Fixed prosthodontics course

(crowns)

 Introduction To fixed prosthodontics.

 Indications & Contraindications For Crowns.

 The Complete Cast Crown Preparation.

 Lab Procedures In Crown And Bridge.

By: Bassam Mashraqi & Israa Ahmed

 Introduction To Fixed Prosthodontics
Prosthodontics : the dental speciality concerned with the making of
artificial replacement for missing parts of the mouth and jaw.

Fixed Prosthodontics :

 Gold crowns ( full/partial ).

 Inlays (gold/all ceramic).
 Porcelain crowns (all ceramic/ PFM).
 Fixed partial dentures/Bridges.

Indications :

1. One or two adjacent teeth are missing in the same arch.

2. The supporting tissues are healthy.
3. Suitable abutment teeth are present.
4. The patient is in good health state and wants the prosthesis placed.
5. The patient has the skills and motivation to maintain good oral
hygiene.

Contraindications :

1. The supporting tissues are diseased or missing.

2. Suitable abutment teeth are not present.
3. The patient is in poor health state or has poor oral hygiene habits.
4. The patient is not motivated to have the prosthesis placed.
5. The patient can’t afford the treatment.
 Intracoronal restorations are those prostheses surrounded by one or
more natural tooth surface(s).
e.g. Inlay : intracoronal restoration covers a portion of the occlusal
and proximal surface excluding cusps.
 -gold inlays
 Extracoronal restorations are those surrounding one or more natural
tooth surface(s). e.g :
Onlay : extra coronal restoration covers a portion of the occlusal and
proximal surface including cusps.

- All ceramic onlay (left). Gold onlay (right).

Porcelain laminate veneers /PLV : thin shell-like covering placed to
improve the appearance of anterior teeth. They are placed to cover
defects as hypo calcification and intrinsic stains.

Before (left) & after (right) placing veneers.

Partial coverage crown : they’re an extension of PLVs occupying a
midpoint between full coverage and the minimally invasive PLVs.
Many configurations e.g ¾, 7/8, .. etc

Full coverage crown : extra coronal restoration completely covers the

anatomic crown of an individual tooth.

Bridge : a prosthesis for missing teeth within the same arch.

Before (left) & after (right) placing a FPD\bridge.

CROWN :
Extracoronal restorations that completely cover anatomical crown of
an individual tooth.
Classification\Types of crowns :
 According to material used :
- cast metal crowns.
- Metal-Ceramic crowns (PFM).
- All ceramic crowns.
 According to time : provisional OR permanent.
 According to location : anterior OR posterior.
 According to coverage : full OR partial.

For vital teeth, a crown can be supported either by coronal dentine or a

core build up.

For endodontically treated teeth, a post and core complex may be

necessary (post retained crowns).
A post is an intraradicular device that provides retention for a core in a
destructed tooth. In fact, by itself, it weaken the tooth rather than
strengthen it.
A core can be fabricated directly in the mouth using amalgam or
composite, or indirectly in a dental laboratory using cast metal or ceramic.
NB : inlay & onlay are indirect restorations means that they are fabricated
outside the patient mouth in a dental laboratory.

Tooth preparation for crown :

Crown preparation is usually for full coverage, but various configurations
are possible as ½, ¾, etc. depending on the remaining tooth substance.
Essentially, tooth preparation for crowns is material-oriented ( the tooth is
prepared to accommodate the properties of specific restorative materials
such as gold, resin based composite or ceramic.

Criteria for crown preparation ( summary ) :-

Crown type Occlusal reduction Axial reduction Finish line design

Cast Metal Functional cusps : 1.5mm All around : 0.5mm Facial : chamfer
Nonfunctional cusps : 1mm Palatal : chamfer

Metal-Ceramic Functional cusps : 2mm Facial : 1.5mm Facial : shoulder

Nonfunctional cusps : 1.5mm Lingual : 0.5-0.7mm Palatal : chamfer

All Ceramic Functional cusps : 1.5mm All around : 1mm Facial : shoulder
Nonfunctional cusps : 1mm Palatal : shoulder
*Axial taper acceptable range for the three types : 6-15 convergence degree
NB :
Finish line ( restorative margin design ) : the terminal portion of a
prepared tooth. Three basic shapes are possible : Knife-edge,
shoulder( with geometry angle range 90-12 deg.), and chamfer finish
line design ( in which gingival aspect meets the external axial surface
at an obtuse angle \135 ). It’s may be located supragingivally,
equigingivally or subgingivally depending on different factors (e.g
periodontal health, type of crown, .. etc ).

