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PRINCIPLES OF TOOTH PREPARATIONS

The principles of tooth preparation may be divided into 3 broad categories: 1. BIOLOGICAL CONSIDERATIONS -Which affect the health of the oral tissues 2. MECHANICAL CONSIDERATIONS -Which affect the integrity and durability of the restoration 3. ESTHETIC CONSIDERATIONS -Which affect the appearance of the patient The design of a preparation for a cast restoration and the execution of that design are governed by five (5) principles: 1. Preservation of Tooth Structure 2. Retention and Resistance 3. Structural Durability 4. Marginal Integrity 5. Preservation of the Periodontium 1. PRESERVATION OF TOOTH STRUCTURE -In addition to replacing lost tooth structure, a restoration must preserve remaining 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 2. RETENTION & RESISTANCE RETENTION -Prevents removal of the restoration along the path of insertion or long axis of the tooth preparation RESISTANCE -Prevents dislodgment of the restoration by forces directed in an apical or oblique direction and prevents any movement of the restoration under occlusal forces A. TAPER -Axial walls must taper slightly to permit the restoration to seat i.e. 2 opposing external walls must gradually converge or 2 opposing internal surfaces must diverge occlusally ***The more nearly || the opposing walls of a preparation, the greater the retention but || walls are impossible to create in the mouth without producing undercuts.

***The greater the surface area of a preparation the greater its retention, therefore, preparation on large teeth are more retentive than on small teeth. B. FREEDOM OF DISPLACEMENT (PATH OF WITHDRAWAL) -Limiting the freedom of displacement from torquing/ twisting forces in a horizontal plane increases the resistance of a restoration -A groove whose walls meet at an oblique angle does not provide the necessary resistance, therefore, there must be a definite wall perpendicular to the direction of the force to sufficiently limit the freedom of displacement and provide adequate resistance. -Similar tx to the proximal box, the buccal and lingual walls must meet the pulpal wall at angles near 90 degrees so that these walls will be perpendicular to any forces which would tend to rotate the restoration.

-A flare is then added to the box to form an acute edge on the cavosurface margin of restoration. C. LENGTH -Occlusogingival length is an important factor in both retention and resistance -Longer preparation will have more surface area, therefore, more retentive -Resistance to displacement for a short walled preparation (A) on a large tooth can be improved by placing grooves in the axial walls (B). -This reduces the rotational radius, and the portion of the walls of the grooves near the occlusal surface of the preparation will interfere with displacement D. SUBSTITUTION OF INTERNAL FEATURES ***The basic unit of retention for a cemented restoration is 2 opposing axial walls with a minimal taper.

-Internal features such as grooves, box form and pinhole are interchangeable and can be substituted for an axial wall or for each other. ***Substitution is important, since conditions often preclude making an ideal preparation. E. PATH OF INSERTION ***An imaginary line along which the restoration will be placed onto or removed from the preparation. -preparation must be viewed with one eye closed. -For a preparation to be surveyed in the mouth, where direct vision is rarely possible, a mouth mirror is used. It is held at an angle approximately inch above the prep., and the image is viewed with one eye. -Path of Insertion (POI) - must be considered in 2 dimensions: faciolingually and mesiodistally. ***Faciolingual orientation of the path affect the esthetics of metal-ceramic / partial veneer crown. ***Mesiodistal inclination of the path must parallel the contact area of adjacent teeth.

3. STRUCTURAL DURABILITY -A restoration must contain a bulk of material that is adequate to withstand the forces of occlusion. This bulk must be confined to the space created by the tooth preparation. Only in this way can the occlusion on the restoration be harmonious and the axial contours normal, preventing periodontal problems around the restoration. A. OCCLUSAL REDUCTION -One of the most important feature for providing adequate bulk of material and strength to the restoration is occlusal clearance. -Inadequate clearance makes restoration weaker, inadequate reduction under the anatomic grooves of the occlusal surface will not provide adequate space to allow good functional morphology. B. FUNCTIONAL CUSP BEVEL -Wide bevel on the lingual inclines of max. lingual cusps and the buccal inclines of mand. buccal cusps provide space for an adequate

bulk of metal in an area of heavy occlusal contact. ***Bevels have been advocated as a means of diminishing marginal discrepancy. They resist fracture and chipping. C. AXIAL REDUCTION -plays an important role in securing space for an adequate thickness of restorative material

