1340 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No.

Principles of Tooth Preparation - Review Article

Ganesh Ramesh1, Sanjna Nayar2, S.Chandrakala3

1
Professor, Department of Prosthodontics, 2Professor and Head, Department of Prosthodontics, 3Post graduate
Student, Department of Prosthodontics, Sree Balaji Dental College and Hospital, Chennai

Abstract
Adequate tooth preparation is essential for the fit of fixed prosthodontics. Insufficient tooth preparation
appears to be responsible for premature failures due to biological aspects, such as caries and endodontic
or periodontal disease complications. The purpose of a fixed prosthodontic therapy may vary from the
restoration of a single tooth to the rehabilitation of the complete occlusion. Successful preparations can
be obtained by systematically following these steps. It is important to critically evaluate each step before
proceeding to the next step to ensure an optimal quality final restoration, which will serve the patient for a
long time.

Keywords: Finish lines, taper, resistance, retention, structural durability

Introduction restoration. The most important element of retention is

the presence of two opposing vertical surfaces. The axial
Crowns and fixed partial dentures are the major
walls of the preparation should taper slightly to allow the
prosthodontic treatment modalities for past several
cementation of the artificial crown. The more parallel
decades with factors like esthetics, contact points and
are the axial walls the greater is the retention4.
pontics playing an important role in varying their design1.
The purpose of a fixed prosthodontic therapy may vary OBJECTIVES OF TOOTH PREPARATION
from the restoration of a single tooth to the rehabilitation
of the complete occlusion. A single tooth can be fully The main objectives of tooth preparation
restored both functionally and aesthetically. A missing • Reduction of a tooth in miniature to provide
tooth can be replaced by a fixed prosthesis, increasing retainer support.
patient masticatory competence and maintaining or
improving dental arches function, often elevating • Preservation of healthy tooth to secure
patient’s self-image. resistance form.

There is a general recognition that adequate tooth • Provision for acceptable finish lines.
preparation is essential for the fit of fixed prosthodontics.
• Performing pragmatic axial tooth reduction to
Insufficient tooth preparation appears to be responsible
encourage favourable tissue responses from
for premature failures due to biological aspects,
artificial crown contours
such as caries and endodontic or periodontal disease
complications2. In the case of finish lines, different TOOTH PREPARATION CAN BE STUDIED
recommendations have been made to improve esthetics, UNDER5
minimize marginal fitting irregularities, and reduce
stress concentration at the margins3. A. Biologic considerations: These affect the health
of the oral tissues which includes conservation of tooth
Tooth preparation should have specific geometrical structure, avoidance of overcontouring, supragingival
characteristics to provide necessary retention and margins, harmonious occlusion, and protection against
resistance to the vertical and lateral forces acting on the tooth fracture.
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4 1341
B. Mechanical consideration: These affect the insertion of crown restorations is parallel to the long axis
integrity and durability of the restoration. of the tooth except in ¾ crown for anterior teeth where
the path of insertion should be parallel to the incisal 2/3
C. Esthetic consideration: These affect the
of the tooth crown (not to the long axis). By limiting the
appearance of a patient.
path of withdrawal, retention is improved
BIOMECHANICAL PRINCIPLES OF
Factors affecting retention and resistance:
PREPARATIONS
a. Taper of the preparation.
The designs and preparations of a tooth for a cast
metal or porcelain restorations are limited by five b. Surface area of the preparation,
principles:-
c. Length and height of the preparation.
1. Preservation of tooth structure.
d. Diameter of the tooth (tooth width).
2. Retention and resistance from.
e. Texture of the preparation.
3. Structural durability of the restoration.
f. Accessary mean.
4. Preservation of periodontium.
a. Taper of the preparation (5-6) degree
5. Marginal integrity. convergence angle is mostly used to provide the needed
retention. The more nearly parallel the opposing walls
1. Preservation of the tooth structure
of preparation the greater will be the retention. But
The preparation of the tooth must be conservative; parallel wall is difficult to be obtained in the patient
the minimal amount of the tooth structure must be mouth without undercuts, also parallel walls might lead
removed. Excessive removal of the tooth structure has to difficulty in seating of the crown restoration, thus (5-
many harmful effects: - 6) degree convergence angle is mostly used to provide
the needed retention.
✓ Excessive reduction lead to thermal
hypersensitivity, pulpal inflammation and necrosis may Taper and Resistance: The more parallel the axial
result from approaching to the pulp closely. walls the more will be the resistance of crown restoration.
The walls of a short wide preparation must be kept nearly
✓ The tooth might be over tapered or shortened parallel to achieve adequate resistance from.
and this might affect the retention and resistance of the
prepared tooth. b. Surface area of the preparation: Increasing the
surface area increase retention. Factors that influence
2. Retention and resistance form surface area are:

