Cracking the Case: Understanding Broken Provisionals

By: Lee Ann Brady DMD
Topic originally appeared on Dr. Brady allowed permission for igniteDDS to share with our readers

Provisionals play a pivotal role, not just in helping the patient adjust through to their final restorations, but they are helpful to us also – to fix our mistakes while we still can. 

Even though it can seem hard to face, when we find that something is wrong in the design of provisionals delivered to the patient, it’s always better to look at the positive side of the story. It’s better to fix the temporaries many times until we get them completely right rather than seeing the final restorations failing later.

I challenge you, in this moment, when a broken provisional comes into your office, to reframe the ‘problem’ as a mystery to be solved. You are the clinical detective who needs to work backward a la Sherlock Holmes to figure out ‘whodunit.’

Mystery of the Broken Anterior Provisional

Remaking and adjusting an anterior provisional from the upper right to the upper left canine (for the second time) is a horror story in the making. Before you allow that narrative to take over and call the lab to have them rush the case back, remember to rely on your intuition and technical expertise.

You may not be able to call the lab because you haven’t taken final impressions. Either way, let the provisionals tell you what the flaw in the design is, rather than believe you can run the solution show. 

A good first place to look and listen for answers is the occlusion. For example, if the patient reports that they wake up with headaches after you’ve placed the provisionals, you would want to look closely at the envelope of function. Is the patient heavy on the centrals and laterals? If so, you can begin the process of adjusting.

Methods of the Dental Detective

As you examine the issue, you may find other clues, such as that the patient is catching on the incisal edge in their return stroke from protrusive. You continue to adjust, beveling edges for a smoother transition. You leave the guidance shared between the canines and central, and keep it smooth, but even this doesn’t stop the patient from breaking the provisional.

If you’ve ever seen or read a good detective story, you know this isn’t the time to quit. When things seem most opaque, the detective is usually at a breaking point where the parts might finally start to fit together. Once they do this, the floodgates open and they rush toward the explanation.

You will reach this point while adjusting again. In response to what you’ve learned, you begin to shallow the patient’s guidance and share protrusive with the premolars. You decide to shorten lower anteriors and increase overjet by proclining the restoration. Here, you’ve come to the solution. You need to work it out on an articulator perhaps and then go back to the mouth.

The main lesson is that we have the most to learn from cases that don’t go perfectly. Plus, it would get pretty boring if there were no dental mysteries left to solve …

If you love to expand your knowledge about occlusion so you can create more predictable provisionals for your patients and treat every other occlusion problem of your patients confidently, explore the The Essential Series at The Pankey Institute, a world-leading dental education. 

Dr. Lee Ann Brady

Dr. Lee Ann Brady

Dr. Lee Ann Brady lives in Phoenix, Arizona with her husband Kelly and three children Sarah, Jenna and Kyle. She owns Desert Sun Smiles Dental Care, a private restorative practice in Glendale, Arizona. Outside of her private practice, Dr. Brady is the Director of Education for The Pankey Institute, recognized for hands-on education programs focused on occlusion and restorative dentistry. She is the founder and lead curator of Restorative Nation, a supportive learning community for dentists.