RESTO 2 LEC (Feb.

13, 2012) Tooth Preparation (Class II Cast Metal Inlays)

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Tooth Preparation (Class II Cast Metal Inlays) - Correctly directed mesial bevel results in 40-degree marginal metal.
<picture> Unbeveled mesial results … margin and unburnishable …
- Distal view. Secondary flare prepared with No. 169L bur or with paper disk. - To conserve dentin support(s), occlusal defects on marginal ridge are
Secondary flares are directed to result in 40-degree marginal metal and included in outline form by applying cavosurface bevel, which may be
140-degree marginal enamel. wider than usual, when necessary
- Prepare 140-degree cavosurface … at regions labeled y usually dictates
40-degree metal – not too thick; malleable, burnishable … bevel be extended over marginal ridge …
Primary flare – found in the axial wall. If on the buccal, it is called Buccal Primary Flare. If - Distal view
on the lingual, it is called the Lingual Primary Flare. Typically, you create at ¼ from the vertical wall
SECONDARY FLARE (reasons why we do a secondary flare) Do not leave a sharp junction on the occlusal and on the proximal. Round the
- Extends the proximal margins (towards the buccal or lingual) into the junctions even at the proximal and gingival.
embrasures for a more self-cleansing and more accessible finishing
procedures and conserve dentin. If you will flare like in amalgam, you will be - … disto-occlusal preparation
cutting more dentin. - Mesio-occlusal view
- Creates a 40-degree marginal metal which produces a more blunted and - Mesio-disto-occlusal preparation for inlay on maxillary right premolar,
stronger enamel margin. disto-occlusal view
- Produces a more blunted and stronger enamel margin Axiopulpal line angle is slightly longer than the axiogingival line angle because the
proximal walls are slightly diverged
OCCLUSAL CAVOSURFACE BEVEL - Occlusal view. No secondary flare on mesiofacial aspect and minimal
- Use a flame-shaped fine-grit diamond instrument extension of mesiofacial margin
- Width [of bevel] is approximately ¼ the depth of the respective wall
- Should create a 40-degree occlusal marginal enamel and to seal and MODIFICATIONS IN INLAY TOOTH PREPARATIONS
protect the margins 1. Mesio-occluso-distal preparation
Gingival CS bevel: 30 degrees 2. Modification of Class II Preparation for Esthetics
3. Facial or lingual surface groove extension
Partial guide in beveling the CS margin (cast gold inlay): strength of the restorative 4. Class II preparation for abutment teeth and extension gingivally to include root-
material surface lesions
5. Maxillary first molar with unaffected, strong oblique ridge
- Guide[?]: maintain an approximate 40-degree angle between the side of 6. Fissures In the facial and lingual cusp ridges or marginal ridges
the diamond instrument and the external enamel surface 7. Capping Cusps
8. Including portions of the facial and lingual smooth surfaces affected by caries or
- No bevel is indicated if cuspal inclines are so steep that is when the
other injury
diamond instrument is positioned at 40-degree angle to the external
enamel surface it already parallels the enamel preparation wall
1. Mesioocclusodistal Preparation
Tooth with steep cuspal incline which sometimes don’t need a bevel: maxillary
premolar <pictures>
- Severely weakened marginal ridge unless ridge enamel is composed of
Tooth Preparation (Class II Cast Metal Inlays) gnarled enamel (stronger than its appearance)
<pictures> - Caries on both proximal surfaces
Check the long axis of tooth crown before preparation because the bur has to be parallel
- Occlusal margin (if indicated) to a 40-degree marginal metal with diamond
with the long axis of the tooth crown. MOD preparation
instrument Gnarled enamel – intertwined or twisted enamel rods particularly in cuspal areas. Stronger
In strudevant’s, the rotary diamond instrument is not referred to as a ‘bur’ but rather than normal enamel.
as a ‘diamond instrument’
- Cross-section view occlusal marginal metal is approximately 40 degrees 2. Modifications of Class II Preparation for Esthetics
Use a flame-shaped diamond instrument
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- Cuspal inclines requires no bevel since a 40-degree metal would … thout
- Occlusal view. No secondary flare on mesiofacial aspect and minimal
beveling
extension (0.25mm) of mesiofacial margin in the maxillary premolars and
- Bevel the mesial margin and the axiopulpal line angle
first molars
Typical Clearance: 0.5 mm
THE RULE OF PROCEDURE In cast gold restoration (premolars, first molars), you may use a 0.25 clearance to
- Always maintain a 40-degree angle between the side of the stone and the minimize the show on that area especially if a patient has a wide smile. Follow a
external enamel surface conservative proximal clearance. OR, do not use a secondary flare. If there is an
