A SEMINAR ON

PRINCIPLES OF
TOOTH
PREPARATION
PRESENTED BY:
Dr. Sukhjit Kaur
Submitted on
--/--/-1

INDEX
1. INTRODUCTION
2. PRINCIPLES OF TOOTH PREPARATION ACCORDING TO:

3.
4.
5.
6.
7.

SHILLINGBURG
DCNA
ROSENSTIEL
BIOLOGICAL CONSIDERATIONS
MECHANICAL CONSIDERATIONS
ESTHETIC CONSIDERATIONS
SUMMARY AND CONCLUSION
REFERENCES

INTRODUCTION
Tooth preparation is defined as the process of removal of diseased and/or healthy
enamel and dentin and cementum to shape a tooth to receive a restoration -GPT-8
Teeth require preparation to receive restoration. As tooth has no regenerative
ability, these preparations must be based on fundamental principles. Careful
attention to every detail is imperative during tooth preparation
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Acc. to Shillingburg (1981), the design of a preparation for a cast restoration and
the execution of that design are governed by five principles:
Preservation of tooth structure

Retention and resistance

Structural durability

Marginal integrity

Preservation of the periodontium

Acc to DCNA (2004), certain guidelines are given for preparation of tooth:
TOC(total occlusal convergence
Occlusocervical /incisocervical length
Ratio of occlusocervical dimension and faciolingual dimension
Circumferntial form of the prepared tooth
Preferred location for auxillary retention
Uniform reduction
Finish line location
Finish line form
Reduction depths
Line angle form
Surface texture

According to Rosenstiel (2007), the tooth preparation can be studied under 3 broad
categories:
1. BIOLOGIC CONSIDERATIONS,
which affect the health of oral tissues
2. MECHANICAL CONSIDERATIONS,
which affect the integrity and durability of the restoration
3. ESTHETIC CONSIDERATIONS,
which affect the appearance of the patient
BIOLOGIC CONSIDERATIONS
1. Prevention of damage during tooth preparation
Adjacent teeth
- iatrogenic damage is a common error resulting in a damaged proximal
contact which is more prone to caries. The technique of tooth preparation
must avoid and prevent damage to adjacent tooth surfaces. This can be
accomplished by using metal bands. However the best way is sparing the
contact area using a tapered diamond bur such that a portion of enamel is left
intact at the contact where the thickness of enamel is 1.5-2mm wide.
Soft tissues
- Tongue and cheeks can be protected by careful retraction with aspirator
tip, mouth mirror or flanged saliva ejector.
Pulp
4

Three types of insult to pulp can occur during tooth preparation:

-

Excessive temperature: heat generated during tooth preparation can

damage pulp. Excessive pressure, higher rotational speeds, and the type,
shape, and condition of the cutting instrument may all increase generated
heat. This can be prevented by using water spray with rotary cutting
instrument. It will also remove debris (important because clogging reduces
cutting efficiency) and prevent desiccation of the dentin (a cause of severe
pulpal irritation. Zach &Cohen in 1965 studied the effect of temperature rise
on pulp in rhesus monkeys. They observed necrosis of pulp with rise in
temperature.
Rise of 5.6C - 15% necrosis
Rise of 11.1C - 60% necrosis
Rise of 16.6C - 100% necrosis
-

Chemical irritation: The chemical action of certain dental materials

(bases, restorative resins, solvents, and luting agents) can cause pulpal
damage, particularly when they are applied to freshly cut dentin. Cavity
varnish or dentin bonding agents will form an effective barrier in most of the
instances.
- Microorganisms: Pulpal damage under restorations has been attributed to
bacteria that either were left behind or gained access to the dentin because of
microleakage. However, many dental materials, including zinc phosphate
cement, have an antibacterial effect.
2. Conservation of tooth structure

 Dowden (1970) stated that any damage to the odontoblastic processes will
adversely affect the cell nucleus no matter how far from the nucleus it
occurs.
Therefore, more the remaining dentin, lesser the pulpal damage. It must be
considered relative to the mechanical and esthetic principles of tooth
preparation.
GUIDELINES FOR TOOTH CONSERVATION:
1. Partial coverage rather than complete coverage restoration
2. Minimum taper

Rosenstiel fig. 7-10. Page 215

3. Planar occlusal reduction following the anatomic planes to give uniform
thickness in the restoration.

Rosenstiel fig. 7-11. Page 215

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2. Even reduction of axial surfaces leaving behind maximum thickness of

residual tooth structure around pulp.

