CAST METAL

RESTORATIONS

Tooth
Preparation
It is the mechanical alteration
of a defective, injured or
diseased tooth to best receive
a restorative material that will
reestablish a healthy state for
the tooth, including esthetic
corrections where indicated
along with normal form and
function

Restoration
Restoration is defined as any
material or prosthesis that restores
or replaces lost or damaged tooth
structures, teeth or oral tissues.

Cast
Life-sized likeness of some desired
form
To produce a shape by thrusting a
molten liquid or plastic material into
a mold possessing the desired shape

Indications
Replace lost tooth structure in extensively
involved teeth
Restoration of endodontically treated teeth
Correction of occlusal & diastema closure
Support for partial or complete dentures
Retainers for fixed prosthesis

Indications
Partially subgingival restorations
Cracked teeth
As an adjunct to successful PDL therapy

by correction of tooth anomalies which

predispose to PDL problems
Esthetics
Dissimilar metals

Contraindicatio
ns
Developing or deciduous teeth
High plaque or caries indices
Occlusal disharmony
Dissimilar metals
Small restorations

Advantages
Higher strength
Ability to reproduce precise form and
minute details
Control of contours & contacts
Biocompatibility of materials (Noble
or passivated alloys)

Advantag
es
Not affected by tarnish and corrosion
Increased longevity of cast
restoration
Fewer voids
Less internal stresses
No layering effect compared to
amalgam
Cast restorations can be better
finished, polished or glazed, thus,
better esthetics & no harm to P-D

Disadvantages
Technique sensitive
Number of appointments &
chairside time
High cost
Splitting forces

Pre-Operative Treatment Procedure:

Cast Metal Restorations
Initial Procedures:

1. Occlusion/Occlusal Equilibration

Before an anesthetic is administered and

before preparation of any tooth, evaluate the
occlusal contacts of the teeth.
Evaluation should include:
The occlusal contacts in maximum intercuspation (MI)
where the teeth are brough into full interdigitation
The occlusal contacts that occur during mandibular
movements.

The pattern of occlusal contacts influences the

preparation design, the selection of interocclusal
records, and type of articulator or cast development
needed.

 Every measure is to be taken to ensure

longevity & success of a cast restoration
Control of plaque
Control of caries
Control of periodontal problems
Control of pulpal health of tooth
Proper foundation
Diagnostic wax-ups & temporary restorations

2. Anesthesia
Local anesthesia of the ttoh to be
operated on, as well as the adjacent soft
tissues, usually is advocated.

3. Considerations for temporary

restorations
Before preparations of the tooth,
consideration must be given to the
method that will be used to fabricate the
temporary restoration.

Features of Tooth
Preparation for
Cast Restoration

Cast Metal Restorations

INTRACORONAL

EXTRACORONAL

Mortise shaped

Created by occlusal and axial

surface reduction

Definite walls & floors joined by

line and point angles

May end gingivally with no

definite flat floor

 The main characteristic feature in these restorations

is taper and bevel incorporation in the outline form.

The gingival to occlusal divergence of these cavity

walls may range from 2 to 5 degree taper on each
wall.

The taper should be minimum in shallow cavities for

better retention and resistance.

 The taper should be more in deep cavities for proper

seating of the restoration.

The taper prevents the undisturbed withdrawal of the

wax pattern and subsequent seating
of the casting.

Resistance form may be defined as that shape and form

of cavity walls that best enable both the restoration and
the tooth to withstand occlusal forces without fracture.

Fundamental principles involved are:

Box shape or mortise shaped with flat floor,

which helps the tooth to resist occlusal loading

by virtue of being at right angles to the forces of
mastication.

Slightly curved than acute line angles decrease

the stress concentration of stresses and hence

reduce the incidence of fracture.

 Conservation of strong cusps and ridges with sufficient dentin

support.Weakened areas should be included in cavity
preparation to prevent fractures (capping of the weakened
cusps).

