Definition principles of tooth reduction:
It is the form given to the prepared coronal portion of the
tooth in order to receive an- extra coronal restoration.
Teeth require preparation to receive restorations, and these
preparations must be based on fundamental principles from
which basic criteria can be developed to help predict the
success of prosthodontic treatment.
Principles of tooth preparation.
The principles of tooth preparation may be
divided
into three broad categories:
1. Biologic 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.
Preventing consideration affecting
tooth damage future dental health
Conservation of
tooth structure
Adjecent tooth Axial and occlusal reduction
Sof tissue Preventing tooth fracture
pulp Marginal integrity
Adaptation
Location
geometry
Preventing damage of adjacent tooth:
During opening the contact by :
Metallic matrix band
Less preferred
Enamel shell
technique
Using thin tapered (ultrafine) diamond
(short &
long needle) stone prox. parallel to long axis,
leaving shell of enamel of prepared tooth to
protect adjacent (because tooth wider occ. than
cervical by 1.5 – 2mm).
Preventing
Lip, check, tongue by retraction with injury of S.T:
Mouth mirror,
Suction tip,
Saliva
ejector.
Preventing damage of
pulp
a. Thermal injury
CAUSES
1) ∆ generation
Caused by friction between rotary
instrument & tooth during prep. lead to
↑ Vascularization of pulp: hyperemia
=reversible pulpitis.
Pulp hemorrhage = irreversible pulpitis
Solution
Air/ H2o spray (air only → D–desiccation)
Sharp instruments
Intermittent, light strokes
↑ Speed except for retentive groove
2) Dry cutting
lead to:
a. Aspirati
tubules
b. Dehydra
Tem
3)Deep prep.
Pulp response is indirectly proportional to
thickness of remaining dentin bridge
Cutting within 50 µm of the pulp as: large,
deep inlay more destructive than superficial Cr.
preparation & may cause indirect, bloodless
pulp exposure so, indirect pulp capping is
required
↑
b. Bacterial
injury:
1)Remaining caries : under rest.
2)Recurrent caries : micro
leakage at margins of :
Composite
due to polymerization shrinkage
Inlay/ Onlay / P.C
due to dissolution of cement
c. Chemical injury
By irritating action of chemical cleaning agents
,some luting agents & restorative resin
Cleaning of tooth
E – debris (15 – 20 µm) removed by flushing
with warm H2o
D – debris (2 – 5 µm) removed by acid but due
to high dentin permeability → irritation
Avoided
by
3% H2O2
Safe, biocompatible & remove smallest particles
by effervescent(bubbling) action
Sealing freshly cut D: immediate D-sealing(IDS)
• Immediate application of cavity varnish, or D-bonding
agent (adhesive resin coating) to the freshly cut dentin after
the preparation and prior to impression making.
• Acting as barriers against some irritating luting agents or
restorative resin
Functions of IDS
1. Desensitization it allows obturation of cut D- tubules > prevent
as hydrodynamic movement of H2O; theory the
accepted physiologic mech. Inducing D sensitivity
hydrodynamic most
2. Allows durable bond to E & D which is a success key of proper adhesion of
minimally adhesive restoration: ex, L.V, occlusal veneer&
RBB….HOW? As D is not yet contaminated by bact. Or remnants of
luting cement > allows easier infiltration
Functions of IDS
1. Collagen not yet collapsed ( as when occurs during stage of impression
& temporization) > allows encapsulation by resin &
formation hybrid layer mature in stress free
polymerization condition:
which shrinkage not affected
of resin cement by
which exceeds bond str.
of
adhesive to D & may separation within hybrid layer
2. Thickness of bonding agent is incorporated into impression> gab& fit
of final restoration because only cement is compensated by die spacer
Steps of IDS
1Preparation> apply bonding agent, scrubbing20s, air thinning&
curing 20s(shiny surface)
2Apply liner: resin based liner as flowable composite& curing to
protect underlying hybrid layer
3Remove O2 inhibited layer by alch. swap leaving matt finish:
its superficial uncured resin which is inhibited by o2 during polymerization
& is wear prone & may cause leakage : so glycerin or oxyguard is
applied around restoration before light curing of resin cement
4Take impression> apply separating agent as glycerin & air dryness
to prevent bonding of provisional restoration to tooth& allow easy
removal of temp. cement by pumice without endangering IDS
5- Final cementation:
A. Selective E etching: only E by 37% H2SO4-acid for 15 s ( no need for
etching D as hybrid layer is already formed, but we do etching in
conventional bonding with no IDS to remove smear layer,
demineralize D& expose collagen
B. Apply bonding agent on both E& D > air thinning& curing: where
phosphate ester gr bond chemically to Ca of E & to BIS-GMA of
resin which infiltrated in D
N.B, Curing of bonding agent separately then resin cement curing to
avoid tearing of uncured resin away of tooth during polymerization of
cement
Conservation of tooth
1- P.C
structure:
More conservative than F.C restoration
2- Conservative F.L
• Design:
Deep chamfer more
conservative than
shoulder
• Location:
Avoid unnecessary apical 1
extension of preparation: 2
Supra-ging. more
conservative than 1: Supraging. FL
subging. F.L 2: Subging. FL
3- Conservative axial
reduction: Avoid over axial
convergence
3 2
1
1 2
1:Optimum stone 1- Optimum
direction reduction
2: Over
4- Conservative occ.
