Principles of tooth preparation

Preservation of
tooth structure

Luting Dislodging Geometry

Preservation of agent used forces -taper
periodontium -freedom of
Retention & displacement
Materials
resistance form -path of insertion
Marginal cemented -length
Roughness of -stress
integrity fitting -preparation type
surfaces
Structural

durability
Occlusal Axial
reduction
reduction
 Al-Fouzan etal quantified the volume of reduction of tooth
structure associated with different commonly used
preparation designs using microcomputed tomography

 The all-ceramic crown preparation design for the

mandibular central incisors had the highest percentage
(65.26% ± 4.14%) of tooth structure reduction, while the
lowest percentage of tooth structure reduction was
associated with the ceramic veneer preparation design for
maxillary central incisors (30.28% ± 5.54%)

Al-Fouzan A.F Volumetric measurements of removed tooth structure

associated with various preparation designs Int J Prosthodont 2013;26:545–8
 Tooth preparation

The process of removal of diseased

and/or healthy enamel, dentin and
cementum to shape a tooth to receive a
restoration
 Biological -maintenance of pulp vitality,
adjacent teeth & soft tissues
-conservation of tooth
structure
 Mechanical - retention & resistance

 Esthetic - minimal display of metal

- adequate thickness of porcelain
- proper shade matching
 Total occlusal convergence
Occlusocervical/incisocervical dimension
 Ratio of OC and FL dimension
 Circumferential form of the prepared tooth
 Reduction uniformity
 Reduction depths
 Finish line location
 Line angle form

Goodacre C J. Designing tooth preparations for optimal success.

Dent Clin N Am 2004; 48: 359-85.
 Preservation of tooth structure

 Retention & Resistance

 Structural durability

 Marginal integrity

 Preservation of the periodontium

 Preserve the remaining tooth
structure
 Conservation guidelines-

 Coverage: Partial v/s complete

 Margin: Supragingival v/s

subgingival
 Preparation of teeth with the minimum practical
convergence angle between axial walls

 Occlusal surface reduction: follow anatomic

planes

 Axial surfaces : if necessary, teeth should be

orthodontically repositioned.
 Retention prevents removal of the
restoration along the path of
insertion or long axis of the tooth
preparation.

 Resistance prevents dislodgment

of the restoration by forces
directed in an apical or oblique
direction and prevents any
movement of the restoration under
occlusal forces.
 Dislodging forces

 Geometry of the tooth preparation

 Roughness of the fitting surface of the restoration

 Materials being cemented

 Luting agent being used

 Forces that tend to remove a cemented
restoration along its path of withdrawal

 FPD subject to dislodging forces-

 Flossing under the connectors
 Sticky food
 Restrained movement (eg. Nut and bolt )
 Sliding pair – two cylindrical surfaces constrained to
slide along one another
 Taper / Total Occlusal Convergence (TOC)
 Substitution of internal features
 Path of insertion
 Freedom of displacement
 Length and Surface area
 Stress concentration
 Type of preparation
 Inclination - relationship of one wall of a preparation to
the long axis of that preparation
 Tapered diamond bur: 2-3° inclination
 Opposing surfaces with 3° inclination= 6° taper

External Internal
walls walls
(converge) (diverge)
 Parallel walls – maximum
retention
 Taper
 visualize preparation walls
 prevent undercuts
 permit more nearly complete
seating of restorations
during cementation

 Ideal taper: 6°
 Retention

 More the taper, lesser the

retention

Jorgenson KD. The relationship between retention and convergence angle in

cemented veneer crowns. Acta Odontol Scand 1955 Feb;59(2):94-8.
 Angle between two opposing prepared axial surfaces

 Historically TOC : 2°-6°

 Clinical goal : 10°-22°
 TOC beyond 10-22° – auxilliary features needed

 Resistance testing was found to be more sensitive to

changes in the TOC than retention testing

Goodacre C J. Designing tooth preparations for optimal success.

