Full metal crown

“indications and preparation guidelines”

ILOs:
1. Quick overview.
2. Type of alloys used in fabrication.
3. Advantages Vs Disadvantages.
4. Indications Vs Contraindications.
5. Laboratory Difficulties.
6. Tooth preparation steps.
7. Impression taking.
8. Lab fabrication (conventional and digital).
9. Try in step.
10. Cementation step.

Quick overview:
 Old cultures told us that Soviet citizens had used gold crowns to
cover their teeth.
 Some central Asian nationalities and an ancient Italians, have
also been discovered that they filled their entire mouths with
gold as a type of wealth, luxury and culture traditions.
 Some Korean mummies' skeletons also showed gold metal
crowns and this was reported as a forensic odonatological and
anthropological identification.

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Type of alloys used in fabrication:
According to the ADA, Metal alloys used in full metal crown
classified depends on the percentage of metal content present (by
its nobility).
1. High noble metal crown – These contain over 60% of high
noble metal alloy of gold, platinum, and palladium.
2. Noble metal crown – These contain at least 25% of gold and
other platinum noble alloys.

For example:

 Gold Alloys (especially type III and IV).

Type III Type IV

High content of gold Low content of gold
(more than 70%) + other (less than 70%) + high
Composition
noble elements. % of silver, Copper and
platinum.
For areas of high stress For areas of high stress
such as pontic, full such as full crown and
Usage
crown and short span long span bridge.
bridge.
 Can be age hardened.  Most responsive for
Mechanical  Burnishable. heat treatment and
properties yield strength.
 Lower ductility.

 Silver-Palladium Alloys

3. Base metal crown – These contain less than 25% of noble

metal content.

For example:

 Copper - Alumium Alloys

 Cobalt - Chromium Alloys
(The most common used for patient allergic to Nickel).
 Nickel – Chromium Alloys
 Titanium and Titanium Alloys.

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 Advantages Vs disadvantages:

Advantages Disadvantages
 More conservative than other full  More tooth structure removal
coverage restorations for when compared to partial
example all ceramic coverage restoration.
restorations.
This is because the removed
tooth structure during full metal
crown preparation is less than
all ceramic preparation.

 According to material properties:  According to material properties:

1. Gold:
 Durable and long-lasting.
 Strong even when thin in
comparison to al ceramics.
The noble alloys range in
strength from 320 to 600 MPa.
These yield strengths are
adequate for dental
applications and are generally
in the same range as those for
the base-metal alloys, which
range from 495 to 600 MPa.
 Gentle on opposing teeth and
zirconia restoration.
It’s proved in study published
2014 Oct to investigate the
wear behaviour of tooth
enamel that opposes Type III
gold that Type ІІІ gold causes
less wear damage on the
enamel.
1. Titanium and Ti alloys
 Very difficult in finishing and
polishing.
 High cost.
2. Silver & Palladium:
 have greater potential for
tarnish and corrosion.
3. Cobalt and Chromium:
 are more difficult than for noble
alloys, as is obtaining a high
degree of accuracy in the
castings.
 Need Molybdenum to help in
lowering the coefficient of
expansion, and ruthenium to
improve castability.

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 It’s proved in study published
2021 Jan that there was no
correlation between the
surface hardness of cast
crowns before and after wear
testing against smooth-
surface monolithic zirconia.

 Burnishable this is due its

ductility.
It’s proved in study published
6791 Oct that one of the major
advantages of ADA gold alloys
is their ease of burnishing.
Note:
 Burnishability is to make or
become shiny or smooth by
friction; polish.
These properties result from the
ability of the atomic centers to
slide against each other into new
positions within the same crystal
lattice.
 Clinically we use ball
burnisher for gold crown margin
burnishing by application gentle
force on the beveled crown
margin by its blunt rounded end
to confirm that there is an
intimate contact between the
restoration and tooth structure.

2. Silver:
 Increases malleability and
ductility.
 The most favourable elastic
modulus for all noble alloys
resulting in excellent sag

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 resistance.
3. Base metals:
It’s proved in study published
2017 Dec that (Co-Cr) alloys
and Ti alloys have elastic moduli
are nearly twice as high as the
noble alloys so it’s more rigid
and can be constructed in thin
thickness.

