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FORCES ACTING ON RESTORATIONS

CONTENTS

Introduction Force Force on dental structure Stress Types of stress Mechanical properties of material Biomechanics for restorative dentistry Stress analysis and design of dental structures a) Finite element stress analysis b) Photoelasticity Stress in the periodontal membrane Stress patterns of teeth On anterior teeth On posterior teeth Occlusal considerations in restoring teeth Forces e erted during occlusion ! mastication and their resolution forces acting on amalgam restorations "lass i "lass ii Forces acting on inlay restoration Forces acting on composite restoration Forces acting on posts Forces acting on a cast metal and porcelain restorations "onclusions

FORCES ACTING ON RESTORATIONS INTRODUCTION: #esign of any structure re$uires a means to predict the stress that %ill develop in the structure under the anticipated applied loads& In many respects the design of structures for the oral environment is among the most demanding because of the comple ity of the functional and parafunctional loads that must be accommodated and because of esthetic and space limitations& In spite of these special conditions ho%ever all dental tissues and structures follo% the same la%s of physics as any other material or structure& By necessity these studies involve the application of physics and engineering to the oral cavity and its surrounding structures& 'll structural analysis and design re$uire (no%ledge of the forces that %ill be applied and the mechanical properties of the materials that must %ithstand these forces& Since most restorative materials must %ithstand forces in service either during mastication or fabrication& Those mechanical properties are important) $uantities of force) stress) strain) strength hardness) and others can help identify the properties of a material& FORCE The general concept of force is gained through the muscular action of pushing or pulling on an ob*ect& +hen there is a tendency to change the position of rest as the motion of a mass) it is said that a force is applied& ' force al%ays has a direction and the direction is often characteristic of the type of force& If the body to %hich the force is applied remains at rest) the force causes the body to deform& ,nits of force are the pound or the (ilogram or -e%ton& FORCES ON DENTAL STRUCTURES : One of the most important applications of physics in dentistry is in the study of forces applied to teeth and dental restorations& There are numerous reports in the dental literature that describe the measurement of biting forces on teeth& The ma imum forces reported have ranged form .// to .00/ - 102 to 22/ lb)&

-umerous instruments have been used to ma(e this measurements) including strain gauges and telemetric devices small enough to be incorporated into dental restorations& NORMAL BITING FORCES : 3 periments conducted on adults have sho%n that the biting force decreases form the molar region to the incisors& Studies have revealed that four patients developed biting forces on the first and second molars that varied form 45/ to 6// - 166 to 756 lb)) %ith the average being 282 - 17.9 lb)& The average force on the bicuspids) cupids and incisors %as .66) ./6 and 722 - 182) 09 and 42 lb) respectively& In a similar investigations of the biting forces in children) 964 boys and girls %ere studied& "hildren form 8 to 79 years of age %ere included) and it %as observed that there %as an increase in force form .42 to 050 - 124 to 777 lb) as age increased) %ith the average yearly increase being in the order of ..&. - 12 lb)& The average biting forces in persons %ith normal and modified occlusion %ere measured& #ata indicate that the %hen the bite %as raised /&2 mm) the measured forces %ere generally higher) approaching t%ice the values obtained %ith normal occlusion& This observation may be e plained by the fact that the force on teeth are determined by muscular effort) and this effort is controlled by the nervous system& Thus some force regulating mechanism %as operating and it probably e ists in case of malocclusion& The ma imum force measured %ill depend on the type of food& FORCES ACTING ON THE TEETH : FORCES AND RESPONSES : The forces %hich act on the teeth and cause them to move %ithin their periodontal tissues vary in magnitude) duration) fre$uency and direction& The responses by the teeth to the forces depend on such factors as the shape and length of the roots the characteristics of the fluid content of the periodontal space) the composition and orientation of the periodontal fibres and the e tent of the alveolar bone& The responses by the teeth %ill also depend on the consistency of the bolus being che%ed and the muscular forces being used to crush it& This %ill also apply to parafunctional clenching and che%ing %ith or %ithout a foreign body bet%een the teeth& It is) therefore) difficult to assess %hat is a normal response to a force on a tooth and %hat is potentially harmful& 's a result of these forces) a tooth can be 4

displaced in one of si directions : ; apically) mesiodistally or buccolingually) and each one producing a rotation or a translation& The result is li(ely to be a combination of all directions leading to an omnidirectional movement& involved& OMNIDIRECTIONAL AND UNIDIRECTIONAL RESPONSES : These omnidirectional tilting and rotations of teeth %ill reach a limit %hen an e$ual and opposite resistance is reached and the periodontal receptors cause a refle arrest of the muscle force& +hen the force is removed) the teeth %ill recover their positions due to the elastic recovery of the compressed periodontal tissues& This is referred to as <replacement= of the teeth& This phenomenon may be modified by 4 factors > i) ii) iii) 'lveolar bone support 'd*acent teeth support ?ori@ontal muscle activity on both buccal and lingual surfaces of the teeth& %hen they %ill become repositioned& Teeth %ill continue to move unidirectionally until positions of stability are reached& The opposing forces are then e$ual to the moving forces& Thus) ma illary incisors %ith poor periodontal support and incompetent lips %ill drift for%ards& This for%ard drift %ill continue until the teeth are shortened or are prevented from moving further by an appliance and by treatment of the periodontal brea(do%n& STRESS +hen a force acts on a body) tending to produce deformation) a resistance is developed to this e ternal force application& Stress is the internal reaction to the e ternal force& Both the applied force and stress are distributed over a given area of the body) and so the stress in a structure is designated as the force per unit area& Force Stress A ;;;;;;;;; 'rea 0 The same principle of movement %ill apply to the opposing tooth

These 4 variable factors may lead to an unidirectional movement of a tooth or teeth

'rea over %hich the force acts is an important factor of consideration especially in dental restorations in %hich areas over %hich the force applied often are e tremely small& Since stress at a constant force is inversely proportional to the area) the smaller the area) the larger the stress& 'nd vice versa& Technically) stress is the internal resistance of the body in terms of force per unit area and is e$ual and opposite in direction to the force 1e ternal) applied& This e ternal force is also (no%n as load& TYPES OF STRESSES : #epending upon the nature of the force) all stresses can be divided into 4 basic types %hich are recogni@ed as > i& ii& iii& Tension "ompression and Shear a%ay from each other in the same straight line& F

7) Tension : Besults in a body %hen it is sub*ected to . sets of forces that are directed

F .) "ompression : Besults %hen the body is sub*ected to . sets of forces in the same straight lien and directed to each other& F

F 4) Shear : Is a result of . forces directly parallel to each other& S F Tensile Stress : Is caused by a load that tends to stretch as elongate a body& The molecules ma(ing up the body must resist being pulled apart& 2 F

Compressi e Stress : Produced by a load that tends to compress the body& The molecules resist being forced more closely together& ' stress that tends to resist a t%isting motion) or a sliding of one portion of a body over another& The molecules resist sliding of one body past another& ' force applied to a dental restoration may be resolved in the structures as a combination of compressive) tensile and shear stresses& Comple# Stresses : +henever force is applied over a body) comple multiple stresses are called comple stresses& MECHANICAL PROPERTIES OF A MATERIAL : The mechanical properties of a material describe its response to loading& It is common to simply describe the e ternal load in terms of a single dimension 1direction) as compression) tension) or shear combination of these can produce Torsion 1T%isting) or Fle ion 1transverse bending)& +hen a load is applied) the structure undergoes deformation as it bonds are compressed) stretched) or sheared& The load deformation characteristics are only useful information if the absolute si@e and geometry of the structure involved are (no%n& Therefore) it is typical to normali@e load and deformation as stress and strain& Stress is load per unit cross sectional area& Strain is deformation per unit length& #uring loading) bonds are generally not compressed as easily as they are stretched& Therefore) materials resist compression more readily and are said to be Materials have different properties under stronger in compression than in tension& as multiple stresses are produced& They may be a combination of tensile) shear or compressive stress& These

S!e"r Stress : -

different directions of loading& <It is important to determine %hat the clinical direction of loading is before assessing the mechanical property of interest=& 's loading continues) the structure is deformed& 't first this deformation 1or strain) is completely reversible 13lastic strain)& ?o%ever) increased loading finally produces some irreversible strain as %ell 1plastic strain)) %hich causes permanent 8

deformation& The point of onset of plastic strain is called the elastic limit& "ontinuing plastic strain ultimately leads to failure by fracture& The highest stress before fracture is the ultimate strength& The total plastic tensile strain at fracture is called the elongation& The slope of the linear portion of the stress strain curve is called the modulus) modulus of elasticity) youngCs modulus) or the stiffness of the material& T%o of the most useful mechanical properties are the modulus of elasticity and elastic limit& ' restorative material generally should be very stiff so that under load) its elastic deformation %ill be e ternally small& 'n e ception is "lass D composite %hich should be less stiff to accommodate tooth fle ure& If the stress is %ell beyond the elastic limit) then the resulting deformation is primarily plastic strain and at some point ultimately results in failure& Often it is convenient to determine the elastic limit in a relative manner by comparing the onset of plastic deformation of different materials using scratch or indentation tests) called hardness tests& The energy that a material can absorb before the onset of any plastic deformation is called its resilience) and is described as the area under the stress;strain curve up to the elastic limit& The total energy absorbed to the point of fracture is called the toughness and is related to the entire area under the stress strain curve& Time;dependent responses to stress or strain also occur& #eformation %ith time in response to a constant stress is called creep 1strain rela ation)& #eformation overtime in response to a constant strain is called stress rela ation& BIOMECHANICS FOR RESTORATI$E DENTISTRY : Teeth are sub*ected to many forces during normal use& The interactions bet%een the applied forces) the shape and structure of teeth) the supporting structures) and the mechanical properties of tooth components and restorative materials are all included in the sub*ect of biomechanics& Biomechanical ,nit : The standard biomechanical unit involves the 7& Bestorative material .& Tooth structure) and 4& Interface bet%een the restoration and tooth

The importance of considering three structures in the biomechanical unit is to detect stresses that may cause un%anted fractures or debonding& The restorative material may be strong enough to resist fracture) but the interface or tooth structure may not be& STRESS TRANSFER : -ormal tooth structure transfers e ternal biting loads through enamel into dentin as compression& The concentrated e ternal loads are distributed over a large internal volume of tooth structure and the local stresses are lo%er& #uring this process a small amount of dentin deformation may occur %hich results in tooth fle ure& ' restored tooth tends to transfer stress differently than an intact tooth& 'ny force on the restoration produces compression) tension) or shear along the tooth restoration interface& Once enamel is no longer continuous) its resistance is much lo%er& Therefore) most restorations are designed to distribute stresses onto sound dentin) rather than to enamel& The process of stress transfer to dentin becomes more complicated %hen the amount of remaining dentin is thin and the restoration must bridge a significant distance to seat onto thic(er dentin 1Einers or bases)& TOOTH FLE%URE : Tooth fle ure has been described as either a lateral bending or an a ial bending of a tooth during occlusal loading& This fle ure produces the ma imal strain in the cervical region) and the strain appears to be resolved in tension or compression %ithin local regions) causing the loss of bonded class D restorations in preparations %ith no relative grooves& Moreover) one current hypothesis is that tensile or compressive strains produce microfractures 1called 'BFB'"TIO-S) in the thinnest region of enamel at the "3F& Such fractures predispose enamel to loss %hen sub*ects to tooth brush abrasion and!or chemical erosion& This process may be (ey in the formation of "lass D defects& PRINCIPLES OF BIOMECHANICS : Stress transfer and the resulting deformations of structures are principally governed by : 7& The elastic limit of the materials .& The ratio of the elastic moduli involved 4& Thic(ness of the structures

Materials %ith a high elastic modulus transfer stresses %ithout much strain& Eo%er modulus materials undergo dangerous strains %here stresses are concentrated) unless there is ade$uate thic(ness& STRESS ANALYSIS AND DESIGN OF DENTAL STRUCTURES The mechanical properties of a material used in a dental restoration must be able to %ithstand the stresses and strains caused by the repetitive forces of mastication& The design of dental restoration is particularly important if the best advantage of a material is to be ta(en& It is necessary to use designs that do not result in stresses or strains that e ceed the strength properties of a material under clinical conditions& Stresses in dental structures have been studied by such techni$ues as brittle coatings) strain gauges) t%o and three;dimensional photoelasticity) and finite element analysis& Stress analysis studies of inlays) cro%ns) bases supporting restorations) fi ed bridges) complete dentures) partial dentures) and implants have been reported& "& T'o Dimension"l P!otoel"sti(it) : The procedure for t%o;dimensional models is to prepare a transparent plastic or other isotropic model of the restoration or appliance& This model is usually larger than the actual si@e& The material becomes a is atropic %hen stressed) and so the behaviour of light is affected by the direction it ta(es& 's a result of the applied stress) the plastic model e hibits double refraction because of its an isotropic structure& The light from the source passes through a polari@er) %hich transmits light %aves parallel to the polari@ing a is) or plane polari@ed light& The plane polari@ed light is converted to circularly polari@ed light by a $uarter %ave plate) and this polari@ed beam is split into t%o components travelling along the direction of principal stress in the model& #epending on the state of stress in the model) the t%o beams travel at different rates& 'fter the light emerges form the model) it passes through a second $uarter %ave plate) %hich is crossed %ith respect to the first) and an analy@er that is most fre$uently perpendicular to the polari@er& The interference pattern may be recorded photographically) %hich is the isochromatic fringe pattern& These isochromatic fringes) or dar( liens) represent locations %here the difference in the principal stresses is a constant& The magnitude of the stress can be determined by identification of the order of the isochromatic fringes& The fringe order multiplied by a constant and divided by the thic(ness of the model gives the value of the differences in the principal stresses& 'reas in the model 5

