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Cavity configurations for in direct partial coverage adhesive-cemented

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Cavity Configurations for Indirect Partial-Coverage
Adhesive-Cemented Restorations
Guido Fichera, DDS1
Walter Devoto, DDS2
Dino Re, MD, DDS3
I ndirect esthetic adhesive restorations in
composite resin and ceramics belong to
the wider category of partial-coverage
crown restorations. As such, they require prepara-
tion designs that leave a certain amount of intact
clinical crown and generally have supragingival
margins.1 To guarantee the fracture resistance of a
partial-coverage crown restoration over time, it is
necessary to determine which part of the clinical
crown that has, by itself or in combination with the
buildup, appropriate structural characteristics and
sufficient biomechanical strength. This decision in-
fluences the clinical outcome of the restoration.
Respecting biologic principles and using a conser-
vative approach are the building blocks for a suc-
cessful outcome.
For indirect tooth-colored adhesive-cemented
restorations, the highest incidence of failure is
fracture of the restoration material and intact
tooth, together with secondary caries.2 To avoid
fracture, cavity preparation should be considered
as both a diagnostic and operative phase.3
1
Private practice, Monza, Italy.
2
Private practice, Sestri Levante (GE), Italy.
3
Researcher, Department of Prosthodontics, University of
Milan, Italy.
Correspondence to: Dr Walter Devoto, Via E. Fico 106/8,
16039 Sestri Levante (GE), Italy. E-mail: dewal@tele2.it
FACTORS AFFECTING STRUCTURAL
STRENGTH
Numerous studies on the biomechanical and
structural analysis of a tooth’s intact healthy struc-
tures are available in the literature, especially from
the era prior to the use of adhesive resins. From
these reports, it appears that the presence of the
marginal ridge is fundamental4; if it is lacking, the
occlusocervical and mesiodistal depth, and the
size of the proximal boxes must be taken into con-
sideration,5–8 as well as the intercuspal width (and
thus, proximity to the tips of the cusps) and the
depth of the occlusal isthmus,5–9 the thickness of
the enamel-dentin layer at the base of each cusp,
the depth of the base of the intact cusp,6 the ab-
sence or presence of the pulp chamber roof4 (ie,
vital or endodontically treated tooth), and the
thickness and depth of interaxial dentin. 7–10
Restoration is further complicated as these factors
must be related to the functional role of the tooth
in question (eg, position in the arch, biotype, oc-
clusal trauma, parafunctional habits, static and dy-
namic occlusion, condition of antagonistic teeth).
Clinical research shows that the adhesive bond
between dentin and resin composite will, over
time, decrease in strength,11,12 and that the extent
of this decrease is in proportion to the mechani-
cal, thermal, hydrolytic, and enzymolytic stresses
to which the bond is subjected. It is also highly
QDT 2006 55
 FICHERA ET AL
ic
ic
D id
mr M
mr
ic
ic
Fig 1 Occlusal view of structural model of the
tooth. id = interaxial dentin, ic = intact cusp,
mr = marginal ridge.
probable that weakening of the adhesive bond
over time is responsible for the mechanical failure
of direct and indirect tooth-colored adhesive-
cemented restorations for which the restoration-
cavity interface is situated close to the tip of the
cusp, or the intact tooth wall is insufficiently thick.
These failures cannot easily be explained except
by hypothesizing a failure over time of the adhe-
sive bond at the interface, where it is subjected to
high physical and chemical stress.
It is the authors’ opinion that for posterior teeth
it is important to place the margins of indirect
tooth-colored adhesive-cemented restorations in
occlusal-axial areas subjected to lower mechanical
stress. An analysis of the literature reveals four
structures that determine the strength of intact
tooth: the interaxial dentin, the pulp chamber roof,
the marginal ridge, and the intact cusp. For their
diagnostic and operative implications, these struc-
tures may be classified topographically as central
or peripheral. The spatial relationship between the
various structures is better clarified through a struc-
tural model of the tooth (Figs 1 and 2).
56 QDT 2006
mr
ic ic
D mr M
id
pcr
Fig 2 Buccolingual view of the structural model
of the tooth. id = interaxial dentin, ic = intact
cusp, mr = marginal ridge, pcr = pulp chamber
roof.
Central structures
The central structures consist of the interaxial
dentin and the pulp chamber roof. The interaxial
dentin is the central core of the tooth. It may be
seen as the occlusocervical continuation of the
pulp chamber roof and, thus, occupies the area
corresponding to the projection of the pulp cham-
ber to the occlusal surface.13 The interaxial dentin
connects the axial walls, in particular the buccal
and lingual walls, and is the most important struc-
ture. When it is intact, the presence of other com-
promised structures will not significantly under-
mine the overall fracture resistance of the intact
tooth.14–17
Studies by Mondelli et al14 and Larson et al15
have shown that the loss of the marginal ridge
(peripheral structure) does not produce signifi-
cant structural weakening when the occlusal isth-
mus (ie, interaxial dentin) remains intact. On the
contrary, exclusive preparation of the interaxial
dentin is associated with significant structural
weakening. The structural significance of the
 Cavity Configurations for Indirect Partial-Coverage Restorations
marginal ridge is affected by any compromise of
the interaxial dentin.16,17
The pulp chamber roof, contrary to common
belief, is less important than the marginal ridge.
Reeh et al4 demonstrated that loss of the pulp
chamber roof when both marginal ridges are
kept intact (ie, endodontic treatment requiring
removal of some of the interaxial dentin and the
pulp chamber roof) produces a less significant
structural weakening than maintenance of the
pulp chamber roof when one or two marginal
ridges are missing (ie, vital tooth with Class 2
cavity, occlusomesial, occlusodistal, and mesial-
occlusodistal).
These considerations are important in making
clinical choices based on the evaluation of healthy
