CONTENTS

Definitions
Objectives of tooth preparation
Principles of tooth preparation
Biologic considerations

Prevention of damage during tooth preparation

Thermal injury

Chemical injury

Conservation of tooth structure

Considerations affecting future dental health

Mechanical considerations

Types of occlusal forces

Retention form

Resistance form

Structural durability

Marginal integrity

Esthetic considerations

Partial coverage restorations

Metal ceramic restorations

Diagnostic tooth preparations

Diagnostic waxing procedures
Common errors of tooth preparation
Conclusion

DEFINITIONS
The process of removal of disease and / or healthy enamel and dentine and
cementum to shape a tooth to receive a restoration.
- GPT: 8
Tooth preparation may be defined as the mechanical treatment of dental
disease or injury to hard tissue that restores the tooth to the original form
- TYLMAN
OBJECTIVES OF TOOTH PREPARATION
PRINCIPLES
According to Shillingburg:
Preservation of tooth structure
Retention and resistance form
Structural durability
Marginal integrity
Preservation of the periodontiu
According to Rosensteil:

BIOLOGIC CONSIDERATIONS
I) Prevention of damage during tooth preparation:
a) Adjacent teeth:This damage can be avoided by;
b) Soft tissues:
c) Pulp:
Pulp affected by,
-

Temperature

Chemical agents

Microorganisms

II. Conservation of Tooth Structure:

Thickness of remaining dentin is inversely proportional to the pulpal response.
Tooth structure conserved using following methods:-

Tooth structure conservation

Minimum convergence angle.

Partial coverage.

Anatomic reduction

Apical extension.

Axial surface reduction.

Conservative margin

III. Considerations Affecting Future Dental Health:

A) Axial Reduction:
B) Margin Placement:
Advantages of Supragingival margins:
Subgingival Margins recommended in:
Root sensitivity,
Modification of axial contours needed.
Margin Adaptation:
Margin Design/ Geometry:
Guidelines:-

Basically 5 types of finis lines:

I) Featheredge / Shoulderless Margin:
Disadvantages:
Use:
II) Chamfer:
Advantages:Disadvantages:
Use:III) Bevel:
Advocated by Rosner in 1963 for gold castings having 3 fold objective:-.
Use:-

.
4

IV) Shoulder:Advantages:Disadvantages:V) Shoulder with bevel:Uses:-

William G. Reeves in 1991 restorative margin placement and periodontal health.

The degree of gingival inflammation was influenced by;
-

Failure to maintain proper emergence profile

Inability to properly finish subgingival margins.

Placement of gingival margins with little or no attached gingiva.

Violation of biologic width.

The feather edge and parallel bevels show the best marginal seal followed

in order by full shoulder, 450 shoulder and finally by 900 shoulder with 300 and
600 bevels.
Featheredge preparation with subgingival margins are recommended in,
-

Subgingival caries/ cervical erosion and abrasions

Subgingival tooth fracture

Defective subgingival restorations

Gingival margins present apical to CEJ

Shoulder preparation in mandibular incisors that may initiate pulpal

involvement and reduce retention.

Occlusal Considerations:

Whenever possible the occlusal plane should be reduced

to direct forces along the long axis of the tooth or to reduce the prematurities during
lateral excursions of mandible.
Preventing Tooth Fracture:

Thus, providing a cuspal coverage (onlay) is preferable than an inlay and a complete
crown is always a better option as it tends to hold the cusps together.

Contour:
According to Yuodelis et al, the restoration should not mimic the original
anatomic contour of the tooth but that of the root.
Tooth preparations of periodontally compromised patients are fluted short of
furca avoiding the triangular region formed by crevicular emergence and roots.
'Flat and not fat contour is now recommended.'
Points to be considered:-

Retention is influenced by occlusogingival length of axial walls

Proximal walls should be nearly equal in vertical length.

Facial and lingual walls are more convergent from the occlusal 3 rd to provide a
narrow occlusal table.
6

Short axial walls may require accessory methods of retention box, grooves,
pins.

