Department of Prosthodontics Including Crown & Bridge, Maxillofacial Prosthodontics & Oral

INTRODUCTION BIOLOGIC CONSIDERATIONS MECHANICAL CONSIDERATIONS ESTHETIC CONSIDERATIONS CONCLUSION REFERENCES

INTRODUCTION
Teeth do not have the regenerating capacity as most other tissues have, once when enamel / dentin are lost as a result of caries, trauma etc, it requires a restorative material to restore the form & function Teeth require preparation to receive restorations and these preparations are based on fundamental principles which determines the success of prosthodontic treatment

Conservation Of Tooth Structure Avoidance Of Over contouring Supragingival Margins Harmonious Occlusion Protection Against Fracture

Retention Form Resistance

Form

Deformation

Minimal Metal Display Maximum Porcelain Thickness Porcelain Occlusal Surface Sub gingival Margins

BIOLOGIC CONSIDERATIONS

PREVENTION OF DAMAGE DURING TOOTH PREPARATION Adjacent Tooth Iatrogenic damage or nicking of adjacent tooth removes fluoride rich superficial enamel layer and creates a rough surface, which has every possibility to accumulate plaque and eventually leads to dental caries

Contd

This

can be prevented with the help of a matrix band placed in the interdental region during proximal tooth preparation

MATRIX BAND PLACED TO PROTECT THE ADJACENT TOOTH STRUCTURE

Contd

The

best way to protect adjacent teeth is by using thin tapered diamond through interproximal contact area to leave a slight lip of enamel or fin of enamel without causing excessive tooth reduction or undesirable angulation of rotary instrument

Contd

 Soft

Tissues Movable soft tissues like lips, cheeks and tongue are kept away from the site of preparation with the help of mouth mirror, aspirator tip and saliva ejector

USE OF MOUTH MIRRORS & SALIVA EJECTORS FOR SOFT TISSUE RETRACTION

Contd

 Pulp Preventing

pulpal injury is very vital to save the tooth Extremes of temperature, chemicals and microorganisms can cause irreversible pulpitis
IRREVERSIBLE PULPITIS

Contd

CAUSES

OF INJURY Temperature o Heat is generated by the friction between the rotary instrument & the tooth being prepared o Excessive pressure, condition of the bur, higher rotational speeds all increase the heat generated

TOOTH PREPARATION USING AN AIRROTOR HANDPIECE

Contd

o Air-water

spray when accurately directed reduces the heat generated, prevents clogging and increases the cutting efficiency of the bur o Special care should be while preparing grooves or pin holes, as the coolant cannot reach the cutting edge of the bur, heat generation can be prevented by using low rotational speed

Contd

Chemical

Action o The chemical action of certain dental materials like bases, restorative resins, solvents & luting agents when applied to freshly cut dentin can cause pulpal damage o Cavity varnish & dentin bonding agents form an effective barrier in most cases but they can affect on the retention of cemented restorations

Contd

Bacterial

Action o Bacteria those are left behind or those which gain access to the dentin because of microleakage can lead to pulpal damage o Dental materials like zinc phosphate cement have an antibacterial effect but, because of property of vital dentin to resist infection the routine use of antimicrobials is not advocated

Contd

 CONSERVATION

OF TOOTH

STRUCTURE One of the basic tenets of restorative dentistry is the conservation of tooth structure as much as possible within mechanical and esthetic principles of tooth preparation

Contd

 Tooth

structure is conserved by employing the following guidelines Use of partial coverage rather than complete coverage Preparation with minimal convergence angle Uniform occlusal reduction following anatomical inclined planes Even preparation of axial surfaces Conservative margin selection Avoid unnecessary apical extension

Contd

CONSIDERATIONS AFFECTING FUTURE DENTAL HEALTH Structural Durability The restoration must contain adequate bulk to withstand forces of mastication Occlusal Reduction Functional Cusp Bevel Axial Reduction

Contd

Occlusal

Reduction Occlusal clearance provides adequate strength and bulk of metal For gold alloys occlusal clearance in non-functional cusps 1.0 mm and for functional cusps 1.5 mm

CORRECT OCCLUSAL REDUCTION PARALLELS THE PLANE OF OCCLUSION

Contd

 For

metal ceramic crowns in nonfunctional cusps 1.0 1.5 mm and in functional cusps 1.5 2.0 mm For all ceramic 2.0 mm throughout The basic inclined planes of the occlusal surface should be followed for adequate clearance and without over shortening

