PRINCIPLES

OF TOOTH PREPARATION
Dr. Punam Bishnoi

CONTENTS ‡ INTRODUCTION ‡ BROAD CATEGORIES OF PRINCIPLES ‡ BIOLOGICAL CONSIDERATIONS ‡ MECHANICAL CONSIDERATIONS ‡ ESTHETIC CONSIDERATIONS ‡ SUMMARY AND CONCLUSION ‡ REFERENCES

INTRODUCTION ´Tooth preparation is defined as mechanical treatment of dental disease or injury to hard tissues that restores a tooth to original form.µ As tooth has no regenerative ability. Teeth require preparation to receive restoration These preparation must be based on fundamental principles. Careful attention to every detail is imperative during tooth preparation ‡ ‡ ‡ .

to Shillinberg the design of a preparation for a cast restoration and the execution of that design are governed by five principles: ‡ ‡ ‡ ‡ ‡ Preservation of tooth structure Retention and resistance Structural durability Marginal integrity Preservation of the periodontium. .Acc.

Acc to DCNA 2004 certain guidelines are given for preparation of tooth ‡ TOC(total occlusal convergence ‡ Occlusocervical /incisocervical length ‡ Ratio of occlusocervical dimension and faciolingual dimension ‡ Circumferntial form of the prepared tooth ‡ Preferred location for auxillary retention ‡ Uniform reduction ‡ Finish line location ‡ Finish line form ‡ Reduction depths ‡ Line angle forn ‡ Surface texture .

CONSIDERATIONS. To Rosenstiel the tooth preparation can be studied under 3 Broad categories : 1. BIOLOGIC CONSIDERATIONS. MECHANICAL CONSIDERATIONS. which affect the health of oral tissues 2. CONSIDERATIONS. ESTHETIC CONSIDERATIONS. which affect the integrity and durability of the restoration 3.Acc. which affect the appearance of the patient .

Best combination of compromises BIOLOGIC Conservation of tooth structure Avoidance of overcontouring Supragingival margins Harmonious occlusion Protection against tooth fracture ESTHETIC MECHANICAL Retention form Resistance form Structural durability Minimum display of metal Maximum thickness of porcelain Porcelain occlusal surfaces Subgingival margins .

4. 6. Prevention of damage during tooth preparation -Adjacent teeth -Soft tissue -Pulp Conservation of tooth structure Avoidance of overcontouring -Axial reduction Marginal integrity and preservation of periodontium -Margin location -Margin adaptation -Margin geometry or Finish line configuration Occlusal considerations Preventing tooth fracture 2. 5.BIOLOGIC CONSIDERATIONS 1. . 3.

damaged proximal contact .careful retraction ‡ Pulp excessive temperature .microorganisms - Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture .To avoid ‡ Soft tissues .chemical irritation .tongue and cheeks .iatrogenic damage .Prevention of damage during tooth preparation ‡ ‡ ‡ ‡ ‡ ‡ ‡ Adjacent teeth .

15% necrosis .D. Camillo Morea & Apollonia Desiate in 1991recorded the temperature changes in the pulp chamber during tooth preparation. ‡ Zach &Cohen .60 C .rise of 16.Laforgia .rise of 5.rise of 11.100% necrosis .60% necrosis . Vito Milano .5 0C .10C .‡ ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture ‡ P.

‡ Conservation of tooth structure ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture Dowden stated that any damage to the odontoblastic processes will adversely effect the cell nucleus no matter how far from the nucleus it occurs ‡ More the remaining dentin ² lesser the pulpal damage ‡ Must be considered relative GUIDELINES: 1. Minimum taper ‡ . Partial coverage 2.

‡ 3. Planar occlusal reduction ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture 4. Even reduction of axial surfaces .

‡ ‡ ‡ ‡ 5. Selection of conservative margin ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture 6. Avoidance of unnecessary apical extension of preparation .

increasing the proximal contour is better .‡ Avoidance of overcontouring ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture ‡ A crown should duplicate the contours and profile of the original tooth ‡ Undercontoured restoration is better than overcontoured restoration ‡ Anterior teeth.

