7

PRINCIPLES OF
TOOTH
PREPARATION

The principles of tooth preparation may be

KEY TERMS divided into three broad categories:
causes of injury margin placement 1. Biologic considerations, which affect the health
clearance path of placement of the oral tissues.
conservation of tooth resistance 2. Mechanical considerations, which affect the
structure retention integrity and durability of the restoration.
diagnostic tooth supragingival 3. Esthetic considerations, which affect the appear-
preparations taper ance of the patient.
margin designs undercut Successful tooth preparation and subsequent
restoration depend on simultaneous consideration of
all these factors. Improvement in one area often
adversely affects another area, and striving for per-
fection in one may lead to failure in another. For
example, in the fabrication of a metal-ceramic crown
eeth do not possess the regenerative ability (see Chapter 24), sufficient thickness of porcelain is

T found in most other tissues. Therefore, once

enamel or dentin is lost as a result of caries,
trauma, or wear, restorative materials must be used
necessary for a lifelike appearance. However, if too
much tooth structure is removed to accommodate a
greater thickness of porcelain for esthetic reasons,
to reestablish form and function. Teeth require prepa- the pulpal tissue may be traumatized (biologic con-
ration to receive restorations, and these preparations sideration) and the tooth unduly weakened
must be based on fundamental principles from (mechanical consideration). In-depth knowledge
which basic criteria can be developed to help predict and an understanding of the various criteria are pre-
the success of prosthodontic treatment. Careful atten- requisite to the development of satisfactory tooth
tion to every detail is imperative during tooth prepa- preparation skills. Predictable accomplishment of
ration. A good preparation ensures that subsequent optimum tooth preparation (Fig. 7-1) often includes
techniques (e.g., interim fabrication, impression finding the best combination of compromises among
making, pouring of dies and casts, waxing) can be the applicable biologic, mechanical, and esthetic
accomplished. considerations.

209
210 PART II CLINICAL PROCEDURES: SECTION 1

BIOLOGIC
MECHANICAL
Conservation of tooth
structure Retention form
Avoidance of Resistance form
overcontouring Deformation
Supragingival margins
Harmonious occlusion A
Protection against
tooth
fracture

ESTHETIC
Minimum display of metal
Maximum thickness of
porcelain
Porcelain occlusal surfaces
Subgingival margins

B
Optimal
restoration
Fig. 7-1
The optimum restoration should satisfy biologic, mechanical,
and esthetic requirements. Fig. 7-2
Damage to adjacent teeth is prevented by positioning the
diamond so a thin lip of enamel is retained between the bur
and the adjacent tooth. A, Note that the orientation of the
BIOLOGIC CONSIDERATIONS diamond parallels the long axis of this premolar. B, Proximal
Surgical procedures involving living tissues must be reduction almost complete. Note that enamel was maintained
carefully executed to avoid unnecessary damage. mesial to the path of the diamond as the reduction progressed.
The adjacent teeth, soft tissues, and the pulp of the
tooth being prepared are easily damaged in tooth
preparation. If poor preparation leads to inadequate prepared for protection of the adjacent structures.
marginal fit or deficient crown contour, plaque Teeth are 1.5 to 2 mm wider at the contact area than
control around fixed restorations becomes more dif- at the cementoenamel junction. Therefore, a thin,
ficult. This impedes the long-term maintenance of tapered diamond can be passed through the inter-
dental health. proximal contact area (Fig. 7-2) to leave a slight lip
or fin of enamel without resulting in excessive tooth
Prevention of Damage during reduction or necessitating undesirable angulation of
Tooth Preparation the rotary instrument. The latter situation, tipping
the diamond unnecessarily away from the adjacent
Adjacent teeth proximal surface, is a common clinical error.
Iatrogenic damage to an adjacent tooth is a common
error in dentistry. Even if a damaged proximal Soft tissues
contact area is carefully reshaped and polished, it is Damage to the soft tissues of the tongue and cheeks
more susceptible to dental caries than was the orig- can be prevented by careful retraction with an aspi-
inal undamaged tooth surface. This is presumably rator tip, mouth mirror (Fig. 7-3), or flanged saliva
because the original surface enamel contains higher ejector. Great care is needed to protect the tongue
fluoride concentrations and the interrupted layer is when the lingual surfaces of mandibular molars are
more prone to plaque retention.1 The technique of being prepared.
tooth preparation must avoid and prevent damage to
the adjacent tooth surfaces. Pulp
A metal matrix band around the adjacent tooth Great care also is needed to prevent pulpal injuries
for protection may be helpful; however, the thin during fixed prosthodontic procedures, especially
band can nonetheless be perforated and the under- complete crown preparation. Pulpal degeneration
lying enamel damaged. The preferred method is to that occurs many years after tooth preparation has
use the proximal enamel of the tooth that is being been documented.2 Extreme temperatures, chemi-
Chapter 7 PRINCIPLES OF TOOTH PREPARATION 211