Knife-edge shoulder chamfer

 BRIDGE ( FPD ) :
Multiple teeth restorations :-
 Fixed bridge : a prosthesis for missing teeth within the same
arch.
 Splint : a prosthesis where multiple crowns are tied together for
support without pontics.
 Resin-bounded bridge : with wing-like extensions coming from
proximal sides ( bonded onto lingual surfaces of the teeth
adjacent to the missing tooth ).

splint. Rsin-bonded bridge\Maryland bridge.

 Types Of Bridges :
1. Conventional : involve removing tooth tissue, or a previous
restoration, and replacing it with a retainer. This may be destructive
to the tooth tissue and will certainly be time-consuming and
expensive.
2. Adhesive : the alternative, minimum-preparation bridge involves
attaching pontics via a metal wing to the unprepared (or minimally
prepared) lingual and proximal surfaces of adjacent teeth.
3. Hybrid.
 Components of FPD :
1. Pontics : part of bridge that replace missing tooth\teeth.
2. Retainer : crown or other restoration attached to an abutment.
3. Connector : part of bridge that join the pontics to retainers.

An abutment is a tooth to which a bridge or partial denture is

retained.

 Impression Materials Used For Fixed Prosthodontics :

 Reversible hydrocolloids.
 Polysulfide polymer.
 Condensation silicone.
 Additional silicone.
 Polyether.
 Provisional\Temporary restorations :
Used as an interim restorations before fitting the indirect
definitive restoration or prosthesis ( e.g polycarbonate, cellulose
acetate, aluminum, tin-silver, nickel-chromium ).

A preformed plycarbonate crown selected & adjusted.

 Laboratory procedure in crown and bridge work ( casting
procedure\ crown fabrication ) :-
 Tooth preparation.
 Impression.
 Temporization (provisional restoration smoothened & polished )
 Cast and die fabrication.
 Wax-up ( exact shape & size of desired crown )
 Investing and casting.
 Crown adjusting & polishing.
 Clinical try-in & cementation.
Indications And Contraindications For Crowns
Before the introduction of techniques to bond restorative materials to
teeth, crowns were the only way of restoring teeth that can now be
restored by these other techniques.

GENERAL INDICATIONS FOR CROWNS :-

1. Badly broken-down teeth :

Extensive composite or amalgam fillings bonded to the remaining tooth
structure or retained by other means have the advantages of being
directly placed, conservative to tooth structure and don’t involve
laboratory procedures. However, when very large, involving most of the
occlusal surface such restorations are rarely able to produce an
acceptable occlusal and proximal contour and have an unpredictable
long-term durability and so a crown may be the treatment of choice.
- Usually before the crown is placed, the lost dentine will need to be
replaced by a suitable core of ret. material sometimes following
endodontic treatment.
2. Primary Trauma :
An otherwise intact tooth may have a large fragment broken off without
damaging the pulp and leaving sufficient dentine to support a crown.
3. Tooth Wear :
Erosion - damage from acid other than that produced by bacteria.
Attrition - mechanical wear of one tooth against another.
Abrasion - mechanical wear by extraneous agents.
 Management Approach :
- Early diagnosis and prevention.
- Monitoring any further progression until the pt complains of the
appearance, sensitivity (which doesn’t respond to other ttt), function is
 affected, or the wear reaches a point where restorations will become
technically difficult.
- At this point, provide minimal restorations (normally directly bonded
composite restorations).
- If the problem continues, provide crowns.

4. Hypoplastic Conditions :
These are divided into :

Congenital - e.g., microdontia (small tooth), peg shaped lateral incisors,

amelogenesis imperfect, and dentinogenesis imperfect.
Acquired - e.g., flurosis, tetracycline stain, enamel hypoplasia resulting
from major nutritional disturbances at the age the enamel was
developing.

5. To Alter The Shape, Size or Inclination of Teeth :

- Major changes in the position of the teeth can be only made
orthodontic treatment.
- Minor changes in appearance can be achieved by building up the tooth
with composite or by composite or porcelain veneers. E.i a large midline
diastema can be closed or reduced by means of addition of composite or
veneers following ortho. Treatment. However, when the space is small
oversized crowns will produce a durable and attractive result.

