Steps of Tooth Reductions

Full Metal Metal Ceramic All Ceramic

Reduction Reduction Reduction
Labial 1.2-1.5mm depth 1.2-1mm ,
0
Correct taper (5-10 ) Ant:2 plane reduction 2 plane reduction,
0.5-1mm at non-functional , Gingivally parallel to cervical
0.5-1.5 mm at functional cusp, part ,incisally Parallel to
450 functional cusp bevel incisal 2/3 of labial surface.
Lingual 1mm clearance for 1- mm
metal contacts and Cingulum :Vertical wall
1.5 for contacts in Parallel to the facial cervical
ceramic Fossa: Retain concavity at a
lower level
Proximal Ideal taper (5-100) Shoulder extends 1mm Taper 5-100
palatal to contact point Cervically shoulder 1mm
Occlusal Follows occlusal anatomy 1.5-2mm clearance 1.5mm clearance ,450
1.5mm at functional cusp incsogingival
1mm at non functional cusp bevel,perpendicular to
masticatory forces.
Finishing Roundation of all line and point angles. Finish line should be smoothe and continuous all
around .Follows free gingival margin.
Path of Parallel to the long axis Ant: parallel to the Parallel to the incisal 2/3 of
Insertion incisal 2/3 ,Post: the labial surface
parallel to the long axis
of tooth
Finish Line Chamfer 0.5mm for adequate Shoulder labially Rounded shoulder 1mm
bulk of metal. ,chamfer lingually wide

Instruments Used For Tooth Reductions :

- Tapered diamond stone with round edge. -Torpedo diamond stone

- Long fine diamond tapered stone. – Football diamond stone
-Short fine diamond tapered stone. Tapered diamond stone with flat edge
-Wheel diamond stone with round edge

1
Full Metal Reduction :

Functional cusp bevel

at 45 0 to the long axis

2
All Ceramic Anterior Preparation :

3
Metal Ceramic Reductions :

Anterior Reduction :

Posterior Reduction :

Premolar veneered Reduction Molar veneered Reduction

Occlusal clearance:
1 – 1.5 mm reduction if occlusion is to be restored in metal.
2 mm if occlusion is to be restored in ceramic.

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 Questionnaire

1.Patient identification:
Name.....................................................................
Sex...................................................
Age............................................................. Occupation..........................................................
Phone number...............................................

2.History:

• Chief complaint:

Pain:
•Onset................................................ Duration...........................................
•Course.............................................. Location..........................................

• Past and present medical history

Do you have any of the following Systemic disease:

a) Heart disease........................................ b) Rheumatic fever ..........................

c) Hepatitis ........................................
e) Epilepsy........................................
g) Raised blood pressure .................................
i) Asthma .......................................
. Have you suffered any allergy to :
d) Jaundice .....................................
f) Diabetes ....................................
h) Anaemia ...................................
j) Bleeding tendencies ...................

i. Penicillin?...........................
ii. Other medicines or tablets?.........................................................................
iii. Substances or chemicals ? ......................................................

ƒ Have you ever experienced unusally prolonged bleeding after injury? Yes/ No
ƒ Have you ever been given penicillin? Yes/ No
ƒ Have you ever received radiotherapy ? Yes/ No
ƒ For female patients, are you pregnant ? Yes/ No
ƒ Are you undergoing any medical treatment at present ? Yes / No
ƒ Are you taking any medicines at present
If so please write them down:
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
………………………………………………………………………

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• Past dental history

a. Dental extraction
b. Restorative and endodontic treatment
c. Prosthetic replacement
d. Periodontal treatment
e. Orthodontic treatment
f. Any complications related to local anesthesia

ƒ Personal habits

1. Smoking Yes / No
2. Alcohol consumption Yes/ No
3. Teeth grinding Yes / No
4. Cheek biting Yes / No
5. Tongue thrusting Yes / No
6. Daily tooth brushing ( regular - irregular - none ) Yes / No
7. The use of other oral hygiene devices Yes / No

ƒ Clinical examination

a) Extra-oral examination..........
.Facial symmetry .TMJ . Neck and lymph nodes

b) Intra-oral examination...........

ƒ Radographic examination

ƒ Treatment plan

ƒ Prosthetic design :

• Follow up

After one week......................................................................................................

