PRINCIPLES OF TOOTH

PREPARATION

By: Dr. AMR SHEBL

Teeth require preparation to
receive restorations, and these
preparations must be based on
fundamental principles.
 Biologic
Consideratio
ns

Prevention
of damage Consideratio
Conservati ns affecting
during
on of tooth future dental
tooth
structure health
preparatio
n
 Adjacent
Teeth
1-Prevention
of damage Soft
during tooth tissues
preparation

Pulp
 Prevention of Damage to adjacent
teeth
 Prevention of damage to soft
tissues
 Prevention of damage to the
pulp

Temperature
Chemical
irritation
Bacterial
irritation
 Biologic
Consideratio
ns

Prevention
of damage Consideratio
Conservati ns affecting
during
on of tooth future dental
tooth
structure health
preparatio
n
Conservation of tooth structure- 2
Tooth structure is
conserved by using the
:following guidelines
1- Use of partial-coverage rather than
complete coverage restorations
when possible
Preparation of teeth with the. 2
minimum acceptable taper
(convergance angle) between the
axial walls
Preparation of the occlusal- 3
surface so reduction follows the
anatomic planes to give uniform
thickness in the restoration
Preparation of the axial surfaces so. 4
tooth structure is removed evenly; if
necessary, teeth should be
orthodontically repositioned
Selection of a conservative margin. 5
compatible with the other principles of
tooth preparation
Avoidance of unnecessary apical. 6
extension of the preparation
 Biologic
Consideratio
ns

Prevention
of damage Consideratio
Conservati ns affecting
during
on of tooth future dental
tooth
structure health
preparatio
n
Considerations affecting future- 3
dental health
1- Axial Reduction:
:Margin placement- 2

Whenever possible, the margin of the

preparation should be supragingival.
Advantages of supragingival margins
include the following:
1. Supragingival margins are easier to prepare
accurately without trauma to the soft tissues.
2. They are more easily kept plaque free.
3. Impressions are more easily made, with less
potential for soft tissue damage.
4. Restorations can be easily evaluated at the
time of placement or at recall appointments.
Subgingival margins have been identified as a major etiologic
factor in periodontal disease, particularly where they encroach on
.the epithelial attachment
Finish lines
A subgingival margin, however, is
justified in the following cases:
1. Dental caries, cervical erosion, or
restorations extending subgingivally.
The finish line sould be 1 mm cervical
to the cavity or restoration border.

2. The proximal contact area extends

subgingivally.
3. Additional retention is needed
so we lengthen the preparation
by extending subgingivally.
4. In esthetic areas to hide the
margin of metal-ceramic
restorations in the subgingival
area.
5. Root sensitivity that cannot be
controlled by more conservative
procedures.

6. When modification of the axial

contour is indicated, such as to
provide an undercut to provide
retention for the clasp of a partial
removable dental prosthesis.
:Margin adaptation- 3

A rough, irregular margin will make

the fabrication of an accurately fitted
restoration almost impossible
 :Margin geometry- 4
Finishline is the area at which the preparation is finished
and against which the margin of the restoration is adapted.
Requirements of the finish line:
1. Ease of preparation without overextension or
unsupported enamel.
2. Ease of identification in the impression and on the die.
3. A definite boundary to which the wax pattern can be
finished.
4. Provides sufficient bulk of material to enable the wax
pattern to be handled without distortion and to give the
restoration sufficient strength and esthetics.
5. Conservation of tooth structure (if the other criteria
are met).
 Types of finish
lines
Indefinit Definite
e finish finish
lines lines
1- Chamfer finish line
1- Feather edge
finish line
2- Shoulder finish line
2- Chisel edge finish
3- Heavy chamfer finish lin
line
4- Beveled finish line

5- Shoulder with bevel finis

line
 a) Indefinite finish lines:
1- Feather edge finish line:
Although they are
conservative of tooth
structure, feather edge
finish lines should be
avoided because they do
not provide adequate bulk
at the margins.

