8

THE COMPLETE
CAST CROWN
PREPARATION

lthough esthetic factors may limit its applica- the axial walls of a complete cast crown have been

A tion, the all-metal complete cast crown should

always be offered to patients requiring restora-
tion for badly damaged posterior teeth. The com-
prepared with the proper degree of taper or conver-
gence, a significant amount of tooth structure must
fail before the crown can be torqued off.
plete cast crown has the best longevity of all fixed The strength of a complete cast crown is superior
restorations. It can be used to rebuild a single tooth to that of other restorations. Its cylinder-like config-
or as a retainer for a fixed dental prosthesis. It uration encircles the tooth and is reinforced by a cor-
involves all axial walls, as well as the occlusal surface rugated occlusal surface. Just as an O-shaped link in
of the tooth being restored (Fig. 8-1). a chain resists deformation better than a C-shaped
Preparation for a complete cast crown requires link, this restoration is less easily deformed than its
that adequate tooth structure be removed to allow counterparts, which are more conservative of tooth
restoration of the tooth to its original contours. Tooth structure.
structure should be preserved when possible, but A complete cast crown allows the operator to
reduction should produce a crown of acceptable modify axial tooth contour. This can be of special sig-
strength. nificance with malaligned teeth, although the extent
of possible recontouring is limited by periodontal
considerations. Similarly, it is possible to allow better
ADVANTAGES access to furcations for improved patient oral hy-
Because all axial surfaces of the tooth are included giene through recontouring of buccal and lingual
in the preparation, the complete cast crown has walls (Fig. 8-2). When special requirements exist for
greater retention than a more conservative restora- axial contours, such as when retainers are needed
tion on the same tooth (e.g., a seven-eighths or three- for partial removable dental prostheses, a complete
quarter crown [see Fig. 7-34]). crown is often the only restoration that allows the
Normally, a complete cast crown preparation also necessary modifications for the creation of properly
has greater resistance form than does a partial- shaped survey lines, guide planes, and occlusal rests
coverage restoration on the same tooth. For a partial (Fig. 8-3) (see Chapter 21).
veneer crown to rotate off the tooth, only the tooth The restoration permits easy modification of the
structure immediately lingual to the occlusal portion occlusion, which is often difficult to accomplish if
of the proximal groove or box need fail. However, if a more conservative restoration is made. This is

258

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Chapter 8 THE COMPLETE CAST CROWN PREPARATION 259

especially important when supraerupted teeth are

present or when the occlusal plane needs to be
reestablished.

A DISADVANTAGES
Because all coronal surfaces are involved in the
preparation for a complete cast crown, removal of
tooth structure is extensive and can have adverse
effects on the pulp and periodontium. Because of the
proximity of the margin to the gingiva, it is not
uncommon to see inflammation of gingival tissues
(although a properly fitting complete cast crown
with good axial contour should minimize this).
After cementation, it is no longer feasible to
B perform electric vitality testing of an abutment
tooth. The conductivity of the metal interferes with
the test. This can be a disadvantage if future compli-
cations occur, although thermal tests occasionally
yield the necessary information.
Fig. 8-1 Patients may object to the display of metal associ-
Complete cast crowns used to restore the molar teeth. A and ated with complete cast crowns, and in those with a
B, The canines and premolars, which are more visible because
normal smile line, the restoration may be restricted
of their more anterior arch position, have been restored with
metal-ceramic crowns.
to maxillary molars and mandibular molars and
premolars.

A B

Fig. 8-2
A, B, and C, Fluting of the axial walls of a molar complete cast crown allows better access to the furcation area for oral hygiene and
improves the long-term prognosis of the restoration.