To provide enough thickness of restorative material to prevent

fracture under load.

Slight roundening of the line angles to prevent stress

concentration.

STRESS PATTERNS OF TEETH

General
Principles
Greater surface extension in outline form

than in amalgam
This facilitates support & efficient marginal

manipulation
More extensive surface involvement to

compensate for the cariogenically weak

joints of cast/cement/tooth interface

 The design for a cast

restoration are
governed by five
principles:
Preservation of the tooth
structures
Retention & resistance
Structural durability
Marginal integrity

PRESERVATION OF TOOTH
STRUCTURE
In addition to replacing lost tooth
structure, cast restoration must
preserve the remaining structure
It may involve limited amount of
tooth being prepared

RETENTION & RESISTANCE

Retention prevents removal of
restoration along the path of insertion
or long axis of the tooth preparation
Resistance prevents the dislodgement
of the restoration by forces directed in
an apical or oblique direction &
prevents any movement of the
restoration under occlusal forces

 Beside applying the general

principles, cast restoration
preparations should have the
following features:
A. PREPARATION PATH
.Preparation should have single path of
insertion
.Path is parallel to long axis of tooth
crown which helps in retention &
decreases the micro-movements of

Single Path of Insertion

opposite to direction of
Occlusal Loading

All reductions in tooth structure

should be oriented towards one path
(withdrawal & insertion path of future
wax pattern)

B. APICO-OCCLUSAL TAPER

For maximum retention,

opposing walls & axial
surfaces should be
perfectly parallel to
each other
Slight divergence of
opposing walls in
intracoronal
Slight convergence of
axial walls in
extracoronal
Taper should be 2-5
from path of preparation

 Taper can be altered according to the

following features:
LENGTH OF PREP AND/OR AXIAL WALL
Greater the length, more the taper (not more
than 10)
Less the length, less taper (approaching 0)

DIMENSIONS OF SURFACE INVOLVEMENT

Greater surf involvement more detailed the
internal anatomy, thus GREATER FRICTION
To diminish friction, taper is increased

NEED FOR RETENTION

Greater the need of retention, more will be
the need to achieve parallelism (thus, less
taper)

C. CIRCUMFERENTIAL TIE
It is the peripheral marginal anatomy of
the preparation.
Should fulfill the requirements
advocated by Noy:

STRUCTURAL
DURABILITY
Occlusal reduction
Functional Cusp Bevel
Axial Reduction

Designs of Cavity & Tooth

Preparation
The general designs of tooth
preparation to accommodate cast
restorations:

Inlays
Onlays

INLAYS
An inlay is an
intracoronal cast
restoration which
involves the
occlusal and
proximal surfaces
of a posterior
tooth.

Tooth Preparation for

Inlays
INDICATIONS:

Armamentarium
Carbide burs are used
Side & end surfaces of
the bur must be
straight to form
uniformly tapered walls

Throughout the preparation for cast inlay,

cutting instruments used to develop the
vertical walls are oriented to as ingle
draw path (long axis of tooth)

BURS
Burs used are no.
271, 169L & no. 8862
Sides & end of 271
bur meet in a rounded
manner to prevent
sharp internal angles
Burs are plane Cut
so that vertical walls
are smooth

General Shape
The outline of the
occlusal portion of this
preparation is dovetail
internally
Proximal portion is
usually boxed in shape

Location of Margins
In occlusal portion, the facial, lingual and sometimes
proximal margins are located on the inclined planes
of the corresponding cusps, triangular ridges or
marginal ridges
Bucco-lingual width of the cavity does not exceed
1/3 intercuspal distance
Facial and lingual margins of the proximal portion is
in the corresponding embrasures
Gingival margins should extend to include surface
defect & concavities & to eradicate marginal
undercuts

TOOTH PREPARATION
Initial Preparation
Final
Preparation
External & Internal
- Removal of
carious
Outline form
dentin
Occlusal Step
- Pulp protection
Proximal box
- Prep of bevels &
flares

