Hello fellow dentists, I used to tutor international applicants for advanced studies at Marquette University when I was resident

so I now would like to share what I had done for others. Before we look into the details, you need to know the following: 1. Understand the type of margin for that particular type of preparation. Full gold coverage preparation is different from porcelain fused to metal (PFM) is different from all ceramic (AC) is different from veneers (V) etc That is because of the type of material being used. Gold can be made very thin (0.5mm) in thickness and you will be OK. However, if you make your porcelain that thin, it will be brittle like rice paper and fail even before it is seated in the mouth! So PFM and AC require more reduction to allow for the materials and also for strength. If you prepare a tooth like a FGC and ask for porcelain, the material will either break as you attempt to seat in the mouth or the technician will call you and inform you that it cant be done. 2. Understand the type of finish that the bur you are using will produce. For example, a rounded tip diamond bur will give you a chamfer finish and a blunt or flat ended tip will give you a shoulder finish. Those burs have different shapes because they are designed to serve a particular purpose so use them intelligently! 3. Understand the amount of occlusal reduction for the type of preparation. Gold as mentioned before can be made thin so you do not need to have reduction like you are preparing for PFM or AC coverage. Excessive occlusal reduction is one of major errors that will lower your grade. 4. Take your time and go slow. As you become competent, you can increase your speed. If you end up with a heavy shoulder for a FGC prep, how are you going to correct that? 5. Know what you want to achieve BEFORE you start! Now, lets look at the FGC criteria for tooth preparation. a. FGC ( example #19): FGC = Full Gold Crown Occlusal Reduction for Functional Cusp: 1.5 mm Occlusal Reduction for Non-Functional Cusp: 1.0 mm Axial Reduction: at least 1.0 mm but less than 3 mm. Chamfer Margin of 0.5 mm. That means there are no sharp corners. Functional Cusp bevel 1.0 mm in width.

b. PFM (example #19)

PMF = Porcelain Fused to Metal

Occlusal Reduction for Functional Cusp: 2.0 mm Occlusal Reduction for Non-Functional Cusp: 1.5 mm Axial Reduction: At least 1.5 mm. Shoulder Margin ( Radial Shoulder like a stair ) of 1.5 mm. Chamfer Margin for the lingual since this part is in metal. Treat it like a FGC here. Functional bevel of 1.0 mm in width. c. All Ceramic (example # 30) Think of this as an all around PFM except the lingual is in porcelain. Just copy what you did on the facial and apply to the lingual. The reason why porcelain margin require a shoulder is for the support of the material. Chamfer margin will result in a very thin porcelain layer that will fail quickly! TIPS: 1. Make your preparation smooth and free of jagged edges. Use your SLOW SPEED to refine your margin. First, the slow rotation of the bur will smooth out the surface out rather than cutting into the surface. Second, you do not have to fear about slipping and cause a gouge in the prep just before you turn the prep in! Start your prep on a high speed and finish your prep on a SLOW speed is my motto! 2. Avoid sharp corners or edges. Use a diamond bur on the SLOW speed will smooth these edges out and give it a professional look! 3. Avoid Flat Top preparation. In other words, you should be able to see facial and lingual cusps regardless of the type of preparation. Why? That is because you want to maximize the surface area for cement bonding and to prevent rotation of the crown. Plus, it simply looks better! 4. Follow the contour of the gingival in the mesial and distal areas. The margins of the preparation should NOT be straight across but should be higher occlusally in these areas because of the bone morphology and the attachment of soft tissues. What if you ignore this and make it straight across? You will GOUGE the plastic ( a major point reduction) and get into the biological space ( in real life application). Not too nice here. 5. Avoid excessive taper. Your prep should have a slight taper when viewed facial lingually. How do you prevent overtapering ( another major point killer)? ALWAYS look at your bur on the side when you do the axial reduction. If you look at your bur from the top down (occlusal-gingivally), you may end up with excessive taper and not knowing it until too late! 6. How do you break contact without damaging the adjacent teeth? First use the wedge to push the