Retention: is the ability of the preparation to resist ✓ Size of the tooth The larger the size of the tooth
the crown restoration from removal along its path of the more will be the surface area of the preparation, the
insertion. more will be the retention thus full metal crown on molar
tooth definitely more retentive than that on premolar
Resistance: is the ability of the preparation to resist
tooth.
the dislodgment of the restoration by forces directed
obliquely or horizontally to the restoration. ✓ Extend of coverage by restoration: The more
the area that will be covered by the crown restoration,
Path of insertion: An imaginary line along which
the more will be the retention, thus full metal crown
the restoration can be inserted and removed without
on molar is more retentive than 3/4 crown on the same
causing lateral force on the abutment.
tooth.
The crown restoration should have a single path of
✓ Accessory feature such as boxes, grooves and
insertion to be retentive. Most of the time the path of
1342 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4

pin holes. Functional cusps: the cusps that give centric stops
of occlusion. (Palatal of upper posterior teeth and buccal
c. Length (height) of the preparation: Increasing
of lower posterior teeth).
the length increase retention and resistance and vice
versa. • Occlusal reduction must reflect the geometric
inclined planes of occlusal surface.
d. Diameter of the tooth (tooth width): Under
some circumstances, crown on narrow tooth can have • Avoid creating steep planes with sharp angles,
grater resistance to tipping than a crown on a wider tooth, because it lead to stress.
this occur because the crown on the narrower tooth has
• Flat occlusal reduction lead to thin metal, this
shorter radius for rotation resulting in a lower tangent
will lead to perforation of the crown restoration
line and a larger resisting area.
in future.
e. Texture of the preparation. Depending on the
• Lowering the entire occlusal surface in attempt
type of cementation agent, texture of the preparation
to providing sufficient space might lead to
might effect on the retention of cast crown. Smooth
tooth structure destruction (non-conservative
surfaces are less retentive than rough (mechanical
preparation) &shortening of the axial wall of
interlocking).
prepped tooth which defiantly will affect the
f. Extra retention means. The retention of a retention-resistance potential of the preparation.
preparation can be greatly enhanced by the addition of
Functional cusp bevel (FCB) Wide bevel should
grooves, pin holes or boxes.
be placed on the functional cusps of posterior teeth
3. Structural Durability (SD): The preparation to provide structural durability (it allows adequate
must be designed so that it provide S.D. to the restoration, thickness of restoration at this critical area without
i.e. the crown restoration must be rigid enough to not structure destruction). If FCB is omitted, the restoration
flex, perforate (metal) or even fracture (plastic). For a is likely to be thin in this stress bearing area. If the
restoration to be rigid it need bulk, so to provide enough restoration thickness is achieved by over tapering, this
bulk to the crown restoration, sufficient tooth structure will compromise the retention. In the absence of FCB
must be removed from the prepared tooth to create --- technician will overbuild the crown restoration in
enough space. By doing so the restoration allowed to attempt to provide structural durability for the restoration
withstand the forces of occlusion, prevent wearing holes this will lead to super-occlusion or premature contact
in the gold and allow proper contouring and carving of with the opposing tooth.
the restoration.
b. Axial reduction: Sufficient reduction is important
Preparation features related to Structural to provide sufficient space so that the restoration can
Durability:- build with sufficient thickness, this will prevent flexing
of the crown restoration when occlusal force is acting
a. Occlusal reduction. Enough tooth structure must
on it.
be removed from occlusal surface so that the restoration
can be built back to ideal occlusion & thick enough to c. Reinforcing struts: the features that serve
prevent wearing or distortion (1- 1.5mm). to provide space for the metal that will improve the
durability and the rigidity of the restoration: Offset the
Occlusal clearance: is the space between the
occlusal shoulder, the isthmus, the proximal grooves,
occlusal surface of the prepared tooth and that of
and the box. Isthmus connects the boxes, and the offset
opposing tooth. It should be evaluated in centric and
ties the grooves together to enhance the reinforcing
eccentric relation. Enough tooth structure must be
“truss effect”.
removed occlusally so that when the restoration is built
back to ideal occlusion it will be thick enough to prevent 4. Preservation of periodontium
wearing through or distortion.
Margin Placement Wherever possible, the margin
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4 1343

of the preparation should be supragingival. Subgingival Supragingival Versus Subgingival Margins

