FPD NOTES:

CHAPTER 8: Tooth Preparation for

Ceramic Restoration
●​ Bonding to enamel is more predictable than bonding to dentin. In addition, a reliable
adhesive bond is more readily achieved on clean and healthy tooth structure than on
sclerotic, decalcified, or discolored tooth structure.
●​ Tooth preparations with slightly rough axial walls enhance micromechanical retention
when classic water-based luting agents are used. Tooth preparation roughness does not
provide improved retention with contemporary adhesive luting agents.
●​ Currently, it is desirable to have a smooth finish on the tooth preparation. A smooth
preparation surface improves the accuracy of fit, delivers a thinner cement space, and
promotes less microleakage.
●​ The most popular current etchable ceramic routinely used for anterior and posterior
ceramic restorations is lithium disilicate.
●​ The design of the occlusion on an all ceramic crown is crucial to avoid fracture.
●​ Centric contacts are best confined to the middle third of the lingual surface.
●​ Anterior guidance should be smooth and consistent with contact on the adjacent teeth

90 degree but joint for inlays and shoulder margin for onlays.

Incisal (Occlusal) Reduction

• Incisal edge reduction should provide 1.5 to 2.0 mm clearance for porcelain in
all excursive movements of the mandible.
• Posterior teeth (rare), 2 mm of clearance is needed on all cusps
Depth grooves are initially kept at 1.3mm occlusally and are further extended during finishing.
Facial and lingual grooves - 0.8mm which after finishing will be around 1mm.
Subgingival Margin Preparation
• For sub gingival margins, displace the tissue with cord before proceeding with the chamfer
margin preparation.
CHAPTER 9: The Complete Cast
Crown Preparation
All-metal complete cast crown should always be considered for patients requiring restorations
for badly damaged posterior teeth. Longevity of complete cast crowns is superior to that of all
other fixed restorations.
• Such a crown can be used to restore a single tooth or as a retainer for a fixed dental
prosthesis. It covers all axial walls and the occlusal surface of the tooth.

INDICATIONS
Extensive destruction from caries or trauma
• Endodontically treated teeth
• Existing restoration
• Necessity for maximum retention and strength
• To provide contours to receive are movable appliance
• Other recontouring of axial surfaces (minor corrections of mal inclinations)
• Correction of occlusalplane

CONTRAINDICATIONS:
The complete crown is contraindicated if treatment objectives can be met with a more
conservative restoration.
For wherever the buccal or lingual wall is intact, the use of a partial-coverage restoration should
be considered
Similarly, if a removable partial denture is planned and an adequate buccal contour exists or can
be obtained through enamel modification (enameloplasty), a complete crown is not warranted.
If high aesthetics are required, a complete metal crown is also contraindicated.

1.​ Axial Reduction/Margin: 0.5 mm

2.​ Non functional cusp: 1mm
3.​ Functional cusp: 1.5mm

●​ Axial reduction should parallel the long axis of the tooth but allow for the recommended
6-degree taper
●​ Ideal margin: Supra gingival chamfer margin
●​ The functional cusp bevel is placed at an angle of approximately 45 degrees to the
long axis of the prepared tooth.

PREPARATION
• Step-by-Step Procedure
1.​ Occlusal depth grooves
2.​ Occlusal reduction and functional cusp bevel
 3.​ Axial alignment grooves
4.​ Axial reduction
5.​ Finishing and evaluation

CHAPTER 10: The Ceramic-Veneer

Crown Preparation
Ceramic-veneered crowns are indicated on teeth that require complete coverage and for which
esthetic demands are significant (e.g., the anterior teeth).

Here are some multiple-choice questions (MCQs) based on the information about ceramic-veneered
crown preparation:

1. Which of the following is an indication for a ceramic-veneered crown?

◦A tooth with a small pulp chamber.
◦An intact buccal wall requiring minimal intervention.
◦Superior esthetics is desired.
◦When a more conservative retainer is technically feasible.

2. Which of the following could be a contraindication for a ceramic-veneered crown?

◦The need for improved esthetics.
◦A large pulp chamber.
◦The presence of gingival involvement.
◦When a monolithic ceramic crown is indicated.

3.What is a primary advantage of a ceramic-veneered crown compared to a complete cast crown?

