Prosthodontics

Tooth Preparation

Occlusal reduction

Axial wall
Functional cusp
bevel

Margin/finish line
Tooth Preparation

Foundation restoration/core
Three Principles of Tooth Preparation

Biologic
Health of oral tissues

Mechanical Esthetic
Integrity and durability Appearance of
of restoration restoration
 Biologic
• Mechanical injury à thinnest gingival tissue is
lingual molars and facial premolars
• Thermal injury à proximity to pulp
– Water spray
– Sharp cutting instruments
– Intermittent light pressure
• Chemical injury à soaked retraction cord,
certain cements
• Bacterial injury à leakage under crown
 Mechanical
• Retention Form= those features that
prevent removal of crown along long
axis of the tooth prep (sticky foods)

• Resistance Form= those features that

prevent removal of crown by apical,
horizontal, or oblique forces (occlusal
forces)
 Mechanical
• Taper or Parallelism= angle of convergence
formed between two opposite prepared
axial surfaces, most operator control
 Mechanical
• Height or Length= from occlusal/incisal
surface to crown margin
– 3mm minimum for incisors and premolars
– 4mm minimum for molars
• Width= mesiodistal or faciolingual
dimension of base
• Height to Base Ratio= minimum ratio is
0.4
 Mechanical
• If you have a short clinical crown
prep…
– Buccal grooves for retention
– Proximal grooves for resistance
 Mechanical
• Ceramic and/or metal must be strong enough
• Minimum metal thickness
– 0.5mm à at the margin
– 1.0mm à non contact areas
– 1.5mm à contact areas
• Minimum porcelain thickness
– 1.5mm
• Minimum PFM thickness= NON-CONTACT AREAS
– 1.5mm (1.2mm porcelain, 0.3mm metal)
• Optimal PFM thickness= CONTACT AREAS
– 2.0mm (1.5mm porcelain, 0.5mm metal)
 Reduction vs. Clearance
• Reduction= amount of occlusal tooth structure
removed during the preparation (1.5 – 2mm*)

• Clearance= amount of space left between tooth

prep and opposing tooth (1.5 – 2mm)
 Esthetic
• Metal vs. PFM vs. all-ceramic
Three Principles of Tooth Preparation

Biologic
Health of oral tissues

Mechanical Esthetic
Integrity and durability Appearance of
of restoration restoration
 Margin #1
• The edge or shelf at the base of a crown
preparation
 Margin #2
• The part of the restoration which forms its
outer limit that adjoins to the cavosurface
margin of the prepared tooth
 Margin Location
1. Supragingival= above the gingival crest
2. Equigingival= at the gingival crest
3. Subgingival= below the gingival crest
 Margin Types
1. Featheredge
2. Light chamfer
3. Heavy chamfer
4. Shoulder
 Featheredge
• Very acute, thin margin
• Less invasive
• Best marginal seal
• Insufficient clearance for most
materials
• Difficult to visualize
 Light Chamfer
• 0.3-0.5 mm thick
• Gold crowns
• Wide gold collars of PFM crowns
 Heavy Chamfer
• 1.0-1.5 mm thick
• PFM crowns and some all-ceramic crowns
• If not given enough room, lab will be forced to
overcontour the crown
 Shoulder
• 1.0-1.5 mm thick
• Porcelain of PFM restorations
• All-ceramic crowns
• Maximizes esthetics—eliminate display of metal
• Aggressive preparation—potential for pulpal
embarrassment
 Inlays, Onlays, and Partial Crowns
• Inlay= within cusps
• Onlay= covers cusps
• 3/4 and 7/8 crowns= hybrid between onlay and
full crown
– Conserves tooth structure
– Less restoration margin in close proximity to gingival
tissues
– More easily seated during cementation
 Occlusal Schemes
• Occlusal point contacts preferred to be broad
and flat to prevent wear
• Cusp-marginal ridge= seen in Class I occlusion
and with unworn teeth
• Cusp-fossa= seen in Class II malocclusion
Prosthodontics
 Bridge
• Abutment= tooth to which the
bridge attaches
• Retainer= crown that attaches
to abutment
• Pontic= fake tooth
• Connector= connects retainer
to pontic
 (1) Hygienic/Sanitary
• Posterior mandible
• Good hygiene
• Poor esthetics
• Requires enough VDO/restorative
space
 (2) Saddle/Ridge-Lap
• NEVER USE
• Bad hygiene
 (3) Conical
• Molars
• Similar to hygienic but marginally
better esthetics
 (4) Modified Ridge-Lap
• Anteriors
• Good esthetics
 (5) Ovate
• Anteriors
• Superior esthetics
• Requires surgery
• Requires good ridge
 Bridge
• Abutment= tooth to which the
bridge attaches
• Retainer= crown that attaches
to abutment
• Pontic= fake tooth
• Connector= connects retainer
to pontic
 Connector Design
• Rigid= either cast in one piece or soldered
• Nonrigid= indicated when it is impossible to
obtain a common path of insertion between
abutments
• Connectors for PFM bridges should have a
minimum of 3mm height
Prosthodontics
 Tissue Management for Impressions
• Fluid control
– Cotton rolls, suction
– Antisialagogues (atropine)
• Tissue displacement
– Retraction cords—stretch circumferential periodontal
fibers
– Impregnated cords
• AlCl= Hemodent
• FeSO4= ViscoStat
• Epinephrine
– Electrosurgery—contraindicated in those with medical
devices like pacemakers or insulin pumps; electrode must
not contact teeth
Impression Materials
 (1) Reversible Hydrocolloid (Agar)
• Changes between sol and gel based on
temperature
• High accuracy
(2) Irreversible Hydrocolloid (Alginate)
• Setting time is 3-4 minutes in patient’s mouth
• Should be poured with gypsum within 10
minutes
• Primary ingredient: diatomaceous earth
• Active ingredient: potassium alginate
• Most inaccurate
(2) Irreversible Hydrocolloid (Alginate)
↓ Setting Time ↑ Setting Time
• Hot water • Cold water
• Less water • More water
 (1 & 2) Hydrocolloids
• Imbibition= absorption of
water

