PRINCIPLES OF TOOTH PREPARATION Dr.

Punam Bishnoi

CONTENTS INTRODUCTION ECHANICAL CONSIDERATIONS ES

BROAD CATEGORIES OF PRINCIPLES BIOLOGICAL CONSIDERATIONS M ESTHETIC CONSIDERATIONS SUMMARY AND CONCLUSION REFERENC

INTRODUCTION Tooth preparation is defined as mechanical treatment of dental disease or injury to hard tissues that restores a tooth to o riginal form. As tooth has no regenerative ability. Teeth require preparation to receive resto ration These preparation must be based on fundamental principles. Careful attent ion to every detail is imperative during tooth preparation

Acc. to Shillinberg the design of a preparation for a cast restoration and the e xecution of that design are governed by five principles: Preservation of tooth structure Retention and resistance Structural durability M arginal 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 occlusocer vical dimension and faciolingual dimension Circumferntial form of the prepared t ooth Preferred location for auxillary retention Uniform reduction Finish line lo cation Finish line form Reduction depths Line angle forn Surface texture

Acc. To Rosenstiel the tooth preparation can be studied under 3 Broad categories : 1. BIOLOGIC CONSIDERATIONS, CONSIDERATIONS, which affect the health of oral tiss ues 2. MECHANICAL CONSIDERATIONS, CONSIDERATIONS, which affect the integrity and durability of the restoration 3. ESTHETIC CONSIDERATIONS, which affect the appe arance of the patient

Best combination of compromises BIOLOGIC Conservation of tooth structure Avoidance of overcontouring Supragingival margin s Harmonious occlusion Protection against tooth fracture ESTHETIC MECHANICAL Retention form Resistance form Structural durability Minimum display of metal Maximum thickness of porcelain Porcelain occlusal surfa ces Subgingival margins

BIOLOGIC CONSIDERATIONS 1. Prevention of damage during tooth preparation -Adjacent teeth -Soft tissue -P ulp Conservation of tooth structure Avoidance of overcontouring -Axial reduction Marginal integrity and preservation of periodontium -Margin location -Margin ad aptation -Margin geometry or Finish line configuration Occlusal considerations P reventing tooth fracture 2. 3. 4. 5. 6.

Prevention of damage during tooth preparation

Adjacent teeth - iatrogenic damage - damaged proximal contact - To avoid Soft ti ssues - tongue and cheeks - careful retraction Pulp excessive temperature - chem ical irritation - microorganisms Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture P.D.Laforgia , Vito Milano , Camillo Morea & Apollonia Desiate in 1991recorded t he temperature changes in the pulp chamber during tooth preparation. Zach &Cohen - rise of 5.5 0C - 15% necrosis - rise of 11.10C - 60% necrosis - rise of 16.60 C - 100% necrosis

Conservation of tooth structure

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture Dowden stated that any damage to the odontoblastic processes will adversely effe ct the cell nucleus no matter how far from the nucleus it occurs More the remain ing dentin lesser the pulpal damage Must be considered relative GUIDELINES: 1. P artial coverage 2. Minimum taper

3. Planar occlusal reduction

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture 4. Even reduction of axial surfaces

5. Selection of conservative margin

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture 6. Avoidance of unnecessary apical extension of preparation

Avoidance of overcontouring

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture A crown should duplicate the contours and profile of the original tooth Undercon toured restoration is better than overcontoured restoration Anterior teeth, incr easing the proximal contour is better

Marginal integrity and preservation of tooth preparation Margin locationlocationBiologic width

Prevention of damage during periodontium

Conservation of tooth structure Avoidance of overcontouring Marginal integrity a nd preservation of periodontium Occlusal considerations Preventing tooth fractur e Its the dimension of space that the healthy gingival tissues occupy above the alv eolar bone. It refers to the combined connective tissue-epithelial tissueattachm ent from the crest of the alveolar bone to the base of the sulcus(2mm;connective tissue-1.07mm and tissueepitheliumepithelium-0.97mm). essential for preservatio n of periodontal health and removal of irritation that might damage the periodon tium

Violation of biological width:width:-

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture Nevins and Sukrow in 1984 recommended that for the maintenance of healthy period ontium, no restoration should violate the attachment ,even though its not possib le for a clinician to identify the most coronal extent of the junctional epithel ium. Wilson and Majnard cautioned against extending restorations so far subgingi vally that the attachment complex is damaged.They stated that Some distance of un prepared tooth structure should remain between the finished line and junctional epithelium and this distance should be ideally 0.5mm.

