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PREPARATION FOR
CAST
RESTORATIONS
DEEPTHI P.R.
II YEAR MDS
CONTENTS
Introduction
Preparation path
Apico occlusal taper of a preparation
Preparation features of the circumferential tie
Mechanical problems for cast restorations and preparation design solutions in
general
INTRODUCTION
Cast alloys & ceramics: intracoronal & extracoronal
Intracoronal: Mortise shaped, definite walls & floors joined at line angles, point
angles
Extracoronal: Occlusal and axial surface reduction, ending gingivally with no
definite flat floor
General principles of tooth preparation- applicable
Greater surface extension in outline form than amalgam
support for tooth structure
excellent marginal manipulation
compensates for cariously weak joints :
self- cleansable & /or protection
PREPARATION PATH
Single insertion path: opposite to the direction of occlusal loading- function
will seat restoration rather than displace it
Tooth reduction: oriented in one path, the path of withdrawal & insertion of
the future wax pattern & restoration
Parallel to the long axis of the tooth crown
Enhanced retention & reduced micro movements during function
APICO-OCCLUSAL TAPER OF A
PREPARATION
Opposing walls & axial surfaces: perfectly parallel to each other- maximum retention
- materials inserted & withdrawn from preparation
- permanent deformation: impractical technique/ misfitting restorations
Exact parallelism: technical problems
Slight divergence of opposing walls intracoronally & slight
convergence of opposing axial surfaces extracoronally
APICO-OCCLUSAL TAPER OF A
PREPARATION
2 to 5 degrees from the path of preparation increased or decreased:
1. Length of the preparation wall and/or axial surfaces
The greater the wall length is, the more taper will b necessary: not> 10 degrees
The less the wall length is, the less the taper will be, approaching 0 degrees: but
should not be less in extremely short walls
2. Dimensions and details of surface involvement and internal anatomy in the
preparation
The greater the surface involved
The more detailed the internal anatomy
APICO-OCCLUSAL TAPER OF A
PREPARATION
3. The need for retention
The greater the need: the lesser the taper- approach parallelism
Greater occlusal reduction and rounded internal & external anatomy for non
noble alloys & cast ceramics - less taper to compensate for loss of retention
Taper: equally at the expense of two opposing walls/ axial surfaces- one
path of insertion
Solely at the expense of one side only: opposing side absolutely parallel to
insertion path
APICO-OCCLUSAL TAPER OF A
PREPARATION
Preparation should not be made with one side having more taper than the
other:
More than one path of insertion
Micromovements of the final restoration
If cariogenic & anatomical conditions dictate two different tapers for opposing
walls: preferable to create two planes- inner & outer
Inner planes: parallel to each other or of equal taper- assure single path of
insertion
Outer planes: satisfy the needs compelling different tapers
APICO-OCCLUSAL TAPER OF A
PREPARATION
Factors determining the choice of design
Cariogenic & anatomical considerations
Different lengths of opposing parts of the preparation
Need for reciprocal retention
Presence of more surrounding walls/ axial surfaces on one side than the other
BEVELS
PARTIAL BEVEL
Part of the enamel wall not > 2/3rd of its dimension
Not used usually
Trims weak enamel rods from margin peripheries
SHORT BEVEL
The entire enamel wall, but not dentin
Used mostly with Class I alloys especially for type 1 and 2
BEVELS
LONG BEVEL
Enamel wall and upto one half of the dentinal wall
Most frequently used for the first 3 classes of materials
Preserves the internal boxed up retention and resistance features
FULL BEVEL
All of the enamel and dentinal walls of the cavity wall or floor
Well reproduced by all 4 classes of alloys
Deprives the preparation of the internal resistance & retention
Used only when any other bevel is impossible to b used
BEVELS
COUNTERBEVEL
Capping cusps to protect and support them
Bevel used opposite to a an axial wall- on the facial or lingual surface
Gingival inclination facially or lingually
HOLLOW GROUND/ CONCAVE BEVEL
Any bevel especially long, full or counter bevels when prepared in a concave
form
More space for cast material: materials castability, retention and better
resistance to stresses
Ideal for Class IV and V
BEVELS- Functions
Bevel portion: specific angulation relative to the remaining portion of the
wall/ floor, the long axis of the crowns or a specific landmark
Extend to certain limits
Create obtuse- angled marginal tooth structure: bulkiest & strongest
configuration
Acute angled marginal cast alloy substance: most amenable to burnishing
Eliminates the cement line by bringing the cast alloy closer to tooth structure
BEVELS- Functions
Only circumferential tie with possibility of a direct retentive frictional
component between the casting & tooth
Resistance form of tooth- restoration complex by encompassing cusps
Compensate for problems in the castability of alloys- produce better details
for retention
Flexible extensions of a cavity preparation, allowing the inclusion of surface
defects, supplementary grooves, or other areas on the tooth surface.