Lee M. Jameson and William F.P. Malone in 1982 evaluated crown contours and
gingival margins.
MECHANICAL CONSIDERATIONS:

3 factors:-

1. Retention form
2. Resistance form
3. Preventing deformation of restoration
1. Retention Form:Various factors:a. Magnitude of dislodging force
b. Geometry of tooth preparation
c. Roughness of fitting surface of restoration
d. Materials being cemented
e. Film thickness of luting agents

a) Magnitude of dislodging forces:-

Stickiness of food

Surface area of restorations

Texture of restoration being pulled

b) Geometry of tooth preparation:non-adhesive and act by increasing the frictional resistance

between tooth and restoration. Cement is effective only if the restoration
has a single path of withdrawal.
7

Taper:
(undercut is defined as a divergence between opposing occlusal walls or wall
segments in cervico-occlusal direction).
i.e. retention decreased as taper increased.
E.g.Retention of GALILTH with 100 taper was half that
of 50 taper. Recommended taper is 5-80 with a rotary
instrument held at constant angle.
Surface Area:Stress Concentration:. Stresses are seen to concentrate around the junction of axial and occlusal
surfaces.
Modifications like rounding of internal line angles will reduce the stress
Types of Preparation: It is seen that retention of complete crowns is almost twice as
that of partial coverage. Grooves or boxes in a preparation which limit the path of
withdrawal enhances the retention.
Freedom of Displacement.
Maximum retention - when there is only one path .long parallel axial walls

- Length
8

More surface area - more retentive

Length - enough to interfere with the arc of the casting
The shorter the wall - more important its inclination.
The walls - little taper

Path of insertion
Survey a preparation
Over a cast- from 12 inches preparation to be surveyed
In the mouth-by holding the mirror inch above the preparation and viewing
indirectly.

c. Roughness of Surface being cemented:

cement restoration interface thus castings are deliberately roughened at the
fitting surface and this has shown to increase retention.
roughening the tooth in an attempt to increase retention is not recommended.
d. Materials being cemented:Retention is affected by both casting metal and core-build up material. It is
seen that the more reactive the alloy is the more will be retention with certain luting
agents.
cement adhered better to amalgam than composite or cast gold.
e. Type of luting agents:
Adhesive resin cements are supposed to be most durable
9

Resistance Form: Lateral forces tend to displace the restoration by causing rotation
around the gingival margins.
Adequate resistance depends on:1. Magnitude and direction of dislodging forces
2. Geometry of tooth preparation
3. Physical properties of luting agents.

1. Magnitude and direction of dislodging forces:occlusal load should be well distributed and favourably directed.
2. Geometry of tooth preparation:Particular areas of axial walls help prevent rotation of the crown.

FEATURES
They demonstrated;
-

Increase preparation taper and rounding of axial walls decreased resistance.

Shorter tooth preparation with large diameter little resistance form.

Partial coverage crown has less resistance than a complete coverage (as no buccal
resistance areas).

Resistance can also be improved by placing grooves and boxes especially with
walls being perpendicular to the direction of applied forces.
10

U-shaped grooves better than V-shaped. .

Additional Resistance and Retention:-

Grooves or boxes e.g. in 7/8th or 3/4th crowns.

Pins increase retention by increasing surface area tapered pins better

retention.
Parallel wall pins failed to demonstrate stability

5 ways to resist displacing forces:

4-100 axial taper

Suitable gingival finish lines

Contouring and placing suitable contact areas

Incorporating occlusal locks, dove tails, boxes

Tapered and parallel pins.

Anthony H.L. Tjan, Gary D. Miller - discussed about two groove flare designs
referred to as Type I and Type II.

Type I groove-flare :
Fishhook design
11

Encroachment on pulp

Type II groove-flare :

placed into the dentin paralleling a line

tangent

Physical Properties of Luting Agent:

Deformation:
Can occur as a result of;
a. Inappropriate alloy selection
b. Inadequate tooth preparation
c. Poor metal ceramic framework

Alloy Selection:

Type I and Type II gold for intracoronal cast restorations not for FPDs. Type
III and Type IV for FPD as they are harder and stronger, hardness can be
further increased by heat treatment.

High noble metal content metal ceramic restorations have hardness equivalent
to type IV alloys.

Ni-Cr alloys are harder indicated for long span bridges or where larger forces
are expected.

Adequate tooth reduction:-

12

gives rigidity to the crown because of Corrugated effect of the planes.

It is recommended that a minimum thickness of 1.5mm over centric cusps

(buccal in mandible and palatal in maxilla). The less stressed non-functional
cusps can be protected with less metal (1mm) for a strong and long lasting
restorations.