After 6 months.....................................................................................................
After one year.......................................................................................................

6
 Chair Position
Operator Posture

7
Patient Position :

Mn parallel to floor

Operator position: Mandibular Right :

Patient position

8
Patient Position

Mn parallel to floor

Operator position: Mandibular Left:

9
 Patient Position

Mx perpendicular to floor

Operator Position : Maxillary Right:

10
 Patient Position

Mx perpendicular to floor

Operator position : Maxillary Left

11
Checking the Reduction:

Monocular vision when viewed with one eye from a distance of 30 cm all the axial
surfaces of a preparation with an ideal taper can be seen
Binocular vision should never be used as with both eyes open an undercut may appear
to have an acceptable taper.

A mirror is used when direct vision is not possible. Correct taper can be detected if an
unobstructed view of the entire finish line outside the circumference of the occlusal surface can
be seen

To assert the presence of a common path of insertion between abutments, the image
of one prepared abutment is centered in the mirror and then the mirror is moved
without tilting until the second abutment is centered. The entire finish line of the
second preparation should be visible.
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 Gingival Tissue Displacement

Chemicomechanical method: Most commonly used method

Aim: Widening of the gingival sulcus to obtain access to subgingival margins.

Technique:
ƒ Chemically impregnated cords push the gingival tissues mechanically while the
chemicals provide an astringent action to stop hemorrhage and provide a dry
field.
ƒ Cords are placed in the crevice using a blunt instrument.
ƒ Procedure takes 5-10 minutes and once the cord is removed, the tissues return to
their original position

Procedure:

The prepared teeth are dried and isolated with cotton rolls.
ƒ Cut enough cords length to encircle the tooth and dip it in an astringent
containing Al or iron salt causing a transient ischemia and shrinkage of the
gingival sulcus.

Fig 1 Fig 2 Fig 3

ƒ Loop the cord around the tooth and gently push it inside the sulcus with a blunt
instrument.The instrument must be slightly angled to the root and toward the
area already tucked into place. Fig 1, Fig 2

ƒ Start interproximally then proceed to the lingual surface and end with the
buccal.

ƒ Excess cord ends are overlapped and packed buccally. Fig 3

ƒ Gently remove the cord after 10 minutes.

ƒ The sulcus closes rapidly after cord removal.

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 Impression Materials

It is often desirable to postpone taking the impression in a secong appointment to allow the tissues to
heal and control heamorhage ,especially if a quality provisional is provided along with strict oral hygiene
home care.

Irreversible Hydrocolloids: (alginate)

To avoid tearing:
1) Rapid snap removal.
2) Tray material should be at least 3 mm.
3) Wait 2-3 minutes after it sets to develop adequate tear strength.

Indications:
1) Diagnostic study casts.
2) Opposing arch impressions for mounting and occlusion.

A- Elastomers:
Rubber base impression materials.
Condensation polymerization → byproduct
Addition polymerization → no byproduct

1. Addition silicone:
ƒ No reaction by-product which makes this material very accurate (additional polymerization)
ƒ Polymerization may be inhibited by contact with latex gloves, due to presence of sulphur in the
gloves. Therefore use vinyl gloves.

2. Polyethers:
Advantages:
1. Excellent dimensional stability as there is no byproducts .
2. May be poured more than a day after impression taking.
3. Short setting time .
Disadvantages:
Stiff material might result in die fracture when separating stone cast from impression.
Storage: Dry storage to avoid imbibition as it has affinity to water.

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 Impression Techniques:

Technique of overall or sectional impression:

I.One Step:
a. Single mix materials:

Used when a single viscosity (medium or regular) material is used with a special tray
ƒ Snap removal Æ to decrease time dependant deformation.
ƒ Impressions should be poured 20-30 minutes after removal to allow some recovery
from deformation.

Clinical Steps: Give anesthesia.

1. Paint the fitting surface of the tray by a suitable adhesive.

2. Gingival displacement of the prepared teeth should be done.
3. Isolation and dryness (if material is hydrophobic should be controlled).
4. Squeeze out equal lengths of base and catalyst of impression material.
5. Mix with spatula till it becomes homogenous, and then load the syringe (or use
automixed material).
6. Load part of the material into the syringe, the remainder is then applied to the
tray.
7. Inject the material around the prepared teeth then seat the loaded tray in place.
8. After setting remove the impression quickly. ( snap removal)

b. Double mix technique: Dual Viscosity (one step)

1. Displacement cord is removed .
2. Light material is syringed into the sulcus around prepared teeth and unto the
occlusal surface .For accurate articulation also syringe edentulous areas, lingual
concavity of anterior teeth and occlosal surface of posterior teeth.
3. The heavy body loaded material is then seated in the patient’s mouth before the
light body material has set, thus forcing the light body into intimate contact with
the preparation and gingival crevice.

