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Introduction

When one considers critically and realistically, all the


advancements achieved in the overall area of restorative dentistry, a
gearing exception comes to the fore; that exception is the technique
for the preparation of teeth and the philosophy behind it. The
approach to preparations has not kept pace with other advances in
dentistry. Almost all dental literature, dental school, teaching,
essayists, programs and philosophies of dentists demonstrate this
traditional holdover.
Teeth require preparation to receive restorations, and these
preparations must be based on fundamental principles from which
basic criteria can be developed that help predict the success of
prosthodontic treatment.
The principles of tooth preparation may be divided into three
broad categories
!" #iologic considerations.
$" %echanical considerations.
&" 'sthetic considerations.
!
(ast week one of my colleague spoke on two mechanical
factors i.e. the retention and resistance form. )ontinuing the
principles of tooth preparation today * will be discussing one more
mechanical principle of tooth preparation i.e. structural durability
and one biologic principle i.e. marginal integrity.
+o today,s topic of this seminar is structural durability and
marginal integrity.
+tructure is any constructed thing here it refers the crown or
bridge.
-urability means .likely to last longer/.
+tructures durability is the durability of the restoration so as
to how longer a crown or bridge lasts.
0eatures that contribute to the durability of the restoration are
!" Alloy selection.
$" Adequate tooth reduction.
1cclusal reduction.
Axial reduction.
2rovision for reinforcing struts.
&" 2oor metal3ceramic framework design.
$
1) Alloy Selection:
The Type * and Type ** gold alloys are satisfactory for
intracoronal cast restorations, they are too soft for crowns and fixed
partial dentures, for which Type *** or Type *4 gold alloys are
choosen. There are harder and their strength and hardness can be
increased by heat treatment.
5igh3noble metal content metal3ceramic alloys have a
hardness equivalent to Type *4 gold whereas nickel3chromium
alloys are considerably harder. These may be indicated when large
forces are anticipated. +uch as long span 02-, although their use
presents some problems.
2) Adequate Tooth Reduction:
Occlusal Reduction:
'nough tooth structure must be removed from the
occlusal surface of the preparation so that when the restoration
is built back to ideal occlusion it must be thick enough to
prevent wearing through or distorting.
&
'ven the stronger alloys need sufficient bulk if they are
to withstand occlusal forces.
The occlusal thickness will vary with the restorative
material used. A gold crown requires approximately !.6mm
clearance over the functional cusps and !.7mm over the non3
functional cusps. 5arder metals require slightly less. *f a
porcelain veneer is extended onto the occlusal surface an
additional 7.6mm of space is needed.
The amount of occlusal reduction is not always the
same as the clearance needed. 1ften part of a tipped tooth is
already short of the occlusal plane and will require less
reduction than would a tooth in ideal occlusion.
1cclusal reductions of the posterior teeth can be
performed in three ways
!" The occlusal surface of a tooth can be reduced entirely in a
flat plane.
8
$" *t can be reduced uniformly following the geometric outline of
cusps or fossae.
&" 'ither a partial reduction in the form of a cavity or a cusp
reduction with a cavity can be made not including all the
surfaces.
The second one is a uniform occlusal reduction,
provides for an adequate thickness of metal without
9eopardi:ing the help, resists shearing stresses, and is more
rigid because of its .)1;;<=AT'- '00')T/.
The third type is the occlusal cavity reduction which
obliterates the occlusal groove for its outline. *ts depth usually
extends into the dentin. The cavosurface may be a margin
unless ad9acent cusps are also reduced.
)reating steep planes with sharp angles should be
avoided since these can increase the stress and hinder
complete seating of the casting. To diminish stress round the
angles and deep grooves in the center of the occlusal surface
6
keeping is avoided and the angulation of the occlusal plane
will be shallow.
Any necessary equilibration of the opposing teeth
should be done before the restorative procedure is begun.
