ORIGINAL ARTICLE

Management of Provisional Restorations’ Deficiencies:

A Literature Review jerd_467 26..38

MICHAEL PATRAS, CDT, DDS*, OLGA NAKA, DDS, PhD†, SPYRIDON DOUKOUDAKIS, DDS, MSc, PhD‡, ARGIRIS
PISSIOTIS, DDS, MSc, PhD§

ABSTRACT
Provisional restorations are designed in order to protect oral structures and promote function and esthetics for a
limited period of time, after which they are to be replaced by a definite prosthesis. They play a particular role in
diagnostic procedures and continued evaluation of the treatment plan, as they should resemble the form and function
of the definite rehabilitation that they precede. Therefore, interim treatment should satisfy the criteria of marginal
adaptation, strength, and longevity. In complicated treatment plans that intend to last for extended periods of time, the
function of provisional prostheses involves the possibility of relining, modification, or repair. These adjustments raise
considerations regarding the strength of the resultant bond. Chemical composition of the base and repair material,
surface characteristics of fracture parts, and time elapsed since the initial set of the rehabilitation should be considered
in the decision of the appropriate repair material and technique. Proper pretreatment of the provisional components’
surfaces is essential to ensure bonding as well.
The purpose of this article is to illustrate the management of provisional restorations’ deficiencies. This article highlights
possible failures of custom-fabricated provisional restorations, describes methods to prevent their occurrence, and
discusses clinical techniques for their management. Finally, the proper combination of materials and surface preparation
to achieve the optimum treatment outcomes are presented.

CLINICAL SIGNIFICANCE
Provisional restorations’ failures and other deficiencies are encountered by clinicians on a daily basis. Adequate
laboratory techniques and material combinations presented herein may contribute to their efficient and predictable
modifications and repairs.
(J Esthet Restor Dent 24:26–39, 2012)

INTRODUCTION The interim treatment focuses on protecting pulpal and

periodontal health, promoting guided tissue healing in
According to the Glossary of Prosthodontic Terms,1 order to achieve an acceptable emergence profile,
“provisional or interim prosthesis or restoration is a evaluating hygiene procedures, preventing migration of
fixed or removable dental or maxillofacial prosthesis the abutments, providing adequate occlusal scheme,
designed to enhance esthetics, stabilization and/or and evaluating maxillomandibular relationships.2–6 From
function for a limited period of time, after which it is to the clinician’s standpoint, provisional restorations play a
be replaced by a definitive dental or maxillofacial key role in the diagnostic procedures and continued
prosthesis.” evaluation of the treatment plan, as they must resemble

*Postgraduate Student, Department of Prosthodontics, University of Athens, Athens, Greece

†
Lecturer, Department of Prosthodontics, Division of Removable Prosthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece
‡
Assistant Professor, Department of Operative Dentistry, University of Athens, Athens, Greece
§
Professor, Department of Prosthodontics, Division of Removable Prosthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece

26 Vol 24 • No 1 • 26–38 • 2012 Journal of Esthetic and Restorative Dentistry DOI 10.1111/j.1708-8240.2011.00467.x © 2011 Wiley Periodicals, Inc.
 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

the form and function of the definitive rehabilitation other hand, the ease of manipulation, the superiority
that they precede.7,8 Provisional treatment can also of the mechanical properties, combined with the
provide an important tool for the psychological disadvantages of increased cost, the need of special
management of patients, whereas a mutual equipment, and the extended time for fabrication
understanding of treatment outcome and limitations of should be taken into consideration in indirect
treatment can be identified.9 It is therefore techniques.20 The main goal should be the
comprehensible that the realization of this essential step construction of properly contoured and well-fitting
and the quality of the provisional restorations can be provisional restorations that maintain their integrity
the difference between overall treatment success or throughout the reasonable time from tooth
failure.2,6,10,11 preparation to completion of definitive treatment.21