Stock Versus Custom made tray:

Improves accuracy of the impression by minimizing the volume of the material.
It should be 2-3mm for adequate rigidity.
A space of 2-3 mm should be present between the teeth and the tray.
With the regular and dual viscosity, (1 step) techniqueÆ custom made trays improve
accuracy due to uniform impression material thickness.

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 II. Two step/Putty Wash Technique.)Double impression/putty wash:

The putty is taken before the reduction and the light is taken after the reduction. In that
case the 1ry impression is used as a tray and possesses minimal dimensional change as it
is (highly filled) while the thickness of the light material is so small that the actual
dimensional change is minimal.
Double impression technique is used with a stock tray as the 1ry impression serves
as a custom tray.

To relieve the impression :

ƒ Cut away some of the tray putty (venting, relief interproximally & channels) i.e.
remove areas of severe undercuts and interdental areas as those areas may prevent
reseating of the putty impression.
ƒ Take the putty after placing a spacer over the teeth.
ƒ Putty may also be taken before the reduction to provide enough space for the light
material.

Proportioning, mixing and loading the impression material:

1) Impression materials should be proportioned according to the manufacturer’s

instructions e.g. usually equal volumes of base and catalyst tubes.
2) Use same brand of heavy and light impression material.
3) The elastomeric impression materials and alginate should be mixed thoroughly
producing homogenous mix with no streaks.

Seating and stabilizing the impression in mouth:

To avoid stress induction during impression taking :

ƒ The tray must remain immobile while the material undergoes polymerization.
ƒ Too much pressure applied to the tray during taking impression should be
avoided.
ƒ Snap removal of the impression is desirable.

Pouring of the impressions:

Hydrocolloid impressions should be poured immediately or stored in 100 %

humidity media formerly short time.
All elastomeric impressions should be left for 20 minutes after removal from the
mouth to allow elastic recovery to take place.
Polysulphide and condensation cured silicones should be poured within 1 hour.

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 However, polyether and addition cured silicones impression can be stored for a long
time (more than 24 h) before pouring.

Special considerations:

A. Disinfection:

After removal from the mouth, all impressions should be rinsed under tap water and
dried with an air syringe then sterilized to prevent cross infection.

Disinfection should not affect the accuracy or surface reproduction of the impression.
Chemicals used in disinfection are 2% glutraldehyde solutions, or sodium hypochlorite
5.25%.
10-30 minute immersion in solutions OR spraying, them followed by sealing in a bag.
Alginate :immerse in sodium hypochlorite OR glutaraldehyde for 10 minutes as more
time might affect dimensional stability.

B. Impression Evaluation:

1. Discard impression if bubbles or voids appear at the margins.

2. An intact uninterrupted cuff of impression material should be present beyond every
margin.
3. Uniform color streaks of base or catalyst indicate improper mixing.

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 Temporary protection
Types of Temporary Restorations:

1. Ready made: Only used for single restorations.

a. Metal:
• Bands: Aluminum shell or cylinders.
• Anatomic metal forms (Aluminum or tin silver) provided as premolars and
molars. Adaptation is improved by occluding force.
• Nickel-chromium anatomic crowns → mostly used for primary teeth.

b. Non-metal:

• Clear-celluloid shells.
• Polycarbonate crown
These should be filled with resin for better fit and retention. Excess should be
removed then finish and polish the restoration before temporary cementing them.

2. Custom Made:

Used for single crowns or fixed partial dentures. A crown form (mold) is essential.
The form of the teeth before reduction is used to reproduce the external form of the
mold while their shape after reduction forms the internal form of the mold.

ƒ Impressions are made in a quadrant tray with irreversible hydrocolloid or putty

silicone rubber to reproduce the external surface form of the teeth before
preparation .

ƒ Templates made from thermoplastic sheets maybe heated and adapted to a cast
before reduction.

