Temporaries: Today's Natural-Looking Provisional Restorations
Today's natural-looking temporaries, also called "temps" or provisional restorations, have undergone radical changes. Provisionals now enable you to "preview" the final result of your smile design or reconstructive treatment. They allow you to make a more informed decision about the size, shape, feel, function and color of your final restorations.
Why Are They Necessary?
Temporaries have become an important and necessary part of any smile or bite reconstruction. They serve several other important functions, including:
- Protecting teeth that have been prepared for a final restoration.
- Covering exposed dentin to prevent tooth sensitivity, plaque buildup, cavities and pulp problems.
- Preventing unwanted tooth movement.
- Enabling patients to eat and speak normally.
- Maintaining the health and contours of the gum tissue.
- Allowing patients to "test drive" the fit, look, comfort and function of the anticipated smile makeover or restoration(s).
- Serving as a discussion point for addressing cosmetic or functional concerns during the interim period they are worn.
- Saving time and money by providing an accurate blueprint of what the final restoration(s) will look and feel like, thereby reducing the need for additional procedures, adjustments and remakes.
When Are They Necessary?
If you choose to have treatment, a temporary restoration placed on your prepared teeth offers protection, comfort and esthetics while you wait for your final restoration to be made and placed. Temporaries are used while you have crowns, bridges, inlays, onlays and porcelain veneers made for you and sometimes even for removable partial dentures, complete dentures and implant treatment.
Provisional restorations are especially important when multiple teeth are to be prepared, or when occlusal (bite) or cosmetic changes are anticipated. It is easier to adjust temporary acrylic resin restorations than to modify final, permanent restorations fabricated from metal, ceramic or metal-ceramic materials.
However, if your dentist uses CAD/CAM (computer-aided design/computer-aided manufacturing) technology to create your restorations in his/her office often referred to as "chairside" CAD/CAM he/she can make, bond and adjust the permanent restoration in just one sitting, thereby eliminating the need for temporaries. Temporary restorations are also not necessary when there is little or no removal of tooth enamel during final placement of some porcelain veneers, as may be the case with some types of "minimal-prep" veneers like Lumineers, Dura-Thin, and IPS e.max Press thin veneers.
The length of time temps need to be worn varies from a few days (short-term) for simple cases, such as a single crown, to several weeks (medium-term) for cases such as inlays, onlays and veneers. Provisionals are required for several months (long-term) for complex cases such as full mouth reconstruction.
How Are They Made?
They can be made using a direct or indirect technique. A direct technique is performed chairside (in your mouth) by your dentist. An indirect technique requires making impressions of your mouth and having your temporaries made outside of your mouth and/or at an outside laboratory.
When temps are to be worn long term or used as diagnostic tools, laboratory-fabricated provisionals are generally best because their materials provide greater strength and higher resistance to wear and discoloration. Since they more closely resemble the final treatment outcome, laboratory-fabricated provisionals also give you and your dentist a more accurate idea of whether you'll be able or want to live with the permanent restorations in that shape, design and fit.
If your permanent restorations are to be fabricated at an offsite dental laboratory, your dentist will make an impression of the teeth to be restored. Impressions and, in some cases, digital images of your smile, are sent to the laboratory where a three-dimensional wax-up is made of your desired smile makeover or restoration(s). The wax-up is returned to your dentist so that you can approve the shape, contours and look of the proposed treatment.
Following treatment approval, your teeth are prepared for their final restorations. Also at this time your dentist will make temporaries from the waxed model and attach them to your teeth using a provisional cement. Alternatively, instead of having your teeth prepared, your dentist could return the approved wax-up to the laboratory and have indirect temps made. If changes are necessary, they also can be made at that time.
Temporary restorations can be made using different materials. Your dentist will select the material that is best for you based on your treatment plan and how long you will need to wear them.
Materials used in the dental office for making provisional restorations include pre-formed (plastic or metal) crowns, self-cured or light-cured resins, or resin composites and cements. Laboratory-formed temporaries are usually made from self-cured, heat-cured acrylic or cast metal.
Pre-formed crowns, also known as proprietary shells, come in various sizes but usually need considerable adjustment. Plastic shells are made from polycarbonate or acrylic; favorable esthetics makes them popular choices among dentists for front (anterior) teeth. Metal shells may be made from aluminum, stainless steel or nickel chromium and are used for back (posterior) teeth.
Several self- or light-cured resins are available for either direct or indirect techniques. These include materials that are strong, wear-resistant, natural looking with good color stability, easily adjustable and capable of producing temporaries with a good, custom fit along the gum line.
Placement and Removal
It is very important that your temps stay in place. If they come out, the teeth and preparations could shift position, and this could cause a change in how your final, permanent restorations will fit. If they won't stay in place or you have a problem, call your dentist to schedule a brief appointment to have them re-cemented or replaced.
Provisionals are typically attached using provisional cement. The temporary cements dentists use often have a soft, creamy consistency and come with a modifier that is used to loosen the cement when it is time for them to be removed. Once the temporaries are sufficiently loose, your dentist will use finger pressure or an instrument such as a towel clip to carefully remove them.
How Much Do They Cost?
Usually there is not a separate charge associated with temporaries, since provisional restorations are a necessary part of many dental treatment procedures. The cost associated with temps is affected by different factors, including whether they were fabricated direct in the dental office by your dentist or a dental assistant, or created by an outside laboratory; the materials used to fabricate them; the types and number of adjustments that might be necessary; whether the temporaries are of one tooth or several.
An important cost consideration is how long the temporaries need to be in place. For example, if the temporary is a bridge with a dental implant underneath, it might need to stay in place for six months to a year. This is sometimes called a "long-term" provisional. Additionally, if the procedures that the temporaries are used for are cosmetic or elective in nature, dental insurance often does not cover the costs associated with them. For a more specific estimate, you should discuss fees with your dentist.
For example, consider that most cosmetic cases or smile makeovers involve the use of a diagnostic wax-up or diagnostic cast in order to determine the best way to enhance a person's smile. Dentists often charge for this service, and these casts may later be used for the creation of the temporaries. The average cost for diagnostic casts is $85.