FDP Anterior

PRINCIPLE OF TOOTH
PREPARATION: ANTERIOR
FDP
Learning outcomes:
By the end of this lecture the student should be able to:
 Describe the principles of all ceramic abutment
preparations for anterior FDPs.
 Describe the esthetic consideration for FDP in the
anterior region.
 Identify the suitable margins preparations for anterior
abutments.
 Compare and contrast between ceramo-metal and all
ceramic anterior restorations
Introduction
■ The all-ceramic restoration is capable of producing
the best esthetic effect of all dental restorations.
■ No underlying metal to block light transmission,
they can resemble natural tooth structure better in
terms of color and translucency than any other
restorative option.
■ However, because it is made entirely of ceramic,
(brittle), it is more susceptible to fracture.
■ The interest in these type of all ceramic FDP has
increased with the use of lithium disilicate and
zirconia
Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

from https://bookshelf.vitalsource.com/#/books/978-0-86715-636-2/
Introduction
■ The position of the tooth in the arch, factors
relating to occlusion, and morphologic features
of the tooth all should be weighed when an all-
ceramic is considered for a restoration.
■ All-ceramic restorations are best suited for use
on incisors.
■ If they are used on other teeth, patients should
know that there is an increased risk of fracture.
■ Their susceptibility to fracture, can however be
lessened by use of the resin-bonded technique
and higher strength ceramics.

All Ceramic Fixed Denture Prosthesis
■ The dimensions of the preparation of an anterior
all ceramic abutment should be kept as long as
possible, to give maximum support to the
porcelain.
■ An over-shortened preparation will create stress
concentrations in the labiogingival area of the
crown, which can produce a characteristic half-
moon fracture in the labiogingival area of the
restoration

■ The original technique (first developed more than
100 years ago) called for a platinum foil matrix to
be intimately adapted to a die.
■ This supported the porcelain during firing and
prevented distortion. The foil would be removed
before cementation of the restoration.

■ The incisal edge should be prepared flat and placed
at a slight inclination toward the linguogingival to
meet forces on the incisal edge and prevent
shearing.
■ The retainer should also have reasonably uniform
thickness circumferentially.

Rosenstiel, S., Land, M., Fujimoto, J. Contemporary Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved
from https://bookshelf.vitalsource.com/#/books/9780323080118/
■ Incisally, a greater ceramic thickness is helpful,

especially when the restoration needs to exhibit
translucency, hence the 1.5-2mm incisal clearance.

■ All sharp angles of the preparation should be
rounded to reduce the danger of fracture
caused by points of stress concentration

■ Use of the all-ceramic anterior restorations
should be avoided on teeth with an edge-to-edge
occlusion that will produce stress in the incisal
area of the restoration.
■ It likewise should not be used when the opposing
teeth occlude on the cervical fifth of the lingual
surface.

■ Teeth with short crowns also are high risks for
all-ceramic crowns because they do not have
enough preparation length to support the lingual
and incisal surfaces of the restoration.

Advantages
■ Superior esthetics in comparison with metal-ceramic
crowns,
■ Excellent translucency (similar to that of natural tooth
structure),
■ A generally good soft tissue response.
■ Lack of a metal substructure enables slightly more
conservative reduction of the facial surface than is
necessary for a metal-ceramic crown.

Advantages
■ The appearance of the completed restoration can be
influenced and modified by the use of different colors
of luting agent (Depending on the inherent
translucency of the chosen material.

Disadvantages
■ Reduced strength of the restoration because of the
absence of a reinforcing metal substructure.
■ Porcelain brittleness, in combination with the lack of
a reinforcing substructure, necessitates the
incorporation of a circumferential support with a
shoulder margin.

Must have
■ A high esthetic requirement, where a more
conservative restoration would be inadequate.
■ Intact sufficient coronal structure to support the
restoration, particularly in the incisal area, where
porcelain thickness must not exceed 2 mm; otherwise,
the brittle material will fail.

Must have
■ Favorable occlusal load should be distributed
■ Centric contact must be in an area where the
porcelain is supported by tooth structure (i.e., in
the middle third of the lingual wall)

Contraindications
■ When a more conservative restoration can be used
■ If occlusal loading is unfavorable particular edge to
edge bite.

Contraindications
■ When not possible to provide adequate support or an even
shoulder margin width of at least 1 mm circumferentially
■ Short clinical crowns often do not offer adequate support
for all-ceramic FDPs

Anterior all ceramic abutment:
The preparation
■ Depth-orientation grooves are placed on the labial
and incisal surfaces with the coarse-grit flat-end
tapered diamond before any reduction is done.
■ The grooves are 1.2 to 1.4 mm deep on the labial
and 1.5-2.0 mm deep on the incisal.
The preparation
■ Three labial orientation depth cuts are made with
the diamond held parallel to the gingival one-third
of the labial surface.
■ A second set of two grooves is made parallel to the
incisal two-thirds of the uncut labial surface.
Flat-end tapered diamond

6847-016
The preparation
The three labial orientation depth cuts can also be
made with a round-end tapered diamond.
Round-end tapered diamond 6856-016

The preparation
■ The labial surface of an all-ceramic preparation

is done in two planes to achieve adequate
clearance for good esthetics without encroaching
on the pulp.

