PRINCIPLES OF

TOOTH
PREPARATION
Dr.RAKESH R NAIR
PG
STUDENT DEPT.OF
CONS & ENDO
KVG DC
• Tooth preparation may be defined as the mechanical treatment of
dental disease or injury to hard tissue that restores a tooth to the
original form (Tylman).

• The mechanical preparation or the chemical treatment of the

remaining tooth structure, which enables it to accommodate a
restorative material without incurring mechanical or biological
failure.(Marzouk)
• The current focus is on conservative tooth preparation that
is
noninvasive and that minimally involves dentin.

• This trend is rational in the light of the reduction of the caries

rate by fluorides, nutritional counseling and oral hygiene
programs. Black’s principles of cavity preparation and Tylman’s
principles of tooth preparation are both presently being modified
to accommodate imaginative approaches i.e., acid etching with
minimum reduction.
• Dentistry changing from macro tooth preparation to
environment
is of
anmolecular chemistry i.e., esthetic bonding. These
techniques are not presently supported by any longitudinal
studies, but are exciting and promising.
Despite these advances,
traditional crowns are still
indicated for majority of patients.
The classic design of the
preparation must be visualized so
that modifications if required can
be instituted.
Diagnosis and disciplined
tooth preparation are
essential to successful fixed
prosthetics.
 OBJECTIVES OF TOOTH PREPARATION

The objectives of preparation remain clearly defined, but

the methods of securing these goals are constantly being
revised.

1. Reduction of the tooth in miniature to provide

retention.

2. Preservation of healthy tooth structure

to
secure resistance form.

3.Provision for acceptable finish line.

4.Performing pragmatic axial tooth reduction to

encourage favorable tissue responses
from
artificial crown contour.
 PRINCIPLES OF TOOTH
PREPARATION
(According to Rosenstiel)

BIOLOGI
C MECHANICAL
Conservation of
Retention form
tooth structure
Resistance
Avoidance of
contouring form
over
Supra gingival margins
Harmonious occlusion
Protection against
tooth
fracture

ESTHETI
C
Minimum display
metal
of
Maximum thickness
of
porcelain
Porcelain
surfaces Optimal restoration
occlusal
Subgingival margins
Damage to adjacent teeth is prevented by positioning the
diamond so a thin lip of enamel is retained between the
bur and the adjacent tooth.

Note that the orientation of the diamond parallels the

long axis.

The enamel should be maintained mesial to the path of

the diamond as the
reduction progresses.
Soft tissues
Damage to the soft tissues of the tongue and cheeks
can be prevented by careful retraction with an
aspirator tip, mouth mirror , or flanged saliva ejector.

Great care is needed to protect the tongue

when the lingual surfaces of mandibular molars are
being prepared.
Pulp
Great care also is needed to prevent pulpal
injuries during fixed prosthodontic procedures,

Especially complete crown preparation.

Pulpal degeneration that occurs many years after tooth preparation
has been documented.
Extreme temperatures, chemical irritation, or microorganisms can cause an
irreversible pulpitis particularly when they occur on
freshly sectioned dentinal tubules.
• Temperature
• Chemical
action
• Bacterial action
 PRINCIPLES OF TOOTH PREPARATION

According to Shillingburg, the design of a

preparation for a cast restorations and the execution of
that design are governed by five principles:

1.Preservation of tooth

structure 2.Retention and

resistance

3.Structural

durability 4.Marginal

integrity
 Preservation of Tooth Structure

• In addition to replacing lost tooth structure, a restoration

must preserve remaining tooth structure.

• Intact surfaces of tooth structure that can be maintained

while producing a strong, retentive restoration should be saved if
patient acceptance and retention requirements will permit it.

• Preservation of tooth structure in some cases may

require that limited amounts of sound tooth structure
be
removed to prevent subsequent uncontrolled loss of
larger
quantities of tooth structure.
This is the rationale for the removal of 1 to 1.5 mm of occlusal
tooth structure when preparing a tooth for an MOD onlay.

