01/05/05- Week 11- Fit and Contouring of #9 PFM

Shofu- ShadeEye: cordless measuring unit digitally analyzes shades and immediately
Transmits data to main unit via infrared interface simply, quickly, and reliably
Creating Beauty in Dentistry
Requires interpretation of:
1. proportion
2. perspective
3. lighting (color)
4 Factors of Aesthetic Composition
frame and reference
proportion and idealism
symmetry
perspective and illusion
1. FRAME and REFERENCE
3 dental frames: face, lips, and gingival
Interpupillary line-incisal plane and gingival margin outline must parallel interpupillary line
Lip line:
average tooth display
i. Males
1.91mm
ii. Females
3.4
iii. Short upper lip
3.65
iv. Long upper lip
0.59
v. Under 29 years
3.37
vi. 30-50 years
1.26
Phonetic references
o M sound incisal display at rest
o F and V lingual tilt of max central incisors
o S sound vertical dimension of speech
o Upper lip line serves to evaluate:
o Length of max incisor exposed at rest and during smile
o Vertical position of gingival margins during smile
o Lower lip lines serves to evaluate:
o B-L position of incisal edge of max incisors
o Curvature of incisal plane
o Vertical reference lines
o Midline of face
o Bridge of nose
o philtrum
o Facial Midline
o Location and axis of dental midline
o Mediolateral discrepancies in tooth position
o Starting point of esthetic treatment
o Reference points: nasion and philtrum
o Max centrals-dental baseline
o Dental Midline
o Facial midline

o Labial frenum
o Lingual papilla
o 75% of cases: max midline does not line up w/ mandibular midline
o Symmetry and natural variation- dental midline coincided w/ facial midline in 70% of population
o Smile line- parallel to interpupillary line
o Convex smile- curvature that follows lower lip w/max centrals incisal edge below
canines incisal edge
o Reverse smile- incisal edges of canines or premolars are longer than central incisors
forming reverse curve
2. IDEALISM and PROPORTION
Tools, not goals
3. SYMMETRY
o Discrepancies Central incisors of .2mm or more in 63% of population (14% totally identical)
o Lateral incisors: differ significantly in size, shape, rotation, and length
4. PERSPECTIVE AND ILLUSION
1. how the perception of shape of an individual tooth may be altered
2. how the elements of an aesthetic composition may effect one another
Principle of Gradation
Is the perception of a progressive reduction in size from the anterior teeth to the
Posterior teeth
Lateral negative space btwn the buccal outline of posterior teeth &corner of
Mouth helps achieve this effect
Increases illusion and depth
Golden Proportions
Ratio of 1:1.618
Central incisor: 1.608
Lat. Incisor:
1.0
Canine:
0.608
Golden Percentages for total width from canine to canine
25% central, 15% lateral, 10% canine
Communication with Lab
1.
shades
2.
anatomical variations
3.
arch irregularities
4.
variations in cervical 3rd
5.
simulation of restorations
For PFM #9 crown
If crown appear too wide:
Begin by rounding facial to the line angles
Appears Too narrow
Add horizontal depressions
Move line angles to lateral borders to aid in widening crown
Appears too wide
Add facial depressions
01/05/05- Week 11- Staining and Glazing

Transparent- clear, we can see thru it

Translucent- semitransparent, milky, foggy
Opaque- cannot see thru, will cover up other colors
Refraction- bending of a ray or wave of light as it passes thru layers of different density
Reflection- light thrown back or mirrored by a surface
Dark (deeper) objects- absorb more light rays and reflect fewer colors of their surfaces
Light (brighter) objects- reflect more rays and give off more intensity of color
7 colors in the prism:
Red, orange, yellow, green blue indigo violet
Light- electromagnetic energy that is produced by sun in different wavelengths
Cadmium yellow pale absorb all rays except yellow which it reflects back to eye
Ultramarine blue absorbs all rays except blue and red which make it an indigo color
Vermillion absorbs all rays except red and speck or yellow making it a warm red
Opaque pigments are made up of small particles suspended in a binding solution
Aspects of Color:
1. hue- name of color
a. any hue, if sufficiently grayed, may serve as a background for other strong hues in small
areas
2. value-level or brightness;
a. lightness or darkness of a color; of all 3 value is most important
3. intensitychroma: level of saturation; amt of pigment in certain color
a. purity of strength of a color
b. no color is more pure than when it comes from a tube
c. mix any color or medium with it and you change its intensity
secondary colors- complementary colors of primary colors
tertiary colors- combination of primary and secondary
A-Shades:
B-Shades:
C-Shades:
D-Shades:

Reddish Brown hue

Reddish-Yellow hue
Grey-Shades hue
Reddish-Grey hues (smallest and least used)

Arranged by Value
B1 - A1 - B2 - D2 - A2 - C1 - C2
D3 - A3 - D4 - B3 - A3.5 - B4
C3 - A4 - C4
Staining may be used to:
stimulate presence of aging restoration
simulate root exposure
simulate wear at incisal edge
simulate fracture line
Porcelain Glazing Instructions:
1. start with furnace at 1200 degrees F

2.
3.
4.
5.

dry and preheat crown at open door of furnace for 2-3 min
place crown in furnace at 1200 degree F. close furnace door after 1 min
increase temp to 1700 degrees F
each furnace different
a. start checking for glaze at 1600 degrees F
b. cont glazing to 1760
c. hold at 1760 for 1 min
if temperature too high, it may melt porcelain
01/12/05-Week 12- WAX PATTERN FABRICATION
CREATING A WAX PATTERN FOR TYPE III RESTORATION
Sawing out the Dies
After cast dried for 24 hrs benchtop or 1hr in drying oven (180F)
1. locate and expose tips of pins # 18,19,20
2. lightly sketch red/blue pencil line on yellow cast base parallel to and superimposing dowel pins #
18,19,20
3. design saw cuts by drawing lines on pink stone parallel to orientation lines of dowel pins
4. saw out die. These cuts should taper slightly to the parallel lines drawn
a. do not nick prepped toothremake!
b. If insufficient room to saw w/out destroying margins, begin by sawing btwn17+18 and
20+21
c. Saw from bottom of die stone btwn 18+19 and 19+20
d. Saw toward CEJ of 19 and 20 to avoid nicking margins
e. Lightly snap die apart once cut is close to CEJ of adjacent teeth
5. firmly push or lightly tap on end of dowel w/blunt instrument
Trimming the Die
1. use watermelon bur trim circumferentially, creating concave profile and base which is the same
area as finish line
a. base should not be larger than marginal area of prep
2. refine marginal area using discoid-cleoid. This should remove excess stone apical to margin so
that there is one distinct line and no stone gingival remaining
3. mark finish line with red/blue wax pencil. Never use graphite pencils (its and antiflux)
4. mount cast after dies cut
Tru-Fit Die Relief
this material provides space btwn wax pattern and die
will translate to space for cement in end product
use on axial-occlusal surfaces only
DO NOT put on margins
Die relief added in 3 separate alternating color
Coat 1: painted on 2.0mm from margin
Coat 2: 1.5 mm from margin
Coat 3: 1.0mm from margin
Coating with Die-Lube
Added to adj teeth and die for easy removal of wax
Blow material to thin film
Surfactant that prevents wax from adhering to stone
Wax up Die to Appropriate Contours and Occlusion

Final Sprued Pattern

Margin must be 5mm from top of casting ring
Reservoir must be centered in middle of ring
1. cut reservoir so that wax pattern can be attached
2. apply sticky wax to incisal/occlusal and sprue
a. smoothness of jxn allows for smooth flow of molten metal
-place 90mm or ring liner in casting ring
01/19/05 Week 13- AM CASTING TECHNIQUE FOR TYPE III METAL
CASTING ALLOYS & CASTING TECHNIQUE REVIEW & EXPANSIONS OF BASIC
UNDERSTANDING
High Heat Oven
1. start in cold oven (inserting in hot oven may result in cracking of investment)
2. max temp should be 900 F
3. leave in 1 hr
blowout- occurs when there in not investment material
Components of Casting Machine
ring
cradle
counterweight
base
pin
bracket
crucible
Gas/Air Torch
1. used for regular alloys only (metal-ceramic castings require gas-oxygen torch)
2. turn red knob first for gas flame
3. turn green know (air) once flame is adequate
4. look for reducing flame (blue)-always use reducing flame to assure even melting
a. oxidizing flame-orange
flux- removes contaminants; used for conventional gold alloys, not metal-ceramic alloys
CASTING ALLOYS
A. Noble Metals
a. Traditionally, basis for inlay, crown and bridge, and metal ceramic alloys due to corrosion
resistance
b. Includes gold, platinum, and palladium
B. Silver
a. Noble metal in periodic table, it is more reactive in mouth therefore not considered noble
metal in dental standpoint
C. Precious metals
a. All noble metals are precious, but not all precious metals are noble (i.e. silver)
b. Includes gold, platinum, palladium, and silver
c. All ware white colored, except for gold
D. Base metals
a. Non-noble metals