50–59
30–39
A
20–29
10–19
years
Fig. 7-3
Soft tissue protection. A mouth mirror is used to retract the
tongue during preparation.

cal irritation, or microorganisms can cause an irre-

versible pulpitis,3 particularly when they occur on
freshly sectioned dentinal tubules. Prevention of
pulpal damage necessitates selection of techniques
and materials that reduce the risk of damage while 50–59
tooth structure is prepared.4
Tooth preparations must account for the structure 30–39 B
20–29
of the dental pulp chamber. Pulp size, which can be
evaluated on a radiograph, decreases with age. Up to 10–19
years
about age 50, it decreases more so occlusocervically
than faciolingually. Average pulp dimensions have
been related to coronal contour5 and are presented
in Table 7-1 and Figure 7-4.
Causes of injury
Temperature
Considerable heat is generated by friction between
a rotary instrument and the surface being prepared
(Fig. 7-5). Excessive pressure, higher rotational
speeds, and the type, shape, and condition of the
50–59
cutting instrument (Fig. 7-6) may all increase gener- 40–49 C
ated heat.6 With a high-speed handpiece, a feather- 30–39
20–29
light touch allows efficient removal of tooth material
10–19
with minimal heat generation. Nevertheless, even years
with the lightest touch, the tooth overheats unless a
water spray is used. This must be accurately directed
at the area of contact between tooth and bur. The
spray also removes debris—which is important
because clogging reduces cutting efficiency (Fig. 7-
7)—and prevents desiccation of the dentin (a cause Fig. 7-4
Relationship between tooth preparation and pulp chamber
of severe pulpal irritation).2,7 Debris accumulation
size. The dotted lines represent pulp chamber structure at
has been shown to vary with rotary instrument various ages. A, Maxillary central incisor with a metal-ceramic
shape. Shoulder- and chamfer-shaped diamonds crown preparation. B, Maxillary lateral incisor with a metal-
may accumulate less debris. Debris is not readily ceramic crown preparation. C, Maxillary canine with a pinledge
removed after 5 minutes of ultrasonic cleaning.8 preparation. (From Ohashi Y: Research related to anterior abutment teeth
If the spray prevents adequate visibility, as may be of fixed partial denture. Shikagakuho 68:726, 1968.)
the case when a lingual margin is being finished,
a slow-speed handpiece or hand instrumentation
should be used. Relying on air cooling with a high-
 212
Table 7-1 DIMENSIONS OF PULP AND THE CORONAL CONTOUR
Mesial Distal Labial Labial Palatal Palatal
Incisal Incisal surface surface surface surface surface surface

PART II
Age range Coronal to MPH to DPH to MPH to DPH to MPH to DPH to MPH to DPH
(years) length (mm) (mm) (mm) (mm) (mm) (mm) (mm) (mm) (mm)
MAXILLARY CENTRAL INCISOR
10–19 12.1 4.7 4.8 1.7 2.1 1.8 1.8 1.4 1.3
20–29 11.5 4.8 5.1 2.2 2.3 1.9 1.9 1.4 1.2

