Metal ceramic & All ceramic

Crown preparation
Made by :
Mennat Allah Hossam Jameel
Fatma El.zahraa Mohamed
Justin latif ramsis tawfik
Ahmed Ali Abdelgawwad Ibrahim
Asmaa Abd El-Aziz Mahrous
Supervised by : Prof.Dr. Amir Azer
Yasmin Mohamed Abdelmohsen
Metal Ceramic Crown
Preparation
Putty index
Before the preparation 2 putty indexes are taken either
intra oral if proper tooth structure present or from wax
up model
One for provisional restoration (temporary crown)
The other one is to assess the preparation and amount
of reduction
Preparation Steps for posterior teeth
Preparation Steps for posterior teeth

Occlusal reduction
1.5 mm non functional cusps
2 mm Functional cusps
with functional cusp bevel

1)Occlusal guiding grooves

using Coarse-grit round-
ended tapered diamond
Fundamentals of Fixed
stone Prosthodontics 4th Edition
2012 Herbert T. Shillingburg jr.
2) Facial reduction using Coarse-grit
flat-ended tapered diamond stone
to give shoulder finish line
3 grooves (center ,mesiofacial
,distofacial)

Fundamentals of Fixed
Prosthodontics 4th Edition
2012 Herbert T. Shillingburg jr.
3) Proximal reduction
using Tapered pointed
ended diamond stone
(short needle stone)
to break contact

4) Lingual reduction using

Coarse-grit tapered torpedo
diamond stone
Fundamentals of Fixed
Prosthodontics 4th Edition
2012 Herbert T. Shillingburg jr.
• Fine-grit flat-end tapered diamond is used for roundation of internal
line angles and any sharp lines should be removed
 Wing Preparation and Wingless preparation

Wing preparation
Shoulder finish line labially
Chamfer finish line lingually
(Prevent rotation , increase resistance,
preservation of tooth structure )

The shoulder and wings should be

lingual to proximal contact so that the
proximal area of ceramic veneer would
have proper translucency
Wingless preparation

Contemporary Fixed Prosthodontics 6th Edition - June 22, 2022 Stephen F. Rosenstiel, Martin F. Land, Robert Walter
Contemporary Fixed
Prosthodontics 6th
Edition - June 22, 2022
Stephen F. Rosenstiel,
Martin F. Land, Robert
Walter
Preparation Steps for Anterior teeth
Preparation Steps for Anterior teeth
Incisal reduction using Coarse-grit flat end
tapered diamond stone
2mm reduction in order not to have any
metal backing in the incisal edge

Contemporary Fixed Prosthodontics 6th Edition - June 22, 2022 Stephen F. Rosenstiel, Martin F. Land, Robert Walter
 Three Guiding grooves on facial
surface one in the center
And one on mesiofacial line angle
and distofacial line angle

Facial reduction is done on 2 planes

Cervical portion parallel to the long axis
The incisal potion follow the normal
facial contour

Contemporary Fixed Prosthodontics 6th Edition - June 22, 2022 Stephen F. Rosenstiel, Martin F. Land, Robert Walter
Contemporary Fixed
Prosthodontics 6th Edition -
June 22, 2022 Stephen F.
Rosenstiel, Martin F. Land,
Robert Walter
 The lingual surface should be
Break contact by using parallel to the gingival one
Tapered pointed ended third of labial surface
diamond stone Cingulum reduction using
(long needle diamond) Coarse-grit football-shaped
diamond stone
1mm
Problems that may occur
from incorrect preparation

1) If the labial surface is not

reduced in 2 planes no enough
space for porcelain lead to
poor esthetics opaque
porcelain may show through
(b) , labial surface may be over
contoured(c) or the pulp may
be exposed(d)
2) Under cut in preparation
3) Sharp angles affect proper
seating of crown
4) Not enough incisal reduction
➢ Indications

1) Teeth need to be completely covered : Teeth with Extensive coronal

destruction due to caries or trauma

2) As a retainer for FPDs and RPDs

3) Occlusal corrections and improvement of function and alignments

(correct minor malinclination)

4) Short clinical crowns

➢Contra-indications
1) Adolescent teeth :where minimal tooth preparation is essential due to large
size of the pulp horns

2) Intact buccal wall :where a more conservative preparation can be used.