Marginal integrity and preservation of ‡ Prevention of damage during periodontium tooth preparation ‡ Margin locationlocationBiologic width ‡ ‡ ‡ ‡ ‡ Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture It·s the dimension of space that the healthy gingival tissues occupy above the alveolar bone.connective tissue-1.97mm).07mm and tissueepitheliumepithelium-0. ‡ essential for preservation of periodontal health and removal of irritation that might damage the periodontium . ‡ It refers to the combined connective tissue-epithelial tissueattachment from the crest of the alveolar bone to the base of the sulcus(2mm.

no restoration should violate the attachment .5mm. ‡ Wilson and Majnard cautioned against extending restorations so far subgingivally that the attachment complex is damaged.‡ Violation of biological width:width:- ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture ‡ Nevins and Sukrow in 1984 recommended that for the maintenance of healthy periodontium.even though its not possible for a clinician to identify the most coronal extent of the junctional epithelium. .They stated that ´Some distance of unprepared tooth structure should remain between the finished line and junctional epithelium and this distance should be ideally 0.

‡ Violation of biologic width ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture ‡ Plaque accumulation ‡ Attachment loss ‡ Periodontal pockets ‡ Advanced periodontitis ‡ Bone loss .

‡ Location of restorative margins:margins:- ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture  Supragingival  Equigingival  Subgingival .

‡ Supragingival margin:     Least traumatic to the soft tissues Margin placement« Easily finished Impressions are easily made Most accessible for cleansing ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture  Restorations can be easily evaluated .

abrasion or erosion« Root sensitivity ‡ ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture Disadvantages of subgingival margins  Plaque retention«  Margin placement«  Mechanical irritation«  Violation of biological width  Soft tissue injury« .Subgingival margins:     Clinical crown is short« Old restorations with subgingival margin Esthetic appearance Caries.

‡ ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture ‡ Criteria for subgingival margin placement:placement:    Emergence profile Margins are closed and properly finished Adequate band of attached gingiva Margin should not violate the biological width .

Crown lengthening procedures:procedures:It·s a procedure similar to the apical repositioning of the flap with concomitant osteoplasty. Indications ²  Short clinical crown  Restoration impinge on the biological width  Hopless teeth with extensive subgingival caries. subgingival fracture and root perforation Crown lengthening procedure  Surgical methods  Orthodontic method .

Reeves in his review article concluded that more supragingivally a restorative margin is placed.Felton in 1991 conducted a study on ´Effects of in vivo crown margin discrepancies on the periodontal healthµ in his study he strongly supported the placement of supragingival margins for artificial crowns and FPD·s.G.the less chance that the margin will contribute to gingival inflammation. William.D.A. .

MARGINAL GEOMETRY OR FINISH LINE CONFIGURATION ‡ shape and bulk of the restorative material in the margin of the restoration ‡ Marginal adaptation ‡ Degree of seating of restoration Guidelines for evaluation for margin design :  Ease of preparation without overextension or unsupported enamel  Ease of identification in the impression and on the die  Sufficient bulk of the material  Conservation of the tooth structure  A distinct boundary to which wax pattern can be finished .

Feather edge B. Sloped shoulder G. Bevel E. Chisel C. Beveled shoulder .Finish lines  The finish line is the peripherel extension of a tooth preparation  The most important consideration in selecting a cervical margin design is its ability to consistently and predictably provide excellent marginal integrity. Shoulder F.  Knife edge  Chisel edge  Chamfer  Shoulder  Sloped shoulder  Shoulder with bevel  Radial shoulder  Heavy chamfer A. Chamfer D.

KNIFE EDGE OR FEATHER EDGE Advantages  Conservation of the tooth structure  Permits an acute margin of the metal Disadvantages:  The axial reduction may fade out  Thin margin may be difficult to accurately wax and cast  More susceptible to distortion  Results in overcontouring Indications:  Not recommended .

CHISEL EDGE ‡ Variation of feather edge ‡ Larger angle between the axial surface and unprepared tooth structure ‡ Associated with excessively tapered preparation ‡ Historic advantage-impression making with rigid advantageimpression compound in coper bands Indications: ‡ Lingual surface of mandibular posterior teeth ‡ The surfaces towards which tooth has tilted ‡ Cementum .

Chamfer It·s a finish line design for tooth preparation in which gingival aspect meets the external axial surface at an obtuse angle Advantages  It provides distinct margin  Adequate bulk to the restoration  Easier to control  Exhibits least stresses  Disadvantage -Care needed to avoid unsupported lip of enamel Indications:  Cast metal restorations  Lingual margin of the metal ceramic crowns .

