How to Make a Great Provisional (AKA temporary crown)

We use bite registration material  and a 2x2 gauze to take a pre-op impression.  By using the bite registration instead of alginate, you will have the impression available if you would need to remake the patient's temporary crown before his or her scheduled delivery date.  Using this technique also saves on the inventory budget and scheduled "chair time" for re-makes. 

Steps:

1.) Dispense the bite registration onto the 2x2 gauze in the form of a thick line.  Keep in mind you will need enough material to cover at least one adjacent tooth on each side of the tooth that is being restored. 

2.) Quickly mold the material onto the three teeth you are going to capture in the impression.  Place it directly on the incisal/occlusal surfaces and evenly mold it to the buccal and lingual surfaces, creating an exaggerated "U" shape.  

3.) Allow the bite registration to fully set in the mouth. 

4.) After the tooth has been prepped for the veneer, crown, or onlay, dispense the acrylic temporization material (We like Protemp Plus) into the pre-op impression and place the impression in the mouth until nearly set. (For most materials, 1 min and 10 sec usually allows the material to be flexible enough to easily remove excess from the impression and adjacent teeth.)

5.) Place your temporary crown back onto the tooth until it has fully set.  Check the bite with articulating paper and adjust if necessary.

6.) Carefully trim the margins and contacts and taper towards the gingival margin.  Be careful not trim too much - you do not want a temporary without interproximal contacts.  (If you are temporizing more than one tooth, and your provisional crowns will be connected, you must trim the contact and embrasures properly to allow a "triangle" for the interdental papilla.  If you skip this important step, the tissue may be traumatized and become blunted.)

7.) "Rough" the inside surfaces of the temporary crown with a slow speed hand piece and a diamond bur.  By taking away the air-inhibited layer on the inside, the cement will adhere to the temporary better.  Again, be careful not to ream out the inside - you just want to gently remove a thin layer and rough the surface.

8.) If a build-up was placed, apply a glycerin gel (We like Ivoclar Vivadent's "Liquid Strip.") to the build-up only, before using temporary cement. This will prevent the cement from adhering to the build-up instead of the tooth. 

9.) Cement the temporary crown, remove marginal excess, and be sure the patient can floss between the interproximal contacts.  ( We like Dent Zar, Inc.'s "Olympian-M" temporary cement.)