The metal on the occlusal surface can protect against dramatic

failures,

such as fracture of tooth structure, as well as the less obvious

failures that may be occasioned by the flexing of tooth
structure
Conservation of tooth structure by using partial-coverage restorations. In this
case, they are used as fixed dental prosthetic abutments to replace
congenitally missing lateral incisors.
 Retention and
Resistance
• No cements that are compatible with living tooth
structure and the biologic environment of the oral
cavity possess adequate adhesive properties to hold a
restoration in place solely through adhesion.
(Shillingburg)

• The geometric configuration of the tooth

preparation must place the cement in compression
to provide the necessary retention and resistance.
Retention prevents removal of the restoration along the
path of insertion or long axis of the tooth preparation.

Resistance prevents dislodgment of the restoration by

forces directed in an apical or oblique direction and prevents
any movement of the restoration under occlusal forces.

Retention and resistance are interrelated and often inseparable

qualities.

The essential element of retention is two opposing vertical

surfaces in the same preparation.
 Tape
r
The axial walls of the preparation must taper slightly to permit
the restoration to seat; ie,
two opposing external walls must gradually converge or
two opposing internal surfaces of tooth structure must
diverge occlusally.

The terms angle of convergence and angle of divergence can be used to

describe the respective relationships between the two opposing walls
of a preparation.

The relationship of one wall of a preparation to the

long axis of that preparation is the inclination of that
wall.
• A tapered diamond or bur will impart an inclination of 2 to 3 degrees to any
surface it cuts if the shank of the instrument is held parallel to the intended
path of insertion of the preparation.
• Two opposing surfaces, each with a 3-degree inclination, would give the
preparation a 6-degree taper.
Prothero (1923) indicated that convergence of peripheral surfaces should
range from 20-50.
Jorgensen (1955) found that retention decreases as the taper increases. A
range of 2-6.50 has been considered to be optimal. He tested the retention
of crowns at various angles by applying a tensile force on cemented crown.
Maximum strength was obtained at 50.
Mack (1980) estimated that a minimum taper of 120 is necessary just to
ensure the absence of undercuts. The tendency to over taper preparations
must be avoided in order to achieve maximum retention.
Ebnashi (1969) to minimize stress in the cement interface between the
preparation and restoration, a taper of 2.5 to 6.50 has been suggested
optimum, but there is only a slight increase in stress as taper is increased
from 0 to 150. However at 200 stress concentration was found to increase
sharply.
• Consciously attempting to cut a taper can easily result in an
overtapered and nonretentive preparation.

• A taper or total convergence of 16 degrees has been proposed

as being achievable clinically while still affording adequate
retention.

• This is probably an acceptable overall target. It can be as low as

10 degrees on preparations on anterior teeth and as high as 22
degrees on molars.
 Freedom of
Displacement
Maximum retention is achieved when there is only one path.

A full veneer preparation with long, parallel axial walls and grooves
would
produce such retention .
On the opposite extreme, a short, overtapered preparation would
be without retention because the restoration could be removed
along an infinite number of paths.

Limiting the freedom of displacement from torquing or twisting forces

in a horizontal plane increases the resistance of a restoration.

A groove whose walls meet the axial wall at an oblique angle does not
provide the necessary resistance. V-shaped grooves produce roughly
one- half as much resistance to lingual displacement as do grooves
with a definite lingual wall.
Surface area :
Greater the area of the cement film bound to the preparation and to
the internal detail of the casting, greater the retention.

