Ministry of Higher Education

& Scientific Research

Middle Technical University
Baghdad/techniques Medical & College of Health

Branch: Department of Prosthodontics Technology

Subject:Crown&Bridge

Seminar number : 4

principles Of tooth preparation

Biological consideration

Supervisory
‫سهى فاضل‬.‫صبيحة مهدي‬.‫د‬

Done by:
)‫نضال محمد بخيت (صباحي‬
)‫احمد عصام ( مسائي‬
Adequate tooth preparation is essential for the fit of fixed prosthodontics.
Insufficient tooth preparation appears to be responsible for premature
failures due to biological aspects, such as caries and endodontic or
periodontal disease complications. The purpose of a fixed prosthodontic
therapy may vary from the restoration of a single tooth to the rehabilitation
of the complete occlusion. Successful preparations can be obtained by
systematically following these steps. It is important to critically evaluate
each step before proceeding to the next step to ensure an optimal quality
final restoration, which will serve the patient for a long time.

Tooth preparation may be defined

•The mechanical preparation of the remaining tooth structure, which

enables it to accommodate a restorative material without incurring
mechanical or biological failure. (Marzouk)

The principles of tooth preparation can be divided into three

broad categories:

1. Biologic consideration: which affect the health of the oral tissues.

2.Mechanical considerations: which affect the retention and the
resistance form and resistance to deformation.
3. Esthetic considerations: which affect the appearance of the
patient.

1_Biologic consideration that include;

_ Conservation of tooth structure:
_Prevention of damage during tooth preparation to:
 a) The adjacent tooth.
b) Soft tissue.
c) The pulp.
_Preservation of periodontal tissue:
__________________________________________________
A_ Conservation of tooth structure:
•In addition to replacing lost tooth structure, a restoration must
preserve remaining tooth structure.

•Intact surfaces of tooth structure that can be maintained while

producing a strong, retentive restoration should be saved if patient
acceptance and retention requirements will permit it.

•Preservation of 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.

•One of the basic tenets of restorative dentistry is to conserve as much

tooth structure as possible because the excessive cutting leads to :

a) Thermal hypersensitivity, pulpal inflammation and may be lead to

necrosis.
b)The tooth might be over tapered or shortened and thus affecting the
mechanical properties (retention and resistance) of the prepared
tooth.

B_Prevention of damage during tooth preparation to:

a) The adjacent tooth.
b) Soft tissue.
c) The pulp.

a)The adjacent tooth:

Iatrogenic damage to the proximal contact area of adjacent tooth
makes it more susceptible to dental caries. Therefore, a metal
matrix band put around the adjacent tooth for protection may be
helpful but the preferred method is to use a fine, tapered fissure
diamond bur to pass through the interproximal contact area
leaving a slight lip of enamel without causing excessive tooth
reduction.

•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.
•Note that the orientation of the diamond parallels the long axis.
•The enamel should be maintained mesial to the path of the
diamond as the reduction progresses.

b)Soft tissues:
•Damage to the soft tissues of the tongue and cheeks can be
prevented by careful retraction with an aspirator tip, mouth
mirror, or flanged saliva ejector
•Great care is needed to protect the tongue when the lingual
surfaces of mandibular molars are being prepared.
 b) The pulp: Tooth preparations must take into consideration
the morphology and size of the dental pulp chamber.

• Great care also is needed to prevent pulpal injuries during fixed

prosthodontic procedures, Especially complete crown
preparation.

Causes of pulpal damage:

1) Extreme temperature: This is generated by friction

between a rotary instrument and the surface being
prepared, and this depends on:-
a) Excessive pressure
b) Higher rotational speed
c) Type and condition of cutting instrument.
 •This heat can be minimized by the use of water coolant
high speed with light touches.Water coolant is useful
because it cools the tooth and the bur, and removes the
tooth debris from the cutting blades because clogging
reduces the cutting efficiency and generates more frictional
heat.

2) Chemical irritation.
Certain dental materials (bases, restorative resins, solvents,
and luting agents) can cause pulpal damage when applied
to freshly cut dentin. cavity varnish or dentin- bonding
agents will form an effective barrier in most instances but
their effect on the retention of a cemented restoration is
controversial.

3)Bacteria irritation.

Bacteria that either left behind or gained access to the dentin

because of microleakage lead to pulpal damage. Because the
vital pulp resist infection, the common use of antimicrobial agent
such as consepsis after tooth preparation has not been
documented in clinical trial.
3)Preservation of periodontal tissue: which is the most
important considerations for the future dental health:

_The restoration should have proper contact, embrasure form,

occlusion and a healthy occluso-gingival contour otherwise a
persistent gingival inflammation occur. (Difficult to maintain
plaque control by the patient).

Whenever possible the margin of the preparation (finishing line)

should be placed supragingivally.

Margin placement (F.L.): Finishing line can be placed

either:
1. Supragingival: Placing the margin above the gingival
tissue for these reasons:
1. Can easily prepared and finished.
2. To provide good vision for the dentist during preparation.
3. Impression can be easily made.
4. The patient can keep the area clean easily.
5. Most of the time such position is situated on hard enamel.
6. Less destructive.
2. Subgingival: Placing the margin below the gingival tissue
within gingival sulcus. The reasons for placing F.L.
subgingivally, or the factors that influence supragingival
position of finish line are:
1. When the esthetic is a factor.
2. When we need extra retention.
3. When we have carries or filling at the area of finish line.
3. Equigingiva: Placing the margin with in the level of the
gingiva.
Advantages: Similar to supragingival margins, it's easy to
impress and finish equigingival margins because it's not going
below the tissue.
References
➤Fundamentals of Fixed prosthodontics Herbert T. Shillingburg,
Hobo, Whitself, Jacobi, and Brackett. Third Edition
➤Contemporary fixed prosthodontics. Stephen F. Rosensteil,
Martin F. Land and Junhei fjujimoto, Second Edition. ➤ Tylman's
theory and practice of fixed prosthodontics. William F.P. Malone
and David L. Koth. Fifth Edition. >Principles of operative
dentistry-Marzouk, 3rd edition