TYPES OF TOOTH PREPARATION

Sahana.R
PG – II yr
 CONTENTS
• Definition

• Principles of tooth preparation

• Classification

• Types of tooth preparation

1) Complete coverage crowns

2) Partial coverage crowns
3) Resin bonded bridges (Minimally
invasive preparation)

• Conclusion

• References
 DEFINITION (GPT – 9)

• Tooth preparation - The process of removal of diseased and/or healthy

enamel and dentin and cementum to shape a tooth to receive a restoration.

• Dentistry is changing from macro tooth preparation to an environment of

molecular chemistry i.e., esthetic bonding. These techniques are not
presently supported by any longitudinal studies,but are exciting and
promising.

• Despite these advances, traditional crowns are still indicated for majority of
patients. The classic design of the preparation must be visualized so that
modifications if required can be instituted. Diagnosis and disciplined tooth
preparation are essential to successful fixed prosthetics.
PRINCIPLES OF TOOTH PREPARATION
(According to Rosenstiel)

BIOLOGIC

Conservation of tooth
structure
Avoidance of over contouring
Supra gingival margins
Harmonious occlusion
Protection against tooth
fracture

ESTHETIC OPTIMAL
MECHANICAL RESTORATION
Minimum display of metal
Maximum thickness of
Retention form
porcelain
Resistance form Porcelain occlusal surfaces
Subgingival margins
(According to Shillingburg)

1. Preservation of tooth structure

2. Retention and resistance
3. Structural durability
4. Marginal integrity
5. Preservation of the periodontium
 CLASSIFICATION OF RETAINERS

RETAINERS

EXTRACORONAL INTRACORONAL RADICULAR

Complete coverage 1. Inlay 1. Cast post

Partial coverage crown
crown 2. Onlay 2. Prefabricated post

• All metal • 3/4 th crown

• All ceramic • Mesial half
• Metal ceramic crown
• 7/8 crown
• FULL COVERAGE CROWN / PARTIAL COVERAGE CROWN : A restoration
that restores missing tooth structure of three or more axial surfaces and
the occlusal surface or incisal edge of a tooth with a material such as cast
metal alloy, ceramics, resin, or a combination of materials (GPT 9).
FULL METAL CROWNS
 FULL METAL CROWN

• Used where the break down of tooth structure is severe to the extent that
has been described as “the final attempt to preserve the tooth”

• Most retentive of veneer preparations

 INDICATIONS

• Extensive destruction from caries

• Endodontically treated tooth

• Existing restoration that needs the use of a more conservative restoration

• Necessity for maximum retention

• Minor correction of malinclinations

• Recontouring of axial surfaces.

• Provide contour to receive removable appliances

• Correction of occlusal plane

 ADVANTAGES

• Strong

• High retentive qualities

• Easy to obtain adequate resistance form

• Option to modify form and occlusion

 ARMAMANTARIUM

• Tapered carbide bur - For occlusal guiding grooves

• Narrow round-tipped tapered diamond (regular grit) (0.8mm)- For occlusal

reduction , axial alignment grooves, axial reduction, chamfer preparation

• Wide round tipped tapered diamond (fine grit) (1.2 mm)- For finishing
 STEP BY STEP PROCEDURE

Guiding grooves for occlusal reduction:-

• Tapered carbide is recommended.

• Place depth groove holes app 1mm deep in

central, mesial, and distal fossa and connect
them.

• Guiding grooves in buccal and lingual

developmental grooves

• Place a functional cusp bevel

• Depth – 0.8 mm for central groove &

nonfunctional cusp, 1.3 mm for functional cusp
Occlusal reduction :

• Half occlusal surface is reduced first and other half can be maintained as
reference

• Minimum clearence of 1.5 mm on functional cusp and 1mm on

nonfunctional cusp.
Axial reduction :

• Place 3 alignment groove on each buccal and lingual wall with narrow
round end tapered diamond.

• The bur should be parallel to proposed path of withdrawal of restoration.

• Diamond bur with 6 degree taper is used and identical axial taper will
result in preparation.
• The remaining islands of tooth structure between alignment grooves are
removed while the chamfer margin is placed.

• Place cervical chamfer of app 0.5 mm width.

• Finishing – with fine grit carbide bur.