intact tooth structures and on scientific evidence,
and not simply on empirical or preconceived no-
tions. The hierarchy of tooth structures is thus: (1)
the interaxial dentin, (2) the marginal ridge, (3) the
roof of pulp chamber, and (4) the enamel-dentin
complex of the intact cusp.
Peripheral structures
The peripheral structures are the marginal ridge
and the enamel-dentin complex of each intact
cusp. The marginal ridge is the peripheral struc-
ture of the proximal wall, whereas the enamel-
dentin complex of the cusp is the peripheral struc-
ture of the axial-buccal or palatolingual wall. The
marginal ridge, its underlying enamel-dentin com-
plex, and the interaxial dentin meet at the junc-
tion of the buccal wall with the palatolingual wall.
The thickness of enamel-dentin complex at the
base of each cusp does not participate in this
structural junction but is rather the last support of
the cusp itself.
Correct evaluation of the marginal ridge must
follow certain criteria. The loss of a marginal
ridge signifies the presence of a proximal box. If
the interaxial dentin has been compromised and
the presence of an occlusal isthmus is antici-
pated, the proximal box must be evaluated in
terms of the presence or absence of the pulp
chamber roof and the thickness of the enamel-
dentin complex at the adjacent intact cusp (it
must be greater than1.5 to 2 mm in a vital
tooth 18 and 2.5 to 3 mm in an endodontically
treated tooth13) and depth at the base.19 The na-
ture of the structural interdependence deter-
mines whether or not it is necessary to cover the
adjacent cusps. Articles by Linn et al20 and Pan-
itvisai et al 21 on the relationship between the
marginal ridge and intact cusps in an endodonti-
cally treated tooth demonstrate a structural and
functional dependence of the intact cusp on the
adjacent marginal ridge. Likewise, the articles
confirm the independent biomechanical be-
haviour among cusps as suggested by Sakaguchi
et al,22 and which has been clinically confirmed
by numerous studies.5–12 The loss of one marginal
ridge in an endodontically treated molar, where
the other marginal ridge is intact and adjacent
cusps are well-supported, should be planned as
a restoration with partial cusp coverage; the
cusps adjacent to the lost marginal ridge are
covered, while the cusps adjacent to the intact
marginal ridge are maintained.
The enamel-dentin complex of the intact cusp
represents the most significant clinical factor in
deciding whether to maintain or cover the cusp.
Hood6 demonstrated that from the mechanical
standpoint the enamel-dentin complex of the in-
tact cusp adjacent to a proximal box behaves
like a cantilever; the thickness and depth at the
base of the intact cusp are the most important
parameters since they vary with the cube of the
deformation and, in the final analysis, are re-
sponsible for the strength of the cusp. This is
why, with equal thickness and in the absence of a
marginal ridge, intact cusps of endodontically
treated teeth flex more than those of vital teeth.
Keeping an intact cusp in a vital tooth is deter-
mined by an enamel-dentin thickness greater
than 1.5 to 2 mm,20 whereas in an endodontically
treated tooth the thickness must exceed 2.5 to 3
mm.13
QDT 2006 57
 FICHERA ET AL
ic
ic
D mr M
mr id
ic
ic
L interaxial dentin, ic = intact cusp, mr = marginal
TRANSITION AREAS AND POSSIBLE
CAVITY CONFIGURATIONS
After analyzing the peripheral and central struc-
tures (ie, the marginal ridge, the intact cusp, and
the interaxial dentin), it is possible, topographi-
cally, to outline the separation areas between
each tooth structure. These areas are valuable in
diagnosing cavity configurations, since they repre-
sent a line of transition between the restoration
and intracoronal and extracoronal cavity to be
outlined in partial-coverage crown preparation.
They also act as spatial references and help ac-
complish a rapid buildup that is stereoscopically
correct.
Taking, for example, a maxillary first molar,
three areas of transition can be outlined between
the marginal ridge and cusp, between cusp and
cusp, and between the interaxial dentin and the
peripheral marginal ridge–cusp unit (Fig 3). Given
the anatomy of posterior teeth, two areas of tran-
sition are associated with each marginal ridge: a
buccal transition, at the beginning of the adjacent
buccal cusp; and a lingual transition, at the begin-
ning of the adjacent lingual cusp.
A number of cavity designs are derived from the
possible combinations based on the absence or
presence of the marginal ridge and on the mainte-
nance or restoration of the two adjacent cusps
58 QDT 2006
Fig 3 Structural model of the tooth, illustrating
the transition area (red) between marginal ridge
and cusp, cusp and cusp, and interaxial dentin
and peripheral marginal ridge–cusp unit. id =
ridge.
(buccal and lingual) (Fig 4). Configurations 1 to 4
(see Figs 4a to 4d) are characterized by the pres-
ence of the marginal ridge, while configurations 5
to 8 (see Figs 4e to 4h) are characterized by the ab-
sence of the marginal ridge, and, therefore, by the
presence of a proximal box. These eight configura-
tions cover all clinical possibilities for cavity design
and cusp coverage in relation to the marginal ridge
and account for half of the possibilities for a pre-
molar (eight configurations associated with the
presence of the opposed marginal ridge and eight
configurations associated with its absence).
By considering mirror images of the eight possi-
ble configurations for a marginal ridge and adja-
cent cusps, it is possible to obtain every type of
cavity preparation for a partial-coverage crown—
inlays, onlays, and overlays—in any combination
(Figs 5 and 6). A simple calculation of the combi-
nations shows that 64 types of cavity preparation
are possible for a partial-coverage crown in a tooth
with four cusps. Thanks to the concept of principal
transition areas, it is simple to standardize cavity
design. Ascertaining the presence or absence of
the marginal ridge is sufficient to determine
whether the adjacent cusp should be maintained
or covered. Following this decision, the geometry
of the cavity configuration can be outlined with
certainty.
 Cavity Configurations for Indirect Partial-Coverage Restorations

