DENTAL CAPS / CROWNS & BRIDGESDENTAL CAPS / CROWNS & BRIDGESDental crowns, also referred to as "dental caps" or "tooth caps," are dental Dental crowns, also referred to as "dental caps" or "tooth caps," are dental

restorations that restorations that cover over and encase the tooth on which they are cementedcover over and encase the tooth on which they are cemented. Dentists make . Dentists make

use of dental crowns when need to use of dental crowns when need to rebuild broken or decayed teethrebuild broken or decayed teeth, , strengthen teethstrengthen teeth, or , or improve the cosmetic appearance of a toothimprove the cosmetic appearance of a tooth,, Placing a Placing a

dental crown on a tooth that has had root canal treatment.dental crown on a tooth that has had root canal treatment.

Crowns can be made out of porcelain (meaning some sort of dental Crowns can be made out of porcelain (meaning some sort of dental ceramic), metal (a gold or other metal alloy), or a combination of ceramic), metal (a gold or other metal alloy), or a combination of

both. Other terms that are used to refer to dental crowns are "dental both. Other terms that are used to refer to dental crowns are "dental

caps" and "tooth caps."caps" and "tooth caps."

How can dental crowns be used to restore a tooth's How can dental crowns be used to restore a tooth's shape?shape?

• Since a dental crown that has been Since a dental crown that has been cemented into place essentially becomes cemented into place essentially becomes the new outer surface for the tooth it is easy the new outer surface for the tooth it is easy to imagine how the placement of a crown to imagine how the placement of a crown can restore a tooth to its original shape. can restore a tooth to its original shape. Dental crowns are routinely made for teeth Dental crowns are routinely made for teeth that have broken, worn excessively, or else that have broken, worn excessively, or else have had large portions destroyed by tooth have had large portions destroyed by tooth decay and also for teeth treated by root decay and also for teeth treated by root canal treatment as inside of teeth becomes canal treatment as inside of teeth becomes slightly weak as compared to healthy teeth.slightly weak as compared to healthy teeth.

•. What a disappointment it would be to . What a disappointment it would be to spend the time, effort, and money to have spend the time, effort, and money to have root canal treatment performed, only to root canal treatment performed, only to have the tooth break or crack irreparably have the tooth break or crack irreparably before it was fully restored by dental crown.before it was fully restored by dental crown.

How can dental crowns be used to improve the How can dental crowns be used to improve the cosmetic appearance of teeth?cosmetic appearance of teeth?

• Since a dental crown serves Since a dental crown serves to cup over and encase the to cup over and encase the visible portion of a tooth, visible portion of a tooth, any dental crown that has a any dental crown that has a porcelain surface can be porcelain surface can be used as a means to idealize used as a means to idealize the cosmetic appearance of the cosmetic appearance of a tooth. Possibly you have a tooth. Possibly you have heard it rumored heard it rumored (especially in past decades) (especially in past decades) that certain movie stars that certain movie stars have had their teeth have had their teeth "capped." This simply "capped." This simply means that the person has means that the person has obtained their "Hollywood obtained their "Hollywood smile" by way of having smile" by way of having dental crowns placed. dental crowns placed.

How can dental crowns strengthen teeth?How can dental crowns strengthen teeth?

• The strengthening capability of The strengthening capability of dental crowns is related to the fact dental crowns is related to the fact that they cup over and encase the that they cup over and encase the tooth on which they are placed. tooth on which they are placed. This means that a crown can act This means that a crown can act as a splint that binds a tooth as a splint that binds a tooth together. This is a very important together. This is a very important feature of dental crowns and one feature of dental crowns and one that makes them a very valuable that makes them a very valuable type of restoration for a dentist to type of restoration for a dentist to have available to them. have available to them.

In contrast, dental fillings, In contrast, dental fillings, especially large ones, can have a especially large ones, can have a weakening effect on the teeth in weakening effect on the teeth in which they are placed. Dental which they are placed. Dental fillings rely on a tooth's remaining fillings rely on a tooth's remaining structure to hold and support structure to hold and support them. Fillings, in general, don't them. Fillings, in general, don't strengthen a tooth and can't strengthen a tooth and can't protect a tooth from the forces protect a tooth from the forces generatedgenerated by biting and chewing. by biting and chewing.

What are the consequences of not protecting a tooth What are the consequences of not protecting a tooth with a dental crown?with a dental crown?