%here the fringer are close together are under higher stress gradients than areas %here there are fe%er fringes) and areas containing fringes of higher order are under higher stress than these having fringes of lo%er order& ' t%o dimensional photoelastic model of a second molar %ith a gold cro%n is analy@ed& The elastic modulus of the plastics used to represent the gold) dentin and bone had the same relative values as the actual materials& The cro%n %as luted to the tooth %ith dental stone) and a layer of silicone rubber) simulating the periodontal membrane) separated the tooth from the bone& ' force of .88 - 18/ lb) %as applied 4/ degrees to the a is of the tooth at a single site on the mesial cusp) and the isochromatic fringes %ere photographed& ?igh stresses are apparent under the contact and in the bone at the tip of the mesial root 1seven fringes)& "onsiderably lo%er stresses occurred in the bone *ust under the distal root and at the crest of the ridge on the mesial side& The effect of various configurations of the pro imal margins %as studied by t%o; dimensional photoelasticity on the stress distribution in "lass II inlays& Eight field isochromatic fringes for rounded shoulder and shoulderless models under a 002 - load %ere analy@ed& The load %as applied at 4 other locations : i) ii) iii) 't the groove in the restoration On the cusp 't the *unction of the restoration and the tooth The ma imum shear stress %as determined at nine critical areas) to% in the restoration) t%o in the tooth and five at the *unction of the restoration and the tooth& The study sho%ed that the chamfer and rounded type of preparations are the optimum designs in pro imo;occlusal posterior restorations) since they demonstrated the lo%est stress %hen loaded vertically& The ma imum fringe order for the rounded shoulder %as 7/ %hereas that for the shoulderless preparation %as 79& It %as also sho%n that rounding the a iogingival line angle in the shoulder geometry reduced the stress concentration factor by upto 2/G& The gingival area of the pro imal shoulder %as the area of high stress) and e tra retentive features such as pins or grooves should not be placed in this area& FINITE ELEMENT STRESS ANALYSIS : The finite element is a ne%er method than photoelasticity and offers considerable advantages& In this method a finite number of discrete structural elements are 7/

interconnected at a finite number of points or nodal points& These finite elements are formed %hen the original structure is divided into a number of appropriately shaped sections) %ith the sections retaining the actual properties of the real materials& The information needed to calculate the stresses and displacement in the model is 7) The total number of nodal points and elements& .) ' numbering system for identifying each nodal point and element& 4) The elastic modulus and PoissonCs ratio for the materials associated %ith each element& 0) The coordinates of each nodal point 2) The type of boundary constraints 8) The evaluation of the forces applied to the e ternal nodes& ' first molar %ith an amalgam restoration %as ideali@ed by an a isymmetrical model and analy@ed by the t%o;dimensional finite element method& interest& The model is divided into a number of triangles& The smaller triangles are located in areas of greater The ability of various types and thic(ness of cement bass to support the amalgam %as studied& The plots of ma imum tensile stress start at the centre of the cavity and e tend to%ard the cavity %all& The stress induced in the amalgam restoration %as from four to five times higher %hen the amalgam %as supported by . mm Hinc O ide 3ugenol cement base) as compared %ith an e$ual thic(ness of @inc phosphate cement base& +hen the stresses induced in the amalgam by a @inc phosphate base of . mm are considered in relation to those induced by a dentin floor alone one can see that replacement of dentin by @inc phosphate to a depth of . mm does not result in any significant increase in the tensile stress induced in the amalgam& The @inc o ide eugenol cement base unli(e the @inc phosphate cement bar) does not function as displacement& In comparison %ith @inc phosphate cement base the @inc o ide eugenol material does not have ade$uate mechanical properties to support a restoration& 3ven thin layers 1/&2 mm) of @inc o ide eugenol cement caused significant changes in the stress induced n the amalgam& Therefore the study indicates that the fracture of amalgam is influenced more by the modulus of elasticity 1Stiffness) of the base material than by the compressive strength of the base& 'n ideal situation %ould be to have a cement base %ith a modulus of elasticity e$ual to that of the restorative material& 'lso) a subse$uent 77 rigid material and induces a larger

study found that tensile and shear stresses occurring in the cement base %ere of sufficient magnitude to e ceed the strength of some cements& The stress distribution in porcelain fused to metal and porcelain *ac(et cro%ns %as conducted using a finite element method& #esign parameters of rounding of shoulders) avoidance of sharp notches) minimum thic(ness of metal copings) and minimum labial bul( of porcelain %ere incorporated into the model of an upper central incisors& ' load of 000 - %as applied at the incisal third of the lingual surface and at the middle third of the lingual surface& Dertical loading and loading 4/ degrees to the vertical %ere used& Since fracture is probably initiated by tensile failure at the periphery) the tensile stress at the boundary is of special importance& +ith vertical loading at the incisal third) the highest tensile stresses %ere found tat the labial third and on the lingual surface near the load) decreasing to%ard the incisal edge& Eo% stresses %ee observed at the margin and on the lingual surface belo% the load& The surface stress %as nearly the same %hether a gold or -i;"r base alloy %as used> the use of -i;"r caused a slight decrease in surface stress& +hen the direction of the loading %as changed to 4/ degrees from the vertical) high tensile stresses %ere observed near the lingual margin that %ould be of sufficient magnitude to fracture the cement in this area& STRESS IN THE PERIODONTAL MEMBRANES : 'lthough limited measurements have been made on the periodontal membrane of animals) the actual stress in the membrane has not been determined e perimentally& ?o%ever) the stress to be e pected has been calculated& In one case) it %as assumed that the periodontal membrane %as incompressible) %hereas in another it %as assumed to be appro imately that of %ater& In both cases the root of the tooth %as assumed to be a cone and the elastic modulus of the membrane %as ta(en as 7&02 M-!m.& +hen the force %as applied to the center o the tooth a is) the stress distribution %as uniform %ith respect to the longitudinal a is of the tooth and the pressure %as greatest at the ape & If the loading %as transverse) the ma imum stress occurred near the apical third of the root on the same side as the compression force&

7.

STRESS PATTERNS OF TEETH 3very tooth has its o%n stress pattern) and every location on a tooth has special stress patterns& Becogni@ing them is vital prior to designing a restoration %ithout failure potential& A& STRESS i) BEARING AND STRESS CONCENTRATION AREAS IN ANTERIOR TEETH : The *unction bet%een the clinical cro%n and clinical root bears shear components of stress) together %ith tension on the loading side and compression at the non;loading side) during e cursive mandibular movements& ii) The incisal angles) especially if they are s$uare) are sub*ect t tensile and shear stress in normal occlusion& Massive compressive stresses %ill be present in edge;to;edge occlusion) and if the incisal angles are involved in a disclusive mechanisms) these stresses are substantially increased& iii) The a ial angles and lingual marginal ridges %ill bear concentration shear stresses& In addition) on the loading side) tensile stresses are present) and on the nonloading side) compressive stresses are found& iv) The slopes of the cuspid %ill bear concentrated stresses 14 types)) especially fi the cuspid is a protector for the occlusion or part of a group function during mandibular e cursions& v) The distal surface of a cuspid e hibits a uni$ue stress pattern as a result of the anterior components of force concentrating compressive loading at the *unction of the anterior and posterior segments of the dental arch and microlateral displacement of the cuspid during e cursive movements& Both of these factors %ill lead to tremendous stress concentration %ith resultant abrasive activity there& vi) The lingual concavity in upper anterior teeth bears substantial compressive stresses during centric occlusion) in addition to tensile and shear stresses during protrusive mandibular movements& vii) The incisal edges of lo%er anterior teeth are sub*ected to compressive stresses& In addition) tensile and shear stresses are present during protrusive mandibular movement& The incisal ridges of upper anterior teeth %ill have 74

these same stresses during the mid;protrusive and sometimes at the protrusive border location of the mandible& B& STRESS i) ii) iii) iv) BEARING AND STRESS CONCENTRATION AREAS OF POSTERIOR TEETH : "usp tips) especially on the functional side) bear compressive stresses& Marginal and crossing ridges bear tremendous tensile and compressive stresses& ' ial angles bear tensile and shear stresses on the non;functional side) and compressive and shear stresses on the functional side& The *unction bet%een the clinical root and the clinical cro%n during function 1especially lateral e cursion) bears tremendous shear stresses) in addition to compression on the occluding contacting side and tension on the non;contracting side& v) 'ny occlusal) facial or lingual concavity %ill e hibit compressive stress concentration) especially if it has an opposing cuspal element in static or functional occlusal contact %ith it& C& *EA+ AREAS OF TOOTH : +ea( areas in the tooth should be identified and recogni@ed before any restorative attempt) in order to avoid destructive loading& They are > i) ii) Bifurcation and trifurcation area& "ementum should be eliminated as a component of a cavity %all& The *unction bet%een the cementum of the dentin is al%ays irregular) so the dentin surface should be smoothed flat after cementum removal& iii) iv) v) Thin dentin bridges in deep cavity preparations& Subpulpal floors in root canal treated teeth& 'ny stress concentration there may split the tooth interceptally& "rac(s or cra@ing in enamel and!or dentin& Both should be treated passively in any restorative design& They may act as shear lines leading to further spread& SOME APPLIED MECHANICAL PROPERTIES OF TEETH: 7& 'lthough the follo%ing figures are averages) they provide an idea about the principal mechanical properties of tooth structure& It must be understood that these figures can differ from one location on a tooth to another and from one tooth to another&

70

a) "ompressive strength of enamel supported by vital dentin is usually 48;0.)/// psi& b) "ompressive strength of vital dentin is 0/;2/)/// psi& c) Modulus of resilience of enamel supported by vital dentin is 8/;6/ inch lbs!cubic inch& d) Modulus of resilience of vital dentin is 7//;70/ inch lbs!cubic inch& e) Modulus of elasticity of enamel supported by vital dentin under compression is 9)///)/// psi& f) Modulus of elasticity of vital dentin is 7)5//)/// psi& .& In general) %hen enamel loses its support of dentin) it loses more than 62G of its strength properties& 4& Tensile strength of dentin is about 7/G less than its compressive strength& 0& Tensile strength and compressive strength of enamel are similar) as long as the enamel is supported by vital dentin& 2& Shear strength of dentin is almost 8/G less than its compressive strength) and this is very critical in restorative design& 8& There is minimal shear strength for enamel %hen it loses its dentin support& 9& +hen the dentin loses its vitality) there is a drop of almost 0/;8/G in its strength properties& $ALE E%PERIMENT : The original e periment involved preparation of occlusopro imal cavities %ith different crossing dimensions at the marginal and crossing ridges %ith a standard depth& The teeth %ere then sub*ected to measured occlusal loads& The load that split the tooth %as recorded and compared to the control) %hich %as the load that split a round tooth& Eater) the same e periment %as repeated by several investigators using more sophisticated e$uipment than that used by vale& The results %ere consistent& ' summary of their findings brought to the closest round figures is as follo%s : i) ii) iii) By crossing one marginal ridge at I the intercuspal distance) there is almost 7/G loss of a toothCs resistance to splitting& By crossing t%o marginal ridges at I the intercuspal distance) there is almost 72G loss of a toothCs resistance to splitting& By crossing one marginal ridge at 7!4 the intercuspal distance) there is almost 4/G loss of a toothCs resistance to splitting& 72

iv) v) vi) vii) viii) i )

By crossing t%o marginal ridges by 7!4 the intercuspal distance) there is almost 42G loss of a toothCs resistance to splitting& By crossing one marginal ridge at J the intercuspal distance) there is almost 0/G loss of a toothCs resistance to splitting& By crossing t%o marginal ridges at J the intercuspal distance) there is almost 02G loss of a toothCs resistance to splitting& By crossing a crossing ridge at I the intercuspal distance) there is almost ./G loss of a toothCs resistance to splitting& By crossing a crossing ridge at 7!4 the intercuspal distance) there is almost 42G loss of a toothCs resistance to splitting& By crossing a crossing ridge at J the intercuspal distance) there is almost 02G loss of a toothCs resistance to splitting& OBTAINING RESISTANCE FORM FOR TOOTH STRUCTURES :

7) To best resist masticatory forces) use floors or planes at right angles to the direction of loading to avoid shearing stresses&

.) If possible) %alls of preparations should be parallel to the direction of the loading forces) in order to minimi@e or avoid shearing stresses&

4) Intracoronal and intraradicular cavity preparations can be done in bo ) or cone or inverted truncated cone shapes&