Fig 4 Basic cavity configuration depending on presence or absence of marginal ridge and maintenance restoration
of adjacent cusps. bc = buccal cusp, lc = lingual cusp, mr = marginal ridge, pid = prepared interaxial dentin, cc =
cusp cover, pb = proximal box.

lc cc lc cc

mr pid mr pid mr pid mr pid

bc bc cc cc

4a 4b 4c 4d

lc cc lc cc

pb pb pb pid pb pid
pid pid

bc bc cc cc

4e 4f 4g 4h

Fig 4a Cavity configuration 1: occlusal inlay. Fig 4e Cavity configuration 5: occlusodistal inlay.

Fig 4b Cavity configuration 2: onlay with lingual cusp Fig 4f Cavity configuration 6: occlusodistal onlay with
cover. lingual cusp cover.

Fig 4c Cavity configuration 3: onlay with buccal cusp Fig 4g Cavity configuration 7: occlusodistal onlay with
cover. buccal cusp cover.

Fig 4d Cavity configuration 4: onlay with lingual and Fig 4h Cavity configuration 8: occlusodistal onlay with
buccal cusp cover. lingual and buccal cusp cover.

L L

1-1 1-2 1-3 2-1 2-2 2-3

D M D M
1-4 1-5 2-4 2-5

1-6 1-7 1-8 2-6 2-7 2-8

B B
Fig 5 Mirror-image associations of mesial configuration Fig 6 Mirror-image associations of mesial configuration
1 with the 8 distal configurations. 2 with the 8 distal configurations.