Dent Clin N Am 2004; 48: 359-85.
Goodacre C J. Designing tooth preparations for optimal success.
Dent Clin N Am 2004; 48: 359-85.
 Basic unit of retention-opposing walls with minimal taper
 Opposing walls not available for use-
 Destroyed previously (severe attrition)
 Partial veneer restorations
 Greater than desirable inclination

Groove Box Pinhole

 Imaginary line along which the restoration will be placed
onto and removed from the preparation
 Paths of all FPD abutments must parallel each other
 Visual survey - ensures preparation is
neither undercut or overtapered

 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
 Path of insertion considered in 2
dimensions- mesiodistally and faciolingually.
 Mesiodistal inclination - parallel to contact areas
of
adjacent teeth
 Faciolingual orientation - affects esthetics of metal
ceramic and partial veneer crowns

Facially inclined path of insertion

prominent facio-occlusal line angle

overcontouring or opaque show-through

 For full veneer crowns

 parallel to long axis of the tooth
 Posterior ¾ crown
 parallel to long axis of the tooth

 Anterior ¾ crown
 parallel to incisal ½ of the labial
surface
 Numbers of paths along which a restoration can be
removed from the tooth preparation

 Only one path – maximum retention

 Longer preparation – more surface area – more retentive
 Length must be great enough to interfere with the arc of
the casting pivoting about a point on margin on
opposite side of restoration
 Short preparations – inclination critical
 Smaller tooth - short
rotation radius

 Grooves in the axial

walls- reduce the
rotation radius
 Retentive failure occurs - cohesive failure
in cement

 Stress concentration- around the junction

of axial and occlusal surfaces

 Rounding the internal line angles

 Complete crown> partial coverage crowns

 Adding groove/ boxes increases retention

 Roughening/grooving the restoration -
retention increased

 Prepared by air-abrading the fitting

surface with 50 µm of alumina
 Airborne particle abrasion -
increase in
vitro retention by 64%

 Roughening the tooth preparation- not

recommended
 Retention affected both by the casting alloy and
the core build-up material
 The more reactive the alloy is, the more
adhesion there will be with certain luting agents

 Type I and II gold alloys- intracoronal

restorations
 Type III and IV gold alloys- crowns
and FPD
 Ni-Cr alloys- long span FPD
 Adhesive cements- most retentive

 Film thickness of luting agent- effect not

certain

 Adhesive resin> Glass ionomer> Zinc

Phosphate= Polycarboxylate> ZnO-
E
 Dislodging forces

 Luting agent being used

 Geometry of the tooth preparation

 Mastication and parafunctional activity - substantial
horizontal or oblique forces

 Lateral forces displace the restoration by causing

rotation around the gingival margin
 Resistance to deformation affected by
compressive strength and modulus of
elasticity

 Adhesive
resin> Glass ionomer> Zinc
Phosphate> Polycarboxylate> ZnO-
E
 Type of preparation
 Freedom of displacement
 Occlusocervical/incisocervical dimension
 Ratio of OC and FL dimension
 Circumferential form of the prepared tooth
 Partial coverage restoration< complete crown
(no buccal resistance areas in partial coverage)

 Adding groove/ boxes increases resistance

(greatest if walls are perpendicular to direction
of force)
 GROOVE PROXIMAL BOX
 Lingual wall Buccal and lingual walls
perpendicular to the must meet the pulpal wall
direction of force at 90°
Oblique angle Oblique angle
V-shaped groove
 Minimal OC dimension:
 Anteriors - 3mm
 Premolars - 3mm
 Molars - 4mm
Occlusocervic Total occlusal
al
dimension convergence
1mm <6°
2mm <12°
3mm <17°

Goodacre C J. Designing tooth preparations for optimal success.

Dent Clin N Am 2004; 48: 359-85.
  Should be 0.4 or higher for all teeth
OC/FL ratio Total occlusal
convergence
0.1 <6°
0.2 <12°
0.3 <18°
0.4 <24°

Goodacre C J. Designing tooth preparations for optimal success.

Dent Clin N Am 2004; 48: 359-85.
  Should possess circumferential irregularity
 Maxillary molars – rhomboidal form
 Mandibular molars – rectangular form
 Premolars and anteriors – oval form

Goodacre C J. Designing tooth preparations for optimal success.