teeth out. Second, use a matrix band to protect them. Finally, use a smallest diamond bur as these do less damage than a big one and gives you much less risk of over-tapering. Overtapering during breaking contact is a very common rookie mistake! 7. How do you correct minor nicks on the adjacent teeth? Swap them out when nobody is watching? No, use composite sandpaper strips to smooth them out. 8. Avoid "knife edge" margin where you can't physically see a definitive margin as this type of preparation has no place for any type of restoration. Guarantee to get your score lowered! Well, here are the basic reviews of tooth preparation. You need to check what exactly the examiners want for a particular preparation such as bevel on the margin or so forth. Remember that once you know what you are looking for in a preparation, you can make what you want regardless of what type of burs they give you. Dont get fixated on what burs do I need for this and that but rather know the proper criterias that are needed for that type of preparation . Good luck and let me know if I can be of some help. DP ===================================== Hello fellow dentists... I am so glad that I can be of some help. I will do my best to answer all the questions so please be patience. Now, it is important that my answers are based on my preference in some cases and you should evaluate these for yourself rather than taking them "in stone...". The best location of a margin is the margin that gives you the EASIEST chance of capturing it in the impression as well as providing the best esthetic outcome for the restoration. If you are restoring a tooth say in the posterior areas, put your margin ABOVE the gingival because it is easier to clean, easier to capture in the impression and who cares if the margin is 0.5 mm above the gum line as no one sees it. However, for restrations that are visible such as anteriors, your margins should be subgingival so you do not see the margins when patient smiles. If patient has low smile line, then it is OK to put it at the gingival or even above it. You must consider cleasability as well as esthetically when you make the decision. On your prep on the manakin, put your margin 0.3-0.5 mm above the plastic since the examiner needs to see it. The best way for undercut is use your perio probe and lay it on the axial wall and watch for "dips"... One eye method sounds ideal but it is much tougher than said. Try it both ways but the perio probe method works well for me. DP ===================================================== Hi there,

Checking the amount of reduction can be achieved in many ways. First by a " reduction jig" made by putty that is cut in half or by a clear matrix. What it involves is that a silicone putty is pressed over the UNPREPARED tooth then cut in halves (M-D and B-L). By using these jigs one can see the amount of reduction by looking at the empty space between the tooth surface and the inner side of the jig. The second way that is much easier is by using a vacummformed clear plastix shell where it is placed over the preparation. Then the perio probe is poked through the shell and one can measure the amount of reduction. Third method is by using "reference grooves" or depth grooves where the length of the diamond bur is "grooved" into the surface of the tooth. After removing the tooth structures between the grooves, then you are at correct depth. The easiest way is by "eyeballing" it as this is how the preps is graded as using matrix is too time consuming. Of course you need to be experienced to know what looks right and what not. I suggest using a clear shell as this is the most simple and quick. There are other methods of checking but they are more troublesome than worth the efforts. If you look at the M-D areas say on #19, you will see that the gingival takes a "uphill" curve since the bone morphology is more toward the occlusal than the buccal and lingual. Accurate plastic typodont should reflect that but some don't. If it does, you need to FOLLOW the contour of the gingival so you don't gouge the plastic (major grade killer!). In clinical setting, the most common error of invading the biological width (nicking the junctional epithelium attachment) is total ignorance of the periodontium morpholorgy in the mesial and distal areas. DP ====================================================== The clear shell is the material that dentists use to make bleaching trays for patients. If you are near a dental school, ask a faculty if he can let you have a piece or two. You can buy this at any dental supplier online and since this is dirt cheap for them to manufacture, ask for some free samples. I am sure they would be happy to send you some. DP The best sourse for understanding the different types of preparations such as FGC, veneers, inlay and onlays comes from quality fixed prosthodontics text books. My favorites are Shillingburg and Rosenstiel. I suggest you buy the Shillingburg since it is very clear and the writting style is very simple to understand. Reading it is one thing but doing it is another animal. As I mentioned before, if you can organize a group I will be willing to help with the practical parts. DP ==================================== You have brought up a point that clearly shows the drawbacks of the typodonts. To answer your question, let's look at two different situations. First, in the clinical setting. If the tooth already have adequate occlusal clearance for the particular restoration, then do you still have a need for occlusal reduction? The answer is Yes but for a different reason. The reason is to "prepare" the surface such as smoothing out pits and grooves and not for obtaining adequate clearance because we already have enough space. This procedure is nothing more than a simple enameplasty on the occlusal surface. This procedure is more correctly called "occlusal adjustments" rather than reduction. Before you start to lay your burs on the tooth, ask yourself is tooth reduction is neccessary. You will find that in some cases,

