Vinay Pavan Kumar K

2 nd year MDS student

Department of Prosthodontics
AECS Maaruti College of Dental Sciences
 Principles of tooth preparation
Preservation of
tooth structure

Luting Dislodging Geometry

Preservation of agent used forces -taper
periodontium -freedom of
Retention & displacement
Materials
resistance form -path of insertion
cemented
Marginal -length
integrity Roughness of -stress
fitting surfaces -preparation type

Structural
durability
Occlusal Axial
reduction reduction
 Al-Fouzan etal quantified the volume of reduction of tooth
structure associated with different commonly used
preparation designs using microcomputed tomography

The all-ceramic crown preparation design for the

mandibular central incisors had the highest percentage
(65.26% 4.14%) of tooth structure reduction, while the
lowest percentage of tooth structure reduction was
associated with the ceramic veneer preparation design for
maxillary central incisors (30.28% 5.54%)

Al-Fouzan A.F Volumetric measurements of removed tooth structure

associated with various preparation designs Int J Prosthodont 2013;26:5458
 Tooth preparation

The process of removal of diseased

and/or healthy enamel, dentin and
cementum to shape a tooth to receive a
restoration
 Biological -maintenance of pulp vitality,
adjacent teeth & soft tissues
-conservation of tooth structure

Mechanical - retention & resistance

Esthetic - minimal display of metal

- adequate thickness of porcelain
- proper shade matching
 Total occlusal convergence
Occlusocervical/incisocervical dimension
Ratio of OC and FL dimension
Circumferential form of the prepared tooth
Reduction uniformity
Reduction depths
Finish line location
Line angle form

Goodacre C J. Designing tooth preparations for optimal success. Dent

Clin N Am 2004; 48: 359-85.
 Preservation of tooth structure

Retention & Resistance

Structural durability

Marginal integrity

Preservation of the periodontium

 Preserve the remaining tooth
structure

Conservation guidelines-

Coverage: Partial v/s complete

Margin: Supragingival v/s

subgingival
 Preparation of teeth with the minimum practical
convergence angle between axial walls

Occlusal surface reduction: follow anatomic planes

Axial surfaces : if necessary, teeth should be

orthodontically repositioned.
 Retention prevents removal of the
restoration along the path of
insertion or long axis of the tooth
preparation.

Resistance prevents dislodgment

of the restoration by forces
directed in an apical or oblique
direction and prevents any
movement of the restoration under
occlusal forces.
 Dislodging forces

Geometry of the tooth preparation

Roughness of the fitting surface of the restoration

Materials being cemented

Luting agent being used

 Forces that tend to remove a cemented
restoration along its path of withdrawal

FPD subject to dislodging forces-

Flossing under the connectors
Sticky food
 Restrained movement (eg. Nut and bolt )

Sliding pair two cylindrical surfaces constrained to

slide along one another
 Taper / Total Occlusal Convergence (TOC)
Substitution of internal features
Path of insertion
Freedom of displacement
Length and Surface area
Stress concentration
Type of preparation
 Inclination - relationship of one wall of a preparation to
the long axis of that preparation
Tapered diamond bur: 2-3 inclination
Opposing surfaces with 3 inclination= 6 taper

External walls Internal walls

(converge) (diverge)
 Parallel walls maximum
retention

Taper
visualize preparation walls
prevent undercuts
permit more nearly complete
seating of restorations during
cementation

Ideal taper: 6
 Retention

More the taper, lesser the retention

Jorgenson KD. The relationship between retention and convergence angle in

cemented veneer crowns. Acta Odontol Scand 1955 Feb;59(2):94-8.
 Angle between two opposing prepared axial surfaces

Historically TOC : 2-6

Clinical goal : 10-22
TOC beyond 10-22 auxilliary features needed

Resistance testing was found to be more sensitive to

changes in the TOC than retention testing

Goodacre C J. Designing tooth preparations for optimal success. Dent

Clin N Am 2004; 48: 359-85.
Goodacre C J. Designing tooth preparations for optimal success. Dent
Clin N Am 2004; 48: 359-85.
Esteves HJ, Costa N, Esteves IS, Clinical determination of angle convergence in a
tooth preparation for a complete crown. Int J Prosthodont. 2014 Sep-Oct;27(5):472-4.
 Basic unit of retention-opposing walls with minimal taper
Opposing walls not available for use-
Destroyed previously (severe attrition)
Partial veneer restorations
Greater than desirable inclination

