Principles of Tooth Preparation Punam Bishnoi

PRINCIPLES
OF TOOTH PREPARATION
Dr. Punam Bishnoi
CONTENTS INTRODUCTION BROAD CATEGORIES OF PRINCIPLES BIOLOGICAL CONSIDERATIONS MECHANICAL CONSIDERATIONS ESTHETIC CONSIDERATIONS SUMMARY AND CONCLUSION REFERENCES
INTRODUCTION Tooth preparation is defined as mechanical
treatment of dental disease or injury to hard tissues that restores a tooth to original form.
As tooth has no regenerative ability. Teeth require preparation to receive restoration These preparation must be based on fundamental principles. Careful attention to every detail is imperative during tooth preparation
Acc. to Shillinberg the design of a preparation for a cast restoration and the execution of that design are governed by five principles:
Preservation of tooth structure Retention and resistance Structural durability Marginal integrity Preservation of the periodontium.
Acc to DCNA 2004 certain guidelines are given for preparation of tooth TOC(total occlusal convergence Occlusocervical /incisocervical length Ratio of occlusocervical dimension and faciolingual dimension Circumferntial form of the prepared tooth Preferred location for auxillary retention Uniform reduction Finish line location Finish line form Reduction depths Line angle forn Surface texture
Acc. To Rosenstiel the tooth preparation can be studied under 3 Broad categories :
1. BIOLOGIC CONSIDERATIONS, CONSIDERATIONS, which affect the health of oral tissues 2. MECHANICAL CONSIDERATIONS, CONSIDERATIONS, which affect the integrity and durability of the restoration 3. ESTHETIC CONSIDERATIONS, which affect the appearance of the patient
Best combination of compromises

BIOLOGIC
Conservation of tooth structure Avoidance of overcontouring Supragingival margins Harmonious occlusion Protection against tooth fracture
ESTHETIC
MECHANICAL
Retention form Resistance form Structural durability
Minimum display of metal Maximum thickness of porcelain Porcelain occlusal surfaces Subgingival margins
BIOLOGIC CONSIDERATIONS
1. Prevention of damage during tooth preparation -Adjacent teeth -Soft tissue -Pulp Conservation of tooth structure Avoidance of overcontouring -Axial reduction Marginal integrity and preservation of periodontium -Margin location -Margin adaptation -Margin geometry or Finish line configuration Occlusal considerations Preventing tooth fracture
2. 3. 4.
5. 6.
Prevention of damage during tooth preparation
Adjacent teeth - iatrogenic damage - damaged proximal contact - To avoid Soft tissues - tongue and cheeks - careful retraction Pulp excessive temperature - chemical irritation - microorganisms -
Prevention of damage during tooth preparation Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture
P.D.Laforgia , Vito Milano , Camillo Morea & Apollonia Desiate in 1991recorded the temperature changes in the pulp chamber during tooth preparation. Zach &Cohen - rise of 5.5 0C - 15% necrosis - rise of 11.10C - 60% necrosis - rise of 16.60 C - 100% necrosis
Conservation of tooth structure
Dowden stated that any damage to the odontoblastic processes will adversely effect the cell nucleus no matter how far from the nucleus it occurs More the remaining dentin lesser the pulpal damage Must be considered relative GUIDELINES: 1. Partial coverage 2. Minimum taper
3. Planar occlusal reduction
4. Even reduction of axial surfaces
5. Selection of conservative margin
6. Avoidance of unnecessary apical extension of preparation
Avoidance of overcontouring
A crown should duplicate the contours and profile of the original tooth Undercontoured restoration is better than overcontoured restoration Anterior teeth, increasing the proximal contour is better
Marginal integrity and preservation of Prevention of damage during periodontium tooth preparation
Margin locationlocationBiologic width
Conservation of tooth structure Avoidance of overcontouring Marginal integrity and preservation of periodontium Occlusal considerations Preventing tooth fracture
Its the dimension of space that the healthy gingival tissues occupy above the alveolar bone. It refers to the combined connective tissue-epithelial tissueattachment from the crest of the alveolar bone to the base of the sulcus(2mm;connective tissue-1.07mm and tissueepitheliumepithelium-0.97mm). essential for preservation of periodontal health and removal of irritation that might damage the periodontium
Violation of biological width:width:-
Nevins and Sukrow in 1984 recommended that for the maintenance of healthy periodontium, no restoration should violate the attachment ,even though its not possible for a clinician to identify the most coronal extent of the junctional epithelium. Wilson and Majnard cautioned against extending restorations so far subgingivally that the attachment complex is damaged.They stated that Some distance of unprepared tooth structure should remain between the finished line and junctional epithelium and this distance should be ideally 0.5mm.
Violation of biologic width
Plaque accumulation Attachment loss Periodontal pockets Advanced periodontitis Bone loss
Location of restorative margins:margins:-
Supragingival Equigingival Subgingival
Supragingival margin: Least traumatic to the soft tissues Margin placement Easily finished Impressions are easily made Most accessible for cleansing
Restorations can be easily evaluated
Subgingival margins: Clinical crown is short Old restorations with subgingival margin Esthetic appearance Caries, abrasion or erosion Root sensitivity
Disadvantages of subgingival margins Plaque retention Margin placement Mechanical irritation Violation of biological width Soft tissue injury
Criteria for subgingival margin placement:placement: Emergence profile Margins are closed and properly finished Adequate band of attached gingiva Margin should not violate the biological width
Crown lengthening procedures:procedures:Its a procedure similar to the apical repositioning of the flap with concomitant osteoplasty. Indications Short clinical crown Restoration impinge on the biological width Hopless teeth with extensive subgingival caries, subgingival fracture and root perforation Crown lengthening procedure Surgical methods Orthodontic method
D.A.Felton in 1991 conducted a study on Effects of in vivo crown margin discrepancies on the periodontal health in his study he strongly supported the placement of supragingival margins for artificial crowns and FPDs. William.G.Reeves in his review article concluded that more supragingivally a restorative margin is placed,the less chance that the margin will contribute to gingival inflammation.
MARGINAL GEOMETRY OR FINISH LINE CONFIGURATION

