The Many Benefits of Using a Long-Term C&B Provisional Material

You're listening to The Dr. Phil Klein Dental Podcast Welcome to the show. I'm Dr. Phil Klein. Today, we'll be discussing the use of a long-term crown and bridge provisional material and why it is beneficial for your practice. Our guest is Dr. Scott Chanin, who is in private practice in Flemington, New Jersey, and is on faculty at University of Pennsylvania School of Dental Medicine. Dr. Chanin, it's a pleasure to have you on Dental Talk. Oh, thank you, Phil. It's a pleasure to be here. We talked a little bit offline about provisional material, and it's interesting that we'll be talking about a product that actually is the only product that exists in its class, technically, based on the material that it's made of. And we'll go into that as we get into this podcast. But before we get too deep, to begin, can you define for our audience what long-term means in respect to crown and bridge provisional material? I think long-term can be defined in different ways. I mean, you can use long-term crowned bridge material when you're doing perioprosthesis type of restorations, when you're going to be doing periodontal work and the provisional has to be on for a long period of time. It could be a year. It could be a year and a half when you're doing surgery, possibly putting in implants, bone grafts, and you need a restoration that's going to last and be reliable and not break on a regular basis so that you can maintain the tissue. You can maintain the vertical dimension, and you can maintain the teeth. So I define a long-term restoration for a provisional as something that's going to last at least a year to a year and a half in order to get this kind of restoration completed. Previous to these new materials, you know, that was basically a lab-processed provisional that you'd have to make and send out models to the lab and make a lab-processed material. These kind of materials allow you to do it in the office, and they work very well. As we discussed before the podcast started, there's really only one material that allows you to make it in the office, right? Yeah, that I'm familiar with and that I've had the opportunity to use. And that one is Luxor Crown. And Luxor Crown is basically, instead of being an acrylic, it's more of a composite material. So it's very hard. It's very aesthetic. And, you know, when I look at them and even when patients see them in their mouth, they really think it's the final restoration because it looks so good. a long-term crown and bridge provisional like this versus the traditional materials that are primarily formulated for shorter periods of time? Well, because number one, it doesn't break. And that's a real key thing. And I can tell you, you know, I teach at Penn Dental, and so I'm teaching students who are doing this. And when they're making provisionals out of the conventional materials, they tend to break. And in the school, of course, provisionals are on, even though it may be a short-term procedure, they end up being on a long period of time because of the process of getting it done in the school. So they break. Well, every time a temporary breaks or a provisional breaks, that requires you bring the patient back, you have to fix it, you have to make an appointment, have chair time, use disposables, redo, and it requires time, assistance time. Just the fact that you don't have to do all that and you have a provisional that's going to last saves a tremendous amount of time besides all the other functions of maintaining the tissue and being able to have tissue health and function and all that kind of stuff. So did you give up using the traditional material and now you're using this new material for all provisionals or you're just saving it for the longer term cases? In my case, I use this for... provisionals in my office that i make and the reason is is because from my experience it has not i haven't had to remake or repair i mean i can't even remember the last time i had to repair one so my time is the most valuable thing no matter when you bring a patient in it's at least a half hour no matter what i mean just to bring them in see them in the chair do whatever you have to do so every time you have to do that it's a waste of time Then the patient gets annoyed and they feel that, you know, there's something wrong. Why does it break? These don't break. I mean, they stay really intact. And besides that, aesthetically, they look great. These are made out of composite resin versus the typical acrylic. Correct. Great. These are composite. It's a composite material. That is a big advantage because it's a much harder surface. So they can function with them. And especially when you get a person who's a Bruxer. You know, the conventional acrylic just fractures or breaks. Right. So the key advantage, what I'm hearing, is the fact that it doesn't fracture. Aesthetics-wise, does it help you with the final case on delivery by matching it up closer and meeting patient expectations? Absolutely. In fact, just recently, I had a patient who was doing veneers on. And I said, you know, let me try making veneer provisionals out of this luxury. It was the first time I've done it. And it actually... stayed on the tooth the whole time didn't break and aesthetically it looked really good i was really actually very satisfied with it the patient was very happy and you know they they came back you know it was about a month later because of his business travel commitments And it was still perfectly intact. So