margins of cemented restorations have been identified as
Ideally the most innocuous position of the margin
major factors in periodontal disease particularly when
for soft tissue health is above the gingival crest. An
the encroach upon the epithelial attachment.
esthetic position for anterior restorations would be
Advantages of supragingival margins subgingivally between the epithelial attachment and the
crest of the gingival,I he area above the gingival crest
• They can be easily finished
is desirable but considered offensive by some patients.
• They are more easily kept clean. Supragingival margins are usually advocated for
restorations placed subsequent to periodontal surgery
• Impressions are more easily made with less and for elderly patients who exhibit a normal recession.
potential for soft tissue damage.
5. Marginal integrity
• Restorations can be easily evaluated at recall
appointment. The restoration can survive in the biological
environment of the oral cavity only if the margins are
However a subgingival margin is justified if any of closely adapted to the cavosurface finish line of the
the following pertain: preparation. The configuration of the preparation finish
line dictates the shape and bulk of restorative material
• Dental caries, cervical erosion, or restorations
in the margin of the restoration It also can affect both
subgingivally and a crown-lengthening
marginal adaptation and the degree of seating of the
procedure is not indicated.
restoration
• The proximal contact area extends to the
TYPES OF FINISH LINES
gingival crest.

• Additional retention is needed.

• The margin of a metal ceramic crown is to be

hidden behind the labiogingival crest.

• Root sensitivity cannot be controlled by more

conservative procedures.

• Modification of the axial contour is indicated.

• High D.M.F. rate of younger patients.

Gingival Termination of Tooth Preparation

The gingival finish lines are very controversial TYPES OF FINISH LINES
when it comes to tooth preparations. The precious
recommendation was to extend crown margins into Chamfer finish line: The preferred finish line
the intracrevicular space because the gingival crevice for the veneer metal restorations is the chamfer. This
was thought to be immune to caries. In spite of the finish line has been shown experimentally to exhibit the
strong evidence that supported supragingival margins, least stress, so that the cement underlying it will less
subgingival margins were still used. Generalities as likelihood of failure. It can be cut with the tip of a round
to where finish lines should be placed for an optimal end diamond, while the axial reduction is being done
contour require analysis. The subgingival area is not an with the side of that instrument. However, a torpedo
immune area. diamond is less likely to produce a butt joint. The margin
of the cast restoration that fits against it combines an
acute edge with a nearby bulk of metal
1344 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4
Heavy chamfer finish line: A heavy chamfer is restoration must be over contoured to possess adequate
used to provide a 90-degree cavosurface angle with a rigidity. Also, since a feather edge is more difficult to see
large radius rounded internal angle. It is created with a visually, occlusocervical undulations and irregularities
round end tapered diamond. In the hands of an unskilled in the finish line are more likely to be present, making
operator, this instrument can create an undesirable fragile it much more difficult to fabricate a restoration that fits
lip of enamel at the cavosurface. The heavy chamfer accurately
provides better support for a ceramic crown than does a
MECHANICAL CONSIDERATIONS
conventional chamfer, but it is as good as a shoulder. A
bevel can be added to the heavy chamfer for use with a 3 factors
metal ceramic restoration.
1. Retention form
Shoulder: The shoulder has long been the finish
line of choice for the all-ceramic crowns. The wide ledge 2. Resistance form
provides resistance to occlusal forces and minimizes
3. Preventing deformation of restoration
stresses that might lead to fracture of the porcelain. It
produces the space for healthy restoration contours 1. Retention Form
and maximum esthetics. However, it does require
destruction of more tooth structure than any other finish The quality of the restoration that prevents the
line, the sharp 90-degree internal line angle associated restoration from being dislodged by force parallel to the
with the classic variety of this finish line concentrates path of withdrawal called as retention form.
stress in the tooth and is conductive to coronal fracture. a. Magnitude of dislodging forces:-
The shoulder generally is not used as a finish line for cast
metal restorations. Forces can be exerted with a floss under the
connectors but mainly force is exerted by adhesiveness
Shoulder with bevel: The shoulder with a bevel is a of foods. The magnitude of dislodging force depends on
used as a finish line in a variety of situations. It is utilized
as the gingival finish line on the proximal box of inlays ✓ Stickiness of food
and onlays, and for the occlusal shoulder of onlays
✓ Surface area of restorations
and mandibular three quarter crowns. This design can
also be used for the facial finish line of metal ceramic ✓ Texture of restoration being pulled
restorations where gingival esthetics is not critical. It can
be used in those situations where a shoulder is already b. Geometry of tooth preparation
present, either because of destruction by caries or the
Most fixed prosthesis depend on the geometric
presence of previous restorations. It is also a good finish
form of tooth preparation rather than on adhesion tooth
line for preparations with extremely short walls, since it
retention as most of the dental cements are non-adhesive
facilities axial walls that are nearly parallel.
and act by increasing the frictional resistance between
Knife-edge: The knife-edge margin provides for an tooth and restoration. Cement is effective only if the
acute margin of metal. But its use can create problems. restoration has a single path of withdrawal.
Unless it is carefully prepared, the axial reduction may
Taper
fade out instead of terminating in a definite finish line.
The thin margin of the restoration that fits this finish line Parallel walls give maximum retention but
may be difficult to accurately wax and cast. It is also sometimes undercuts may be created (undercut is defined
more susceptible to distortion in the mouth when the as a divergence between opposing occlusal walls or wall
casing is subject to occlusal forces. segments in cervico-occlusal direction).