• Syneresis= loss of water

 (3) Polysulfide Rubber
• Water byproduct
• Moisture tolerant
– Hydrophobic
– Syneresis
• 30 to 45 minutes to pour
 (4) Condensation Silicone
• Alcohol byproduct, which causes shrinkage of
the impression when evaporated
• 30 minutes to pour
 (5) Polyether
• Very stable but easily influenced by
water and humidity
– Hydrophilic
– Imbibition
• Very stiff and easy to break teeth
on cast
• 60 minutes to pour
 (6) Addition Silicone (PVS)
• No byproducts
• PVS= Polyvinyl Siloxane
• Best fine detail, elastic
recovery, dimensional
stability
• Inhibited by the sulfur in
latex gloves and rubber dam
Impression Materials
Prosthodontics
 Gypsum
• Mined as calcium-sulfate dihydrate (CaSO4•2H2O)
• Manufactured with heat to get rid of some water to
become calcium-sulfate hemihydrate (CaSO4• ½H2O)
• All gypsum products are chemically same, but differ in
size and shape of particles
 Gypsum Materials
• Type I—impression plaster
• Type II—model plaster
• Type III—dental stone
• Type IV—dental stone, high
strength, low expansion
• Type V—dental stone, high
strength, high expansion
 Water
• Gauging water—extra water needed to obtain
a workable mix of material, does not
chemically react with gypsum
 Water
↑ Water ↓ Water
• Less strength • More strength
• More porosity • Less porosity
• Less expansion • More expansion
• Increased setting • Decreased setting
time time
 (1) Impression Plaster
• Low expansion
• For mounting casts in articulator
• Sets quickly, “no time for expansion”
 (2) Model Plaster
• Mouth guards and Essex retainers
 (3) Dental Stone
• Removable prostheses and diagnostic casts
 (4) Dental Stone HS/LE
• Best abrasion resistance
• Least gauging water
• Least amount of expansion
• Used for fabrication of dies
 (5) Dental Stone HS/HE
• Also used for fabrication of dies
 Gypsum
• 20 second vacuum mix or 30 second hand
spatulate
• Setting time is 45 to 60 minutes
• Disinfect with 1:10 bleach solution,
glutaraldehyde, or iodophor spray
 Setting Time
↓ Setting Time ↑ Setting Time
• Hot water • Cold water
• Less water • More water
• Use of slurry water • Decreased
• Increased spatulation time
spatulation time
 Gypsum Materials
Porosity

• Type I—impression plaster

• Type II—model plaster
• Type III—dental stone
• Type IV—dental stone, high
strength, low expansion
• Type V—dental stone, high
strength, high expansion
Strength
Prosthodontics
 Noble Metals
• Gold= tarnish resistance
• Platinum= strength, increases melting
temperature
• Palladium= strength