CLINICAL PROCEDURES: SECTION 1

30–39 11.2 5.3 5.5 2.1 2.5 2.3 2.4 2.1 2.0
40–49 10.8 6.3 6.2 2.5 2.9 2.0 2.1 2.0 1.8
50–59 12.3 6.3 6.2 2.6 2.6 2.8 2.3 2.2 2.1
Mean ± SD 11.58 ± 0.34 5.5 ± 0.25 5.6 ± 0.28 2.2 ± 0.16 2.5 ± 0.14 2.2 ± 0.12 2.1 ± 0.12 1.8 ± 0.16 1.7 ± 0.19
Range 9.70–14.00 4.0–6.2 4.0–6.2 1.2–3.3 1.4–3.5 1.5–2.9 1.5–2.9 1.0–2.9 1.1–2.9

MAXILLARY LATERAL INCISOR

10–19 10.1 3.9 4.3 2.4 2.6 2.0 2.1 1.3 1.3
20–29 10.2 4.8 5.2 2.5 3.2 2.4 2.4 1.9 1.9
30–39 10.0 4.8 — 2.4 3.2 2.1 2.3 2.0 1.7
40–49 9.0 4.8 5.2 1.9 2.2 2.1 2.1 1.7 1.5
50–59 9.7 6.0 — 2.2 2.3 2.3 2.3 2.6 2.5
Mean ± SD 8.84 ± 0.23 4.9 ± 0.40 4.9 ± 0.32 2.3 ± 0.20 2.7 ± 0.19 2.2 ± 0.04 2.2 ± 0.15 1.9 ± 0.11 1.8 ± 0.17
Range 7.90–11.91 3.6–6.2 3.6–6.4 1.2–3.2 1.8–3.6 1.7–2.7 1.8–2.7 1.2–3.2 1.1–2.9

Mesial Distal Labial Palatal

Incisal surface surface surface surface
Age range Coronal to PH to PH to PH to PH to PH
(years) length (mm) (mm) (mm) (mm) (mm) (mm)
MAXILLARY CANINE
10–19 10.7 4.4 3.4 4.0 2.7 2.3
20–29 10.6 4.6 3.3 3.7 3.1 2.6
30–39 10.5 4.8 3.0 4.0 2.9 2.5
40–49 9.5 4.8 3.0 3.6 2.8 2.8
50–59 9.5 5.4 2.8 3.4 2.9 3.0
Mean ± SD 10.23 ± 0.26 4.8 ± 0.20 3.1 ± 0.13 3.7 ± 0.12 2.9 ± 0.11 2.6 ± 0.15
Range 8.29–12.70 3.8–7.2 2.3–3.6 2.9–4.8 2.5–3.5 1.9–3.7
From Ohashi Y: Research related to anterior abutment teeth of fixed partial denture. Shikagakuho 68:726, 1968.
DPH, distal pulp horn; MPH, mesial pulp horn; PH, pulp horn.
Chapter 7 PRINCIPLES OF TOOTH PREPARATION 213

°C

pulp temperatures
10
Increase in
8 Critical
range
6
4 Group IV

2 Fig. 7-5
Group II Pulpal temperature rise during tooth preparation. Group I, air
Starting level 0
turbine, water cooled. Group II, air turbine, dry. Group III, low
pulp temperatures

Safe
–2 range speed, water cooled. Group IV, low speed, dry. (From Zach L,
Decrease in

–4 Cohen G: Pulp response to externally applied heat. Oral Surg Oral Med Oral
Group I
Pathol 19:515, 1965.)
–6 Group III
–8
–10
–5 0 5 10 15 20 25 30 35
Bur Tooth contact (sec)
contact

A B

180 ␮m 130 ␮m

C D

185 ␮m 18 ␮m

Fig. 7-6
Scanning electron micrographs of a rotary instrument. A, Unused diamond. B, Unused carbide. C, Worn diamond.
D, Diamond particles have fractured at the level of the binder. (Courtesy of Dr. J. L. Sandrik.)

