Principles of Tooth

Preparation
Dr. Khadijah Baik
Email: kbaik@kau.edu.sa
ILO’s

1. Recognize biologic, mechanical and esthetic considerations.

2. Identify retention and resistance.

3. Justify the role of parallelism on retention and resistance.

4. Recognize structural durability.
5. Recognize marginal integrity as affected by finish line configuration.
6. Explain the role of margin placement and thickness on success of
restorations.
7. Estimate the role of optimum reduction on the esthetic outcome.
Principles of Tooth Preparation
1. Biologic considerations: which affect the health of the oral tissues
2. Mechanical considerations: which affect the integrity and durability
of the restorations
3. Esthetic considerations: which affect the appearance of the patient
Principles of Tooth Preparation
Biologic
• Conservation of tooth
structure Mechanical
• Avoidance of over
• Retention form
contouring
• Resistance form
• Supragingival margins
• Preventing Deformation
• Harmonious occlusion
• Protection against tooth
fracture

Esthetic
• Minimum display of
metal
• Maximum thickness of
porcelain
• Porcelain occlusal
surfaces
• Subgingival margins
Biologic Consideration
1. Prevention of damage during tooth preparation
A. Adjacent teeth (metal matrix band- proximal enamel)
B. Soft tissues (suction tip- flanged saliva ejector- mirrors)
C. Pulp
Biologic Consideration
C. Pulp
Morphology (size – radiographs)
• extreme temperature- chemical irritation- microorganisms
Temperature
1. Excessive pressure
2. Higher rotational speed
3. Type, shape and condition of cutting
instrument
• Water spray (coolant)
1. Remove debris
2. Prevents desiccation of dentin
• Feather light-intermittent touch
Chemical irritation
Dental material (bases, resins,
solvents, luting agents)
Bonding agents forms a barrier
layer
Bacterial action
Either
• Bacterial left behind or
• Gained access due to
microleakage (open crown
margin)
• Zinc phosphate cement
(antibacterial action)
• Chlorohexidine gluconate
Biologic Consideration
Biologic Consideration
Biologic Consideration
Conservation of tooth structure
• The thickness of remaining dentin is inversely proportional to the
pulpal response
Biologic Consideration
Conservation of Tooth Structure
Biologic Consideration
Conservation of Tooth Structure
Biologic Consideration
Conservation of tooth structure
1. Use of partial coverage rather than complete coverage
2. Preparation with minimum convergence angle (taper)
3. Preparation of occlusal surface so reduction follows the anatomic
planes
4. Preparation of axial surfaces so tooth structure is removed evenly, if
necessary teeth should be orthodontically repositioned
5. Selection of conservative margins
6. Avoidance of unnecessary apical extension of the preparation
Biologic Consideration
Consideration affecting future dental health:
1. Insufficient axial reduction >> overcontoured restoration>>
hampers plaque control
2. Inadequate occlusal reduction >> occlusal dysfunction
3. Poor marginal placement at occlusal contact >> chipped enamel or
cusp fracture
Biologic Consideration
Consideration affecting future dental health
Axial reduction

• Insuffiencet > excessive axial contours > difficult plaque control

• Should duplicate the contours of the original tooth
• Suffienct reduction is extremely important especially in posterior
teeth (why): Periodontal disease always begins in interproximal and
furcation areas.
Biologic Consideration
Consideration affecting future dental health
Margin placement
• Aim for supragingival margin whenever possible
• Subgingival margin if encroach on epithelial attachment > PDL
disease.. Situated on dentin or cementum

Biological width : the width of the junctional epithelium

and supracrestal connective tissues that lie between
the base of the gingival sulcus and the alveolar crest’
and represents the area of attachment of the
periodontal soft tissues to the tooth
Biologic Consideration
Consideration affecting future dental health
Margin placement

• Advantages of supragingival margin

1. easy to prepare w/o trauma to soft tissues
2. situated on enamel
3. Easily finished
4. Easily kept clean
5. Impressions are easily made with less soft tissue damage
6. Restorations easily evaluated at recall appointments
Biologic Consideration
Consideration affecting future dental health
Subgingival margin (when?)
Biologic Consideration
Consideration affecting future dental health
Subgingival margin (when?)
1. Caries, erosion, restoration extending subgingivally
2. Proximal contact area extends to the gingival crest
3. Additional retention needed
4. To hide the metal ceramic margin
5. Root sensitivity cannot be controlled by more conservative
procedures
6. Modification of axial contour is needed
Biologic Consideration
Consideration affecting future dental health
Margin adaptation
• Potential caries at junction between restoration and tooth (why?)
1. Dissolution of luting agent
2. Roughness

