PROSTHODONTICS 1

TRANS: PRELIM DFP1 32 DMED 32 PROF: DR. XYRA CAMET

INTRODUCTION TO FIXED PROSTHODONTICS 3. IMPLANT PROSTHODONTICS – concerned with the

“PROSTHODONTICS” - the branch of dentistry pertaining to fabrication and placement of fixed or removable
the restoration and maintenance of oral function, comfort, dentures on an implant device
appearance, and health of the patient by the restoration of the
natural teeth or the replacement of missing teeth and
contiguous oral and maxillofacial tissues with artificial
substitutes, or by both

˃ PROSTHESIS – artificial replacement of a missing

body part.
˃ DONTICS – referring to teeth

WHY DO WE NEED TO REPLACE TEETH?

1. Function (mastication 4. MAXILLOFACIAL PROSTHODONTICS – concerned
2. Aesthetics with the correction of deformities of the face and head
3. Proper speech and restoration of normal function by means of a
4. Stability prosthesis.

CONSEQUENCE OF TOOTH REMOVAL WITHOUT

REPLACEMENT:
Loss of mandibular first molar
not replaced with an FPD may
result in the following:
1. Supraeruption of the
opposing tooth
2. Tilting of the adjacent
teeth
3. Loss of proximal
contacts
4. Collapsed bite

WHY DO WE NEED TO RESTORE TEETH? – MAPS

- M-astication/function
- A-esthetics
- P-roper speech
- S-tability

WHAT ARE THE CONSEQUENCES OF NOT RESTORING THE

TOOTH AFTER REMOVAL? STAR LC FIXED PROSTHODONTICS
A branch of prosthodontics concerned with the replacement or
- Supraeruption, Tilting of adjacent teeth, Resorption of
restoration of teeth, or both, by artificial substitutes that are not
Bone, Loss of Proximal contacts, Collapsed bite
removable from the mouth
SUBSPECIALTIES OF PROSTHODONTICS
TYPES OF FIXED PROSTHESIS:
1. REMOVABLE PROSTHODONTICS
a. Partial dentures 1. Crown – full or partial crowns
b. Complete dentures 2. Fixed bridge/fixed partial denture
3. Inlays/onlays

CROWN
An artificial replacement that restores missing tooth structure
by surrounding part or all of the remaining structure with a
material such as metal, porcelain, or a combination of
materials.

2. FIXED PROSTHODONTICS

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 Non-removable prosthesis that is rigidly attached to one or
more abutment teeth to replace one or more missing teeth
TYPES OF CROWNS ACCORDING TO TOOTH COVERAGE:
1. FULL CROWN – covers all of the surface of the clinical PARTS OF A FIXED BRIDGE:
crown of the tooth. 1. ABUTMENT – the natural tooth or teeth, usually 2 or
more that support the prosthesis and to which it is
attached
2. RETAINER – the restoration rebuilding of the prepared
abutment tooth, by which the bridge is attached to the
abutment and to which the pontic is connected
3. PONTIC – the substitute for the missing tooth
4. CONNECTOR – connects the pontic to the retainers

3-UNIT FIXED BRIDGE:

2. PARTIAL CROWN – covers all but one surface of a tooth

Example: ¾ crown, 7/8 crown

CLASSIFICATION OF INDIVIDUAL RESTORATIONS AND

RETAINERS

PARTIAL CROWN: ¾ CROWN

• Type of crown that restores all
surface except facial/buccal
surface retained by proximal
grooves

EXTRACORONAL RESTORATIONS
Covers the outer surface of the clinical crown.
• Reproduces the morphology and contours of the
damaged coronal portions of a tooth.
• Protects the remaining tooth structure from further
damage.
PARTIAL CROWN: 7/8 PARTIAL CROWN
• Modified type of ¾ crown 1. Full crown (full veneer, full coverage,
• Covers all surfaces except complete coverage crown) – covers the entire
mesiobuccal cusp of clinical crown
maxillary molars a. All metal crown
b. Porcelain-fused-to-metal crown
c. All porcelain or ceramic crown
d. Resin and metal or resin only

2. Partial crowns – covers only portions of

the clinical crown
a. ¾ crown
b. Reverse ¾ crown
c. 7/8 crown
d. Veneers or laminate veneers

Laminate veneers – a thin layer of porcelain or ceramic

bonded or cemented only on the facial surface of a tooth with a
FIXED BRIDGE (FIXED PARTIAL DENTURE, FIXED resin cement.
PROSTHESIS)

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INTRACORONAL RESTORATIONS
Fit within the anatomic contours of the clinical crown of a
tooth.
1. Inlays – used to restore proximal-occlusal (class II)
caries; should only be used in patients with low caries
rate

2. Onlays – intracoronal restoration that covers the

damaged occlusal surface (cusps); useful for
restoring more extensively damaged posterior teeth
needing wide mesio-occlusodistal restorations.

ORAL DIAGNOSIS AND TREATMENT PLANNING IN FIXED

PROSTHODONTICS

Fixed prosthodontic treatment can range from restoration of

POST AND CORE WITH CROWN a single tooth with a full crown, replacement of one or more
A severely broken down tooth may still be saved and restored missing teeth with a fixed bridge to a highly complex
with endodontic treatment (root canal treatment) and restoration involving all the teeth in an entire arch
placement of a post and core with crown.

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To achieve predictable success in fixed prosthodontics, the • It is important to take a good medical history before
clinician must follow a series of steps in identifying the dental the start of treatment to determine if any special
needs of the patient through a thorough examination of the precautions may be necessary
patient, knowledge of the patient’s medical and dental history • Some elective treatments might be eliminated or
and a correct diagnosis of existing dental problems postponed because of a patient’s physical or
emotional health
• Or it may be necessary to pre-medicate some
patients for certain medical conditions or to avoid
certain medications for other

Examples of relevant medical findings:

˃ Infectious diseases such as hepatitis, AIDS, TB
˃ Allergies to food, drugs, dental materials
˃ No patient with uncontrolled hypertension should
be treated until the blood pressure has been
lowered; any diastolic above 140 or systolic
above 90 should preempt any dental treatment
and be referred to a physician; also, use of
epinephrine with patients with CV diseases is
cautioned
˃ Patients with prosthetic heart valves, history of
bacterial endocarditis, rheumatic fever, mitral
valve prolapse, congenital heart malformation–
DIAGNOSIS – the process of identifying the nature and cause should receive prophylactic antibiotic before any
of a disease through evaluation of the patient history, dental procedure that may involve bleeding
examination, and review of findings ˃ Patients taking anticoagulants (Heparin,
• Examination of the physical state, evaluation of the Coumadin)
mental or psychological makeup and understanding ˃ Diabetes– if well controlled, patient can receive
the needs of each patient to ensure a predictable dental treatment; patients with poorly controlled
result diabetes may be affected by stress during dental
treatment and go into diabetic coma
Making a correct diagnosis is a prerequisite to making an ˃ Systemic diseases with oral manifestations:
appropriate treatment plan. ˃ Xerostomia (dry mouth)– caused by Sjogren’s
syndrome, rheumatoid arthritis, lupus,
Treatment Planning – developing a course of action that scleroderma, radiation therapy in the oral cavity
encompasses the ramifications and sequalae of treatment to
serve the patient’s needs. (4) Dental History
• Know previous dental treatments the patient had in
5 REQUIREMENTS OF A GOOD DIAGNOSTIC WORKUP the past and their attitude towards them and their
1. Health history (dental and medicine) previous dentists
2. Examination • Know the patient’s expectations of the result of the
a. General examination treatment and determine if they are realistic
b. Extraoral examination
c. Intraoral examination a. Periodontal history – oral hygiene status, any
d. Occlusal exam previous oral hygiene prophylaxis
e. Abutment tooth evaluation b. Restorative history – note all amalgam and tooth-
3. Diagnostic casts colored restorations and when they were made
4. Full mouth radiographs c. Endodontic history – note any root canal treatment
5. TMJ/occlusal evaluation procedures done especially if these were done on
prospective abutment teeth
HISTORY d. Orthodontic history
(1) Chief complaint – a brief description of why the patient is e. Removable prosthodontics history – previous
seeking medical or dental attention removable dentures must be evaluated and duration
of wear needs to be noted
FOUR CATEGORIES OF CHIEF COMPLAINT: f. Oral surgical history – missing teeth and period of
a. Comfort—pain, sensitivity, swelling, etc.; take note of edentulousness must be noted
the location, character, severity, frequency, triggers, g. TMJ dysfunction history– note any history of:
when it started, etc. ˃ Pain or clicking in the TMJ
b. Function – can’t chew on a tooth; difficulty in ˃ Tenderness to palpation
speaking ˃ Difficulty in opening mouth
c. Social – bad taste or bad breath ˃ Deviation while opening
d. Appearance – unattractive teeth or restorations ˃ Any treatments done to correct above
(2) Personal Information - includes patient’s name, address, symptoms such as wearing occlusal
contact number, sex, occupation, marital status, etc. appliances, medications or exercises