Shoulder      Bulk of the restoration Wide ledge provides resistance to occlusal forces Provides space for healthy restorative contours Maximum esthetics It offers resistance against distortion during processing Disadvantages:  Less conservative of tooth structure  The sharp 900 internal line angle« Indications:  All ceramic restorations  Facial magins of metal-ceramic crowns metal- .

120° 120° ‡ Reduces the possibility of leaving unsupported enamel and yet leaves sufficient bulk to allow thinning of the metal framework to a knife edge for acceptable aesthetics. ‡ Indicated for facial margin of metal ceramic crowns .SLOPED SHOULDER ‡ Cavosurface margin .

SHOULDER WITH BEVEL ‡ Removes unsupported enamel.Inlay and onlay margin -Shoulder is already present because of destruction by caries or presence of previous restorations . allows finishing of metal ‡ Recommended for extremely short walls ‡ Disadvantage ² extends the preparation into the sulcus if used on apical margin ‡ Indications ² -facial margins of maxillary partial coverage restorations .

RADIAL SHOULDER:
‡ Shoulder with rounded internal line angle ‡ Stress concentration is less in the tooth structure

HEAVY CHAMFER
‡ Internal line angle is large radius rounded ‡ Provides better support for a ceramic crown than chamfer, but it is not as good as shoulder ‡ Easier to prepare than shoulder

MARGINAL ADAPTABILITY
‡ The restorative margins must fit as closely as possible against the finish line of the preparation to minimize the width of exposed cement. ‡ They must have sufficient strength to withstand the forces of mastication ‡ More accurate the adaptation ² lesser the chance of recurrent caries ‡ A well designed preparation should have a smooth and even margins ‡ Whenever possible they should be located in the areas where the dentist can finish and inspect them and the patient can clean them

TO BEVEL OR NOT TO BEVEL
‡ Controversial by Ostlund ‡ Trignometric analysisanalysismore acute the bevelbevel-lesser the marginal discrepancy -lesser the seating with cement as D will increase. ‡ So, bevel improves the marginal adaptation but reduces the seating of restoration ‡ Empirical clinical results dictate that acute margin of metal should continue to be used on metal restorations but that angle should be in 30-45° 30-45° ‡ Less angles will lead to thin and weak margins. ‡ More angle will lead to more marginal gap.

4 factor 150 prevent by 3.d=D sin u d=D cos q or D=d/sin u D=d/cos q Bevel of 450 prevent seating by 1.9 50 prevent by11.5 .

‡ OCCLUSAL CONSIDERATIONS ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture ‡ Occlusal scheme should not be traumatic ‡ Tooth preparation should allow sufficient space for developing a functional occlusal scheme in the finished restoration ‡ Supraerupted or tilted teeth ² reduce the teeth ‡ Sometimes even the endodontic treatment is necessary to make enough room ‡ Careful judgment is needed and diagnostic tooth preparation and waxing procedures are essential to determining the exact amount of reduction required to develop an optimum occlusion .

PREVENTING THE TOOTH FRACTURE ‡ ‡ ‡ ‡ ‡ ‡ Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture ‡ The likelihood that a restored tooth will fracture can be lessened if the tooth preparation be designed to minimize the potentially destructive stresses ‡ Inlay.greater potential for fracture Inlay‡ Onlay ² lessens the chance of fracture ‡ Complete crown ²greatest protection against fracture .

RESISTANCE FORM 3. RETENTION FORM 2.MECHANICAL CONSIDERATIONS 1. STRUCTURAL DURABILITY .

RETENTION FORM RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY DEFINITION‡ DEFINITION-The feature of a tooth preparation that resists dislodgement of a crown in a vertical direction or along the path of placement. placement. distinguishable. . ‡ In practice retention and resistance are closely related and they are not always clearly distinguishable.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY FACTORS AFFECTING RETENTION ‡ Magnitude of dislodging forces ‡ Geometry of tooth preparation -Taper -Surface area -stress concetration -Type of preparation and secondary retentive features ‡ ‡ ‡ ‡ Roughness of surfaces being cemented Materials being cemented Type of luting agent Film thickness of luting agent .

‡ when exceptionally sticky food is eaten ‡ Depends on the stickiness of food and the surface area and texture of the restoration being pulled .RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY MAGNITUDE OF DISLODGING FORCES ‡ small compared to those that tend to seat or tilt it ‡ by pulling the FPD with floss under the connectors.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY GEOMETRY OF TOOTH PREPARATION Essential elements of retention:retention:‡ opposing vertical surfaces in same preparation. ‡ Path of insertion ‡ Area under shear stress ‡ Freedom of displacement FACTORS ‡ Taper ‡ Surface area Length of preparation Width of preparation ‡ stress concetration ‡ Type of preparation and secondary retentive features .