In malaligned or supraerupted teeth, it is necessary to prepare the occlusal

Margin design:

Distortion of the restoration margin is prevented by designing the preparation outline

to avoid occlusal contact in this area.

Should provide room for sufficient bulk of material Anatomic

occlusal reduction conservation of tooth structure and gives rigidity.

ESTHETIC CONSIDERATIONS
Points to be considered:

The esthetic requirements are then made

with relation to the oral hygiene needs
and potential for diseases.

Whenever

possible

partial

coverage

restoration is preferable to a metal ceramic crown because of the more natural

appearance and also conservation of tooth structure.

A. PARTIAL COVERAGE CROWN:

Esthetic partial coverage crown depends on accurate placement of visible
facial and proximal margins, many patients dont accept any visible display of metal.
Proximal margins:-

13

Especially mesial;
-

margin placed just buccal to proximal contact areas so that metal can
be hidden by distal line angle of neighboring teeth.

Tooth preparation angulation should follow the long axis of posterior

tooth and of incisal 2/3rd of facial surface of anterior tooth.

Facial margin:-

B. METAL CERAMIC RESTORATION:

Facial Tooth Reduction
The labial surface of anterior teeth should be prepared in 2 distinct plane.
Incisal Reduction:
Proximal Reduction:
Labial Margin Placement:

14

DEFINITIONS
The process of removal of disease and / or healthy enamel and dentine and
cementum to shape a tooth to receive a restoration.
- GPT: 8
Tooth preparation may be defined as the mechanical treatment of dental
disease or injury to hard tissue that restores the tooth to the original form
- TYLMAN

OBJECTIVES OF TOOTH PREPARATION

2. Reduction of a tooth in miniature to provide retainer support.
3. Preservation of healthy tooth to secure resistance form.
4. Provision for acceptable finish lines.
5. Performing pragmatic axial tooth reduction to encourage favorable tissue
responses from artificial crown contours i.e. fluting of molars.

PRINCIPLES
According to Shillingburg:
Preservation of tooth structure
Retention and resistance form
Structural durability
Marginal integrity
Preservation of the periodontium

15

According to Rosensteil:

BIOLOGIC CONSIDERATIONS
Tooth preparations affect the adjacent teeth, soft tissues and tooth pulp. This
may lead to inadequate fit, crown contour and plaque control. Thus, impeding with
the long term maintenance of a fixed restoration ultimately leading to the failure of
the restoration.
Factors to be considered here are:I) Prevention of damage during tooth preparation:
a) Adjacent teeth:The technique of tooth preparation must avoid damage to adjacent teeth
because a damaged tooth even if reshaped and recontoured is always more susceptible
to caries as,
16

Less fluoride content than surface layer

-

More plaque retention

This damage can be avoided by;

-

Placing a matrix band interproximally

Better method is by using a thin tapered diamond and by passing it

interproximally leaving thin lip/ fin of enamel intact.

b) Soft tissues:
Includes the tongue, cheek, lip, soft tissues should be carefully retracted using
an aspirator tip, mouth mirror and saliva ejector especially, the tongue while preparing
lingual surfaces of mandibular molars.

c) Pulp:
Here, proper knowledge of the anatomy and morphology of the tooth is
important. Diagnostic radiographs for assessing the pulp size and its proximity to the
outer surface.Pulp affected by,
-

Temperature

Chemical agents

Microorganisms

17

i) Temperature: Heat generated due to friction between rotary instrument and surface
being prepared. Excessive pressures, high speed, type, shape and condition of cutting
alters the heat produced precautions.

A light touch should be used for preparations.

Use of water spray, removes the debris and cools the tooth but the
disadvantage is it may hamper the visibility so a slow speed handpiece is used
while preparing grooves and pinholes.

ii) Chemical Action:

Cements, bases and luting agents are known pulpal irritants. Hence, the use of
cavity varnish (forms barrier) recommended. Chemicals commonly used to clean and
debride the preparation are contraindicated.
iii) Bacteria:
Due to bacteria left behind after preparation or having gained access to dentin
due to microleakage. Thus, removal of all carious dentin is essential before tooth
preparation.

II. Conservation of Tooth Structure:

Thickness of remaining dentin is inversely proportional to the pulpal response.
So the preparation should not extend very deep as this may damage the odotoblastic
processes which will adversely affect the cell nucleus at dentin pulp interface
(Dowden).
Thus, special care has to be taken when preparing vital teeth for complete
coverage.
Tooth structure conserved using following methods:

Use of partial coverage instead of full coverage crowns.

