solar (a light-cured material). The light-cured Luxatemp Solar has extended working time since it “sets on command” when cured with a light source. The manufacturer reports that it has high strength—with compressive strength being 250 MPa5—making it an ideal choice for long-span temporary bridges.
The latest in the Protemp™ (3M ESPE, www.3mespe.com) line of provisional materials, Protemp Plus, is reported to be a highly fracture-resistant material with high gloss without polishing.6 It comes in five shades designed to match 3M ESPE Filtek™ Supreme Ultra Flowable Restorative materials. It can be used for single- or multiple-unit provisional restorations. The manufacturer reports that Protemp Plus is a unique bis-acryl material that contains “a new generation of sophisticated (nanotechnology) fillers,” which makes it a strong and long-lasting provisional material with high esthetics through natural gloss and fluorescence that requires no polishing or glaze to bring out the sheen. A sheen is generated by simply using an alcohol gauze to wipe the provisional restoration with ethanol.
Working time for Protemp Plus is 40 seconds and it should be removed from the mouth between 1:40 to 2:50 minutes after start of the mix (the set should be monitored carefully). It is recommended to keep the provisional restoration in the matrix for at least 5 minutes before removal and trimming to achieve optimal esthetic properties.
Another interesting addition to the Protemp line is the Protemp Crown Temporization Material. These preformed, malleable composite temporary crowns come in nine preformed sizes, can be custom fit for single-unit crowns that provide remarkable strength—with compressive strength of 395.6 MPa—and are light curable. Even so, they exhibit low intraoral heat during the fitting and curing process.
Another new bis-acryl provisional material, Integrity® Multi-Cure (DENTSPLY Caulk, www.caulk.com), is reported by the manufacturer to deliver durable results due to wear resistance and strength properties (compressive strength of 386 to 394 MPa), minimal shrinkage, and fast procedure times (5-minute self-cure, 20- to 60-second light cure). Available in five shades, Integrity Multi-Cure has added fluorescence for esthetics and can be polished to a natural luster. The material has a working time of 45 seconds, and is removed from the mouth after approximately 90 seconds. Once removed, the material can either set for 5 minutes before removal from the matrix or can be light-cured for 20 seconds to enable faster trimming and polishing. This reduction in procedure time can certainly be important when time is of the essence.
Inspire™ (Clinician’s Choice, www.clinicianschoice.com) is another provisional material available to the profession. The manufacturer states that it has an elastic modulus of 3136 MPa,7 and it is reported to have high flexural and compressive strength, is designed to be easy to trim, and is resistant to fracture. Working time is 40 seconds with removal from the oral cavity between 1:20 and 2:30 minutes. Total cure occurs at 4:30 minutes. The manufacturer also states that it has one of the lowest exothermic reactions, coming in at 53°C. The product comes in four shades.
Perfectemp® 10 (DenMat, www.denmat.com) has a 1:30 minute intraoral and 4:30 full-cure set time. The material’s elastic modulus is reported at 3500 MPa, flexural strength 120 MPa, and volumetric shrinkage less than 3.4%.8 The flexural strength makes it “stiffer” than other materials. Perfectemp 10 is available in five shades.
The Structur® (VOCO America, Inc., www.voco.com) family of provisional materials consists of a variety of products, including Structur 3 and Structur Premium. Structur 3 is reported by the manufacturer to be a quick-setting (45 seconds intraoral setting time) nanofilled material with high fracture resistance and compressive strength (more then 500 MPa).9 It features what the manufacturer calls “Wipe and Go” technology, which provides a natural gloss and tooth-like fluorescence that comes in eight shades. Again, this high sheen is achieved with the use of an alcohol wipe after completion of trimming and polishing.
Structur Premium is a 1:1 cartridge mix like Structur 3 that the manufacturer reports as being a fast setting bis-acryl provisional material with ceramic-like esthetics, high fracture resistance ideal for long-span bridges, a brilliant gloss, natural fluorescence, and a lifelike incisal shade that also comes in eight shades with a fast intraoral setting time (30 to 45 seconds). The wide range of shades in the Structur products helps clinicians match almost every possible tooth shade in a cost-effective manner, because the mixture is 1:1 versus the 10:1 base-to-catalyst auto-mix cartridges of other provisional materials.
Visalys® Temp (Kettenbach, www.kettenbach.us) is a self-cured fluorescent provisional material with high translucency that is based on a multifunctional acryl composite that uses no bisphenol A or bisphenol A precursors. The manufacturer reports it is an easy-to-use, highly fracture-resistant material, can be precisely trimmed with minimal dust, and has a high luster without polishing by using an alcohol wipe.10 Like many of the other materials, working time is 40 seconds, and the temporary crown and bridge material should be removed from the mouth from 1:20 to 2:20 minutes. Visalys Temp can be removed from the matrix at 2:20 and trimmed after 4 minutes. The material comes in six shades.
A diurethane dimethacrylate material, Tuff-Temp™ Plus (Pulpdent Corp., www.pulpdent.com) features a synthetic rubber molecule inserted into it to produce a tough, impact-resistant, dimensionally stable provisional material that the manufacturer calls a “rubberized urethane.” This material is reported to be a fluorescent, strong, impact-resistant provisional product that does not shrink or distort and grips the tooth tightly.11 It virtually eliminates fractures and debonding due to its rubberized-urethane chemistry.12 The material grinds and powders during trimming without softening or distorting, which makes refinement of the margins very easy for the operator. It comes in six shades that can be used in self-cure or light-cure modality. The working time of the material is similar to the previously discussed materials (45 seconds), and it is removed from the mouth 2:15 from the beginning of the mix. The oxygen layer is removed with an alcohol wipe, and then the material can be light-cured or self-cure at 5 minutes after mix was initiated. The compressive strength is 200 MPa, Vickers Hardness is 514 MPa, and flexural strength is 75 MPa.11 This flexural strength indicates that the material is less brittle and, as such, has both fracture and impact resistance due to the rubberized urethane component as compared to traditional bis-acrylics.12
Selecting a Material
Any one of the aforementioned products can work very effectively depending upon a case’s specific needs. Materials have diverse pros and cons. Only after thorough samplings of various products can a clinician determine which ones are best for his or her use.