Note:
Modulus of elasticity is a
measure of material's stiffness
or resistance to elastic
deformation. If the Young
modulus of material is greater,
it's more rigid.

4. Copper:
 Increases malleability and
ductility.

5. Cobalt and Chromium:

 Contribute in corrosion
resistance.

6. Nickel:
 Increases its strength and
hardness.

7. Titanium and Ti allays:

 Excellent biological
properties, good corrosion
resistance.
 Alloys due to its high melting
point 2000 C, it has rapid
oxidation and reaction with
investment materials).

 Has greater retention and

resistance than partial coverage
restoration.
This is because its retention
depends on mechanical means

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 (frictional) and chemical means
(luting agent) but in case of
partial coverage restoration
retained mainly by chemical
means (luting agent).
 Cementation process is less
technique sensitive than all
ceramic bonding techniques.
This is because cementation of
full metal crown needs only
proper tooth isolation, proper
crown fitting surface dryness
then application of luting agent
inside the crown then patient
intraoral insertion with slight
pressure to let excess material
flow outside the bonded crown
and finally all excess cement
removed by dental probe.
 Can cause patient allergic
reaction:
1. Nickel is the most common
metal allergy. It’s less common
in dental restorations.
2. The second most common
metal allergy: gold.
3. Cobalt is the third metal most
likely to cause allergic reaction.
Local symptoms: in form of
gingivitis, grayish – bluish
discoloration and abnormal tongue
morphologies and may extend to
be clinically similar to lichen planus.

On the other hand, cementation

of all ceramic crown needs
proper
tooth isolation  Phosphoric
acid etching for the abutment,
hydrofluoric acid etching for the Psychosomatic symptoms:
crown fitting surface  proper general fatigue, muscle and joints
crown fitting surface and tooth pain, dizziness and headache.
rinsing then dryness 
application of silane coupling
agent on crown fitting surface,
application of bonding agent on
abutment then light curing 
application of luting agent inside
the crown then patient intraoral
insertion with slight pressure to
let excess material flow outside
the bonded crown and finally all
excess cement removed by
dental probe.

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  General advantages:
 Allow operator within reason
to modify axial tooth contour
which is helpful with
malaligned tooth.
Indications Vs contraindications:
Indications
 To compensate the tooth
structure loss:
 In case of badly coronally
destructed posterior tooth due
to trauma or caries.
 In endotreated posterior tooth.
 According to material:
1. Gold:
 In high load locations as
long as it is not visible.
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 General disadvantages:
 May interfere with taste.
 Difficulty to test the vitality of
the tooth.
 Display of metal.
contraindications
 If high esthetics demands
required.
 If more conservative restoration
can be attempted such as
partial coverage restoration.
 When less tooth structure  In case of patient allergic
removal during tooth reaction towards metal.
preparation needed:
 In need of axial contour
correction.

 In short clinical crowns and

inaccessible areas.

 For partial denture retainer

coverage in case of dentine
exposure.

 As metal retainer coping for

overdenture :
 The vertical space available
is the main constraint, for it
must be appreciated that
which design of projects
above mucosal level.

1. The dome-shaped coping

 Extend only 1 or 2mm above

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 the ridge crest, produces
significant improvement in
the crown/root ratio.
 Mainly for support unless
attachments used.
 This approach occupies
minimal space  least
influence on the path of
insertion of the denture.
least compromises the
strength of the overlying
denture.
 Lateral loads are reduced.
 The space occupied is at a
minimum.
 The roots are being
employed to give a measure
of support against vertical
loads.
 Offers little additional
stability and no extra
retention.

2. Stud attachment coping

 Providing both stabilisation

and retention .
 Less vertical space is
occupied by intra radicular
stud attachments
component placed within the
centre of the root.