18

Preparation of teeth with minimum possible axial taper (i.e. not more than 80).

Preparation of occlusal surfaces so that reduction follows the anatomic planes

to give uniform thickness to the taper.

Preparation of axial surfaces so that tooth surface removed evenly and if

required the tooth can be repositioned orthodontically.

Selection of a conservative margin.

Avoiding unnecessary apical extension of the restoration.

Tooth structure conservation

Minimum convergence angle.

Partial coverage.

Anatomic reduction

Apical extension.

Axial surface reduction.

Conservative margin

III. Considerations Affecting Future Dental Health:

B) Axial Reduction:
Crown should replicate original tooth contour.
Axial wall ideally should have (5-80 taper mostly 60)

19

 An undercontoured restoration preferably to an overcontoured one as it is

easier to maintain oral hygiene. Sufficient tooth reduction to maintain good
axial contours enabling the junction between the tooth and restoration to be
smooth without any ledges or abrupt change in direction.

This is especially true for interproximal and furcation areas where periodontal
problems actually begin.

B) Margin Placement:

Very controversial.

Earlier, intracrevicular margins were recommended as gingival crevice was

considered

resistant

to

caries,

but,

according

to

recent

concepts

supragingival/equigingival margins preferred.

Bader et al., in 1991, studied the effect of crown margins on periodontal
conditions of patients receiving regular care.
They concluded that even in such patients subgingival margins are associated
with unfavorable periodontal conditions.
Advantages of Supragingival margins:
2. Easy to prepare and finish,
3. Easy to keep clean,
4. Impression made easily with less
potential for damaging soft tissues,
20

5. Restorations can be easily evaluated during recall appointments,

6. Usually rests on hard enamel.

Subgingival Margins recommended in:

1. Dental caries/ cervical erosions extending subgingivally,
2. Proximal contact areas extending to gingival crest,
3. additional retention,
4.
4.
4.
4. Margin of metal ceramic restorations is to be hidden behind labiogingival
crest,
5. Root sensitivity,
6. Modification of axial contours needed.
Margin Adaptation:
A well defined casting should have a smooth and even margin that makes the
subsequent steps of tissue displacement,
impression making, die formation, waxing and
finishing easier whereas a rough, irregular or
stepped margin increases the length of margin,
reducing the adaptation of restoration.
A casting that fits to within 10 m and a
porcelain margin that fits to within 50 m is desirable.
21

Margin Design/ Geometry:

Guidelines:-

Ease of preparation without extension

Readily identifiable on the impression and the die

A distinct boundary to which the wax pattern can be

finished.

Sufficient bulk of material (allow the wax pattern to be

handled without distortion and also giving strength to
the restoration).

Conservation of tooth structure.

Basically 5 types of finis lines:

I) Featheredge / Shoulderless Margin:
Formed when there is a larger angle between axial surface and unprepared
tooth structure.
Disadvantages:
-

Associated with excessively tapered preparation

Axial reduction not correctly with long axis of

tooth

Results in overcontoured restorations to gain

adequate bulk.

Knife edge/ chisel edge is a variation of

featheredge margin.

22

It is of historical advantage now; it facilitated the making of impression with

rigid modeling compound in copper bands as there was no ledge in which a band
would catch.
Use:
-

Younger patients

Inaccessible areas of cavity and cementum

Pinledge preparation

In tipped teeth (chamfer results in excessive reduction).

II) Chamfer:

Rounded axiogingival angle and obtuse angle to external surface of tooth.

Concave extra coronal finish line.

Advantages:-

Distinct margin, placed with precision

Adequate bulk of material with accurate stress distribution.

Easier to control even for sub-gingival margins.

Disadvantages:
-

Care needed to avoid unsupported lip of enamel

Metal margin can distort during firing of porcelain.

Use:-

Cast metal crowns

Metal only portion of metal ceramic restorations

23

III) Bevel:
Advocated by Rosner in 1963 for gold castings having 3 fold objective:

To allow the cast metal margin to be burnished against the tooth surface.

To minimize marginal discrepancy caused by complete

cast crown that fails to seat completely.

To protect the unprepared tooth surface from chipping.

Use:-

Cast restoration particularly if a ledge or shoulder

already exists.

Facial margins of maxillary partial coverage rest.