Provisional material selection should be based However, the Muse of interim prostheses in
on how their mechanical, physical, and complicated rehabilitations for extended periods of time
handling properties fulfill specific requirements involves the possibility of relining, modification, or
for any clinical case. Other factors to be repair. It also raises considerations regarding failures as
considered are biocompatibility and complications a direct reflection of the physical properties of the
from intraoral use, such as chemical injury provisional material.
from the presence of monomer residue and
thermal injury from an exothermic The purpose of this article is to illustrate the
polymerization reaction.12 Nonirritating management of provisional restorations’ deficiencies.
reaction to the dental pulp and gingival This approach intends to highlight the possible failures
tissues, appropriate marginal adaptation, of the custom-fabricated provisional restorations,
great tensile strength, dimensional stability, display their prevention of occurrence, and demonstrate
esthetically acceptable shade selection, ease their inevitable rehabilitation as well. The combination
of contour, and repair are extremely important of materials and preparation of the restorations’
parameters to the success of provisional surfaces in order to achieve the optimum treatment
treatment.2,3,5,13–16 The most common materials outcome are emphasized.
used for custom interim-fixed restorations
are several types of acrylic resins such as (1)
polymethyl methacrylate (PMMA) resin, (2) DEFICIENCIES AND THEIR HANDLING
polyethyl methacrylate (PEMA) resin, (3) polyvinyl
methacrylate resin, (4) bis-acryl composite Marginal Inaccuracy
resin, and (5) visible light-cured urethane
dimethacrylates.3,5,17–19 Provisional restorations should exhibit accurate
marginal adaptation to the finish line of the
Direct, indirect, or combination technique, and prepared tooth in order to protect the pulp from
custom fabrication or fabrication with preformed thermal, bacterial, and chemical insults.22
materials are well documented in the literature. Intrasulcular extension of the preparation requires
The selection of the appropriate technique for the additional support for the free gingival margin
corresponding adjustment involves factors such to provide the appropriate emergence profile.23
as the strength of the bond, the working and Deficiencies can occur when autopolymerizing acrylic
setting time of the material, the ease of resin is used, due to dimensional contraction because
handling, and the cost. One should consider the of the difference in density between the polymer and
advantages of saving time and low cost, along with the the monomer. It has been stated that volumetric
disadvantages of the presence of saliva, reduced polymerization shrinkage for PMMA is 6% compared
visibility, and access in direct techniques.20 On the with 1 to 4% for composite materials.24 The longer the

© 2011 Wiley Periodicals, Inc. DOI 10.1111/j.1708-8240.2011.00467.x Journal of Esthetic and Restorative Dentistry Vol 24 • No 1 • 26–38 • 2012 27
 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

FIGURE 1. Fracture of an implant-supported provisional FIGURE 2. Fracture of an acrylic resin interim prosthesis at
restoration due to parafunctional activity. the connector’s site.