shape and bulk of the restorative material in the margin of the restoration Marginal adaptation Degree of seating of restoration
Guidelines for evaluation for margin design :

Ease of preparation without overextension or unsupported enamel Ease of identification in the impression and on the die Sufficient bulk of the material Conservation of the tooth structure A distinct boundary to which wax pattern can be finished
Finish lines
The finish line is the peripherel extension of a tooth preparation The most important consideration in selecting a cervical margin design is its ability to consistently and predictably provide excellent marginal integrity. Knife edge Chisel edge Chamfer Shoulder Sloped shoulder Shoulder with bevel Radial shoulder Heavy chamfer
A. Feather edge B. Chisel C. Chamfer D. Bevel E. Shoulder F. Sloped shoulder G. Beveled shoulder
KNIFE EDGE OR FEATHER EDGE

Advantages Conservation of the tooth structure Permits an acute margin of the metal Disadvantages: The axial reduction may fade out Thin margin may be difficult to accurately wax and cast More susceptible to distortion Results in overcontouring Indications: Not recommended
CHISEL EDGE
Variation of feather edge Larger angle between the axial surface and unprepared tooth structure Associated with excessively tapered preparation Historic advantage-impression making with rigid advantageimpression compound in coper bands
Indications:
Lingual surface of mandibular posterior teeth The surfaces towards which tooth has tilted Cementum
Chamfer
Its a finish line design for tooth preparation in which gingival aspect meets the external axial surface at an obtuse angle Advantages It provides distinct margin Adequate bulk to the restoration Easier to control Exhibits least stresses Disadvantage -Care needed to avoid unsupported lip of enamel Indications: Cast metal restorations Lingual margin of the metal ceramic crowns
Shoulder
Bulk of the restoration Wide ledge provides resistance to occlusal forces Provides space for healthy restorative contours Maximum esthetics It offers resistance against distortion during processing
Disadvantages: Less conservative of tooth structure The sharp 900 internal line angle Indications: All ceramic restorations Facial magins of metal-ceramic crowns metal-
SLOPED SHOULDER
Cavosurface margin - 120 120 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. Indicated for facial margin of metal ceramic crowns
SHOULDER WITH BEVEL