Minimum tooth involvement and no sacrifice of the resistance & retention
Gingival bevels: Gingival margins to cleansable or protected areas
Facial & lingual proximal walls:
FLARES
Flat or concave peripheral portions of the facial and lingual walls
Facial and lingual proximal walls in intracoronal cavity preparations for
castings
2 types: Primary & Secondary
PRIMARY FLARE:
The conventional and basic part of the circumferential tie facially & lingually
for an intracoronal preparation
Similar to long bevel
Specific angulation: 450 to the inner dentinal wall proper
Hollow ground: cast ceramics/ non noble alloys
FLARES
Functions: same as bevels
The most peripheral part of proximal preparation: if they fulfill the objectives
of a circumferential tie
SECONDARY FLARE
A flat plane superimposed peripherally to a primary flare
Sometimes, prepared in hollow ground form to accommodate materials with
low castability
Solely in enamel, with some dentin in all or parts of its surfaces
Different angulations, involvement & extent, depending on function
CIRCUMFERENTIAL TIE:
Extracoronal
CHAMFER FINISHING LINE
Class I, II, III materials
Bulk & definite termination for the preparation marginally, with little tooth
involvement 0.5mm maximal depth
Placed gingivally on any involved axial surface: if finishable- cleansable /
protected
Subgingival extracoronal preparations if gingiva floor considerations are
precluded
Liability of
transitional
continuation of a
circumferentia tie
with adjacent
bevel ties
Limited
burnishability of
marginal cast
alloy
CIRCUMFERENTIAL TIE:
Extracoronal
KNIFE EDGE/ FEATHER EDGE FINISHING LINE:
The least tooth structure involvement
Involves enamel only: when the margin is on enamel
Very castable- burnishable type of alloy- Type II Gold alloy
Accessible areas of tooth surface for proper finishing
Minimal axial depth required for biologic / anatomic purposes
Easy & efficient blending with beveled constituents
CIRCUMFERENTIAL TIE:
Extracoronal
Disadvantages:
Indefinite termination for the casting
Margins not being covered with a casting: less wetting alloys
Thin cross- section
Ease of over- strain- hardening
burnishing-finishing-polishing
Risk of fracture:
CIRCUMFERENTIAL TIE:
Extracoronal
BEVELLED SHOULDER FINISHING LINE:
The most tooth structure involvement
Definite gingival floor: wall proper + bevel
Maximum bulk of the cast is needed marginally for materials that are limited
in their castability & burnishability
Easy blending with the bevelled constituents
Maximum reduction of marginal problems of internal spacing
Ideal for subgingivally located margins- maximum predictability of the
casting termination gingivally
CIRCUMFERENTIAL TIE:
Extracoronal
HOLLOW GROUND/ CONCAVE BEVEL:
Exaggerated chamfer or a concave beveled shoulder
Tooth involvement : Chamfer< Hollow ground < Bevelled shoulder
Termination: not as predictable, but mechanically comparable to a beveled
shoulder
Superior to chamfer
Care: no residual frail enamel/ thinned tooth structure
CIRCUMFERENTIAL TIE:
Extracoronal
Advantages:
Good transitional continuity with the beveled portion of the circumferential
tie
Helps the casting to seat preferentially
Aids in stabilizing the casting
Ideal for Class IV & V cast materials
Used successfully for materials with limited castability
CIRCUMFERENTIAL TIE:
Extracoronal
Functions similar to bevels & gingival floors
Minimize symptoms of internal spacing marginally: chamfer & hollow ground
Combinations used: cariogenic & anatomic needs; castability & finishability of
restorative material
Avoid sharp angles/ interruptions at the junction
of the gingival & occlusal corners of the tie
Round the junctions at the level of the circumferential tie,Non coverage of the margin
by the casting
Possible minor undercuts
not internally
CIRCUMFERENTIAL TIE:
Extracoronal
Maximal depth at the junction of the tie with the wall/ floor/ axial surface
Complete reproduction and coverage of the details in the casting
Best resist stresses
No element in occlusal contact
Peripheral margin: linear- paralleling the periphery/ curvature of anatomy
Smoothest & continuous: impression materials, die materials, waxes,