The total surface area of the preparation is influenced by the size of the
tooth, the extent of the coverage by the restoration, and internal features
such as grooves and boxes
Area under shear:
 Most important for retention is the
area of cement that will experience
shearing rather than tensile
stress.
 For the shear strength of the cement
to be utilized, the preparation must
have the opposing walls nearly
parallel with each other.
 The direction in which a restoration
can be removed must be limited
to one path. A severely over
tapered preparation has many
paths along which tensile force
could remove a crown.
 Types of preparation :
Different types of preparations have different retentive values
and these correspond fairly closely to the surface area of the axial
walls, provided other factors (e.g. taper) are kept constant. Thus the
retention of full veneer crowns are almost double that of partial
coverage restorations.
Adding grooves or boxes to a preparation with a limited path of
withdrawal does not markedly affect its retention because the surface
area is not increased significantly(Rosenstiel). However other authors
have reported that, where the addition of grooves or boxes limits the
path of withdrawal, retention is increased.
 For the grooves to be effective, the
lingual wall of the groove must be
distinct and perpendicular to adjoining
axial wall
 The walls of a groove that meet the
axial wall at an oblique angle do not
provide necessary resistance (A).
The walls of a groove must be
perpendicular to rotating forces to
resist displacement (B).
 Length of the preparation is important
factor in retention
 Longer preparation has a greater
retention than does a short
preparation, due to greater surface
area.
 The preparation with longer walls
interferes with the tipping
displacement of the restoration better
than the short preparation. Because
of greater surface area preparation
with larger diameter will have greater
retention than with narrow
preparation of same length
Surface roughness:
 The adhesion of the dental
cements primarily depends on
microscopic irregularities and the
recesses on the surfaces being
joined the prepared tooth
surface should not be highly
polished
Resistance:

Resistance prevents dislodgement of restoration by

forces directed in the apical or oblique direction

Resistance to sliding or tipping must be designed into

the preparation

Leverage And Resistance:

Leverage, is the predominant factor in the dislodgement

of the cemented restoration, occur when line of action of
force passes outside the supporting tooth structure.
Length of preparation has strong influence on its
resistance Shortening a preparation will produce a
proportionally greater diminution of the resisting area
 A short restoration on a short
preparation is less likely to fail
through tipping than is a long
restoration on same preparation as
the force on it acts through a
longer lever arm.
 A preparation on a tooth with a
smaller diameter resists pivoting
movements better than a preparation
of equal length on a tooth of larger
diameter because smaller teeth will
have a short rotational radius for the
arc of displacement and the incisal
portion of the axial wall will resist
displacement
 When relatively long crown must be
made on a short preparation
additional resistance form, in form of
pin retained core must be created.
 Resistance and Tooth Width
 A wider preparation has greater
retention than narrower one of equal
height. Under some circumstances a
crown on the narrow tooth can have
greater resistance to tipping than one
on wider tooth. This is because
crown on narrower tooth has a
shorter radius of rotation resulting in
larger resisting area
 Resistance of a preparation on a
short, wide tooth can be enhanced by
addition of grooves
 Path of
insertion is an imaginary line along which
• The path of insertion
the
• restoration will be placed onto or removed from the
• preparation.

• It is determined mentally by the dentist

• before the preparation is begun, and all features of
the
• preparation are cut to coincide with that line.
If the center of the occlusal surface of a preparation
is viewed with one eye from a distance of
approximately 30 cm (12 inches), it is possible to
sigh! down the
axial walls of a preparation with a minimum taper
For a preparation to be surveyed in the mouth, where
direct vision is rarely possible, a mouth mirror is used.
It is held at an angle approximately 1/2 inch above the preparation,
and the image is viewed with one eye.

If fixed partial denture abutment preparations are

being evaluated for a common path of insertion, a
firm finger rest is established and the mirror is
maneuvered until one preparation is centered.

Then, pivoting on the finger rest, the mirror is moved, without

changing its angulation, until it is centered over the second
preparation
Structural Durability

• A restoration must contain a bulk of material that is adequate to

withstand the forces of occlusion.
• This bulk must be confined to the space created by the tooth
preparation.
• Only in this way can the occlusion on the restoration be harmonious
and the axial contours normal, preventing periodontal problems
around the restoration
• There are three preparation features that contribute to the
durability of the restoration that is (1)Occlusal reduction (2)axial
reduction ( 3)provision for reinforcing struts
 Occlusal Reduction