An extracoronal restoration is an example of veneer. Buccal & lingual walls of surfaces: full veneer crown.jpg .eg.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Opposing vertical surfaces in same preparation: 1) External surfaces:. Scan0001. or sleeve retention.

.eg. proximoAn intracoronal restoration resists displacement by wedge retention.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY 2) Internal surfaces:. Buccal & lingual walls of the surfaces: proximal box of a proximo-occlusal inlay.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY . ‡ It is of special importance when preparing teeth to be fixed partial denture abutments.PATH OF INSERTION:INSERTION:‡ It is an imaginary line along which the restoration will be placed onto or removed from the preparation. ‡ Surveying visually. since the paths of all the abutment preparations must parallel each other. since it is the primary means of ensuring that the preparation is neither undercut nor overover-tapered.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ The mesiodistal inclination of the path must parallel the contact areas of adjacent teeth. . the restoration will be held up at the proximal contact areas & be ´locked outµ. ‡ So if path is inclined mesially or distally.

Area under Shear Stress: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Most important feature for retention is that the total surface area of cement which will experience shearing rather than tensile stress. ‡ To achieve this the preparation must have opposing walls nearly parallel to each other. .

.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ To obtain the greatest area of cement under shear stress. the direction in which a restoration can be removed must be limited to one path.

When compared to partial veneer crown because reducing the path of insertion to a narrow range. .RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Full veneer crown has excellent retention.

. boxes or pinholes for the missing wall. ‡ A grooved lingual wall must be distinct and perpendicular to the axial wall.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ If axial wall left unveneered retention is achieved by substituting a grooves.

.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY FREEDOM OF DISPLACEMENT:DISPLACEMENT: ‡ Retention is improved by geometrically limiting the numbers of paths along which a restoration can be removed from the tooth preparation. ‡ Maximum retention is achieved when there is only one path.

TAPER RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY The axial walls of the preparation must taper slightly to permit the restoration to seat. i.e. 2 opposing external walls must gradually converge ² ANGLE OF CONVERGENCE. ‡ The relationship of one wall of a preparation to the long axis of that preparation is the INCLINATION of that wall. . 2 opposing internal surfaces of the tooth structure must diverge occlusally ² ANGLE OF DIVERGENCE.

‡ Most retentive preparation should be one with parallel walls. . but the parallel walls are impossible to create in the mouth without producing certain degree of taper. the greater should be the retention.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ The more nearly parallel the opposing walls of a preparation.

. ‡ Retention of a crown with 10 degree of taper was approximately half that of a crown with 5 degree taper. ‡ Jogensen said as taper increases retention decreases. ed taper ed retention ed taper ed retention.‡ Tooth preparation taper should be kept minimal because of its adverse effects on retention.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Ideal taper should be within the range of 2-6.5° ‡ A taper of 6° have 6° been proposed as being clinically achievable while affording adequate retention.5°. . 2-6.

1988. The 10° angle. convergence angles of a full coverage preparations performed in a clinical environment. maxillary. 60. ² Conducted a study to measure the vol. 10° achieved. projector. ‡ Auxillary retention should be used in molar region because these preparations were found to have larger convergence angle. participants to attempt a 4-10° convergence angle. Teeth were prepared by the environment. Dennis Weir. 1988. vol. ‡ The convergence angle for mandibular preparations were greater than maxillary. Warren Stoffer and Shigaro Ochi. convergence angles of all preparations were determined by projecting the faciolingual and mesiodistal silhouttes of the dies with an overhead projector. 60. ‡ the ideal convergence angle of 4-10° is seldom achieved. angle.‡ Jeffrey Nodlander. . JPD. They concluded that.

SURFACE AREA RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Provided the restoration has limited path of withdrawal. Greater the surface area of a preparation. ‡ Crowns with long axial walls are more retentive« ‡ Molar crowns are more retentive than premolar crowns of same taper . ‡ Length«. greater is its retention..

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY STRESS CONCENTRATION ‡ If line angle between axial and occlusal surface is sharp. it leads to concentration of stresses around that junction ‡ Induced stresses exceeds the strength of the cement ‡ Leads to cohesive failure of cement ‡ Rounding the internal line angles reduces the stress concentration and thus increases the retention of restoration .