(3) Medical History EXAMINATION

• Include all relevant medical conditions and any (1) General Examination – pt’s general appearance, height,
medications the patient is taking gain, weight, and skin color; vital signs are also taken such as
respiration, pulse, temperature, blood pressure
(2) Extraoral Examination

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 a. TMJ – watch out for clicking, crepitation, and
limitation of movement on opening, closing, or moving
laterally.
˃ Tenderness or pain on movement–
inflammation
˃ Average mandibular opening is about 50
mm; less than 35 mm is restrictive
˃ Midline deviation on opening/closing
˃ Normal lateral movement is about 12 m
With gingivitis, the gingiva are enlarged, bulbous, and red and
there is loss of stippling; the margins and papillae are blunted;
bleeding and exudates are seen.

b. Muscles of Mastication
• Palpate the muscles of mastication
(masseter, temporalis, medial and lateral
pterygoid), trapezius and
sternocleidomastoid muscles for signs of
tenderness b. Examination of Teeth
˃ Caries
˃ Missing teeth
˃ Color variations involving enamel such as in
fluorosis, amelogenesis imperfecta,
tetracycline stains
˃ Abrasions and erosions
˃ Occlusal wear – may indicate parafunctional
activity
˃ Tooth fractures
˃ Tooth malformations
c. Palpation of head and neck lymph nodes ˃ Condition and type of existing restorations
d. Lips – position of lips and tooth visibility during normal ˃ Alignment of teeth, crowding, rotation,
and exaggerated smiling supraeruption, spacing, malocclusion, and
vertical and horizontal overlap

RADIOGRAPHS
(1) Full periapical radiographic series (14 periapical
radiographs and 4 bitewings)
˃ Bone loss and bone support
˃ Presence of residual roots
˃ Root number and morphology
˃ Axial inclination of teeth
(3) Intraoral Examination – condition of soft tissues, teeth, ˃ Presence of apical disease or root resorption
and supporting tissues. Check the tongue, floor of the mouth, ˃ Quality of supporting bone
vestibules, cheeks, and hard & soft palate are examined for ˃ Width of periodontal ligament
lesions. ˃ Continuity and integrity of the lamina dura
a. Periodontal Examination ˃ Areas of vertical and horizontal bone loss, periodontal
˃ Periodontal health is important to the pockets, and root furcation involvement
success of fixed prosthodontics ˃ Calcular deposits
˃ Any existing periodontal disease must be ˃ Presence of caries and assessment of restorations
corrected first before doing and their relation to the pulp
˃ Any definitive prosthodontic treatment ˃ Assessment of root canal fillings and pulp morphology
˃ Check for signs of periodontal pockets with a
periodontal probe
˃ Check oral hygiene
˃ Check tooth mobility
˃ Gingival recession
Healthy gingiva – pink, stippled, and firm; gingival margins
are knife-edge and sharply pointed papillae fill the
interproximal spaces.

(2) Panoramic Radiograph

˃ Assessment of 3rd molars and impactions
˃ Assessment of bone before placement of implants
˃ Screening edentulous spaces for buried root tips

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 5. Evidence of present status of occlusion by observing
wear facets
6. Occlusal relationship of maxilla and mandible–
overbite, overbite
7. Alteration of alteration of midline location
8. evaluation of the degree and direction of masticatory
forces in a particular bridge area
9. Evaluation of the need to establish a new occlusal
plane
10. Evaluation of the “path of insertion” for the proposed
bridge
11. Evaluation of edentulous areas for selection and
positioning of pontics
12. Evaluation of length of abutment teeth to help in
(3) Special radiographs for assessment of TMJ disorders determining the type of preparation design to provide
such as transcranial radiograph, serial tomography, CT scan, adequate retention and resistance
MRI, etc.
(4) Clinical photographs – recommended is a set of 12 OCCLUSAL EXAMINATION
pictures for planning and documentation (1) General alignment of teeth – check for crowding,
rotations, supraeruptions, spacings, malocclusion, and
vertical and horizontal overlap.
(2) Lateral and protrusive contacts – the presence or
absence of tooth contact in eccentric movements are
noted; tooth movement (fremitus) on tooth contact should
be noted.
(3) Centric relation – the relationship of teeth in centric
relation and intercuspal position (maximum intercuspation,
centric occlusion) should be evaluated.

DIAGNOSIS AND PROGNOSIS

After history taking and examination are completed, a
diagnosis is made.

Diagnosis– summation of the observed problems and their

underlying etiologies.

Example of Diagnosis:
► 30-year-old female patient with no significant medical
history; vital signs are within normal limits
► Patient has high smile line
► Caries present on teeth 16MO, 11D, 26O, 27O, 45M
DIAGNOSTIC CASTS indicating irreversible pulpitis
An accurate replication form of the maxillary and mandibular ► Mesiolingual cusp fracture on tooth 46 and missing
dental arch showing the relationships of the remaining teeth tooth 36
and surrounding tissues. ► Generalized gingivitis on all four posterior quadrants
with recession noted on teeth 15, 14, 24, 25, 26, 35,
Articulated diagnostic casts are an integral part of the 44, 45
diagnostic procedure. ► Panoramic radiograph show all 3rd molars are
impacted

Prognosis - estimation of the likely course of a disease; it is

the overall outcome of the success of treatment
◦ Prognosis is influenced by general factors and local
factors

General factors – age, medical conditions that may affect

periodontal health, ability of the patient to practice good oral
hygiene
Local factors – tooth mobility, root angulations and
morphology, crown-to -root ratio, etc.

