COMPLETE

CROWN
CAST
PROSTHODONTICS –
FPD
Contemporary Fixed Prosthodontics
ROSENSTIEL | Land | Fujimoto
INTRODUCTION

All metal complete cast crown

should always be used for
restorations for badly
damaged posterior teeth.
Longevity of complete cast
crown is superior to that of
all other fixed restorations. As
its name implies, it covers all
axial walls and the occlusal
surface of the tooth.
 TYPES OF METAL ALLOYS USED FOR
FULL METAL CROWN
1. High noble alloys (gold alloys)
2. Low noble alloys (silver-palladium and gold-palladium alloys).
3. Non-noble alloys (Nickle-chromium alloy).
ADVANTAGES

1. Greater retention and strength.

2. High resistance to deformation.

3. Modification of axial tooth contour is possible

4. More conservative than other types of full crown

such as porcelain fused to metal and all ceramic
crowns.
 DISADVANTAGES

1. Extensive tooth structure removal as compared with

partial crown such as 3/4crown.
2. Difficulty to test the vitality of the tooth especially by
electrical pulp tester.
3. May interfere with taste.
4. Display of metal.
Fig: Gingival inflammation around the cast metal crown.
 Fig: Zirconia crowns for anterior tooth
restoration

Indications of full metal crown Contra-indications of full metal crown

• 1. A tooth with extensive destruction due to caries or trauma 1. If high esthetic need is demanded.
in order to protect the remaining tooth structure from 2. When less than maximum retention
fracture. and resistance necessary.
• 2. A tooth with large amalgam restoration in order to protect 3. When a more conservative crown
the remaining tooth structure and amalgam from fracture. could be used such as 3/4 crown as in a
• 3. Endodontically treated teeth. tooth with intact buccal surface and
• 4. When maximum retention and resistance needed as in a very short span bridge.
tooth with short crown.
• 5. Recontouring of the tooth as in a tooth receiving a clasp for
removable partial denture.
• 6. As a bridge retainer.
• 7. Correction of minor inclination. 8. A patient with high caries
index. 9. Correction of the occlusal plane.
 Preparation steps
1. Occlusal surface preparation.
2. Buccal surface preparation.
3. Lingual surface preparation.
4. Proximal surfaces preparation.
Depth Orientation grooves
(D.O.G)
Depth Orientation grooves (D.O.G) are grooves prepared in the
surface of the tooth to act as a guide or reference to
determine the amount of tooth structure removed by
preparation. If the preparation is done without these grooves,
under and over preparation is possible, and more time will be
spent by repeated checking of the preparation. The type of
finishing line recommended for full metal crown is chamfer
finishing line; therefore, a round end tapered fissure bur is
used in the preparation. Knife edge finishing line may also be
used. The recommended tooth reduction for full metal crown
is shown in the figure below:
 OCCLUSAL SURFACE PREPARATION

The aim of the occlusal surface preparation is to create 1.5mm occlusal clearance over the functional cusps and 1
mm over the non-functional cusps.
Planar occlusal reduction (anatomical reduction) following the geometric inclined planes of the occlusal surface
should be done for the following objectives:
-To provide a restoration with uniform thickness.
-To preserve the tooth structure (axial wall length). –
To improve the retention- resistance features of the preparation.
 The sequence of the occlusal surface preparation is as follows:
1. Depth orientation grooves (D.O.G) are prepared in the occlusal surface by a
fissure bur to follow the inclines of the cusps. A D.O.G is prepared in each cusp
extending from the cusp tip to the central groove, which represents the deepest
part of the occlusal surface. The depth of each groove corresponds to the diameter
of the fissure bur used. i.e. a fissure bur with 1.5 mm diameter is used to prepare
D.O.G on the functional cusps, while a fissure bur with 1 mm diameter is used to
prepare D.O.G on the non-functional cusps.
2. Any tooth structure between D.O.G should be removed following the normal
contour of the cusps.
3. A wide bevel is placed on the functional cusps.
4. The occlusal clearance is then checked in centric & eccentric occlucal relations.
 Functional
cusp

45
Functional cusp bevel – it is a type of bevel which is
placed on the functional cusp i. e the cusp having an degree
opposing
cusp.
On most posterior teeth, the functional cusp bevel is
placed at an angle of approximately 45 degrees to the
long axis of the prepared tooth.

