Sunteți pe pagina 1din 68

Good morning

Full Veneer Retainers in


Fixed Partial Denture
PRESENTED BY
DR. SUKHJIT KAUR
Components of FPD

In fixed prosthodontics it is the retainer which provides
retention and resistance against horizontal oblique and
vertical dislodging forces.
Retainer:
Any type of device used for stabilization or retention
of a prosthesis (GPT-8)
Fixed partial denture retainer:
The part of a fixed dental prosthesis that unites the
abutment(s) to the remainder of the restoration (GPT-8)
Extra coronal retainers:
That part of a fixed dental prosthesis uniting the
abutment to the other elements of a prosthesis that
surrounds all or part of the prepared crown (GPT-8)
INTRODUCTION
Requirements of an Ideal retainer
Prime requirement is mechanical function
to be constructed without injury to pulp &
supporting tissues
should protect and maintain the pulp against
thermal and galvanic shock.
ability of the retainer to provide safety for the
tooth during the lifetime of the restoration
establishment of self-cleaning property of the
retainer
Retainer with least tooth reduction is more
advisable
Stress should be dispersed to the more
receptive areas of the abutment
Uses of retainer

To improve the masticatory efficiency.
To establish the contact point to prevent
food lodgment.
To be useful in correcting malalignment.
To close diastema in anterior teeth.
To prevent drifting of teeth.

Classification of retainers
I. Based on type of preparation
A. Intra coronal retainers.
Modified class II inlay and MOD onlays.
Pinledge retainers.
B. Extra coronal retainers
Full veneer crown.
Partial veneer crowns.
C. Radicular retainers
Dowel crowns
Richmond crowns

II. Based on type of materials used in the
construction of retainers.
Metals e.g. Nickel chrome, Titanium,
Cobalt chrome.
Porcelain
Acrylic resins
Composite resins
Combination of any metal with porcelain or
acrylic resin or composite resin.
III. BASED ON TOOTH COVERAGE

1.Major retainers-

-Full veneer crown and partial veneer crowns

2.Minor retainers
Inlays and onlays
Indications for multiple retainers
Abutment teeth with short roots.
Lack of sufficient bone support.
Density of alveolar bone.
Excessive length span.
Excessive lever arm action because of shape of
anterior arch.
Distal extension of pontic for increased function.
Replacement of a missing cuspid.

TELESCOPIC RETAINERS
This type of retainer is used when the path of insertion of
the fixed partial denture does not coincide with the long
axis of the abutment tooth. The design involves the
fabrication of two copings, one over the other. The internal
or primary coping functions to modify the morphology of
the tooth. The secondary coping is designed to fit over the
primary coping along the new path of insertion.
Selection of retainers

Retainer selection is usually dictated by:
1) age
2) DMF rate
3) edentulous span
4) Periodontal support
5) arch position of the teeth
6) Skeletal relationships
7) Inter occlusal and intra occlusal conditions such as
crown length
8) Existing and projected oral hygiene of the patient
9) Vitality of the potential abutment


CRITERIA FOR SELECTING TYPE
OF RETAINERS

Alignment of abutment teeth
If the abutment teeth are aligned parallel to
one another, a full veneer crown can be
given. A fixed-fixed bridge can be designed.
If the abutment teeth are not aligned parallel
to one another, a pin retained crown which
need not to be placed along the long axis of
the tooth.
Appearance
Sometimes full veneer crowns show superior esthetics to partial
veneer crowns and sometimes neither type will be completely
satisfactory.
It is best to retain facial /buccal surface of the natural tooth as
they provide the best aesthetics.
In cases with inadequate pontic space, full coverage restoration
can be designed for better appearance.

The condition of abutment teeth
Partial veener crowns are preferred for non
carious abutment or abutments with large
restoration but intact facial/buccal surface.
Endodontically treated teeth may have to be
restored with core/post before designing the
retainer.
Cost
Anterior restorations are best restored with
all ceramic crowns but they are the most
expensive.
Metal ceramic crowns could be
economically the best replacement for both
anterior and posterior teeth.