Violation of biologic width

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture Plaque accumulation one loss Attachment loss Periodontal pockets Advanced periodontitis B

Location of restorative margins:margins:-

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture Supragingival Equigingival Subgingival

Supragingival margin: Least traumatic to the soft tissues Margin placement Easily finished Impressions are easily made Most accessible for cleansing

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture Restorations can be easily evaluated

Subgingival margins: Clinical crown is short Old restorations with subgingival mar gin Esthetic appearance Caries, abrasion or erosion Root sensitivity

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture Disadvantages of subgingival margins Plaque retention Margin placement Mechanical irritation Violation of biological width Soft tissue injury

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture Criteria for subgingival margin placement:placement: Emergence profile Margins ar e closed and properly finished Adequate band of attached gingiva Margin should n ot violate the biological width

Crown lengthening procedures:procedures:Its a procedure similar to the apical rep ositioning of the flap with concomitant osteoplasty. Indications Short clinical crown Restoration impinge on the biological width Hopless teeth with extensive s ubgingival caries, subgingival fracture and root perforation Crown lengthening p rocedure Surgical methods Orthodontic method

D.A.Felton in 1991 conducted a study on Effects of in vivo crown margin discrepan cies on the periodontal health in his study he strongly supported the placement o f supragingival margins for artificial crowns and FPDs. William.G.Reeves in his r eview article concluded that more supragingivally a restorative margin is placed ,the less chance that the margin will contribute to gingival inflammation.

MARGINAL GEOMETRY OR FINISH LINE CONFIGURATION shape and bulk of the restorative material in the margin of the restoration inal adaptation Degree of seating of restoration

Marg

Guidelines for evaluation for margin design : Ease of preparation without overextension or unsupported enamel Ease of identifi cation in the impression and on the die Sufficient bulk of the material Conserva tion of the tooth structure A distinct boundary to which wax pattern can be fini shed

Finish lines The finish line is the peripherel extension of a tooth preparation The most impo rtant consideration in selecting a cervical margin design is its ability to cons istently and predictably provide excellent marginal integrity. Knife edge Chisel edge Chamfer Shoulder Sloped shoulder Shoulder with bevel Radial shoulder 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 me tal Disadvantages: The axial reduction may fade out Thin margin may be difficult to accurately wax and cast More susceptible to distortion Results in overcontou ring Indications: Not recommended

CHISEL EDGE Variation of feather edge Larger angle between the axial surface and unprepared tooth structure Associated with excessively tapered preparation Historic advanta ge-impression making with rigid advantageimpression compound in coper bands Indications: Lingual surface of mandibular posterior teeth as tilted Cementum The surfaces towards which tooth h

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 margi n Adequate bulk to the restoration Easier to control Exhibits least stresses Dis advantage -Care needed to avoid unsupported lip of enamel Indications: Cast meta l restorations Lingual margin of the metal ceramic crowns

Shoulder Bulk of the restoration Wide ledge provides resistance to occlusal forces Provid es space for healthy restorative contours Maximum esthetics It offers resistance against distortion during processing Disadvantages: Less conservative of tooth structure The sharp 900 internal line angle Indications: All ceramic restorations Facial magins of metal-ceramic crowns metal-

SLOPED SHOULDER Cavosurface margin - 120 120 Reduces the possibility of leaving unsupported enamel and yet leaves sufficient bulk to allow thinning of the metal framework to a kn ife edge for acceptable aesthetics. Indicated for facial margin of metal ceramic crowns

SHOULDER WITH BEVEL Removes unsupported enamel, allows finishing of metal Recommended for extremely short walls Disadvantage extends the preparation into the sulcus if used on apic al margin 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 oth structure

