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Chair-Side Provisional Restorations Utilizing Acrylic Shells and Alginate Impressions Case Series

Applications and Fabrication of

PART 3 IN A SERIES

Stuart J. Froum DDS, Sang-Choon Cho DDS, Takanori Suzuki DDS, PhD

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EDUCATIONAL OBJECTIVES

The overall goal of this article is to provide the reader with information, based on a case series, evaluating the results and describing the step-by-step procedures involved in the acrylic shell and alginate impression (ASAI) technique, as well as the indications, contraindications, advantages and limitations of this technique. On completing this article, the reader will be able to do the following:1. Define the options available for the fabrication of provi-

sional restorations for implants;2. Delineate and describe the steps required for fabrication

of an implant-supported provisional restoration using the ASAI technique;

3. List the prosthetic-related complications that clinicians might face; and

4. Review the advantages and disadvantages of direct and indirect implant-supported provisional restorations.

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Provisional restoration fabrication is a critical part of successful implant treatment. Several types of direct and indirect provisional restorations are currently used, each with advantages and disadvan-tages. Fixed provisional restorations are preferred by many clinicians and patients, as they eliminate transmucosal loading and are not removable. The acrylic shell and alginate impression (ASAI) tech-nique involves a series of sequential steps for the indirect fabrication of provisional restorations. It offers a simple-to-use technique that results in reliable and esthetic provisional restorations for implants until the time the definitive restoration will be placed.

ABSTRACT ABOUT THE AUTHORSStuart J. Froum DDS Dr. Stuart J. Froum is an international lecturer, and Clinical Professor and the Director of Clinical Research in the Depart­ment of Periodontology and Implant Dentistry, at New York University Dental Center and has been in private practice for over 35 years. He is on the Research Committee for the Academy of Osseointegration, and is Vice President of the

American Academy of Periodontology where he has previously served as Board Liaison to the Continuing Education Oversight Committee, a member of the Con­tinuing Education Committee and as a District Trustee. Dr. Froum has published over 100 articles in peer­reviewed journals, was the editor for the recently­pub­lished book titled ‘Dental Implant Complications Etiology, Prevention and Treat­ment’, co­author of ‘Comprehensive Periodontics for the Dental Hygienist’ (2001), and a contributing author for the 11th edition of Carranza’s Clinical Periodontology as well as a co­author of 3 chapters in ‘Sinus Bone Graft’ (2006) and Implant Site Development (2010). He is also a reviewer for the Journal of Periodontology, Inter­national Journal of Periodontics and Restorative Dentistry and for Compendium. Dr. Froum was awarded the William J. Gies Award for Service to the American Academy of Periodontology in 2006, the American Academy of Periodontology “The Special Citation Award” in 2005, the Hirschfeld Award – NESP in 1999, the Clinical Research Award in both 2004 and 2005, and the J. Coslet – Distinguished Lecturer Award from the University of Pennsylvania Dental School in 2003.

Sang-Choon Cho DDS, MSDr. Sang-Choon Cho is a full­time Clinical Assistant Professor and Director of Advanced Program for International Dentists in Implant Dentistry in the Department of Periodontology and Implant Dentistry, at New York University College of Dentistry (NYUCD). He is a graduate of both the DDS program and the Advanced Program in Implant Dentistry for International Dentists

at NYUCD and also holds a dental degree and an MS degree from Kyungpook National University in South Korea. In addition to teaching and conducting research at NYUCD, Dr. Cho serves as a liaison to the NYUCD South Korean Alumni Study Club.

Takanori Suzuki DDS, PhD Dr. Takanori Suzuki is a Visiting Clinical Instructor in the Department of Periodontology and Implant Dentistry, at New York University College of Dentistry. Dr. Suzuki holds a dental degree and a PhD.