QDT 2006 59
 FICHERA ET AL

L marginal ridge cusp cusp

occlusocervical
3.5 levels
mm
2 mm
D M
pu cu pu
B L
1.2 mm
1.2
mm B 3.5 mm
1.5-2 mm
mesiodistal
levels de me

Fig 7 Horizontal cross section of in-
tact tooth structure at a specific oc-
clusocervical level to identify
enamel-dentin thickness on the
mesiodistal line.
Fig 8 Frontal cross section of intact
tooth structure at a specific mesio-
distal level to identify enamel-dentin
thickness on the occlusocervical line.
Fig 9 Diagnostic model for type of
cusp cover facilitates analysis of
occlusocervical and mesiodistal
enamel-dentin thickness of the intact
cusp. pu = peripheral unit, cu = cen-
tral unit, de = distal extremity, me =
mesial extremity, red grids = transi-
tion area.

TYPES OF CUSP COVER By definition, the thickness of the cusp wall is a

As stressed in a previous publication,3 cusp cover-
age in indirect esthetic adhesive restorations may
be accomplished by either shoeing or capping. The
diagnostic model for cusp cover outlines parame-
ters of how to decide whether or not a cusp cover
is necessary and what type of cover is appropriate.
To use the model requires analyzing the cusps in
three planes: transversal, frontal, and sagittal.
The thickness of the enamel-dentin complex on
the cusp dictates the need for cusp coverage. As
previously indicated, the limit for enamel-dentin
thickness in a vital tooth must be around 1.5 or 2
mm; if it is any less, the wall would be exclusively
supported by enamel and reinforcement provided
by the buildup would not be reliable. An endo-
dontically treated tooth requires greater enamel-
dentin thickness; when the cusp has lost the adja-
cent marginal ridge, even if it is supported by an
enamel-dentin thickness greater than 1.5 or 2 mm,
it has lost all structural links (interaxial dentin, pulp
chamber roof, and marginal ridge) to the opposite
marginal wall and, thus, behaves as a cantilever. In
this case, the cusp height becomes an essential
factor, due to the loss of the pulp chamber roof.
Covering the cusp is strongly recommended, un-
less the intact cusp has a remarkable thickness
greater than 2.5 to 3 mm.
spatial attribute on the transversal and frontal
planes. For an overall evaluation, the enamel-
dentin thickness should be considered at various
occlusocervical and mesiodistal levels. A transver-
sal section at a specific occlusocervical level pro-
vides information on the thickness of the enamel-
dentin complex along the mesiodistal line (Fig 7).
A frontal cross section at a specific mesiodistal
level provides information about the enamel-
dentin thickness along the occlusocervical line
(Fig 8). By combining the information concerning
the enamel-dentin thickness at varying occlu-
socervical and mesiodistal levels, it is possible to
determine whether a cusp cover is required and
the most appropriate type.
Transversal and frontal examination is effec-
tively supplemented by the diagnostic model for
type of cusp cover, shown in lateral view (sagittal
plane) with the start of the marginal ridge and the
adjacent cusp. A grid of horizontal and vertical
lines can be traced on the cusp, to represent the
occlusocervical levels (spaced by approximately 2
mm) and the mesiodistal levels (where the lines
coincide with the mesial and distal extremities of
the transition area, between cusp and marginal
ridge, and between cusp and cusp) (Fig 9). These
lines produce a grid of structural units, which are
valuable for ascertaining the enamel-dentin thick-