◦Less removal of tooth structure.
◦Increased fracture resistance.
◦Superior esthetics.
◦Simpler preparation technique.

4.What is a primary disadvantage of a ceramic-veneered crown?

◦Limited esthetic potential.
◦Removal of substantial tooth structure.
◦Difficulty in achieving a precise marginal fit.
◦Contraindicated in anterior teeth.

5.Which rotary instrument is recommended for the lingual reduction of a maxillary central incisor for
a ceramic-veneered crown?
◦Tapered flat-ended diamond.
◦Tapered round-ended diamond.
◦Football-shaped diamond.
◦Cylindrical tungsten carbide bur.

6.In the recommended sequence of preparation for a maxillary central incisor for a
ceramic-veneered crown, after facial reduction in two planes, the next step is typically:
◦Placing the lingual chamfer margin.
◦Incisal edge reduction.
◦Breaking proximal contact, maintaining a “lip” of enamel.
◦Placing facial depth grooves.

7. A common error during the placement of facial depth grooves for a ceramic-veneered crown is
placing the cervical groove at too labial an angle. This can lead to:
◦Excessive occlusal reduction.
◦Inadequate proximal reduction.
◦Inadequate space for porcelain and creating an undercut.
◦A supragingival margin placement.

8.The lingual chamfer margin for an anterior tooth prepared for a ceramic-veneered crown should
ideally be approximately:
◦1.0 mm.
◦1.5 mm.
◦0.5 mm.
◦2.0 mm.

9.The aim of lingual reduction for a ceramic-veneered crown on an anterior tooth is to achieve how
much clearance in all mandibular excursive movements?
◦0.5 mm.
◦1.5 mm.
◦2.0 mm.
◦1 mm.

10.For short posterior teeth planned for a metal-ceramic retainer, which preparation design offers
better resistance form?
◦Wingless preparation.
◦Preparation with a heavy chamfer margin.
◦Wing-type preparation.
◦Preparation with a supragingival margin.

11.What is an important step after obtaining a satisfactory facial margin in a ceramic-veneered crown
preparation?
◦Refining the proximal contacts.
◦Rounding all sharp line angles within the preparation.
◦Verifying occlusal clearance.
◦Placing additional retentive grooves.

12. Finishing of a shoulder margin for a ceramic-veneered crown can be done with which
instrument?
◦Round-ended diamond bur.
◦Football-shaped diamond bur.
◦Tapered, flat-ended diamond.
◦Flame-shaped finishing bur.

13. Compared to a complete cast crown preparation, a ceramic-veneered crown preparation

generally requires:
◦Less occlusal reduction.
◦A more conservative axial reduction.
◦More reduction overall.
◦Supragingival margin placement only.

14.The buccolingual dimension at the prepared incisal edge for a ceramic-veneered crown is
important because it can affect the:
◦Marginal adaptation.
◦Cement space due to milling unit limitations.
◦Esthetic outcome of the porcelain.
◦Retention of the crown.
15.What is the primary purpose of the functional cusp ledge in a preparation for a ceramic onlay
(mentioned in the context of reduction, implying relevance to bulk which is also a concern in
veneered crowns)?
◦To aid in seating the restoration.
◦To improve marginal adaptation.
◦To provide restoration bulk in a high-stress area, preventing deformation.
◦To increase retention of the restoration.

CHAPTER 14: Tissue Management,

Scanning, and Impression Making.
commonly needed to obtain adequate access to the prepared tooth and to expose all necessary
surfaces, both prepared and not prepared
Mechanical methods
Copper band
Displacement/retraction cord
Rubber dam
Chemico- mechanical method
●​ Displacement/ retraction cord - Al chloride and Ferric Sulphate
Surgical methods
●​ Rotary curettage - done with torpedo diamond bur
●​ Electrosurgical retraction: Not suitable for - Patients with any electronic medical device
(e.G., A cardiac pacemaker,
●​ Transcutaneous electrical nerve stimulation [tens]unit,
●​ Insulin pump),
●​ Thin attached gingivae (e.G., The labial tissue of maxillary canines)
●​ Metal instruments because contact could cause electric shock