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Introduction

Fabrication of a provisional restoration is a critical part of successful implant treatment. It allows res-toration of the integrity of the dental arch, occlusal

stability of the opposing arch, masticatory function, proper speech and esthetic replacement of the missing dentition.1-4 Several types of provisional restorations are currently used. These include removable provisional restorations (flipper, Essix) or fixed provisional restorations (resin bonded bridge, fixed prosthesis with or without the use of transitional implants).1-4 When support for the removable provisional restoration is provided by the underlying soft tissue or grafted site, undesired pressure may be applied to a healing surgical site.1-4 Therefore, provisional restorations using fixed partial dentures (FPDs) are preferred by many clinicians and patients because they eliminate transmucosal loading and are not removable.1-4

Fixed provisional restorations have additional indica-tions, including use with immediate loading protocols to provide proper occlusal balance and cross-arch stabilization, with guided bone regeneration to protect the surgical site, for creating adequate emergence profiles following implant placement and during the restorative phase, and for repair-ing broken prostheses.4-6

Clinicians are often faced with prosthetic-related compli-cations such as porcelain fracture, metal framework frac-ture, abutment fracture and implant-related complications such as fixture fracture.7-9 In these instances it is usually necessary for the prosthesis to be sent to the dental labora-tory for repair. During this time, the patient is without the prosthesis or might be forced to function with a removable prosthesis, which can affect both function and esthetics.

Often, interim provisional restorations require recon-

touring of the fractured porcelain, re-establishing the lost occlusion and rebuilding the missing soft tissue volume. Therefore, simple, easy and accurate techniques for fabricat-ing chair-side provisional restorations are desirable. Fabrica-tion of provisional restorations chair-side utilizing an acrylic shell and alginate impression (ASAI) is a useful technique that satisfies these goals.

Materials and MethodsClinical data in this study was obtained from the Implant

Database (ID). This data set was extracted as de-identified information from the routine treatment of patients at the Ashman Department of Periodontology and Implant Dentistry at New York University College of Dentistry (NYUCD). The ID was certified by the Office of Quality Assurance at NYUCD. This study is in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Study Subjects Thirteen patients were included in this retrospective

study. The group consisted of 9 male and 4 female patients with a mean age of 67 years (range: 35 to 82). Each sub-ject selected for this study from the anonymous database had undergone the fabrication of the following provisional restoration using the ASAI technique.

The ASAI ProcedureThe ASAI procedure for chair-side fabrication of a fixed

provisional restoration consists of the following sequential steps:1) A preliminary impression is made. The broken prosthesis is

removed and a diagnostic wax-up is fabricated. (Figs. 1-2)

Applications and Fabrication of

Chair-Side Provisional Restorations Utilizing Acrylic Shells and Alginate ImpressionsPart 3 in a series.

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2) If necessary, an impression is taken to fabricate a master cast. (Fig. 3)

3) The diagnostic cast is recontoured with wax to deter-mine the appropriate shape and contour of the proposed final restorations. (Fig. 4)

4) Master and opposing casts are mounted on an articula-tor. (Fig. 5)

5) An impression is taken of the diagnostic cast with a hydrocolloid impression material. (Fig. 6)

6) A film of acrylic monomer is used to line the alginate impression. Acrylic polymer is then insufflated by hand to flow into the alginate impression to make an acrylic shell. (Figs. 7-8)

7) The alginate impression is carefully removed from the impression tray in order to isolate the acrylic resin shell in a nondestructive fashion. (Figs. 9-10)

8) The acrylic resin shell is trimmed with scissors, burs or disks. (Fig. 11)

9) The acrylic resin shell is mounted to the opposing cast and secured with sticky wax. (Fig. 12)

10) Temporary cylinders or acrylic copings on abutments are placed into the master cast. (Fig. 13)

11) The space present from the temporary cylinder or acryl-ic coping to the acrylic resin shell is filled with acrylic resin. (Figs. 14-15)

12) The acrylic resin shell is filled with acrylic resin and/or

Figure 2. A diagnostic cast was made for recontouring and duplication

Figure 4. Recontouring and reinforcing the provisional restoration with wax

Figure 1. The lower prosthesis required replacement except for the metal framework

