How do you make your anterior temporary crowns?

My associate Dr. Natalie Goldstein suggested I write some posts aimed at helping young dentists. She felt that many young dentists would appreciate me sharing posts explaining some of the techniques I use. I am sure that many of my colleagues do not need my help, but here goes.

I like copying or modifying pre-existing teeth if present.  I usually take an impression (alginate or quick setting polyvinyl silicone) in an anterior quadrant tray. Before taking the impression If I would like to make the temporary look different than the original tooth , I will add some composite free hand onto the tooth and sculpt it , prior to taking the impression. Prime and bond when dipped onto a plastic instrument will help me to shape my composite modified tooth. After setting my light cured composite,if needed I use a fine et diamond to further refine the shape. Once I and the patient is happy with any modifications, I will take my preliminary impression.

After I have completed my crown preparation, I most often use  A1 Protemp or Luxatemp to fill up my impression and seat it in the mouth. As in most things in life trimming is very important. When using Protemp, I set a timer and remove the impression in 1min - 1 min and 15 seconds. Hopefully when I remove it , the semi-set temporary comes out in one piece without any cracks in the proximal walls. If left in too long Protemp tends to crack if it gets locked into inter proximal spaces.

If it comes out with my impression that great. I place it on to my bracket table and wait a couple of minutes more for it to become more solid. Its usually not the best idea to re seat the temporary until it is at least rough trimmed ( don't want for it to become distorted or worse, break).

If it stays in my patients mouth when I remove the impression, I quickly use a cord packing instrument to pry it out from the inter proximal. The packer is place interproxmally at the gingiva and moved slightly towards the incisal. This is usually all I need to do to remove the temporary. Occasionally, especially if I have let the material become too set, the temporary may develop a crack on the proximal surface and if this happens , I make a new one.

Once I have a suitable version of the temporary made, I trim away any excess using a flame tipped beveling bur. with a slight water and air spray. I turn the crown over so I am viewing the hole for my preparation and trim any excess away from my visible finish line. I find that when I do it this way I am less likely to over trim my temporary at the margin. Once my margin is the right thickness, I trim any other flash that is left on the temporary making sure not to touch my margins.

Once trimmed its time to trial seat it back in the mouth. If the temporary is short at the margin, its not a big deal, since flowable composite can be added in the mouth to add the margin ( a tip from Frank Spear).

Now its time to adjust the bite. Its important to check the patients mouth to make sure that no excess composite material remains in their mouth that might affect the bite. I find there often is and I will remove it using a tiny sickle shaped scaler. This is sharp enough to locate any composite hanging out on adjacent incisal or lingual surfaces that might make adjusting the bite harder. Once I make sure that any residual composite is removed I will adjust my temporaries bite with a standard foot ball diamond and Accufilm articulating paper.

Usually fabricating and cementing a well fitted and cosmetic temporary will take about 10 minutes. I make sure that the shade of my temporary is lighter than the adjacent teeth. Most patients will accept this, but will complain if my temporary is lower in value than the adjacent teeth.