DIAGNOSTIC PLAN

Allow the dentist to further analyze the structures in the mouth

even without the presence of the patient:
1. Evidence of collapsed posterior arches
2. Evidence of supraeruption of teeth
3. Evidence of tooth movement such as drifting and
rotation
4. Evidence of changes in the axial inclination of teeth

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 Proper sequencing of treatment is very important
a. Treatment of symptoms
b. Stabilizing of deteriorating conditions
c. Definitive therapy
d. Follow up care

TREATMENT OF SYMPTOMS
1st priority in treatment planning is to give relief to any
pain/discomfort because of an acute condition such as in:
a. Fractured teeth
b. Acute pulpitis
c. Acute exacerbation of chronic pulpitis
d. Dental abscess
e. Acute pericoronitis or gingivitis
f. Other dental infections that may cause pain or
abscess

Treatment may include extraction, emergency endodontic

treatment, prescription of analgesics or antibiotics to give relief
to pain or control an infection

Non-acute conditions that may not be causing the patient

discomfort but needs to be treated immediately includes lost
anterior crown, broken porcelain veneers or fractured
removable dentures

STABILIZATION OF DETERIORATING CONDITIONS

2nd phase of treatment is stabilizing conditions such as
dental caries or periodontal disease by removing its etiologic
factors

Caries are restored with fillings; defective restorations are

replaced

Oral prophylaxis, effective OHI (oral hygiene instructions) for

treatment of gingivitis

DEFINITIVE TREATMENT
After the stabilization phase is complete, more definitive long-
term treatments can be done

Definitive treatment– the aim is to promote dental health,

restore function, and improve the appearance of the patient

Order or sequence of definitive treatment:

a. Oral surgery
b. Periodontics
c. Endodontics
d. Orthodontics
e. Restorative dentistry
f. Fixed prosthodontics
g. Removable prosthodontics

1. Oral Surgery
TREATMENT PLANNING (PART TWO) • Teeth with hopeless prognosis, unerupted/impacted
Treatment planning– making a logical sequence of treatment and root fragments should be removed early to give
to restore the patient’s teeth to good health with optimal time for healing and ridge remodeling
function and appearance.

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 occlusal surfaces of restorations on posterior teeth
are made

◦ In cases where both left and right-side posterior teeth

need work, one side of the mouth should be
completed first before doing the other side

Doing all 4 posterior areas at the same time might lead to

many complications such as:
a. Difficulty in recording jaw relationships
b. Discomfort of the patient during tooth preparation
c. Fracturing or breaking of the temporary
2. Periodontics restorations
• May already have been done during the stabilization
phase- 6. Removable Prosthodontics
• Other periodontal surgeries such as pocket • Whenever possible, missing teeth should be restored
elimination, mucogingival procedure, guided tissue with fixed prosthodontics
regenerating or root resection is done at this time • FPD provides better health and function than a RPD
and is preferred by more patients

THERE ARE CONDITIONS WHERE AN RPD IN INDICATED:

a. Vertical support from the edentulous ridge is needed
such as in the absence of a distal abutment tooth

b. Resistance to lateral movement is needed from

contralateral teeth and soft tissues to ensure stability
with a long edentulous space

3. Endodontics
• May also be done during 1st phase of treatment if the
tooth was symptomatic (painful or with abscess)
• Elective root canal therapy may be done to
asymptomatic teeth that are badly damaged and are c. There is considerable bone loss in the anterior area and
to be used as abutments for crowns or bridges a FPD might have an unacceptable appearance
4. Orthodontics
• Abutment teeth that are tilted, rotated, supraerupted,
or out of position may be corrected by orthodontic
treatment before doing fixed prosthodontics

5. Fixed Prosthodontics  If a patient comes to you with a long-standing

• If both anterior and posterior teeth are to be restored, edentulous area with little or no drifting or
the anterior teeth are usually done first supraeruption of the nearby teeth-???
• Anterior teeth influence the border movements of the  The question of replacing the missing teeth should be
mandible and thus they have an effect on how the left to the patient’s wishes

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FOLLOW UP CARE e. Preservation of periodontium
Adequate follow-up will help maintain the long-term health of
the teeth. TOOTH PREPARATION
A clinical procedure consisting of the removal of tooth
Aims of follow-up care program: structures and/or shaping of the tooth to accommodate a fixed
a) Monitor dental health restoration
b) Identify early signs of disease
c) Initiate prompt corrective measures if necessary

Includes regular check-ups and oral prophylaxis (every 6

months

PROBLEMS IN FIXED RESTORATION:

Most problems in fixed restorations can be avoided by correct

tooth preparation.

CORRECT TOOTH PREPARATION:

► Removal of tooth structure does not weaken the
tooth
► The amount of reduction follows the requirements of
restoration
► Resist displacement in all directions
► Presence of optimum tooth height
► Finish line that can accommodate margin with close
adaption
► Provide optimal space for the crown which has
enough thickness to prevent fracture, distortion, or
perforation

BIOMECHANICAL PRINCIPLES OF TOOTH PREPARATION INCORRECT TOOTH PREPARATION

Topic outline: ► Unnecessary reduction
1. Definition of tooth preparation ► Endangers the pulp
2. Requirements of tooth preparation: Biological, ► Lack of retention and resistance features
Mechanical, Esthetics ► Finish line that causes microleakage
3. Principles of tooth preparation ► Inadequate space for the crown (which makes it thin),
a. Preservation of tooth structure and may cause fracture, distortion, or perforation
b. Retention and resistance
c. Structural durability
d. Marginal integrity

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 • Thermal hypersensitivity, pulpal inflammation, and
pulpal necrosis can result from approaching the pulp
too closely

WAYS TO PRESERVE TOOTH STRUCTURE:

1. Use of partial crowns rather than full crowns – the
decision to use a full crown should only be reached only
after a partial crown has been considered and found
wanting because of inadequate retention or esthetics
2. Preparation of teeth using a minimum taper – 6
degrees convergence of the axial
3. Preparation of occlusal surfaces of posterior teeth
so reduction follows the anatomic contours to give
uniform thickness in the restoration.

REQUIREMENTS OF TOOTH PREPARATION:

4. Preparation of the axial surfaces so tooth structure
is removed evenly
5. Selection of a conservative margin - A chamfer
margin (1) is a more conservative preparation than a
shoulder margin (2)
6. Avoidance of unnecessary apical extension of the
preparation – placement of the margin of the
preparation above the gingival margin is more
conservative than placing it below the gingival margin

• To prevent damage to the adjacent teeth, use a metal

matrix band when preparing the proximal
surfaces
• To prevent damage to the soft tissues (tongue and
cheeks), use a mouth mirror or saliva ejector to
retract the tissues

To protect the pulp during preparation:

1. Know the size and morphology of the pulp via
radiographs
2. Use high-speed handpiece with water spray to
prevent heat buildup

(2) RETENTION AND RESISTANCE

• The restoration’s capability for retention and
resistance must be great enough to withstand the
dislodging forces, it will encounter inside the oral
cavity in function
• The geometric form of the preparation of the tooth
is the most important factor that determines the
retention and resistance of the restoration

RETENTION – prevents removal of the restoration along the

long axis of the tooth or the path of insertion
RESISTANCE – prevents dislodgement of the restoration by
the forces directed in an apical, horizontal or oblique direction
and prevents any movement of the restoration under occlusal
5 PRINCIPLES OF TOOTH PREPARATION forces
1. Preservation of tooth structure
2. Retention and resistance
3. Structural durability
4. Marginal integrity
5. Preservation of the periodontium

(1) PRESERVATION OF TOOTH STRUCTURE

• Tooth conservation to reduce harmful effects on the
pulp

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SOURCES OF RETENTION?
˃ Preparation of the tooth – primary retention and
resistance
˃ Dental cement – a secondary source of retention and • The ideal taper is found to be 6 degrees of
resistance convergence
FACTORS THAT AFFECT RETENTION AND RESISTANCE:
1. TAPER
◦ Axial walls of the tooth preparation must taper slightly
to allow the restoration to seat
◦ For extracoronal restorations, the buccal, lingual,
and proximal walls should slightly converge cervico-
occlusally (angle of convergence)

