PRINCIPLES OF TEETH PREPARATION FOR

FIXED PROSTHODONTICS
Dr Mahmoud Belal

Comprehensive Prosthodontics Clinic 1

PRINCIPLES OF TEETH PREPARATION FOR
CROWNS
• Tooth preparation may be defined as the mechanical treatment of
dental disease or injury to hard tissue that restores a tooth to the
original form (Tylman).

• The mechanical preparation or the chemical treatment of the

remaining tooth structure, which enables it to accommodate a
restorative material without incurring mechanical or biological failure.
(Marzouk)
• The current focus is on conservative tooth preparation that
is
noninvasive and that minimally involves dentin.

• This trend is rational in the light of the reduction of the caries rate
by fluorides, nutritional counseling and oral hygiene
programs. Black’s principles of cavity preparation and Tylman’s
principles of tooth preparation are both presently being
modified to accommodate imaginative approaches i.e., acid
etching with minimum reduction.

• Dentistry is changing from macro tooth preparation to an

environment of molecular chemistry i.e., esthetic bonding. These
techniques are not presently supported by any
longitudinal studies, but are exciting and promising.
Despite these advances,
traditional crowns are still
indicated for majority of patients.
The classic design of the
preparation must be visualized so
that modifications if required can
be instituted.
Diagnosis and disciplined
tooth preparation are essential
to successful fixed prosthetics.
 OBJECTIVES OF TOOTH PREPARATION

The objectives of preparation remain clearly defined,

but the methods of securing these goals are constantly
being revised.

1.Reduction of the tooth in miniature to

provide
retention.

2.Preservation of healthy tooth structure

to
secure resistance form.

3.Provision for acceptable finish line.

4.Performing pragmatic axial tooth reduction

to
encourage favorable tissue responses
 PRINCIPLES OF TOOTH
PREPARATION
(According to Rosenstiel)
BIOLOGIC
MECHANICAL
Conservation of tooth
Retention form
structure
Resistance form
Avoidance of
contouring
over
Supra gingival margins
Harmonious occlusion
Protection against tooth
fracture

ESTHETIC

Minimum display of
metal
Maximum thickness of
porcelain
Porcelain
surfaces Optimal restoration
occlusal
Subgingival margins
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.
 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
Great care is needed to protect the tongue
ejector.
when the lingual surfaces of mandibular molars
are
being prepared.
Pulp
Great care also is needed to prevent pulpal
injuries during fixed prosthodontic procedures,

Especially complete crown preparation.

Pulpal degeneration that occurs many years after tooth preparation
has been documented.
Extreme temperatures, chemical irritation, or microorganisms can cause
an irreversible pulpitis particularly when they occur on
freshly sectioned dentinal tubules.
• Temperature
• Chemical
action
• Bacterial action
 PRINCIPLES OF TOOTH PREPARATION

According to Shillingburg, the design of

a preparation for a cast restorations and the execution
of that design are governed by five principles:

1.Preservation of tooth structure

2.Retention and resistance

3.Structural durability

4.Marginal integrity

5.Preservation of the
periodontium.
 Preservation 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.
This is the rationale for the removal of 1 to 1.5 mm of
occlusal
tooth structure when preparing a tooth for an MOD onlay.

The metal on the occlusal surface can protect against

dramatic
failures,

such as fracture of tooth structure, as well as the less

obvious failures that may be occasioned by the flexing of tooth
structure
Conservation of tooth structure by using partial-coverage restorations. In this
case, they are used as fixed dental prosthetic abutments to replace
congenitally missing lateral incisors.
 Retention and Resistance

• No cements that are compatible with living tooth

structure and the biologic environment of the oral
cavity possess adequate adhesive properties to hold a
restoration in place solely through adhesion.
(Shillingburg)

• The geometric configuration of the tooth preparation

must place the cement in compression to provide the
necessary retention and resistance.
Retention prevents removal of the restoration along
the path of insertion or long axis of the tooth
preparation.

Resistance prevents dislodgment of the restoration by

forces directed in an apical or oblique direction and
prevents
any movement of the restoration under occlusal forces.

Retention and resistance are interrelated and often inseparable

qualities.

The essential element of retention is two opposing vertical

surfaces in the same preparation.
 Tape
r
The axial walls of the preparation must taper slightly to permit
the restoration to seat; ie,
two opposing external walls must gradually converge
or two opposing internal surfaces of tooth structure
must diverge occlusally.

The terms angle of convergence and angle of divergence can be used

to describe the respective relationships between the two opposing
walls of a preparation.