b. Influence physical properties, control of amt and type of oxidation or their strengthening
effects
c. Metals that are reactive with their environment= base metals
Karat- parts of pure gold in 24 parts of an alloy
i.e. 24 karat gold is pure gold; 22 karat gold is an alloy containing 22 parts pure gold and 2 parts
other metals
Fineness-describes gold alloys by # of parts per thousand of gold, with pure gold being 1000 fine
Rating is 10X the percentage gold composition (an alloy that is 75% pure gold is 750 fine)
More practical rating method than karat
Often used to identify gold alloy solders
DENTAL ALLOY TYPES
1. Type 1 (soft): small inlays can be easily burnished and subject to very slight stress; rarely used
2. Type II (Medium): inlays subject to moderate stress;
a. thick crowns, abutments, pontics, & full crowns
b. Rarely used
3. Type III (hard): inlays subject to high stress;
a. thin crowns, thin cast backings, abutments, pontics, full crowns and denture bases, &
short span bridges
4. Type IV (extra hard): denture base bars and clasps, partial denture frameworks, full crowns, and
long-Span fixed partial dentures
5. Metal Ceramic (hard & extra hard): PFM crowns, short span bridges (hard types), & long span
bridges (extra hard type)
a. these alloys vary greatly in composition.
b. Olympia Gold we use is primarily gold, and palladium
6. RPD alloys: RPD frameworks for the most part, use lighter weight, stronger, and less expensive
nickel or cobalt based alloys instead of type IV alloys
7. Nickel & cobalt-based alloys: have vastly different physical properties & handling characteristics
a. Used for crowns and bridges due to low cost
b. Margins much harder to finish & pts may experience allergies to NICKEL
GOLD ALLOY COMPOSITION
GoldAu
Precious/Noble
78-62%
SilverAg
Precious/Strength
26-8
CopperCu
Hardness/Strength
11-8
PalladimPd
Precious/Noble/Hardness
4-2
PlatinumPt
Precious/Noble/Hardness
7.5-0
ZincZn
Oxidizes easily (scavenger)
1
ADA classifications for dental alloys:
High noble: noble metal of 60% or greater; at least 40% must be gold
Noble: noble metal content of at least 25%
Predominantly base: noble metal content is less than 25%
Avoid overheating gold b/c composition changes
Always use at least 50% new gold when casting to replenish zinc that has been lost from old gold
MELTING RANGES:
Type III Gold (Firmilay):

1652-1760 F (900-960 C)

Ceramo metal (Olympia gold):

2192-2336F (1200-1280C)

Casting temperature ranges generally about 100-150F greater than melting ranges
HOWES GOLD COLOR SCALE
Temp (F)
890
1020-1150
1300
1560
1650
1740-1830
1920
>2100

Temp (C)
475
550-625
700
850
900
950-1000
1050
>1050

Color
just visible red
dull red
cherry red
light red
orange
full yellow
light yellow
white

Recovery of casting
1. plunge under cold water (quench) once red gold disappeared (5 min)
2. gypsum investment will disintegrate or break down
3. remove gross residue with toothbrush
4. oxides are removed by placing in 50% HCl (prevox) pickling
Common Defects in Casting
1. nodules
a. large- b/c air trapped during investment
b. multiple random nodules- b/c inadequate vacuum during mixing
2. roughness
a. black, rough casting-b/c breakdown of investment from excessive heat
3. finning
4. porosity
a. subsurface
b. back pressure
c. suck back
short rounded margins w/sharp button-b/c pattern too far from end of ring or, if casting is shiny,
incomplete burnout of wax
short rounded margins w/rounded or lumpy button-b/c alloy not hot enough or insufficient casting force
random porosity- b/c debris in wax pattern, loose particles of investment from sharp edges
shrink spot porosity- b/c sprue attachment too bulky. Sprue too long or thin. Button too small
nodules on underside only- b/c prolonged vibration after pouring
01/19/05 Week 13- FINISHING AND POLISHING
Finish: taking a surface w/ deep scratches and reducing them to finer scratches that are almost
undetectable to naked eye
Polish: acquiring smooth, shiny, lustrous surface layer
Beilby layer: as gold surface is polished, minute amts of abraded surface material (possibly even
Molecular sizes) are filled into surface irregularities, resulting in microcrystalline surface layer
Finishing and polishing helps prevent tarnish and corrosion

