I keep finding myself running into difficult situations with fixed prosthodontics where clinical crowns for patients tend to be very short, or the interocclusal distance after crown preparation is very thin. It’s to the point where any second or third molars are the bane of my existence and my least favorite teeth to prepare for full coverage crown work.
Most of this frustration stems from the fact that the temporization phase seems to disrupt my daily schedule. Who hasn’t had that temporary crown that’s come out or fractured prior to the final crown being back from the lab, and you now have to remake a temporary in the middle of your packed schedule?
It seems that the majority of these are the crowns that are short in preparation height and minimal in occlusal reduction. A tertiary problem stems from the dentist not being on their game at times, which results in a less than stellar preparation design.
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What historically has been the solution to the first two problems? Endodontic therapy is always an option to allow for more occlusal reduction. Anyone who is in practice knows that convincing a patient to undergo prophylactic endodontic therapy for a restoration is an uphill battle.
Another solution (for problems nos. 2 and 3) is having the axial angulation and height of preparation fall within the guidelines set by Goodacre et al.1 (Please use and read the reference at the bottom to find the article. Trust me, it’s worth the refresher.) Being able to address any of those three clinical problems leads to an obvious solution. However, if the clinical situation does not allow an alteration in your preparation design, what is there?
A more realistic day-to-day clinical answer is using a material that can be thin enough and strong enough to withstand the occlusal forces of the temporization phase, before the final restoration is placed.
Traditional monomer-powder acrylic has been the answer for many years. Those of us who don’t use it in our daily practice find it cumbersome and time consuming to use. Plus, the patient smelling monomer or seeing the dentist/ assistant look like a mad scientist mixing the material isn’t always the best experience.
What many of us rely on is a bis-acryl-based temporary restorative material. We know that it’s easy to use, highly polishable, and esthetic. The downfall is that it is difficult to maintain a clean margin and thickness to avoid fracture of the material. So, along the way, what have I found to address these issues?
My proverbial “knight in shining armor” is Pulpdent’s Tuff-Temp Plus. If you haven’t heard of Pulpdent, you should open your eyes and ears to this company. It is a Massachusetts, US-based company that is probably best known for its bioactive materials but also has several hidden gems in its product lineup (Activa Presto, LimeLight, Activa Restorative/Cement/Base Liner).
Tuff-Temp Plus checks all the boxes for me. It’s easy to use, the chemistry and physical properties of the material are superior in my day-to-day clinical practice, and I’ve found that it’s my go-to for fixed prosthodontics temporization. You’ll find that this product has handling characteristics similar to that of other bis-acryl based materials (e.g., Luxatemp, Protemp, TempSpan, etc.).
What’s unique about Tuff-Temp Plus is its subtleties in clinical practice. I’m not having issues with fractured temporary crowns, and the margins of this restoration feel cleaner and grab on tighter when compared to bis-acryl materials. I’m able to achieve more confluent margins from temporary to tooth structure, which also reduces the gingival inflammation associated with poor-fitting temporary restorations.
So how is Tuff-Temp Plus different from other common temporary materials? Tuff-Temp Plus is a rubberized-urethane resin that is able to be light-cured and is more fracture resistant when compared to bis-acryl and acrylic based materials. This product addresses the big three clinical problems mentioned at the beginning of this article of short clinical crowns, thin occlusal clearance, and poor crown preparation.
It is easily dispensed out of a 50 mL cartridge into the matrix that you created. Any voids can be repaired by either using a new tip or using their convenient 5 mL cartridge. And if you’re using this material for an esthetic case, you can use their Tuff-Temp Glaze to add a nice shine to the temporaries.
Tuff-Temp Plus has been my go-to material for temporization. I grab it first when needing to temporize teeth in clinical practice and have found that the main problems that arise in the temporization phase of fixed prosthodontics are solved by this unique material. You won’t regret trying out a Pulpdent product. Along the way, I’ve found that it has made my clinical practice easier and more predictable.
Editor’s note: Pulpdent is a financial supporter of Dental Economics. All products mentioned are used in the author’s normal course of clinical practice.
Editor's note: This article appeared in the May 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
Reference
1. Proussaefs P, Campagni W, Bernal G, Goodacre C, Kim J. The effectiveness of auxiliary features on a tooth preparation with inadequate resistance form. J Prosthet Dent. 2004;91(1):33-41. doi:10.1016/j.prosdent.2003.10.005
