Making A Quick Temporary When There Is No Crown To Work With
There are many ways to treat this broken lateral incisor. Some may want to extract it for an implant. Some may want to save it with a crown. This is a young patient with a gummy smile on limited funds. We decided to save this tooth for now. The question is how do I give him a temporary crown the fastest way possible so he is not so embarrassed with his smile?
I’m sure there are many tricks out there. But I am sharing with you what I did for this particular case. I did not take pictures…there was no time….but here is what I did…..
1/Making a Matrix: Chairside wax up
I don’t have time to take an impression and to make a template from a diagnostic wax up. Instead I softened my rope wax and applied it over the tooth and have the patient bite into it. I used my finger or instrument to mold the rope wax as best as I can to make it look like an over contoured lateral incisor. Then I take a sectional impression of the area using bite registration material. I use bite registration material instead of impression material because it sets faster. This will serve as my template for making a temporary crown later. The temporary crown will likely be too bulky but I can reshape it easily afterwards to make it a pretty temporary. If I have an under contoured crown, it takes me longer to build it up. I am quicker at trimming away then building up contour.
2/Prepare the canal space for a cast post and core and prepare the tooth for full coverage restoration
Then I proceed with preparing the canal for a post and at the same time prepare the tooth for a crown. In this case, I took a post impression to be sent to the lab. Alternatively, I can also make a resin pattern to be sent to the lab for the cast post and core.
3/Making a Temporary Post
Once I finished getting a post pattern or taking an impression for the cast post, then I proceed with making a temporary post and a temporary crown. In this case, I used prefabricated post that sits passively inside the canal space. In the past, if I do not have pre-fabricated post, I have used paper clips and trimmed to fit the canal space. I may have to create some notches on the post for mechanical retention. In some cases, I may preserve the curvy part of the paper clip for more mechanical retention. The temporary post should be very loose fitting. The post should be trimmed to not interfere with occlusion as well as allowing you to re-seat the sectional impression.
4/Making a temporary crown
Once the temporary post sits passively into the canal space, then I will place my chairside temporary material (e.g. Protemp, Integrity )into the sectional impression and seat it back onto the teeth and allowed to set. Once it is set, I will remove the sectional impression and gently remove the temporary crown that should have the temporary post embedded inside the crown. Continue to do all the trimming and to improve contour until you are satisfied with the aesthetics of the temporary crown. In this step, try not to put too much temporary material such that you have an excess going into the canal space. You don’t want that get locked inside the canal. You will spend more time getting that out later….time you don’t want to waste.
Once the temporary crown has been contoured properly, it is ready for cementation. For such a compromised tooth, I will check and relieve any occlusion on this temporary crown and cement it with temp bond or with something stronger such as polycarboxylate cement. Note then when you are ready to remove the temporary crown with a post, sometimes I sectioned it in pieces so I minimized the risk of breaking the remaining tooth structure further.
That’s it! These are my go to steps whenever I find myself having to make a quick temporary crown on a tooth that is very compromised…in situations where I don’t have a lot time but want to make the patient smile again.
Thanks for reading!