4. MARGINAL INTEGRITY -Margins should be adapted to the cavosurface finish line of the preparation. The configuration of the prepared finish line dictates the shape and bulk of restorative material in the margin of the restoration -It can also affect both marginal adaptation and the degree of seating of the restoration

ADVANTAGES(a), DISADVANTAGES(d), AND INDICATIONS(i) OF DIFFERENT MARGIN DESIGNS: 1. Feather edge a-conservative of tooth structure d-does not provide sufficient bulk i-not recommended 2. Chisel edge a-conservative of tooth structure d-location of margin difficult to control i-occasionally on tilted teeth

3. Bevel a-removes unsupported enamel, allows finishing of metal d-extends prep into sulcus if used on apical margin i-facial margin of max partial coverage resto. 4. Chamfer a-distinct margin, adequate bulk, easier control

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d-care needed to avoid unsupported lip of enamel i-cast metal resto, lingual margin of metal-ceramic crowns 5. Shoulder a-bulk of resto material d-less conservative of tooth structure i-facial margin of metal-ceramic crowns, complete ceramic crowns 6.Sloped shoulder a-bulk of material, advantages of bevel d-less conservative of tooth structure i-facial margins of metal-ceramic crowns 7. Shoulder with bevel a-bulk of material, advantages of bevel d-less conser-vative, extends preparation apically i-facial margin of posterior metal-ceramic crowns with supra-gingival margins

5. PRESERVATION OF THE PERIODONTIUM -Finish line should be placed in an area where the margin of the resto can be finished by the dentist and kept clean by the px. -Finish lines must be duplicated by the impression, without tearing or deforming the impression when it is removed -Finish line should be placed in enamel ***Subgingival restoration is a major etiologic factor in periodontitis. The deeper the restorative margin resides in the gingival sulcus, the greater the inflammatory response. ***Subgingival inflammation. margin causes gingival

-The placement of finish line can also be altered from ideal location by caries, extension of previous resto, trauma, or esthetics.

ESTHETIC CONSIDERATIONS -Dentist should develop skill in determining the esthetic expectations of the px. -Care must be taken that esthetic considerations are not pursued at the expense of a pxs long term oral health or functional efficiency -Pxs esthetic requirement must be discussed related to oral hygiene needs and the potential for disease. PARTIAL COVERAGE RESTORATION -Depends on accurate placement of visible facial and proximal margin A. Proximal Margin -Should be placed just to the proximal contact areas where metal will be hidden by the distal line angle of the adjacent tooth -Tooth prep angulations should follow the long axes of posterior teeth and the labial 2/3 of the facial surface of anterior teeth

MANDIBULAR -Metal display is unavoidable because the occlusal surface can be seen during speech -Chamfer is recommended for the buccal margin because it provides a greater bulk of metal around the highly stressed centric cusp -If the appearance of metal is unacceptable to the px, a metal-ceramic restoration with porcelain coverage on the occlusal surface can be made B. Facial Margin MAXILLARY -Should be extended just beyond the occlusofacial line angle -Short bevel is needed to prevent enamel chipping -Chamfer can be placed where appearance is less important (molars) because this will provide greater bulk of metal for strength MANDIBULAR -Metal display is unavoidable because the occlusal surface can be seen during speech

-If the appearance of metal is unacceptable to the px, a metal-ceramic restoration with porcelain coverage on the occlusal surface can be made ANTERIOR -Lingual prep. is extended beyond the highest contour of the incisal edge but not quite to the incisolabial line angle, metal will protect the tooth from chipping but will not be visible

METAL-CERAMIC RESTORATION -Poor appearance is due to insufficient thickness of porcelain A. Facial tooth reduction -Adequate reduction of the facial is essential; a minimum reduction of 1.5mm is required for optional appearance B. Incisal reduction -2.0mm reduction is recommended -Incisal edge has no metal backing -Incisal over-reduction must be avoided because it reduces retention and resistance form of the preparation

C. Proximal reduction -Extent is contingent on exact predetermination of the location of the metal-ceramic junction -Proximal surfaces of anterior teeth will look most natural if they are restored at the incisal edge without metal backing D. Labial margin placement -Supragingival margins are easier to prepare properly and easier to keep clean but subgingival margins are more indicated for esthetic reasons.