Non – functional cusp bevel – it is a type of bevel which is

placed on the non-functional cusp i.e which has no
opposing cusp present on it.
Step-by-Step Procedure

PREPARATION – the clinical tooth preparation of complete

cast crown consists of following steps:

• Occlusal depth grooves

• Occlusal reduction and functional cusp bevel
• Axial alignment grooves
• Axial reduction
• Finishing and evaluation
A- Guiding grooves are placed on the occlusal
surface.
B - After the guiding grooves are placed, the
reduction is performed. Either the mesial or the distal
occlusal
is maintained initially as a reference to facilitate
half
of adequacy of the
evaluation
reduction.
 Triangular ridge

Buccal developmental
groove

Central groove

Lingual
developmental
groove
 Some points to remember:

• The depth grooves should follow anatomic configuration and thus minimizes the loss of
tooth structure while ensuring adequate clearance.

• The depth grooves must be placed with accuracy, the practitioner should concentrate on
position, depth and angulation of each groove.
• To achieve correct depth—0.8 mm for the central groove and nonfunctional cusps and 1.3
mm for the functional cusps (allowing approximately 0.2 mm for preparation finishing
and
smoothing).
• instruments facilitates assessment of the adequacy of the reduction

• If necessary, a periodontal probe can be used to measure the extent of the reduction that
has been achieved.

• Correct groove angulation is necessary to ensure that the occlusal reduction will
allow appropriate crown form and thickness
OCCLUSAL
REDUCTION:
Once the depth grooves have been placed, the remaining tooth
structure between the grooves is removed with the tungsten carbide
or the narrow, round-ended, tapered diamond.
Proper placement of the grooves automatically results in
adequate occlusal clearance.

• Complete the occlusal reduction in two stages:

 Half the occlusal surface is reduced first so that the other

half can be maintained as a reference.
 When the first half is reduced, the remaining half is
then removed.
 On completion, verify that a clearance of 1.5mm has
been
established on functional cusps and at-least 1 mm on
non-FUNCTIONAL
 if you are uncertain about the clearance then ask
the patient to bite many times on a utility wax in
maximum intercuspation.

A. The patient closes the teeth into softened

B. wax.
After the wax has been removed from the
mouth, its thickness is assessed visually
and measured with a wax caliper.
B
REDUCTION
GAUGE:
Occlusal clearance can be judged intraorally with a
reduction gauge.

A. Reduction gauge

B.The instrument has two spherical tips: one that is 1.5

mm in diameter.

C. and one that is 1.0 mm in diameter.

 BUCCAL SURFACE PREPARATION

 Three D.O.G with 1 mm depth are prepared in the buccal surface of the tooth, one placed in the center of
the wall and one in each medial and distal transitional line angles.
 These grooves are prepared parallel to the long axis of the tooth or to the proposed path of insertion of the
restoration.
 Move the bur mesially and distally following the inclination of this surface to remove any islands of tooth
structure between D.O.G.
 The gingival extent of the preparation will determine the position of the margin (whether to be placed
supragingivally, which is preferable, or there is a need to extend the finishing line subgingivally. A round-end
tapered fissure bur is used during axial reduction to obtain chamfer finishing line.
 ALIGNMENT GROOVES FOR AXIAL REDUCTION

Once the occlusal reduction has been completed,

alignment grooves are placed in each buccal and lingual
wall with a
narrow, round-ended tapered diamond.

On molars, one alignment groove may be placed in the center

of the wall, and one in each mesial and distal transitional line
angle.
.
Fig: Alignment grooves. One buccal and one lingually
[on the walls] , one on each line angles. [ mesio-
lingual, mesio-buccal, disto-lingual, disto-buccal].
 Buccal D.
D-B groove M-B
groove groove

ALIGNMENT GROOVES FOR AXIAL

REDUCTION
Once the occlusal reduction has been
M-L
completed, alignment grooves are placed in
groove
each buccal and lingual wall with a narrow,
round-ended tapered diamond.

