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Laboratories are typically asked to fabricate a transitional partial denture or "flipper" as a temporary restoration in single-implant cases. The problem is that the esthetics are less than acceptable, the patient has trouble eating with the flipper in place and it can be detrimental to the supportive tissues in the maxilla. In fact, the patient often ends up not wearing the flipper, which can lead to movement of the adjacent teeth and failure to maintain desired tissue condition and profile. Flippers are also subject to frequent breakage and non-revenue repair time for the laboratory.
Alternatively, a bondable temporary restoration for a single-tooth implant can go a long way to satisfy retentive, esthetic and functional requirements. The bonded restoration is very stable in the patient's mouth and is easily retrievable by the dentist when the patient is ready for a permanent restoration.
Here is a quick-and-easy technique for an esthetic, bondable provisional restoration using eFiber, a very strong, opaque glass fiber that is impregnated with both PMMA resin and BIS GMA. Both the clinical and laboratory techniques are simple and the restoration can be fabricated in advance and delivered when the implants are placed.
What do we need from the dentist?
- Maxillary and mandibular model or impressions.
- A bite registration if necessary.
- A tooth shade.
- Instructions as to desired pontic design or shape.
Below is the process:
STEP 8: Using the measured length of floss, cut the eFiber to the proper length (it’s easier if you leave it in the silicone carrier while you cut).
STEP 7: Using the silicone matrix, reposition the prepared tooth on the model. Use floss or wax rope to measure the length of eFiber needed.
STEP 12: Remove the eFiber from the tooth and place a small amount of flowable composite in the retentive groove of the tooth.
STEP 14: Light cure the flowable composite and reinforcement material with a hand-held curing light. Be careful to keep the flowable composite off the retentive wing areas of the eFiber. Again, I recommend that two people complete this step: one holds the eFiber in position with an instrument while the other holds the curing light. Otherwise, the eFiber might move during curing.
STEP 13: Place the eFiber back in the groove on top of the flowable composite, then lightly cover it with more flowable composite.
STEP 11: Light cure the eFiber in position so it maintains its shape during the rest of the process. This is easier to accomplish if you have someone hold the light while you keep the material in proper position.
STEP 5: Using the putty matrix to position the tooth back on the cast, draw or mark the position of the retentive groove to be cut on the lingual of the tooth. Keep in mind you want the retention wings to be out of occlusion, so you may want to cut the retentive groove as a semi-circle or arc to assist in positioning the retention wings in the cingulum area.
STEP 9: Paint a small amount of eFiber adhesive, and then the eFiber, in the prepared groove in the denture tooth.
STEP 3: Select the appropriate mold and shade of composite denture tooth to fill the space. Adjust the tooth to fit the space and the desired pontic design or ridge relationship.
STEP 17: The bondable, non-invasive esthetic temporary is ready to be sent to the dentist. I recommend cutting back the putty matrix so the dentist can use it as a bonding index to hold the restoration in place during bonding. Include the bonding instructions for the dentist.
STEP 1: Mount casts on a simple articulator using the bite registration if supplied. When you’re preparing the restoration prior to tooth extraction, remove it from the cast as you do for an immediate denture and keep in mind the pontic design.
STEP 4: Use a little utility wax to hold the tooth on the cast in the desired position and make a labial putty matrix, which holds the tooth in position during fabrication and may also be used later by the dentist as a bonding matrix (see Step 17). Place eFiber within the normal contours of the denture tooth by cutting a retentive groove in the lingual of the tooth.
STEP 2: Check to be sure there is adequate interocclusal space for the retention wings to be bonded to the adjacent teeth. Often times, the wings fit best in the cingulum area.
STEP 15: I like to add tooth-colored acrylic to fill in the pontic area. If necessary, you can add a flange on the labial with tissue-shaded acrylic. Don’t forget to place a separator on the model and eFiber adhesive on the tooth before adding the acrylic.
STEP 16: Complete any final adjustment to the lingual surfaces of the eFiber and composite using silicone polishers. I use a small polishing wheel made of chamois sandwiched between goat hair brushes along with some eFiber polish to achieve a beautiful luster.
STEP 10: Using a broad-bladed tool, put a small amount of pressure on the eFiber wing areas. This broadens or widens the eFiber and provides an increased surface area for bonding to the adjacent teeth.
STEP 6: Remove the tooth and use a small round bur to cut the retentive groove or slot.
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