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FIXED PROS

TO

Daily Lab Projects 50%

Quiz, Midterm, Final 50%
You must pass both the lab
and the written independently

Do not be late

YOU HAVE 5min FOR EACH ESSAY

EACH QUESTION IS 2PTS
50 QUESTIONS TOTAL:
15 QUIZ
15 Midterm
20 final

Some of you
Will........

Fail

Worse situations exist

What happens when I fail?

remediation
90 crown preparations
and a 3hr 10
preparation practical

Perfection

CAD-ucation

Save Dental
Education

240k
160K
105K
Of students will have over
$100,000 of debt

85K

2000
Of female dental students

2004

2008

Cost of tuition

2012

Pre-clinical Curriculum

Of classes that are

not dental

Grading

The NEW way

Vision trumps all other senses.

DR. JOHN J. MEDINA

PFM

70%

Gold PFMAll-Ceramic
Gold
PFM

30% 70%

0%70%
30%

PFM
All-Ceramic
Gold
All-Ceramic

30%0%

70%
0%

Gold PFMAll-Ceramic
Gold
PFM

30% 70%

0%70%
30%

All-Ceramic
Gold
All-Ceramic

30%0%

0%

7 years
ago
7 years
ago
7
years
ago
7
years
ago
7
years
ago
7
years
ago
Dental School Private Practice

3%
MOSTLY 2ND
MOLARS

Gold Preparation

1-1.5 occlusal reduction

Functional cusp bevel

1mm axial

3-6 taper

878K 016

1mm supra-gingival

0.5mm chamfer

Posterior PFM

Ceram metal
Restorati ns
(PFM, PBM)

Incisal Porcelain
Dentin Porcelain
Opaque
Metal Coping

1950's by Dr Abraham Weinstein

in 1997 they made up 80% of all crowns
and bridges

2016 they made up 10% of all

crowns and bridges
replaced by all-ceramic crowns

PFM crowns as seen here can have metal exposed in unestetic

areas to allow for more conservative reduction in those areas
(1mm vs 1.5mm)

metal occlusals are perfect for bruxers

Ceram metal
Restorations
(PFM, PBM)

2mm
1mm

Rule:
Do not want >2mm
porcelain unsupported

Porcelain fracture from the metal framework

Porcelain fracture from the metal framework

PFM Preparation
follow reduction for gold if you
have areas that you want to keep
in metal

1.5-2mm occlusal reduction

Functional cusp bevel

or

1.5mm axial

3-6 taper
1mm supra-gingival unless in esthetic zone may
place 0.5mm sub-gingival using cord for
controlled margin lowering

878K 018 847kr 018

1mm heavy chamfer

1mm round
shoulder

When you use greater than 1/2 the diameter of a

chamfer diamond or greater than the entire
diameter of a shoulder diamond. Therefore it is
easier to lip a finish line with a chamfer diamond
than a shoulder diamond.

Things to avoid with

Finish Line design

We do not use a beveled

shoulder at MUSC

over
reduced

lipped

chamfer lip

shoulder lip

Beveled
Shoulder

Do not over reduce

Things to avoid
over taper

arbitrarily placing subgingival finish lines

Bridges

PFM alloys:
High noble: 60% with 40%
usually
phosphate
Noble:

25%
noble
bound
investment
Base: < 25% noble

gold

Porcelain bonds through covalent chemical bond to

oxide layer. Must add tin indium iron or gallium for
oxide to form.
Must have CTE of metal>ceramic
want melt temp 300-500 > porcelain fusing temp

never
more than
3 pontics,
even 2 is
risky

Antes Law
In 1926 Ante suggested that is was unwise to provide a fixed partial
denture when the root surface area of the abutment was less than the
root surface area of the teeth being replaced.

CEMENT
Zinc Phosphate:
Classic cement, long track, Low PH (sensitivity without varnish?) No Bond,
Mixed on frozen glass slab to increase working time. Not pop anymore
Zinc Polycarboxylate
weak but present bond to tooth esp enamel through calcium chelation, kind
to pulp
Glass Ionomer
Chemical bond to tooth, FL release, Good strength, sensitive to moisture/
desiccation during placement, CTE same as tooth
RMGI
Like GI but lower solubility, higher strength. Bad CTE, contradicted for all
ceramics.
Resin
Good mechanical properties and high bond, ideal for all-ceramic restorations

Terminology

Fixed Partial Denture

Retainer: 1:2 ratio ideal, 1:1 very

minimum and must be small span(1
pontic)

Soldering Flux: dissolves oxides and Increase flow

and Wets melts 150 below fusion temps.
anti- Flux: graphite, limits area of flux
Sodium Pyroborate
Borax
Silica

Strength depends on SA but

Height most important
double width, strength doubled
double height strength cubed!

0.25mm

Ridge lap, (Saddle)

Modified Ridge lap

Bullet (Heart, Conical)

Ovate

Sanitary, (Hygienic)

Saddle Pontic

(ridge lap)

plaque accumulation

Chronic inflammation

Modified Ridge Lap

eliminate concavity

Tissue
contacting
crest of
ridge.