Removes unsupported enamel, allows finishing of metal Recommended for extremely short walls Disadvantage extends the preparation into the sulcus if used on apical margin Indications -facial margins of maxillary partial coverage restorations - Inlay and onlay margin -Shoulder is already present because of destruction by caries or presence of previous restorations
RADIAL SHOULDER:
Shoulder with rounded internal line angle Stress concentration is less in the tooth structure
HEAVY CHAMFER
Internal line angle is large radius rounded Provides better support for a ceramic crown than chamfer, but it is not as good as shoulder Easier to prepare than shoulder
MARGINAL ADAPTABILITY
The restorative margins must fit as closely as possible against the finish line of the preparation to minimize the width of exposed cement. They must have sufficient strength to withstand the forces of mastication More accurate the adaptation lesser the chance of recurrent caries A well designed preparation should have a smooth and even margins Whenever possible they should be located in the areas where the dentist can finish and inspect them and the patient can clean them
TO BEVEL OR NOT TO BEVEL

Controversial by Ostlund Trignometric analysisanalysismore acute the bevelbevel-lesser the marginal discrepancy -lesser the seating with cement as D will increase. So, bevel improves the marginal adaptation but reduces the seating of restoration Empirical clinical results dictate that acute margin of metal should continue to be used on metal restorations but that angle should be in 30-45 30-45 Less angles will lead to thin and weak margins. More angle will lead to more marginal gap.
d=D sin u d=D cos q or D=d/sin u D=d/cos q Bevel of 450 prevent seating by 1.4 factor 150 prevent by 3.9 50 prevent by11.5
OCCLUSAL CONSIDERATIONS
Occlusal scheme should not be traumatic Tooth preparation should allow sufficient space for developing a functional occlusal scheme in the finished restoration Supraerupted or tilted teeth reduce the teeth Sometimes even the endodontic treatment is necessary to make enough room Careful judgment is needed and diagnostic tooth preparation and waxing procedures are essential to determining the exact amount of reduction required to develop an optimum occlusion
PREVENTING THE TOOTH FRACTURE
The likelihood that a restored tooth will fracture can be lessened if the tooth preparation be designed to minimize the potentially destructive stresses Inlay- greater potential for fracture Inlay Onlay lessens the chance of fracture Complete crown greatest protection against fracture
MECHANICAL CONSIDERATIONS
1. RETENTION FORM 2. RESISTANCE FORM 3. STRUCTURAL DURABILITY
RETENTION FORM
RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY
DEFINITION DEFINITION-The feature of a tooth preparation that resists dislodgement of a crown in a vertical direction or along the path of placement. placement. In practice retention and resistance are closely related and they are not always clearly distinguishable. distinguishable.
FACTORS AFFECTING RETENTION

Magnitude of dislodging forces Geometry of tooth preparation -Taper -Surface area -stress concetration -Type of preparation and secondary retentive features Roughness of surfaces being cemented Materials being cemented Type of luting agent Film thickness of luting agent
MAGNITUDE OF DISLODGING FORCES

small compared to those that tend to seat or tilt it by pulling the FPD with floss under the connectors, when exceptionally sticky food is eaten Depends on the stickiness of food and the surface area and texture of the restoration being pulled
GEOMETRY OF TOOTH PREPARATION