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260 PART II CLINICAL PROCEDURES: SECTION 1

The complete cast crown is indicated on

endodontically treated teeth. Its superior strength
compensates for the loss of tooth structure that
results from previous restorations, carious lesions,
and endodontic access.
A
CONTRAINDICATIONS
The complete cast crown is contraindicated if treat-
ment objectives can be met with a more conserva-
tive restoration. Wherever an intact buccal or lingual
wall exists, use of a partial-coverage restoration
should be considered. In particular, if less than max-
imum retention and resistance are needed (e.g., on a
short-span fixed dental prosthesis), a preparation
more conservative of tooth structure is called for.
B
Similarly, if an adequate buccal contour exists or can
be obtained through enamel modification (enam-
eloplasty), a complete crown is not indicated. If a
high esthetic need exists (e.g., for anterior teeth), a
Fig. 8-3 complete cast crown is also contraindicated.
Complete cast crowns used as retainers to accommodate a
mandibular partial removable dental prosthesis. Metal-ceramic
crowns have been placed on the mandibular left canine (A) and CRITERIA
the maxillary first molar (B). Note the occlusal rests (A, arrows)
The occlusal reduction must allow adequate room for
and the survey contours (B), which extend to form reciprocat-
ing guide planes. (See Chapter 21.)
the restorative material from which the cast crown is
to be fabricated: type III or IV gold casting alloy or
their low–gold content equivalent. Minimum recom-
INDICATIONS mended clearance is 1 mm on nonfunctional (non-
centric) cusps and 1.5 mm on functional (centric)
The complete cast crown is indicated on teeth that cusps. The occlusal reduction should follow normal
exhibit extensive coronal destruction by caries or anatomic contours to remain as conservative of tooth
trauma. It is the restoration of choice whenever structure as possible. Axial reduction should parallel
maximum retention and resistance are needed. On the long axis of the tooth but allow for the recom-
short clinical crowns or when high displacement mended 6-degree taper or convergence, which is the
forces are anticipated, such as for the retainer of a angle measured between opposing axial surfaces.
long-span fixed dental prosthesis, grooves should be The margin should have a chamfer configuration
included as additional retentive features. and is ideally located supragingivally. Sometimes
This restoration is fabricated when correction of crown lengthening is indicated to obtain a supragin-
axial contours is not feasible with a more conservative gival margin, rather than risk future periodontal
technique. The restoration also may be used to support disease (see Chapter 6). The chamfer should be
a partial removable dental prosthesis, because obtain- smooth and distinct and allow for approximately
ing the necessary contours with a partial-coverage 0.5 mm of metal thickness at the margin. Typically,
restoration is more difficult. Although proximal guide it is an exact replica of half the rotary instrument that
planes can sometimes be prepared through simple was used to prepare it. (The recommended dimen-
enamel modification, arriving at properly oriented sions for reduction are shown in Fig. 8-4.)
reciprocal guide planes and survey contours is often
impractical. The minimum dimensions required for Special Considerations
occlusal rests of a partial removable dental prosthetic
framework necessitate removing significant amounts Functional (centric) cusp bevel
of enamel and, if the dentin is exposed, restoring the Proper tooth preparation for a complete cast crown
tooth with a cast crown.* results in the reduction’s being directly beneath
the cusps of the crown (see Fig. 7-45). This is impor-
*On mandibular premolars, a rest can sometimes be placed on top of the mod- tant for ensuring optimum restoration contour with
ified occlusal surface without interfering with the occlusion or articulation. maximum durability and conservation of tooth struc-

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Chapter 8 THE COMPLETE CAST CROWN PREPARATION 261

0.5 mm

1 mm

1.5 mm
Lingual Buccal
1.5 mm

1 mm

Buccal Lingual
Fig. 8-6
Fig. 8-4 The configuration of the facial wall of the maxillary molars may
Recommended dimensions for a complete cast crown. On func-
necessitate slight additional reduction in the occlusal third to
tional cusps (buccal mandibular and lingual maxillary), the
prevent overcontouring of the restoration. This reduction is
occlusal clearance should be equal to or greater than 1.5 mm.
termed the nonfunctional cusp bevel.
On nonfunctional cusps, a clearance of at least 1 mm is needed.
The chamfer should allow for approximately 0.5 mm of metal
thickness at the margin.