- The occlusal cavosurface should produce a 40-degree marginal metal to overextended caries, do a composite insert.
strengthen the marginal enamel and help seal the margins. If less, the
marginal gold alloy will be too thin or weak. If greater, the marginal metal is Modifications of preparation when extending to include proximal root-surface
difficult to burnish satisfactorily. lesions after moderate gingival recession. Extension of gingival floor not as wide
- If the cuspal inclines are steep that the diamond stone is at 40-degree as pulpally as when the floor level is at a normal position for draft requirement
angle to the external enamel surface, parallel to the enamel cavity wall, no and since tooth is smaller apically.
bevel is indicated.
3. Facial or lingual surface groove extension
in some teeth like maxillary premolars wherein there is a steep cuspal incline: when you - Extend to include occlusal fissure that is continuous with facial fissure on
position the diamond instrument, it already parallels the external surface of the tooth so facial surface
you don’t need to bevel anymore. Tapered preparation in the buccal groove. Include all the fissures or extend
[gingivally?] to improve retention form. Depth is around 1.5 mm. You may use a 271
AXIOPULPAL LINE ANGLE bur (tapered fissure bur with end diameter of 0.8 mm, diameter near the shank area
- Lightly bevel to provide a thicker and stronger wax pattern at this critical at 1 mm). Use the dimensions of the bur as depth gauge. In dentin, 1mm or slightly
region more than 1mm. make sure that the orientation of the bur is tilted lingually and is
aligned to the line of draw. Check the line of draw of the MO or DO tooth
preparation. Don’t forget to tilt. Check the anatomic characteristic of the tooth.
You will be doing a wax pattern for the cast metal restoration.
- Bevel the occlusal margin and mesial and distal margins of fissure
extension
Depth: 1.5 mm
Gingival bevel: not more than 1/3 of the depth of the gingival floor
Distal and mesial wall CSM should also result in a 40-degree marginal metal
Gingival wall CSM: result in a 30-degree marginal metal (same with proximal
gingival wall)
4. Class II Preparation for Abutment Teeth and Extension Gingivally to
Include Root-Surface Lesions
- Facial, lingual and gingival margin extensions may be indicated on the
proximal surfaces of abutments for removable partial dentures to increase
the surface area for development of guide planes
- Occlusal outline wide enough faciolingually to accommodate any
contemplated rest preparation(s) without involving the margins of the
restoration; extensions may be done by increasing width of bevels
When doing a rest seat in cast gold inlay, do not place it on the margin between the
tooth and the cast gold restoration.
- Gingival extensions may include root lesion on the proximal surface by
lengthening the gingival bevel and a minimal pulpal extension
- Modifications of preparation when extending to include proximal root-
surface lesions after moderate gingival recession. Extension of gingival
floor not as wide as pulpally as when the floor level is at a normal position
for draft requirement and since tooth is smaller apically.
5. Maxillary First Molar With Unaffected, Strong Oblique Ridge
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Do not cross the oblique ridge if you have an unaffected strong oblique ridge. If
there is caries on the distal pit, you will have to make another tooth prep on the
distal if the oblique ridge is still sound and unaffected.
- Mesio-occlusal preparation on maxillary molar
- Preparation of the lingual groove extension of disto-occlusolingual
preparation
- Retention grooves being cut in lingual surface extension and distal box
What cases are retention grooves indicated: small vertical wall and you think you
need additional retention in that area. Depth of retention groove 0.3 mm bisect the
mesioaxial and distoaxial line angle. Short crown on proximal, do the retention
grooves.
- Completed DOL preparation on maxillary molar with unaffected oblique
ridge
Distal cusp was prepared to be covered with gold. It is considered an inlay in
sturdevant’s concept. Protect the distal cusp so cover it with cast gold metal
- Preparations for treating both proximal surfaces of maxillary molar having
strong, unaffected oblique ridge
6. Fissures in the Facial and Lingual Cusp Ridges or Marginal Ridges
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In areas with fissures, you usually do beveling or enameloplasty. Do not extend all
of the preparation on the lingual groove. Conservative approach.
- Extend preparation if enameloplasty has not eliminated fissure in lingual
ridge or facial ridge
- Completed preparations after beveling margins of extensions through
lingual ridge and facial ridge
- Fissure remaining on mesial marginal ridge after unsuccessful
