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Table of Contents
Year : 2023  |  Volume : 13  |  Issue : 1  |  Page : 39-42

Use of protemp 4 in pediatric patients: A novel approach to make bitter smiles better

Department of Pedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India

Date of Submission01-Dec-2022
Date of Acceptance23-Feb-2023
Date of Web Publication28-Apr-2023

Correspondence Address:
Dr. Sakshi Singh
Department of Pedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad - 244 001, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jid.jid_31_22

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Early childhood caries is a multifactorial chronic disease affecting the general life of a child. Functional along with esthetic rehabilitation of decayed primary teeth should be the main focus of pediatric dentists. The advent of new restorative materials and techniques has helped to create beautiful smiles for children. As the retention time of primary teeth is short, hence using temporary material for primary teeth restoration could be a good alternative. This case series depicts a novel clinical technique of using a temporization material –Protemp 4 for intra- and extracoronal restorations in primary teeth.

Keywords: Early childhood caries, protemp 4, strip crown, temporization material

How to cite this article:
Krishnan P, Singh S, Biswas P, Sharma N. Use of protemp 4 in pediatric patients: A novel approach to make bitter smiles better. J Interdiscip Dentistry 2023;13:39-42

How to cite this URL:
Krishnan P, Singh S, Biswas P, Sharma N. Use of protemp 4 in pediatric patients: A novel approach to make bitter smiles better. J Interdiscip Dentistry [serial online] 2023 [cited 2023 May 30];13:39-42. Available from: https://www.jidonline.com/text.asp?2023/13/1/39/375285

   Clinical Relevance to Interdisciplinary Dentistry Top

  • The present case report describes the use of Protemp 4 in primary dentition
  • Esthetic rehabilitation was done for anterior primary teeth using Protemp 4
  • Protemp 4 was used as a restorative material along with strip crowns.

   Introduction Top

Early childhood caries is a significant chronic disease of childhood leading to loss of structural integrity of primary teeth affecting esthetics, causing poor phonetics, compromised masticatory system along with difficulty in social and physiological adjustment.[1],[2]

Various restorative materials such as miracle mix, composites, glass ionomer cements (GICs), resin-modified glass ionomers, and polyacid-modified resins are good intracoronal treatment options in primary teeth.[3],[4]

Conventionally, strip crowns are used with light-cured composites.[4] In this series, a new bis-acryl group composite resin and temporization material are used. This is ideally used for temporary crowns[5] but here, we have used it as a restorative material for intracoronal and extracoronal restoration considering shorter time span of primary teeth in the oral cavity.

Protemp 4 is a chemically cured resin of the bis-acryl group, consisting of an organic matrix and inorganic fillers having low polymerization shrinkage, reduced tissue toxicity, good wear resistance, and strength.[6],[7]

This case series represents the rehabilitation of primary teeth using novel Protemp 4 as intracoronal and extracoronal restorative material.

   Case Reports Top

Patients with dental caries in primary tooth were selected for the case series from the Outpatient Department of Pedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India. Informed consent was taken from the parents. Classification of International Caries Detection and Assessment System II (ICDAS II) was specified for each tooth.[8] This scoring system was developed tp allow the standardized caries detection and diagnosis in different situations.

Case selection

Inclusion criteria

  • Teeth having dentinal and enamel caries
  • Children with Frankl behavior score – 3 or 4.

Exclusion criteria

  • Teeth with pulpal involvement or showing mobility.

Case 1

A 4-year-old child reported to the department with chief complaint of dirty anterior teeth for few months. On intraoral examination, decayed teeth in relation to 51, 52, 61, and 62 [Figure 1]a. ICDAS II code was assigned 5 in relation to 51, 52, 61, and 62. 51, 61 were rehabilitated with strip crown using Protemp 4. 52, 62 were restored with GIC.
Figure 1: (a) Carious 51, 52, 61, 62, (b) Crown preparation of 51, 61, (c) Checking the size of Strip Crown, (d) Strip crowns in 51, 61 and GIC restoration in relation to 52, 62

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Steps for restoring maxillary central incisors using Protemp 4:

  • Step 1: Caries were excavated in relation to 51, 61
  • Step 2: Crown cutting was done, ~1.0 mm from all sides [Figure 1]b
  • Step 3: The mesiodistal dimension of the tooth was measured, accordingly, a correct size of strip crown was selected for the crown [Figure 1]c
  • Step 4: The teeth were air-dried and isolated using cotton rolls
  • Step 5: Shade A3 was selected for the following cases. Strip crowns were loaded with Protemp 4 with the help of automix syringe. Loaded strip crowns were placed on the prepared teeth, and the celluloid portion of crowns was removed as the material set.
  • Step 6: Finishing of the restoration was done using finishing burs [Figure 1]d.