Rosenstiel fig. 7-12. Page 216

5. Selection of conservative margin

Shoulder

(2)

is

less

conservative than chamfer(1). Rosenstiel fig. 7-13. Pp. 216

6. Avoidance of unnecessary apical extension of preparation
3. Avoidance of overcontouring
A crown should duplicate the contours and profile of the original tooth.
An undercontoured restoration is better than overcontoured restoration.
In anterior teeth, increasing the proximal contour is better to maintain the
interproximal papilla.

4. Marginal integrity and preservation of periodontium

4.1.

Margin location-

Biologic width
Its the dimension of space that the healthy gingival tissues occupy above the
alveolar bone. It refers to the combined connective tissue-epithelial attachment
from the crest of the alveolar bone to the base of the sulcus(2mm;connective
tissue-1.07mm and epithelium-0.97mm). It is essential for preservation of
periodontal health and removal of irritation that might damage the periodontium.

Violation of biological width

Nevins and Sukrow in 1984 recommended that for the maintenance of
healthy periodontium, no restoration should violate the attachment ,even
though its not possible for a clinician to identify the most coronal extent of
the junctional epithelium.
Wilson and Majnard cautioned against extending restorations so far
subgingivally that the attachment complex is damaged. They stated that
Some distance of unprepared tooth structure should remain between the
finished line and junctional epithelium and this distance should be ideally
0.5mm.
Violation of biologic width results in:
Plaque accumulation
Attachment loss

 Periodontal pockets
Advanced periodontitis
Bone loss
Location of restorative margins can be:
Supragingival
Equigingival
Subgingival
Supragingival margin: The supragingival finish line was proposed by Orban as
early as 1941 for improved periodontal health.

should be the finish line of choice for optimum periodontal health

It is the least traumatic to the soft tissues
Margin placement is on enamel
Can be easily finished
Impressions are easily made
Most accessible for cleansing
Restorations can be easily evaluated

Subgingival margins: The origin of the subgingival margin is attributed to the

concept of extension for prevention and the caries free zone by G.V.Black. These
are indicated if:

Clinical crown is short

Old restorations with subgingival margin
Esthetic requirement is high
Caries, abrasion or erosion extending subgingivally
Root sensitivity in recession/ periodontal conditions

Disadvantages of subgingival margins

9

Plaque retention
Margin placement
Mechanical irritation
Violation of biological width
Soft tissue injury

Criteria for subgingival margin placement:

Emergence profile
Margins are closed and properly finished
Adequate band of attached gingiva is present
Margin should not violate the biological width

Equigingival margin:
Marcum suggested an equigingival finish line, the success of which he
attributed to better marginal finish.
Harrison was of the opinion that the reason for the success of equigingival
finish line was the presence of keratinized epithelium in this region.
The equigingival finish line is considered positively due to its aesthetic
acceptability and accessible margin placement
Crown lengthening procedures:
Its a procedure similar to the apical repositioning of the flap with concomitant
osteoplasty.
Indications
Short clinical crown
If the restoration impinges on the biological width
Hopeless teeth with extensive subgingival caries, subgingival fracture and
root perforation.
10

Crown lengthening procedure can be Surgical

Orthodontic

4.2 Marginal geometry or finish line configuration

It is the shape and bulk of the restorative material in the margin of the
restoration.
The margin of restoration holds good only in the presence of a good
marginal adaptation
It also gives a n idea about degree of seating of restoration
Guidelines for evaluation for margin design :

Ease of preparation without overextension or unsupported enamel

Ease of identification in the impression and on the die
A distinct boundary to which wax pattern can be finished
Sufficient bulk of the material
Conservation of the tooth structure

