CnA1Lk 7

1 margln deslgn (1able 72 on pg220 ls a good summary)

2 when you do crown u deflnlLely need waLer spray for any klnds hand plece lf waLer obsLrucLs ur
vlslon alLernaLlves?
3 supra and subglnglval margln lndlcaLlons and conLralndlcaLlons
4 reLenLlon and reslsLance baslcally everyLhlng under Lhls (Lable 74 pg 237 Lable 73 pg 242 are
Lwo very conclse summarles Lells u how Lo enhance 88)
3 how Lo u remedy a over conLoured LooLh?
6 why 6 degree Laper
7 crown deformaLlon whaL wlll resulLs ln deformaLlon how Lo prevenL deformaLlon
8 donL over conLour any LooLh
blologlc mechanlcal and esLheLlc are llkely Lo confllcL should balance Lhem as much as posslble
glve slmulLanesou conslderaLloln raLher Lhan emphaslze on one
dlagonosLlc waxlng procedure usu ls only for anLerlor LeeLh
we can advlce orLho Lo ad[ucL a malallgned LooLh before dolng crown

CnA1Lk 822
1 ompllcaLlons of crown procedure
2 LffecL of overLaperlng
3 ulsadvanLage of compleLe casL crown
4 Margln deslgn
3 leaLure for max durablllLy of resLo w/o compromlslng on LooLh sLrucLure
6 onLralndlcaLlons of casL crown
7 Pow Lo modlfy Lapered preps achleve deslred ob[ecLlve
810 how Lo choose Lype of meLal alloy (parLlcularly based on lnLended use)
1114 sprue llners

CnA1Lk 11
ll ceramlc crowns
WhaL margln ls requlred?
lndlcaLlons for all ceramlc crowns
lndlcaLlons for ceramlc onlays
ulfferences beLween all ceramlc and meLal ceramlc
oorer marglnal seal (vs oLher crowns)
LuLlng agenL
Ltchab|e and noneLchable ceramlcs (whlch luLlng agenL would you use)
ldeal properLles of luLlng agenLs
LlmlLaLlons of each luLlng agenL
Whlch luLlng agenL Lo use for provlslonals?
S\`W^
8esLoraLlve maLerlals are used Lo reesLabllsh form and funcLlon coz enamel and denLlne have no
regeneraLlve ablllLy

lundamenLal prlnclples of prep subsequenL Lechnlques accompllshed success of prosLho
LreaLmenL
1 lologlc conslderaLlons whlch affecL Lhe healLh of Lhe oral Llssues
Lg conservaLlon of LooLh sLrucLure avoldance of overconLourlng supraglnglval marglns
harmonlous occluslon proLecLlon agalnsL LooLh fracLure
2 Mechanlcal conslderaLlons whlch affecL Lhe lnLegrlLy and durablllLy of Lhe resLn
Lg reLenLlon form reslsLance form deformaLlon
3 LsLheLlc conslderaLlons whlch affecL Lhe appearance of Lhe paLlenL
Lg mlnlmum dlsplay of meLal maxlmum Lhlckness of porcelaln porcelaln occlusal surfaces
subglnglval marglns

lmprovemenL ln one area ofLen adversely affecLs anoLher area eg lncrease Lhlckness of porcelaln
for llfellfe looklng mlghL expose pulp weakened Lhe LooLh 1herefore besL comblnaLlon of
compromlses among Lhese Lhree glves opLlmum prep

8|o|og|c cons|derat|ons
vold unnecessary damage of ad[acenL LeeLh sofL Llssues and Lhe pulp
lnadequaLe marglnal flL or deflclenL crown conLour plaque conLrol become dlfflculL lmpedes Lhe
longLerm malnLenance of denLal healLh

revent|on of Damage
d[acenL LeeLh (laLrogenlc)
Lven a damaged proxlmal conLacL area ls carefully reshaped and pollshed sLlll more suscepLlble Lo
carles Lhan Lhe orlglnal undamaged LooLh surface 1hls ls because Lhe orlglnal LooLh surface enamel
conLalns hlgher conc of l lnLerrupLed layer ls more prone Lo plaque reLenLlon

meLal maLrlx band around Lhe ad[acenL LooLh ls helpful buL lL ls Lhln and can noneLheless be
perforaLed and damage enamel

uslng Lhe proxlmal enamel of Lhe LooLh belng prepared for proLecLlon

1eeLh are 13 Lo 2 mm wlder aL Lhe conLacL area Lhan aL Lhe L! 1herefore a Lhln Lapered dlamond
can be passed Lhrough Lhe lnLerproxlmal conLacL area Lo leave a sllghL llp or fln of enamel wlLhouL
resulLlng ln excesslve LooLh reducLlon or necesslLaLlng undeslrable angulaLlon of Lhe roLary
lnsLrumenL 1lpplng Lhe dlamond unnecessarlly away from Lhe ad[acenL proxlmal surface ls a
common cllnlcal error


ofL Llssues
uamage Lo Longue and cheeks can be prevenLed by careful reLracLlon wlLh an asplraLor Llp mouLh
mlrror or flanged sallva e[ecLor CreaL care for proLecLlon of Longue ls needed when Lhe llngual
surfaces of mandlbular molars are belng prepared





ulp
revenL pulpal ln[urles ls especlally cruclal ln compleLe crown preparaLlon ulp degeneraLlon can
happen many years afLer LooLh preparaLlon LxLreme LemperaLures chemlcal lrrlLaLlon or
mlcroorganlsms can cause an lrreverslble pulplLls parLlcularly when Lhey occur on freshly secLloned
denLlnal Lubules elecLlon of Lechnlques and maLerlals can reduce Lhe rlsk
1ooLh prep musL accounL for Lhe sLrucLure of denLal pulp chamber ulp slze decreases wlLh age up
Lo age 30 lL decreases more so occlusocervlcally Lhan faclollngually


auses lf ln[ury
1emperaLure
PeaL ls generaLed by frlcLlon beLween a roLary lnsLrumenL and Lhe surface belng prepared
Lxcesslve pressure hlgher roLaLlonal speeds and Lhe Lype shape and condlLlon of Lhe
cuLLlng lnsLrumenL may all lncreases generaLed heaL feaLherllghL Louch for hlghspeed
handplece allows efflclenL removal of LooLh maLerlal wlLh mlnlmal heaL generaLlon Lven
wlLh llghLesL Louch LooLh overheaLs unless a waLer spray ls used 1he spray also removes
debrls whlch ls lmporLanL because clogglng reduces cuLLlng efflclency and prevenLs
deslccaLlon of denLlne (a cause of severe pulpal lrrlLaLlon uebrls accumulaLlons vary wlLh
roLary lnsLrumenL shape houlder and chamfer shape dlamonds accumulaLe less debrls
(uebrls ls noL readlly removed afLer 3 mln of ulLrasonlc cleanlng)

slowspeed handplece or hand lnsLrumenLaLlon should be used for flnlshlng aL llngual
margln slnce spray prevenLs adequaLe vlslblllLy lrcoollng wlLh a hlghspeed ls hazardous
because lL can easlly overheaL a LooLh and cause pulp damage
arLlcular care ls needed for preparlng grooves or plnholes because coolanL cannoL reach
Lhe cuLLlng edge of Lhe bur 1o prevenL heaL bulldup Lhese reLenLlon feaLures should be
prepared aL low roLaLlonal speed

hemlcal acLlon
erLaln denLal maLerlals (bases resLoraLlve reslns solvenLs and luLlng agenLs) can cause
pulpal damage parLlcularly when Lhey are applled Lo freshly cuL denLlne avlLy varnlsh or
u from an effecLlve barrler ln mosL lnsLances buL Lhelr effecL on Lhe reLenLlon of a
cemenLed resLn ls conLroverslal

hemlcal agenLs are someLlmes used for cleanlng and degreaslng LooLh prep Powever
Lhey can be pulpal lrrlLanLs 1hus Lhelr use ls generally conLralndlcaLed parLlcularly because
Lhey do noL lmprove Lhe reLenLlon of cemenLed resLns

acLerlal acLlon
acLerlal LhaL were lefL behlnd or galned access Lo Lhe denLln because of mlcroleakage
Many denLal maLerlals lncludlng zlnc phosphaLe cemenL have an anLlbacLerlal effecL
ecause vlLal denLlne seems Lo reslsL lnfecLlon Lhe rouLlne use of anLlmlcroblal agenLs may
noL be advanLageous Many denLlsLs now use anLlmlcroblal agenLs such as chlorhexldlne
gluconaLe dlslnfecLlng soluLlon afLer LooLh prep and before cemenLaLlon alLhough Lhe
beneflL has noL been documenLed

lmporLanL all carlous denLln should be removed before placemenL of a resLn LhaL wlll serve
as a foundaLlon for a flxed prosLhesls n lndlrecL pulp cap ls noL recommended on LeeLh
LhaL wlll subsequenLly recelve casL resLn because lLs laLer fallure ls llkely Lo [eopardlze
exLenslve prosLhodonLlc LreaLmenL

Conservat|on of 1ooth Structure
s much as posslble whlle prep deslgn remalns conslsLenL wlLh mechanlcal and aesLheLlc prlnclples
1lssue preservaLlon reduces Lhe harmful pulpal effecLs of Lhe varlous procedures and maLerlals used
1he Lhlckness of remalnlng denLln has been shown Lo be lnversely proporLlonal Lo Lhe pulpal
response and LooLh prep exLendlng ln close proxlmlLy Lo Lhe pulp should be avolded
uowden any damage Lo Lhe odonLoblasLlc processes would adversely affecL Lhe cell nucleus aL Lhe
denLlnpulp lnLerface no maLLer how far from Lhe nucleus lL occurred amounL of denLlne removed
ls lmporLanL parLlcular care musL be exerclsed when vlLal LeeLh are prepared for compleLecoverage
resLns

Culdellnes
1 use of parLlalcoverage raLher Lhan compleLecoverage resLns
2 rep of LeeLh wlLh Lhe mlnlmum pracLlcal coverage angle (Laper) beLween axlal walls
3 rep Lhe occlusal surface so LhaL reducLlon follows Lhe anaLomlc planes Lo glve unlform
Lhlckness ln Lhe resLn
4 rep of Lhe axlal surfaces so LhaL a maxlmal Lhlckness of resldual LooLh sLrucLure surroundlng
pulpal Llssues ls reLalned lf necessary LeeLh should be orLhodonLlcally reposlLloned whlch
permlL LeeLh Lo be prepared wlLh less axlal convergence Lhan necessary when LooLh allgnmenL ls
less Lhan opLlmal Lo accommodaLe flxed denLal prosLheLlc reLalner preps
3 elecLlon of a margln geomeLry LhaL ls conservaLlve and yeL compaLlble wlLh Lhe oLher prlnclples
6 voldance of unnecessary aplcal exLenslon of Lhe prep

Cons|derat|ons Affect|ng Iuture Denta| nea|th
Lg lnsufflclenL axlal reducLlon lnevlLably resulLs ln overconLoured resLns LhaL hamper plaque conLrol
cause perlodonLal dlsease denLal carles
lLernaLlvely lnadequaLe occlusal reducLlon may resulL ln poor form and subsequenL occlusal
dysfuncLlon oor cholce of margln locaLlon such as ln Lhe area of occlusal conLacL may cause
chlpplng of enamel or cusp fracLure

xlal reducLlon
Clnglval lnflammaLlon ls commonly assoclaLed wlLh crowns and flxed denLal prosLheLlc abuLmenLs
LhaL have excesslve axlal conLours more dlfflculL for Lhe paLlenL Lo malnLaln plaque conLrol around
Lhe glnglval margln 1ooLh prep musL provlde sufflclenL space for Lhe developmenL of good axlal
conLours 1hls enables Lhe [uncLlon beLween Lhe resLn and Lhe LooLh Lo be smooLh and free of any
ledges or abrupL changes ln dlrecLlon

usually a crown should dupllcaLe Lhe conLours and proflle of Lhe orlglnal LooLh (unless Lhe resLn ls
needed Lo correcL a malformed or malposlLloned LooLh) lf an error ls made a sllghLly
underconLroued flaL resLn ls beLLer because lL ls easler Lo keep free of plaque however lncreaslng
proxlmal conLour on anLerlor crowns Lo malnLaln Lhe lnLerproxlmal papllla may be beneflclal
ufflclenL LooLh sLrucLure musL be removed Lo allow Lhe developmenL of correcLly formed axlal
conLours parLlcularly ln Lhe lnLerproxlmal and furcaLlon areas of posLerlor LeeLh where perlodonLal
dlsease ofLen progresses wlLh serlous consequences








Margln placemenL
Whenever posslble Lhe margln of Lhe prep should be supraglnglval ubglnglval marglns of
cemenLed resLns have been a ma[or eLlologlcal facLor ln perlodonLal dlsease parLlcularly where Lhey
encroach on Lhe eplLhellal aLLachmenL upraglnglval marglns are easler Lo prepare accuraLely
wlLhouL Lrauma Lo Lhe sofL Llssues 1hey can usually also be slLuaLed on hard enamel whereas
subglnglval marglns are ofLen on denLln or cemenLum

CLher advanLages of supraglnglval marglns
1 1hey can easlly flnlshed wlLhouL assoclaLed sofLLlssue Lrauma
2 1hey are more easlly kepL plaque free
3 lmpresslons are more easlly made wlLh less poLenLlal for sofL Llssue damage
4 8esLns can be easlly evaluaLed aL Lhe Llme of placemenL or aL recall appolnLmenLs
Powever subglnglval margln ls [usLlfled lf any of Lhe followlng perLalns
1 uenLal carles cervlcal eroslon or resLns exLend subglnglvally and a crownlengLhenlng
procedure ls noL lndlcaLed
2 1he proxlmal conLacL area exLends Lo Lhe glnglval cresL
3 ddlLlonal reLenLlon and/or reslsLance ls needed
4 1he margln of a meLalceramlc crown ls Lo be hldden behlnd Lhe labloglnglval cresL
3 8ooL senslLlvlLy cannoL be conLrolled by more conservaLlve procedures such as Lhe appllcaLlon
of u
6 ModlflcaLlon of Lhe axlal conLour ls lndlcaLed such as Lo provlde an undercuL Lo provlde
reLenLlon for Lhe clasp of a parLlal removable denLal prosLhesls

Margln adapLaLlon
!uncLlon beLween a cemenLed resLn and Lhe LooLh ls poLenLlal slLe for recurrenL carles because of
dlssoluLlon of Lhe luLlng agenL and lnherenL roughness 1he more accuraLely Lhe resLn ls adapLed Lo
Lhe LooLh Lhe lesser ls Lhe chance of recurrenL carles or perlodonLal dlsease reclse calculaLlon for
accepLable margln adapLaLlon ls noL avallable buL skllls can flLs up Lo wlLhln 10um for meLal and
30um for porcelaln welldeslgned prep has a smooLh and even margln 8ough lrregular or
sLepped" [uncLlons greaLly lncrease overall margln lengLh and subsLanLlally reduce Lhe adapLaLlon
accuracy of Lhe resLn 1lme spenL obLalnlng a smooLh margln also makes Lhe subsequenL sLeps of
Llssue dlsplacemenL lmpresslon maklng dle formaLlon waxlng and flnlshlng much easler and
ulLlmaLely resulLs ln a longerlasLlng resLn

