Extracoronal Cast Restorations FULL VENEER CROWN

Dr AUJ Yap
Department of Restorative Dentistry Faculty of Dentistry

Full Veneer Gold Crown

Introduction Indications and Contraindications Advantages and Disadvantages Biological Considerations Preparation Techniques Features of a full veneer crown preparation Characteristics of Ideal Preparation Common Faults

Introduction
A metal restoration that covers the entire clinical crown and replaces crown morphological contours To be differentiated from porcelain-fusedto metal (PFM) crown

Indications
Extensive destruction from caries or trauma Endodontically treated teeth Large existing restoration that requires cuspal coverage

Indications
To provide contours to receive a removable appliance Minor recontouring of axial surfaces Correction of occlusal plane

Contraindications
Esthetic zone Less than maximum retention necessary Active caries and/or periodontal disease

Advantages
Strong, good retention and resistance Allows for modification to tooth morphology and occlusion

Disadvantages
Removal of large amount of tooth structure Possible adverse effects on gingival and pulpal tissues Vitality test not readily feasible Display of metal

Biological Considerations
Reduction opens a great number of dentinal tubules Heat generated by rotary instrumentation

 Tooth reaction to full veneer preparation dependent on

Patient age Previous carious damage Previous dental restoration

Preparation Technique
Pre-operative evaluation Occlusal reduction Functional cusp bevel Buccal / Lingual reduction Proximal reduction Margination Finishing

Armamentarium
Periodontal probe, straight explorer, mouth mirror High speed diamond burs
Round bur, tapered round-end diamond

Slow speed burs

Stones

Silicone preparation guide

Pre-operative evaluation

Pre-operative evaluation
Observe tooth position Observe centric occlusal contacts Identify functional and non-functional cusps

 Observe free gingival margin Evaluate depth of gingival sulcus Identify / visualise planned preparation and occlusion Silicone preparation guide

Occlusal Reduction

Objectives
Provide clearance with opposing surfaces
1.5 mm occlusal clearance over functional and 1.0 mm over non-functional areas

 Execute planned and controlled reduction of tooth structure Provide even thickness of metal to replace and reproduce occlusal morphology

Procedure
Depth orientation grooves (Depth cuts)
Controlled uniform removal of tooth structure Prevent inadequate tooth reduction

 Placement of depth cuts Round-end diamond (1 mm diameter) Occlusal primary developmental grooves Crest of triangular ridges Parallel to inner inclines Should be reduced accordingly to occlusal clearance with opposing tooth exist prior to tooth reduction

 Occlusal tooth removal Remove tooth structure between grooves in a sweeping motion Follow contours of the ridge inclines and occlusal morphology Altered occlusal relationships may require less or more tooth reduction Occlusal must not be prepared to a flat configuration

Functional Cusp Bevel

Objectives
To position prepared functional cusp directly opposite the opposing central groove To provide adequate clearance over a functional cusp for morphologic tooth contours

 To provide sufficient bulk of metal for structural durability

Location
Functional cusps
Palatal cusps of maxillary teeth Buccal cusps of mandibular teeth

Procedure
Use tapered round-end diamond Place bevel on functional outer incline
Occlusal axial line angle below opposing central fossa

Methods of verification
Silicone reduction guide Softened utility wax No.4 round bur (1.4 mm diameter) Plastic thickness gauges

Buccal / Lingual Reduction

Objectives
To conserve tooth structure with a controlled tooth surface removal technique To establish an axis of insertion with sufficient convergence with the occlusal

 To provide for adequate bulk of metal and prevent overcontoured morphology

Thin walls and weak restoration

Bulbous, overcontoured restoration

Procedure
Determination of axis of insertion (path of draw)
Long axis of clinical crown Long axis of tooth Orientation of adjacent teeth and their proximal contacts

 Placement of depth cuts

Use tapered round-end diamond Buccal and then lingual surfaces Developmental grooves, proximal line angles and mid-cusp Two planes (where applicable) 0.7 to 1 mm occlusally; 0.3 - 0.5 mm cervically

 Tooth removal Remove tooth structure between depth cuts Maintain convergence taper by aligning the axis of bur parallel with the axis of insertion Extend apically till 0.5 mm short of free gingival margin Carry out lingual reduction Ensure no undercuts

Proximal Reduction

Objectives
To eliminate proximal contact with adjacent teeth To establish a common axis of insertion with the buccal and lingual axial surfaces To create sufficient convergence to the occlusal

 To provide resistance form determined by the height of the axial walls and degree of taper To provide for sufficient bulk of restorative material

Procedure
Determination of axis of insertion
Long axis of clinical crown Long axis of tooth Prepared buccal and lingual surfaces Orientation of adjacent teeth and their proximal contacts

 Breaking of contact
Slender tapered bur Align bur parallel to long axis of crown in harmony with contact areas of adjacent teeth Sweeping / sawing motion Maintain shelf of enamel to protect adjacent teeth

 Tooth removal
Switch to tapered round-end diamond Hold bur parallel to selected axis of insertion

Margination

Objectives
To establish a termination of the preparation with a definite finish line configuration To provide for dimension for morphological contours in the margin area

Margin placement
Supragingival placement recommended
Greater access for oral hygiene

 Subgingival placement may be required for: Extension of caries Extension by previous restoration Additional resistance and retention form Aesthetic demands Non-carious cervical tooth loss (abrasion cavities)

Soft tissue protection

Adjacent tissues must be protected Damaged or lacerated tissues will interfere with clinical procedure Retraction cord

Procedure
Use fine-grit tapered round-end diamond Should be carried out after tissue retraction if margin is intracrevicular Establish light to medium chamfer marginal configuration

Finishing

Finishing of axial reduction

Join proximal and buccal / lingual surfaces at the line angles ensuring a smooth continuous flow to the axial reduction

Rounding of angles
Use fine-grit diamond or abrasive stones All line and point angles
Occlusal-axial Functional cusp bevel Central groove Line angles

Additional Retentive Features

Objectives
Increase resistance and retention form Prevents any rotation tendency during cementation (seating groove)

Procedure
Use No. 170 carbide bur Placed in axial wall with greatest bulk Usually on buccal surface of mandibular and palatal of maxillary preparations

Features of a full veneer crown preparation

 Occlusal clearance - at least 1.5 mm over functional cusps and 1.0 mm over nonfunctional cusps Functional cusp bevel present Axial reduction of 0.5 - 1.0 mm Axial surfaces converging to the occlusal with combined taper of 6 degrees

Characteristics of Ideal Preparation

 Proximal axial wall of at least 3 mm height for resistance form Chamfer margin with approximately 0.5 mm metal thickness Finish line well defined and continuous adjacent teeth not abraded or damaged during tooth preparation

Common Faults

Occlusal surface
Occlusal surface, grooves, marginal ridges under-reduced No or insufficient functional cusp bevel Over-reduced functional cusp Over tapered axial surface

Axial surfaces
Undercut Under-reduction Over-reduction Short, occlusal over-reduction or inadequate apical extension Line angles under reduced

Margins
Indistinct Irregular Excessive

Adjacent teeth
Tooth removal Surface abraded

Surface finish
Rough Axial-occlusal line angle not rounded

References
Rosenstiel SF, Land MF and Fujimoto J (1995) Contemporary Fixed Prosthodontics (2nd edition) Chapter 7. CV Mosby Company Shillingburg HT, Hobo S and Whitset (1981) Fundamentals of Fixed Prosthodontics (2nd edition) Chapter 5. Quintessence Publishing Company