PRINCIPLES OF TOOTH PREPARATION

 Preservation of tooth structure

 Preservation of the periodontium
 Retention and resistance
 Structural durability
 Marginal integrity

1. Preservation of Tooth Structure

 Conservation of Tooth Structure

 Depth of Reduction
 Control of Frictional Heat

Conservation of Tooth Structure

 Use of partial coverage preparations, when possible
 Full coverage: Retain as much tooth structure as practicable
 Preservation of adjacent tooth structure
I. Use of matrix band
II. Leave a “lip” or “fin” of enamel

Depth of Reduction
 Control the amount of reduction
 Depth cuts, grooves

Control of Frictional Heat

2. Preservation of the Periodontium
(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 location of finish lines, as much as possible.

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
Margin Adaptation
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
3. Retention and Resistance form
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.
Retention and resistance are interrelated and often inseparable qualities
RETENTION FORM
Dislodging forces
Geometry of the tooth preparation
Roughness of the fitting surface of the restoration
Materials being cemented
Luting agent being used
Dislodging Forces
Forces that tend to remove a cemented restoration along its path of withdrawal
FPD subject to dislodging forces
Flossing under the connectors
Sticky food
Geometry of the tooth preparatio
Taper / Total Occlusal Convergence (TOC)
Substitution of internal features
Path of insertion
 Freedom of displacement
Length and Surface area
Stress concentration
Type of preparatio
TAPER
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° tape
TOTAL OCCLUSAL CONVERGENCE
Angle between two opposing prepared axial surfaces
Historically TOC : 2°-6°
Clinical goal : 10°-22°
TOC beyond 10-22°
– auxilliary features needed
FREEDOM OF DISPLACEMENT
Numbers of paths along which a restoration can be removed from the tooth
preparation
Only one path – maximum retention
LENGTH AND SURFACE AREA
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
STRESS CONCENTRATION
Retentive failure occurs - cohesive failure in cement
Stress concentration- around the junction of axial and occlusal surfaces
Rounding the internal line angles
TYPE OF PREPARATION
Complete crown, partial coverage crowns
Adding groove/ boxes increases retention
Roughness of the fitting surface of restoration
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
Materials being cemented
 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
Luting agents being used
Adhesive cements- most retentive
Film thickness of luting agent- effect not certain
Adhesive resin> Glass ionomer> Zinc Phosphate= Polycarboxylate> ZnO-E
RESISTANCE FORM
Dislodging forces
Luting agent being used
Geometry of the tooth preparation
Dislodging Forces
Mastication and parafunctional activity - substantial horizontal or oblique
forces
Lateral forces displace the restoration by causing rotation around the gingival
margin

Luting agent being used

Resistance to deformation affected by compressive strength and modulus of
elasticity
Adhesive resin> Glass ionomer> Zinc Phosphate> Polycarboxylate> ZnO-E
Geometry of tooth preparation
Type of preparation
Freedom of displacement
Occlusocervical/incisocervical dimension
Ratio of OC and FL dimension
Circumferential form of the prepared tooth
TYPE OF PREPARATION
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)
FREEDOM OF DISPLACEMENT
GROOVE
 Lingual wall perpendicular to the direction of force
CIRCUMFERENCE FORM OF PREPARED TOOTH
Should possess circumferential irregularity
Maxillary molars – rhomboidal form
Mandibular molars – rectangular form
Premolars and anteriors – oval form
4. Structural Durability
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
OCCLUSAL 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
FUNCTIONAL CUSP BEVEL
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
AXIAL REDUCTION
Thin walls of casting– subject to distortion
Overcontouring- disastrous effect on the periodontium
5. Marginal Integrity
Margins of restoration must be closely adapted to finish line of
preparation
Configuration of finish line-
dictates the shape and bulk of metal at the margins
 affects the marginal adaptation
affects degree of seating
FINISH LINE CONFIGURATIONS
Chamfer
Heavy chamfer
Shoulder
Sloped shoulder
Radial shoulder
Shoulder with a bevel
Knife edge
SHOULDER
Destruction of more tooth structure
Sharp 90° internal line angle
concentrates stress on tooth
Coronal fracture
Not used for cast metal restorations
CROWN PREPARATION For MAXILLARY PREMOLARS
(PFM Facing Crown)
PFM restorations require aggressive reduction of tooth structure. An
accepted way of fulfilling aesthetics and function, while still conserving
tooth structure is the use of a PFM prosthesis with porcelain
(buccal/labial) facing.

Such prostheses require specific alterations to be performed as part of

their proximal preparation, where the wider reduction for porcelain
meets the shallower reduction for metal. This junction is referred to as
‘wing’, and it helps communicate the proposed position of the porcelain-
metal junction with the technician.

If a metal proximal contact is planned, the wing is to be prepared buccal

to the contact. Conversely, if a proximal contact is to be fabricated in
porcelain, the wing is to be prepared lingual/palatal to the contact. To
avoid an undercut, it is important that the wing is made parallel to the
bucco-axial reduction.

Advantages of facing prosthesis

Conserves tooth structure, while providing an aesthetic prosthesis.
 Reduces the risk of porcelain fracture.
The metal occlusal surface is less abrasive than porcelain.
The near parallel walls of the wings add to the resistance form of the
preparation.

Buccal reduction starts with placement of depth grooves along the gingival and
occlusal plane. This is done with the MS 1.0 bur which is sunken to its full depth.
The occluso-buccal view clearly shows the depth grooves as placed in two distinct
planes.
Using the same bur, the labial surface is reduced by connecting the depth
grooves.
Next, the interproximal contacts are opened out using the MI 0.5 bur.
The lingual margin is then prepared using the DC 1.0 bur.
Occlusal reduction for a premolar requires only one depth groove to be made on each
cusp along the cusp ridge (as marked).
For the non-functional cusp reduction, a 1 mm buccal groove is made using the OR
1.2 bur, by sinking it slightly short of full depth.
The bur is then moved downward and outward towards the proximal surfaces on
either side, thus reducing the cusp following the pre-existing anatomy.
For reduction of the functional cusp, a groove is made along the palatal cuspal incline
using the same bur. However, here the bur is sunken full depth.
The palatal cusp is then reduced anatomically using the same bur. This completes the
occlusal preparation.
Next, the functional cusp bevel is placed using the plane 2 incline of the adjacent
molar as a guide.
The proximal wing is prepared during the Finishing stage. First, the buccal aspect of
the preparation is Finished using the MS 1.3F bur and extended into the interproximal,
up to the desired porcelain extension. Following this, the remainder of the proximal
aspect and lingual walls are Finished using the DC 1.2F bur. A wing is thus produced,
where the wider shoulder margin meets the shallower deep chamfer margin.
Close up of the Final preparation: Occlusal view. Note, here the mesial
(aesthetic) contact is planned in porcelain and the distal contact is planned in
metal. Accordingly, the mesial wing is prepared palatal to the proximal
contact, while the distal wing is prepared buccal to the future proximal contact.
Close up of the Final preparation: Buccal view. Note, the vertical component of the
proximal wing preparation.