Margln geomeLry
le Lhe crosssecLlonal conflguraLlon of Lhe margln should follow Lhe guldellnes for deslgn
1 Lase of prep wlLhouL overexLenslon or unsupporLed enamel
2 Lase of ldenLlflcaLlon ln Lhe lmpresslon and on Lhe dle
3 dlsLlncL boundary Lo whlch Lhe wax paLLern can be flnlshed
4 ufflclenL bulk of maLerlal (Lo enable Lhe wax paLLern Lo be handled wlLhouL dlsLorLlon and Lo
glve Lhe resLn sLrengLh and when porcelaln ls used esLheLlcs)
3 onservaLlon of LooLh sLrucLure (lf Lhe oLher crlLerla are meL)









Margln
deslgn
dvanLages ulsadvanLages lndlcaLlons
leaLher
edge
onservaLlve of
LooLh sLrucLure
uoes noL provlde
sufflclenL bulk
noL recommended
hlsel
edge
onservaLlve of
LooLh sLrucLure
uoes noL provlde
sufflclenL bulk
LocaLlon of margln
dlfflculL Lo conLrol
Cccaslonally on LllLed LeeLh
evel 8emoves
unsupporLed
enamel allows
flnlshlng of meLal
LxLends prep lnLo sulcus
lf used on aplcal margln
laclal margln of maxlllary parLlal
coverage resLns and lnlay/onlay
marglns
hamfer ulsLlncL margln
adequaLe bulk
easler Lo conLrol
are needed Lo avold
unsupporLed llp of
enamel
asL meLal resLns llngual margln of
meLalceramlc crowns
houlder ulk of resLoraLlve
maLerlal
Less conservaLlve of
LooLh sLrucLure
laclal margln of meLalceramlc
crowns compleLe ceramlc crowns
loped
shoulder
ulk of maLerlal
advanLages of bevel
Less conservaLlve of
LooLh sLrucLure
laclal marglns of meLalceramlc
crowns
houlder
wlLh
bevel
ulk of maLerlal
advanLages of bevel
Less conservaLlve
exLends prep aplcally
laclal margln of posLerlor meLal
ceramlc crowns wlLh supraglnglval
marglns

CverconLoured resLns ofLen resulL from feaLher edge marglns because Lhe Lechnlclan can handle Lhe
wax paLLern wlLhouL dlsLorLlon only by lncreaslng lLs bulk beyond Lhe orlglnal conLours hlsel edge
margln (mod from feaLher larger angle beLween Lhe axlal surfaces and Lhe unprepared LooLh
sLrucLure) unforLunaLely frequenLly assoclaLed wlLh prep wlLh excesslve angles of convergence
(Laper) and prep ln whlch Lhe orlenLaLlon of Lhe axlal reducLlon ls noL correcLly allgned wlLh Lhe long
axls of Lhe LooLh

usually feaLher edges and chlsel edges are unaccepLable hlsLorlcally Lhelr maln advanLage was LhaL
Lhey faclllLaLed lmpresslon maklng wlLh rlgld modellng compound ln copper bands (rare nowadays)
1hey were useful for LhaL purpose because Lhere was no ledge on whlch a band could caLch
chamfer margln ls parLlcularly sulLable for casL meLal crowns and Lhe meLalonly porLlon of meLal
ceramlc crowns lL ls dlsLlncL and easlly lndenLlfled and lL provldes room for adequaLe bulk of
maLerlal and developmenL of anaLomlcally correcL axlal conLours hamfers can be placed
expedlenLly and whlch preclslon alLhough care ls needed Lo avld leavlng a ledge of unsupporLed
enamel (!margln)

1apered dlamond wlLh a rounded Llp ls Lhe besL lnsLrumenL for maklng a chamfer margln Marglnal
accuracy depends on havlng a hlghquallLy dlamond and a Lruerunnlng handplece 1he glnglval
margln ls prepared wlLh Lhe dlamond held preclsely ln Lhe lnLendlng paLh of placemenL of Lhe resLn
1llLlng away from Lhe LooLh creaLe undercuL angllng lL Lowards Lhe LooLh overreducLlon and loss
of reLenLlon

1he chamfer should never be prepared wlder Lhan half Lhe Llp of Lhe dlamond oLherwlse an
unsupporLed llp of enamel may resulL (!margln) (ulamond wlLh noncuLLlng gulde Llp lnLend Lo ald
accuraLe chamfer placemenL buL damage LooLh sLrucLure beyond Lhe lnLended prep more ofLen)
omeLlmes a beveled margln ls more sulLable for casL resLns parLlcularly lf ledge or shoulder already
exlLs posslbly as a resulL of denLal carles cervlcal eroslon or a prevlous resLn Cb[ecLlve ln bevellng
ls Lhreefold (1) Lo allow Lhe casL meLal margln Lo be benL or burnlshed agalnsL Lhe prepared LooLh
sLrucLure (2) Lo mlnlmlze Lhe marglnal dlscrepancy caused by a compleLe crown LhaL falls Lo seaL
compleLely (however when an overslzed crown ls consldered Lhe dlscrepancy ls lncreased raLher
Lhan decreased lf Lhe crown ls Lhe same as or less Lhan Lhe slze of prep LooLh a bevel can decrease
Lhe marglnal dlscrepancy by 70) (3) Lo proLecL Lhe unprepared LooLh sLrucLure from chlpplng (eg
by removlng ! margln) noLe when access for burnlshlng ls llmlLed Lhere ls llLLle advanLage ln
bevellng 1hls applles parLlcularly Lo a glnglval margln where bevellng would lead Lo subglnglval
exLenslon of Lhe prep or placemenL of Lhe margln on denLln raLher Lhan on enamel laclal marglns of
maxlllary parLlalcoverage resLns should be beveled Lo ellmlnaLe all unsupporLed enamel Lo proLecL
Lhe remalnlng LooLh sLrucLure from facLure and Lo allow for burnlshlng of Lhe casLlng

houlder margln allows room for porcelaln recommended for faclal parL of meLalceramlc lL should
form a 90 degree angle wlLh Lhe unprepared LooLh surface n acuLe angle ls llkely Lo chlp
underprepared faclal shoulder wlll lead Lo resLns wlLh lnferlor aesLheLlcs or poor axlal conLour
120 degree sloped shoulder margln ls someLlmes used as an alLernaLlve Lo Lhe 90 degree for faclal
margln of meLalceramlc crowns 1he sloped shoulder reduces Lhe posslblllLy of leavlng unsupporLed
enamel buL leaves sufflclenL bulk Lo allow Lhlnnlng of Lhe meLal framework Lo a knlfeedge for
accepLable aesLheLlcs

beveled shoulder margln ls recommended for Lhe faclal surface of a meLalceramlc resLn ln whlch a
meLal collar (as opposed Lo a porcelaln lablal margln) ls used 1he bevellng removes ! margln and
may allow some flnlshlng of Lhe meLal Powever a shoulder or sloped shoulder ls preferred for
blologlc and aesLheLlc reasons 1hls allows lmproved esLheLlcs because Lhe meLal margln can be
Lhlnned Lo a knlfe edge and hldden ln Lhe sulcus wlLhouL Lhe need for poslLlonlng Lhe margln closer
Lo Lhe eplLhellal aLLachmenL

Margln deslgn selecLlon should be based on Lhe Lype of crown appllcable esLheLlc requlremenLs
ease of formaLlon and operaLor experlence LxpecLaLlon of enhanced flL belng assoclaLed wlLh
selecLlon of cerLaln Lype of flnlsh llne geomeLry has noL valldaLed yeL

Ccclusal conslderaLlons
saLlsfacLory LooLh prep allows sufflclenL space for developlng a funcLlonal occlusal scheme ln Lhe
flnlshed resLn omeLlmes Lhe paLlenL's occluslon ls dlsrupLed by supraerupLed or LllLed LeeLh When
Lheses LeeLh are prepared for resLn Lhe evenLual occlusal plane musL be carefully analyzed and Lhe
LeeLh reduced accordlngly onslderable reducLlon ls ofLen needed Lo compensaLe for Lhe
supraerupLlon of abuLmenL LeeLh ln Lurn Lhls may shorLen LooLh prep axlal wall helghL wlLh
assoclaLed mechanlcal consequences such as reduced reLenLlon and reslsLance

omeLlmes even endodonLlc LreaLmenL ls necessary Lo make enough room Powever under Lhese
clrcumsLances compromlslng Lhe prlnclple of conservaLlon of LooLh sLrucLure ls preferable Lo Lhe
poLenLlal harm from a LraumaLlc occlusal scheme areful [udgmenL ls obvlously needed ulagnosLlc
LooLh prep and waxlng procedures are essenLlal Lo help deLermlne Lhe exacL amounL of reducLlon
necessary Lo develop an opLlmum occluslon









revenLlng LooLh fracLure
no LooLh ls unbreakable lf LeeLh are smashed LogeLher (as ln an auLomoblle accldenL sporL ln[ury
or blLlng unexpecLedly on a hard ob[ecL) a cusp may break uspal fracLure also can occur from para
funcLlonal hablLs such as bruxlsm

1ooLh prep ls deslgned Lo mlnlmlzed poLenLlally desLrucLlve sLresses lessen chance for fracLure
lor example an lnLracoronal casL resLn (lnlay) has a greaLer poLenLlal for fracLure because when
occlusal forces are applled Lo Lhe resLn lL Lends Lo wedge opposlng walls of Lhe LooLh aparL 1hls
wedglng musL be reslsLed by Lhe remalnlng LooLh sLrucLure lf Lhe remalnlng LooLh sLrucLure ls Lhln
(as wlLh a wlde prep lsLhmus) Lhe LooLh may fracLure durlng funcLlon rovldlng a uspal coverage
resLn (onlay) raLher Lhan an lnlay lessens Lhe chance of such fracLure Powever alLhough noL as
conservaLlve of LooLh sLrucLure a compleLe crown ls ofLen a beLLer soluLlon because lL offers Lhe
greaLesL proLecLlon agalnsL LooLh fracLure Lendlng Lo hold" Lhe cusps of Lhe LooLh LogeLher


,echan|ca| Cons|derat|ons
revenL dlslodgemenL dlsLorLlon and fracLure durlng servlce ulvlded lnLo Lhree caLegorles
1 rovldlng reLenLlon form
2 rovldlng reslsLance form
3 revenLlng deformaLlon of Lhe resLn

ketent|on form
erLaln forces (eg when Lhe [aws are moved aparL afLer blLlng on very sLlcky food) acL on a
cemenLed resLn ln Lhe same dlrecLlon as Lhe paLh of placemenL 1he quallLy of a prep LhaL prevenLs
Lhe resLn from becomlng dlslodglng by such forces parallel Lo Lhe paLh of placemenL ls known as
reLenLlon Cnly denLal carles and porcelaln fallure ouLrank lack of reLenLlon as a cause of fallure o
crowns and flxed denLal prosLheses
lollowlng facLors are consldered Lo decldes wheLher reLenLlon ls adequaLe
1 MagnlLude of Lhe dlslodglng forces
2 CeomeLry of Lhe LooLh prep
3 8oughness of Lhe flLLlng surface of Lhe resLn
4 MaLerlals belng cemenLed
3 lllm Lhlckness of Lhe luLlng agenL

MagnlLude of Lhe dlslodglng forces
lorces LhaL Lend Lo remove a cemenLed resLn along lLs paLh of placemenL are small ln comparlson
wlLh Lhose LhaL Lend Lo seaL or LllL lL flxed denLal prosLhesls or spllnL can be sub[ecLed Lo such
forces by pulllng wlLh floss under Lhe connecLors however Lhe greaLesL removal forces generally
arlse when excepLlonally sLlcky food (eg caramel) ls eaLen
1he magnlLude of Lhe dlslodglng forces exerLed by Lhe elevaLor muscles depends on Lhe sLlcklness of
Lhe food and Lhe surface area and surface LexLure of Lhe resLn

CeomeLry o Lhe LooLh preparaLlon
MosL l depends on Lhe geomeLrlc form of Lhe prep raLher Lhan on adheslon for reLenLlon because
mosL of Lhe LradlLlonal cemenLs (eg zlnc phosphaLe) are nonadheslve le Lhey acL by lncreaslng Lhe
frlcLlonal reslsLance beLween LooLh and resLn) 1he gralns of cemenL prevenL Lwo surfaces from
slldlng alLhough Lhey do noL prevenL one surface from belng llfLed from anoLher 1hls ls analogous
Lo Lhe effecL of parLlcles of sand or dusL wlLhln machlnery 1hey do noL have a speclflc adheslon Lo
meLal buL Lhey lncrease Lhe frlcLlon beLween slldlng meLal parLs lf sand or dusL geLs lnLo an old
fashloned mechanlcal cameral or waLch Lhe lncrease ln frlcLlon can effecLlvely [am Lhe mechanlsm

emenL ls only effecLlve only lf Lhe resLn has a slngle paLh of placemenL (le Lhe LooLh ls shaped Lo
resLraln Lhe free movemenL of Lhe resLn) 1he relaLlonshlp beLween a nuL and a bolL ls an example o
f resLralned movemenL 1he nuL ls noL free Lo move ln any dlrecLlon buL can move only along Lhe
preclsely deLermlned hellcal paLh of Lhe Lhreads on Lhe bolL

1he relaLlonshlp beLween Lwo bodles one (ln Lhls case a LooLh prep) resLralnlng movemenL of Lhe
oLher (a cemenLed resLn) ls known as a closed lower palr of klnemaLlc elemenLs (maLhemaLlcal
deflnlLlon) ln l a slldlng palr ls Lhe only palr LhaL has relevance lL ls formed by Lwo cyllndrlcal
surfaces are consLralned lf Lhe curve LhaL deflnes Lhe cyllnder ls closed or shaped Lo prevenL
movemenL aL rlghL angles Lo Lhe axls of Lhe cyllnder