The preparation
■ Incisal reduction is done with the coarse-grit flat-
end tapered diamond, approximately 1.5 to 2.0
mm of tooth structure is removed

The preparation
■ The gingival portion of the labial surface is reduced
with the coarse-grit flat-end tapered diamond to a
depth of 1.2 to 1.4 mm, and verify that at least 1 mm
of clearance is adequate of porcelain thickness.
■ This reduction extends around the labioproximal line
angles and fades out on the lingual aspects of the
proximal surfaces
The preparation
■ The end of the coarse-grit flat-end tapered diamond
bur will form the shoulder finish line.
■ The axial reduction is done with the sides of the
diamond.
■ The shoulder should be a minimum of 1.0 mm wide.
The preparation
Shoulder With A Beveled Finish Line ?!
• Some believe a beveled shoulder make a better

crown fit!
• While acceptable to use but it does not make the
crown fit better and does not work well with a
porcelain margin
The preparation
■ Lingual reduction incisal to the cingulum is done with the
coarse-grit football-shaped diamond,
■ Ensure adequate clearance of 1mm in all mandibular
excursive movements for room for the porcelain in all
load-bearing areas
■ Careful not to overreduce the junction between the
cingulum and the lingual wall (apical to the cingulum).
■ Overshortening the lingual wall will reduce the retention
of the preparation.
The preparation
• Repeat the shoulder margin preparation, until the lingual
shoulder margin meets the facial shoulder margin.
• This margin should follow the free gingival crest and
should not extend too far subgingivally (equi-gingival or
0.5mm subgingival in healthy gingival tissues).
• It is recommended to initial place margin slightly above
the intended endpoint, then bring to the final point as the
esthetic demands (equi-gingival or 0.5mm subgingival in
healthy gingival tissues).

The preparation
■ The radial shoulder is at least 1.0 mm wide and
should be a smooth continuation of the labial and
proximal radial shoulders.
■ All-ceramic crowns made over shoulder finish lines
exhibit greater strength than those made over
chamfers.

Ideal All Ceramic Fixed Denture Prosthesis
■ A shoulder of uniform width (approximately 1
mm) is used as a gingival finish line to provide a
flat seat to resist forces directed from the incisal
■ The occlusal reduction of the abutment teeth
was 1.5 to 2.0 mm.
■ The convergence angle of the preparation was
6–8°.
Ideal All Ceramic Fixed Denture Prosthesis
■ All axial walls should be smoothed with a fine-

grit flat-end tapered diamond or a carbide rotary
instrument of choice, accentuating the shoulder at
the same time.
■ All sharp angles should be rounded over at this
time.
■ A chisel is used to smooth the shoulder, removing
any loose enamel rods at the cavosurface angle.
■ Care must be taken not to create undercuts in the
axial walls where they join the shoulder.

The preparation
Lingual Aspect Labial Aspect

Things to consider in an FDP
■ Tooth preparation for fixed partial denture (FPD)
abutments is identical to single units but with the
following additional considerations:
– Parallelism – all abutment teeth should have the same
path of insertion/withdrawal.
– Connector dimensions – are the weakest link of FPD
frameworks, and their dimensions depend on the type of
restorative material.
– Cast metal or titanium frameworks require less surface
area for connectors than ceramics, e.g. 12–20 mm2 is
necessary for glass ceramics, 9–16 mm2 for alumina and
zirconia and 6.25 mm2 for porcelain fused to metal;
– Pontic design and size
Pontic Designs
Ovate
■ The ovate pontic is a round-end design currently in
use where esthetics is a primary concern.
■ Its convex tissue surface resides in a soft tissue
depression or hollow in the residual ridge, which
makes it appear that a tooth is literally emerging from
the gingiva.
Shillingburg, H. T., Jr. (04/2012). Fundamentals of Fixed Prosthodontics, 4th Edition [VitalSource Bookshelf version]. Retrieved from
vbk://978-0-86715-636-2.
Rosenstiel, S., Land, M., Fujimoto, J. (072015). Contemporary Fixed Prosthodontics, 5th Edition [VitalSource Bookshelf version].
Retrieved from vbk://9780323080118
Path of insertion
Alert !
■ Proper preparation design is critical for mechanical
success. A 90-degree cavosurface angle is needed to
prevent unfavorable distribution of stresses and to
minimize the risk of fracture.
■ The preparation should provide support for the
porcelain along its entire incisal edge, unless the
ceramic system chosen includes a high-strength core.
Incisal loading leads to tensile stresses near the margin if the forces are
not reciprocated (arrows), may cause brittle failure.
Anterior metal-ceramic crowns
■ It remains one of the most widely used offering a

predictable esthetic result, coupled with sound
physical properties.
■ Metal-ceramic crowns consist of a complete-
coverage metal crown (or substructure) that is
veneered with a layer of fused porcelain to mimic
the appearance of a natural tooth.