Groove Box Pinhole

 Imaginary line along which the restoration will be placed
onto and removed from the preparation
Paths of all FPD abutments must parallel each other
 Visual survey - ensures preparation is
neither undercut or overtapered

Center of the occlusal surface of the

preparation is viewed with one eye
from a distance of 30 cm (12)

Binocular vision avoided- undercut

preparation can appear to have an
acceptable taper
 In patients mouth mouth mirror is held at an angle
approximately inch above the preparation

Image viewed with one eye

 FPD abutments common path of insertion
Firm finger rest established mirror maneuvered until
one preparation is centered mirror moved by pivoting
on the finger rest without change in angulation till the 2nd
preparation is centered
 Path of insertion considered in 2 dimensions-
mesiodistally and faciolingually.

Mesiodistal inclination - parallel to contact areas of

adjacent teeth
 Faciolingual orientation - affects esthetics of metal
ceramic and partial veneer crowns

Facially inclined path of insertion

prominent facio-occlusal line angle

overcontouring or opaque show-through

For full veneer crowns

parallel to long axis of the tooth
 Posterior crown
parallel to long axis of the tooth

Anterior crown
parallel to incisal of the labial surface
 Numbers of paths along which a restoration can be
removed from the tooth preparation

Only one path maximum retention

 Longer preparation more surface area more retentive
Length must be great enough to interfere with the arc of
the casting pivoting about a point on margin on opposite
side of restoration
Short preparations inclination critical
 Smaller tooth - short
rotation radius

Grooves in the axial

walls- reduce the
rotation radius
 Retentive failure occurs - cohesive failure
in cement

Stress concentration- around the junction

of axial and occlusal surfaces

Rounding the internal line angles

 Complete crown> partial coverage crowns

Adding groove/ boxes increases retention

Potts RG, Shillingburg HT Jr, Duncanson MG Jr,Retention and resistance of
preparations for cast restorations. J Prosthet Dent. 1980 Mar;43(3):303-8
 Roughening/grooving the restoration -
retention increased

Prepared by air-abrading the fitting

surface with 50 m of alumina
Airborne particle abrasion - increase in
vitro retention by 64%

Roughening the tooth preparation- not

recommended
 Retention affected both by the casting alloy and
the core build-up material
The more reactive the alloy is, the more
adhesion there will be with certain luting agents

Type I and II gold alloys- intracoronal

restorations
Type III and IV gold alloys- crowns and FPD
Ni-Cr alloys- long span FPD
 Adhesive cements- most retentive

Film thickness of luting agent- effect not

certain

Adhesive resin> Glass ionomer> Zinc

Phosphate= Polycarboxylate> ZnO-E
 Dislodging forces

Luting agent being used

Geometry of the tooth preparation

 Mastication and parafunctional activity - substantial
horizontal or oblique forces

Lateral forces displace the restoration by causing

rotation around the gingival margin
 Resistance to deformation affected by
compressive strength and modulus of
elasticity

Adhesive resin> Glass ionomer> Zinc

Phosphate> Polycarboxylate> ZnO-E
 Type of preparation
Freedom of displacement
Occlusocervical/incisocervical dimension
Ratio of OC and FL dimension
Circumferential form of the prepared tooth
 Partial coverage restoration< complete crown
(no buccal resistance areas in partial coverage)

Adding groove/ boxes increases resistance

(greatest if walls are perpendicular to direction
of force)
 GROOVE PROXIMAL BOX
Lingual wall Buccal and lingual walls
perpendicular to the must meet the pulpal wall
direction of force at 90
Oblique angle Oblique angle
V-shaped groove
 Minimal OC dimension:
Anteriors - 3mm
Premolars - 3mm
Molars - 4mm
Occlusocervical Total occlusal
dimension convergence
1mm <6
2mm <12
3mm <17