Figure 3. A pickup impression was taken for fabrication of the master cast

Applications and Fabrication of Chair-Side Provisional Restorations Utilizing Acrylic Shells and Alginate Impressions - Case Series

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Figure 5. The diagnostic and master casts were mounted on an articulator

Figure 8. Fabrication of a resin shell utilizing an alginate impression

Figure 6. Duplication of the wax-up model with an algi-nate impression

Figure 9. Alginate removed to retrieve the intact resin shell

Figure 7. Insufflator used to spray polymer of acrylic resin Figure 10. The resin shell

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Figure 11. Excess resin was trimmed with scissors Figure 14. Acrylic resin was applied only between the plastic coping and resin shell

Figure 12. Intimate occlusion is established with oppos-ing arch

Figure 15. Plastic copings were connected to the resin shell

Figure 13. Four abutments were selected to support the provisional restoration from the master cast

Figure 16. Pink acrylic was added to make an esthetic provisional restoration

Applications and Fabrication of Chair-Side Provisional Restorations Utilizing Acrylic Shells and Alginate Impressions - Case Series

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pink acrylic resin. (Fig. 16)13) The occlusion is checked and the provisional restoration

is polished. (Fig. 17)14) The fixed prosthesis is delivered and the occlusion again

adjusted if necessary. (Figs. 18-19)

ResultsIn this retrospective study, a total of 13 patients were

provisionalized with the ASAI technique. On the day of the patient visit for abutment placement stage II surgery or for treatment of prosthetic complications, provisional restora-tions were fabricated and delivered to the patients. Patient satisfaction with the provisional restorations was high. All of the provisional restorations fabricated chair-side using the ASAI technique maintained their integrity and function until the final restoration was inserted. All of the patients in this study received their final prostheses without the occur-rence of complications with the provisional prosthesis (such as broken, fractured or chipped restorations). (Table 1)

DiscussionImplant-supported restorations for partially and fully

edentulous patients are a well-accepted and predictable treatment modality. The success rate of implant-retained prostheses for complete and partial edentulism has been documented to be greater than 90 percent.10-12 With the increase in treatment acceptance of dental implants, both patients and clinicians have greater expectations for suc-cessful esthetic and functional outcomes. Patients facing loss of their teeth might experience apprehension toward their compromised social image or daily function. Therefore, patients often expect to have their implants restored with a provisional and final fixed prosthesis that is similar to their natural dentition. Clinicians also desire that the restorations be functional, esthetic, and in harmony with the surround-ing hard and soft tissues.2 The obvious goals of provisional restorations include the esthetic and functional substitution of the missing dentition during treatment.13-14 Provisional restorations can also be utilized for the shaping/preservation

Figure 17. The provisional restoration was delivered and the occlusion checked and adjusted

Figure 18. The final fixed prosthesis was delivered

Figure 19. Extraoral view of the final implant-supported restoration

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and contouring of the soft tissues in the coronal aspect of the peri-implant mucosa.5,14 Finally, the provisional restora-tion can also serve the important functions of esthetic and functional prototyping, thus acting as a blueprint for the fabrication of the definitive restoration.14-15

Clinicians are often faced with restorative complications such as porcelain fracture, metal framework fracture or abut-ment fracture, as well as implant complications such as fix-ture fracture.7-9 The risk of porcelain fracture for an implant-supported metal ceramic crown or FPD is greater than the risk of fracture for the same types of prostheses supported by the natural dentition.7 Fractures, especially major ones, were found to be more frequent when the restoration was occluding with an implant-supported single crown or FPD, or when the patient had a parafunctional habit (i.e., bruxing or clenching). It has also been shown that not using an occlusal device was a significant factor for porcelain fracture.7 In these instances intra-oral repair techniques using composite resin material are useful.16 However, it is difficult to recontour the fractured porcelain and to recover the quality of esthetics

that porcelain provides. Therefore, it is often necessary for the prosthesis to be sent to the dental laboratory for repair of this prosthetic complication. During this time, the patient is often without a prosthesis, compromising both function and esthetics. In these cases, the ASAI technique can provide a provisional restoration as a simple, easy and accurate chair-side solution at the time of the patient visit.