Tarnish-surface discoloration on a metal or even slight loss or alteration of surface finish or luster
-in mouth, occurs from formation of calculus and plaque
-forerunner of corrosion
Corrosion- actual deterioration of a metal by reacting w/ its envt
-may occur thru action of moisture, acid, or alkaline solns, and certain chemicals
-ingredients in foods and water, oxygen and Cl present in saliva all contribute to corrosion
KNOOP HARDNESS NUMBER (KHN) OF DENTAL MATERIALS
Type III Gold
Gold-Pd (Cameo)
Enamel
Porcelain
Pumice
Aluminum oxide
Silicon carbide
Diamond

40
230
343
460
560
1900
2500
8000+

Diamond-hardest of all abrasives, should be reserved for use on hard, brittle substances (enamel,
porcelain); when used on ductile substances (gold), abrasive particles become clogged w/
material being abraded
silicon carbide- pressed into many shapes to form separating discs & the many points & wheels
known as green stones
aluminum oxide- course grit used in brown, pink, or coral stones used for finishing metal ceramic
copings; fine grit used in white stones, which may also be used on gold
Sand- sandpaper discs coated with dense crystalline form of quartz, called flint
Flint-naturally occurring mineral that chips to form sharp cutting edges
Not as durable of strong as some other abrasives, but is useful abrasive in finishing cast gold
Impregnated rubber wheels, discs, & points- used for polishing metals and ceramics,
BBC (buffing bar cmpd)- fine polishing powder combined w/wax binder to form black cake
Used in initial polishing step of gold on either bristle brush or cloth buff wheel
Rouge-composed of iron oxide (Fe2O3) also in cake form
Used in final step of polishing gold castings
FORMS OF ABRASIVES
these materials are bonded to paper backing or mixed w/binder and pressed into various shapes
come in form of stone or rubber wheels, discs, and points used for specific processes
also incorporated into pastes for use on brushes, cloth wheels, or rubber cups
1. Separating discs (joe dandy)- stiff discs that cut on edges as well as on sides
a. Useful for removing sprues from castings, for sectioning FPD, contouring embrasures
2. moores discs-flexible papers discs coated on one side with various grits of garnet, sand, emery, &
cuttle, and are used for contouring & smoothing large convex areas on gold
a. each disc has square hole for mounting on special mandrel which allows reverse rotation
3. heatless stones (mizzy stones)- extremely coarse stones for bulk removal of metal
4. busch silent stones-large, fine-grained stones for reducing broad areas of porcelain
5. green stones-contain silicon carbide
a. permanently mounted to mandrels
6. white stones-contain fine grained aluminum oxide
a. useful for smoothing rough surfaces left by green stones and for adapting gold margins

7. rubber wheels, discs, and point- for finishing & polishing metals & ceramics
a. course discs
b. finer discs (Burlew)
c. even finer discs ( brownies and greenies)
wheels-good for adjusting contact areas
discs-good for broad surfaces (axial surfaces of crown
points-good for grooves
01/26/05- Week 14- CLINICAL SEATING
Lab Phase- Seating
Internal adjustment
Clinical Seating and Try-in
CIMOE
C= Contacts (proximal)
Crown seated clinically and proximal contacts assessed with floss and accufilm
Adjust proximal contacts using articulating paper
Sauder proximal to gain contact
I= Internal fit
Fit checker used during clinical try-in (equal lengths expressed and mixed)
Material placed in crown and completely seated
Any area of show through indicates high spot
Red felt pen used for lab try in
M= Marginal adaptation
Margins checked with #17 explorer
Margin can be closed but have a margin with a tooth or restoration ledge
(Acceptable proximity, but inadequate profile)
If margin undercontoured, may take off tooth structure but may lead to tooth sensitivity
O= Occlusion
Contact points should be positioned on cusp tips or in fossae.
All teeth must meet in centric contact
After axial surface complete, adjust occlusion using articulating paper
E= Esthetics
Anatomy must be re-established and surface polished
02/02/05- CAST POST AND CORE FABRICATION
RESTORATION OF ENDO TREATED TEETH
Treatment Planning
1. amount of tooth structure
2. functional demands of tooth
3. is the tooth an abutment?
Check pulpal situation
1. Non-endo treated tooth- prophylactic endo procedure even if tooth alive b/c need post & core
buildup
a. Check need for RCT
b. Check need for build up