The relationship of one wall of a preparation to the

long axis of that preparation is the inclination of that
wall.
• A tapered diamond or bur will impart an inclination of 2 to 3 degrees to
any surface it cuts if the shank of the instrument is held parallel to the
intended path of insertion of the preparation.
• Two opposing surfaces, each with a 3-degree inclination, would give
the preparation a 6-degree taper.
Prothero (1923) indicated that convergence of peripheral surfaces
should
range from 20-50.
Jorgensen (1955) found that retention decreases as the taper increases. A
range of 2-6.50 has been considered to be optimal. He tested the retention
of crowns at various angles by applying a tensile force on cemented
crown. Maximum strength was obtained at 50.
Mack (1980) estimated that a minimum taper of 120 is necessary just
to ensure the absence of undercuts. The tendency to over taper
preparations must be avoided in order to achieve maximum retention.
Ebnashi (1969) to minimize stress in the cement interface between
the preparation and restoration, a taper of 2.5 to 6.50 has been
suggested optimum, but there is only a slight increase in stress as taper is
increased from 0 to 150. However at 200 stress concentration was found to
increase sharply.
• Consciously attempting to cut a taper can easily result in an
overtapered and nonretentive preparation.

• A taper or total convergence of 16 degrees has been proposed

as being achievable clinically while still affording adequate
retention.

• This is probably an acceptable overall target. It can be as low as

10 degrees on preparations on anterior teeth and as high as 22
degrees on molars.
 Freedom of Displacement
Maximum retention is achieved when there is only one path.

A full veneer preparation with long, parallel axial walls and grooves
would
produce such retention .
On the opposite extreme, a short, overtapered preparation would be
without retention because the restoration could be removed along
an infinite number of paths.

Limiting the freedom of displacement from torquing or twisting forces in

a horizontal plane increases the resistance of a restoration.

A groove whose walls meet the axial wall at an oblique angle does not
provide the necessary resistance. V-shaped grooves produce roughly
one- half as much resistance to lingual displacement as do grooves with
a definite lingual wall.
 Surface area :
Greater the area of the cement film bound to the preparation and to the
internal detail of the casting, greater the retention.
The total surface area of the preparation is influenced by the size of the
tooth, the extent of the coverage by the restoration, and internal features
such as grooves and boxes
Area under shear:
 Most important for retention is the
area of cement that will experience
shearing rather than tensile stress.
 For the shear strength of the cement
to be utilized, the preparation must
have the opposing walls nearly
parallel with each other.
 The direction in which a restoration
can be removed must be limited to
one path. A severely over tapered
preparation has many paths along
which tensile force could remove a
crown.
 Types of preparation :
Different types of preparations have different retentive
values and these correspond fairly closely to the surface area of
the axial walls, provided other factors (e.g. taper) are kept
constant. Thus the retention of full veneer crowns are almost
double that of partial coverage restorations.
Adding grooves or boxes to a preparation with a limited path of
withdrawal does not markedly affect its retention because the surface
area is not increased significantly(Rosenstiel). However other authors
have reported that, where the addition of grooves or boxes limits the
path of withdrawal, retention is increased.
 For the grooves to be effective, the
lingual wall of the groove must be
distinct and perpendicular to adjoining
axial wall
 The walls of a groove that meet the
axial wall at an oblique angle do not
provide necessary resistance (A). The
walls of a groove must be
perpendicular to rotating forces to
resist displacement (B).
 Length of the preparation is important
factor in retention
 Longer preparation has a greater
retention than does a short
preparation, due to greater surface
area.
 The preparation with longer walls
interferes with the tipping
displacement of the restoration better
than the short preparation. Because
of greater surface area preparation
with larger diameter will have greater
retention than with narrow
preparation of same length
Surface roughness:
 The adhesion of the dental
cements primarily depends on
microscopic irregularities and the
recesses on the surfaces being
joined the prepared tooth
surface should not be highly
polished
Resistance:

Resistance prevents dislodgement of restoration by

forces directed in the apical or oblique direction

Resistance to sliding or tipping must be designed into the

preparation

Leverage And Resistance:

Leverage, is the predominant factor in the dislodgement

of the cemented restoration, occur when line of action of
force passes outside the supporting tooth structure.
Length of preparation has strong influence on its
resistance Shortening a preparation will produce a
 A short restoration on a short
preparation is less likely to fail
through tipping than is a long
restoration on same preparation as
the force on it acts through a longer
lever arm.
 A preparation on a tooth with a
smaller diameter resists pivoting
movements better than a preparation
of equal length on a tooth of larger
diameter because smaller teeth will
have a short rotational radius for the
arc of displacement and the incisal
portion of the axial wall will resist
displacement
 When relatively long crown must be
made on a short preparation
additional resistance form, in form of
pin retained core must be created.
 Resistance and Tooth Width
 A wider preparation has greater
retention than narrower one of equal
height. Under some circumstances a
crown on the narrow tooth can have
greater resistance to tipping than one
on wider tooth. This is because crown
on narrower tooth has a shorter
radius of rotation resulting in larger
resisting area
 Resistance of a preparation on a
short, wide tooth can be enhanced by
addition of grooves
 Path of insertion
• The path of insertion is an imaginary line along which
• restoration
the will be placed onto or removed from
the
• preparation.

• It is determined mentally by the dentist

• before the preparation is begun, and all features of
the
• preparation are cut to coincide with that line.
If the center of the occlusal surface of a preparation
is viewed with one eye from a distance of
approximately 30 cm (12 inches), it is possible to sigh!
down the
axial walls of a preparation with a minimum taper
For a preparation to be surveyed in the mouth, where
direct vision is rarely possible, a mouth mirror is used.
It is held at an angle approximately 1/2 inch above the preparation,
and the image is viewed with one eye.

If fixed partial denture abutment preparations are

being evaluated for a common path of insertion, a
firm finger rest is established and the mirror is
maneuvered until one preparation is centered.

Then, pivoting on the finger rest, the mirror is moved, without

changing its angulation, until it is centered over the second
preparation
Structural Durability

• A restoration must contain a bulk of material that is adequate

to
withstand the forces of occlusion.
• This bulk must be confined to the space created by the tooth
preparation.
• Only in this way can the occlusion on the restoration be harmonious
and the axial contours normal, preventing periodontal problems
around the restoration
• There are three preparation features that contribute to the durability
of the restoration that is (1)Occlusal reduction (2)axial reduction
( 3)provision for reinforcing struts
 Occlusal Reduction

• One of the most important features for providing

adequate
• bulk of metal and strength to the restoration is
Occlusal Clearance. For gold alloys, there should be
1.5 mm of clearance on the functional cusps
(lingual of maxillary molars and premolars and
buccal of mandibular molars and premolars)
• Metal-ceramic crowns will require 1.5 to 2.0 mm on
functional cusps that will be veneered with porcelain
and
• 1.0 to 1.5 mm on nonfunctional cusps to receive
ceramic
coverage.
• There should be 2.0 mm of clearance on preparations
for all-
ceramic crowns.
• Malposed teeth may have occlusal surfaces that are not
parallel with the occlusal table. Therefore, it may not be
necessary to reduce the occlusal surface by 1.0 mm to
achieve
The basic inclined plane pattern of the
occlusal
surface
should be duplicated to produce
adequate clearance
without overshortening the preparation
 Functional Cusp Bevel

An integral part of the occlusal reduction is the

functional cusp bevel . A wide bevel on the lingual
inclines of the maxillary lingual cusps and the buccal
inclines of mandibular buccal cusps provides space
for an adequate bulk of metal in an area of heavy
occlusal contact.

If a wide bevel is not placed on the functional

cusp, several problems may occur
To prevent a thin casting
when there is no functional cusp bevel, an attempt
may be made to wax the crown io optimal thickness in
this area. An overcontoured restoration will result and
a deflective occlusal contact is likely to occur unless
the opposing tooth is reduced
Axial reduction:
Second prerequisite for structural durability is axial
reduction. When it is sufficient, restoration walls have
satisfactory thicknesses with out over contouring

Reinforcing struts: the features that serve to provide space for

the metal that will improve the durability and the rigidity of the
restoration: Ofset the occlusal shoulder, the isthmus, the
proximal grooves, and the box. Isthmus connects the boxes, and
the ofset ties the grooves together to enhance the reinforcing
“truss efect”.
 Marginal
Integrity

The restoration can survive in the biological

environment of the oral cavity only if the margins are
closely adapted to the cavosurface finish line of the
preparation. The configuration
of the preparation finish line dictates the shape
and bulk of restorative material in the margin of the
restoration It also can affect both marginal
adaptation and the degree of seating of the
restoration
 FINISH LINE REQUIREMENTS

Definition:
The point at which a preparation terminates on
the tooth is called the finish line. It is also defined as the
peripheral extension of a tooth preparation (GPT).
There are three requirements for
successful restoration margins.