LooLh prep ls cyllndrlcal lf Lhe axlal surfaces are prepared by a cyllndrlcal bur held aL a consLanL
angle 1he glnglval margln of Lhe prep becomes Lhe flxed curve of Lhe maLhemaLlcal deflnlLlon and
Lhe occlusoaxlal llne angle of Lhe LooLh prep should be a repllca of Lhe glnglval margln geomeLry 1he
curve of a compleLe crown prep ls closed whereas Lhe grooves of a parLlal crown prep prevenLs
movemenL aL rlghL angles Lo Lhe long axls of Lhe cyllnder Powever lf one wall of Lhe compleLe
crown prep ls overLapered lL ls no longer cyllndrlcal and Lhe cemenLed resLn ls noL consLralned by
Lhe prep because Lhe resLn Lhen has mulLlple paLhs of wlLhdrawal under Lheses clrcumsLance Lhe
cemenL parLlcles Lend Lo llfL away from raLher Lhan sllde along Lhe preparaLlon and Lhe only
reLenLlon ls a resulL of Lhe cemenL's llmlLed adheslon
1aper
1aper ls deflned as Lhe convergence of Lwo opposlng exLernal walls of a LooLh prep as vlewed ln
a glven plane 1he exLenslon of Lhose planes form an angel deslred as Lhe angle of converge
1heoreLlcally maxlmum reLenLlon ls obLalned lf a LooLh prep has parallel walls Powever lL ls
nelLher deslrable nor pracLlcal Lo prepare a LooLh Lhls way wlLh currenL Lechnlques and
lnsLrumenLaLlon because sllghL undercuLs LhaL prevenL Lhe resLn from seaLlng are Lhen creaLed

n undercuL on a compleLe crown prep ls deflned as any lrregularlLy ln Lhe wall of a prepared
LooLh LhaL prevenLs Lhe wlLhdrawal or seaLlng of a wax paLLern or casLlng uch ls Lhe case when
dlvergence ls lnadverLenLly creaLed beLween opposlng axlal walls or wall segmenLs ln a
cervlcalocclusal dlrecLlon ln oLher words lf Lhe cervlcal dlameLer of a LooLh prep aL Lhe margln
ls narrower Lhan aL Lhe occlusoaxlal [uncLlon (reverse Laper) lL ls lmposslble Lo seaL a compleLe
casL crown of slmllar geomeLry undercuLs can be presenL whenever Lwo axlal wall face ln
opposlLe dlrecLlons 1hus Lhe meslal wall of a compleLe casL crown prep can be undercuL ln
relaLlon Lo Lhe dlsLal wall slmllarly buccal Lo llngual meslobuccal Lo dlsLollngual ln a parLlal
veneer prep ln accordance wlLh Lhe same prlnclple Lhe llngual wall of a proxlmal groove can be
undercuL ln relaLlon Lo Lhe llngual wall of Lhe prep buL Lhe buccal wall of Lhe same groove
cannoL be undercuL ln relaLlon Lo Lhe llngual prep wall elLher of Lhese walls may resLrlcL Lhe
number of dlrecLlons ln whlch a casLlng can be placed on Lhe prep ln relaLlon Lo Lhe oLher
however

llghL convergence or Laper ls cllnlcally deslrable ln compleLe crown prep s long as Lhls Laper
ls small Lhe movemenL of Lhe cemenLed resLn wlll be effecLlvely resLralned by Lhe prep and wlll
have whaL ls known as llmlLed paLh of placemenL s Laper lncreases however so does Lhelr
free movemenL of Lhe resLn and consequenLly reLenLlon wlll be reduced
1he relaLlonshlp beLween Lhe degree of axlal wall Laper and Lhe magnlLude of reLenLlon was
flrsL demonsLraLed experlmenLally by !orgensen ln 1933 Pe cemenLed brass caps on CalallLh cones of
dlfferenL Lapers and measure reLenLlon wlLh a LenslleLesLlng machlne Lhe relaLlonshlp was found Lo be hyperbollc
wlLh reLenLlon rapldly becomlng less as Laper lncreased alLhough Lhe relaLlonshlp was no longer
hyperbollc when Lhe lnLernal surfaces of Lhe caps were roughened 1he reLenLlon of a cap wlLh 10 degrees of Laper
was approxlmaLely half of a cap wlLh 3 degrees
elecLlon of Lhe approprlaLe degree of Laper for LooLh prep lnvolves compromlse 1oo small a
Laper may lead Lo unwanLed undercuLs Loo large leads Lo a lack of reLenLlon 1he
recommended convergence beLween opposlng walls ls 6 degrees whlch has been shown Lo
opLlmlze reLenLlon for zlnc phosphaLe cemenL elng able Lo recognlze Lhls angle ls lmporLanL lL
ls necessary Lo be able Lo rapldly quanLlfy Lhe approxlmaLe angle of convergence beLween prep
walls lL ls noL necessary Lo dellberaLely LllL a roLary cuLLlng lnsLrumenL Lo creaLe a Laper
because Lhls lnvarlably leas Lo overpreparaLlon 8aLher LeeLh are readlly prepared wlLh a roLary
lnLermenL of Lhe deslred Laper held aL a consLanL angulaLlon 1he roLary lnsLrumenL ls moved
Lhough a cyllndrlcal paLh as Lhe LooLh ls prepared and Lhe Laper of Lhe lnsLrumenL should
produce Lhe deslred axlal wall Laper on Lhe compleLed prep (ln pracLlce palns are Laklng Lo
prevenL excesslve Laper esp on posLerlor LeeLh wlLh llmlLed access)
Plgher Lendency Lo overLaper prep ln a buccollngual dlrecLlon more so Lhan meslodlsLally and
abuLmenLs for l denL Lo be prepared wlLh greaLer Laper Lhan do slngle crown prep Crooves?
unclear noL very conservaLlve and cannoL assure accuraLe allgnmenL
urface area
lf Lhe resLn has a llmlLed paLh of placemenL lLs reLenLlon depends on Lhe lengLh of Lhls paLh or
more preclsely on Lhe surface area LhaL ls ln slldlng conLacL 1herefore crowns wlLh Lall axlal
walls are more reLenLlve Lhan Lhose wlLh shorL axlal walls and molar crowns are more reLenLlve
Lhan premolar crowns of slmllar Laper because of Lhe greaLer dlameLer of Lhe molar urfaces
on whlch Lhe crown ls essenLlally belng pulled away from raLher Lhan slldlng along Lhe LooLh
such as occlusal surface so noL add slgnlflcanLly Lo LoLal reLenLlon
Lress concenLraLlon
When a reLenLlve fallure occurs cemenL ofLen adheres Lo boLh Lhe LooLh prep and Lhe flLLlng
surface of Lhe resLn ln Lhese cases coheslve fallure occurs Lhrough Lhe cemenL layer because
Lhe sLrengLh of Lhe cemenL ls less Lhan Lhe lnduced sLresses compuLerlzed analysls of Lhese
sLresses reveals LhaL Lhey are noL unlform LhroughouL Lhe cemenL buL are concenLraLed around
Lhe [uncLlon of Lhe axlal and occlusal surface harp occlusoaxlal llne angles should be rounded
Lo mlnlmlze Lheses sLresses whlch can preclplLaLe reLenLlve fallure hanges ln prep geomeLry
may Lhus lndlrecLly lncrease Lhe reLenLlon of Lhe resLn
1ype of preparaLlon
ulfferenL Lypes of prep have dlfferenL reLenLlve values LhaL correspond falrly closely Lo Lhe LoLal
surface area of Lhe axlal walls wlLh resLrlcLed Laper as long as oLher facLors (eg prep helghL)
are kepL consLanL 1hus Lhe reLenLlon of a compleLe crown ls more Lhan double LhaL of parLlal
coverage resLns
ddlng grooves or boxes Lo a prep wlLh a llmlLed paLh of placemenL does noL markedly affecL lLs
reLenLlon because Lhe surface area ls noL lncreased slgnlflcanLly Powever where Lhe addlLlon
of a groove llmlLs Lhe paLhs of placemenL reLenLlon ls lncreased
8oughness of Lhe surfaces belng cemenLed
When Lhe lnLernal surface of a resLn ls very smooLh reLenLlve fallure occurs noL LhroughL Lhe
cemenL buL aL Lhe cemenLresLn lnLerface under Lhese clrcumsLances reLenLlon ls lncreased lf Lhe
resLn ls roughened or groove 1he casLlng ls mosL effecLlvely prepared by alrabradlng Lhe flLLlng
surface wlLh 30um of alumlna 1hls should be done carefully Lo avold abradlng Lhe pollshed surfaces
or marglns lrborne parLlcle abraslon has been shown Lo lncrease ln vlLro reLenLlon by 64
lmllarly acldeLchlng of Lhe flLLlng surface of resLns can lmprove reLenLlon wlLh cerLaln luLlng
agenLs
lallure rarely occurs aL Lhe cemenLLooLh lnLerface 1herefore dellberaLely roughenlng Lhe LooLh
prep hardly lnfluences reLenLlon and ls noL recommended because roughness adds Lo Lhe dlfflculLy
of subsequenL Lechnlcal sLeps ln crown fabrlcaLlon such as lmpresslon maklng and waxlng
MaLerlals belng cemenLed
8eLenLlon ls affecLed by boLh Lhe Lype of casLlng alloy and any core or bulldup maLerlal LhaL ls
presenL on Lhe axlal walls of Lhe crown prep 1he cllnlcal slgnlflcance of laboraLory LesLlng resulLs
have yeL Lo be conflrmed by longer Lerm cllnlcal sLudles buL lL appears LhaL Lhe more reacLlve Lhe
alloy ls Lhe more adheslon Lhere ls wlLh selecLed luLlng agenLsLherefore base meLal alloys are
beLLer reLalned Lhan are less reacLlve meLals wlLh hlgh gold conLenL 1he effecL of adheslon Lo
dlfferenL core maLerlals also has been LesLed wlLh confllcLlng resulL cemenL adhere beLLer Lo
amalgam Lhan Lo 8 or casLlng gold buL reLenLlon ls hlgher Lo 8 Lhan amalgam cores
1ype of luLlng agenL
1he Lype of luLlng agenL chosen affecLs Lhe reLenLlon of a cemenLed resLn Powever Lhe declslon
regardlng whlch agenL Lo use ls also based on oLher facLors ln general Lhe daLa suggesL LhaL
adheslve resln cemenLs are Lhe mosL reLenLlve alLhough longLerm cllnlcal evldence abouL Lhe
durablllLy of Lhe bond ls noL avallable Cf concern ls LhaL longLerm ln vlLro sLudles have shown
deLerloraLlon of Lhe reslndenLln bond assoclaLed wlLh permeablllLy of Lhe hybrld layer Lo small lons
or molecules socalled nanoleakage
lllm Lhlckness of Lhe luLlng agenL
1here ls confllcLlng evldence abouL Lhe effecL of lncreased Lhlckness of Lhe cemenL fllm on reLenLlon
of a resLn 1hls may be lmporL lf a sllghL overslzed casLlng ls made
lacLors LhaL lnfluence Lhe reLenLlon of a cemenLed resLn
CreaLer 8eLenLlon Lesser 8eLenLlon
1aper arallel 6 degrees Lxcesslve
urface area Large mall
1ype of prep Molar compleLe crown remolar compleLe crown arLlal crown lnLracoronal resLn
urface LexLure 8ough mooLh
lllm Lhlckness LffecL uncerLaln
LuLlng agenL dheslve resln Cl olycarboxylaLe/Zlnc phosphaLe Zlnc oxldeeugenol


kes|stance Iorm
erLaln feaLures musL be presenL ln Lhe prep Lo prevenL dlslodgmenL of a cemenLed resLn
MasLlcaLlon and parafuncLlonal acLlvlLy may sub[ecL a prosLhesls Lo subsLanLlal horlzonLal or obllque
forces 1hese forces are normally much greaLer Lhan Lhe ones overcome by reLenLlon especlally lf
Lhe resLn ls loaded durlng eccenLrlc conLacL beLween posLerlor LeeLh LaLeral forces Lend Lo dlsplace
Lhe resLn by causlng roLaLlon around Lhe glnglval margln 8oLaLlon ls prevenLed by any areas of Lhe
LooLh preparaLlon LhaL are placed ln compresslon called reslsLance areas MulLlple reslsLance areas
cumulaLlvely make up Lhe reslsLance form of a LooLh preparaLlon whlch ls deflned as Lhe feaLures of
a LooLh prep whlch ls deflned as Lhe feaLures of a LooLh prep LhaL enhance Lhe sLablllLy of a resLn
and reslsL dlslodgemenL along an axls oLher Lhan Lhe paLh of placemenL
dequaLe reslsLance depends on Lhe followlng
1 MagnlLude and dlrecLlon of Lhe dlslodglng forces
2 CeomeLry of Lhe LooLh prep
3 hyslcal properLles of Lhe luLlng agenL

MagnlLude and dlrecLlon of Lhe dlslodglng forces
ome paLlenLs an develop enormous blLlng forces (443kg of Lhls speclal paLlenL) lLhough Lhls ls
consldered exLraordlnary resLns should neverLheless be deslgned Lo wlLhsLand forces approachlng
such magnlLude Lg a compleLe crown cemenLed on a nlckelchromlum LesL dle was found Lo e capable of
wlLhsLandlng more Lhan 13300n a far greaLer force Lhan would occur ln Lhe mouLh before becomlng dlsplaced
ln a normal occluslon blLlng force ls dlsLrlbuLed over all Lhe LeeLh mosL of lL ls axlally dlrecLed lf a
l ls carefully made wlLh a properly deslgned occluslon Lhe load should be well dlsLrlbuLed and
favorably dlrecLed Powever lf paLlenL has a blLlng hablL such as plpe smoklng or bruxlng lL may be
dlfflculL Lo prevenL falrly large obllque forces from belng applled Lo a resLn onsequenLly Lhe
compleLed LooLh prep and resLn musL be able Lo wlLhsLand conslderable obllque forces a swell s Lhe
normal axlal ones and lL has been argued LhaL from a cllnlcal durablllLy perspecLlve adequaLe
reslsLance form may be more cruclal Lhan overall preparaLlon reLenLlveness

CeomeLry of Lhe LooLh preparaLlon
s wlLh reLenLlon prep geomeLry plays a key role ln aLLalnlng deslrable reslsLance form 1he LooLh
prep musL be shaped so LhaL parLlcular areas of Lhe axlal wall prevenL roLaLlon of Lhe crown good
way Lo deLermlne wheLher LooLh prep geomeLry provldes adequaLe reslsLance form ls Lo answer
how much LooLh sLrucLure needs Lo break off ln order for Lhls crown Lo be dlsplaced by Llpplng off
Lhe LooLh?
8eslsLance ls a funcLlon of Lhe relaLlonshlp beLween axlal wall Laper prep dlameLer and prep helghL
lL decreases as Laper or dlameLer lncreases or prep helghL ls reduced
1he relaLlonshlp beLween prep helghL or dlameLer and reslsLance Lo dlsplacemenL ls approxlmaLely
llnear
rep Laper of 3 Lo 22 degrees has been suggesLed as belng wlLhln a cllnlcally accepLable range
Powever aL Lhe hlgher end of Lhls range Lhe Llpplng reslsLance of boLh cemenLed and uncemenLed
casL resLns ls lnadequaLe buL lncrease slgnlflcanLly as Laper ls reduced
horL LooLh prep wlLh large dlameLers were found Lo have very llLLle reslsLance form ln general
molar LeeLh requlre more parallel preparaLlon Lhan do premolar or anLerlor LeeLh Lo achleve
adequaLe reslsLance form 3mm prep helghL provldes adequaLe reslsLance lf Laper ls resLrlcLed Lo
10 degrees or less buL addlLlonal helghL ls necessary as LooLh dlameLer lncreases 1hus on molar
crown prep ln whlch many more preps are observed LhaL lack reslsLance mlnlmal prep wall helghL
should ldeally be ln 33 Lo 4 mm
reas LhaL provlde reslsLance form change as modlflcaLlons are made ln Lhe geomeLry of Lhe LooLh
prep 1hey demonsLraLed LhaL lncreaslng prep Laper and roundlng of axlal angles Lend Lo reduce
reslsLance pyramldal prep Lhus havlng greaLer reslsLance Lhan conlcal ones roxlmal grooves or
boxes placed ln healLhy LooLh sLrucLure are parLlcularly effecLlve ln enhanclng Lhe reslsLance form of
crown prep because Lhese lnLerfere wlLh roLaLlonal movemenL (Llpplng) of Lhe crown and ln so dolng
sub[ecL addlLlonal areas of Lhe luLlng agenL Lo compresslon 1hus Lhe reslsLance form of an
excesslvely Lapered prep can be lmproved by addlng such grooves or boxes s an alLernaLlve
plnholes can be prepared Lo achleve Lhe same effecL
rep modlflcaLlons may noL be used as ofLen as cllnlcal fallure daLa suggesL Lhey should be
parLlalcoverage resLn may have less reslsLance Lhan a compleLe crown because lL has no buccal
reslsLance areas Pere reslsLance ls provlde by boxes or grooves and ls greaLesL lf Lhe groove and/or
box walls are perpendlcular Lo Lhe dlrecLlon of Lhe applled force 1hus ushaped grooves or flared
boxes provlde more reslsLance Lhan vshaped ones lmllarly ln order Lo more effecLlvely enhance
reslsLance groves LhaL are placed ln excesslvely lncllned prep walls should be prepared Lo greaLer
depLh ln Lhelr cervlcal aspecL Lhan occlusally 1aper resLrlcLlon ln Lhe cervlcal aspecL of an excesslvely
Lapered crown prep has been shown Lo be more effecLlve Lhan grooves LhaL are prepared flush wlLh
excesslvely lncllned preparaLlon wall

hyslcal properLles of Lhe luLlng agenL
8eslsLance Lo deformaLlon ls affecLed by physlcal properLles of Lhe luLlng agenL such as compresslve
sLrengLh and modulus of elasLlclLy 1o saLlsfy u Lhe compresslve sLrengLh of zlnc phosphaLe
cemenL musL exceed 70 Ma aL 24 hours Cl and mosL reslns have hlgher compresslve sLrengLh
whereas polycarboxylaLes have slmllar values Lo Lhose of zlnc phosphaLe
lncreaslng Lemp has a dramaLlc effecL on Lhe compresslve sLrengLh of luLlng agenLs parLlcularly
weakenlng relnforced zlnc oxldeeugenol cemenL n lncrease from room Lemp (23
o
) Lo body Lemp
(37
o
) halves Lhe compresslve sLrengLh of relnforced ZCL cemenLs and a rlse ln Lemp Lo 30
o

