hello and welcome to chairside live I'm your host Megan strong thanks for tuning
in today in this episode registered dental assistant will Schmidt is back
with another edition of across the chair he's discussing the temporary
cements he uses for Provisionals let's hand it over to will and see what sticks
well thank you Megan quite often on chair side live I present detailed tips and techniques on
bio tip fabrication and placement I recently received a viewer question regarding temporary
cements and my preferred choices during the bio temp placement stage I don't believe that any case
is typical and there's no single universal cement that is advised for all cases today let's revisit
some previously featured treatments where I assist Gladwell's own dr. Anna Maria Murray
Sean and take a closer look at the methods behind secured provisional placement leading to effective
permanent restoration bond strength starting off with a pretty straightforward low-risk treatment
this patient from chairside lives episode 178 needed replacement of three old failing anterior
crowns upon removal of the existing crowns the preparations were found to be comprised largely
of natural tooth structure from a provisional standpoint this gives me more room to choose
from a wider array of interim cements due to the negligible chance that cement would adhere to the
preparations or cause a bonded core build-up to fail I've also taken into consideration the
darker stump shade that could very well cause the temporaries to have a lower value or a gray
appearance with these factors in mind my go-to cement is tempo sim any by dmg America in a of
course is an acronym indicating that this cement is non eugenol based however this product is also
sold in a you journal containing version this patient has experienced a 0% sensitivity level
throughout treatment so I feel confident that a non usual based cement is sufficient to continue
this trend until the final seat date the opaque appearance of this cement helps to mask the dark
underlying stump shade and relieve any worry that too much of a gray tone might be present moving on
to today's second example this patient required the preparation of teeth 13 and 15 before the
same-day extraction of number fourteen and an immediate bio temps bridge placement factors to
consider in this multifaceted appointment include keeping cement clear of the fresh extraction site
and the amount of time the patient will wear the bio tamp while healing before final impression
and a second timeframe under provisional before a restoration can be permanently secured iead
in the prevention of scattered temporary cement by placing a layer of teflon tape under the bio
temp and removing it in a manner that will wick it away from the site I have chosen to use tempo
sim in this instance but this time in the usual infused formulation the inclusion of eugenol in
dental products is meant as an antiseptic and anti-inflammatory sedative however clinical
studies have shown that permanent restoration bond strength is reduced in some instances by
the use of usual based temporary cements especially when seating final restorations
with resin eluding cements dr. gordon christensen addresses this topic in a very practical approach
he suggests that the time between the use of new journal containing cement and seating of
the final restoration is the key factor if seating the restoration with resin cement a
day or two after seating the bio temps with you journal containing cement the final seat would
be affected by the free eugenol in the provisional cement in this instance the fixed prosthesis are
being seated weeks after extraction site healing final impression and a second provisional stage
therefore the free you journal has been dissipated by chemical integration with the zinc oxide and
the final cement is not affected by the mature you journal containing provisional cement I can
comfortably seat this bio timpz bridge with tempo sim or even temp bond and ensure that
the prepared teeth can get the soothing you journal benefit without suffering long-term
bond strength consequences a typically tricky temporary situation deals with the adherence
of a single unit anterior single units are more fragile easier to floss off and have the least
retentive qualities throughout additionally when dealing with a single anterior provisional shade
matching is also a priority in most cases when seating a single unit crown or veneer bio temp
my trusted cement is temp on clear now temp on clear is a resin cement so care must be
focused on areas where a composite build-up may be present in these cases it is a good idea to
sweat a thin layer of Vaseline over the composite to prevent the resin cement from pulling it out
when you remove the temporary the best benefit to the use of temp unclear is its high retention
value a recently published traction and thermal cycling test of provisional cements showed that
out of the top five most popular cements available all cements showed reduce retention values after
thermo cycling and this is the simulation of heat fluctuations within the mouth during wear
with the single exception of course of temp bond clear where the retention value remained constant
throughout the cured cement peels off cleanly and removes easily on the final seat date causing
no interference to the seating of the Obsidian monolithic crown and the sera mere eluding cement
the most common question I'm asked in regards to seating Provisionals deals with combination
cases since the bio temp units are most likely splinted into one continuous unit a combination
of veneer crown bridge or even in layer on lay can be included in combination cases that only
involve crown and bridge units the application of temp bond tempo sem or similar cements can
be used in any instance where a veneer unit is attached to the temporary or aesthetics are a
factor to consider temp unclear should be used for all units absolutely try to avoid using multiple
cement types under a splinted provisional as to maintain the predictability of the seating
cleaning and finalization process due to the less retentive properties of a veneer bio temp and the
increased retentive properties studies have shown on temp on clear it is the safest decision I feel
I can make when seating these units all too often when difficulties arise in the temporization of
veneers and easy fixes to bond the temporaries the dual cure methods such as a spot of bonding
agent or flowable composite I try to avoid this method entirely unless it is the last effort
and all other attempts are unsuccessful the temporaries are usually destroyed upon removal
and cannot be replaced if needed the cleaning and preparation before final seat has also been
compromised it is important to keep in mind that if an immediate Denton sealing technique was used
then it is absolutely recommended that dual cure cements or composites be avoided as the two stump
is protected with a resin after preparation and there is a risk of union between the resin and
the temporary cement tint bond clear once again removes easily and this Brooks our interior crown
and veneer combination case is successfully seated in closing considerations and decisions
regarding provisional cements should be based upon your individual patients dental history
the composition of the preparation the length of time the temporary will be worn the final
restoration desired now this includes the final restorative cement choice plus the retentive and
aesthetic outcomes that are acceptable for a smooth workflow and a comfortable patient
experience as a dental assistant or a doctor who routinely seats provisional restorations whether
bio temps or chair side fabricated thinking ahead and keeping strict situational awareness of each
procedure will assist you in a more predictable outcome right back to you Megan thank you for that
well well that about wraps it up for this episode of chair side life so on behalf of everyone here
at Global laboratories thank you for watching and I'll meet you right back here next time
you