One of the most important features for providing adequate

bulk of metal and strength to the restoration is Occlusal Clearance.
For gold alloys, there should be 1.5 mm of clearance on the
functional cusps (lingual of maxillary molars and premolars and
buccal of mandibular molars and premolars)
• Metal-ceramic crowns will require 1.5 to 2.0 mm on
functional cusps that will be veneered with porcelain
and
• 1.0 to 1.5 mm on nonfunctional cusps to receive
ceramic coverage.
• There should be 2.0 mm of clearance on preparations for
all- ceramic crowns.
• Malposed teeth may have occlusal surfaces that are not
parallel with the occlusal table. Therefore, it may not be
necessary to reduce the occlusal surface by 1.0 mm to
achieve
1.0 mm of clearance.
The basic inclined plane pattern of the
occlusal
surface
should be duplicated to produce
adequate clearance
without overshortening the preparation
 Functional Cusp
Bevel

An integral part of the occlusal reduction is the

functional cusp bevel . A wide bevel on the lingual
inclines of the maxillary lingual cusps and the buccal
inclines of mandibular buccal cusps provides space
for an adequate bulk of metal in an area of heavy
occlusal contact.

If a wide bevel is not placed on the functional

cusp, several problems may occur
To prevent a thin casting
when there is no functional cusp bevel, an attempt
may be made to wax the crown io optimal thickness
in this area. An overcontoured restoration will result
and a deflective occlusal contact is likely to occur
unless the opposing tooth is reduced
Axial reduction:
Second prerequisite for structural durability is axial
reduction. When it is sufficient, restoration walls have
satisfactory thicknesses with out over contouring

Reinforcing struts: the features that serve to provide space for

the metal that will improve the durability and the rigidity of the
restoration: Offset the occlusal shoulder, the isthmus, the
proximal grooves, and the box. Isthmus connects the boxes, and
the offset ties the grooves together to enhance the reinforcing
“truss effect”.
 Marginal
Integrity

The restoration can survive in the biological

environment of the oral cavity only if the margins are
closely adapted to the cavosurface finish line of the
preparation. The configuration
of the preparation finish line dictates the shape
and bulk of restorative material in the margin of the
restoration It also can affect both marginal
adaptation and the degree of seating of the
restoration
 FINISH LINE
REQUIREMENTS

Definition:
The point at which a preparation terminates on
the tooth is called the finish line. It is also defined as the
peripheral extension of a tooth preparation (GPT).
There are three requirements for successful restoration
margins.

Fundamentals of tooth
Functions :
The finish line serves the following functions :
• During visual evaluation of the tooth preparation, it is
a measure of the amount of tooth structure already
removed. It also delineates the extent of the cut in an
apical direction. The more distinct it is, the better it
serves these purposes.
• The finish line is one of the features that can be used
to evaluate the accuracy of the impression made for
indirect procedures.
• In the die, a distinct finish line helps to evaluate the
quality of the die and helps in accurate die trimming.
• The correct marginal adaptation of the wax pattern
depends on an obvious finish line.
• The evaluation of the restoration is also aided by a
proper finish line.
• At cementation, a sharp finish line aids in determining
whether the restoration is fully seated.
• Historically a bevel was introduced to compensate for the casting
shrinkage of alloys used to fabricate crowns.

• Metal margins should be ideally acute in cross section rather than

right- angled to facilitate a closer fit.

• D is the distance by which the crown fails to seat

• d is the shortest distance between the tooth structure and the

restoration
• If the inner angle of the metal margin forms an angle m ,of less than
90 degrees with the path of insertion ,as does a bevel or a
chamfer ,d will be smaller than D.