(equlvalenL Lo hoL food) reduces Lhe compresslve sLrengLh by over 80 LqulvalenL LesLlng of more
modern cemenLs has noL been reporLed
Zlnc phosphaLe cemenLs have a hlgher modulus of elasLlclLy Lhan do polycarboxylaLe cemenLs whlch
exhlblL relaLlvely large plasLlc deformaLlon 1hls may accounL for Lhe observaLlon LhaL Lhe reLenLlve
ablllLy of polycarboxylaLe cemenL ls more dependenL on Lhe Laper of Lhe preparaLlon Lhan ls Lhe
reLenLlon whlch zlnc phosphaLe cemenL
lacLors LhaL affecL Lhe reslsLance Lo dlsplacemenL of a cemenLed resLn
Plgher 8eslsLance Lower 8eslsLance
ulslodglng forces PablLs LccenLrlc lnLerferences nLerlor guldance
1aper Mlnlmum 6 degrees Lxcesslve
ulameLer mall (premolar) Large (molar)
PelghL Long verage horL
1ype of prep ompleLe coverage arLlal coverage Cnlay
LuLlng agenL dheslve resln Cl Zlnc phosphaLe olycarboxylaLe ZCL


revent|ng Deformat|on
ueformaLlon wlll cause fallure aL Lyplcally resLn cemenL or Lhe meLalporcelaln lnLerface 1hls may
be a resulL of lnapproprlaLe alloy selecLlon lnadequaLe LooLh prep or poor meLalceramlc frame
work deslgn
lloy selecLlon
lLhough Lype l and Lype ll gold alloys are saLlsfacLory for lnLracoronal casL resLns Lhey are Loo sofL
for crowns and ls for whlch Lype lll or Lype lv gold alloys (or an approprlaLe lowgold alLernaLlve)
are chose 1hese are harder and Lhelr sLrengLh and hardness can be furLher lncreased by LhaL
LreaLmenL
MeLalceramlc alloys wlLh hlgh noble meLal conLenL have a hardness equlvalenL Lo LhaL of Lype lv
gold alloys whereas nlckelchromlum alloys are conslderably harder 1heses may be lndlcaLed where
large forces are anLlclpaLed such as wlLh a longspan l alLhough Lhelr use presenLs cerLaln
problems (ee hapLer 19)
dequaLe LooLh reducLlon
Lven Lhe sLronger alloys need sufflclenL bulk however lf Lhey are Lo wlLhsLand occlusal forces
Largely accordlng Lo emplrlcal daLa Lhere should be a mlnlmum alloy Lhlckness of abouL 13mm over
funcLlonal cusps (buccal ln Lhe mandlble llngual ln Lhe maxllla) 1he less sLressed nonfuncLlonal
cusps can be proLecLe3d wlLh less meLal (1mm ls adequaLe ln mosL clrcumsLances) for a sLrong and
longlasLlng resLn Ccclusal reducLlon should be as unlform as posslble followlng Lhe uspal planes
of Lhe LeeLh Lhls ensures LhaL sufflclenL occlusal clearance ls comblned wlLh preservaLlon of as much
LooLh sLrucLure as posslble ln addlLlon an anaLomlcally prepared occlusal surface glves rlgldlLy Lo
Lhe crown because of Lhe corrugaLed effecL" of Lhe planes
When LeeLh are malallgned or overerupLed Lhe occlusal surface needs Lo be prepared wlLh Lhe
Lhlckness requlremenLs of Lhe evenLual resLn ln mlnd Lg a supraerupLed LooLh may need
conslderably more Lhan 13mm of reducLlon Lo esLabllsh adequaLe clearance ln order Lo reesLabllsh
opLlmal occlusal form and Lhe approprlaLe plane whlle ensurlng adequaLe resLn Lhlckness ulagnosLlc
LooLh prep and waxlng are helpful ln deLermlnlng Lhe correcL LooLh reducLlon
Margln deslgn
ulsLorLlon of Lhe resLn margln ls prevenLed by deslgnlng Lhe prep ouLllne form so LhaL occlusal
conLacL ls avolded ln Lhls area keeplng preparaLlon marglns approxlmaLely 1 Lo 13 mm away from
occlusal conLacL areas saLlsfles Lhls requlremenL lso LooLh reducLlon should provlde sufflclenL
room for bulk of meLal aL Lhe margln Lo prevenL dlsLorLlon Lg as dlscussed prevlously one
dlsadvanLage of Lhe feaLher edge prep ls LhaL Lhe resulLlng Lhln layer of gold ls noL as sLrong as Lhe
comparaLlvely Lhlcker resLn of a chamfer prep When LeeLh have been prepared wlLh lncreased
Laper however lL ls advlsable Lo reduce margln wldLh ln order Lo malnLaln adequaLe denLlne
Lhlckness beLween Lhe axlal prep wall and Lhe pulpal Llssues
1he grooves and ledges lncorporaLed ln a parLlalcoverage prep provlde essenLlal sLrengLhenlng for
Lhe casLlng ln parLlcular anLerlor plnledge reLalners beneflL from Lhe resulLlng beamllke
relnforcemenL LhaL resulLs


Lsthet|c Cons|derat|ons
uevelop skllls ln deLermlnlng Lhe esLheLlc expecLaLlons of Lhe paLlenL mosLly as naLural as posslble
Powever esLheLlc conslderaLlons should noL be pursued aL Lhe expense of Lhe prognosls of Lhe
paLlenL's longLerm oral healLh or funcLlon
L Lhe lnlLlal examlnaLlon a full assessmenL ls made of Lhe appearance of each paLlenL noLhlng
whlch areas of whlch LeeLh show durlng speech smlllng and laughlng 1he paLlenL's esLheLlc
expecLaLlons musL be dlscussed and relaLe Lo oral hyglene needs and Lhe poLenLlal for developmenL
of fuLure dlsease 1he flnal declslon regardlng an approprlaLe resLn can Lhen be made wlLh Lhe full
cooperaLlon and lnformed consenL of Lhe paLlenL
LsLheLlc resLns lnclude parLlal veneer crown whlch malnLaln an lnLacL lablal or buccal surface ln
orlglnal LooLh sLrucLure meLalceramlc resLns whlch conslsL of a meLal casL subsLrucLure LhaL ln
vlslble areas has an esLheLlc porcelaln veneer and allceramlc resLns
lleramlc 8esLns
ome of Lhe mosL pleaslng esLheLlc resLns are allceramlc crowns lnlays onlays and veneers 1hey
can mlmlc orlglnal LooLh color beLLer Lhan Lhe oLher resLoraLlve opLlons lLhough aL somewhaL
greaLer rlsk of brlLLle fracLure Lhe newesL maLerlals have lmproved physlcal properLles and can be
sLrengLhened Lhrough Lhe use of reslnbonded luLlng agenLs
noL all ceramlc crown preps are conservaLlve of LooLh sLrucLure as a wlde 90 degree heavy chamfer
margln musL be prepared around Lhe enLlre LooLh Lo ensure lncreased maLerlal Lhlckness and
maLerlal sLrengLh lor Lhe same reason addlLlonal reducLlon on Lhe llngual surface ls needed for
Lheses resLns mlnlmal maLerlal Lhlckness of approxlmaLely 1 Lo 12mm ls necessary Lo ensure
opLlmal esLheLlcs 1hls llmlLs Lhe use of Lhese resLns on faclollngually Lhln LeeLh and on LeeLh wlLh
large pulps as ln young lndlvlduals

MeLaleramlc 8esLns
compromlsed appearance of some meLalceramlc resLns l sofLen caused by lnsufflclenL porcelaln
Lhlckness Cne Lhe oLher hand adequaLe porcelaln Lhlckness ls someLlmes obLalned aL Lhe expense
of proper axlal conLour (such overconLoured resLns almosL lnvarlably lead Lo perlodonLal dlsease) ln
addlLlon Lhe lablal margln of a meLalceramlc crown ls noL always accuraLely place 1o correcL all
Lhese deflclencles cerLaln prlnclples are recommended Lo ensure sufflclenL room for porcelaln and
accuraLe placemenL of Lhe marglns CLherwlse good appearance would be achlevable only aL Lhe
expense of perlodonLal healLh

laclal LooLh reducLlon
dequaLe reducLlon ls essenLlal Lo glve sufflclenL bulk of porcelaln for appearance and meLal for
sLrengLh 1he exacL amounL of reducLlon depends Lo some exLenL on Lhe physlcal properLles of
Lhe alloy used for Lhe subsLrucLure as well as on Lhe manufacLurer and Lhe shade of Lhe
porcelaln good color maLch for some resLns ln older lndlvlduals Lyplcally requlres a sllghLly
greaLer porcelaln Lhlckness Lhan ls needed ln younger paLlenLs mlnlmum reducLlon of 13mm
Lyplcally ls requlred for opLlmal appearance dequaLe Lhlckness of porcelaln ls needed Lo
creaLe a sense of color depLh and Lranslucency hade problems are frequenLly encounLered ln
maxlllary lnclsor crowns aL Lhe lnclsal and cervlcal Lhlrds of Lhe resLn where dlrecL llghL
reflecLlon from Lhe opaque layer can make Lhe resLn appear very noLlceable ecause opaque
porcelalns generally have a shade dlfferenL from LhaL of body porcelalns Lhey ofLen need Lo be
modlfled wlLh speclal sLalns ln Lhese areas
WlLh very Lhln LeeLh (eg mandlbular lnclsors) lL may be lmposslble Lo achleve adequaLe LooLh
reducLlon wlLhouL exposlng Lhe pulp or leavlng a severely weakened LooLh prep under Lhese
clrcumsLances a lessLhanldeal appearance may have Lo be accepLed
1he lablal surfaces of anLerlor LeeLh should be prepared for meLalceramlc resLns ln Lwo dlsLlncL
planes lf Lhey are prepared ln a slngle plane lnsufflclenL reducLlon ln elLher Lhe cervlcal or Lhe
lnclsal area of Lhe prep resulLs
lnclsal reducLlon
1he lnclsal edge of a meLalceramlc resLn has no meLal backlng and can be made wlLh a
Lranslucency slmllar Lo LhaL of naLural LooLh sLrucLure n lnclsal reducLlon of 2mm ls
recommended for good esLheLlcs Lxcesslve lnclsal reducLlon musL be avolded because lL
reduces Lhe reslsLance and reLenLlon form of Lhe prep
roxlmal reducLlon
1he exlsLenL of proxlmal reducLlon ls conLlngenL on exacL predeLermlnaLlon of Lhe locaLlon of
Lhe meLalceramlc [uncLlon ln Lhe compleLed resLn 1he proxlmal surfaces of anLerlor LeeLh look
mosL naLural lf Lhey are resLored aL Lhe lnclsal edges wlLhouL meLal backlng 1hls allows some
llghL Lo pass Lhrough Lhe resLn ln a manner slmllar Lo whaL occurs on a naLural LooLh Cbvlously
lf Lhe resLn ls parL of a l Lhe need for connecLors makes Lhls lmposslble
Lablal margln placemenL
upraglnglval margln placemenL has many blologlc advanLages 1he resLns are easler Lo prepare
properly and easler Lo keep clean neverLheless subglnglval marglns may be lndlcaLed for
esLheLlc reasons parLlcularly when Lhe paLlenL has a hlgh llp llne and when Lhe use of a meLal
collar lablal margln ls conLemplaLed
1he paLlenL's smlle ls observed as parL of Lhe lnlLlal examlnaLlon lL ls lmporLanL Lo record whlch
LeeLh and whlch parLs of each LooLh are exposed aLlenLs wlLh a hlgh llp llne whlch exposes
conslderable glnglval Llssue presenL Lhe greaLesL problem lf compleLe crowns are needed
Where Lhe rooL surface ls noL dlscolored appearance can be resLored wlLh a meLalceramlc
resLn wlLh a supraglnglval porcelaln lablal margln lf Lhe paLlenL has a low llp llne a meLal
supraglnglval collar may be placed because Lhe meLal ls noL seen durlng normal funcLlon MeLal
marglns generally have a more accuraLe flL Lhan porcelaln marglns
Powever lL cannoL be assumed LhaL Lhe paLlenL wlll be happy wlLh a supraglnglval meLal collar
[usL because Lhe meLal ls noL vlslble durlng normal funcLlon ome paLlenLs have reservaLlons
abouL exposed meLal and Lhe advanLages of such supraglnglval marglns musL be carefully
explalned before LreaLmenL
MeLal collars can be hldden below Lhe glnglval cresL alLhough Lhere ls some dlscoloraLlon lf Lhe
glnglval Llssue ls Lhln uccessful margln placemenL wlLhln Lhe glnglval sulcus requlres fare Lo
ensure LhaL lnflammaLlon and/or recesslon wlLh resulLlng meLal expose are avolded or
mlnlmlzed 1he perlodonLlum musL be healLhy before Lhe LooLh ls prepared lf perlodonLal
surgery ls needed Lhe sulcular space should noL be ellmlnaLed compleLely raLer a posLsurglcal
depLh of abouL 2mm should be Lhe ob[ecLlve ufflclenL Llme should be allowed afLer surgery for
Lhe perlodonLal Llssues Lo sLablllze (abouL 20 weeks)