UNDESIRABLE OVER SHORTENING OF THE TOOTH STRUCTURE

Contd

The

amount of occlusal reduction is not always the same as the clearance needed Often part of a tipped tooth is already short of the ideal occlusal plane & will require less reduction than would a tooth in ideal occlusion

OCCLUSAL REDUCTION FOR A TIPPED TOOTH

Avoid creating steep planes with sharp angles, since these can increase stress & hinder complete seating of the casting For diminishing stresses rounding of the angles & avoidance of deep grooves in the centre of the occlusal surface & keeping the angulation of the occlusal planes shallow

Contd

Functional

Cusp Bevel A bevel increases the surface area of metal covering the cusp and hence provides adequate bulk and strength for the restoration When adequate bevel is not given, the thin metal resulting over the functional cusps is easily damaged because of weakness and creates deflective occlusal contacts

Contd

The

functional cusp bevel is usually placed on the facial cusps of the mandibular teeth & on the lingual cusps of the maxillary teeth, paralleling the inclination of the cusp plane it opposes

FUNCTIONAL CUSP BEVEL

Contd

In a cross bite occlusal relationship, the functional cusps are reversed & the functional cusp bevel is placed on the facial cusps of the maxillary teeth & lingual cusps of mandibular teeth

FUNCTIONAL CUSP BEVELS IN A CROSS BITE RELATIONSHIP

Contd

Axial

Reduction Inadequate axial reduction is commonly associated with gingival inflammation, probably because it is more difficult for the patient to maintain plaque control around the gingival margin

ADEQUATE REDUCTION

INADEQUATE REDUCTION CROWN WITH THIN WEAK WALLS

INADEQUATE REDUCTION OVER CONTOURED RESTORATION

Contd

The

crown should duplicate the contours & profile of the original tooth unless it is malformed or malpositioned If an error is made, a slightly under contoured flat restoration is better as it is easier to keep free of plaque

Contd

 Margin

Placement Whenever possible the margin of a preparation should be Supragingival as Subgingival margins of cemented restorations have been identified as a major factor in periodontal disease Supragingival margins are easier to prepare accurately without trauma to the soft tissues They can be situated on hard enamel, whereas Subgingival margins are often on dentin or

Advantages

margins:They can be easily finished They are more easily kept clean Impressions are more easily made, with less potential for soft tissue damage Restorations can be easily evaluated at recall appointments

of supragingival

Indications

for subgingival margins:Dental caries, cervical erosion, or restorations extending subgingivally, & a crown lengthening procedure is not indicated The proximal contact area extends to the gingival crest Additional retention is required The 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 dentin bonding agents Modification of the axial contour is indicated

MARGIN PLACEMENT Subgingival margins of cemented restorations are a major factor in periodontal disease
Block. JPD 1987; Bader. JPD 1991

No

difference between subgingival and supragingival margins

Richer & Uno. JPD 1973, Koth. JPD 1982

Margins

should be 2mm away from the alveolar crest

Garguilo. J Periodontol 1961

 If

the margin intrudes into this biologic width, the inflammation will result

INFLAMMATION & OSTEOCLASTIC ACTIVITY WHEN MARGIN OF A RESTORATION INTRUDES INTO THE BIOLOGIC WIDTH

 The

bone will recede until once again it is at least 2 mm away from the margin

CONTINUOUS BONE RESORPTION UNTIL THE ALVEOLAR CREST IS AT LEAST 2 mm FROM THE RESTORATION MARGIN

 Margin

Adaptation The junction between a cemented restoration and tooth is always a potential site for recurrent caries The more accurately the margins are adapted to the tooth, the less chance for recurrent caries A well designed preparation has a smooth & even margin

Rough,

irregular or stepped junctions greatly increase the length of the margin & substantially reduce the adaptation of the restoration For a properly prepared tooth a skilled technician can make a casting that fits to within 10 m & a porcelain margin that fits to within 50 m

 Marginal

Integrity For survival of a restoration in the biological environment of the oral cavity the margins should be closely adapted to the cavosurface finish line of the preparation The configuration of the preparation finish line dictates the shape & bulk of restorative material in the margin of the restoration

Historically,

the bevel was used as a device for compensating for the solidification shrinking of alloys used in fabricating cast restorations Margins should be acute in crosssection rather than right angled to facilitate a closer fit To accomplish this, preparation finish lines should take forms that permit acute edges in the restoration margins