Single Cord Technique

single cord technique is the most commonly used gingival retraction technique

●​ indicated when impression of 1-3 prepared teeth is required

Double Cord Technique

●​ indicated when impression of multiple prepared teeth is required
●​ can be used in compromised tissue health
●​ smaller cord placed first
●​ larger cord placed on top
●​ larger cord removed
●​ smaller cord left in sulcus
●​ impression taken with smaller cord still in place

ferric sulphate darkens/ stains the gingival sulcus - MCQferric sulphate darkens/ stains the
gingival sulcus - MCQ

Elastomeric IM
Hydrocolloids: Reversible/irreversible
Polyether hydrophilic
Silicons

Non Elastomeric IM
Impression plaster, wax and compound

Slides
CUSTOM TRAY FABRICATION
• Improves the accuracy of an elastomeric impression by limiting the volume of the material,
thus reducing two sources of error: stresses during removal and thermal contraction
• Made from
• Auto polymerizing acrylic resin,
• Thermoplastic resin, or
• Photo polymerized resins.

Evaluation of Tray
• Custom tray needs to be rigid, with a consistent thickness of 2 to 3 mm.
• Should extend about 3 to 5 mm cervical to the gingival margins
• Should be shaped to allow muscle attachments.
• Should be stable on the cast with stops that can maintain an impression thickness of 2 or 3
mm.
• Must be smooth, with no sharp edges.

Reversible Hydrocolloid
• Requires a special conditioning unit that is made up of three thermostatically controlled water
baths
• A liquefaction (boiling) bath (100°C [212°F]) for the heavy-bodied tray material and the
light-bodied syringe material
• A storage bath (≅65°C [150°F]) for maintaining liquefied materials until they are needed
• A tempering bath (≅40°C [105°F]) for reducing the temperature of the heavy-bodied tray
material enough to avoid tissue damage

Closed-mouth Impression Technique

• Also called the dual-arch or triple-tray technique,
• Impressions for single units and less expensive restorations made to conform to the existing
occlusion.
• Impression is made in maximum intercuspation with a high-viscosity polyvinyl siloxane or
polyether impression material supported by a thin mesh in a frame.

Impression includes
• The prepared tooth,
• The adjacent teeth,
• And the opposing teeth and records their maximum intercuspation relationship - Hence the
name “triple tray”
With the high dimensional stability of polyether, accurate casts can be produced when the
material is poured more than a day after the impression has been made. This is especially
useful when pouring the impression immediately is impossible or inconvenient

IMPRESSION FOR POST AND CORE:

•​ Cut pieces of orthodontic wire to length and shape them like the letter J
•​ Verify the fit of the wire in each canal. It should fit loosely and extend to the full depth of
 the post space. 3. Coat the wire with tray adhesive.
•​ Lubricate the canals to facilitate removal of the impression without distortion (die lubricant
is suitable).
•​ Using a Lentulo spiral fill the canals with elastomeric impression material
•​ Seat the wire reinforcement to the full depth of each post space, use a syringe to fill in more
impression material around the prepared teeth, and insert the impression tray
•​ Remove the impression, evaluate it, and pour the definitive cast

https://docs.google.com/presentation/d/1LTW61NKZcQkk7gWVycZvAd5EbJ-H4zhZ/edit?slide=i
d.p86#slide=id.p86

15 Interim Fixed Restorations, 439

Definition of Interim fixed restoration
• Requirement
– Biological
– Mechanical
– Esthetics

provisional restoration: a fixed or removable dental prosthesis, or maxillofacial prosthesis,

designed to enhance aesthetics, stabilization and/or function for a limited period of time, after
which it is to be replaced by a definitive dental or maxillofacial prosthesis. Such prosthesis is
used to assist in determination of the therapeutic effectiveness of a specific treatment plan or
the form and function of the planned definitive prosthesis

PMMA is the most commonly used material for provisional restorations.

Classification
There are two general categories of ESFs: customized template and preformed.