arLlaloverage 8esLns
Whenever posslble accompllshmenL of an esLheLlcally accepLable resulL wlLhouL Lhe use of
compleLe crowns ls preferred because LooLh sLrucLure ls conserved and because no resLoraLlve
maLerlal can approach Lhe appearance of lnLacL LooLh enamel LsLheLlc parLlalcoverage resLns
depend on accuraLe placemenL of Lhe poLenLlally vlslble faclal and proxlmal marglns
undersLandably many paLlenLs do noL readlly accepL a vlslble dlsplay of meLal lf a parLlalcoverage
resLn ls poorly prepared Lhe paLlenL my demand LhaL lL be replaced by a meLalceramlc crown and
Lhe resulL ls unnecessary loss of LooLh sLrucLure and a greaLer poLenLlal for Llssue damage
roxlmal margln
reclse placemenL of Lhe proxlmal marglns (parLlcularly Lhe meslal generally more vlslble) ls
cruclal for Lhe esLheLlc resulL of a parLlalcoverage resLn 1he rule ls Lo place Lhe margln [usL
buccal Lo Lhe proxlmal conLacL area where meLal ls hldden by Lhe dlsLal llne angle of Lhe
nelghborlng LooLh and yeL provldes adequaLe access Lo Lhe LooLhresLn lnLerface for plaque
conLrol 1ooLh prep angulaLlon ls crlLlcal and should normally follow Lhe long axes of posLerlor
LeeLh and Lhe lnclsal Lwo Lhlrds of Lhe faclal surface of anLerlor LeeLh lf a buccal or llngual LllL ls
glven Lo Lhe LooLh prep Lhe llkellhood LhaL meLal wlll be vlslble lncrease slgnlflcanLly
1he dlsLal margln of posLerlor parLlalcoverage resLns ls less vlslble Lhan Lhe meslal margln ln
Lhls area lL ls ofLen advanLageous Lo exLend Lhe prep farLher beyond Lhe conLacL polnL for
easler prep and flnlshlng of Lhe resLn and easler access for oral hyglene
laclal margln
1he faclal margln of a maxlllary parLlalcoverage resLn should be exLended [usL beyond
occlusofaclal llne angle shorL bevel ls needed Lo prevenL enamel chlpplng chamfer can be
placed where appearance ls less lmporLanL (eg on molars) because Lhls provldes greaLer bulk
of meLal for sLrengLh
lf Lhe buccal margln of meLal ls correcLly shaped lL does noL reflecL llghL Lo an observer s a
resulL Lhe LooLh appears Lo be merely a llLLle shorLer Lhan normal and noL as Lhough lLs buccal
cusp ls ouLllned ln meLal lf Lhe buccal margln ls sklllfully placed so as Lo follow Lhe orlglnal
uspal conLour Lhe flnal resLn has an accepLable appearance
When mandlbular parLlal casL crowns are made meLal dlsplay ls unavoldable because Lhe
occlusal surface of mandlbular LeeLh can be seen durlng speech chamfer raLher Lhan a bevel
ls recommended for Lhe buccal margln because lL provldes a greaLer bulk of meLal around Lhe
hlghly sLressed funcLlonal cusp lf Lhe appearance of meLal ls unaccepLable Lo Lhe paLlenL a
meLalceramlc resLn wlLh porcelaln coverage on Lhe occlusal surface can be made
nLerlor parLlalcoverage resLns can be fabrlcaLed Lo show no meLal buL Lhelr prep requlres
conslderable care 1he faclal margln ls exLended [usL beyond Lhe hlghesL conLour of Lhe lnclsal
edge buL noL qulLe Lo Lhe lnclsolablal llne angle Pere Lhe meLal proLecLs Lhe LooLh from
chlpplng buL ls noL vlslble


ann|ng and Lva|uat|ng 1ooth reparat|ons
1ooLh prep ls a Lechnlcally compllcaLed and lrreverslble procedure 1hus lL ls Lhe pracLlLloner's
responslblllLy Lo carry lL ouL properly very Llme MlsLakes are ofLen dlfflculL lf noL lmposslble Lo
correcL

D|agnost|c 1ooth reparat|ons
ulagnosLlc LooLh preps are performed on arLlculaLed casLs before Lhe acLual cllnlcal prep 1he ylld
lnformaLlon wlLh regard Lo Lhe followlng
elecLlng Lhe approprlaLe paLh of placemenL for a l parLlcularly when Lhe abuLmenL LeeLh are
LllLed or have an aLyplcal coronal conLour
uecldlng on Lhe amounL of LooLh reducLlon necessary Lo accompllsh a planned change ln Lhe
occluslon
ueLermlnlng Lhe besL locaLlon for Lhe faclal and proxlmal marglns of a parLlalcoverage resLn so
LhaL Lhe meLal ls noL vlslble
n lmporLanL advanLage of dlagnosLlc LooLh prep ls LhaL Lhe operaLor can pracLlce each sLep of Lhe
lnLended resLn MlsLakes are noL permanenLly desLrucLlve lso dlagnosLlc prep can be used ln Lhe
prefabrlcaLlon of lnLerlm resLns slgnlflcanLly reduclng appolnLmenL Llme duraLlon aL LooLh prep (Lhe
lndlrecL/dlrecL Lechnlque ls descrlbed ln hpL 13)
ulagnosLlc waxlng procedures
lor all buL Lhe mosL sLralghLforward prosLhodonLlc LreaLmenL plans a dlagnosLlc waxlng procedure
should be performed 1hls ls done on dlagnosLlc LooLh preps and esLabllshes Lhe opLlmum conLour
and occluslon of Lhe evenLual prosLhesls 1he procedure ls of parLlcular beneflL lf Lhe paLlenL's
occlusal scheme or anLerlor (lnclsal) guldance requlres alLeraLlon
LvaluaLlve procedures durlng LooLh preparaLlon
Lach sLep of a LooLh prep should be carefully evaluaLed wlLh dlrecL vlslon or lndlrecLly wlLh a denLal
mlrror llgnmenL of mulLlple abuLmenL LeeLh can be a speclal problem and uslng Lhe mlrror helps
Lo superlmpose Lhe lmage of ad[acenL abuLmenL LeeLh omplex preps should be evaluaLed by
maklng an alglnaLe lmpresslon and pourlng lL ln fasLseLLlng sLone denLal surveyor can Lhen be
used Lo preclsely measure Lhe axlal lncllnaLlons of Lhe LooLh prep 1he less experlenced denLlsL may
heslLaLe Lo make such an lmpresslon for fear of loslng Llme Powever Lhe lnformaLlon obLalned
ofLen saves Llme ln subsequenL procedures by ldenLlfylng problems LhaL can Lhen be addressed
lmmedlaLely lor LooLh prep lL ls useful Lo learn Lo use Lhe conLraangle handplece as boLh a
measurlng and a cuLLlng lnsLrumenL 1hls ls done by concenLraLlng on Lhe Lop surface of Lhe Lurblne
head whlch ls perpendlcular Lo Lhe shank of Lhe bur lf Lhe Lop surface ls kepL parallel Lo Lhe occlusal
surface of Lhe LooLh belng prepared Lhe bur ls auLomaLlcally ln Lhe correcL orlenLaLlon 1o prevenL
undercuLs or excesslve convergence durlng axlal reducLlon Lhe handplece musL be malnLalned aL
Lhe same angulaLlon 1he correcL Laper ls lmparLed by Lhe dlamond lnsLrumenL keeplng Lhe Lurblne
head aL lLs correcL angulaLlon lnlLlally ls ofLen mosL effecLlvely done by supporLlng lL wlLh a flnger of
Lhe opposlLe hand

aLlenL and CperaLor oslLlonlng
Learnlng Lhe proper paLlenL and operaLor poslLlons ls as beneflclal as learnlng Lhe proper prep sLeps
Cf parLlcular lmporLance are Lhe advanLages of obLalnlng a dlrecL vlew of Lhe prep whlch ls always
preferred Lo an lndlrecL or mlrror vlew Powever cerLaln areas (eg Lhe dlsLal surfaces of maxlllary
molars) cannoL be seen dlrecLly
lnexperlence coupled wlLh a heslLaLlon Lo move Lhe paLlenL's head lnLo a more facLorable poslLlon
can unnecessarlly compllcaLe LooLh prep lor lnsLance havlng Lhe paLlenL roLaLe Lhe head Lo Lhe lefL
or rlghL slde can conslderably lmprove Lhe vlslblllLy of molar LeeLh LhaL are belng prepared ln mosL
lnsLances a dlrecL vlew can be obLalned by subLly changlng Lhe operaLor's or Lhe paLlenL's poslLlon
Pavlng Lhe paLlenL open maxlmally does noL necessarlly provlde Lhe besL vlew lf Lhe [aw ls
parLlcularly open Lhe cheek may be reLracLed more easlly and lf Lhe paLlenL ls encouraged Lo make
a laLeral excurslon Lhe dlsLobuccal llne angle LogeLher wlLh Lhe buccal Lhlrd of Lhe dlsLal wall may
be seen dlrecLly ln pracLlce Lhe mlrror ls essenLlal only for vlsuallzlng a small porLlon of Lhe dlsLal
surface When a compleLe crown ls prepared Lhe parLs of Lhe LooLh mosL easlly seen should be
prepared flrsL leavlng Lhe oLher areas for prep wlLh Lhe help of Lhe mlrror as a flnal sLage

art|a| Veneers
lndlcaLlons
O lor posLerlor LeeLh LhaL have losL moderaLe amounLs of LooLh sLrucLure lf buccal wall ls
lnLacL and well supporLed by sound LooLh sLrucLure
O lor use as reLalners for a lu or where resLoraLlon or alLeraLlon of Lhe occlusal surface ls
needed
O lor reesLabllshlng anLerlor guldance/spllnLlng LeeLh ln Lhe case of anLerlor parLlal veneers

onLralndlcaLlons
O 1eeLh wlLh a shorL cllnlcal crown due Lo lnadequaLe reLenLlon
O 8eLalners for long span lus
O Weakened buccal cusps wlLh access cavlLy or exLenslvely damaged crowns
O roxlmally bulbous LeeLh as proxlmal grooves made on Lhese LeeLh are llkely Lo resulL ln
unsupporLed enamel

dvanLages
O onservaLlon of LooLh sLrucLure
O 8educed pulpal and perlodonLal lnsulL durlng LooLh preparaLlon
O Lasy access Lo supraglnglval marglns for flnlshlng
O llows relaLlvely good seaLlng of Lhe resLoraLlon durlng cemenLaLlon as Lhe luLlng agenL can
escape more readlly
O uurlng servlce Lhe exlsLlng buccal LooLh sLrucLure allows for elecLrlc vlLallLy LesLlng

ulsadvanLages
O Less reLenLlon and reslsLance Lhan compleLe casL crowns
O ulfflculL Lo prepare slnce only llmlLed ad[usLmenLs can be made ln Lhe paLh of placemenL
and lL ls dlfflculL Lo prepare Lhe grooves plnholes and boxes
O ome meLal mlghL be vlslble whlch ls unaesLheLlc

reparaLlon of a crown for posLerlor LeeLh
ln a crown 3 ouL of Lhe 4 axlal surfaces are lnvolved ll surfaces excepL Lhe buccal surface are
prepared Lo accommodaLe a casLlng ln Lhe same manner as a compleLe crown prep dlfferlng only ln
Lhe need for axlal reLenLlon grooves
1) Ccclusal reducLlon of aL leasL 13 mm on funcLlonal cusp and 10 mm on nonfuncLlonal cusp
and ln Lhe cenLral groove
2) xlal reducLlon of llngual meslal and dlsLal surfaces and placemenL of cervlcal chamfer aL
Lhe same Llme
3) roxlmal grooves are placed parallel Lo Lhe paLh of placemenL and perpendlcular Lo Lhe
prepared surface 1he groove ls flared Lowards Lhe buccal wall (Lo remove all unsupporLed
enamel) and Lhe llngual wall of Lhe groove ls perpendlcular Lo Lhe axlal wall of Lhe
preparaLlon (Lo reslsL llngual dlsplacemenL) 1he floor or Lhe groove ls sllghLly more occlusal
Lhan Lhe chamfer and Lhe groove should be aL leasL 4 mm ln lengLh occlusocervlcally
ervlcal wldLh of Lhe groove ls abouL 1 mm buL occlusal wldLh ls greaLer due Lo Lhe Laper of
Lhe bur

reparaLlon of osLerlor arLlal veneer for 7/8 crown
ln addlLlon Lo Lhe surfaces covered by Lhe crown lL also lncludes Lhe dlsLal half of Lhe buccal
surface fLer axlal and buccal reducLlon a buccal groove and a meslal groove should be placed 1he
buccal groove should reslsL meslodlsLal dlsplacemenL

nLerlor arLlal veneer reparaLlon
1here are 2 Lypes of anLerlor parLlal veneers Lhe crown (usually for maxlllary canlnes) and Lhe
plnledge lnledge ls usually used Lo esLabllsh anLerlor guldance or as a reLalner for an lu or Lo
spllnL perlodonLally compromlsed LeeLh
lndlcaLlons for Lhe lnledge
O undamaged anLerlor LeeLh wlLh low carles
O ulbous LeeLh LhaL would be unsulLable for crowns(s lL could resulL ln a large amounL of
unsupporLed enamel)
onLralndlcaLlons
O aLlenLs wlLh poor oral hyglene
O oung paLlenLs wlLh large pulps (as Lhese paLlenLs are beLLer served by reslnreLalned lus)
O nonvlLal LeeLh
O When allgnmenL of Lhe abuLmenL confllcLs wlLh Lhe proposed paLh of placemenL of Lhe lu
O When opLlmum reLenLlon ls needed (lnledges are noL so reLenLlve due Lo less surface area)
lnledge preparaLlon
1here are 3 Lypes of plnledge preparaLlons Lhe convenLlonal plnledge Lhe plnledge wlLh a proxlmal
sllce (usually for LeeLh wlLh a sllghL proxlmal convexlLy) and Lhe plnledge wlLh a proxlmal groove (
usually for LeeLh wlLh small carlous leslon) 1he procedure below ls for Lhe plnledge wlLh proxlmal
sllce
1) repare Lhe proxlmal sllce wlLh a Lapered dlamond 1he reducLlon lncludes Lhe proxlmal
conLacL area
2) lnclsal reducLlon ls carrled ouL wlLh Lhe bur sllghLly lncllned Lowards Lhe llngual aspecL Lo
mlnlmlze dlsplay of meLal on Lhe lablal surface
3) Llngual reducLlon ls carrled ouL Lo allow for 1 mm Lhlckness of meLal ln Ml and excurslve
movemenLs
4) repare 2 ledges across Lhe reduced llngual surface Lo provlde room for sufflclenL bulk of
meLal Lo ensure rlgldlLy 1he ledges should be parallel Lo Lhe lnclsal edge of Lhe LooLh wlLh
Lhe lnclsal ledge abouL 223 mm cervlcal Lo Lhe lnclsal edge and Lhe cervlcal ledge on Lhe
cresL of Lhe clngulum aL Lhe cenLer of Lhe cervlcal x of Lhe prep
3) Make lndenLaLlons on Lhe lefL and rlghL sldes of Lhe lnclsal ledge and sllghLly off cenLer ln Lhe
cervlcal ledge Lo prevenL subsequenL pulp exposure when Lhe plnholes are placed Make
sure Lhe lndenLaLlons are such LhaL plnholes wlll be compleLely ln denLlne
6) lnk plloL channels lnLo Lhe lndenLaLlons wlLh a small round bur on a small LwlsL drlll uepLh
of Lhese channels should be 23 mm
7) evel Lhe [uncLlon beLween Lhe plnhole and Lhe lndenLaLlon wlLh a round bur sllghLly larger
Lhan Lhe largesL dlameLer of Lhe plnhole
reparaLlon for crown on a maxlllary canlne
1) lnclsal reducLlon Lo allow 1mm of meLal Lhlckness 1he lnclsal margln should noL conLacL Lhe
opposlng LooLh
2) Llngual reducLlon whlch should noL exLend onLo Lhe clngulum
3) ueLermlne Lhe paLh of placemenL before carrylng ouL axlal reducLlon 1he paLh of placemenL
should parallel Lhe long axls of Lhe LooLh meslodlsLally and should parallel Lhe mlddle Lhlrd
or lnclsal 2/3 of Lhe faclal surface buccollngually
4) ecause of Lhe llLLle bulk of llngual LooLh sLrucLure ln Lhe canlne compared Lo a premolar or
molar a sllghLly more exaggeraLed llngual chamfer can be placed as well as a guldlng groove
ln Lhe mlddle of Lhe llngual wall resulLlng ln a proxlmal flange
3) reaLe an ln lnclsal offseL/groove Lo provlde a band of Lhlcker meLal for a sLaple"
conflguraLlon Lo provlde addlLlonal rlgldlLy and reslsLance agalnsL bendlng of Lhe casLlng
1he lnclsal offseL should connecL Lhe meslal and dlsLal grooves and should have a v shaped
conflguraLlon Lo lmprove llngual reslsLance
6) lace a plnhole ln Lhe clngulum area sllghLly offcenLre Lo lmprove Lhe reLenLlon and
reslsLance form of Lhe prep

n|ays and Cn|ays
lndlcaLlons
O lnlays can be used lnsLead of amalgam for paLlenLs wlLh low carles requlrlng a small class ll
resLoraLlon ln a LooLh wlLh ample supporLlng denLlne
O Cnlays can be used Lo resLore a damaged occlusal surface ln a conservaLlve manner
O Cnlays can also be used for MCu resLoraLlons ln a LooLh wlLh sufflclenL LooLh sLrucLure for
reLenLlon and reslsLance

onLralndlcaLlons
O 1eeLh wlLhouL sufflclenL bulk (slnce Lhese resLoraLlons rely on wedglng le lnLracoronal
reLenLlon)
O LxLenslve onlays are conLralndlcaLed unless plns are used Lo supplemenL reLenLlon and
reslsLance
dvanLages
O Plgh longevlLy due Lo good mechanlcal properLles of gold alloy
O no corroslon
O no LooLh dlscolouraLlon
O Cnlays can also supporL cusps reduclng rlsk of LooLh fracLure
ulsadvanLages
O lnlays are noL conservaLlve of LooLh sLrucLure lf Lhe carlous leslon ls small
O Plgh occlusal forces mlghL lead Lo cusp fracLure as a resulL of wedglng from Lhe lnlay
kosenst|e| Chapter 8(Comp|ete Cast Crown reparat|on)