.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY TYPE OF RESTORATION AND SECONDARY RETENTIVE FEATURES ‡ Full veneer crown has excellent retention when compared to partial veneer crown because reducing the path of insertion to a narrow range.

‡ But where these features limits the path of withdrawal. ‡ Secondary retentive features doesnot significantly affect the retention because the surface area is not increased significantly. retention is increased . boxes or pinholes for the missing wall. retention is achieved by substituting a grooves.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ If axial wall left unveneered.

So roughening tooth preparation hardly influences retention. ‡ Failure rarely occurs at the cement tooth interface. .‡ Surface roughness: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Adhesion of dental cements depends primarily on projections of the cement into microscopic irregularities. ‡ Jorgensen found retention of castings cemented with ZnPO4 cement on test dies with a 10° taper to be 10° twice as great on preparations with 40 m scratches than 10 m. ‡ Retention increases when restoration is roughened or grooved.

‡ Base metal alloys are better retained than less reactive high gold content metals. ‡ More reactive the alloy is more adhesion.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Materials being cemented: ‡ Retention is affected by both the casting alloy and the core material. ‡ Type of luting agent: ‡ Studies show that adhesive resin cements are more retentive than compared to conventional ZnPO4 and GIC cements. .

agent. .RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Film thickness of the luting agent. wall. ‡ Ideal dimension for luting agemt space is 202040 microns for each wall.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

‡ Steven M. Carter, Peter R. Wilson, IJP, vol. 9, 1996.- Conducted a study to see the 1996. effect on die spacing on pre and post cementation crown removal and crown elevation. Different layers of die spacer was used. They observed that the force required to remove a crowns before cementation decreased with increased layers of die spacers.

RESISTANCE FORM

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

‡ The features of a tooth preparation that enhance the stability of restoration and resist dislodgement along an axis other than the path of placement (GPT). (GPT). ‡ It prevents dislodgement of a restoration by forces directed in an apical, oblique or horizontal direction. direction. ‡ The geometric configuration of tooth structure must place the cement in compression to provide the necessary resistance. resistance. ‡ Lateral forces tend to displace the restoration by causing rotation around gingival margin

Methods to analyse resistance form

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY FACTORS AFFECTING RESISTANCE FORM ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Magnitude and direction of dislodging forces Leverage Length of the preparation Width of the preparation Taper Type of preparation Rotation about vertical axis Physical properties of luting agent .

axially directed forces occlusion- .habits (pipe smoking and bruxing) ² large oblique forces to restoration .eccentric interferences .normal occlusion.anterior guidance .RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Magnitude and direction of dislodging forces ‡ Resistance decreases in following order: .

‡ If the force passes within the margin of a crown no tipping of the restoration when compared to the line of action passing outside the margins of the restoration .RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY LEVERAGE AND RESISTANCE: ‡ Leverage occurs when the line of action of a force passes out side the supporting tooth structure.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Forces are outside the margin in the following cases: .retainers for cantilever bridge .crowns on tipped teeth .wide occlusal table of restoration .force at an oblique angle .

.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ If a line drawn from the center of rotation perpendicular to the cement film on the opposite wall of the preparation the point where the line intersects the cement film is known as tangent point.

‡ Rotation is prevented by any areas of the tooth preparation that are placed in compression and are called as RESISTANCE AREA ‡ To have effective resistance the tangent line should extend at least halfway down the preparation. .RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ If the tangent points of all the arcs of rotation around a given axis are connected they form the tangent line. The area above the tangent line is resisting area.

‡ Preparation length and resistance: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY -Shortening of preparation will reduce the resistance area. . -In short crown lifting force is small when compared to long crown. -Small restoration is less likely to fail through tipping than long restoration (on preparation of equal length).

Because of smaller diameter a tangent line falls low on the wall opposite to axis of rotation. Resulting in a large resisting area. . Weak resistance can be enhanced by placing vertical grooves/ boxes/ pinholes.‡ Resistance and tooth width: width: ‡ A wider preparation has a greater retention but a narrow tooth can have greater resistance to tipping.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ A grooved lingual wall must be distinct and perpendicular to the axial wall.shaped grooves or flared boxes Uprovides more resistance than V-shaped ones V- . ‡ So U.

‡ Taper and Resistance: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ More tapered a preparation less is resistance. Over tapered small resisting area near the occlusal surface. Ideal taper < ½ the axial wall. . No taper the resisting area cover half the axial wall.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Permissible taper of a preparation is directly proportional to height : width ratio. ‡ Taper that permit an effective resisting area for a preparation in which height equals width is double than in a preparation where height is only half width. .

