Fixed prosthodontics
Fixed prosthodontics is the area of prosthodontics fo-
cused on permanently attached (xed) dental prosthe-
ses. Such dental restorations, also referred to as indi-
rect restorations, include crowns, bridges (xed dentures),
inlays, onlays, and veneers. Prosthodontists are special-
ist dentists who have undertaken training recognized by
academic institutions in this eld. Fixed prosthodontics
can be used to restore single or multiple teeth, spanning
areas where teeth have been lost. In general, the main ad-
vantages of xed prosthodontics when compared to direct
restorations is the superior strength when used in large
restorations, and the ability to create an aesthetic looking restoration, such as amalgam or a resin like uorocore,
tooth. As with any dental restoration, principles used to
determine the appropriate restoration involves consider-
ation of the materials to be used, extent of tooth destruc- apy would then be indicated, as the post descends into the
tion, orientation and location of tooth, and condition of
neighboring teeth.
1 Preparation techniques
Preparation of a tooth for a crown involves the irre-
versible removal of a signicant amount of tooth struc-
ture. All restorations possess compromised structural and
functional integrity when compared to healthy, natural
tooth structure. Thus, if not indicated as desirable by
an oral health-care professional, the crowning of a tooth
would most likely be contraindicated. It should be evi-
dent, though, that dentists trained at dierent institutions
in dierent eras and in dierent countries might very
well possess dierent methods of treatment planning and
case selection, resulting is somewhat diverse recommen-
dations for treatment.
Traditionally more than one visit is required to complete rication). At the same time, though, too much taper will
crown and bridge work, and the additional time required severely limit the grip that the crown has while on the pre-
for the procedure can be a disadvantage; the increased pared tooth, thus contributing to failure of the restoration.
benets of such a restoration, however, will generally o- Generally, 6 of taper around the entire circumference of
set these considerations.
1.1 Dimensions of preparation
When preparing a tooth for a crown, the preparation
should, ideally, exist entirely in enamel. As elaborated
on below, the amount of tooth structure required to be
removed will depend on the material(s) being used to re-
store the tooth. If the tooth is to be restored with a full
gold crown, the restoration need only be .5 mm in thick-
ness (as gold is very strong), and therefore, a minimum of
only .5 mm of space needs to be made for the crown to
be placed. If porcelain is to be applied to the gold crown,
an additional minimum of 1 mm of tooth structure needs
to be removed to allow for a sucient thickness of the
porcelain to be applied, thus bringing the total tooth re-
duction to minimally 1.5 mm. For porcelin or ceramic
crowns the amount of tooth reduction is 2 mm. For metal
it is 1 mm.
If there is not enough tooth structure to properly retain
the prosthetic crown, the tooth requires a build-up mate-
rial. This can be accomplished with a pin-retained direct
or in more severe cases, may require a post and core.
Should the tooth require a post and core, endodontic ther-
devitalized root canal for added retention. If the tooth,
because of its relative lack of exposed tooth structure,
also requires crown lengthening, the total combined time,
eort and cost of the various procedures, together with
the decreased prognosis because of the combined inher-
ent failure rates of each procedure, might make it more
reasonable to have the tooth extracted and opt to have an
implant placed.
1.2 Taper
The prepared tooth also needs to possess a certain degree
of taper to allow for the restoration to be properly placed
on the tooth. Fundamentally, there can be no undercuts
on the surface of the prepared tooth, as the restoration
will not be able to be removed from the die, let alone t
on the tooth (see explanation of lost-wax technique below
for understanding of the processes involved in crown fab-
the prepared tooth, giving a combined taper of 12 at any
given sagittal section through the prepared tooth, is ap-
propriate to both allow the crown to t yet provide enough
grip.
1.3 Margin
The most coronal position of untouched tooth structure
(that is, the continual line of original, undrilled tooth
structure at or near the gumline) is referred to as the
margin. This margin will be the future continual line
1
2 2 RESTORATION TYPES