Fabrication of an implant-supported fixed provisional restoration can be completed either directly in the mouth, “direct approach,” or in the dental laboratory using the “indirect approach.”17 To use the direct approach, a clear vacuum-formed matrix,18 a silicone matrix (putty index)19 or a prefabricated resin shell20 is filled with an acrylic material and relined over the prepared temporary abut-ments. The main advantage of this option is the reduced number of clinical and laboratory steps. This approach can also be advantageous in cases of immediate provisionaliza-tion following implant placement, because of the reduced patient-waiting time. Additionally, the clear vacuum-formed matrix technique has the advantage of providing immediate

Table 1. Results of 13 cases in which the ASAI technique was used

Case Age M/F PFM/Hyb Full/Part Max/Man Reason Screw/Cement Longevity Pt Satisfaction (Y/N)

1 82 M Hyb Part Max Denture teeth broken Cement High* Yes

2 68 F PFM Full Max Temporization Screw High Yes

3 80 M PFM Full Man Porcelain fracture Cement High Yes

4 81 M PFM Part Max Porcelain fracture Cement High Yes

5 70 M PFM Full Max Temporization Cement High Yes

6 57 M PFM Part Max Temporization Cement High Yes

7 59 M PFM Full Max Porcelain fracture Screw High Yes

8 35 F PFM Part Max Porcelain fracture Cement High Yes

9 61 M PFM Full Man Temporization Screw High Yes

10 58 M PFM Part Max Temporization Screw High Yes

11 65 M PFM Full Max Temporization Screw High Yes

12 77 F PFM Full Man Porcelain fracture Cement High Yes

13 71 F PFM Full Man Temporization Screw High Yes

AVE 66.5 9/4 12/1 8/5 9/4 6/7 100%

*High – All of provisional restorations remained functioning and intact until final restorations were inserted.

Applications and Fabrication of Chair-Side Provisional Restorations Utilizing Acrylic Shells and Alginate Impressions - Case Series

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implant loading. A disadvantage of this technique is the lack of detail in the esthetics of the restoration. The putty index technique (PIT) has the same esthetic advantages as the ASAI technique; however, the disadvantage of the PIT is that occlusal adjustment is difficult. The prefabricated resin shell technique has esthetic advantages, but the thickness of the resin shell makes it difficult to adjust to the abutment.

On the other hand, when using the indirect approach, the provisional fabrication is outsourced to the dental labo-ratory. The obvious disadvantages include additional clinical and laboratory steps as well as the associated laboratory cost. The advantages include a controlled environment for prosthesis fabrication as well as reduced chair time. The ad-vantages of the indirect approach are especially appreciated in cases where a provisional is fabricated for multiple miss-ing teeth and/or there is a need to create a restoration that closely resembles the natural tooth structure.21 The ASAI technique has many advantages compared with the other techniques. (Table 2) These include immediate function and esthetics, significantly reduced fees compared with the cost of laboratory processed provisional restorations, and flex-ibility of use from immediate temporization and loading to the ability to immediately treat a damaged provisional or permanent restoration.

Provisional restorations can be made chair-side on the day the patient presents with the prosthetic complication. This entails alginate duplication of the denture and the hopeless teeth or fabrication of a wax-up model. If neces-sary, it is easy to reinforce the provisional restoration by adding wax lingually on the diagnostic cast. The technique of using the resin shell is part of the alginate impression technique. The thinness of the resin shell allows the clini-cian to make a space for placement of an implant abutment and temporary cylinder in the resin shell which can easily be trimmed with scissors or discs. The resin shell which can fabricated from the corrected cast. It adapts to the opposing arch accurately and does not need further occlusal adjust-ment for centric contact, due to the accuracy of the occlusal table. Maintenance of optimal vertical dimension is easy when the resin shell is relined chair-side. The ASAI tech-nique does not damage existing dentures or restorations. Shrinkage of acrylic resin can be minimized with the use of small amounts of acrylic resin used to connect the resin shell and temporary cylinder. An ideal dimension can be achieved using different layers of acrylic resin or pink resin. The ASAI technique is a cost-effective technique because it does not re-quire the use of a dental laboratory or expensive materials. The disadvantage of the ASAI technique is that it involves