Goodacre C J. Designing tooth preparations for optimal success. Dent

Clin N Am 2004; 48: 359-85.
 Should be 0.4 or higher for all teeth
OC/FL ratio Total occlusal
convergence
0.1 <6
0.2 <12
0.3 <18
0.4 <24

Goodacre C J. Designing tooth preparations for optimal success. Dent

Clin N Am 2004; 48: 359-85.
 Should possess circumferential irregularity
Maxillary molars rhomboidal form
Mandibular molars rectangular form
Premolars and anteriors oval form

Goodacre C J. Designing tooth preparations for optimal success. Dent

Clin N Am 2004; 48: 359-85.
 Preserve corners of a tooth preparation
No axial grooves, boxes should be provided in corners

Chewing and parafunctional habits

Dislodging forces largely faciolingual

So, grooves and boxes on the proximal surfaces

Goodacre C J. Designing tooth preparations for optimal success. Dent

Clin N Am 2004; 48: 359-85.
 A restoration must contain a bulk of material that is
adequate to withstand the forces of occlusion

Bulk should be confined to the space created by the

tooth preparation

To provide adequate bulk:

Occlusal reduction
Functional cusp bevel
Axial reduction
 Full metal restoration:
1.5 mm functional cusp
1mm non functional cusp

Metal-ceramic crowns :
1.5 to 2mm functional cusp
1 to 1.5mm non functional cusp

All ceramic crowns :

2mm over all
Adequate reduction Inadequate clearance Overpreparation
 Wide bevel on-
Lingual inclines of the maxillary lingual cusps
Buccal inclines of mandibular buccal cusps

Adequate bulk of metal in area of heavy occlusal contact

 Lack of functional cusp bevel:

Thin area in casting Overcontouring Overinclination

 Thin walls of casting subject to distortion
Overcontouring- disastrous effect on the
periodontium
 Closely adapted margins to finish lines of preparation-
survival of restoration in the oral environment

Configuration of finish line-

dictates the shape and bulk of metal at the margins
affects the marginal adaptation
affects degree of seating
 Chamfer
Heavy chamfer
Shoulder
Sloped shoulder
Radial shoulder
Shoulder with a bevel
Knife edge
 Indications-
Cast metal crowns
Metal-only portion of PFM crowns

Distinct, easily identified

Least stress

Round end tapered diamond

Half the tip of the diamond
 Indicated for all-ceramic crowns
90 degree cavosurface angle with a large radius
rounded internal angle
Round end tapered diamond
Better than conventional chamfer but not shoulder
Bevel added - to use with metal restoration
 All-ceramic crowns
Facial margin of PFM crowns

Wide ledge-
resistance to occlusal forces
minimizes stresses which leads to fracture of porcelain

Flat-end tapered bur

Healthy contours
Maximum esthetics
 Destruction of more tooth structure

Sharp 90 internal line angle

concentrates stress on tooth

Coronal fracture

Not used for cast metal restorations

 120 sloped shoulder margin
Facial margin of a metal-ceramic crown
No unsupported enamel, yet sufficient bulk to allow
thinning of the metal framework to a knife-edge for
acceptable esthetics
 Modified shoulder
Cavosurface 90
Shoulder width lessened with rounded internal angles
Lesser stress concentration
Good support for porcelain
 Indications:
Proximal box of inlays, onlays
Occlusal shoulder of onlays and mandibular crowns
Facial finish line of metal-ceramic restorations (gingival
esthetics not critical)
Situations where a shoulder is already present
(destruction by caries, previous restorations)
 Bevel:
allows the cast metal margin to be bent or
burnished against the prepared tooth structure
minimizes the marginal discrepancy
removes unsupported enamel
 Permit acute margin of metal
Axial reduction may fade out
Thin margin - difficult to wax and cast
Susceptible to distortion
Indications:
Mandibular posterior teeth with very convex axial
surfaces
Lingually tilted lower molars
 All metal crowns
Chamfer depth: 0.3-0.5 mm
Axial surface reduction: 0.5 -0.8 mm
Occlusal reduction: 1- 1.5 mm