Dent Clin N Am 2004; 48: 359-85.
 Preserve corners of a tooth preparation
No axial grooves, boxes should be provided in corners

Chewing and parafunctional habits

Dislodging forces largely faciolingual

So, grooves and boxes on the proximal surfaces

Goodacre C J. Designing tooth preparations for optimal success.

Dent Clin N Am 2004; 48: 359-85.
 A restoration must contain a bulk of material that is
adequate to withstand the forces of occlusion

 Bulk should be confined to the space created by

the
tooth preparation

 To provide adequate bulk:

▪ Occlusal reduction
▪ Functional cusp bevel
▪ Axial reduction
 Full metal restoration:
 1.5 mm – functional cusp
 1mm – non functional cusp

 Metal-ceramic crowns :
 1.5 to 2mm – functional cusp
 1 to 1.5mm – non functional cusp

 All ceramic crowns :

 2mm over all
Adequate Inadequate Overpreparation
reduction clearance
 Wide bevel on-
 Lingual inclines of the maxillary lingual cusps
 Buccal inclines of mandibular buccal cusps

 Adequate bulk of metal in area of heavy occlusal contact

 Lack of functional cusp bevel:

Thin area in Overcontouring Overinclination

casting
 Thin walls of casting– subject to distortion
Overcontouring- disastrous effect on the
periodontium
 Closely adapted margins to finish preparation-
lines of survival of restoration in the oral
environment
 Configuration of finish line-
 dictates the shape and bulk of metal at the margins
 affects the marginal adaptation
 affects degree of seating
 Chamfer
 Heavy chamfer
 Shoulder
 Sloped shoulder
 Radial shoulder
 Shoulder with a bevel
 Knife edge
 Indications-
 Cast metal crowns
 Metal-only portion of PFM crowns

 Distinct, easily identified

 Least stress

 Round end tapered diamond

 Half the tip of the diamond
  Indicated for all-ceramic crowns
 90 degree cavosurface angle with a large radius
rounded internal angle
 Round end tapered diamond
 Better than conventional chamfer but not
shoulder
 Bevel added - to use with metal restoration
  All-ceramic crowns
 Facial margin of PFM crowns

 Wide ledge-
 resistance to occlusal forces
 minimizes stresses which leads to fracture of porcelain

 Flat-end tapered bur

 Healthy contours
 Maximum esthetics
 Destruction of more tooth structure

Sharp 90° internal line angle

concentrates stress on

tooth Coronal fracture

 Not used for cast metal
restorations
 120° sloped shoulder margin
 Facial margin of a metal-ceramic crown
 No unsupported enamel, yet sufficient bulk to allow
thinning of the metal framework to a knife-edge for
acceptable esthetics
 Modified shoulder
 Cavosurface 90°
 Shoulder width lessened with rounded internal angles
 Lesser stress concentration
 Good support for porcelain
 Indications:
 Proximal box of inlays, onlays
 Occlusal shoulder of onlays and mandibular ¾ crowns
 Facial finish line of metal-ceramic restorations (gingival
esthetics not critical)
 Situations where a shoulder is already present
(destruction by caries, previous restorations)
 Bevel:
 allows the cast metal margin to be bent or
burnished against the prepared tooth structure
 minimizes the marginal discrepancy
 removes unsupported enamel
 Permit acute margin of metal
 Axial reduction may fade out
 Thin margin - difficult to wax and cast
 Susceptible to distortion
 Indications:
 Mandibular posterior teeth with very convex axial
surfaces
 Lingually tilted lower molars
 All metal crowns –
 Chamfer depth: 0.3-0.5 mm
 Axial surface reduction: 0.5 -0.8 mm
 Occlusal reduction: 1- 1.5 mm

 Metal ceramic crowns –

 Finish line depth: 1-1.5 mm
 Occlusal reduction: 2mm

 All ceramic crowns–

 Finish line and facial reduction depth: 1mm
 Incisal/occlusal reduction: 2mm

Goodacre C J. Designing tooth preparations for optimal success.

