HDR 722
FIXED PROSTHODONTICS REVIEW
Patricia Swanson, DDS, FACP
REVIEW OF GOALS
- In this presentation are recommended preparation guidelines.
- Remember to always familiarize yourself with the material you are going to use before
beginning a preparation. As you have learned previously, “ceramics” (Empress, eMax,
Zirconia) have different preparation guidelines and should not all be treated the same.
- For ease of calibration, the numbers I include in today’s presentation are based off of
the CDCA examination. I have the numbers as safe into the passing criteria as possible,
and supported by the material guidelines.
- The bullet points are my recommendations for reduction. Below, you will see tables
from the CDCA Exam Manual.
PREPARATION GOALS - FOR ALL PREPS
- No damage to adjacent teeth or gingiva
- Line of draw of the original tooth should be parallel to, or <20 degrees deviated from
the long axis of the tooth
PREPARATION GOALS - FOR ALL PREPS
- 6-10 degrees taper
- All line angles are smooth
- No undercuts
- No rough areas, burn marks
- No chipping of margins (use new burs!)
ALL CERAMIC PREPARATION GOALS
- Cervical Margin: Equigingival to 0.5mm supra gingival (Lingual often needs to be
equigingival to allow reduction and lingual wall height)
- Margin should be smooth and continuous, NO bevel, NO J shape.
- Margin should be 1mm wide
ALL CERAMIC PREPARATION GOALS
-Axial tissue reduction should be 1.5mm
- CDCA Prep: 1.5mm on Midfacial, 1mm on entire lingual surface
-Walls should be smooth, with no undercuts
ALL CERAMIC PREPARATION GOALS
-6-10 Degrees of Taper
-Incisal Reduction of 1.5mm (eMax lithium disilicate) or 2.0mm (Empress)
- CDCA Prep: 2.5-3mm Incisal reduction to prevent excess sharpness
-Rounded line angles
-Lingual wall height of 1.25mm
PFM PREPARATION GOALS
- The margin is 0.5mm above the simulated free gingival margin.
- If the simulated gingival margin is recessed below the CEJ, prepare the margins to
within 0.5 mm of the supra-gingival CEJ.
- Margin is continuous, with NO bevel, NO J-Shape
- (I recommend forgoing beveling as it can cause issues in reading the margin for your
laboratory technician, and with many metal substructures being formed via a digital
process, it cannot be milled or printed accurately )
PFM PREPARATION GOALS
- The facial margin should be a 1-1.2mm wide shoulder
- The lingual margin should be a 0.5 mm wide chamfer
- The transition from the facial shoulder to the lingual margin should begin to occur at
the interproximal-buccal line angles
PFM PREPARATION GOALS
- I prefer a non-winged
preparation, or a smooth
transition from buccal to
lingual margin design -
this makes it easier to
CADCAM fabricate the
metal substructure, less
likely to accidentally
create undercuts
- However, I include this
“winged” example here
because I like how it
shows the preparation
difference on the mesial
and distal surfaces of the
tooth.
Source: Rosensthiel
PFM PREPARATION GOALS
-Axial reduction of 1.5mm
- This allows adequate space for porcelain, opaque, and metal layers
-Walls should be smooth, with no undercuts
-6-10 degree taper
PFM PREPARATION GOALS
- Occlusal reduction of 1.5 (non functional cusp) and 2.0mm (functional cusp)
- Excessive occlusal reduction reduces axial wall height, compromising form
- Unsupported porcelain is prone to chipping
- Internal line angles are rounded
ALL METAL PREPARATION GOALS
- The margin is 0.5mm above the simulated free gingival margin
- The margin is a 0.5mm chamfer circumferentially
- Margin is continuous, with NO bevel, NO J-Shape (see bevel commentary on PFMs)
ALL METAL PREPARATION GOALS
- Walls are smooth, with no undercuts
- 6-10 degree taper
- All line angles are smooth
ALL METAL PREPARATION GOALS
- Axial reduction of 1.0mm circumferentially
- Occlusal reduction of 1mm (non-functional cusp) 1.5mm (functional cusp)
- CDCA Prep: 1.5mm occlusal reduction
- Technically, 0.6mm is minimal thickness for cast gold. Additional clearance enables
ease of provisionalization, and ensuring adequate material thickness to allow for
adjustment on insertion. Beware occlusal reduction failing criteria on CDCA
BRIDGE PREPARATION GOALS
- You must have a path of draw / path of insertion
- I like to assess this using a buccal mirror
- You can also use a traditional mirror, and hold it at the same angle when assessing
each tooth
ASSESSING POI
- Essentially - you need to view BOTH preparations at the same time
- Visualize the entire finish line of both preparations
- See no undercuts on either tooth (ideal)
- Methods:
- Single Mirror (one at a time)
- Buccal mirror (both preps)
- Impress, pour in snap stone, survey
SHOULD YOU CLOSE YOUR
EYES WHEN YOU PREP
SHOULD YOU CLOSE YOUR EYES WHEN PREPPING?
