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Chairside technique for expediting indirect interim restorations

Mohiddin R. Dimashkieh, DDS, MSca and Mohammad R. Rayyan, BDS, MDSb

The use of flexible casts and dies for the chairside fabri-
cation of interim restorations has been reported to
overcome the drawbacks of the direct technique and
provide a safe and biocompatible fabrication process.1-5
Because of the elasticity of these casts, removing the
interim restoration after complete setting is easy, and
the integrity of the casts is maintained. Unlike stone
casts, the flexible cast can be reused if a new interim
restoration is needed later.1
Different elastomeric impression materials and con-
sistencies have been used to make flexible casts.
Although materials such as polyvinyl siloxane have
excellent dimensional stability, they are relatively
expensive and adhere to the already set impression
material.6 For this reason, a second alginate impression is Figure 1. Injecting melted hot melt adhesive material in definitive
usually made to produce the flexible cast.1 impression.
To overcome these limitations, this article proposes
the use of hot melt adhesive material (HMA) for the
fabrication of flexible casts. HMA is a thermoplastic
material usually supplied in sticks, which are melted
using an electric gun. It typically consists of a base
material such as an ethylene-vinyl acetate copolymer
with additives such as wax, resins, plasticizers, and
pigments.7
HMAs do not adhere to elastomeric impression ma-
terials. This allows easy separation of impressions made
with any material, including polyvinyl siloxane without
the need for a separating agent. Obtaining the flexible
cast from the definitive impression eliminates the need
for an additional impression, reduces the time needed for
the procedure, and improves the accuracy of flexible cast
details. HMAs are also less expensive than elastomeric
impression materials. Figure 2. Hot melt adhesive-made flexible cast.

a
Professor and Postgraduate Program Director of Prosthodontics, Prosthodontic Department, College of Dentistry, Riyadh Colleges of Dentistry and Pharmacy, Riyadh,
Saudi Arabia.
b
Assistant Professor, Prosthodontic Department, College of Dentistry, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia.

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Figure 3. Interim crown before excess removal.
PROCEDURE
1. Make a putty (Express STD; 3M ESPE) index mold
of the tooth intended for preparation, including
1 neighboring tooth on each side.
2. Prepare the tooth in the usual manner.
3. Make the definitive impression of the prepared
tooth and the surrounding tissue with the
preferred impression material (Imprint II Garant
regular and light body; 3M ESPE) and technique.
Wash, disinfect, and dry the definitive impression.
4. To produce the flexible cast, fill the prepared and
adjacent teeth by injecting the heated HMA ma-
terial (3M Scotch-Weld hot melt adhesive; 3M)
with an electric gun (Glue Gun LC 606N; Meta
Precision Industry Co., Ltd) (Fig. 1).
5. When the HMA material cools, remove it from the
definitive impression (Fig. 2). Inspect the flexible
cast for bubbles or defects. If necessary, reapply a
small amount of the heated HMA material to the
impression and replace the cast in the impression.
6. Place the flexible cast into the preoperative index
mold and examine it carefully for complete seating.
Prepare a mix of autopolymerizing resin material
(Success CD; Promedica Dental Material GmbH)
and place the mix in the index mold. Immediately
seat the flexible cast fully into the index mold and
hold both firmly in place by hand or with a rubber
band until the resin completely polymerizes.
7. To accelerate the polymerization of resin, immerse
the assembly in warm water.
8. After the resin has completely polymerized, sepa-
rate the putty index mold from the flexible cast
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Figure 4. Finished interim crown on prepared tooth.
(Fig. 3). Flexibility allows easy removal of the
interim restoration without damaging either the
cast or the restoration.
9. Trim any excess material, remove any undercuts,
and shape the interim restoration with rotary in-
struments in the usual manner.
10. Evaluate and fit the interim restoration on the
prepared tooth and adjust the occlusion if needed
(Fig. 4).
11. Polish the restoration and cement it in the usual
manner.
REFERENCES
1. Boberick KG, Bachstein TK. Use of a flexible cast for the indirect fabrication of
provisional restorations. J Prosthet Dent 1999;82:90-3.
2. Campbell TM, Nagy WW. A vinyl polysiloxane die used to make interim
restorations. J Prosthet Dent 1992;68:201-3.
3. Roberts DB. Flexible casts used in making indirect interim restorations.
J Prosthet Dent 1992;68:372-4.
4. Antonelli J, Torio R. A new and indirect working die technique for fabricating
temporary restorations. Gen Dent 1998;47:202-5.
5. Antonelli JR, Gulker I. A modified indirect working die technique for fabri-
cating provisional restorations for multiple teeth. Quintessence Int 2000;31:
392-6.
6. Gerrow JD, Price RB. Comparison of the surface detail reproduction of flexible
die material systems. J Prosthet Dent 1998;80:485-9.
7. Li W, Bouzidi L, Narine SS. Current research and development status and
prospect of hot-melt adhesives: a review. Ind Eng Chem Res 2008;47:7524-32.
Corresponding author:
Dr Mohammad R. Rayyan
Riyadh Colleges of Dentistry and Pharmacy
PO Box 84891
Riyadh, 11681
SAUDI ARABIA
Email: mohammadrayyan1979@gmail.com
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Dimashkieh and Rayyan