By Lauren Krzyzostankiak
We know that offering patients amazing provisionals can be a practice builder. Even though the end goal is to replace them with the final restoration, provisionals serve many important purposes, even outside of what they do for the patient. With beautiful, functional provisionals and happy patients, dentists can reap major rewards of providing the best care possible in the provisional workflow.
In dental practices today, it’s all about optimizing the workflow and making things as efficient as they can be. That doesn’t mean cutting corners, however. In fact, it often means taking an extra step to ensure a successful final product, from provisional to final. I talked with Kathryn DeWood, DMD, a dentist in Bellevue, Washington, about how she makes sure to get the most from her provisional workflow. Here are her five tips for better results, a better patient experience, and a better seat day.
1. Use a reliable alginate substitute so you don’t have pulling
Many doctors think that provisionals don’t have to be perfect because they’re temporary, but the issue is in the time it takes to create a good provisional impression from the beginning.
One frustration that many dentists experience is pulling at the margin, but there is an easy fix for the problem: using a reliable alginate substitute.
“The most frustrating issue I have encountered in trying out many materials is getting pulls,” Dr. DeWood says. “One material in particular that I used always had pulls right at the margin. In the moment, it seems like a small problem because you think you can trim it back. Unfortunately, dealing with the pulls increases chair time, which can have a negative effect
on the patient experience.”
A reliable alginate substitute is the solution to headacheinducing pulls at the margin. Dr. DeWood’s patients appreciate how nice the provisional looks and are pleasantly surprised at how quickly it’s done now that she has transitioned to a more consistent material.
“My favorite material to use for avoiding pulls is StatusBlue from DMG,” she says. “It has a more viscous working time without being messy. It flows just enough.”
Before the prep, her assistant will rinse and dry everything really well and make sure there is no plaque build up. Dr. DeWood then uses the triple tray with StatusBlue, where it sets quickly and doesn’t pull. Her assistant relines with a very small amount of light-body flowable.
Dr. DeWood proceeds to get a good impression along the edges of the tooth. This ensures marginal integrity later on when making the final provisional. The overall process combined with StatusBlue saves her time in finishing and polishing.
“I hardly ever have to reline my provisionals when I start from a good alginate substitute with no pulls.”
2. Be conscious of where things could lock in
Taking a little bit of extra time with each step may feel unnecessary and time-consuming in the moment, but the time saved by producing a great product the first time around is worth it. In this case, the step that makes all the difference is using block-out resin or bite registration material to keep things from locking in.
“I’m always conscious of any area where temporary material could lock in. The simple solution is to use a block-out resin or bite registration material,” Dr. DeWood says. “An example of this is if I have a whole quadrant of exposed interproximal areas.”
Dr. DeWood’s favored technique is to express a small amount of bite registration material from a handgun on only one side (the material will flow in to the other). She then wipes the excess off.
“If you have good isolation, bite registration is fast and effective,” she says. “However, if you’re finding that the bite registration is not working, an easy alternative is block-out resin. It takes a little more time and can be slightly more expensive, but it will save you from having to deal with lock in.”
For Dr. DeWood, what makes the most difference is spending an extra five to 10 seconds with each step. This can save hours in the long run and reduce stress.
3. Polish impressions well
While the rewards of polishing provisionals often don’t show up until seat day, it’s critical to get the best polish and finish on provisionals as possible to keep the soft tissue cleansable and healthy. Doing so will ensure an easier seat day with no bleeding.
“I always want to get as smooth a polish and finish on my provisionals as possible, even if the result isn’t visible,” she says. “The rewards of using a highly-polishable esthetic provisional material like DMG’s Luxatemp Ultra really show up on final seat day. If you have a really well-polished provisional with great marginal integrity, the seat day will be a breeze.”
Dr. DeWood asserts that complications may also arise if a clinician uses an unsuitable cement.
“If your provisional fits excellently with good marginal integrity, and you use a great temporary cement that is easy to see and clean up like TempoCem ID from DMG, there will be minimal washout of the temporary cement while the patient wears the provisional. You’ll get less flash around the gingiva and less irritation.”
As a result, seat day will be faster, more predictable, and more comfortable for the patient. Another benefit is that the doctor is better able to assess the final restoration if the gum tissue is healthy.
“If gum tissue is unhealthy, you may not know what the margin will look like when it heals,” Dr. DeWood says.
“Unless you’ve set it subgingivally, you might have a line that the patient isn’t happy with. They won’t see it on seat day, so you won’t have a chance to rectify the situation.”
4. Place a retraction cord
Another step where taking a little extra time really helps is in placing a retraction cord. Dentists can make provisionals with the cord in place or immediately after removing it. Simply place the cord and let it sit for about five minutes before taking the final impression. You can take it out beforehand if you need to.
“When I finalize the prep, I place the cord and let it sit for five minutes. I then remove either one or both cords before taking the final impression,” Dr. DeWood says.
Dr. DeWood explains that using a quality impression material for your final impressions is crucial. For this process, Dr. DeWood uses Honigum by DMG. During the three minutes when the final impression sets up, the sulcular space is held by Honigum light-body flow material. Because she doesn’t need to repack the cord, she gets the benefit of Luxatemp Ultra flowing into that space when making her temporaries. The result is an excellent marginal seal in her temporaries.
“If you get that good initial impression, use enough material, and plant the cord correctly, every step flows and leads to a better result. Cutting corners only ends in spending twice as much time on troubleshooting problems.”
5. Use a varnish or gel
Dentists often try to get through procedures as efficiently as possible, but it’s important to remember that haste makes waste, especially in the operatory.
“I will place Cervitec Plus around the margin on the gingiva after I seat every provisional,” Dr. DeWood says. “It functions as the belt and suspenders in terms of keeping tissues healthy while the provisional is in place.”
While applying the varnish is an extra step in the workflow, Dr. DeWood is confident that it helps her be more efficient in the operatory.
“I advocate for the ‘haste makes waste’ theory,” she says.
Using all five of Dr. DeWood’s provisional workflow tips will ensure a more streamlined, efficient, and overall successful process. These techniques reduce the frustrations that can come up while making a temporary restoration. The ultimate outcome is less chair time and a superb patient experience.