• Required : smooth, regular margin

Biologic Consideration
Consideration affecting future dental health
Margin Geometry
Guidelines for margin design
1. Ease of preparation without overextension or unsupported enamel
2. Ease of identification in the impression and on the die
3. Distinct for wax pattern to be finished
4. Sufficient bulk of material (wax- strength- ceramic esthetics)
5. Conservation of tooth structure
Margin designs
a) Featheredge (H)
b) Chisel (H)
c) Chamfer (I)
d) Bevel (J)
e) Shoulder (K)
f) Sloped shoulder (L)
g) Beveled shoulder (M)
Type of margin Advantages Disadvantages Indications
Featheredge Conservative of Does not provide Not recommended
tooth structure sufficient bulk
Chisel Conservative of Location of margin Tilted teeth
tooth structure is difficult to control
Bevel Removes Extends margin into Facial margins of
unsupported sulcus if used on maxillary partial
enamel, allows apical margin coverage
finishing of metal restorations and
inlay/ onlay margins
Chamfer Distinct margin, Care needed to Cast metal Tapered diamond
adequate bulk, avoid unsupported restorations, lingual with rounded tip
easier to control lip of enamel margin of metal
ceramic crowns
Type of margin Advantages Disadvantages Indications
Shoulder Bulk of restorative Less conservative of Facial margins of Tapered diamond
material tooth structure metal ceramic with flat tip
crowns, complete
ceramic crowns
Sloped shoulder Bulk of material, adv Less conservative of Facial margins of
of bevel tooth structure metal ceramic
crowns
Shoulder with bevel Bulk of material, adv Less conservative of Facial margins of
of bevel tooth structure, posterior metal
extends preparation ceramic crowns with
apically supragingival margin
Biologic Consideration
Consideration affecting future dental health
Biologic Consideration
Consideration affecting future dental health
• Objective of beveling

1. To allow cast metal margin to be bent or burnished against

prepared tooth structure
2. Minimise marginal discrepancy
3. Protect unprepared tooth structure from chipping
Biologic Consideration
Consideration affecting future dental health
• Occlusal considerations
Supra-eruption
Tilted teeth

Diagnosis
Waxing procedures
• Supra erupted teeth:

1. Enameloplasty
2. Endodontic treatment
3. Extraction
• Preventing tooth fracture
Inlay > wedging cusps > more potential to fracture
Onlay > minimal coverage of cusps > less potential to fracture
Complete coverage > holds the cusps together > best solution
Mechanical Considerations
Mechanical Consideration
• Divided into three categories
1. Providing retention form
2. Providing resistance form
3. Preventing deformation of the restoration
Mechanical Consideration
Retention form
Retention definition: The quality of the preparation that prevents the
restoration from becoming dislodged by forces acting in the direction
of the path of withdrawal.
Factors must be considered to achieve adequate retention:
1. magnitude of the dislodging force
2. geometry of the tooth preparation
3. roughness of the fitting surface of the restoration
4. materials being cemented
5. film thickness of the luting agent
Retention Form
1- Magnitude of the dislodging force
e.g. sticky food and depends on

1. Stickiness of the food

2. Surface area of the restoration
3. Texture of the restoration
Retention Form
2- Geometry of the tooth preparation
Retention Form
Taper
• Taper: is the convergence of two opposing external walls of a crown
preparation
• Maximum retention ? Parallel walls (impossible- not desirable) why?
• An undercut: divergence between opposing walls in cervical-occlusal
direction/ or any irregularity in the wall of the prepared tooth the
prevents the withdrawal or seating of wax pattern or crown
• To seat and have optimal retention? 6 degree taper from cervical to
occlusal
• Increased taper leads to? Loss of retention
• Angle of Convergence:
Retention Form
Total Occlusal Convergence

The angle of convergence between two axial opposing walls

Retention Form
Occlusocervical- Incisocervical dimension

• Anterior teeth
• Posterior teeth
Retention Form
Ratio of Occlusocervical to Faciolingual dimension