• It's impossible to know precisely what the future holds for It's impossible to know precisely what the future holds for a tooth that seems to be a candidate for a dental crown.a tooth that seems to be a candidate for a dental crown.

• The tooth will experience no problems.The tooth will experience no problems.• The tooth will crack.The tooth will crack.• 1) Teeth that have cracked but no piece has broken off or has 1) Teeth that have cracked but no piece has broken off or has

become mobile. The tooth produces no pain or discomfort. become mobile. The tooth produces no pain or discomfort. In In many cases unless a portion of your tooth has many cases unless a portion of your tooth has broken off you may not be aware that a crack has broken off you may not be aware that a crack has formed.formed.

• 2)*Teeth that have cracked and no piece has 2)*Teeth that have cracked and no piece has broken off or has become mobile. The tooth broken off or has become mobile. The tooth does produce some pain or discomfort.does produce some pain or discomfort.

• Cracked teeth can be sensitive. Biting Cracked teeth can be sensitive. Biting pressure can separate the portions of the pressure can separate the portions of the tooth associated with each side of the crack tooth associated with each side of the crack and as a result trigger a painful response. and as a result trigger a painful response.

3) Teeth which crack and as a result have a portion that breaks off or 3) Teeth which crack and as a result have a portion that breaks off or

becomes mobilebecomes mobile..Sometimes these teeth: Sometimes these teeth: • are totally asymptomatic. are totally asymptomatic. • are sharp or rough and therefore irritating to the person's are sharp or rough and therefore irritating to the person's

tongue or cheek. tongue or cheek. • have an increased sensitivity to hot and cold stimuli. have an increased sensitivity to hot and cold stimuli. • are painful to biting pressure. are painful to biting pressure. • are spontaneously painful. are spontaneously painful.

• a) The tooth breaks in a fashion that is a) The tooth breaks in a fashion that is easily repaired.easily repaired.

• b)*The tooth breaks, but it requires other types b)*The tooth breaks, but it requires other types of dental work before the dental crown can be of dental work before the dental crown can be made.made.

• The tooth fractures, root canal The tooth fractures, root canal treatment is required. treatment is required.

• Deep tooth cracks or extensive tooth Deep tooth cracks or extensive tooth breakage can compromise the health breakage can compromise the health of a tooth's nerve. In these cases your of a tooth's nerve. In these cases your dentist cannot simply place a dental dentist cannot simply place a dental crown on the tooth. They must first crown on the tooth. They must first perform root canal treatment so to perform root canal treatment so to remedy the problem with the tooth's remedy the problem with the tooth's nerve, then thenerve, then the dental crown can dental crown can be placed.be placed.

• c)*The tooth breaks in a fashion in which it c)*The tooth breaks in a fashion in which it cannot be repairedcannot be repaired

What steps are involved when dental crowns What steps are involved when dental crowns

are made?are made? • It typically takes two separate It typically takes two separate

appointments for a dentist to make a appointments for a dentist to make a dental crown for a tooth:dental crown for a tooth:

• I) The initial dental crown appointment.I) The initial dental crown appointment.

• A) Your dentist will numb your tooth.A) Your dentist will numb your tooth.

• B) Your dentist will shape your tooth.B) Your dentist will shape your tooth.

• C) Your dentist will make an impression of C) Your dentist will make an impression of your tooth.your tooth.

• D) A temporary dental crown will be made D) A temporary dental crown will be made for your tooth.for your tooth.

• E) Your dentist will select the proper shade E) Your dentist will select the proper shade of porcelain needed for your dental crown.of porcelain needed for your dental crown.

• II) Your second dental crown appointment.II) Your second dental crown appointment.

• Cementing your permanent crown in place.Cementing your permanent crown in place.

TOOTH PREPRATIONTOOTH PREPRATION

• Technique Tips Technique Tips • Ensure even reduction of the anatomic form.Ensure even reduction of the anatomic form.• Provide enough room for the ceramic to allow Provide enough room for the ceramic to allow

adequate strength.adequate strength.• Sharp transitions and sharp internal edges/line Sharp transitions and sharp internal edges/line

angles or undercuts MUST be avoided.angles or undercuts MUST be avoided.• Margins should have a pronounced chamfer or Margins should have a pronounced chamfer or

shoulder with butt joint margins. Avoid tapered shoulder with butt joint margins. Avoid tapered margins, feathered edges or bevelled shoulders.margins, feathered edges or bevelled shoulders.