Finish lines
The finish line is the peripheral extension of a tooth preparation
The most important consideration in selecting a cervical margin design is its
ability to consistently and predictably provide excellent marginal integrity.
Various types of finish lines are:
a) Knife edge/ feather edge
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b) Chisel edge
c) Chamfer
d) Shoulder
e) Sloped shoulder
f) Shoulder with bevel
g) Radial shoulder
h) Heavy chamfer

A. Feather edge, B. Chisel, C. Chamfer, D. Bevel, E. Shoulder, F. Sloped shoulder, G. Beveled shoulder

Knife edge or feather edge

Advantages
Conservation of the tooth structure
Permits an acute margin of the metal
Disadvantages:
The axial reduction may fade out

12

 Does not provide adequate bulk at the margin

Thin margin may be difficult to accurately wax and cast
More susceptible to distortion
Results in overcontouring in an effort to handle the pattern easily
Indications:
Not recommended

Chisel edge
A variation of feather edge
Larger angle between the axial surface and unprepared tooth structure
Associated with excessively tapered preparation and one in which the axial
reduction is not correctly aligned with the long axis of the tooth.
Historic advantage-impression making with rigid impression compound in
coper bands
Indications:
Lingual surface of mandibular posterior teeth
13

 The surfaces towards which tooth has tilted

Where the margin is to be placed on cementum

Chamfer
Its a finish line design for tooth preparation in which gingival aspect meets the
external axial surface at an obtuse angle
Advantages
It provides distinct margin
Provides adequate bulk to the restoration
Easier to control and can be placed with precision
Exhibits least stresses
Disadvantage
Care needed to avoid unsupported lip of enamel
Indications:
Cast metal restorations
Lingual margin of the metal ceramic crowns

14

Shoulder
A finish line design for tooth preparation in which gingival floor meets the
external axial surfaces at approximately a right angle.
Advantages:
Bulk of the restoration
Wide ledge provides resistance to occlusal forces
Provides space for healthy restorative contours
Maximum esthetics
It offers resistance against distortion during processing
Disadvantages:
Less conservative of tooth structure

15

 The sharp 900 internal line angle results in stress concentration at the internal
margin.
Indications:
All ceramic restorations
Facial magins of metal-ceramic crowns

Sloped shoulder
Cavosurface margin is 120
Reduces the possibility of leaving unsupported enamel and yet leaves
sufficient bulk to allow thinning of the metal framework to a knife edge for
acceptable aesthetics.
Indicated for facial margin of metal ceramic crowns
Disadvantage:
Less conservative of tooth structure
Shoulder with bevel

16

 The beveling removes unsupported enamel and may allow some finishing of
the metal.
Recommended for extremely short walls.
Disadvantage
McLean and Wilson have disputed the use of bevels for metal-ceramic
crowns because the bevel margin must be 10 to 20 degrees to noticeably
improve adaptation.
The finish line must also be placed too far subgingivally to hide the resultant
metal collar.
Indications
-facial margins of maxillary partial coverage restorations
- Inlay and onlay margin
-Shoulder is already present because of destruction by caries or presence of
previous restorations

Radial shoulder
Shoulder with rounded internal line angle
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 Stress concentration is less in the tooth structure

Heavy chamfer
Internal line angle is rounded to a large radius
Provides better support for a ceramic crown than chamfer, but it is not as
good as shoulder
Easier to prepare than shoulder

4.3 Marginal Adaptability

The restorative margins must fit as closely as possible against the finish line
of the preparation to minimize the width of exposed cement.
They must have sufficient strength to withstand the forces of mastication
More accurate the adaptation lesser the chance of recurrent caries
A well designed preparation should have a smooth and even margins
Whenever possible they should be located in the areas where the dentist can
finish and inspect them and the patient can clean them
Margin adaptability of a metal casting should be within 10micrometers
whereas for porcelain, it is within 50 microns.
TO BEVEL OR NOT TO BEVEL
Controversial by Ostlund
more acute the bevel18

-lesser the marginal discrepancy

-lesser the seating with cement as D will increase (the vertical discrepancy in
fit).
So, bevel improves the marginal adaptation but reduces the seating of
restoration
Empirical clinical results dictate that acute margin of metal should continue
to be used on metal restorations but that angle should be in 30-45
Less angles will lead to thin and weak margins.
More angle will lead to more marginal gap.