span of the prosthesis, the greater the shrinkage and the taper or marginal configuration of the prepared
distortion are, resulting in less satisfactory adaptation tooth occurs.
over the abutments.25,26
In these instances, the resulting marginal gaps may be
Additionally, marginal defects are closely related minimized by relining the restorations. The addition of
to the direct or indirect technique chosen. Indirect provisional material allows closer adaptation to the
fabrication provides significant improvements finish line of the prepared teeth.23 Relining has been
in marginal fit relative to direct methods when recommended at the time of fabrication25,37 in order to
polymethyl (PMMA) or polyethyl (PEMA) compensate for the polymerization shrinkage of the
methacrylate resins are used,27,28 as the acrylic resin resin4,25 and to improve the initial retention.38 Likewise,
polymerizes in an undisturbed manner.29 the smaller the marginal gap, the less is the dissolution
Direct fabrication is usually carried out by successive of temporary luting cements and plaque accumulation.23
removals and repositioning of the material over the
prepared teeth or bench polymerization after initial set Fractures
in order to avoid pulp damage.16 The time of the
removal plays a crucial role in limiting the material’s Fracture of provisional restorations may occur upon
distortion.30 removal from the mouth, during construction,
trimming, or function.21,39 This failure often occurs as a
Other causes of defective marginal fit regard provisional result of a crack propagating from a surface flaw,40
restorations that fall short in length, either during inadequate transverse strength, impact strength, or
construction or after the removal of the marginal fatigue resistance.41,42 Stress concentration during
flash.25,31 The moisture of the oral cavity, temperature functional or parafunctional activities often leads to
changes, and occlusal forces after prolonged intraoral fractures (Figure 1), especially in a connector’s area of a
service also affect the fit of provisional long-span interim restoration14,43 or where voids have
restorations.23,32–36 Furthermore, recementations during occurred during fabrication.44 Additionally, the minimal
various stages of a treatment plan require the removal preparation of a tooth results in a thin interim
of temporary cement, followed by inevitable trimming restoration that is more subject to fracture, particularly
of their intaglio surface, in a way that progressively in the cervical region.44 Fractured connectors (Figure 2)
compromises the initial marginal accuracy.25,29 Finally, and missing margins can compromise function,
the fit and marginal integrity of an existing provisional jeopardize tooth and soft tissues’ structures, and cause
restoration can be compromised when an alteration of embarrassment and discomfort to the patient.14,45

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 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

The best method to reduce the likelihood of fracture is Nonintegrity of the External Contour
to select the appropriate material based on its
behavior in the oral environment when it will be subject Adding material to achieve the desired morphology and
to aging, fatigue, water sorption, and wear proper contacts with opposing or adjacent teeth is often
processes.35,36,46 Hence, it is important to know the necessary.38 The correct shaping of the external
flexural strength of various types of resins for contours provides proximal and occlusal stability, and
provisional restorations, as most of them are brittle.47 maintains tooth positions while the restorative plan is
Despite conflicting reports in the literature, it is executed. Moreover, it enables the patient to
generally accepted that PMMAs exhibit higher fracture self-evaluate the appearance, especially in the esthetic
toughness than bisphenol A glycidyl methacrylate region, and provides a blueprint for the definitive
(bis-GMA) resins.48–50 Recently, the resins have become restoration.26 Alterations to the external contour of a
more widely used even though they are more prone to provisional restoration may also be required after tooth
fractures when used in long-span bridges. As extraction(s) or surgical alteration(s). The shape of an
heat-polymerized acrylic resin materials are denser, unfavorable residual ridge61 may be transformed by the
stronger, and more resistant to fracture than their gradual addition of material to create pressure, resulting
auto-polymerized20,40,51 and light-polymerized in a more favorable tissue configuration (site
counterparts,52 they should be considered for use when conditioning).62
provisional treatment for prolonged time or additional
strength are required.
MATERIALS AVAILABLE AND BONDING
Metal castings and swaged metal substructures, in STRENGTHS CONCERNING RELINING,
combination with resinous materials, have been MODIFICATION, OR REPAIRS
reported as especially useful with long-term or
long-span interim treatment.2 When utilized, Making additions to remedy many of the deficiencies
care must be exercised to prevent violation of the cited above may require the use of the same material or
physiologic contours of the provisionals, the combination of different materials.63 Compatibility
given the additional thickness of the reinforcing issues may arise affecting the overall success of bonding
substrate.53 between the provisional base material and the
correcting material. In that instance, it seems that the
Attempts have been made to strengthen provisional most critical step is the appropriate surface treatment
dental resins by the application of fibers. Compared with before the bonding between the two materials is
metals, fiber reinforcement possesses superior attempted.39
mechanical, esthetic, and cohesive characteristics and
has the advantage of being a lighter-weight In general, the chemical similarity of the materials
composite.54 Materials used for fiber reinforcement have seems to be of great importance in polymer repair.39
included glass, carbon graphite, sapphire, polyester, and Using provisional base and repair resins with similar
rigid polyethylene.40,55–57 Most of these materials have chemical skeletons seems to provide greater bond
had little or no success in increasing the resulting tensile strengths compared with using dissimilar ones.39
strength of the overall restoration.52,55 The fiber quantity
and the reinforcement location rather than the length Among the materials used for these instances, self-cured
affect the strengthening efficiency.54,58,59 acrylic resins have the ability to easily reconstruct the
Preimpregnation of the fibers using the shape defects, allowing simple and quick manipulation.
polymer–monomer mix for methacrylates and a Unfortunately, the use of this material is also associated
bonding agent for bis-acryl resins provides optimal with unpleasant odor, significant shrinkage, short
adhesion between the fibers and the polymer matrix,49 working time, and a pronounced exothermic setting
upgrading the strengthening effect.60 reaction.16,39 Moreover, residual methacrylate monomer