6. To Alter Occlusion :
Crowns may be used to alter angulation or occlusal relationships of
anterior and posterior teeth as part of an occlusal reconstruction either to
solve an occlusal problem or to improve function.
7. As Part Of Another Restoration :
- As component of fixed splints.
- They are also made to alter the alignment of teeth to produce guide
planes for partial dentures or to carry precision attachments for precision
attachment retained PDs.
8. Multiple Crowns :
With some of these indications, notably tooth wear and hypoplastic
conditions, many or all of the teeth may need to be crowned.

9. Mechanical Problems :
Sometimes, although it would be possible to restore a tooth by means of a
filling, the pattern of damage to the tooth gives rise to anxieties
about the retention of the restoration, the strength of the remaining tooth
tissue, or the strength of the restorative material.
10. Appearance :
One of the principal reasons for patients seeking dental treatment is to
maintain or improve their appearance. Much more can now be done to
improve appearance with the current range of composite materials than
was the case a few years ago.
Composite has the advantage of being more adaptable than porcelain. It is
applied, shaped and polished at the chair-side and later it can be repaired
and resurfaced . This means that crowns are now less often indicated to
improve appearance.
Many patients simply wish to lighten the colour of their teeth, which may
have darkened with age or from smoking. If the teeth are substantially
sound and their position and shape are acceptable to the patient, a
significant improvement can be made by thorough cleaning and external
bleaching. However, sometimes the discoloration is so intense that
bleaching alone will not provide a satisfactory result . Initial bleaching to
lighten the tooth as much as possible helps because the crown then does
not have to disguise too dark a preparation.

11. Severely discolored non-vital anterior teeth :

when a pulp becomes necrotic the tooth often discolors due to the
hemoglobin breakdown products which results in darkening of the teeth .
Staining could also be due to tetracycline use.
12. Combined Indications :
More than one of these indications may be present, so that, for example, a
broken-down posterior tooth that is over-erupted and tilted may be
crowned as a repair and at the same time to alter its occlusal relationships
and its inclination, providing a guide plane and rest seat for a partial
denture.

ALTERNATIVES To Anterior Crowns :-

- Microabrasion \ Macroabrasion
- Internal \ External bleaching.
- Composite restorations (fillings).
- Composite \ Porcelain veneers.
NB : Priority is always to achieve the best appearance with minimal
destruction.
ALTERNATIVES To Posterior Crowns :-
- Pin retained amalgam restorations.
- Bonded amalgam restorations.
- Tooth colored posterior restorations.
- Gold inlays \ onlays protect weak cusps.
- Ceramic inlays & onlays.
CONTRAINDICATIONS FOR CROWNS :
There is no absolute contraindications for making crowns, however they
are better over-thought in the following situations :-
1. When a more conservative approach can be provided with satisfactory
results.
2. With patients below 18 due to gingival recession and large pulps.
3. Unfit patient that can’t tolerate long treatment sessions (e.g.,
handicapped, pt with depleting disease).
4. Patients with bad oral hygiene (better to delay treatment until controlled).
 The Complete Cast Crown Preparation
 Although aesthetics may limit it’s application, the all-metal complete
cast crown should always be offered to patients requiring restoration for
badly damaged posterior teeth.
 The complete cast crown has the best longevity of all fixed restorations.
 It can be used to rebuild a single tooth or as a retainer for a fixed dental
prosthesis.
 It involves all axial walls, as well as the occlusal surface of the tooth
being restored.

ADVANTAGES Of All-Metal Crowns :-

1. They have a greater retention than a more conservative restoration

on the same tooth (since all axial walls are included in the prep.).
They also have greater resistance than partial coverage restorations.
2. Superior strength when compared to other restorations.
3. More conservative with other types of crowns (which require more
tooth prep. and hence destruct tooth structure).
4. Allow the operator to modify axial tooth contour. This can be of
special significance with malaligned teeth, although the extent of
possible recontouring is limited by periodontal consideration.
5. It’s possible to allow better access to furcations for improved pt oral
hygiene through recontouring of buccal and lingual walls.
6. The only restoration that allows the necessary modification for the
creation of properly shaped survey lines, guide planes, and occlusal
rests when retainers are needed for RPDs.
7. The restoration permits easy modification of the occlusion which is
often difficult to accomplish if a more conservative restoration is
made. (This is especially important when supraerupted teeth are
present or when the occlusal plane needs to be reestablished).

