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Definitions
Objectives of tooth preparation
Principles of tooth preparation
Biologic considerations
Thermal injury
Chemical injury
Mechanical considerations
Retention form
Resistance form
Structural durability
Marginal integrity
Esthetic considerations
DEFINITIONS
The process of removal of disease and / or healthy enamel and dentine and
cementum to shape a tooth to receive a restoration.
- GPT: 8
Tooth preparation may be defined as the mechanical treatment of dental
disease or injury to hard tissue that restores the tooth to the original form
- TYLMAN
OBJECTIVES OF TOOTH PREPARATION
PRINCIPLES
According to Shillingburg:
Preservation of tooth structure
Retention and resistance form
Structural durability
Marginal integrity
Preservation of the periodontiu
According to Rosensteil:
BIOLOGIC CONSIDERATIONS
I) Prevention of damage during tooth preparation:
a) Adjacent teeth:This damage can be avoided by;
b) Soft tissues:
c) Pulp:
Pulp affected by,
-
Temperature
Chemical agents
Microorganisms
Anatomic reduction
Apical extension.
.
4
in order by full shoulder, 450 shoulder and finally by 900 shoulder with 300 and
600 bevels.
Featheredge preparation with subgingival margins are recommended in,
-
Occlusal Considerations:
to direct forces along the long axis of the tooth or to reduce the prematurities during
lateral excursions of mandible.
Preventing Tooth Fracture:
Thus, providing a cuspal coverage (onlay) is preferable than an inlay and a complete
crown is always a better option as it tends to hold the cusps together.
Contour:
According to Yuodelis et al, the restoration should not mimic the original
anatomic contour of the tooth but that of the root.
Tooth preparations of periodontally compromised patients are fluted short of
furca avoiding the triangular region formed by crevicular emergence and roots.
'Flat and not fat contour is now recommended.'
Points to be considered:-
Facial and lingual walls are more convergent from the occlusal 3 rd to provide a
narrow occlusal table.
6
Short axial walls may require accessory methods of retention box, grooves,
pins.
Lee M. Jameson and William F.P. Malone in 1982 evaluated crown contours and
gingival margins.
MECHANICAL CONSIDERATIONS:
3 factors:-
1. Retention form
2. Resistance form
3. Preventing deformation of restoration
1. Retention Form:Various factors:a. Magnitude of dislodging force
b. Geometry of tooth preparation
c. Roughness of fitting surface of restoration
d. Materials being cemented
e. Film thickness of luting agents
Stickiness of food
Taper:
(undercut is defined as a divergence between opposing occlusal walls or wall
segments in cervico-occlusal direction).
i.e. retention decreased as taper increased.
E.g.Retention of GALILTH with 100 taper was half that
of 50 taper. Recommended taper is 5-80 with a rotary
instrument held at constant angle.
Surface Area:Stress Concentration:. Stresses are seen to concentrate around the junction of axial and occlusal
surfaces.
Modifications like rounding of internal line angles will reduce the stress
Types of Preparation: It is seen that retention of complete crowns is almost twice as
that of partial coverage. Grooves or boxes in a preparation which limit the path of
withdrawal enhances the retention.
Freedom of Displacement.
Maximum retention - when there is only one path .long parallel axial walls
- Length
8
Path of insertion
Survey a preparation
Over a cast- from 12 inches preparation to be surveyed
In the mouth-by holding the mirror inch above the preparation and viewing
indirectly.
Resistance Form: Lateral forces tend to displace the restoration by causing rotation
around the gingival margins.
Adequate resistance depends on:1. Magnitude and direction of dislodging forces
2. Geometry of tooth preparation
3. Physical properties of luting agents.
1. Magnitude and direction of dislodging forces:occlusal load should be well distributed and favourably directed.
2. Geometry of tooth preparation:Particular areas of axial walls help prevent rotation of the crown.
FEATURES
They demonstrated;
-
Partial coverage crown has less resistance than a complete coverage (as no buccal
resistance areas).
Resistance can also be improved by placing grooves and boxes especially with
walls being perpendicular to the direction of applied forces.
10
Anthony H.L. Tjan, Gary D. Miller - discussed about two groove flare designs
referred to as Type I and Type II.