Fig. 7-7
Clogging on the tapered tip of a cylindrical diamond after one molar
tooth preparation reduces cutting efficiency.
214 PART II CLINICAL PROCEDURES: SECTION 1

speed handpiece is hazardous, because it can easily response, and tooth preparations extending in close
overheat a tooth and damage the pulp.9 proximity to the pulp should be avoided. Dowden22
Particular care is needed for preparing grooves or argued that any damage to the odontoblastic
pinholes, because coolant cannot reach the cutting processes would adversely affect the cell nucleus at
edge of the bur. To prevent heat buildup, these reten- the dentin-pulp interface, no matter how far from
tion features should be prepared at low rotational the nucleus it occurred. For this reason, in the assess-
speed. ment of likely adverse pulpal response, the amount
Chemical action of removed dentin is important; particular care must
The chemical action of certain dental materials be exercised when vital teeth are prepared for com-
(bases, restorative resins, solvents, and luting agents) plete-coverage restorations (Fig. 7-8).
can cause pulpal damage,10 particularly when they Tooth structure is conserved through adherence
are applied to freshly cut dentin. Cavity varnish or to the following guidelines:
dentin bonding agents form an effective barrier in 1. Use of partial-coverage rather than complete-cov-
most instances, but their effect on the retention of a erage restorations (Fig. 7-9).
cemented restoration is controversial.11-13 2. Preparation of teeth with the minimum practical
Chemical agents are sometimes used for cleaning convergence angle (taper) between axial walls
and degreasing tooth preparations. However, they (Fig. 7-10).
have been shown14 to be pulpal irritants. Thus, their 3. Preparation of the occlusal surface so that reduc-
use is generally contraindicated, particularly be- tion follows the anatomic planes to give uniform
cause they do not improve the retention of cemented thickness in the restoration (Fig. 7-11).
restorations.15 4. Preparation of the axial surfaces so that a
Bacterial action maximal thickness of residual tooth structure sur-
Pulpal damage under restorations has been attrib- rounding pulpal tissues is retained; if necessary,
uted16,17 to bacteria that either were left behind or teeth should be orthodontically repositioned (Fig.
gained access to the dentin because of microleakage. 7-12) which permits teeth to be prepared with
However, many dental materials, including zinc
phosphate cement, have an antibacterial effect.18
Because vital dentin seems to resist infection,19 the
routine use of antimicrobial agents may not be
advantageous. Many dentists now use an antimicro-
bial agent, such as chlorhexidine gluconate disin-
fecting solution (Consepsis*), after tooth preparation
and before cementation, although the benefit has
not been documented in clinical trials.20
Of importance is that all carious dentin should be
removed before placement of a restoration that will
serve as a foundation for a fixed prosthesis. An indi-
rect pulp cap is not recommended on teeth that will
subsequently receive cast restorations, because its
later failure is likely to jeopardize extensive prostho-
dontic treatment.

Conservation of Tooth Structure

One of the basic tenets of restorative dentistry is to
conserve as much tooth structure as possible while
preparation design remains consistent with the
mechanical and esthetic principles of tooth prepa-
ration. Tissue preservation reduces the harmful
pulpal effects of the various procedures and materi-
als used. The thickness of remaining dentin has been Fig. 7-8
shown21 to be inversely proportional to the pulpal A considerable amount of care is needed when a tooth is pre-
pared for a complete crown, because of the extensive nature of
the reduction, with many dentinal tubules sectioned. Each
*Ultradent Products, Inc., South Jordan, Utah. tubule communicates directly with the dental pulp.
Chapter 7 PRINCIPLES OF TOOTH PREPARATION 215

A B

Fig. 7-9
Conservation of tooth structure by using partial-coverage restorations. In this case, they are used as fixed dental prosthetic abut-
ments to replace congenitally missing lateral incisors.

1
2
M D

Fig. 7-10
Excessive taper results in considerable loss of tooth structure
(shaded area).
Minimally required clearances:
Buccal cusp—1.5 mm
Lingual cusp—1.0 mm
less axial convergence than necessary when tooth Marginal ridges and fossae—1.0 mm
alignment is less than optimal to accommodate
fixed dental prosthetic retainer preparations.
Fig. 7-11
5. Selection of a margin geometry that is conserva-
An anatomically prepared occlusal surface results in adequate
tive and yet compatible with the other principles clearance without excessive tooth reduction. A flat occlusal
of tooth preparation (Fig. 7-13). preparation will result in either insufficient clearance (1) or an
6. Avoidance of unnecessary apical extension of the excessive amount of reduction (2).
preparation (Fig. 7-14).
or dental caries. Alternatively, inadequate occlusal
reduction may result in poor form and subsequent
Considerations Affecting Future
occlusal dysfunction. Poor choice of margin location,
Dental Health
such as in the area of occlusal contact, may cause
Improper preparation of a tooth may have an chipping of enamel or cusp fracture.
adverse effect on long-term dental health. For
example, insufficient axial reduction inevitably Axial reduction
results in overcontoured restorations that hamper Gingival inflammation is commonly associated with
plaque control. This may cause periodontal disease23 crowns and fixed dental prosthetic abutments that
216 PART II CLINICAL PROCEDURES: SECTION 1

