ABDULLAH ALNASSER

DENISSE MACIAS
ADVANCED PROSTHODONTICS
PROGRAM, LOMA LINDA
THE COMPLETE
CAST CROWN
UNIVERSITY

PREPARATION
GUIDELINES
 INTRODUCTION

•
Although esthetic factors can limit its application, longevity of complete cast
crowns is superior to that of all other fixed restoration. It should always be
considered for patients requiring restorations for badly damaged posterior
teeth.
•
An esthetic alternative is zirconia. The preparation design for anatomic-
contour zirconia is similar to that for cast metal, although additional occlusal
clearance is usually required.
•
The difference between occlusal clearance and reduction: Clearance is the
amount of space between the completed preparation and the opposing
tooth; reduction is the amount of tooth structure that is removed to establish
the desired clearance.
•

Rosenstiel,
• S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.
Elsevier Health Sciences.
 ADVANTAGES
• The complete cast crown has greater retention than do more conservative
restorations on the same tooth (e.g., a seven-eighths or three-quarter crown)
• Normally, a complete cast crown preparation has greater resistance form than
does a partial coverage restoration on the same tooth
• Strength is superior to that of other restorations because of better resistance .
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
 ADVANTAGES
•Allows for the modification of axial tooth contour e.g., Fluting of buccal walls
to enable better access to the furcation for plaque control.
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
DISADVANTAGE
• Display of metal.
• In patients with a normal smile line, such restorations may be restricted to
maxillary molars, mandibular molars, and premolars.
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
 INDICATION
• Restoration of choice whenever maximum retention and resistance are
needed: for instance, in posterior, high-load locations that are not readily
visible.
• Endodontically treated posterior teeth.
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
 If treatment objectives can be met with a more conservative restoration.
CONTRAINDICATION
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
 PREPARATION

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
PREPARATION
PREPARATION
1. Guiding grooves for occlusal reduction:
• tapered tungsten carbide or a narrow tapered or small round-ended
diamond is recommended.
• In situations where existing crowns or occlusal discrepancy are present, a
reduction guide can be made from a diagnostic waxing procedure
• Depth holes approximately 1 mm deep in the central, mesial, and distal
fossae are placed, then connected.
• Buccal, lingual developmental grooves and triangular ridge depth holes are
placed.
• Depth grooves for the functional cusp bevel in the area of occlusal contact
with the opposing tooth are placed. The depth of these grooves should be
slightly less than 1.5 mm (to allow for smoothing)
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
PREPARATION
1. Guiding grooves for occlusal reduction:
• Depth grooves for the functional cusp bevel in the area of occlusal contact
with the opposing tooth are placed. The depth of these grooves should be
slightly less than 1.5 mm (to allow for smoothing)
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
 PREPARATION
2. Occlusal Reduction:
• Grooves removed with the tungsten carbide or the narrow,
round- ended tapered diamond.
• Half the occlusal surface is reduced first so that the other half
can be maintained as a reference.
• Verify clearance has been established on functional cusps
and on nonfunctional cusps. These clearances must also be
verified in all excursive movements.
• Clearance on the lingual aspect of a tooth preparation is
checked by asking the patient to close into several layers of
dark- colored utility wax in maximum intercuspation. The wax
can be evaluated intraorally using periodontal probe or
extraorally by removing the wax and evaluating it for thin
spots using wax caliper.
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
PREPARATION

3. Alignment Grooves for Axial Reduction:

• Place buccal and lingual wall grooves with a narrow, round-ended,
tapered diamond.
• Verify that the shank of the diamond is parallel to the proposed path of
placement of the restoration. Such positioning automatically produces a
convergence between the axial walls of the alignment grooves that is
identical to the taper of the diamond
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
PREPARATION
3. Alignment Grooves for Axial Reduction:
• The diamond tip should not cut into the tooth beyond its midpoint;
otherwise, a “lip” of tooth enamel will be unsupported.
• Periodontal probe is used to assess the relative parallelism of the
alignment grooves with the proposed path of placement of a secondary
retainer if a fixed dental prosthesis is used.
• An impression made with irreversible hydrocolloid alginate can also. Be
used to evaluate.
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
 PREPARATION
4. Axial Reduction:
• The residual islands of tooth structure between the
alignment grooves are removed and the chamfer margin is
created.
• When breaking interproximal contact, pay special attention
to prevent unintentional damage to the adjacent teeth.
Enamel lip can be left
• If lip of enamel cannot be left, metal matrix band can be
placed instead.
• Lip is removed by using thinner, tapered diamonds.
• If the adjacent proximal surface is accidentally damaged,
polish with white stones, silicone points, and prophylaxis
paste before impression making. Ideally, a fluoride
application is given to improve caries resistance and to
prevent demineralization of the surface enamel.
•
Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.
Elsevier Health Sciences.
 PREPARATION
4. Axial Reduction:
• A distinct resistance against vertical displacement
should be detected when the margin is probed with
the tip of an explorer.
• The chamfer margin must be at least 0.6 mm from
the proximal surface of the adjacent tooth.
• Unsupported enamel cannot be tolerated on the
chamfer margin because it is likely to fracture when
the restoration is evaluated or cemented, which, if
undetected, will result in an open margin and
premature restoration failure.

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
PREPARATION

5. Finishing
• Smooth transitions blend occlusal and axial surfaces. This facilitates many subsequent
laboratory steps because the risk of bubble formation is reduced.
• Use a fine-grit diamond or tungsten carbide rotary instrument of slightly greater diameter
to finish the chamfer margin at reduced speed.
• It is verified with the tip of an explorer.
• Slightly round all line angles.
• The larger diamond is recommended because it will eliminate any unwanted ripples that
were created during axial reduction
• Place additional retentive features as needed with the tapered tungsten carbide bur with
the slow-speed handpiece
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
PREPARATION
6. Evaluation:
• Verify that adequate occlusal clearance has been achieved.
• View the preparation from the buccal and lingual aspects to verify that appropriate mesiodistal
taper exists.
From the mesial aspect:
a. Evaluate the buccolingual path of placement. The lingual wall should be perpendicular to the
occlusal plane or have a slight lingual inclination.
b. Evaluate the buccolingual angle of convergence, followed by the angulation of the functional cusp
bevel.
c. Evaluate that the occlusal reduction is adequate next to the marginal ridges of the adjacent teeth.
d.

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
PREPARATION
6. Evaluation:
• View the preparation from the occlusal aspect to evaluate that concentricity has been achieve
• If more vertical wall is visible on one side of the preparation, the preparation is over- tapered.
• If it is impossible to see part of the axial wall in the occlusal view, an undercut may be present.
•

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
PREPARATION
6. Evaluation:
• To check for the parallelism after finishing, the tip of the diamond bur is rested on the margin
and the instrument is moved around the tooth, the entire hight of the preparation should touch
the bur and no light should be visible between the instrument and the axial surface.
• A common error in complete cast crown preparations is over-tapering of the opposing axial
walls, If a tooth preparation has been inadvertently over-reduced through excessive tapering
of axial walls an approach slightly less conservative may be warranted:
a) Up-righting over-tapered axial walls
b) Using grooves, boxes, or pinholes.
c)

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
 SUMMARY CHART

Rosenstiel, S. F., & Land, M. F. (Eds.). (2015). Contemporary Fixed Prosthodontics-E-Book.

Elsevier Health Sciences.
ADA METAL ALLOY CLASSIFICATION
GOLD ALLOY CLASSIFICATION
Thank you