Fundamentals of Fixed Prosthodontics Fixed Partial Denture
Herbert T. Shillingurg (3rd edition) • Prosthetic appliance attached to remaining
Topics:
Chapter 1: An Introduction to Fixed Prosthodontics
Chapter 9: Principles of Tooth Preparations
CHAPTER 1: AN INTRODUCTION TO FIXED
PROSTHODONTICS
Terminologies
Crown
• a cemented extracoronal restoration that
covers, or veneers, the outer surface of the
clinical crown
• reproduce tooth morphology while
performing its function
• protects tooth from further damage
Full/Complete veneer crown
• covers all the clinical crown
• may be fabricated from
✓ gold alloy
✓ untarnishable metal
✓ ceramic veneer fused to metal
✓ resin only
Partial Veneer Crown
• if only portions of the clinical crown are
veneered.
Intracoronal cast
• restorations that fit within the anatomic
contour of the clinical crown
• types:
1. Inlays
• Single-tooth restorations for
proximo-occlusal or gingival
lesions with minimal to
moderate extensions
• Made of alloy/ceramic
2. Onlay
• Modified, use to restore
extensive damage posterior
teeth (mesio-occluso-distal)
All-ceramic Laminate veneer/Facial veneer
• Improved cosmetic appearance on the
sound anterior teeth
• Consist of thin layer porcelain/ceramic with
resin
teeth permanently.
• Also known as “bridge”
Abutment
• Tooth serving as an attachment for FPD
Pontic
• Artificial tooth suspended from the
abutment.
FPD retainers
• Connected in pontic
• Extracoronal restorations that are cemented
to the prepared abutment teeth.
Connectors
• Between the pontic and retainer may be
rigid (soldier joints/casr connectors) or non
rigid (precision attachments/stress breakers)
Diagnosis
There are five elements to a good diagnostic
workup in preparation for fixed prosthodontic
treatment:
1. History
2. TMJ/Occlusal Evaluation
3. Intraoral examination
4. Diagnostic cast
5. Full Mouth Radiographs
1. History
• It is important to take a good history of a
patient before dental treatment to
determine if any special precautions are
necessary
• Infectious diseases such as hepatitis and
AIDS should be known to provide protection
for other patients as well as office personnel
• All medications should be identified, and
their contraindications noted before
proceeding with treatment
• Local anesthetics and antibiotics are the
most common offenders
• Reaction to impression materials and nickel
containing alloys
 • Patients with cardiovascular problems may
require special treatment and those with
uncontrolled hypertension should not be
treated until blood pressure has been
lowered
• Patients with a prosthetic heart valve, a
history of previous bacterial endocarditis,
rheumatic fever with valvular dysfunction, or
mitral valve prolapse with valvular
regurgitation should be premedicated
before treatment (amox, eryhthro and
clinda)
• Epilepsy does not contraindicate dentistry,
but appropriate measures should be taken in
the event of a seizure
• Diabetic patients are predisposed to
periodontal breakdown or abscess
formation and their blood sugar level should
be controlled during treatment
• Xerostomia, or dry mouth, is extremely
hostile to the margins of cast metal or
ceramic restorations
2. TMJ/Occlusal Evaluation
• Normal occlusion = all treatment is design to
maintain occlusal relationship.
• Dysfunctional occlusion = further appraisal
to improve or correct the occlusion by
restoration.
• Head, neck and shoulder pain should be
investigated
• Healthy TMJ-= sound quietly
• Clenching/playing with the bite =
fatigue/muscle spasm = square-jowled
appearance, overdeveloped masseter
muscles.
• Opening of the patient’s mouth
✓ Hurt in muscle area = neuromuscular
system dysfunction
3. Intraoral Examination
• Check for plaque or periodontal diseases.
• Mandibular 3rd molars lack attached gingiva
therefore, poor candidate to receive a
crown.
• Presence/absence of inflammation, pockets,
tooth mobility should be recorded.
• Examine edentulous ridges (one or more)
• Presence of caries (wide or localized)
• Previous restorations and prosthesis if need
to replace and for future work to be done.
• Position of maximum intercuspation
4. Diagnostic Casts
• Integral part to give the dentist as complete
a perspective as possible for the patient’s
dental needs.
• Production of max and mandi arches from
alginate.