19

 A bevel of 450 prevent seating by 1.4 factor, 150 prevent by 3.9, 50 prevent
by11.5
5. OCCLUSAL CONSIDERATIONS
Occlusal scheme should not be traumatic
Tooth preparation should allow sufficient space for developing a functional
occlusal scheme in the finished restoration
Supraerupted or tilted teeth reduce the teeth according to the eventual
occlusal plane.
Sometimes even the endodontic treatment is necessary to make enough room
Careful judgment is needed and diagnostic tooth preparation and waxing
procedures are essential to determining the exact amount of reduction
required to develop an optimum occlusion
6. PREVENTING THE TOOTH FRACTURE
The likelihood that a restored tooth will fracture can be lessened if the tooth
preparation be designed to minimize the potentially destructive stresses
Inlay- greater potential for fracture
Onlay lessens the chance of fracture
Complete crown greatest protection against fracture
MECHANICAL CONSIDERATIONS
The mechanical principles have evolved from theoretical and clinical observations
and are supported by experimental studies. These can be divided into:
1. RETENTION FORM
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2. RESISTANCE FORM
3. STRUCTURAL DURABILITY

RETENTION FORM
The feature of a tooth preparation that resists dislodgement of a crown in a
vertical direction or along the path of placement.
In practice, retention and resistance are closely related and they are not
always clearly distinguishable.
Lack of retention is the third most common cause of failure of crown/ bridge
after caries and porcelain failure.
FACTORS AFFECTING RETENTION
Magnitude of dislodging forces
Geometry of tooth preparation
-Taper
-Surface area
-stress concentration
-Type of preparation and secondary retentive features
Roughness of surfaces being cemented
Materials being cemented
Type of luting agent
21

 Film thickness of luting agent

A. MAGNITUDE OF DISLODGING FORCES
These forces are small compared to those that tend to seat or tilt it
e.g. by pulling the FPD with floss under the connectors,

Force is greater when exceptionally sticky food is eaten

The magnitude of dislodging forces exerted by the elevator muscles depends

on the stickiness of food and the surface area and texture of the restoration
being pulled.
B. GEOMETRY OF TOOTH PREPARATION
Essential elements of retention: opposing vertical surfaces in same preparation.
Path of insertion
Area under shear stress
Freedom of displacement
Opposing vertical surfaces in same preparation
1) External surfaces:- eg. Buccal & lingual walls of full veneer crown.
An extracoronal restoration is an example of veneer, or sleeve retention.
2) Internal surfaces:- eg. Buccal & lingual walls of the proximal box of a proximoocclusal inlay. An intracoronal restoration resists displacement by wedge retention.

22

Path of insertion: It is an imaginary line along which the restoration will be placed onto or
removed from the preparation.
It is of special importance when preparing teeth to be fixed partial denture
abutments, since the paths of all the abutment preparations must parallel
each other.
Surveying visually, since it is the primary means of ensuring that the
preparation is neither undercut nor over-tapered.
The mesiodistal inclination of the path must parallel the contact areas of
adjacent teeth.
So if path is inclined mesially or distally, the restoration will be held up at
the proximal contact areas & be locked out.

Area under shear stress:

Most important feature for retention is that the total surface area of cement
which should experience shearing rather than tensile stress.
To achieve this, the preparation must have opposing walls nearly parallel to
each other.
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To obtain the greatest area of cement under shear stress, the direction in which a
restoration can be removed must be limited to one path

Full veneer crown has excellent retention when compared to partial veneer
crown because of reducing the path of insertion to a narrow range.
If axial wall is left unveneered, retention is achieved by substituting grooves,
boxes or pinholes for the missing wall.