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 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

FIGURE 3. Patient presented with a fractured provisional FIGURE 4. The application of methacrylate monomer
restoration in the region between #25 and #26. activates the polymer chains of the substrate matrix and
enhances bonding of the repair material.

demonstrates cytotoxicity and potential allergic

reactions.64,65 Heat-cured acrylic resins have lower
repair strength compared with self-cured PMMA resin
maybe due to fewer free carbon double bonds available
for reaction with the PMMA repair resin.57,64 The
surface design seems to be an important issue in the
strength of the repair; however, the mechanical
retention of the rough, untreated PMMA surface does
not provide a strong enough bond between the repair
surfaces and the self-cured resin.66 Wetting the repair
surfaces with methyl methacrylate monomer or
acetone67 has been suggested to dissolve the PMMA,
permit the diffusion of added acrylic resin, and ensure a FIGURE 5. View of the provisional prosthesis after the
repair process.
good bond,66,68 especially in aged restorations,21 due to
the formation of new polymer chains66 (Figures 3–5).
manipulation, adequate working time, minimal odor,
Bis-acryl resin composites have become extremely low polymerization shrinkage, and increased marginal
popular during the past decade due to ease of use, accuracy.39,63 The shear bond strength between them and
minimal shrinkage, and low exothermic reaction.30,31,69 A bis-acryl resins has been shown to be effective and
more accurate mixing, due to the cartridge dispensing durable,44 although the resistance to fracture of this
system, may contribute to improved marginal fit. Many approach remains questionable.39
authors report that the use of methacrylate resins to
repair bis-acryl provisional restorations results in a Attempting to bond newly polymerized composite to
weaker bond between the two materials due to aged composite raises concerns about the predictability
incompatibility.5,14,39,44,70 More recently, light-cured of adhesion. It has been stated that the primary
flowable resin composites have been suggested for the interfacial bonding between layers of composites
intraoral repair of bis-acryl resin composite provisional decreases as the original layer sets,71 perhaps because the
restorations.21,44,63 Light-cured flowable resin materials number of unreacted methacrylate groups decreases
offer various advantages including availability in during polymerization.72 As polymerization proceeds,
numerous shades and viscosities, ease of application and the solubility and permeability of the polymer decrease,

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 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