3) Patient with bad oral hygiene.

➢ Advantages
1) Visually pleasing: Since PFM crowns have porcelain on the outside, they
are valued for their visual appeal. Porcelain can be matched to the color of
the surrounding teeth and it also has similar visual properties to natural
teeth.

2) Longevity: Both metal and porcelain are extremely durable dental

materials that can easily endure the stress of chewing and years of wear
and tear. Therefore, PFM crowns can last for several years.

3) Affordability: PFM crowns are more affordable while still offering the visual
benefits of an all-porcelain crown.

4) High retentive qualities as all axial walls are included in the preparation vs
partial coverage
➢ Disadvantages
1) Dark Line: Although PFM crowns have a porcelain exterior, they still contain metal. This metal
is visible at the bottom of the crown. Normally the gums cover it, but a dark line can show if
the gums recede.
2) Subgingival margin usually increase the risk of PDL disease ( Violation of Biological width)

3) Possible allergies: People who have metal allergies or are sensitive to metal may have an
allergic reaction to PFM crowns.

4) Removes more natural tooth structure: In order to place a PFM crown, more of the natural
tooth structure must be removed to accommodate this type of crown.

5) Difficulty in creating color translucency : due to dense opaque porcelain

6) Technique-sensitive porcelains may be more liable to ‘devitrification’ which can produce

cloudiness ( this occur due to multiple firing of porcelain )
 All Ceramic Restorations :
• All-ceramic restorations now can
be the most esthetically pleasing
restorations currently available.

• They can be made to match

natural tooth structure accurately
in terms of color, surface texture,
and translucency.

• Well-made all-ceramic
restorations can be virtually
indistinguishable from
unrerestored natural teeth
Designs Of All-Ceramic Restorations :

• All – ceramic crowns.

• All – ceramic bridges.

• Ceramic laminate Veneers.

• Ceramic inlays & onlays.

• Ceramic foundation restoration ( Post & core ).

Tooth Preparation for All-Ceramic
Restorations:
 Tooth Preparation for All-
Ceramic Restorations:
➢ Armamentarium:
➢ Coarse-grit flat-end tapered diamond
➢ Coarse-grit football-shaped diamond
➢ Fine-grit flat-end tapered diamond
➢ Chisels or hatchets

Fundamentals of Fixed
Prosthodontics 4th Edition
2012 Herbert T. Shillingburg jr.
 Tooth Preparation for All-
Ceramic Restorations:
The preparation sequence for a ceramic crown is similar to that for a
metal-ceramic crown; the principal difference is the need for a 1-mm-
wide circumferential chamfer margin (deep chamfer or shoulder)
margin.
 Tooth Preparation for All-
Ceramic Restorations:
➢ Step-by-Step Procedure :
1. Depth-orientation grooves are placed on the labial and incisal surfaces with the
coarse-grit flat-end tapered diamond 1.2 to 1.4 mm labially
2.0 mm deep incisally

2. Incisal (Occlusal) Reduction 1.5 to 2.0 mm of clearance.

Fundamentals of Fixed
Prosthodontics 4th Edition
2012 Herbert T.
Shillingburg jr.
 Tooth Preparation for All-
Ceramic Restorations:
3. Facial And Axial Reduction clearance should be adequate for 1.2 to 1.4
mm porcelain thickness.

4. Lingual Reduction Lingual axial surface (flat-end tapered diamond)

Lingual reduction incisal to the cingulum

(football-shaped diamond)
 Tooth Preparation for All-
Ceramic Restorations:
5. Chamfer Margin Preparation
The completed heavy chamfer margin should be :
• 1 mm wide.
• have a rounded internal angle (Radial shoulder).
• smooth, continuous, and be free of any irregularities.