Fundamentals of tooth preparation:Shillingburg,Jacobi,Bracket

Functions :
The finish line serves the following functions :
•During visual evaluation of the tooth preparation, it is
a measure of the amount of tooth structure
already removed. It also delineates the extent of the
cut in an apical direction. The more distinct it is,
the better it serves these purposes.
•The finish line is one of the features that can be used
to evaluate the accuracy of the impression made
for indirect procedures.
•In the die, a distinct finish line helps to evaluate
the quality of the die and helps in accurate die
trimming.
•The correct marginal adaptation of the wax
pattern depends on an obvious finish line.
•The evaluation of the restoration is also aided by
a proper finish line.
•At cementation, a sharp finish line aids
in determining whether the restoration is fully seated.
• Historically a bevel was introduced to compensate for the casting
shrinkage of alloys used to fabricate crowns.

• Metal margins should be ideally acute in cross section rather than

right- angled to facilitate a closer fit.

• D is the distance by which the crown fails to seat

• d is the shortest distance between the tooth structure and the

restoration
• If the inner angle of the metal margin forms an angle m ,of less than 90
degrees with the path of insertion ,as does a bevel or a chamfer ,d will
be smaller than D.

• The shortest distance from the casting margin to tooth structure ,d,
can be stated as a function of D and the sine of the angle m or the
cosine of the angle p,which is the angle between the surface of the
d = D sin m

or

d = D cos p

As the angle
m is reduced
its sine
value also
reduces and
so does
the value of
d…thus
reducing the
marginal
discrepancy.
An angle of 30 to 45 degrees is considered
optimal
• Angles above 50 degrees will not reduce the value of
d.
• Angles below 45 degrees will result in too thin a
 TYPES OF FINISH LINES
Chamfer finish line :
The preferred finish line for the veneer metal
restorations is the chamfer. This finish line has
been shown experimentally to exhibit the least stress,
so that the cement underlying it will less likelihood of
failure. It can be cut with the tip of a round end diamond,
while the axial reduction is being done with the
side of that instrument. However, a torpedo diamond
is less likely to produce a butt joint. The margin of the
cast restoration that fits against it combines an acute
edge with a nearby bulk of metal.
Heavy chamfer finish line :
A heavy chamfer is used to provide
a 90-degree cavosurface angle with a large
radius rounded internal angle. It is created
with a round end tapered diamond. In the
hands of an unskilled operator, this instrument
can create an undesirable fragile lip of
enamel at the cavosurface. The heavy
chamfer provides better support for a
ceramic crown than does a conventional
chamfer, but it is as good as a shoulder. A
bevel can be added to the heavy chamfer
for use with a metal ceramic
restoration.
Shoulder :
The shoulder has long been the
finish line of choice for the all-ceramic
crowns. The wide ledge provides resistance
to occlusal forces and minimizes stresses that
might lead to fracture of the porcelain. It
produces the space for healthy restoration
contours and maximum esthetics. However, it
does require destruction of more tooth
structure than any other finish line, the
sharp 90-degree internal line angle
associated with the classic variety of this
finish line concentrates stress in the tooth
and is conductive to coronal fracture. The
shoulder generally is not used as a finish
line for cast metal restorations.
Shoulder with bevel :
The shoulder with a bevel is a used as a
finish line in a variety of situations. It is
utilized as the gingival finish line on the
proximal box of inlays and onlays, and
for the occlusal shoulder of onlays and
mandibular three quarter crowns. This design
can also be used for the facial finish line of
metal ceramic restorations where gingival
esthetics is not critical. It can be used in those
situations where a shoulder is already
present, either because of destruction by caries
or the presence of previous restorations. It is
also a good finish line for preparations with
extremely short walls, since it facilities
axial walls that are nearly parallel.
Knife-edge :
The knife-edge margin provides for
an acute margin of metal. But its use can
create problems. Unless it is carefully
prepared, the axial reduction may fade
out instead of terminating in a definite
finish line. The thin margin of the restoration
that fits this finish line may be difficult to
accurately wax and cast. It is also more
susceptible to distortion in the mouth when the
casing is subject to occlusal forces.
Featheredge :
A featheredge finish line is
unacceptable because it is not sufficiently
distinct and results in so little cervical tooth
reduction that the restoration must be over
contoured to possess adequate rigidity. Also,
since a feather edge is more difficult to see
visually, occlusocervical undulations and
irregularities in the finish line are more
likely to be present, making it much more
difficult to fabricate a restoration that fits
accurately.
 Instrumentation
The advent of hand piece capable of speeds in excess of 100,000 rpm made possible
efficient cutting with smaller instruments,which made more sophisticated
preparations practical.