A grooved lingual wall must be distinct and perpendicular to the axial wall.

24

Freedom of displacement: Retention is improved by geometrically limiting the numbers of paths along
which a restoration can be removed from the tooth preparation.
Maximum retention is achieved when there is only one path.

FACTORS
Taper
Surface area
Length of preparation
Width of preparation
stress concentration
25

 Type of preparation and secondary retentive features

TAPER
The axial walls of the preparation must taper slightly to permit the restoration to
seat.

i.e. 2 opposing external walls must gradually converge ANGLE OF

CONVERGENCE.
2 opposing internal surfaces of the tooth structure must diverge occlusally
ANGLE OF DIVERGENCE.

The relationship of one wall of a preparation to the long axis of that

preparation is the INCLINATION of that wall.

The more nearly parallel the opposing walls of a preparation, the greater
should be the retention.
Most retentive preparation should be one with parallel walls, but the parallel
walls are impossible to create in the mouth without producing certain degree
of taper.
Tooth preparation taper should be kept minimal because of its adverse
effects on retention.
Jogensen said as taper increases retention decreases.
Retention of a crown with 10 degree of taper is approximately half that of a
crown with 5 degree taper.

26

 Ideal taper should be within the range of 2-6.5.

A taper of 6 has been proposed as being clinically achievable while
affording adequate retention with zinc phosphate cement.

To minimize stress in the cement interface between the preparation and

restoration, a taper of 2.5 to 6.5 degrees has been suggested as optimum, but
there is only a slight increase in stress as taper is increased from 0 to 15
degrees. However, at 20 degrees, stress concentration increases sharply.
SURFACE AREA
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Provided the restoration has limited path of withdrawal, greater the surface
area of a preparation, greater is its retention.
Length of preparation
Crowns with long axial walls are more retentive.
Diameter
Molar crowns are more retentive than premolar crowns of same taper
STRESS CONCENTRATION
If line angle between axial and occlusal surface is sharp, it leads to
concentration of stresses around that junction
Induced stresses exceeds the strength of the cement
Leads to cohesive failure of cement
Rounding the internal line angles reduces the stress concentration and thus
increases the retention of restoration
TYPE OF RESTORATION AND SECONDARY RETENTIVE FEATURES
Full veneer crown has excellent retention when compared to partial veneer
crown because reducing the path of insertion to a narrow range.
If axial wall left unveneered, retention is achieved by substituting grooves,
boxes or pinholes for the missing wall.
Secondary retentive features do not significantly affect the retention because
the surface area is not increased significantly.

28

But where these features limits the path of withdrawal, retention

is

increased
C. SURFACE ROUGHNESS:
1. Air abrasion of fitting surface of casting with 50 micron alumina
2. Acid etching
Adhesion of dental cements depends primarily on projections of the
cement into microscopic irregularities.
Retention increases when restoration is roughened or grooved.
Failure rarely occurs at the cement tooth interface. So roughening
tooth preparation hardly influences retention.
D. MATERIALS BEING CEMENTED:
Retention is affected by both the casting alloy and the core material.
More reactive the alloy, more is adhesion.
Base metal alloys are better retained than less reactive high gold
content metals.
E. TYPE OF LUTING AGENT:
Studies show that adhesive resin cements are more retentive than
compared to conventional ZnPO4 and GIC cements. However,
nanoleakage is a cause of concern in such cements.
F. FILM THICKNESS OF THE LUTING AGENT.
Ideal dimension for luting agent space is 20-40 microns for each wall.