you can get by without doing much on the occlusal at all. Now, how about in the practical setting? I believe that you need to do some preparations on the occlusal to demonstate that you know how to do such procedure. Leaving the occlusal surface barely untouched because it "already has adequate occlusal clearance, Mr. Examiner" would certainly won't get you very far at all. So you would certainly need to do occlusal reduction to show that you know how to do such task. But now you are stuck with excessive occlusal clearance that gives the impression of over reduction which that is not the case at all. Well, the way to prevent such situation is to equilibrate your typodont to your best ability. If it cannot be done, bring your concern to the examiners and include a clear shell matrix so they can see the actual reduction for themselves. When I grade my students preps, I take the typodont error into account so I do not deduct points unless it is obviously grossly reduced. I am sure with the experience that the examiners have, they would agree the same thing. DP ========================= The clear shell is vacumm formed over a plaster cast of your tooth. Don't vacummform over your plastic typodont because you will melt it! Then place this matrix over your PREPARED tooth to judge the amount of reduction. You need to do this several times as you prep so you don't end up over reduction. If you place the matrix over UNPREPARED tooth then your reduction will be ZERO since there is no seperation between the tooth surface and the inside of your shell. DP ================================ Regarding the clear shell, look up in the yellow pages and check for dental lab. Ask them if they can sell you some pieces of materials used to make bleaching trays (clear plastic). If they are not willing to give or sell you some, you can go to hobby shops and buy clear sheets used to vacummform toy parts. There are companies online that you can Google by typing in " Dental Supplies" that sell or give away this stuff. If you still can't find it, just use the putty matrix as the guide. You can see these proven methods in the book called " Fundamentals of Fixed Prosthodontics" by Herbert Shillingburg. DP ================================ The torpedo bur can be used for achieving the chamger margin as well as the round-end tapered diamond bur. If you look at the tips, the torpedo has more "pointed" shape than the round-end so this type would give you less of a deep shamfer margin. If you want deep chamfer, use the round-end diamond. The chatters of the slow handpiece means that it needs to be oiled as older unlubricated handpiece tends to do this. If your bur jumps while cutting, it may mean your bur is bent or your rotation is reversed. Check the setting. Any brand will do the trick just fine. A pararallel wall is much better than severely tapered walls. However, you should be able to see the walls converging toward the occlusal since this is how the examiners are used to see. If a person cuts the preparation at 6 degree convergence like text book says, you will see that the walls are parallel with each other as the human eyes can't detect a tilt at 3 degrees on each side. If you do this, although "text

book" like, you will loose points for not tapering the walls too much! This to show you that what the text book says and what we percieved as ideal don't always go hands in hands with each other. DP ========================================== The material used to make a jig to judge the amount of reduction is silicone putty in which two equal parts are hand mixed then hand pressed over UNPREPARED tooth. Then it is cut into labial-lingual half then cut the labial half into gingival and incisal half. As you prepared the tooth, this jig is held against the prepared surface to judge the amonut of reduction. There is no tray needed for this procedure. DP ========================================= Hello, You are right about the massive numbers of burs in the catalogs! This is what I suggest, call the companies (plenty to choose from like Dentsply) and tell them you would like to buy a fixed prosthodontics and operative burs kit. Also ask one for veneer prepration too. They have sets like this that you can buy as they make them for dental students kit. The fixed kit consists of different diamond burs like flat end, rounded end, torpedoes... and operative kit mostly consists of carbides. DP I believe that competent examiners will NOT grade you down for roughness on the preps but rather for deep gouges. Common areas of deep gouges are seen on the margin (jagged edges) or in the proximals where the person is overzealous when trying to break contact. Like I mentioned in my earlier posts, use your SLOW speed with the diamond and you will be able to remove some deep gouges without fear. The roughness created by the diamond (NOT the finishing diamonds as these have colored bands on them) burs is what you need. DP ======================================== The boxes of the onlays should be divergent toward the occlusal like the angulation of your crown preps. The reason is that you can withdraw the pattern from the cast. Using carbide bur in my opinion in harder than using a small tapered diamond. In the hands of the beginner, you tend to gouge the preps (and opposing tooth) since these cut more efficicient than the diamond. Try the diamond and you will see that your chance of "tooth burning" is reduced. The reason of burning the tooth is you held too long and pressing too hard at the surface. Next time, ease up the pressure and go easy on the pedal too will help. DP ======================================== For the all metal such as the FGC, the margins should be chamfer. Now, for the PFM (metal-ceramic), the lingual should be chamfer because this part is in metal. The facial should be a shoulder because porcelain cannot rest on a chamfer margin because it will crack. People who ask for a porcelain margin on a chamfer prep will often find that the porcelain margins crack as the person attempts to seat it. You however can have a deep chamfer margin if the porcelain is backed with a metal layer as in posterior molars. In the anteriors where a metal backing would make an ugly crown, shoulder margin is required.