Stress concentration is less in the to

HEAVY CHAMFER Internal line angle is large radius rounded Provides better support for a cerami c crown than chamfer, but it is not as good as shoulder Easier to prepare than s houlder

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 suffi cient strength to withstand the forces of mastication More accurate the adaptati on 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

TO BEVEL OR NOT TO BEVEL Controversial by Ostlund Trignometric analysisanalysismore acute the bevelbevellesser the marginal discrepancy -lesser the seating with cement as D will increa se. So, bevel improves the marginal adaptation but reduces the seating of restor ation Empirical clinical results dictate that acute margin of metal should conti nue to be used on metal restorations but that angle should be in 30-45 30-45 Less angles will lead to thin and weak margins. More angle will lead to more marginal gap.

d=D sin u d=D cos q or D=d/sin u D=d/cos q Bevel of 450 prevent seating by 1.4 f actor 150 prevent by 3.9 50 prevent by11.5

OCCLUSAL CONSIDERATIONS

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing tooth fracture Occlusal scheme should not be traumatic Tooth preparation should allow sufficien t space for developing a functional occlusal scheme in the finished restoration Supraerupted or tilted teeth reduce the teeth Sometimes even the endodontic trea tment 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

PREVENTING THE TOOTH FRACTURE

Prevention of damage during tooth preparation Conservation of tooth structure Av oidance of overcontouring Marginal integrity and preservation of periodontium Oc clusal considerations Preventing 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 Inlaygreater potential for fracture Inlay Onlay lessens the chance of fracture Complet e crown greatest protection against fracture

MECHANICAL CONSIDERATIONS 1. RETENTION FORM 2. RESISTANCE FORM 3. STRUCTURAL DURABILITY

RETENTION FORM RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY DEFINITION DEFINITION-The feature of a tooth preparation that resists dislodgemen t of a crown in a vertical direction or along the path of placement. placement. In practice retention and resistance are closely related and they are not always clearly distinguishable. distinguishable.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY FACTORS AFFECTING RETENTION Magnitude of dislodging forces Geometry of tooth preparation -Taper -Surface are a -stress concetration -Type of preparation and secondary retentive features Rou ghness of surfaces being cemented Materials being cemented Type of luting agent Film thickness of luting agent

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY MAGNITUDE OF DISLODGING FORCES small compared to those that tend to seat or tilt it by pulling the FPD with flo ss under the connectors, when exceptionally sticky food is eaten Depends on the stickiness of food and the surface area and texture of the restoration being pul led

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY GEOMETRY OF TOOTH PREPARATION Essential elements of retention:retention: opposing vertical surfaces in same pre paration. Path of insertion Area under shear stress Freedom of displacement FACT ORS Taper Surface area Length of preparation Width of preparation stress concetr ation Type of preparation and secondary retentive features

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Opposing vertical surfaces in same preparation: 1) External surfaces:- eg. Bucca l & lingual walls of surfaces: full veneer crown. An extracoronal restoration is an example of veneer, or sleeve retention. Scan0001.jpg

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY 2) Internal surfaces:- eg. Buccal & lingual walls of the surfaces: proximal box of a proximo-occlusal inlay. proximoAn intracoronal restoration resists displace ment by wedge retention.

PATH OF INSERTION: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, sinc e it is the primary means of ensuring that the preparation is neither undercut n or overover-tapered. RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY The mesiodistal inclination of the path must parallel the contact areas of adjac ent 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: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Most important feature for retention is that the total surface area of cement wh ich will experience shearing rather than tensile stress. To achieve this the pre paration must have opposing walls nearly parallel to each other.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY 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.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Full veneer crown has excellent retention. When compared to partial veneer crown because reducing the path of insertion to a narrow range.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY If axial wall left unveneered retention is achieved by substituting a grooves, b oxes or pinholes for the missing wall. A grooved lingual wall must be distinct and perpendicular to the axial wall.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY FREEDOM OF DISPLACEMENT: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 a chieved when there is only one path.