Even

the best crowns fail to seat by several microns If the prepared surface that is adjacent to a finish line is perpendicular to the path of insertion, as a shoulder is, the marginal gap, d, will be as great as the distance by which the crown fails to seat, D If the inner surface of the metal margin forms an angle, m, of less than 900 with the path of insertion, as does a bevel or a chamfer, d will be smaller than D

D = distance by which a crown fails to seat a restoration d = marginal opening (in the but joint) In the presence of a bevel, the shortest distance from the margin to the tooth structure is less than D & is a function of the sine of the acute angle of the margin m, or of the cosine of the obtuse angle of the finish line

 The

shortest distance from the casting margin to the tooth structure, d, can be stated as a function of D & the sine of the angle m or the cosine of angle p which is the angle between the surface of the bevel & the path of insertion
d d = = D sin m, or D cos p

As

the angle m is reduced, its sine becomes smaller & so does d The more obtuse the angle of tooth structure at a horizontal finish line, therefore more acute the restoration margin, the shorter the distance between the restoration margin & the tooth The margin angle must be quite acute before the actual distance is diminished to a great extent

An angel of 350 400 is considered optimal If it is made much more acute then it becomes weak

THE SMALLER THE ANGLE BETWEEN THE PREPARED TOOTH SURFACE AT THE FINISH LINE & THE PATH OF INSERTION, THE LESS THE MARGINAL OPENING FOR THE SAME AMOUNT OF INCOMPLETE SEATING

 Margin

Geometry
configuration of the margin has

Cross-sectional

been the subject of controversy and debate

Rosner. JPD 1963; Hunter. JPD 1990

Different

shapes have been described and

Dykema. 1986; Shillenberg 1997

advocated

 Configurations
Chamfer o Heavy Shoulder

chamfer

shoulder o Shoulder with bevel Knife edge

o Radial

CHAMFER

Preferred for veneer metal restorations Exhibits least stress, so that cement under it will have less likelihood of failure
Panno et al, JPD 1986

Care needed to remove unsupported

HEAVY CHAMFER

Rounded internal angle Provides better support than chamfer for ceramic restorations Not as good as shoulder
Hoffman, DCNA 1965

SHOULDER

Margin of choice for all ceramic More destruction of tooth but space minimizes stress that might lead to fracture 90 degree internal line angle concentrates stress in the tooth and is conducive to coronal fracture Shillingburg 1997, Rosenstiel 2001

RADIAL SHOULDER

Internal line angle is rounded by modified binangle chisel Stress concentration is less in the tooth structure
Shillingburg 1997, Rosenstiel 2001

SHOULDER WITH BEVEL

Gingival finish line on the proximal box for inlays and onlays Facial finish line where esthetics is not critical Good finish line for preparation with extremely short walls, since it facilitates axial walls that are nearly parallel

Gage. Aus Dent J 1977

KNIFE EDGE
Lingual

surface of mandibular posterior teeth teeth

Tilted

Shillingburg 1997, Rosenstiel 2001

Effect Of Finish Line On Marginal Seal & Marginal Seat Of Full Crown Preparation
Feather

edge & parallel bevel demonstrated the best marginal seal 900 demonstrated the best seating of restoration
JPD 2004; 92: 1 7

DISTORTION RELATED TO MARGIN DESIGN IN PFM RESTORATIONS

Three margin designs were compared

Chamfer Shoulder Shoulder

with bevel
Faucher & Nicholas 1980

Chamfer exhibited more distortion than shoulder or shoulder with bevel Type of distortion of shoulder and shoulder with bevel were almost similar Study supports the theory that placing of additional metal at the gingival margin reinforces the margin and inhibits marginal distortion

ABUTMENT EVALUATION
Evaluated for 3 factors:

CROWN-ROOT RATIO

Klaffenbach. JADA 1936

ROOT CONFIGURATION

PERIODONTAL LIGAMENT AREA

CROWN-ROOT RATIO 1:1 minimum 2:3 optimum >1:1 when opposing tooth is artificial

ROOT CONFIGURATION Roots broader labio-lingually are preferred than they are mesio-distally Irregular preferred than conical

ROOT SURFACE AREA

ANTES
Irvin

LAW
et al

H Ante.1928

Dykema Tylman

Shillingberg

SUPPORTED THE ANTES LAW

 Nyman Nyman

& Erikson, J Clin Periodontol 1982 & Lindhe. J Clin Periodontol 1976

Cast doubt on the validity of Antes Law by demonstrating that teeth with considerably reduced bone support can be successfully used as FPD abutments

 No

loss of attachment after 8 to 11 yrs because of

Meticulous

planing Proper plaque control Occlusal design of prosthesis

root

FPDS SUPPORTED BY PERIODONTALLY COMPROMISED TEETH

Criteria For Inclusion In Study:

50%

loss of attachment Probing depth of 5mm at 1 site Grade II or III mobility Minimum of 3mm osseous support

Attachment level, probing depth, bleeding upon probing & gingival index scores were non significant after 2 yrs when compared with contralateral teeth
Freilich et al. JPD 1991.