3. The thimble shaped coping

(Telescopic coping)

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 The thimble forms the inner
section of a two-layered
telescopic prosthesis.
 This approach occupies the
greatest amount of vertical
and bucco-lingual space.
 Has a profound influence
upon the denture design and
thickness.
 Depending on the contours
of the copings, a significant
increase in both retention
and support is offered.

Note (Alloys used):

 There was controversy over
using different metals for inner
and outer layers of the
crowns.
 The main fears were
excessive wear and of
galvanic action.
 The most difficult yet
important aspect is to produce
well adapted surfaces. Any
high spots are likely to result
in wear.
 It would proved that working
with two layers of type III or IV
yellow gold is the ideal way to
produce two perfectly adapted
surfaces.
 Platinised gold can be used
for the outer layer.
 Chrome cobalt alloy can be
used.

 General indication as a full

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 coverage restoration:
Posterior teeth where cosmetic
concerns are lower; patients with
habitual clenching and grinding
habits.

Preparation parameters:

 Recommended minimal dimensions for a complete cast crown.

 On functional cusps (buccal mandibular and lingual maxillary),
occlusal clearance should be 1.5 mm or greater.
 On nonfunctional cusps, the clearance should be at least 1 mm.
 The chamfer margin should allow for approximately 0.5 mm of
metal thickness at the margin.
 Note that the buccal wall of the maxillary molar is prepared in
two planes.

Preparation steps:
1-occlusal reduction
2-open the contact
3-removing height of contour
4-Increasing reduction for the desired form
N.B this method prevent over reduction

Another method of preparation:

The clinical tooth preparation for a complete cast Crown consists of
the following steps:

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  Occlusal depth grooves
• Occlusal reduction and functional cusp bevel

• Axial alignment grooves

• Axial reduction

• Finishing and evaluation

A. Occlusal Surface Reduction

 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.
Typically, type III or IV gold casting alloy or its
low–gold content equivalent is used for complete
cast crown fabrication.
 The difference between occlusal clearance and reduction should be
noted: 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 tooth structure between the grooves is removed with the

tungsten carbide or the narrow, round ended, tapered diamond

Thickness
 1.0 mm uniform reduction of occlusal surface and following the
contour of the tooth
 1.0mm for non-functional cusp -1.5mm for functional cusp.

Depth grooves:
Aim: Depth grooves are
1- helpful in guiding occlusal reduction only if the tooth is in good
occlusal relationship before preparation
2- 2-ensure that occlusal reduction generally follows anatomic
configuration and thus minimizes the loss of tooth structure
while ensuring adequate clearance
Bur: A tapered tungsten carbide or a narrow tapered or small round-
ended diamond is recommended for placing the depth grooves for
occlusal reduction
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Position:
1. Place depth holes approximately 1 mm deep in the Central, mesial,
and distal fossa
2. Place depth grooves in the buccal and lingual developmental
grooves

Verify the uniformity and the amount of occlusal reduction:

a. The silicone putty index
b. Articulating the maxillary and the mandibular arch
c. A softened piece of wax

1-Flexible Clearance Tabs:

Material Type
Indication
Checks Posterior Occlusal Clearance for Crown Preparations

Method of Measuring
Tabs With Preset Thicknesses Of:
1 mm ( pink Tabs are designed for full cast crowns )
1.5 mm
2 mm

2- Softened wax / silicone:

A-These clearances must also be verified in all excursive movements
that the patient can make. If any
uncertainty remains, as is often the case in
evaluations of clearance on the lingual
aspect of a tooth preparation the patient
should be asked to close into several
layers of dark colored utility wax(1.5 to 2
mm) in maximum intercuspation
B-the thickness of wax is assessed visually and measured with caliper
after it has been removed from mouth
 It should pass through the occlusal surface without obstruction

3- Clearance Gauge:
One end of the gauge has a calibrated ball that is 1.5
mm in diameter, while the other end is calibrated to 2.0
mm. The gauge is angled so that the appropriately
sized ball may be slipped between the prepared tooth
and the opposing dentition

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 B. Proximal Surface Reduction:

The initial proximal cuts are made with a fine tapered needle
diamond. The thin diamond is worked through the proximal area in an
faciolingual sawing motion, carefully avoiding the adjacent teeth.
Once sufficient manoeuvring room has been obtained, the coarse-grit
tapered torpedo diamond is introduced to plane the walls while
simultaneously forming a chamfer as the interproximal gingival finish
line

 principles :
1. The minimum necessary tooth structure is removed.