• Should be mounted in semi adjustable
articulators
• Mandibular cast is set in optimum condylar
position (disc interposed)
• Diagnostic casts can accurately gauge the
length and inclination of abutment teeth for
adequate retention and resistance.
• Abnormalities like mesiodistal drifting,
rotation, and faciolingual displacement of
abutment teeth can be identified through
diagnostic casts.
• Wear facets, occlusal discrepancies, and
centric prematurities can be evaluated using
diagnostic casts.
• A diagnostic wax-up can be used to
determine the need for pontics that are
wider or narrower than normal teeth or
changes in contour.
5. Full-Mouth Radiographs
• should be examined carefully for signs of
caries, both on unrestored proximal surfaces
and recurring around previous restorations
• alveolar bone levels
• possible to trace the outline of the soft tissue
in edentulous area so that the thickness of
the soft tissue overlying the ridge can be
determined.
Protection against Infectious Disease
• Cross-contamination and infectious diseases
are important concerns in dentistry.
• Patients should be asked about HBV and HIV
history, and treated as potentially infectious.
• Healthcare professionals should wear
protective gear and receive the hepatitis B
vaccine.
CHAPTER 9: PRINCIPLES OF TOOTH PREPARATION
5 principles of cast restoration and thai design
1. Preservation of tooth structure
2. Retention and resistance
3. Structural durability
4. Marginal integrity
5. Preservation of the periodontium
1. PRESERVATION OF TOOTH STRUCTURE
• Intact surfaces of tooth structure that can be
maintained while producing a strong,
retentive restoration should be save if the
patient accepts and permit it.
• Whole surfaces of tooth structure should not
be sacrificed to the bur in the name of
convenience and speed.
• Prevent loss of larger tooth structure
• MOD onlay – removal of 1 – 1.5 mm of
occlusal tooth structure.
• Metal on occlusal surface can protect against
fractures and flexing tooth structures
2. RETENTION AND RESISTANCE
Retention
• Prevents removal of the restoration along
the path on insertion or long axis of the tooth
preparation.
Resistance
• Prevents dislodgement of the restoration by
forces directed in an apical or oblique
direction.
• Prevents any movement of the restoration
under occlusal forces.
Essential element of retention
• Is 2 opposing vertical surfaces
1. External surfaces
➢ Ex. Buccal and lingual walls of
a full veneer crown
➢ Extracoronal restorations is
an example of veneer or
sleeve, retention
2. Internal surfaces
➢ Ex. Buccal and lingual walls of
the of the proximal box of a
proximo-occlusal inlay
➢ Intracoronal restorations
resist displacement by wedge
retention
***many restorations are combined of the 2 types.
TAPER
• Axial walls must taper slightly to permit the
restoration to seat
✓ Ex. Angle of convergence and angle
of divergence
➢ 2 opposing internal or
external walls diverge or
converge occlusally.
• Inclination
✓ The relationship of one wall to the
long axis of the preparation
✓ Tapered diamond will impart an
inclination of 2-3 degrees (shank
must be parallel to the intended part
of insertion)
✓ 2 opposing surface = 6-degree taper
• The more nearly parallel the opposing walls
of a preparation, the greater should be the
retention.
• Parallel walls = most retentive but produce
undercuts in mouth preparation
Goals:
a) Visualize
b) Prevent undercuts
c) Compensate for inaccuracies in the
fabrication process
d) Complete seating of restorations during
cementation
• Retention decreases → taper increases
• Taper should be kept minimal due to
retention
• Minimum of 12 degrees taper insure the
absence of undercuts (Mack)
Importance of avoiding overtapering preparations
• Goal: achieve least taper and maximum
retention
• Consciously cutting a taper can result in
nonretentive preparations
Recommended degree of taper
• convergence of 16 degrees
✓ Acceptable overall target
 • Range of taper can vabased on tooth
location
✓ Anterior teeth: as low as 10 degrees
✓ Molars: as high as 22 degrees
• Cements creates a weak bond between
restorations and axial wall, therefore, THE
GREATER SURFACE AREA = GREATER
RETENTION
• Boxes and grooves can increase surface area
FREEDOM OF DISPLACEMENT
• Maximum retention is improved by one path
✓ Ex. Full veneer w/ long, parallel axial
walls and grooves
• Limiting freedom of displacement increases
resistance form
• Groove with oblique angles → no resistance
• V-shaped groove and definite lingual wall =
½ resistance
• Presence of definite wall perpendicular to
the direction of the force to limit the FOD
and provide sufficient resistance.