• Ensure there is an adequate path of insertion.Ensure there is an adequate path of insertion.

Suggested Margin Suggested Margin PreparationPreparation

Shoulder with rounded axio-cervical line angle, uniform circular ablation

Chamfer preparation (with reduced mechanical support of the crown). Particularly used with reduced substructure (e.g., after repeated crowning).

Common Preparation ErrorsCommon Preparation Errors

• Insufficiently defined and finished preparation margins. Insufficiently defined and finished preparation margins. • Uneven preparation limit ("gutter" preparation, vertical Uneven preparation limit ("gutter" preparation, vertical

unevenness).unevenness).• Irregular marginal reduction of layers (horizontal unevenness).Irregular marginal reduction of layers (horizontal unevenness).• Wrong shape of preparation limit.Wrong shape of preparation limit.• Unnecessarily deep subgingival preparation.Unnecessarily deep subgingival preparation.• Preparation in root dentin.Preparation in root dentin.• Poorly controlled tooth reduction.Poorly controlled tooth reduction.• Excessive reduction, especially in the upper anterior teeth Excessive reduction, especially in the upper anterior teeth

(vestibular) and premolars.(vestibular) and premolars.• Excessive incisal/occlusal reduction causing reduced retention Excessive incisal/occlusal reduction causing reduced retention

and stability.and stability.• Insufficient reduction at the palatal side of the upper anterior Insufficient reduction at the palatal side of the upper anterior

teeth (malfunction occlusion).teeth (malfunction occlusion).• Excessive taper.Excessive taper.

Common Preparation ErrorsCommon Preparation Errors

Incorrect preparation of the labial surface: Preparation in one plane; therefore insufficient reduction of substance. Fracture of the crown may result due to insufficient wall thickness of the crown.

Incorrect preparation of the labial surface, risk of damage to the pulp.

Effect of finish line variants on marginal accuracy Effect of finish line variants on marginal accuracy and fracture strength of ceramic optimized and fracture strength of ceramic optimized polymer/fiber-reinforced composite crownspolymer/fiber-reinforced composite crowns

• Titre du document / Document titleTitre du document / Document title• Effect of finish line variants on marginal accuracy and fracture strength of Effect of finish line variants on marginal accuracy and fracture strength of

ceramic optimized polymer/fiber-reinforced composite crownsceramic optimized polymer/fiber-reinforced composite crowns• Auteur(s) / Author(s)Auteur(s) / Author(s)• CHO Leera ; CHOI Jongmi ; YANG JIN YI ; CHAN JIN PARK ; CHO Leera ; CHOI Jongmi ; YANG JIN YI ; CHAN JIN PARK ; • Résumé / AbstractRésumé / Abstract• Statement of problem. Ceramic optimized polymer (Ceromer)/fiber-reinforced Statement of problem. Ceramic optimized polymer (Ceromer)/fiber-reinforced

composite (FRC) crowns have been promoted as alternatives to conventional composite (FRC) crowns have been promoted as alternatives to conventional crowns. However, little is known regarding the ideal tooth preparation for this crowns. However, little is known regarding the ideal tooth preparation for this type of crown. Purpose. This in vitro study evaluated the marginal adaptation type of crown. Purpose. This in vitro study evaluated the marginal adaptation and fracture strength of ceromer/FRC crowns with respect to the various types and fracture strength of ceromer/FRC crowns with respect to the various types of finish lines. Material and methods. Four metal dies with different finish lines of finish lines. Material and methods. Four metal dies with different finish lines (0.9-mm chamfer, 1.2-mm chamfer, 1.2-mm rounded shoulder, and 1.2-mm (0.9-mm chamfer, 1.2-mm chamfer, 1.2-mm rounded shoulder, and 1.2-mm shoulder) were prepared. Forty (10 for each finish line) Targis/Vectris crowns shoulder) were prepared. Forty (10 for each finish line) Targis/Vectris crowns were fabricated on duplicated base metal alloy dies. The restorations were were fabricated on duplicated base metal alloy dies. The restorations were stereoscopically evaluated at 56 points along the entire circumferential margin stereoscopically evaluated at 56 points along the entire circumferential margin for measuring the margin adaptation before and after cementation with a resin for measuring the margin adaptation before and after cementation with a resin luting agent. The specimens were then compressively loaded to failure using a luting agent. The specimens were then compressively loaded to failure using a universal testing machine. The marginal adaptation (universal testing machine. The marginal adaptation (μμm) was analyzed with the m) was analyzed with the Kruskal-Wallis test and post-hoc Dunnett test (Kruskal-Wallis test and post-hoc Dunnett test (αα=.05). The fracture load (N) was =.05). The fracture load (N) was analyzed with a 1-way analysis of the variance and the Scheffe adjustment analyzed with a 1-way analysis of the variance and the Scheffe adjustment ((αα=.05). The fractured surfaces of the crowns were examined with a scanning =.05). The fractured surfaces of the crowns were examined with a scanning electron microscope to determine the mode of fracture. Results. The electron microscope to determine the mode of fracture. Results. The

