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Fixed Prosthodontics II

1st & 2nd Lectures

Indications & Alternatives for Crowns

General Indications:
1. Caries extra coronal restorations (crowns).
2. Primary trauma extirpation of pulp crown.
3. Badly broken down teeth.
4. Root-filled teeth (root canal).
5. Teeth wear (chemical erosion, mechanical attrition).
6. Hypoplastic conditions.
These can be divided:
a) Hereditary defects: dentinogenesis imperfect,
amelogenesis imperfect & hypodontia.
b) Acquired defects: fluorosis.
7. To alter the shape or size or inclination of teeth.
8. To alter the occlusion.
9. Appearance: mid-line diastemas.
10. Function.
11. As part of another restoration.
Abutment-stress-breaker (precision attachment).
12. Combined indications.
13. Multiple crowns crowns + pontic...etc

What are the alternatives to anterior crowns?

A. Bleaching: H2O2(hydrogen peroxide), fluorosis, tetracycline
B. Restoration in composite or glass ionomer cement.
C. Veneers restorations.

What are alternative to posterior crowns :

A. Gold inlay.
B. Pin-Retained amalgam restorations.
C. Ceramic inlay.

Fixed Prosthodontics II
1st & 2nd Lectures

Restoration of the Endodontically Treated Tooth

An endodontically treated tooth should have a good prognosis. It

can resume full function and serve satisfactorily as an abutment for
a fixed or removable partial denture. However, special techniques
are needed to restore such a tooth.
Usually a considerable amount of tooth structure has been lost
because of caries, endodontic treatment, and the placement of
previous restorations. The loss of tooth structure makes retention
of subsequent restorations more problematic and increases the
likelihood of fracture during functional loading.

Two factors influence the choice of technique:

a) Type of tooth (e.g. incisor, canine, premolar, or molar)
b) The amount of remaining coronal tooth structure.

The latter is probably the most important indicator when

determining the prognosis. Different clinical techniques have been
proposed to solve these problems, and opinions vary about the
most appropriate one. Recent experimental data have improved our
understanding of the difficulties inherent in restoring an
endodontically treated tooth.

A to C, A severely damaged tooth can sometimes be retained after orthodontic extrusion

D and E, Plaque control around periodontally compromised teeth may be improved after hemisectioning.

Fixed Prosthodontics II
1st & 2nd Lectures

When the decision is made to treat the tooth endodontically,

consideration must have been given to its subsequent restoration.
Before restoration, existing endodontically treated teeth need to be
assessed carefully for the following:
Good apical seal.
No sensitivity to pressure.
No exudates.
No fistula.
No apical sensitivity.
No active inflammation.

A, An anterior tooth with intact clinical crown can be predictably restored with a composite restoration in
the access cavity. B, When most coronal tissue is missing, a cast post-and-core is indicated to obtain
optimal tooth preparation form. C, In mandibular molars an amalgam foundation is supported by a
cemented prefabricated post in the distal canal. D, In maxillary molars the palatal canal is most often used.

Inadequate root fillings should be retreated. If doubt remains, the

tooth should be observed until there is definite evidence of success
or failure. If the coronal structures are largely intact and loading is
favorable as on anterior teeth that are farther removed from the
fulcrum, a simple filling can be placed in the access cavity (A).
However, if a substantial amount of coronal structure is missing, a
cast post-and-core is indicated instead (B). Molars are often
restored with amalgam or a combination of one or more cemented
posts and amalgam or composite resin (C & D).

Fixed Prosthodontics II
1st & 2nd Lectures

Although one-piece post-crowns were once made, such prostheses

are of historical interest only. Superior results can now be obtained
with a two step technique (Next Fig.) consisting of a post-&-core
foundation and a separate crown.
Prefabricated metal, carbon fiber, ceramic, and glass fiber posts
are available. These last two options provide esthetic alternatives
to metal posts. They are used in conjunction with a plastic material
such as composite resin, amalgam, or glass ionomer.

A, The first molar and second premolar have been restored with post-and-cores. Note the margins,
optimally located on sound tooth structure, cervical to the castings. B, Extracoronal restorations placed in.

With the two-step approach of fabricating a separate crown over a

cast post-and-core, achieving a satisfactory marginal fit is easier
because the expansion rate of the two castings can be controlled
individually. A cast post-and-core needs to be slightly smaller than
the canal to achieve optimal internal seating, whereas the crown
needs to be slightly larger to achieve optimal seating.
The two-step approach further permits fabrication of a replacement
crown, if necessary, without the need for post removal. Finally, a
different path of placement than the one selected for the post-and
core may be selected for the crown. This is often helpful when the
tooth is restored to serve as an abutment for a fixed partial denture

Fixed Prosthodontics II
1st & 2nd Lectures


(Cross Section through a Central Incisor)

The dotted line indicates the original tooth contour
before preparation for a metal-ceramic restoration. Even
with minimum reduction for the extracoronal restoration,
note the weakened facial wall, which would not be able
to support the prosthesis successfully. The sharp lingual
wall complicates pattern fabrication.


When a metal-ceramic crown is to be used, considerable tooth

reduction is required. This results in further weakening of the
remaining tooth structure. In general, when significant coronal
tooth loss has occurred, a cast post-and-core (Next Fig.) or an
amalgam foundation restoration is needed.

A, Mandibular premolar and hemisected molar restored with cast


B, Waxed three-unit FPD.

C, The FPD cemented in place.