PREVENTION OF DAMAGE BIOLOGIC WIDTH

DURING TOOTH PREPARATION • A band of soft tissues attachment between the

base of the gingival sulcus and the alveolar crest
• The preparation of the tooth must be conservative It's the dimension of space that the healthy
• Excessive amount of removal of tooth structure can gingival tissues occupy above the alveolar bone.
be harmful and can lead to • Essential for preservation of periodontal health
• Thermal hypersensitivity and removal of irritation that might damage the
• Pulpal inflammation periodontium.
• Necrosis
• Over taper VIOLATION OF BIOLOGIC WIDTH
• short
• Plaque accumulation
Compromise retention and • Attachment loss
resistance form • Periodontal pockets
• Advanced periodontitis
• ADJACENT TEETH
• Bone loss
• latrogenic damage
• SOFT TISSUE DAMAGE LOCATION OF RESTORATIVE MARGINS:-
• Gums, tongue and cheek
• PULP • Supragingival
• Temperature • Equigingival
• Chemical and • Subgingival
• Bacterial
1. SUPRAGINGIVAL MARGIN
More remaining dentin- lesser the pulpal damage
• Least traumatic to the soft tissues
GUIDELINES • Easily finished
• Impressions are easily made
1. Partial coverage
• Most accessible for cleansing
2. Minimum taper
• Restorations can be easily evaluated
• Buccolingual taper
• Mesiodistal taper DISADVANATGE
3. Planar occlusal reduction
4. Even reduction of axial surfaces • More susceptible to cement dissolution
5. Selection of conservative margin 2. SUBGINGIVAL MARGINS
6. Avoidance of unnecessary apical extension of
preparation • Clinical crown is short Old restorations with
subgingival margin
AVOIDANCE OF OVER CONTOURING
• Esthetic appearance Caries, abrasion or
• A crown should duplicate the contours and erosion...
profile of the original tooth • Root sensitivity
• Under-contoured restoration is better than over-
DISADVANTAGES
contoured restoration
• Anterior teeth, increasing the proximal contour • Plaque retention...
is better • Margin placement
• Mechanical Irritation
MARGINAL INTEGRITY AND PRESERVATION
• Violation of biological width
OF PERIODONTIUM
• Soft tissue Injury
• biological width
• location of restorative margin
• margin adaptation
• margin geometry (finish line configuration)
CROWN LENGTHENING PROCEDURES: • A well-designed preparation should have a
smooth and even margins Whenever possible
• It's a procedure similar to the apical they should be located in the areas where the
repositioning of the flap with concomitant dentist can finish and inspect them and the
Restorative Crown I lengthening osteoplasty. patient can clean them
INDICATIONS GUIDELINES FOR EVALUATION FOR MARGIN
DESIGN:
• Short clinlcal crown
• Restoration impinge on the biological width • Ease of preparation without overextension or
• Hopeless teeth with extensive subgingival unsupported enamel
cories, subgingival fracture and root perforation • Ease of identification in the impression and on
the die
CROWN LENGTHENING PROCEDURE
• Sufficient bulk of the material
• Surgical methods • Conservation of the tooth structure
• Orthodontic method • A distinct boundary to which wax patter can be
finished
MARGINAL ADAPTABILITY
FINISH LINES (CFL: Cervical finish line)
• The restorative margins must fit as closely as
possible against the finish line of the preparation • The finish line is the peripheral extension of a
fo minimize the width of exposed cement. tooth preparation
• They must have sufficient strength to withstand • The most important consideration in selecting a
the forces of mastication cervical margin design is its ability to
• More accurate the adaptation-lesser the chance consistently and predictably provide excellent
of recurrent caries marginal integrity.

FINISH LINES INDICATIONS: ADVANTAGES DISADVANTAGES:

1. KNIFE EDGE • Not recommended • Conservation of the • Does not provide

(FEATHER EDGE) • For stainless steel tooth structure adequate bulk
crown and strip of • Permits an acute margin
crown of the metal

2. CHISEL EDGE • Tilted tooth • Conservation of the • Location of margin is

• Variation of feather tooth structure difficult to control
edge
• Larger angle between
the axial surface and
unprepared tooth
structure
3. CHAMFER • Cast metal restorations • It provides distinct • Care needed to avoid
• It’s a finish line design • Lingual margin of the margin unsupported lip of
for tooth preparation in metal ceramic crowns • Adequate bulk to the enamel
which gingival aspect restoration
meets the external axial • Easier to control
surface at an obtuse • Exhibits least stresses
angle
• Chamfer gives the
ceramic an adequate
bulk
 4. SHOULDER • All ceramic restorations • Bulk of restorative • Less conservative of
• Creates a 90 deg • Facial magins of metal- material tooth structure
internal line angle ceramic crowns • The sharp 90 internal
• For all ceramic line angle