• Proximal box
✓ Buccal and lingual walls form oblique
angles → no resistance
✓ Buccal and lingual walls must meet
near 90 degrees (perpendicular)
✓ Flare is added to create acute edge of
gold at cavosurface margin of
restorations.
LENGTH
• .Occlusogingival length is important factor in
both resistance and retention
• Longer preparations = more surface area =
more retentive
• Resistance → because the axial wall occlusal
to the finish line interferes with the
displacement, therefore the length and
inclination becomes resistance in tipping
forces.
• Successful restorations → length must be
Great enough to interfere with the arc of the
casting pivoting about a point on the margin
on the opposite side of the restoration.
• Shorter wall
✓ No resistance
✓ Must be taper a little to increase
resistance
✓ Can restore if has small diameter
• Grooves in axial walls of short-walled
preparations on large teeth can improve
resistance by reducing rational radius.
SUBSTITUTION OF INTERNAL FEATURES
• 2 opposing axial walls with minimal taper
✓ Basic unit of retention
• Internal features
✓ Groove
✓ Box form
✓ Pin hole
• Much shorter distance between the walls
allows the dentist to prepare them more
precisely.
PATH OF INSERTION
• Imaginary line which the restoration will be
place onto or removed from the preparation.
• It is the primary means of ensuring the
preparation undercut or overtapered.
• One eyed sight
✓ 30 cm away (12 inches)
✓ Possible to sight axial walls with
minimum taper
• In mouth, use a mouth mirror and place it ½
inch above the preparation with one eye
closed.
• 2 dimensions
1. Faciolingually
➢ Affects the esthetics of
metal-ceramic or partial
veneer crowns.
➢ Path is roughly parallel with
the long axis of the tooth
➢ Result to over contouring
“opaque show-through”
2. Mesiodistally
➢ Must parallel the contact
areas of adjacent teeth.
➢ “Locked out”
3. STRUCTURAL DURABILITY
• Restorations must contain bulk material to
withstand forces of occlusion.
OCCLUSAL REDUCTION
• Most import features to provide adequate
bulk of metal and strength to the
restorations.
• Occlusal Clearance for Gold Alloys
✓ 1.5 mm clearance on functional
cusps
✓ 1. 0 mm clearance on nonfunctional
cusps
• Occlusal Clearance for Metal-Ceramic
Crowns
✓ 1.5 to 2.0 mm clearance on
functional cusps veneered with
porcelain
✓ 1.0 to 1.5 mm clearance on
nonfunctional cusps receiving
ceramic coverage
• Occlusal Clearance for All-Ceramic Crowns
✓ 2.0 mm clearance on preparations
• Considerations for Malposed Teeth
✓ Occlusal surface may not need to be
reduced by 1.0 mm to achieve 1.0
mm of clearance
• Duplicating Inclined Plane Pattern for
Adequate Clearance
✓ Overshortening of preparation with
flat occlusal surface
✓ Inadequate clearance weakens
restoration and hinders functional
morphology
✓ Inadequate reduction under
anatomic grooves perforates
restoration easily
FUNCTIONAL CUSP BEVEL
• Integral part of occlusal reduction
• A wide bevel on lingual inclines of maxillary
lingual cusps and buccal inclines of mandibular
buccal cusps provides space for adequate bulk of
metal in an area of heavy occlusal contact.
• Without functional cusp bevel, several problems
may occur:
✓ Thin casting in the area overlying the
junction between occlusal and axial
reduction
✓ Overcontoured restoration resulting in
deflective occlusal contact unless
opposing tooth is reduced
✓ Overcut axial surface, unnecessary
destruction of tooth structure and
useless for retention.
AXIAL REDUCTION
• Axial reduction is crucial to secure space for
adequate restorative material thickness
• Inadequate axial reduction leads to thin walls
that can distort
• Overcontouring axial surfaces is not
recommended as it can harm the periodontium
• Other features like offset, occlusal shoulder,
isthmus, proximal groove, and box improve
rigidity and durability of restoration
• Isthmus connects boxes and offset ties grooves
to enhance reinforcing "truss effect"
4. MARGINAL INTEGRITY
• Should be closely adapted to cavosurface finish
line to survive the restoration.