. r = (w sin T) / 2 .Preparation height h = [w tan (90°.Height of tangency point.T/2)]/2.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Formula to calculate: ‡ Taper: T = arc sin (2r/w). (90° .

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ Rotation around a vertical axis: A partial veneer crown which has no grooves offer little resistance to rotation. Axial symmetry of a full veneer crown preparation may allow rotation of the restoration. .

Enhancing the resistance form by placing groove RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY .

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY TYPE OF PREPARATION ‡ Partial coverage restoration may have less resistance than a complete crown because it has no buccal resistance area PHYSICAL PROPERTIES OF LUTING AGENT ‡ Resistance to deformation is affected by physical properties of the luting agent. such as compressive strength and modulus of elasticity ‡ Adhesive resin >GIC > ZnPO4 > Polycarboxylate > ZOE .

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY STRUCTURAL DURABILITY ‡ A restoration must have sufficient strength to prevent permanent deformation during function ‡ DEFINITION. .´The ability of a restoration to DEFINITIONwithstand destruction due to external forces is known as structural durabilityµ.

3. Alloy selection. Margin design . .axial reduction 2.functional cusp bevel . Adequate tooth reduction.occlusal reduction . Metal4. Metal-ceramic framework design.RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Factors affecting structural durability 1.

5-2mm(FC)&1AllAll-ceramic crowns ² 2mm of clearance on preparation .5mm(NFC) crowns.5-2mm(FC)&1-1.1. .ADEQUATE TOOTH REDUCTION OCCLUSAL REDUCTION:REDUCTION: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY ‡ An important feature for providing adequate bulk of metal & strength to the restoration is occlusal clearance.5mm (FC) & 1mm(NFC) MetalMetal-ceramic crowns.Occlusal thickness varies with different restorative materials Gold alloys ² 1.1.

opposing occlusal equilibration is to be achieved eg.Uniform and planar occlusal reduction. .. avoid deep grooves in the center of the occlusal surfaces to prevent stress concentration and to distribute the forces over a larger surface area. . Plunger cusps to be rounded. .Round line and point angles.Firstly.

preservation of tooth structure ‡ OCCLUSAL OFFSET can be given on posterior partial veneer crown preparation to provide space for a TRUSS of metal to form reinforcing strap ‡ INCISAL OFFSET can be given on anterior partial veneer crown preparation to provide space for metal that helps to strengthen the linguallingual-incisal margin .‡ This ensures: -sufficient occlusal clearance .

FUNCTIONAL CUSP BEVEL:BEVEL: ‡ It is an integral part of the occlusal reduction. ‡ A wide bevel on the lingual inclines of the maxillary lingual cusps & the buccal inclines of the mandibular buccal cusps provides space for an adequate bulk of metal in an area of heavy occlusal contact. .

‡ If a wide bevel is not placed on the functional cusp. several problems may occur : .To prevent this the crown may be waxed to optimal thickness resulting in overcontouring & poor occlusion. .If the crown is waxed & cast to normal contour it can cause a thin area or perforation in the casting. .

it will result in over inclination of the buccal surface which will destroy excessive tooth structure while lessening retention. ..If an attempt is made to obtain space for an adequate bulk in a normally contoured casting without a bevel.

AXIAL REDUCTION:REDUCTION: ‡ It plays an important role in securing space for an adequate thickness of restorative material. overcontoured restoration which will strengthen the restoration but may have a disastrous effect on periodontium. . ‡ Inadequate axial reduction can cause thin walls & a weak restoration subjected to distortion or a bulbous.

. the occlusal shoulder.‡ Other features that provide space for metal and improve the rigidity & durability of the restoration are: The offset. the proximal groove & the box. the isthmus.

Selection of the alloy: -It is essential that there be sufficient clinical evidence of superiority. before selecting a particular material. DESIRABLE PROPERTIES OF DENTAL CASTING ALLOYS: ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Biocompatibility Ease of melting Ease of casting Ease of brazing (soldering) Ease of polishing Little solidification shrinkage Minimal reactivity with the mold material Good wear resistance High strength Excellent corrosion resistance Porcelain Bonding .