TAPER RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY 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 CONVER GENCE. 2 opposing internal surfaces of the tooth structure must diverge occlusal ly ANGLE OF DIVERGENCE. The relationship of one wall of a preparation to the lon g axis of that preparation is the INCLINATION of that wall.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY 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. ed taper ed retention ed taper ed retention. Jogensen said as taper increases retention decreases. Retention of a crown with 10 degree of taper was approximately half that of a crown with 5 degree taper.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Ideal taper should be within the range of 2-6.5. 2-6.5 A taper of 6 have 6 been prop osed as being clinically achievable while affording adequate retention.

Jeffrey Nodlander, Dennis Weir, Warren Stoffer and Shigaro Ochi, JPD, vol. 60, 1 988. Conducted a study to measure the vol. 60, 1988. convergence angles of a ful l coverage preparations performed in a clinical environment. Teeth were prepared by the environment. participants to attempt a 4-10 convergence angle. The 10 angl e. convergence angles of all preparations were determined by projecting the faci olingual and mesiodistal silhouttes of the dies with an overhead projector. They concluded that, projector. the ideal convergence angle of 4-10 is seldom achieve d. 10 achieved. The convergence angle for mandibular preparations were greater th an maxillary. maxillary. Auxillary retention should be used in molar region beca use these preparations were found to have larger convergence angle. angle.

SURFACE AREA RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Provided the restoration has limited path of withdrawal, Greater the surface are a of a preparation, greater is its retention. Length.. Crowns with long axial wal ls are more retentive Molar crowns are more retentive than premolar crowns of sam e taper

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY STRESS CONCENTRATION If line angle between axial and occlusal surface is sharp, it leads to concentra tion of stresses around that junction Induced stresses exceeds the strength of t he cement Leads to cohesive failure of cement Rounding the internal line angles reduces the stress concentration and thus increases the retention of restoration

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY 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.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY If axial wall left unveneered, retention is achieved by substituting a grooves, boxes or pinholes for the missing wall. Secondary retentive features doesnot significantly affect the retention because the surface area is not increased significantly. But where these features limits the path of withdrawal, retention is increased

Surface roughness: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Adhesion of dental cements depends primarily on projections of the cement into m icroscopic irregularities. Jorgensen found retention of castings cemented with Z nPO4 cement on test dies with a 10 taper to be 10 twice as great on preparations w ith 40 m scratches than 10 m. Retention increases when restoration is roughened or grooved. Failure rarely occurs at the cement tooth interface. So roughening t ooth preparation hardly influences retention.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Materials being cemented: Retention is affected by both the casting alloy and the core material. More reac tive the alloy is more adhesion. Base metal alloys are better retained than less reactive high gold content metals. Type of luting agent: Studies show that adhesive resin cements are more retentive than compared to con ventional ZnPO4 and GIC cements.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Film thickness of the luting agent. agent. Ideal dimension for luting agemt space is 202040 microns for each wall. wall.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Steven M. Carter, Peter R. Wilson, IJP, vol. 9, 1996.- Conducted a study to see the 1996. effect on die spacing on pre and post cementation crown removal and cr own elevation. Different layers of die spacer was used. They observed that the f orce required to remove a crowns before cementation decreased with increased lay ers of die spacers.

RESISTANCE FORM RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY The features of a tooth preparation that enhance the stability of restoration an d resist dislodgement along an axis other than the path of placement (GPT). (GPT ). It prevents dislodgement of a restoration by forces directed in an apical, ob lique or horizontal direction. direction. The geometric configuration of tooth s tructure must place the cement in compression to provide the necessary resistanc e. resistance. Lateral forces tend to displace the restoration by causing rotati on around gingival margin

Methods to analyse resistance form RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

FACTORS AFFECTING RESISTANCE FORM Magnitude and direction of dislodging forces Leverage Length of the preparati Width of the preparation Taper Type of preparation Rotation about vertical axis Physical properties of luting agent

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Magnitude and direction of dislodging forces Resistance decreases in following o rder: - normal occlusion- axially directed forces occlusion- habits (pipe smoking and bruxing) large oblique forces to restoration - eccent ric interferences - anterior guidance