29

RESISTANCE FORM
The features of a tooth preparation that enhance the stability of restoration
and resist dislodgement along an axis other than the path of placement
(GPT).
It prevents dislodgement of a restoration by forces directed in an apical,
oblique or horizontal direction.
Mastication and Parafunctional activity cause substantial horizontal or
oblique forces.
The geometric configuration of tooth structure must place the cement in
compression to provide the necessary resistance.
Lateral forces tend to displace the restoration by causing rotation around
gingival margin
FACTORS AFFECTING RESISTANCE FORM
Magnitude and direction of dislodging forces
Geometry of tooth preparation
Leverage
Length of the preparation
Width of the preparation
Taper
Type of preparation
30

 Rotation about vertical axis

Physical properties of luting agent
A. MAGNITUDE AND DIRECTION OF DISLODGING FORCES
Resistance decreases in following order:
- normal occlusion- axially directed forces
- habits (pipe smoking and bruxing) large oblique forces to restoration
- eccentric interferences
- anterior guidance

B. GEOMETRY OF TOOTH PREPARATION

Leverage and resistance:
Leverage occurs when the line of action of a force passes outside the
supporting tooth structure.
If the force passes within the margin of a crown, no tipping of the restoration
occurs when compared to the line of action passing outside the margins of
the restoration

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 Forces are outside the margin in the following cases:

- wide occlusal table of restoration
- crowns on tipped teeth
- retainers for cantilever bridge
- force at an oblique angle
If a line is drawn from the center of rotation perpendicular to the cement
film on the opposite wall of the preparation, the point where the line
intersects the cement film is known as tangent point.

32

 If the tangent points of all the arcs of rotation around a given axis are
connected they form the tangent line. The area above the tangent line is
resisting area.
Rotation is prevented by any areas of the tooth preparation that are placed in
compression and are called as RESISTANCE AREA
To have effective resistance the tangent line should extend at least halfway
down the preparation.

Preparation length and resistance

Shortening of preparation will reduce the resistance area.
In short crown lifting force is small when compared to long crown.
Small restoration is less likely to fail through tipping than long restoration
(on preparation of equal length).
Resistance and tooth width:
A wider preparation has a greater retention but a narrow tooth can have greater
resistance to tipping.
Because of smaller diameter, a tangent line falls low on the wall opposite to axis of
rotation. Resulting in a large resisting area.
33

Weak resistance can be enhanced by placing vertical grooves/ boxes/ pinholes.

A grooved lingual wall must be distinct and perpendicular to the axial wall.
So U- shaped grooves or flared boxes provides more resistance than Vshaped ones

Taper and Resistance:

More tapered a preparation, less is resistance.
If there is no taper, the resisting area covers half the axial wall.
In ideal taper, the resistance area covers less than half the axial wall.
In over-tapered preparations, small resisting area is present near the occlusal
surface.
Permissible taper of a preparation is directly proportional to height : width
ratio.
Taper that permits an effective resisting area for a preparation in which height
equals width is double than in a preparation where height is only half width.
Rotation around a vertical axis
A partial veneer crown which has no grooves offer little resistance to rotation
34

Axial symmetry of a full veneer crown preparation may allow rotation of the
restoration.

C. TYPE OF PREPARATION
Partial coverage restoration may have less resistance than a complete crown
because it has no buccal resistance area
D. PHYSICAL PROPERTIES OF LUTING AGENT
Resistance to deformation is affected by physical properties of the luting
agent, such as compressive strength and modulus of elasticity
Adhesive resin >GIC > ZnPO4 > Polycarboxylate > ZOE

STRUCTURAL DURABILITY
A restoration must have sufficient strength to prevent permanent
deformation during function. The ability of a restoration to withstand
destruction due to external forces is known as structural durability.
35

Factors affecting structural durability

1. Adequate tooth reduction.
- occlusal reduction
- functional cusp bevel
- axial reduction
2. Alloy selection.
3. Metal-ceramic framework design.
4. Margin design
1. ADEQUATE TOOTH REDUCTION
OCCLUSAL REDUCTION
An important feature for providing adequate bulk of metal & strength to the
restoration is occlusal clearance.
- Occlusal thickness varies with different restorative materials
Gold alloys 1.5mm (Functional Cusp) & 1mm (Non Functional Cusp)
Metal-ceramic crowns- 1.5-2mm (Functional Cusp) &1-1.5mm (Non
Functional Cusp)
All-ceramic crowns 2mm of clearance on preparation

36

Opposing occlusal equilibration is to be achieved eg. Plunger cusps should be

rounded.
- Round line and point angles, avoid deep grooves in the center of the occlusal
surfaces to prevent stress concentration and to distribute the forces over a
larger surface area.
- Uniform and planar occlusal reduction.