• Silver is NOT a noble metal (in dentistry) and

causes greening of porcelain
 Metal Alloys
• High noble alloys are ≥60% noble, of which at
least 40% is gold
• Noble alloys are ≥25% noble
• Base metal alloys are <25% noble (Ni-Cr, Ni-Cr-
Be, Co-Cr, Ti)
 Gold Alloys
• Type I soft inlays
• Type II medium onlays
• Type III hard crowns
• Type IV extra hard bridges, post and cores,
clasps
 Type I Gold
• 98-99% gold
• Class V restorations only
 Type II Gold
• 77% gold
• Inlays
 Type III Gold
• 72% gold
• Crowns
 Type IV Gold
• 69% gold
• RPD castings
 Gold
% Gold

• Type I soft inlays

• Type II medium onlays
• Type III hard crowns
• Type IV extra hard bridges, post and cores,
clasps

Strength
Prosthodontics
 Compressive Strength
• Ability to resist fracture during compression
 Tensile Strength
• Ability to resist fracture during pulling
 Flexural Strength
• Ability to resist fracture during bending
 Fracture Toughness
• Ability to resist the propagation of a crack
• Zirconia has the best fracture toughness
Modulus of Elasticity/Elastic Modulus
• Measure of stiffness or rigidity
• Stress divided by strain
• Sustain deformation without permanent
change in size or shape
 Brittle
• Fractures easily without substantial
dimensional changes
• Porcelain is prime example
 Ductility
• Deforms easily under tensile strength
• Wires are prime example
 Malleability
• Deforms easily under compressive stress
• Gold is prime example
 Percentage Elongation
• Ability to be burnished
• Contact stress locally exceeds the yield
strength of the material
• Gold is prime example
 Coefficient of Thermal Expansion
• Measures the fractional change in size per degree
change in temperature
• So higher CTE means more tendency to change
• A possible break in the marginal seal of any restoration
becomes imminent when there is a marked difference
between the tooth and restorative material
• Composite > Metal > Tooth > Ceramic
– Composite 30 (unfilled resin is worst)
– Amalgam 25
– Gold 14 (best)
– Tooth 11.4
– Porcelain 6
“Composite metOl Tooth cEramic”
 Desirable Mechanical Properties
• High yield strength—does not permanently
deform
• High elastic modulus—does not flex
• Casting accuracy—gold is more accurate than
base metal
• CTE close to that of the tooth
• Biologic compatibility—Ni and Be allergies
• Corrosion resistance
• Minimal wear of opposing dentition
Prosthodontics
 The Process
Crown Prep
Impression
Gypsum
Provisional
Crown
Cement
 Provisional Restoration
• Designed to enhance esthetics and provide
function for a limited period of time after
which it is replaced by a definitive prosthesis
 Three Principles

Biologic
Health of oral tissues

Mechanical Esthetic
Integrity and durability Appearance of
of restoration restoration
 (1) Method
• Direct= made directly in patient’s mouth
• Indirect= made outside of patient’s mouth,
usually in a laboratory setting on a cast
 (2) Mold
• Prefabricated crown
– Polycarbonate
– Aluminum
– Stainless steel
• Cellulose acetate crown form
• Putty or shim
 (3) Material
• PMMA= indirect, exothermic
• PEMA
• Bis-Acryl Composite= direct
 Clean the Prep
• Anesthesia will make it much harder to
confirm occlusion
• Provisional cements have Eugenol which
inhibits polymerization of resin so remove as
much as possible with excavator, explorer, or
wet cotton pellet before proceeding
Prosthodontics
 Bonding of Porcelain to Metal
• Monomolecular oxidative layer must be
present for porcelain to bond to the alloy
 Metal-Ceramic Crown
• Opaque porcelain= masks dark oxide color, provides
porcelain-metal bond, masking must be accomplished with
minimum thickness (0.1mm)
• Body or dentin porcelain= contains most of the shade,
builds up most of the crown
• Incisal or enamel porcelain= most translucent layer