Advantages(cf part|a| coverage crown)
1 reater retent|on as all axlal surfaces are lncluded ln Lhe prep
2 reater res|stance
3 reater strength Lhus less easlly deformed
4 A||ows operator to mod|fy ax|a| tooth contourmodlflcaLlons can be done Lo allow feaLures
for removable denLal prosLheses Lo be lncorporaLed ad[usL malallgned LeeLh
S A||ows easy mod|f|cat|on of occ|us|on
D|sadvantages
1 LxLenslve removal of LooLh sLrucLure
2 Margln close Lo glnglvacommon Lo see g|ng|va| |nf|ammat|on
3 oor va||d|ty of L1( LlecLrlc pulp/vlLallLy LesLlng) as conducLlvlLy of meLal lnLerferes wlLh
Lhe LesL
4 esLheLlcally unpleasanLresLrlcLed appllcaLlon(usually maxlllary and mandlbular molars)
nd|cat|ons
1 LxLenslve coronal desLrucLlon due Lo carles/Lrauma
2 orrecLlon of axlal conLours needed
3 upporL parLlal removable denLal prosLheses needed
4 LndodonLlcally LreaLed LeeLh
Contra|nd|cat|ons
1 ame ob[ecLlves can be meL wlLh more conservaLlve resLoraLlon
a) lnLacL buccal/llngual wall
b) dequaLe buccal conLour/achlevable Lhrough enamel modlflcaLlon
2 Less Lhan maxlmum reLenLlon reslsLance needed
3 Plgh aesLheLlc requlred
Cr|ter|a
1 Ccclusal reducLlon (musL allow sufflclenL room for resLoraLlve maLerlal le 1ype lll/lv gold)
a) learance funcLlonal13mm nonfuncLlonal1mm
b) lollow anaLomlc conLours
2 xlal reducLlon 6 Laper
3 Margln
a) 03mm chamferfor opLlmum axlal conLour LxcepLlon small premolarsnarrower
chamfer wldLh Lo conserve LooLh sLrucLure reLenLlon form
b) locaLed supraglnglvally
4 luncLlonal cusp bevel
O urposeensure opLlmum resLoraLlon conLour wlLh max durab|||ty conservat|on of
tooth structure
O 1echnlqueplace lL [ 4S Lo long axls of LooLhLo achleve addlLlonal reducLlon for
funcLlonal cusp
3 nonfuncLlonal cusp bevelCcc|usoax|a| ||ne ang|e c|earance musL mlnlmally be 06mm for
adequaLe sLrengLh(esp needed for max|||ary mo|ars)
Steps |n reparat|on
(Atmomeototlom tefet to pq 262 toble 81)
Ccclusal guldlng groovesensures LhaL occlusal reducLlon follows anaLomlc conflg and
mlnlmlze loss of LooLh sLrucLure whlle ensurlng adequaLe reducLlon
lmpL Lo Lake noLe of poslLlon depLh angulaLlon of grooves
O oslLlon groove should be placed ln Lhe |ow po|nts(cenLral devL grooves) h|gh
po|nts(cusp Llps Lrlangular rldges)
O uepLh 08mm(cenLral groove nonfuncLlonal cusps 13mm (funcLlonal cusps)
O ngulaLlon
a) nonfuncLlonal cusps $$ Lo lnLended cuspal lncllnaLlon
b) funcLlonal cuspsang|ed s||ght|y f|atter Lo ensure addlLlonal reducLlon of
funcLlonal cusps
Ccclusal reducLlon(toooJtlppeJtopeteJ JlomooJteqolot qtlt 08mm)
O 8educe half of Lhe occlusal surface flrsL(use Lhe remalnlng half as reference)
O use uLlllLy wax Lo evaluaLe sufflclenL clearance ln boLh Ml and excurslve
movemenLs10 mm(nonfuncLlonal cusps)1Smm(funcLlonal cusps)
xlal grooves
oslLlon cenLermeslal dlsLal LranslLlonal llne angle of buccal llngual walls
WldLh half of Lhe 08mm bur
ngulaLlon shank of bur ls // Lo proposed paLh of placemenL of resLoraLlon
u xlal reducLlon(toooJtlppeJ topeteJ JlomooJ teqolot qtlt 08mm)
O 8educe half Lhe LooLh aL a Llme(use Lhe remalnlng half as reference)
O roLecL Lhe ad[acenL LooLh uslng meLal maLrlx band lf necessary
O uL lnLo Lhe proxlmal areas from boLh sldes unLll a Lhln sllLher of enamel ls lefL
conLacL ls Lhen broken uslng a Lhlnner Lapered dlamond
O hamfer wldLh0Smm smooLhconLlnuous and have a dlsLlncL res|stance aga|nst
vert|ca| d|sp|acement when probed wlLh Llp of explorer
L llnlshlng (toooJtlppeJ topeteJ JlomooJ floe qtlt 12mm)
good flnlsh Lo Lhe prep faclllLaLes lmpresslon maklng waxlng lnvesLlng casLlng
O hamfer flnlshed wlLh wlder bur [ a reduced speed/slowspeedmargln musL be
smooLh when Louched by Llp of explorer
O 8ound all llne anglesreduces bubble formaLlon durlng Lhe lab sLages
O lacemenL of addlLlonal reLenLlve feaLures
l LvaluaLlon
ldeal prep ls characLerlzed by smooLh even chamfer 6 Laper gradual LranslLlons beLween
all prepared surfaces
Common Lrrors Lffect now to rect|fy
CverLaperlng 8educed reLenLlon
reslsLance
repare a band of
several mm of LooLh
sLrucLure
clrcumferenLlally wlLh
a resLrlcLed 6
Laperdon'L need Lo
compensaLe foor
areas of excesslve
reducLlon ln Lhe
occlusal
Lhlrd(preferred)
uprlghL overLapered
wall
lncorporaLe reLenLlve
feaLures eg Crooves
boxes plnholes
undercuLs ulfflculLyof removal/fracLure
of wax paLLern
LllmlnaLe Lhe undercuLs by
addlLlonal LooLh prep/blocked
ouL wlLh a sulLable base
maLerlal
under reducLlon LrengLh of resLoraLlve
maLerlal ls compromlsed
lncrease reducLlon

Chapter 9 (,eta|Ceram|c Crown reparat|on)
,eta| substructure
O asL ln speclal meLalceramlc alloy wlLh a hlgher fuslng range and lower Lhermal expanslon
Lhan convenLlonal gold alloys
O Modern denLal porcelalns fuse aL 960 degrees
4 onvenLlonal gold alloys melL aL Lhls LemperaLure Lherefore speclal alloys are
necessary
nd|cat|ons
O 1eeLh LhaL requlre compleLe coverage and slgnlflcanL esLheLlc demands
O More durable and has superlor marglnal flL compared Lo full ceramlc
O erve as reLalner for flxed denLal prosLhesls because meLal subsLrucLure can accommodaLe
casL/soldered connecLors occlusal and clngulum resLs mllled proxlmal and reclprocal gulde
planes
Contra|nd|cat|ons
O Large pulp chambers
O lf more conservaLlve approach ls posslble
Advantages
O LrengLh of meLal and esLheLlcs of ceramlcs (can be characLerlzed wlLh sLalns)
O Cood reLenLlve and reslsLanL quallLles
O ermlL correcLlon of axlal form
O Lower dlfflculLy Lhan parLlal crowns
D|sadvantages
O lgnlflcanL reducLlon
O ubglnglval marglns may cause perlodonLal dlsease
keduct|on
nc|sa| (occ|usa|) reduct|on
O 2 mm (lnclsal)
O 13 mm (posLerlor LeeLh as esLheLlcs noL as crlLlcal)
O luncLlonal cusp bevel for sLrucLural durablllLy
O Lxcesslve reducLlon shorLens axlal wall reduclng reslsLance and reLenLlon
ab|a| (bucca|) reduct|on
O L leasL 12 mm (13 preferred)
O houlder margln
4 1 mm wlde exLendlng lnLo proxlmal embrasures
4 evel/slope marglns Lo remove unsupporLed enamel
horL bevel wlLh cavosurface angle of 133 degrees
Ax|a| reduct|on of prox|ma| and ||ngua| surfaces
O hamfer margln of 03 mm
4 avosurface margln should be sllghLly obLuse or 90 degrees
O Cn anLerlor LeeLh llngual concavlLy of 1mm (meLal) or more (ceramlc) ls requlred
Chapter 11 1ooth reparat|ons for A||Ceram|c kestorat|ons
Comp|ete Ceram|c Crown
eoetol Jeslqo of tbe ctowo
1 Lven Lhlckness clrcumferenLlally of 1 Lo 13mm
2 lnclsally a greaLer Lhlckness may be requlred
AJvootoqes
1 uperlor esLheLlcs excellenL Lranslucency (slmllar Lo naLural LooLh sLrucLure)
2 Cood Llssue response
3 More conservaLlve reducLlon on Lhe faclal compared Lo a meLalceramlc crown as lack of
meLal subsLrucLure (buL greaLer reducLlon on Lhe llngual for a hlgher bulk sLrengLh requlred
of ceramlc)
4 ppearance of resLoraLlon can be alLered by selecLlng dlfferenL colour of luLlng agenL
lsoJvootoqes
1 8educed sLrengLh of Lhe resLoraLlon as absence of meLal subsLrucLure (meLalceramlc)
2 lgnlflcanL LooLh reducLlon as a shoulder Lype margln ls requlred
3 houlder margln ls needed as porcelaln ls brlLLle and Lhere ls no relnforclng meLal
subsLrucLure (bulk sLrengLh Lo make up for lnLrlnslc weakness)
4 lnadequaLe LooLh preparaLlon can cause fracLure ln Lhe lssued crown (prevenLed by 90
degree cavosurface angle prevenL unfavourable dlsLrlbuLlon of sLresses)
3 noL effecLlve as reLalners for a flxed denLal prosLhesls (brldge)
a lf employed large connecLors are requlred whlch lmplnge on Lhe lnLerdenLal papllla
and may cause perlodonLal fallure
6 Cpposlng naLural LooLh ls suscepLlble Lo wear (mandlbular lnclsor)
oJlcotloos
1 reas of hlgh esLheLlc requlremenL
2 roxlmal or faclal carles LhaL can no longer be resLored uslng composlLe resln
3 8elaLlve lnLacL LooLh wlLh sufflclenL coronal sLrucLure Lo supporL Lhe resLoraLlon (lnclsal
areas lmpL Lo also noL exceed 2mm Lhlckness Lo prevenL fracLure)
4 Ccclusal load should be favourably dlsLrlbuLed
3 enLrlc conLacL musL be ln Lhe area where Lhe porcelaln ls supporLed by LooLh sLrucLure
oottoloJlcotloos
1 More conservaLlve resLoraLlon can be used
2 noL recommended for molar LeeLh ( occlusal load esLheLlc requlremenL)
3 unfavourable occlusal loadlng
4 noL able Lo provlde adequaLe LooLh supporL
3 unable Lo achleve even shoulder wldLh of aL leasL 1mm clrcumferenLlally
teps
lnclsal reducLlon
13 Lo 2mm clearance for porcelaln ln all excurslve movemenLs of Lhe mandlble
uepLh grooves are made orlenLed perpendlcular Lo Lhe long axls of Lhe opposlng LooLh
(provlde adequaLe supporL for Lhe porcelaln)
laclal reducLlon
learance for 1mm porcelaln Lhlckness
2 plane reducLlon 1 ervlcal componenL parallel Lo Lhe proposed paLh of placemenL 2
lnclsal componenL followlng Lhe conLour of Lhe LooLh
Llngual reducLlon
1mm clearance ln all mandlbular excurslve movemenLs
1ransfer Lhe selecLed paLh of placemenL from Lhe cervlcal wall of Lhe faclal preparaLlon
lace depLh groove ln Lhe clngulum wall
arry Lhe marglns proxlmally Lo meeL Lhe faclal shoulder margln
Margln should follow Lhe free glnglval cresL and should noL exLend Loo far subglnglvally

CrlenLaLlon of Lhe margln
loplng shoulder leads Lo unfavourable loadlng of Lhe porcelaln
90 degree cavosurface angle dlrecLs sLresses opLlmally
llnlshlng
no unsupporLed enamel round sharp llne angles

Ceram|c |n|ays and on|ays
uurable alLernalLlve Lo posLerlor composlLe reslns
ond ceramlc resLoraLlon Lo Lhe prepared LooLh wlLh an acld eLch Lechnlque and resln cemenL
cld eLch enamel
orcelaln (eLchable) eLched wlLh hydrofluorlc acld and wlLh Lhe use of sllane coupllng agenL
oJlcotloos
1 Low carles raLe
2 ln place of amalgam or gold lnlay
3 esLheLlcs orlglnal appearance
4 MosL conservaLlve ceramlc resLoraLlon
oottoloJlcotloos
1 poor oral hyglene hlgh carles raLe
2 Lxcesslve occlusal loadlng (bruxlsm)
AJ
1 LxLremely aesLheLlc
2 uoes noL wear (unllke posLerlor composlLe resln)
3 Marglnal leakage due Lo polymerlzaLlon shrlnkage and hlgh C1L reduced as resln luLlng
agenL ls very Lhln (vs pcr)
lsoJ
1 ccuraLe occluslon hard Lo achleve
2 Pard Lo do lnLraoral occlusal ad[usLmenLs
3 brades opposlng enamel lf rough
4 Wear of composlLe luLlng agenL causlng marglnal leakage
3 erlodonLal dlsease may resulL from resln flash ln lnaccesslble areas (proxlmal)
teps
CuLllne form
reparaLlon governed by exlsLlng resLoraLlon and carles and ls slmllar Lo LhaL for
convenLlonal meLal lnlays and onlays (chapLer 10)
8MCl can be used Lo block ouL undercuLs preservlng addlLlonal enamel for adheslon
(severely undermlned enamel should be removed)
Ccclusal
enLral groove reducLlon 18mm followlng anaLomy of Lhe unprepared LooLh
CuLllne form should avold occlusal conLacLs
reas Lo recelve onlay need 13mm clearance
ox
ox exLends 6mm proxlmal clearance margln kepL supra glnglval (beLLer flnlshlng
and beLLer lsolaLlon durlng luLlng)
WldLh of Lhe glnglval floor of Lhe box should be 1mm
8ound lnLernal llne angles ( sLress concenLraLlon and volds durlng luLlng procedure)
arles excavaLlon
8emove carles ln Lhe ouLlne form w excavaLor or round bur on slow speed hp
8MCl Lo replace excavaLed carlous Llssue
Margln deslgn
90 degree buLL [olnL for lnlay
Peavy chamfer for onlay
evels are conLralndlcaLed (bulk needed Lo prevenL fracLure)

llnlshlng
8eflne Lhe margln
Ccclusal clearance (onlays)
13mm clearance
orce|a|n am|nate Veneers
onservaLlve meLhod of resLorlng Lhe appearance of dlscoloured plLLed or fracLured anL LeeLh
ondlng Lhln ceramlc lamlnaLes onLo Lhe lablal surface of affecLed LeeLh
hoLopolymerlze luLlng resln used
AJ ooJ oJlcotloos
1 onservaLlve of LooLh sLrucLure (3mm faclal reducLlon needed)
2 L noL requlred as prep ls conflned Lo enamel
3 lavoured for LreaLmenL of mulLlple dlscoloured buL relaLlvely healLhy LeeLh
lsoJ ooJ coottoloJlcotloo
1 Cver/excesslvely conLoured resLoraLlons (especlally ln Lhe glnglval reglon)
2 LxLenslve exlsLlng resLoraLlons presenL
teps
uepLh holes w round bur mln 03mm
8educLlon followlng Lhe exLenL of dlscolouraLlon and Lhe anaLomlc conLour of Lhe LooLh
Margln
Long chamfer margln followlng Lhe glnglval cresL (obLuse cavosurface angle Lo lncrease
eLchlng)
lace preparaLlon margln lablal Lo proxlmal conLacL (preserve enamel) (maybe exLended
llngually Lo lnclude exlsLlng resLoraLlons)
lnclsal Ldge
uo noL reduce lnclsal edge (supporL porcelaln and reduce chlpplng)
LxLenslon Lo llngual aspecL lf lnclsal edge ls lnvolved
ll prepared surfaces rounded ( sLress)