This ensures:
-sufficient occlusal clearance
- preservation of tooth structure
OCCLUSAL OFFSET can be given on posterior partial veneer crown
preparation to provide space for a truss of metal to form reinforcing strap

37

 INCISAL OFFSET can be given on anterior partial veneer crown

preparation to provide space for metal that helps to strengthen the lingualincisal margin
Functional cusp bevel
It is an integral part of the occlusal reduction.
A wide bevel on the lingual inclines of the maxillary lingual cusps & the
buccal inclines of the 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 :
- If the crown is waxed & cast to normal contour, it can cause a thin area or
perforation in the casting. To prevent this, the crown may be waxed to optimal
thickness resulting in overcontouring & poor occlusion.
If an attempt is made to obtain space for an adequate bulk in a normally contoured
casting without a bevel, it will result in over inclination of the buccal surface which
will destroy excessive tooth structure while lessening retention.

AXIAL REDUCTION: It plays an important role in securing space for an adequate thickness of
restorative material.
38

 Inadequate axial reduction can cause thin walls & a weak restoration
subjected to distortion or a bulbous, overcontoured restoration which will
strengthen the restoration but may have a disastrous effect on periodontium.
Other features that provide space for metal and improve the rigidity &
durability of the restoration are:
The offset, the occlusal shoulder, the isthmus, the proximal groove & the box.
SELECTION OF THE ALLOY:
-It is essential that there be sufficient clinical evidence of superiority, before
selecting a particular material.
Desirable properties of dental casting alloys:

Biocompatibility

Ease of melting

Ease of casting

Ease of brazing (soldering)

Ease of polishing

Little solidification shrinkage

Minimal reactivity with the mold material

Good wear resistance

High strength

Excellent corrosion resistance

39

Porcelain bonding

Factors to be considered when selecting an alloy:

1. Color: The patients view on the subject should be sought if the metal will be
visible in the mouth; otherwise the color is irrelevant.
2. Composition: The percentage composition by weight of the main ingredients
must be mentioned.
3. Cost.
4. Clinical performance:
A) Biologic properties
-Gingival irritation.
-Recurrent caries.
-Plaque accumulation.
-Allergies.
B) Mechanical properties:
-Wear resistance and strength.
-Marginal fit.
-Ceramic bond failure.
-Connector failure.
-Tarnish and corrosion
5. Laboratory performance:
40

Factors like casting accuracy, surface roughness, strength, metal-ceramic bond

strength should be considered.
Choice of material:
Gold:
Indications1. In situations of severe occlusal stress.
2. Following endodontic treatment of posterior teeth.
3. Full or partial coverage of posterior teeth where there has been significant loss
of coronal dentin.
4. For restoration of adjacent or opposing teeth to avoid problems arising from use
of dissimilar metals.
Contraindications:
-Aesthetics
--Cost
Porcelain (Ceramic):
Indications:
- Large inadequate restorations on the anterior teeth provided there is enough tooth
substance.
- Severely discolored teeth.
- Over an existing post and core substructure.
41

Contraindications:
-Teeth with short clinical crown
-Edge to edge occlusion
-Teeth which do not allow ideal preparation form to support the porcelain.
Metal ceramic:
Indications:
- Esthetics
- Failure of porcelain jacket crowns.
- Posterior teeth where esthetics is necessary and partial coverage gold crowns
are contraindicated
Contraindications:
-Young patients at risk of pulp being exposed
-large pulp chamber
-Traumatic occlusion (heavy occlusal forces) , where wear of opposing occlusal
surfaces is expected.
METAL CERAMIC FRAMEWORK:
-A metal occlusal contact requires 1-1.5mm of reduction
-A porcelain contact requires 2mm of reduction
-Occlusal contacts need to be 1.5-2.0mm from the porcelain- metal junction