Thus from the above figures) it is possible to deduce that the inverted truncated cone shapes %ill have a higher resistance to loading than the bo shapes) and the bo shapes %ill have a higher resistance than the cone shapes& Therefore) if conditions and 78

re$uirements allo%) cavity preparations should be prepared in an inverted truncated cone shape& 0) #efinite floors) %alls and surfaces %ith line and point angles are essential to prevent micromovements of restorations) %ith concomitant shear stresses on remaining tooth structures&

2) Increasing the bul( of a restorative material or leaving sufficient bul( of tooth structure in critical areas is one of the most practical %ays of decreasing stresses per unit volume& Eoad ' Eoad '

7/ stress units!mm4 7 stress unit ! mm4 8) #esigning the outline form %ith minimal e posure of the restoration surface to occlusal loading %ill definitely minimi@e stresses and the possibility of mechanical fracture in the restoration& 9) Functions bet%een different parts of the preparation) especially those acting as fulcra) should be rounded in order to minimi@e stress concentration in both tooth structure and restorations and to prevent any such sharp components from acting as shear lines for fracture future& 6) Betentive features must leave sufficient bul( of tooth structure to resist stresses resulting from displacing forces& OCCLUSAL CONSIDERATIONS IN RESTORING TEETH The %ay %e occlude teeth affects the periodontium) the temporomandibular *oints) throat muscles) tongue) chee(s) lips) nerves and so son& The occlusion of the restored teeth should hence establish healthy relations bet%een the dentition and rest of the stomatognathic system& ' clinician must have ade$uate (no%ledge about the principles of occlusion) %hich enables him to diagnose cases that need modifications ! alteration of occlusion %ith or %ithout the use of various restorative materials& Before initiating any restorative care) thorough occlusal e amination should be carried out& 79

The (ind of occlusion) a patient should have) must be *ustified by the principles of physiology& The occlusion affects almost every part of stomatognathic system) mainly : a) The pulp of the tooth is a very sensitive organ& IT reacts immediately to abnormal occlusal forces& ?ence) occlusion should not be detrimental to pulp& b) The pro imal relations of the occlusion should prevent food impaction bet%een teeth& c) The cusp;fossa relationship should be such that the ade$uate forces e erted during functional movement) aids in optimum health of the periodontium& 3ach tooth should be restored follo%ing the principles of occlusion) so as to achieve optimum functions of the neuromusculature *oints and the supporting structures of the teeth& -e% restoration should not introduce any premature contacts and cuspal interferenceCs& POSTERIOR RESTORATIONS : 'll posterior restorations should be planned (eeping in mind the basic principles of occlusion& Prior to cutting a tooth) its opposing occlusal surface should be e amined& Malpositioned opposing supporting cusps and ridges should be recontoured in order to achieve optimal occlusal contacts in the restored tooth& ,se articulating paper to register the centric holding spots and e cursive contacts so that these mar(ed areas can either be e cluded form the outline form or properly restored& Plunger cusps and over erupted teeth should be reduced) removing all the cuspal interferenceCs so as to improve the plane of occlusion and decrease the chances of fracture of ne% restoration as a result of occlusal forces& +hen carving for occlusion) attempt to establish stable centric contacts of cusps %ith opposing surfaces that are perpendicular to occlusal forces should be made& Occlusal contacts located on a cuspal incline or ridge slope are undesirable because these create a deflective force on the tooth and hence should be ad*usted until the resulting contact is stable& i& AMALGAM RESTORATIONS : Sufficient bul( of amalgam is mandatory %hen restoring a cavity %ith amalgam so as to %ithstand the load of occlusion& 76

'de$uate thic(ness of amalgam should be provided at the marginal ridges in order to support the opposing supporting cusps& 'malgam restorations are carved follo%ing the cuspal inclines& In case of large restorations) %here there are no cuspal planes to guide carving) the operator should follo% a cautious approach : Buccal and lingual cusp tips should be placed in lines *oining those of ad*acent teeth& The level of central fossa and the marginal ridge should be carved similar to that of ad*acent teeth& The bucco;lingual %idth of the occlusal surface is (ept narro%er than the original buccolingual %idth of the tooth& In case both the %or(ing cusps on more than . cusps are restored) preferably the occlusal table is (ept narro%ed& This narro%er occlusal table leads to : Beduction of force : +hen the occlusal table is made narro%er) lesser force is applied over the same to undergo masticatory functions& Force is transmitted to all structures underlying the occlusal table) %hich include the restoration) the tooth structure and the periodontium& Beduction of the effect of force : The direction in %hich the applied force is transmitted is governed by muscular activities and the area on %hich the force is applied& ?o%ever) the effect of the force may be modified by altering the surface at %hich the force is applied) thus altering the direction of resolved components& Beduction of tor$ue : The tendency to rotate may be reduced by altering the point of application of the force relative to the fulcrum& The point of application of the force may be altered by modifying the occlusal table %hich indirectly depends upon the design of the cavity and the restoration& ii& CAST METAL RESTORATIONS : Similar to amalgam restorations) before preparations of any tooth) evaluate the occlusal contacts of the teeth in centric occlusion and in e cursive movements& 's part of this evaluation decide if the e isting occlusal relationships can be improved %ith the cast metal restorations&

75

The cuspal interferences are depicted in mandibular %or(ing movements) non %or(ing movements and protrusive movements& The opposing occlusal surfaces should be e amined an he malpositioned cusps) plunger cusps and over erupted teeth should be recontoured& Premature contacts or cuspal interferences from the teeth opposing the re$uired restoration should be removed& The remaining tooth structure and the length of clinical cro%n dictates us to choose the type of cast restoration& ANTERIOR RESTORATIONS : The resin composites and the glass ionomer cements are mainly used in anterior restorations& Though these teeth do not come under direct occlusion) ho%ever) they do ta(e part in various movements of the mandible& The restoration should be carved and finished) maintaining the contacts and the cervical curvature of these restorations& The lingual area is carved to maintain the anatomy of cingulum and the lingual marginal ridges& Patient is as(ed to protrude and the interferences are chec(ed and removed& Similarly) the relationship of lips %ith the labial surfaces of restored teeth are chec(ed and the over;contouring) if any) is removed& The gingival e tension of the material is ta(en care of to maintain the gingival health& Role o, Cont"(t Are"s : Kood restorative dental procedures must reproduce the proper contact areas& Bestorations %ith contact areas %hich are flat) open) improperly placed) rough or poorly polished %ill lead to failure& ' slight frictional movement of teeth al%ays occurs bet%een the interpro imal surfaces of teeth during physiologic movement> and %ith time) the contact point becomes broad resulting in a %ider contact area& IF the teeth remained in contact %ith each other merely by contact points) they %ould eventually be forced out of the dental arch in either a buccal or lingual direction& +hereas %ith a %ider contact bet%een teeth) this is not li(ely to occur& The opposing interpro imal surfaces of restorations must be hard in order not to flo%) flatten) %ear or become abraded %ith use& ./

Rel"tions!ip -et'een toot! 'e"r "n. restor"ti e m"teri"ls : Occlusal forces lead to %ear of enamel& The %ear is) ho%ever) very slo% if occlusal forces are appropriately transmitted to underlying bony tissues& The pattern of %ear varies individually depending upon various factors& -on;uniform ear of opposing teeth is $uite common %hen one teeth is restored %ith a restorative material %hose %ear resistance is different as compared to that of enamel& Dery rarely) the %ear resistance of a restorative material e$ual the %ear resistance of enamel& 't present) no restorative material is available %hich %ears at the same rate as enamel or as enamel and dentin at later stages& #ifferential %ear can result in locali@ation of occlusal loads %ith subse$uent failure of restorative materials or development of deflective contacts %ith mandibular repositioning and an effect on a distant tooth& ?ypothetically) if t%o restorative materials) %hich %ear at a slo%er rate than the natural teeth) are placed so as to oppose each other in a dentition undergoing %ear) the restorations %ill produce occlusal interferences at a later stage& -on;%earing materials opposing each other can lead to natural teeth %ear during contact in lateral and protrusive movements& "onversely) if the materials %ear faster than the teeth) the opposing cusp might over erupt into the %orn material& I- lateral e cursion) this cusp might then come in contact %ith an opposing cusp and if %ea(ened by previous caries can lead to fracture& Compens"tion ,or O((l/s"l *e"r : Occlusal interferences can develop through differential %ear patterns and unmatched compensatory mechanisms& The clinician can shape and regulate the form of occlusal surfaces of teeth and restorations so that he can determine surfaces of teeth and restorations) %hich contact during activities such as mastication) s%allo%ing and bru ism& The advantage of this approach are : ;

.7

The direction of stresses through the strongest portions of the restorations an the remaining tooth structure can be arranged& The effect of occlusal interferences developing from differential %ear can be minimi@ed& It is possible to maintain the partially restored dentition by means of periodic ad*ustment& Since %ear defects are not repaired automatically) the dentist should replace and maintain the configuration of teeth in accordance %ith the functional activities& FORCES E%ERTED DURING OCCLUSION 0 MASTICATION AND THEIR RESOLUTION Darious types of forces are e erted on teeth during movement of mandible and also during mastication& Since the tooth surfaces are curved or at an incline) these forces are not only vertical but other types of forces may also be e erting n these surfaces& The tooth) in turn) counteracts these forces %ith the help of periodontal membrane and alveolar bone& If the surfaces are flat and perpendicular to the force of mastication) only vertical forces %ould ta(e part& But in curved surfaces) other forces are also set up and the resulting forces might not be e erted along the long a is of the tooth& This phenomenon can be understood by studying the resolution of forces on inclined planes& The cuspal planes are ta(en as inclined planes& +hen a force acts perpendicular to a fi ed hori@ontal surface) the resolving force reacts perpendicular to the surface %ith an e$ual and opposite force& If the surface is tilted at an angle to the hori@ontal) it still reacts at right angle to the surface& F Surface F Surface B

Thus) the reaction force no longer opposes the applied force in direction nor is e$ual to its magnitude& ?ence the forces are not in e$uilibrium %hen applied on inclined planes& The e$uilibrium can be maintained if more than one force is e erted on tooth or the forces are resolved in both directions& ..

Forces acting on inclined planes& 'B is a tangent dra%n at inclined plane or the contact bet%een . cusps& 'ngle L C represents the angle made %ith the hori@ontal '" by the tangent 'B of the cuspal contact& M is the force of mastication and - is the resolving force& M is perpendicular to the hori@ontal '" and - is perpendicular to the incline plane) tangent 'B) ? is the hori@ontal component of the resolving force) %hich maintains the e$uilibrium& 's the angle LC decreases) i&e& incline plane decreases) - and ? become shorter and finally merge %ith M i&e& e$ual to @ero& The effect of friction bet%een cusps also plays an important role& Friction is the resistance to a sliding motion of one body over another and the coefficient of friction is the force of friction over normal force& Many a times) t%o or more inclined surfaces %ith slopes facing each other of one tooth contact the buccal and lingual cusps of the opposing tooth or the buccal and lingual cusps and marginal ridges& This condition accounts for the proper balance in occlusion and in case the contact is not normal) it may account for displacements of the restoration or the fracture of the teeth& The effect so produced is termed as %edging effect& The hori@ontal components of the normal force are responsible for this %edging effect& These hori@ontal components set up by inclines are e$ual and opposite and tend to push the inclined surfaces apart& FORCES ACTING ON THE TOOTH : A& In (entri( o((l/sion a) b) c are forces %hich acts at 4 contact points& Bab is the resultant of forces a and b& Bab and c are the . ad*acent sides of the parallelogram passing through a given point as sho%n& The resultant is represented by diagonal passing through the same point i&e& Dabc& ?c is the hori@ontal component of force c& ? ab the hori@ontal component of force a and b and ?c should be e$ual for achieving e$uilibrium that is %hy B abc and Dabc are e$ual& B& D/rin1 C!e'in1 : +hen mandible moves form lateral to centric occlusion) the resultant of forces acting is not vertical but inclined medially& .4

+hen tough food is compressed or all cusps are in intimate contact at the 4 points) the forces a and b are decreased and c is increased %ith resultant changes in hori@ontal and vertical components& Since during che%ing) ? c is greater than ?ab and the net resultant is ?abc& So the hori@ontal component is along the direction of c& By using triangle of vector addition) the resultant is represented by Babc& The resultant Babc is a thrust inclined palatally on the ma illary teeth and buccally on the mandibular teeth) %hose hori@ontal component is ?abc& MECHANICAL FUNCTIONS OF THE MARGINAL RIDGES : Role o, M"r1in"l Ri.1es : The marginal ridges play an important role in %ithstanding and dissipating the occlusal stresses& The correct form of marginal ridge compatible %ith the ad*acent tooth and also %ith its o%n surrounding is important during carving of posterior restorations& The absence of marginal ridge) or marginal ridge %ith improper height can lead to altered dissipation of forces subse$uently damaging the underlying periodontium& 23 Norm"l M"r1in"l Ri.1e : Forces 7 and . act on marginal ridges of teeth ' and B respectively& The hori@ontal component of 7) ?7 and the hori@ontal component of .) ?.) counteract each other& The vertical component D7 and D. are resolved normally by the underlying tissues& 43 No m"r1in"l ri.1e Tooth B has no marginal ridge& Force 7 and . are acting on tooth a and B respectively& The hori@ontal component of .) ?. is missing in the tooth B) because force . is mainly directed to%ards tooth '& ?ori@ontal component ?. %ill drift the tooth ' apart and the vertical component D 7 and D. of both the forces 7 and . %ill help the food impact vertically& The vertical force D. %ill be more than re$uired) there may occur slight tilting of the tooth B& This %ill further deteriorate the resolution of forces and lead to further food impaction& 53 A M"r1in"l Ri.1e 'it! " 'i.er o((l/s"l em-r"s/re3