Essential elements of retention:retention: opposing vertical surfaces in same preparation. Path of insertion Area under shear stress Freedom of displacement FACTORS Taper Surface area Length of preparation Width of preparation stress concetration Type of preparation and secondary retentive features
Opposing vertical surfaces in same preparation: 1) External surfaces:- eg. Buccal & lingual walls of surfaces: full veneer crown. An extracoronal restoration is an example of veneer, or sleeve retention.
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2) Internal surfaces:- eg. Buccal & lingual walls of the surfaces: proximal box of a proximo-occlusal inlay. proximoAn intracoronal restoration resists displacement by wedge retention.
PATH OF INSERTION:INSERTION: It is an imaginary line along which the restoration will be placed onto or removed from the preparation. It is of special importance when preparing teeth to be fixed partial denture abutments, since the paths of all the abutment preparations must parallel each other. Surveying visually, since it is the primary means of ensuring that the preparation is neither undercut nor overover-tapered.
The mesiodistal inclination of the path must parallel the contact areas of adjacent teeth. So if path is inclined mesially or distally, the restoration will be held up at the proximal contact areas & be locked out.
Area under Shear Stress:
Most important feature for retention is that the total surface area of cement which will experience shearing rather than tensile stress. To achieve this the preparation must have opposing walls nearly parallel to each other.
To obtain the greatest area of cement under shear stress, the direction in which a restoration can be removed must be limited to one path.
Full veneer crown has excellent retention. When compared to partial veneer crown because reducing the path of insertion to a narrow range.
If axial wall left unveneered retention is achieved by substituting a grooves, boxes or pinholes for the missing wall.
A grooved lingual wall must be distinct and perpendicular to the axial wall.
FREEDOM OF DISPLACEMENT:DISPLACEMENT:
Retention is improved by geometrically limiting the numbers of paths along which a restoration can be removed from the tooth preparation. Maximum retention is achieved when there is only one path.
TAPER
The axial walls of the preparation must taper slightly to permit the restoration to seat. i.e. 2 opposing external walls must gradually converge ANGLE OF CONVERGENCE. 2 opposing internal surfaces of the tooth structure must diverge occlusally ANGLE OF DIVERGENCE. The relationship of one wall of a preparation to the long axis of that preparation is the INCLINATION of that wall.
The more nearly parallel the opposing walls of a preparation, the greater should be the retention. Most retentive preparation should be one with parallel walls, but the parallel walls are impossible to create in the mouth without producing certain degree of taper.
Tooth preparation taper should be kept minimal because of its adverse effects on retention. ed taper ed retention ed taper ed retention.
Jogensen said as taper increases retention decreases. Retention of a crown with 10 degree of taper was approximately half that of a crown with 5 degree taper.
Ideal taper should be within the range of 2-6.5. 2-6.5 A taper of 6 have 6 been proposed as being clinically achievable while affording adequate retention.
Jeffrey Nodlander, Dennis Weir, Warren Stoffer and Shigaro Ochi, JPD, vol. 60, 1988. Conducted a study to measure the vol. 60, 1988. convergence angles of a full coverage preparations performed in a clinical environment. Teeth were prepared by the environment. participants to attempt a 4-10 convergence angle. The 10 angle. convergence angles of all preparations were determined by projecting the faciolingual and mesiodistal silhouttes of the dies with an overhead projector. They concluded that, projector. the ideal convergence angle of 4-10 is seldom achieved. 10 achieved. The convergence angle for mandibular preparations were greater than maxillary. maxillary. Auxillary retention should be used in molar region because these preparations were found to have larger convergence angle. angle.
SURFACE AREA
Provided the restoration has limited path of withdrawal, Greater the surface area of a preparation, greater is its retention. Length.. Crowns with long axial walls are more retentive Molar crowns are more retentive than premolar crowns of same taper
STRESS CONCENTRATION
If line angle between axial and occlusal surface is sharp, it leads to concentration of stresses around that junction Induced stresses exceeds the strength of the cement Leads to cohesive failure of cement Rounding the internal line angles reduces the stress concentration and thus increases the retention of restoration
TYPE OF RESTORATION AND SECONDARY RETENTIVE FEATURES

Full veneer crown has excellent retention when compared to partial veneer crown because reducing the path of insertion to a narrow range.
If axial wall left unveneered, retention is achieved by substituting a grooves, boxes or pinholes for the missing wall.
Secondary retentive features doesnot significantly affect the retention because the surface area is not increased significantly. But where these features limits the path of withdrawal, retention is increased
Surface roughness:
Adhesion of dental cements depends primarily on projections of the cement into microscopic irregularities. Jorgensen found retention of castings cemented with ZnPO4 cement on test dies with a 10 taper to be 10 twice as great on preparations with 40 m scratches than 10 m. Retention increases when restoration is roughened or grooved. Failure rarely occurs at the cement tooth interface. So roughening tooth preparation hardly influences retention.
Materials being cemented:

Retention is affected by both the casting alloy and the core material. More reactive the alloy is more adhesion. Base metal alloys are better retained than less reactive high gold content metals.
Type of luting agent:

Studies show that adhesive resin cements are more retentive than compared to conventional ZnPO4 and GIC cements.
Film thickness of the luting agent. agent.

