Ideally we want is for our patients to come for their insert appointment with gorgeous tissue. We don’t want any issues or complications for our day of ceramics, a fundamental key to success in this is the fabrication of your provisional restorations.
Below is a step by Step guide of how I handle most anterior aesthetics temporaries using a shrink Wrap Provisional technique.
1) So for me it all starts with a Diagnostic Waxup
2) From the waxup the lab fabricates the Siltech. Gold Dust Dental Lab will fabricate a siltech with a gasket if you ask, to minimize splash when seating.
3) The shrink to fit or shrink wrap technique works great with preps like these, but can even work well with more aggressive preps. Just be ready to have to cut the temps off.
4) Paint the preps with Telio CS or Gluma Desensitizer. I blot this dry with a cotton roll or 2×2. Do not over dry the preps with your air water syringe tip.
5) Next paint your preps with Optibond FL Primer using a micro brush. This step is crucial for eliminating the black scuz. Air dry this!!
6) Now load your siltech and seat it to place. You can use your favorite Bisacryl, like Heraeus Venus Temp II. I let it set for 2 minutes. Tease off the Siltech and if you didn’t overfill it you should be left with some flash on the tissue. Start to remove the access immediately. I use rotary instruments almost exclusively to trim. I go around all the margins, making sure they are smooth, and I open up the interpoximal embrasures so that I am able to get superfloss through each area.
7)Temps finished and polished (prior to sealing). This gloss is achieved with the white carbide burr.
8) NOW COMES THE KEY- THE POST OP INSTRUCTIONS
- If I used the laser on the patient- they are given a rubber tip stimulator and told to go around the area that was lasered for next 3 weeks.
- Patients are given Endo syringes with fuzzy tip applicators to fill with Hydrogen peroxide. They are told to use to flush around the temporaries for the next two weeks.
- Super floss is to be used every day, at least twice a day.
- Brush as normal
- Patients are given Chlorehexidine and told to stop using peroxide and to use the chlorehexidine in it’s place for 1 week prior to their insertion appointment.
At the insertion visit, I use a hemostat interproximally and squeeze! I warn the patient of the load cracking sound that is going to occur. The temps will “pop” right off.
This technique is predictable and one I’ve been using for about the last ten years with great success.
Originally Posted on the Clinical Mastery Series blog, including a photo tutorial of the steps.
Sanford Daniel says
What technique do you utilize when you have a combination of veneers and full coverage restorations?
Lee Ann Brady says
If the number of full crowns is small, like one tooth I will still use shrink wrap. When I do posterior quadrants with crowns, and anteriors in veneers. I use shrink wrap for the anteriors, and once they are in place use an indirect technique for the posterior full coverage units.
Russell Colclough says
Im chiming in 5years late! My question is, why not shrink wrap all provisionals regardless of prep design?