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY LEVERAGE AND RESISTANCE: Leverage occurs when the line of action of a force passes out side the supportin g tooth structure. If the force passes within the margin of a crown no tipping o f the restoration when compared to the line of action passing outside the margin s of the restoration

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Forces are outside the margin in the following cases: - wide occlusal table of r estoration - crowns on tipped teeth - retainers for cantilever bridge - force at an oblique angle

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY If a line 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 cem ent film is known as tangent point.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY If the tangent points of all the arcs of rotation around a given axis are connec ted they form the tangent line. The area above the tangent line is resisting are a. Rotation is prevented by any areas of the tooth preparation that are placed i n compression and are called as RESISTANCE AREA To have effective resistance the tangent line should extend at least halfway dow n the preparation.

Preparation length and resistance: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY -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: 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 t he wall opposite to axis of rotation. Resulting in a large resisting area. Weak resistance can be enhanced by placing vertical grooves/ boxes/ pinholes.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY A grooved lingual wall must be distinct and perpendicular to the axial wall. So U- shaped grooves or flared boxes Uprovides more resistance than V-shaped one s V-

Taper and Resistance: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY More tapered a preparation less is resistance. No taper the resisting area cover half the axial wall. Ideal taper < the axial wall. Over tapered small resisting area near the occlusal surface.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Permissible taper of a preparation is directly proportional to height : width ra tio. Taper that permit an effective resisting area for a preparation in which he ight equals width is double than in a preparation where height is only half widt h.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Formula to calculate: Taper: T = arc sin (2r/w), - Height of tangency point. r = (w sin T) / 2 - Prepa ration height h = [w tan (90- T/2)]/2. (90

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Rotation around a vertical axis: A partial veneer crown which has no grooves offer little resistance to rotation. Axial symmetry of a full veneer crown preparation may allow rotation of the rest oration.

Enhancing the resistance form by placing groove RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY TYPE OF PREPARATION Partial coverage restoration may have less resistance than a complete crown beca use it has no buccal resistance area 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 > Z nPO4 > Polycarboxylate > ZOE

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY STRUCTURAL DURABILITY A restoration must have sufficient strength to prevent permanent deformation dur ing function DEFINITION- The ability of a restoration to DEFINITIONwithstand dest ruction due to external forces is known as structural durability.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY Factors affecting structural durability 1. Adequate tooth reduction. - occlusal reduction - functional cusp bevel - axia l reduction 2. Alloy selection. 3. Metal-ceramic framework design. Metal4. Margi n design

ADEQUATE TOOTH REDUCTION OCCLUSAL REDUCTION:REDUCTION: RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY An important feature for providing adequate bulk of metal & strength to the rest oration is occlusal clearance. - Occlusal thickness varies with different restorative materials Gold alloys 1.5 mm (FC) & 1mm(NFC) MetalMetal-ceramic crowns- 1.5-2mm(FC)&1-1.5mm(NFC) crowns- 1 .5-2mm(FC)&1AllAll-ceramic crowns 2mm of clearance on preparation

- Firstly, opposing occlusal equilibration is to be achieved eg. Plunger cusps t o 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 for ces over a larger surface area. - Uniform and planar occlusal reduction.

This ensures: -sufficient occlusal clearance - preservation of tooth structure CCLUSAL OFFSET can be given on posterior partial veneer crown preparation to pro vide space for a TRUSS of metal to form reinforcing strap INCISAL OFFSET can be given on anterior partial veneer crown preparation to provide space for metal th at helps to strengthen the linguallingual-incisal margin

FUNCTIONAL CUSP BEVEL: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 overc ontouring & poor occlusion.

- If an attempt is made to obtain space for an adequate bulk in a normally conto ured casting without a bevel, it will result in over inclination of the buccal s urface which will destroy excessive tooth structure while lessening retention.

