When I teach provisional fabrication I discuss three methods for veneers, direct, indirect and shrink wrap. For many years I have preferred using an indirect technique for the fabrication of veneer provisionals, and last week reminded me why it is my favorite approach. So I can’t even tell you why, but last week I attempted to make a set of veneer provisionals for six maxillary anterior teeth directly in the mouth, after the third failed attempt my brain kicked in and I remembered why I do them indirectly. The learning was in regards to the setting of bisacryl provisional material. Ideally we remove the material from the mouth when it is in a gel phase, it comes out inside the matrix and then we can allow it to reach a full set. Veneers present two challenges, one is that in the gel phase for conservatively prepared teeth the bisacryl pulls and tears and is not easy to remove without damaging it.
The second is that bisacryl does undergo polymerization shrinkage, and when not on the preps for veneers the material warps enough that reseating on the teeth is not possible. Hence the development of a shrink wrap technique which allows the bisacryl to reach a full set in the mouth, and all the trimming and shaping is done in the mouth. Also the development of an indirect technique, which again allows us to over come both challenges, early removal and shrinkage. Of course working indirectly always has the advantage of allowing the patient to rest, no taste of bisacyl in their mouth, no uncured bisacryl against the preps and quiet time in the lab for me to make the provisionals.
After taking my final impression I capture a quick alginate impression of the final preps. From this impression I fabricate a silicone model made from Mach II die silicone and bite registration silicone. The flexibility of the silicone model and it’s smooth surface are an advantage over stone, not to mention the rapid set. I use a silicone matrix, but copyplast or other types of matrix will work. I load the matrix with bisacryl, the model which has a flat base is resting on the counter, I seat the matrix and apply light pressure while the bisacryl sets. Do not do this with the model and the matrix in your hands as you can flex it and introduce distortion. After the provisional has been trimmed and shaped another advantage is being able to polish it on the model and prevent breaking it at the very last stage.
Your indirect veneer provisionals look really beautiful Lee Ann!
Great technique. I have been shrink wrapping mine, didn’t even know it was called that, but trimming after is always so tedious. I cant wait to try this. What are you using to cement your temps in? Have you ever found it necessary to spot etch and bond them in? For cases of less than 6 I usually do, but the trade off is they can be tough to remove.
Great Blog keep it up!
Michael,
I actually spot etch and use flowable to cement all my veneer temps. You are correct it’s a tradeoff, but I’d rather cut the temps off than have a patient with temps that fall off. I place a 3mm diameter spot of etch on the direct labial, rinse and dry, then load the temps with flowable, seat, clean the excess then light cure. Normally to remove I slice up the facial, and through the interproximal if the preps went through. Use a plastic instrument or crown remover and twist in each slot and the pieces pop off. I then use a FG brownie on low speed to get any residual resin off the preps as it will not cut the tooth structure, just the resin.
Lee
Awesome post Leann thank you!! Do you cement the temps in segments like 2 or 3 teeth per segment? Thank you!!
Thanksn a lot for your information! Would it be possible to get some information how to fabricate temporaries crowns and bridge. I’m pretty sure you know different and fast techniques of doing this. I’m from NJ I wish you could be in this are so I could be able to go to your workshops. Thanks again.