IV) Shoulder:Forms a 900 angle with unprepared tooth surface i.e., the external line angle of
the preparation is perpendicular to the long axis of tooth (An acute angle is likely to
chip).

Advantages:24

Adequate removal of tooth structure in the cervical

area resulting in more parallel preparation.

Distinct margins.

Good control over cervical reduction.

Resistance to marginal distortion during firing of porcelain.

Disadvantages:-

Ardous to prepare

More likely to promote pulpal involvement

A 1200 shoulder margin used as an alternative to 900
facial margin of metal ceramic restoration is a sloped
shoulder reduces the possibility of leaving unsupported enamel. This leaves

sufficient bulk of metal to allow thinning of metal framework for good esthetics.
V) Shoulder with bevel:The bevelling reduces unsupported enamel and allows finishing of metal.
However, a shoulder or sloped shoulder is preferred for biologic and aesthetic reasons
because the metal margin can be thinned to knife edge and placed in gingival sulcus
without the need to position the margin closer to epithelial attachment.
Uses:-

Bevel with a rounded axial angle: PFM.

Veneers and selected posterior teeth.

25

William G. Reeves in 1991 restorative margin placement and

periodontal health.
The degree of gingival inflammation was influenced by;
-

Failure to maintain proper emergence profile

Inability to properly finish subgingival margins.

Placement of gingival margins with little or no attached gingiva.

Violation of biologic width.

So, supragingival margins are of choice but while giving subgingival margins

above factors are to be considered.

Gravelis et al., in 1981, evaluated the effect of various finish lines preparation
on the marginal seal, of full crown preparation.
The feather edge and parallel bevels show the best marginal seal followed
in order by full shoulder, 450 shoulder and finally by 900 shoulder with 300 and
600 bevels.
With regard to seating of restoration, the 900 full shoulder showed the best seat
followed by 450 shoulder, 900 shoulder with 450 bevel, feather edge, 900 shoulder with
800 bevel and finally 900 shoulder with parallel bevel.
Edgar O Schweikert in 1984 conducted a study on Knife edge and feather
edge margins and impression techniques:
He recommended the use of featheredge and knife edge margins as they
simplify impression techniques, improve gingival health provided they have adequate
form, marginal seal and a well polished surface.

26

Featheredge preparation with subgingival margins are recommended in,

-

Subgingival caries/ cervical erosion and abrasions

Subgingival tooth fracture

Defective subgingival restorations

Gingival margins present apical to CEJ

Shoulder preparation in mandibular incisors that may initiate pulpal

involvement and reduce retention.

Occlusal Considerations:

A satisfactory tooth preparation should allow sufficient

space for developing a functional occlusal scheme in the finished restoration. The
occlusal plane is carefully planned and teeth reduced accordingly to compensate for
supraeruptions of opposing teeth. Thus, violation of principle of conservation of tooth
structure is preferable to the harm from a traumatic occlusal scheme. So, sometimes
endodontic treatment may be necessary to obtain the desired plane. Whenever
possible the occlusal plane should be reduced to direct forces along the long axis of
the tooth or to reduce the prematurities during lateral excursions of mandible.

Preventing Tooth Fracture:

An intracoronal cast restoration like inlay has a greater potential for fracture
because when occlusal forces are applied, the restoration tends to wedge against the
opposite walls of the tooth leading to fracture.

27

Thus, providing a cuspal coverage (onlay) is preferable than an inlay and a complete
crown is always a better option as it tends to hold the cusps together.

Contour:
Enhances accessibility for cleaning.

According to Yuodelis et al, the

restoration should not mimic the original anatomic contour of the tooth but that of the
root.
Tooth preparations of periodontally compromised patients are fluted short of
furca avoiding the triangular region formed by crevicular emergence and roots.
'Flat and not fat contour is now recommended.'
Points to be considered:-

Retention is influenced by occlusogingival length of axial walls

Proximal walls should be nearly equal in vertical length.

Facial and lingual walls are more convergent from the occlusal 3 rd to provide a
narrow occlusal table.

Short axial walls may require accessory methods of retention box, grooves,
pins.

Lee M. Jameson and William F.P. Malone in 1982 evaluated crown contours and
gingival margins.
-

Deflective contours or over contouring should be avoided in the cervical 3 rd

and interproximal areas.

Over contouring of the interproximal region is common and harmful to

periodontal health.