Chamfer width
Increasing the faciolingual width of a complete
crown is a common error in practice and is a leading
cause of periodontal disease associated with restora-
tions. Adequate chamfer width (minimum 0.5 mm)
is important for developing optimum axial contour.
On small premolars, however, it may be advanta-
Fig. 8-5 geous to prepare a slightly narrower chamfer to
The functional cusp bevel is prepared by slanting the bur at a
flatter angle than the cuspal angulation. This ensures additional
conserve tooth structure and retention form. This
reduction for the functional cusp. requires increasingly careful manipulation of the
wax pattern during fabrication of the restoration and
careful assessment to ensure that the crown is not
ture. Proper placement of the functional cusp bevel excessively contoured.
achieves this outcome. Because additional reduction
is needed for the functional cusps (to provide 1.5
mm of occlusal clearance), the bevel must be angled
PREPARATION
flatter than the external surface (Fig. 8-5). On most The clinical procedure to prepare a tooth for a com-
teeth, the functional cusp bevel is placed at about 45 plete cast crown consists of the following steps:
degrees to the long axis. • Occlusal guiding grooves.
• Occlusal reduction.
Nonfunctional (noncentric) cusp bevel • Axial alignment grooves.
All complete crown preparations should be assessed • Axial reduction.
for adequate reduction at the occlusoaxial line • Finishing and evaluation.
angles of the nonfunctional cusps. A minimum of • Armamentarium (Fig. 8-7 and Table 8-1).
0.6 mm of clearance is needed here for adequate
strength. Maxillary molars in particular often
Step-by-Step Procedure
require an additional reduction bevel in this area
(Fig. 8-6). Without it, an overcontoured restoration In this chapter, the tooth preparation steps have been
that does not follow normal configuration may illustrated for a mandibular second molar. Depend-
result. Such additional reduction is often unneces- ing on the tooth to be prepared (e.g., a premolar
sary for mandibular molars, however, because they versus a molar) the exact number of guiding grooves
are lingually inclined and their profile is relatively may vary. The recommended sequence remains
straight. identical, however.

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262 PART II CLINICAL PROCEDURES: SECTION 1

Table 8-1 ARMAMENTARIUM

INSTRUMENT USE
Tapered carbide bur or diamond Occlusal guiding grooves
Additional retentive features

Narrow, round-tipped, tapered diamond (regular grit) (0.8 mm) Occlusal reduction
Axial alignment grooves
Axial reduction
Chamfer preparation

Wide, round-tipped, tapered diamond (fine grit) (1.2 mm) Finishing

Utility wax and wax caliper Verification of occlusal clearance

Occlusal reduction gauge

High- and low-speed friction grip contra-angles

Note that the

grooves are deeper
for the functional
cusp.

Fig. 8-7
Armamentarium for the complete cast crown preparation.
Fig. 8-8
Guiding grooves are placed on the occlusal surface. They are
Guiding grooves for occlusal reduction deeper on the functional cusp, and for the functional cusp bevel
they diminish in depth from the cusp tip to the cervical margin.
A tapered carbide or a narrow, tapered diamond is
recommended for placing the guiding grooves for
occlusal reduction.*
1. Place depth holes approximately 1 mm deep in 3. To ensure that the centric or functional cusp will
the central, mesial, and distal fossae, and connect be protected by an adequate thickness of metal,
them so that a channel runs the length of the place a functional cusp bevel in the area of
central groove and extends into the mesial and contact with the opposing tooth. The depth of
distal marginal ridge. this guiding groove should be slightly less than
2. Place guiding grooves in the buccal and lingual 1.5 mm (to allow for smoothing) in the area of the
developmental grooves and in each triangular centric stop, and it should gradually diminish in
ridge extending from the cusp tip to the center of a cervical direction.
its base (Figs. 8-8 and 8-9). 4. Use the guiding grooves to ensure that occlusal
reduction follows anatomic configuration and
thus minimizes the loss of tooth structure while
*The use of guiding grooves for occlusal reduction is helpful only if the ensuring adequate reduction, as dictated by the
tooth is in good occlusal relationship before preparation. On most teeth, mechanical properties of the alloy from which
this can be achieved with a foundation restoration and is done as part of the restoration is to be fabricated. The guiding
the mouth preparation phase of treatment. When this is not practical (e.g.,
in correcting occlusal discrepancies or replacing existing crowns), a matrix
grooves must be placed with accuracy; the practi-
is made from the diagnostic waxing procedure, and this is used to assess tioner should concentrate on the position, depth,
optimal reduction (see Fig. 15-14A). and angulation of each groove. A groove should

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Chapter 8 THE COMPLETE CAST CROWN PREPARATION 263

Half of the occlusal reduction

is performed; the other half is
maintained for reference
B purposes.