of tooth-to-restoration contact, and should be a smooth, for a signicantly higher failure rate of endodontically-
well-dened delineation so that the restoration, no matter treated crown-restored teeth. When a tooth is not en-
how it is fabricated, can be properly adapted and not allow dodontically treated, the remaining tooth structure will
for any openings visible to the naked eye, however slight. invariably provide the 2-mm height necessary for a fer-
An acceptable distance from tooth margin to restoration rule, but endodontically treated teeth are notoriously de-
margin is anywhere from 40-100 nm. However, the R.V. cayed and are often missing signicant solid tooth struc-
Tucker method of gold inlay and onlay restoration pro- ture. Contrary to popular belief, endodontically treated
duces tooth-to-restoration adaptation of potentially only teeth are not brittle after being devitalized according to
2 nm, conrmed by scanning electron microscopy; this is the following study -CM Sedglay & Messer 1992 Journal
less than the diameter of a single bacterium. of Endodontics. Contrary to what some dentists believe,
a bevel is not at all suitable for implementing the ferrule
Naturally, the tooth-to-restoration margin is an unsightly
thing to have exposed on the visible surface of a tooth eect, and beveled tooth structure may not be included
in the 2 mm of required tooth structure for a ferrule.
when the tooth exists in the esthetic zone of the smile.
In these areas, the dentist would like to place the margin
as far apical (towards the root tip of the tooth) as pos-
sible, even below the gum line. While there is no issue, 2 Restoration types
per se, with placing the margin at the gumline, problems
may arise when placing the margin too subgingivally (be- 2.1 Crown
low the gumline). First, there might be issues in terms of
capturing the margin in an impression to make the stone
Main article: Crown (dentistry)
model of the prepared tooth (see stone model replication
of tooth in photographs, above). Secondly, there is the se-
riously important issue of biologic width. Biologic width A crown is used to cover a tooth and may be com-
is the mandatory distance to be left between the height of monly referred to as a cap. Traditionally, the teeth to be
the alveolar bone and the margin of the restoration, and if crowned are prepared by a dentist, and records are given
this distance is violated because the margin is placed too to a dental technician to construct the prosthesis. The
subgingivally, serious repercussions may follow. In situa- records include models, which are replicas of a patients
tions where the margin cannot be placed apically enough teeth, and the impressions used to make these models.
to provide for proper retention of the prosthetic crown on There are many dierent methods of crown fabrication,
the prepared tooth structure, the tooth or teeth involved each using a dierent material. Some methods are quite
should undergo a crown lengthening procedure. similar, and utilize either very similar or identical materi-
als. Crowns may be made of gold or other similar metals,
There are a number of dierent types of margins that
porcelain, or a combination of the two. Crowns made of
can be placed for restoration with a crown. There is
Zirkonia Oxide are being made more popular due to its
the chamfer, which is popular with full gold restorations,
high translucency and durability as opposed to chipping
which eectively removed the smallest amount of tooth
disadvantages of porcelain crowns.
structure. There is also a shoulder, which, while remov-
ing slightly more tooth structure, serves to allow for a
thickness of the restoration material, necessary when ap- 2.2 Bridge
plying porcelain to a PFM coping or when restoring with
an all-ceramic crown (see below for elaboration on var- Main article: Bridge (dentistry)
ious types of crowns and their materials). When using a
shoulder preparation, the dentist is urged to add a bevel;
the shoulder-bevel margin serves to eectively decrease A bridge is used to span, or bridge, an edentulous area
the tooth-to-restoration distance upon nal cementation (space where teeth are missing), usually by connecting to
of the restoration. xed restorations on adjacent teeth. The teeth used to
support the bridge are called abutments. A bridge may
also refer to a single-piece multiple unit xed partial den-
1.4 Ferrule eect ture (numerous single-unit crowns either cast or fused to-
gether). The part of the bridge which replaces a missing
The single most important consideration when restoring tooth and attaches to the abutments is known as a pon-
with a crown is, undeniably, the incorporation of the tic. For multiple missing teeth, some cases may have sev-
ferrule eect. As with the bristles of a broom, which eral pontics.
are grasped by a ferrule when attached to the broom-
stick, the crown should envelop a certain height of tooth
structure to properly protect the tooth from fracture after 2.3 Inlay
being prepared for a crown. This has been established
through multiple experiments as a mandatory continu- Main article: Inlays and onlays
ous circumferential height of 2 mm; any less provides
 3

An inlay is a restoration which lies within the connes of

the cusps. These restorations are considered to be more
conservative than onlays or crowns because less tooth
structure is removed in preparation for the restoration.
They are usually used when tooth destruction is less than
half the distance between cusp tips.

2.4 Onlay
Main article: Inlays and onlays

An onlay is a method of tooth restoration, which cov-

ers, protects or reinforces one or more cusps. Onlays are
methods for restoring teeth in an indirect way. Onlays are
often used when teeth present extensive destruction due
to caries or to trauma.

2.5 Veneer
Main article: Veneer (dentistry)

A veneer is a thin layer of restorative material placed over

a tooth surface, either to improve the esthetics of a tooth,
or to restore a damaged tooth surface. Materials used for
veneers may include composite and porcelain. In some
cases, removal of tooth structure is needed to provide suf-
cient space for the veneer, whereas sometimes a restora-
tion may be bonded to a tooth without preparation of the
tooth.

3 See also
Dentures
Dental restoration

Dental materials
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