Ideal dimension for luting agemt space is 202040 microns for each wall. wall.
Steven M. Carter, Peter R. Wilson, IJP, vol. 9, 1996.- Conducted a study to see the 1996. effect on die spacing on pre and post cementation crown removal and crown elevation. Different layers of die spacer was used. They observed that the force required to remove a crowns before cementation decreased with increased layers of die spacers.
RESISTANCE FORM
The features of a tooth preparation that enhance the stability of restoration and resist dislodgement along an axis other than the path of placement (GPT). (GPT). It prevents dislodgement of a restoration by forces directed in an apical, oblique or horizontal direction. direction. The geometric configuration of tooth structure must place the cement in compression to provide the necessary resistance. resistance. Lateral forces tend to displace the restoration by causing rotation around gingival margin
Methods to analyse resistance form
FACTORS AFFECTING RESISTANCE FORM

Magnitude and direction of dislodging forces Leverage Length of the preparation Width of the preparation Taper Type of preparation Rotation about vertical axis Physical properties of luting agent
Magnitude and direction of dislodging forces Resistance decreases in following order:

- normal occlusion- axially directed forces occlusion-
- habits (pipe smoking and bruxing) large oblique forces to restoration - eccentric interferences - anterior guidance
LEVERAGE AND RESISTANCE:

Leverage occurs when the line of action of a force passes out side the supporting tooth structure. If the force passes within the margin of a crown no tipping of the restoration when compared to the line of action passing outside the margins of the restoration
Forces are outside the margin in the following cases: - wide occlusal table of restoration - crowns on tipped teeth - retainers for cantilever bridge - force at an oblique angle
If a line drawn from the center of rotation perpendicular to the cement film on the opposite wall of the preparation the point where the line intersects the cement film is known as tangent point.
If the tangent points of all the arcs of rotation around a given axis are connected they form the tangent line. The area above the tangent line is resisting area. Rotation is prevented by any areas of the tooth preparation that are placed in compression and are called as RESISTANCE AREA
To have effective resistance the tangent line should extend at least halfway down the preparation.
Preparation length and resistance:
-Shortening of preparation will reduce the resistance area.
-In short crown lifting force is small when compared to long crown.
-Small restoration is less likely to fail through tipping than long restoration (on preparation of equal length).
Resistance and tooth width: width:

A wider preparation has a greater retention but a narrow tooth can have greater resistance to tipping. Because of smaller diameter a tangent line falls low on the wall opposite to axis of rotation. Resulting in a large resisting area.
Weak resistance can be enhanced by placing vertical grooves/ boxes/ pinholes.
A grooved lingual wall must be distinct and perpendicular to the axial wall.
So U- shaped grooves or flared boxes Uprovides more resistance than V-shaped ones V-
Taper and Resistance:
More tapered a preparation less is resistance.
No taper the resisting area cover half the axial wall.
Ideal taper < the axial wall.
Over tapered small resisting area near the occlusal surface.
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 double than in a preparation where height is only half width.
Formula to calculate:
Taper: T = arc sin (2r/w), - Height of tangency point. r = (w sin T) / 2 - Preparation height h = [w tan (90- T/2)]/2. (90
Rotation around a vertical axis:
A partial veneer crown which has no grooves offer little resistance to rotation.
Axial symmetry of a full veneer crown preparation may allow rotation of the restoration.
Enhancing the resistance form by placing groove
TYPE OF PREPARATION
Partial coverage restoration may have less resistance than a complete crown because it has no buccal resistance area
PHYSICAL PROPERTIES OF LUTING AGENT