Chapter 18 (Wax atterns)
ostwax process
1 CbLaln accuraLe lmpresslon of prepared LooLh
2 Make casL of lmpresslon
3 Waxup
4 Make mould around wax paLLern uslng lnvesLmenL maLerlal
3 vaporlse wax ln an elecLrlc furnace
6 llll hollow mould wlLh molLen casLlng alloy
7 8eLrace casLlng and pollsh
8 llnlcal evaluaLlon
rerequ|s|tes
Correct|on of defects
O LllmlnaLe undercuLs wlLh zlnc phosphaLe cemenL
rov|s|on of adequate |ut|ng agent space
O 2040 mlcrons
O lf Loo narrow casLlng doesn'L seaL properly durlng cemenLaLlon because of hydraullc
pressure LhaL develops when vlscous mass of luLlng agenL cannoL escape Lhrough Lhe narrow
gap wlLh crown and preparaLlon
O lf Loo wlde casLlng ls loose reslsLance form ls reduced and poslLlonlng of casLlng ls
lnaccuraLe
4 LongevlLy decreases
O lncreaslng space
4 lncrease Lhermal and polymerlsaLlon shrlnkage of lnvesLmenL maLerlal
4 use sofL wax lnLernally
4 use solld casL wlLh lndlvldual sLone dles
4 lncrease expanslon of lnvesLmenL mould
4 8emove meLal from flLLlng surface
4 use dle spacers
Leave 1 mm band above margln for adequaLe marglnal adapLaLlon
O 8educlng space
4 8educe Lhermal and polymerlsaLlon shrlnkage of lnvesLmenL maLerlal
4 use resln/elecLroplaLed dles
4 use alloys wlLh hlgher melLlng range
4 8educe expanslon of lnvesLmenL mould
O ulfflculLy wlLh seaLlng casL ls due Lo
4 Wax dlsLorLlon
4 resence of flash exLendlng pasL marglns
4 underexpanslon
4 asLlng nodule
,ark|ng marg|ns
O uo noL use lead pencll
4 brades dle
4 uark colour does noL conLrasL agalnsL wax
4 CraphlLe ls an anLlflux prevenLlng compleLe casLlng of marglns
O oaL marglns wlLh lowvlscoslLy cyanoacrylaLe resln
Wax|ng sequence
nterna| surface
1 ule lubrlcanL
2 lnserL plns lnLo holes lf presenL
3 llow molLen wax onLo surface
a LxLra bulk aL proxlmal Lo prevenL dlsLorLlon
4 1rlm wax Lo marglns for evaluaLlon
Wax pattern remova|
1 ull dle from paLLern
2 use rubber dam for exLra grlp
3 heck lnLernal defecLs (folds/creases/bubbles)
rox|ma| surface
1 1ends Lo be flaL/sllghLly concave from conLacL areas Lo L!
2 vold over conLourlng as lL makes malnLalnlng perlodonLal healLh dlfflculL
3 onLacL areas (scrape sLone of ad[acenL LeeLh Lo ensure LhaL conLacLs are noL deflclenL)
a Large dlfflculL plague conLrol
b mall drlfLlng and food lmpacLlon
c osLerlor
l Ccclusal Lhlrd
ll LxcepL beLween max 1
sL
and 2
nd
molar (mlddle Lhlrd)
lll enLral for mandlbular LeeLh and maxlllary molars
lv uccal beLween maxlllary premolars and molars
4 Lmbrasures should be symmeLrlcal Lo provlde adequaLe room for free glnglval Llssues of
ad[acenL LeeLh
Ax|a| surfaces
1 lollow conLour of ad[acenL LeeLh
2 PelghL of conLour ls generally ln Lhe glnglval Lhlrd
a Mlddle Lhlrd on llngual surface of mandlbular molars
3 Lmergence proflle ls flaL/concave
Ccc|usa| surface
1 usps and rldges shaped Lo allow even conLacL wlLh opposlng LeeLh and dlrecL forces along
long axes of LeeLh
2 olnL conLacLs preferred Lo mlnlmlse wear and lmprove masLlcaLlon
3 Ccclusal schemes
a uspmarglnal rldge (more common)
l Mandlbular cusps conLacL embrasure space (each LooLh conLacLs 2 LeeLh)
b uspfossa (lass ll maloccluslon)
l Mandlbular cusps conLacL more dlsLal lnLo fossa of maxlllary LooLh and
conLacLs only 1 LooLh
ll 8ecommended ln occlusal reconsLrucLlon
1 revenL food lmpacLlon
2 enLrlc closure forces nearer long axes of LeeLh
3 lmprove sLablllLy from Lrlpod conLacLs for each funcLlonal cusps
c lf nelLher scheme ls presenL
l ulsLorL coronal axlal form Lo accommodaLe preferred scheme
ll lLer occlusal surface Lo accommodaLe normal axlal form
d usps follow
l nLeroposLerlor curve (urve of pee)
ll MedlolaLeral curve (urve of Wllson)
e Make 2 supplemenLary rldge ad[acenL Lo each Lrlangular rldge
l MosL meslal and dlsLal rldges conLlnuous wlLh marglnal rldges
,arg|n f|n|sh|ng
O 8eflowed and reflnlshed lmmedlaLely before lnvesLlng Lo opLlmlse adapLaLlon of wax paLLern
Lo dle reduclng demenL dlssoluLlon
O use a large wellheaLed lnsLrumenL Lo melL compleLely Lhrough wax aL marglns (12 mm)
O llll depresslon wlLh addlLlonal wax
O 1rlm excess from beyond margln
Anter|or teeth
O Culde Lo lablal and llngual conLours necessary
4 8ecreaLed uslng anLerlor gulde Lable
4 hape affecLs speech llp supporL and appearance
|ngua| and |nc|sa| surfaces
O ueLermlned by overall arch form of anLerlor LeeLh and funcLlonal occlusal requlremenLs
4 ullshlm ln Ml
4 Cpposlng lnclsors conLacL evenly durlng proLruslve buL noL laLeral excurslve
movemenLs
4 oncavlLy ln llngual surface of maxlllary anLerlors
Lnsure smooLh surface for smooLh envelope of movemenL Lhus avoldlng
poLenLlal neuromuscular dlsLurbances
4 Llngual surfaces of mandlbular anLerlors noL overconLoured for easy plague conLrol
ab|a| surfaces
O LocaLlon of meslolablal and dlsLolablal llne angles deLermlne appearance
O lf Loo bulbous
4 ulfflculL plague conLrol
4 Llngual LllL due Lo force exerLed by upper llp
O use ad[acenL LeeLh Lo check embrasures
Wax cutback
O lor ceramlc veneers
O Lven Lhlckness of 1 mm for room for porcelaln fused onLo casL meLal subsLrucLure
Wax|ng connectors
O reaLed [usL before flnallslng marglns
O s large as posslble for opLlmal sLrengLh
O hould noL lmplnge on glnglval Llssue and aL leasL 1 mm above cresL of lnLerproxlmal sofL
Llssue
O Lmbrasure form glnglval Lo connecLlons musL enable opLlmal plague conLrol
O ervlcal aspecL musL have a smooLh archllke conflguraLlon
O laced sllghLly llngual for anLerlor prosLhesls Lo hlde behlnd aesLheLlc ceramlc veneer
kosenst|e| Chapter 22(nvest|ng Cast|ng)

nvest|ng
O rocess conslsLs of surroundlng Lhe wax paLLern wlLh a mold made from heaLreslsLanL
lnvesLmenL maLerlal ellmlnaLlng wax by heaLlnglnLroduclng molLen meLal lnLo Lhe mold
Lhrough Lhe sprue channel
O efore placemenL of sprue lnspecL wax paLLern(smooLh good flnlsh anaLomlcal conLour
removal of resldual flash LhaL exLends beyond Lhe margln)
O recauLlon wax paLLern musL be lnvesLed lmmedlaLely ny delay leads Lo dlsLorLlon coz of
sLress rellef of wax
A SkUL

8osic requirements of sprue
l llow escape of molLen wax from mold
ll MolLen meLal musL flow lnLo Lhe mold wlLh as llLLle Lurbulence posslble
lll MeLal wlLhln sprue musL remaln molLen sllghLly longer Lhan Lhe alloy LhaL has fllled
Lhe moldprovldes reservolr Lo compensaLe for casLlng shrlnkage
@pes of sprues
1ypes of sprues dvanLages ulsadvanLages
Wax MosL preferred coz melL
[same raLe as wax
paLLernallow easy escape of
molLen wax

lasLlc Mlnlmlze dlsLorLlon of 1plece
flxed denLal prosLheses casLlngs
8eason CreaLer rlgldlLy
May block escape of wax
cause rough casLlngs
8eason mp of plasLlc
spruewax paLLern
MeLal
4 CfLen hollow lncrease
conLacL sLrengLhen
aLLachmenL beLween
sprue paLLern
4 usually separaLed from
lnvesLmenL aL Lhe same
Llme as Lhe cruclble
former
osslblllLy of lncompleLe
casLlng lf removal of meLal
sprue cause Lhe breaklng off of
some lnvesLmenL maLerlal

iometer
Large dlameLer preferred lmprove flow of molLen meLal lnLo mold ensure a reservolr
durlng solldlflcaLlon (compensaLe for casLlng shrlnkage)
4 Molar meLalceramlc paLLerns 2Smm
4 remolar parLlal coverage resLoraLlons20mm
4 lrpressure machlne casLlngssprue LhaL narrows [polnL of aLLachmenLprevenL
molLen meLal from flowlng lnLo Lhe mold premaLurely
ocotion
4 Sprue shou|d be attached to nonfunct|ona| cusp where lL ls bulklesL noncrlLlcal
away from marglns occlusal conLacLs 1hls wlll a||ow stream of meta| to be
d|rected to a|| parts of the mo|d w$o hav|ng to f|ow |n oppos|te d|rect|on to the
cast|ng force
4 Cusp t|ps noL on proxlmal surface
keason Lxpans|on w|th|n the mo|d |s nonun|form Spru|ng on prox|ma| surface
produce a cast|ng that's too w|de md too short occ|usocerv|ca||y
4ttochment
4 olnL of aLLachmenL musL be smooLhedmlnlmlze Lurbulence
4 lor cenLrlfugal casLlng Lechnlque aLLachmenL area cannoL be
a) 1oo narrow lL causes cast|ng poros|ty reduce mo|d f||||ng
b) 1oo wlde lL wlll cause Lhe molLen meLal [ Lhe polnL of aLLachmenL Lo
so||d|fy |ast causlng a vold ln lnLernal aspecL of Lhe casLlng(shr|nkspot
poros|ty)
Ientinqmall auxlllary sprues/venLs |mprove cast|ng of th|n patterns
8eason
a) cL as heaL slnkensure solldlflcaLlon occurs ln crlLlcal areas flrsL
b) Pelp gases escape durlng casLlng
8 CkUC8L ICk,Lk
made of rubber serve as base for casLlng rlng durlng lnvesLlng
C CAS1- k- -Lk
asLlng rlng conLalner for lnvesLmenL whlle lL seLs resLrlcLs seLLlng expanslon of Lhe
mold
recaut|on Don't squeeze ||ner aga|nst the r|ngprevent expans|on restr|ct|on

LffecLs of varlous modlflcaLlons
a) Llner placed lnslde Lhe rlng Lo allow for more expanslon (coz of lLs
compresslblllLy) no of llner seLLlng expanslon
b) WeLLlng of llner lncrease hygroscoplc expanslon
c) bsorbenL dry llner removes waLer from lnvesLmenLLhlcker mlx lncrease ln
expanslon
oslLlon of wax paLLern ln casLlng rlng
O lngle crown cenLred ln rlng equldlsLanL from walls of rlngs
O 1plece flxed prosLheses use larger rlng so LhaL lL can be placed ln Lhe cenLre
Dk-LSS -VLS1,L-1 1LCn-;UL
O lor Lhe sLronger phosphaLebonded lnvesLmenL
O lnvolve Lhe use of paper/plasLlc rlngallow unresLrlcLed expanslonuseful for hlgher
mp alloys LhaL shrlnk more due Lo larger coollng Lra[ecLory
L S1LS - SkU- 1LCn-;UL
1 LLach approprlaLeslzed sprue Lo Lhe bulklesL nonfuncLlonal cusp angle lL so LhaL lL's
aprrox 133 Lo Lhe ad[acenL axlal walls occlusal surface
8eason faclllLaLe fllllng of mold
2 dd wax Lo Lhe polnL of aLLachmenL smooLh lL
8eason prevenL Lurbulence
3 8emove paLLern from dle w/o dlsLorLlng lL Pold sprue wlLh forceps lnserL lL lnLo Lhe
hole ln Lhe cruclble former before luLlng lL ln place wlLh wax
4 mooLh Lhe [uncLlon beLween sprue cruclble wlLh wax
3 use surfacLanL Lo lncrease Lhe weLLlng of paLLern
6 Llne Lhe casLlng rlng keeplng lL flush wlLh Lhe open end molsLen Lhe llner
7 lace Lhe paLLern 6mm away from Lhe openend of Lhe rlng

lor mulLlple casLlng Lhe dlfferenL unlLs are [olned LogeLher uslng a runner bar slngle sprue ls Lhen
used Lo feed Lhe runner bar lLernaLlvely each unlL may be fed from a separaLe sprue

kCSL-1L CnA1Lk 22 ( 687)
nvestment mater|a|
1 8efracLory maLerlal (slllca quarLz or crlsLoballlLe)
2 lnder provldes sLrengLh (gypsumbonded phosphaLebonded slllcabonded)
3 ddlLlves lmprove handllng properLles (eg 8egulaLe seLLlng expanslon reduce oxldaLlon
dea| ropert|es
1 onLrollable expanslon Lo compensaLe preclsely for shrlnkage of casL alloy durlng coollng
2 blllLy Lo produce smooLh casLlngs wlLh accuraLe surface reproducLlon wlLhouL nodules
3 hemlcal sLablllLy aL hlgh Lemp
4 dequaLe sLrengLh Lo reslsL casLlng force
3 ufflclenL poroslLy Lo allow for gas escape
6 Lasy recovery of Lhe casLlng
ypsumbonded
O asLlngs for Lype ll lll and lv gold alloy
O rlsLoballLe and quarLz Lhermal expanslon durlng wax ellmlnaLlon
O noL chemlcally sLable aL 1630
o

