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chedule S ecture - Principles of Tooth Preparation L eadings / Journals / Paper R valuation Rubric E ab Session L

PRINCIPLES OF TOOTH PREPARATION

Ranier M. Adarve, DMD,MS, MHPE

INTRODUCTION
ooth Preparation T clinical procedure consisting of removal a of tooth structures and / or shaping of the tooth to accommodate a fixed restoration

INTRODUCTION
Problems in Fixed Restorations
Crown Perforation Occlusal Problem Periodontal Problem

Marginal Leakage

Esthetic Problem

Dislodgement / Non-retention

INTRODUCTION
Problems in Fixed Restoration

Can be avoided by

Correct Tooth Preparation

INTRODUCTION

What is a Correct Tooth Preparation? What are the principles that govern Tooth Preparation?

TOOTH PREPARATION
What is a Correct Tooth Preparation?
emoval of tooth structure R does not weaken the tooth mount of reduction follows A the requirements of restoration esist displacement in all directions R resence of optimum tooth height P inish line that can accommodate F robust margin with close adaptation rovide optimal space for crown P which is sufficiently thick to prevent fracture, distortion or perforation

TOOTH PREPARATION

nnecessary reduction U ndangers the pulp E ack of retention and resistance features L inish line that cause micro leakage F nadequate space for crown which is thin I and may cause fracture, distortion or perforation

Incorrect Tooth Preparation

PRINCIPLES
What are the principles that govern Tooth Preparation?
1.Conservation/ Preservation of Tooth Structure 2.Retention and Resistance Form 3.Marginal Integrity and Preservation of Periodontium 4.Structural Durability and Esthetic Considerations

PRINCIPLES
1.Conservation/ Preservation of Tooth Structure
void over reduction of all surfaces A of the tooth void excessive occlusal reduction A chieve correct occlusal planar A reduction void flat occlusal surface A

Reduction based on the requirement of restoration

Occlusal planar reduction

xcessive Reduction: E
hermal hypersensitivity T ulpal inflammation and necrosis P oss of retention and resistance L

PRINCIPLES
2. Retention and Resistance Form

Retention prevents removal of the

restoration along the path of insertion or long axis of the preparation

Resistance prevents dislodgement of

the restoration by forces directed in an apical or oblique direction

PRINCIPLES
2. Retention and Resistance Form
ave an ideal taper H reserve tooth height P equire Parallelism when needed R ppropriate use of retentive features A void undercut A stablish Path of Insertion E

6 degrees TOC

Minimum of 4mm axial wall Height Avoid Undercut

PRINCIPLES
2. Retention and Resistance Form

reparation primary source of retention and resistance P ementation secondary source of retention and resistance C

PRINCIPLES
2. Retention and Resistance Form
ementation secondary C source of retention and resistance

PRINCIPLES
2. Retention and Resistance Form Types of Stress
Crown Force Cement film Tooth

Tension Shear Combination Compression

PRINCIPLES
2. Retention and Resistance Form

Factors under the Operators control:

APER T ENGTH / HEIGHT L URFACE AREA S URFACE ROUGHNESS S

PRINCIPLES
2. Retention and Resistance Form TAPER

PRINCIPLES
2. Retention and Resistance Form TAPER

s the degree of taper of the preparation increases, A Its ability to retain a restoration decreases

PRINCIPLES
2. Retention and Resistance Form

TAPER and R&R

Directly proportional Inversely proportional

PRINCIPLES
2. Retention and Resistance Form LENGTH / HEIGHT

force

Resisting area Resisting area

PRINCIPLES
2. Retention and Resistance Form

HEIGHT and R&R

Directly proportional Inversely proportional

PRINCIPLES
2. Retention and Resistance Form SURFACE AREA

PRINCIPLES
2. Retention and Resistance Form

SURFACE AREA and R&R

Directly proportional Inversely proportional

PRINCIPLES
2. Retention and Resistance Form SURFACE ROUGHNESS

dhesion of dental cements depends primarily on A projections of the cement into microscopic irregularities

xial surface-rough a argins-smooth m

PRINCIPLES
2. Retention and Resistance Form

SURFACE ROUGHNESS and R&R

Directly proportional Inversely proportional

Path of Insertion

Path of Insertion

One path of insertion

Path of Insertion

multiple paths of insertions

Path of Insertion

no path of insertion

Path of Insertion

Common path of insertion

Path of Insertion

Uncommon paths of insertion

Path of Insertion

Path of Insertion

Path of Insertion

PRINCIPLES
3. Marginal Integrity and Preservation of Periodontium
ell-defined margins W ontinuous margins C ven and smooth margins E ocated at appropriate level L ollow contour of the ginigival margin F reak contact with adjacent tooth B

Break Contact with adjacent tooth

Continuous and follow contour of gingiva

Well-defined, Even and Smooth Margins

argin Configurations M
houlder S hamfer C houlder with bevel S eather / Knife edge F