Method of Fabrication/EXTERNAL SURFACE FORM

●​ prefabricated
●​ custom made

Preparation Surface Form- There are two primary categories of PSFs:

indirect (impression required for lab procedure) and direct (intraoral procedure). A third
category, indirect-direct, is the sequential application of these.
 ●​ direct
●​ indirect
●​ indirect-direct

Material
●​ resin based
●​ metal based
○​ aluminium
○​ stainless steel
○​ tin-silver
○​ nickel-chromium

Time Duration
●​ short term temporary
○​ less than 2 weeks
○​ single crowns
○​ short span bridges
●​ long term temporary
○​ 2 weeks to a few months
○​ periodontally compromised teeth
○​ full mouth rehab
●​ matrix is always required to form the external contours of the provisional restorations;
internal contours can be made with direct or indirect techniques
●​ resin material for provisional restorations is teased out of the patient’s mouth in rubbery
stage

Prefabricated Crowns
●​ available in different shapes, sizes and materials
●​ mostly for single crowns
●​ require relining with autopolymerising or light cure resin for marginal adaptation

Types
1.​ resin based
1.​ cellulose acetate
■​ thin shells that act as matrices
■​ available in various tooth shapes and sizes
■​ can be used in anterior and posterior regions
 ■​ resin loaded onto shell and placed on tooth then polymerised
■​ the shell does not bond to the resin and is removed
■​ the resin that has now become fixed onto the prepared tooth is contoured,
finished and polished
2.​ polycarbonate- has the most natural appearance of all the generic preformed materials.
1.​ anterior and premolar single crowns
■​ not available for molars
2.​ highly colour stable
3.​ highly aesthetic
4.​ only available in one shade
■​ requires shade relining resins to alter colour to match patient’s teeth
5.​ requires extensive reshaping and recontouring to get desired aesthetics
3.​ metal based
1.​ aluminium
■​ posteriors only
■​ shells may be anatomical or cylindrical
1.​ cylindrical require extensive shaping but are less expensive
■​ anatomical crowns preferred
4.​ silver-tin
1.​ posteriors only
2.​ shells may be anatomical or cylindrical
■​ cylindrical require extensive shaping but are less expensive
3.​ anatomical crowns preferred
5.​ nickel-chromium
1.​ rigid
2.​ more durable
3.​ high strength
4.​ indicated for damaged deciduous dentition
5.​ cannot be relined with resin material
6.​ luted with high strength luting cements
7.​ long term provisional
8.​ difficult to adapt
9.​ do not produce good occlusal contacts

metal based prefabricated provisionals are used in posteriors that require

immediate coverage, e.g. fractured molars

●​ There are a variety of luting materials used for interim purposes. The most common
include
(1) calcium hydroxide
(2) zinc-oxide eugenol
(3) non-eugenol materials.

BOX 15.1 Indications for Reinforced Interim Restorations

●​ A long-span posterior fixed partial denture
 ●​ Prolonged treatment time
●​ Patient’s inability to avoid excessive forces on the prosthesis
●​ Above-average masticatory muscle strength
●​ History of frequent breakage

Indirect Direct Technique

●​ matrix fabricated on the diagnostic cast (indirect technique)
●​ resin material filled in the matrix and placed on prepared tooth and allowed to polymerise
(direct technique)
●​ finishing and polishing in the lab after polymerisation is complete

Advantages
●​ best marginal accuracy
●​ least damaging to the pulp

Disadvantages
●​ time consuming
●​ lab help needed for matrix and polishing
8. Alginate impression is recorded before the crown preparation to aid in interim crown
fabrication at chairside. This impression acts as:

a. Pre-formed template ESF

b Custom template ESF

c. Preparation surface form

d. Custom Preparation surface form

e. Internal surface form

9. Which of the following is an indication for Reinforced Interim Restoration:

a. Short span fixed partial denture

b. Anterior crown

c. Prolonged treatment time

d. Missing opposing dentition

e. High esthetic requirements

23 Color, the Color-Replication Process,

and Esthetics, 680
1.​ The patient should be viewed at eye level so that the most color-sensitive part of the
retina will be used.
2.​ Shade comparison should be made under different lighting conditions. Normally the
patient is taken to a window, and the color is confirmed in natural daylight after initial
selection under incandescent and fluorescent lighting.
3.​ The teeth to be matched should be clean. If necessary, stains should be removed by
prophylaxis.
4.​ Shade comparisons should be made at the beginning of a patient's visit. Teeth increase
in value when they are dry, particularly if rubber dam has been used.
5.​ Brightly colored clothing should be draped and lipstick removed. The operatory walls
should not be brightly painted.
 6.​ Shade comparisons should be made quickly, with the color samples placed under the lip
directly next to the tooth being matched. This will ensure that the background of the
tooth and the shade sample are the same, which is essential for accurate matching.
7.​ The dentist should be aware of eye fatigue, particularly if very bright fiber-optic
illumination has been used. The eyes should be rested by focusing on a gray-blue
surface immediately before a comparison, because this balances all the color sensors of
the retina and resensitizes the eye to the yellow color of the tooth.