reduction:
Anatomical/planner reduction
following occ. anatomy & cusp planes : provide
occ. clearance without endangering pulp &
provide corrugated effect which allow uniform
thickness of restoration over cusp tip same as
over fossae & grooves
1
2
33
(1 & 2) Incorrect flat occlusal preparation:
(1) Insufficient clearance. (2) Excessive amount of
reduction.
(3) Anatomical reduction
Considerations affecting future dental health
1) Axial:
Adequate axial
reduction
In case :
of Inadequate reduction one of 2
scenarios may occur
Under contoured restoration
Thin, weak rest. > forced, traumatic food
deflection> ging. recession, inflammation & Pd.
disease
Over contoured restoration:
Plaque accumulation> ging. & Pdl. disease: poorer
prognosis than under contouring
cause of more difficult plaque control
Thin, under Bulky, over contoured
contoured
2)Occlusal
Excessive occ. reduction
Required in some cases of
• Tilting
• Over eruption
………..To avoid traumatic
occlusion.
3)Preventing tooth fracture.
Inlay > conservative than Onlay
but ↑ wedging & tooth fx.
fx
Inlay Onlay
4)Margin integrity
a-Adaptation:
• Even, smooth margin
↑ margin fit
• Rough, irregular
↑ margin discrepancy > dissolution of cement &
leakage of bact., saliva & fluids → caries & pulp
irritation
• Clinically accepted margin discrepancy
According to literature → 50 – 70 µm of metal
casting & 50 – 200 µm for ceramic rest.
b-Location:
1) Sub gingival:
↑ Esthetic, ↓ Hygienic due to:
Encroach epith. attachment during prep.
Ging. retraction which may be traumatic
Ging. recession as reported in 60% of cases 2-y
after cementation
≃ 0.5 – 1 mm beneath ging. crest & 2 – 3 mm
from alveolar bone
Sub gingival F.L
indications
Labial of M/C in esthetic region → hide
metal collar beneath ging. crest.
All ceramic & ↑↑ esthetic
demands
Short prep. → ↑ retention
Sub gingival F.L
indications
Cervical caries, abrasion, rest. → to rest margins on
sound tooth structure.
Deep prox. contact which extend to ging crest
Cervical ferrule of RCT tooth
Rt. exposure & hypersensitivity which can’t ttt-ed by
bonding agent (as conservative approach)
b-Location:
2) Supragingival
↓ Esthetic
↑ Hygienic………Due to:
Accessible during prep.→ no injury of S.T
Accessible during imp.→ no reaction or
injury of S.T
Accessible during margin evaluation: try-in/
periodic recall visits
Accessible cementation & removal of excess
Accessible during cleaning by Pt.
Uses:
All ceramic restoration
M/C with collarless
design: shoulder porcelain
Labial of conventional M/C in case of
low lip line & patient acceptance
Controversy:
Traditional theories
C.I due to ↑ plaque accumulation at ging.
Margin of restoration ↑ ging inflammation
Recent theories
Accept this with recently available restorations of ↑
finished, polished margins & recent tech. of fabrication
providing improved margins adaptation options.
C- Margin geometry
Featheredge. Chisel Chamfer. Bevel sloped shoulder Beveled
. Shoulder shoulder.
c)Geometry:
Feather edge: Shoulder-less: knife edge Full
metal swaged crown: just removal of height
of contour
Chisel F.L:
Full metal crown : tilted of lower molars,
or highly convex axial surfaces to avoid
pulp exposure, made
by ultra fine tapered stone.
Chamfer:
Full metal /or metal portion of M/C (0.3–0.5 mm)
by tapered stone with rounded end, Torpedo
diamond
Conservative, allow adequate
bulk of restoration
½
Shoulder:
• All ceramic
• Facial of veneered M/C especially if
shoulder porcelain
• (0.8 – 1 mm) by tapered with flat
end.
Criteria:
Sharp internal line angle…so better
↓ conservative
alternatives are:
Deep chamfer:
More recommended by authors
because more conservative (0.8
mm)
….but ↑ risk of unsupported E – lip.
Radial: Rounded shoulder:
shoulder with rounded internal line
angle; roundation is done by
chisel or radial finishing hand
bur
metal
Shoulder with bevel
Facial of M/C with metal collar
porcelain
…..but
less useful with base metals
of burnishing ability
Deep extension in sulcus,
Weakening of margin.
120◦ – Sloped shoulder
Facial of M/C with metal collar