.0

Inspite of putting optimal pressure on marginal ridges of tooth ' and B) the forces 7 and . act on ad*acent teeth& The force . %ill put pressure on tooth ' and force 7 %ill put pressure on tooth B& This %ill lead to drifting of both the teeth& The vertical components of forces %ill %edge the food is bet%een the t%o teeth& Similar effect is seen %hen one marginal ridge is higher than other&

63 No o((l/s"l em-r"ss/re In totality) the vertical component of forces 7 and . %ill be more concentrated than hori@ontal components& Though there %ill to be any vertical impaction of food) the continuous impact of higher concentration of vertical component of forces may lead to changes in alveolar bone after sometime& $ERTICAL LOADS AND DISTRIBUTION OF STRESSES : 's the load is applied over the teeth) stresses are distributed& i) ii) Parallel to the long a is and Perpendicular to the long a is

The force or the load is applied at different areas at a time and the stress distribution depends upon various factors& a) If the cross section of that area is constant) stress distribution is practically uniform& b) If there is variation in cross;section 1such areas are normally termed as prisms)> here stress varies form point to point) being inversely proportional to area& c) If change of cross;section area is abrupt> greater concentration of stress occurs at that point& In vertical loading) there %ill be shearing stresses in prism in any plane& This haring stress increases to a ma imum at 02o and then decreases to @ero at 5/ o& Therefore) materials that are %ea(er in shear than in compression or tension replace in planes at 02o to the a is& The modulus of elasticity of the material is an important property and should be ta(en care of& If a cavity is restored %ith gold inlay or porcelain) the modulus of elasticity varies bet%een the tooth and the restorative material& +ith the vertical force e erting on both) the compression %ill be the same for the restoration and the tooth) but since gold!porcelain is much stiffer) they %ill be highly stressed) since S A d3& .2

S 1Stress) A S 1,nit strain)

3 1Modulus of elasticity)

+hen the force is applied perpendicular to the prism a is) the resultant resolution is (no%n as beam& Beam can be supported form both the ends 1simple beam) and may be supported form one end 1cantilever beam)& 3 ample of simple beam : MO# preparation 3 ample of "antilever beam : MO ! #O preparation The retention of the restoration depends upon these beams) although the strength and the deflection of the material also play part& Moment of Force A Force restoration out of the cavity& Kingival retention %ith a moment e$ual to F +here l is the depth of the a ial %all& If %e ta(e depth of gingival %all 1d) into account) then B and d %ill be in the same direction) so their moment of force is @ero& Therefore) the depth of the gingival %all does not ta(e part in retention& In MOD Prep"r"tion : In MO# preparation) the force 1F) is divided e$ually on both the sides& The mesio distal distance 1E) is also divided into t%o& The moment of force at the midpoint is : F ! . E ! . A FE ! 0 If this moment of force is divided into t%o 1because it is actually acting on both the ends) then the moment of force : FE ;;;;; 0 7 . FE 6 ;;;;; A ;;;;; E is re$uired to counteract this moment& The total retentive force 1B) is e$ual to F E ! l Perpendicular #istance The bonding moment is at the a iopulpal line angle) %hich tends to rotate the

Since the beam forces a concave do%n%ard curvature bet%een the load and the fi ed end) therefore) by sign convention) this end moment is ta(en as negative& By e$uation B l A FE ! 6 So B A FE ! 6 l The negative sign is used only in vector form and in magnitude only positive sign is used& .8

If %e ta(e depth of gingival %all 1d) into account) then B and d %ill be in the same direction) so their moment of force remains @ero& It is presumed in MO# preparations that the length of the a ial %all 1l) is (ept e$ual on booth the ends& If there is mar(ed discrepancy bet%een the t%o ends) the end result may not be the same as is described earlier& Therefore) preferably the length of the t%o a ial %alls should be the same& In Cer i("l 0 Gin1i "l Restor"tions : It has been established that certain forces act on the cervical reign) %hich could destabili@e the restoration and even lead to crac(s at the cemento;enamel *unction& The forces acting on inclined planes of the occluding cusps conse$uently lead to transverse stresses& These transverse stresses try to bend the tooth gingivo;occlusally& Since the teeth are firmly held in alveolar soc(et) these rotations are minimum and counteracted& In cases %here a cavity is cut on the cervical surfaces) depending upon the height of the a ial %all) the deflective force is increased& If the restorative materials are not adhesive in nature) a gap can be created at the cervical surface of the restoration on buccal side and occlusal surface on the lingual side& Force 1F) is applied at incline plane perpendicular to the tangent of the planes& The hori@ontal component 1?) acts appro imately at the centre of the tooth& The vertical component 1D) is constant& The deflection is mainly by the hori@ontal component) %hich depends upon the height of the a ial %all 1E) and the depth of the occlusal 1d 7) and cervical %alls 1d.)& APPLICATION OF STRESSES AND THEIR DISTRIBUTION IN INDI$IDUAL RESTORATIONS : 7) "lass I restoration a) If restored %ith amalgam It is recommended to converge the side %alls occlusally and to (eep the floor flat& In case the floor is not (ept flat) the forces %ill rotate the restoration on both the sides& 'nd also) since the remaining dentin %ill be less at the centre and if the restoration is deep) the forces might fracture the tooth& b) "ast restorations : .9

Movement ! rotation of the cast restoration is easy) if the pulpal floor is not (ept flat& Since the %alls are diverging occlusally) the chances of rotation are much more& c) "omposites or KI" These adhesive materials counteracts such rotational forces& .) "lass II restoration Stresses %hich tend to rotate the restoration) mostly act on marginal ridges& Stresses also is more at a iopulpal line angle) hence) this a iopulpal line angle should be %ell rounded) thereby decreasing stress concentration and increasing the bul( of the material at this point& In MO# restorations) bending of the occlusal portion is caused by the difference bet%een the total masticatory force and the support given by the pulpal floor of the cavity& Kingival retention and rounding of the a iopulpal line angles are re$uired as in MO and #O cavity& In cases %here the opposing cusps occlude in such a %ay that one contact point is on a pro imoocclusal restoration %hile the other is on tooth structure) there is a tendency to %edge the t%o apart& To prevent this %edging) the occlusal loc( is used even though occlusal surface is not involved by caries& 4) "lass III and "lass ID Bestorations : Since these lesions are not in direct contact %ith opposing teeth) only transverse stresses play part in dislodging ! rotating the restoration In such restorations) there is tendency to rotate about an a ial appro imately parallel to the long a is of the tooth& 's incisal retention cannot be made due to thin labiolingual si@e) so lingual loc() is placed on lingual surface& It should be as close to the incisal edge as possible and still be in dentin to reduce the stress in this lingual loc(& In ma illary teeth) force of mastication ahs labial component) %hich provides the seating effect on the restoration& In case the labial enamel is not intact) the chances of dislodgment of the restoration %ill increase& In mandibular teeth) the component of the masticatory force is from the labial to the lingual so chances of dislodgement of restoration are more& 0) "lass D restorations : .6

'nalysis indicates that physical forces putting on occlusal surfaces could result in displacement of the restoration& #uring occlusion) the vertical stresses on the teeth led to transverse stresses and this component of stresses tends to rotate the cervical restoration& The mandibular teeth bend more than ma illary teeth& ' gap is evident on the cervical ! occlusal %all of the cavity and if the depth of these %alls is less) the restoration may come out&

.5

FORCES ACTING ON AMALGAM RESTORATION CLASS 7 I : By definition) "lass I cavity preparations are placed in pit and fissure lesions that occur in one more of the follo%ing locations : '& Occlusal surfaces of molars and premolars B& Occlusal .!4 of the buccal and lingual surfaces of molars "& Eingual surfaces of the upper anterior teeth 1usually the central and lateral incisors) #& 'ny other usually located pit or fissure involved %ith decay& Me(!"ni("l pro-lems in Cl"ss I restor"tion "n. t!eir sol/tions3 '& 'll "lass I cavity preparations %ill have a mortise shape) i&e& each %all and floor is in the form of a flat plane) meeting each other at definite line and point angles& The seat of the restoration is placed at a distinct right angle to the direction of stresses& It is advantageous to have a mortise shape preparation in an inverted cone shape to minimi@e shear stresses that tend to seperate the buccal and lingual cuspid elements i&e& to prevent the splitting of the tooth& So %henever the anatomical and cariological factors allo%) the cavity preparation should be an inverted cone shape& B& +hen a caries cone penetrates deeply into dentin) removing undermined and decayed tooth structures can lead to a conical 1hemispherical in cross;section) cavity preparation& Mechanically) t%o problems can occur if a restoration is inserted into such a cavity preparation& 7& If the occlusal loading is applied centrically) the restoration may act as a %edge) concentrating forces at the pulpal floor) and leading to dentin bridge crac(ing) and an increased tendency for tooth splitting& .& If the occlusal loading is applied eccentrically the restoration %ill have tendency to rotate laterally) for there %ould be no lateral loc(ing %alls in definite angulation %ith a floor& 'lthough these lateral movements are microscopic) they occur fre$uently enough to encourage microlea(age around the restoration) predisposing to a recurrence of decay& These movements can also lead to fracture of marginal tooth structure) and even to splitting of lateral %alls& To solve these problems) flatten the pulpal end of the cavity preparation& ?o%ever) if accomplishing this at a deep location incurs increased ris( of involving the pulp chamber) pulp horns) or recessional lines containing remnants of pulp tissues) ma(e 4/

the pulpal floor at more than one level& One level %ill be the ideal depth level 17&2 mm) and the others %ill be the caries cone1s) level1s)) dictated by the pulpal e tent of the decay& The shallo% level creates the flat portion of the pulpal floor at definite angles to the surrounding %alls) ade$uately resisting occlusal forces and laterally loc(ing the restoration) %ithout impinging on pulp tissues& Beiterating) the other level1s) is 1are) only necessitated by the caries e tent&) creating one or more concavities or cones in the pulpal floor& "& +hen a cavity %all comes in contact %ith a marginal ridge) the %all should be divergent pulpo;occlusally) ma(ing an obtuse angle %ith the pulpal floor& This design allo%s for ma imum bul( of tooth structure supporting the marginal ridge and avoids undermining of the marginal ridge) creating more mechanical and biological problems& #& If cariogenic conditions do not dictate other%ise) the %idth of the cavity should be limited to I to 7!2 the intercuspal distance 1not less than 7&2 mm)& This minimi@es loss of tooth structure in this critical cross;section of the tooth& This %idth %ill also facilitate easy carving of the restoration) and minimi@e the possibilities of occlusal interferenceCs& 3& 'll cavosurface angles should be right angled to create a butt;*oint %ith the marginal amalgam& This configuration allo%s marginal amalgam to %ithstand stresses %ith the least possibility of failure& F& 'll line and point angles) or any *unction bet%een different details in the cavity preparation) should be rounded but definite& This design has all the advantages of the mortise shape) %hile avoiding stress concentration in the tooth structure and restorative materials that may occur from sharp angulations& K& Occluding forces %ill tend to move marginal amalgam and tooth structures from position M7 to position M.& 's vital tooth structures are more deformable than set amalgam) the displacement %ill not be e$ual thereby creating a gap bet%een them& This places the marginal amalgam under intolerable tensile loading %hich may lead to amalgam failure if the amalgam is in thin cross sections) i&e& acute angled marginal amalgam %ill fracture& B) If marginal amalgam is right angled) it can be stand induced stresses from occlusal loading %ith less possibility of failure) even if the stresses are tensile in nature& CLASS II AMALGAM RESTORATION By definition "lass II cavity preparation is pro imal preparations of molars and premolars& 47