With high speed instruments the problem of over heating the tooth during
preparation
is critical.

Cutting dry can cause three times more dentinal burning and thermal changes
leading to pulpal inflammation and necrosis than with adequate air water spray.

Brown et` al calculated the temperature of high speed dry cutting to be 118
degree celcius.
The seriousness of which can be understood from Zach`s contentions that even
an increase of 20 degree Fahrenheit will lead to pulpal death in 60% of the teeth.

Dry cutting of non-vital teeth also should be avoided as it can lead to micro fractures
in the enamel.
There are basically three main rotary instruments used in tooth
preparation.
1. Diamond stone
2. Tungsten carbide
bur
3. Twist drill
Diamond stones
Numerous small ,irregularly placed sharp diamond chips
are electroplated with a nickel or chromium bonding
medium to steel instrument blanks whose head is
machined to the desired final shape of the instrument.
They most effective against cutting enamel and porcelain.
An ideal diamond instrument should have diamond stones
evenly placed with intimate contact between the chips
and the binding material.
Tunsten carbide burs
They are best suited for making precise preparation
features and smooth surfaces on enamel and
dentin. They can also be used to cut metal.
The metal in the head of the tungsten carbide bur is
formed by sintering tungsten carbide powder and
cobalt powder under heat and vacuum.
These are then cut into desired lengths and attached to
steel rods using soldering or welding.
Most burs have six and occasionally eight
blades. Finishing burs will have 12 blades.
The finer the finish more the number of blades.
The angle at which the face of the blade meets a line extending from the cutting
edge to the bur axis is known as the rake angle.
The more positive the rake angle.
The twist deill is made up of steel
It cuts only at its tip as it is pushed into the tooth in
the direction of the long axis of the instrument
It has deep twin heliocal flutes that wind around the
shaft
in a tight spiral,helping to remove chips from the hole.
Used to make small,uniform diameter,parallel-sided
holes in dentin to receive retentive pins for restorations.
The drill diameter is slightly larger than the pins that
are incorporated into cast restorations to allow for a
small cement space.
The working portion of this type of drill should be 3 –
5 mm long.
a shallow pilot hole is made with no.1/2 round bur on
a narrowhorizontal ledge to ensure that the hole will
be drilled precisely in its intended position.
0.6 mm twist drill,pin holes for parallel pins for
cast restorations
0.5 mm Kodex drill used for creating pinholes for
minim threaded pins,which retain amalgam and
compositecores.
Dual instrumentation

Diamond burs cut through enamel more

efficiently than carbide burs but they leave micro
scratces on the surface reducing the finish of the
preparation.

Leading to rough cavosurface and marginal

preparation with diamond burs.

Hence for preparation of grooves ,box forms

, isthmus etc
Here both diamond and carbide burs are used
of the same length and diameter which are
configured
 Clearance angle

Rake
angle
Common errors of tooth preparation :
1.Insufficient occlusal or incisal reduction.
2.Lack of uniform reduction of labial or
buccal surfaces compromising esthetics.
3.Minimum axial reduction on the buccal and lingual surface of the posterior teeth,
which increases the incidence of working prematurities. The distinction
between reduction and clearance is crucial.
4.Inappropriate proximal reduction, which prevents having a cleanable
embrasure space.
5.Over reduction of teeth and/or violation of the biologic width.
6.Insufficient gingival reduction to accommodate a definite finish line.
7.Undercuts on the distolingual surface of the preparation and/or
lack of parallelism
of the FPD abutments.
8.Failure to contour proximal surfaces of adjacent teeth to allow seating of
a restorations.
ESTHETIC CONSIDERATIONS

The restorative dentist should develop skill in

determining the esthetic expectations of the patient.
Patients prefer their dental restorations to look as natural as
possible.
However, care must be taken that the esthetic
considerations are not preserved at the expense of the patient’s
long term oral health or functional efficiency.
Whenever possible, accomplishment of an esthetically
acceptable result without the use of metal-ceramic crowns is
preferred, not only because tooth structure is conserved but
also because no restorative material can approach the
 CONCLUSION

The principles of tooth preparation can be categorized into

biologic, mechanical and esthetic considerations. Often those principles
conflict, and the clinician must decide how the restoration should be
designed. Each tooth preparation must be measured by clearly defined
criteria, which can be used to identify and correct problems. It is important to
understand the pertinent theories underlying each step. 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.
PRINCIPLES OF TEETH PREPARATION FOR
VENEERS
Definition

A dental veneer is a thin layer of composite material or 

dental porcelain bonded to the surface of a tooth
Indication
• Improve extreme discolorations such as tetracycline 
staining, flourosis, devitalized teeth, and teeth darkened from
age.
• Repair chipped or fractured teeth. 

