PROSTHODONTICS

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PRINCIPLES OF TOOTH PREPARATION: PART-8
Prosthodontics

Dr. Moez I. Khakiani, Prosthodontist, MIK Dental, Mumbai, India

LOWER INCISOR PREPARATION FOR A MONOLITHIC LIDISI/ZIRCONIA CROWN

Owing to its smaller dimension, preparing a mandibular incisor tooth can often be a challenge. A slight compromise in
the amount of tooth reduction would have to be made if a multilayered prosthesis like PFM is planned. Such a
preparation is sure to end up in a biologically, mechanically and aesthetically unacceptable prosthesis.

Hence, a monolithic restoration (Lithium disilicate or zirconia) is a better choice for such teeth, as it requires less tooth
reduction.

Fig. 4.217: First, a single depth groove is made in the gingival plane, (plane 1), using the DC 1.0 bur which is sunken to
half its width.

Fig. 4.218: The same depth groove is then extended onto the incisal plane (plane 2) using the same bur.

Fig. 4.219: Next, the labial surface is reduced along the gingival plane using the same bur.

Fig. 4.220: Following this, the incisal plane is reduced, thereby completing the labial reduction.

Fig. 4.221, 4.222: The proximal surfaces are prepared using the MI 0.5 bur, leaving a thin lip of enamel. Care should be taken to
ensure that the margin is kept above the interdental papilla.

Fig. 4.223: The wings are broken using a straight probe. The uneven nature of the margin should not be of concern at this stage,
as protecting the adjacent tooth is of utmost priority.

Fig. 4.224, 4.225: The IR 2.0 bur is then used to scribe a 2 mm groove on the incisal edge.

Fig. 4.226, 4.227: The DC 1.2F bur (Finishing bur offers greater control) is used to reduce the incisal edge. This bur is angled to
follow the proposed incisal edge position (as shown) and the edge is reduced.

Fig. 4.228: Next, the lingual margin is prepared (relatively parallel to the gingival plane of the labial surface) using the DC 1.0 bur
which is sunken to half its width.

Fig. 4.229, 4.230: Lastly, the lingual concavity is reduced using the CR 2.3 bur, ensuring the concave architecture is maintained.

The preparation is then finished using the DC 1.2F bur, taking utmost care to avoid damage to the adjacent teeth. Here again, it is best
to keep the preparation margin supra-gingival.

Fig. 4.231: Final preparation: Incisal view.

Fig. 4.232: Final preparation: Labial view.

Fig. 4.233: Final preparation: Lingual view.

Fig. 4.234: Final preparation: Lateral view.

PREMOLAR PREPARATION FOR A PFM FACING CROWN

As mentioned earlier, PFM restorations require aggressive reduction of tooth structure. An accepted way of fulfilling aesthetics and function,
while still conserving tooth structure is the use of a PFM prosthesis with porcelain (buccal/labial) facing.

Fig. 4.235: Sections (axial and transverse) through a maxillary premolar showing how metal can be used to minimize the amount of
tooth reduction required. A: Porcelain restricted to the buccal cusp; B: Porcelain covering proximal and occlusal surfaces, but not
extending to the lingual aspect.

Such prostheses require specific alterations to be performed as part of their proximal preparation, where the wider reduction for porcelain
meets the shallower reduction for metal. This junction is referred to as ‘wing’, and it helps communicate the proposed position of the
porcelain-metal junction with the technician.

If a metal proximal contact is planned, the wing is to be prepared buccal to the contact. Conversely, if a proximal contact is to be fabricated in
porcelain, the wing is to be prepared lingual/palatal to the contact. To avoid an undercut, it is important that the wing is made parallel to the
bucco-axial reduction.

Advantages of facing prosthesis Conserves tooth structure, while providing an aesthetic prosthesis.
Reduces the risk of porcelain fracture.
The metal occlusal surface is less abrasive than porcelain.
The near parallel walls of the wings add to the resistance form of the preparation.

Fig. 4.236: Buccal reduction starts with placement of depth grooves along the gingival and occlusal plane. This is done with the MS 1.0
bur which is sunken to its full depth.

Fig. 4.237: The occluso-buccal view clearly shows the depth grooves as placed in two distinct planes.

Fig. 4.238: Using the same bur, the labial surface is reduced by connecting the depth grooves.

Fig. 4.239: Next, the interproximal contacts are opened out using the MI 0.5 bur.

Fig. 4.240: The lingual margin is then prepared using the DC 1.0 bur.

Fig. 4.241: Occlusal reduction for a premolar requires only one depth groove to be made on each cusp along the cusp ridge (as
marked).

Fig. 4.242: For the non-functional cusp reduction, a 1 mm buccal groove is made using the OR 1.2 bur, by sinking it slightly short of full
depth.

Fig. 4.243: The bur is then moved downward and outward towards the proximal surfaces on either side, thus reducing the cusp
following the pre-existing anatomy.

Fig. 4.244: For reduction of the functional cusp, a groove is made along the palatal cuspal incline using the same bur. However, here
the bur is sunken full depth.

Fig. 4.245: The palatal cusp is then reduced anatomically using the same bur. This completes the occlusal preparation.