By

Dr. Zarah Afreen

Assistant Professor/Head of Department
Prosthodontics
• Although esthetic factors can limit its application, the all-metal
complete cast crown should always be considered for patients
requiring restorations for badly damaged posterior teeth.
• Longevity of complete cast crowns is superior to that of all other
fixed restorations.
• Such a crown can be used to restore a single tooth or as a
retainer for a fixed dental prosthesis.
• As its name implies, it covers all axial walls and the occlusal
surface of the tooth
• Extensive destruction from caries and trauma
• Endodontically treated teeth
• Existing restoration
• Necessity for maximum strength and retention
 for instance, in posterior, high-load locations that are not
readily visible.
 Particularly for long-span fixed dental prostheses.
• When correction of axial contours is sought but is not
achievable with a more conservative technique.
• Complete cast crowns can support a partial removable dental
prosthesis.
 The minimum dimensions required for occlusal rests of a partial
removable dental prosthetic framework necessitate removing
significant amounts of enamel.
 if the dentin is exposed, restoring the tooth with a cast crown.
• If treatment objectives can be met with a more conservative
restoration.
 Wherever the buccal or lingual wall is intact, use of a partial-
coverage restoration should be considered.
• No need for maximum retention (e.G., On a short-span fixed
dental prosthesis)
• Presence of active caries or untreated periodontal disease
• In young patients with large pulp chambers
• Esthetics
• if a removable partial denture is planned and an adequate
buccal contour exists or can be obtained through enamel
modification (enameloplasty), a complete crown is not
warranted.
GREATER RETENTION:
• Because all axial surfaces of the tooth are included in the
preparation, the complete cast crown has greater retention than
do more conservative restorations on the same tooth
GREATER RESISTANCE FORM:
• A complete cast crown
preparation has greater
resistance form than does a
partial-coverage restoration on
the same tooth.
• If the axial walls of a complete
cast crown have been prepared
with reasonable axial wall height
and the proper convergence, a
significant amount of tooth
structure must fail before the
crown can be displaced.
STRENGTH:
• Complete cast crown strength is superior to that of other
restorations.
• Its cylindrical configuration encircles the tooth and is reinforced
by a corrugated occlusal surface.
OPTIONS TO MODIFY FORM AND OCCLUSION:
• A complete cast crown allows the operator, within reason, to
modify axial tooth contour.
• This can be helpful with malaligned teeth, although the extent
of possible recontouring is limited by periodontal
considerations.
FLUTING OR BARRELING:
• allow improved access for oral hygiene for teeth with
furcal involvement through alteration of buccal and
lingual wall contours.
• This is sometimes referred to as fluting or barreling
• Complete crowns facilitate modification of
the occlusion, this is especially important
when teeth are supra-erupted or when the
occlusal plane needs to be reestablished.
• A complete crown is often the only
restoration that allows achieving properly
shaped survey lines, guide planes, and
occlusal rests in the restored tooth
REMOVAL OF LARGE AMOUNT OF TOOTH STRUCTURE:
• Preparation for complete cast crowns involves all coronal
surfaces.
• Thus removal of tooth structure is extensive and can have
adverse effects on the pulp and periodontium.

ADVERSE EFFECTS ON TISSUES:

• Because of the proximity of the margin to the gingiva,
inflammation of gingival tissues is not uncommon (although a
properly adapted complete cast crown with good axial contour
should minimize this)
VITALITY TESTING NOT READILY FEASIBLE

DISPLAY OF METAL
• The display of metal associated with complete cast crowns may
be objectionable, and in patients with a normal smile line, such
restorations may be restricted to
 maxillary molars
 mandibular molars
 premolars.
FUNCTIONAL (CENTRIC) CUSP BEVEL

• additional reduction is needed for the functional cusps (to

provide a minimum of 1.5 mm of occlusal clearance), the
functional cusp bevel must be angled flatter than the external
surface of the original tooth
• On most posterior teeth, the functional cusp bevel is placed at
an angle of approximately 45 degrees to the long axis of the
prepared tooth.