DISADVANTAGES :-

1. Less conservative when compared to partial coverage crowns.

2.After cementation, it’s no longer feasible to perform electric vitality
testing of an abutment tooth (the conductivity of metal interferes with the
test).
3. Patient may object to the display of metal associated with complete cast
crowns.
4. In those with a normal smile line, the restoration may be restricted to
maxillary molars and mandibular molars and premolars.

INDICATIONS To Use All-Metal Crowns :-

1. On teeth that exhibit extensive coronal destruction by caries or trauma.
2. It’s the restoration of choice whenever maximum retention and
resistance are needed.
3. On short clinical crowns or when high displacement forces are
anticipated (e.g., for the retainer of along-span fixed dental prosthesis).
4. When correction of axial contours is not feasible with a more
conservative technique.
5. May be used to support a partial removable dental prosthesis because
obtaining the necessary contours with a partial coverage restoration is
more difficult.
6. On endodontically treated teeth.

CONTRAINDICATIONS :-
1. If treatment objectives can be met with a more conservative restoration.
2. Wherever an intact buccal or lingual wall exists (partial coverage rest.
should be considered rather).
3. If less than maximum retention and resistance are needed (e.g., on a
short-span fixed dental prosthesis).
4. If an adequate buccal contour exists or can be obtained through enamel
modification (enameloplasty).
5. If a high esthetic need exists (e.g., for anterior teeth).

Preparation criteria :
 The occlusal reduction must allow adequate room/clearance for the
restorative material from which the cast crown is to be
fabricated(Minimum recommended clearance is 1 mm on nonfunctional
and 1.5 mm on functional cusps).
 The occlusal reduction should follow normal anatomic contours (cons.).
 Axial reduction should parallel the long axis of the tooth but allow for
the recommended 6-degree taper or convergence.
 The margin should have a chamfer configuration and is ideally located
supragingivally
 The chamfer should be smooth and distinct and allow for approximately
0.5 mm of metal thickness at the margin (Typically, it is an exact replica
of half the rotary instrument that was used to prepare it).
 Functional\centric cusp bevel :
Because additional reduction is needed for the functional cusps (to
provide 1.5 mm of occlusal clearance), the bevel must be angled flatter
than the external surface. On most teeth, the functional cusp bevel is
placed at about 45 degrees to the long axis.
 Nonfunctional/noncentric cusp bevel :
For adequate strength, a minimum of 0.6 mm of clearance is needed at
the occlusoaxial line angles of the nonfunctional cusps. An additional
reduction bevel is often necessary in maxillary molars, but not in
mandibular ones because they are lingually inclined and their profile is
relatively straight.
 Chamfer width :
Adequate chamfer width (minimum 0.5 mm) is important for
developing optimal axial contour.
 PREPARATION PROCEDURE

The clinical procedure to prepare a tooth for a complete cast crown consists
of the following steps:
1. Occlusal guiding grooves.
2. Occlusal reduction.
3. Axial alignment grooves.
4. Axial reduction.
5. Finishing and evaluation.
Guiding grooves for occlusal reduction :-

Instrument used : tapered carbide or a narrow, tapered diamond.