Table 2. Comparison of various techniques of preparing a fixed provisional restoration

TechniquesCriteria

Indirect Direct

Lab processed Omnivac Putty ASAI

Technique sensitivity Low Moderate Moderate High

Detail/Esthetic Excellent Moderate Good Excellent

Material condensed Excellent Not good Good Good

Adaptation to oposing arch Excellent Good Moderate Excellent

Modification/Remake Difficult Moderate Moderate Easy

Durability Excellent Good Good Good

Economical Bad Excellent Good Excellent

Chair time Minimal Moderate Lengthy Lengthy

Patient visit time More than once Less Less Less

Patient comfort Excellent Moderate Good Good

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a learning curve and utilizes more chair time than when laboratory-processed provisional restorations are utilized. Moreover, the thickness of provisional restorations might compromise the patient’s comfort.

The complications of the ASAI technique are the same as those with all prosthetic procedures. The use of provisional metal-free acrylic restorations in large spans exposes them to flexion and fracture under the effect of occlusal forces.3 Hence, a greater distribution of the masticatory forces has been deemed clinically important to avoid the fracture of the provisional restoration.22

ConclusionThe results of this case series show that the ASAI tech-

nique is a viable treatment option for providing provision-al restorations simply, easily, inexpensively and accurately on the day of implant placement (immediate provision-alization) or implant exposure (abutment insertion) or when treating prosthetic complications. In this limited case series, satisfaction with the fixed provisional restora-tions was high and all restorations remained intact and functioning until replaced by the final restorations. More research with a greater number of cases will be necessary to confirm the outcomes achieved in this investigation.

References1. Cho SC, Shetty S, Froum S, Elian N, Tarnow D. Fixed and remov­able provisional options for patients undergoing implant treatment. Compend Contin Educ Dent. 2007;28:604­8.2. Santosa RE. Provisional restoration options in implant dentistry. Aust Dent J. 2007;52:234­42.3. Suarez­Feito JM, Sicilia A, Angulo J, Banerji S, Cuesta I, Millar B. Clinical performance of provisional screw­retained metal­free acrylic restorations in an immediate loading implant protocol: a 242 con­secutive patients’ report. Clin Oral Implants Res. 2010;21:1360­9.4. Drew HJ, Alnassar T, Gluck K, Rynar JE. Considerations for a staged approach in implant dentistry. Quintessence Int. 2012;43:29­36.5. Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res. 2008;19:73­80.6. Romanos GE, Nentwig GH. Immediate functional loading in the maxilla using implants with platform switching: five­year results. Int J Oral Maxillofac Implants. 2009;24:1106­12.7. Kinsel RP, Lin D. Retrospective analysis of porcelain failures of

metal ceramic crowns and fixed partial dentures supported by 729 implants in 152 patients: patient­specific and implant­specific predic­tors of ceramic failure. J Prosthet Dent. 2009;101:388­94.

8. Sailer I, Philipp A, Zembic A, Pjetursson BE, Hämmerle CH, Zwahlen M. A systematic review of the performance of ceramic and metal implant abutments supporting fixed implant reconstructions. Clin Oral Implants Res. 2009;20:4­31.

9. Bozini T, Petridis H, Garefis K, Garefis P. A meta­analysis of prosthodontic complication rates of implant­supported fixed dental prostheses in edentulous patients after an observation period of at least 5 years. Int J Oral Maxillofac Implants. 2011;26:304­18.

10. Adell R, Lekholm U, Rockler B, Brånemark PI. A 15­year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg. 1981;10:387­416.

11. Buser D, Mericske­Stern R, Bernard JP, Behneke A, Behneke N, Hirt HP, Belser UC, Lang NP. Long­term evaluation of non­submerged ITI implants. Part 1: 8­year life table analysis of a prospective multi­center study with 2359 implants. Clin Oral Implants Res. 1997;8: 161­72.