Resistance to deformation is affected by physical properties of the luting agent, such as compressive strength and modulus of elasticity Adhesive resin >GIC > ZnPO4 > Polycarboxylate > ZOE
STRUCTURAL DURABILITY
A restoration must have sufficient strength to prevent permanent deformation during function DEFINITION- The ability of a restoration to DEFINITIONwithstand destruction due to external forces is known as structural durability.
Factors affecting structural durability

1. Adequate tooth reduction. - occlusal reduction - functional cusp bevel - axial reduction 2. Alloy selection. 3. Metal-ceramic framework design. Metal4. Margin design
ADEQUATE TOOTH REDUCTION

OCCLUSAL REDUCTION:REDUCTION:
An important feature for providing adequate bulk of metal & strength to the restoration is occlusal clearance.
- Occlusal thickness varies with different restorative materials Gold alloys 1.5mm (FC) & 1mm(NFC) MetalMetal-ceramic crowns- 1.5-2mm(FC)&1-1.5mm(NFC) crowns- 1.5-2mm(FC)&1AllAll-ceramic crowns 2mm of clearance on preparation
- Firstly, opposing occlusal equilibration is to be achieved eg. Plunger cusps to be rounded. - Round line and point angles, avoid deep grooves in the center of the occlusal surfaces to prevent stress concentration and to distribute the forces over a larger surface area. - Uniform and planar occlusal reduction.
This ensures: -sufficient occlusal clearance - preservation of tooth structure OCCLUSAL OFFSET can be given on posterior partial veneer crown preparation to provide space for a TRUSS of metal to form reinforcing strap INCISAL OFFSET can be given on anterior partial veneer crown preparation to provide space for metal that helps to strengthen the linguallingual-incisal margin
FUNCTIONAL CUSP BEVEL:BEVEL: It is an integral part of the occlusal reduction.
A wide bevel on the lingual inclines of the maxillary lingual cusps & the buccal inclines of the mandibular buccal cusps provides space for an adequate bulk of metal in an area of heavy occlusal contact.
If a wide bevel is not placed on the functional cusp, several problems may occur : - If the crown is waxed & cast to normal contour it can cause a thin area or perforation in the casting.
- To prevent this the crown may be waxed to optimal thickness resulting in overcontouring & poor occlusion.
- If an attempt is made to obtain space for an adequate bulk in a normally contoured casting without a bevel, it will result in over inclination of the buccal surface which will destroy excessive tooth structure while lessening retention.
AXIAL REDUCTION:REDUCTION:
It plays an important role in securing space for an adequate thickness of restorative material. Inadequate axial reduction can cause thin walls & a weak restoration subjected to distortion or a bulbous, overcontoured restoration which will strengthen the restoration but may have a disastrous effect on periodontium.
Other features that provide space for metal and improve the rigidity & durability of the restoration are: The offset, the occlusal shoulder, the isthmus, the proximal groove & the box.
Selection of the alloy:
-It is essential that there be sufficient clinical evidence of superiority,