28

Fluting or barreling of exposed furcations eliminates plaque shelves and

promotes accessibility for hygiene.

Minimal disruptions within intracrevicular space during tooth preparation

allows a more predictable and favorable response.

MECHANICAL CONSIDERATIONS:

3 factors:-

4. Retention form
5. Resistance form
6. Preventing deformation of restoration

1. Retention Form:The quality of the restoration that prevents the restoration from being
dislodged by force parallel to the path of withdrawal called as retention form.

Various factors:a. Magnitude of dislodging force

b. Geometry of tooth preparation
c. Roughness of fitting surface of restoration
d. Materials being cemented
e. Film thickness of luting agents

a) Magnitude of dislodging forces:Forces can be exerted with a floss under the connectors but mainly force is
exerted by adhesiveness of foods. The magnitude of dislodging force depends on:-

Stickiness of food
29

Surface area of restorations

Texture of restoration being pulled

b) Geometry of tooth preparation:Most fixed prosthesis depend on the geometric form of tooth
preparation rather than on adhesion tooth retention as most of the dental
cements are non-adhesive and act by increasing the frictional resistance
between tooth and restoration.

Cement is effective only if the

restoration has a single path of withdrawal.

Taper:
Parallel walls give maximum retention but sometimes undercuts may be
created (undercut is defined as a divergence between opposing occlusal walls or wall
segments in cervico-occlusal direction).
The relationship between taper and
magnitude of retention was demonstrated by
Jorgensen in 1955. He cemented brass caps of
different tapers and measured retention. The
relation was found to be hyperbolic i.e.
retention

decreased

as

taper

increased.

E.g.Retention of GALILTH with 100 taper was half that of 50 taper. Recommended
taper is 5-80 with a rotary instrument held at constant angle.
Surface Area:

Crowns with long axial walls are more retentive than crowns with short axial
walls.

Molar crowns are more retentive than premolar crowns of similar taper.
30

Stress Concentration:Cohesive failure occurs within the cement as the stress within cement is less
than that of induced stresses. Stresses are seen to concentrate around the junction of
axial and occlusal surfaces.
Modifications like rounding of internal line angles will reduce the stress
concentration and increase retention of the restoration.
Types of Preparation: It is seen that retention of complete crowns is almost twice as
that of partial coverage. Grooves or boxes in a preparation which limit the path of
withdrawal enhances the retention.
Freedom of Displacement.
Maximum retention - when there is only one path .long parallel axial walls
Definite wall perpendicular to the direction of the force .
Proximal box - Buccal and lingual wallmeet the pulpal wall near 90

- Length
More surface area - more retentive
Length - enough to interfere with the arc of the casting
The shorter the wall - more important its inclination.
The walls - little taper

31

Path of insertion
Imaginary line along which the restoration will be placed.
Survey a preparation
Over a cast- from 12 inches preparation to be surveyed
In the mouth-by holding the mirror inch above the preparation and viewing
indirectly.

c. Roughness of Surface being cemented:

If fitting surface made very smooth failure seen to occur at the cement
restoration interface thus castings are deliberately roughened at the fitting surface and
this has shown to increase retention. E.g. roughening the surface by air abrading with
50 m alumina increases retention by 64%.
Failure rarely occurs at the cement tooth interface thus roughening the tooth in
an attempt to increase retention is not recommended.
d. Materials being cemented:Retention is affected by both casting metal and core-build up material. It is
seen that the more reactive the alloy is the more will be retention with certain luting
agents.
So, base metal alloys are more reactive than the less reactive high gold content
metals. A study examining adhesion between cement and core materials found that
cement adhered better to amalgam than composite or cast gold.
e. Type of luting agents:
Adhesive resin cements are supposed to be most durable although long term
clinical evidence about the durability of bond is not yet available.

32

Resistance Form: Restorations are also subjected to horizontal or oblique forces e.g.
mastication/ parafunctional habits. Lateral forces tend to displace the restoration by
causing rotation around the gingival margins. This rotation is prevented by areas of
the preparation that are placed under compression called as Resistance areas. Many
such areas make up the resistance form.
Adequate resistance depends on:4. Magnitude and direction of dislodging forces
5. Geometry of tooth preparation
6. Physical properties of luting agents.