Binocular (two eyes) vision can lead to undercuts being undetected
However, monocular vision has been associated with increased TOC
Small undercuts can be blocked out if they do not affect the margin
Often, TOC (total occlusal convergance) of the abutments in an FDP
must be increased in order to maintain a POI of the restoration.
SPLIT THE DIFFERENCE!
- [Link]
CDCA MANUAL NOTES
- Margins:
- If the simulated gingival margin is recessed below the CEJ, prepare the margins to
within 0.5 mm of the supra-gingival CEJ.
- The lingual margin for the MCC should be prepared for a metal margin, 0.5 mm. The
transition from the facial shoulder to the lingual margin should begin to occur at the
interproximal-buccal line angles.
- Occlusal reduction:
- The tooth for the PFM crown should be prepared for a porcelain occlusal surface
with an optimal occlusal reduction of 2 mm.
- For the full cast metal crown preparation, the occlusal reduction is optimally 1.5 mm.
PUTTY MATRICES
- Putty matrices or reduction guides must be fabricated during the setup time or (using
full infection control procedures) once the Prosthodontic Exam has begun.
- Fabricate 2 Matrices PER prep
- Section 1 Mesiodistally
- Section 1 Faciolingually over each tooth to be prepared
- The CDCA exam requires putty matrices to be handed in. You are graded against the
matrix. Please note: clearance and reduction do not always correlate in a human mouth,
or on a typodont, due to premature contacts. In a human patient, always go by
interocclusal clearance. In the CDCA, always go by your reduction guide.*
- *I am not an examiner for the CDCA but this is what I instructed the students to do
last year, and they had a 100% pass rate following this advice.
TAPER
CDCA INFORMATION
- four hours to prepare:
- #9 (ACC)
- #3 (CCC) - X - #5 (MCC)
- No provisionalization of CDCA exam teeth
- 1 hour to set up for Endo/Prosth, including making putty matrices (cannot bring pre-
made matrices to the exam)
- Clean your typodonts with soap, water, and a brush, and then dry with paper towels &
your air syringe before handing in for grading during THIS class and also CDCA.
CDCA GRADING
CDCA GRADING
- Become well acquainted with the grading sheet. Your familiarity with the grading sheet
is the key to passing the examination.
- In addition to the grading sheets, there are other rules which must be followed (no cell
phones / smart watches, you must keep your typodont in a physiologically acceptable
position, you must clean your station, Etc) which should be reviewed
- You CAN (and should) have your manual with you, at all times, during the exam, so you
can review your notes as needed.
AGENDA
- DAY 1:
- AM: Prep #9 ACC
- PM: Provisionalize #9 ACC
- DAY 2:
- AM: Prep #3 (CCC) - X - #5 (MCC)
- PM: Provisionalize #3-X-5
- DAY 3:
- AM: Prep & Temp #9 (ACC) START TO FINISH IN 2.5 HOURS
- PM: Prep & Temp #3 (CCC) - X - #5 (MCC) START TO FINISH IN 3.5 HOURS
- DAY 4:
- AM: Prep #3-X-5 and #9
- Review grading of AM session; Additional PROSCE Review
CDCA CHEAT SHEET
ACC PFM CCC
#9 #5 #3
Occlusal Reduction 2.5-3mm 2mm 1.5mm
Axial Reduction
1.5mm 1.5mm 1.0mm
Facial/Buccal
Axial Reduction
1mm 1mm 1mm
Lingual
Margin location Equigingival on Lingual Supragingival 0.5mm Supragingival 0.5mm
1mm shoulder 1mm shoulder buccal 0.5mm chamfer
Margin Design
circumferentially 0.5mm chamfer lingual circumferentially
Must have >1mm lingual Keep line of draw within 20 Make sure distal margin is
Common trouble spots
wall height degrees of long axis not too high or too wide