• A tapered diamond bur will produce a 2–3-degree

taper if it is held parallel to the long axis of the tooth

◦ For intracoronal restorations, the internal surfaces

such as in the buccal and lingual walls of the proximal
box in an inlay should slightly diverge cervico-
occlusally (angle of divergence)

Acceptable taper for teeth (that will still provide adequate

retention):
• Anterior teeth - up to 10-degree taper
• Premolars - up to 14-degree taper
• Molars - up to 20-degree taper
When the taper exceeds 30 degrees or more, failure through
the loss of retention of the crown becomes common

2. SURFACE AREA
◦ Molar tooth > Premolar

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 ◦ A full crown preparation is more retentive on a molar
than on a premolar because the molar preparation
has a greater surface area

3. FREEDOM OF DISPLACEMENT
◦ Maximum retention is achieved when there is only
one path of insertion (path of withdrawal) for the
restoration
◦ The path of insertion is an imaginary line along which
the restoration will be placed onto or removed from
the preparation

Path of insertion considered in 2 dimensions: mesiodistally

and faciolingually
Mesiodistal inclination – parallel to contact areas of adjacent
teeth
PATH OF INSERTION
- Paths of all FPD abutments must parallel each other

VISUAL SURVEY – ensures preparation is neither undercut or

over tapered.
◦ The center of the occlusal surface of the preparation
is viewed with one eye from a distance of 30 cm
(12”)
◦ Binocular vision avoided undercut preparation can
appear to have an acceptable taper
◦ In patient’s mouth– mouth mirror is held at an angle
approximately ½ inch above the preparation
◦ Image viewed with one eye

• FPD abutments – common path of insertion

• Firm finger rest established – mirror maneuvered
until one preparation is centered – mirror moved by
pivoting on the finger rest without change in
angulation till the 2nd preparation is centered

4. LENGTH OF THE PREPARATION/TOOTH HEIGHT

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 ◦ Longer preparations will have more surface area and • It must be rigid enough not to flex and break the
therefore will be more retentive cement film
◦ Minimum height of axial walls for adequate retention -
4 mm Occlusal reduction – adequate occlusal reduction is
◦ For the restoration to succeed, the length must be important to provide enough bulk of metal and strength to the
great enough to interfere with the arc of rotation of the restoration
crown pivoting about a point on the margin on the
opposite side of the restoration

◦ It is possible to successfully restore a tooth with a

Functional cusp bevel – wide bevel on the functional cups
short preparation if the tooth has a small diameter; the
provides space for adequate bulk of metal in an area of
preparation on the smaller tooth will have a short
heavy occlusal contact
rotational radius for the arc of displacement and will
- The functional cusp bevel is placed on the palatal
resist displacement (a)
inclines of the maxillary palatal cusps and buccal
◦ The longer rotational radius on the larger preparation
inclines of the mandibular buccal cusps
allows for a more gradual arc of displacement and the
axial wall does not resist removal (b)

If no bevel is placed on the functional cusp, several problems

may occur:
◦ Resistance to displacement for a short preparation on
a large tooth can be improved by placing grooves in
the axial walls; this reduces the rotational radius and
the portion of the walls of the grooves near the
occlusal surface will interfere with displacement

Axial reduction – If you have inadequate axial reduction, this

Another way to improve retention and resistance of a short might result in a restoration that:
preparation is to make sure that the axial walls have as little - is weak with thin walls
taper as possible (more parallel) - it can result in a restoration that is bulbous and
overcontoured
5. SURFACE ROUGHNESS
◦ Because the adhesion of dental cements depends
primarily on projections of the cement into the
microscopic irregularities on the surfaces being
joined, the prepared tooth surface should not be
highly polished
◦ The rougher the surface, the greater the retention

(4) MARGINAL INTEGRITY

(3) STRUCTURAL DURABILITY • The restoration can survive in the oral cavity only if its
• A restoration must contain a bulk of material that is margins are closely adapted to the finish line of the
adequate to withstand the forces of occlusion preparation

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 ◦ Preparation finish line dictates the shape
and the restorative material in the margin
of the restoration
◦ Affect both the marginal adaptation and
degree of seating of the restoration

Knife edge / Feather edge Margin – not recommended under

TYPES OF FINISH LINE/MARGIN: most circumstances
- Most conservative type of margin
Chamfer Margin
Disadvantages:
• Preferred margin for metal restorations
˃ Margins may not be easily distinguished or seen
◦ Because it is rounded, this finish line exhibits
˃ Thin margin of the restoration may be difficult to
the least stress and so the cement will have
accurately waxed and casted by the laboratory
less chance of failure at the margin
˃ Metal restoration with thin margins may also distort
under occlusal forces

Shoulder Margin
• Margin of choice for porcelain crowns
• Allows enough space for healthy contours for the
restoration and maximum esthetics

Shoulder Margin with Bevel

• used as finish line on the proximal box of inlays and
onlays and the occlusal shoulder of onlays; can also
be used as the facial finish line of PFMs where
gingival esthetics are not critical

(5) PRESERVATION OF THE PERIODONTIUM

• Finish lines should be placed in enamel whenever
possible

3 POSSIBLE PLACEMENT OF FINISH LINES:

1. Supragingival
2. Subgingival
3. Equigingival

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SUPRAGINGIVAL
Whenever possible, place the margins above the gingival crest
(0.5 to 1.0 mm)

Other advantages:
˃ Margins are easily finished
˃ Restorations can be easily cleaned by the patient
˃ Impressions are made more easily
˃ Restorations can easily be evaluated at recall
appointments

SUBGINGIVAL EQUIGINGIVAL
Margins are placed below the level of the gingival crest. Limit is Good compromise between supragingival and subgingival.
0.5 mm above the sulcus Margin is placed at the level of the gingival crest

Disadvantages:
˃ Likely to cause gingival inflammation and lead to
periodontal problems
˃ Patients have more difficult time cleaning restoration
˃ Subgingivial margins can be more difficult to finish,
evaluate and make an impression of

SUBGINGIVAL MARGINS CAN BE USED IN THE FOLLOWING

SITUATIONS:
 Dental caries, cervical erosions or restorations extend
subgingivally and crown lengthening procedure is not
indicated
 Proximal contact area extends to the gingival crest
 Additional retention is needed especially if tooth
preparation is short
 The margin of a PFM crown is to be hidden below the
gingival crest for esthetics especially in anterior teeth
 Root sensitivity cannot be controlled by more
conservative treatment
 Modification of the axial contour is indicated

For subgingival margins, make sure it is > 2.0 mm above the

alveolar crest of the bone (biologic width); at least 3.0 mm
above the alveolar crest

Biologic width = 1.0 mm junctional epithelium + 1.0 mm

connective tissue

FACTOR INFLUENCING FPD DESIGN

EVALUATION OF ABUTMENT TEETH FOR A BRIDGE
In a FPD or bridge, the occlusal forces that is normally
If you violate the biologic width, this will result in: absorbed by the missing tooth are transmitted, through the
- Gingival inflammation, loss of alveolar crest height pontic, connectors and retainers to the abutment teeth
and formation of periodontal pocket

TRANSCRIBED BY: NATALIE G. 15

 - Abutment teeth need to be strong enough to
withstand the forces directed to the missing addition
teeth to in those usually applied to the abutments

• Roots that are broader labiolingually than they are

mesiodistally are preferrable to roots that are round

WHEN CONSIDERING A TOOTH OR TEETH TO BECOME

ABUTMENTS FOR A FIXED BRIDGE, THERE ARE CROWN-ROOT RATIO
SEVERAL FACTORS NEED TO BE CONSIDERED: Crown-root ratio is a measure of the length of the tooth
occlusal to the alveolar crest compared to the length of root
1. Crown length embedded in bone
2. Crown form
3. Degree of mutilation
4. Rooth length and form OPTIMUM CROWN-
5. Crown: root ratio ROOT RATIO – 2:3
6. Ante’s law
7. Periodontal health MINIMUM ACCEPTABLE
8. Tooth mobility RATIO – 1:2
9. Span length
10. Arch curvature
11. Alveolar ridge form
12. Endodontically treated abutments As the level of the alveolar bone moves apically, the
13. Occlusion lever arm of that part of the tooth above the bone increases,
14. Age of the patient and the chance for harmful lateral forces is increased
CROWN LENGTH
Abutment teeth must have adequate occluso-cervical crown
length to have sufficient retention
• Short crowns – poor retention
• For short crowns, to increase retention:
a. use full coverage restorations
b. gain additional length thru crown lengthening; OR,
extend margins subgingivally
c. use of grooves and boxes

CROWN FORM
Some teeth have conical or tapered crown form which is not
ideal for parallel preparation
- E.g., peg laterals

DEGREE OF MUTILATION/AMOUNT OF SOUND TOOTH

STRUCTURE REMAINING
Refers to size, number and location of carious lesions or
restorations in a tooth
- The more in number and size of the caries are, the
weaker the tooth and thus are not good abutments for
a bridge
ANTE’S LAW
Says that the root surface area the abutment should be of
ROOT LENGTH AND FORM equal or greater than that of the teeth being replaced with
Important for the stability of the abutment tooth pontics
• Long multi-rooted, widely separated roots – better - Ante’s law helps determine the number and what
periodontal support abutment teeth are needed to support a fixed bridge
• Roots that are short, fused, converge or have a
conical form – poorer periodontal support

TRANSCRIBED BY: NATALIE G. 16

 The combined root
surface area of the
2nd premolar and 2nd
molar is greater than
that of the 1st molar
being replaced.

The combined root

surface area of the
1st premolar and 2nd
molar abutments is
approximately equal
to that of the 2nd
premolar and 1st
molar being
replaced.
If the span length is tripled (3p), the deflection will be 27x as
PERIODONTAL HEALTH great
Extensive bone loss may need the use of multiple abutment
teeth
- Make sure patient is practicing good oral hygiene
before any prostheses is made

TOOTH MOBILITY
 Grade 1 mobility – can be used as abutment
 Grade 2 mobility – needs assessment
 Grade 3 mobility – can’t be used as abutment
Teeth with slight mobility can be used as abutments if
stabilized and if oral hygiene is maintained

Classification of tooth mobility:

a) Normal mobility
b) Grade 1 – slightly more than normal (<0.2 mm
horizontal movement)
c) Grade 2 – moderately more than normal (1-2 mm
horizontal movement) ARCH CURVATURE
d) Grade 3 – severe mobility (>2 mm with vertical When pontics lie outside the interabutment line, the pontics act
movement) as a lever which can torquing movement abutments
SPAN LENGTH
All FPDs flex slightly when subjected to load
• The longer the span, the greater the flexing or
bending; the relationship of span length and bending
can be expressed as “bending or deflection varies
directly with the cube of the length of the span”

BENDING OF THE BRIDGE = (LENGTH OF THE BRIDGE)3

TRANSCRIBED BY: NATALIE G. 17

 ENDODONTICALLY TREATED ABUTMENT
If a tooth has been treated properly endodontically, it can be
used as an abutment with a post and core
- If a tooth is badly damaged, has short roots or has
little remaining coronal tooth structure, it may be
better to just extract it

OCCLUSION
If the patient has bruxism or other parafunctional habit,
Common problem in replacing all 4 maxillary incisors with FPD excessive occlusal force can cause tooth mobility or fracture of
with the canines as abutments the porcelain in crowns
- To counteract this tipping movement on the canine
abutment, the 1st premolars are added as secondary BRUXISM - excessive grinding of teeth and/or excessive
abutments clenching of the jaw

Consequences of bruxism include:

˃ Excessive tooth wear – attrition, abfractions
˃ Tooth fractures including restorations
˃ Hypersensitive teeth
˃ Inflammation of periodontal ligaments which causes
pain on biting down on the teeth
˃ Burning sensation on the tongue
˃ Grinding or tapping noise during sleep
˃ Hypertrophy of the muscles of mastication particularly
the masseter
˃ Tenderness or fatigue of the muscles of mastication
˃ Trismus
˃ Pain or tenderness on the TMJ
˃ Headaches particularly in the temples

AGE OF PATIENT
You can’t put a fixed bridge on children because of continuing
jaw growth and continuous replacement of temporary teeth
with permanent teeth. Generally, the teeth of children are short
and are not ideal as abutments for bridges
To counter act tipping movement, add secondary - Because of large pulp size in young patients,
abutments (1st premolars) extensive tooth reduction for a crown may lead to
exposure of the pul

ALL METAL CROWN

ARCH RIDGE FORM ALL METAL CROWN: one of the best kind of restorations for
If anterior bone loss is severe, there may be a ridge defect badly damaged posterior teeth.
- If this is the case in anterior area and patient has a - Best longevity of all crown restorations
high lip line, better do RPD Used to rebuild a single tooth or as a retainer for a fixed dental
- Surgical ridge augmentation can also be done to prosthesis
correct the ridge defect)
INDICATIONS:

TRANSCRIBED BY: NATALIE G. 18

 1. Extensive destruction from caries or trauma
2. Endodontically treated teeth
3. Existing restoration
4. Necessity for a maximum retention and strength
5. To provide contours to receive a removable
appliance, other recontouring of axial surfaces (minor
malinclinations), or correction of occlusal plane

CONTRAINDICATIONS:
1. Less than maximum retention necessary
2. Esthetics

ADVANTAGES:
1. Strong
2. High retention qualities
3. Usually easy to obtain adequate resistance form
4. More conservative preparation than any other type of
full-coverage crown
5. Option to modify form and occlusion

DISADVANTAGES:
(1) OCCLUSLA DEPTH GUIDES
1. Removal of large amount of tooth structure
Place depth holes (round bur no. 2) approximately 1 mm deep
2. Adverse effects on the tissue
in the central, mesial, and distal fossae and connect them so
3. Vitality testing not readily feasible
that a groove runs the length of the central groove and extends
4. Display of metal
into the mesial and distal marginal ridge
POSTERIOR TOOTH PREPARATION
Recommended reductions for all metal tooth prep:

Place depth guides in the buccal and lingual grooves and each
triangular ridge from the cusp tip to the center of its base (with
tapered diamond bur)

Place depth guides also on the developmental grooves of the

cusps

FEATURES OR TOOTH PREPARATION OF ALL METAL CROWNS:

On FUNCTIONAL CUSPS (buccal of mandibular & lingual of
maxillary) – the occlusal clearance is 1.5 mm
On NON-FUNCTIONAL CUSPS, the occlusal clearance of at
least 1 mm is needed

Type of margin: chamfer margin all around (0.5 mm width)

Place depth guides also on the developmental grooves of the
cusps and on the functional and nonfunctional cusps
 Occlusal reduction should follow normal anatomic
contours to conserve as much tooth structure as
possible
 Axial reduction should parallel the long axis of the
tooth allowing for a 6-degree taper or convergence
between opposing axial surfaces

ARMAMENTARIUM:
FINAL DEPTH:
1. High speed handpiece
2. Diamond burs – tapered round end bur (chmafer), • Non-functional cusp – 1.0 mm
round bur, finishing burs • Functional cusp – 1.5 mm
3. Periodontal probe, explorer
4. Finishing/polishing strips Initial depth:
- Central groove & non-functional cusps – 0.8 mm;
- Functional cusps – 1.3 mm

TRANSCRIBED BY: NATALIE G. 19

** Use a round-end tapering diamond bur to make depth
grooves on the triangular ridges and in the primary
developmental grooves of the molar

A. Note the angulation

of the bur as the
The depth grooves should be 1.5 mm deep on the functional functional cusp
cusps and 1.0 mm deep on the functional cusps. Depth can be bevel is placed,
gauged from the diameter of the diamond bur used for the angled slightly
reduction. flatter than the
original cusp angle
to provide more
clearance for the
centric cusp than for
the axial wall.

B. Completed occlusal
reduction. Note that
(2) OCCLUSAL REDUCTION
it follows normal
Complete the occlusal reduction in two stages: Half the
occlusal form three
occlusal
distinct slopes can be seen buccolingually.
surface is reduced first so that the other half can be maintained
as a reference. When the necessary reduction of the first half
has been accomplished, the reduction of the remaining half
can be completed
• Verify that a minimum clearance
• If any uncertainty remains, the patient should be
asked to close into several layers of dark-colored
utility wax from the mouth and evaluate it for thin
spots, which can be measured with a wax caliper.

Occlusal reduction consists of removing the tooth structure

remaining between the depth grooves. It should be done in an
inclined-plane pattern following the cuspal contours. The
occlusal surface should never be flat after reduction. The • A convenient alternative method is to use occlusal
cuspal planes should still be evident after occlusal reduction. reduction gauge (Hu-Friedy Mfg. Co.)

(3) CREATING THE FUNCTIONAL CUSP BEVEL

1. Depth: 1.5 mm
2. Place depth grooves for a functional cusp bevel across the
facial occlusal line angle.

(4) LABIAL, PROXIMAL, AND LINGUAL REDUCTION

(AXIAL)
1. Depth: 1.0 mm

TRANSCRIBED BY: NATALIE G. 20

2. Finish line: Chamfer (circumferentially)

FINISHING
3 alignment grooves are placed on the buccal and lingual
surfaces with a narrow round-end tapered diamond bur – on a. Use fine grit diamond bur at reduced speed to finish
the center, mesial, and distal line angle the margins and round all the line angles
- When making the grooves, the bur should be parallel b. Place additional retentive features (such as grooves
to the path of insertion/withdrawal. or boxes) with a tapered carbide bur if needed

The completed preparation is characterized by a smooth, even

chamfer; a 6-degree taper and gradual transitions between all
The remaining tooth between the grooves are removed while prepared surfaces.
the chamfer margin is being placed.
- Perform the axial reduction on half the tooth first.

Cut the proximal area from the buccal and lingual sides until
only a few millimeters of interproximal island remain.
- Remove the contact area by using thinner, tapered
diamond burs.

Place the cervical chamfer concurrently with axial reduction. Its

width should be approximately 0.5 mm, which allows an
adequate bulk of metal at the margin. This chamfer must be
smooth and continuous mesiodistally, and a distinct resistance Internal features such as this buccal groove can be used to
against vertical displacement should be detected when probed improve retention and resistance form
with the tip of an explorer.

MARGINS
a. Place the chamfer margin all around the preparation
b. Margin width should be 0.5 mm circumferentially
c. Clearance of margin from the adjacent tooth must be
≥0.6mm

TRANSCRIBED BY: NATALIE G. 21

 Evaluation of reduction APPLICATIONS OF PORCELAIN
1. Porcelain denture teeth
2. Porcelain jacket crown
3. Porcelain inlay
4. Porcelain veneer
5. Porcelain fused to metal prosthesis
6. Implant material

Porcelain Fused to Metal Crown – combines the strength

and accurate fit of a cast restoration.
- Composed of metal casting/coping that fits over the
tooth preparation and ceramic that is fused to coping.

PORCELAIN
• Insoluble to oral fluids
• Abrasion resistance is high
• Well tolerated by soft tissue
• Excellent color that mimics the tooth structure

COMPONENTS OF PORCELAIN:
1. FELDSPAR (70% - 90%) – responsible for
translucency (matrix for high fusing quartz)
2. QUARTZ (11% - 18%) – helps porcelain maintain its
form during firing (form and shape)
3. KAOLIN (1% - 10%) – binds all porcelain constituents
before firing (adhesive)

Oxides – make produce the opaque color

CLASSIFICATION OF DENTAL PORCELAIN:

According to their FUSION TEMPERATURES:
1. High-fusing (1300-1400°C)
2. Medium-fusing (1100-1300°C)
3. Low-fusing (850-1100°C)
4. Ultra-low-fusing (<840°C)

According to the METHOD OF FURING

1. Atmospheric firing
2. Vacuum, firing (lower percentage of porosity)

1,2 – are fused for denture teeth production

3,4 – are used for crown and bridge construction

CHARACTERISTICS OF DENTAL PORCELAIN

1. Biologic Properties
• Inert – has no interaction with surrounding
PORCELAIN FUSED TO METAL CROWN
soft tissue (biocompatible)
DENTAL CERAMICS
2. Interfacial Properties
• Generally, ceramic is used to name any material with
• Does not adhere chemically to dental
both metallic and non-metallic ions in its
cements
compositional formula.
3. Chemical Properties
e.g., cements, gypsum, porcelain, and glasses
• Not soluble in oral fluids and resists acid
attachment
Dental porcelain – an early type of dental ceramic that has
• Both hydrofluoric acid and stannous fluoride
been modified to improve its properties.
can cause an increase in surface roughness
4. Mechanical Properties

TRANSCRIBED BY: NATALIE G. 22

 • Brittle ◦ Ionic bond between the metal oxide layer and the
• Low DTS and fracture toughness opaque porcelain.
• Hard, can cause wearing of opposing ◦ Metal degassing is important for oxide formation,
dentition removing surface contaminants and greases.
5. Thermal Properties ◦ Thin oxide later (in case of noble alloys) provides a
• Low thermal diffusivity stronger bond than the thick one (in case of base
• Coefficient of thermal expansion similar to alloys)
that of enamel and dentin
6. Esthetic Properties 3. Van der Waals Forces
• Excellent esthetics and color matching ◦ Compromise of an affinity based on mutual attraction
• Difficult to stain of charged molecules.
7. Practicability Properties ◦ Molecular attraction makes only a minor contribution
• Sensitive to manipulation technique, to overall bond strength, thus significant in the
requiring skilled operator and special initiation of the most important bond – Chemical Bond
equipment
• Firing shrinkage – operator builds up 4. Chemical Bonding
restoration to a bigger size to allow for ◦ Indicated by the formation of an oxide layer on the
shrinkage metal and by bond strength that is increased by firing
in an oxidizing atmosphere.
LAYERS OF PORCELAIN:
1. Opaque Porcelain ALLOY
• Plays an important role in the development Characteristics:
of the bond between ceramic and metal 1. Melting range is above porcelain maturing
• Conceals the metal underneath temperature
• It initiates the development of the shade 2. Resistance to high temperature sag
3. Sufficient rigidity
2. Dentin/Body Dentin 4. Thermal expansion similar to porcelains
• Makes up the main bulk of the restoration 5. Acceptable compatibility to porcelain
• Provide most of the color shade 6. No pigmented products used

3. Enamel/Incisal PRODUCTION OF METAL COPINGS

• Porcelain imparts translucency to the A. Casting of pure metals or metallic aloys
restoration 1. Commercially-pure titanium (CP Ti)
2. High gold alloy
3. Gold-palladium alloy
4. Palladium-silver alloy
5. High palladium alloy
6. Nickel-chromium alloy
B. Burnishing and heat-treating metal foils on a die
1. Platinum foil
2. Gold foil
3. Captek system
C. Electro-deposition of metal on a duplicate die
D. CAD-CAM processing of metal ingot

PORCELAIN FUSED TO METAL CROWNS

INDICATIONS
1. Complete coverage for which significant esthetic
demand
2. In case of extensive tooth destruction as a result of
caries, trauma, or existing previous failed restoration
3. When superior retention and resistance is need
4. In cases of root canal treated tooth (with post and
core)
5. To recontour axial surfaces or correct minor mal-
MECHANISM OF BONDING OF PORCELAIN TO METAL inclinations of the teeth
COPING
1. Mechanical Entrapment CONTRAINDICATIONS
◦ Achieved by interlocking the ceramic with micro 1. When patient have an active carious lesion
abrasion in the surface of the metal coping 2. Periodontal problems
◦ Infiltration (flow) of the fused ceramic into the surface 3. Young patients with large pulp chambers (high risk of
irregularities of the metal coping pulp exposure)
◦ Sandblasting of the metal surface or using plastic 4. In case of tooth with clinical crown
beads using waxing are important for this issue 5. In case of edge to edge or overbite occlusion
6. Where more conservative restoration can be made
2. Compressive Forces
◦ Occurs when the coefficient of thermal expansion of a ADVANTAGES
poorly designed metal coping is slightly higher than 1. Have the strength of cast metal crowns with esthetic
that of porcelain veneered over it. of all ceramic crowns

TRANSCRIBED BY: NATALIE G. 23

 2. Natural appearance can be closely matched by good ◦ Extensions of porcelain of 2.0 mm beyond and are
technique prone to fracture
3. Retentive qualities are excellent because all axial
walls are included 2. Porcelain Support
4. Good aesthetic and liable staining ◦ The outer junction of porcelain should be at a right
5. Long-term clinical durability (2-7 years) angle to avoid burnishing of the metal and
6. Less preparation compared to all ceramic crowns subsequent fracture of the porcelain
7. Biocompatible – thermal properties are similar to ◦ The uniform thickness of porcelain should be
enamel and dentin established that the metal should be contoured so
that the overlying veneer will be subject to
DISADVANTAGES compressive rather than shearing forces when load is
1. Tooth reduction providing sufficient space for applied.
restorative material
2. Slightly inferior esthetics
3. Can subject too brittle fracture (due to poor design)
and due to low tensile strength
4. Metal display could result at the thin marginal area
5. Using opaque porcelain is essential to overcome the
metal color
6. High hardness, makes abrasion to antagonist natural
dentitions
7. Difficult to adjust and polish
8. Facial margins for anterior teeth often placed
subgingivally which increase risk of periodontal 3. Thickness of Metal
disease ◦ The maximum restoration strength and longevity is
9. Difficult of accurate shade selection (frequent achieved by coping rigidity. The metal must not flex
problem) during seating or under occlusal forces.
◦ For adequate strength and rigidity, a noble metal
coping should be at least 0.3 mm – 0.5 mm thick
◦ The ultimate goal of achieving a uniform thickness of
approximately 1.0 mm of porcelain will dictate the
thickness of the metal coping.

4. Occlusal and Proximal Contacts

◦ Occlusal contacts should occur on metal if possible or
whenever possible, well away from Porcelain-Metal
Junction line
◦ The Porcelain-Metal Junction should be placed 1.0
mm away from occlusal contact at the position of
maximal intercuspation.
◦ When lingual contacts on maxillary restorations must
be placed too close to the incisal edge – it will result
in fracture
◦ To minimize stress resulting from occlusal contacts on
the palatal surface of maxillary anterior restorations,
the porcelain metal junction should not be placed in
the vicinity of those contacts with the mandibular teeth
◦ An optimum stress distribution also occurs when
porcelain-metal jacket is lingual to the proximal
contact areas
◦ If the decision is made to place complete lingual
coverage in porcelain, the lingual reduction necessary
is 1.3 mm to 1.5 mm
COPING DESIGN: IMPORTANT FEATURES OF METAL
DESIGN
METAL COPING DESIGN
• Metal coping is an important part of the metal ceramic
restoration, that is often overlooked
• This design can affect the success and failure of the
restoration
• The coping must allow the porcelain to remain in
compression by supporting the incisal table, occlusal
table as well as the marginal ridge. (5) Extent of Veneered Area
◦ A logical framework design of a maxillary posterior
1. Thickness of Porcelain Veneer teeth is to veneer esthetically critical facial surfaces
◦ Porcelain should be kept a minimum thickness that with porcelain while maintaining occlusal contact
there is still compatible good esthetics metal
◦ The absolute minimum thickness of porcelain is 0.7
mm and the desirable is 1.0 mm -1.5 mm

TRANSCRIBED BY: NATALIE G. 24

 ANTERIOR TOOTH PREPARATION
1. Incisal Depth Cuts/Grooves
◦ Depth: 1.5 mm – 1.8 mm
◦ Form three notches at the incisal edge
◦ Use your periodontal probe as you measure the depth
of the guide groove
(6) Design of Facial Margins
◦ Conventional facial margin for a metal ceramic crown
has a narrow metal collar
◦ To avoid unsightly band of metal, ceramists began to
extend porcelain to cover the collar
◦ Gingival recession may occur from trauma of tooth
preparation, impression taking or improper contoured
provisional restoration. (usually visible within 2 year
period) --- Make the incisal plane grooves first by aligning the bur with
the incisal portion of the facial surface and embedding the bur
MINIMUM DIMENSIONS to its full diameter. Make 2-3 incisal plane grooves

2. Facial Depth Cuts/Grooves

◦ Depth: 1.3 m
◦ Form two (2) planes according to facial contour
◦ Follow mesiodistal curvature of the incisal edge

◦ Depth grooves in the facial wall are placed in two

directions:
˃ Incisally – parallel to the tooth contour
˃ Cervically – parallel to the long axis of the
tooth (the path of placement)
◦ The grooves should be prepared initially to a depth of
about 1.3 mm
◦ A common fault is to place the cervical groove at too
labial an angle (red line). This will lead to inadequate
space for porcelain and may create and undercut

TOOTH PREPARATION
ARMAMENTARIUM:

˃ Round-ended rotary
diamonds (regular grit for
bulk reduction, fine grit for
finishing) or tungsten
carbide burs 3. Facial Reduction
˃ Football – or wheel shaped ◦ Two plane according to facial contour
diamond (for lingual ◦ The incisal portion of the facial surface is reduced
reduction of anterior teeth) with a shoulder bur removing the tooth structure
˃ Flat-ended, tapered remaining between the depth guides
diamond (for shoulder
margin preparation)
˃ Finishing stones
˃ Explorer and periodontal probe
˃ Off angle hatchets

TRANSCRIBED BY: NATALIE G. 25

 ◦ A football-shaped bur can be used for this step of the
tooth reduction
◦ Be careful not to extend the lingual reduction so far
gingivally over the cingulum that the vertical lingual
wall is over shortened.

◦ The facial surface is reduced in 2 planes following the

depth grooves made in the previous step. The
gingival portion of the facial surface is reduced next
using the same bur.