60 QDT 2006
 Cavity Configurations for Indirect Partial-Coverage Restorations
cusp
marginal ridge
Figs 10a and 10b Structural defi-
ciencies in the occlusal 2 mm of in-
tact cusps require cusp coverage pb
by shoeing. The model is shown
on the left and the frontal cross
section on the right. pb = proximal
box, red grids = transition area.
10a
ness of the cusp. A Johannson thickness gauge
for metals may be used as a diagnostic aid.
The structural units (nine in all) may be subdi-
vided into central3 and peripheral units (three on
each side, ie, six per cusp). The peripheral struc-
tural units coincide with the mesial and distal
halves of the transition area, and, as such, will be
the site of maintenance or restoration (ie, the pas-
sage of the cavity perimeter) depending on the
clinical situation.
By examining the various parts of this model, it
is possible to obtain all the necessary diagnostic
information related to cuspal coverage. Before an-
alyzing the model, it is important to observe that
a mesial and a distal extremity can be distin-
guished in the transition areas. For example, dur-
ing the preparation phase the cutting line may be
traced through the transition area between cusp
and marginal ridge, or between cusp and cusp,
anywhere from the mesial to the distal extremity,
ie, within a range of approximately 1.5 to 2 mm.
Conceptually, wherever the cutting line runs within
this range of 1.5 to 2 mm, the design of the gen-
eral cavity shape (types 1 to 8) does not change
(see Fig 4). If the transition line is located at the
mesial or distal extremity of the area, it will affect
the type of cusp cover that is required.
Identifying transition areas and their extremities
limits the preparation line and avoids unnecessary
cusp
1.5-2 mm
B
buildup
10b
preparation. To simplify analysis of the model, it is
appropriate to consider first the structural defi-
ciency of the enamel-dentin thickness in the 2-mm
occlusal area of the cusp. This deficiency indicates
the need for shoeing (Figs 10a and 10b). When the
perimeter of the intracoronal cavity is in proximity
to or coincides with the tip of the cusp, shoeing is
indicated. This is true for all situations in which the
occlusal isthmus is intact and conventional capping
is not considered a conservative enough ap-
proach. The lateral view shows the cusp cover with
its mesiodistal extension, whereas the frontal cross
section shows its conservative quality and the ease
of performing this type of cusp cover.
Depending on the combination of mesial and
distal extremities of the transition area, the shoe-
ing will have four possible configurations; the most
conservative approach does not involve the adja-
cent ridge or cusp, and the most extensive ap-
proach involves both. There are schematic distinc-
tions between minimum-extension shoeing
(required exclusively for a deficiency of a central
structure), intermediate-extension shoeing (for a
deficiency of a central structure plus one periph-
eral structure), and maximum-extension shoeing
(for a deficiency of a central structure and both pe-
ripheral structures) (Figs 11a to 11f). Should the
structural deficiency in enamel-dentin thickness in-
volve the middle third as well as the occlusal band,
QDT 2006 61
 FICHERA ET AL

cusp cusp
marginal ridge

11a 11b

cusp cusp
marginal ridge

11c 11d

cusp cusp
marginal ridge

11e 11f

Figs 11a to 11f Models (left) and occlusal views (right) of cusp cover by shoeing
with minimum (a and b), intermediate (c and d), and maximum (e and f) mesiodistal
extension. red grids = transition area.

capping will be required (Figs 12a and 12b). Four
combinations of capping are also possible, one
classic total capping and three partial capping of
minimum to intermediate extension (Figs 13a to
13f). A structural deficiency in the cervical third in-
volves the same combinations as outlined above,
the only clinical difference being that the cervical
margin will lie closer to the gingival margin, and,
consequently, the axial wall will be longer (Figs 14
and 15).
Out of the possible 64 cavity designs, configura-
tions with the greatest space for cusp coverage are
those in which an intact cusp is combined with a
structural deficiency involving a missing adjacent
marginal ridge and an adjacent cusp requiring
complete restoration (eg, 2-6,2-8,3-7,3-8 [see Figs
5 and 6]). Such situations allow full exploitation of
the operative space, due to the absence of transi-
tion areas adjacent to the cusp. Despite this, it is
possible to resort to maximum-extension cover in
the presence of adjacent marginal ridge and cusp.
By exploiting the transition areas bordering the in-
tact cusp and using a cavity perimeter that passes
through the more distant mesial and distal extremi-

62 QDT 2006
 Cavity Configurations for Indirect Partial-Coverage Restorations

cusp cusp
marginal ridge
1.5-2 mm

Figs 12a and 12b Structural defi-

ciency in the middle and occlusal B
thirds of the intact cusp requires buildup
pb cusp coverage by capping the
middle third. The model is shown
on the left and the frontal cross
section on the right. pb = proximal
box, red grids = transition area.
12a 12b

cusp cusp
marginal ridge

13a 13b

cusp cusp
marginal ridge

13c 13d

cusp cusp
marginal ridge

13e 13f

Figs 13a to 13f Models (left) and occlusal views (right) of cusp cover by capping
the middle third with minimum (a and b), intermediate (c and d), and maximum
(e and f) mesiodistal extension. red grids = transition area.