Preservation of tooth structure
Buccal/facial surface should be conserved.
Partial veneer crowns are more
conservative than full crowns.
All ceramic crowns are the least
conservative.
EXTRA CORONAL RETAINERS

Full veneer crowns
They are of three types
Complete metal veneer crowns
Metal ceramic crowns
All ceramic crowns

Complete cast crown/ full crown/ full cast crown/
complete crown :
Complete cast metal crowns can be used where the
breakdown of tooth structure is severe. Full veneer crown
describes a restoration entirely made of cast metal.

Has the best longevity of all fixed restorations

Advantages
1) Greater retention
2) Greater resistance form
3) Strength
4) Modification of axial tooth contour
-special significance when dealing with malaligned teeth
-better access to improved oral hygiene.
5) special requirements
-when retainers are needed for RPD
6) Easy occlusal modifications
- in supra erupted teeth

Disadvantages
1) Extensive removal of tooth structure
2) Adverse effects on soft tissue
3) Vitality tests not feasible
4) Display of metal

Indications
Any posterior tooth in non-esthetic zone.
Short clinical crowns.
Fractured tooth.
Long edentulous span.
Occlusal forces greater than average.
Abutment tooth alignment that requires full coverage
preparation to achieve adequate retention.
Extensive destruction from caries or trauma.
Endodontically treated teeth.
Necessity for maximum retention and strength.
To provide contours to receive a removable appliance.
Other recontouring of axial surfaces (minor corrections of mal-
inclinations).
Correction of occlusal plane.

Contraindications
1) When conservative treatment can be
carried out
2) If intact buccal or lingual wall exists
3) If less than maximum retention and
resistance are needed
4) High esthetic needs

Rotary instruments used for full veneer preparations:


Shape

Use
Round end tapered
diamond
Depth orientation grooves ,Occlusal reduction,
Functional cusp bevel
Torpedo diamond Axial reduction , Chamfer finish line
Short needle Initial interproximal axial reduction in posterior
teeth
Long needle Initial proximal axial reduction in anterior teeth
Small wheel diamond Lingual reduction in anterior teeth
Tapered fissure bur
(171L)
Seating groove , Proximal groove (posterior
teeth) , Smoothing and finishing,
Occlusal and incisal bevels
Tapered fissure burs
(169L & 170L)
Initial groove alignment , Angles of proximal
boxes , Smoothing and finishing, Occlusal
and incisal bevels
End cutting bur Conventional shoulder finishing
Torpedo bur Axial wall finishing , Chamfer finishing
Flame bur Flare and bevel finishing
TOOTH PREPARATION FOR COMPLETE CAST
CROWN
The clinical procedure to prepare a tooth for a
complete cast crown consists of the
following steps:
Occlusal guiding grooves
Occlusal reduction
Axial alignment grooves
Axial reduction
Finishing and evaluation
PUTTY INDEX AS GUIDE FOR
TOOTH REDUCTION

Occlusal guiding grooves:
Using a round end tapered diamond
and no: 171 bur, depth orientation
grooves are made on the triangular
ridges and primary developmental
grooves.
The depth orientation grooves should
be 1.3mm deep on functional cusps
and 0.8mm deep on non-functional
cusps, allowing 0.2 mm for smoothing
the preparation.
The tooth structures between the
orientation grooves are removed
following cuspal contours.
Functional cusp bevel is
placed using round end tapered
diamond and no: 171 bur. The
bevel should parallel the inward
facing inclines of the cusps of
the opposing tooth, at a depth
of 1.5 mm usually forming a 45
angle with the axial wall.

