Provisional restorations serve an important purpose in restorative dentistry because they set the stage for the final result. From an account rep’s perspective, here are insights into “temporary” sales
Temporary, or provisional, restorations may be stand-ins for permanent prostheses, but that doesn’t mean they don’t have a big job to do. Far from being mere understudies, they protect the oral cavity, help patients function normally, and, like a dress rehearsal before the performance, allow dental professionals to create a preview of the final result.
Provisionals function by protecting teeth that have been prepared for final restoration, preventing movement, and letting patients eat and speak normally. They can also prevent further decay or damage to the tooth, which is particularly important for pediatric patients. Dental sales professionals can assist practices in navigating the differences in provisional materials — including temporary cements used for luting. It’s also important for account reps to understand esthetic considerations and the need for patient education until the permanent crown, bridge or implant is ready.
Before diving into the details of temporary materials, take a moment to step back and look at the big picture: an attractive smile where a provisional blends in with natural teeth by matching shade, size and shape. A big area of opportunity for sales reps is to emphasize the importance of esthetics in material selection.
Robert A. Lowe, DDS, an author and lecturer who practices cosmetic and general dentistry in Charlotte, North Carolina, notes that some dental schools teach students not to make a temporary look too good or a patient won’t return for the final restoration. “I think that’s ridiculous,” he says. “Good-looking temporaries give patients immediate gratification and improved self-esteem, but, most importantly, they offer a preview of what’s possible.”
Lowe says that when he contours a patient’s temporary chairside, he asks the patient if the tooth looks too small or large, too round or square. He aims to find a color that matches as closely as possible to the final desired shade — although it’s important that patients understand temporary materials come in fewer colors than dental ceramics. There are also bleach shades for patients who have whitened their teeth.
“Patients don’t know what they want until they see what they don’t want,” Lowe says. “We can customize the temporary because it’s plastic.” Once Lowe and a patient have agreed on the final esthetic look and occlusal design of the temporary, he captures a digital photo and takes an impression, both of which are sent to the lab for use in fabrication of the prosthesis. “These provide a ‘visual prescription’ for the technician to follow,” he notes.
POINT of SALE
CEMENTS AND MATERIALS
Provisional materials and cements have an important, albeit short-term job to do. And sales reps can help practitioners think through the best options in terms of durability, patient comfort and ease of removal. Materials create the form and function of the temporary crown. They should be flexible for manipulating as long as needed, easy to adjust and cure quickly. Varnishes that glaze the surface of the finished provisional can eliminate the time and effort of hand polishing.
Cements must hold a provisional restoration in place for anywhere from a few weeks to a few months. But provisionals also need to be removed easily and without damaging the prepared tooth. They should provide a good seal to prevent sensitivity, pain or additional decay.
Dentists have many choices for cements and materials and the array can be overwhelming. A helpful salesperson will provide samples so practitioners can choose several standbys to have on hand. Asking a few questions will be useful in recommending products. For example, does a dentist want to hand mix, or use cement in a capsule or cartridge dispenser? And for offices that prefer auto-mix guns, it’s wise to point out that cartridge compatibility can be an issue when attempting to use products from different manufacturers. Knowledgeable reps can advise clients accordingly.
As for temporary materials, products with self-curing bis-acryl composite resin are a frequent choice. They look good and have minimal odor, but may cost more than older materials. Products that contain nanoparticles are quite smooth and require minimal finishing time. The polished surface looks more natural to patients, is easier to keep clean and feels more comfortable in the mouth.
When selecting cements, it’s important to consider not only retention, but the ability to minimize sensitivity for patients. A 2012 study published in the Journal of Advanced Prosthodontics states that during restorative procedures, the prepared teeth are often a source of dentinal hypersensitivity. Additionally, the study notes that approximately 1 million to 2 million dentinal tubules (that lead through the dentin into the pulp) are exposed during an average tooth preparation for a posterior crown.
The most commonly used cements are zinc oxide eugenol based and noneugenol based. The former produce a sedative effect on sensitive teeth, meaning they can soothe inflamed dental pulp. They are also antibacterial due to the zinc oxide. Eugenol is a component of clove oil, which has been used to relieve toothaches for centuries. Noneugenol-based cements contain desensitizing and antibacterial agents, but some studies have shown that they can cause tooth sensitivity. Resin-based products are strong, retain well, and are easy to clean up. But they can also leak and discolor, an important consideration for temporary restorations of anterior teeth.
A MORE PERMANENT FIX
What if temporary cements could not only hold a provisional restoration in place, but also promote lasting healing? Temporary luting agents are available that release fluoride, but there are permanent cements that do even more. Some contain phosphate and calcium ions to replenish and rebuild teeth that have been demineralized, which is when the enamel dissolves. Robert A. Lowe, DDS, a lecturer and general practitioner in Charlotte, North Carolina, says he expects that manufacturers are working to develop temporary cements with similar characteristics. If these eventually come to market, he says the benefit would be to protect the tooth that the temporary is on from further damage. “And some patients,” he notes, “must function with temporaries for long periods because they’re getting implants.”
TEMPORARIES IN PEDIATRIC CASES
When it comes to treating children, the use of temporaries becomes more complicated. Sales professionals can familiarize themselves with the unique anatomical and behavioral issues surrounding the youngest dental patients. Not only are kids’ oral cavities in a state of flux as their teeth and jaws grow, but children often lack the ability and understanding to cooperate with treatment. Additionally, they have most often suffered either injury or severe decay in order to need such invasive treatment to begin with.
Anxious parents may make the dentist’s role harder. In the case of damage from caries, ongoing risk of decay must also be addressed in the treatment plan. Reps can offer temporary cement that releases fluoride to help with this concern, but parental education is critical.
“Primary teeth are different,” notes Wanda Claro, DDS, MS, who practices pediatric dentistry and orthodontics in Irvine, California. “The enamel on baby teeth is not the same as permanent teeth. It is also thinner than adult enamel and therefore cavities advance at a faster rate. There are behavioral and developmental issues between pediatric and adolescent dental patients versus adult patients that are very different, as well.”
Caries is the most common disease of childhood. In March, the U.S. Centers for Disease Control and Prevention released a report stating that 23% of children between ages 2 and 5 had dental caries in their primary teeth, and that 21% of children between 6 and 11 had caries in their permanent teeth. When decay is particularly severe, pediatric cases are often restored using crowns of either steel (preferred for molars) or acrylic.
The American Dental Association says that interim therapeutic restorations may be used in caries lesions in “young, uncooperative, and special-health-needs patients” when a definitive permanent restoration is not feasible.
Claro uses cement that releases fluoride to continue treating the tooth. She says it aids in remineralizing the affected tooth surfaces and helps prevent further decay after removal of the infected dentin. Children will keep these temporary crowns until their permanent teeth grow in. When the primary tooth comes out to make room for the permanent tooth, the crown goes with it. But until that happens, their temporaries need to last. Unfortunately, that’s not always the case, especially if the child grinds his or her teeth. As Claro explains, this is because the material is not as hard as normal tooth structure. In addition, she notes that the plastic may break and need to be repaired or replaced.
No matter what type of temporary goes in, whether for an adult or child, sales pros can discuss the importance of patient education on proper care to make sure the temporary lasts until its job is done. That will save time and expense from replacing provisionals before the permanent prosthesis is ready.
So while temporaries don’t offer the final solution, they are a lasting fixture in every restorative practice, affording sales reps the chance to offer provisional materials and cements that allow practitioners to carry patients through the restoration process with an attractive, pain-free smile.