thereby reducing the extent of primary and secondary

bonding of new composite to the aged composite
surface.71 The composition of the base material, the
composition and viscosity of the repair material, the
repair liquid, and the surface texture seem to have an
influence on the bond strength. It has been found that
the increased surface roughness can promote
mechanical interlocking, and the coating of composite
substrate with unfilled resin bonding agents (bis-GMA/
triethyleneglycol dimethacrylate (TEGDMA)) can
advance surface wetting and chemical bonding.44,71–76
The viscosity of light-cured resins may have certain
effects on the repair strength as far as their penetration FIGURE 6. Roughening of the cervical areas prior to
in the interface is concerned,73 and low viscosity repair relining.
composite material leads to better adaptation.71 can be solved to a great degree by venting prior to
Furthermore, a combination of air abrasion and a relining.25,26 Alternatively, the removal of part of the
bonding agent seems to be the most effective protocol internal layer of the provisional restoration is
for composite-to-composite repairs.75,77 recommended prior to adding the material to allow
sufficient space for the new resin addition, reduce
Light-cured flowable resin materials can also be hydrostatic pressure, and permit complete seating.23,26,34
incorporated into freshly prepared provisional Trimming of cement remnants and roughening of the
restorations fabricated from PMMA in order to external surface of the margins prior to relining are also
improve their esthetic appearance, contour, and critical to ensure good adhesion of the new resin to the
marginal adaptation.78,79 The bond strength between aged restoration (Figure 6).
PMMA and flowable composite resin can be increased
by first wetting the surface with a bonding agent in Additional preparatory steps are recommended
order to promote a more effective chemical bond according to the chemical composition of the materials
between the surfaces.77,80 involved. A fresh wash of acrylic resin may be added
with a “salt and pepper” technique or can lightly be
Alternative indirect or direct procedures for fabricating adapted over the margins with a fine brush38 (Figures 7
multiple-unit provisional restorations suggested the use and 8). Immediately, strong finger pressure38 or a
of a light-cured composite as a shell, and a combination repositioning key81,82 is applied to ensure proper seating.
of self-cured bis-acryl composite and flowable The potential trauma from excess monomer and the
light-cured composite to improve marginal heat generated by the exothermic reaction, although
adaptation.81 limited to the low volume of the reline material,26,81 may
be reduced by lightly spraying water over the area
Specific Clinical Procedures during active polymerization.29,38,83,84

Relining The difficulty of achieving satisfactory intrasulcular

Self-cured acrylic materials23,70 or light-cured flowable adaptation28 could be overcome by the placement of a
composite resin materials63 may be used to reline a retraction cord and by subsequent exposure of the
provisional restoration. Special attention is required as margins during direct fabrication.4
it has been reported that a majority of restorations are
not fully seated to their original position following the Repairs
reline procedure due to the interference of hydrostatic Repair may often be preferred to refabrication due to
pressure25 caused by the additional resin. This problem better efficiency, reduced cost, and time savings.21,39

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 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

FIGURE 7. Addition of the new layer utilizing the FIGURE 8. View of the margins after the intraoral reline.
bead-brush technique.

FIGURE 9. Roughening of the fractured parts removes the FIGURE 10. Sandblasting enhances overall roughness and
contaminated surface layers and the preparation of the micro-mechanical retention.
proximal boxes (marked in pencil) increases the
macro-retention thus creating more surface area for bonding.

However, the decision to repair or fabricate a new surface layer prior to the addition step, thus providing
provisional construction should be taken individually additional mechanical roughness that facilitates
according to the requirements of the case and always mechanical interlocking.89 Common methods for the
considering that the repaired provisional’s strength is provisional component’s adjustment include
inferior to the new ones.14,85 It is well documented that pretreatment of their surfaces in a 45-degree bevel and
the repair of aged restorations is less structurally rounded surface design,90 roughening with a rotary
effective than that of freshly fabricated provisional cutting instrument,89 open proximal boxes45 (Figure 9),
restorations.71,72,86 This is due to the fact that aged or air abrasion (micro-etching with aluminum oxide
restoration has a reduced number of free radicals87 and powder) (Figures 10 and 11) with or without
has absorbed water from saliva and other fluids into its intermediate bonding resin.44
surface.88
External Modification
Attainment of the appropriate chemical bonding For minor modifications, the previously mentioned
requires the repair surfaces to be free of technique of adding wash of acrylic resin with a brush
contamination.66 Therefore, it is critical to remove a allows easy and quick adjustment of the external

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 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

FIGURE 11. View of the repaired interim prosthesis. FIGURE 12. During intraoral fabrication, voids (marked in
pencil) or marginal gaps may occur due to air entrapment or
insufficient volume of the material.