Type I groove-flare :
Fishhook design
11
Encroachment on pulp
Type II groove-flare :
tangent
Deformation:
Can occur as a result of;
a. Inappropriate alloy selection
b. Inadequate tooth preparation
c. Poor metal ceramic framework
Alloy Selection:
Type I and Type II gold for intracoronal cast restorations not for FPDs. Type
III and Type IV for FPD as they are harder and stronger, hardness can be
further increased by heat treatment.
High noble metal content metal ceramic restorations have hardness equivalent
to type IV alloys.
Ni-Cr alloys are harder indicated for long span bridges or where larger forces
are expected.
12
ESTHETIC CONSIDERATIONS
Points to be considered:
Whenever
possible
partial
coverage
13
Especially mesial;
-
margin placed just buccal to proximal contact areas so that metal can
be hidden by distal line angle of neighboring teeth.
Facial margin:-
14
DEFINITIONS
The process of removal of disease and / or healthy enamel and dentine and
cementum to shape a tooth to receive a restoration.
- GPT: 8
Tooth preparation may be defined as the mechanical treatment of dental
disease or injury to hard tissue that restores the tooth to the original form
- TYLMAN
PRINCIPLES
According to Shillingburg:
Preservation of tooth structure
Retention and resistance form
Structural durability
Marginal integrity
Preservation of the periodontium
15
According to Rosensteil:
BIOLOGIC CONSIDERATIONS
Tooth preparations affect the adjacent teeth, soft tissues and tooth pulp. This
may lead to inadequate fit, crown contour and plaque control. Thus, impeding with
the long term maintenance of a fixed restoration ultimately leading to the failure of
the restoration.
Factors to be considered here are:I) Prevention of damage during tooth preparation:
a) Adjacent teeth:The technique of tooth preparation must avoid damage to adjacent teeth
because a damaged tooth even if reshaped and recontoured is always more susceptible
to caries as,
16
b) Soft tissues:
Includes the tongue, cheek, lip, soft tissues should be carefully retracted using
an aspirator tip, mouth mirror and saliva ejector especially, the tongue while preparing
lingual surfaces of mandibular molars.
c) Pulp:
Here, proper knowledge of the anatomy and morphology of the tooth is
important. Diagnostic radiographs for assessing the pulp size and its proximity to the
outer surface.Pulp affected by,
-
Temperature
Chemical agents
Microorganisms
17
i) Temperature: Heat generated due to friction between rotary instrument and surface
being prepared. Excessive pressures, high speed, type, shape and condition of cutting
alters the heat produced precautions.
Use of water spray, removes the debris and cools the tooth but the
disadvantage is it may hamper the visibility so a slow speed handpiece is used
while preparing grooves and pinholes.
Preparation of teeth with minimum possible axial taper (i.e. not more than 80).
Anatomic reduction
Apical extension.
19
This is especially true for interproximal and furcation areas where periodontal
problems actually begin.
B) Margin Placement:
Very controversial.
resistant
to
caries,
but,
according
to
recent
concepts
22
Younger patients
Pinledge preparation
II) Chamfer:
Advantages:-
Disadvantages:
-
Use:-
23
III) Bevel:
Advocated by Rosner in 1963 for gold castings having 3 fold objective:
To allow the cast metal margin to be burnished against the tooth surface.
Use:-
IV) Shoulder:Forms a 900 angle with unprepared tooth surface i.e., the external line angle of
the preparation is perpendicular to the long axis of tooth (An acute angle is likely to
chip).
Advantages:24
Distinct margins.
Disadvantages:-
Ardous to prepare
sufficient bulk of metal to allow thinning of metal framework for good esthetics.
V) Shoulder with bevel:The bevelling reduces unsupported enamel and allows finishing of metal.
However, a shoulder or sloped shoulder is preferred for biologic and aesthetic reasons
because the metal margin can be thinned to knife edge and placed in gingival sulcus
without the need to position the margin closer to epithelial attachment.