4 noL sulLable for meLalceramlc allows as Lhey are unsLable aL hlgh Lemp and may
lead Lo sulflde conLamlnaLlon of alloy
O Lxpanslon obLalned by manlpulaLlng
4 eLLlng expanslon by
w/p raLlo
rlng llners
mlxlng Llme
Lore aL 100 humldlLy
Pygroscoplc Lechnlque [ upper parL of rlng
4 Pygroscoplc waLer added Lo seLLlng gypsum lnv lmmedlaLely ln a waLer baLh aL
37
o
for up Lo 1 hr
llows use of sllghLly lower wax ellmlnaLlon LemperaLure
4 Lhermal expanslon
due Lo solldsLaLe phase LransformaLlon ln crysLal form ( bond angles
and axls dlmenslon denslLy and volume)
lnverslon Lemp crlsLoballlLe (200270
o
)/ quarLz (373
o
)
hosphatebonded
O MeLalceramlc frameworks meLal and ceramlc fuse aL 1400
o
addlLlonal meLal shrlnkage
occurs when casLlngs cools Lo rLp requlre added expanslon for compensaLlon
O More expanslon due Lo
4 Plgh conc of slllca refracLory maLerlal Lhan gypsumbonded lnv
4 PeaL from seLLlng lnv sofLen wax and allows for freer seLLlng expanslon
4 sLrengLh of maLerlal aL hlgh Lemp resLrlcLs shrlnkage of alloy when lL cools
4 uslng colloldal slllca
O lnder MgC and (nP
4
)
3
C
4

O chemlcally sLable aL 1630
o

O Mlxed wlLh suspenslon of colloldal slllca ln waLer
O onLaln carbon cannoL be used Lo casL base meLals because lL affecLs flnal allow
composlLlon
O used for hlgh gold or palladlum alloys
O Lxpanslon obLalned by
4 w/p raLlo (phosphaLebonded maLerlals are more senslLlve Lhan gypsum bonded
le llghL lncrease ln w/p raLlo effecL slgnlflcanL change ln seLLlng expanslon
4 uslng colloldal slllca waLer (also surface smooLhness)
O Worklng Llme
4 horLer Lhan gypsum due Lo exoLhermlc rxn ( Lemp acceleraLes rxn)
4 Longer mlxlng Llme accerleraLed rxn
4 ulluLlng colloldal slllca suspenslon worklng Llme wlLh some loss of seLLlng
expanslon
O Cas ls formed durlng rxn musL be removed by malnLalnlng a vacumm long perlod (60s) of
Llme Lo mlnlmlze nodules
O ompared Lo gypsum bonded lnv maLerlal phosphaLe bonded lnv produces rougher casLlngs
whlch are more dlfflculL Lo remove lso as phosphaLe bonded lnv has lower poroslLy
compleLe mould fllllng ls more dlfflculL (back pressure poroslLy)
S|||cabonded
O Plgh melLlng base alloys
Cast|ng A||oys
1ype of casLlng alloy used deLermlnes Lype of lnv maLerlal and casLlng Lechnlque used
Iactors to be cons|dered
lnLended use
1 1ype l slmple lnlay
2 1ype ll complex lnlay
3 1ype lll crowns and flxed denLal prosLheses
4 1ype lv parLlal removable denLal prosLheses and plnledges
3 orcelaln meLalceramlc alloys
hyslcal properLles le hardness
1 1ype l sofL
2 1ype ll medlum
3 1ype lll hard
4 1ype lv exLra hard
3 orcelaln hlgh noble meLal conLenL hardness slmllar Lo Lype ll allows
6 ase meLal alloys harder Lhan Lype lv
olour
1 Cold/sllver
omposlLlon
1 ManufacLurers musL sLaLe Lhe composlLlon by wL of 3 maln lngredlenLs and any noble
meLal
2 Cold conLenL deLermlnes corroslon reslsLance and Larnlsh reslsLance ( 73 u by wL
good corroslon and Larnlsh reslsLance
osL
1 ase meLal alloys low cosL
2 30 gold lower cosL buL more Lhan proporLlonal reducLlon ln funcLlonal characLerlsLlcs
3 du meLal cheaper alLernaLlve for menLalceramlc Lechnlque buL resulLs are less
predlcLable
4 rlce volume of casLlng x denslLy of meLal
3 crap recovery Lechnlques may be used Lo collecL noble meLals (eg MeLal caLchers or fllLer
sucLlon machlne
llnlcal performance
1 lologlcal properLles glnlglval lrrlLaLlon recurrenL carles plaque reLenLlon allergles
2 Mechanlcal properLles wear reslsLance sLrengLh marglnal flL ceramlc bond fallure
connecLor fallure and Larnlsh and corroslon
LaboraLory performance
1 asLlng accuracy surface roughness sLrengLh sag reslsLance meLalceramlc bond sLrengLh
2 nlr has lower casLlng accuracy and greaLer surface roughness Lhan gold alloys buL hlgher
sLrengLh and sag reslsLance due Lo hlgher melLlng rangers
Pandllng properLles ease of manlpulaLlon
1 blllLy Lo burnlsh Lo reduce marglnal gap wldLh and Lhus reduce exposed Lhlckness of luLlng
agenL ls lmporLanL
locompaLlblllLy
1 Pazardous maLerlals mercury chloroform sllver cyanlde hydrofluorlc acld asbesLos
uranlum salLs (ln denLal porcelaln)
2 nl allergy

nvest|ng
1 WeL wax paLLern wlLh surface Lenslon reducer dry genLly Llne casLlng rlng wlLh llner weL
llner
2 Measure waLer add lnLo dry vacuum mlxlng bowl
3 dd lnv powder Lo waLer
8rush 1echn|que
4 paLulaLe 8esldual spaLula ls wlped onLo mlxlng blade Lo malnLaln correcL w/p raLlo
conLrols expanslon
3 LLach vacuum mlxlng bowl Lo machlne LLach vacuum hose and mlx accordlng Lo Llme
recommended by manufacLurer
6 uslng a Lhln brush coaL Lhe enLlre wax paLLern wlLh lnvesLmenL maLerlal whlle genLly
vlbraLlng e especlally careful when coaLlng lnLernal surface and margln of paLLern
9osltloo floqet ooJet tbe ctoclble fotmet oo tbe toble of vlbtotot to mlolmlze tlsk of excesslve
vlbtotloo ooJ posslble bteokloq of tbe potteto ftom tbe sptoe
7 lace casLlng rlng over paLLern and flll rlng by vlbraLlng Lhe lnvesLmenL ouL of bowl lnLo Lhe
slde of Lhe rlng slowly
8 When lnvesLmenL reaches level of wax paLLern LllL Lhe rlng several Llmes Lo cover and
uncover Lhe paLLern Lhereby mlnlmlzlng Lhe posslble enLrapmenL of alr lnvesLlng should be
performed qulckly before Lhe lnvesLmenL maLerlal seLs
9 fLer rlng ls fllled Lo rlm allow Lhe lnvesLmenL Lo seL
10lf hygroscoplc Lechnlque ls used place Lhe rlng ln 37o waLer baLh for 1 hr
Vacuum 1echn|que
4 Pand spaLulaLe
3 WlLh casLlng rlng placed lnLo cruclble former aLLach he rlng Lo Lhe mlxlng bowl
6 LLach vacuum hose and mlx accordlng Lo Llme recommended by manufacLurer
7 lnverL Lhe bowl and flll Lhe rlng under vlbraLlon
8 8emove vacuum hose before shuLLlng off Lhe mlxer
9 8emove Lhe fllled rlng from bowl
10lmmedlaLely clean Lhe bowl and mlxlng blade under waLer
Wax LllmlnaLlon
O urnouL heaLlng Lhe lnvesLmenL ln a LhermosLaLlcally conLrolled furnace unLll all Lraces of
wax are vaporlzed
O 1emperaLure furnace reaches deLermlnes Lhermal expanslon of lnv maLerlal
O ll waLer ln Lhe lnvesLmenL musL be drlven off
O PeaL soak Lo malnLaln LemperaLure for a perlod of Llme Lo mlnlmlze sudden drop ln
LemperaLure upon removal CLherwlse lncompleLe casLlng may resulL because of excesslvely
rapld solldlflcaLlon of alloy durlng casLlng
O Cnce lnv ls heaLed casLlng musL be compleLed oollng and reheaLlng of lnvesLmenL can
cause casLlng lnaccuracy because refracLory mould and blnder do noL reverL Lo Lhelr orlglnal
form leadlng Lo lnadequaLe expanslon and cracklng of lnv maLerlal
Leps
1 llow lnvesLmenL Lo seL for 1 hr remove cruclble former 8emove meLal sprue lf used
a lf sLored overnlghL rlng should be placed ln humldor
b mooLh skln" of phosphaLe bonded lnv should be removed and any loose parLlcles
of lnvesLmenL shld be blown off w compressed alr
2 8eexamlne Lhe rlng for any resldual parLlcles and Lhen place lL wlLh Lhe sprue faclng down ln
Lhe furnace wlLh rlbbed Lray allow molLen wax Lo flow ouL freely
3 rlng furnace Lo 200
o
and hold Lhls Lemp for 30 mln mosL wax ls by Lhen ellmlnaLed
4 heaL Lo flnal burnouL Lemp (630
o
or 480
o
lf hygroscoplc expanslon used) Pold Lemp for
43 mlnuLes s heaLlng raLe affecLs expanslon lL should be sLandardlzed for accuraLe
casLlngs
3 Mold ls noL ready for casLlng
6 lnv should noL be overheaLed or kepL aL Lemp for Loo long as gypsumbonded lnv are noL
sLable aL 630o lso some carbon ln carbonconLalnlng lnv burns off and cause surface
roughness
7 efore casLlng check lf sprue ls properly heaLed lL should be cherryred colour
cceleraLed casLlng meLhod
asLlng produced ln 3040 mlnuLes ln a onevlslL procedure lL enLalls Lhe use of phosphaLebonded
lnvesLmenL (13 mln bench seL 13 mln wax ellmlnaLlon aL preheaLed furnace of 813o) rocedure
has been found Lo produce casLlngs wlLh accuracy and surface roughness slmllar Lo Lhose of
LradlLlonal meLhods
asLlng
Machlnes
1 PeaL Lo melL alloy
a 8educlng flame/Lorch
l Casalr Lorch
ll Casoxygen Lorch meLalceramlc alloys (hlgher melLlng range)
lll MulLlorlflce gasoxygen Lorch or oxyaceLylene Lorch base meLal allow
b LlecLrlc heaLlng by lnducLlon currenL or convecLlon from heaLlng elemenL more
evenly conLrolled Lhan Lorch prevenLlng volaLlzaLlon and ln alloy composlLlon
2 rovlde casLlng force alr pressure or cenLrlfugal
a Plgh enough Lo overcome hlgh surface Lenslon of molLen allow
b 8eslsLanL Lo gas wlLhln Lhe mold
c vacuum has been shown Lo lmprove mold fllllng
1echnlque
1 uo noL remove rlng from furnace unLll allow has been melLed and ls ready Lo casL
2 1o reuse prevlously casLed alloys
a need Lo remove lnvesLmenL debrls and oxldes
b noble meLal can be melLed on a charcoal block wlLh gasalr Lorch Lo provlde
reduclng env
c 8emalnlng lmpurlLles are removed Lhrough plcklng and ulLrasonlc or sLeam cleanlng
3 asLlng machlne glven 3 clockwlse Lurns (4 for meLalceramlc casLlng)
4 radle and counLerbalance welghLs checked for approprlaLe slze of casLlng rlng
3 reheaL cruclble prevenLs excesslve slag formaLlon durlng casLlng and ensure compleLe
melLlng of alloy
6 lloy ls added Lo cruclble ufflclenL mass requlred for adequaLe casLlng pressure lor hlgh
noble meLal alloy
a remolar anLerlor LeeLh casLlng 6g
b Molar casLlng 9g
c onLlcs 12g
7 lloy ls heaLed wlLh reduclng parL of flame llux can be added Lo gold alloy
8 When allow ls ready Lo be casLed
a Cold alloys ball up and have mlrrorllke surface LhaL appears Lo be splnnlng
b nlr and cobalL alloy sharp edges of lngoL round over
9 lace rlng ln cradle
10asLlng arm ls Lhen allowed Lo spln
8ecovery of casLlng
1 lunge rlng lnLo bowl of runnlng cold waLer
2 Cypsumbonded lnv dlslnLegraLe and ellmlnaLlon of resldue ls accompllshed wlLh a LooLh
brush
3 More dlfflculL Lo remove phosphaLebonded lnvesLmenL
a knlfe ls used Lo Lrlm aL Lhe buLLon end of Llng when llner ls exposed push lnv ouL
of rlng
b lL ls Lhen broken aparL under runnlng waLer
4 llnal Lraces removed ulLrasonlcally
3 Cxldes removed by plckllng (30 Pl)
LvaluaLlon
asLlng ls never flLLed on Lhe dle unLll lnner surface has been carefully evaluaLed under
magnlflcaLlon
uefecLs ln casLlng examlned under mlcroscope
1 8oughness llnes of grooves near marglns or flLLlng surface necesslLaLe a remake
generallzed roughness lndlcaLe breakdown of lnv from excesslve burnouL Lemp
2 nodules bubbles Lrapped durlng lnvesLlng remove wlLh x or Z round bur
a volded by careful lnvesLlng Lechnlque used of surfacLanL vacuum spaLulaLlon
careful coaLlng of wax
b hosphaLebonded lnvesLmenL ls prone Lo lmperfecLlons
3 llns due Lo cracks ln Lhe lnvesLmenL weak mlx of lnvesLmenL excesslve casLlng force Loo
rapld heaLlng reheaLlng of lnvesLed paLLern wax paLLern slLuaLed Loo close Lo perlphery
premaLure/rough handllng of rlng afLer lnvesLmenL
4 lncompleLe casLlng
a Wax Loo Lhln (03mm)
b lnadequaLe heaLlng of meLal (solldlfy before fllllng mold)
c lncompleLe wax ellmlnaLlon
d Lxcesslve coollng or mold before casLlng
e lnsufflclenL casLlng force
f lnsufflclenL meLal/meLal splllage
3 volds or poroslLles
a uebrls Lrapped ln mould (wellwaxed smooLh sprue prevenLs Lhls)
b uckback poroslLy (sprue solldlfles before meLal lf sprue ls Loo narrow Loo long or
lncorrecLly locaLed absence of chllle cenL
c Cases may dlssolve molLen alloy
6 ack pressure poroslLy
a uue Lo alr pressure ln mold caused by lnsufflclenLly porous lnvesLmenL or excesslve
Lhlckness of lnvesLmenL near end of rlng
7 Marglnal ulscrepancles
a uue Lo dlsLoraLlon durlng removal of wax paLLer
b uue Lo seLLlng expanslon afLer uneven expansl of mould
8 ulmenslonal lnaccuracles
a lncorrecL w/p raLlo spaLulaLlon Llme rlng llner mold heaLlng
8efer Lo pg 702 and 703