AXIAL REDUCTION:REDUCTION: It plays an important role in securing space for an adequate thickness of restor ative material. Inadequate axial reduction can cause thin walls & a weak restora tion 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 & durabilit y of the restoration are: The offset, the occlusal shoulder, the isthmus, the pr oximal 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) Eas e of polishing Little solidification shrinkage Minimal reactivity with the mold material Good wear resistance High strength Excellent corrosion resistance Porce lain Bonding

Classification : 1.Intended use: 1.Intended Traditionally alloys for casting wer e classified on the basis of their intended useuse-Type I: Simple inlays -Type I I: Complex inlays -Type III: Crowns and fixed partial dentures -Type IV: Removab le partial dentures and pin ledges. Porcelain: metal-ceramic alloys. metal2. Phy sical properties: FDI (1965) classified casting alloys according to their physic al properties as: Type I: Soft Type II: Medium Type III: Hard Type IV: Extra-har d Extra-

Factors 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 pe rcentage composition by weight of the main ingredients must be mentioned. 3. Cos t. 4. Clinical performance: A) Biologic properties -Gingival irritation. -Recurr ent caries. -Plaque accumulation. -Allergies.

B) Mechanical properties: -Wear resistance and strength. -Marginal fit. -Ceramic bond failure. -Connector failure. -Tarnish and corrosion. 5. Laboratory perform ance: Factors like casting accuracy, surface roughness, strength, metal-ceramic bond strength should be metalconsidered.

Choice of material: Gold: IndicationsIndications1.In situations of severe occlus al stress. 2.Following endodontic treatment of posterior teeth. 3.Full or partia l coverage of posterior teeth where there has been significant loss of coronal d entin. 4.For restoration of adjacent or opposing teeth to avoid problems arising from use of dissimilar metals. Contraindications: -Aesthetics --Cost --Cost

Porcelain (Ceramic): Indications: - Large inadequate restorations on the anterio r teeth provided there is enough tooth substance. - Severely discolored teeth. Over an existing post and core substructure. Contraindications: -Teeth with sho rt clinical crown -Edge to edge occlusion -Teeth which do not allow ideal prepar ation form to support the porcelain.

Metal ceramic: Indications: - Esthetics - Failure of porcelain jacket crowns. -P osterior teeth where esthetics is necessary and partial coverage gold crowns are contraindicated Contraindications: -Young patients at risk of pulp being expose d -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 1-A porcelain contact re quires 2mm of reduction -Occlusal contacts need to be 1.5-2.0mm from the porcela in1.5porcelainmetal junction -The substructure must support an even thickness of the porcelain veneer (1mm minimum and 2mm maximum). -The minimum thickness of t he metal is 0.2-0.3mm. 0.2-Cut-back: porcelain-metal junction should be 90r or g reater. Cutporcelain90r -Metal should preferably be in the area of the centric s top to enhance the durability of the restoration.

MARGIN DESIGN - distortion of restoration margin is prevented by designing the p reparation outline to avoid occlusal contact in this area - tooth reduction shou ld provide sufficient room for bulk of metal at the margin to prevent distortion

ESTHETIC CONSIDERATIONS METALMETAL-CERAMIC RESTORATION - Usually poor appearance is due to insufficient porcelain thickness - In additi on, the labial margin of metal ceramic crown is not always accurately placed - T o correct all these deficiencies, certain principles are recommended during toot h preparation

FACIAL REDUCTION - Adequate thickness of porcelain is needed to create a sense o f color depth and translucency - Adequate reduction sufficient bulk of porcelain for appearance and metal for strength - Minimum reduction of 1.5 mm is required - Shade problems incisal and cervical 3rd of restoration (here direct light ref lection from the opaque layer can make the restoration appear very noticeable

- Opaque porcelain generally have a different shade from body porcelain, they of ten need to be modified with special stains in these areas. - with very thin tee th like mandibular incisors. INCISAL REDUCTION - Incisal edge no metal backing. So, it can be made with a translucency similar to that of natural tooth structure - reduction 2 mm - Excessive reduction reduces retention and resistance

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 as the incisal edges without metal backing.