0.4 or greater

Circumferential morphology
Retention Form
Surface area
• Long axial walls more retentive than short axial walls
• Molars are more retentive than premolars
Stress concentration
• Retentive failure occurs > cement can be found on restoration and on
tooth > failure at the cement is called (cohesive failure) why??
Retention Form
Type of preparation
Retention Form
Roughness of the surface being cemented
• Smooth internal surface of restoration > failure at cement-restoration
interface not through the cement.
• Rough or grooved surface > better retention
• Air abrasion using 50 microns alumina oxide
• Acid etching of fitting surface can improve retention
• Failure rarely occurs at cement-tooth interface so?
Retention Form
Materials being cemented
• Base metal alloys are better retained than high gold metals
Retention Form
Type of luting agent
• Most retentive ? Adhesive resin cements > Glass ionomer > Zinc
phosphate
Retention Form
Film thickness of luting agent
• Effect uncertain
Factors influencing the retention of a cemented
restoration
Resistance Form
Definition: features of a tooth preparation that enhances the stability
of a restoration and resist dislodgment along any axis other than the
path of placement

RETENTION

RESISTANCE
Resistance Form
• Horizontal and oblique forces of parafunctional habits and
mastication may dislodge a cemented restoration
• Much greater than forces overcome by retention
• Lateral forces causes dislodgment by rotation around the gingival
margin
• Rotation is prevented by any areas of tooth preparation that are
placed in compression
Resistance Form
• Adequate resistance depends on:
1. Magnitude and direction of the dislodging forces
2. Geometry of the tooth preparation
3. Physical properties of the luting agent
Resistance Form
Magnitude and direction of the dislodging forces
• Biting forces (magnitude- direction)
• Parafunctional habits ; bruxism- pipe smoking (magnitude- direction)
 Resistance Form
Geometry of the tooth preparation
Resistance is the function of the relationship:
1- taper
2-diameter
3-height
Resistance Form
Geometry of the tooth preparation
• Increased taper and rounding axial angels reduce resistance
• Short and large diameter > little resistance
• Short tooth preparations have little resistance
• Linear relationship between preparation height and resistance
• Molars require more parallel preparation than premolars or anteriors
Resistance Form
Geometry of the tooth preparation
• Minimal molar preparation wall height is ??
• Adequate height to width ration is ??
• Partial coverage restoration have less resistance than complete crown
• Resistance can be provided by boxes or grooves
Resistance Form
Physical properties of the luting agent
• Resistance to deformation is affected by physical properties of the
luting agent such as:
1. Compressive strength (effect of temperature)
resins cements > glass ionomer > zinc phosphate
2. Modulus of elasticity
zinc phosphate > polycarboxylate
Deformation
• Restoration must have sufficient strength to prevent permanent
deformation and withstand occlusal forces
• Failure can occur at: restoration cement or metal ceramic interface
• Causes:
1. Inappropriate alloy selection
2. Inadequate tooth prep
3. Poor metal ceramic framework design
Deformation
Alloy Selection
• Type I & II gold alloys are soft > intracoronal restorations
• Type III & VI are harder > crowns and fixed partial dentures
• Nickle chromium is harder > large forces such as long span FPD
Deformation
Adequate tooth reduction
• 1.5 mm on functional (centric) cusps: Buccal mandible and palatal
maxilla
• 1 mm non-functional (non-centric) cusps: lingual mandible and buccal
maxilla
• Occlusal reduction : uniform and follows cusp planes (why)
• Over erupted teeth ?
Deformation
Margin design
• Avoid occlusal contact in margin area (why)
• Preparation should provide bulk for metal at margin
• Featheredge > very thin layer of gold > not strong enough
• Grooves and ledges provides strengthening for casting
• For gold and high strength zirconia (how much?)
• For ceramic (how much)
Esthetic Consideration
Esthetic Consideration
• Aim for natural smile
• Initial examination: asses areas of teeth showing during smiling,
speech and laughing
• Chief complaint
• Patient type and expectations
• Diagnostic measures
• Final decision
• Esthetic restorations: partial veneer crowns, metal ceramic, all
ceramic restoration
Esthetic Consideration
1- All ceramic restorations
• Most pleasing restorations
• Mimic original tooth color
• Greater risk of brittle fracture
• Newer materials improved physical properties and can be
strengthened through use of resin bonded luting agents
• Requires 90 degree heavy chamfer
• Minimal thickness 1 to 1.2 mm
• Limits the use on teeth with large pulps and thin teeth faciolingually
Esthetic Consideration
2- Metal ceramic restorations
• Insuficient tooth reduction > Compromised esthetics with insufficient
porcelain thickness > overcontoured restoration > PDL disease
• Metal ceramic margin placement …