investment, alloy & ceramic melts can wet details- precise reproduction
AUXILLARY MEANS OF
RETENTION
Compound & complex tooth involvement
Formability of cast restorations: myriad retention & resistance means
Luting cements
Grooves
Reverse bevel
Internal box
External boxes
Slot
Pins
Collar
Skirts
Capping of
cusps
Capping of the
marginal ridge
Posts
Gross
roughening
Reciprocal
retention
Capping of
occlusoproximo- facial
or lingual
corners
Precementatio
n grooving
Electrolytic
etching
LUTING CEMENTS
Locking the cast to tooth structure
Fill the space
between them
GROOVES
Completely in dentin
Internal grooves: as internal as possible, adjacent to the axial wall
Dentinal portion
of the facial/
lingual walls
Gingival floors
proximally
Mesial or distal
walls
Gingival floors of
the facial or
lingual portion
GROOVES
Contraindicated:
- impinge on the pulp chamber or root canal system
- undermine/ involve axial angle of the tooth
- undermine adjacent enamel
External grooves: Preparations lacking retention
Short/ severe taper/ extreme width
Placed in areas of sufficient dentin bulk
Periphery of surface extension
Cut in a step form inwards or outwards- increases locking
GROOVES
Reciprocal means of retention: improves seating of the restoration,
minimize marginal discrepancies
Standardized tapered fissure bur: No. 168/ 699
Maximum 2mm depth- at the expense of the side walls or axial surfaces
Accentuated: Wedelstaedt/ Hatchet
All types of cast materials: ceramics- no definite internal line angles
REVERSE BEVEL
Expense of the gingival floor- internal dentinal plane inclining gingivallyaxially
Locks the restoration & prevents proximal displacement
Flat dentinal transition with the gingival bevel
Gingival floor with sufficient dimension without decreasing the resistance
Gingival marginal trimmers
Class I, II, III materials- rarely class IV
INTERNAL BOX
One of the most efficient immobilizing retention resistance means
In dentin
4 vertical surrounding walls joining the floor at definite line and point angles
Next to a marginal ridge with intact proximal wall as one of the walls
Anywhere in the preparation floor with sufficient dentin bulk
Peripheries : ideal location for even immobilization
Reciprocated at the opposite ends of the preparation
Shallow cavities/ short preparations- dovetail cannot be prepared
INTERNAL BOX
Minimum 2mm in three dimensions, but not equal length, width,
depth
Stepped apically or occlusally with different levels in th epulpal floor
No. 168/ 699
Surrounding walls shaved to be parallel & have definite angles: Hatchet,
Monangle chisel, angle former
Contraindicated: Class IV & V materials
EXTERNAL BOX
Box shaped preparations opening to the axial tooth surface
3,4,5 surrounding walls & floors- proximal, facial or lingual
Stepped occlusally or gingivally or not stepped
Accommodate grooves in their surrounding walls
Peripheral portions: beveled or flared
Armamentaria: similar to internal box
Contraindicated for cast ceramics
SLOT
Internal cavity- floor of a preparation
Continuous surrounding wall non defined angles & floor, junction between
floor and walls very rounded
Less locking, but more readily reproduced in casting
Indication: same as internal box
Suitable size round bur & tapered fissure bur
2-3 mm depth compatible dimensions with the size of restoration
All five classes of materials
PINS
Cemented & threaded/ Parallel & non- parallel/ Vertical & horizontal/ Cast &
wrought
Used for Pinlay design of cast restoration
I. According to the mode of incorporating in a casting
A. Wrought pins: Cast on/ Soldered. Threaded in
B. Cast pins
II. According to their relationship to the ong axis of the tooth
A. Vertical
B. Horizontal
RECIPROCAL RETENTION
Placing retention modes at every end of the preparation or parts of the
preparation: Basic principle
Every retention mode opposite retention mode for complete immobilization
of the restoration
Otherwise: Substantial stresses in the locked side, especially at the interface
Opposite grooves or internal box to oppose an internal box/ dovetail to
oppose a proximal external box etc.