Overcontoured restorations
often result from feather
edge margins.
 :Chisel edge finish line( 2
Is a variation of the feather edge
finish line. The chisel edge margin is
formed when there is a larger angle
between the axial surfaces and the
unprepared tooth structure.
This margin is frequently associated
with preparations with excessive
angles of convergence (taper).
Occasionally on tilted teeth
Under most circumstances
feather edge and chisel edge
finish lines are
unacceptable
 b) Definite finish
lines:
1) Chamfer finish
line:
It is definite and easily
identified, and it provides
room for adequate bulk of
material
suitable for cast metal
crowns and the metal only
portion of metal ceramic
crowns
The thickness of the
chamfer finish line ranges
between 0.3-0.5 mm
chamfer finish line is
The chamfer should never be prepared
wider than half the tip of the diamond,
otherwise an unsupported lip of enamel
may result
 Shoulder finish line( 2
It is a distinct finish line and
allows an adequate bulk of
material at the margin
It is recommended for all-
ceramic restorations and the
facial part of metal-ceramic
crowns
Its thickness ranges between
0.8-1 mm
prepared using a tapered
diamond stone with flat end
A l20-degree sloped shoulder
finish line is sometimes used as
an alternative to the 90-degree
shoulder for the facial margin of
metal-ceramic crowns
The sloped shoulder reduces the
possibility of leaving unsupported
enamel
 Heavy chamfer finish line( 3
Some studies have recommended
a heavy chamfer rather than a
shoulder margin, and some find a
chamfer easier to prepare
Prepared using a tapered stone
with round end giving it the same
shape of a chamfer finish line but
with the thickness of a shoulder
Suitable for all-ceramic
restorations as it decreases the
stress concentration at the
margins. It can also be used for
the facial part of metal-ceramic
crowns
Beveled finish line( 4
beveled margin is more suitable for cast
restorations, particularly if a ledge or
shoulder already exists, possibly as a
result of dental caries, cervical erosion,
or a previous restoration
The objective of beveling is:
To allow the cast metal margin to be
burnished against the prepared tooth
structure. This is applicable in case of
using high gold alloys due to the high
burnishing ability of gold
To minimize the marginal discrepancy
caused by a complete crown that fails
to seat completely

To protect the unprepared tooth

structure from chipping by removing
unsupported enamel
 The beveled finish line is
prepared using tinker stone
 Shoulder with bevel finish line ( 5
shoulder with bevel finish line
may be used for the facial surface
of a metal-ceramic restoration in
which a metal collar is used
The beveling removes
unsupported enamel and may
allow some burnishing of the
metal in case of gold alloys
The bevel will be covered by the
metal only, while the ceramic
cannot be extended to the bevel
to allow for the metal to be
burnished
The shoulder is prepared using the
tapered stone with flat end, and the
bevel is performed using the tinker
stone
 Mechanical
Considerati
ons

Providin Preventing Achieving

g Providing a proper
deformatio
retenti resistanc Path of
n of the
on form e form insertion
restoration
RETENTION FORM( 1)
Certain forces act on a cemented
restoration in the same
direction as the path of
placement e.g. Sticky food
Retention : The quality of a
preparation that prevents the
restoration from becoming
dislodged by such forces parallel
to the path of placement
The following factors are
:important for retention
1. Magnitude of the dislodging forces

2. Geometry of the tooth preparation

3. Roughness of the fitting surface of
the restoration

4. Materials being cemented

5. Type of the luting agent

:l. Magnitude of the dislodging forces

Forces that tend to remove a

cemented restoration along its
path of placement are small in
comparison with those that tend
to seat or tilt it.

The greatest removal forces

generally arise when
exceptionally sticky food (e.g.
caramel) is eaten.
Geometry of the tooth. 2
preparation
a) Geometric form
Fixed dental prostheses depend on
the geometric form of the
preparation rather than on cement
for retention

most of the traditional cements

(e.g., zinc phosphate) are non-
adhesive. The grains of cement
prevent two surfaces from sliding
Taper is defined as the
convergence of two opposing
external walls of a tooth
preparation. The extension of
those surfaces form an angle
described as the angle of
convergence
 As long as this taper is small the
preparation will have what is known
as a limited path of placement
The recommended convergence
angle between opposing walls is 6
degrees, which has been shown to
optimize retention
Itis not necessary to deliberately tilt
a rotary cutting instrument to create
a taper, because this invariably
leads to overconvergance

The instrument is held parallel to the

long axis of the tooth and the taper of
the instrument will produce the
desired axial wall taper
An undercut on a
complete crown
preparation is defined as
any area in the wall of a
prepared tooth that
prevents the withdrawal
or seating of a wax
pattern or casting

Such is the case when

divergence is created
between opposing axial
walls in a cervical-
occlusal direction
Undercut occurs when
the cervical diameter of a
tooth preparation at the
finish line is narrower than
at the occlusal area

itis impossible to seat a

complete cast crown of
similar geometry
 b) Surface Area

crowns with long axial walls are

more retentive than those with
short axial walls
molar crowns are more retentive
than premolar crowns of similar
taper
because
of increasing of friction related to
the overall surface area
c) Stress Concentration
The stresses induced in the cement
are not uniform but are
concentrated around the sharp line
and point angles

Rounding the internal sharp line

angles reduces stress concentration
on the cement and thus increases
the retention of the restoration.
 d) Type of Preparation
the retention of a full-coverage
crown is about double that of
partial-coverage restorations
Adding grooves or boxes to a
preparation does not increase the
surface area significantly, but limits
the paths of withdrawal, thus
retention is increased
Roughness of the fitting. 3
surface of the restoration
When the internal surface of a
restoration is very smooth, retentive
failure occurs not through the
cement but at the cement-
restoration interface
retention will be increased if the
fitting surface of the restoration is
roughened i.e sandblasting the
fitting surface with 50 um of alumina
This should be done carefully to
roughening the tooth preparation
does not influence retention and is
not recommended, because
roughness adds to the difficulty of
impression making and waxing.
Materials being cemented .4

The more reactive the alloy, the

more adhesion with certain luting
agents.

Therefore, base metal alloys are

better retained than less reactive
high-gold content metals
Type of luting agent .5
The type of luting agent chosen
affects the retention of a
cemented restoration.

Adhesive resin cements are more

retentive than conventional
cements
 Mechanical
Considerati
ons

Providin Preventing Achieving

g Providing a proper
deformatio
retenti resistanc Path of
n of the
on form e form insertion
restoration
RESISTANCE FORM( 2)
Resistance form is defined as
the features of a tooth preparation
that enhance the stability of a
restoration and resist dislodgment
along an axis other than the path
of placement
Itthe ability to resist the Lateral
Forces which tend to displace the
restoration by causing rotation
around the gingival margin i.e.
tipping path
The tipping path is the path
along which the restoration could
be displaced under the displacing
occlusal forces
Rotation is prevented by any areas
of the tooth preparation that are
placed in compression, called
resistance areas
These areas of the tooth structure
lie outside the tipping path and will
resist the displacing forces
Adequate resistance depends
on the following:
1. Magnitude and direction of the
dislodging forces

2. Geometry of the tooth

preparation

Physical properties of the luting .3

agent
Magnitude and direction of the dislodging forces .1

In normal occlusion, most of the biting

forces are axially directed
if a patient has a biting habit such as
pipe smoking or bruxing, it may be
difficult to prevent large oblique forces
from being applied to a restoration
Therefore the complete tooth
preparation and restoration must be
able to withstand considerable oblique
forces as well as the normal axial ones
 Geometry of the tooth preparation. 2
a) Degree of occlusal
convergence
Slight occlusal convergence
between the prepared axial
surfaces will leave a
reasonable amount of tooth
structure outside the
tipping path that will give
good resistance to the
displacing forces
 b) Height of the preparation
normal occluso-gingival
reduction will preserve
sufficient tooth structure
outside the tipping path to
resist the displacing forces
while severe occlusal reduction
will lead to very short occluso-
gingival height, thus no
sufficient tooth structure will
be left outside the tipping path
to resist the displacing forces
occlusal reduction should not
exceed one third of the
occluso-gingival height
b) Width of the
preparation
 c) Type of the preparation
A partial coverage restoration (e.g. 3/4 crown)
will have less resistance than a complete
coverage crown because the buccal surface is
left unprepared so it has no buccal resistance
areas
Resistance must be provided by grooves and will
be greatest if they have walls that are
perpendicular to the direction of the applied force
 There are three forms of the
axial grooves
V-shaped grooves:
They are used in anterior teeth
with limited dimensions
U-shaped grooves:

The lingual wall of the groove is

perpendicular to the proximal
surface
Box-shaped grooves:

provides high resistance to

displacing force. Used in case
of proximal caries or beside the
connector when used as a
retainer
 The relation between the axial grooves
:and the tipping path will depend on
The length of the groove:
The longer the groove the more the
resistance to displacing forces
The position of the groove:
Placing the groove more buccal will give
enough tooth structure lingual to the
groove that will resist the displacing
.force
The depth of the groove:
The U-shaped and box-shaped grooves
will resist the displacing forces better
than the V-shaped grooves
Physical properties of the luting . 3
agent
Resistance to displacement is affected
by physical properties of the luting
agent such as compressive strength
and modulus of elasticity
Glass ionomer cements and resin
cements have high compressive
strength, whereas zinc polycarboxylate
cements have similar values to those of
zinc phosphate
Increasing temperature may decrease
the compressive strength of some
luting agents, e.g. zinc oxide-eugenol
 Mechanical
Considerati
ons

Providin Preventing Achieving

g Providing a proper
deformatio
retenti resistanc Path of
n of the
on form e form insertion
restoration
PREVENTING DEFORMATION OF (3)
THE RESTORATION
1. Alloy Selection
Type I and Type II gold alloys are
satisfactory for intracoronal cast
restorations. Type III or Type IV gold
alloys are chosen for crowns and fixed
partial dentures
Nickel-chromium alloys have high
modulus of elasticity and thus they are
indicated when large forces are
anticipated, e.g. long-span fixed partial
dentures
 Adequate tooth reduction. 2

a) Occlusal reduction
There should be a minimum alloy
thickness of about 1.5 mm over
functional cusps and 1 mm over non-
functional cusps for a strong and long-
lasting restoration
Occlusal reduction should be as uniform as
possible, following the cuspal planes of the
teeth. This will ensure that sufficient
occlusal clearance is combined with
preservation of tooth structure

In special cases such as mal-aligned

or super-erupted teeth,
occlusal reduction of
more than 1.5 mm
may be needed
b) Functional cusp bevel
Abevel on the functional cusps
provides space for an adequate bulk
of metal
 c) Margin Design and axial
reduction
Tooth reduction should provide
sufficient room for bulk of metal at
the margin to prevent distortion
Featheredge finish line produces
thin weak margin that is liable to
deformation compared with the
thicker restoration of a chamfer
finish line
In case of partial coverage
restorations, the grooves and ledges
incorporated in a partial coverage
restoration provide essential
strengthening for the restorations
The preparation is designed so that
the occlusal margins are 1 to 1.5
mm away from the occlusal contacts
 Mechanical
Considerati
ons

Providin Preventing Achieving

g Providing a proper
deformatio
retenti resistanc Path of
n of the
on form e form insertion
restoration
:PATH OF INSERTION( 4)

It is an imaginary line along which the

restoration will be placed onto or removed
from the preparation.
 :PATH OF INSERTION( 4)
A path of insertion must be selected that
will allow the margins of the retainers to
fit against the respective preparation
finish lines with the removal of minimum
sound tooth structure

For a full single crown, path of insertion

should be parallel the long axis of the
tooth, otherwise the seating of the crown
will be interrupted by the adjacent teeth
To evaluate the preparation taper
view it with one eye from a distance
of approximately thirty centimeters.
The entire finish line should be
visible to one eye from one fixed
position with no obstruction by any
part of the prepared tooth
To verify parallel paths of insertion
of bridge abutments, the image of
one preparation is centered in the
mirror. Then using firm finger rests
the mirror is moved bodily without
changing its angulations until the
image of the second preparation is
also centered
Ifdirect vision is possible, the
mesial surface of the anterior
abutment should be convergent
with the distal surface of the
posterior abutment
On the contrary, the distal surface
of the anterior abutment should be
divergent with the mesial surface of
the posterior abutment
 Esthetic
Consideratio
ns

Metal- All- Partial

ceramic ceramic coverage
Restoratio Restoratio restorations
ns ns
All-Ceramic Restorations
Some of the most pleasing esthetic
restorations are all-ceramic restorations
The newest materials have improved
physical properties and can be strengthened
through the use of adhesive resin luting
agents
A minimal material thickness of
approximately 1 to 1.2 mm is necessary to
ensure optimal esthetics. a wide heavy
chamfer margin must be prepared around
the entire tooth
This limits the use of these restorations on
faciolingually thin teeth and on teeth with
large pulps, as in young individuals
 Metal-ceramic restorations
1) Facial Tooth Reduction
reduction of 1.5 mm is required for
optimal appearance. Adequate
thickness of porcelain is needed to
create a sense of color depth and
translucency.
Reduction of the facial surface for a
tooth to receive a metal-ceramic
crown should be done in two
planes, one parallel with the path
of insertion, and one parallel with
the incisal two-thirds of the facial
surface
 Incisal Reduction( 2
The incisal edge of a metal-ceramic
restoration has no metal backing
An incisal reduction of 2mm is
recommended for good esthetics
 Proximal Reduction( 3
The proximal surfaces of anterior
teeth will look most natural if they
are restored without metal backing
In case of FPD connectors in anterior
bridges should be placed towards
the lingual
 Labial Margin Placement( 4
Supragingival margin placement has
many biologic advantages
Subgingival margins may be
indicated for esthetic reasons to hide
the dark metal-ceramic junction at
the margin referred to as "the black
line, particularly when the patient
has a high lip line
The margin should be placed
subgingivally midway between the
crest of the free gingiva and the
base of the sulcus
Extension to within 1.5 mm of the
alveolar crest will lead to bone
Good appearance can be restored
with a metal-ceramic restoration
having a supragingival porcelain
labial margin sometimes called a
"collarless" design
The metal is trimmed at the
margin area about 1 mm and the
margin is constructed entirely with
a special type of porcelain called
"shoulder porcelain"
 Partial Coverage Restorations
1) Proximal Margin
The margin should be
placed just buccal to the
proximal contact area,
where metal will be
hidden by the distal line
angle of the neighboring
tooth
The distal margin of
posterior partial-
coverage restorations is
less visible than the
mesial margin. The
 Facial Margin( 2
The facial margin of a
maxillary partial-coverage
restoration should be
extended just beyond the
occluso-facial line angle. A
short bevel is needed to
prevent enamel chipping
If the buccal margin of
metal is correctly shaped,
it will not reflect light to an
observer. As a result, the
tooth appears to be a little
shorter than normal
When mandibular partial
cast crowns are made,
metal display is
unavoidable because the
occlusal surface of
mandibular teeth can be
seen during speech

A chamfer, rather than a

bevel, is recommended
for the buccal margin
because it provides a
greater bulk of metal
around the highly
stressed functional cusp
In anterior partial-coverage
restorations The facial margin is
extended just beyond the highest
contour of the incisal edge but not
fully to the inciso-labial line angle
Here the metal will protect the
tooth from chipping but will not be
visible
THANKYOU