42

-The substructure must support an even thickness of the porcelain veneer (1mm
minimum and 2mm maximum).
-The minimum thickness of the metal is 0.2-0.3mm.
-Cut-back: porcelain-metal junction should be 90 or greater.
-Metal should preferably be in the area of the centric stop to enhance the durability
of the restoration.
MARGIN DESIGN
- distortion of restoration margin is prevented by designing the preparation
outline to avoid occlusal contact in this area
- Preparation margin should be kept approximately 1-1.5mm away from
occlusal contact areas.
- tooth reduction should provide sufficient room for bulk of metal at the
margin to prevent distortion

ESTHETIC CONSIDERATIONS
At the initial examination, a full assessment is made of the appearance of each
patient i.e. show of teeth during speech, smile and laugh as well as patients
expectations.
METAL-CERAMIC RESTORATION
- Usually poor appearance is due to insufficient porcelain thickness on the
labial surface.

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- In addition, the labial margin of metal ceramic crown is not always

accurately placed
- To correct all these deficiencies, certain principles are recommended during
tooth preparation
FACIAL REDUCTION
- Adequate thickness of porcelain is needed to create a sense of color depth
and translucency
- Adequate reduction creates sufficient bulk of porcelain for appearance and
metal for strength
- Minimum reduction of 1.5 mm is required
- Shade problems arise at incisal and cervical 3rd of restoration (here direct
light reflection from the opaque layer can make the restoration appear very
noticeable). Two plane reduction in incisors avoids insufficient reduction in
either cervical or incisal area of the preparation.
- The exact amount of reduction depends to some extent on the physical
properties of the alloy used, manufacturer and shade of porcelain.

- In older individuals, more thickness of porcelain is usually required.

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- Opaque porcelain generally have a different shade from body porcelain, they
often need to be modified with special stains in these areas.
- with very thin teeth like mandibular incisors, adequate reduction may not be
possible without compromising pulp and resistance form of tooth structure.
INCISAL REDUCTION
- Incisal edge of metal-ceramic has no metal backing. So, it can be made with a
translucency similar to that of natural tooth structure
- incisal reduction of 2 mm gives good esthetics.
- Excessive reduction reduces retention and resistance form of the preparation.
PROXIMAL REDUCTION
- Esthetics depends on exact location of the metal ceramic junction in complete
restoration
-

Proximal surface of anterior tooth will look most natural if they are restored

without metal backing.

SUMMARY AND CONCLUSION
Proper attention should be given during margin placement and the principle
of Do no harm to the soft tissues should be followed. All preparations
require the incorporation of factors to prevent the dislodgement of
restoration by functional stresses. If too much emphasis is given on any one
of the principles then the success of the procedure may be limited by a lack
of consideration of the other factors. An analysis of these principles and
factors should enable the dentist to effectively apply them during the design
of any preparation.
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REFERENCES
1. Tylman SD, Malone WFP. Tylman's Theory and practice of fixed
prosthodontics.
2. Shillingburg HT, Hobo S, Whitsett LD. Fundamentals of fixed
prosthodontics. 3rd ed. Chicago: Quintessence Publishing Co, 1981.
3. Blair FM, Wassell RW, Steele JG, Crowns and other extra-coronal
restorations: Preparations for full veneer crowns.

British Dental Journal

2002;192:561-71.
4.

Rosenstiel

SF,

Land

MF,

Fujumoto

J.

Contemporary

Fixed

Prosthodontics.4th ed. St. Louis: Mosby; 2007.

5. Langeland K, Langeland LK. Pulpal reactions to crown preparation,
impression, temporary crown fixation and permanent cementation. J Prosthet
Dent 1965;15:129-43.
6. Hunter AJ, Hunter AR. Gingival crown margin configurations. A review and
Discussion : Terminology and widths. J Prosthet Dent 1990;64:548-52
7. Goodacre CJ. Designing tooth preparatios for optimal success. Dent Clin N
Am 2004;48:359-385.
8. Sarandha D.L. Effects of location of gingival finish lines on periodontal
integrity. J Nepal Dent Assoc 2013;13(1):74-77.

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