2. No damage to adjacent teeth.

3. No undercut exists

4. Move in swing motion buccolingual

 If desired, protect the adjacent teeth by placing a metal matrix

band.

 If the adjacent proximal surface is accidentally damaged, it must

be polished 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.

N.B To check contact is open:

 By moving the probe from gingiva toward occlusal surface to

make sure that the deep contact is open

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Axial reduction:

Axial reduction should parallel the long axis

of the tooth but allow for the recommended
6-degree taper, which is the angle
measured between opposing axial surfaces.

2014:

 Optimum taper or total convergence of 16 degrees achievable

clinically while still affording adequate retention.

 Low as 10 degrees on anterior teeth and as high as 22 degrees on

molar teeth.

Recently:

Ideal wall taper of 2 to 5 degrees but the average taper is 9.5

degrees (19.0 degrees convergence angle)

c. Buccal and Lingual Surfaces Reductions

 The facial and lingual walls are reduced with a round end
tapered diamond, whose sides produce the desired axial
reduction, while its tapered tip forms a chamfer finish line
 A definite, even finish line is necessary to enable the fabrication
of a restoration with a good fit, and the chamfer is the best for
providing the bulk needed for strength while still allowing good
adaptation.
 The same procedure on the lingual surface extending the
reduction apically up to 0.5 Mm to the margin of the gingiva.

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 D. Functional Cusp Bevel:

 Reasonably uniform tooth reduction results in a preparation that

somewhat mimics the form of the original clinical crown.
 Proper placement of a functional cusp bevel achieves this because
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.
 The goal of functional cusp bevel is to reduce further the cuspal
height by 0.5 mm on the functional cusp to provide adequate
thickness of the restorative material on the area of significant
functional loading.
 Functional cusp bevel: coarse-grit round-end tapered diamond and
no. 171L bur.

E. finish line Preparation

 Adequate chamfer finish line width (0.5 mm in gold alloy crowns

/ 0.3 in base metal crown) is important for developing optimum
axial contour. Insufficient chamfer margin width forces the
dental technician to over contour the restoration. Such
increased faciolingual width of a complete crown is a common
error in practice and a leading cause of periodontal disease in
association with restorations.
 On small teeth (e.g., selected premolars), however, it may be
advantageous to prepare a slightly more conservative chamfer
margin to preserve tooth structure. This requires increasingly
careful manipulation of the wax pattern during fabrication of the
restoration and careful assessment at clinical evaluation to
ensure that the crown is not over contoured.
 The dimension is 0.5 mm and is placed 0.5mm supragingival all
around the cervical area of the prepared tooth

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 Types of finish lines for full metal
crowns:
(FEATHER EDGE – CHAMFER –
CHISL – BEVEL)

1-Chamfer F.L.:

 It is well defined f.l it form or greater than Cavosurface

line angle.

Marginal width: 0.3 to 0.5

Indication: full metal crowns

The required bur: Round end tapered diamond stone.

Advantages:

 1. Well defined f.l.

 2. Provide enough space at the cervical area to ensure the

marginal integrity.

 3.Easily identified in both impression and die

 4. It is slightly more difficult to burnish.

DISADVANTGES: Care must be taken to avoid making enamel lip

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2-Featheredge or knife edge F.L:

It's the most conservative type of F. . the least

amount of tooth structure is removed but the margin
is ea . It forms Cavosurface line angle (C.S.L).

Finish line width: less than 0.3

The required bur: Pointed end tapered diamond bur

Indications:

1-full casted metal crowns

2-small crowns

3-already designed finish line by previous dentist

Advantages

. it’s the most conservative type of f.l.

2. it’s easy to prepare.