6. Lingual Reduction
◦ Depth: 0.5 mm margin (half of the chamfer bur)
◦ Forming, follow the CEJ
◦ Cervical shoulder margin: tooth structure between the ◦ To create the chamfer margin, embed half of the
depth grooves is removed chamfer bur into the tooth surface
◦ Rotary instrument is moved parallel to the intended ◦ Embedding more than half of the bur will create a lip
path of placement during this procedure of unsupported enamel on the margin
◦ The facial reduction should be completed in two
phases: one hald is maintained intact for evaluation of
the adequacy of reduction --- a “wingless” variation of a PFM
◦ Note the two distinct planes of reduction on the facial preparation, - the shoulder preparation
aspect should gradually narrow towards the lingual
◦ The proximal aspect parallels the cervical reduction side and gradually transition into the
on the facial wall chamfer preparation.

7. Evaluation of Reduction
◦ All negative taper / undercut must be eliminated
◦ Use one eye from a distance approximately 12 inches

4. Proximal Reduction
◦ Depth: 1.5 mm
◦ The shoulder should be extended 1.0 mm lingual to
the contact area

Evaluation of reduction:

◦ The proximal surfaces should have to a 5 to 7

degrees convergence which is created by holding the
bur parallel to the long axis of the tooth. The natural
taper of the bur imparts this convergence.

8. Smoothening and Finishing

◦ The margins should provide distinct resistance to
vertical displacement to an explorer tip and should be
smooth and continuous circumferentially. A properly
finished margin should feel like a smooth glass slab
5. Lingual Depth Cuts ◦ Use and end cutting bur to properly finish the
◦ Depth: 0.7 mm shoulder margins making sure that it is smooth and

TRANSCRIBED BY: NATALIE G. 26

 continuous throughout the facial and proximal 5. Unfavorable distribution of occlusla load
surfaces 6. Bruxism
◦ Round off all sharp line angles in the preparation with
the fine-grit diamond burs. Doing so reduces all ADVANTAGES:
internal stresses that may develop in the restoration. 1. Superior esthetics
◦ The completed preparation should have a satin finish 2. Excellent translucency (similar to natural tooth
free from obvious diamond scratch marks. Use the structure)
fine grit diamond burs to smoothen and finished all 3. Good tissue response even for subgingival margins
the prepared surfaces. 4. Slightly more conservative of facial wall than metal
ceramic crowns

DISADVANTAGES:
1. Reduced strength in comparison with metal ceramic
crowns
2. Proper preparation is extremely crucial to ensuring
mechanical success (90-degree cavosurface margin)
3. Among the least conservative preparations
4. Brittle nature of material
5. Can only be used as a single restoration

Minimum measurements:

DESIGN:
• The design of the occlusion
on an all-ceramic crown is
crucial to avoid fracture
• Centric contacts are best
confined to the middle third
of the lingual surface
• Anterior guidance should be
smooth and consistenet with
contact on the adjacnet teeth
• Leaving the restoration out
of contact is not
recommended.

ALL PORCELAIN CROWN TOOTH PREPARATION: CERAMIC CROWN

• Most esthetically pleasing in prosthodontic ARMAMENTARIUM:
restorations - Round-ended, tapered diamonds, regular and coarse
• No metal to block light transmission grit (0.8 mm)
• Can resemble natural tooth structure; better terms of - Square-ended, tapered diamond, regular grit (1.0
color and translucency mm), or end-cutting diamond
• Relatively thickness circumferentially - Football-shaped diamond
- Fine grit finishing diamonds or carbides
INDICATIONS: - Mirror
1. Optimal esthetic is desired - Periodontal probe
2. Malformed incisors - Explorer
3. Extensive restoration - Chisels and hatchets
4. Endodontically treated teeth with post and cores - High and low-speed handpieces
5. Favorable distribution of occlusal load

CONTRAINDICATIONS:
1. When superior strength is needed and metal-ceramic
crown is more appropriate
2. High caries index
3. Insufficient coronal tooth structure for support
4. Thin teeth faciolingually

TRANSCRIBED BY: NATALIE G. 27

 5. Lingual Reduction (Lingual Fossa)
◦ Depth: 1.0 mm
◦ A football-shaped bur can be
used for this step of the tooth
reduction
◦ Be careful not to extend the
lingual reduction so far
gingivally over the cingulum
that the vertical lingual wall is
over shortened

1. Labial and Incisal Depth Grooves

◦ With a shoulder bur, create

depth grooves in the labial
surface of about 0.7 mm 6. Lingual Reduction
depth ◦ Depth: 1.0 mm
◦ Place 3 grooves in the ◦ Use shoulder bur to
gingival plane and 2 prepare axial
grooves in the incisal plane surface of lingual
wall

2. Incisal Reduction
◦ Depth: 2.0 mm 7. Smoothening and Finishing
◦ Reduce the incisal edge, ◦ Carefully blend the reduction of each axial surface
any reduction of more than with that on the adjacent axial surface. If the junctions
2.0 mm will increase the between the axial surfaces are not rounded over, the
stress on the labial surface crown will be thin and prone to fracture in these
can result in porcelain areas.
fracture. ◦ Finish the margins using the end cutting bur making
◦ Maintain 45 incisolingual bevel sure they are smooth and continuous throughout the
preparation.
3. Labial Reduction

Depth: 1.0 mm
Should be done in two (2)
planes
a. incisal plane
b. gingival plane

4. Proximal Reduction

◦ Depth: 1.0 mm
◦ Use a thin needle bur to
begin with the proximal
reduction without damaging
the adjacent tooth
◦ Finish the reduction with
shoulder bur

TRANSCRIBED BY: NATALIE G. 28

• Good luck

RECALL: WHAT ARE THE WAYS TO PRESERVE

TOOTH STRUCTURE:
1. Use of partial-coverage rather than complete
coverage restorations
2. Preparation of teeth using a minimum taper

TRANSCRIBED BY: NATALIE G. 29

 3. Preparation of occlusal surfaces of posterior teeth so WHAT ARE THE COMPONENETS OF
reduction follows PERIODONTIUM? CPAG
4. the anatomic contours to give uniform thickness in the
• Cementum
restoration
• Periodontal ligaments
5. Preparation of the axial surfaces so tooth structure is
• Alveolar bone
removed evenly
• Gingiva
6. Selection of a conservative margin
7. Avoidance of unnecessary apical extension of the
preparation
BIOLOGICAL WIDTH MEASUREMENTS? 2.04 MM
1. Junctional epithelium: 0.97 mm
RECALL: WHAT ARE THE FACTORS THAT AFFECT 2. Connective tissue: 1.07 mm
RETENTION AND RESISTANCE:
1. Taper
2. Surface area
3. Freedom of displacement
4. Length of preparation/tooth height
5. Surface roughness

DIFFERENTIATE RETENTION VS. RESISTANCE

WHAT IS THE IDEAL TAPER (IN DEGREES) IN

TOOTH PREPARATION? 6 DEGREES.
CONVERGENCE

RECALL: WHAT ARE THE FACTORS THAT AFFECT

RETENTION AND RESISTANCE?
1. Taper
2. Surface area
3. Freedom of displacement – ONE PATH OF
INSERTION
4. Length of preparation / tooth height – 4 mm minimum
height of axial walls
5. Surface roughness: rougher surface = more
retention

REVIEW: FUNCTIONAL VS NON-FUNCTIONAL CUSP

BULL – nfc
BLLU – fc

RECALL: HOW CAN WE ENSURE STRUCTURAL

DURABILITY?
1. Occlusal reduction
2. Functional cusp bevel
3. Axial reduction

TRANSCRIBED BY: NATALIE G. 30