All
preparations should have the maximum height and
minimum taper for optimal resistance and retention
form consistent with the chemical situation. To
achieve this and to permit an adequate thickness
of restorative material without over-contour,
the surface of the preparation should mimic that
of the intended restoration, both occlusally and
axially.
Features
of preparations for indirect restorations
•
Undercut-free preparation – there must be one
point above the preparation from which all the
margins and internal line angles can be seen.
• A single path of insertion over as great a distance
as possible – this is achieved by preparing opposing
walls to be near-parallel to give maximum retention.
The position of the adjacent teeth should be considered
as they may overhang the margins of the prepared
tooth. The path of insertion is therefore dictated
by the adjacent teeth.
• Resistance form needs to be provided by restoration
to displacing forces which are usually occlusal
in origin.
• The opposing walls in the gingival half of the
preparation should be made near-parallel.The occlusal
third to half will usually be more tapered as
a result of the two plains of labial reduction
required to provide sufficient room for the restorative
material within the original tooth contours.
• With short clinical crowns there is an increased
risk of failure because of the short insertion
path. Preparation length can be increased by crown
lengthening, and resistance form may be improved
by the use of grooves, slots or boxes and by converting
sloping surfaces into vertical and horizontal
components.
• Occlusal reduction should follow cuspal outline
to maximise retention and minimise tooth reduction.
For porcelain fused to metal crowns and for gold
crowns these distances are 2 and 1 mm, respectively.
• The finished margin position and type are determined
by the gingival contour, the nature of the restorative
material, the presence or absence of a core margin
and the choice of luting agent.Whenever possible,
the margin should be supragingival following the
natural gingival contours. Finish margins should
ideally extend at least 1 mm past core margins
to rest on sound tooth tissue.
• The finished margin position and type are determined
by the gingival contour, the nature of the restorative
material, the presence or absence of a core margin
and the choice of luting agent.Whenever possible,
the margin should be supragingival following the
natural gingival contours. Finish margins should
ideally extend at least 1 mm past core margins
to rest on sound tooth tissue.
Types of finish margins
Chamfers
and shoulders give definite finish margins which
may be identified on preparations, temporary crowns
and dies. Occasionally, knife-edge preparations
may be indicated for full veneer crowns where
there are deeply subgingival margins (however,
periodontal surgery may be more appropriate here),
bulbous teeth or pins close to the preparation
margin. Metal ceramic crowns may be constructed
with metal collars, especially on long preparations
on posterior teeth. Lipline on smiling may indicate
whether this is a practical proposition. A chamfer
or knifeedge finish may avoid excessive tooth
reduction in this situation.
(a) Knife edge; (b) bevel; (c) chamfer; (d) shoulder; (e) bevelled shoulder.
• Full veneer crown – chamfer
• Metal ceramic crown – buccal shoulder/palatal
chamfer normally
• Porcelain jacket crown – shoulder
Preparation
Stage
• Occlusal reduction using depth grooves as a
guide to the amount of tooth reduction. Grooves
are only of use when the shape of the restoration
is intended to match the original tooth.
• Gross
buccal and palatal/lingual axial reduction. The
preparation is kept near-parallel cervically and
the labial reduction is made to mimic the contour
of the final restoration in two, or occasionally
three, planes. The preparation is extended as far interproximally
as possible without risking contact with adjacent
tooth structure.
• Initial interproximal reduction is achieved
with a narrow tapered diamond. A sliver of tooth
substance/restoration may be left to protect the
adjacent tooth at this stage.
• Complete axial reduction can determine final
finishing line position. Finish margins at least
1 mm past any existing restorations and just below
the gingival margin labially if required for aesthetics.
INDIRECT ADHESIVE RESTORATIONS Tooth-coloured inlays
The increasing expectation of patients that restorations
be tooth-coloured has led to an increasing interest
in direct and indirect composite and ceramic restorations
in posterior teeth. Ceramic and composite inlays
are generally considered to be appropriate for
larger rather than smaller cavities, given that
direct placement resin composite restorations
may provide good service in small- to medium-sized
cavities.
Examples of
tooth-coloured ceramic
inlay materials
• Feldspathic porcelain
• Reinforced ceramics (such as Fortress: Chameleon
Dental, KS, USA )
• Pressed ceramics (such as Empress II:
Ivoclar-Vivadent, Leichtenstein)
Computer-aided design and manufacture
techniques (CAD-CAM, e.g. Cerec, Siemens , Germany
) are capable of producing increasingly accurately
fitting inlays from blocks of ceramic material.
These techniques have the distinct advantage of
producing the inlay at the chairside in a short
time (within 15 minutes), thereby obviating the
need for placement of a temporary restoration
and a second visit for placement.
Comparison between typical inlay
cavities for gold and
composite
•
Crown & Bridge basic
• Restoration Assessment
• Restoration choice
• Tooth preparation
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