Dent Clin N Am 2004; 48: 359-85.
 Uniformly reduced :
 normal crown form
 improved aesthetic

 Makes easier for laboratory technician to create

esthetic restorations

 Best achieved by placing depth grooves

Goodacre C J. Designing tooth preparations for optimal success.

Dent Clin N Am 2004; 48: 359-85.
 Should be rounded (increases crown
strength)
 Sharp line angles – stress concentration

 Facilitates laboratory fabrication and fit

 Ease to pour impressions

Goodacre C J. Designing tooth preparations for optimal success.

Dent Clin N Am 2004; 48: 359-85.
 Margin placement

 Direct effect on ultimate success of restoration

 Margins should be as smooth as possible
 Placed in area that can be finished well by the dentist
and kept clean by the patient
 Placed in enamel whenever possible
 Should be supragingival whenever possible
 Supragingival margins

 Less potential for soft tissue damage

 Easily prepared and finished
 More easily kept clean
 Impressions are more easily made
 Restorations easily evaluated at recall
appointments
 Subgingival margins:
 Esthetics
 Existing caries, cervical erosion, or restorations extend
subgingivally, and crown-lengthening is not indicated
 Proximal contact area extends to the gingival crest
 Additional retention is needed
 Margin of a metal-ceramic crown is to be hidden behind
the labiogingival crest
 Root sensitivity cannot be controlled by more
conservative procedures, such as the application of
dentin bonding agents
 Finish line should not be closer than 2mm to the alveolar
crest

 Placement in this area –

 gingival inflammation
 loss of alveolar crest height
 pocket formation
 Junction between a cemented restoration and
the tooth - potential site for recurrent caries

 Casting- fits within 10 µm

 Porcelain margin- 50 µm

 Stepped irregular margin- poor adaptation

 Adjacent teeth :
 Iatrogenic damage
 Metal matrix band
 Leave a slight lip or fin of proximal enamel

 Soft tissues:
 Careful retraction of lips, cheeks
 Care to protect tongue when lingual surfaces of
mandibular molars prepared

 Pulp
 Temperature
 Chemical action of cements
 Bacterial action (microleakage)
Borelli etal In vitro analysis of residual tooth structure of maxillary anterior teeth
after different prosthetic finish line preparations for full-coverage single crowns
Journal of Oral Science, Vol. 55, No. 1, 79-84, 2013
  Different preparation depths
 With/without coolants

 Rise in temperature was noted without coolants

 1mm depth – 0.540 C
 2mm depth – 10 C
 3 mm depth - 1.840 C
 Drop in temperature was noted with coolants
 1mm depth – 0.400 C
 2mm depth – 0.820 C
 3mm depth – 1.130 C

Chhatwal N. Effect of tooth preparation and coolants on temperature

within the pulp chamber. TPDI 2010;1(2):45-48.
 Shillingburg HT, Fundamentals of Fixed Prosthodontics, 4th
edition, USA, Quintessence publications,2012, pp119-137.
 Rosenstiel SF, Contemporary Fixed Prosthodontics, 4th
edition, USA, Mosby, 2006, pp 166-201.
 Goodacre C J. Designing tooth preparations for optimal
success. Dent Clin N Am 2004; 48: 359-85.
 Borelli etal In vitro analysis of residual tooth structure of
maxillary anterior teeth after different prosthetic finish line
preparations for full-coverage single crowns Journal of Oral
Science, Vol. 55, No. 1, 79-84, 2013
 Al-Fouzan A.F Volumetric measurements of removed tooth
structureassociated with various preparation designs Int J
Prosthodont 2013;26:545–8
 Parker MH. Resistance form in tooth preparations. Dent
Clin N Am 2004; 48: 387-96.

 Owen CP, Retention and resistance in preparations for

extracoronal restorations. Part II: Practical and clinical
studies, J Prosthet Dent 1986;56(2):148-153.

 Gilboe DB, Teteruck WR. Fundamentals of extracoronal

tooth preparation. Part I-Retention and resistance form.
J Prosthet Dent 2005;94:105-7.

 Chhatwal N. Effect of tooth preparation and coolants on

temperature within the pulp chamber. TPDI
2010;1(2):45-48.