Margin Configurations

Chamfer

Shoulder

Deep Chamfer

Biologic Width
he combined width of connective tissue and epithelial attachment superior to T crestal bone. his includes the width of supra-alveolar connective tissue fibers (average 1.07) T and the junctional epithelium (average 0.97), which totals an average of 2.04 mm. uring placement of restorative margins, an additional 1-2 mm of sound structure D coronal to the epithelial attachment is needed, hence the minimum distance between the alveolar crest and the restorative margin should be 3-4 mm (to allow a gingival sulcus of approx. 1 mm. mpinging on this width by a restoration will trigger loss of bone and epithelial I attachment. An interproximal encroachment leads to osseous crater that will be unmanageable from oral hygiene standpoint

Margin Location
upragingival S quigingival E Chamfer ubgingival S
resence of subgingival caries P ncrease retention of preparation I sthetics E
argins of restoration should be placed supragingivallyChamfer M Shoulder Deep whenever possible

PRINCIPLES
4. Structural Durability and Esthetic Considerations
Avoid Sharp Angle and Corners Avoid Damage to Adjacent Teeth

void Under Reduction A rovide Occlusal Clearance P unctional Cusp Bevel F void Sharp Angles and Corners A void Damage to adjacent teeth A

unctional Cusp Bevel F

Functional Cusp Bevel

uccal cusps of mandibular teeth B ingual cusps of maxillary teeth L

PRINCIPLES
4. Structural Durability and Esthetic Considerations
Adequate reduction based on the requirement of the restoration Functional cusp bevel

PRINCIPLES
4. Structural Durability and Esthetic Considerations

nadequate occlusal I clearance oes not provide needed D space for restoration of adequate thickness ompromises the structural C durability of the restoration

PRINCIPLES
4. Structural Durability and Esthetic Considerations

void flat occlusal surface A ollow occlusal planar F reduction nnecessary tooth U reduction

PRINCIPLES
4. Structural Durability and Esthetic Considerations

ack of functional cusp L bevel can cause thin area or perforate the restoration

PRINCIPLES
4. Structural Durability and Esthetic Considerations

ack of functional cusp L bevel can cause overcontouring and poor occlusion

PRINCIPLES
4. Structural Durability and Esthetic Considerations

ver inclination can cause O unnecessary tooth reduction ecrease retention D

Restoration Requirements
1.Biological 2.Mechanical 3.Esthetics

COMMON ERRORS
1. 2. 3. 4. 5. 6. 7. 8. 9. Over Reduced / Under Reduced Over Tapered / Under Tapered Sharp Angles / Corners Undefined Margin Irregular Margin Margin Position Marred Adjacent Tooth Contact Unbroken Functional Cusp Bevel location

RELEVANT INFORMATION FROM JOURNALS

Preservation of tooth structure in some cases may require that limited amounts of sound tooth structure be removed to prevent subsequent uncontrolled loss of larger quantities of tooth structure. Retention prevents removal of the restoration along the path of insertion or long axis of the preparation Resistance prevents dislodgement of the restoration by forces directed in an apical or oblique direction Essential element of retention is two opposing vertical surfaces in the same preparation Taper permits the restoration to seat Inclination vs taper Occlusogingival length is an important factor in both retention and resistance Longer preparation will have more surface area and therefore be more retentive The shorter the wall, the more important its inclination Internal features such as groove, the box form and pin hole can be substituted for an axial wall Path of insertion must be considered in two dimensions: faciolingually and mesiodistally A restoration must contain a bulk of material that is adequate to withstand forces of occlusion. The restoration can survive in the biologic environment of the oral cavity only if the margins are closely adapted to the cavosurfaces finish line of the preparation Whenever possible, the finish line should be placed in an area where the margins of the restoration can be finished by the dentist and kept clean by the patient

CLINICALLY RELEVANT INFORMATION

Violation in principles of tooth preparation has biologic, mechanical and / or esthetic repercussion Configuration of the preparation depends on the type of restoration Axial walls provide for retention and stability. Increase Taper, decrease in retention Decrease in height, decrease in retention Height of prepared molar tooth should be at least 3-4mm Surface area and roughness increase retention

Today
chedule S ecture - Principles of Tooth Preparation L eadings / Journals / Paper R valuation Rubric E ab Session L ooth #18 T imulate clinical procedure S
ear eye protection, mask and glove W hair position / ergonomics C

LWAYS REFER TO RUBRIC A ISCUSS WITH YOUR FACULTY D

TOOTH PREPARATION
.0 mm occlusal reduction 1 dditional 0.5 mm bevel for A functional cusp degree taper 6 .5 mm chamfer margin 0 .5 mm above the margin of 0 gingiva ough surface finish R mooth margin finish S