Posterior

Anterior

Hygienic Pontic
(sanitary)

Hygienic Designs

conventional

Perel

Bullet Pontic

(heart shaped)

Ovate Pontic

No black triangles

Bridges may have rigid connectors

(Ideal)

or non-rigid connectors
(Contraindicated for mobile retainers)

Posterior Ceramic

All Ceramic
Measure Twice Cut Once

1.5-2mm occlusal reduction

more rounded
Functional cusp bevel
1.0mm

1mm round
shoulder

1.5mm axial

6-10 taper

847kr 018

In Posterior preserve enamel at margins!

Round internal line angle

preserve enamel

Non-anatomical Reduction

Non-anatomical does not mean

Flat!

D
M
B

Non-An
a

tomical

ica
m
o
t
a
n
A

Non anatomic reduction improved

crown adaptation

Anatomic reduction
increased gap, thinner ceramic

Heavy Chamfer

No undercuts

No

Le

g
n
i
an preps

1.5mm

1mm

Smooth Margins???

Rounded Shoulder

Li

pp

ed

Rounded Shoulder

Clinical Case

Anterior PFM

No form of Nature is inferior to Art;

for the arts merely imitate natural forms
Marcus Aurelius

imitate nature

Laboratory Technique

incisal (enamel) porcelain

body (dentine) porcelain

opaque

metal coping

PFM

(cross-section)

Pros

1.
Strong
2.
Can be esthetic
3.
Can be used for Bridges
4.Can have metal on occluding surfaces

Cons

Expensive
1.
Usually not esthetic
2. Prep must have retention
3. Porcelain breaks off over time
4.
Must hide unaesthetic
margins below tissue

margins exposed

margins exposed

not natural

not natural

"If I had eight hours to chop down

a tree, I'd spend six sharpening
my axe."
Abraham Lincoln

Get a good look at the natural tooth

Visualize the prep before you start

Visualize prep within tooth

2mm

1.5mm
F

1mm

1mm
0.5mm

1.3mm

1mm

1.5mm

"measure twice and cut once."

Inadequate

facial reduction

HEAVY facial reduction

Lingual wall undercut

correct

incorrect

Inadequate

lingual reduction

(variations)
Terminology Variations

Sloped
Shoulder

Shoulder

Heavy
Chamfer

Beveled
Shoulder

Chamfer

Shoulder
(rounded internal line angle)

Feather

Metal Only
Chamfer

Beveled
Shoulder

Feather

Beveled Shoulder

60%

sub-gingival margins
will be exposed within
2 years
Shillingburg, Jr, DDS, Herbert T.. Fundamentals of Fixed Prosthodontics, 3rd Edition. Quintessence Publishing (IL), 011997. 25.3.4)

No Metal Collar

00 cord will lower the tissue 0.25-0.5mm

(variations)
Terminology Variations

Sloped
Shoulder

Shoulder

Heavy
Chamfer

Beveled
Shoulder

Chamfer

Shoulder
(rounded internal line angle)

Feather

Avoid a lipped margin

lipped

chamfer lip

lipped

shoulder lip

Avoid a lipped margin

greater than
1/2 the
diameter of a
chamfer
diamond

greater than
80% the
diameter of a
round shoulder
diamond

1. mm

1.5mm

0.5 mm

1. Describe a PFM crown preparation on an anterior tooth

including mm of reduction, planes of reduction, reduction
for metal lingual vs ceramic lingual and finish line design.

2. Describe a PFM crown

including layers, thickness of layers, composition of
ceramic, bonding mechanism

Gold Preparation

1-1.5 occlusal
anatomical
reduction
Functional cusp bevel
1mm axial

3-6 taper

878K 016

1mm supra-gingival

0.5mm chamfer

PFM Preparation
follow reduction for gold if you
have areas that you want to keep in
metal

1.5-2mm anatomical
occlusal reduction
Functional cusp bevel

or

1.5mm axial

1mm supra-gingival unless in esthetic

zone may place 0.5mm sub-gingival
using cord for controlled margin
lowering

3-6 taper
878K 018

847kr 018

1mm heavy chamfer

1mm round
shoulder

All Ceramic
Measure Twice Cut Once

847kr 018

1.5-2mm occlusal reduction

non-anatomical=smooth and
rounded

1.0mm

Functional cusp bevel

1.5mm axial
1mm supra-gingival unless in esthetic
zone may place 0.5mm sub-gingival
finish line using cord for controlled
finish line lowering. In Posterior
preserve enamel at margins!

6-10 taper

847kr 018

preserve enamel
0.8-1mm round
shoulder

Round internal line angle

At MUSC we must achieve

a circumferential 2mm
vertical
ferrule effect where the
finish line is on solid tooth
structure cervical to a
filling or core.

2mm
3mm

It is important to maintain
biologic width where 3mm is
needed between the margin of
the crown and the crest of
the ridge. If this is in violation,
or predicted to be in violation,
a perio consult for crown
lengthening is mandatory.

3mm

2mm

When you use greater

than 1/2 the diameter of
a chamfer diamond or
greater than the entire
diameter of a shoulder
diamond. Therefore it is
easier to lip a finish line
with a chamfer diamond
than a shoulder diamond.

Critical errors that

may result in an
automatic failure
We do not use a beveled
shoulder at MUSC

847kr 018
1.0mm

over reduced

lipped

chamfer lip

shoulder lip

Beveled
Shoulder

Do not over reduce

over taper

Critical errors that

may result in an
automatic failure

arbitrarily placing subgingival finish lines