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 Temporary Cement
1. Temporary restorations are used in between visits from the time of reduction till
delivery of the final restoration. They are cemented with temporary cements for
ease of removal during try-in visits of the final restoration.

2. Trial cementation of final restorations is advised so that the patient and dentist may
evaluate the restoration’s esthetics and function over a long period, making any
further adjustments possible.

Zinc oxide and Eugenol is used as a temporary cement as it is easily removed and has an
obtundent and sealing property. Glass ionomer,Zinc phosphate and carboxylate cannot
be used as their high strength renders their removal difficult with risk of fracture to the
tooth.

1. Free Eugenol may cause softening of some methacrylate resins, therefore always use
proper P:L ratio.

2. Both Eugenol and non-Eugenol containing ZnO cause reduced tensile bond
strength of resin luting agents. Therefore, all traces of temporary cement should be
removed to maximize adhesion.
Ex. Etch with 37% phosphoric acid when a resin cement is used or abrasion with
Al2O3.

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 Try In and Checking
Restorations should fulfill 3 functions:Preserve Health – Restore Function- Esthetics

Finished Metal Ceramic Restoration:

Require a try in of the metal framework and a separate evaluation after firing the ceramic to
evaluate esthetics, occlusion, contour, and alignment

A.Metal Framework Try in :

1. Seating and Marginal fit.
Failure of seating maybe due to:
ο Nodule on the fitting surface.
ο Overextension of the gingival margin.
ο Interference due to tight casting or die

Gaps more than 50 μm are clinically unacceptable. Since sharp explorer tips are 80μm in diameter,
therefore, if the tip enters between the casting and the tooth it is considered unacceptable (open
margin).
Interproximal margin adaptation is best checked radiographically.

Fig A Fig B Fig C

Defective Margins examined with a probe

Fig A: Overhang corrected by careful casting adjustment.
Fig B. Ledge ,if small maybe accepted but with risk of recurrent carie is increased.
Fig C: Open margin requires new casting

Defective Margins:
a. Over extended (overhang)
b. Underextended (ledge)
c. Thick (overhang)
d. Open

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2. Retention and Stability:

There should be adequate retention of the restoration through friction. Casting should be stable i.e. no
rocking should be present .This is tested by applying pressure on one retainer and checking to see if the
other retainer rocks.
ƒ If rocking is caused by a small nodule it maybe localized and removed.
ƒ Rocking maybe corrected by separating one of the soldered connectors, reassembling the units
through indexing and soldering of the parts. This maybe tried in case individual units are well
seated on the dies.

3. Pontic Contour Ridge Adaptation:

Saddle Modified ridge lap Sanitary Ovate

Recommended Disadvantage
Advantage/Function
Location

Poor esthetics
a. No mucosal contact
Non esthetic area Metal
Good Hygiene
ƒ Sanitary
Mand molar with
broad ridges

Inaccessibility to
b. Mucosal contact.
OH measures
ƒ Saddle(Ridge lap) Good Esthetics Not recommended

Poor esthtics
ƒ Conical Mand molars May allow food
Good access for hygiene
Thin knife edge ridge entrapment in case
of broad ridges
ƒ Modified ridge lap
Anteriors
Good Esthetic and access
Premolars
for hygiene
Max. Molars

Require surgical
ƒ Ovate Easy cleaning Optimum esthetcs
intervention
Maxillary Anteriors
→↓Food entrapment Premolars

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4) Occlusal Clearance:

After complete seating of the metal framework adequate occlusal clearance should be present
to place the ceramic and obtain balanced articulated occlusion in the restoration.
At least 1 1.5 mm should be present. This is checked by passing a probe between the
restoration and the opposing teeth.

5) Connectors:

ƒ Solder joint should be tested for strength.

ƒ Its size, form and location should also allow access for cleansing, and oral hygiene aids.

6) Steps of color and Shade Selection:

1. Teeth to be matched should be polished and moist. As a tooth dehydrates its value increases.
2. Operator should stand between the patient and the light source:
3. Shade selection should be made at the beginning of the visit.
4. Patients with bright clothes should be covered and lipstick should be removed.
5. The patient should be in an upright position which is the same conditions he would be
generally seen in. Patient should be viewed at the operator’s eye –level so that the most
color sensitive part of the retina will be used.