1 1
2 2

A
Fig. 7-13
A shoulder margin (2) is indicated when esthetic restorations
are planned to achieve sufficient material thickness to achieve
Uniform tooth reduction a lifelike appearance, but it is much less conservative than a
is conservative of tooth chamfer (1).
structure.

9 degrees

B A

C
B

Fig. 7-12
To conserve tooth structure, the preparation of axial walls
should be as uniform as possible. A, The path of placement
should coincide with the long axis of the tooth, which for a
mandibular molar is typically inclined 9 to 14 degrees lingually.
Preparing such a tooth with a path of placement that is per-
pendicular to the occlusal plane of the mandibular arch is a
commonly observed clinical error that results in additional C
unnecessary removal of tooth structure (shaded area).
Malaligned teeth, such as a mesially tipped molar (B), necessi-
tate additional removal of tissue on the mesial aspect of the
molar abutment to achieve compatible paths of placement for
a planned fixed dental prosthesis. C, If the molar abutment is Fig. 7-14
orthodontically uprighted before tooth preparation, a more A, Apical extension of the preparation can necessitate addi-
conservative crown preparation can be achieved. tional tooth reduction because coronal diameter becomes
smaller. B, Preparations for periodontally involved teeth may
necessitate considerable reduction if the margins are to be
placed subgingivally for esthetic reasons. C, Supragingival
margins are preferred where applicable.
Chapter 7 PRINCIPLES OF TOOTH PREPARATION 217

have excessive axial contours, probably because it is cemented restorations have been identified26-31 as a
more difficult for the patient to maintain plaque major etiologic factor in periodontal disease, partic-
control around the gingival margin24 (Fig. 7-15). A ularly where they encroach on the epithelial attach-
tooth preparation must provide sufficient space for ment (see Chapter 5). Supragingival margins are
the development of good axial contours. This easier to prepare accurately without trauma to the
enables the junction between the restoration and the soft tissues. They can usually also be situated on hard
tooth to be smooth and free of any ledges or abrupt enamel, whereas subgingival margins are often on
changes in direction. dentin or cementum.
Under most circumstances, a crown should dupli- Other advantages of supragingival margins
cate the contours and profile of the original tooth include the following:
(unless the restoration is needed to correct a mal- 1. They can be easily finished without associated
formed or malpositioned tooth). If an error is made, soft-tissue trauma.
a slightly undercontoured flat restoration is better 2. They are more easily kept plaque free.
because it is easier to keep free of plaque; however, 3. Impressions are more easily made, with less
increasing proximal contour on anterior crowns to potential for soft tissue damage.
maintain the interproximal papilla25 (see Chapter 5) 4. Restorations can be easily evaluated at the time of
may be beneficial. Sufficient tooth structure must be placement or at recall appointments.
removed to allow the development of correctly A subgingival margin (Fig. 7-17), however, is jus-
formed axial contours (Fig. 7-16), particularly in the tified if any of the following pertain:
interproximal and furcation areas of posterior teeth, 1. Dental caries, cervical erosion, or restorations
where periodontal disease often progresses with extend subgingivally, and a crown-lengthening
serious consequences. procedure (see Chapter 6) is not indicated.
2. The proximal contact area extends to the gingival
Margin placement crest.
Whenever possible, the margin of the preparation 3. Additional retention and/or resistance is needed
should be supragingival. Subgingival margins of (see “Mechanical Considerations” section, p. 226).

A B

Fig. 7-15
A, Unhealthy gingival tissue resulting from overcontoured restorations. B, The tooth preparations are underreduced; C, Once the
restorations are recontoured, gingival health returns.
 A B

Fig. 7-16
A and B, Tooth preparations with adequate axial reduction allow the development of properly contoured embrasures. Tissue is con-
served through the use of partial coverage and supragingival margins where possible. C, Preparing furcation areas adequately is
important (arrows); otherwise, the restoration is excessively contoured, making plaque control difficult.