• Round off all line angles

METAL CERAMIC CROWNS
 METAL CERAMIC CROWNS

• PFM crowns grew with the development of first commercially successful

porcelain/gold alloy by Weinstein etal in 1950s.

• Ceramic layer bonded to a thin cast metal coping that fits over the tooth
preparation

• Greater strength than all ceramic crowns

 INDICATIONS

 • Esthetic demands

• Durability More ( than all ceramic )

• Allows placement of rests, if RPD is a part of treatment.

• Extensive tooth destruction

• Correction of malocclusion.

• Correction of occlusal plane

 ADVANTAGES

• Strength

• Mimic natural appearance

• Good retention
 ARMAMANTARIUM

• Round tipped rotary diamonds (regular grit for buccal reduction, fine grit
for finishing)

• Foot ball or wheel shaped diamonds ( for lingual reduction)

• Flat end tapered ( for shoulder prepration)

• Finishing stones

• Hatchet and chisel

 STEP BY STEP PROCEDURE

Guiding grooves:-

• Place 3 depth grooves- centre, mesiofacial and distofacial line angles.

• Place in 2 planes- the cervical portion is parallel to long axis of tooth, for
incisal (occlusal) follows normal facial contour.

• 1.2 mm deep
Incisal (occlusal)reduction:

• Bur – Flat end tapered

• Criteria – 1.2 to 1.5mm reduction for the metal and porcelain

 A uniform reduction of approximately 1.2 mm is needed over the entire facial
surface.

Labial reduction guide grooves ( two plane):-

• Bur – Flat end tapered

• Criteria- 1.2- 1.5mm reduction for metal and porcelain.

Labial reduction ( two plane):-

• Bur – tapered flat- tipped diamond

Axial reduction:-

• Bur – Tapered torapedo diamond

Lingual reduction:-

• Bur – Football shaped diamond

• Criteria- 0.7 mm clearance .

Finishing of shoulder (or beveled shoulder):-
• Bur – tapered flat tipped bur , hand instrument

• Criteria – extend 1mm lingual to proximal contact area.

Finishing :-

• Bur – tapered round tipped diamond or carbide bur

• Criteria – round off all line angles

ALL CERAMIC RESTORATION
 ALL CERAMIC RESTORATIONS

• Non metallic full coverage ceramic restoration

• Restoring the prepared anterior teeth functionally & esthetically

 INDICATIONS

• High aesthetic requirement

• Incisal egde reasonably intact

• Endodontically treated teeth

• Considerable proximal caries

• Favourable distribution of occlusal load.

 ADVANTAGES

• Excellent aesthetic

• Good tissue response

• More conservative of facial wall

 STEP BY STEP PROCEDURE

Depth grooves for the facial reduction:-

• Bur – tapered diamond

• Criteria – 0.8mm needed for the additional reduction during finishing

Facial reduction:-  
• Bur- tapered diamond

• Criteria – reduction of 1mm is needed

Depth grooves for the incisal reduction:-
• Bur – tapered diamond

• Criteria – 1.3 mm deep to allow the for additional reduction

during finishing, perpendicular to the long axis of opposing
tooth

Incisal reduction :-
• Bur – tapered diamond

• Criteria – clearance 1.5 mm

Depth grooves and lingual reduction:-
• Bur –tapered and football-shaped diamonds

• Criteria – initial depth 0.8mm , recreate the concave

configuration (avoid stress)

Depth grooves for cingulum reduction:-

• Burs – tapered diamond

• Criteria – parallel to cervical aspect of facial

preparation. - 1mm reduction - shoulder follows free
gingival margin
Lingual shoulder preparation:-
• Bur – square-tipped diamond

• Criteria – shoulder 1mm wide , 90 degree cavosurface angle.

Finishing :-
• Bur – fine grit diamond or carbide

• Criteria- all surfaces smooth and continous - no unsupported enamel - 90

degree cavosurface angle
PARTIAL VENEER CROWNS
 PARTIAL VENEER CROWNS

• Three quarter crown – covers three surfaces of the crown leaving one
surface intact.

• Seven eighth crown – used in maxillary molars and premolars. It

encompasses seven eighth the gingival circumference of the tooth.

• Mesial half crown – is a three quarter crown rotated 90 o , preserving the

distal surface of the tooth. This preparation design is primarily indicated
for the distal retainer of a mandibular FPD with a tilted molar abutment.
 INDICATIONS

• Intact or minimally restored teeth.