• Closing of diastemas between teeth.

•  Ability to lengthen anterior teeth.
earance of rotated or misaligned teeth
•  Improve the app 
Contraindication

• If little or no enamel is present, full crown should be 

considered.
• Certain tooth-to-tooth habits like bruxing or 
clenching, or other para-functional habits such as pencil
chewing or ice crushing.
• Teeth that exhibit severe crowding. 
• Certain types of occlusal problems such as Class III & 
end-to-end bites.
There are three types of veneers

(1) Conventional Porcelain Veneers.

(2) Lumineers. 
(3) Composite Resin Veneers. 
(1) Conventional Porcelain Veneers.

A conventional porcelain veneer is a thin piece of

porcelain that is bonded to the front of a tooth.
Porcelain is a durable, translucent, strong, natural-
looking, and beautiful material.

In most cases, Conventional Porcelain 

Veneers will create the most beautiful results,
and are thus the most common type of
veneer used.
It is done either in one appointment by using
the prefabricated porcelain(ready made)
veneer or in two appointments by using
porcelain veneer fabricated in the lab.
First Appointment (VENEER PREPARATION PROCEDURE) 

Tooth preparation

We have four aspects of tooth preparation

1-Labial reduction
2-Interproximal reduction
3-Incisal modification
4-Cervical definition
-Place a horizontal facial depth cut, it is usually 0,3 mm from
proximal line angle to proximal line angle. Make this depth
cut at the junction of the cervical and middle one-third of the
facial surface of the tooth.*
-Paralleling the entire gingival margin, prepare a definitive
chamfer finish line.
-Continue the definitive chamfer finish line with diamond bur
from the papilla tip toward the incisal edge on both the
mesial and distal proximal surfaces.
-The facial depth cuts are removed with the diamond bur,
and the long axis of the diamond bur is “rolled” into the
proximal chamfer area to eliminate any sharp line angles.

Good prep Bad prep

How to handle incisal edge ?

Path of Insertion Restricted

Unrestricted

Most Less
common common
-There are three ways to manage incisal edge
coverage.
no incisal edge coverage- easiest to manage, requires
provisionalization less because there is less dramatic
change in appearance.
cover incisal edge – less stress on internal aspect of
veneer if rounded, less chance of die abrasion, I use on
centrals and laterals most for unworn teeth
wrap around incisal edge- this technique used more
when significant wear already exists and B-L width is
thick. Also provides some mechanical retention for
longer extensions (>1.5mm)
Impression
The retraction cord should be left in place if
possible during the impression.. It is best to use
a polysiloxane or polyethermaterial for the
impression since multiple pours are often
needed for the laboratory procedures. Placing
soft wax in the lingual embrasures prior to
taking the impression will minimize tearing of
the impression in these areas

Temporary Veneers
If they are necessary or desired, they are hand sculptured using
composite, kept supragingival, out of heavy occlusion, and attached by
spot etching the enamel in the center of the tooth away from any
margins. Other methods can be used which include acrylic type indirect
methods.
Shade selection

Clean teeth with pumice and water to remove any extrinsic

stains which exist
Between
appointments

The laboratory 
procedures
Second Appointment (VENEER CEMENTATION PROCEDURE)

Remove temporary 

Clinical try-in.
Evaluate fit and esthetics
All veneers should be placed without bonding medium on teeth to assess the fit.
Preparing the restoration for cementation.
-Clean the restorations with acetone or Cavilax if you 
have tried it in with resin based systems. If you have
used only water soluble medium (glycerin, K-Y jelly, Try-in
pastes) you need only to rinse. It is a good idea to clean
with enamel etchant (35% phosphoric acid) to help clean
any salivary contaminants that may have come in contact
with the bonding surface.