Fig. 8-10
After the guiding grooves are placed, the occlusal reduction is
performed. Either the mesial or the distal half is maintained ini-
tially as a reference.
Fig. 8-9
A, A complete cast crown is indicated on this mandibular
second molar with occlusal, proximal, and cervical lesions, as grooves is removed with the carbide or the narrow,
well as a buccal longitudinal fracture. B, Initial depth grooves round-end, tapered diamond. Proper placement of
placed for occlusal reduction. Note that they have not yet been the grooves automatically results in adequate
extended onto the buccal surface, where the functional cusp occlusal clearance.
bevel will be placed. 5. Complete the occlusal reduction in two steps
(Fig. 8-10). Half the occlusal surface is reduced
be placed in the low point and high point of each first so that the other half can be maintained as a
cusp. The low points are the central and develop- reference. When the necessary reduction of the
mental grooves; the high points are the cusp tips first half has been accomplished, reduction of the
and triangular ridges. Correct depth (0.8 mm remaining half can be completed (Fig. 8-11).
for the central groove and nonfunctional cusps, 6. On completion, check that a minimum clearance
1.3 mm for the functional cusps*) is achieved by of 1.5 mm has been established on functional
knowledge of the instruments being used. The cusps and at least 1.0 mm on nonfunctional
practitioner should memorize the diameters of cusps. This clearance must be verified in all
the rotary instruments; this facilitates assessment excursive movements that the patient can make.
of the adequacy of the reduction in progress. If The patient should close into several layers of
necessary, a periodontal probe can be used to dark-colored utility wax in maximum intercuspa-
measure the extent of reduction. Correct angula- tion (Fig. 8-12A).
tion of the grooves is needed to ensure that the 7. Remove the wax from the mouth and evaluate it
occlusal reduction is correctly situated beneath for thin spots, which can be measured with a wax
the occlusal surface of the restoration. On the caliper (Fig. 8-12B).
nonfunctional cusp, the groove should parallel 8. Place the wax back in the patient’s mouth and
the intended cuspal inclination; on the functional have the patient move the mandible into protru-
cusp, it should be angled slightly flatter to ensure sive and excursive positions. On removal, the
the additional reduction of the functional cusp. thickness of the utility wax is again measured, this
time to verify that adequate clearance exists in
Occlusal reduction the dynamic range, as well as in maximum inter-
Once the guiding grooves have been deemed satis- cuspation. A convenient alternative is to use an
factory, the tooth structure that remains between the occlusal reduction gauge† (Fig. 8-13).

†
*Allow 0.2 mm in both for smoothing the preparation. Hu-Friedy, Chicago, Illinois.

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264 PART II CLINICAL PROCEDURES: SECTION 1

B
C

Fig. 8-13
Fig. 8-11 Occlusal clearance can be judged intraorally with a reduction
A, Note the angulation of the bur as the functional cusp bevel
gauge. This instrument (A) has 1.5-mm-diameter (B) and 1-mm-
is placed. B, Completed occlusal reduction. Note that it follows
diameter (C) spherical tips.
normal occlusal form. Three distinct planes can be seen
buccolingually.
Alignment grooves for axial reduction
After the occlusal reduction is completed, three
alignment grooves are placed in each buccal and
lingual wall with a narrow, round-end, tapered
diamond. One is placed in the center of the wall, and
one in each mesial and distal transitional line angle
(Fig. 8-14).
A 1. When these guiding grooves are placed, be sure
that the shank of the diamond is parallel to the
proposed path of placement of the restoration.
This automatically produces a convergence be-
tween the axial walls of the alignment grooves
that is identical to the taper of the diamond. If a
diamond with a 6-degree taper is used, an iden-
tical axial convergence on the preparation wall
will result.
2. Do not let the diamond cut into the tooth beyond
the point where its tip is buried in tooth structure
B up to the midpoint; otherwise, a lip of unsup-
ported tooth enamel will be created (see Fig.
7-21). Gingivally, the resulting depth of the align-
ment grooves therefore should be no more than
one half the width of the tip of the diamond.
Fig. 8-12 Occlusocervically, the placement of the tip of the
Evaluation of the adequacy of occlusal clearance. A, The patient instrument determines the location of the margin
closes into softened wax. B, The thickness of the wax is (Fig. 8-15).
assessed visually and measured with a wax caliper after it has 3. Note that the alignment grooves determine the
been removed from the mouth. path of placement of the restoration. They should

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Chapter 8 THE COMPLETE CAST CROWN PREPARATION 265

When placing these Fig. 8-16

grooves, keep reduction If axial reduction is completed first on either the distal or the
to a minimum at the tip mesial half of the tooth, evaluation is simplified because the
of the diamond. remaining intact tooth can serve as a reference.