For 3/4 and 7/8 crowns, the lingual margins are chamfer because this part is in metal. However in the buccal cusp area it will have a bevel margin so that the metal margin can feather into the tooth structure smoothly. DP ======================================= Right, the crown preps must have slight convergence of the axial walls while inlays and onlays boxes must be divergence so the restorations can be seated and removed (from the dies). Alloy boxes must be convergence so the material can be "locked" in. Remember that we are talking from gingival to occlusal direction. DP One thing you need to consider is that you can convert from chamfer to shoulder but not from shoulder to chamfer unless the margin is lowered. That's why always give yourself at least 1.0 mm away from the gingival to allow room for "refining". Another point to consider is where would you put the junction between the chamfer and shoulder? Buccal or lingual or in the center? Think about that... I will post the response after I heard what you have to say... DP BTW: To wing or not to wing? I am at loss to your inquiry. ===================================== Hi Doc Phan: I would say lingual to the contact area so you can get some bulk of porcelain there for esthetics and gingival health. If placed buccally then the junction allows little space for the metal, opaquer and porcelain. This will result to an "opaque" and unnatural looking restoration at the proximals, since the porcelain there is thin. Or the metal backing will show on the proximals. Besides the lab guy may have to overcontour this area to compensate for the thinness of the porcelain, compromising the periodontium. .. Just a guess. To wing or not to wing? I was pertaining to the two designs of PFM, Doc. One is the more common, where the shoulder margins blend with the chamfer at the transition--no wing. The other one is to create a uniform shoulder and a uniform chamfer and they meet ubruptly at the proximal. The difference in the width of these margins will cause a "wing" on the proximal junction, as described by Schillinburg, who mentioned that it will provide some resistance to torque, or turning of the crown, aside from conserving tooth structure. Thanks!!!! Excellent reply on my question. I can see a future prosthodontist in you. Regarding wing or no wing, I can see that wing design will have more resistance and more bulk of porcelain but if your prep is right, I do not see that it makes a difference. Now if you tapered your prep severely then the wing design makes more sense. Since the porcelain is baked into the metal structure, it will be enough for strength

for the no wing design. So what all of this mumbo jumbo means? If your prep is ideal, either design is OK in my book. DP =================================== Quoting Dentzy: The way I have learnt is that shoulder and chamfer merge "buccal to the contact area"because to merge,shoulder needs to extend till that area & I don't remember ever studying /learning of taking shoulder all the way on proximal till lingual to contact area. =================================== On the anteriors, certainly the junction has to be lingual but in posteriors, it does not matter. Make sure there is equal amount of chamfer and shoulder so it "looks" right. DP

Hi Dentzy: I did a little reading last night(Tooth Preparations for Metal, Etc. by Schillingburg and Jacobi) and verified that you indeed need to set the junction a little lingual to the contact--specially on an anterior PFM. The reason is the same as I guessed--for esthetics. A thin porcelain on the bucco-proximal will look "opaque". Maybe for the distal of a posterior tooth, you can set the junction buccally if you like, but patients would not appreciate a lackluster restoration. And I don't know how the examiners will judge that. Comments, Dr. Phan? Thanks.