1pposing cusps that are missing or short of their ideal
position should be replaced in a diagnostic wax up on a cast so
that the required amount of occlusal reduction can be
determined.
Functional Cusp Bevel
A wide bevel should be placed on the functional cusps
of posterior teeth to provide structural durability in this
critical area. *t also rounds over the occlusal line angle, which
is the area of high stress concentrations. The angle on the non3
functional cusp is rounded over lightly.
0ailure to place a functional bevel can result in thin,
weak areas in the restoration.
>
*n crossbite occlusal relationship the functional cusps
are revered.
#evel is placed on the facial cusps of the maxillary teeth
and the lingual cusps of mandibular teeth.
Axial Reduction
A second prerequisite for structural durability is
adequate axial reduction.
When axial reduction is sufficient, restoration walls can
have satisfactorily thick.
Therefore the more common result of inadequate axial
reduction is an overcontoured restoration.
) Rein!orcin" Struts
+tructural durability at the margins of full veneer crown is
relatively easy to achieve because of high tensile strength of
the metal.
?
The circumferential axial walls of a restoration hold
themselves together much as a barrel is held together by its
hoops.
When one or more surfaces of a tooth are left uncovered in a
partial veneer crown, the circumferential binding is lost. The
restoration margins can distort during fabrication, cementation
unless features are added to reinforce the structure.
*n a three3quarter crown it is a connecting rib of metal that
9oins the grooves to provide a .trussing effect/. This
reinforcing rib takes the form of an offset on a maxillary
preparation and an occlusal shoulder on a mandibular one.
#ar"inal Inte"rity
The restoration can survive in the biological environment of
the oral cavity only if the margins are closely adapted to the
cavosurface finish line of the preparation. %arginal integrity
includes the location, configuration and marginal fit of the crown.
The configuration dictates the shape and bulk of the restoration. *f
@
can also affect both the marginal adaptation and the degree of
seating of the restoration.
A
#ar"in $lace%ent:
The placement of finish lines has a direct bearing on the ease
of fabricating a restoration and on the ultimate success of the
restoration. The best results can be expected from margins that are
as smooth as possible and are fully exposed to a cleansing action.
0inish lines should be placed in enamel when it is possible to do so.
There are three locations in which to prepare crown margin
!. +upragingival.
$. At the crest of the gingival or equigingival.
&. +ubgingival.
*n the past, the traditional concept has been to place the
finishlines as far subgingivally as possible based on the mistaken
concept given by =.4. #lack, that the subgingival sulcus is caries
free. The preponderance of recently published literature, however,
strongly supports and have advocated the use of the supragingival
margin. *n early !A8! 1rban proposed supragingival margin for
improved periodontal health.
!7
(arato showed that the most crowns with subgingival margins
exhibited gingival inflammation compared with supragingival.
+ilness used plaque index, an index of gingival health, and pocket
depth to compare crowns that had subgingival and supragingival
margins. 5e showed an increased accumulation of plaque when
compared with crowns with supragingival margins.
*n a study on dogs, %A;)<% found that crown margins
located at the crest of the gingival caused less inflammation than
either those below or above the gingival crest. 5A;;*+1B
supported this view and pointed out that possibly the reason for
successful crown margins located at the gingival crest was the
presence of keratini:ed epithelium in this region, unlike the
epithelium deeper in the gingival sulcus.
;itcher and 4eno reported that there was no difference
between subgingival and supragingival margins in a & year clinical
study. '++%ABB et al and C1T5 made a similar recommendation.
These studies merely demonstrate that margin location is not as
!!
crucial when placed properly. )rown fit and finish may be more
significant to gingival health than the location of the margin.
5owever whenever possible margins are placed
supragingivally on the enamel of the anatomic crown.
Advanta"es o! Supra"in"ival $laced #ar"ins
3 0avourable reaction of gingiva.
3 Wider shoulder tooth preparation can accommodate an
adequate bulk of porcelain without3pulpal in9ury.
3 %etal margin finishing is easy.