A B

C D

Fig. 7-17
Examples of when subgingival margins are indicated. A, To include an existing restoration. B, To extend apical to the proximal contact
(adequate proximal clearance). C and D, To hide the metal collar of metal-ceramic crowns.
Chapter 7 PRINCIPLES OF TOOTH PREPARATION 219

4. The margin of a metal-ceramic crown is to be (Fig. 7-18). The clinical significance of preparing
hidden behind the labiogingival crest. smooth margins cannot be overemphasized. Time
5. Root sensitivity cannot be controlled by more spent obtaining a smooth margin makes the subse-
conservative procedures, such as the application quent steps of tissue displacement, impression
of dentin bonding agents. making, die formation, waxing, and finishing much
6. Modification of the axial contour is indicated, easier and ultimately results in a longer-lasting
such as to provide an undercut to provide reten- restoration.
tion for the clasp of a partial removable dental
prosthesis (see Chapter 21). Margin geometry
The cross-sectional configuration of the margin has
Margin adaptation been the subject of much analysis and debate.35-42
The junction between a cemented restoration and Different shapes have been described and advo-
the tooth is always a potential site for recurrent cated.43,44 For evaluation, the following guidelines for
caries because of dissolution of the luting agent and margin design should be considered:
inherent roughness. The more accurately the resto- 1. Ease of preparation without overextension or
ration is adapted to the tooth, the lesser is the unsupported enamel.
chance of recurrent caries or periodontal disease.32 2. Ease of identification in the impression and on
Although a precise calculation for acceptable margin the die.
adaptation is not available, a skilled technician can 3. A distinct boundary to which the wax pattern can
routinely make castings that fit to within 10 mm33 be finished.
and a porcelain margin that fits to within 50 mm,34 4. Sufficient bulk of material (to enable the wax
provided the tooth is properly prepared. A well- pattern to be handled without distortion and to
designed preparation has a smooth and even margin. give the restoration strength and, when porcelain
Rough, irregular, or “stepped” junctions greatly is used, esthetics).
increase overall margin length and substantially 5. Conservation of tooth structure (if the other
reduce the adaptation accuracy of the restoration criteria are met).

A B

A smooth margin is
considerably shorter
than a jagged one.

C D

Fig. 7-18
A and B, Poor preparation design, leading to increased margin length. C, A rough, irregular margin makes the fabrication of an accu-
rately fitted restoration almost impossible. D, An accurately fitting margin is possible only if it is prepared smoothly.
220 PART II CLINICAL PROCEDURES: SECTION 1

Proposed margin designs are presented in Table and it provides room for adequate bulk of material
7-2. and development of anatomically correct axial con-
Although they are conservative of tooth structure, tours. Chamfers can be placed expediently and with
feather edge or shoulderless crown preparations precision, although care is needed to avoid leaving a
(Fig. 7-19A) should be avoided because they do not ledge of unsupported enamel.
provide adequate bulk at the margins. Overcon- Probably the most suitable instrument for making
toured restorations often result from feather edge a chamfer margin is the tapered diamond with a
margins because the technician can handle the wax rounded tip; the resulting margin is the exact image
pattern without distortion only by increasing its of the instrument (Fig. 7-21). Marginal accuracy
bulk beyond the original contours. A variation of the depends on having a high-quality diamond and a
feather edge, the chisel edge margin (Fig. 7-19B), is true-running handpiece. The gingival margin is pre-
formed when there is a larger angle between the pared with the diamond held precisely in the
axial surfaces and the unprepared tooth structure. intended path of placement of the restoration (Fig.
Unfortunately, this margin is frequently associated 7-22).
with preparations with excessive angles of conver- Tilting it away from the tooth will create an under-
gence (taper) and preparations in which the orien- cut, whereas angling it toward the tooth will lead to
tation of the axial reduction is not correctly aligned overreduction and loss of retention. The chamfer
with the long axis of the tooth. should never be prepared wider than half the tip of
Under most circumstances, feather edges and the diamond; otherwise, an unsupported lip of
chisel edges are unacceptable. Historically, their enamel may result (Fig. 7-23). Some authorities have
main advantage was that they facilitated impression recommended the use of a diamond with a noncut-
making with rigid modeling compound in copper ting guide tip to aid accurate chamfer placement.45
bands (a technique rarely used today). They were However, such guides have been shown to damage
useful for that purpose, because there was no ledge tooth structure beyond the intended preparation
on which a band could catch. A chamfer margin margin.46
(Fig. 7-19C) is particularly suitable for cast metal Under some circumstances a beveled margin (see
crowns and the metal-only portion of metal-ceramic Fig. 7-19D) is more suitable for cast restorations, par-
crowns (Fig. 7-20). It is distinct and easily identified, ticularly if a ledge or shoulder already exists, possi-