NONFUNCTIONAL (NONCENTRIC) CUSP BEVEL

• In this location, metal thickness must be at least 0.6 mm for
adequate strength.
• Maxillary molars in particular often require additional
reduction in this area
CHAMFER MARGIN WIDTH
• Adequate chamfer margin width (minimum, 0.5 mm) is important
for developing optimum axial contour.
• Insufficient chamfer margin width forces the dental technician to
overcontour the restoration.
• The occlusal reduction must allow adequate room for the
restorative material from which the cast crown is to be
fabricated.
• Therefore, the material that is selected to fabricate the
restoration has a direct effect on the minimal amount of tooth
structure that must be removed.
• 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
• the clinical tooth preparation for a complete cast crown consists
of the following steps:
• Occlusal depth grooves
• Occlusal reduction and functional cusp bevel
• Axial alignment grooves
• Axial reduction
• Finishing and evaluation
DEPTH GROOVES FOR OCCLUSAL REDUCTION
• Tapered tungsten carbide or diamond
• Minimum clearance on non centric cusps: 1 mm

FUNCTIONAL CUSP BEVEL

• Minimum clearance on centric cusps: 1.5 mm

OCCLUSAL REDUCTION:
• Flatter than cuspal plane, to allow additional reduction at
functional cusp
ALIGNMENT GROOVES FOR AXIAL REDUCTION
• Following normal anatomic configuration of occlusal surface

AXIAL REDUCTION (HALF AT A TIME)

• Chamfer margin allows 0.5 mm of thickness of wax at margins
1. Verify that adequate occlusal clearance has been achieved.
2. View the preparation from the buccal and lingual aspects to
verify that appropriate mesiodistal taper exists.
3. View the preparation from the mesial aspect: This allows
evaluation of the buccolingual path of placement.
• Depending on the original alignment of the tooth, the lingual
wall should be perpendicular to the occlusal plane or have a
slight lingual inclination.
4. View the preparation from
the occlusal aspect to evaluate
that concentricity has been
achieved between the outline
form of the cervical and
occlusal aspects of the axial
walls.
• Teeth that require complete coverage and for which esthetic
demands are significant (e.g., the anterior teeth).
• the metal-ceramic crown may be a better choice to serve as a
retainer for fixed dental prostheses because its metal
substructure can accommodate cast or soldered connectors.
• Metal-ceramic crowns may successfully be modified to
incorporate occlusal and cingulum rests and milled proximal and
reciprocal guide planes in their metal substructure
• extensive tooth destruction —as a result of caries, trauma, or
existing previous restorations
• the need for superior retention and strength
• an endodontically treated tooth in conjunction with a suitable
supporting structure (a post and core)
• the need to recontour axial surfaces or correct minor
malinclinations.
• Within certain limits, metal-ceramic restorations can also be
used to alter the occlusal plane.
• presence of active caries or untreated periodontal disease.
• large pulp chambers, the metal-ceramic crown is
contraindicated because of the high risk of pulp exposure
• A metal-ceramic restoration should not be considered whenever
a more conservative retainer is feasible, unless maximum
retention and resistance form are needed, as for a long-span
fixed dental prosthesis.
• The metal-ceramic restoration combines, to a large degree, the
strength of cast metal with the esthetics of ceramics.
• Natural appearance can be matched closely by good
technique and, if desired, through characterization of the
restoration with internally or externally applied stains.
• Retentive qualities are excellent because all axial walls are
included in the preparation, and it is usually straightforward to
achieve adequate resistance form in the tooth preparation.
• The complete-coverage aspect of metal-ceramic crowns enables
easy correction of axial form.
• The preparation is much less demanding than for partial-
coverage retainers.
• In general, the degree of difficulty of a metal ceramic
preparation is comparable with that of preparing a posterior
tooth for a complete cast crown.
• The metal-ceramic crown preparation requires significant tooth
reduction to provide sufficient space for the restorative
materials.
• To achieve better esthetics, the facial margin of an anterior
restoration is often placed subgingivally, which increases the
potential for periodontal disease.
• In comparison with all-ceramic restorations, metal ceramic
crowns may have slightly inferior esthetics.
• Because of the glasslike nature of the veneering material, a
metal-ceramic crown is subject to brittle fracture.
• In comparison with all-ceramic restorations, metal ceramic
crowns may have slightly inferior esthetics.
• Because of the glasslike nature of the veneering material, a
metal-ceramic crown is subject to brittle fracture.
• Cost
• A frequent problem is the difficulty of accurate shade selection
and its communication to the dental ceramist.
ARMAMENTARIUM
• Round-ended rotary diamonds (regular grit for bulk reduction,
fine grit for finishing) or tungsten carbide burs
• Football- or wheel-shaped diamond (for lingual reduction of
anterior teeth)
• Flat-ended, tapered diamond (for shoulder margin preparation)
• Finishing stones
• Explorer and periodontal probe
• Depth grooves
• Incisal or occlusal reduction
• Labial or buccal reduction in the area to be veneered with
porcelain
• Axial reduction of the proximal and lingual surfaces
• Final finishing of all prepared surfaces
• Fundamentals of fixed prosthodontics 4th ed
• Contemporary fixed prosthodontics 4th ed