Hue Selection: Therefore, the region with the highest chroma (i.e., the cervical region of
canines) should be used for initial hue selection.

Value Selection:
●​ By holding the second shade guide close to the patient, the operator should be able to
determine whether the value of the tooth is within the shade guide's range.
●​ Attention is then focused on the range of shade that best represents the value of the
tooth and how that range relates to the tab matching for hue and saturation.
●​ An individual will be able to assess the value most effectively by observing from a
distance, standing slightly away from the chair, and squinting the eyes.
●​ By squinting, the observer can reduce the amount of light that reaches the retina.
Stimulation of the cones is reduced, and a greater sensitivity to achromatic conditions
may result.
●​ While squinting, the observer concentrates on which disappears from sight first-the tooth
or the shade tab. The one that fades first has the lower value.
40.A dentist is preparing for a restorative procedure and needs to select the appropriate shade
for a patient's dental restoration. To ensure a precise match, the dental technician records which
of the following special characteristics of the natural teeth?
a. Areas of high chroma intensity
b. translucent zones
c. Hyper calcifications
d. Crack lines
e. All of the above
 20 Pontic Design, 596

●​ The modified ridge-lap design is the most common pontic form used in areas of the
mouth that are visible during function (maxillary and mandibular anterior teeth, maxillary
premolars, and first molars).
●​ Conical: This design is recommended for the replacement of mandibular pos terior
teeth, for which esthetic appearance is a lesser concern.
●​ Ovate: Highest esthetics

19. A 45-year-old female patient requires a three-unit fixed partial denture to replace her
missing maxillary right central incisor. She is highly concerned about aesthetics but also wants a
design that maintains oral hygiene. Which pontic design is most appropriate for this case? A)
Ridge lap pontic B Modified ridge lap pontic C) Sanitary pontic D) Conical pontic E) Ovate
pontic
20. A 55-year-old male patient presents with a missing mandibular first molar. He has a
history of poor oral hygiene and periodontal disease. Which pontic design is most suitable for
long-term periodontal health? A) Ridge lap pontic B) Ovate pontic C) Modified ridge lap pontic
D.Hygienic (sanitary) pontic E) Conical pontic

21. A patient presents with severe ridge resorption in the maxillary anterior region. The dentist
wants to achieve the best aesthetic outcome while compensating for the lost tissue contour.
Which pontic design is most appropriate? A) Hygienic (sanitary) pontic B) Modified ridge lap
pontic C.Ovate pontic D) Conical pontic E) Saddle and Ridge lap pontic

-​ Factors of specific influence are pontic-ridge contact, amenability to oral hygiene,

and the direction of occlusal forces.
-​ Modified ridge lap is recommended for most anterior teeth. It compensates for lost
bucco-lingual width in the ridge by overlapping the existing ridge.
-​ When esthetics is of utmost concern, the ovate pontic used in conjunction with alveolar
preservation or soft tissue augmentation can provide indistinguishable appearance

29 Evaluation, Characterization, and

Glazing
https://docs.google.com/presentation/d/1Lcy9jSfg6kD8FgpbYKfYEEHQWndqhW94/edit?slide=i
d.p25#slide=id.p25

30 Luting Agents and Cementation

Procedures,
Zinc Phosphate
●​ mechanical interlocking
●​ low water solubility
●​ pH = 2 at the time of cementation
○​ increases to 5.5 24 hours after cementation
●​ the highly acidic pH at the time of cementation can cause pulpal irritation

zinc phosphate is the gold standard cement

Zinc Polycarboxylate
●​ pseudoplastic behaviour
●​ can bond with SS crowns
●​ cannot bond with gold
●​ pH = 4.8
○​ less irritating to the pulp than zinc phosphate. USED IN CHILDREN WITH
LARGE PULP CHAMBERS