1. Place depth holes approximately 1 mm deep in the central, mesial, and
distal fossae, and connect them so that a channel runs the length of the
central groove and extends into the mesial and distal marginal ridge.
2. Place guiding grooves in the buccal and lingual developmental grooves
and in each triangular ridge extending from the cusp tip to the center of its
base.
3. place a functional cusp bevel in the area of contact with the opposing
tooth. The depth of this guiding groove should be slightly less than 1.5 mm
(to allow for smoothing) in the area of the centric stop, and it should
gradually diminish in a cervical direction.
4. Use the guiding grooves to ensure that occlusal reduction follows
anatomic configuration and thus minimizes the loss of tooth structure
while ensuring adequate reduction.
Occlusal reduction :-
Once the guiding grooves have been deemed satisfactory, the tooth
structure that remains between the grooves is removed with the carbide or
the narrow, round-end, tapered diamond.
5. Complete the occlusal reduction in two steps (Half the occlusal surface
is reduced first so that the other half can be maintained as a reference).
6. On completion, check that a minimum clearance of 1.5 mm has been
established on functional cusps and at least 1.0 mm on nonfunctional
cusps. This clearance must be verified in all excursive movements that the
patient can make. The patient should close into several layers of dark-
colored utility wax in maximum intercuspation.
7. Remove the wax from the mouth and evaluate it for thin spots, which
can be measured with a wax caliper.
8. Place the wax back in the patient’s mouth and have the patient move the
mandible into protrusive and excursive positions.
Alignment grooves for axial reduction :-
After the occlusal reduction is completed, three alignment grooves are
placed in each buccal and lingual wall(One is placed in the center of the
wall, and one in each mesial and distal transitional line angle).
Instrument used : narrow, round-end, tapered diamond.
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 (
to produce convergence).
2. Do not let the diamond cut into the tooth beyond the point where its tip
is buried in tooth structure up to the midpoint; otherwise, a lip of
unsupported tooth enamel will be created. Gingivally, the resulting depth
of the alignment grooves therefore should be no more than one half the
width of the tip of the diamond. Occlusocervically, the placement of the tip
of the instrument determines the location of the margin.
3. Note that the alignment grooves determine the path of placement of the
restoration (they should be placed parallel to the proposed path of
placement, typically the long axis of the tooth).
4. Use a periodontal probe to assess the relative parallelism of the
alignment grooves.
Axial reduction :-
The remaining islands of tooth structure between the alignment grooves
are removed while the chamfer margin is being placed.
5. As with the occlusal reduction, perform the axial reduction for half the
tooth at a time.
6. Pay special attention to the interproximal areas to prevent unintentional
damage to the adjacent teeth.
7. If desired, protect the adjacent teeth by placing a metal matrix band.
8. Cut into the proximal area from both sides until only a few millimeters
of interproximal island remain (This area can then be removed and contact
broken by using thinner, tapered diamonds).
9. Place the cervical chamfer concurrently with axial reduction.

Finishing :-
A smooth surface finish and continuity of all prepared surfaces aid most
phases of fabrication of the restoration (This will facilitate impression
making, waxing, investing, and casting because bubble formation is
reduced).
1. Use a fine-grit diamond or carbide bur of slightly greater diameter for
finishing the chamfer margin.
2. Finish all prepared surfaces and slightly round all line angles.
3. Place additional retentive features as needed (e.g., grooves or boxes)
with the tapered carbide bur, using the slow speed handpiece.
Evaluation :-
Upon completion, the preparation is evaluated to assess whether all the
criteria have been fulfilled.
e.g, evaluation of tapering of axial walls, undercuts between opposing axial
walls, and assessment of occlusal and proximal clearances.
Step By Step Clinical Procedure :

1. Occlusal guiding grooves 2.Occlusal reduction

3. Axial Alignment grooves 4. Axial Reduction

 5. Finishing & Evaluation

NB : 1.For the upper teeth, functional (centric) cusps are palatal cusps while
nonfunctional cusps are buccal cusps.
For the lower teeth, functional (centric) cusps are buccal cusps while
nonfunctional cusps are palatal cusps.
2. The practitioner should memorize the diameters of the rotary instruments; this
facilitates assessment of the adequacy of the reduction in progress. If necessary, a
periodontal probe can be used to measure the extent of reduction. Correct
angulation of the grooves is needed to ensure that the occlusal reduction is
correctly situated beneath the occlusal surface of the restoration. On the
nonfunctional cusp, the groove should parallelthe intended cuspal inclination; on
the functional cusp, it should be angled slightly flatter to ensure the additional
reduction of the functional cusp.
 Lab Procedure In Crown And Bridge

- The key to high-quality fixed prosthodontics is good communication between

the dentist and the technician.
 1. Working Cast & Die
Definition :
The definitive cast (or master or working cast) : is the replica of the
prepared teeth, ridge areas, and other parts of the dental arch. It’s the cast
mounted on the articulator.
Die : is the model/replica of the individual prepared tooth on which the
margins of the wax pattern are finished.

Requirements of a good cast :