• The shortest distance from the casting margin to tooth structure ,d,
can be stated as a function of D and the sine of the angle m or the
cosine of the angle p,which is the angle between the surface of the
d = D sin
m
or

d = D cos p

As the angle m is reduced its sine value also reduces and so

does the value of d…thus reducing the marginal discrepancy.
An angle of 30 to 45 degrees is considered optimal

• Angles above 50 degrees will not reduce the value of

d.
• Angles below 45 degrees will result in too thin a
 TYPES OF FINISH LINES
Chamfer finish line :
The preferred finish line for the veneer metal
restorations is the chamfer. This finish line has been
shown experimentally to exhibit the least stress, so that
the cement underlying it will less likelihood of failure. It
can be cut with the tip of a round end diamond, while the
axial reduction is being done with the side of that
instrument. However, a torpedo diamond is less likely to
produce a butt joint. The margin of the cast restoration
that fits against it combines an acute edge with a nearby
bulk of metal.
Heavy chamfer finish line :
A heavy chamfer is used to provide a
90-degree cavosurface angle with a large radius
rounded internal angle. It is created with a
round end tapered diamond. In the hands of an
unskilled operator, this instrument can create an
undesirable fragile lip of enamel at the
cavosurface. The heavy chamfer provides better
support for a ceramic crown than does a
conventional chamfer, but it is as good as a
shoulder. A bevel can be added to the heavy
chamfer for use with a metal ceramic
restoration.
Shoulder :
The shoulder has long been the finish
line of choice for the all-ceramic crowns. The
wide ledge provides resistance to occlusal
forces and minimizes stresses that might lead to
fracture of the porcelain. It produces the space
for healthy restoration contours and maximum
esthetics. However, it does require destruction
of more tooth structure than any other finish
line, the sharp 90-degree internal line angle
associated with the classic variety of this finish
line concentrates stress in the tooth and is
conductive to coronal fracture. The shoulder
generally is not used as a finish line for cast
metal restorations.
Shoulder with bevel :
The shoulder with a bevel is a used as a
finish line in a variety of situations. It is utilized
as the gingival finish line on the proximal box
of inlays and onlays, and for the occlusal
shoulder of onlays and mandibular three quarter
crowns. This design can also be used for the
facial finish line of metal ceramic restorations
where gingival esthetics is not critical. It can be
used in those situations where a shoulder is
already present, either because of destruction by
caries or the presence of previous restorations.
It is also a good finish line for preparations with
extremely short walls, since it facilities axial
walls that are nearly parallel.
Knife-edge :
The knife-edge margin provides for an
acute margin of metal. But its use can create
problems. Unless it is carefully prepared, the
axial reduction may fade out instead of
terminating in a definite finish line. The thin
margin of the restoration that fits this finish line
may be difficult to accurately wax and cast. It is
also more susceptible to distortion in the mouth
when the casing is subject to occlusal forces.
Featheredge :
A featheredge finish line is unacceptable
because it is not sufficiently distinct and results
in so little cervical tooth reduction that the
restoration must be over contoured to possess
adequate rigidity. Also, since a feather edge is
more difficult to see visually, occlusocervical
undulations and irregularities in the finish line
are more likely to be present, making it much
more difficult to fabricate a restoration that fits
accurately.
 Instrumentation
The advent of hand piece capable of speeds in excess of 100,000 rpm made possible
efficient cutting with smaller instruments,which made more sophisticated
preparations practical.

With high speed instruments the problem of over heating the tooth during
preparation
is critical.

Cutting dry can cause three times more dentinal burning and thermal changes
leading to pulpal inflammation and necrosis than with adequate air water spray.

Brown et` al calculated the temperature of high speed dry cutting to be 118
degree celcius.
The seriousness of which can be understood from Zach`s contentions that even
an increase of 20 degree Fahrenheit will lead to pulpal death in 60% of the
teeth.