Featheredge: A featheredge finish line is The relationship between taper and magnitude of
unacceptable because it is not sufficiently distinct retention was demonstrated by Jorgensen in 1955. He
and results in so little cervical tooth reduction that the cemented brass caps of different tapers and measured
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4 1345

retention. The relation was found to be hyperbolic i.e. cast gold.

retention decreased as taper increased. E.g. Retention
e. Type of luting agents
of GALILTH with 10° taper was half that of 50 taper.
Recommended taper is 5-8° with a rotary instrument Adhesive resin cements are supposed to be most
held at constant angle. durable although long term clinical evidence about the
durability of bond is not yet available.
Surface Area
2. Resistance Form
✓ Crowns with long axial walls are more retentive
than crowns with short axial walls. Restorations are also subjected to horizontal or
oblique forces. E.g. mastication/ parafunctional habits.
✓ Molar crowns are more retentive than premolar
Lateral forces tend to displace the restoration by causing
crowns of similar taper.
rotation around the gingival margins. This rotation is
Stress Concentration prevented by areas of the preparation that are placed
under compression called as Resistance areas. Many
✓ Cohesive failure occurs within the cement as the
such areas make up the resistance form. Adequate
stress within cement is less than that of induced stresses.
resistance depends on:-
Stresses are seen to concentrate around the junction of
axial and occlusal surfaces. ✓ Magnitude and direction of dislodging forces

✓ Modifications like rounding of internal line ✓ Geometry of tooth preparation

angles will reduce the stress concentration and increase
✓ Physical properties of luting agents.
retention of the restoration.
a. Magnitude and direction of dislodging forces
✓ It is seen that retention of complete crowns
is almost twice as that of partial coverage. Grooves or In normal occlusion biting force distributed over
boxes in a preparation which limit the path of withdrawal all the teeth. Similarly in FPD, occlusal load should be
enhances the retention. well distributed and favourably directed. In patients with
pipe smoking, bruxism habits, oblique forces are exerted
c. Roughness of Surface being cemented
over FPDs. Thus, an ideal restoration should be able to
✓ If fitting surface made very smooth failure seen withstand these forces as well as the normal axial forces.
to occur at the cement restoration interface thus castings
b. Geometry of tooth preparation
are delibrately roughened at the fitting surface and this
has shown to increase retention. E.g. Roughening the Particular areas of axial walls help prevent rotation
surface by air abraiding with 50 fm alumina increases of the crown. Hegdahl and Silness analyzed how these
retention by 64%. resisting areas alter as changes are made in geometry of
tooth preparation. They demonstrated;
✓ Failure rarely occurs at the cement tooth
interface thus roughening the tooth in an attempt to ✓ Increase preparation taper and rounding of axial
increase retention is not recommended. walls decreased resistance.
d. Materials being cemented ✓ Shorter tooth preparation with large diameter -
little resistance form.
Retention is affected by both casting metal and core
build up material. It is seen that the more reactive the ✓ Partial coverage crown has less resistance than
alloy is the more will be retention with certain luting a complete coverage (as no buccal resistance areas).
agents.So, base metal alloys are more reactive than the
less reactive high gold content metals. A study examining ✓ Resistance can also be improved by placing
adhesion between cement and core materials found that grooves and boxes especially with walls being
cement adhered better to amalgam than composite or perpendicular to the direction of applied forces.
1346 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4

✓ U-shaped grooves better than V-shaped. These be measured by clearly defined criteria, which can be
grooves and pinholes interfere with rotational movement used to identify and correct problems. It is important
and subject other areas of luting agent to compression. to understand the pertinent theories underlying each
step. Successful preparations can be obtained by
Additional Resistance and Retention
systematically following these steps. It is important to
Grooves or boxes e.g. in 7/8- or 3/4- crowns. Pins critically evaluate each step before proceeding to the
increase retention by increasing surface area tapered. 5 next step to ensure an optimal quality final restoration,
ways to resist displacing forces which will serve the patient for a long time.

✓ 4-10° axial taper Ethical Clearance – Not required since it is a

review article
✓ Suitable gingival finish lines
Source of Funding – Nil
✓ Contouring and placing suitable contact areas
Conflict of Interest – Nil
✓ Incorporating occlusal locks, dove tails, boxes
References
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