On molars, one alignment groove may be placed D-L Lingual

in the center of the wall, and one in each mesial groove
and distal transitional line angle. groov
e

Fig: Alignment grooves. One buccal and one

lingually [on the walls] , one on each line angles.
[
mesio-lingual, mesio-buccal, disto-lingual, disto-
buccal].
As these alignment grooves are placed, ensure
that the shank of the diamond is parallel to the
proposed
path of placement of the restoration, [which is
typically the long axis of the tooth]. Such
positioning automatically produces a convergence
between the axial walls of the alignment
grooves that is identical to the taper of
the diamond.
Gingivally, the depth of the alignment grooves
should therefore be no more than half the
width of the tip of the diamond bur.

The diamond tip should not cut into the

tooth beyond its midpoint; otherwise, a “lip”
of
tooth, enamel will be unsupported.

A B

A. Normal chamfer margin B. lip of the tooth enamel is

formed.
AXIAL
REDUCTION
The technique for axial reduction is similar to that of

occlusal r ed u ct io n . T h e r id u al is la n d s o
a il g nm e n t g r o ov es ar e e
r m o v e d ,

f t o o t st r u c tu r e b et w e e n t he
a n d t he c h a m f e r m a r g n
i is

simultaneously created and the same narrow, round-ended

diamond is used for the procedure.

The axial reduction may be performed for half the tooth,

while the other half is maintained as a reference to check
how much reduction has been done.
B
 PROXIMAL SURFACES PREPARATION

Using a very thin long pointed tapered diamond bur (long needle), the contact is
removed carefully with the bur rested on the prepared tooth (to prevent any
damage to the adjacent tooth), moving the bur up & down, the contact will be
opened bucco-lingually. Once the contact is opened, a round-end tapered fissure
bur is used to plane the wall while forming a chamfer finishing line. Safe-sided
disc can also be used during the proximal reduction in order to prevent any
damage to the adjacent tooth. Placing a matrix band on the adjacent tooth can
also help.
When breaking interproximal contact, pay special
attention to prevent unintentional damage to
the adjacent teeth. This often results if the
practitioner attempts to force the diamond into
the proximal
aspect too rapidly.

Sufficient time must be allowed for the

cutting instrument to create space for its
passage.
Typically, if the proper cervical placement of the margin
has been selected with correct axial alignment of the
instrument, a “lip” of tooth enamel is maintained
between the diamond and the adjacent tooth, protecting
the adjacent tooth from iatrogenic damage.

If desired, protect the adjacent teeth by placing a

metal matrix band.
Cut into the proximal area from both sides until only
a few millimetres of interproximal island remain. If
necessary, this area can then be removed (and proximal
contact broken) by using thinner, tapered diamonds.
Place the cervical chamfer margin concurrently
with axial reduction. Finished chamfer margin width should be
approximately 0.5 mm, which allows for adequate bulk
of metal at the margin.

The chamfer margin must be smooth and continuous.

The chamfer margin must be at least 0.6 mm from the

proximal surface of the adjacent tooth.
Unsupported enamel cannot be tolerated on the chamfer
margin because it is likely to fracture when the restoration
is
evaluated or cemented, which, if undetected, will result in
an
open margin and premature restoration failure.

Open margin can cause sensitivity when air is sucked

by mouth.

open
margin
FINISHING

A smooth surface finish and continuity of all

prepared surfaces aid most phases of fabrication of
the restoration.
Smooth transitions blend occlusal and axial surfaces.

Use a fine-grit diamond or tungsten carbide rotary

instrument of slightly greater diameter to finish the
chamfer margin. This should be done as smoothly
as possible, with a high-speed handpiece operating
at reduced speed.

Some clinicians favor using a low-speed contra-

angle handpiece for the finishing steps. A properly
finished margin should be smooth as glass, as
verified
with a touch by the tip of an explorer.
FINISHING & POLISHING
Place additional retentive features as needed (e.g.,
grooves or boxes) with the tapered tungsten carbide
bur and the slow-speed handpiece
During margin finishing, the use of air cooling alone
is recommended to improve visibility.

However, when only air cooling is used, a water

s p ra y s h o u dl b e ap p l eid rf o m it m e
p re ve n t t h e to o th fr o m de h y dr a ti n
ot t m
i e o
t
g , t o a vo id the possible development of
pulpal damage, and to wash away debris.

The larger diamond is recommended because it will

eliminate any unwanted ripples that were created
during axial reduction
THE
END