There are some situations which require intracrevicular
margin placement they are
3 'sthetic demands.
3 )aries removal.
3 +ubgingival tooth fracture.
3 )over existing subgingival restorations.
3 To gain needed crown length.
3 To provide a more favourable crown contour that is
furcation involvement.
!$
#erman has given a method of placing the margins
subgingivally with a collar of metal.
0irst step is to prepare the tooth to the crest of the gingiva.
=ingival retraction is obtained with a chord or electrosurgery. A
diamond point with an angled tip of calibrated length is introduced
to prepare the bevel. This instrument eliminates the sharp edge of
the shoulder and the undercut which extends apically from the
shoulder.
#ar"in Con!i"urations:
There are four basic types of finish lines
3 +houlder D 2A;-1 in !A@$ hori:ontal.
3 #eveled shoulder.
3 )hamfer D 2A;-1 in !A@$ *nclined vertical.
3 Cnife edge or feather edge.
The question seems to be whether to use shoulders or
chamfers with or without bevels or whether which of these
acceptable forms should be used in which situation.
!&
%iller and #elsky in !A>6 advocated a full3shoulder
preparation.
+tein in !A?? recommended a uniform chamfer with bevel.
2reston in !A?? advocated a multiple approach using chamfers
with or without bevels in non3porcelain bearing areas shoulders with
bevels in porcelain bearing areas.
&ther authors:
;osner -., +o:io ;.#., #erman and 2reston strongly
advocated a beveled finishline, pointing out as superior marginal
closing through the .+(*23E1*BT/ effect.
There are studies either to support or re9ect the commonly
held opinions on marginal configurations. Two areas have been
tested.
'l3'brashi et al studied experimental stress analysis on
photoelastic models as it relates to differing marginal geometry.
They found that the shoulder with a rounded internal line angle and
the chamfer showed the least stress concentration and that shoulders
!8
with bevels and feather edges showed the most stress concentration.
*n general they showed that margins with relatively large bulk and
no sharp line angles were superior to margins with either sharp or
acute line angles. 0A;A5 and );A*= found the similar results.
They showed that the chamfer was the optimum marginal
configuration.
1ther area of research tested has been the effect of porcelain
firing distortion on different marginal shapes. +5*((*B=#<;= et
al found that under routine firing cycles used to condition and apply
porcelain to metals, the shoulder configuration with or without bevel
showed significantly less distortion than did a shamfer with or
without a bevel. This is because of metal found at the internal line
angle of a shoulder when compared with a chamfer.
The consensus on the matter of marginal configurations seem
to be that feather edge or knife edge margins are usually not
desirable. #ut this does not imply that we should throw reason and
experience to the wind and 9ust stick to the shoulder and chamfer.
!6
There can be a situation where knife edge margin can have a distinct
advantage.
Chamfer margin: Eacobsen and ;obinson defined chamfer as width
greater than 7.&mm at its cervical termination precluded any margin
being called a chamfer. A chamfer margin is particularly suitable for
cast metal veneers. *t is an obtuse angled gingival termination. *t is a
concave extracoronal finishline that possesses greater angulation
than a knife edge with less width than a shoulder. This finish line
has been shown experimentally to exhibits the least stresses so that
the cement underlying it will have less likelihood of failure.
The most suitable instrument for making a chamfer margin is
the tapered diamond with a rounded tip, the margin formed is the
exact image of the instrument.
Tilting the bur away from the tooth will create an undercut,
angling it toward the tooth will lead to overreduction.
A heavy chamfer is used to provide a A7F cavosurface angle
with a large radius rounded intraoral angle.
!>
+ometimes it may create an undesirable fragile .lip/ of
enamel at the cavosurface. The heavy chamfer provides better
support for a ceramic crown.
Shoulder Margin: -efined using marginal geometry, where the
discriminating features are an external cavosurface angle of A7F and
a corresponding butt 9oint of restoration G tooth at the margin.
