I constantly find myself in difficult situations with the fixed prosthesis where patients’ clinical crowns tend to be very short, or the interocclusal distance after crown preparation is very thin. It’s to the point where all second or third molars are the bane of my existence and my least favorite teeth to prepare for a full coverage crown job.
Most of this frustration comes from the fact that the procrastination phase seems to disrupt my daily schedule. Who hasn’t had that temporary crown that popped out or fractured before the final crown returned from the lab, and now you have to redo a temporary crown in the middle of your busy schedule?
It seems that the majority of them are crowns with a short preparation height and minimal occlusal reduction. A tertiary problem stems from the dentist sometimes not being on their game, resulting in a less than stellar preparation design.
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What has historically been the solution to the first two problems? Endodontic therapy is always an option to allow further occlusal reduction. Anyone in practice knows that convincing a patient to undergo prophylactic endodontic treatment for a restoration is a daunting task.
Another solution (for problems #2 and #3) is to have the axial angulation and height of the preparation conform to the guidelines established by Goodacre et al.1 (Please use and read the reference at the bottom to find the article. Believe me, it’s worth remembering.) Being able to deal with any of these three clinical problems leads to an obvious solution. However, if the clinical situation does not allow you to modify the design of your preparation, what is there?
A more realistic day-to-day clinical response is to use a material that can be thin and strong enough to withstand the occlusal forces of the temporization phase, prior to placement of the final restoration.
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. Also, the patient smelling the monomer or seeing the dentist/assistant look like a mad scientist mixing the material is not always the best experience.
Many of us rely on a bis-acrylic based temporary restorative material. We know it’s easy to use, highly polishable and aesthetically pleasing. The disadvantage is that it is difficult to maintain a clean margin and thickness to avoid material fracture. So, along the way, what did I find to fix 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. This is a Massachusetts, USA-based company that is probably best known for its bioactive materials, but also has several hidden gems in its product line (Activa Presto, LimeLight, Activa Restorative/Cement /Base Liner).
Tuff-Temp Plus checks all the boxes for me. It is easy to use, the chemistry and physical properties of the material are superior in my daily clinical practice, and I have found it to be my go-to for fixed prosthesis temporization. You will find that this product has similar handling characteristics to other bis-acryl materials (eg Luxatemp, Protemp, TempSpan, etc.).
What is unique about Tuff-Temp Plus is its intricacies in clinical practice. I have no issues with fractured temporary crowns, and the margins of this restoration look cleaner and grip more firmly compared to bis-acrylic materials. I am able to achieve more confluent margins between the temporary and the tooth structure, which also reduces gingival inflammation associated with ill-fitting temporary restorations.
So how is Tuff-Temp Plus different from other common temporary materials? Tuff-Temp Plus is a rubberized urethane resin that can be light cured and is more fracture resistant than bis-acryl and acrylic based materials. This product solves the three major clinical problems mentioned at the beginning of this article, namely short clinical crowns, thin occlusal clearance and poor crown preparation.
It is easily dispensed from a 50ml cartridge into the matrix you created. Any voids can be repaired by using a new tip or by using their handy 5ml cartridge. And if you’re using this material for a cosmetic 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 tempering. I first grab it when I need to temporize teeth in clinical practice and have found that the main issues that arise in the temporization phase of fixed prosthesis are solved by this unique material. You won’t regret trying a Pulpdent product. Along the way, I found that it made my clinical practice easier and more predictable.
Editor’s note: Pulpdent financially supports Dental Economics. All products mentioned are used in the normal course of the author’s clinical practice.
Editor’s note: This article originally appeared in the May 2022 print edition of Dental economy magazine. Dentists in North America can take advantage of a free print subscription. Register here.
Reference
1. Proussaefs P, Campagni W, Bernal G, Goodacre C, Kim J. The effectiveness of ancillary features on a tooth preparation with an inadequate resistance form. Denture tooth J. 2004;91(1):33-41. doi:10.1016/j.prosdent.2003.10.005