6. Selection is made at 3 to 6 feet (30 cm or an arm) from the oral cavity, since as this is the
normal distance of viewing the patient. Avoid close ups. However, distant selection is helpful
in evaluating value.

7. A light grey wall for the clinic is the ideal background for color matching intense colors
should be avoided.

8. Shade comparison should be made under different lighting conditions. Selection is done
under incandescent or fluorescent lighting then confirmed in natural lighting to avoid
metamerism.

Fig B Cervical match Fig B Incisal match

9. Selection should be done by looking at the cervical aspect of the tooth.

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 10. Shades should be selected rapidly to avoid eye fatigue .Five second glances with periods of rest in
between are recommended.

11. In case of eye fatigue the dentist should rest his eyes by focusing on a blue surface between
comparison to balance all color sensors .

12. Another opinion, at times, is needed to confirm some selected shade guides.Any surface
characteristics or relevant data should be recorded.

Commercial Shade Guides :

A. The Vita Lumen Shade Guide :

It is composed of four hues:
A=Reddish Brown, B= Orange Yellow, C=Greenish grey , D= Pinkish grey
1. Choose the tab with the nearest hue first then select the appropriate match of chroma and value
from the tabs available. The cervical region of canines should be used for hue selection.

2. Chroma selection is next from within the same hue group A (A1,A2,A3,or A4) ,B (…….),C
(……..)or D.

3. Between comparisons the operator should glance at a blue object to rest his eye and avoid retinal
cone fatigue.

4. Value is determined with a second shade guide whose orders are arranged in order of increasing
lightness.Value is assessed more effectively by observing from a distance ,standing away from the
chair ,and squinting to reduce the amount of light that reaches the retina.

5. A diagram of the tooth is drawn and divided by 2 horizontal & vertical lines into zones. Further
information can be thus transferred to the technician accurately such as surface characteristics and
any special stains

B. Vitapan 3D Master Shade Guide :(Fig C)

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This system was recently introduced and is considered to be very precise and user friendly.
1. The value is selected first from the five lightness values :groups ( 1 to 5)

2. This is followed by vertical descent from within the selected group for chroma selection .
(1,2,3)

3. Last of all is determination of which hue (yellow or red L,M,R) which are the tabs to the
left or right of the selected M tab.

4. Intermediate shades can be formed by combining porcelain powders.

5. Shade distribution Chart ( Zone transfer diagram)is required to match each region of the
tooth independently :cervical, middle and incisal.

B.Try in of Finished Metal Ceramic Restoration:

Esthetics:

To acquire optimum esthetics, contours should be in harmony with the rest of the patient’s
dentition. Restorations should match the patient’s natural teeth in color, size, form and surface
characteristics.

Occlusal Adjustment:

After ceramic placement occlusion is checked again in both centric and eccentric positions. To
detect any prematurities glaze is removed to mark the articulating paper.

1. Simultaneous contact of restored and unrestored teeth.

2. Unrestored teeth should contact similarly with and without restorations.
3. Contact should exist only in centric and all other posterior eccentric contacts should be
eliminated (for canine guidance). While working side contact may be present in group
function occlusion.
4. Any prematurities should be eliminated.

ο Adjustments are done using articulating paper, abrasive stones, and flame shaped finishing burs.

Contours and Alignment:

Correct contouring is essential for gingival health. It should be in harmony with the neighboring
and similar teeth on the opposite side. Interproximal embrasures should not impinge on the dental
papilla and should be wide enough to allow proper oral hygiene .

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 Permanent Cementation

Selection of the appropriate cement:

1. Conventional casting → require traditional cements.
2. Adhesive-bonded restoration such as ceramic inlay or resin-bonded prosthesis → require
adhesive resins.

Zinc Phosphate:
An old strong cement which has proved its success. In case of concern to pulpal response resort to
another. It still has its place for normal conservatively prepared teeth.

Zinc Polycarboxylate:
When concerned about pulp vitality it is more biologically acceptable cement.

Glass Ionomer:
Should be used in case of high caries incidence; due to its anticariogenicity (FL release) and relative
insolubility.

Resin Cements:
Used in new conservative intraenamel preparations such as veneers and Maryland Bridges. Also used
in cases where higher retention through micromechanical bonding is desired .

