Indirect Restorations Metal-Ceramic (PFM) Crown Prep.

Upper 1st Premolar

Metal-ceramic crowns are also known as "Porcelain Fused to Metal" (PFM) crowns. Where porcelain is needed, extra reduction must be undertaken to make room for both metal and ceramic. In places where porcelain is not needed, for example the palatal margin, less reduction is done.

Slide show: Metal-Ceramic Crown Prep. Upper 4.

ASSESSMENT. Study the unprepared tooth; visualize the preparation shape you want to achieve. Decide which areas will be restored with alloy and which areas will require more room for alloy and porcelain only. Plan where you will place your finishing lines, and what type of margin will be where.

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ASSESSMENT. Study the unprepared tooth; visualize the preparation shape you want to achieve. Decide which areas will be restored with alloy and which areas will require more room for alloy and porcelain only. Plan where you will place your finishing lines, and what type of margin will be where.

OCCUSAL DEPTH SLOTS (GROOVES) BUCCAL CUSP Using 501 round-ended tapered diamond* cut a depth slot into the central ridge of the buccal cusp. As this cusp will be covered in alloy and porcelain, reduction should be 2.0mm. Cut 2 more occlusal slots mesially and distally to the first. *The 501 bur acts as your depth gauge, its dimensions are: Tip 1.1mm; Maximum diameter 1.6mm; length 7.0mm ; Taper 4.5 (9 convergence)

OCCLUSAL DEPTH SLOTS PALATAL CUSP Cut 3 slots in the palatal cusp, at depth 1.5mm if it is to be covered in alloy only or 2.0mm if porcelain coverage is required.

JOIN DEPTH SLOTS BUCCAL CUSP. Using 501 join depth slots on the buccal cusp to create a smooth, uniform, planar reduction that follows the general occlusal morphology. Note that a thin band of marginal ridge can be left unprepared to prevent bur contact with the adjacent tooth and aid in depth orientation.

JOIN DEPTH SLOTS PALATAL CUSP. Repeat for palatal cusp.

FUNCTIONAL CUSP BEVEL. Use 501 to prepare a smooth, uniform functional cusp bevel on the palatal cusp, at an angle that approximates the inclination of the opposing cusps (about 45). Reduction is 1.5mm for alloy; 2.0mm for gold, and can be begun with depth grooves.

BUCCAL DEPTH SLOTS OCCLUSAL HALF. Buccal axial reduction is completed in 2 (or more) planes because of the curvature usually present in premolars. Use 501 bur to cut 1.5mm depth slots in the occlusal half of the buccal surface, fading out at the maximum bulbosity.

BUCCAL DEPTH SLOTS CERVICAL HALF. Using 501 bur cut 1.0mm deep marginal depth slots parallel to the cervical half of the buccal surface. Finish depth slots supragingivally.

BUCCAL DEPTH SLOTS CERVICAL HALF. Alternative view

PLANAR BUCCAL REDUCTION. Attempting the buccal axial reduction in one plane will: - Cut too much tooth away in the middle of the buccal surface. - Create an irretrievable over-taper of the buccal surface. - Risk pulpal exposure. - Leave occlusal 1/3 of axial wall under-prepared, resulting in a finished crown of poor contour.

BUCCAL REDUCTION OCCLUSAL HALF (View 1) Join the buccal depth slots in the occlusal half of the preparation.

BUCCAL REDUCTION OCCLUSAL HALF (View 2) Join the buccal depth slots in the occlusal half of the preparation.

BUCCAL REDUCTION OCCLUSAL HALF (View 3) Join the buccal depth slots in the occlusal half of the preparation.

BUCCAL REDUCTION / SHOULDER CREATION. Using 501 join the marginal depth slots and create a shoulder that: - Is 1.0mm in depth. - Is supra-gingival, even if the finished shoulder is to be sub-gingival - Has a rounded internal line angle. - Follows the contour of the gingivae buccally Keep the long axis of the bur parallel to the buccal surface, in the same way as the depth slots.

EXTEND SHOULDER INTERPROXIMALLY Extend the shoulder interproximally until it is out of sight buccally when looking along the line of the arch. This creates the so-called wings which conserve tooth tissue and mark the point at which porcelain coverage will terminate. NB: These are not slots/grooves.

CLEAR CONTACTS Use 582 needle point diamond to cut through the marginal ridge inside the contact point. Great care is needed to prevent damage to the adjacent teeth. Cut through the tooth so that a strip of proximal enamel protects the adjacent tooth from bur contact; do not attempt to take the bur between the teeth. The aim of this part of the preparation is simply to separate the teeth.

PLANE PROXIMAL SURFACES. Once the contacts are clear, use the needle point diamond to plane the proximal surfaces until there is sufficient access for your torpedo diamond, without contacting the adjacent teeth. Clinical note: your technician is going to have to saw the model between your prep and the adjacent tooth. If you dont leave enough room, your margin and/or the proximal surface of the adjacent tooth may be lost.

15.PALATAL CHAMFER. Using your 877 Torpedo diamond prepare the palatal axial surface to create the correct convergence relative to the cervical half of the buccal axial preparation.

INTERPROXIMAL CHAMFER. Use the torpedo diamond to join the palatal chamfer and the buccal shoulder. - Keep the margin supra gingival. - Monitor the bur angulation to create the correct taper between proximal axial walls.

BLEND PALATAL AND INTERPROXIMAL CHAMFERS Round any line angle between palatal and proximal axial preparations to ensure alloy will have the correct contour and a natural emergence profile. Do not over-round your preparation.

SHOULDER FINISHING (View 1) The position for the buccal margin should be planned in advance. Keep the margin supragingival. Preparation with 501 diamond will produce a rounded internal line angle that will reduce stress concentration when fabricating, cementing and using the crown. The 501 will also create a rounded lip towards the outside of the shoulder, this must now be carefully flattened with a flat-tipped bur eg: 847 tapered diamond (Tip diameter 1.01mm) and/or a sharp margin trimmer.

SHOULDER FINISHING (View 2) ... using the chisel

CHECK AXIAL TAPER Dry and carefully view your preparation from all angles and check the following: No undercuts. 10-20 convergence angle. The whole margin and all internal angles are visible, when viewed from one position above. Smooth any sharp line angle where the buccal axial planes meet, to reveal any part of the shoulder hidden when viewed from above.

SMOOTH PREPARATION Using composite finishing burs, fine discs or rubber cups + pumice, gently smooth line and point angles.

FINISH.

FINISH.