■ Only when a crown is sufficiently thick can the

darker color of the metal substructure be masked
and the veneer duplicate the appearance of a
natural tooth.

■ The porcelain veneer over the metal must have a

certain minimum thickness for esthetics.
■ Consequently, much tooth reduction is
necessary, and the metal-ceramic preparation is
one of the methods least conservative of tooth
structures

Compare and contrast between ceramo-
metal and all ceramic: The evidence
■ In a meta-analysis, the 5-year survival of metal–ceramic
FDPs was significantly higher with 94.4% [95 confidence
interval (CI): 91.1–96.5%] than the survival of all- ceramic
FDPs, being 88.6% (95 CI: 78.3–94.2%).
■ The frequencies of material fractures (framework and
veneering material) were significantly higher for all-
ceramic FDPs (6.5% and 13.6%) compared with those of
metal–ceramic FDPs (1.6% and 2.9%).
■ Other technical complications like loss of retention and
biological complications like caries and loss of pulp vitality
were similar for the two types of reconstructions over the
5-year observation period.
Sailer I, Pjetursson BE, Zwahlen M, Hämmerle CH. A systematic review of the survival and complication rates of all-ceramic and
metal-ceramic reconstructions after an observation period of at least 3 years. Part II: Fixed dental prostheses. Clin Oral Implants
Res. 2007 Jun;18 Suppl 3:86-96.
Compare and contrast between ceramo-
metal and all ceramic: The evidence
■ The most frequent reason for failure of ceramic

FDPs was fracture of the framework and/or
veneering ceramic.
■ However, when zirconia was used as framework
material, the reasons for failure were primarily
biological and technical complications other than
framework fracture.
Conclusions
•The main reason to use of the all ceramics instead of

metal-ceramics is based on more favorable esthetics. All-
ceramic materials mimic very naturally the optical
properties of teeth.
•Another more recent factor influencing the choice of
materials and leading to an increasing use of all-
ceramics is treatment costs, mostly due to the costs for
high precious metals.
■ https://oasisdiscussions.ca/2015/06/22/12504/
■ [1] Pjetursson BE, Sailer I, Zwahlen M, Hammerle CH. A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of
at least 3 years. Part I: Single crowns. Clin Oral Implants Res 2007;18(Suppl. 3):73–85.
■ [2] Sailer I, Pjetursson BE, Zwahlen M, Hammerle CH. A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of
at least 3 years. Part II: Fixed dental prostheses. Clin Oral Implants Res 2007;18(Suppl. 3):86–96.
■ [3] Edelhoff D, Brix O. All-ceramic restorations in different indications: a case series. J Am Dent Assoc 2011;142(Suppl. 2):14S–9S.
■ [4] Walton TR. Making sense of complication reporting associated with fixed dental prostheses. Int J Prosthodont 2014;27:114–8.
Conclusions
• While metal-ceramics remained to be the
“gold standard” type of reconstruction. Yet, a
high number of new manuscripts of all-
ceramic single- and multiple-unit FDPs was
published since the mentioned systematic
review by Sailer et al 2007.
■ https://oasisdiscussions.ca/2015/06/22/12504/
■ [1] Pjetursson BE, Sailer I, Zwahlen M, Hammerle CH. A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of
at least 3 years. Part I: Single crowns. Clin Oral Implants Res 2007;18(Suppl. 3):73–85.
■ [2] Sailer I, Pjetursson BE, Zwahlen M, Hammerle CH. A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of
at least 3 years. Part II: Fixed dental prostheses. Clin Oral Implants Res 2007;18(Suppl. 3):86–96.
■ [3] Edelhoff D, Brix O. All-ceramic restorations in different indications: a case series. J Am Dent Assoc 2011;142(Suppl. 2):14S–9S.
■ [4] Walton TR. Making sense of complication reporting associated with fixed dental prostheses. Int J Prosthodont 2014;27:114–8.
Thank you
Photo by Gustavo Yoneya on Unsplash

FDP Anterior

Caricato da

Informazioni sul documento

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

FDP Anterior

Caricato da

Copyright:

Formati disponibili

PRINCIPLE OF TOOTH

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

■ Incisally, a greater ceramic thickness is helpful,

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Flat-end tapered diamond

Round-end tapered diamond 6856-016

■ The labial surface of an all-ceramic preparation

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

• Some believe a beveled shoulder make a better

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

■ All axial walls should be smoothed with a fine-

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

Lingual Aspect Labial Aspect

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

■ It remains one of the most widely used offering a

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

■ Only when a crown is sufficiently thick can the

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

■ The porcelain veneer over the metal must have a

Shillingburg, H. T., Jr. Fundamentals of Fixed Prosthodontics. [VitalSource Bookshelf]. Retrieved

■ The most frequent reason for failure of ceramic

•The main reason to use of the all ceramics instead of

Photo by Gustavo Yoneya on Unsplash

Potrebbero piacerti anche