Resist"n(e Form : The fundamental concept of resistance form is based on the reaction %ithin the restoration and the remaining tooth structure to occlusal loading& The ob*ective of a cavity preparation design is to establish the best possible configuration that can cope %ith the distribution and magnitude of the stresses in both structure and the restoration %ithout failure& To design such a configuration) one must first comprehend the nature of loading and of resistance to such loading& A3 O((l/s"l Lo".in1 "n. Its E,,e(t : #uring centric and e cursive movements of the mandible both restoration and the tooth structure are periodically loaded both separately and *ointly& This brings about different stresses patterns depending on the actual morphology of the occluding area of the both the tooth in $uestion and opposing contacting cuspal elements& For the purpose of this discussion) one can classify these loading situations and their induced stress patterns in the follo%ing %ay& 7) ' small cusp contacts the fossa a%ay from the restored pro imal surface) in a pro imo occlusal restoration at centric closure& 's sho%n due to the elasticity of the dentin) 1in young teeth) a restoration %ill bevel at the a io;pulpal line angle 1provided the pro imal part of the restoration is self; retained)& This creates tensile stresses at the isthmus portion of the restoration) shear stresses at the *unction of the main bul( of the pro imal part of the restoration and self retained parts and compressive stresses in the underlying dentin& .) ' large cusp contacts the fossa ad*acent to the restored pro imal surface in a pro imo;occlusal restorations at centric closure) either in the early stages of moving out of centric or at the late stages of moving to%ard it& 's sho%n) the large cusps %ill tend to separate the pro imal part of the restoration from the occlusal part& This crates tensile stresses at the isthmus portion of the restoration even fi the pro imal portion is self retained& This loading situation %ill deliver compressive forces in the remaining tooth structure) apical to the restoration& 4) Occluding cuspal elements contact facial and lingual tooth structure surrounding a pro imo;occlusal or pro imo;occluso;pro imal restoration) during centric and e cursive movements& "oncentrated shear stresses %ill occur at the *unction of the surrounding tooth structure and corresponding floors) %ith a tendency to%ards failure there& 4. This

loading situation can be unilateral or bilateral) depending on the mandibular movement it is the most deleterious to tooth structure especially on the orbiting side if there is interference during lateral e cursion& 0) Occluding facial elements contact facial and lingual parts of the restoration surrounded by tooth structure) during centric and e cursive movements& This arrangement %ill induce tensile and compressive stresses in the restoration %hich %ill be transmitted to the surrounding tooth structure& 2) Occluding cuspal elements contact facial or lingual parts of the restoration completely replacing facial or lingual tooth structure during centric or e cursive movements& The tensile stresses %ill be induced at the *unction of the occlusal and facial and!or lingual part of the restoration in both occluding situations& 8) Occluding cuspal elements contact a restorationCs marginal ridge1s) or part of a marginal ridge during centric or e cursive movements 1assuming the restoration is loc(ed occlusally)) there %ill be concentrated tensile stresses at the 1*unction of the occlusal and facial or lingual parts of the restoration at full intercuspation and to end from that position) at the *unction of the marginal ridge and the rest of the restoration& This %ill be true if its an area of advance contact during mandibular closure& 9) "uspal elements occlude or disclude via the facial or lingual groove of a restoration& There %ill be tensile stresses at the *unction of the occlusal and facial or lingual parts of the restoration at full intercuspation) and to and from that position& 6) "usps and crossing ridges are part of the restoration in centric and e cursive movement& Both %ill be sub*ected to compressive stresses during such positions and movement& Besides tensile stresses could concentrate at their *unction %ith the main restoration) specially during contacting e cursive movement& 5) ' ial portions of the restoration during centric occlusion and e cursive movement contacts: +henever these portions are in contact %ith opposing occlusal surfaces) there %ill be induced compressive and shear stresses %hen they are not reciprocating 1one side not in contact %ith occluding surfaces %hile other a ial portion)& The a ial surfaces %ill be stressed in a slight tensile and shear pattern at their *unction %ith the main bul( of the restoration& 44

7/)Bestoration is not in occluding contact or is in premature contact during centric occlusion or e cursive movement of the mandible& The first situation is not conducive to function) insofar as the restoration %ill not be involved %ith direct loading from the opposing occluding teeth& 'fter a period of time) ho%ever) the tooth %ill supraerupt) rotate) and or tilt) establishing contact %ith the opposing cuspal elements& ,sually) this ne%ly ac$uired location %ill not be the most favorable position for the restoration) tooth) or the remainder of the gnatho stomatic system) either mechanically or biologically& It is safer to build the restoration to predetermined contacting areas %ith opposing teeth %hich %ill lead to predictable physiologic stress patterns in the tooth structure and restoration& "onversely) any portion of the restoration occluding prematurely %ill tremendously e aggerate the same types of stresses normally induced in that area of the restoration& Besides) additional shear components of stress could be precipitated there& This) too) could lead to locali@ed or generali@ed gnatho stomatic disturbances) %ith eventual mechanical and biological failures& -eedless to say) pre;e isting premature contacting areas should be eliminated before restorative treatment& This is done for many reasons) but primarily) because cavity preparation increases the susceptibility of remaining tooth structure to fracture failure& Besides) the restoration should be built to the predetermined occlusal position) even fi the pree isting tooth structures %ere not& Several factors must be accommodated in designing "lass II preparations for amalgam& Occlusal loading is dynamic and cyclic in nature) %hich is a far more destructive type of loading than static loading& 'malgam is least resistant to tensile stress and most resistant to compressive stress& Tooth structure) particularly %hen interrupted by a cavity preparation) is least resistant to shear stress& Therefore) "lass II cavity preparations for amalgam restorations should be designed to resist cyclic loading %hile minimi@ing tensile loading in the amalgam and shear loading in the remaining tooth stricture& B3 Desi1n ,e"t/res ,or t!e prote(tion o, t!e me(!"ni("l inte1rit) o, t!e restor"tion : 1. Isthmus : In the isthmus) i&e& the *unction bet%een the occlusal part of a restoration and the pro imal) facial or lingual parts) potentially deleterious tensile stresses occur under any type of loading& 40

Most mathematical) mechanical and photoelastic analyses of these stresses reveal three things : 7) The fulcrum of bending occurs at the a io;pulpal line angle .) Stresses increase closer to the surface of a restoration) a%ay from that fulcrum) and 4) Tensile stresses concentrate at the marginal ridge area of a "lass II restoration& Materials tend to fail) therefore) starting from the surface) near the marginal ridge) and proceeding internally) to%ard the a io;pulpal line angle& These problems may be solved by applying common engineering principles& ' theoretical solution might be : 7) to increase amalgam bul( at the a io;pulpal line angle) thereby) placing the surface stresses a%ay from the fulcrum& ?o%ever) its actually results in increased stresses %ithin the restorative material and a deepened cavity preparation) dangerously close to pulp anatomy& Therefore) such a solution) in and of itself) is %holly unacceptable& .) 'nother solution might be to bring the a io;pulpal line angle closer to the surface) in an effort to reduce tensile stresses occurring near the marginal ridge& ?o%ever) this) too) is unacceptable in that the conse$uent diminished bul( of amalgam %ould no longer ade$uately resist compressive forces& 4) ' combination of the t%o solutions i&e& increasing amalgam bul( near the marginal ridge) %hile bringing the a io;pulpal line angle a%ay from that stress concentration area and closer to the surface) can be achieved simply by slanting the a ial %all to%ard the pulpal floor& a) The obtuse a ial pulpal line angle thereby created not only provides greater amalgam bul( in the marginal ridge area of the restoration) but also reduces tensile stresses per unit area by bringing this critical area of the preparation closer to the surface of the restoration& Furthermore) this design feature improves accessibility to the pro imal facial and pro imal lingual parts of the cavity during preparation procedures& This is the first design feature& b) Secondly) if the a io pulpal line angle is rounded) structural pro*ections or sharp *unctions that may concentrate stresses at the isthmus %ould be avoided& This second feature %ill also improve the visibility for the facial and lingual gingivo; a ial corners of the preparation pro imally) as %ell as increase the amalgam bul( at the fulcrum&

42

c) Thirdly) by slanting the a ial %all) bul( is improved by increased depth rather than increased %idth& Increasing the %idth at the isthmus portion only increases the surface area receiving deleterious occluding stresses& 0) 's a fourth design feature) the pulpal and gingival floors at the isthmus should be perfectly flat in order to resist forces at the most advantageous angulation& 2) The fifth design feature is that every part of the preparation 1occlusal) facial) lingual or pro imal) should be self;retentive& If every part of the restoration is loc(ed in tooth structure independently from other parts) there %ill be minimum stresses at the *unction of one part %ith another) i&e& the isthmi& This can be achieved in amalgam preparations by retentive grooves) internal bo es) and undercuts& 8) Si th) one should avoid) as much as possible) placing or leaving any surface discontinuities) such as carved developmental grooves) scratches) etc at these critical areas in the restoration& These can precipitate and accentuate stresses leading to fatigue failure& Finally) by chec(ing occlusion to eliminate prematurities in the restoration) immediate overloading and failure can be avoided& 2. Margins : 'malgam has good compressive strength %hen it has sufficient bul( 17&2 mm minimum)& ?o%ever) frail) feather edged margins of amalgam) %hich %ill occur %hen the cavosurface angles of preparations are bevelled) %ill fracture easily& Occluding forces %ill cause amalgam at the bevel to bend %ith ma imum tensile stresses) occurring as a result of elastic deformation of the tooth structure beneath the bevel& Marginal e cess of amalgam %ill similarly fracture) leaving a ditch around the restoration that %ill enhance recurrence of decay& So) for the margins of these p reparations) four design features should be observed > create butt *oint amalgam tooth structure at the margins) leave no frail enamel at the cavosurface margins) remove flashes of amalgam on tooth surface ad*acent to amalgam margins) and) as practically as possible) the interface bet%een amalgam and tooth structure should not be at an occluding contact area %ith opposing teeth either in centric or e cursive mandibular movements& 3. Cuspal and Axial angles : The follo%ing are the design features for these parts of a restoration& a& 'malgam bul( in all three dimensions should be atleast 7&2 mm 48

b& 3ach portion of the amalgam should be completely immobili@ed %ith retention modes& c& 'malgam should be seated on a flat floor or table in these areas& d& 'malgam replacing cusps or a ial angles should have a bul(y connection to the main part of the restoration %ith similar design features as for the isthmus areas& C3 Desi1n ,e"t/res ,or t!e prote(tion o, t!e p!)siome(!"ni("l inte1rit) o, rem"inin1 toot! str/(t/re : In addition to design features in the restoration) there are also certain design features in the tooth structure) %hich enhance resistance of the restored tooth to deleterious stresses& Retention ,rom : In order to design a cavity preparation that %ill hold a restorative material) it is necessary to (no% the possible displacements that can happen to such a restoration) the forces that can cause them) and the fulcrum of these movements& There are four such displacements for a "lass II pro imo;occlusal restoration& '& Pro imal #isplacement of the 3ntire Bestoration : In analy@ing the obli$uely applied force <'= into a vertical component <D= and a hori@ontal component <?=&) it can be seen that <D= %ill try to seat the restoration further into the tooth) ) but <?= %ill tend to rotate the restoration pro imally around a is <N= at the gingival cavosurface margin& To prevent such displacement) self;retaining facial and lingual grooves pro imally are necessary) in addition to an occlusal dovetail& B& Pro imal #isplacement of the Pro imal Portion : If one %ere to consider the restoration as being E;shaped) %ith the long arm of the E occlusally and the short arm pro imally) %hen the long arm is loaded by vertical force <D=) it %ill seat the restoration more into the tooth& This is due to the elasticity of the dentin) especially in young teeth) %herein the pulpal floor %ill change location from position 7 to position .& ?o%ever) since metallic restorations are more rigid than the dentin) the short arm of the E %ill move pro imally) as sho%n in the figure& The fulcrum of this rotation is the a io;pulpal line angle& In order to prevent such a displacement) pro imal self;retention in the form of facial) lingual and!or gingival grooves are re$uired& ?o%ever) shear stresses %ill be induced at the *unction bet%een the amalgam of the main restoration and that in the grooves& Therefore) it is to be 49

understood that these grooves are prepared only %hen there is complete assurance that there %ill be sufficient dentinal bul( to accommodate them) and that they %ill not impinge on the a ial angle or on the pulp anatomy& "& Eateral Botation of the Bestoration 'round ?emispherical Floors 1Pulpal and Kingival) 's in "lass I cavity preparations this displacement can be prevented by definite point and line angles) and ledges %here indicated& #& Occlusal displacement : The can be prevented by directing occlusal loading to seat the restoration and by inverted truncated cone shaping of (ey parts of the preparation& 'lthough the magnitude of these four displacements is minute) they are repeated thousands of times per day& This can definitely increase microlea(age and initiate mechanical and biological failure of the restoration and surrounding tooth structure& Therefore) proper loc(ing of the restoration into the tooth should be e ercised to minimi@e these ha@ards& To repeat every part of the cavity preparation should be self;retaining) if possible) i&e& independent in its retention from the rest of the cavity& to be e pected as a result& FORCES ACTING ON INLAY RESTORATION The cavity should have such retention form that the restorations %ill be firmly held in place) the cavity should also have resistance form that the restoration %ill %ithstand the stress %ithout being dislodged& 'n understanding of the materials used in constructing an inlay) together %ith a (no%ledge of correct manipulation is also an important factor in the success or failure of an inlay 1inlay is not only a part of mechanical structure replacing lost teeth) but it is also intimately related to the vital tissues) it is the medium through %hich mechanical and physical forces are translated into physiological functions and biological reactions in living tissues& The other preparation features that %ill help solve the mechanical problems of cast restorations are as follo%s : This minimi@es shear concentration areas at the *unctions of different parts of the restoration) %ith less failure