Special Situations:

I. Cementation of a long Span Bridge:

Requirements:
1. Long working time.
2. High mechanical properties.
3. Adhesive cement is better.
Selection:
1. Glass Ionomer.
2. Zinc Phosphate.
3. Adhesive Cement.

Note:
Zinc Polycarboxylate and ZnO should not be used due to their short working time and low
strength properties.

II. Patients with high caries index:

Cement with anticariogenic properties should be used.ex Glass Ionomer or Resin cements with Fluoride
additions.

III. Deep Reductions:

Cement should be biocompatible : polycarboxylate or reinforced ZnO & E.

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IV. Cementation of Porcelain Jacket Crown and Porcelain Laminates:

Cement should be:

• Translucent.
• Early mechanical Strength.
• Adhesive to the etched ceramic restoration.
Composite resin cement.
Glass Ionomer should not be used as it would be result in fracture due to slow development of
strength properties.

V. Cementation of a restoration to a core:

• Amalgam core : any cement maybe used.

High copper amalgam enhances bonding with polycarboxylate cement.
• Composite Resin core : Use resin cement as it bonds to it chemically.
• Glass Ionomer core : Use a glass ionomer cement due to chemical similarity.
• Cast Core:

o Precious ………No adhesion with conventional cements . Polycarboxylate cement exhibits

higher bond to Au than phosphate.
Resin cements bond better to Au.
o Non Precious……glass ionomer , Carboxylate.
Resin cements maybe used as they bond well to non-precious alloys.

VI. Cementation of Posts:

Requirements of Cement:
1. High flow.
2. High Strength.

Selection:
1. Glass Ionomer or ZnPo4.
2. Adhesive cements are preferred.
( Panavia sets rapidly in the canal due to lack of oxygen)

VII. Cementation of Inadequate Reductions:( No retention :ex short, tapered)

Requirements:
Strong, Insoluble, Adhesive cements are required.

Selection: Adhesive Resin cements.

VIII. Cementation of Resin Bonded Retainers:

Requirements:
a. Bonds to treated metal and enamel surface.
b. High mechanical Properties

26
 c. Insoluble

Selection: Choice is restricted to Resin cement

IX. In oral cavities with difficult moisture control:

Modified Zn O & E cements maybe used.

Clinical Cementation Procedures with Traditional Cements:

1. Preparations must be cleaned of any provisional cements and dried without overdrying to avoid
damaging the odontoblasts. Cleaning may be done with pumice and water or hydrogen
peroxide.

2. Local anesthesia is administered to decrease pain and sensitivity during the procedure.

3. Before any cement mixing the teeth to be cemented have to be isolated and any moisture
should be controlled throughout the procedure.

4. The fitting surface of the casting may be air abraded with 50 μm Al2O3. Restorations should be
cleaned using steam, ultrasonic devices and organic solvents.

5. When the desired cement consistency is achieved, a thin coat is applied to the
clean axial surface of the restoration, and firmly seated on the clean dry teeth with
rocking pressure. This is to decrease hydraulic pressure and ensure seating.

6. After seating the margins are checked.

7. Excess cement is removed after setting as early cement removal may lead to early moisture
exposure. Knotted dental floss is used to remove interproximal excess. Cements take 24 hours
to develop their final strength.

8. Occlusion is checked.

9. In case of using Glass Ionomer cement cover the restoration margins with varnish to protect it
from early moisture contamination.

Clinical Cementation Procedure with resin cements:

1. Same steps are taken for teeth cleaning, isolation and moisture control throughout the
procedure.

2. Procedural steps for each commercial brand have to be followed strictly.

27
 3. Excess cement is usually removed before polymerization is completed with a sharp
curette.
4. In case of using Panavia resin cement (an oxygen inhibiting gel) is placed to initiate
polymerization.

5. Any remaining excess after hardening is removed with fine diamonds using water spray.

6. Finishing strips are used for interproximal margins. Final polishing may be done with
rubber wheels.

Follow up schedule:
ƒ One week to ten days after cementation the patient is recalled to check:

1. The presence of excess cement in the crevice.

2. Occlusion : Any patient discomfort during biting or the presence of polished facets at the site
of occlusal contacts indicate the need for occlusal adjustment .