• Principles of PFM preparation

1. Facial tooth reduction
2. Incisal reduction
3. Proximal reduction
4. Labial margin placement
Esthetic Consideration
2- Metal ceramic restorations
1. Facial tooth reduction
• amount depends on the physical properties of the alloy and shade
of porcelain
• minimum 1.5 mm
• Problems in maxillary centrals (why and where)
• Mandibular incisors
• Labial surfaces of anterior teeth ??
Esthetic Consideration
2- Metal ceramic restorations
2. Incisal tooth reduction
• 2 mm
• Excessive reduction > reduces resistance and retention form
Esthetic Consideration
2- Metal ceramic restorations
3. Proximal reduction
Depends on the location of the metal ceramic junction
Esthetic Consideration
2- Metal ceramic restorations
Follow the contour of the free gingiva (apical in the middle and
4. Labial margin placement incisal interproximally
Supra-gingival margin Sub-Gingival margin

Advantages 1- easy to prepare 1- esthetic

2- easy to keep clean
Indication Low lip line High lip line

Drawbacks Patient acceptance Discoloration in cases of thin

gingiva
• Biologic width
• Surgery healing time (20
weeks)
Esthetic Consideration
3- Partial coverage restorations
• Conservative of tooth structure
Esthetic Consideration
3- Partial coverage restorations
1. Proximal margin
• Mesial margin > more visible > esthetic challenge
• Where to place the margin?

• Distal margin of posterior partial coverage restoration > less visible

• Where to place the margin?
Esthetic Consideration
3- Partial coverage restorations
2- Posterior facial margin of maxillary partial coverage restoration

• Beyond the occlusofacial line angle

• Short bevel to prevent enamel chipping
• Chamfer finish line in molars

Q. Which surface of teeth show during speech ? Implication on metal display

?!
• Chamfer finish line for buccal margin of mandibular teeth (why)
• Patient concern of metal display in lower teeth ?
Esthetic Consideration
3- Partial coverage restorations
• Anterior partial coverage restorations can be fabricated to show no
metal (how)
Planning and evaluating tooth preparation
• Rehearsing the preparation on diagnostic casts helps
1. Diagnostic tooth preparations
2. Diagnostic waxing procedures
3. Evaluating procedure during tooth preparation
Planning and evaluating tooth preparation
1. Diagnostic tooth preparations
on articulated study models, they yield the following information

1) Selecting the path of placement (complex cases- tilted- rotated)

2) Deciding the amount of tooth reduction (esthetics and occlusion)
3) Determine the best location for margins to avoid metal display

Advantages:
1) Practice before clinic
2) Mistakes are not permanent
3) Used for fabrication of interim restorations to reduce chair time
Planning and evaluating tooth preparation
2- diagnostic waxing procedures
• Helps determine optimal contour and occlusion of final prosthesis
• Important for anterior guidance
Evaluating procedures during tooth
preparation
• Direct vision
• Indirect with dental mirror
• Alginate impression > stone > surveyor > preparation on cast
Patient and Operator Positioning
• Best > direct view
• Distal of maxillary molars >> always indirect
• Patient head
• Patient opening (Partially vs maximum)
• Lateral excursion
• Bite block (advantages)
References
• Stephen F. Rosenstiel, Martin F. Land and Junhei Fujimoto.,
Contemporary Fixed Prosthodontics, 4th ed.
• Herbert T. Shillingburg, David A. Sather Jr., Edwin L. Wilson Jr., Joseph
R. Cain, Donald L. Mitchell, Luis J. Blanco, James C. Kessler.
Fundamentals of Fixed Prosthodontics, 4th ed
• Goodacre CJ, Campagni WV, Aquilino SA. Tooth preparations for
complete crowns: an art form based on scientific principles. J Prosthet
Dent. 2001;85(4):363-376. doi:10.1067/mpr.2001.114685