Occlusal Step
No. 271 bur is held parallel to
long axis of tooth enter
pit/fossa closest to marginal
ridge
Punch cut of 1.5 mm
Maintaining 1.5 mm extend
to the outline to involve the
central groove/fissure
Outline is extended to a
dovetail (retention form)

 Widen the preparation to

desired facio-lingual
width in anticipation for
proximal box preparation
Facial & lingual walls of
occlusal step should go
around the cusps in
curves
Isthmus should be only
slightly wider than bur;
conserving dentin for
pulpal protection

Proximal
Box

No. 271 used to cut a

proximal ditch
Mesio distal width of ditch
should be 0.8 mm (0.3
mm in enamel & 0.5 mm
in dentin)
A thin layer of enamel is
left on the proximal
surface to protect the
adjacent tooth while the
proximal box is being
prepared

 Box should be slightly divergent

(5-10) towards pulpal floor in
gingivo-occlusal direction
Gingival extent to be checked
with length of bur (extent of
caries determines the depth)
Flat gingival floor with a slightly
converging axial wall is created
A hand instrument, such as
enamel hatchet, is helpful in
smoothening walls of
preparation

 Over cutting the facial or lingual

walls may result in:
Over extension of margins in the
completed preparation
A weakened tooth structure
Posiible injury to the soft tissues

Variations in Proximal Margin

Design
Design of proximal margins will vary
with:
Extent of tooth tissue loss
Location of that loss
Tooth form
Positional relationship with adjacent
tooth
Need for retention form
Convenience

 The axial wall is made to an even

depth into the tooth from the
facial to lingual wall
Should be flat or slightly rounded
(buccolingually)
Should meet pulpal floor in an
extremely rounded junction
(Prevents stress concentration in
tooth & casting)
Depth axially is 1-1.5 mm from
DEJ (depends on the cariogenic
lesion proximally

Axial
Wall

Final Preparation
Removal of infected dentin & pulp
protection
After initial prep, evaluate for any
carious dentin
If present, excavate using a spoon
excavator or a No. 2 or 4 round bur

Pulp protection may be done using:

Light cured GI
Ca(OH)2

Bevels and Flares

Slender, flame shaped, fine grit
diamond (8862) bur is used
Occlusal and gingival bevels are
given
Secondary flare is given to facial and
lingual wall

OCCLUSAL BEVEL
Long bevel (almost 1/3 of
facial & lingual walls)
Angulation of 30-45 to the
long axis of crown
A tapered diamond or finishing
bur is used to create a short
but distinct bevel at the
occlusal finish lines
Angulation should increase in
cavity width; to accommodate
the bulk of the cast metal &

GINGIVAL BEVEL

Secondary Flare
Flaring of the proximal walls to extend the margins into
embrasures
Makes them more self cleansing and accessible to finishing
procedures
A blunted and stronger enamel margin is produced
Direction of flare results in 40 marginal metal which is more
burnishable

 The tapered fissure bur (No. 169L)

is positioned at an angle to give an
occlusal divergence for the
retentive grooves. The grooves
should be at a depth of 0.3 mm
The proximal bevel or flare should
be established slightly beyond the
contact area & is blended with the
gingival bevel
A rotary disk, placed at angle of
45, can provide a smooth, flat
bevel without undercuts

Clinical Tips for Inlays

Avoid sharp internal line angles and undercuts
Smooth preparation walls & trim excess lining
material with finishing diamond bur
Do not include undercuts
Create a 5-10 divergence in the proximal
walls from the floor to the occlusal margin of
the preparation

FEATURES OF CLASS II
INLAYS
MARGINAL
INTEGRITY
Gingival &
Occlusal Bevel
Proximal Flare

RETENTION &
RESISTANCE
FORM
Dovetails
Isthmus
Proximal Box

Variations in Inlay Preparation

ONLAYS
An onlay caps one or
more than one of the
cusps of a posterior
tooth and is
designated to help
strengthen a tooth
that has been
weakened by caries or
previous restorative
experience

General Principles
All finish lines are bevelled
The bevel creates second plane for close
adaptation of the gold to the tooth
Bevelled shoulder centric cusp
Nonbevel or Chamfer Non-centric cusp
Gingival margin, facial & lingual walls of
proximal box are like inlays.