5. SLOPED SHOULDER • Indicated for facial

• Cavosurface margin - margin of metal
120° ceramic crowns
• Reduces the possibility
of leaving unsupported
enamel and yet leaves
sufficient bulk to allow
thinning of the metal
framework to a knife
edge for acceptable
aesthetics.
6. SHOULDER WITH • facial margins of • Removes unsupported • extends the preparation
BEVEL maxillary partial enamel, allows into the sulcus if used
coverage restorations finishing of metal on apical margin
• Inlay and onlay margin • Recommended for
• Shoulder is already extremely short walls
present because of
destruction by caries or
presence of previous
restorations

OCCLUSAL CONSIDERATIONS MECHANICAL CONSIDERATIONS

• Occlusal scheme should not be traumatic • RETENTION FORM
• Tooth preparation should allow sufficient space for • RESISTANCE FORM
developing a functional occlusal scheme in the
• STRUCTURAL DURABILITY
finished restoration
• Supraerupted or tilted teeth – reduce the teeth 1. RETENTION FORM
• Sometimes even the endodontic treatment is
necessary to make enough room • The feature of a tooth preparation that resists
• Careful judgment is needed and diagnostic tooth dislodgement of a crown in a vertical direction
preparation and waxing procedures are essential to or along the path of placement.
determining the exact amount of reduction required • Classification of Retention:
to develop an optimum occlusion o Primary Retention –
▪ Sleeve retention – more
PREVENTING THE TOOTH FRACTURE
retentive
• The likelihood that a restored tooth will fracture ▪ Wedge type retention
can be lessened if the tooth preparation be o Secondary retention
designed to minimize the potentially destructive
FACTORS AFFECTING RETENTION
stresses
• Inlay- greater potential for fracture • Magnitude of dislodging forces
• Onlay – lessens the chance of fracture • • Geometry of tooth preparation
Complete crown – greatest protection against
fracture
 • Surveying visually, since it is the primary means
of ensuring that the preparation is neither with
FACTORS AFFECTING GEOMETRY
undercut nor overtapered.
• Taper • The mesiodistal inclination of the path must
• Surface area parallel the contact areas of adjacent teeth.
• stress concetration • So if path is inclined mesially or distally, the
• Type of preparation and secondary retentive restoration will be held up at the proximal
Features contact areas & be “locked out”.
• Roughness of surfaces being cemented AREA UNDER SHEAR STRESS:
• Materials being cemented
• Type of luting agent • Most important feature for retention is that the
• Film thickness of luting agent total surface area of cement which will
experience shearing rather than tensile stress.
MAGNITUDE OF DISLODGING FORCES • To achieve this the preparation must have
opposing walls nearly parallel to each other.
• Small compared to those that tend to seat or tilt
it by pulling the FPD with floss under the • Full veneer crown has excellent retention. When
connectors, compared to partial veneer crown because
• when exceptionally sticky food is eaten reducing the path of insertion to a narrow range.
• If axial wall left unveneered retention is
• Depends on the stickiness of food and the
achieved by substituting a grooves, boxes or
surface area and texture of the restoration being
pinholes for the missing wall.
pulled
• A grooved lingual wall must be distinct and
GEOMETRY OF TOOTH PREPARATION perpendicular to the axial wall.
ESSENTIAL ELEMENTS OF RETENTION
FREEDOM OF DISPLACEMENT
• Opposing vertical surfaces in same preparation.
• Retention is improved by geometrically limiting
• Path of insertion
the numbers of paths along which a restoration
• Area under shear stress
can be removed from the tooth preparation.
• Freedom of displacement
• Maximum retention is achieved when there is
OPPOSING VERTICAL SURFACES IN SAME only one path.
PREPARATION:
FACTORS AFFECTING GEOMETRY
1) External surfaces:- eg. Buccal & lingual walls of
1. TAPER
• full veneer crown.
• An extracoronal restoration is an example of • The axial walls of the preparation must taper
slightly to permit the restoration to seat. i.e. 2
veneer, or sleeve retention.
opposing external walls must gradually converge
2) Internal surfaces:- eg. Buccal & lingual walls of the – ANGLE OF CONVERGENCE.
• 2 opposing internal surfaces of the tooth
• proximal box of a proximo-occlusal inlay.
structure must diverge occlusally – ANGLE OF
• An intracoronal restoration resists displacement DIVERGENCE.
bywedge retention.
• The relationship of one wall of a preparation to
PATH OF INSERTION: the long axis of that preparation is the
INCLINATION of that wall.
• It is an imaginary line along which the • The more nearly parallel the opposing walls of a
restoration will be placed onto or removed from preparation, the greater should be the retention.
the preparation. • Most retentive preparation should be one with
• It is of special importance when preparing teeth parallel walls, but the parallel walls are
to be fixed partial denture abutments, since the impossible to create in the mouth without
paths of all the abutment preparations must producing certain degree of taper.
parallel each other.
 2. SURFACE AREA MATERIALS BEING CEMENTED:

• Provided the restoration has limited path of • Retention is affected by both the casting alloy
withdrawal, Greater the surface area of a and the core material.
preparation, greater is its retention. • More reactive the alloy is more adhesion.
• Crowns with long axial walls are more • Base metal alloys are better retained than less
retentive… reactive high gold content metals.
• Molar crowns are more retentive than premolar
TYPE OF LUTING AGENT:
crowns of same taper
3. STRESS CONCENTRATION • Studies show that adhesive resin cements are
more retentive than compared to conventional
• If line angle between axial and occlusal surface ZnPO4 and GIC cements.
is sharp, it leads to concentration of stresses • Film thickness of the luting agent.
around that junction • Ideal dimension for luting agent space is 20-40
• Induced stresses exceeds the strength of the microns for each wall.
cement
• Leads to cohesive failure of cement
• Rounding the internal line angles reduces the 2. RESISTANCE FORM
stress concentration and thus increases the
retention of restoration • The features of a tooth preparation that enhance
the stability of restoration and resist
TYPE OF RESTORATION AND SECONDARY dislodgement along an axis other than the path
RETENTIVE FEATURES of placement (GPT).
• It prevents dislodgement of a restoration by
• Full veneer crown has excellent retention when
forces directed in an apical, oblique or horizontal
compared to partial veneer crown because
direction.
reducing the path of insertion to a narrow range.
• The geometric configuration of tooth structure
• If axial wall left unveneered, retention is
must place the cement in compression to provide
achieved by substituting a grooves, boxes or
the necessary resistance.
pinholes for the missing wall.
• Lateral forces tend to displace the restoration by
SURFACE ROUGHNESS: causing rotation around gingival margin
• Adhesion of dental cements depends primarily FACTORS AFFECTING RESISTANCE FORM
on projections of the cement into microscopic
irregularities. 1. Magnitude and direction of dislodging forces
• Jorgensen found retention of castings cemented 2. Leverage
with ZnPO4 cement on test dies with a 10° taper 3. Length of the preparation
to be twice as great on preparations with 40µm 4. Width of the preparation
scratches than 10µm. 5. Taper
• Retention increases when restoration is 6. Type of preparation
roughened or grooved. 7. Rotation about vertical axis
• Tooth should remain smooth since bonding 8. Physical properties of luting agent
agents are meant to stick on the to the tooth and
the rough surface is inside the crown since the
bonding agent does not stick to it as well to the it
does to the tooth
• Failure rarely occurs at the cement tooth
interface. So roughening tooth preparation
hardly influences retention.
1. MAGNITUDE AND DIRECTION OF double than in a preparation where height is only
DISLODGING FORCES half width.

• Resistance decreases in following order: 6. TYPE OF PREPARATION

o normal occlusion- axially directed forces
• Partial coverage restoration may have less
o habits (pipe smoking and bruxing) –
resistance than a complete crown because it has
large oblique forces to restoration
no buccal resistance area
o eccentric interferences
o anterior guidance •

