Contents

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Problem

Introduction

Chapter 1

Biomechanical Principles of Preparations

13

Chapter 2

Finish Lines and the Periodontium

45

Chapter 3

Instrumentation

61

Chapter 4

Full Veneer Crowns

83

Chapter 5

Maxillary Posterior Three-Quarter Crowns

95

Chapter 6

Mandibular Posterior Three-Quarter Crowns

115

Chapter 7

An terior Three-Quarter Crowns

133

Chapter 8

Pin-Modified Three-Quarter Crowns

153

Chapter 9

Seven-Eighths Crowns

173

Chapter 10

Proximal Half-Crowns

189

Chapter 11

tnlays

205

Chapter 12

MOD Ontays

237

Chapter 13

Anterior Porcelain-Fused-Io-Metal Crowns

259

Chapter 14

Posterior Porcelain-Fused-Io-Melal Crowns

279

Chapter 15

All-Ceramic Crowns

295

Chapter 16

Preparation Modifications for Damaged Teeth

321

Chapter 17

Preparation Modifications for Special Situations

359

Author Index

377

Subject Index

385

Chapter 1

Biomechanical Princ iples of Preparations

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Problem
The design and preparation of a tooth
for a cast metal or porcelain restoration
are governed by five princi p les:
1.
2.
3.
4.
5.

Preservation of tooth st ructure

Retention and resistance form
Structural durability of the restoration
Marginal integrity
Prese rvation of the pe riodontium

At times it may be necessary to compromise one or more for the sake of

another. For example, sound tooth
structure may have to be sacrificed in
order to produce a more retentive form,
to create space for the bulk of restorative material necessary for structural
durability or an esthetic veneer, and to
allow the restoration to seat with closefitting margins. Sound judgment must
be exercised in making these compromises , with the requirements of the
individual situation taken into careful
conside ration.

Preservation of tooth structure

Excessive removal of tooth structu re
can have many ill effects. If a tooth is
overtapered or shortened too much,
there will be an unnecessary sacrifice of
retention and resistance. Thermal hypersensitivity, pulpal inflammation, and
necrosis can result from approaching
the pulp too closely. As a guide to how

much tooth structu re can be safely removed, or how deeply a preparation

may extend, the average thicknesses of
enamel and dentin for permanent maxillary teeth are given in Table 1-1. Those
for mandibular teeth are shown in Table 1-2.
One of the most common violations of
this principle is seen in the indiscriminate use of full-coverage porcelain
veneered crowns in situations where
partial veneer coverage with an allmetal restoration could be used. It is
true that fUll-coverage restorations have
long been recognized by clinicians as
offering superior retention and resistance . 1 This has been borne out in recent years by several studies. 2-4 Howeve r, the shift in emphasis from partial
venee r to full veneer restorations is
more probably related to the ease and
convenience associated with the design. 5--7 The decision to use full coverage should be reached only after a partial veneer crown has been considered
and found wanting because of inadequate retention or esthetics . 8-- 11
Preservation of tooth structure entails
more than simply avoiding excessive
destruction. II also requires designing
the restoration so that it will reinforce
and protect the remaining enamel and
dentin even when this means sacrificing
a small amount of additional tooth structure on the occlusal surface to protect
underlying cusps.

13

"-

Table ,-,

Enamel and dentin thicknesses in maxillary teeth (mm)"

Midcrown

Occlusal
Material

Incisal

CEJ

0.9
3.4

0.7
1.6

1.0
1.4

0.7
1.6

0.7
1.0

2.2

2.5

2.3

3.1

0.9
3.3

0.8

1.0

0.6

0.7

1.2

1.1

1.2

0.9

1.8

2.2

1.7

2.4

1.1

0.7
1.8

0.8
2.0

0.8
2.2

0.7
2.0

2.0

2.7

2.2

2.9

1.2

1.3

1.3

1.4
2.2

2.6

2.2

2.7

2.0

2.2

1.9

2.3

2.5

2.8

2.6

2.8

2.6

2.9

2.6

3.0

Cent

Central incisor

Enamel
Dentin

Lateral Incisor

Enamel
Dentin
Canine

Enamel
Dentin

4.4
Cusp

Cusp

1 .5

Groove
1 .3

3.0

3. 1

3.3

Cusp

Groove

1.7

1.3

Cusp
1.7

3.3

3.2

3.4

MF

DF

Cent

ML

DL

Cusp
1.8

Cusp
1.9

Fossa
0,6

Cusp
1.9

Cusp
1.9

First premolar

Enamel
Dentin
Second premolar

Enamel
Dentin

First molar

Enamel
Dentin
Second molar

Enamel
Dentin

3.9

1.8

1.1

1.3

1.1

1.4

1.31.51 .41.6

4.0

Cusp

Cusp

2.0
3.8

1.9

Fossa
0.5

Cusp
2.1

Cusp
1.9

1.3

1.4

1.3

4.4

'Mod,toed from H T ShoIIingburg and C S Grace. ThIckness of enamel and denim. J Soutn. Calil Dent Assoc_. 41 33. 1973

1.6

Table 1-2

Enamel and dentin thicknesses in mandibular teeth (mm)"

Occlusal

Material

Incisal

Cent

CEJ

Midcrown
M

0.9
3.7

0.6

0.9

1.1

1.1

0.7
1.2

0.6
0.9

15

23

1.5

2.4

1.0
3.6

0.6
2.0

0.8
2.0

0.8
2.1

0.6
2.1

2.8

22

2.9

1.0

1.2

1.0

1.1

2.1

2.5

2.1

2.8

22

2.6

2.2

2.5

2.5

2.8

2.7

2.6

2.5

3.0

2.8

2.6

Incisor
Enamel
Dentin
Canine
Enamel

Dentin
First premolar

Enamel
Dentin

Second premolar
Enamel
Dentin

First molar

Enamel
Dentin
Second molar

Enamel
Dentin

Cusp

Groove

Cusp

1.3
3.2

1.2
2.0

1.1

3.0

Cusp

Groove

Cusp

1.6
3.4

1.3
2.7

1.6
3.8

1.1

MF

DF

CENT

ML

DL

Cusp

Cusp
1.8

Cusp
1. 9

Fossa
0.5

Cusp

Cusp

1.9
3.7

1.8
3.3

2.0
3.8

3.3

Cusp

Cusp

Fossa

Cusp

Cusp

2.0
3.6

1.9
36

0.5

1.8

1.8
3.6

3.3

1.2

1.4

1.3

1.5

1.6

1.1

1.3

1.5

Ul

"MOd,had from H T Shillingburg and C S, Graco, Thickness 01 enamel and denlln. J South Cal"

Dent Assoc , <I t 33, 1973

1.7

1.2

1.3

1.5

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