Metal ceramic crowns

Finish line depth: 1-1.5 mm
Occlusal reduction: 2mm

All ceramic crowns

Finish line and facial reduction depth: 1mm
Incisal/occlusal reduction: 2mm

Goodacre C J. Designing tooth preparations for optimal success. Dent

Clin N Am 2004; 48: 359-85.
 Uniformly reduced :
normal crown form
improved aesthetic

Makes easier for laboratory technician to create

esthetic restorations

Best achieved by placing depth grooves

Goodacre C J. Designing tooth preparations for optimal success. Dent

Clin N Am 2004; 48: 359-85.
 Should be rounded (increases crown strength)

Sharp line angles stress concentration

Facilitates laboratory fabrication and fit

Ease to pour impressions

Goodacre C J. Designing tooth preparations for optimal success. Dent

Clin N Am 2004; 48: 359-85.
 Margin placement

Direct effect on ultimate success of restoration

Margins should be as smooth as possible
Placed in area that can be finished well by the dentist
and kept clean by the patient
Placed in enamel whenever possible
Should be supragingival whenever possible
 Supragingival margins

Less potential for soft tissue damage

Easily prepared and finished
More easily kept clean
Impressions are more easily made
Restorations easily evaluated at recall
appointments
 Subgingival margins:
Esthetics
Existing caries, cervical erosion, or restorations extend
subgingivally, and crown-lengthening is not indicated
Proximal contact area extends to the gingival crest
Additional retention is needed
Margin of a metal-ceramic crown is to be hidden behind
the labiogingival crest
Root sensitivity cannot be controlled by more
conservative procedures, such as the application of
dentin bonding agents
 Finish line should not be closer than 2mm to the alveolar
crest

Placement in this area

gingival inflammation
loss of alveolar crest height
pocket formation
 Junction between a cemented restoration and
the tooth - potential site for recurrent caries

Casting- fits within 10 m

Porcelain margin- 50 m

Stepped irregular margin- poor adaptation

 Adjacent teeth :
Iatrogenic damage
Metal matrix band
Leave a slight lip or fin of proximal enamel

Soft tissues:
Careful retraction of lips, cheeks
Care to protect tongue when lingual surfaces of mandibular
molars prepared

Pulp
Temperature
Chemical action of cements
Bacterial action (microleakage)
Borelli etal In vitro analysis of residual tooth structure of maxillary anterior teeth
after different prosthetic finish line preparations for full-coverage single crowns
Journal of Oral Science, Vol. 55, No. 1, 79-84, 2013
 Different preparation depths
With/without coolants

Rise in temperature was noted without coolants

1mm depth 0.540 C
2mm depth 10 C
3 mm depth - 1.840 C
Drop in temperature was noted with coolants
1mm depth 0.400 C
2mm depth 0.820 C
3mm depth 1.130 C

Chhatwal N. Effect of tooth preparation and coolants on temperature

within the pulp chamber. TPDI 2010;1(2):45-48.
 Shillingburg HT, Fundamentals of Fixed Prosthodontics, 4th
edition, USA, Quintessence publications,2012, pp119-137.
Rosenstiel SF, Contemporary Fixed Prosthodontics, 4th
edition, USA, Mosby, 2006, pp 166-201.
Goodacre C J. Designing tooth preparations for optimal
success. Dent Clin N Am 2004; 48: 359-85.
Borelli etal In vitro analysis of residual tooth structure of
maxillary anterior teeth after different prosthetic finish line
preparations for full-coverage single crowns Journal of Oral
Science, Vol. 55, No. 1, 79-84, 2013
Al-Fouzan A.F Volumetric measurements of removed tooth
structureassociated with various preparation designs Int J
Prosthodont 2013;26:5458
 Parker MH. Resistance form in tooth preparations. Dent
Clin N Am 2004; 48: 387-96.

Owen CP, Retention and resistance in preparations for

extracoronal restorations. Part II: Practical and clinical
studies, J Prosthet Dent 1986;56(2):148-153.

Gilboe DB, Teteruck WR. Fundamentals of extracoronal

tooth preparation. Part I-Retention and resistance form.
J Prosthet Dent 2005;94:105-7.

Chhatwal N. Effect of tooth preparation and coolants on

temperature within the pulp chamber. TPDI
2010;1(2):45-48.