FEATURES OF DIFFERENT TYPE OF PREPARATIONS

ENDODONTICALLY TREATED TEETH stance form

Conservation of tooth structure

Retention form

Resi

Conservation of tooth structure PREPARATION OF CANAL Only minimum tooth structure should be removed from the can al Root canal should be enlarged only enough to enable the post to fit accuratel y yet passively while ensuring strength and retention

PREPARATION OF CORONAL TISSUE Coronal tooth structure should be saved as much as possible because.. Ferrule: - Extension of the axial wall of the crown apical to the missing tooth structure provides what is known as a ferrule. - helps to bin d the remaining tooth structure together, preventing root fracture during functi on

Retention form Preparation geometry

Post length

Post diameter

Post surface texture

Luting agent

Resistance form Stress distribution

Rotational resistance

Fibre reinforced composite prostheses Posterior FRC tooth preparation Occlusal isthmus (1.0 mm depth) Proximal step(1.0 mm axial depth) Shoulder/deep chamfer (1.2-1.5 mm)

Anterior FRC tooth preparation Linguoproximal step(1.0 mm axial depth) Shoulder/deep chamfer (1.2-1.5 mm)

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 inco rporation of factors to prevent the dislodgement of restoration by functional st resses. If too much emphasis is given on any one of the principles then the succ ess of the procedure may be limited by a lack of consideration of the other fact ors. An analysis of these principles and factors should enable the dentist to ef fectively apply them during the design of any preparation.

REFERENCES 1. Tylman SD, Malone WFP. Tylman's Theory and practice of fixed prost hodontics. 7th ed. St. Louis: Louis: Mosby; Mosby; 1978. 2. Shillingburg HT, Hob o S, Whit&t LD. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintesse nce Publishing Co, 1981. 3. Blair FM, Wassell RW, Steele JG, Crowns and other ex traextra-coronal restorations: Preparations for full veneer crowns. British Dent al Journal 2002;192:561-71. 2002;192:561 4.Rosenstiel SF, Land MF, Fujumoto J. Co ntemporary Fixed Prosthodontics.4th ed. St. Louis: Mosby; 2007. 5.Langeland K, L angeland LK. Pulpal reactions to crown preparation, impression, temporary crown fixation and permanent cementation. J Prosthet Dent 1965;15:129-43. 1965;15:129 6 .Laforgia PD, Milano V, Morea C, Desiate A. Temperature change in the pulp chamb er during complete crown preparation. J Prosthet Dent 1991;65:561991;65:5661.

7. Brannstrom M, Nyborg H. Cavity treatment with a microbicidal fluoride solutio n: Growth of bacterial and effect on the pulp. J Prosthet Dent 1973;30:303-10 19 73;30:303 8. Dowden WE. Discussion of methods and criteria in evaluation of denti n and pulpal responses. Int Dent J 1970;20:5311970;20:531-5. 9. Perel ML. Axial crown contours. J Prosthet Dent 1971;25:6421971;25:642-8. 10. Black GV. The mana gement of enamel margins. Dent Cosmos 1891;33: 85-100. 85 11. Bader JD et al. Eff ect of crown margins on periodontal conditions in regularly attending pataients. J Prosthet Dent 1991;65:75-82. 1991;65:75 12. Hunter AJ, Hunter AR. Gingival cro wn margin configurations. A review and Discussion : Terminology and widths. J Pr osthet Dent 1990;64:5481990;64:548-52.

13. Bell CJ, Bowden JR, Saund P, Smith M, Stephenson RI. The Dicer castable cera mic crown. Dent Practice 1987;25:20-5. 1987;25:20 14. Rosner D. Function,placemen t and reproduction of bevels for gold. J Prosthet Dent 1963:10:1160-66. 1963:10: 1160 15. Ostlund LE. Cavity design and mathematics: their effect on gaps at the m argins of cast casting. J Prosthet Dent restorations. Operative Dent 1985;10:122 1985;10:122-37. 16. Schweikert E . Feather-edged or knife-edged FeatherknifeDrep aration and impression technique. J Prosthet Dent 1984;52:243-6. 1984;52:243 17. Goodacre CJ. Designing tooth preparatios for optimal success. Dent Clin N Am 200 4;48:359-385. 2004;48:359-

THANK YOU