Nonfunctional (Noncentric) Cusp
Bevel: A minimum of 0.6 mm of
clearance at the occlusoaxial line
angles of the nonfunctional cusps is
needed for adequate strength.
Maxillary molars in particular often
require an additional reduction bevel
in this area to avoid an
overcontoured restoration that does
not follow normal configuration.
Such additional reduction is often
unnecessary for mandibular molars,
however, because they are lingually
inclined and their profile is relatively
straight.

Alignment Grooves for Axial Reduction:

Three alignment grooves are placed in each buccal and
lingual wall with a narrow, round-end, tapered diamond.
One is placed in the center of the wall, and one in each
mesial and distal transitional line angle.
position of the bur automatically produces a 6 degree
convergence between the axial walls.
Use a periodontal probe to assess the relative parallelism of
the alignment grooves with one another or with the proposed
path of withdrawal, of a secondary abutment.
Making an impression with irreversible hydrocolloid
(alginate) and pouring in rapid-setting stone generates a cast
that can be analyzed with a dental surveyor.
Facial and lingual axial reduction is done
with a torpedo diamond producing a definite
chamfer finish line at the same time. The
facial and lingual reduction is carried as far as
possible into the interproximal embrasures
without nicking the adjacent teeth.

Mesial and distal axial
reduction. A short thin tapered
diamond is placed against the
facial surface of the remaining
interproximal tooth structure.
Ensure that adequate clearance
( 0.6 mm) exists between the
external surface of the proximal
chamfer and the adjacent tooth.
Finishing
Use a fine-grit diamond or carbide torpedo
bur of slightly greater diameter for finishing
the chamfer margin. This should be done as
smoothly as possible, with the handpiece
operating at reduced speed. A properly
finished margin should be glassy smooth
when touched by the tine of an explorer.
Finish all prepared surfaces and slightly
round all line angles.
Seating groove is made on
the axial surface using no:
171 bur. The groove should
be cut to the full diameter and
it should extend gingivally to
a point 0.5 mm above the
chamfer.
The completed preparation
is characterized by a
smooth, even chamfer; a 6-
degree taper; and gradual
transitions between all
prepared surfaces.
Features of full veneer crown preparation and the
function served by each
METAL CERAMIC RESTORATION:

The use of porcelain fused to metal
restorations has grown from the development
of the first commercially successful porcelain/
gold alloy restoration by Weinstein et al in
1950s. A porcelain-fused to metal crown can
serve as a strong and esthetic restoration.
indications
Single and multiple restorations for both anterior and posterior
teeth.
Mandibular anterior teeth where full shoulder preparations are
prohibitive.
Peg shaped laterals or malformed teeth.
Patients with reduced interocclusal clearance.
Extensive tooth destruction as a result of caries, trauma or
existing previous restorations.
Need for superior retention and strength.
An endodontically treated tooth with post.
Need to recontour axial surfaces or correct minor malocclusions.
Esthetics
If porcelain jacket crown is contraindicated.
Contraindications
Large pulp chamber because of high risk of
pulp exposure.
Intact facial wall
When more conservative retainer is
technically feasible.
Patients with active caries or untreated
periodontal disease

Advantages
Superior esthetics as compared to complete cast crowns.

Strength imparted to tooth is superior as compared to
partial veneer.

Excellent retentive qualities

Two in one property
-because it is a combination
-Underlying principle
-Natural appearance
Disadvantages:
Removal of substantial tooth structure.
Subject to fracture because porcelain is brittle.
Difficult to obtain accurate occlusion in glazed
porcelain.
Inferior esthetics compared to porcelain jacket crown.
Expensive.
Shade selection can be difficult.

POSTERIOR PORCELAIN FUSED TO METAL
CROWN PREPARATION
Planar occlusal reduction is done using round
and tapered diamond and no: 171 bur.
The depth orientation grooves should be 1.5 to
2.0 mm in occlusal areas where porcelain
coverage is required.
The tooth structures between the orientation
grooves are removed following cuspal
contours.