46

'll the line and point angles should be definite) but not angular) so they can be easily reproduced in a casting and to avoid stress concentration in the casting and the tooth structure& The roundness must be substantial for "lass D materials& The a ial %all should slant to%ard the pulpal floor) as part of the taper& This) together %ith rounding of the a io;pulpal line angle) can reduce stresses at the isthmus area& Beduction of tooth structure should follo% the original anatomy of the tooth) to create even reduction) %ith minimum tooth involvement) and even physiologic distribution of forces applied on the restoration and remaining tooth structure& Ma imum reduction should be at the occluding surfaces) especially the parts of the tooth surfaces that are in contact during static and dynamic relations of the mandible& 'n average of 7 mm should be cleared for metallic casting in the inclined planes of the cusps& This reduction should be 7&2 mm for cast ceramics& The reduction of the occluding inclined planes should be cut in a concave form) to accommodate ma imal bul( of the casting %here stresses are at their ma imum& The internal parts of the cavity preparation should be mortised to preserve the resistance and retention features of the preparation 1and to assure one path for the preparation)& The internal bo ed up portion should occupy the ma imum dimensions of the cavity preparation as practically as possible& This %ill necessitate ma(ing the cavity %all in different planes& 't least) the internal planes are fi ed in their angulation 1almost right angle) %ith the ad*acent floors or %alls& Since the retention of an inlay and its resistance to displacement are primarily mechanical problems) a group of the principles of retention is based on understanding the forces of mastication and the analysis of strains %hich are present in the restoration& It has been stated that %hen a force is applied at right angles to a surface its effectiveness %ith the direction of force and that is proportional to its magnitude li(e%ise) the opposing forces are e$ual and opposite in direction& 'nother la% states that if the force is applied at an angle to the surface other than right angle) the magnitude of %hich depends n the angle of application ad that the reacting force is neither e$ual nor opposite in direction& Eateral or tangential forces may cause displacement of the restoration unless ade$uate resistance and retention have been incorporated in the preparation& Frictional retention can be achieved by the action of dentin and enamel %alls grasping the restoration 1intracoronal retention)& 45

-o% let us consider the forces applied at right angles to the flat surface of a restoration& P/lp"l Floor "n. Gin1i "l Se"l : 7) ' typical pro imoocclusal cavity %ill have t%o such surfaces to vertical forces the pulpal and gingival %alls& If the forces are perpendicular to these surfaces the opposing forces are e$ual and opposite) then there is no tendency to displace the filling& Floors positioned perpendicular to these lines of force absorbs the stress over a broad area of tooth& .) It is only %hen the pulpal %all is flat and the t%o vertical %alls are parallel to each other that the ma imum retention form is obtained& +hile these above illustration refer to simple bo type cavity preparation) the same principles hold good %hen the force is applied at right angles to the occlusal surfaces of pro imo occlusal inlay& 4) In a tooth %ea(ened by e tensive caries) the resistance form is obtained by e tracoronal e tension of the preparation in the form of e tra long reverse bevel in capped cusps or by partial or complete coverage of facial or lingual surfaces& 0) If the dentin of the pulpal %all is compressed elastically under vertical forces) if the compression is conical then the gingival portion of the filling %ould rotate out of the cavity %ith the a iopulpal line angle acting as the fulcrum& Because of the added retention obtained by the pulpal e tension and if the diagonal force is applied to the casting %hich is LEC shaped& It %ill have a tendency to straighten out) so this causes the metal to move out laterally at the gingival area& To resist this lateral spreading) at the gingival %all provision is made for the depression of the %all and creating the gingival groove %hich restores the retentive form to a certain e tent&

A#iopro#im"l *"lls 8F"(i"l 0 Lin1/"l& : "ompressive forces resulting from vertical pressure have an important bearing on the retention of the inlay& This bears on the relationship of the buccal and lingual pro imal %alls& -o% %hether they should flare a iopro imally or be parallel to each other 1that is the part of the %all lying %ithin the dentin)& 0/

There are 4 different relationships of %all ' to %all B in the gingivoocclusal direction& 7) The %alls are parallel to each other& .) +alls are %idely divergent& 4) #ivergence not e ceeding 2o from the vertical plane& +hen forces are applied at an angle other than right angle) force is resolved in . %ays) one of %hich reacts in its effectiveness at right angle to the surface& This force is not opposite in direction) nor is it e$ually magnitude to the original force& The tendency in a tooth is for the cusp of the opposing tooth to slide do%n the inclined plane or for an inlay to be pushed out of the cavity in a hori@ontal plane& +hen a vertical force is applied to a pro imal e tension the filling is rotated occlusopro imally out of its cavity& movement& point& Slice : Slice preparation provides e ternal support of %ea(ened tooth or areas sub*ected to high stresses during function& It increases the resistance and retention form by e posing a larger amount of tooth structure to the frictional grasp of the restoration& O((l/s"l Do e T"il : Tensile stresses developed by this is one of the strongest means of resisting the displacement of an inlay& "linical precaution demands that by lingual inclined planes %hich e tend into the isthmus of the occlusal bloc( be on sound cusps %ith a sufficient amount of supporting dentin& If these are lac(ing) there is li(elihood) of fracture of one or both the cusps %henever inlay is sub*ected to hori@ontal forces& -o% the buccal and lingual a ial %alls) instead of flaring from the a ial line angles to the cavosurface margin in a continuous plane) are no% changed into t%o narro%er but parallel planes and t%o smaller diverging planes& It is evident that in this type of preparation) it is possible to retain the retentive form of the preparation) even if the %alls diverge in a continuous plane) %hen stress is applied to the occlusal surface) the reaction of the opposite forces %ill tend to dislodge the filling& So retention in this type of preparation is by placing a gingival groove in the gingival %all and by adding an 07 The rotation point of fulcrum being gingival marginal %all& These forces are al%ays effective unless counteracted by an opposing This can be achieved by properly prepared occlusal loc() by proper preparation of gingival %all) pulpal %all and lastly by the proper contour and contact

occlusal loc(& ?ence effort is made to parallel at least part of the buccal and lingual pro imal %alls that lie in dentin& Second method of resisting hori@ontal displacing forces is by the proper preparation of gingival %alls& The properly prepared gingival groove assist in preventing the lateral displacement of an inlay& But because of the inherent %ea(ness of the gingival groove the possible fracture to this %all of the tooth structure bet%een the groove an the cavosurface angle) so many operators prefer the in%ard beveling of the gingival %all) forming an acute angle bet%een the a ial and gingival %alls& P/lp"l *"ll : Third method of obtaining opposing movements to hori@ontal displacing force is by establishing resistance into pulpal %all& The pulp %all %hich is flat offers no resistance to hori@ontal displacement %hen it is prepared %ith t%o inclined planes it %ill prevent the lateral displacement of the inlay& 'nother modification is placement of grooves parallel to the long a is of the tooth at the a ial angles& Such preparation resist hori@ontal displacement of the inlay& This %ill also resist rotary displacement because of the frictional resistance of the dentin at this point of the cavity& In addition to increased mechanical retention resulting from slight modification of cavity preparations) it is essential that suitable gold alloys be used and casting made of such alloys be properly heat treated in order that their ma imum physical properties are made available& ' iopulpal Eine 'ngle : This line angle is slightly rounded to dissipate the stresses& Kingival Bevel : 4/;02o to have sliding lap fit *oint) cement tooth interface& "ertain forces collectively act on a cemented restoration mainly in the same direction as the path of %ithdra%al& Some of the factors pertaining to these forces are : 7) Magnitude of the dislodging forces : Forces that tend to remove a cemented restoration along its path of %ithdra%al are small compared to those that tend to tilt it& Kenerally e ceptionally stic(y food stuffs act as a pulling force& The $uantum of vertical and obli$ue forces also tend to dislodge the restoration& The magnitude of the dislodging forces depends on the stic(iness of food) occluding and lateral 0.

movement forces of the *a%s and the surface area and te ture of restoration being pulled& .) Stress "oncentration : Stresses are not uniform throughout the cement but are concentrated around the *unction of the a ial and occlusal surfaces 1a io pulpal line angle)& This may e plain the retentive failure of the cast restoration& The strength of the cement is less than the induced stresses& FORCES ACTING ON DIRECT TOOTH COLOURED RESTORATIONS For any pro imal restoration in anterior teeth) there are t%o possible displacing forces& The first is a hori@ontal force displacing or rotating the restoration in a labio; pro imo lingual or linguo pro imo labial direction& It has its fulcrum almost parallel to the long a is of the tooth being loaded& The second is a vertical force displacing or rotating the restoration pro imally1sometimes facially or lingually)& The latter has a loading arrangement similar to occluso;pro imal 1occluso;facial or occluso;lingual) restorations in posterior teeth& The amount of teeth depends upon the location) e tent and type of occluding contacts bet%een the upper and lo%er teeth during function& The mechanical picture can be summari@ed as follo%s : 7& In anterior teeth %ith normal overbite and over*et during centric closure of the mandible 1from centric relation to centric occlusion)) mainly the hori@ontal forces %ill be in action& Those forces) if loading the pro imal restoration directly) %ould try to move it linguo;pro imo labially 1for the upper restoration) and labio;pro imo lingually 1for the lo%er one)& The magnitude of the hori@ontal force component at this stage of mandibular movement is not very substantial) and the vertical one is almost nil& In protrusive and lateral protrusive movements of the mandible) directly loaded pro imal restorations in anterior teeth %ill be sub*ected to substantial hori@ontal as %ell as vertical displacing forces) especially in restorations replacing the incisal angel& The results of this loading are rotational forces 1previously described)) as %ell as forces rotating the restoration labially and pro imally 1for the upper) or lingually and pro imally 1for the lo%er)& .& If anterior teeth meet in edge;to;edge fashion at centric occlusion) loading of the pro imal restoration) involving incisal angles 1"lass ID) %ill be similar to any "lass II pro imo;occlusal restorations) i&e& vertical displacing forces %ith very limited hori@ontal components& This loading %ill continue during all centric closures and 04

e cursion movements of the mandible& ?o%ever) if the incisal angle is intact 1"lass III)) these displacing forces %ill be minimal& 4& If the upper and lo%er anterior teeth meet such that the lo%ers are labial to the uppers in centric occlusion 1'ngleCs "lass III)) there %ill be the same type of loading conditions mentioned in 17) e cept the hori@ontal loading %ill tend to rotate or displace restorations labio pro imo lingually 1for uppers) and linguo;pro imo labially 1for lo%ers)& #uring e cursive movements) if teeth are in contact and there is a possibility of retrusive mandibular movements) the loading %ill be much less than that described in 17)) %ith its hori@ontal displacement capability e actly the reverse to that described in 17)& 0& In occlusions %ith deep anterior overbite and normal or no over*et) the hori@ontal type of loading %ill be greatly e aggerated& The vertical displacement) although present) %ill be minimal by comparison& 2& In occlusion %ith anterior open bite or severe over*et) or any other condition that creates a no;contact situation bet%een upper and lo%er anterior teeth during centric occlusion and e cursive movements of the mandible) pro imal restorations %ill not be loaded directly either vertically or hori@ontally& 8& In cases %hen the pro imal restoration of an anterior tooth is a part of a mutually protective occlusion) i&e& an incisor and the ad*acent cuspid are involved in an anterior lateral disclusion mechanism) the teeth and restoration %ill be part of that disclusion mechanism %ith e cessive hori@ontal and vertical loading forces& This situation should be properly diagnosed) so that the tooth preparation can be designed and prepared accordingly& It should be understood that none of these loading forces %or( separately& They %or( together and simultaneously& ?o%ever) they may differ in magnitude at different stages of mandibular movement& It should be mentioned here that a restoration replacing part or all of the incisal ridges of an anterior tooth %ill have the same pattern of loading as mentioned in 17) 18)) but %ith increased intensity& Eoss of the incisal angle of a tooth) i&e& conversion from a "lass III to a "lass ID represents a ma*or complication in the mechanical problems of anterior tooth restorations& This loss %ill lead to definite direct loading of the restoration) loss of the incisal %all %hich %ould normally accommodate one of the t%o possible main internal retentive modes for the restoration) definite vertical loading %ith its se$uelae) and the placement of margins on the incisal ridge& This further e poses the restoration to the ma imal loading possible in anterior teeth) and it is %ith the 00

minimal tooth structure to be used for resistance and!or retention against such loading& The structure of anterior teeth themselves) have a comparatively different stress pattern) as a result of occlusal loading from that of posterior teeth& The uni$ue shape as %ell as the mechanical structure and function of these teeth is very important to comprehend before designing a cavity and!or tooth preparation for a direct tooth colored restoration& The follo%ing is a summary of these uni$ue features : a) 'nterior teeth have their ma imal bul( gingivally& They taper incisally %ith the least bul( at the incisal ridge& So resistance to stress fractures %ill be ma imum at the gingival end and decrease incisally& b) Forces are directed hori@ontally and vertically on anterior teeth as mentioned %ith the force analyses on restorations for these teeth& These forces accumulate ma imal shear stresses at the *unction of the clinical root %ith the clinical cro%n and ma imum tensile stresses at the incisal ridges) especially their corners 1incisal angles)& c) The labial enamel plate is much thic(er than the lingual or pro imal ones) %ith ma imal thic(ness of enamel usually at the incisal ridge& d) The incisors may be involved in a disclusion mechanism of the mandible %ith loading similar to that of the cuspid) but to a much lesser e tent& e) "ervical portions of anterior teeth %hen they are affected %ith a "lass D lesion or cavity preparation %ill have a stress pattern similar to posterior teeth) and the stress pattern is governed by the same factors as in posterior teeth& In addition) the deeper the overbite is) the more induced the stresses are at these cervical areas& f) 'S mentioned previously) loss of an a ial angle) incisal angle) or tooth structure at the nec( of the tooth %ill dramatically reduce that toothCs ability to resist loading %ithout fracture failure& Ideally) a restoration made of tooth colored materials should not be loaded directly) i&e& there should be intervening tooth structure bet%een the occluding tooth and the restoration& This situation can only be achieved by four intact %alls surrounding the restoration& dramatically& ,nfortunately) this is usually not the case& That is %hy the clinical performance of tooth colored materials differs from one situation to another) sometimes