Fig. 8-14
Alignment grooves for axial reduction are placed in the buccal be placed parallel to the proposed path of
and lingual surfaces parallel to the long axis of the tooth buc- placemnt, typically the long axis of the tooth.
colingually and mesiodistally. 4. Use a periodontal probe to assess the relative
parallelism of the alignment grooves with one
another or with the proposed path of placement
of a secondary retainer if the prepared tooth
is to serve as a fixed dental prosthesis abut-
ment. When the correct placement of alignment
grooves is uncertain (as is likely on long-span
fixed dental prosthetic abutments), making an
impression with irreversible hydrocolloid (algi-
nate) is especially helpful. This can be poured in
rapid-setting stone, and the resulting cast can be
analyzed with a dental surveyor.* At this time, cor-
rections may still be easily made before unneces-
A sary tooth reduction has occurred.
Axial reduction
The technique for axial reduction is similar to that
for occlusal reduction. The remaining islands of
tooth structure between the alignment grooves are
removed while the chamfer margin is being placed,
and the same narrow, round-tipped diamond is used
for the procedure (Figs. 8-16 and 8-17).
5. As with the occlusal reduction, perform the axial
reduction for half the tooth at a time, maintain-
B ing the other half as a reference for assessing ade-
quacy of the preparation.
6. Pay special attention to the interproximal areas to
prevent unintentional damage to the adjacent
teeth. This often results if the practitioner is impa-
tient and attempts to force the diamond into the
Fig. 8-15
A, The diamond is aligned parallel to the long axis of the tooth
area. Sufficient time must be allowed for the
as the buccal guiding grooves for axial alignment are placed.
B, All six grooves have been placed. Note that they are deep *The same cast can be used to fabricate the interim restoration (see
occlusally but shallower toward the cervical margin. Chapter 15).

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266 PART II CLINICAL PROCEDURES: SECTION 1

A A

B
B

Fig. 8-18
Fig. 8-17 A, As the mesiobuccal axial reduction is performed, a cervical
A, Note the alignment of the diamond as tooth structure
chamfer is placed. B, Make the chamfer of relatively even width
between the alignment grooves is removed. B, Axial reduction.
and maintain the somewhat angular preparation outline form
The distobuccal axial reduction has been completed.
to maximize resistance form.

cutting instrument to create its own space (Fig.

8-18).
Typically, if the proper cervical placement of the
margin has been selected with proper axial align-
ment of the instrument, a lip of tooth enamel is
maintained between the diamond and the adjacent
tooth that protects it from any damage (Fig. 8-19).
7. If desired, protect the adjacent teeth by placing
a metal matrix band. The most difficult inter-
proximal areas to reduce are those with signifi-
cant buccolingual dimension and those with root
Fig. 8-19
proximity. Typically, however, the critical area is
A lip of enamel (arrow) protects the adjacent tooth from iatro-
only a few millimeters in length. genic damage as the axial reduction is completed.
8. Cut into the proximal area from both sides until
only a few millimeters of interproximal island
remain (Fig. 8-20). This area can then be removed tinct resistance against vertical displacement
and contact broken by using thinner, tapered should be detected when probed with the tip of
diamonds. If the adjacent proximal surface is an explorer (Fig. 8-21). Unsupported enamel
damaged, it must be polished with white stones, cannot be tolerated because it is likely to fracture
silicone points, and prophylaxis paste before when the restoration is evaluated or cemented,
impression making. Ideally, a fluoride application which results in an open margin and early failure
is given for improved resistance and to prevent of the restoration.
demineralization of the surface enamel.
9. Place the cervical chamfer concurrently with Finishing
axial reduction. Its width should be approxi- A smooth surface finish and continuity of all pre-
mately 0.5 mm, which allows adequate bulk of pared surfaces aid most phases of fabrication of
metal at the margin. This chamfer must be the restoration. Smooth transitions from occlusal to
smooth and continuous mesiodistally, and a dis- axial surfaces facilitate impression making, waxing,