ELECTROLYTIC ETCHING OF
TOOTH SURFACE OF THE
CASTING
Internal/ tooth surface of Class IV cast material : electrolytic etching
Margins & external surface : covered with sticky wax
Electrolytic cell: 0.5 N HNO3 ,Anodic electrode of the casting, Cathode of
another non- noble alloy higher in the electromotive force table
Low voltage current passed selective etching of the casting, dissolution of
grain boundaries & less noble elements
Microscopic irregularities similar to acid etching of enamel
10- 15 minutes
ELECTROLYTIC ETCHING OF
TOOTH SURFACE OF THE
CASTING
Suitable cementing agent wets irregularities on both casting & tooth
surface increase retention
Principal means of retention if microscopic retaining irregularities on the alloy
reciprocated to similar ones on the tooth
Tooth preparation: confined to enamel
Several techniques use the phenomenon as a sole retaining device for fixed
prosthesis & cast restorations based on few principles:
* The luting bonding agent is always a composite resin
* Tooth should have adequate enamel thickness to be etched by phosphoric
acid
* Class IV cast alloy- for better selective etching
ELECTROLYTIC ETCHING OF
TOOTH SURFACE OF THE
CASTING
* Minimal tooth preparation- requiring only enough reduction to
accommodate the metal, with no attempt to create mortise, cone or boxshaped preparations
* Cast alloy should be in contact with the maximum surface area of available
enamel
* If the casting is an attachment for a fixed prosthesis, the pontic should be
an indexing tooth for lateral movement of the mandible
Failures: cohesive in the luting agent, so a minimum thickness should be used
ELECTROLYTIC ETCHING OF
TOOTH SURFACE OF THE
CASTING
- The tooth surface is reduced to allow 1- 1.1 mm cast thickness
- Casting is fabricated in the conventional way
- The casting is tried in the mouth
- The internal (tooth) surface of the casting is etched
- The involved enamel surface is etched
- The composite is flowed into both the enamel and the casting and allowed
to cue under pressure
- Excess composite is flaked off
- The exposed surface of the composite resin is polished
Similar procedure with cast ceramic restorations: etching with HF 5-10% for
15 minutes
INLAY
INDICATIONS:
Width of the cavity does not exceed one- third the intercuspal distance
Strong, self- resistant cusps remain
Minimal or no occlusal facets, and if present, are confined to the occlusal
surfaces
The tooth is not to be an abutment for a fixed or removable prosthesis
Occlusion or occluding surfaces are not to be changed by restorative
procedure
Steepnes
s of the
cusps
Direct wax
pattern
- More marginal
bulk required
Extensions:
Remotely
located defects,
supplementary
grooves,
decalcifications
on occlusal
surface
Rounded
REFERENCES
Sturdevants Art & Science of Operative Dentistry
Operative Dentistry- Marzouk
Principles and Practice of Operative Dentistry- Charbeneau GT
Cast Restorations- Shillingburg
Fundamentals of Operative Dentistry- Summit