Thursday, October 18, 2012

Blog of the Day: Provisional Crowns

When a crown is being fabricated for you, the tooth or teeth treated will have an acrylic provisional (temporary) restoration that is retained by temporary cement. This is part of the treatment and does not warrant an additional fee.  However, there are several instances when provisional crowns need to be made as a separate and intermediate procedure. Because of extra time and work involved, beyond that needed for a crown or bridge, there is a separate fee for the procedure.

One situation where a provisional crown warrants a separate fee involves a tooth or teeth that are severely decayed or broken, where the vitality of the nerve or the periodontal (gum) health is in question. It may be necessary to rebuild the tooth as soon as possible so that the health of the nerve inside the tooth, and the periodontal tissue surrounding the tooth, can be evaluated over time before proceeding with the final crown. When multiple teeth need this treatment, it is customary to place the provisional crowns on each at the same time. If each tooth is taken to completion individually before beginning the next tooth, there is too much opportunity for the remaining damaged teeth to deteriorate further, thereby complicating treatment and adding to the total cost. Provisional crowns may be in place for several months before further treatment is started on the tooth,  after which time the tooth will need to have further preparation and a new provisional crown made.

When the nerve in the damaged tooth has a chance of dying, it is easier to save the tooth with root canal therapy if the final crown has not been placed. It often takes months for the health of the nerve to be determined. And, in fact, despite using a long-term provisional crown, the nerve may die years after the final crown is placed. When that happens, the access for the endodontic treatment is made through the crown. With respect to the periodontal tissues, if they are infected or in poor health, they must be healed before final impressions are made. Periodontal treatment coupled with a well-fitted provisional crown will promote proper healing. After the periodontal tissue is healthy, its position with respect to the crown margins will change, and the tooth will be re-prepared and a second provisional restoration will be made.

Another reason for long-term provisional crowns to be placed is to stabilize loose teeth and determine the necessary support for the final cast crowns. When a tooth involved in support for a bridge or splint has a questionable prognosis, it is a good idea to make a provisional bridge first and let the tooth (or teeth) function together for some time to see how well they respond. If the tooth turns out to be hopeless, it can be removed. If teeth are restored in quadrants at a time (three, four, five, or more), it may be necessary to do the opposing arch in long-term provisional crowns in order to establish the ideal occlusal (biting) relationships between the arches.

There are many and varied reasons why long-term provisional bridges might be needed. They might stay in place from months to years, especially in very complicated cases such as many teeth that are broken down and moderate to severe gum disease needing correction before the crowns are finally placed. In larger cases, financial limitations may dictate that treatment be phased over a longer time frame. Rather than let the teeth get worse during this time, long-term provisional crowns are made to hold things in place until the treatment can continue.

Call Omni Dental today at (512) 250-5012 to speak with one of our specialists about the latest ways of enhancing your smile and dental health. You can also go to our website: for more information. 



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