Finding detailed, in-depth data on the overall physical properties of a number of provisional materials can be difficult or near impossible. Products where no specific data was found regarding the mechanisms used to make such general claims as “high strength” and “high shine” are not included in this article. While it would be beneficial for clinicians to compare materials and understand any ramifications of using one material versus another, this is not always possible. Therefore, often times clinicians must “test drive” products to see what works best in their hands. Cost, of course, is usually a consideration when selecting a material; however, it should not be the focal point of a clinician’s decision. Factors such as ease of use, fracture resistance, the ability to function well and retain over the period of time that the provisional will be present, and how well the marginal integrity can be achieved should have the greatest weight in the decision-making process.
About the author
John C. Comisi, DDS, MAGD
Private Practice
Ithaca, New York
Provisional Materials Showcase
Figure 1 | PRO-V FILL®
PRO-V FILL® from BISCO is a higher viscosity, packable composite for creating provisional onlays with excellent handling and sculpting properties for direct placement.
800-247-3368
www.bisco.com
Figure 2 | Filtek™ SupremeUltra Flowable
Filtek™ Supreme Ultra Flowable from 3M ESPE is a flowable composite ideal for multiple indications, including repair of resin and acrylic temporary restorations.
800-634-2249
www.3mespe.com
Figure 3 | Integrity® Multi-Cure
DENTSPLY Caulk’s Integrity® Multi-Cure Temporary Crown and Bridge Material is a dual cure 10:1 bis-acrylic material with improved flexural strength. It can also be used as a self-cure material.
800-532-2855
www.caulk.com
Figure 4 | Luxatemp® Ultra
Luxatemp® Ultra from DMG America incorporates proprietary technology that gives it unsurpassed strength when used for temporary crowns, bridges, inlays, onlays, and veneers.
800-662-6383
www.dmg-america.com
Figure 5 | GC Fuji Temp LT
GC Fuji Temp LT from GC America is a glass ionomer cement for temporary of all-ceramic, resin, and metal-based crowns and bridges, as well as implant abutments. It has excellent handling and low film thickness.
800-323-7063
www.gcamerica.com
Figure 6 | Tuff-Temp™ Plus
Tuff-Temp™ Plus from Pulpdent is an impact-resistant, rubberized urethane that doesn’t shrink or distort, virtually eliminating fractures and debonding with excellent margins.
800-343-4342
www.pulpdent.com
Figure 7 | Structur 3
VOCO’s Structur 3 is indicated for the quick fabrication of strong and esthetic provisional crowns and bridges, inlays and onlays, veneers, and temporary posts.
888-658-2584
www.voco.com
Figure 8 | INSPIRE™
INSPIRE™ from CLINICIAN’S CHOICE makes provisional fabrication easy, efficient, and predictable, with results that are strong as well as esthetic.
800-265-3444
www.clinicianschoice.com
References
1. Strassler HE. In-office provisional restorative materials for fixed prosthodontics: Part 1 – polymeric resin provisional materials. Inside Dentistry. 2009;5(4). www.dentalaegis.com/id/2009/04/in-office-provisional-restorative-materials-for-fixed-prosthodontics. Accessed December 1, 2014.
2. Bis-acryl provisional materials. CRA Newsletter. 1997;21(2):3.
3. Kurtzman GM, Strassler HE. Provisional fixed restorations. Dental Economics. 2006;3(suppl):1-12.
4. Yilmaz A, Baydas S. Fracture resistance of various temporary crown materials. J Contemp Dent Pract. 2007;8(1):44-51.
5. Luxatemp®–The Ultimate Esthetic Provisional System. Englewood, NJ: DMG America; www.dmg-america.com/files/product/literature/[nid]/Luxatemp_Provisional_Brochure_Web_4.pdf. Accessed December 1, 2014.
6. Protemp™ Plus Temporization Material Technical Data Sheet. St. Paul, MN: 3M ESPE; https://multimedia.3m.com/mws/media/526384O/protemptm-plus-temporization-material.pdf. Accessed December 1, 2014.
7. Inspire™ Product Description. Clinician’s Choice website. www.clinicianschoice.com/posecom/products.php?product=Inspire. Accessed December 1, 2014.
8. Perfectemp® 10. DenMat website. www.denmat.com/PERFECtemp10. Accessed December 1, 2014.
9. Structur 3. Briarcliff Manor, NY: VOCO; www.voco.com/us/products/_products/Structur_3/Structur-3-US-brochure-Web.pdf. Accessed December 1, 2014.
10. Visalys Temp. Kettenbach website. www.kettenbach.us/dental/products/temporary-crowns-and-bridges/visalys-temp_948.html. Accessed December 1, 2014.
11. Product Presentations – Tuff-Temp™. PULPDENT® website. www.pulpdent.com/content/education-articles/product-presentations/. Accessed December 1, 2014.
12. Glazer HS, Lowe R, Strassler HE. Rubberized-urethane composite for provisional restorations. Inside Dentistry. 2012;8(6):78-82.