c. Check biologic width and periodontal status

d. Check restorability
2. Endo treated tooth
a. Check crown/root ratio
b. Check periodontal status
c. Check biologic width
d. Check restorability
Choices in Buildup Material for Endo Treated Tooth
1. Prefabricated Dowel with amalgam or resin core
2. Custom fabricated dowel with amalgam or resin core
3. custom dowel and core Indirect or Direct
Post-goes into canal, used to retain core
Endodontist says that 7mm of gutta-percha needed remaining in canal
Restorative dentist says 4mm needed remaining in canal
Compromise5mm of gutta-percha needs to stay in canal
Core-surrounds post
Cast post and core reserved for severely damaged tooth
*if a tooth is fractured, height of remaining tooth structure should not exceed 2x the width(thickness)*
-must have 1.0-2.0 mm of vertical axial tooth structureFerrule effect
Studies of endo treated teeth show 94% success of teeth w/coverage
56% success of teeth w/out coverage
Cast dowel pattern fabricated w/acrylic resin or composite resin
Dowels should extend at least length of crown or 2/3 length of root, whichever is greater
Direct method for custom cast dowel and core:
1. canal prep
2. pattern fabrication
3. finishing and cementation
finished crown should create a ferrule effect requires 1.0-2.0mm of tooth structure below dowel
Ferrule effect: action of surrounding an object with a ring
Precision attachment RPD adds additional stress to already compromised situation
Inadequate dowel length
increases risk of root fracture
dowel must be below crest of bone
may lead to horizontal root fracture
Ability of posts to resist forces
increased length
parallel sides
moderate diameter
Morphologic Cast Posts
less retentive than parallel-sided posts in large root diameters
minimal stress during cementation
act as wedges during occlusal loading in short lengths

 not used often

in young pts, can use dentin substitute to build dentin wall so that post can be parallel
-too much taper can case fracture when vertical forces are applied
-ideal post diameter should not exceed 1/3 diameter of tooth
-violation of post size increases risk of fracture due to large size of cast post and core
-in large teeth w/morphologic design-resin reinforcement significantly improved structural resistance to
Fracture of thin walled teeth compared to morphologic dowel restorations
Dowel Shape
active-some form of threading that engages dentinal walls
o more retentive but puts lateral forces on dentinal wallfracture
passive-no threading
taper (morphologic) vs. parallel
at PACIFIC- we used parallel passive post system
Consider morphologic cast posts
in narrow ribbon shaped roots:
o mandibular incisors
o max premolars
o mand molar distal roots
o all doomed to fail
consider preformed posts
in roots with large cross sectional diameters
o max incisors
o max canines
o max molars palatal root
ferrule effect should be created using remaining tooth structure prior to pattern fabrication
Ferrule Effect
1. 1.5-2.0 mm long
2. parallel walls
3. totally encircle tooth
4. end on sound tooth structure
5. not invade attachment apparatus
standard parameter for dowel length
1. 2/3 of length of canal- up to 5mm from apex
2. equal coronal and radicular lengths
3. bone supported length of root
4. preservation of endo seal (3-5mm)
ideal dowel
1. 3mm from a fixed pros point of view
2. 7mm from endo
3. 4-5mm-compromise
Part I- CANAL PREP
Prep tooth using conventional anterior PFM
o Groove placed on facial or lingual wall 3-4mm apically
Never on M-D wall
An anti-rotational feature
Para post kit: for build up and cast dowel fabrication