before selecting a particular material.
DESIRABLE PROPERTIES OF DENTAL CASTING ALLOYS:
Biocompatibility Ease of melting Ease of casting Ease of brazing (soldering) Ease of polishing Little solidification shrinkage Minimal reactivity with the mold material Good wear resistance High strength Excellent corrosion resistance Porcelain Bonding
Classification : 1.Intended use: 1.Intended Traditionally alloys for casting were classified on the basis of their intended useuse-Type I: Simple inlays -Type II: Complex inlays -Type III: Crowns and fixed partial dentures -Type IV: Removable partial dentures and pin ledges. Porcelain: metal-ceramic alloys. metal2. Physical properties: FDI (1965) classified casting alloys according to their physical properties as: Type I: Soft Type II: Medium Type III: Hard Type IV: Extra-hard Extra-
Factors considered when selecting an alloy:
1. Color: The patients view on the subject should be sought if the metal will be visible in the mouth; otherwise the color is irrelevant. 2. Composition: The percentage composition by weight of the main ingredients must be mentioned. 3. Cost. 4. Clinical performance: A) Biologic properties -Gingival irritation. -Recurrent caries. -Plaque accumulation. -Allergies.
B) Mechanical properties: -Wear resistance and strength. -Marginal fit. -Ceramic bond failure. -Connector failure. -Tarnish and corrosion. 5. Laboratory performance: Factors like casting accuracy, surface roughness, strength, metal-ceramic bond strength should be metalconsidered.
Choice of material: Gold: IndicationsIndications1.In situations of severe occlusal stress. 2.Following endodontic treatment of posterior teeth. 3.Full or partial coverage of posterior teeth where there has been significant loss of coronal dentin. 4.For restoration of adjacent or opposing teeth to avoid problems arising from use of dissimilar metals. Contraindications: -Aesthetics --Cost --Cost
Porcelain (Ceramic): Indications: - Large inadequate restorations on the anterior teeth provided there is enough tooth substance. - Severely discolored teeth. - Over an existing post and core substructure. Contraindications: -Teeth with short clinical crown -Edge to edge occlusion -Teeth which do not allow ideal preparation form to support the porcelain.
Metal ceramic: Indications: - Esthetics - Failure of porcelain jacket crowns. -Posterior teeth where esthetics is necessary and partial coverage gold crowns are contraindicated Contraindications: -Young patients at risk of pulp being exposed -large pulp chamber -Traumatic occlusion (heavy occlusal forces) , where wear of opposing occlusal surfaces is expected.
Metal ceramic framework:

-A metal occlusal contact requires 1-1.5mm of reduction 1-A porcelain contact requires 2mm of reduction -Occlusal contacts need to be 1.5-2.0mm from the porcelain1.5porcelainmetal junction -The substructure must support an even thickness of the porcelain veneer (1mm minimum and 2mm maximum). -The minimum thickness of the metal is 0.2-0.3mm. 0.2-Cut-back: porcelain-metal junction should be 90r or greater. Cutporcelain90r -Metal should preferably be in the area of the centric stop to enhance the durability of the restoration.
MARGIN DESIGN - distortion of restoration margin is prevented by designing the preparation outline to avoid occlusal contact in this area - tooth reduction should provide sufficient room for bulk of metal at the margin to prevent distortion
ESTHETIC CONSIDERATIONS
METALMETAL-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
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 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.
INCISAL REDUCTION - Incisal edge no metal backing. So, it can be

made with a translucency similar to that of natural tooth structure - reduction 2 mm - Excessive reduction reduces retention and resistance
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.
FEATURES OF DIFFERENT TYPE OF PREPARATIONS
ENDODONTICALLY TREATED TEETH Conservation of tooth structure Retention form Resistance form
Conservation of tooth structure

PREPARATION OF CANAL Only minimum tooth structure should be removed from the canal 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 Coronal tooth structure should be saved as much as possible because.. Ferrule: - Extension of the axial wall of the crown apical to the missing tooth structure provides what is known as a ferrule. - helps to bind the remaining tooth structure together, preventing root fracture during function
Retention form
Preparation geometry Post length Post diameter Post surface texture Luting agent
Resistance form
Stress distribution Rotational resistance
Fibre reinforced composite prostheses

Posterior FRC tooth preparation
Occlusal isthmus (1.0 mm depth)
Proximal step(1.0 mm axial depth)
Shoulder/deep chamfer (1.2-1.5 mm)
Anterior FRC tooth preparation
Linguoproximal step(1.0 mm axial depth)
Shoulder/deep chamfer (1.2-1.5 mm)
SUMMARY AND CONCLUSION