FIGURE 13. Addition of flowable composite resin in newly FIGURE 14. Minor repairs and modifications may enhance
fabricated provisionals corrects the deficiencies without the the contours and the emergence profile of the prosthesis.
need of conditioning with a bonding agent.

contours26,38,91 in order to correct a marginal gap, the valuable management strategy to enhance the tissue
emergence profile, or proximal and occlusal contacts of conditioning. The amount of resin to be added is
the provisionals (Figures 12–14). Surface treatment and judged through an analysis of the shape of the tissue
conditioning seem to be mandatory depending on the and esthetics.92
combination of the materials as mentioned above,
especially in aged restorations. Although effective, this
technique is time consuming,21 and the limited working DISCUSSION
time of these materials adds a hurdle in accurate
modification, especially when the process includes By definition, provisional restorations are an
multiple teeth and extended prostheses.39,42 indispensable and demanding step in prosthodontic
The use of flowable composite resin is effective in this treatment. Provisional treatment focuses on protecting
case too.21,63 oral structures and promoting function and esthetics. In
complex cases, interim treatment is critical and must
In order to improve underlying tissue contour, adding a satisfy the criteria of marginal adaptation, strength, and
new layer of acrylic or composite resin has been a longevity. Limitations due to mechanical properties of

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 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

the materials used, as well as defects due to technical TABLE 1. Key points for achieving successful repairs
procedures, involve the possibility of relining,
Suitable material choice (compatibility)
modification, or repair of interim prostheses. Relining
may be necessary to maintain the accurate fit of Removal of a surface layer of appropriate thickness

provisional restorations due to distortion during setting Rational use of pretreatment procedures
or function. Modifications allow the development of the
Adequate viscosity and volume of repair material improves fracture
provisionals’ contour which mimics the proper anatomy strength
(size and shape) of the teeth. When interim
In aged restorations the repairability may be compromised and less
rehabilitation is intended to function for extended
predictable
periods of time or extends over long-span edentulous
spaces, deformation or fracture may occur during Identification and elimination of causative factors to reduce the risk
for additional fractures
chewing or attempted removal by the dentist. All of the
above compose a challenging task from a material or
clinical perspective.
restorations require a different approach due to the
Thus, it is important to be aware of the behavior of limited number of free radicals and the absorption of
each material in the oral environment, as there is an oral fluids.72 Repair of fractured, aged restorations needs
association between their physical properties and sufficient surface preparation by means of mechanical
clinical performance. None of the available provisional roughening or air abrasion. Roughening seems to
materials meet the requisite standards or covers the provide mechanical retention for the repair resin, thus
wide range of the clinical cases.39 Even among different increasing the cohesive strength. An increase in the
brands, the materials’ properties and clinical cross-sectional diameter of the connector where the
performance may vary considerably.14 As physical tensile stress occurs, combined with a reduction in
properties are material specific, clinicians should be depth and sharpness of the embrasures, is also
familiar with the essential characteristics and follow suggested, considering at the same time the
manufacturers’ instructions. preservation of oral hygiene.26 Finally, as the bond is
mostly chemical, it is important that it not be
If a deficiency occurs, its management should contaminated by residual cement or other substances.66
be based on information gathered from a research of All the above parameters serve as important guidelines
the current literature. The practitioner should be to be considered before initiating a repair process
mindful that reviewed studies often constitute (Table 1).
laboratory findings only and may not reflect intraoral
conditions. The information derived from in vitro Nevertheless, the resultant bond is weak. This raises
studies is helpful nevertheless, as it is established concerns about the benefit to carry out a process with a
under controlled situations and therefore a useful possible short longevity or to fabricate a new interim
predictor of clinical performance, although not a restoration. In that case, the existing conditions and the
guarantee. cost/benefit ratio in terms of the requisite cost and time
to repair or to remake should be taken into account.
Several parameters should be considered in the decision
of the appropriate repair material and technique, Among the materials outlined above, weak bonds in
including the chemical similarities or discrepancies modification areas are reported regarding
between the base and repair material, the surface heat-polymerized resins,39,64 leading to adhesive failures.
characteristics of fractured parts, and time elapsed since Instead, auto-polymerized resins are the material of
the initial set of the rehabilitation. Proper pretreatment choice as they show residual carbon bonds able to
of the provisional components’ surfaces seems to be obtain chemical connection to repair resins with similar
essential to ensure bonding. Moreover, aged provisional chemical structures.39,64,65 The use of flowable composite