• Teeth with crown length that is average or exceeds average.

• Teeth with normal anatomic crown form, ie, without cervical constriction.
•
• Anterior teeth with adequate labio-lingual thickness
 ADVANTAGE

• Conserves tooth structure

• Easy access to margins for finishing (for dentist)

• Less gingival involvement than with complete cast crown

• Aesthetics are superior to that of the complete crowns

• Electric pulp testing can be done on the intact surface

• Complete seating of the restoration can be easily verified.

 ARMAMANTARIUM

• Narrow (0.8mm) round tipped , tapered diamond – For bulk reduction

• Regular size (1.2mm) round tipped tapered diamond or carbide – Finishing

• Wheel shaped diamond - Bulk reduction

• Tapered and straight carbide fissure burs - preparation of boxes, ledges and
pinhole finalisation.

• Small round carbide bur

• Finishing stones

• Inverted cone carbide bur – preparation of incisal offset 

 STEP BY STEP PROCEDURE

Incisal Reduction:

• Depth orientation grooves are placed at about 1 – 1.5mm depth.

• Using tapered round ended diamond bur reduce the incisal edge 1mm at
45 degree to the long axis of tooth.

• Follow the facial contour of the tooth and uniformly remove 1 – 1.5mm of
enamel

• Design of incisal bevel should prevent contact with opposing teeth and
incisal margin
Lingual Reduction:
Accomplished in two stages:

A)Lingual surface reduction :

• Depth orientation groove placed

• Football or wheel shaped diamond bur used to reduce lingual surface

• Slight ridge left running incisogingivally along the centre of the lingual
surface.

• Clearance with opposing tooth should be atleast 0.7 – 1mm

• Do not over reduce cingulum

B) Lingual gingival reduction

• Using tapered round ended diamond, a chamfer of 0.5mm deep is made at

the cervical finish line.

• Reduction parallels long axis of the preparation (in this case the incisal two
thirds of the labial surface)

• The path of placement of the restoration must be accurately determined

before axial reduction

• Mesiodistally it should be parallel to the long axis of the tooth , buccolingually

, it should parallel the middle third or incisal third of the tooth.

• To enhance the retention and resistance form, a slightly exaggerated chamfer

is placed in the lingual aspect and a guiding groove is placed in the middle of
the lingual surface
Inter proximal reduction:

• Three steps are involved

1) Using a 169L carbide bur, reduce the proximal surface by moving bur
from lingual to the facial surface. Position bur so that the tip of the bur is
further facial than the shank. Do not break contact with the adjacent
teeth. The facial line angles must remain intacet to provide aesthetically
pleasing results

2) Using a narrow chamfer diamond, establish a light chamfer finish line on

the proximal surface

3) Using a hatchet instrument, the contact with the adjacent tooth is

broken to establish labial proximal extensions. A flame shaped bur is
used to finish the flare. Axial reduction is now complete
Proximal grooves:

• These are placed as far labially as possible without undermining the labial
enamel plate

• First groove is begun by cutting a 1mm deep template with a 170L bur.
This groove is extended gingivally in increments to the full length.

• Second groove is cut parallel to the first on the opposite side.

• Lingual wall of the groove has a 2 – 5 degree incisal convergence with the
lingual gingival wall of the preparation.
• Facial wall of the groove should be continuous with the proximal flare to
contribute bulk to the facial margin.

• The grooves are parallel to the incisal half or two thirds of facial surface.

• Boxes may be used as substitutes for the grooves where there are existing
proximal restorations or caries. Boxes must be narrow to resistant, hence
lingual wall of the box shortens as it moves lingually.

• The grooves are a minimum of 3mm long and terminate within 0.5mm of
the gingival finish line.
Incisal groove :
• Using 37 inverted cone bur, develop a 0.5 to 1mm groove connecting the
proximal groove . This should be in the dentin and parallel to the DEJ.

• Groove is not placed at the expense of the incisal edge.

Facial bevel:
• Using a fine, flame shaped diamond bur, develop a narrow bevel < 0.5mm
on the labioincisal finish line at right angles to incisal two thirds of the
facial surface.