Table 7-2 ADVANTAGES AND DISADVANTAGES OF DIFFERENT MARGIN DESIGNS

Margin design Advantages Disadvantages Indications
Feather edge Conservative of tooth Does not provide Not recommended
structure sufficient bulk
Chisel edge Conservative of tooth Location of margin Occasionally on tilted
structure difficult to control teeth
Bevel Removes unsupported Extends preparation into Facial margin of maxillary
enamel, allows sulcus if used on partial-coverage
finishing of metal apical margin restorations and inlay/
onlay margins
Chamfer Distinct margin, Care needed to avoid Cast metal restorations,
adequate bulk, unsupported lip of lingual margin of metal-
easier to control enamel ceramic crowns
Shoulder Bulk of restorative Less conservative of Facial margin of metal-
material tooth structure ceramic crowns,
complete ceramic
crowns
Sloped shoulder Bulk of material, Less conservative of Facial margins of metal-
advantages of bevel tooth structure ceramic crowns
Shoulder with bevel Bulk of material, Less conservative, Facial margin of posterior
advantages of bevel extends preparation metal-ceramic crowns
apically with supragingival
margins
 A B C D E F G

H I

0.5 mm 0.5 mm

J K

0.5 mm
0.5 mm

L M

0.5 mm
0.5 mm
Fig. 7-19
Margin designs. A, Feather edge. B, Chisel. C, Chamfer. D, Bevel. E, Shoulder. F, Sloped shoulder. G, Beveled shoulder. H to M,
Scanning electron micrographs. H, Feather-chisel edge. I, Bevel. J, Chamfer. K, Shoulder. L, Sloped shoulder. M, Beveled shoulder.
(Courtesy of Dr. H. Lin.)

A B

Fig. 7-20
Chamfer margins are recommended for cast metal crowns (A) and the lingual margin of a metal-ceramic crown (B).
222 PART II CLINICAL PROCEDURES: SECTION 1

bly as a result of dental caries, cervical erosion, or a to a gingival margin, where beveling would lead to
previous restoration. The objective in beveling is subgingival extension of the preparation or place-
threefold: (1) to allow the cast metal margin to be ment of the margin on dentin rather than on enamel.
bent or burnished against the prepared tooth struc- Facial margins of maxillary partial-coverage restora-
ture; (2) to minimize the marginal discrepancy35 tions should be beveled to eliminate all unsupported
caused by a complete crown that fails to seat com- enamel, to protect the remaining tooth structure
pletely (however, Pascoe40 showed that when an from fracture, and to allow for burnishing of the
oversized crown is considered, the discrepancy is casting.
increased rather than decreased [Fig. 7-24]); and (3) Because a shoulder margin (Fig. 7-19E) allows
to protect the unprepared tooth structure from chip- room for porcelain, it is recommended for the facial
ping (e.g., by removing unsupported enamel). part of metal-ceramic crowns, especially when the
NOTE: when access for burnishing is limited, there is porcelain margin technique is used. It should form
little advantage in beveling. This applies particularly a 90-degree angle with the unprepared tooth
surface. An acute angle is likely to chip (Fig. 7-25A).
In practice, dentists tend to underprepare the facial
shoulder,47 which leads to restorations with inferior
All unsupported
esthetics or poor axial contour.
enamel must be Some authorities48 have recommended a heavy
removed. chamfer rather than a shoulder margin, and some
find a chamfer easier to prepare with precision.
Earlier workers38,39 found less distortion of the
metal framework during porcelain application with
a shoulder margin, although with modern alloys,
these results could not be replicated.49-52
A 120-degree sloped shoulder margin (Fig. 7-
19F) is sometimes used as an alternative to the
90-degree shoulder for the facial margin of metal-
ceramic crowns. The sloped shoulder reduces the
possibility of leaving unsupported enamel but leaves
sufficient bulk to allow thinning of the metal frame-
work to a knife-edge for acceptable esthetics.
Fig. 7-21 A beveled shoulder margin (Fig. 7-19G) is recom-
A chamfer margin is formed as the negative image of a round- mended by some authorities for the facial surface of
ended tapered diamond. a metal-ceramic restoration in which a metal collar