o Para post drills: never begin with desired end size

0.9 smallest
1.0
1.25
Para post-2 fxns:
o For prefabricated dowel & core w/direct technique
o To retain provisional
o Post should not be > 1/3 F-L of tooth size
o Steel posts-for post and core w/direct technique
Also used to make temp
Plastic posts-burnout posts; cast build up
o Corresponds to drill size in para post kit
Initial gutta percha and tooth structure removed w/
o Lux plugger
o Gate glidden burs
o Peeso reamers
Select desired post size and mark working length with rubber stopper on instrument
Duralay acrylic used to fabricate dowel patters
o Also used as bite registration
Duralay lubricant placed using:
o Paper points
o Small paper brush
o Kerr applicator
o Always apply to adjacent teeth and tissue
Part II- PATERN FABRICATION
Initial placement of Post and Acrylic- place post in canal before initial shine is lost
After initial set, remove pattern and confirm accuracy, replace and allow for full set
After complete set, material will withstand indentation w/ explorer and possess no shine
Reprep tooth after set
LAB

Sprue patter- sprue in vertical orientation using sticky wax and sprue former
Pattern setup-adjust height so the position of dowel pattern is in thermal zone of casting ring
o Dont want post to expand b/c it will be converted to an active post
o Accomplished by not using ring liner
Debubblizer-cover pattern w/debubblizer completely and dry prior to investment
Casting ring prep- completely coat internal of casting ring w/ petroleum jelly
Investment material- invest patter w/ distilled water and phosphate bonded investment material
o Omit use of expansion liquid
Invested pattern
o Allow ring to bench set
o After set, scrape top flat

02/02/05- Week 15- ALTERNATIVE TECHNIQE FOR CAST POST CORE FABRICATION

Dr. Streackers method

o Isolate and prep post space
o Lube canal space and coronal portion of tooth w/ Vaseline, and adjacent teeth
o Mix acrylic and load needle tube tip and insert fully into post space and express
o Loading duralay
o Insert canula to base of canal
o Dispense acrylic while slowly w/drawing canula
Continue filling post space w/acrylic
Fill completely to orifice
Immediately insert burn-out post completely to depth of post space
Remove gross excess w/instrument and tamp excess around base of post
When acrylic looses its shine, begin pumping until fully set
Build coronal tooth structure w/new duralay
Clinically insert back into tooth and remove rubber dam
Prep core pattern to completion
Finished cast post core made of REXILLIUM
02/09/05 INDIRECT PROVISIONAL RESTORATIONS
Steps Take Prior to Prep
1. review health history
2. review dental history
3. FMX
4. treatment planning- pt involved
5. financial arrangements
6. study models-face bow transfer
7. mount study models
8. diagnostic wax-up and model fabrication
9. pressed form splint fabrication
10. indirect provisional fabrication
11. prep design
12. build-up fabrication
Template-Fabricated Provisional FPD
when FPD is to be made, prov restoration should also be in the form of a FPD
in posterior, the method will better stabilize teeth than individual crowns
pt can become accustomed to having a tooth in edentulous space
step 1. to make a splint, place denture tooth or crown form in edentulous space on
diagnostic cast
steps 2-6 : make splint
step 7. cut pressed form splint 2 teeth distal and mesial to abutment teeth, for 3-unit
bridge, there should be 7 teeth in splint
step 8- prep quadrant arch- preps should be more conservative than planned for final
restoration (more than mm reduction)
Step 9- try template on quadrant and confirm fit
Step 10- fill splint w/ bosworths trim
Step 11- place acrylic in interproximal areas of cast

Step 12- fully seat splint and hold in position with rubber bands
Step 13- place in Aqua-press for 10-15 min with warm water at 15 PSIs
02/16/05 BRIDGE PREP DESIGN AND CONCEPTS
KNOW HOW 6, 8, 10, and 20 TAPER LOOKS

as length increases, it is more difficult to judge draw

always think of bridge prep as a single tooth
the longer the span, the greater the potential to fail
more taper and shorter prep temp fails