Recommended minimum dimensions for a
PFM crown
Functional cusp
bevel is done using
round end tapered
diamond and no: 171
bur.
The bevel should
parallel the inward
facing inclines of the
cusps of the opposing
tooth, at a depth of
1.5 mm usually
forming a 45 angle
with the axial wall.
Depth orientation grooves for axial
reduction
A flat end tapered diamond is first aligned with the
occlusal portion of the facial surface and three vertical cuts
are made to the full diameter of the diamond, fading out at
the break where the curvature of the facial surface is the
greatest.
Two similar grooves parallel to the gingival segment of the
facial surface.
Facial reduction, occlusal half: A flat end tapered
diamond is used to remove the tooth structure remaining
between the orientation grooves in the occlusal portion of
the facial surface.


Facial reduction, gingival half: A flat end tapered
diamond is used to reduce the gingival segment and
extend well into the proximal surface. 1.2 mm to 1.4 mm
is the accepted reduction
Proximal axial reduction:
Short needle diamond facilitates
interproximal reduction without nicking
the adjacent tooth. Once separation
between the teeth is achieved, the
needle diamond is used to plane the
proximal axial wall.

Lingual axial reduction: A
torpedo diamond is used for lingual
axial reduction and to round over the
corner created at the line angle with
the proximal surfaces.

Axial finishing: All axial surfaces to be
veneered with metal are finished using a
torpedo finishing bur producing the chamfer
finish line.
The facial surface and those areas of the
proximal surfaces to be veneered with
porcelain are smoothened with the flat end
tapered bur or no: 171 bur.
Lingual to the proximal contact, the transition
from the deeper facial reduction to the
relatively shallower lingual axial reduction
result in a vertical wall or wing of tooth
structure.


Shoulder finishing: No: 957 bur is used
to finish the shoulder and is planed with a
sharp 1.0 m wide chisel.
Gingival bevel: Flame shaped diamond
and finishing bur are used to produce a
narrow bevel, no wider than 0.3 mm.

criteria
PREPARATION FOR ANTERIOR PORCELAIN
FUSED TO METAL CROWN

Incisal reduction: Depth grooves are placed
(about 1.8mm) in the incisal edge of the anterior
tooth that will provide needed reduction of
2mm.

Facial reduction:
Depth grooves are placed one at the
centre of the facial surface and one
each in approximate locations of
mesiofacial and distofacial line angles.
These grooves will be placed in two
planes:
Cervical portion - parallel to the long
axis of tooth
Incisal portion - follow the normal
facial contour.
The cervical portion will determine the
path of withdrawl while incisal portion
will provide the space for porcelain
veneer.

Finish line:
If a restoration with a narrow subgingival metal collar is
to be fabricated and sufficient sulcular depth is present,
the shoulder is placed 0.75-lmm subgingivally.

The resulting shoulder should be 1mm wide and should
extend well into the proximal embrasure at least 1 mm
lingual to the proximal contact. On the mesial (visible)
side, the preparation extends slightly farther than on the
distal (cosmetically less critical) side.
Lingual reduction
Lingual surface is reduced with the
diamond held parallel to the intended
path of withdrawl. A Cervico Incisal
taper of approx 6 is indicated.
The lingual concavity is prepared for
adequate clearance using a football
shaped bur.
Typically lmm is required if centric
contacts in the completed restoration
are to be located in metal where as
on porcelain additional clearance is
needed.
Lingual chamfer is indicated.

Interproximal reduction
A short needle diamond is used to begin
the proximal axial reduction without
touching the adjacent tooth.
The axial reduction interproximally is
completed by running the flat end tapered
diamond labially and torpedo bur lingually.


Winged preparation
Wingless preparation
Finish line configuation:
A porcelain labial margin requires proper support for the
porcelain. A shoulder with 90
0
cavosurface angle is
recommended.
A sloping shoulder has been advocated to ensure the
elimination of unsupported enamel and to minimize the
marginal gap width. Such a shoulder of 120
0
cavosurface
angle can be accomplished by flat end diamond by changing
its alignment, paying particular attention to the configuration
of tooth structure cervical to the margin.
Lingually chamfer and Interproximally shoulder is indicated.