Intended Traditionally alloys for casting were classified on the basis of their intended useuse-Type I: Simple inlays -Type II: Complex inlays -Type III: Crowns and fixed partial dentures -Type IV: Removable partial dentures and pin ledges.Intended use: 1. metal2.Classification : 1. Physical properties: FDI (1965) classified casting alloys according to their physical properties as: Type I: Soft Type II: Medium Type III: Hard Type IV: Extra-hard Extra- . Porcelain: metal-ceramic alloys.

Color: The patients view on the subject should be sought if the metal will be visible in the mouth. -Recurrent caries. Cost. otherwise the color is irrelevant. 3. . Composition: The percentage composition by weight of the main ingredients must be mentioned. -Plaque accumulation. 2. Clinical performance: A) Biologic properties -Gingival irritation. 4.Factors considered when selecting an alloy: 1. -Allergies.

-Tarnish and corrosion. strength.B) Mechanical properties: -Wear resistance and strength. metal-ceramic bond strength should be metalconsidered. surface roughness. -Ceramic bond failure. -Marginal fit. . 5. -Connector failure. Laboratory performance: Factors like casting accuracy.

3.Full or partial coverage of posterior teeth where there has been significant loss of coronal dentin.In situations of severe occlusal stress.Choice of material: Gold: IndicationsIndications1. 2. Contraindications: -Aesthetics --Cost --Cost .For restoration of adjacent or opposing teeth to avoid problems arising from use of dissimilar metals. 4.Following endodontic treatment of posterior teeth.

Porcelain (Ceramic): Indications: . . Contraindications: -Teeth with short clinical crown -Edge to edge occlusion -Teeth which do not allow ideal preparation form to support the porcelain.Large inadequate restorations on the anterior teeth provided there is enough tooth substance. . .Severely discolored teeth.Over an existing post and core substructure.

where wear of opposing occlusal surfaces is expected.Metal ceramic: Indications: . -Posterior teeth where esthetics is necessary and partial coverage gold crowns are contraindicated Contraindications: -Young patients at risk of pulp being exposed -large pulp chamber -Traumatic occlusion (heavy occlusal forces) . .Failure of porcelain jacket crowns.Esthetics .

5mm of reduction 1-A porcelain contact requires 2mm of reduction -Occlusal contacts need to be 1.2-Cut-back: porcelain-metal junction should be 90r or greater. -The minimum thickness of the metal is 0.5-2.2-0.Metal ceramic framework: -A metal occlusal contact requires 1-1.5porcelainmetal junction -The substructure must support an even thickness of the porcelain veneer (1mm minimum and 2mm maximum). . 0. Cutporcelain90r -Metal should preferably be in the area of the centric stop to enhance the durability of the restoration.3mm.0mm from the porcelain1.

distortion of restoration margin is prevented by designing the preparation outline to avoid occlusal contact in this area .tooth reduction should provide sufficient room for bulk of metal at the margin to prevent distortion .MARGIN DESIGN .

ESTHETIC CONSIDERATIONS

METALMETAL-CERAMIC RESTORATION
- Usually poor appearance is due to insufficient porcelain thickness - In addition, the labial margin of metal ceramic crown is not always accurately placed - To correct all these deficiencies, certain principles are recommended during tooth preparation

FACIAL REDUCTION - Adequate thickness of porcelain is needed to create a sense of color depth and translucency - Adequate reduction sufficient bulk of porcelain for appearance and metal for strength - Minimum reduction of 1.5 mm is required - Shade problems incisal and cervical 3rd of restoration (here direct light reflection from the opaque layer can make the restoration appear very noticeable

- Opaque porcelain generally have a different shade from body porcelain, they often need to be modified with special stains in these areas. - with very thin teeth like mandibular incisors.

INCISAL REDUCTION - Incisal edge no metal backing. So, it can be
made with a translucency similar to that of natural tooth structure - reduction 2 mm - Excessive reduction ² reduces retention and resistance

.PROXIMAL REDUCTION .Proximal surface of anterior tooth will look most natural if they are restored as the incisal edges without metal backing.Esthetics depends on exact location of the metal ceramic junction in complete restoration .

FEATURES OF DIFFERENT TYPE OF PREPARATIONS .

.

.

.

.

.

.

.

ENDODONTICALLY TREATED TEETH ‡ Conservation of tooth structure ‡ Retention form ‡ Resistance form .

Conservation of tooth structure PREPARATION OF CANAL ‡ Only minimum tooth structure should be removed from the canal ‡ Root canal should be enlarged only enough to enable the post to fit accurately yet passively while ensuring strength and retention .