QDT 2006 63
 FICHERA ET AL

cusp cusp
marginal ridge
1.5-2 mm

Figs 14a and 14b Structural defi- B

pb ciency of the entire intact cusp re- buildup
quires cusp cover by capping the
cervical third. The model is shown
on the left and the frontal cross sec-
tion on the right. red grids = transi-
tion area.
14a 14b

cusp cusp
marginal ridge

15a 15b

cusp cusp
marginal ridge

15c 15d

cusp cusp
marginal ridge

pb

15e 15f

Figs 15a to 15f Models (left) and occlusal views (right) of cusp cover by capping
the cervical third with minimum (a and b), intermediate (c and d), and maximum
(e and f) mesiodistal extension. pb = proximal box, red grids = transition area.

64 QDT 2006
 Cavity Configurations for Indirect Partial-Coverage Restorations

cusp cusp
marginal ridge

Figs 16a to 16b Structural defi-

ciency of the central and lateral
structures of the entire distal intact
cusp and the occlusal third of the
mesial intact cusp requires cusp
cover by total capping and by
shoeing with maximum extension.
The model is shown on the left
and the occlusal view on the right.
red grids = transition area.
16a 16b

Fig 17 Diagnostic algorithm with flowchart.

Fig 18 Initial radiograph showing

distal secondary caries at the sec-
ond premolar and direct capping
of mesial pulpal horn at the first
molar, which is affected by pulpitis
and occlusal caries.

Fig 19 Radiograph showing endo-

dontic therapy.
18 19

ties, the minimum operative space needed to ac-
complish a maximum-extension cusp cover can be
obtained. Furthermore, understanding of the
mesial and distal extremities of a transition area
makes it possible to consider different designs for
cusp coverage, provided that one or both transition
areas adjacent to the undermined intact cusp are
not involved. Partial capping and minimum- and in-
termediate-extension shoeing, combine the biome-
chanical benefits of cusp covers with the advan-
tages of maximum conservation of tooth structure.
Various combinations of enamel-dentin thick-
ness on the intact cusp have been illustrated to
simplify explanation of the model and clarify the
differences between various cusp covers. Clinical
practice produces a wide range of possible com-
binations (Figs 16a and 16b), but by following a
number of guidelines it is possible to make the
best compromise between maximum conserva-
tion of tooth structure and optimal biomechanics
of the tooth restoration (Fig 17).
Furthermore, the grid and its central and pe-
ripheral subdivisions allow a realistic evaluation of
buildup possibilities for reinforcing the intact
enamel-dentin complex (Figs 18 to 33).

QDT 2006 65
 FICHERA ET AL
Fig 20 Examination of the first
molar, with intact healthy tooth
structure at and onlay treatment
covering the mesiobuccal and
mesiolingual cusps.
Fig 23 Application of primer and
bonding agent.
Fig 26 Application of restoration
composite buildup.
Fig 29 Construction of mesial wall
of the second premolar.
Fig 32 Direct resin composite
restoration of the second molar.
66 QDT 2006
Fig 21 Placement of modified Fig 22 Etching.
glass-ionomer cement at canal en-
trances.
Fig 24 Bright white chrome com- Fig 25 Application of fluid com-
posite facilitates potential endo- posite buildup.
dontic re-treatment and enhances
value of buildup.
Fig 27 Preparation of onlay cavity Fig 28 Sectional matrix, wedge, and
with cusp cover by shoeing of retractor ring for Class II occluso-
mesiolingual cusp and by capping mesial cavity at the second premolar.
middle third of mesiobuccal cusp.
Fig 30 Direct resin composite Fig 31 Adhesive cementing of
restoration of the second premolar. composite onlay to the first molar.
Field for adhesive cementing of
onlay to the first molar is placed
under rubber dam.
Fig 33 Removal of dam, followed
by finishing and polishing of the
restorations.
 Cavity Configurations for Indirect Partial-Coverage Restorations
CONCLUSION
By looking to biomechanical studies and a struc-
tural model of the tooth, it is possible to standard-
ize the diagnosis of cavity configuration and the
application of clinical and operative guidelines.
Determining the strength of the intact healthy
tooth structures represents the starting point for
all analysis. In examining the adequacy and defi-
ciency of intact tooth structures, a clinician can de-
termine all biomechanically valid cavity configura-
tions. Using a model of the enamel-dentin complex
of the intact cusp, an analysis can provide indica-
tions for restoring any intact cusp, as well as the
choice of type of cusp cover. This approach en-
courages cavity configurations and types of cusp
cover that offer structural strength and maximum
conservation of the natural tooth.
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