To bevel,
• To diminish marginal discrepancies
• The more acute the angle of the margin, \i, or the
more obtuse the angle of the finish line, , the
shorter the distance between the restoration
margin and the tooth
Not to bevel
• The film thickness of the cement will prevent the
complete seating of a casting with bevels that
are nearly parallel with the path of insertion of
the restoration
• As the angle of the margin bevel becomes more
acute, its sine becomes smaller, and as the angle
of the finish line becomes more obtuse, its
cosine becomes smaller, and D becomes larger
• The more nearly the bevel parallels the path of
insertion, the greater the distance by which the
restoration fails to seat
FINISH LINE CONFIGURATIONS
• Wide, shallow bevels should be avoided
✓ Overcontouring
✓ Thin
✓ Unsupported wax
✓ Breakage and distortion of margin
• For gold alloy
✓ Optimum margin is acute edge
• Chamfer
✓ Preferred gingival finish line for veneer
metal restorations
✓ Less stress
✓ Round end diamond
• Heavy chamfer
✓ Provide 90 degrees cavosurface angle
with large radius rounded internal angle
✓ Round end tapered diamond
✓ Can create fragile “lip”
✓ Provides better support for ceramic
crown
✓ Bevel can be added for metal restoration
• Shoulder
✓ Finish line of choice for all ceramic crown
✓ Provides resistance and minimize stress
✓ Provide space for contours and esthetics
✓ Disadvantage:
➢ Require destruction of more
tooth structure
➢ Not use for cast metal
restorations
• Radial shoulder
✓ Modified form of shoulder finish line
✓ Flat end tapered diamond → initial
instrumentation
✓ End cutting parallel sided carbide
finishing bur → small-radius rounded
internal angle
✓ Modified bin-angle chisel→finishing
✓ Less stress than classic shoulder
✓ Good support
✓ Less tooth distruction
• Shoulder with a bevel
✓ Used a finish line in a variety of
situations:
➢ Gingival finish line for proximal
box of inlays and onlays, and
occlusal shoulder of onlays and
mandibular quarter crowns
➢ For metal-ceramic restorations
➢ Presence of shoulder due to
caries
➢ For extremely short walls
✓ Not for full veneer restorations
• Knife edge
✓ Permit an acute margin of metal
✓ Disadvantages:
➢ Axial reduction may fade out
➢ Thin margin may be difficult to
wax and cast
➢ Susceptible to distortion in
mouth
➢ Overcontoured
✓ Advantages:
➢ Use in lingual surface of
mandibular posterior teeth
➢ Teeth with very convex axial
surface
➢ Tilted tooth
• 0.3 – 0.5 mm is common finishing bevel
• Contrabevel
✓ For heavy function and minimal
esthetics
• Bevel is not required if a cusp is bulky enough to
allow acute edge metal and still be able to finish
the enamel at the cavosurface angle.
• Bevel is required if has unsupported edge of
enamel.
5. PRESERVATION OF PERIODONTIUM
• The deeper the restoration margin resides in the
gingival sulcus, the greater the inflammatory
response.
• Length is important for resistance and retention
that’s why the preparation is extended gingivaly.
• Finish line placed 2.0mm in alveolar crest will
result to:
✓ Gingival inflammation
✓ Loss of alveolar crest height
✓ Formation of periodontal pocket
• “crown lengthening” to adjust the alveolar crest
• “extraction” if located interproximally and
removal of bone structure
Instrumentation
Excavation of Caries
• Sharp spoon excavators and round burs (no. 4 or
no. 6)
• Contra-angle handpiece used
• Hand chisels for facial and lingual walls of
proximal boxes
Use of High-speed Air Turbine Handpiece
• Small diamond points with water-air spray
✓ precise
• Large diamond cutting discs not recommended
✓ Overextended prep
Cavosurface Finish Line
• Importance of smooth and continuous finish line
• Gross reduction with coarse diamonds
 • Use of diamonds and carbide finishing burs of
the same size and shape
• Torpedo diamonds, H158 carbide finishing burs,
flame diamonds for gingival bevels and
conservative proximal flares
• Use of abrasive paper discs for vertical flares
with rubber dam protection

Use of Nondentate Tapered Burs

• Grooves, boxes, isthmuses, and offsets
• Smoothing surfaces not terminating in a curved
finish line
• Creating occlusal and incisal bevels

Use of Cross-cut or Dentate Burs

• Removal of old restorations
• Horizontal ridges left on tooth structure not
suitable for planing tooth surfaces.