‡ Ferrule: . ..PREPARATION OF CORONAL TISSUE ‡ Coronal tooth structure should be saved as much as possible because«. preventing root fracture during function .Extension of the axial wall of the crown apical to the missing tooth structure provides what is known as a ferrule.helps to bind the remaining tooth structure together.

‡ Retention form ‡ Preparation geometry ‡ Post length ‡ Post diameter ‡ Post surface texture ‡ Luting agent .

‡ Resistance form ‡ Stress distribution ‡ Rotational resistance .

Fibre reinforced composite prostheses Posterior FRC tooth preparation Occlusal isthmus (1.0 mm axial depth) Shoulder/deep chamfer (1.0 mm depth) Proximal step(1.2-1.5 mm) .

5 mm) .Anterior FRC tooth preparation Linguoproximal step(1.2-1.0 mm axial depth) Shoulder/deep chamfer (1.

‡ If too much emphasis is given on any one of the principles then the success of the procedure may be limited by a lack of consideration of the other factors. . ‡ An analysis of these principles and factors should enable the dentist to effectively apply them during the design of any preparation. ‡ All preparations require the incorporation of factors to prevent the dislodgement of restoration by functional stresses.SUMMARY AND CONCLUSION ‡ Proper attention should be given during margin placement and the principle of ´Do no harmµ to the soft tissues should be followed.

Desiate A.192:561‡ 4. Wassell RW. ‡ 2. Louis: Mosby.65:5661. 1981. Chicago: Quintessence Publishing Co. 7th ed. Morea C. St.15:129‡ 6.REFERENCES ‡ 1. Mosby. Milano V. Temperature change in the pulp chamber during complete crown preparation. Crowns and other extraextra-coronal restorations: Preparations for full veneer crowns. British Dental Journal 2002.Rosenstiel SF. Whit&t LD. Malone WFP.192:561-71. J Prosthet Dent 1965. Fundamentals of fixed prosthodontics.Langeland K. Blair FM.4th ed. impression. Louis: Louis: Mosby.65:561991. ‡ 3. Land MF. 1965.Laforgia PD. 2007. St. temporary crown fixation and permanent cementation. Tylman SD. Pulpal reactions to crown preparation. ‡ 5. . J Prosthet Dent 1991. Shillingburg HT. Tylman's Theory and practice of fixed prosthodontics. Langeland LK. Contemporary Fixed Prosthodontics. 2002.15:129-43. Hobo S. Fujumoto J. 1978. Steele JG. 3rd ed.

Dent Cosmos 1891.33: 85-100. J Prosthet Dent 1971. 1991. J Prosthet Dent 1973.64:5481990. Discussion of methods and criteria in evaluation of dentin and pulpal responses. Effect of crown margins on periodontal conditions in regularly attending pataients.30:303‡ 8. Int Dent J 1970.20:531-5. ‡ 10. Cavity treatment with a microbicidal fluoride solution: Growth of bacterial and effect on the pulp. A review and Discussion : Terminology and widths. Hunter AJ. 85‡ 11. Gingival crown margin configurations. Hunter AR. Dowden WE. Perel ML. The management of enamel margins.64:548-52. J Prosthet Dent 1991. Brannstrom M. Axial crown contours. .65:75-82.25:642-8.65:75‡ 12.30:303-10 1973. J Prosthet Dent 1990.‡ 7. Black GV.20:5311970.25:6421971. ‡ 9. Bader JD et al. Nyborg H.

placement and reproduction of bevels for gold.10:122-37. 1963:10:1160‡ 15. Operative Dent 1985. Dent Clin N Am 2004. Bowden JR. ‡ 16. Schweikert E .10:1221985. Smith M.52:243-6. Function. 2004. Feather-edged or knife-edged FeatherknifeDreparation and impression technique. 1984. Designing tooth preparatios for optimal success. Goodacre CJ. Dent Practice 1987. Saund P. The Dicer castable ceramic crown.52:243‡ 17. 1987.‡ 13. Ostlund LE. J Prosthet Dent 1963:10:1160-66.48:359- . Rosner D. J Prosthet Dent 1984. Cavity design and mathematics: their effect on gaps at the margins of cast casting.25:20-5.48:359-385. J Prosthet Dent restorations. Bell CJ.25:20‡ 14. Stephenson RI.

THANK YOU .

Master your semester with Scribd & The New York Times

Special offer for students: Only $4.99/month.

Master your semester with Scribd & The New York Times

Cancel anytime.