3. Burnishable margin of the restoration.

Disadvantages

1. Thin margin that is difficult to identified or accurately wax and cast.

2. More susceptible to distortion so it is rarely used nowadays

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3-Chisel edge margin:

It is a variation of the feather edge finish line and it is

formed when there is a large angle between the axial
surfaces and the unprepared tooth structure tooth

Indication:

1. Excessively tapered preparation

2. Axial reduction is not correctly aligned with the long axis of the
tooth

3. Tilted teeth

4-Bevelled Finish Line:

used with metals used in extremely short crowns

Indication:

(1) to allow the cast metal margin to be bent or

burnished against the prepared tooth structure
(2) To minimize the marginal discrepancy caused by a
complete crown that fails to seat completely

(3) To protect the unprepared tooth structure from chipping

The position of finish line used:

In some cases we use subgingival margins:

1. Cervical caries

2. Cervical erosions or restorations extending subgingival.

3. Proximal contact extended to the gingival crest

4. Additional retention and /or resistance

5. Root sensitivity

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It’s more recommended to use supragingival FL because of its
Advantages:
 Easily prepared

 No soft tissue trauma

 Easy impression

 Easy finishing,

 easy cleaning

 Easy evaluation of the preparation margins at the time of

placement and at the call appointments

Conclusion:

both supragingival and equigingival are well tolerate to gingival and

plaque accumulation is old consideration

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 Tooth preparation consideration

All of the axial surfaces are smoothed with a finishing stone, whose
size and shape enable it to finish the chamfer finish line as well.

 Special care should be taken in rounding the corners from the

facial or lingual surfaces to the proximal surfaces to ensure that the
finish line will be smooth and continuous
 Line angles are rounded to facilitate pouring impressions without
trapping air bubbles
 The prepared surfaces and finish line are smoothed not to be stress
concentration

Special preparations steps

 A seating groove :

On the buccal surface of the lower molar and the palatal surface of
the upper molar. It should be slight divergent

Objective:

1. Acts as a guide during the placement of the crown.

2. Prevents the rotation of the crown ( resistance).

3. Improves the retention.

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 The groove should be cut to the full diameter and should extend
gingival to appoint 0.5mm above the chamfer

Objective:
A, When opposing axial walls are excessively tapered, internal
features such as this buccal groove can be
used to improve resistance form.

B, Mesially tipped molars and short

premolars often benefit from grooves or
boxes, or both, incorporated in the
preparation design

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Finishing:

 Finishing with ultrasonic instruments created better-defined

margins and a smoother marginal surface (half as rough as the
margins prepared with the conventional rotary instruments
which produce a sharper and more continuous external line
angle).

 The ultrasonic instruments improve the quality and accuracy of

crown preparations, which may lead to better impressions and
closer adaptation of restorations.

 The use of ultrasonic instruments to prepare dentin resulted in

comparable bond strengths to the use of diamond burs.

 Final appearance of tooth preparation

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Telescopic crowns Preparation:

 Metal crown consisting of two conical crowns placed one over

the other

 consist of an inner or primary telescopic coping which is

permanently cemented to an abutment and an outer or
secondary telescopic coping which is attached to the prosthesis

 there is a primary telescopic - designed to a minimum thickness

according to the material properties. the secondary telescopic is
pushed over the primary telescopic like a telescope and is firmly
connected to the removable part of the denture. The two crowns
fit together exactly. For this reason, it is essential to ensure that
they are inserted in a parallel direction. The wafer-thin saliva
film has a positive effect with this technique, as the crowns slide
smoothly into one another and an adhesive bond is created
between the crowns.

telescopic crown In tilted molar:

 Used as retainer on the distal abutment

 A full crown preparation with heavy reduction is made to follow the
long axis of tilted molar
 Inner coping is made to fit the tooth preparation
 The proximal half-crown that will serve as the retainer for the fixed
partial denture is fitted over the coping

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 Indication of fixed telescopic dental prosthesis (FTDP):

 the periodontally compromised abutment teeth that need

splinting and cross arch stabilization

 get the common path of insertion and reduce the amount of

stress in tilted abutments

Advantages:

a) minimization of destructive horizontal torque and enhancement

of vertical long axis forces,
b) achievement of parallelism of abutments using primary copings
for common path of insertion,

c) cross arch stabilization

d) retrievability due to the use of provisional cement

Disadvantages:

1- Complicated Procedures: fabrication requires very complicated

clinical and laboratory procedures

2-difficulty in achieving aesthetics (metal collar of primary

telescopic coping present)

3- Retention Related Problems: difficult to achieve the exact

retention required between the 2 crowns

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 4-cervical caries: failure in providing the accurate fit of the crowns
or the poor oral hygiene may lead to the occurrence of cervical
caries

5-Technical Failures:

Loss of cementation, loss of facings, or fracture of artificial teeth

Lab fabrication

Conventional Digital
1.Master cast fabrication.
2.Wax up. Software designing
3.Investing.
4.Casting the metal alloy. Subtractive Additive
5.Finishing & polishing. (Milling) (laser
Sintering)
(3D printing)

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 Conventional
 Master cast fabrication:

A cast is a positive replica of the individual prepared tooth on which

the margins of the wax patterns are finished.

Fabricated from hard or extra hard stone (type IV and V).

 Wax up

The first step is to build up the metal frame using a wax-up

technique. Basically, the entire metal core is sculpted in wax at the
precise shape and size considering all aspects demanded by the
particular clinical situation.

a. Wax-up for dental crowns metal frame

b. Wax-up for pontics metal frame

c. Attaching the casting rods (spruing)

 Investing

Investing is the operation of surrounding the wax pattern with a

material that can accurately duplicate its shape and anatomic
features.

There is 2 types of investment materials:-

o Gypsum bonded (for gold cannot withstand high temperature )

o Phosphate bonded (for base metal alloys can withstand high
temperature)

 Casting the metal alloy

Casting is the process by which a wax pattern of a restoration is

converted to a replicate in dental alloy.

 Polishing & finishing:

Even if all the steps were perfectly completed, minor touches are still
required. The rough casting is pickled to remove oxides.

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 Digital
 Soft ware designing:

Dental software is designed to guide a clinician through designing a

3D digital model of a crown, bridge.

 Metal milling:

Milling is a subtractive process (where the material is removed from a

disc leaving the planned shape by grinding away excess material.

The ra material milled in a milling machine is referred to as “stoc ”

or “Discs”

Dental alloys used in milling:

Gold, titanium and Chrome Cobalt.

 Milled Gold Crowns

o Milled full gold crowns eliminate the "lost wax" casting method
traditionally used to fabricate gold crowns.
o Models are scanned and milled directly from a solid gold disc.
o Eliminates any possibility of porosity results in high quality
restorations with
o minimal chair side finishing or polishing.

 Titanium:
o Lightweight, strong, and biocompatible for full-contour restorations.
o Available in several grades, based on purity (Grade 5 ”Ti-6Al-4V is
the most common grade used in dental applications (stronger &
less prone to flex).
o Full-contour restorations are milled from disks.

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 Advantages of milling
Much more accuracy & fitting to the tooth, So more intimate meaning
 less chance for problems.

The metal doesn’t need to change states from liquid to solid.

Its physical properties don’t change So metal in the thin areas of the
crowns exhibit the exact same physical properties as the thick areas.

Disadvantages
wasting material.

Milling burs wear by use which can introduce inaccuracy

Conclusion:-

o Most of the CAD-CAM restorations were within the clinically

acceptable marginal discrepancy (MD) range.
o The performance of a CAD-CAM system relative to marginal
adaptation is influenced by the restorative material.

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Conclusion:-

o Milled gold restoration with a beveled margin had a smaller

marginal gap than cast gold restoration with a beveled margin
o Cast gold restoration with a chamfer margin had a smaller marginal
gap than milled gold restoration with a chamfer margin

Direct Laser Sintering:

It is an additive technique (where building the restoration is by fusing
thin layers to create a 3d object).