02

'nterior teeth have their ma imal bul( gingivally& They taper incisally %ith the lest bul( at the incisal ridge& So resistance to stress fractures %ill be ma imum at the gingival end and decrease incisally& Forces are directed hori@ontally and vertically on anterior teeth as mentioned %ith the force analyses on restorations for these teeth& These forces accumulate ma imal shear stresses at the *unction of the clinical root %ith the clinical cro%n and ma imum tensile stresses at the incisal ridges) especially their corners 1incisal angles)& The labial enamel plate is much thic(er than the lingual or pro imal ones) %ith ma imal thic(ness of enamel usually at the incisal ridge& The incisor may be involved in a disclusion mechanism of the mandible %ith loading similar to that of the cuspid) but to a much lesser e tent& Ideally) a restoration made of tooth colored materials should not be loaded directly) i&e& there should be intervening tooth structure bet%een the occluding tooth and the restoration& This situation can only be achieved by four intact %alls surrounding the restoration& dramatically& FORCES ACTING ON POSTS 'n endodontically treated tooth has been structurally compromised by caries and its removal) prior restorations) and finally) endodontic preparation and filling& It should be emphasi@ed again that posts are only used for retaining the restorative material in the remaining tooth structures) and by no means %ill they reinforce or improve the strengths of these tooth structures& Because the retention of posts is accomplished by various means) it might be e pected that different stresses are associated %ith post installation& +ith posts retained by the cement alone) the main potential for installation induced stresses is the build up of hydrostatic bac( pressure& This potential %ith parallel sided post is circumvented by means of longitudinal vents along the posts) %hich provide an outlet for the pressure& Tapered post are self;venting) and conse$uently there is no pressure build up& 3ndodontic posts provide a protection function through their ability to distribute the forces of mastication to the remaining tooth structure& ?o% %ell this protection is achieved depends upon post design) embedment depth and diameter& 08 ,nfortunately) this is usually not the case& That is %hy the clinical performance of tooth colored materials differs form the situation to another) sometimes

MECHANICAL ASPECTS OF POST9RETAINED RESTORATIONS AND FOUNDATIONS : A3 Stressin1 C"p"-ilities o, Posts : The follo%ing features and factors of posts and the involved tooth %ill govern the stress patter induced in the surrounding tooth structures due to the use of posts as retentive means : 7& Type of Posts : Parallel sided posts %ill have the tendency to evenly distribute the forces it receives at and around its cavity end onto the root canal %alls) if these forces are applied parallel 1a) to the post a is 1vertical occlusal loading& IF the forces applied are at a right angle 1b) or obli$ue 1c) to the post a is) the induced stresses in the root canal %alls %ill be unevenly distributed) i&e& there is a great possibility of stress concentration due to uneven thic(ness of the root canal %alls around the post 1root taper) %hile the post remains the same diameter& This leads to a thin sectioned %all at the very apical end of the post& On the contrary) taper sided posts and combination type posts %ill concentrate stresses due to apical loading 1a) in the root canal %alls resulting from its %edge shape& Eateral loading on and around cavity ends of the post) ho%ever) %ill induce evenly distributed stresses in the root canal %alls for the taper of the post %ill correspond %ith the root and root canal taper) leading to an even thic(ness of %alls occlusoapically& .& Method of Inserting root canal posts : #uring insertion of a post into the root canals) highly threaded posts can induce ten times the amount and e tent of stresses as smooth sided posts& Serrated surface posts %ill induce about one and a half to t%o times the stresses that are induced by smooth surfaced posts& This can be e plained by the cemented techni$ue utili@ed by the serrated and smooth surfaced posts& 4& Bul( of dentin in root canal %alls : -aturally) the bul(ier that the dentin surrounding a root canal post is) the less %ill be the induced stresses per unit volume during the post insertion and functional use of the post retained restoration& It has been estimated that a minimum of . mm of dentinal root canal %all should surround a post) so that the stresses induced there %ill not lead to dentinal failure in the form of crac(s and gross fracture& 0& Eength of clinical root involved %ith the root canal post : 09

'lthough the tooth to receive a root canal post should be non;vital and endodontically treated) the clinical cro%n portion of the tooth is much more dehydrated than the clinical root portion as the dentin portion of the root still receives some fluids from the ad*acent periodontal ligament& The more dehydration that there is) the less %ill be the modulus of resilience and elasticity of the dentin) and conse$uently the less %ill be the dentinCs ability to absorb and resist stresses %ithout failure& 2& Ferrule or embracing features of the restoration : Post;core and do%el coping foundations for endodontically treated teeth %ill al%ays induce stresses in the root canal %alls and remaining tooth structures %hich can only be counteracted by embracing the buccal and lingual cuspal elements of the tooth and!or banding 1circumferential embracing) the tooth at its most apical part of the clinical cro%n 1i&e& area of ma imum stresses)& Such bracing is referred to as the Ferrule effect& The Ferrule feature of the restoration should involve at least . mm of cro%n length to counteract stresses induced by the post& ,sing less than . mm of cro%n tooth structure) the counteracting Ferrule effect %ill be reduced& The closer this embracing feature is to the *unction bet%een the clinical cro%n and the root) the more effective it %ill be& This is the ma*or protecting feature against induced stresses in a restoration for endodontically treated teeth& 8& Eateral Eoc(ing Mechanisms for the post and restoration : Because most premade posts are rounded in cross;section there is a great tendency for the post and the restoration retained by the post to rotate under torsional forces& This rotational tendency can induce unnecessary stresses in remaining tooth structures& The presence of a method to loc( the post and the restoration against such rotation 1e&g& a lateral pin) internal bo es) opposing %alls) etc) %ill drastically reduce the effect of torsional forces& 9& Presence of a pulp chamber %ith pronounced %alls : +alls of the pulp chamber) especially if they are opposing each other) %ill increase the frictional retention of the foundation or restoration) minimi@ing the retention demands on the pot and thereby minimi@ing stresses in the root canal %alls& 6& Presence of intact marginal or crossing ridges : These ridges %ill act as a binder bet%een the buccal and lingual cuspal elements) resulting n better distribution and resistance of induced stresses& 5& Pro imity of the post to the root canal filling : 06

Boot canal fillings should not be involved in the mechanical problems of the posts& For this reason) there should be a space bet%een the apical end of the post and the occlusal end of the root canal filling& IF the post appro imates the root canal filling) forces can be transmitted to that filling) %hich mechanically is made of very %ea( materials) and lead to profound straining& This can move the post in an undesirable direction) and it may induce unnecessary stresses in the remaining tooth structure& In addition) the direct or indirect loading of the root canal filling may change its relationship to the surrounding %alls and apical anatomy) resulting in endodontic failure& 7/& Presence of flat planes in the remaining tooth structures) at a right angle to occluding forces : Flat planes) in the form of tables) gingival floors and ledges) etc) %hich %ill be able to receive and resist occluding forces before arriving to the post) are the second ma*or feature used to reduce induces stresses in the remaining tooth structure& Besides partially protecting the post from direct loading) these flat planes %ill protect a very %ea( subpulpal floor from being directly loaded& 77& Presence of lateral %alls in the remaining tooth structure : 3 tra or intracoronal a ial %alls) that %ill receive and resist laterally applied forces on the restoration before they arrive at the post) %ill drastically reduce stresses I the remaining %ea(ened tooth structure) primarily in the root canal %alls& 7.& The root post portion relative to the cro%n post portion : The ideal ratio is to have the root portion of the post t%ice as long as the cro%n portion) i&e& a ratio of .:7& Eess than that) especially less than a ratio of 7:7) %ill definitely concentrate intolerable stresses on the lateral %alls of the root canal ad*acent to the apical end of the post& 74& ?ydraulic pressure during post cementation : If there are no lateral vents in the post) or if the post diameter is very close to that of the post channel diameter) the semi;li$uid cement mi ) during the cementation of the posts) may e ert tremendous amounts of hydraulic pressure that e ceed the elastic limit of the surrounding dentin or prevent complete seating of the post& 70& Surface te ture and shape of the root end of the post : Kreater post surface roughness and!or the presence of a chisel) %edge) or irregular configuration on the root end of the post) increases the possibilities of stress concentration on the root canal %alls& The concentration of these stresses %ill increase %ith increasing pro imity of the pot to the involved root canal anatomy& 05

72& The length of the post relative to the entire length of the root : Kenerally) spea(ing the more that the root canal length is involved %ith a post) the more evenly distributed and the better resisted the stresses %ill be in the root canal %alls& On the other hand) the apical one third of root canals usually have a very limited thic(ness of dentin %alls& By placing the tip of the root pot there) %ith attendant possibilities of substantial stresses being concentrated at that tip) catastrophic failures become inevitable& 's a rule from one half to t%o thirds of the root canal should encapsulate the post if the forces transmitted by the post are to be ade$uately dissipated& 78& Shape of the post in cross section relative to the shape of the post channel : ' post should have a circumference that coincides %ith the post channel& #ifferences) e&g& rounded post in an oval post channel) %ill concentrate stresses at isolated locations in the root canal %all) possibly e ceeding the local brea(ing point of the dentin& 79& Eoose post in the post channel : ,nconfined movements of a post %ithin a root canal can e aggerate stresses in the root canal %alls upto the fracture point of dentin& 76& Post ending apically at the *unction of the clinical root %ith the clinical cro%n& This specific location is an area of appreciable stress concentration in normal) sound teeth& +ith root canal therapy) the strength of the area is decreased& If) in restoring a tooth) the apical end of the root canal post is placed at this *unction) a %hen the clinical cro%n is far longer than the anatomical cro%n) three problems %ill be concentrated at these locations& Eess strength than normal 1due to a decrease in bul( resulting from the postCs taper) above normal stress concentration resulting from a reduced cro%n root ratio and ma imum stresses from the apical end of the post) as it is) in effect) the end of a level& These stresses may approach the failure level of the dentin& 75& "entral Slitting of Posts : Eength %ise slitting of a post involving one half or more of its length %ill ma(e the post elastically collapsible in a lateral direction& If such a post is a threaded type) and during threading into the root e cessive stresses are induced at the post dentin interface) instead of these stresses being consumed in detrimental deformation of dentin) they may be consumed) in part) to partially close the central slit& The rigidity of the t%o parts of the post at this area %ill (eep the post engaged in dentin for retention) and their elasticity %ill reduce the stress concentration in that dentin& ./& Thread numbers and patterns : 2/

"ontinuous threads from one end of a post to another create more stresses than interrupted threading& The greater that the spacing is bet%een threads) the less %ill be the attendant stresses& The sharper that the threads are) the less %ill be the stresses& "ircumferentially interrupted threading creates less stresses than continuous threading& The %ider and more fre$uent that the interruptions are) the less %ill be the stresses& Interruptions 1cross cuts) further serve to facilitate escape of debris during post insertion& The more e tended that the threads are laterally) the more the surface interfacial contact %ith dentin %ill be and conse$uently) the higher the stresses& FORCES ACTING ON A CAST METAL AND PORCELAIN RESTORATIONS BIOMECHANICAL PRINCIPLES OF PREPARATIONS: The design and preparation of a tooth for a cast metal or porcelain restoration are governed by : 7) Preservation of tooth structures& .) Betention and resistance forms 4) Structural durability of the restoration 0) Marginal integrity 2) Preservation of the periodontium& ' restoration can meet its functional) biological and esthetic re$uirements if it remains firmly attached to the tooth& Its capability for retention and resistance must be great enough to %ithstand the dislodging forces it %ill encounter in function& 'n estimate as to the prevailing occlusal forces can be had by noting the degree of %ear on the other teeth) firmness of the opposing teeth) thic(ness of the supporting base and the bul( of masticatory muscles& RETENTION AND RESISTANCE : If a restoration does not remain firmly attached to the tooth) it cannot meet its functional) biological) and esthetic re$uirements& Its capability for retention and resistance must be great enough to %ithstand the dislodging forces it %ill encounter in function& Some estimate of the prevailing occlusal forces in an individual patient can be made by noting the degree of %ear on the other teeth) the firmness of the opposing teeth) the thic(ness of the supporting bone) and the bul( of the masticatory muscles&

