1.

Left maxillary first molar# 14 or # 26 Occlusal

view
2. Undercut on mesiobuccal
3. Inadequate taper on mesial, buccal and palatal side
4. Ditching on margin in mesiobuccal side
5. Second molar damaged
6. Sharp occlusal line angles
7. No bevel on paaltal cusps

Buccal view

Margins more than 1mm away from gingiva

Occlusal reduction inadequate

Tooth slightly mesial tilted

Undercut on mesial surface

Second molar nicked

Step in mesial margin

Margin location

Mesial surface undercut

Damage to gingiva distally

Inadequate occlusal reduction

Slightly mesially tilted

Palatal view

1
Gold crown CORRECTION

It will be better to make gold crown if aesthetic is not concern as it will be more
conservative and less damaging to tooth structure and minimal alterations will be
required to make it clinical acceptable preparstion.
Clinically margin thickness more than required

Occlusal reduction 1.5 mm

Occlusal line angles rounding and bevelling of functional cusp

Taper correction as conservatively possible with consideration to block undercut where we are able to
get adequate margin thickness available all over.

Change in margin location to place it 0.5 mm to 1. Oo mm

Correction of mesial tilt to improve path of insertion an withdrawl

Enameloplasty of adjacent teeth

2
Wax build up:

Tooth mandibular right first molar, wax build up on cavity prepared for partial MOD
onlay with missing distolingual cusp.

mesial and distal side lacks adequate contact

mesial side wax pattern is overcarved and no distinct marginal ridge

lack of proximal anatomy like no demarcated marginal ridge and triangular foss

cusp height as well its contour is short.

Cavosurfca margin on distolingual cusp is deficient.

Overall wax pattern seems to be deficient occlusally where central groove areas are
depply carved resulting in deficient pattern

Proximal contacts are open on both side will result in food impaction and resulting
periodontal and secondary decay problem

Cusp tip lacks height along with cuspal contours are short which will result in lack of
definite occlusion and supraeruption of opposite tooth. Since pattern is short as well it
will not be able to support the tooth during mastication and tooth remains susceptible for
fracture.

Wax patern should be fabricated new with convex proximal conours, optimal contact
location which are buccally and occlusally present with no overhang on gingival side
and occlusal, buccal and lingual embrasure adequately carved/

3
Marginal ridge should appear v shaped when viewed proximally and should follow the
cuspal contours and matching its height with adjacent tooth.

Central groove should demarcate the individual cusps approprotaely and it should not
be deep and high as well with adequate triangular fossa on mesial and distal side,

Cusp should be anatomically carved so that it should have adequate height with mesial
and distal ridge following the cuspal contours with triangular ridge present occlusal.
Cusp should come appropriately inward to confirm occlusal table and it should follo the
appropriate lingual contour without any deficiney and overcontiuring, wax pattern should
have adequate adaptation on all along cavosurface margins to prevent any leakage and
provide strong cavosurfce seal.
Right mandibular first molar: #30 or #46

Distal marginal ridge weak

Cavity not centralised in distal area.

Lingual wall divergent on distolingual cusp

Contact opening more than 0.5mm buccally and

lingually

Gingival clearance more than 1mm

Gingival seat going subgingivally

Damage to gingiva

Axial wall very deep

Sharp axiopulpal line angle

Axial wall not following the contour

Gingival seat width more than 2mm

Pulpal depth adequate
Sharp cavosurface margins
Buccal wall of the box extended buccaly near gingival seat

4
For direct restoration amalgam will be better after pulpal protection, but vontact areas will be difficult
to build and contacts and contour may bot be optimal, since the tensile strength of amalgam is weak,
restoration may fracture although restoration will be cost effective.

For composite same above considerations like amalgam additionally if there is no enamel present on
gingival side it can lead to sensitivity and leakage e around that margin in future.

Composite difficult to build contact

Indiract restoration inlay, walls need to be divergent

Buccal wall of the box will need more extension to get appropriate configuration, several areas may
require blockage of undercuts.

Cavosurface margins bevelling to provide thin margins for gold

Tooth RIGHT MAXILLARY LATERAL incisor # 7 or #12 and right maxillary first premolar #5 0r #14

Right molar in cross bite

Gingival recession and cervical abrasios due to tooth brush trauma and periodontal disease

5
22 in cross bite

Periodontal evaluation: pocket depth, radiograph full mouth series and IOPA

STUDY MODELS

Occlusal trauma evaluation

Periodontal treatment

Orthodontic evaluation

Abrasion rstoration

Tooth replacemnt

R L

OPG VIEW:

RIGHT lower quadrant third molar

Second molar RCT Treated showing cap. Radiographically RCT is not appropriate with short filling and
inadequate canal preparation and condensation although periapical area looks fine.

6
First molar is carious occludally, require clinicl correlation to see extent and surfaces involved by the
caries. Other teeth from second premolar to other side looks fine radiographically and require clinical
examination .

Left mandibular first molar is grossly decayed hardly with any coronal structure left and is RCT tewated,
radiographically its restoration prognosis looks poor and probably will require extraction its showing the
supraeruption as well.

Mandibular second molar is missing, a slight raadioopacity near the ridge that be small root stump left,
mandibular left third molar shows large metallic restoration with RCT treatment and quality obturation
is lacking, I can see radiolucency present around the distal rooth which may indicative of development
of periapical lesion.

Presence of implant on 26, slight bone loss visible around the marginal area of implant although need
clinicl correlation with probing depth and presence of any bleeding

First premolar RCT TREATED AND RADIOGRAPHICALLY extensive loss of coronal tooth structure and
presence of periapical lesion, tooth prognosis seems poor.

Canine to canine looks good,

Same observation for second premolar on right upper side.

Missing upper first molar

Enamel outline is not complete on mesial side which may represent fracture of marginal ridge area or
preparation of csvity, require clinical correlation

Third molar may have crieds present occlusally

Due to multoiple missing teeth and grossly carious teeth, dentition may not be supporting the occlusion
very well so consideration to be given to replacement to prevent supreruption of opposite tooth and
migration of djacent ooth which can result in deep bite and teeth become periodontally compromised.

7
46 amalgam

15 palatal composite, mesial contact almost tight and goes with little effort, distal contact okay

Otherwise its good

23 crown cutting , putty slightly slow setting but not more than five minutes.

36 caries punch present

Endo 16