that showed me that this material really has a lot of potential for a lot of different uses. So it had to be very thin, obviously, to be used as a veneer. Yeah, right. You can make it very thin. Which is an advantage over acrylic. Yes. And you can also make very fine knife-edge margins that are thin, and they stay intact. They don't break off. You've got aesthetics. You've got strength, patient satisfaction. What are the benefits to the practice and the patient, or do we cover most of them? Well, I think, you know, from a point of view, if you look at the material just to buy the material, it might be a little more expensive than conventional material. But if you look at when you're doing, you know, sophisticated kind of restorations or simple restorations, the time that you save is way more valuable than the minimal amount you're going to spend on a temporary crown. So if it costs you $2 more for a temporary crown. but saves you having to bring a patient back for a half hour. How much is a half hour of your time, your assistant's time, your front desk time, disposables, cleaning the room? There's no comparison. So you have to look at the whole picture, not just how much the material costs. That's the least of it. Now, tell us about the actual fabrication of this provisional compared to traditional acrylic. What's the workflow change? Does it take more time? What are some of the things that we're talking about chair side? so actually what you do is you take an impression of the existing teeth and um i use a triple tray and with some kind of polyvinyl material you know it doesn't really matter what kind you use then after you prepare the tooth you syringe from the gun that this comes in into the impression and the material then is placed in the impression in the uh impression on the tooth and the patient bites together And all you do is express a little out on the tray, wait for it to harden, take the impression out of the mouth, and typically your crown is almost done. You just have to use a disc, remove, you know, the excess flash, thin out the margins. You typically have a tooth that's almost in occlusion perfectly because you're taking in a model of the existing crown. So, you know, it's literally a five or ten-minute procedure to make a temporary crown with this material. And as far as shade? Guys, is there a shade system with this? Yes. It comes in different shades. It comes in the Vita shades. Not all the Vita shades, but it comes in enough Vita shades. You don't necessarily want to have the temporary look better than the final restoration, so you don't need to have every single shade. But it comes in plenty of shades to be adequate, to match whatever you need to match. And then the other thing you can do is... I do with it, if it's a case where the teeth are not matching, I use some kind of staining material. There's some different kind of composite stains that they have that I'll use to color the temporary so it matches better if you need to do that. Yeah. And are they using this at the dental school at Penn? I think possibly in the graduate clinic, but I don't think not in the main clinic, no. Right. It takes some years to catch up. Both of us graduate. I'm talking to the audience now. Scott and I both graduated in the same year, and we know very well how long it takes a dental school to catch up to where they should be. They're still approving things from when we graduated. Right. I heard that. The audience got a good insight into the benefits of a long-term crown abridgment material, which, as you mentioned, there's only one that exists. in the form of making it chair side versus what you said earlier offline which was milling it right what's the other option if you don't use this material and you want to composite provisional Not for a composite provisional, but the other option which I used, you know, for most of my life was having a lab process provisional where you send the models to the lab and they make a wax up and they make a laboratory process provisional. They send it back to you and you reline it. And, you know, like, for example, I always make a metal reinforced provisionals when I did it from the lab. You can do the same thing with this. You can just put some, you know, there's a lot of new splitting materials out now which you can use. to incorporate into this material when you do, if you're doing a temporary bridge, incorporate it in the material to give it extra strength. So there's a lot of flexibility with this material that you can, you know, strengthen it, support it, and, you know, it'll last a very long time. And there's no question the value of chairside time for a dentist is so much more important than saving a few dollars on material. Just like you said, the infection control considerations, the staff, the scheduling, a cancellation. There's no question. There's no comparison. You've got to get the material that's going to save you chairside time. To me, you know what? The most important things to look at in dental material is ease of use, longevity, not cost because it's minimal. You want to save your time because the only thing you really have to sell is your time. Yeah, absolutely. That's all you have. You only have so many hours in a day. Yeah. You mentioned ease of use. Is the material easy to use? Extremely easy to use. It's really a very simple procedure. Thank you so much, Dr. Chanin. We appreciate all your insight. Hope to have you on another podcast soon. Have a great night. Thank you. It's been a pleasure. Thank you.