CANTILEVER F.P.Ds

Long term prognosis is poor

Cheung et al, J Oral Rehabil 1990

Cantilever designs may be preferred since readhesion after failure is greatly facilitated and often leads to predictable long term success

Brigs et al, Br Dent J 1996

RESIN BONDED F.P.Ds

Bonded pontics Cast perforated Resin retained F.P.Ds Rochette type Etched cast resin retained F.P.Ds
Maryland

type

Virginia bridge Chemical bonded resin F.P.Ds

STUDY

MONTHS TO 50% FAILURE

110 250
Boyer et al, J Dent Res 1993

UNIVERSITY OF IOWA Perforated design Etched metal

UNIVERSITY OF MARYLAND
Etched

metal

190
De Rijk et al, J Dent Res 1996

AN ANLYSIS OF CLINICAL STUDIES ON RESIN-BONDED BRIDGES

60 publications 16 included in study Survival rate 1yr - 89 1% 2yr - 84 1% 3yr - 80 1% 4yr - 74 2%

Creugers & Hoffman, J Dent Res 1991

RESIN-BONDED FPD RETENTION :A RETROSPECTIVE 13-YR FOLLOW-UP

51 resin-bonded FPDs were inserted and evaluated after 13 yrs Three levels of survival were defined:
Complete

survival (no debonding) - 85 months,13% Functional survival (loss of retention on 1 occasion with rebonding) - 112 months,10% Multiple survival (loss of retention on several occasions with rebonding of original RBFPD) 131months, 8%
Zalkind, Handani & Hochman, J Oral Rehabil 2003

MECHANICAL CONSIDERATIONS

RETENTION FORM: Quality of preparation that prevents the restoration from becoming dislodged by forces parallel to the path of withdrawal
Dental

caries and porcelain failure outrank lack of retention as a cause of failure

Walton et al JPD 1986 Karlsson & Lindquist, Int J Prostho 1998

 RETENTION

DEPENDS ON: Magnitude of dislodging force Geometry of tooth preparation Roughness of fitting surface Materials being cemented Film thickness of luting cement

MAGNITUDE OF DISLODGING FORCES

Greatest

removal forces generally arise when exceptionally sticky food is taken depends on surface area and texture of restoration being pulled

Also

GEOMETRY OF TOOTH PREPARATION

Taper Surface Stress

area

concentration

TAPER

Parallel walls were advocated for inlay restorations Conzett; Dent Cosmos 1910 3 to 5 degrees
Dykema

6 degrees 10 to 14 degrees

Shillingberg; Wilson, J Prosthod 1994

Tylman

Overall 2.5 to 6.5 degrees has been suggested as optimum This is based on an inclination of approximately 30 being produced on each surface external or internal, by the sides of the tapered instrument The result would be an overall taper or an angle of convergence of 60

AN OPTIMAL 60 TAPER

 VITAL
14.20 Mesiodistally 230

Faciolingually Mesiodistally Faciolingually

Ohm, Sillness. J Oral Rehabil 1978

NONVITAL
12.80 22.50

Average of 16.50

Mack. J Oral Rehabil 1980

A taper of 160 has been proposed as Dodge et al. Quint Int 1985 being achievable clinically while still affording retention Average of 19.20
Nonan & Goldfoger. JPD 1991

OPTIMUM DEGREE OF TAPER ARCH MESIODISTAL FACIOLINGUAL OVERALL

MAXILLARY
ANTERIOR PREMOLAR MOLAR 10 14 17 10 14 21 10 14 17

MANDIBULAR
ANTERIOR PREMOLAR MOLAR 10 16 24 10 12 20 10 14 22

SURFACE AREA

More the surface area covered more the retention Long axial walls are more retentive than short walls
Shillingberg, Calif Dent Assoc J 1975