6. Finishing
• Finish the prepared surfaces to a be smooth.
• Round any remaining sharp line angles.
• The shoulder margin should be as smooth as possible.
Contemporary Fixed Prosthodontics 6th Edition - June 22, 2022 Stephen F. Rosenstiel, Martin F. Land, Robert Walter
All-Ceramic Crown Preparation Can Present Several
Challenges, including :
➢ Inadequate Occlusal Reduction insufficient space for the bulk of ceramic leading
to weak areas prone to fracture.
➢ Inadequate Preparation of Axial Walls overcontoured crowns and compromises
both esthetics and self-cleansing design of the restoration.
➢ Lack of Uniform Anatomic Reduction affect both of strength and esthetics.

➢ Sharp Line Angles cause undue stresses, initiate fracture and may cause fit
problems.

➢ Beveled or Feather Finish Lines chipping or bulk fracture.

➢ Indications
• Anterior crowns and bridges
• Discolored teeth
• The need for recontouring axial surface or correct minor
malinclination
• Where there’s favorable distribution of occlusal load ( centric contact
at middle third of palatal surfaces of anterior teeth > porcelain is
supported by tooth structure )
• When there’s enough tooth structure to support the restoration
➢ Contraindications
1. Unfavorable distribution of occlusal load as in edge to edge relation
ship , deep bite or parafunctional habits
2. More conservative restoration can be used as laminated veneer or
composite filling
3. Superior strength of metal ceramic crown is needed
4. Short clinical crowns as abutments ( connector size is 4x4 mm > in
short crowns , may impinge on the interdental papilla causing
inflammation)
5. Thin teeth faciolingually ( better to use pfm due to the conservative
palatal reduction )
 Advantages Disadvantages
1. Superior esthetics and translucency due to
absence of metal substrate and opaque porcelain 1. Reduced strength
2. Biocompatible even with subgingival placement compared to pfm due to its
due to its smooth surface without joint between
metal and ceramic poor ability to withstand
3. More conservative reduction of facial and incisal tensile and shear force
/occlusal surfaces ( 1 mm )
4. high color stability 2. Could cause wear at the
5. low thermal conductivity it is 300 times less than surfaces of opposing natural
metal so it give less pulp sensitivity teeth
6. Subgingival preparation isn’t required unless
there’s another indication ( if short clinical
crowns or cervical caries or restoration present )
7. Its radiodensity is similar to that of enamel so it
could show coronal structure
 Overview of Available All-
Ceramic Systems
1. Conventional feldspathic porcelain jacket crown constructed on platinum foil.
2. High-strength ceramics (1987)
3. In-Ceram : slip casting crown (1989) In-ceram Spinell (VITA In-ceram)
In-ceram Zirconia
4. Heat-Pressed Ceramics Leucite Based: IPS Empress (Ivoclar Vivadent)
Lithium Silicate Based: IPS e.max (Ivoclar Vivadent)
5. Machined and Sintered Ceramics : Zirconia Ceramics.
6. CAD/CAM system.
 Types of all ceramics

They are classified according to microstructure into :