1. The cast must be bubble free especially on the finish line of the
prepared tooth.
2. All portions of the cast must be free of distortion.
3. The cast must be trimmed to make carving of the wax pattern
margins easy.
4. The cast & die should have a hard surface to prevent surface abrasion
when the wax pattern is fabricated.
Materials ( gypsum ) :
The two characterstics of cast and die materials are :
A. Dimensional accuracy.
B. Resistance to abrasion.
Gypsum’s greatest disadvantage is it’s relatively poor resistance to
abrasion. This may be partly overcome through use of “gypsum
hardeners”. Although these materials (e.g., colloidal silica) have relatively
little effect on the hardness of the stone, they improve abrasion resistance
(some by as much as 100%).
Laboratory Steps Of Manufacture :
Pouring The Impression :
 High strength type IV or high strength type V stones should be used
for fabricating the die.
 Impression should be washed and disinfected.
 Impression should be carefully dried and no moisture should be
present in it’s surface.
 Place measured amount of water and add a measured amount of the
powder to a mixing bowl carefully following the manufacturers
instructions.
  Vacuum mix for 15 seconds.
 Use a small instrument to carry stone to the impression of the
prepared tooth.
 Place small amount of the stone on the side of the impression above
the preparation and vibrate.
 Tilt the impression so that the stone flows slowly across the bottom of
the preparation displacing air as it moves.
 Add stone in small increments ( if large layers are added, air
entrapment my occur ).
 Build up the stone into a height of approximately 1.0 inch over the
preparation to allow for an adequate handle on the die.
 To pour full arch impression place the tray on a vibrator and add
small pieces of stone to the distal area of the impression.
 Slowly raise distal end of the impression so that the stone will move
mesially.
 Allow the poured impression to set for at least 1 hour.

Types Of Dies Based On Design :-

1. Working cast with separate die system :
Produced by producing two separate casts; a sectional cast and a full arch
cast obtained from the same impression ( elastomeric impressions ) or by
taking an impression twice.

- Advantages :
a. Easy to do.
b. Keeps the relation between the abutments fixed.
c. Better gingival contours can be fabricated.
- Disadvantages :
Wax pattern must be transferred from die to working cast, causing
distortion.
2. Working cast with a removable die :
 Dowel pin system ( straight, curved ).
 Di-lok tray system.
 Pindex system.
- Advantages :
a. Convenient, there is no need to transfer the wax pattern.
b. Eliminate differences caused by impression distortion.
c. Eliminate differences that can occur when the die is coated with a
relief agent.
- Disadvantages :
The risk of introducing an error if the die is not seated properly.
- Requirements :
1. The die must return to it’s exact position.
2. The die must remain stable even when inverted.
3. The cast containing the die must easy to be mounted on
articulator.
Types of working cast with removable die systems :

a) Straight dowel pin :

Easy to prepare.
No special equipment is necessary.
Disadvantage: the pin may be displaced while pouring the cast.

 Methods of repositioning of a die in its working cast :

Pre-pour technique: oriented in the impression before it is poured.

Post- pour technique: Attached to the underside of the a cast that has
already been poured.
b) Curved dowel pin :
Curved pin project from the side of the cast.
When pressed the die pop out.
c) Di-lok tray system :
This is a snap apart plastic tray with internal orienting grooves which
is used to produce the cast
Advantages:
- simple & easy to prepare
- Cast can be mounted on an articulator
Disadvantage:
- Special equipment is required.
d) Pindex system :
Device with a reverse drill press is used to create a master cast with
dies that can be removed accurately.
 2. Wax Pattern
Is the precursor of the finished cast restoration that will be placed on the
prepared tooth. It will be duplicated exactly through the investing and
casting technique.

The definitive die and cast may require small modifications before waxing
is started. Depending on the procedure, the size of the die can be slightly
increased by applying a thin layer of painted-on spacer, which helps obtain
a slightly larger internal diameter of the restoration.
Techniques For Fabrication :
1. Direct technique : fabricate in the mouth, using type I wax ( medium
hardness wax ).
2. Indirect technique : most commonly used technique. Fabricated in the
cast, using type II wax ( softer wax ).
Requirements of wax used for wax pattern :-
 Should be in different color from the stone. E.g blue, green or red.
 It must flow when heated, without chipping or loosing it’s
smoothness.
  When cooled, it must be rigid.
 It must be capable of being carved without distortion.
Steps involved in wax pattern fabrication :
1. After correction of defects, mark the preparation margin with a pencil
(the color of the pencil should contrast the color of the wax).
2. A die spacer is added to the surface of the die. This will provide
space for the cement later ( 1 mm away from the margin ).
3. Coping preparation : wax can be coated on tooth either using a wax
spatula or by dipping the die into hot wax.
4. Build up of proximal contours and establish contact areas. Contact
areas should be formed so that the gingival embrasures are
symmetric.
5. Axial surface contoured to follow the shape of adjacent teeth.
6. For occlusal surface build up, wax cones should be added to
determine cusp height and location.
7. Occlusal build up should allow even contact with opposing tooth.
8. The occlusal surface should follow the curve of Spee ( anterio-
posteriorly) & the curve of Wilson ( in a medio-lateral direction ).
Examination of marginal discrepancy :
 Over waxed : beyond finish line.
 Short margin.
 Ripples ( roughness of wax near margin ).
 Thick margin.
 Open margin.
 A, Marginal excess or flash (arrow). B, A small defect (arrow) is easier to see in the metal
but harder to correct.

