Dr.

Mohamed Abd-el Aziz

 Presented by

Dr. Mohamed Abd-el Aziz

Lecturer of Fixed Prosthodontics
 • At the initial examination, it is important to
make a full assessment of the appearance of
each patient, noting which areas of which teeth
show during smiling, talking and laughing.

 • The patient’s esthetic requirements must be
discussed and related to oral hygiene needs
and the potential for disease.

 • The final decision regarding an appropriate
restoration can then be made with the full
cooperation and informed consent of the
patient.

 The poor appearance of some metal-ceramic
restorations is often due to :
◦ Insufficient porcelain thickness.
◦ The labial margin of a metal-ceramic crown is not
accurately placed.

 To correct these deficiencies, certain principles
are recommended during tooth preparation that
will ensure sufficient room for porcelain and
accurate placement of the margins.

 (a) Facial tooth reduction :

• Two principles should be fulfilled during facial

tooth reduction to obtain excellent esthetics:
◦ Adequate thickness of porcelain is needed to
create a sense of color depth and translucency.
◦ The labial surfaces of anterior teeth should be
prepared for metal-ceramic restoration in two
distinct planes.

◦ If they are prepared in a single plane,

insufficient reduction in either the cervical or
the incisal area of the preparation will result.
 (b) Incisal reduction:
◦ • An incisal reduction of 2 mm is
recommended for good esthetics.
◦ • The incisal edge of a metal-ceramic
restoration is constructed with no metal
backing and can be made with a translucency
similar to that of natural tooth structure.
◦ • Excessive incisal reduction must be avoided
because it will reduce the resistance and
retention form of the preparation.
 (c) Proximal Reduction :

◦ The proximal surfaces of an anterior teeth will

look most natural if they are restored as the
incisal edges, without metal backing. This will
allow some light to pass through the restoration
in a manner similar to what occurs on a natural
both.
 (d) Labial margin placement :
◦ • Although supragingival margin plcement
has many biologic advantages, subgingival
margins may be indicated for esthetic reasons.

◦ • The patient’s smile is observed as part of
the initial examination. It is important to
record which teeth and which parts of each
tooth are exposed.
 ◦ • Patients with high lip line,
which exposes considerable
gingival tissue, present the
greatest problem if complete
crowns are needed. The tooth
can be restored with a metal-
ceramic restoration having a
supragingival porcelain-labial
margin.

◦ • If the patient has a low lip
line, a metal supragingival
collar may be placed because
the metal is not seen during
normal function.
◦ Whenever possible, partial-coverage
restorations are preferred, not only because
tooth structure in conserved but also because no
restorative material can approach the
appearance of intact tooth enamel.
◦ Esthetic partial-coverage restorations depend
on accurate placement of proximal and facial
margins.
◦ • The proximal margin should be placed just
buccal to the proximal contact area, where
metal will be hidden by the distal line angle of
the neighbouring tooth.
◦ • Tooth preparation angulation is critical and
should normally follow the long axes of
posterior teeth and incisal two thirds of the
facial surface of anterior. If a buccal or lingual
tilt is given to the tooth preparation, metal
may be visible.
 (2) Facial margin:
◦ • The facial margin of a maxillary partial-
coverage restoration should be extended just
beyond the occlusofacial line angle.
If the buccal margin is skilfully placed
following the original cuspal contour, the final
restoration will have an acceptable
appearance.
◦ • Anterior partial-coverage restorations can
be fabricated with no metal display, but their
preparation requires considerable care. The
facial margin is extended just beyond the
highest contour of the incisal edge but not
quite to the incisolabial line angle. Here the
metal will protect the tooth from chipping but
will not be visible.