• Finishing the preparation Using a carbide finishing bur, round the angles
to ensure continuity of all the finish lines
RESIN BONDED BRIDGE
 PREPARATION FOR RESIN BONDED BRIDGES

• A little or no tooth preparation is advocated for this type of prosthesis.

• Preparation features are used to enhance the resistance of resin-bonded fixed

partial dentures.

• The tooth preparation includes axial reduction and guide planes on the
proximal surfaces with a slight extension onto the facial surface to achieve a
faciolingual lock.

• The preparation should encompass at least 180 degrees of the tooth to

enhance the resistance of the retainer.

• The preparation must be extended as far as possible to provide maximum

bonding area.
 SEQUENCE OF PREPARATION

• First, the centric occlusal

contacts are marked with
articulating ribbon.

• To ensure adequate occlusal

clearance in this area, a football-
shaped diamond is used to
remove 0.5 mm of tooth
structure . This particular step is
necessary only on maxillary
anterior teeth.
• The same football-shaped
diamond is used to create a
concave reduction on the entire
cingulum surface of the incisor,
producing 0.5 mm of lingual
clearance .

• This reduction should end 1.5 to

2.0 mm from the incisal edge,
or just incisal to the most incisal
occlusal contact, whichever is
closer to the incisal edge.

• A flat-end tapered diamond is

used to prepare flat notches or
countersinks on the lingual
surface of the tooth to provide
resistance to gingival
displacement
• Proximal reduction on the surface
adjacent to the edentulous space is
done with a flat-end tapered
diamond, producing a small plane
that extends slightly facial to the
facioproximal line angle.

• A second plane is produced lingual to

the first with the same diamond bur.
• Light upright lingual axial
reduction is done from the
biplanar proximal axial
reduction around the
cingulum to a point just
short of the proximal
contact on the opposite
side of the cingulum from
the edentulous space.

• To minimize any
deleterious effect on the
periodontium, the very
light chamfer finish line
should remain
approximately 1.0 mm
supragingival throughout
its length.
• Short groove is placed at
the facialmost extension of
the reduction on the
opposite side of the
cingulum with a short
needle diamond.

• The same thin diamond is

used to place a groove in
the vicinity of the
wraparound or break
between the facial and
lingual planes of proximal
axial reduction adjacent to
the edentulous space.
 CONCLUSION

• Each tooth preparation must be measured by clearly defined criteria,

which can be used to identify and correct problems.

• Understanding the pertinent theories underlying each step is crucial.

• Successful preparation can be obtained most easily by systematically

following the steps.

• It is critical to refrain from "jumping ahead" before the previous step has
been evaluated and, if necessary, corrected.

• If the clinician proceeds too rapidly, precious chair time will be lost, and
the quality of the preparation will probably suffer.
 REFERENCE

• Castellani D. La preparazione dei pilastri per corone in metal ceramica.

Bologna: Edizioni Martina, 2015.

• Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of

fixed prosthodontics. 3rd ed. Chicago, IL: Quintessence Publishing Co, 1997.

• Goodacre CJ, Compagni WV, Aquilino SA. Tooth preparations for complete
crowns: An art form based on scientific principles. J Prosthet Dent. 2011
Apr;85(4):363-76.

• Parker MH, Calverley MJ, Gardner FM, Gunderson RB. New guidelines for
preparation taper. J Prosthodont. 1993;2:61-6.

• Preston JD. Rational approach for tooth preparation to ceramo- metal

restoration. Dent Clin North Am. 1977;21:683- 698.
• Miller L. A clinician’s interpretation of tooth preparations andthe design of
metal substructures for metal-ceramic restorations in McLean JW (ed):
Dental Ceramics; Proceedings of the First International Symposium on
Ceramics. Chicago, Quintessence Publ Co. 1983;173-206.

• Farah JW, Craig RG, Payton FA. Experimental stress analysis of a restored
axisymmetric first molar. J Dent Res. 1974;53:859-866.

• Maxwell AW, Blank LW, Pelleu GB Jr. Effect of crown preparation height on
the retention and resistance of gold castings. Gen Dent. 1990;38:200-2.

• Woolsey GD, Matich JA. The effect of axial grooves on the resistance form
of cast restorations. J Am Dent Assoc. 1978;97:978-80.

• Hegdahl T, Silness J. Preparation areas resisting displacement of artificial

crowns. J Oral Rehabil. 1977;4:201-7.