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Chapter 8 THE COMPLETE CAST CROWN PREPARATION 267

As the axial reduction is performed,

B
eventually a small island of tooth
structure will remain in the inter-
proximal area. When removing this,
maintain a narrow “lip” of tooth
structure between the diamond and
the adjacent tooth to protect the
latter from damage.

Fig. 8-20
Preparation of the proximal contact area.
C

A B Fig. 8-22
A, The transition from lingual to occlusal surfaces is rounded
with a fine-grit diamond. B, All sharp line angles between
occlusal reduction and functional cusp bevel are similarly
≥0.6 mm ≥0.6 mm rounded. C, The margin is refined, and any minor irregularities
are removed.
Fig. 8-21
A, Note that adequate clearance (≥0.6 mm) exists between the
external surface of the proximal chamfer and the adjacent
tooth. B, Occlusal view of the preparation. applied from time to time to prevent the tooth
from dehydrating, and the possible development
of pulpal damage, as well as to wash away debris.
investing, and casting because bubble formation is The wider diamond is recommended because it
reduced (Fig. 8-22). smooths out any unwanted ripples that may have
1. Use a fine-grit diamond or carbide bur of slightly been created during axial reduction and elimi-
greater diameter for finishing the chamfer nates any unsupported enamel at the margin (Fig.
margin. This should be done as smoothly as pos- 8-23).
sible, with the handpiece operating at reduced 3. Place additional retentive features as needed (e.g.,
speed. Some practitioners favor using a low-speed grooves or boxes) with the tapered carbide bur
contra-angle for the finishing. A properly finished using the slow speed handpiece (Fig. 8-24).
margin should be glassy smooth when touched by The criteria used to determine the need for such
the tine of an explorer. features to enhance retention and resistance are
2. Finish all prepared surfaces and slightly round all described in Chapter 7.
line angles. If necessary, place a nonfunctional
cusp bevel at this time. During finishing of the Evaluation
chamfer, the use of air cooling alone is recom- Upon completion, the preparation is evaluated to
mended to improve visibility. However, when assess whether all the criteria have been fulfilled
only air cooling is used, a water spray should be (Fig. 8-25).

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268 PART II CLINICAL PROCEDURES: SECTION 1

A
A

Fig. 8-23
Completed preparation. The carious lesions have been
excavated and the resulting irregularities blocked out with
amalgam. A, Buccal appearance. B, Occlusal appearance.

One of the more common errors in complete cast Fig. 8-24

A, When opposing axial walls are excessively tapered, internal
crown preparations is overtapering of the opposing features such as this buccal groove can be used to improve
axial walls. This significantly reduces the retention of retention and resistance form. B, Mesially tipped molars and
the completed restoration. If a tooth preparation has short premolars often benefit from grooves and/or boxes incor-
been inadvertently overreduced through excessive porated in the preparation design.
tapering of axial walls, it should be carefully evalu-
ated to determine how it can be corrected. If a band
of several millimeters of tooth structure can be pre-
pared circumferentially with a restricted taper of
approximately 6 degrees, it is probably unnecessary
to modify the preparation further to compensate for
areas of excessive reduction in the occlusal third. If
this is not the case, an approach slightly less conser-
vative of tooth structure may be warranted: (1)
uprighting overtapered axial walls to obtain the
mechanical advantage of increased retention or (2)
using grooves, boxes, or pinholes as needed.
No undercuts between any opposing axial walls
can be accepted. When the diamond is placed
against the axial surface of the prepared tooth, par-
allel to the path of placement, it should be possible
to move the instrument around the tooth so that the
entire height of the preparation is touching the Fig. 8-25
The completed preparation is characterized by a smooth, even
diamond at all times. The tip of the diamond should
chamfer; a 6-degree taper; and gradual transitions between all
rest on the chamfer throughout this movement, and prepared surfaces.
no light should be visible between the instrument
and the axial surface.
Finally, occlusal and proximal clearances are
assessed. They should be adjusted if inadequate pro-

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Chapter 8 THE COMPLETE CAST CROWN PREPARATION 269

vision has been made for the restorative material.