Uses:-
25
26
Occlusal Considerations:
space for developing a functional occlusal scheme in the finished restoration. The
occlusal plane is carefully planned and teeth reduced accordingly to compensate for
supraeruptions of opposing teeth. Thus, violation of principle of conservation of tooth
structure is preferable to the harm from a traumatic occlusal scheme. So, sometimes
endodontic treatment may be necessary to obtain the desired plane. Whenever
possible the occlusal plane should be reduced to direct forces along the long axis of
the tooth or to reduce the prematurities during lateral excursions of mandible.
27
Thus, providing a cuspal coverage (onlay) is preferable than an inlay and a complete
crown is always a better option as it tends to hold the cusps together.
Contour:
Enhances accessibility for cleaning.
restoration should not mimic the original anatomic contour of the tooth but that of the
root.
Tooth preparations of periodontally compromised patients are fluted short of
furca avoiding the triangular region formed by crevicular emergence and roots.
'Flat and not fat contour is now recommended.'
Points to be considered:-
Facial and lingual walls are more convergent from the occlusal 3 rd to provide a
narrow occlusal table.
Short axial walls may require accessory methods of retention box, grooves,
pins.
Lee M. Jameson and William F.P. Malone in 1982 evaluated crown contours and
gingival margins.
-
28
MECHANICAL CONSIDERATIONS:
3 factors:-
4. Retention form
5. Resistance form
6. Preventing deformation of restoration
1. Retention Form:The quality of the restoration that prevents the restoration from being
dislodged by force parallel to the path of withdrawal called as retention form.
a) Magnitude of dislodging forces:Forces can be exerted with a floss under the connectors but mainly force is
exerted by adhesiveness of foods. The magnitude of dislodging force depends on:-
Stickiness of food
29
b) Geometry of tooth preparation:Most fixed prosthesis depend on the geometric form of tooth
preparation rather than on adhesion tooth retention as most of the dental
cements are non-adhesive and act by increasing the frictional resistance
between tooth and restoration.
decreased
as
taper
increased.
E.g.Retention of GALILTH with 100 taper was half that of 50 taper. Recommended
taper is 5-80 with a rotary instrument held at constant angle.
Surface Area:
Crowns with long axial walls are more retentive than crowns with short axial
walls.
Molar crowns are more retentive than premolar crowns of similar taper.
30
Stress Concentration:Cohesive failure occurs within the cement as the stress within cement is less
than that of induced stresses. Stresses are seen to concentrate around the junction of
axial and occlusal surfaces.
Modifications like rounding of internal line angles will reduce the stress
concentration and increase retention of the restoration.
Types of Preparation: It is seen that retention of complete crowns is almost twice as
that of partial coverage. Grooves or boxes in a preparation which limit the path of
withdrawal enhances the retention.
Freedom of Displacement.
Maximum retention - when there is only one path .long parallel axial walls
Definite wall perpendicular to the direction of the force .
Proximal box - Buccal and lingual wallmeet the pulpal wall near 90
- Length
More surface area - more retentive
Length - enough to interfere with the arc of the casting
The shorter the wall - more important its inclination.
The walls - little taper
31
Path of insertion
Imaginary line along which the restoration will be placed.
Survey a preparation
Over a cast- from 12 inches preparation to be surveyed
In the mouth-by holding the mirror inch above the preparation and viewing
indirectly.
32
Resistance Form: Restorations are also subjected to horizontal or oblique forces e.g.
mastication/ parafunctional habits. Lateral forces tend to displace the restoration by
causing rotation around the gingival margins. This rotation is prevented by areas of
the preparation that are placed under compression called as Resistance areas. Many
such areas make up the resistance form.
Adequate resistance depends on:4. Magnitude and direction of dislodging forces
5. Geometry of tooth preparation
6. Physical properties of luting agents.
1. Magnitude and direction of dislodging forces:In normal occlusion biting force distributed over all the teeth. Similarly in
FPD, occlusal load should be well distributed and favourably directed.
In patients with pipe smoking, bruxism habits, oblique forces are exerted over
FPDs. Thus, an ideal restoration should be able to withstand these forces as well as
the normal axial forces.
2. Geometry of tooth preparation:Particular areas of axial walls help prevent rotation of the crown. Hegdahl and
Silness analyzed how these resisting areas alter as changes are made in geometry of
tooth preparation.