-Etch. etch with porcelain etchant (porcelain

conditioners- 10% HF acid). The time of etch depends
on the ceramic materials used. (Porcelain > 3min Empress
< 1 min).
-Apply Porcelain Primer or Silane Coupling 
Agent.
use a prehydrolized silane which means you
do not have to mix two components (usually
contained in cementation kit (Nexus, Kerr) It
is applied with a brush. The coupling agent
acts to wet the surface of the porcelain. The
silane coupling agent is allowed to set on the
surface (usually for at least 60 sec but some
are shorter periods). It can be dried with a
gentle stream of air. Do Not Rinse.
Set prepared veneer in a lightproof box until
ready for cementation
Prepare tooth for bonding.
Isolation. Rubber damn isolation is usually not 
practical for multiple anterior cementation
techniques. Cotton roll isolation and an assistant
are usually sufficient for cementation.

Clean all tooth surfaces with rubber cup and

pumice/water mixture or chlorohexidine
soap/pumice mixture and rinse thoroughly.

Place clear Mylar strip between involved adjacent teeth to

minimize etching and placement of adhesive and cement on the
adjacent unbonded teeth . Do two veneers at a time. The
sequence I usually use is: both centrals first, then lateral and
cuspid on one side and finally the lateral and cuspid on the
opposite side.
Etch the preparation. The enamel is etched for 15-30
seconds with 35% phosphoric acid. Gel etches are easier
to control. Rinse the tooth thoroughly to make
sure no etchant remains and air dry with air syringe
or high evacuation.

Adhesive is applied to the surfaces of the

preparation. In the Nexus system this layer is
air thinned and cured prior to cementation.
In other systems this layer may be left
to cure during the cementation.
Apply the cement (Nexus, Kerr) to the 
preparation and the surface of the veneer
with a brush or plastic instrument. Light
cured materials are used for
cementation since the veneers are
extremely thin and transmit enough
light. Most cementation kits now contain
two viscosities of cement.
Seat the restoration with firm finger
pressure and hold in place while the excess
cement is removed with a sable brush
Light cure veneer from the facial
surface for at least 60 seconds. You
cannot overcure these restorations. Cure
from lingual surface if the incisal edge is
included in the restoration.
Finishing and polishing procedures.
Remove excess set bonding material with sharp carvers. 
Keep instruments stable against restoration and tooth
surface to minimize soft tissue damage. Recontouring and
occlusal adjustments of the porcelain are done with a
fine diamond and high speed using water coolant. Any
surface which has been modified with a finishing diamond
needs to be polished. If no marginal discrepancies were
present between the tooth and ceramic, finishing can be
initiated with finishing carbides, discs and rubber points
(2) Lumineer
What is the difference between Lumineers and standard 
porcelain veneers?
The main difference is that Lumineers are made from a 
special patented cerinate porcelain that is very strong
but much thinner than traditional laboratory-fabricated
veneers. Their thickness is comparable to contact lenses.
 Advantages
• Lumineers can be placed on the teeth without removal 
of the tooth structure.

• Patients can receive their veneers quickly, usually within

two weeks from the date that the impressions are made.

• Lumineers bond directly to the tooth, making the bond

very strong. They are also very long-lasting- up to twenty
years or longer.

• Lumineers are a reversible procedure.

Although Lumineers are the most advantageous 
option, there are certain limitations to be considered:
• Lumineers can only be placed on teeth that are in good
structural condition. The teeth must be free of decay. Any
existing fillings must also be in good condition, along with
the surrounding gum in the area where the Lumineers will
be placed..
• The patient must have good oral hygiene, with no
receding gums or signs of gum disease. Bleeding of the
gums will interfere with the bonding process.
• Because there is very little or no tooth preparation, a
small bump is likely to develop between the veneers and
the gum.. The bump may create an irritation to the
gum, and may increase the chances for staining and tooth
decay.
The LUMINEERS
No-Prep Technique
allows LUMINEERS to be placed over the existing teeth without
the removal of any form of tooth structure.
Therefore, anesthesia and temporaries are also not required.

The LUMINEERS Minimal

Contouring Technique
requires slight modification of the enamel but never touches dentin
during LUMINEERS placement. Only .3 mm-.5 mm enamel is
removed, causing no sensitivity for the patient and therefore no
need for any anesthesia.
PREPARATION OF LUMINEERS

1. Polishing
Clean the teeth with Porcelain Laminate
Polishing Paste and rinse.

2. Refresh the Enamel

Perform minimal enamelplasty with a
prep diamond bur, using light pressure.
–Use the whole length of the bur,
keeping contact with the teeth.
3. Interdental Strips
Isolate the teeth receiving
LUMINEERS from the teeth not
receiving LUMINEERS by applying
Paint-On Dental Dam or placing
metal interdental strips in order to
prevent etchant from contacting
adjacent teeth.