Features such as grooves & boxes that are placed in the preparation increase the surface area thereby increasing retention
GROOVES & PIN HOLES FOR RETENTION

STRESS CONCENTRATION
More important for retention than the total surface area is the area of cement that will experience shearing rather than tensile stress when the restoration is subjected to forces along the path of insertion To decrease failure potential, it is essential to minimize tensile stress

TENSILE STRESS

SHEAR STRESS

SHEAR & COMPRESSIVE STRESS

COMPRESSIVE STRESS

 Stress

is more concentrated at the junction of axial and occlusal surfaces

Nicholls. JPD 1974

Rounding

of margins will decrease stress concentration

For utilization of the shear strength of the cement, the preparation must have opposing walls i.e. the 2 surfaces must be nearly parallel with each other These surfaces may be internal, as the facial & lingual walls of the proximal box of an inlay or external such as axial walls of a full veneer crown

AN INLAY

A FULL VENEER CROWN

To obtain greatest area of cement under shear, the directions in which a restoration can be removed must be restricted to essentially one path If features are added to the preparation so that only a force in one direction can move a restoration without compressing the cement film against one or more surfaces, the retention is enhanced

A full veneer crown preparation has an excellent retention because of mesial, distal, & facial walls limit the path of insertions to a narrow range However, when the facial surface is left uncovered the crown on this preparation could be removed towards the lingual, the incisal, or any direction in between

PATHS OF INSERTION FOR FULL & PARTIAL VENEER CROWNS

To create a more retentive form, grooves, boxes, or pinholes are substituted for the missing axial wall These features are also useful for augmenting retention on severely damaged teeth

GROOVES & PIN HOLES FOR RETENTION

For a groove to effectively substitute for the uncovered facial surface, the lingual wall of the groove must be distinct & perpendicular to the adjoining axial surface Otherwise a lingually directed force would cause the ribs of the metal to slide along the inclined planes of the lingual walls of the grooves, spreading the axial walls & opening the margins

LINGUALLY DIRECTED FORCES ACTING ON A 3 QUARTER CROWN

Length of a preparation is an important factor in retention A long preparation has greater retention than does a short preparation This is due to greater surface area of the longer preparation & to the fact that most of the additional area is under shear than tension This greater surface area would lead to a preparation with larger diameter, which will have greater retention than will a narrow preparation

ROUGHNESS OF SURFACES BEING CEMENTED The adhesion of the dental cements depends primarily on the projections of the cement into microscopic irregularities & recesses on the surfaces being joined The prepared tooth surfaces therefore should not be highly polished

Retention increases if surface is roughened or grooved Airborne particle abrasion has been shown to increase retention by 64% when cemented with zinc phosphate
OConnor. JPD 1990

MATERIALS BEING CEMENTED

Base

metals are more retentive than high gold metals

Saito et al, JPD 1976

TYPE OF LUTING CEMENT

Adhesive

resins are the most retentive

El Mowafy et al, JPD 1996; Ayed et al, JPD 1997

FILM THICKNESS
Conflicting

evidence 20 to 25 m most cements 40 to 50 m resin cements

RESISTANCE FORM

Prevents dislodgement of the restoration by forces directed in an apical or oblique direction and prevents any movement of restoration under occlusal forces

RESISTANCE FORM
Depends

on: Magnitude & direction of dislodging forces Geometry of tooth preparation Physical properties of luting agent Deformation of material

Increased preparation taper and rounding of axial angles tend to reduce resistance
Hegdahl & Silness. J Oral Rehabil 1977

GEOMETRY OF TOOTH PREPARATION

Molars require more parallel preparation than Premolars or Anterior Teeth to achieve adequate resistance form Parker. JPD 1993 Relationship between preparation height, diameter and resistance to displacement is approx. linear

Wiskott et al, Int J Prostho 1997

The resisting area of a cylindrical preparation would include half of its axial surface As the degree of taper increases, the tangent line approaches the occlusal surface & the resisting area decreases

long narrow preparation can have a greater taper than a short & wide one without jeopardizing resistance Conversely the walls of a short wide preparation must be kept nearly parallel to achieve adequate resistance form

The permissible taper of a preparation is directly proportional to the height/width ratio The preparation taper that will still permit an effective resisting area, for a preparation in which the height equals the width, is double than permissible in a preparation in which the height is only one half the width

EFFECTIVE RESISTANCE FOR A PREPARATION WITH 1:1 HEIGHT/WITH RATIO WITH 150 TAPER & WITH 1:2 HEIGHT/WIDTH RATIO WITH 70 TAPER

Formulae used to calculate allowable preparation tapers (convergence angles) & for determining the height of the tangency point & preparation height are:

T r h

= = =

arc sin (2r/w) (w sin T) / 2 [ w tan (900 T/2] /2

T = Degrees r mm w
= = Preparation Taper In

Height Of Tangency Point In Preparation Width In mm

MAGNITUDE & DIRECTION OF DISLODGING FORCES

The strongest forces encountered during function are apically directed & can produce tension & shear in the cement film only through leverage This leverage, which is probably the predominant factor in dislodgement of cemented restorations, occurs when the line of action of a force passes outside the tooth structure, or when the structures flex

If the force passes within the margin of a crown, there will be no tipping of the restoration The margin on all sides of the restoration is supported by the preparation The torque produced merely tends to seat the crown further

LINE OF ACTION OF FORCE PASSING WITHIN THE MARGINS OF THE RESTORATION NO SECONDARY LIFTING FORCES

If the occlusal table of the restoration is wide, even a vertical force can pass outside the supported margin & produce a destructive torque This can also occur in crowns on tipped teeth & retainers for cantilever bridges

LINE OF ACTION OF FORCE PASSING OUTSIDE THE MARGINS OF THE RESTORATION SECONDARY LIFTING FORCES

force applied to a cemented crown at an oblique angle can produce a line of action which will pass outside the supporting tooth structure The point on the margin that lies closest to the line of action is the fulcrum point or the centre of rotation

The magnitude of the torque produced is equal to the applied force multiplied by its lever arm, which is the closest distance between the line of action & the fulcrum In equilibrium this torque is balanced by the sum of all the resisting tensile, shear & compressive stresses generated in the cement film The farther these resisting forces lie from the fulcrum, the greater their mechanical advantage

If a line is drawn from the centre of rotation perpendicular to the cement film on the opposite wall of the preparation, the point where this line intercepts the cement film can be referred to as the tangent point

TANGENT LINE & POINT

At P1 arc of rotation is tangent to the surface of the preparation & cement film is subjected only to shear At P2 there is a component of compression & at all points occlusal to it At P3 here & at all points apical to the tangent point, stresses have a component of tension Mechanical advantage is provided only by points

The area encompassed by this tangent line is referred to as the resisting area by Hegdahl & Silness Within this area the luting material is subjected to varying degrees of compression as well as shear, while all other points on the surface of the preparation will experience some degree of tension & will contribute little to the resistance of the preparation

LENGTH OF THE PREPARATION

Length of a preparation has a strong influence on its resistance Shortening a preparation will produce a proportionately greater diminution of the resisting area The ability of a restoration to resist tipping depends not only on the preparation, but also on the magnitude of torque

If two crowns of unequal length on 2 preparations of equal length are subjected to identical forces, the longer crown is more likely to fail because the force on it acts through a longer lever arm

 When

a relatively long crown must be made on a short preparation, additional resistance form, usually in the form of a pin retained core, must be created before the cast restoration can be made

A wide preparation has greater retention than a narrower one of equal height Under some circumstances a crown on the narrow tooth can have greater resistance to tipping than one on the wider tooth This occurs because the crown on the narrower tooth has a shorter radius of rotation resulting in a lower tangent line & a larger resisting area

WIDTH OF THE PREPARATION

The resistance of a preparation on a wide, short tooth can be greatly enhanced by the addition of grooves

Here the arc of radius r2 is effectively blocked by the resisting area of the groove walls, while the arc of radius r1 encounters little or no resistance on the far axial wall

GROOVES ENHANCING RESISTANCE

PHYSICAL PROPERTIES OF LUTING AGENT

Mostly

dependent on:

Compressive

Strength Modulus Of Elasticity Creep Fatigue Resistance

COMPARATIVE EVALUATION
CEMENTS COMPRESSIVE STRENGTH MODULOUS OF ELASTICITY

ZINC PHOSPHATE

104

13.5

RESIN

70 to 172

2.1 to 3.2

POLYCARBOXYLATE

55

5.1

GLASS IONOMER

86

7.3

BIOLOGIC PROPERTIES

BIOCOMPATIBLE:

There is little association between the choice of Zinc phosphate & GIC and increased pulpal sensitivity, provided manufacturers recommendations are followed Application of desensitizing agents reduces retention Biocompatibility of resin cements is related to its degree of polymerization
Swift et al. JADA 1997; Mausner et al. JPD 1996
Kern et al. JPD 1996 Bebermeyer & Berg Quint Int 1994 Johnson et al. 1993

 Caries
GIC

Inhibition:

has been shown to increase the fluoride concentration in the short term Rezk-lega. Scand J Dent Res1991 adhesive resins have increased microleakage as compared to traditional cements, least is of modified glass ionomer
Mash et al. JPD 1991

Microleakage
Non

MECHANICAL PROPERTIES
Compressive
ADA

Strength:

Specification: 70 Mpa at 24hrs Glass Ionomer increases over weeks to 200 Mpa

MECHANICAL PROPERTIES

Flexure strength, diametrical tensile

strength, mod. of elasticity, fracture toughness, hardness: Resins exhibits higher values

Creep:
Composites

are similar to G.I.C

Papadogiannis et al. Dent Mat 1991

Zinc

phosphate has little creep

Wilson & Lewis. J Biomed Mater Res I980

Water Sorption Adhesive Resins & Resin Modified Glass Ionomer exhibits greatest sorption
Blaem et al. Dent Mater 1995

Retention
Adhesive

Resin > Resin > Glass Ionomer > Zinc Phosphate > Polycarboxylate

WORKING PROPERTIES
Mixing

technique greatly influences film thickness & viscosity Increased risk of incomplete seating is seen with resin cements As film thickness increases, tensile bond strength decreases

ESTHETICS

Color Stability
Amine

accelerator necessary for dual polymerization causes color to change

Braurer et al. J Dent Res 2000

Changes

are not visually perceptible

Noil et al. Int J Prosth 1995

Radiopacity
Should

have increased radioopacity than

Goshima & Goshima. Oral Surg 1991

dentin

DEFORMATION OF MATERIAL
Depends
Alloy

on:

selection tooth reduction

Adequate

Geryer. JPD 1970

 Alloy

Selection Type I & Type II gold alloys are satisfactory for intracoronal cast restorations, they are too soft for crowns & fixed partial dentures for which Type III or Type IV gold alloys are chosen High-noble metal content metalceramic alloys are considerably harder They may be indicated when large forces are anticipated, such as with a long span FPD

When a crown is subjected to an eccentric horizontal force a rotation about the vertical axis is also possible Movements of torque occur around a vertical axis as well as horizontal axis

ROTATION AROUND A VERTICAL AXIS

THE HORIZONTAL COMPONENT OF OCCLUSAL FORCES ROTATING INFLUENCE ON A CROWN

A three quarter crown without grooves has little resistance to rotational displacement The addition of grooves places a resisting surface at right angles to the arc of rotation, effectively blocking it

PARTIAL VENEER CROWN WITH NO GROOVES LITTLE RESISTANCE TO ROTATION

RESISTANCE PROVIDED BY LINGUAL WALLS OF THE GROOVES

A full veneer crown on a cylindrical preparation can rotate enough to break the cement bond before the compressive resistance is encountered Geometric forms such as grooves or wings increase resistance by blocking rotation around a vertical axis

AXIAL SYMMETRY OF A FULL VENEER CROWN ALLOWS ROTATION OF THE RESTORATION

AXIAL SYMMETRY OF A FULL VENEER CROWN ALLOWS ROTATION OF THE RESTORATION

PATH OF INSERTION

Before any tooth structure is cut the path of placement should be decided keeping in mind the principles of tooth preparation A path must be selected that will allow the margins of the retainers to fit against their respective preparation finish lines with the removal of minimum of sound tooth structure This path should not encroach upon the pulp or the adjacent teeth

The path of insertion for posterior full & partial veneer crowns is usually parallel with the long axis of the tooth

THE IDEAL PATH OF INSERTION PARALLEL TO THE LONG AXIS OF THE TOOTH

On the other hand the path of insertion for an anterior 3 quarter crown should be inclined to parallel the incisal 2/3rds of the facial surface enabling the restoration to have almost no metal visible on the facial surface

MAKING THE PATH OF INSERTION PARALLEL TO THE LONG AXIS OF THE TOOTH RESULTS IN UNNECESSARY METAL DISPLAY

THE PREFERRED PATH OF INSERTION PARALLEL TO THE INCISAL 2/3RDS OF THE INCISAL SURFACE

For a full crown to have structural durability, with proper contours, its path of insertion should be parallel to the long axis of the tooth

PATH OF INSERTION FOR A FULL VENEER CROWN ON A POSTERIOR TOOTH IN NORMAL ALIGNMENT PARALLELS LONG AXIS OF THE TOOTH

In case of a tilted tooth, a path of insertion paralleling the long axis of the tooth may be blocked by the proximal contours of the adjacent tooth In such cases the path of insertion is made perpendicular to the occlusal plane FOR A TILTED TOOTH CORRECT PATH OF PLACEMENT IS
PERPENDICULAR TO OCCLUSAL PLANE

A long standing loss of proximal contact is usually accompanied by tipping of the adjacent tooth into the space In such cases the path of insertion parallel with the long axis of the tooth might not allow a crown to seat even if the its distal wall is grossly under contoured

The space between the adjacent tooth must be made greater than the mesiodistal diameter of the prepared tooth at the gingival finish line This can be achieved by inclining the path of insertion so that removal of equal amounts of enamel from each of the adjacent teeth will allow a crown to seat on the prepared tooth

INCLINING THE PATH OF INSERTION TO FACILITATE SEATING OF THE CROWN

 In

cases where more than 50% of the enamel thickness has to be removed from either adjacent tooth, or if there isnt adequate space for gingival embrasures then, teeth should be separated & uprighted orthodontically

A negative taper or undercut must be eliminated or it will prevent the seating of the restoration Preparation taper can be evaluated by viewing it with one eye from a distance of approximately 30 cm or 12 inches

VIEWING PREPARATION TAPER

In this way it is possible to see all the axial walls with an ideal taper of 60 An undercut as great as 80 can be overlooked if both the eyes are used

BINOCULAR VISION SHOULD NEVER BE EMPLOYED

A mouth mirror can be used when it is difficult to survey the preparation under direct vision The entire finish line should be visible to one eye from one fixed position with no obstruction by any part of the prepared tooth To verify the parallel paths of insertion the image should be centered in the mirror

MIRROR USED TO EVALUATE THE PREPARATION WHERE DIRECT VISION IS NOT POSSIBLE

Then using the finger rest the, mirror is moved bodily without changing its angulation until the image of 2nd preparation is also centered If the angulation of the mirror has to be changed in order to see all the finish lines, then there must be a discrepancy between the paths of insertion of the preparation

MATCHING BRIDGE ABUTMENT PATH OF INSERTION WITH A MOUTH MIRROR

CONCLUSION
Preparations for restorations should be based on fundamental principles i.e a preparation must satisfy all the three principles i.e biologic, mechanical & esthetic principles which inturn are responsible for the success of the prosthodontic treatment

REFERENCES

Goodacre CJ, Bernal G, Rungcharassaeng K, Kan YK. Clinical complications in fixed prosthodontics. J Prosthet Dent. 2003; 90: 31 41 Walton JN, Gardner FM, Agar JR. A survey of crown & fixed partial denture failures: Length of service & reason for replacement. J Prosthet Dent. 1986; 56: 416 19 Creugers NHJ, Van MA. An analysis of clinical studies on resin bonded cements. J Dent Res. 1991; 70: 146 9 Rijk WG, Wood M, Thompson VP. Maximum likelihood estimates for the lifetime of bonded dental prostheses. J Dent Res. 1996; 75: 1700 05

Freilich MA, Breeding LC, Keagle JG, Garnick JJ. Fixed partial dentures supported by periodontally compromised teeth. 1991; 65: 607 11 Hunter AJ, Hunter AR. Gingival crown margin configurations: A review & discussion. Part I: Terminology & widths. J Prosthet Dent. 1990; 64: 548 52 Bader JD, Rozier GR, Mc Fall TW, Ramney DL. Effect of crown margins on periodontal conditions in regularly attending patients. J Prosthet Dent. 1991; 65: 75 9 Koth DL. Full crown restorations & gingival inflammation in a controlled population. J Prosthet Dent.1982; 48: 681 85

Goodacre CJ. Gingival esthetics. J Prosthet Dent. 1990; 64: 1 12 Shillingburg HT, Jacobi R, Brackett SE. Fundamentals of tooth preparations for cast metal & porcelain restorations. 1st ed. Carol stream. Qintessence Publishing Co. Inc 1991. p. 13 59 Rosenstiel SF, Land MF, Fujimoto J. contemporary fixed prosthodontics. 3rd ed. Missouri (CN). Mosby 2001. p. 166 201

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