12. Weber C, Crohin CC, Fiorellini JP. A 5­year prospective clinical and radiographic study of non­submerged dental implants. Clin Oral Implants Res. 2000;11:144­53.

13. Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical consider­ations. Int J Oral Maxillofac Implants. 2004;19:43­61.

14. Priest G. Esthetic potential of single implant provisional restora­tions: selection criteria of available alternatives. J Esthet Restor Dent. 2006;18:326­38.

15. Donovan TE, Cho GC. Diagnostic provisional restorations in restorative dentistry: the blueprint for success. J Can Dent Assoc. 1999;65:272­5.

16. Ozcan M. Evaluation of alternative intra­oral repair techniques for fractured ceramic­fused­to­metal restorations. J Oral Rehabil. 2003;30:194­203.

17. Ganddini MR, Tallents RH, Ercoli C, Ganddini R. Technique for fabricating a cement­retained single­unit implant supported provi­sional restoration in the esthetic zone. J Prosthet Dent. 2005; 94:296­8.

18. Park J, Horowitz I, Termechi O, Cho SC, Froum S, Elian N, Tarnow D. Use of a Multi­Purpose Omnivac Shell for Immediate Loading in the Mandible ­ a Case Series. 25th Annual Meeting of Academy of Osseointegration in Orlando, FL, 2010.

19. McDonald T. Contemporary temporization. Available at www.ineedce.com.

20. Infante L, Lee H. An acrylic resin shell with guide extensions for accurate positioning of provisional restorations. J Prosthet Dent. 2011;106:340­2.

21. Shor A, Schuler R, Goto Y. Indirect implant­supported fixed provisional restoration in the esthetic zone: fabrication technique and treatment workflow. J Esthet Restor Dent. 2008;20:82­95.

22. Romanos GE. Treatment of advanced periodontal destruction with immediately loaded implants and simultaneous bone augmen­tation: a case report. J Periodontol. 2003:74:255­61.

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1. Fabrication of a provisional restoration is a critical part of suc-cessful implant treatment for __________. a. restoration of the integrity of the dental archb. occlusal stability of the opposing arch c. masticatory function d. all of the above

2. When support for a removable provisional restoration is pro-vided by the underlying soft tissue or grafted site, __________ may be applied to a healing surgical site. a. desired pressureb. undesired pressurec. desired estheticsd. none of the above

3. Provisional restorations using fixed partial dentures (FPDs) are preferred by many clinicians and patients because they __________. a. are not removable b. apply transmucosal loadingc. eliminate transmucosal loading d. a and c

4. _______ can be used with guided bone regeneration to protect the surgical site. a. Fixed provisional restorationsb. Removable provisional restorations applying mucosal pressurec. Tacks d. b and c

5. __________ is a prosthetic-related complication. a. Porcelain fractureb. Metal framework fracturec. Abutment fracture d. all of the above

6. Interim provisional restorations often require recontouring of the fractured porcelain, to __________. a. rebuild the missing soft tissue volumeb. re-establish the lost occlusionc. enlarge the restoration proximally d. a and b

7. Clinicians desire that restorations be __________. a. in harmony with the surrounding hard and soft tissuesb. functionalc. estheticd. all of the above

8. Acrylic polymer is __________ by hand to flow into the alginate impression to make an acrylic shell. a. inflatedb. insufflated c. deflated d. exposed

9. During the use of the ASAI technique, temporary cylinders or acrylic copings on abutments are placed into the __________ cast. a. diagnostic b. secondaryc. primaryd. master

10. With the ASAI technique, the space present from the tempo-rary cylinder or acrylic coping to the acrylic resin shell is filled with __________. a. impression material b. block-out materialc. acrylic resind. none of the above

11. The success rate of implant-retained prostheses for complete and partial edentulism has been shown to be greater than __________. a. 80 percentb. 85 percentc. 90 percentd. 95 percent