Proper attention should be given during margin placement and the principle of Do no harm to the soft tissues should be followed. All preparations require the incorporation of factors to prevent the dislodgement of restoration by functional stresses. If too much emphasis is given on any one of the principles then the success of the procedure may be limited by a lack of consideration of the other factors. An analysis of these principles and factors should enable the dentist to effectively apply them during the design of any preparation.
REFERENCES 1. Tylman SD, Malone WFP. Tylman's Theory and practice of fixed prosthodontics. 7th ed. St. Louis: Louis: Mosby; Mosby; 1978. 2. Shillingburg HT, Hobo S, Whit&t LD. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintessence Publishing Co, 1981. 3. Blair FM, Wassell RW, Steele JG, Crowns and other extraextra-coronal restorations: Preparations for full veneer crowns. British Dental Journal 2002;192:561-71. 2002;192:561 4.Rosenstiel SF, Land MF, Fujumoto J. Contemporary Fixed Prosthodontics.4th ed. St. Louis: Mosby; 2007. 5.Langeland K, Langeland LK. Pulpal reactions to crown preparation, impression, temporary crown fixation and permanent cementation. J Prosthet Dent 1965;15:129-43. 1965;15:129 6.Laforgia PD, Milano V, Morea C, Desiate A. Temperature change in the pulp chamber during complete crown preparation. J Prosthet Dent 1991;65:561991;65:5661.
7. Brannstrom M, Nyborg H. Cavity treatment with a microbicidal fluoride solution: Growth of bacterial and effect on the pulp. J Prosthet Dent 1973;30:303-10 1973;30:303 8. Dowden WE. Discussion of methods and criteria in evaluation of dentin and pulpal responses. Int Dent J 1970;20:5311970;20:531-5. 9. Perel ML. Axial crown contours. J Prosthet Dent 1971;25:6421971;25:642-8. 10. Black GV. The management of enamel margins. Dent Cosmos 1891;33: 85-100. 85 11. Bader JD et al. Effect of crown margins on periodontal conditions in regularly attending pataients. J Prosthet Dent 1991;65:75-82. 1991;65:75 12. Hunter AJ, Hunter AR. Gingival crown margin configurations. A review and Discussion : Terminology and widths. J Prosthet Dent 1990;64:5481990;64:548-52.
13. Bell CJ, Bowden JR, Saund P, Smith M, Stephenson RI. The Dicer castable ceramic crown. Dent Practice 1987;25:20-5. 1987;25:20 14. Rosner D. Function,placement and reproduction of bevels for gold. J Prosthet Dent 1963:10:1160-66. 1963:10:1160 15. Ostlund LE. Cavity design and mathematics: their effect on gaps at the margins of cast casting. J Prosthet Dent restorations. Operative Dent 1985;10:1221985;10:122-37. 16. Schweikert E . Feather-edged or knife-edged FeatherknifeDreparation and impression technique. J Prosthet Dent 1984;52:243-6. 1984;52:243 17. Goodacre CJ. Designing tooth preparatios for optimal success. Dent Clin N Am 2004;48:359-385. 2004;48:359-
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Principles of Tooth Preparation Punam Bishnoi

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Principles of Tooth Preparation Punam Bishnoi

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PRINCIPLES

INTRODUCTION Tooth preparation is defined as mechanical

Best combination of compromises

Retention form Resistance form Structural durability

Prevention of damage during tooth preparation

Conservation of tooth structure

3. Planar occlusal reduction

4. Even reduction of axial surfaces

5. Selection of conservative margin

6. Avoidance of unnecessary apical extension of preparation

Margin locationlocationBiologic width

Violation of biological width:width:-

Violation of biologic width

Location of restorative margins:margins:-

 Supragingival  Equigingival  Subgingival

Restorations can be easily evaluated

MARGINAL GEOMETRY OR FINISH LINE CONFIGURATION

Guidelines for evaluation for margin design :

KNIFE EDGE OR FEATHER EDGE

SHOULDER WITH BEVEL

TO BEVEL OR NOT TO BEVEL

PREVENTING THE TOOTH FRACTURE

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

FACTORS AFFECTING RETENTION

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

MAGNITUDE OF DISLODGING FORCES

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

GEOMETRY OF TOOTH PREPARATION

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

Area under Shear Stress:

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

TYPE OF RESTORATION AND SECONDARY RETENTIVE FEATURES

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

Materials being cemented:

Type of luting agent:

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

Film thickness of the luting agent. agent.

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

Methods to analyse resistance form

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

FACTORS AFFECTING RESISTANCE FORM

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

Magnitude and direction of dislodging forces Resistance decreases in following order:

RETENTION FORM RESISTANCE FORM STRUCTURAL DURABILITY

LEVERAGE AND RESISTANCE:

Supragingival Equigingival Subgingival