1. Magnitude and direction of dislodging forces:In normal occlusion biting force distributed over all the teeth. Similarly in
FPD, occlusal load should be well distributed and favourably directed.
In patients with pipe smoking, bruxism habits, oblique forces are exerted over
FPDs. Thus, an ideal restoration should be able to withstand these forces as well as
the normal axial forces.
2. Geometry of tooth preparation:Particular areas of axial walls help prevent rotation of the crown. Hegdahl and
Silness analyzed how these resisting areas alter as changes are made in geometry of
tooth preparation.

33

They demonstrated;
-

Increase preparation taper and rounding of axial walls decreased resistance.

Shorter tooth preparation with large diameter little resistance form.

Partial coverage crown has less resistance than a complete coverage (as no buccal
resistance areas).

Resistance can also be improved by placing grooves and boxes especially with
walls being perpendicular to the direction of applied forces.
U-shaped grooves better than V-shaped. These grooves and pinholes interfere
with rotational movement and subject other areas of luting agent to compression.

Additional Resistance and Retention:-

Grooves or boxes e.g. in 7/8th or 3/4th crowns.

Pins increase retention by increasing surface area tapered pins better

retention.
Parallel wall pins failed to demonstrate stability

5 ways to resist displacing forces:

4-100 axial taper

Suitable gingival finish lines

Contouring and placing suitable contact areas

Incorporating occlusal locks, dove tails, boxes

Tapered and parallel pins.

Anthony H.L. Tjan, Gary D. Miller - discussed about two groove flare designs
referred to as Type I and Type II.
34

Type I groove-flare :

Fishhook design

Encroachment on pulp

Type II groove-flare :
placed

paralleling a line

into

the

dentin

tangent

Physical Properties of Luting Agent:

According to ADA No.8, the compressive strength of Zinc phosphate at 24 hrs
must be more than 70 mpa. Silicophosphate has higher strength whereas GIC, Zinc
polycarboxylate, and Zinc oxide eugenol have lesser.

35

Increase in temperature alters the compressive strength e.g. reinforced zinc

oxide eugenol when temperature increased from 230C to body temperature
compressive strength is halved.
Zinc oxide eugenol has a higher modulus of elasticity than polycarboxylate
cement. So, retention for polycarboxylate cement depends more on the taper of
preparation than for Zinc oxide eugenol.

Deformation:
Can occur as a result of;
d. Inappropriate alloy selection
e. Inadequate tooth preparation
f. Poor metal ceramic framework

Alloy Selection:

Type I and Type II gold for intracoronal cast restorations not for FPDs. Type
III and Type IV for FPD as they are harder and stronger, hardness can be
further increased by heat treatment.

High noble metal content metal ceramic restorations have hardness equivalent
to type IV alloys.

Ni-Cr alloys are harder indicated for long span bridges or where larger forces
are expected.

Adequate tooth reduction:-

36

Occlusal reduction should follow cuspal planes this ensures sufficient occlusal
clearance plus it will preserve as much as the tooth structure as possible and
also gives rigidity to the crown because of Corrugated effect of the planes.

It is recommended that a minimum thickness of 1.5mm over centric cusps

(buccal in mandible and palatal in maxilla). The less stressed non-functional
cusps can be protected with less metal (1mm) for a strong and long lasting
restorations.

In malaligned or supraerupted teeth, it is necessary to prepare the occlusal

surfaces of teeth keeping in mind the final restoration; diagnostic tooth
preparation and waxing are helpful in determining correct tooth reduction.

Margin design:
Distortion of the restoration margin is prevented by designing the preparation outline
to avoid occlusal contact in this area.

Should provide room for sufficient bulk of material e.g. feather edge thin layer
of metal not as strong as thicker chamfer.
Anatomic occlusal reduction conservation of tooth structure and gives

rigidity.

ESTHETIC CONSIDERATIONS
Points to be considered:

Make

full

assessment

appearance of each patient.

of

the

Observe

which teeth show while talking, smiling

etc.

37

The esthetic requirements are then made with relation to the oral hygiene
needs and potential for diseases.

Whenever possible a partial coverage restoration is preferable to a metal ceramic

crown because of the more natural appearance and also conservation of tooth
structure.

A. PARTIAL COVERAGE CROWN:

Esthetic partial coverage crown depends
on accurate placement of visible facial and
proximal margins, many patients dont accept
any visible display of metal.

Proximal margins:Especially mesial;

-

margin placed just buccal to

proximal contact areas so that
metal can be hidden by distal
line angle of neighboring teeth.

Tooth preparation angulation should follow the long axis of posterior

tooth and of incisal 2/3rd of facial surface of anterior tooth.

Facial margin:-

Facial margin of a maxillary partial coverage

restoration should extend just beyond the
occluso-facial line angle.

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Buccal margin should follow original anatomic

contour.

In mandibular partial coverage restoration, metal

display is unavoidable if metal unacceptable than a
metal ceramic restoration can be given.

Anterior partial coverage crown can be fabricated to show no metal facial

margin extended just beyond the highest contour of the incisal edge but not
inciso-labial line angle here, metal protects the tooth from chipping but wont
be visible.

B. METAL CERAMIC RESTORATION:

Facial Tooth Reduction
Adequate reduction is essential, it provides sufficient bulk of procelain and
adequate strength of metal. A minimum reduction of 1.5mm is considered adequate
proper thickness of porcelain is needed to create a sense of color, depth and
translucency with very thin teeth (e.g. mandibular incisors) it may be impossible to
achieve adequate tooth reduction without exposing pulp or leaving a severely
weakened preparation. A less than ideal appearance may have to be accepted
The labial surface of anterior teeth should be prepared in 2 distinct plane. If
prepared in one plane insufficient reduction in either the cervical or the incisal area of
the preparation will result.
Incisal Reduction:
An incisal reduction of 2mm is recommended for good esthetics excessive
incisal reduction must be avoided.
39

Proximal Reduction:
The extent of proximal reduction depends on the location of the metal ceramic
junction in the completed restoration.
Labial Margin Placement:
In patients with high lip line, exposing considerable gingival tissue poses the
greatest problem if complete crowns are need, where the root surface is not
discolored, the appearance can be restored with a metal ceramic restoration, having a
supragingival porcelain margin collar less design.
If a patient has a low lip line, a metal supra gingival collar as metal not visible
during function.
Metal margin can also be hidden below the gingival crest, for this care should
be taken the periodontium is healthy, margin should not be placed so far apically that
encroaches on the attachment.
Extension to within 1.5mm of alveolar crest will lead to resorption.
A common error is to prepare the tooth so that margin lies in one plane, with
exposure of collar labially and irreversible loss of bone and papilla proximally.

SUMMARY
The principles of tooth preparation can be categorized as biologic mechanical
and esthetic, often these principles conflict and operator must decide the design of the
restoration.
There are a lot of controversies regarding the preparation and geometry of
finish lines. So the various finish lines, their advantages and disadvantages can be
summarized as:-

40

Design

Advantages

Disadvantages

Indications

Featheredge

Conserves tooth
structure

Does not provide

sufficient bulk

Not recommended

Chisel edge

Conserves tooth
structure

Location of margin
difficult to control

Occasionally on tilted
teeth

Bevel

- Removes un
supported enamel.

Extends preparation
into sulecus if used
on apical margin

- Facial margins of
max. partial coverage
rest.

All.

- Inalys, onlay rest

- Allows finishing of
metal
Chamfer

- Distinct margins.
- Adequate bulk.
Easy to control

Design
Shoulder

Advantages
- Bulk of material

Care needed to avoid

unsupported lip of
enamel.
Disadvantages
Less conservative
tooth preparation

- Cast metal rest.

- Lingual margins of
metal ceramic
crowns.
Indications
- Facial margins of
metal ceramic.
- complete ceramic
crowns

Sloped
shoulder

- Bulk of material
- advantages of bevel

- Less conservation
of tooth structure

Facial margins of
metal ceramic
restorations.

Shoulder
with bevel

- Bulk of material

- Less conservative

- Advantageous
bevel.

- Extends apically

- Facial margins of
posterior metal
ceramic crowns with
supragingival

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margins

42

REFERENCES
1. Johnstons modern practice in fixed Prosthodontics.
2. Contemporary fixed Prosthodontics: Rosenstiel, Land Fujimolo.
3. Fundamentals of fixed Prosthodontics: Shillingburg
4. Fundamentals of fixed Prosthodontics: Tylman
6.

Journal of prosthetic Dentistry 1982.

7.

Journal of prosthetic Dentistry 1981

8.

Journal of prosthetic Dentistry 1984

9.

Journal of prosthetic Dentistry 1990

10.

Journal of prosthetic Dentistry 1991

11.

Journal of prosthetic Dentistry2001

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