The shoulder has long been the finish line of choice for the
all3ceramic crown. The wide ledge provides resistance to
occlusal forces and minimi:es stresses that might lead to
fracture of porcelain.
*t produces the space for healthy restoration contours and
maximum esthetics.
*t requires the destruction of more tooth structure than any
other finish line.
The sharp A7F line angle associated with shoulder concentrates
stress in the tooth and is conducive to coronal fracture.
!?
To overcome this a modified shoulder line is used with the
shoulder width being slightly lessened by the rounded internal
angle. +o that the stress concentration is less. This type is also
called as ;A-*A( +51<(-';.
0ull shoulder usage was increased after the introduction of
in9ectable ceramics such as dicor and cerestore, hiceram, *2+
empress.
The shoulder with a beveled margin is often recommended for
the facial surface of a metal3ceramic restoration where a metal
collar is to be used.
*t is also utili:ed as the gingival finish line on the proximal
box of inlays and onlays, and for the occlusal shoulder of
onlays and mandibular three quarter crowns.
*t can be used in those situations where a shoulder is already
present, either because of destruction by caries or the presence
of previous restorations.
!@
The beveling removes unsupported enamel and may allow
finishing of the metal.
#eveled shoulder is referred to as a biologic and esthetic
finish line. 'sthetic, because the metal margin can be thinned
to a knife edge and hidden in the sulcus without the need to
position the margin closer to the epithelial attachment.
*t is a good finish line for preparations with extremely short
walls, since it facilitates axial walls that are nearly parallel.
According to =iboe and Thayer an advantage of beveled
shoulder preparation were that they allowed the incorporation
of physiologic contours in tooth the temporary and final
crown.
'(IF) )*+) #AR+I(
The ultimate in finish lines that permits an acute margin of
metal is the CB*0' '-='.
!A
<nfortunately its use can create problems unless it is cut
carefully, the axial reduction may slide out instead of
terminating in a definite finish line.
The thin margin of the restoration that fits this finish line may
be difficult to accurately wax and cast resulting in
overcontoured restorations when an attempt is made to obtain
adequate bulk.
*nspite of its drawbacks in some situations knife edge margins
has a distinct advantage.
3 <sed on lingual surfaces of mandibular posterior teeth.
3 1n teeth with very convex axial surfaces and on the
surfaces toward which a tooth may have tilted.
3 *n younger patients.
3 1n cementum.
3 2rivilege preparations and outline of partial veneer
crowns.
$7
5istorically their main advantage was that they facilitated the
making of impressions with rigid modeling compound in
copper bands Ha technique which is severely used today",
because there was no ledge on which band covered catch.
#AR+I(A, FIT
According to A-A specification Bo. @ the marginal adaptation
of cemented castings should be in the range of $6Im. This
range is below the range of visual acuity.
;ecently =avelis et al used an experimental design intended to
eliminate all casting error and measure only the marginal
opening.
They found that feather edges and shoulders and chamfers
with parallel bevels had the least opening. This showed that
Jslip 9oint, margins provide the least marginal discrepancy.
;osner showed a mathematical trigonometric analysis of
marginal discrepancy. 5e said that bevels have been
advocated as a means of diminishing marginal discrepancy.
$!
*f the vertical discrepancy in fit is designated as -, the closest
distance between the margin and the surface of the preparation
is a line d that is perpendicular to the surface of the tooth.
0igure 3 ;efer +hillingburg
Bow it can be stated as a function of -
d K - sin I 3333333i
d K - cos 333333ii
As I becomes smaller Hmore acute". The sine of I becomes
smaller or becomes larger Hmore obtuse" cosine becomes
smaller.
#y either computation d diminishes by the same amount.
The more acute the angle of margin or more obtuse the angle
of finish line. The shorter the distance between finishline and
margin.
5owever this is true only if there is no cement between the
restoration and the preparation.
$$
The presence of cement changes the scenario completely as
suggested by osteoid.
The film thickness of the cement will prevent the complete
seating of a casting with bevels that are nearly parallel with
the path of insertion.