ALL CERAMIC CROWN:
The porcelain jacket crown was developed in 1886.
In 1965 Mclean and Hughes developed an inner core of
aluminous porcelain containing 40% to 50% of alumina
crystals to improve material characteristics. Later, platinum
foil was included to further improve the porcelain crown.
In the 1980s Dicor, a castable ceramic became widely
used. Today the latest generation of materials utilizes high
strength ceramics with composite materials to reinforce the
ceramic. Todays materials include Procera, In-Ceram,
Empress I and Empress II.
ALL CERAMIC CROWNS
Indications:
High esthetic requirement
Considerable proximal
caries
Incisal edge reasonably
intact
Endodontically treated
teeth with post and cores
Favourable distribution of
occlusal load

Contraindications:
When superior strength is
warranted because of
absence of reinforcing
metal substructure.
Significant caries with
insufficient coronal tooth
structure for support.
Thin teeth faciolingually.
Unfavourable distribution
of occlusal load.
Advantages:
Superior esthetics.
Good tissue response even
for subgingival margins.
Slightly more conservative
of facial wall.
Disadvantages:
Reduced strength compared
to metal ceramic crown.
Proper preparation extremely
critical to ensure mechanical
success.
Least conservative.
Brittle nature of material.
Causes wear on the functional
surfaces of natural teeth that
oppose porcelain restorations.


Tooth preparation for posterior all
ceramic crown
Occlusal reduction: A large round end tapered
diamond is used to place depth orientation grooves on
triangular ridges and major grooves.
The final occlusal reduction should be 1.5 mm to 2.0 mm
deep.
Remove the tooth structure remaining between the
depth-orientation grooves with the large round-end
tapered diamond.

Functional cusp bevel: A minimum of 1.5 mm of
clearance is necessary.
Facial and lingual axial reduction: The large round end
tapered diamond is used to obtain axial reduction ranging
from 1.0 to 1.5 mm
Proximal axial reduction: A short needle diamond and
then round end tapered diamond. Depth - 1.0 to 1.5 mm
Preparation finishing: round end tapered carbide bur is
used to finish the axial surfaces, the functional cusp bevel
and chamfer finish line all around.
Uniform circular preparation without grooves is preferred.
The shoulder preparation should have an angle of 90-120
degrees.
Flat chamfers, tangential preparations and bevels are
contraindicated.
The features for an all ceramic crown on a posterior tooth and
the function served by each

TOOTH PREPARATION FOR ALL CERAM
ANTERIOR CROWNS:

Incisal reduction:
2.0 mm deep
flat-end tapered diamond
Labial reduction:
1.2 to 1.4 mm deep
The rounded shoulder or
chamfer should be a
minimum of 1.0 mm wide.
Lingual reduction
done with the small wheel
diamond AND the flat-end
tapered diamond
radial shoulder
Proximal reduction: is
similar to labial and
lingual reductions
Tooth reduction for zirconia-based crowns is less than
that for PFM or traditional all-ceramic crowns.
The reasons are that zirconia is very strong (>1000 MPa)
and no opaque layer is required.
This is also true regarding other bonded porcelain
veneers.
The reduction can be kept less than 1mm all around with
a chamfer as finish line.


Summary and Conclusion
The objective in selection of retainer whether it involves
a single tooth, several teeth or complete restoration of
masticatory mechanism, it should restore and maintain
function of dental arch. It should be therefore both
restorative and preventive.
To accomplish this objective preventive as well as
therapeutic measures should be utilized. The efficiency in
selecting the retainer depends on the intelligent application
of mechanical, physiological, hygienic and esthetic
principles within the limits of the supporting tissues.