At left, the diamond is tipped away

from the path of placement, resulting
A B in an undercut; at right, the diamond
is tipped into the tooth too far, leading
to an excessively tapered preparation.

Fig. 7-22
Precise control of the orientation of the diamond is very important. A, Tilting away from the tooth creates an undercut: Opposing
axial preparation walls diverge in an occlusal direction. B, Tilting toward the tooth results in an excessive convergence angle of the
preparation.
Chapter 7 PRINCIPLES OF TOOTH PREPARATION 223

All unsupported
enamel must be
removed.
A

Shoulder 45° Bevel

Fig. 7-23
A chamfer should not be wider than half the bur used to form it. Properly seated castings
Otherwise, a lip of unsupported enamel will be left. should have minimal
marginal gap widths.

Fig. 7-24
(as opposed to a porcelain labial margin) is used. The Effect on marginal fit of beveling the gingival margin. A, If the
beveling removes unsupported enamel and may internal cross-section of a crown is the same as or less than that
allow some finishing of the metal. However, a shoul- of the prepared tooth, a 45-degree bevel decreases the mar-
der or sloped shoulder is preferred for biologic and ginal discrepancy by 70%. B, If the internal diameter is slightly
esthetic reasons. This allows improved esthetics larger than the prepared tooth, beveling increases the marginal
because the metal margin can be thinned to a knife discrepancy. In practice, crowns are made slightly larger than
the prepared tooth to allow for the luting agent.
edge and hidden in the sulcus without the need for
positioning the margin closer to the epithelial
attachment (Fig. 7-25B). Table 7-3 illustrates
chamfer and shoulder preparations obtained with
selected instruments. Sometimes even endodontic treatment is neces-
A comprehensive 2001 literature review of sary to make enough room. However, under these
current scientific knowledge on complete coverage circumstances, compromising the principle of con-
tooth preparations suggests that margin design selec- servation of tooth structure is preferable to the
tion should be based on the type of crown, applica- potential harm from a traumatic occlusal scheme.
ble esthetic requirements, ease of formation, and Careful judgment is obviously needed. Diagnostic
operator experience. Research has not validated the tooth preparations and waxing procedures are
expectation of enhanced fit being associated with essential to help determine the exact amount
selection of certain types of finish line geometry.53 of reduction necessary to develop an optimum
occlusion.
Occlusal considerations
A satisfactory tooth preparation allows sufficient Preventing tooth fracture
space for developing a functional occlusal scheme in No tooth is unbreakable. If teeth are smashed
the finished restoration. Sometimes the patient’s together (as in an automobile accident, sport injury,
occlusion is disrupted by supraerupted or tilted teeth or biting unexpectedly on a hard object), a cusp may
(Fig. 7-26). When these teeth are prepared for break. Cuspal fracture also can occur from para-
restoration, the eventual occlusal plane must be care- functional habits such as bruxism.
fully analyzed and the teeth reduced accordingly. The likelihood that a restored tooth will fracture
Considerable reduction is often needed to compen- can be lessened if the tooth preparation is designed
sate for the supraeruption of abutment teeth. In turn, to minimize potentially destructive stresses (Fig. 7-
this may shorten tooth preparation axial wall height, 27). For example, an intracoronal cast restoration
with associated mechanical consequences such as (inlay) has a greater potential for fracture because
reduced retention and resistance (see p. 226). when occlusal forces are applied to the restoration,