Waxing the metal ceramic restoration :

 The wax pattern is built to full contour.
 Areas to be veneered by porcelain are cut back.
Technique review ( pics.) :

Die spacer is added.

Coping preparation (using spatula or wax dipping pot)

proximal contours build up & contact area establishment.

waxing axial contours.

Occlusal surface build up-wax cones.
3. Sprueing :

Sprue : Its a channel through which molten alloy can reach the mold in an
invested ring, after the wax has been eliminated.

Functions of sprue :
1. Creates a channel for elimination of wax & entry of molten metal.
2. Provides a reservoir of molten metal to compensate for the all shrinkage .

Types of sprues according to material used :

wax
metal plastic

Sprue
1. Wax sprues are preferred for most castings because they melt at the
same rate as the pattern.
Advantages:
Inexpensive.
Easy to manipulate.
Easy to burn out.
Available in a variety of diameters.
Easily designed for complex castings .
Have low thermal conductivity.
Disadvantage:
Lack rigidity.
2. Plastic Sprues can still be burned out but in longer times than the
wax, and this may block the escape of wax resulting in increased
casting roughness.
Advantages:
Rigid.
Easily burnable.
Also have low thermal conductivity.
3. Metal sprues Can be solid or hollow. The hollow are preferred
because they hold less heat and are more retentive.
To avoid this, metal sprue are uniformly coated with wax before
investing, so that at the time of burn out the sprue former comes out
on its own because of melting of wax.
 Sprue design varies depending on the type of restoration being cast, the alloy used,
and the casting machine.

Diameter of the sprue :

 Sprue Former should be thicker than the pattern to which it is

attached.
 Diameter of 3mm, 2.5mm, 2mm are available.
 A 2.5-mm (10-gauge) sprue is recommended for molar and metal-
ceramic patterns.
 A 2.0-mm (12-gauge) is adequate for premolars and partial coverage
restorations.

Location of the sprue :

 The sprue should be attached to the bulkiest part of the pattern, away
from margins and occlusal contacts.
 Normally the largest noncentric cusp is used.

Angulation of the sprue :

 Sprue is never directed at right angle to a flat portion of a wax

pattern as this will create a reverse flow causing Hot pot (suck back
porosity).

 Ideal angulation is 45 degrees.

a) Wrong angulation. B) Right angulation.

Attachment of the sprue :

 The sprue's point of attachment to the pattern should be carefully

smoothed.
 The attachment area shouldn’t be restricted or excessively wide.

Reservoir of sprue system :

 Reservoir portion of a Sprueing system is a round ball or a bar

located 1-2mm away from the wax pattern.
 Reservoir should be positioned in the heat centre of the ring so that the
metal remains molten for longer time until complete solidification
process.
Venting :

Small auxiliary sprues or vents to improve casting. They help gases to

escape during casting.

The crucible former :

Also called sprue base or sprue former base. It serves as a base for the casting
ring and it’s usually made of rubber (mostly), metal , or plastic.
Its shape depends on type of the ring and casting machine used.

SPRUEING TECHNIQUES :

1. Direct Sprueing : the sprue former provides a direct connection

between the pattern area and the crucible former area.
2. Indirect Sprueing : a connector or reservoir bar is positioned between
the pattern and the crucible former.

Casting ring and liner :

The casting ring holds the investment in place during setting and restricts
the expansion of the mould.
The metal used in the construction of a ring should be :

 Non corrodible

 Hard

 Have thermal expansion similar to investment used.

Stainless steel has been found to produce the most acceptable rings.

The dimensions of the ring may vary according to the desire of the
operator but the average dimensions are approximately 29 mm in diameter
and 38 mm in height.