This fusing technique can be by using 3D printing and Direct laser

sintering.

o Each layer of a part is created by aiming a laser at the powder bed

in specific points in space, guided by a digitally produced CAD
(computer-aided design) file. Once a layer is printed, the machine
spreads more powder over the part and repeats the process.
o The process is ideal for printing precise, high-resolution parts with
complex geometries.
o The resulting parts are accurate, have excellent surface quality.

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Advantages
• Producing unique shapes and designs with stable mechanical
and material properties
• Reduce the stress and waste of milling.
• There is relatively wide material availability and the machines
are repeatable once a part is printed successfully.

Disadvantages
• Difficult to purchase and operate the machines
• Require skilled operators,and powder managements.

Cobalt Chromium restoration

 1. Milling (origin: bulk metal)

CAD/CAM milling based on a virtual impression or a 3D image.

o This is quite a hard task in case of CoCr blanks due to high

demands such as coolant delivery, rigidity of the machine, being
placed on the milling device.
o A great improvement was made by using units with 4 or 5 axes
which permit milling and dry or wet grinding of very good quality
prosthetic pieces.

 2. CAD/CAM sintering (origin: powder)

o This new technology uses metal blanks with a wax-like texture

which allows easy dry milling
o These CoCr blanks are similar to partially sintered zirconia blanks
and can be easily milled in this green body state (unsintered metal
powder held together by a binder).
o Afterwards they are debinded and densely sintered in a special
furnace. The result apparently has a homogeneous structure.
Distortion-free frameworks without contraction cavities are usually
obtained.

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  3. 3D Printing Technologies (origin: powder)

o Selective laser sintering (SLS) which uses a high power laser to

fuse small particles of metal powder into a desired 3D object.
Based on a virtual image, the CoCr alloy powder is slowly added,
layer by layer, as the 3D CAD software measures thousands of
cross-sections to determine exactly how each layer of the
prosthetic piece is to be constructed.
o After scanning each cross-section, the powder bed is lowered by
one layer thickness. Additional powder is than added on top of
previous solidified layer and sintered. The powder is maintained at
an elevated temperature so that it fuses easily upon exposure to
the laser.

Conclusion:-

Based on the findings of this systematic review and meta-analysis,

the following conclusions were drawn:

1. Improved marginal and internal adaptation were observed with

shoulder and rounded shoulder finish line designs when CAD-CAM
methods were used for coping fabrication.

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 2. Soft milling and direct metal laser sintering methods showed better
overall marginal and internal adaptations in chamfer and deep
chamfer finish line designs whereas hard milling showed better results
with the shoulder finish line design.

Preparation parameters difference in advanced technology

There is slight difference in the preparation parameters for the CAD-

CAM process

 Finish line :-
For gold milled crowns  Beveled finish line shows better marginal
adaptation than the conventional chamfer finish line

Because gold alloy could be milled to a bevelled margin without

negatively affecting marginal adaptation. Also, the continuity of the
milled margins was smooth and consistent

For Cobalt Chromium  shoulder and rounded shoulder shows

better marginal
adaptation in Hard milling

 chamfer and deep chamfer finish line

shows better marginal adaptation in Soft milling & Direct laser
sintering

 Convergence:-
Ideal convergence degree from 10-20

Try in
 Proximal contants
o Restoration should not be neither too tight nor too light
o If it is too tight it will interfere with the correct positioning of the
restoration and make it difficult for the patient to floss
o Too light contact will allow food impaction and gingival
inflammation
o If both contants feel too tight the tighter contact should be
adjusted first some times this relief the pressure on the other
contact with no need for adjustment

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 Marginal adaptation
o The restoration should be inserted with out any interference with
the occlusal surface or the axial aspects
o Margins should be fully seated & adapted on the finish line
o Margins should be examined closely should not be
overextended, underextended or open

 Stability
o Restoration should not rock or rotate when force applied
o Any degree of instability will cause failure during function

 Occlusal adjustment
o After checking the marginal adaptation & stability occlusal
contact is carefully checked
o Any undesirable centric or eccentric interference must be
removed

Cementation

o Restoration is air abraded to increase the mechanical retention

o Total dryness and isolation of the abutment.
o Cemented with any type of cements (zn phosphate- glass
ionomer – resin modified glass ionomer )