Occlusal contacts ≥1.5mm away

from porcelain-metal junction
 Metal-Ceramic Failures
• Adhesive failures (between different materials)
– Porcelain-metal if oxide was not formed
– Oxide-metal if metal is contaminated
– Porcelain-oxide if porcelain is contaminated
• Cohesive failures (between same material)
– Porcelain-porcelain if inclusions or voids
– Oxide-oxide if oxide layer is too thick
– Metal-metal never happens
• Long-span PFM bridges are subject to fracture
under flexing due to porcelain’s low ductility
 All-Ceramic Crown
• Esthetics
• Glass-infiltrated ceramics are etched with
hydrofluoric acid and treated with silane coupling
agent and bonded to the tooth
• Ceramics with no glass content (zirconia and
alumina) are luted to the tooth with cement
 Porcelain Veneer
• 0.3mm gingival third reduction
• 0.5mm facial reduction
• 1-2mm incisal reduction
• Intra-enamel preparation
 Maryland Bridge
• Conventional bridge requires more removal of
tooth structure
• Resin-bonded bridge can experience debonding
Prosthodontics
 Munsell Color System
• Hue= color family
• Chroma= saturation or intensity of color
• Value= lightness or darkness, most important
– Measured from 0 (black) to 100 (white)
 Effect of Light Source
• Metamerism
• Fluorescence
• Opalescence
 Metamerism
• Color appears different under different
lighting
• 5500K and 100% CRI is ideal light
 Fluorescence
• Object emits visible light when exposed to
ultraviolet light
 Opalescence
• Light effect of a translucent material
appearing blue in reflected light and red-
orange in transmitted light
 Shade Selection and Color
• Value first à middle third of crown
• Chroma second à cervical third of crown
• Hue last à incisal third of crown
 Characterization
• Reproducing natural defects on a crown
• Staining= loss of fluorescence and increases
metamerism, usually decreases value
• Glazing= surface layers of porcelain melt
slightly coalescing particles and filling in
defects
• You can always add more color and make
something darker, but not the reverse
 Crown Delivery
1. Shade (esthetics)
2. Proximal contacts
– Open à send crown back
– Heavy à adjust before moving on
3. Margins
4. Fit
5. R&R form
6. Occlusion
7. Contour
8. Cement
Prosthodontics
 Cements (Luting Agents)
1. Zinc Oxide Eugenol
2. Zinc Phosphate
3. Zinc Polycarboxylate
4. Glass Ionomer
5. Resin Modified Glass Ionomer
6. Resin
 (1) Zinc Oxide Eugenol
• Soothes pulp
• Eugenol inhibits polymerization of resin
 (2) Zinc Phosphate
• Phosphoric acid irritates pulp
• Mix on a chilled glass slab due to exothermic
reaction
 (3) Zinc Polycarboxylate
• Chelation to calcium
• Minimal pulpal irritation
 (4) Glass Ionomer
• Adheres to enamel and dentin
• Releases fluoride
 (5) Resin Modified Glass Ionomer
• Higher strength and lower solubility than GI
• Not to be used with all-ceramic crowns due to
expansion from water absorption (exception
to this rule is zirconia)
 (6) Resin
• Most compressive strength
• Bonds to dentin
• Light cure, chemical cure, or dual cure varieties

Light cure cement is more color stable than dual cure cement
 Cements (Luting Agents)
Solubility
1. Zinc Oxide Eugenol
2. Zinc Phosphate
3. Zinc Polycarboxylate
4. Glass Ionomer
5. Resin Modified Glass Ionomer
6. Resin
Technique
Sensitivity
Crown & Cement Armamentarium
1. Zirconia (ceramic but no silica)
2. Metal (PFM or full gold)
3. Lithium disilicate (emax)
4. Feldspathic porcelain (veneers)

A. Resin cement—for 3 and 4, chemical bond

Dentin – bond – resin – silane – silica
B. Luting cement (GI or RMGI)—for 1 and 2,
fluoride release and less post-op sensitivity
Crown & Cement Armamentarium
• Zirconia à GI or RMGI cement
• Metal à GI or RMGI cement
• Lithium disilicate à dual-cure resin cement
• Feldspathic porcelain à light-cure resin
cement
Prosthodontics
 Die
• Ditching a die exposes the margin of the prep
• Die spacer allows room for cement
Positive vs. Negative
 (1) Waxing
• Making a "positive" of the object that you
eventually want to make
• Wax builds up internal stress as it is manipulated
and these stresses will relax overtime causing
distortion in shape and contour
 (2) Spruing
• Making a path with wax for metal to go into
the prosthesis as it is being casted
• Attach to crown in area of biggest bulk
 (3) Investing
• Making a "negative" by covering the wax with
investment material
– Gypsum-bonded investments à gold
– Phosphate-bonded investments à PFM
– Silica-bonded investments à base metal
 (4) Burnout
• Melt out the wax positive to leave room for
the metal to take its place
 (5) Casting
• Melting metal into the investment
 (6) Recovery
• Retrieving the cast framework by breaking
open the investment
 (7) Quenching
• Very hot cast metal immediately placed in cool
water to make more malleable for finishing
 Porosity Issues
• Porosity of porcelain à inadequate condensing
of porcelain
• Porosity of acrylic à too fast heating
• Shrinkage porosity of metal à too thin sprue
prevents molten metal from flowing effectively
into the mold
• Back-pressure porosity of metal à too short
sprue prevents venting of gas, gas was still
present in an area prohibiting fluid from flowing
in