• The marginal adaptation of crowns with a shoulder finish line was The marginal adaptation of crowns with a shoulder finish line was significantly better than crowns with a chamfer finish line before significantly better than crowns with a chamfer finish line before and after cementation (P<.001). The increased marginal gap after and after cementation (P<.001). The increased marginal gap after cementation was the lowest in the 1.2-mm rounded shoulder cementation was the lowest in the 1.2-mm rounded shoulder group. The fracture strength of the crowns with the 0.9-mm group. The fracture strength of the crowns with the 0.9-mm chamfer and crowns with 1.2-mm chamfer was significantly greater chamfer and crowns with 1.2-mm chamfer was significantly greater than those of the crowns with the 1.2-mm shoulder or rounded than those of the crowns with the 1.2-mm shoulder or rounded shoulder (P=.011, P=.049, respectively). The mean fracture load of shoulder (P=.011, P=.049, respectively). The mean fracture load of all crowns, regardless of the finish line design, was 1646 N. The all crowns, regardless of the finish line design, was 1646 N. The fractured surface of the crown revealed adhesive failure and 3 fractured surface of the crown revealed adhesive failure and 3 types of cohesive failure (fracture of the Targis and Vectris, Targis types of cohesive failure (fracture of the Targis and Vectris, Targis fracture with a crack in the Vectris layer, and crushing without fracture with a crack in the Vectris layer, and crushing without fracture). Conclusion. The marginal gaps were greater for the fracture). Conclusion. The marginal gaps were greater for the chamfer finish line specimens than in the shoulder finish line chamfer finish line specimens than in the shoulder finish line specimens. However, the fracture strength of the chamfer finish specimens. However, the fracture strength of the chamfer finish line specimens was greater than that of the shoulder finish line line specimens was greater than that of the shoulder finish line specimens.specimens.

• Revue / Journal TitleRevue / Journal Title• The Journal of prosthetic dentistry ISSN 0022-3913 CODEN The Journal of prosthetic dentistry ISSN 0022-3913 CODEN

JPDEATJPDEAT

ANTERIOR CROWN ANTERIOR CROWN PREPARATIONPREPARATION

Reduce lingual surface 1.5 mm at the area of centric contact (not less than 1.0 mm) and 0.8 to 1.0 mm along the remaining lingual surface.

Tooth preparation length should reflect a 1.5 to 2.0 mm occlusal (incisal) reduction.

Incorporate taper of 8 to 10 degrees (never more than 12º)

STAGES OF TOOTH PREPSTAGES OF TOOTH PREP

Original position of teeth.

Preferred final position of teeth.

Actual preparation required to achieve preferred final position of teeth.

VENEER PREPARATION VENEER PREPARATION

• Technique Tips Technique Tips • On average, allow for a minimum of 1 mm of porcelain. A On average, allow for a minimum of 1 mm of porcelain. A

reduction greater than 1 mm may be required in areas masking reduction greater than 1 mm may be required in areas masking severely discolored enamel.severely discolored enamel.

• Allow for veneer thickness of approximately 0.8 mm labially Allow for veneer thickness of approximately 0.8 mm labially (with incisal covering).(with incisal covering).

• Proximal margins are completed labial to contact point. Preserve Proximal margins are completed labial to contact point. Preserve contacts wherever possible. It may be necessary to prepare contacts wherever possible. It may be necessary to prepare through the proximal contact point when clinical conditions through the proximal contact point when clinical conditions dictate (such as slice prep), interproximally to obtain proper dictate (such as slice prep), interproximally to obtain proper emergence profile.emergence profile.