Review Treatment Plan

QS asked
1. Is design of FPD chosen the best alternative?
2. Should RPD or implant be considered?
3. How is the individual crown to root ratio of each proposed abutment tooth?
4. How is the root configuration of each abutment?
5. Will antes law be violated?
6. Are the individual abutments sound?
7. Are they strong enough to withstand the pts occlusal forces?
8. How will I restore occlusion?
9. Are there other teeth that need addressing prior to FPD prep?
10. Am I ready for prep appt?
Conforming dentistry- take less than ideal situation and work way around it
Prior to Prep Appt
A. Have any medical concerns been addressed?
B. Are all teeth perio stable?
C. Has caries been arrested?
D. Is OH of pt acceptable?
E. Have financial arrangements been made?
F. Do I have mounted study models?
G. Do I have pressed formed splint?
H. Diagnostic wax-up completed?
I. Completed provisional shell?
J. Determined abutment design?
K. Clear goal of what must be accomplished at 1st appt?
Retainer Designs-there are many options and combos to select from
Range from conservative to heavily prepped
Most conservative = Maryland Bridge retainer
Least conservative = Porcelain Jacket retainer
Other retainers options include inlay, onlay, FVC, PFM
Combo of these could be considered
Restoration Design

 What material will be used?

What material will pt occlude against?
What type of connector will be used?
What will be shape of pontic?
Where will margins be located?
Prep criteria
1. each abutment prep must have individual draw
2. each abutment prep must draw with each other
3. the preps should be centered along long axis of tooth/teeth
4. finish line positioned:
a. lingual- .5mm supragingivally
b. facial- .5mm subgingivally
5. chamfer finish line used lingually, & should facially
6. total occlusal reduction 1.5mm on all cusps
7. cusps should be centered along arch form
8. cusp inclines should not be modified
9. 6-10 taper maintained
10. chamfer-shoulder blend occur just lingual to contact pts
02/23/05 Wk 18- # 4 PFM PREP
General Criteria for PFM Crown
Crown- Occlusal Reduction
How much reduction?depends if restoration will have metal occlusal, porcelain
Occlusal, or combo of both
-porcelain very brittle
Must watch shoulder depth when prep is below CEJ due to constriction at root trunk
-vertical concavity in axial wall of tooth prep extend occlusally from invagination where
Finish line crosses furcation
---------------45 yr old male w/history of bruxism and parafxnal behavior- has large MOD amalgam with
decay at gingival margin. Buccal cusp has been undermined and appears at risk for future fracture.
What are our treatment options?-----------TREATMENT OPTIONS
1.
2.
3.
4.
5.
6.
7.
8.

MOD amalgam
MOD gold inlay or onlay
MOD composite direct or indirect(fixed composite restoration; lab fabricated)
MOD porcelain inlay or onlay
MOD composite onlay
gold crown
full gold crown
PFM crown

9. porcelain jacket crown

Design Variations When Using a PFM Crown
1. metal occlusal w/metal collar(band of metal circumferentially)
a. most sealed
b. 90 shoulder w/ 45 bevel
2. metal occlusal w/ metal collar
3. Porcelain occlusal w/metal collar
4. metal occlusal w/ disappearing metal margin
a. 120 shoulder
b. Porcelain and metal disappear together at margin
5. metal occlusal w/ disappearing metal margin
6. porcelain occlusal w/ disappearing metal margin
7. metal occlusal w/ porcelain margin
8. metal occlusal w/ porcelain margin
9. porcelain occlusal w/ porcelain margin
a. most aesthetic
basically:
3 occlusal options:
1. full porcelain
2. full metal
3. metal (partial)\
3 Margin options:
1. full porcelain
2. disappearing metal
3. metal collar
-other decisions must be made:
1. will margin be supra- or subgingival?
2. will proximal contacts be porcelain or metal?
3. how large should facial margin be?
-for PFM, if margin on cementumno big issue
-porcelain on cementum leakage at margin
-but, best to avoid placing margin on cementum b/c tooth can flex and resin bond can
Break offopen margin
According to Dr. Straeaker,
90 shoulder on anterior teeth (all teeth seen in patients smile)
120 shoulder on posterior teeth
90 more aesthetic than 120 b/c no metal at margin
In a 120 shoulder prep, porcelain and metal terminates at shoulder, therefore, can see the grey
hue
#4 PFM Criteria for this exercise
metal occlusal
0.5mm metal collar
Supragingival margin- 120 shoulder facially
Proximal contacts in metal

Mesial: shoulder-chamfer blend just lingual to contact

Distal: shoulder-chamfer blend just facial to contact
Occlusal reduction
o Lingual (fxnal) cusp- 1.5 mm reduction
o Facial (nonfxnal) cusp- 2.0 mm reduction
Bevel
o Lingual- bevel height ~ 1/3 of total occlusal-cervical height
o Facial (aesthetic) bevel- ~ 2mm
o
o