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The Many Advantages of a Premade Custom Provisional

Steven Barrett, DDS

article by Steven Barrett, DDS

drbarrett@greenbergdental.com

As a partner and clinical director of Greenberg Dental & Orthodontics, a private group practice with more than 80 offices in Florida and over 170 dentists, I often find myself speaking about the importance of developing a vision for the esthetic possibilities modern dentistry has to offer our patients. Within our practice, we put a high priority on working with committed laboratories, using quality materials and staying attuned to predictable processes. For many years, within our restorative workflow, BioTemps® Provisionals (Glidewell Laboratories; Newport Beach, Calif.) have helped our doctors deliver on the esthetic vision we create for our patients.

Rethinking Provisionals

I remember being in dental school and hearing, “Don’t make your temporaries too nice or your patients will not come back.” That was almost 30 years ago, but even today, when I speak at dental schools and show slides of before-and-after cases, a student will always ask, “Aren’t you worried that your patients won’t come back because your temporaries are so nice?” My reply is always, “If your temporaries are not that nice, your patients will not come back.” The analogy I use is for them to think of their temporaries as their business cards — business cards that their patients will wear for weeks or even months. I have been fortunate to have had the opportunity to work chairside with — and mentor — hundreds of new dentists over my career. As early as their first day, I try to instill in them the philosophy that temporaries are as critical to the success of their case as their crown preparations and the quality of their impressions.

Dental students are so busy trying to fulfill their requirements to graduate, finding board patients and passing the board exam, that learning how to make great anterior temporaries is not on their radar. In fact, most newly graduated dentists think there is a magical dental assistant just waiting for them after graduation who will work for them for 30 years and always be there to do this for them. I believe if a younger dentist can master making great anterior temporaries —  and all other temporaries, for that matter — they will have developed a skill and a process that will serve them well for many years. The truth is this talent will outlast the inevitable staff changes that will occur over the course of the average dental career.

In order to be successful, cosmetically minded dentists need to invest time in honing their ability to visualize the esthetic possibilities for patients. And if that vision is firmly based in smile-design fundamentals and highly detailed products and processes, they are setting themselves up for predictable final outcomes that are as rewarding for the dentists as they are for the patient.

More Than a Temporary

About 18 years ago, I started using BioTemps Provisionals, fabricated by Glidewell Laboratories, and right away I noticed several things. To begin with, these custom-made temporaries were absolutely beautiful — far better than I could make from any acrylic or bis-acryl material. With BioTemps Provisionals, I can dial in esthetic changes, choose custom shades, deliver a much stronger temporary (with the use of fiber or wire reinforcement), reduce chair time and, if relined and trimmed properly, ensure that the patient’s soft tissue will be in great shape at the seating appointment. With BioTemps Provisionals, you can change the arch form to be more ideal, add or reduce the length of teeth with precision, create ovate pontics, and even add pink acrylic if needed.

When sending models to the lab for the fabrication of BioTemps Provisionals, the better the instructions, the better the result. I often do a complimentary composite mock-up chairside to help the patient and me visualize the changes that I would like to make. This simple five- to 10-minute process is often overlooked by many dentists. Photographs, a study model of my mock-up or both are then sent to the lab to aid in the fabrication of the BioTemps Provisionals. In addition, I can even mark the model and simulate where a gingivectomy or crown lengthening may be done. By meeting and exceeding the esthetic expectations of my patients through the delivery of exceptional provisionals, I have received hundreds of referrals. Equally as important is the fact that I can teach a new dentist and their dental assistant how to make great temporaries in a matter of weeks, not years!

Patient Presentation

I am often asked, “How do you sell BioTemps Provisionals to patients?” I never sell BioTemps Provisionals — they are just a part of what I do. By explaining the benefits of BioTemps Provisionals to my patients, it becomes clear that they are vital to the success of their case. The conversation typically starts with an explanation of the necessity of a custom temporary.

“Mrs. Smith, when I shape your front teeth for your crowns, it will be necessary for me to make you a custom temporary. You will wear this custom temporary while your crowns are being made for you at the lab. Let me show you what a custom temporary looks like.”

I then show the patient a presentation model with BioTemps Provisionals and continue: “I can customize the shade for you, and because these temporaries will not discolor, you will look great. You will feel very comfortable going to work or going out with your friends and family.”

The reality is that many patients have had a bad experience with a temporary crown — either posterior or anterior — and I want them to know these temporaries are made using a vastly superior process.

Smile Makeovers

For cases where I am making esthetic changes, I explain to the patient how BioTemps Provisionals allow me to create the best smile possible for them.

“Mrs. Smith, all of the changes that we just talked about will be incorporated into your custom temporaries. This way, you and I can see what the final crowns will look like and, if there are any changes to be made, I can make those changes while you are in your temporaries. My goal is for you to look in the mirror and tell me that you love your temporaries. Once I get your temporaries exactly the way you like them, I can take photographs and an impression, and ask the lab to duplicate that for you. Using your custom temporaries as a stepping stone is critical if we are going to deliver crowns you will be happy with. Does that make sense to you? Do you have any questions for me?”

Extraction Cases

While BioTemps Provisionals are a part of my typical extraction treatment plan, it does not take much to convince patients of the benefits following an extraction.

“Mrs. Smith, when your tooth is removed, I will make you a custom temporary that will be placed the same day as your extraction. You will never have to walk around with a missing tooth. With this temporary, I can match the color of your teeth to give you a very natural appearance. From start to finish, this case will take us about 12 weeks to complete. Your custom temporary will hold up long-term, it will not break, and you will not have to make any unplanned trips to the office to have your temporary remade.”

Esthetic Emergencies

At times, a patient will come to the office with an emergency, and an anterior tooth will have to be removed at the first visit. For these cases, I will extract the tooth and make an acrylic temporary chairside. At the end of the appointment, I will take impressions to order a custom BioTemps provisional. Ten days later, I will have the patient return to the office and replace my chairside acrylic temporary with a custom-made, long-lasting BioTemps provisional. If I want to develop an ovate pontic, I can do that with BioTemps Provisionals. Because the development of an ovate pontic can take 10 weeks or more, a BioTemps provisional is the perfect choice.

Conclusion

BioTemps Provisionals are not only ideal for multiunit esthetic cases, extraction cases, or cases that involve an entire quadrant, but they are also well-suited for single-unit anterior cases. I have had many patients over the years who have benefited from a custom anterior temporary because they were public speakers or actors, they were getting married, or they just needed a custom shade for that single tooth.

Whether you are a new dentist, an experienced dentist, or empowering a junior staff member, premade custom temporaries like BioTemps Provisionals can serve as an integral part of your restorative protocol. Incorporating BioTemps Provisionals as a transitional tool within your office will lead to predictable results, happy patients and more confidence for your entire team.

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Chairside Magazine: Volume 12, Issue 2

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