0ilm thickness imposes a limit on the reduction of the
perpendicular distance from the margin to the tooth d. The
distance d, therefore becomes a constant and the previous
equation is solved for - instead of d.
- K
d
G
sinI
33333iii - K
d
G
cos
3333333 iv
As angle of margin bevel more acute since Dsmaller on as
angle of finish line become more obtuse Deosine3smaller and
- become larger.
The more nearly the bevel pallels the path of insertion, the
greater the distance by which the restoration fails to seat.
$&
*f a bevel of 86F is added to a shoulder, the crown will be
prevented from seating by a factor of !.8.
&7F 3 the crown is displaced twice.
!6F 3 factor &.A.
6F 3 factor !!.6
%clean and Wilson have disputed the use of bevels for metal3
ceramic crowns because the bevel margin must be !73$7F to
noticeably improve adaptation.
2anno and associates reported no better adaptability of crowns
with highly acute @7F bevels than those with less acute 86F
bevels.
2ascoe in !A?@ showed the trigonometric analysis of
relationship between internal casting discrepancy and
marginal opening.
Taking ;osner,s equation as a basic theorem 2asco applied it
to the internal discrepancy.
$8
As ;osner showed the marginal opening of a vertically
displaced casting Hd" is related to the displacement H-" by the
formula
d K - cos 3333333Hi"
Where K angle of the bevel
0rom the figure it can be seen that this theorem is valid only
when there is
i" *nitial adaptation of the
casting is exact.
ii" There is a purely vertical
displacement of the casting such that point L
$
is directly
above L
!
.
Bow this situation can arise as a result of !" )ement film
thickness, $" defect on the internal surface of the casting.
-istance between the axial wall of the tooth and casting is
designated as f.
Bow we can derive the equations for internal discrepancy.
$6
- K
f
G
cos
333333333333Hii"
'quating Hi" and Hii"
- K
d
G
cos
K
f
G
cos
K f cos K d cos
d K
f. cos
G
cos
33333333333Hiii"
Thus a direct relationship is shown between the internal
discrepancy and marginal opening.
;osner said that a 6 degrees is the minimum acceptable taper.
%ost recommended marginal bevel is 86F.
According to A-A specification Bo. @ the cement should meet
the thickness of $6Im.
#y substituting these values in equation Hiii".
f K $6Im
K @6F
K 86F
d K
f.cos
G
cos
K $6.cos 86
G
cos @6F
K
$6 x 7.?7?
G
7.7@?
$>
K $7&Im
+o the marginal opening would be $7&I which is considerably
more than the 87I that has been advocated as acceptable
value.
+imilarly by compacting for undersi:ed cemented casting D
$??I.
1versi:ed cemented casting K $6I.
+o 2ascoe demonstrated that slightly oversi:ed casting with
shoulder exhibit the least marginal discrepancy.
Functions o! a -evel:
3 #ulk of material.
3 2rotection of enamel rods at the margin.
3 Allowance for burnishing and cementation.
3 -evelopment of circumferential retention.
$?
S.##AR/ 0 C&(C,.SI&(
2rinciples of tooth preparation can be categori:ed into
biologic, mechanical and esthetic consideration. *f too much
emphasis is given for any one of the principle then the success of the
procedure may be limited by a lack of considerations of other
factors.
The structure of a restoration must be sound and have
sufficient strength to prevent it from being permanently deformed
during function.
The margin is one of the components of the cast restoration
must susceptible to failure, both biologically and mechanically. *f all
the principles of tooth preparation are achieved in a restoration
excluding marginal integrity the prosthesis may become detrimental
to the dental tissues, finally leading to the failure of the prosthesis.
The quality of margin may be of as much importance to gingival
health as location.
$@
As long as fixed prosthodontics must rely on the cemented
castings, the search for more knowledge about an innocuous,
esthetic, indestructible margin must continue.