enameloplasty is treated in same manner as lingual or facial ridge fissures
Instead of having a class II, just remove the fissure on the mesial or distal area of
tooth preparation.
7. Capping Cusps
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- Capping of cusp is considered when the occlusal margin is ½ mm distance
from primary groove of cusp tip but usually indicated (mandatory to cap) if
distance is 2/3 or more
- Extension to uncover caries indicates that mesiolingual cusp should be
reduced for capping
- Depth cuts (depth gauge grooves)
o Serve as guide
o Help prevent thin spots in the restoration
o Use the No. 271 carbide bur
- Reduced mesiolingual cusp. Caries removed and cement base placed
- Apply bur vertically to help establish vertical wall that barely includes
lingual groove
- Counterbeveling reduced cusp (lingual)
- Improve retention form by cutting proximal retention grooves
- Rounding axiopulpal line angle
- Rounding junction of counterbevel and secondary flare
- Preparation with reduced one facial cusp on mandibular molar. Facial
surface groove extension improves retention and resistance form
- Capping one of two facial cusps on maxillary molar
- Blunting margin of reduced cusp when esthetics is major consideration
Don’t counterbevel in the facial
- Treatment made where margin crossed distal cusp. Distofacial margin
(and wall) slightly mesial of the distofacial groove or cap the remaining
portion of the distal cusp
- Reduce the cusps for capping as soon as the indication for such capping is
determined because this improves access and visibility for subsequent
steps in preparation
o If in intraocclusion, less cusp reduction; just provide required
clearance with the desired occlusal plane
o Reduction should provide a uniform 1.5 mm of metal thickness over
the reduced cusp
o Minimal reduction of 0.75 – 1 mm on the facial cusp ridge of maxillary
premolars and first molars to decrease the display of metal.
Reduction increases progressively to 1.5 mm towards the center of
the tooth to help provide rigidity to the capping metal
o If only one of the two lingual cusps is to be capped, extend to just
include the lingual groove between the reduced and the unreduced
cusps terminating with a distinct vertical wall height of 1.5 mm
o Bevel the facial (lingual) margin (reverse bevel or counterbevel),
should extend beyond any occlusal contact with the opposing teeth
and should result in 30-degree marginal metal except on the facial
margin of maxillary premolars and first molars (blunt and smooth
enamel margin [slub margin])
- Cusp reduction appreciably decreases retention form due to decrease
vertical height of walls
o Proximal retention groove
o Extend facial and lingual groove regions of the respective surfaces
o Create collar or skirt features
- Verification of occlusal clearance
o Check with wax interocclusal record
 For wax-bite: dry preparation; do not desiccate
 Lightly press portion of softened wax, low-fusing inlay wax over
the prepared tooth Do not melt
 Instruct patient to close into the soft wax and slide in all
directions
- Verify movement in right lateral, left lateral, and protrusive
movements
- Adjacent unprepared teeth are in contact with the opposing
teeth
- Wax stable (not loose and rocking)
- Wax not in infraocclusion
 Cool and remove wax. Hold against a light, check degree of
light transmitted (good indicator of thickness of wax or use wax
calipers or section wax)
 If there’s insufficient thickness, more reduction is needed
**Maximum intercuspation position..?
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- Preparation walls dried of visible moisture by air
- Softened low-fusing inlay wax of the same length mesio-distally of inlay
preparation and pressed over prepared teeth
8. Including Portions of the Facial and Lingual Smooth Surfaces
Affected by Caries or Other Injury
Treatment options: inlay, onlay, three-quarter crown, full crown, or multiple
amalgam or composite restorations
- Full crown: if lingual and facial smooth surfaces defective
- Inlay or onlay: only portion of facial smooth surface carious and lingual
surface no caries mesio-occlusal, distofacial, and distolingual prep with
lingual groove extension

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- Maxillary molar with caries in distofacial and mesial surface
- Tooth preparations: distofacial, occlusal, distal view
- Distolinguo-occlusal
- Mesio-occlusal view
- Completed preparation (MO, DF, DL)

- Maxillary molar with deeper caries on distofacial with mesial caries

- Preparation without bevels and flares
- No. 271 bur prepares gingival shoulder and vertical walls
- Beveling of margins
- Completed preparation. Gingival and facial bevels blend at x and y is
cement base

- Lingual surface groove was not prepared and facial wall of proximal boxing
mostly or totally missing. Forces directed to displace inlay facially opposed
by lingual skirt extension