1) Glass based ceramics with no fillers
2) Glass based ceramics with fillers
3) Crystalline based ceramics infiltrated by glass
4) Polycrystalline
 Types of all ceramics
Category Glass based Ceramics Glass based Ceramics
With no fillers with Fillers
Type Fieldspathic Porcelain Leucite Lithium disilicate based
Based
Description Mainly made of silicon dioxide Leucite crystals Lithium disilicate crystals
( silica ) dispersed in glass matrix providing more loading of
crystalline phase in glass
base
Transluceny The most translucent Good translucency - Good transluceny
( three degrees of opacity )
but less than Fieldspathic
Strength Weak and brittle Higher strength than Three times stronger than
Fieldspathic leucite based
Example ( Vita Mark II , vita North ( IPS Empress , Ivoclar ( IPS Emax Press
America ) Vivadent ) IPS Emax CAD , Ivocalr
( Cerec blocs C , Dentsply ( OPC , Pentron Clincal ) Vivadent )
Sirona ) ( OPC 3G , Pentron Clinical )
( IPS Classic ,Ivoclar Vivadent )
 Category Crystalline based ceramics infiltrated by Polycrystalline
glass
Type Inceram Inceram Inceram Zirconia
Alumina Spinell Zirconia
Description 85% alumina Contains Glass infiltrated Polycrystalline monophase ceramic
crystals magnesium alumina core without any glass component
infiltrated by spinell with 35% ( sintering crystals together without any
glass ( MgAl2O4 ) zirconia and 65% interveneing matrix )
alumina
Transluceny Good Higher Less translucent Pure zirconia is opaque
Types of zirconia improving translucency :
Transluceny translucency
1) Veneering zirconia with porcelain
than inceram 2) Full contour monolithic zirconia
alumina ( Monochormatic )
3) Ultra-Translucent zirconia
4) Multilayered zirconia

Strength Five times less strength 1.5 times Highest strength of all ceramic
stronger than than inceram stronger than materials
Fieldspathic alumina inceram alumina
Example Vita Inceram Vita Inceram Vita Inceram ( IPS Emax ZirCAD , Ivoclar Vivadent )
Alumina Spinell Zircona ( LAVA , 3M ESPE ) , ( VITA YZ )
 Hybrid Ceramics
Description Recent type of ceramics combining
ceramic with resin

Strength It combines the strength of ceramics

with resiliency of resin
Example VITA ENAMIC
Vertical preparation
Indications of vertical preparation:
1. Deep margins
2. Periodontally affected teeth (Recession)
3. Deciduous teeth
4. Retreatment of old restorations
Prosthetic procedures
• 1. Diagnosis and examination
• 2. Periodontal assessment
• 3. Vertical preparation
• 4. Temporization
• 5. Impression recording
• 6. Laboratory procedures
• 7. Cementation
Materials can be used:
• 1- Monolithic zirconia
• 2- Zirconia reinforced glass
ceramic
• 3- Lithium silicate
References
• Contemporary Fixed Prosthodontics 6th Edition - June 22, 2022 Stephen F. Rosenstiel, Martin F.
Land, Robert Walter
• Fundamentals of Fixed Prosthodontics 4th Edition 2012 Herbert T. Shillingburg jr. / David A.
Sather / Edwin L. Wilson jr. / Joseph R. Cain / Donald L. Mitchell / Luis J. Blanco / James C. Kessler
• Ashour, A.M., El-Kateb, M.M. & Azer, A.S.The effect of two preparation designs onthe fracture
resistance and marginaladaptation of two types of ceramic crownsusing CAD/CAM technology (In
vitrostudy). BMC Oral Health 24, 1065 (2024).https://doi.org/10.1186/s12903-024-04742-4
• Loi I, di Felice A. (2013) Biologically orientedpreparation technique (BOPT): A newapproach for
prosthetic restoration ofperiodontically healthy teeth. TheEuropean Journal of Esthetic Dentistry
8,10-23.
• Abdulazeez MI, Majeed MA. Fracture strength of monolithic Zirconia crowns with Modified
Vertical Preparation: a comparative in Vitro Study. Eur J Dent. 2022;16:209–14.
• Kasem, Ammar & Ellayeh, Mohamed & Özcan, Mutlu & Sakrana, Amal. (2022). Three-year clinical
evaluation of zirconia and zirconia-reinforced lithium silicate crowns with minimally invasive
vertical preparation technique. Clinical Oral Investigations. 27. 10.1007/s00784-022-04779-1.
• Comparison of horizontal and vertical methods of tooth preparation for a prosthetic crown.P
Łabno, K Drobnik - Journal of Pre-Clinical and Clinical …, 2020 –