Ring liner ( of a compressible material )Placed inside the ring to helps

provide investment expansion it also helps removal of the investment
block. It serves as :

1. A pliable lining that allows different types of investment expansion.

2. A thermal insulator that prevent rapid cooling & contraction of the
investment.
3. Facilitate venting during casting procedure.
4. Facilitate the removal of the investment block after casting.
4. Investing :
Classification of investment material ( according to the binder ) :
1. Gypsyum bonded investment: used for ADA Type II, Type III & Type IV
gold alloys.
2. Phosphate bonded investment: used for metal ceramic frameworks.
3. Silica bonded investment: used for high melting base metal alloys used
for removable prosthesis.

Procedures for investment by 2 techniques :

1. Brush technique : involves coating the wax pattern with gysum

using a brush first then slowly filling the ring held in a vibrator.

2. Vacuum technique : the ring is attached to the mixing bowl with

vacuum.

NB : Investment is left to set for a recommended 1 hr.

Burn Out :
Types of burn out oven :

 Manual
 Semiautomatic
 Fully programmable
Technique :
 The crucible former is removed.
 Place the ring in the oven with the sprue facing down
 Raise the oven temp to 200˚C & hold this temp for 30 min (most of
the wax is removed in this temp).
 Increase the heat to the final burn out temp 650 ˚C or 480 ˚C.

Wax Elimination or Burnout:

It consists of heating the investment in a thermostatically controlled
furnace until all the wax is vaporized.
Waxes are organic materials they are composed of C, H, O and N. Any
organic material when heated to higher temperatures decomposes and
forms Co2, (H2O), No2 that can be easily eliminated.

5. Casting :
Is the transformation of the molten metal into the mold cavity by use of a
casting machine.

Casting procedure :

• Once the investment has set for approximately 1 hour ,it is ready for
burnout.

• The crucible former and any metal sprue former are carefully
removed.

• Any debris is cleaned with a brush.

• If the burnout procedure does not immediately follow the investing

procedure, the invested ring is placed in a 100% humidity.
Objectives of casting :

1. To heat the alloy as quickly as possible to a completely molten condition.

2. To prevent oxidation by heating the metal with a well adjusted torch.
3. To produce a casting with sharp details by having adequate pressure to
force the metal into the mold.

Casting machine :
It is a device which uses heat source to melt the alloy.
Casting machine consist of :

 Heat source (flame of a torch or electrical heat source ) to melt the alloy.
 Casting force to drive the alloy into the mould. It must be high
enough to resist surface tension of the molten alloy as well as
resistance of gas within the mold.

NB : Present day casting machines use either air pressure or centrifugal force to
fill the mold.

a) Centrifugal Casting Machine b) Air pressure type machine

Recovery of the casting :

After the red glow has disappeared

from the button, the casting ring is
plugged under running cold water.

When water contacts the hot investment,

it becomes soft granular and can be
easily removed.

Cleaning the casting :

Pickling process : It is the process of heating the discolored casting in an

acid to remove surface oxides.
One of the best pickling solutions is a 50% Hcl solution, also sulfuric acid
can be used.
Disadvantages with Hcl :

a) It corrodes the laboratory metal.

b) Fumes are health hazard and should be vented.
Other aids of cleaning the metal are :
- Ultrasonic devices with the prosthesis in a Teflon
container.
- Abrasive blasting devices.

Casting defects :

 Roughness
 Nodules
 Fins
 Porosity
  Incomplete casting
 Marginal discrepancy
 Dimensional inaccuracies

Fins are caused by cracks in the investment that have been filled with
molten metal. These cracks can result from :

1. High water-powder ratio of investment.

2. Excessive casting force.
3. Too-rapid heating.
4. Reheating an invested pattern.
5. Improperly situated pattern.
6. Premature or rough handling of the ring after
investing.

Incompleteness :
may result from :

1. Inadequate heating of the metal.

2. Incomplete wax elimination.
3. Excessive cooling "freezing“ of the mold.
4. Insufficient casting force.
5. Not enough metal.
6. Areas of very thin wax.

Voids or Porosity :

Voids may be caused by debris trapped in the mold.

Classification of porosity :
1. Those caused by solidification shrinkage :
- Localised shrinkage porosity.
- Suck back porosity.
- Microporosity.

2 . Those caused by air trapped in the mold :

- Back pressure porosity.
3 . Those caused by gas :
- Pin hole porosity.
- Gas inclusions.
- Subsurface porosity.

Steps of lost wax technique :

1. Preparing wax pattern.
2. Sprueing the wax pattern.
3. Attach the sprue to the crucible former.
4. Investing the pattern in casting ring.
5. Burn out of the wax.
6. Casting.
7. Recovery.
8. Finishing and polishing.