Dry cutting of non-vital teeth also should be avoided as it can lead to micro
There are basically three main rotary instruments used in tooth
preparation
1. Diamond . stone
2. Tungsten carbide
bur
3. Twist drill
Diamond stones
Numerous small ,irregularly placed sharp diamond chips
are electroplated with a nickel or chromium bonding
medium to steel instrument blanks whose head is
machined to the desired final shape of the instrument.
They most effective against cutting enamel and porcelain.
An ideal diamond instrument should have diamond
stones evenly placed with intimate contact between the
chips and the binding material.
Tunsten carbide burs
They are best suited for making precise preparation
features and smooth surfaces on enamel and
dentin. They can also be used to cut metal.
The metal in the head of the tungsten carbide bur is
formed by sintering tungsten carbide powder and
cobalt powder under heat and vacuum.
These are then cut into desired lengths and attached
to
steel rods using soldering or welding.
Most burs have six and occasionally eight
blades. Finishing burs will have 12 blades.
The finer the finish more the number of blades.
The angle at which the face of the blade meets a line extending from the cutting
edge to the bur axis is known as the rake angle.
The more positive the rake angle.
The twist deill is made up of steel
It cuts only at its tip as it is pushed into the tooth in
the direction of the long axis of the instrument
It has deep twin heliocal flutes that wind around the
shaft
in a tight spiral,helping to remove chips from the hole.
Used to make small,uniform diameter,parallel-sided
holes in dentin to receive retentive pins for restorations.
The drill diameter is slightly larger than the pins that
are incorporated into cast restorations to allow for a
small cement space.
The working portion of this type of drill should be 3
– 5 mm long.
a shallow pilot hole is made with no.1/2 round bur
on a narrowhorizontal ledge to ensure that the hole
will be drilled precisely in its intended position.
0.6 mm twist drill,pin holes for parallel pins for
cast restorations
0.5 mm Kodex drill used for creating pinholes for
minim threaded pins,which retain amalgam and
compositecores.
Dual
instrumentation
Diamond burs cut through enamel more
efficiently than carbide burs but they leave
micro scratces on the surface reducing the finish
of the preparation.

Leading to rough cavosurface and

marginal preparation with diamond burs.

Hence for preparation of grooves ,box

forms , isthmus etc
Here both diamond and carbide burs are used
of the same length and diameter which are
configured
 Clearance
angle

Rake
angle
Common errors of tooth preparation :
1. Insufficient occlusal or incisal reduction.
2. Lack of uniform reduction of labial or buccal surfaces compromising esthetics.
3.Minimum axial reduction on the buccal and lingual surface of the posterior teeth,
which increases the incidence of working prematurities. The distinction between
reduction and clearance is crucial.
4.Inappropriate proximal reduction, which prevents having a cleanable embrasure
space.
5.Over reduction of teeth and/or violation of the biologic width.
6.Insufficient gingival reduction to accommodate a definite finish line.
7. Undercuts on the distolingual surface of the preparation and/or lack
of parallelism
of the FPD abutments.
8.Failure to contour proximal surfaces of adjacent teeth to allow seating of
a restorations.
ESTHETIC CONSIDERATIONS

The restorative dentist should develop skill in

determining the esthetic expectations of the patient.
Patients prefer their dental restorations to look as natural
as possible.
However, care must be taken that the esthetic
considerations are not preserved at the expense of the
patient’s long term oral health or functional efficiency.
Whenever possible, accomplishment of an esthetically
acceptable result without the use of metal-ceramic crowns is
preferred, not only because tooth structure is conserved but
also because no restorative material can approach the
 CONCLUSION

The principles of tooth preparation can be categorized into biologic,

mechanical and esthetic considerations. Often those principles conflict, and the
clinician must decide how the restoration should be designed. Each tooth
preparation must be measured by clearly defined criteria, which can be used to
identify and correct problems. It is important to understand the pertinent theories
underlying each step. Successful preparations can be obtained by systematically
following these steps. It is important to critically evaluate each step before
proceeding to the next step to ensure an optimal quality final restoration, which
will serve the patient for a long time.
References

Fundamentals of Fixed prosthodontics Herbert T.

Shillingburg, Hobo, Whitself, Jacobi, and Brackett. Third
Edition
Contemporary fixed prosthodontics. Stephen F.
Rosensteil, Martin F. Land and Junhei fjujimoto, Second
Edition.
Tylman’s theory and practice of fixed prosthodoontics.
William F.P. Malone and David L. Koth. Fifth Edition.
 Principles of operative dentistry-Marzouk,3rd edition.
THANK