ƒPatient recall once every 6 months to :

1. Monitor the plaque control scheme .

2. Maintain the longitivity of the prosthesis and detect any problem at an early stage
3. Use any corrective treatment which may delay or arrest restoration failure.

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 Post Requirement
1-Place the tooth in plaster block
2-Decapitate (shorten the crown 3 mm above C.E.J.)
3-Prepare a circumferential F.L. 2 mm below coronal portion or 1 mm above C.E.J. (concave buccally,
convex palatally)
4-Preparation of the root space:
a-Remove the gutta percha leaving at least 4mm apically to preserve apical seal
using hot instruments or rotary drill (peeso/ gates)
b- Shape root space for dowel insertion.
c- Enlarge the space 1-2 sizes more than the actual sizes.

Custom made post Remove undercuts, flare cervical 1/3

Prefabricated posts Use the drills provided by kits
Start with small sizes
STEPS:
MOLAR: (Prefabricated posts)
palatal canal of upper/distal canal of lower Date Signature
1st STEP :x- rays after endodontic TTT
2nd STEP: Removal of 2/3 of G.p and widening of cervical 2/3 of canal
3rd STEP: Insertion of post and x-rays before cementations
4th STEP: Cementation of the post and core build up with
(amalgam / ketac AG)
PREMOLAR : (Prefabricated posts)
1ST STEP: X- rays after endodontic TTT
2ND STEP: Removal of 2/3 of G.p & widening of cervical 2/3 of canal

3RD STEP: Insertion of post and x-rays before cementations

4th STEP: Cementation of the post and core build up with composite
( use celluloid core former )
ANTERIORS: (CUSTOM MADE)
1ST STEP: X- rays after endodontic TTT.
2nd STEP: Removal of 2/3 of G.p.& widening of cervical 2/3 of canal
3RD STEP: Select suitable serrated or plastic post which fits loosely in the
canal
Adjust its length and take a rubber impression of the root space
4TH STEP: Lubricate the canal and select suitable serrated or plastic post to
build a direct resin or wax pattern
5TH STEP: After building a direct resin or wax pattern + build core
representing a prepared abutment.
Note: The length of gutta percha to be removed should be determined first by using a peeso reamer against an
x-ray of the tooth. The optimum depth should be marked with a silicone rubber stopper aligned with a
reference point.

29
 Post Requirement
1-Place the tooth in plaster block
2-Decapitate (shorten the crown 3 mm above C.E.J.)
3-Prepare a circumferential F.L. 2 mm below coronal portion or 1 mm above C.E.J. (concave buccally,
convex palatally)
4-Preparation of the root space:
a-Remove the gutta percha leaving at least 4mm apically to preserve apical seal
using hot instruments or rotary drill (peeso/ gates)
b- Shape root space for dowel insertion.
c- Enlarge the space 1-2 sizes more than the actual sizes.

Custom made post Remove undercuts, flare cervical 1/3

Prefabricated posts Use the drills provided by kits
Start with small sizes
STEPS:
MOLAR: (Prefabricated posts)
palatal canal of upper/distal canal of lower Date Signature
1st STEP :x- rays after endodontic TTT
2nd STEP: Removal of 2/3 of G.p and widening of cervical 2/3 of canal
3rd STEP: Insertion of post and x-rays before cementations
4th STEP: Cementation of the post and core build up with
(amalgam / ketac AG)
PREMOLAR : (Prefabricated posts)
1ST STEP: X- rays after endodontic TTT
2ND STEP: Removal of 2/3 of G.p & widening of cervical 2/3 of canal

3RD STEP: Insertion of post and x-rays before cementations

4th STEP: Cementation of the post and core build up with composite
( use celluloid core former )
ANTERIORS: (CUSTOM MADE)
1ST STEP: X- rays after endodontic TTT.
2nd STEP: Removal of 2/3 of G.p.& widening of cervical 2/3 of canal
3RD STEP: Select suitable serrated or plastic post which fits loosely in the
canal
Adjust its length and take a rubber impression of the root space
4TH STEP: Lubricate the canal and select suitable serrated or plastic post to
build a direct resin or wax pattern
5TH STEP: After building a direct resin or wax pattern + build core
representing a prepared abutment.
Note: The length of gutta percha to be removed should be determined first by using a peeso reamer against an
x-ray of the tooth. The optimum depth should be marked with a silicone rubber stopper aligned with a
reference point.

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