Crown and bridge

Metal-ceramic crown preparation

Criteria:
1. Incisal (occlusal) reduction 1.5-2mm.
2. Facial reduction 1.5mm.
3. Lingual reduction 1mm.
4. 90° shoulder finishing line facially of 1mm.
5. Chamfer finishing line lingually.
6. Axial wall with 6 degrees convergence.

Step-by-step preparation:
Depth orientation grooves (guiding grooves):
Place three depth grooves, one in the center of the facial surface and one
each near the mesiofacial and distofacial line angles using a flat end tapered
diamond.
These will be in two planes: the cervical portion to parallel the long axis of
the tooth, the incisal (occlusal) portion to follow the normal facial contour.
Place three depth grooves (about 1.8 mm deep) in the incisal edge of an
anterior tooth. This will provide the needed reduction of 2mm and allow
finishing.
On posterior teeth where the occlusion is to be established in porcelain, 2
mm of clearance must exist. If the occlusion is to be established in metal, the
same minimum clearances are needed as for a complete cast crown.

Incisal (occlusal) reduction:

Remove the islands of remaining tooth structure. On anterior teeth, access is
usually unrestricted. On posterior teeth, the same pattern is followed as in
preparing depth grooves for a complete cast crown. This will include the use
of a centric cusp bevel, although additional occlusal reduction will be
needed where the porcelain is to be applied.

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Crown and bridge

Labial (buccal) reduction:

The cervical shoulder is established as the tooth structure between the depth
grooves is removed using a flat end tapered diamond. The rotary instrument
is moved parallel to the intended path of withdrawal during this procedure.
The resulting shoulder should be approximately 1 mm wide and should
extend well into the proximal embrasures and extend at least 1 mm lingual
to the proximal contact for better esthetic.
The facial reduction is completed in 2 planes.

Use adequate water spray during the entire phase of preparation, because a
significant amount of tooth structure is being removed and copious irrigation
will prevent unnecessary trauma to the pulp.
From a periodontal point of view, a supragingival margin is always
preferred. Its application is restricted, however, because patients often object
to a visible metal collar or discolored root surface. Such objections are
common, even when the gingival margin is not visible during normal
function, as in patients with a low lip line. This generally limits the use of
supragingival margins to posterior teeth. Where a subgingival margin is to
be placed, careful tissue manipulation is essential; otherwise, there will be
damage that leads to permanent gingival recession and subsequent exposure
of the metal collar. This is most effectively avoided through meticulous
gingival displacement with a cord before finishing.

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Crown and bridge

Axial Reduction of the Proximal and Lingual Surfaces:

Reduce the proximoaxial and linguoaxial surfaces with the diamond held
parallel to the intended path of withdrawal of the restoration. A taper of
approximately 6 degrees is recommended.
On anterior teeth, a lingual concavity is prepared for adequate clearance for
the restorative material(s). Typically, 1 mm is required if the centric contacts
in the completed restoration are to be located on metal. When contact is on
porcelain, additional reduction will be necessary.
For anterior teeth, usually only one groove is placed, in the center of the
lingual surface. For molars, three grooves can be placed in a manner similar
to that described for the all-metal complete cast crown.
As the lingual chamfer is developed, extend it buccally into the proximal to
blend with the interproximal shoulder placed earlier.
On posterior teeth, the lingual wall reduction blends into the functional cusp
bevel placed during the occlusal reduction. Anterior teeth require an
additional step: After preparation of the cingulum wall, one or more depth
grooves are placed in the lingual surface. These are approximately 1 mm
deep. Use a football-shaped diamond to reduce the lingual surface of
anterior teeth.

Finishing:
The margin must provide distinct resistance to vertical displacement of an
explorer tip, and it must be smooth and continuous circumferentially. All
other line angles should be rounded.

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Crown and bridge

The "wingless" variation does not exhibit the defined transition from
chamfer to shoulder. Rather, the shoulder gradually narrows toward the
lingual side. Interproximally, the same criteria for minimum extension of the
shoulder apply as for the wing-type or flange preparation.