Usual treatment: Normally, when a crown is being fabricated for you, after preparation of the tooth (teeth) the tooth or teeth treated will have a custom acrylic provisional (temporary) restoration fabricated that is then retained by temporary cement while the definitive crown is being fabricated at the laboratory. This is part of the treatment and does not warrant an additional fee.
Extended Treatment: We understand that patient's invest considerable time and money into their treatment and we value that. We also want to have any work we perform for our patients to be the best possible available and a sound investment that will last for years to come. Because the future health of the tooth depends on many factors, there are several instances when provisional crowns need to be made as a separate and intermediate procedure, or for a longer term use. This usually occurs because there is an adjunctive procedure needed before a final preparation and impression of the crown or bridge can be made. These procedures are will be discussed below in more detail. Because of extra time and work involved, beyond that needed for a crown or bridge, there is a separate fee for the procedure of extended treatment. This occurs in many instances and usually requires more than one tooth preparation procedure appointment. The first preparation is a rough approximation of the definitive preparation and after resolving any adjunctive procedure, the final preparation is made, each requiring its own custom fitted provisional crown.
Unknown Prognosis (future health): Sometimes a tooth's long term prognosis is in question. In this case fabricating definative crowns may be a major investment that is thenlost because the tooth (teeth) are in a questionable state of health and need further evaluation before proceding. This may include one or more of the items below.
Periodontal Treatment: If the teeth need periodontal treatment due to periodontal disease, then before definative crowns are fabricated they may also need long term provisional crowns until final healing has occured. With respect to the periodontal tissues, if they are infected or in poor health, they must be healed before final impressions are made. Periodontal treatment coupled with a well-fitted provisional crown will promote proper healing. After the periodontal tissue is healthy, its position with respect to the crown margins will change, and the tooth will be re-prepared and a second provisional restoration will be made. This is a case where they would need extended treatment time in the mouth and most probably need more than one preparation due to the subsequent changes in tissue height and contour.
Decayed or Broken teeth: One situation where a provisional crown warrants a separate fee involves a tooth or teeth that are severely decayed or broken, where the vitality of the nerve or the periodontal (gum) health is in question. It may be necessary to rebuild the tooth as soon as possible so that the health of the nerve inside the tooth, and the periodontal tissue surrounding the tooth, can be evaluated over time before proceeding with the final crown. This also occurs when a tooth is suspected of having a crack in it and we need some time to evaluate its prognosis before deciding on a definitive path of treatment. A tooth may require root canal therapy before continuing on, or even may be deemed unsalvagable, and require extraction. In this case an implant may be an alternative to either of the previous treatments.
Root Canal Therapy: When the nerve in the damaged tooth has a chance of dying, it is easier to save the tooth with root canal therapy if the final crown has not been placed. It often takes months for the health of the nerve to be determined. And, in fact, despite using a long-term provisional crown, the nerve may die years after the final crown is placed. When that happens, the access for the endodontic treatment is made through the crown. With respect to the periodontal tissues, if they are infected or in poor health, they must be healed before final impressions are made. Periodontal treatment coupled with a well-fitted provisional crown will promote proper healing. After the periodontal tissue is healthy, its position with respect to the crown margins will change, and the tooth will be re-prepared and a second provisional restoration will be made.
Lack of good tooth to build upon: Sometimes a tooth needs crown lengthening and since the treatment time is extended and it (they) may require two or more provisionals. See the link to Crown Lengthening for more information.
Several Teeth: When multiple teeth need this treatment, it is customary to place the provisional crowns on each at the same time. If each tooth is taken to completion individually before beginning the next tooth, there is too much opportunity for the remaining damaged teeth to deteriorate further, thereby complicating treatment and adding to the total cost. Provisional crowns may be in place for several months before further treatment is started on the tooth, after which time the tooth will need to have further preparation and a new provisional crown made.
Loose Teeth: Another reason for long-term provisional crowns to be placed is to stabilize loose teeth and determine if they have the necessary support for the definitive crowns. When a tooth involved in support for a bridge or splint has a questionable prognosis, it is a good idea to make a provisional bridge first and let the tooth (or teeth) function together for some time to see how well they respond. If the tooth turns out to be hopeless, it can be removed. If teeth are restored in quadrants at a time (three, four, five, or more), it may be necessary to do the opposing arch in long-term provisional crowns in order to establish the ideal occlusal (biting) relationships between the arches.
Implants: Many times a tooth/root can be extracted and an implant placed at the same time. If the implant is stable at the time of placement it may be a candidate for an immediate provisional crown. Because this is an additional time consuming procedure there is a separate fee from the standard implant crown. As with most periodontal procedures, since the tissue heights and contours change in the months following placment during healing, they usually need revision to fit more precisely in the surrounding tissue. If they do not require any changes, then the fee will be deducted from the normal implant crown fee. Implant crowns normally have provisionals placed after several months of healing to help mature the tissue, and do not require an additional fee.
Summary: There are many and varied reasons why long-term provisional crowns or bridges might be needed. They might stay in place from months to years, especially in very complicated cases such as many teeth that are broken down and moderate to severe gum disease needing correction before the crowns are finally placed. In larger cases, financial limitations may dictate that treatment be phased over a longer time frame. Rather than let the teeth get worse during this time, long-term provisional crowns are made to hold things in place until the treatment can continue.
It is important that you understand why provisional crowns might be necessary for your dental health.
If you have any questions about normal or long-term provisional crowns, please feel free to ask us.
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