$A
R)F)R)(C)S:
!. Abrahams '.E. )ombination of shoulder3feather edge veneer
crown preparation. E2-, !& A7!, !A>&.
$. #ecker %.). et al )urrent theories of crown contours margin
placement and pontic design. E2-, 86 $>@, !A@!.
&. #ehrand -. )erammometal restoration with supragingival
margins. E2-, 8? >$6, !A@$.
8. #ridger -.4. -istortion of ceramometal 02- during firing
cycle. E2-, 86 67?, !A?A.
6. #ryant ;.A. %easurement of distortions in 02- resulting
from degassing. E2-, 8$ 6!6, !A?A.
>. -onovan T. An analysis of margin configuration for metal3
ceramic crowns. E2-, 6& !6&, !A@6.
?. 0aucher ;.;. -istortion related to margin design in porcelain
fused to metal restoration.
@. =ardiner 0.%. %argins of complete crowns D A review. E2-,
8@ &A>, !A@$.
&7
A. =ra9ower ;. A mathematical treatise on the fit of crown.
E2-, 8A >>&, !A@7.
!7.5unter A.E. =ingival crown margins configurations D A
review. E2-, >8 68@, !AA7.
!!.Eacobson 2.5. et al #asic techniques and materials for
conservative dentistry. E -ent, A !7!, !A@!.
!$.Cashani 5.=. et al The effect of bevel angulation on
marginal integrity. EA-A, !7& @@$, !A@!.
!&.2anno 'valuation of the 86F labial bevel with a shoulder
preparation. E2-, 6> >66, !A@>.
!8.2ardo =.*. A full cast restoration design of firing superior
maginal characteristics. E2-, 8@ 6&A, !A@$.
!6.2ascoe -.0. Analysis of the geometry of finishing liner for
full crown restorations. E2-, 87 !6!, !A?@.
!>.2erel %.(. Axial crown contours. E2-, $6 >8$, !A?!.
!?.2rince E. The all porcelain labial margins E2-, 67 !@6,
!A@&.
&!
!@.2rince E. The all porcelain labial margin for ceramo3metal
restoration D A new concept. E2-, 67 ?A&, !A@&.
!A.;osensteil )ontemporary fixed prosthodontics, $
nd
edition.
$7.;osner -. 0unction, placement and reproduction of bevels
for gold castings. E2-, !& !!>!, !A>&.
$!.+amuel '.=. %ultiple preparations for fixed prosthodontics.
E2-, $& 6$A, !A?7.
$$.+chweikert '.1. 0eather edged or knife edged and
impression techniques. E2-, 6$ $8&, !A@8.
$&.+chwart: *.+. A review of methods and techniques to
improve the fit of cast restorations. E2-, 6> $!A, !A@>.
$8.+hillingberg 5.T. 2reparation design and margin distortion in
20% restoration. E2-, $A $?>, !A?&.
$6.+hillingburg 5.T. 0undamentals of tooth preparations.
$>.+hillingburg 5.T. 0undamentals of 02- &
rd
edition.
$?.+myd '.+. The role of torque, torsion, and bending in
prosthetic failures. E2-, !! A6, !A>!.
$@.Tylman Theory and practice of 02- @
th
'dition.
&$
$A.Watson %argin placement of esthetic veneers crowns. E2-,
86 8AA, !A@!.
&7.Willis ).%. -istortion in dental soldering as affected by gap
distance. E2-, 8& $?$, !A@7.
&&
STR.CT.RA, *.RABI,IT/ A(* #AR+I(A,
I(T)+RIT/
C&(T)(TS
*ntroduction
+tructural -urability
3 Alloy +election
3 Adequate Tooth ;eduction
o 1cclusal ;eduction
o Axial ;eduction
o ;einforcing +truts
3 2oor %etal3)eramic 0ramework -esign
%arginal *ntegrity
3 %argin 2lacement
3 %argin )onfigurations
3 %argin 0it
+ummary M )onclusion
#ibliography
&8