33
They demonstrated;
-
Partial coverage crown has less resistance than a complete coverage (as no buccal
resistance areas).
Resistance can also be improved by placing grooves and boxes especially with
walls being perpendicular to the direction of applied forces.
U-shaped grooves better than V-shaped. These grooves and pinholes interfere
with rotational movement and subject other areas of luting agent to compression.
Anthony H.L. Tjan, Gary D. Miller - discussed about two groove flare designs
referred to as Type I and Type II.
34
Type I groove-flare :
Fishhook design
Encroachment on pulp
Type II groove-flare :
placed
paralleling a line
into
the
dentin
tangent
35
Deformation:
Can occur as a result of;
d. Inappropriate alloy selection
e. Inadequate tooth preparation
f. Poor metal ceramic framework
Alloy Selection:
Type I and Type II gold for intracoronal cast restorations not for FPDs. Type
III and Type IV for FPD as they are harder and stronger, hardness can be
further increased by heat treatment.
High noble metal content metal ceramic restorations have hardness equivalent
to type IV alloys.
Ni-Cr alloys are harder indicated for long span bridges or where larger forces
are expected.
36
Occlusal reduction should follow cuspal planes this ensures sufficient occlusal
clearance plus it will preserve as much as the tooth structure as possible and
also gives rigidity to the crown because of Corrugated effect of the planes.
Margin design:
Distortion of the restoration margin is prevented by designing the preparation outline
to avoid occlusal contact in this area.
Should provide room for sufficient bulk of material e.g. feather edge thin layer
of metal not as strong as thicker chamfer.
Anatomic occlusal reduction conservation of tooth structure and gives
rigidity.
ESTHETIC CONSIDERATIONS
Points to be considered:
Make
full
assessment
of
the
Observe
37
The esthetic requirements are then made with relation to the oral hygiene
needs and potential for diseases.
Facial margin:-
38
Proximal Reduction:
The extent of proximal reduction depends on the location of the metal ceramic
junction in the completed restoration.
Labial Margin Placement:
In patients with high lip line, exposing considerable gingival tissue poses the
greatest problem if complete crowns are need, where the root surface is not
discolored, the appearance can be restored with a metal ceramic restoration, having a
supragingival porcelain margin collar less design.
If a patient has a low lip line, a metal supra gingival collar as metal not visible
during function.
Metal margin can also be hidden below the gingival crest, for this care should
be taken the periodontium is healthy, margin should not be placed so far apically that
encroaches on the attachment.
Extension to within 1.5mm of alveolar crest will lead to resorption.
A common error is to prepare the tooth so that margin lies in one plane, with
exposure of collar labially and irreversible loss of bone and papilla proximally.
SUMMARY
The principles of tooth preparation can be categorized as biologic mechanical
and esthetic, often these principles conflict and operator must decide the design of the
restoration.
There are a lot of controversies regarding the preparation and geometry of
finish lines. So the various finish lines, their advantages and disadvantages can be
summarized as:-
40
Design
Advantages
Disadvantages
Indications
Featheredge
Conserves tooth
structure
Not recommended
Chisel edge
Conserves tooth
structure
Location of margin
difficult to control
Occasionally on tilted
teeth
Bevel
- Removes un
supported enamel.
Extends preparation
into sulecus if used
on apical margin
- Facial margins of
max. partial coverage
rest.
All.
- Allows finishing of
metal
Chamfer
- Distinct margins.
- Adequate bulk.
Easy to control
Design
Shoulder
Advantages
- Bulk of material
Sloped
shoulder
- Bulk of material
- advantages of bevel
- Less conservation
of tooth structure
Facial margins of
metal ceramic
restorations.
Shoulder
with bevel
- Bulk of material
- Less conservative
- Advantageous
bevel.
- Extends apically
- Facial margins of
posterior metal
ceramic crowns with
supragingival
41
margins
42
REFERENCES
1. Johnstons modern practice in fixed Prosthodontics.
2. Contemporary fixed Prosthodontics: Rosenstiel, Land Fujimolo.
3. Fundamentals of fixed Prosthodontics: Shillingburg
4. Fundamentals of fixed Prosthodontics: Tylman
6.
7.
8.
9.
10.
11.
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