Any problems must be corrected before making the
interim restoration (Fig. 8-26) and the impression.

SUMMARY
A
The complete cast crown, an all-metal restoration
often used on single posterior teeth as a retainer for
a fixed dental prosthesis, provides greater retention
and resistance than any other type of restoration. It
is not indicated for every restorative circumstance,
however. It is unnecessary if the buccal and/or
lingual walls of a tooth are intact or if less than
maximum retention is needed. The rather extensive
removal of tooth structure required in its preparation
can have adverse pulpal and periodontal effects. The
high strength of the complete cast crown makes it
especially suitable for restoring an endodontically
B
treated tooth, although in patients who find visible
metal a significant drawback, the metal-ceramic or a
more conservative partial-coverage restoration may
be preferred.
A well-organized approach to preparation for a
complete cast crown should be based on the selec-
tive use of guiding grooves of predetermined depth
correlated with specific properties of the restorative
material. Adequate occlusal reduction is necessary,
in accordance with the normal anatomic tooth con-
tours, and the axial reduction should also conform
C
to the normal configuration of the tooth, with
minimum taper (6 degrees). Under no circum-
stances should undercuts remain in the proximal
walls. These must be removed by additional tooth
preparation or blocked out with a suitable base
material. The chamfer is the margin of choice for a
complete cast crown. It should be distinct and of
Fig. 8-26 adequate width. No unsupported enamel can be per-
A, Acrylic resin interim restoration is cemented. B and C, Com- mitted. Occlusocervically, the margin should be
plete cast crown is cemented. supragingival, and it should be smooth and continu-
ous mesiodistally. When assessing the adequacy of
the chamfer, the examiner should be able to feel dis-
tinct resistance against vertical displacement by an
explorer or periodontal probe.

? STUDY QUESTIONS

?
1. What are the indications and contraindications for complete cast crowns?
2. What are the advantages and disadvantages of complete cast crowns?
3. What is the recommended armamentarium, and in what sequence should a mandibular molar be prepared,
for a complete cast crown?
4. What are the minimum criteria for each step described in question 3?

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270 PART II CLINICAL PROCEDURES: SECTION 1

SUMMARY CHART
COMPLETE CAST CROWN

Indications Contraindications Advantages Disadvantages

Extensive destruction from Less than maximum Strong Removal of large amount of
caries or trauma retention tooth structure
necessary
Endodontically treated Esthetics High retentive qualities Adverse effects on tissue
teeth
Existing restoration — Usually easy to obtain Vitality testing not readily
adequate resistance feasible
form
Necessity for maximum — Option to modify form Display of metal
retention and strength and occlusion
To provide contours to — — —
receive a removable
appliance
Other recontouring of — — —
axial surfaces (minor
corrections of
malinclinations)
Correction of occlusal — — —
plane

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Chapter 8 THE COMPLETE CAST CROWN PREPARATION 271

Recommended
Preparation steps armamentarium Criteria
Depth grooves for occlusal Tapered carbide or diamond Minimum clearance on noncentric cusps:
reduction 1 mm

Functional cusp bevel Tapered carbide or diamond Minimum clearance on centric cusps:
1.5 mm
Occlusal reduction (half at a Regular-grit, round-tipped Flatter than cuspal plane, to allow
time) diamond additional reduction at functional cusp

Alignment grooves for axial Tapered diamond Should follow normal anatomic
reduction configuration of occlusal surface
Axial reduction (half at a Tapered diamond Chamfer allows 0.5 mm of thickness of
time) wax at margins

Finishing of chamfer Tapered diamond Reduction performed parallel to long

axis

Additional retentive features Wide, round-tipped Smooth mesiodistally and buccolingually;

if needed diamond or carbide resistance to vertical displacement by
tip of explorer or periodontal probe
Finishing Tapered carbide Grooves, boxes, pinholes as described for
partial-coverage restorations
Fine-grit diamond or Rounding of all sharp line angles to
carbide to facilitate impression making, die
pouring, waxing, and casting

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