2. LEVERAGE AND RESISTANCE: 7. ROTATION ABOUT VERTICAL AXIS

• Leverage occurs when the line of action of a • A partial-coverage restoration may have less
force passes out side the supporting tooth resistance than a complete crown because it has
structure. no buccal resistance areas. Resistance can be
achieved by the following
• If the force passes within the margin of a crown
1. A grooved lingual wall must be distinct and
no tipping of the restoration when compared to
perpendicular to the axial wall.
the line of action passing outside the margins of
2. So U- shaped grooves or flared boxes provides
the restoration
more resistance than V-shaped ones
FORCES ARE OUTSIDE THE MARGIN IN THE
8. PHYSICAL PROPERTIES OF LUTING AGENT
FOLLOWING CASES:
• Resistance to deformation is affected by physical
• Wide occlusal table of restoration
properties of the luting agent, such as
• Crowns on tipped teeth
compressive strength and modulus of elasticity
• Retainers for cantilever bridge
• Adhesive resin :GIC , ZnPO4 , Polycarboxylate ,
• Force at an oblique angle
ZOE
3. RESISTANCE AND TOOTH LENGTH • Higher compressive strength: GIC
• High modulus of elasticity: ZnPO4
• Shortening of preparation will reduce the
resistance area.
• In short crown lifting force is small when
compared to long crown. STRUCTURAL DURABILITY
• Small restoration is less likely to fail through
tipping than long restoration (on preparation of • A restoration must have sufficient strength to
equal length). prevent permanent deformation during function
• DEFINITION- “The ability of a restoration to
4. RESISTANCE AND TOOTH WIDTH: withstand destruction due to external forces is
known as structural durability”.
• A wider preparation has a greater retention but a
narrow tooth can have greater resistance to FACTORS AFFECTING STRUCTURAL
tipping. DURABILITY
• Because of smaller diameter a tangent line falls
low on the wall opposite to axis of rotation. • Adequate tooth reduction.
Resulting in a large resisting area. o occlusal reduction
• Weak resistance can be enhanced by placing o functional cusp bevel
vertical grooves/ boxes/ pinholes. o axial reduction
• Alloy selection.
5. TAPER AND RESISTANCE: • Metal-ceramic framework design.
• More tapered a preparation less is resistance. • Margin design
• Permissible taper of a preparation is directly
proportional to height : width ratio.
• Taper that permit an effective resisting area for a
preparation in which height equals width is
1. ADEQUATE TOOTH REDUCTION strengthen the restoration but may have a
disastrous effect on periodontium.
a. OCCLUSAL REDUCTION
2. SELECTION OF THE ALLOY
• An important feature for providing adequate
bulk of metal & strength to the restoration is • essential that there be sufficient clinical evidence
occlusal clearance. of superiority, before selecting a particular
• Occlusal thickness varies with different material.
restorative materials • TiLit - best bonding agent for PFM
• GOLD ALLOYS
DESIRABLE PROPERTIES OF DENTAL
o 1.5mm (FC) & 1mm(NFC)
CASTING ALLOYS:
• METAL-CERAMIC CROWNS
o 1.5-2mm(FC)&1-1.5mm(NFC) • Biocompatibility
• ALL-CERAMIC CROWNS • Ease of melting
o 2mm of clearance on preparation • Ease of casting
• Firstly, opposing occlusal equilibration is to be • Ease of brazing (soldering)
achieved eg. Plunger cusps to be rounded. • Ease of polishing
• Round line and point angles, avoid deep grooves • Little solidification shrinkage
in the center of the occlusal surfaces to prevent • Minimal reactivity with the mold material
stress concentration and to distribute the forces • Good wear resistance
over a larger surface area.
• High strength
• Uniform and planar occlusal reduction.
• Excellent corrosion resistance
b. FUNCTIONAL CUSP BEVEL (FCB) • Porcelain Bonding

• It is an integral part of the occlusal reduction. CLASSIFICATION OF DENTAL ALLOYS

• A wide bevel on the lingual inclines of the
• INDICATION
maxillary lingual cusps & the buccal inclines of
o Type I: Simple inlays
the mandibular buccal cusps provides space for o Type II: Complex inlays
an adequate bulk of metal in an area of heavy o Type III: Crowns and fixed partial
occlusal contact.
dentures
• If a wide bevel is not placed on the functional o Type IV: Removable partial dentures
cusp, several problems may occur : and pin ledges.
• If the crown is waxed & cast to normal contour o Porcelain: metal-ceramic alloys.
it can cause a thin area or perforation in the • PHYSICAL PROPERTIES
casting. o Type I: Soft
• To prevent this the crown may be waxed to o Type II: Medium
optimal thickness resulting in overcontouring & o Type III: Hard
poor occlusion. o Type IV: Extra-hard
• If an attempt is made to obtain space for an
adequate bulk in a normally contoured casting FACTORS CONSIDERED WHEN SELECTING AN
without a bevel, it will result in over inclination ALLOY:
of the buccal surface which will destroy 1. Color: The patients view on the subject
excessive tooth structure while lessening
should be sought if the metal will be visible
retention. F
in the mouth; otherwise the color is
c. AXIAL REDUCTION irrelevant.
2. Composition: The percentage composition
• It plays an important role in securing space for by weight of the main ingredients must be
an adequate thickness of restorative material. mentioned.
• Inadequate axial reduction can cause thin walls 3. Cost.
& a weak restoration subjected to distortion or a 4. Laboratory performance: Factors like
bulbous, overcontoured restoration which will casting accuracy, surface roughness,
 strength, metalceramic bond strength should B) Mechanical properties:
be considered.
• Wear resistance and strength.
Clinical performance: • Marginal fit.
• Ceramic bond failure.
A) Biologic properties
• Connector failure.
• Gingival irritation. • Tarnish and corrosion.
• Recurrent caries.
CHOICE OF MATERIAL
• Plaque accumulation.
• Allergies.

CHOICE OF MATERIAL INDICATIONS CONTRAINDICATIONS

1. GOLD • In situations of severe occlusal • Aesthetics

stress. • Cost
• Following endodontic treatment of
posterior teeth.
• Full or partial coverage of
posterior teeth where there has
been significant loss of coronal
dentin.
• For restoration of adjacent or
opposing teeth to avoid problems
arising from use of dissimilar
metals.
2. PORCELAIN (CERAMIC): • Large inadequate restorations on • Teeth with short clinical crown
the anterior teeth provided there is • Edge to edge occlusion
enough tooth substance. • Teeth which do not allow ideal
• Severely discolored teeth. preparation form to support the
• Over an existing post and core porcelain.
substructure.
3. METAL CERAMIC: • Esthetics • Young patients at risk of pulp
• Failure of porcelain jacket crowns. being exposed
• Posterior teeth where esthetics is • large pulp chamber
necessary and partial coverage • Traumatic occlusion (heavy
gold crowns are contraindicated occlusal forces) , where wear of
opposing occlusal surfaces is
expected.

3. METAL CERAMIC FRAMEWORK: • Metal should preferably be in the area of the

centric stop to enhance the durability of the
• A metal occlusal contact requires 1-1.5mm of
restoration.
reduction
• A porcelain contact requires 2mm of reduction 4. MARGIN DESIGN
• Occlusal contacts need to be 1.5-2.0mm from
• Distortion of restoration margin is prevented by
the porcelain- metal junction
designing the preparation outline to avoid
• The substructure must support an even thickness
occlusal contact in this area
of the porcelain veneer (1mm minimum and
• Tooth reduction should provide sufficient room
2mm maximum).
for bulk of metal at the margin to prevent
• The minimum thickness of the metal is 0.2-
distortion
0.3mm.
• Cut-back: porcelain-metal junction should be
90° or greater.
ESTHETIC CONSIDERATIONS METAL-
CERAMIC RESTORATION

• Usually poor appearance is due to insufficient

porcelain thickness
• In addition, the labial margin of metal ceramic
crown is not always accurately placed
• To correct all these deficiencies, certain
principles are recommended during tooth
preparation
a. FACIAL REDUCTION

• Adequate thickness of porcelain is needed to

create a sense of 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 at incisal and cervical 3rd of
restoration (here direct light reflection from the
opaque layer can make the restoration appear
very noticeable
• Opaque porcelain generally have a different
shade from body porcelain, they often need to be
modified with special stains in these areas with
very thin teeth like mandibular incisors.

b. INCISAL REDUCTION

• Incisal edge has no metal backing. So, it can be

made with a translucency similar to that of
natural tooth structure
• Reduction of 2 mm
• Excessive reduction – reduces retention and
resistance
c. 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.
 2. RETENTION FORM

• Preparation geometry
• Post length
• Post diameter
• Post surface texture
• Luting agent
3. RESISTANCE FORM

• Stress distribution
• Rotational resistance
FIBRE REINFORCED COMPOSITE
PROSTHESES

ENDODONTICALLY TREATED TEETH

• Conservation of tooth structure

• Retention form
• Resistance form
1. CONSERVATION OF TOOTH STRUCTURE

• PREPARATION OF CANAL
o Only minimum tooth structure should
ANTERIOR FRC TOOTH PREPARATION
be removed from the canal
o Root canal should be enlarged only
enough to enable the post to fit
accurately yet passively while ensuring
strength and retention
• PREPARATION OF CORONAL TISSUE
o Coronal tooth structure should be saved
as much as possible.
o Ferrule:
▪ Extension of the axial wall of
the crown apical to the missing
tooth structure provides
▪ helps to bind the remaining
tooth structure together,
preventing root fracture during
function