34 Vol 24 • No 1 • 26–38 • 2012 Journal of Esthetic and Restorative Dentistry DOI 10.1111/j.1708-8240.2011.00467.x © 2011 Wiley Periodicals, Inc.
 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

TABLE 2. Material combinations and suggested surface treatment for effective and durable bonds
Provisional substrate Repair material
material Self-cured acrylic resin Bis-acryl composite resin Light-cured flowable resin

Self-cured acrylic resin roughening, sandblasting + monomer low shear bond strengths 39
roughening, sandblasting + monomer
(MMA)39,86 (not recommended) (MMA)
+ bonding agent39,77,80
(material specific)

Heat-cured acrylic resin roughening, sandblasting + monomer low shear bond strengths39 roughening, sandblasting + bonding
(MMA)39,80 (not recommended) agent80

Bis-acryl composite resin low shear bond strengths39,44 roughening when newly roughening,21,44 sandblasting +
(not recommended) fabricated39,44,63,86 bonding agent39,63
(not recommended in aged (material specific)
restorations14,86)

Light-cured composite resin roughening + bonding agent when roughening + bonding agent when roughening, sandblasting + bonding
(material-specific) newly fabricated39 newly fabricated39 agent39,76,77,85
(low shear bond strengths in aged (low shear bond strengths in aged
restorations) restorations)

MMA = methyl methacrylate monomer.

resins, which can be placed, contoured, and CONCLUSIONS

cured on command and are compatible to
bis-acrylic and PMMA resins,39 make the adjustments Marginal adaptation and durability are of high
more time- and cost-effective as the materials required clinical relevance in provisional treatment.
are used in routine remedial rehabilitations. This in As the direct method of fabrication continues to be
turn eliminates the unpleasant odor and tissue irritation popular because of time- and financial-related
of the PMMA monomer, reduces clinical time, advantages, modifications will be common
increases the productivity in the dental office, and procedures during a treatment period. Those
differentiates the cost of the repair process. adjustments require additional chair-time,
proper materials’ combination, surface
In the authors’ experience, Table 2 provides the preparation, and adjustment prior to bonding.
adequate sequence of steps along with The use of practical methods and efficient
recommendations for reliable repairs in a simplified techniques enhances the longevity of provisional
way. It should be noted, though, that most of the in restorations, maintains or restores the health and
vitro studies provide results regarding newly contour of the underlying and surrounding
fabricated specimens. Also, different brands tissues, and ensures the patient’s comfort and
present materials with different chemical satisfaction. Precise knowledge of available materials
compositions. Consequently, the suggested and techniques enables the clinician to reline,
combinations of treatments may not be modify, or repair these restorations through a simple
applicable to aged restorations and to all combinations and reliable process.
of substrate and repair materials; therefore, the fracture
resistance at the repaired joints may vary. Because there
is usually a lack of residual monomers in aged DISCLOSURE
composite resins, and hence the likelihood of a
weakened chemical bond for future repairs, The authors have no financial interest in any of the
micromechanical features should always be included as companies whose products are mentioned in this
part of the repair process. article.

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 MANAGEMENT OF PROVISIONAL RESTORATIONS’ DEFICIENCIES Patras et al

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