34
 References:
1. Craig’s RESTORATIVE DENTA MATERIA S 3th EDITION
2. Contemporary Fixed Prosthodontics Rosenstiel, Land,
Fujimoto, 5th edition.
3. https://www.drmartharich.com/tpn/c/C1251/docs/A-
Comparison-Of-Dental-Crown-Materials
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250188/
5. https://anas.ru/en/catalog/product/tip-d1/
6. https://amesweb.info/Materials/Modulus-of-Elasticity-
Metals.aspx
7. https://www.degruyter.com/document/doi/10.1515/eng-2017-
0043/html
8. Overdentures Made Easy
9. A Guide to Implant and Root Supported Prostheses
10. Harold W. Preiskel
11. http://cdl.ae/products/galvano/
12. https://08106ze7j-1105-y-https-www-engineeringvillage-
com.mplbci.ekb.eg/search/doc/abstract.url?docid=cpx_M2d94f
8ed177ab8097b8M6e8610178163190&usageOrigin=share
13. https://www.hiltonheadcosmeticdentistry.com/are-metal-
restorations-irritating-your-gums/
14. https://www.hiltonheadcosmeticdentistry.com/are-metal-
restorations-irritating-your-gums/
15. Fixed Prosthodontics: Principles and Clinics by H. W. Anselm
Wiskott (2011-06-21) [H. W. Anselm Wiskott]
16. https://www.intechopen.com/chapters/39184#B1
17. 16. https://pubmed.ncbi.nlm.nih.gov/25311791/
18. https://www.infodentis.com/fixed-prosthodontics/wax-up-and-
metal-casting.php
19. https://www.oralhealthgroup.com/features/3d-technology-in-
the-dental-practice/
20. https://www.aegisdentalnetwork.com/idt/2013/01/an-
introduction-to-millable-dental-materials
21. https://www.nakanishidentallab.com/alloy/full-gold
22. https://www.sciencedirect.com/science/article/abs/pii/S002239
1317304882
23. https://onlinelibrary.wiley.com/doi/10.1111/jopr.12432#jopr124
32-bib-0009
24. https://markforged.com/resources/learn/3d-printing-basics/3d-
printing-processes/what-is-direct-metal-laser-sintering-dmls
25. https://06122zwdp-1105-y-https-iopscience-iop-
org.mplbci.ekb.eg/article/10.1088/1757-
899X/416/1/012039/pdf

35
26. https://06101zwer-1105-y-https-www-sciencedirect-
com.mplbci.ekb.eg/science/article/pii/S0022391321003474
27. file:///C:/Users/Essam/Downloads/43.ManagementofTiltedMola
rAbutmentbyTelescopicCrownACaseReport%20(1).pdf
28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897958/
29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988822/
30. https://www.jcdr.net/articles/PDF/2351/53-
%203886_E(C)_F(T)_PF1(V)_PF(A)_PF(R)_OLF(P)_U.pdf
31. https://opendentistryjournal.com/VOLUME/12/PAGE/246/FULL
TEXT/
32. Ultrasonic Margin Preparation for Fixed Prosthodontics: A Pilot
Study
Journal of Esthetic and Restorative Dentistry
33. Contemporary fixed prosthodontics
34. https://www.jstage.jst.go.jp/article/jmds/45/3/45_450307/_articl
e/-char/ja/
35. https://www.ffofr.org/education/lectures/fixed-
prosthodontics/fixed-prosthodontics-tooth-preparation-
guidelines-for-complete-coverage-metal-crowns/
36. ve, DMD, MS, MHPE University of Minnesota School of
Dentistry 16 Ranier M. Adarve, DMD, MS, MHPE
37. https://www.ffofr.org/education/lectures/fixed-
prosthodontics/fixed-prosthodontics-tooth-preparation-
guidelines-for-complete-coverage-metal-crowns
38. https://www.dentalcompare.com/4695-Occlusal-Clearance-
Devices/39134-PrepCheck/?pda=4695|39134_1_0|||

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