Figure 3 - The upper right front tooth was lost at a young age and was replaced with a bridge. The temporary was worn for several weeks to make sure the patient liked the overall size of the teeth, and the patient was seen by the bridge-maker to make sure the final color would be just right. In this case, the temporary was an important tool used to ensure an end result that the patient will like.
Dentistry

Temporaries

In previous posts I have talked a bit about crowns – what they are, why they are needed, and what is involved in making them. In this post I will explain temporaries. Some readers may have had this experience – a dentist tells you that you need a crown, and that it is going to take a few weeks to have the crown made and returned from the lab, so in the meantime you will wear a temporary. This may leave you wondering with what exactly you’re going to be walking out of the office.

What is a temporary? In the context of replacing teeth, a temporary is a version of your tooth or teeth that is only designed to last a short period of time while we are waiting on something – which could be the dental lab to make the final version, or waiting on your mouth to heal from a surgical procedure (like having a tooth taken out). The temporary could be in place for weeks or months depending on the situation. Temporaries are commonly made by the dentist from a preliminary impression (a mold of your teeth that was taken before the work was started) while you are in the chair. It can be made from a variety of materials – various resins or acrylics (both are like hard plastics), and are generally cemented on the teeth with temporary cement – which is designed to be just strong enough to hold it in place, but weak enough that the dentist can remove it without too much trouble. There are many kinds of temporaries, but in this post I will focus on temporaries for crowns, bridges, and veneers.

You may wonder why the dentist doesn’t make the final crown himself? Well, some dentists do have machines in their office that can make crowns right away so a temporary isn’t necessary, but these machines cannot be used for every situation – getting the color just right on front teeth is difficult and often requires the skill of a lab technician to accomplish. Other dentists do their own crowns in a lab at their office, but this again is rare because it is expensive and time intensive to do this – generally a dentist has a partnership with a dental lab that handles the making of the crowns while they focus on patient care (this is what I do).

Something important for patients to understand is that a temporary (in most cases) does not look as good as the finished product. This is largely because of the limitations of the materials and tools used to make temporaries. Temporary materials come in a variety of colors to accommodate the variations in the colors of people’s teeth, but they are approximations at best. In a dental lab there is much more control over color – the subtle changes in color that exist in all teeth can be expressed by painting layers of porcelain over one another. A temporary is generally just one solid color, so it often can stick out from the adjacent teeth. I explain this to patients as the temporary is like “buying off the rack” and the final restoration will be like a tailored suit (or dress).

The lack of blending in that temporaries achieve with the teeth adjacent to them can be a bit of a shock to some patients, particularly when working on front teeth. Sometimes this can cause patients to lose faith in the dentist once they take a look at the temporaries. Patients may think “Is this what my crowns are going to look like? Wow this dentist isn’t that good!” Temporaries can also feel a bit rough to your lip or tongue compared to your natural tooth structure. This is again due to the limitations of what is possible in the dental office. It is important to understand that a dental lab technician has much more control of the color, shape, and smoothness of the restoration than a dentist does in the office. Just because you are not happy with the color of a temporary does not mean that you won’t be happy with the end result.

In some cases, temporaries can be made in a laboratory which are stronger, smoother, and more esthetic than ones made in the office. These can be used when working on lots of teeth to help visualize the end result, or when the temporaries are going to be worn for long periods of time for various reasons. However, lab fabricated temporaries can be expensive and add cost to an already expensive treatment.

Let’s look at an example. Figure 1 shows a patient who had her two front teeth veneered to correct some discoloration. The temporaries in this case were made out of composite – the same material used to do tooth colored fillings. The bottom picture shows the finished veneers after they have been in the mouth for two years. Note that the final veneers are much nicer looking than the temporaries. If the patient had not been educated on this difference before treatment started, I could understand how they could be quite nervous about the end result while the temporaries were on.

Homewood-Dentist-veneer-temp-pics_w

Figure 1 – Veneers placed on the two front teeth to correct discolorations. Note the temporaries are rougher and just not as pretty and smooth as the final veneers. The “veneers” picture was taken two years after they were placed.

 

In Figure 2, we see an example of a bridge temporary (a bridge is a crown containing three or more teeth). This patient had his front tooth knocked out at a young age and wanted it replaced. The patient did not want to go through the bone grafting required for an implant, so a bridge was chosen to replace the tooth. The two teeth next to the space were trimmed down and a temporary was placed. Notice that the temporary (made from acrylic) is a flat color that sticks out from the other teeth. In this case, the temporary was used to make sure the patient liked the overall shape and size of the teeth before the bridge was made. The patient was also sent to the ceramics lab, where the bridge was made, to make sure the color was matched as well as it could be. This could not have been done without the temporary being worn for a few weeks.

Figure 2 - The upper right front tooth was lost at a young age and was replaced with a bridge. The temporary was worn for several weeks to make sure the patient liked the overall size of the teeth, and the patient was seen by the bridge-maker to make sure the final color would be just right. In this case, the temporary was an important tool used to ensure an end result that the patient will like.

Figure 2 – The upper right front tooth was lost at a young age and was replaced with a bridge. The temporary was worn for several weeks to make sure the patient liked the overall size of the teeth, and the patient was seen by the bridge-maker to make sure the final color would be just right. In this case, the temporary was an important tool used to ensure an end result that the patient would like.

 

This is by no means a comprehensive lesson on this subject – some temporaries look better than these, some look worse. My intention here is to let the reader have a general understanding of what to expect if they have to go through something like this themselves. New experiences, especially with front teeth, can be scary. The more mystery that can be taken out of things, the better. In future posts I will go into more detail about different types of temporaries. As always, contact me with any questions.

Marc