4. Etching
1. Etch the teeth with Etch ‘N’ Seal®
for 20 seconds.
2. Rinse thoroughly with water, then dry.
5. Bonding Application

1. Add 5 coats of Tenure® A+B.

2. Add 1 coat of Tenure S to the
teeth.
Note: Tooth surfaces must be shiny.
6. Prime-Bonding on
LUMINEE RS

1. Add 1 coat of Tenure A+B on the

inner side of the LUMINEERS.
2. Add 1 coat of Tenure S on the
inner side of the LUMINEERS.

7. Ultra-Bond® Plus on LUMINEE RS

Add an even layer of Ultra-Bond® Plus
resin cement to the inner side of the
LUMINEERS. Work upwards from
incisal edge of the LUMINEERS to
gingival edge and keep light contact
with the LUMINEERS
8. Insert the LUMITray

1. Remove the Paint-On Dental Dam or

interdental strips.
2. Center the LUMITray (midline).
3. Insert the tray in one smooth movement.
Apply light and continuous buccal pressure.
Take your time for the placement.
4. Remove excess Ultra-Bond Plus resin
cement from the gingiva with a microbrush.
9. Cure LUMINEE RS Through
LUMITray

1. Tack-cure each tooth using a sweeping

movement.Set Light for 3 seconds.
2. Remove more excess cement with a
probe.
3. Light-cure each tooth for 3 seconds
through the tray.
10. Clean-Up and Open
Interdental Spaces
1. Remove Ultra-Bond Plus cement from
interproximal spaces.Maintain complete control
over the
instrument. If difficult, postpone to follow-up
visit.
2. Remove excess cement using the finishing
bur kit.
11. Light-Cure the LUMINEERS
Light-cure each LUMINEERS individually
for a second time, on both the lingual and
buccal sides, for 5 seconds with
Sapphire Light.

12. Check Occlusion and Polish

1. Check and finish the occlusion.

2. Polish the LUMINEERS with Porcelain
Laminate Polishing Paste.
PRINCIPLES OF TEETH PREPARATION FOR
INLAY AND ONLAY
 INLAY
• A n inlay is d e f i n e d as a
indirect r e s t o r a t i o n ( f i l l i n g )
which h as been
constructed out of the
mouth from gold,
p o r c e l a i n or o t h e r me t a l
and(cured compositeresi n)
then cemented into the
prepared cav ity of the
tooth.
 ONLAY
T h e o n l a y is same as an inlay ,
except t h a t only c o v e r s o n e or more
cusp a n d adjoining occlusal surface
of t h e t o o t h .
1. L a rg e re s t o r a t i on s

2. En d o d onti c ally t re a t e d t e e t h

3. Te e t h at risk for f r a c t u re

4. Dental Rehabilitation w i t h cast Metal Allo ys

5. Diastema c l o s u re a n d occlusal pl a n e c o r re c t
ion

6. Re mo v a b le p ro s t h o d o n t i c a b u t m e n t
• High caries r a t e

• Yo u n g p a tie n ts

• Esthetics

• Sm all re s t o r a t i o n s
• S t re n g t h

• Biocompatibilty

• Lowwear

• C o n t ro l of c o n t o u r s
• N u m b e r of appointm e n t

• Higher chair t i me

• Te m p o r a r y Restorationa

• Cost

• Te c h n i q u e sensitive

• Splitting f o rces
 METHODS

DIRECT INDIRECT
METHOD METHOD
•Initial entry is made in the central fossa with a
tapered fissure bur
•Ideallyocclusal depth 1mm in dentine or 2.5mm at triangular ridges.
•Bur should be vertical its taper provide 3 to 5-degree
divergence

6 flare
1-Tapered fissure bur is used to create mesial and
or distal proximal boxes 2-thin layer of enamel is
left to protect the adjacent tooth
3-Gingival floor of box should have an axial depth of 1.0 to
1.5mm
4.The axial wall of the box should follow the faciolinual contour of external surface
of tooth
0.5 MM WIDE Bevels
wide
At occlusal proximal and gingival angles
Additional retention features
• Used when opposing walls (primary
retention) are short

 Dovtails
 Grooves
 slots
• Occlusal preparation
• Proximal boxes
• Cuspal reduction
• Shoulder preparation
• Noncentric cusp
• Gingival bevel
• Shoulder bevel
• Proximal bevels
• Retention grooves
Cuspal Reduction
Thank You