12. Patients facing loss of their teeth might experience apprehen-sion toward their compromised __________. a. intellectual image b. social imagec. daily function d. b and c

13. Provisional restorations can also be utilized for the __________ of the soft tissues in the coronal aspect of the peri-implant mucosa. a. immediate removal b. shaping/preservationc. pressure-applied recession d. a and b

14. The use of provisional metal-free acrylic restorations in large spans, including those fabricated using the ASAI tech-nique, exposes them to __________ under the effect of occlusal forces. a. tension b. flexion and fracture c. discolorationd. none of the above

15. The __________ goals of provisional restorations include the esthetic and functional substitution of the missing dentition during treatment. a. secondaryb. obviousc. tertiary d. a and b

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16. The provisional restoration can serve as __________. a. an impediment b. a definitive restoration c. a blueprint for the fabrication of the definitive restorationd. a and c

17. The risk of porcelain fracture for an implant-supported metal ceramic crown or FPD is __________ the risk of fracture for the same types of prostheses supported by the natural dentition. a. greater thanb. less than c. the same as d. none of the above

18. Fractures, especially major ones, have been found to be more frequent when __________. a. the restoration was occluding with an implant-supported single

crownb. the patient had a parafunctional habitc. the restoration was occluding with an implant-supported FPDd. all of the above

19. Not using an occlusal device has been found to be a significant factor for __________. a. porcelain preservation b. porcelain fracturec. gingival preservation d. a and c

20. Fabrication of an implant-supported fixed provisional restoration using the direct approach can be performed using a __________. a. clear vacuum-formed matrixb. putty indexc. prefabricated resin shell d. all of the above

21. During the use of the ASAI technique, the __________ cast is recontoured with wax to determine the appropriate shape and contour of the proposed final restorations. a. diagnostic b. master c. secondary d. primary

22. Significantly reduced fees compared with the cost of laboratory-processed provisional restorations can be achieved with the __________. a. direct approach b. indirect approach c. hybrid approach d. none of the above

23. __________ is a disadvantage of the clear vacuum-formed matrix technique. a. The lack of detail in the esthetics of the restorationb. The lack of visibility of the matrix c. The strength of the matrix d. none of the above

24. With the putty index technique (PIT), __________. a. occlusal adjustment is easyb. occlusal adjustment is difficultc. interdependence is difficultd. b and c

25 The thickness of the resin shell makes it difficult to adjust to the __________. a. opposing teeth b. adjacent teeth c. abutment d. all of the above

26. The __________ is a disadvantage of the “indirect approach” whereby the provisional fabrication is outsourced to the dental laboratory.a. number of additional clinical steps b. number of additional laboratory stepsc. associated laboratory cost d. all of the above

27. The advantage of an indirect approach is the __________. a. controlled environment for prosthesis fabricationb. reduced chair timec. increased chair timed. a and b

28. The ASAI technique can be used for __________. a. fabricating provisional restorations b. immediate treatment of damaged provisional restorationsc. immediate treatment of damaged permanent restorationsd. all of the above

29. The __________ can be used to immediately treat a damaged provisional or permanent restoration. a. indirect approachb. direct approach c. hybrid approach d. all of the above

30. The ASAI technique is a viable treatment option for providing provisional restorations __________. a. on the day of implant placementb. on the day of implant exposurec. when treating prosthetic complicationsd. all of the above

CE QUIZ

13August 2015

Applications and Fabrication of Chair-Side Provisional Restorations Utilizing Acrylic Shells and Alginate Impressions - Case Series

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PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.

QUIZ ANSWERSFill in the circle of the appropriate answer that corresponds to the question on previous pages.

EDUCATIONAL OBJECTIVES1. Define the options available for the fabrication of provisional restorations for implants;2. Delineate and describe the steps required for fabrication of an implant-supported provisional restoration using

the ASAI technique;3. List the prosthetic-related complications that clinicians might face; and4. Review the advantages and disadvantages of direct and indirect implant-supported provisional restorations.

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