Case 2

A 5-year-old child reported with the chief complaint of blackish discoloration in the upper front teeth region for 1 year. Clinical examination revealed decayed tooth in relation to 53, root stumps in relation to 51,52,61, and 62 [Figure 2]a. ICDAS II code 3 was assigned in relation to 53.
Figure 2: Case 2-(a) Carious in relation to 53, (b) Restoration done using Protemp 4, Case 3-(c) Carious in relation to 51, 52, 61, 62; (d) Strip crown in relation to 61.62 and GIC in relation to 51, 52, Case 4-(e) Carious in relation to 74,84; (f) Restoration done using Protemp 4

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Protemp 4 was manipulated according to the manufacturer's instructions using an automix syringe followed by the restoration of the decayed right maxillary canine [Figure 2]b.

Case 3

A 5-year-old child reported with chief complaint of decayed teeth in the upper anterior region for few months. On intraoral examination, decayed teeth in relation to 51, 52, 53, 61, 62, and 63 [Figure 2]c. ICDAS II code was assigned 5 to all the teeth. GIC restoration was done in relation to 51 and 52, whereas 61 and 62 were rehabilitated using strip crown with Protemp 4 in place of conventional composite material [Figure 2]d. However, the parents were not willing to the restoration of 53 and 63 during the same appointment.

Case 4

A 6-year-old child reported with the chief complaint of food accumulation in posterior teeth for several days. On clinical examination, occlusal caries in relation to 74 and 84 [Figure 2]e. ICDAS II code was assigned 3 in relation to 74 and 84. Caries excavation was done using small round bur followed by restoration with Protemp 4 in relation to 74 and 84 [Figure 2]f. High points were trimmed with diamond burs.

   Discussion Top

Bis-acryl composites consist of bifunctional substrates to provide cross-linkage with one another and form monomer chain cross-linkage leading to increase in impact strength and toughness. They have overcome the disadvantages of polymethylmethacrylate (PMMA) resins.[9] Young et al. claimed that bis-acryl composite resin were superior to PMMA with respect to contour, occlusion, fit, and finish because of increased filler content.[10] A new variant of bis-acryl composites, Protemp 4 having flexible monomer chain unlike rigid intermediate chain of other bis-acryl resins. This creates balance between high mechanical strength and limited elasticity allowing it to withstand higher stresses.[7] Protemp 4 (3M ESPE, Seefeld, Germany) comprises catalyst paste: ethanol, 2,2-[(1-methylethylidene) bis (4,1-phenyleneoxy)] bis-diacetate, benzyl-phenyl-barbituric acid, silane-treated silica, tert-butylperoxy-3, 5, 5-trimethylhexanoate, base paste: dimethacrylate (BISEMA6), silane-treated amorphous silica.[11]

Protemp 4 has a working time of 40 s. It chemically binds to the tooth. In uncured state, it acts like wax or clay. In the wax stage, material can be easily adapted to the tooth. The earliest point of removal from the mouth is 1:40 min. Latest point of removal from the mouth is 2:50 min. A study stated that Protemp 4 contains dimethacrylate polymer and bisphenol A glycidyl methacrylate resins with fillers and stabilizers and rigid central structure of bis-acryls reduces the dissolution of the resin-filler particles, rendering it with better hardness than heat cure acrylic resins.[12] According to Khajuria et al., Protemp 4 on comparison to other provisional materials, it showed less intrapulpal temperature change and exothermic heat release.[13] Protemp 4 has good color stability due to the fact that it utilizes modified Bowen resin, which is a derivative of the bis-acryl compounds, rendered hydrophobic in nature causing major reduction in water absorption.[11] Protemp 4 has reduced cytotoxic effects due to its free radical defense system. Reactive oxygen species (ROS) are generated from these resins which have direct scavenging effect and promotive effect on the glutathione system – a direct ROS scavenger.[14] The value for flexural strength of Protemp 4 material was measured to be 110 ± 12 MPa. The flexural strength of Protemp 4 increases when cured at 60°C.[13]

Other findings of Protemp 4 were, change in optical characteristics, after storage time of 30 days. It may be seen due to water sorption, swelling effect, and unreacted monomers being oxidized. Swelling leads to relaxation of polymer, making the polymer chain more mobile and causing removal of unreacted monomers, pigments, and fillers. Hence, it interferes with the overall polymer strength.[15] A study conducted by Vignesh et al. comparing fracture toughness of packable composite resin versus Protemp 4 when used inside a strip crown to restore primary incisors and concluded that the fracture toughness of both materials was comparable and Protemp 4 can be used as an alternative.[16]

In the present case series, GIC was used in some teeth so as to compare its esthetics and longevity with Protemp 4 temporization material. To the best of our knowledge, a few in vitro studies have been conducted using Protemp 4 in the primary teeth; however, no clinical studies have been reported to date. Hence, to check the applicability of this material in primary teeth, a few cases were carried out. Protemp 4 has been proved to be cost-effective owing to its multiple usage in primary dentition in the form of restoration, strip crowns, and in permanent dentition as fabrication of temporary (inlays, onlays, bridges, veneers, and crowns).