General Shape
Capping of the functional cusps &
shoeing of the non functional cusp
The outline of the occlusal portion of
this preparation is dovetaild internally
and follow the cusp externally
Proximal portion is usually boxed or
cone shape

Location of margins

Tooth Preparation for Onlay

Tapered fissure bur is used for
preparing the outline (6-10 degree
taper)
Occlusal Preparation

Proximal boxes
Facial & lingual walls should
exhibit a combined divergence
of 6-10 from each other
Facio-lingual dimension is
determined by extent of caries,
old restoration
& adjacent tooth
Bevels extend the preparation
beyond the proximal contact
area

Cuspal Reduction

Shoulder & Chamfer Preparation

Shoulder should be prepared on
the centric cusps and should
have precise line angles
Bur is held parallel to tooth &
shoulder of 1.0 mm height & 1.0
mm in axial depth is cut
Barrel shaped bur to create
chamfer on non-centric cusps
Bur is positioned 45 to the axial
surface

 GINGIVAL BEVEL
Flame shaped Diamond (8862)
Distinct bevel given on gingival margins
0.5 mm width & 45 to external surface of
tooth

PROXIMAL BEVEL
Flame shaped diamond (8862)
Proximal bevel should blend smoothly with
gingival bevel & buccal & lingual bevels

RETENTION GROOVES
No. 169L bur is used
Grooves placed at linguoaxial & facioaxial
line angles

RESTORATIV
E
TECHNIQUE

1. Interocclusal Records
Before preparation of tooth, the
interocclusal contacts in MI & in all
lateral and protrusive movements
should have been carefully evaluated
The interocclusal record works well
when preparing one tooth; the full
arch casts are preferred when more
than two prepared teeth are involved

 The MI interocclusal record can be made

from one of several commercially available
bite registration pastes with or without a
disposable gauze-covered bite frame
Observe teeth not covered by the bite
registration paste to verify that teeth are in
MI

Once the material has set, remove the

interocclusal record from the teeth and
inspect it for completeness

2. Temporary Restoration
Between the time the tooth is
prepared & the cast metal
restoration is delivered, it is
important that the patient be
comfortable & the tooth be protected
and stabilized with adequate
temporary restoration.

TECHNIQUES USED IN MAKING

TEMPORARY RESTORATION
DIRECT TECHNIQUE:
Temporaries can be fabricated
intraorally directed on the prepared
teeth

INDIRECT TECHNIQUE
Temporaries can be fabricated outside
the mouth using a post-operative cast of
the prepared teeth

INDIRECT
TECHNIQUE

DIRECT TECHNIQUE

 The temporary restoration should

satisfy the following requirements:
It should be non irritating & protect the
prepared tooth from injury
It should protect & maintain the health of
the periodontium
It should maintain the position of the
prepared, adjacent & opposing teeth
It should provide for esthetic, phonetic,
and masticatory function as indicated
It should have adequate strength &
retention to withstand the forces to
which it will be subjected.

3. Final Impression
The indirect technique for making
cast metal restoration is accurate &
dependable/
Fabrication of cast metal restoration
takes place in the laboratory, using a
gypsum cast made from an
impression of the prepared &
adjacent unprepared teeth.

 The impression material used for the

final impression should have the
following qualities:
1. It must become elastic after placement
in the mouth because it must be
withdrawn from the undercut regions
that usually exist on the prepared &
adjacent teeth

2. It must have adequate strength to resist

breaking or tearing on removal from the
tooth.
3. It must have adequate dimensional
accuracy, stability & reproduction of
detail so that it is an exact negative
imprint of the prepared & adjacent
unprepared teeth,.
4. It must have handling and setting
characteristics that meet clinical
requirements.

5. It must be free of toxic or irritating

components.
6. It must be able to disinfected
without distortion.

4. Working Cast & Dies

The working cast is an accurate
replica of the prepare & unprepared
adjacent teeth that allows the cast
metal restoration to be fabricated in
the laboratory.
During this fabrication procedure, it
is more helpful if the replicas of
prepared & adjacent unprepared
teeth called dies are individually
removable.

 The most used methods for creating

a working cast with removable dies
from an elastic impression require
two pours.
The 1st pour is made to produce the
removable dies and the 2nd pour is
made to establish inta-arch
relationship. (Working cast in this
manner is called split casts)

Pouring the Final Impression:

Make a mix of high strength die
stone using a vacuum mechanical
mixer & pour the dies with the aid of
a vibrator & a no. 7 spatula
Apply the 1st increment in small
amounts, allowing the material to
flow into remote corners and angles
of the preparation without trapping
air.

 The impression should be sufficiently

filled so that the dies will be
approximately 15-20 mm tall
occlusogingivally after trimming.
This may require surrounding the
impression with boxing wax before
pouring.
After the die stone has set, remove
the cast from the impression &
inspect it for completeness. (The first

Completing the working cast:

Trim the base of the die segment flat on a
model trimmer
Once the base of the die segment is flat,
trim the sides closer to facial & lingual of
the teeth
Remove deep scratches left by the model
trimmer by wet sand paper

GENERAL
RULE:

The teeth to be removable

are the prepared teeth with
proximal gingival margins &
any unprepared teeth
adjacent to prepared
proximal surfaces.

 There are two advantages to

making removable dies of
unprepared teeth adjacent to
prepared proximal surfaces:
1. The adjacent tooth will not interfere
with removing the die that has the
preparation as occasionally may
happen otherwise.
2. Adjusting the contacts is easier and
more accurate when waxing & finishing
the castings.

 Usually place one dowel pin in each

prepared & adjacent tooth
Place the cast on the pindex drilling
machine & drill one hole to the die
base precisely in the middle of each
tooth that is to be removed.
Once all the holes are drilled, a small
drop of cyanoacrylate glue is placed
in each hole, & a dowel pin is
inserted.

 Cast must be dry before cementing the pins.

To prevent rotation of dies on the model
base, a small dimple may be placed just
facial & lingual to each dowel pin with 1/3
the diameter of a no. 6 round bur
Place a bead of rope wax around the die
segment level with the base of the dies.
Now add boxing wax around this to form a
container for the base pour.

 Allow at least 1 mm of the ends of the

dowel pins to protrude.
To provide adequate strength, the base
of the cast shoulkd not be less than 10
mm thick.
After the stone has hardened, remove
the boxing & rope wax.
Remove the cast from the impression

 Tap the end of each dowel pin lightly with the

end of an instrument handle until a different
sound is heard; this indicates that the die
segment has moved slightly from its seating
Carefully push the ends of the pins conjointly
causing the die segment to move equally
away from its seating
After the die segment is removed from that
manner, teeth that are to be removable must
be cut apart from one another.

5. Wax Pattern
FORMING THE PATTERN BASE:
Lubricate the die & incrementally
add liquid wax from a no. 7 wax
spatula by the flow & pree
method to form the proximal, facial
& lingual surface aspects of the
pattern
Then add a thin layer of wax on the
occlusal surface

6. Spruing, Investing and Casting

When there is a delay between the

forming of wax pattern & investing
procedure, it is suggested to add the
sprue to the pattern before the delay
period

7. Seating, Adjusting & Polishing the Casting

It is critical to closely examine the

casting.

8. Trying in the Casting

9. Cementation