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It is the geometric form that determines the orientation of the tooth;restorations interfaces to the direction of forces encountered& This in turn determines %hether the cement in a given area %ill be sub*ected to tension) shear) or compression& 'll cements e hibit their greatest strength under compression& They are %ea(est under tension) %ith the value for shear strength lying in bet%een& +here a part of the restoration is pulled directly from the tooth) separation is prevented only by the relatively %ea( tensile strength and adhesive properties of the cement& If the applied force is parallel %ith the cement film) movement at the cement;tooth and cement;metal interfaces is more effectively impeded by the minute pro*ections of cement into the surface irregularities than %hen the force is tensile in nature& Movement %ithin the cement film itself is resisted by its relatively greater shear strength& ' force directed at an angle to%ard the restoration) has one component parallel %ith and one component perpendicular to the *oined surfaces& Thus the cement is sub*ected to a combination of shear and compression) and movement is resisted ore effectively than if the forces %ere purely tensile or shear in nature& ' compressive force perpendicular to the cement film can produce no movement of the restoration relative to the tooth unless it is great enough to crush the cement or deform the structures& Such forces are seldom encountered in function& Betention and resistance can be ma imi@ed by shaping the preparation so that as much of its surface as possible %ill e perience compression and shear %hen the restoration is sub*ected to an unseating force& RETENTION : It is the ability of the preparation to impede removal of the restoration along its path of insertion& ,nder this condition) the cement bond sub*ected to tension and shear& ' restoration can e perience %ithdra%ing forces along its path of insertion during mastication of stic(y foods& There are 0 factors under the control of the operator during tooth preparation %hich influence retention& i) #egree of taper 2.

ii) iii) iv)

Total surface area of the cement film 'rea of cement under shear Boughness of the tooth surface

i& De1ree o, T"per : The more nearly parallel the opposing %alls of a preparation) the greater %ill be the retention& Thus retention decreases as taper increases& ?o%ever) in order to avoid undercuts and to allo% complete seating of the restoration during cementation) the %alls must have some taper& 'n overall taper or angle of convergence of 8 degrees is considered as appropriate i&e& appro imately 4 degrees being produced on each surface) e ternal or internal) by the sides of a tapered instrument& ii& Tot"l S/r,"(e Are" o, Cement Film : The greater the surface area of cement film or the of the preparation) the greater the retention of the restoration& The total surface are of preparation is influenced by the si@e of the tooth) the e tent of coverage by the restoration and features such as grooves and bo es that are placed in the preparation& iii& Are" /n.er s!e"r : More important for retention than the total surface area is the area of cement that %ill e perience shearing rather than tensile stress %hen the restoration is sub*ected to forces along the path of insertion& To decrease the failure potential) it is essential to minimi@e tensile stress& For the shear strength of the cement to be utili@ed) the preparation must have opposing %alls) i&e& t%o surfaces of the preparation in separate planes must be nearly parallel %ith each other an the line of dra%& To obtain the greatest area of cement under shear) the direction in %hich a restoration can be removed must be limited to essentially one path& Thus the addition of parallel sided grooves) limits the path of %ithdra%al to one direction) thereby reducing the possibility of dislodgment&

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The length and %idth of the preparation is an important factors in retention : a long preparation as %ell as %ider preparation has greater retention than does a shorter or a narro%er preparation& i & S/r,"(e Ro/1!ness : 'dhesion of dental cements depends primarily on pro*ections of the cement into microscopic irregularities on the surfaces to be *oined& Therefore prepared tooth surface should not be highly polished& RESISTANCE : it is the ability of the preparation to present dislodgment of the restoration by forces directed in an apical) obli$ue) or hori@ontal direction& +here there is effective resistance) much of the cement film %ill be placed under compression) although some parts %ill be still be sub*ected to tension and shear& If the cement film is disrupted by the restorations sliding or tipping on its preparation) the smallest fraction of a millimeter) the restoration is doomed through percolation of fluids) dissolution of the cement) and recurrent caries& Besistance to sliding and tipping must be designed into a preparation by forming %alls to bloc( the anticipated movements& The more nearly perpendicular it lies to the force) the greater is the resistance provided by the supporting surface) because the cement %ill be compressed) and failures are less li(ely to occur form compression than shear& Le er"1e "n. Resist"n(e : The strongest forces encountered in function are apically directed and can produce tension and shear in the cement film only through leverage& Eeverage) probably the predominant factor in the dislodgment of cemented reiterations) occurs %hen the line of action of a force passes outside the supporting tooth structure) or %hen the structures fle & If the line of action of force passes %ithin the margin of a restoration) there %ill be no tipping of restoration& The margin on all sides of the restoration is supported by the preparation& The tor$ue produced merely tends to seat the cro%n further& If the line of action of force passes outside the margins of restoration the occlusal table of the restoration is %ide) even a vertical force can pass outside the supported 20

margin and produce destructive tor$ue& This can also occur in cro%ns on tipped teeth& ' force applied to a cemented cro%n at an obli$ue angle can also produce a line of action %hich %ill pass outside the supporting tooth structure& Prep"r"tion Len1t! "n. Resist"n(e : The ability of a restoration to resist tipping depends not only on the preparation) but also on the magnitude of the tor$ue If t%o cro%ns of une$ual length on t%o preparations of e$ual length) are sub*ected to identical forces) the longer cro%n is more li(ely to fail because the force on it acts through a longer lever arm& Resist"n(e "n. Toot! *i.t! : ' %ide preparation has greater retention than a narro%er one of e$ual height& T"per "n. Resist"n(e : The resisting area decreases as the preparation taper increases& The %alls of a short) %ide preparation must be (ept nearly parallel to achieve ade$uate resistance form& Rot"tion "ro/n. " erti("l "#is : +hen a cro%n is sub*ected to an eccentric hori@ontal force) movements of tor$ue occur around a vertical as %ell as hori@ontal a is& It is possible for a full cro%n on a cylindrical preparation to rotate enough to brea( the cement bond before may compressive resistance is encountered& Keometric forms such as grooves or <%ings= increase resistance by bloc(ing rotation around a vertical a is&

P"t! o, Insertion : The path of insertion for posterior full and partial veneer cro%n is usually parallel %ith the long a is of the tooth& ' tipped tooth must be handled differently& 22

If the path of insertion on a tipped tooth parallels the long a is) the cro%n %ill be prevented form seating by those parts of the ad*acent teeth %hich protrude into the path of insertion& The correct path of insertion for such a tooth is perpendicular to the occlusal plane& 'll negative taper or undercut) must be eliminated or it %ill prevent the restoration form seating& O((l/s"l Re./(tion : It should reflect the geometric inclined planes underlying the morphology of the finished cro%n& 'void creating steep planes %ith sharp angles) since these ca increase stress and hinder complete seating of the casting& To diminish stress) round the angels and avoid deep grooves in the centre of the occlusal surface& FORCES ACTING ON PARTIAL $ENEER CRO*N Since vertical occlusal forces have hori@ontal resultants) displacing forces have a tendency to tip or rotate a restoration) usually the tipping is in the lingual direction and rotation occurs mesiolingually or distolingually& Observe the pro imal groove of a force LPC) directed lingually %hich is applied at the incisal edge& It %ill have a tendency to tip the casting out of the cavity) turning on the fulcrum LfC& The resistance to the displacement is offered by a rib of L'a) %hich lies in the a ial groove LabC also by that part of the a ial %all lying lingually to the a ial groove and encompasses area e and s& It is observed that the lingual %all of the mesial groove does not furnish any resistance to lingual displacement& Since the plane of this %all lies in the tipping path of arc L"C for this reason) the incisal edge is usually prepared in a plane and not %ith a groove& +hen force P is applied mesiolingually to the marginal ridge of the upper central) the tendency is to rotate the restoration out of the mesiolabial %all of the cavity) point LFC acting as the centre of rotation& Obviously then the resistance to this rotational displacement is furnished by the distopro imal groove and that portion of the pro imal surface lying %ithin the arcs B7 and B.&

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'nalogous resting forces are present %hen acting forces are in a distolingual direction) then the distolabial %all act as to point of rotation) the mesio pro imal %all and groove furnish the resistance to displacement& There is a hori@ontal force LPC applied distally to the incisal area& This has a tendency to tip the casting mesially) rotating on point LFC& This displacing force is resisted by the pro imodistal groove and that portion of the pro imodistal surface lying bet%een B7 and B.& The same general displacing forces are present in the posterior partial cro%n as in the anterior partial cro%n) but the ability of the preparation to resist displacement is more favourable than in the anterior teeth& The occlusal forces may be occlusal) hori@ontal or any one component of force indicated by LPC& Minimum problems e erts %hen the force is vertical) for the resistance is e$ual and opposite& +hen the force tends to displace the casting lingually) it does so along the paths B7) B. and B4 %ith its rotation center at point F& Besistance in this displacing force is furnished by the ribs of gold lying %ithin the a ial groove and by that portion of the pro imal and surface e tending lingually from the pro imal groove and lying %ithin the areas B 7) B. and B4& In addition) the occlusal surface lying to plane B. B4 offers resistance %hen force LPC is applied in mesiolingual direction) the tendency is to rotate the casting mesiodistally %ith the rotation centre being point F) the mesiobuccal %all& The resistance is this displacing force is developed by the rib of gold lying into distopro imal groove and by the portion of the casting coming in contact %ith the pro imal surface lying bet%een the areas B 7 and B.& 'dditional resistance to displacement is offered by the occlusal inclined planes B 4) B0 and B2& +hen force P is applied in the distal direction) the tendency is to rotate the casting occlusally) %ith its dislodgment along the areas B7 and B. %ith F serving as the point of fulcrum& The resistance to this displacing force is furnished by the rib of gold lying in the mesio pro imal groove and also by the buccal and mesiopro imal %alls lying %ithin the areas B7 and B.& FULL CO$ERAGE CRO*N 8ANTERIOR PORCELAIN :AC+ET CRO*N& : 's mentioned earlier the anticipated forces place don the restoration cannot be ta(en lightly& 29

In(is"l Re./(tion : In (eeping %ith the rule that planes are placed at right angles to the applied forces) the incisal edges of the upper anterior teeth slopes lingually %hereas that of the lo%er teeth slopes labially& The incisal reduction should be ade$uate to ensure clearance in protrusive movements of the mandible and permit satisfactory esthetics and enhance optimal function& ;.;2o parallelism is desired %ith pro imal reduction& 'fter the removal of enamel) the labial gingival termination is made at or *ust above the crest of the labial gingiva& 'nother retention area is immediately belo% the cingulum& More than any other restoration) porcelain *ac(et cro%n depends on its tooth preparation& Tooth support is more critical to fracture resistance of the restoration than is the bul( of porcelain& The crescent moon fracture seen on the labial cervical region is a direct result of inade$uate preparation length& Incisal reduction recommended ranges from 7&2 to . mm& For esthetic result) it is best to reduce the incisal edge by . mm to the level of depth orientation grooves& 'ny greater reduction %ill increase the stress on the facial surface %hich can result on the facial half moon fracture& The plane of the reduced incisal surface should parallel %ith the former incisal surface and more importantly perpendicular to the forces of mastication& Failure to create this near incisolingual bevel 102 o") %ill produce e cessive stress at the shoulder& 1Shoulder /&2 /&9 mm) Plane of shoulder is perpendicular to long a is of the tooth& If it is at obtuse angle possibilities of fracture at the cervical region is more& The mesioa ial and distoa ial %alls are more favourable for developing parallelism to frictional resistance& The buccal and lingual surfaces due to their natural contour) do not afford the same opportunity for paralleling %alls& The occlusal planes are reproduced at a lo%er level& These planes help considerably to resist stability or displacement& +hen necessary and %here indicated) additional resistance form may be obtained by placing pins) grooves or bo es in any available surface %here the length of this surface is ade$uate& If an occlusal force is directed LPC buccally) the lingual portion of the cro%n tends to be dislodged occlusally and buccally %ith the point of rotation situation at LFC) this displacement is resisted by that lingual surface %hen it lies outside the arc B 7& On the other hand) an occlusal force P. directed lingually is li(ely to dislodge the cro%n lingually) since the buccal %all of the preparation lies %ithin the tipping path of the arc ?.& 26

+hen such a condition prevails either in the buccal or lingual %all) resistance to displacement can be developed by placement of . pro imal grooves at K in the mesial and distal surface as sho%n in the figure and it is evident that an occlusal force P directed mesially %ill not dislodge the cro%n) since the distal %all of the preparation lies outside the tipping path of arc B7& CONCLUSION Optimal functional capacity and stability of occlusal relationships are ma*or considerations in every phase of restorative dentistry& The first phase ob*ective of a cavity preparation design is to establish the best possible configuration that can cope %ith the distribution and magnitude of stresses in tooth structure and restoration %ithout failure& To design such a configuration one must first comprehend the nature of loading and resistance to such loading& Bestoration not only mechanically replace the lost part but) acts as a medium through %hich physical and mechanical forces are transmitted to the tooth and investing tissues& 3ach tooth ahs its o%n stress patterns& ' thorough (no%ledge in dental materials is necessary to understand the physical properties including their response to stress& Before any restorative procedure) al%ays chec( location of the tooth in the arch and the patients occlusal relationship& The functional) non functional cuspal elements should be noted bye e amining the involved teeth during static and functional mandibular movements The operator can then recogni@e the nature of stresses that can be e pected in the remaining tooth structure especially the occluding ones& From these informationCs obtained during the patient evaluation) the operator must envision the restoration replacing lost tooth structure being sub*ected to functional loading and then try to plan the best tooth preparation to both retain this restoration and ma(e it resistant to these loads&

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