Zinc Oxide Eugenol

●​ least irritating to the pulp
●​ temporary cement
●​ eugenol impedes polymerisation of resins

⭐ zinc oxide eugenol is temporary cement - MCQ

Glass Ionomer Cement (GIC)
●​ anticariogenic
○​ releases fluoride
●​ chemical bonding
●​ less soluble than zinc phosphate
●​ post cementation hypersensitivity
●​ calcium hydroxide layer recommended if preparation is close to the pulp
●​ cement at margin should be protected with varnish or petroleum
●​ more translucent than zinc phosphate
○​ metal show through

GIC is the most commonly used cement

Resin Cements
●​ flowable composites
●​ higher strength than conventional cements
●​ very low solubility
●​ chemically activated, light activated or dual cure
●​ dentin bonding agent critical to reduce pulpal sensitivity and microleakage
●​ micromechanical bonding
●​ useful when preparation is confined to enamel and has accessible finish line
●​ luting agent of choice for all ceramic inlays, crowns and bridges

⭐ adhesive resin cements are used for cementation of zirconia crowns - MCQ
 cement uses bonding advantages disadvantages

zinc phosphate cast micromechanic gold standard pulpal irritation

restorations al

cavity varnish used

to reduce pulpal
irritation can reduce
retention

zinc restorations chemical less irritating to lower compressive

polycarboxylate with good the pulp strength than zinc
resistance and phosphate
retention forms

children (large higher tensile cannot bond with

pulp strength than gold
chambers) zinc phosphate

can bond with

SS crowns

more
biocompatible
than zinc
phosphate

zinc oxide temporary least irritating eugenol interferes

eugenol cement to the pulp with resin
polymerisation

stronger cement

glass ionomer most chemical anticariogenic postcementation

cement commonly hypersensitivity
used

cast metal see through

restorations

susceptible to
moisture
contamination during
setting - needs
protection
resin cements all ceramic micromechanic higher strength require dentin
inlays, crowns al than bonding agents
and bridges conventional
cements

Failures in FPDs
1.​ loss of retention
2.​ mechanical failure
1.​ porcelain fracture
2.​ fracture of soldered joints
3.​ distortion
4.​ occlusal wear and perforation
5.​ lost facings
3.​ changes in abutments
1.​ periodontal diseases
2.​ problems with the pulp
3.​ caries
4.​ fracture of the prepared natural crown or root
5.​ movement of the tooth
4.​ design failures
1.​ underprescribed bridges
2.​ overprescribed bridges
5.​ inadequate clinical or laboratory technique
1.​ positive ledge
2.​ negative ledge
3.​ defect
4.​ poor shape and contour
6.​ occlusal problems

Factors in FPD Failures

Biological

●​ caries
●​ pulp degeneration
●​ gingival recession
●​ periodontal breakdown
●​ occlusal problems
●​ tooth perforation
●​ cementation failure
Mechanical

●​ loss of retention
●​ pontic failure
●​ connector failure
●​ occlusal wear
●​ tooth fracture
●​ porcelain fracture

Aesthetic

●​ improper shade selection

●​ failure to identify patient expectation
●​ failure to communicate proper shade to laboratory
●​ opaque layer too thick
●​ thick metal margin at incisal and cervical regions
●​ failure to produce translucency
●​ overcontoured/ undercontoured crown
●​ exposed metal margin in connector, incisal or cervical region
●​ overglazing

⭐ metamerism is a phenomenon in which an object appears to be of different colours in

different light sources - MCQ

What to check for in an FPD

1.​ Proximal contacts

2.​ margins
3.​ stability
4.​ occlusion
5.​ aesthetics

Zirconia/silica based restoration : etch with HF acid

https://docs.google.com/presentation/d/16KGBII4xFwBtY9PQkGxPhtc0xHqBfN4H/edit?sli
de=id.p14#slide=id.p14

Post op care:​
43. A patient returns to the dental clinic with a complaint about their metal-ceramic restoration,
which appears to have failed. Upon examination, the dentist considers possible reasons for the
mechanical failure of the restoration.

a. improper laboratory procedures

b. Excessive occlusal function

c. Trauma

d. Incorrect framework design

e. All of the above

Bad taste and odour after RPD is placed - Loose abutment