The follow-up of cases one, three, and four was done at 6 months, whereas case two did not show up on recall appointment. In case 1- Strip crowns made using Protemp 4 were intact along with the GIC restoration irt 52 with no color change, however the GIC restoration done irt 62 chipped off. In case 3 and case 4- Restorations done using Protemp 4 were intact with color stability.

Overall, Protemp 4 has proved to be superior in its properties. However, its effect on primary teeth is yet to be evaluated properly, due to paucity of literature.

   Conclusion Top

The use of temporization material, as a restorative material and as a strip crown material for permanent rehabilitation of primary teeth is a good treatment alternative than using conventional restorative materials. Protemp 4 chemically bonds to the tooth and with its advanced properties, it could be a good recommendation in pediatric dentistry.

Declaration of patient consent

The authors declare that they have obtained consent from patients. Patients have given their consent for their images and other clinical information to be reported in the journal. Patients understand that their names will not be published and due efforts will be made to conceal their identity but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

De Grauwe A, Aps JK, Martens LC. Early childhood caries (ECC): What's in a name? Eur J Paediatr Dent 2004;5:62-70.  Back to cited text no. 1
Feldens CA, Giugliani ER, Duncan BB, Drachler Mde L, Vítolo MR. Long-term effectiveness of a nutritional program in reducing early childhood caries: A randomized trial. Community Dent Oral Epidemiol 2010;38:324-32.  Back to cited text no. 2
Marquezin MC, Zancopé BR, Pacheco LF, Gavião MB, Pascon FM. Aesthetic and functional rehabilitation of the primary dentition affected by amelogenesis imperfecta. Case Rep Dent 2015;2015:790890.  Back to cited text no. 3
Walia T, Salami AA, Bashiri R, Hamoodi OM, Rashid F. A randomised controlled trial of three aesthetic full-coronal restorations in primary maxillary teeth. Eur J Paediatr Dent 2014;15:113-8.  Back to cited text no. 4
Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of Fixed Prosthodontics. 3rd ed. USA: Quintessence Publishing (IL); 1997. p. 226-7.  Back to cited text no. 5
Singh A, Garg S. Comparative evaluation of flexural strength of provisional crown and bridge materials – An Invitro Study. J Clin Diagn Res 2016;10:ZC72-7.  Back to cited text no. 6
Dokania R, Nayakar RP, Patil R. Comparative evaluation of fracture resistance of three commercially available resins for provisional restorations: An in vitro study. Br J Appl Sci Technol 2015;7:520-7.  Back to cited text no. 7
Criteria Manual: International Caries Detection and Assessment System (ICDAS II). International Caries Detection and Assessment System (ICDAS) Coordinating Committee. Workshop Held in Baltimore, Maryland: 12th-14th March, 2005.  Back to cited text no. 8
Haselton DR, Diaz-Arnold AM, Vargas MA. Flexural strength of provisional crown and fixed partial denture resins. J Prosthet Dent 2002;87:225-8.  Back to cited text no. 9
Young HM, Smith CT, Morton D. Comparative in vitro evaluation of two provisional restorative materials. J Prosthet Dent 2001;85:129-32.  Back to cited text no. 10
Kuphasuk W, Ponlasit N, Harnirattisai C. Flexural strengths and color stability of bis-acryl resin materials for provisional restorations. Mahidol Dent J 2018;38:135-46.  Back to cited text no. 11
Mehraj N, Agarwal SK, Singhal R, Abrol K. An evaluation of hardness of commercially available provisional restorative materials: An in vitro study. J Clin Adv Dent 2020;4:001-3.  Back to cited text no. 12
Khajuria RR, Madan R, Agarwal S, Gupta R, Vadavadgi SV, Sharma V. Comparison of temperature rise in pulp chamber during polymerization of materials used for direct fabrication of provisional restorations: An in-vitro study. Eur J Dent 2015;9:194-200.  Back to cited text no. 13
[PUBMED]  [Full text]  
Perchyonok VT, Augusto de Souza J, Zhang S, Moodley D, Grobler S. Bioactive materials for temporary restorations: From design to applications. Ann Mater Sci Eng 2015;2:1024.  Back to cited text no. 14
Schwantz JK, Oliveira-Ogliari A, Meereis CT, Leal FB, Ogliari FA, Moraes RR. Characterization of bis-acryl composite resins for provisional restorations. Braz Dent J 2017;28:354-61.  Back to cited text no. 15
Vignesh KC, Kandaswamy E, Muthu MS. A comparative evaluation of fracture toughness of composite resin vs. protemp 4 for use in strip crowns: An in vitro study. Int J Clin Pediatr Dent 2020;13:57-60.  Back to cited text no. 16


  [Figure 1], [Figure 2]


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