• Provide a definite finish line for the technician with a chamfer Provide a definite finish line for the technician with a chamfer lingual preparation and a 0.5 mm labial gingival finishing area.lingual preparation and a 0.5 mm labial gingival finishing area.

Use medium grit, round-ended diamond bur to remove uniform thickness of facial enamel by joining the depth-cut grooves.

Incisal Preparation:Incisal Preparation:

• Overlap of incisal edge is Overlap of incisal edge is recommended.recommended.

• Long bevel lingual Long bevel lingual preparation.preparation.

• Lingual butt margin provides Lingual butt margin provides greatest strength as butt greatest strength as butt shoulder.shoulder.

• 0.5 mm labial gingival 0.5 mm labial gingival finishing line.finishing line.

• All line angles rounded, All line angles rounded, preparation smoothpreparation smooth

Interproximal Extension:Interproximal Extension:

• Using round-ended diamond bur, Using round-ended diamond bur, extend the interproximal extend the interproximal preparation from the gingival preparation from the gingival chamfer into the interproximal chamfer into the interproximal space. NOTE: Eliminate all space. NOTE: Eliminate all discolored enamel into the discolored enamel into the interproximal (i.e., elbow prep).interproximal (i.e., elbow prep).

Lingual Reduction to Increase Length:

Reduce tooth surface in stress bearing areas to provide bulk of porcelain for function.Angle diamond bur to eliminate undercuts and establish deep chamfer on lingual aspect of preparation.

POSTERIOR CROWN POSTERIOR CROWN PREPARATIONPREPARATION

INLAYS/ONLAYSINLAYS/ONLAYS

• Inlay Preparation Inlay Preparation

• Technique Tips Technique Tips • Ensure all walls end in a butt Ensure all walls end in a butt

margin. No flared or feather edge margin. No flared or feather edge margins.margins.

• Enamel surfaces created by Enamel surfaces created by parallel preparation are generally parallel preparation are generally sufficient for acid etching with flat sufficient for acid etching with flat cusps; a diverging preparation cusps; a diverging preparation helps optimize acid etching of the helps optimize acid etching of the enamel.enamel.

• Avoid sharp internal line angles Avoid sharp internal line angles and undercuts.and undercuts.

• Smooth prep walls and trim Smooth prep walls and trim excess lining material with excess lining material with finishing diamond or burfinishing diamond or bur

• Do not include undercutsDo not include undercuts• Create a 5º to 15º divergence in Create a 5º to 15º divergence in

the proximal walls from the floor the proximal walls from the floor to the occlusal margin of the to the occlusal margin of the preparation.preparation.

Inlay PreparationInlay Preparation

Onlay PreparationOnlay Preparation

• Avoid sharp internal line Avoid sharp internal line angles and undercuts.angles and undercuts.

• With onlays, cuspal With onlays, cuspal reduction of a minimum of reduction of a minimum of 1.5 mm is required.1.5 mm is required.

• Smooth prep walls and trim Smooth prep walls and trim excess lining material with excess lining material with finishing diamond or bur.finishing diamond or bur.

• Do not include Do not include undercuts.undercuts.

• Create a 5º to 15º Create a 5º to 15º divergence in the divergence in the proximal walls from proximal walls from the floor to the the floor to the occlusal margin of the occlusal margin of the preparation.preparation.

• Here at RATRA MULTISPECIALITY AND Here at RATRA MULTISPECIALITY AND COSMETIC DENTAL CENTRE. we are COSMETIC DENTAL CENTRE. we are dedicated to the concept that all people dedicated to the concept that all people should have the right to retain their natural should have the right to retain their natural teeth for a lifetime. Preventive measures, teeth for a lifetime. Preventive measures, high quality care, and cooperation high quality care, and cooperation combined with timely treatment make it combined with timely treatment make it possible for most people to retain their possible for most people to retain their natural teeth with optimum comfort, natural teeth with optimum comfort, function, and appearance. We are function, and appearance. We are dedicated to this concept and with your dedicated to this concept and with your cooperation, we will do everything we can cooperation, we will do everything we can to help you reach your goals for dental to help you reach your goals for dental health.health.

• Our plan is for you to achieve and keep a Our plan is for you to achieve and keep a HEALTHY & BEAUTIFUL MOUTH.HEALTHY & BEAUTIFUL MOUTH.

• Thank you …………..Thank you …………..

Dear New Patient:Dear New Patient: