10

The Ceramic-Veneered
Crown Preparation

In many dental practices, the metal-ceramic crown remains fabrication. However, since zirconia does not possess the out-
one of the most widely used fixed restorations. This restoration standing translucency that can be achieved with feldspathic
offers a predictable esthetic result, coupled with sound physical porcelain, the latter permits the fabrication of restorations that
properties. Metal-ceramic crowns consist of a complete-cover- combine the strength of a strong substructure with the excellent
age metal crown (or substructure) that is veneered with a layer esthetics of the more lifelike veneer.
of fused porcelain to mimic the appearance of a natural tooth.
The extent of the veneer can vary. In recent years, ceramic mate-
rials such as zirconia reinforced lithium silicate and sintered
INDICATIONS
zirconia have gained in popularity over metal cast substructures Ceramic-veneered crowns are indicated on teeth that require
(see Chapters 19 and 25). However, the use of metal may be complete coverage and for which esthetic demands are sig-
advantageous when fabricating a fixed partial denture (FPD), nificant (e.g., the anterior teeth). If esthetic considerations are
since ceramic FPDs require larger connectors than needed a priority, however, a ceramic crown (see Chapters 11 and 25)
when metal is used, lest connector fracture occurs. has cosmetic advantages over the metal-ceramic restoration.
In comparison with the tooth preparation for cast or mono- However, the metal-ceramic crown may be a better choice to
lithic zirconia crowns, successful veneered crown preparations serve as a retainer for FPDs because its metal substructure can
require substantial additional tooth reduction wherever the accommodate cast or soldered connectors. Particularly for long-
substructure is to be veneered with dental porcelain. Only when span FPDs, metal-ceramic crowns offer a more predictable prog-
a crown is sufficiently thick can the veneer duplicate the appear- nosis than what can be achieved with ceramic prostheses, which
ance of a natural tooth, and if metal is used, can its darker color are generally not efficacious for long spans. Also, ceramic resto-
be masked. The porcelain veneer must have a certain minimum rations cannot as predictably accommodate occlusal rests for a
thickness for esthetics. Consequently substantial tooth reduc- removable prosthesis. Metal-ceramic crowns may successfully be
tion is necessary, and the ceramic veneered preparation is one modified to incorporate occlusal and cingulum rests and milled
of the methods least conservative of tooth structure (Fig. 10.1). proximal and reciprocal guide planes in their metal substructure
Historically, attempts to veneer metal restorations with (see Chapter 21).
porcelain faced several problems. A major challenge was the Typical indications are similar to those for metal complete
development of an alloy and a ceramic veneering material with crowns with the addition of an esthetic concern: extensive tooth
physical properties sufficiently compatible to provide adequate destruction—as a result of caries, trauma, or existing previous
bond strength. In addition, it was initially difficult to obtain a restorations—that precludes the use of a more conservative
natural appearance. restoration; the need for superior retention and strength; an
The technical aspects of the fabrication of metal substruc- endodontically treated tooth in conjunction with a suitable sup-
tures and their subsequent veneering are discussed in detail porting structure (a post-and-core); and the need to recontour
in Chapters 19 and 24 and the fabrication of zirconia-based axial surfaces or correct minor malinclinations. Within certain
restorations in Chapter 25. Here, only a brief summary is pro- limits, ceramic-veneered restorations can also be used to alter
vided: The metal substructure is fabricated in a special alloy the occlusal plane.
that has a higher fusing range and a lower thermal expansion
than do conventional gold alloys. After preparatory finishing
procedures, this substructure, or framework, is veneered with
CONTRAINDICATIONS
multiple layers of dental porcelain. The porcelain is fused onto Contraindications for the ceramic-veneered crown, as for
the framework in much the same manner as household articles all fixed restorations, include the presence of active caries or
are enameled. Modern dental porcelains fuse at a temperature untreated periodontal disease. In young patients with large
of about 960°C (1760°F). Because conventional gold alloys pulp chambers, the ceramic-veneered crown is contraindicated
would melt at this temperature, the special alloys are necessary. because of the high risk of pulp exposure (see Fig. 7.5). If possi-
Similarly, the sintering temperature of zirconia is significantly ble, a more conservative restorative option such as a composite
higher than the fusing temperature of the feldspathic veneering resin or porcelain laminate veneer (see Chapter 25) or a ceramic
porcelains. As for metal, this enables their use for substructure crown with less axial reduction (see Chapter 11) is preferred.
279
280 PART II Clinical Procedures: Section 1

of a ceramic-veneered preparation is comparable with that of

To ensure good preparing a posterior tooth for a complete cast crown.
esthetics, substantial
tooth reduction is
necessary.
DISADVANTAGES
Facial The ceramic-veneered crown preparation requires significant
Lingual tooth reduction to provide sufficient space for the restorative
materials. To achieve a superior esthetic result, the facial margin
0.3 mm
of an anterior restoration is often placed subgingivally, which
increases the potential for periodontal disease. However, a
1.2 mm 1 mm
supragingival margin can be used if significant cosmetic con-
0.5 mm cerns do not preclude its use or if the restoration incorporates a
1.5 mm porcelain labial margin (see Fig. 10.1A and Chapter 24).
A In comparison with ceramic restorations, metal-ceramic
crowns may have slightly inferior esthetics: they may appear
slightly grayish in comparison with the translucency that can
be achieved with ceramic crowns. Also, with ceramic crowns, a
Buccal
Lingual somewhat greater range of brightness can be achieved. However,
0.3 mm
the superior strength of the metal-ceramic crowns allows their
1.2 mm 0.6 mm use in higher stress situations and on teeth that would not pro-
vide adequate support for a ceramic restoration.
Because of the glasslike nature of the veneering mate-
rial, ceramic-veneered crowns are subject to brittle fracture
1.3-1.7 mm
(although such failure is usually attributable to poor substruc-
1.3-1.7 mm
0.8-1.2 mm ture design or poor fabrication technique). A frequent problem
B is the difficulty of accurate shade selection and its communica-
Fig. 10.1 Recommended minimum dimensions for a ceramic- tion to the dental laboratory technician (see Chapter 23). The
veneered restoration on an anterior tooth (A) and a posterior tooth difficulty in achieving an accurate shade match is often under-
(B). Note the significant reduction needed in comparison with estimated by novice dentists. Because many procedural steps are
that for a complete cast or partial veneer crown (see Fig. 9.4). required for fabrication of a metal substructure and porcelain
application, laboratory costs generally render the metal-ceramic
restoration among the more expensive of dental procedures.
In comparison, monolithic ceramic restorations can often be
A ceramic-veneered restoration should not be considered ­fabricated at a lesser cost.
when a more conservative retainer is feasible, unless maximum
retention and resistance form are needed, as for a long-span
FPD. If the facial or buccal wall is intact, the dentist should con-
PREPARATION
sider if involving all axial tooth surfaces in the proposed res- The recommended preparation sequence is described for a
toration is truly necessary. Although perhaps technically more maxillary right central incisor (Fig. 10.2); however, the same
demanding and time consuming, a more conservative solution step-by-step approach can be applied to other teeth (Fig. 10.3).
that satisfies the patient’s needs while providing superior long- As with all tooth preparations, a systematic and organized
term service can usually be found. approach to tooth reduction saves time.

Armamentarium
ADVANTAGES The instruments needed to prepare teeth for a ceramic-veneered
The ceramic-veneered restoration combines, to a large degree, crown (Fig. 10.4) include the following:
the strength of its substructure with the esthetics of ceramics. • Round-ended rotary diamonds (regular grit for bulk reduc-
The underlying principle is to reinforce a brittle, more cos- tion, fine grit for finishing) or tungsten carbide burs
metically pleasing material through support derived from the • Football- or wheel-shaped diamond (for lingual reduction of
stronger substructure. Natural appearance can be matched anterior teeth)
closely by good technique and, if desired, through character- • Flat-ended, tapered diamond (for shoulder margin
ization of the restoration with internally or externally applied preparation)
stains. Retentive qualities are excellent because all axial walls are • Finishing stones
included in the preparation, and it is usually straightforward to • Explorer and periodontal probe
achieve adequate resistance form in the tooth preparation. The • Off-angle hatchets (see Fig. 10.4B–D)
complete-coverage aspect of ceramic-veneered crowns enables The actual sequence of steps can be varied slightly, ­depending
easy correction of axial form. In general, the degree of difficulty on the operator’s preference.
 CHAPTER 10 The Ceramic-Veneered Crown Preparation 281

A B C

D E F

G H I

J K L

M N O
Fig. 10.2 Preparation of a maxillary incisor for a ceramic-veneered crown. (A) Heavily restored maxillary central incisor. (B and C)
Rotary instrument aligned with the cervical one third and incisal two thirds to gauge correct planes of reduction. (D and E) Placement
of depth grooves in two planes. The cervical groove is made parallel to the path of placement, which usually coincides with the long
axis of the tooth. The secondary facial depth groove is prepared parallel to the facial contour of the tooth. (F and G) Placement of
incisal depth grooves. (H) Incisal edge reduction. (I–K) Facial reduction accomplished in two planes. (L) Breaking proximal contact,
maintaining a “lip” of enamel to protect the adjacent tooth from inadvertent damage. (M and N) Proximal reduction. (O) Placing a
0.5-mm lingual chamfer margin.
282 PART II Clinical Procedures: Section 1

P Q R

S T
Fig. 10.2 Cont’d (P) Lingual reduction of anterior teeth with a football-shaped diamond. (Q–S) Finishing the preparation with a fine-
grit diamond. (T) The completed preparation.

A B C D

E F G
Fig. 10.3 Preparation of a maxillary premolar for a metal-ceramic crown. (A) Depth holes. (B) Occlusal depth cuts. (C) Completed
occlusal reduction. Lingual chamfer margin (D) and facial shoulder margin (E) are prepared on half the tooth. (F and G) Completed
preparation. The proximal wings are often eliminated for ceramic-veneered crowns (see also Fig. 10.19) but can prove advantageous
on short teeth when non-adhesive luting procedures will be used.
 CHAPTER 10 The Ceramic-Veneered Crown Preparation 283

Red cervical plane

axis
incorrectly tracks
form of labial surface

Long
1
R
A
T
I
O
2
A

A B
Fig. 10.5 (A) Depth grooves in the facial wall are placed in two
B
directions: incisally, parallel to the tooth contour, and cervically,
parallel to the long axis of the tooth (i.e., the path of placement).
The grooves should be prepared initially to a depth of about
1.3 mm. (B) A common fault is to place the cervical groove at
too labial an angle (red line). This will lead to inadequate space
for porcelain and may create an undercut.
C D
Fig. 10.4 Armamentarium for the ceramic-veneered crown
preparation. (A) Diamond rotary instruments. (B–D) Off-angle
3. In order to achieve the necessary 2-mm clearance on the
hatchets. These are useful for smoothing the shoulder margins incisal aspect of an anterior tooth, place three depth grooves
of ceramic-veneered crown preparations. (about 1.8 mm deep) in the incisal edge of an anterior tooth,
if it is normally aligned (see Fig. 10.2F and G). Verify groove
depth with a periodontal probe. On a posterior tooth, if the
Step-by-Step Procedure occlusal surface is to be established in porcelain, clearance
The preparation is divided into five major steps: depth grooves, must be a minimum of 2 mm. If posterior occlusion is to
incisal or occlusal reduction, labial or buccal reduction in the area be established in metal, the same minimum clearances are
to be veneered with porcelain, axial reduction of the proximal needed as for a complete cast crown. On maxillary teeth,
and lingual surfaces, and final finishing of all prepared surfaces. posterior occlusal reduction incorporates a functional cusp
bevel on the lingual cusp, similar to that for a complete cast
Depth Grooves crown. When the diamond is initially positioned for anterior
1. Place three depth grooves (Fig. 10.5), one in the center of the teeth, it is helpful to observe the long axis of the opposing
facial surface and one each in the approximate locations of tooth in maximum intercuspation and to orient the instru-
the mesiofacial and distofacial line angles (see Fig. 10.2A–E). ment perpendicular to that axis (Fig. 10.6). The grooves must
These are placed in two planes: The cervical portion parallels not be too deep, to avoid an overreduced and possibly undu-
the long axis of the tooth, and the incisal (occlusal) portion lating surface.
follows the normal facial contour (see Fig. 10.2D and E).
2. Perform the facial reduction in the cervical and incisal Incisal (Occlusal) Reduction
planes. The cervical plane determines the path of placement The completed reduction of the incisal edge on an anterior tooth
of the completed restoration. The incisal or occlusal plane should allow 2 mm of clearance for adequate material thickness to
provides the space needed for the porcelain veneer; facial achieve translucency in the completed restoration. Posterior teeth
reduction should be uniform and approximately 1.3 mm may still be restorable with less reduction because esthetics is not
deep, in the understanding that some additional reduction as critical. Caution must be used during the occlusal preparation
will occur during finishing. The incisal portion of the facial phase because excessive occlusal reduction will shorten the axial
grooves usually extends half to two thirds of the way down preparation walls and thus is a common cause of inadequacies
the facial surface, depending on the shape of the tooth. The in mechanical retention and resistance form in the completed
cervical third of the facial reduction parallels the long axis of preparation. Loss of retention form can be especially problematic
the tooth. Slight adjustments to these guidelines are feasible; on anterior teeth (on which, as a consequence of tooth form, most
for example, a slight labial inclination can improve retention mechanical retention is derived from the proximal walls).
on a tooth with little cingulum height. On small teeth, it may 4. Remove the islands of remaining tooth structure. On ante-
be advisable to keep the cervical grooves somewhat shal- rior teeth, access is usually unrestricted, and the thickest
lower than 1.3 mm near the margin: 1.0 mm labial reduction portion of the cutting instrument can be used to maximize
in the cervical third still allows the fabrication of an estheti- cutting efficiency (see Fig. 10.2H). On posterior teeth, the
cally acceptable restoration. same protocol is followed as in preparing depth grooves for
284 PART II Clinical Procedures: Section 1

A B
Fig. 10.6 (A) Depth grooves 1.8 mm deep placed in the incisal edges to ensure adequate and even reduction. (B) Incisal reduction
completed on the left central and lateral incisors. Note the angulation of the diamond, perpendicular to the direction of loading by
the mandibular anterior teeth.

a complete cast crown (see Chapter 9). This includes the

use of a functional cusp bevel, although additional occlusal
reduction is needed where the porcelain is to be applied (see
Fig. 10.3A–C).

Labial (Buccal) Reduction

When completed, the facial reduction should have produced
sufficient space to accommodate the substructure and porcelain
veneer. A minimum of 1.2 mm is necessary for the ceramist to
produce a restoration with satisfactory appearance (1.5 mm is
preferable). This requires significant tooth reduction. For com-
parison, the cervical diameter of a maxillary central incisor
averages between 6 and 7 mm. A
In the cervical area of small teeth, obtaining optimal reduction
is not always feasible (see Fig. 7.4). A compromise is often made
with less reduction in the area of the cervical shoulder margin.
5. Remove the tooth structure that remains between the depth
grooves (see Fig. 10.2I–L), creating a shoulder margin at
the cervical margin (Fig. 10.7). If a restoration with a nar-
row subgingival metal collar is to be fabricated and sulcular
depth is sufficient, place the shoulder margin approximately
0.5 mm apical to the crest of the free gingiva at this time.
Additional finishing will place the margin further subgin-
givally. Use adequate water spray during the entire phase of
preparation because a significant amount of tooth structure is
being removed and copious irrigation (along with intermit- B C
tent strokes) expedites the preparation process while reduc- Fig. 10.7 (A) The cervical shoulder margin is established as
ing the risk of pulpal trauma. The resulting shoulder margin the tooth structure between the depth grooves is removed.
should be approximately 1 mm wide and should extend well The rotary instrument is moved parallel to the intended path of
into the proximal embrasures when viewed from the incisal placement during this procedure. (B) The facial reduction should
(occlusal) side (Fig. 10.8). Where access allows, refining this be completed in two phases; initially, one half is maintained
shoulder margin from the proximal gingival crest toward the intact for evaluation of the adequacy of reduction. Note the two
middle of the facial wall is preferred. This minimizes the risk distinct planes of reduction on the facial aspect. The proximal
of preparing the initial shoulder margin too close to the epi- aspect parallels the cervical reduction on the facial wall. (C)
Facial reduction completed. A 6-degree taper has been estab-
thelial attachment. If the margin is prepared from the facial
lished between the proximal walls.
to proximal aspects, there is a tendency to “bury” the instru-
ment and encroach on the epithelial attachment. Proper mar-
gin position must be maintained in relation to the crest of zirconia substructure is used. It may be necessary to extend the
the free gingiva (see Fig. 7.65). The location and specific con- preparation farther in an apical direction to ensure adequate
figuration of the facial margin depend on several factors: the vertical wall height. Patients often object to the sight of a visible
type of ceramic-veneered restoration selected, the cosmetic metal collar or discolored root surface. Such objections are com-
expectations of the patient, and the operator’s preference. mon, even when the gingival margin is not visible during nor-
To reduce the risk of periodontal disease, a supragingi- mal function, as in patients with a low lip line. In general, this
val margin is preferable. Its application is restricted, however, esthetic drawback limits the use of metal supragingival margins
because of mechanical and esthetic considerations, unless a to posterior teeth (Fig. 10.9) and to undiscolored anterior teeth
 CHAPTER 10 The Ceramic-Veneered Crown Preparation 285

To ensure esthetics,
the shoulder margin
must extend into the
interproximal area.

A B
A

B
Fig. 10.8 (A) The facial shoulder margin preparation should wrap
around into the interproximal embrasure and extend at least 1 mm
lingual to the proximal contact. (B) The shoulder margin prepara-
tion extends adequately to the lingual side of the proximal contact.
Note that on the mesial (visible) side, the preparation extends
slightly farther than on the distal (cosmetically less critical) side. C
Fig. 10.10 (A) Gingival displacement cord (under tension) is
placed in the interproximal sulcus. (B) A second instrument can
be used to prevent the cord from rebounding from the sulcus
after it has been packed. (C) The preparation margin is extended
apically. The cord must not engage with the diamond rotary
instrument because extensive tissue trauma would result.

(see Fig. 10.2M–P), although a slightly wider margin is desirable

for the zirconia reinforced lithium silicate substructures.
6. Reduce the proximoaxial and linguoaxial surfaces with the
diamond held parallel to the intended path of placement of
the restoration. These walls should converge slightly from
Fig. 10.9 Supragingival margins on the maxillary premolars. cervical to incisal or occlusal. A taper of approximately 6
They were possible because of a favorable lip line hiding the degrees, measured as the angle between opposing axial walls,
cervical aspect of these posterior teeth. The subgingival mar- is recommended. On anterior teeth, a lingual concavity is
gins on the mandibular premolars were prepared only because
prepared for adequate clearance for the restorative materials.
of previously existing restorations.
Typically, a 1-mm thickness is required if the centric con-
tacts in the completed restoration are to be located on metal.
(in which case a ceramic substructure or a porcelain labial mar- When contact is planned on porcelain, additional reduc-
gin is indicated; see Chapter 24). The optimum margin location tion is necessary. For anterior teeth, usually only a single
should be carefully determined with the full cooperation of the depth groove is placed in the center of the lingual surface.
patient. Where a subgingival margin is to be placed, careful tis- For molars, three grooves can be placed in a manner simi-
sue manipulation is essential; otherwise, the resulting soft-tissue lar to that described for the metal complete cast crown (see
damage can readily lead to permanent gingival recession and Chapter 9).
subsequent exposure of the tooth-restoration interface. This is 7. Make a lingual alignment groove by positioning the diamond
most effectively avoided through meticulous gingival displace- parallel to the cervical plane of the facial reduction. When
ment with a cord before margin finishing (Fig. 10.10). The con- the round-ended diamond of appropriate size and shape is
figuration of the margin is also finalized at this time (Fig. 10.11). aligned properly, it is submerged almost halfway into the
tooth structure. Verify the alignment of the resulting orien-
Axial Reduction of the Proximal and Lingual Surfaces tation groove, and carry the axial reduction from the groove
Sufficient tooth structure must be removed to provide a along the lingual surface into the proximal aspect; maintain
­distinct, smooth chamfer margin of about 0.5 mm in width the originally selected alignment of the diamond at all times.
286 PART II Clinical Procedures: Section 1

A B

C D
Fig. 10.11 (A) After tissue displacement, the facial margin is extended apically. Caution is needed because if the diamond inadver-
tently grabs the cord, it may be ripped out of the sulcus and injure the epithelial attachment. (B) Note the additional apical extension
of the shoulder margin on the distal aspect. (C) The entire facial shoulder margin is placed at a level that will be subgingival after the
tissue rebounds. (D) The facial margin has been prepared to the level of the previously placed cord.

far subgingivally and thereby infringe on the attachment appa-

ratus. It must follow the soft tissue contour (see Chapter 7).
On posterior teeth, occlusally, the lingual wall reduction
blends into the functional cusp bevel placed during the
occlusal reduction. Anterior teeth require an additional step:
After preparation of the cingulum wall, one or more depth
grooves are placed in the lingual surface. In teeth that are
well aligned and in occlusal contact, these depth grooves are
approximately 1 mm deep.
9. Use a football-shaped diamond to reduce the lingual surface
of anterior teeth (see Fig. 10.2P). When half this reduction has
been completed, it is helpful to stop and evaluate clearance in
maximum intercuspation and all excursions. The remaining
Fig. 10.12 A lingual chamfer margin is prepared to allow ade- intact tooth structure can serve as a reference. Once clearance
quate space for the substructure. The transition from interproxi- is deemed satisfactory, the lingual reduction is then completed.
mal shoulder margin to chamfer margin must be smooth. Finishing. The margin must provide distinct resistance to
vertical displacement of the tip of a periodontal probe or an
explorer, and it must be smooth and continuous circumferen-
8. As the lingual chamfer margin is developed, extend it buccally tially. (A properly finished margin should give the dentist a feel
into the proximal area to blend with the interproximal shoul- similar to running an explorer over a smooth unscratched glass
der margin that was placed earlier (Fig. 10.12). Alternatively, surface.) All line angles should be rounded, and the completed
a facial approach may be used. Although this is slightly more preparation should have a satin finish, free from obvious dia-
difficult initially, after some practice it should be easy to mond scratch marks. Tissue displacement is especially help-
eliminate the lingual orientation groove and to perform the ful when subgingival margins are being finished (Fig. 10.14).
proximal and lingual axial reduction in one step; however, Sometimes this step is postponed until just before definitive
this requires the diamond to be held freehand, parallel to the impression making after initial tissue displacement to reduce
path of placement. The proximal flange that resulted from the the risk of soft tissue trauma (see Chapter 14).
shoulder margin preparation can be used as a reference for 10. Finish the margins with diamonds (see Fig. 10.2Q and R),
judging alignment of the rotary instrument (Fig. 10.13). The hand instruments such as off-angle hatchets (see Fig. 10.4B),
interproximal margin should not be inadvertently placed too or tungsten carbide burs. All internal line angles should be
 CHAPTER 10 The Ceramic-Veneered Crown Preparation 287

Fig. 10.14 Controlled tissue displacement can be helpful when

the margin is finished with a fine-grit diamond or another rotary
instrument.

B
Fig. 10.13 (A) Proximal reduction of the flange with a facial
approach. (B) Once sufficient tooth structure has been removed,
the cervical chamfer margin is prepared simultaneously with the
lingual axial surface. After the distolingual preparation has been
completed, the mesial chamfer margin is blended into a smooth
transition with the shoulder margin. The dentist must be espe-
cially careful not to encroach on the biologic width interproxi-
mally. It is easiest to start the margin preparation interproximally
and move toward the facial aspect. Preparing from the facial
aspect to the proximal aspect may easily lead to margin place-
ment that is too far subgingival.
A B

rounded to facilitate the impression-making and subse-

quent fabrication steps (see Fig. 10.2S). The finishing steps
for the facial margin depend on the design of margin cho-
sen (Figs. 10.15 and 10.16; see also Table 7.2). A shoulder
margin for a crown with a porcelain labial margin must be First plane First plane
shaped to support the brittle ceramic properly. A shoulder parallel to parallel to
long axis 6-8° 6-8° long axis
margin with a 90-degree cavosurface angle is recommended.
This type of shoulder margin can also be used for a crown
with a conventional metal collar and enables the dentist to
Second plane
make a restoration with a narrower metal collar than when parallel to
a bevel is added to the shoulder margin preparation (see external
Fig. 7.29). However, if residual unsupported enamel remains, anatomy
Normal
its potential for fracture during cementation may jeopardize Functional cusp bevel
the restoration’s longevity. For this reason, the margin is often Occlusal reduction normally approximately
C at least 1.5 mm 45 degrees to long axis
beveled or sloped to create a slightly obtuse cavosurface angle
(see Fig. 10.16). A flat-ended diamond in a low-speed hand- Fig. 10.15 (A) Completed preparation. Note that the transition
piece creates the 90-degree shoulder margin. Any unsup- from incisal to axial walls is rounded, and a distinct 90-degree
ported enamel must be removed subsequently by careful or slightly sloped shoulder margin has been established. It is
important that the proximal axial reduction of both the shoulder
planing with a sharp chisel. Care must also be taken to adjust
and chamfer margins of the preparation are exactly in the same
the alignment of the rotary instrument properly as it moves plane. (B) An even chamfer margin width and a smooth transi-
around the tooth if inadvertent undercuts are to be avoided. tion between lingual and axial surfaces. The chamfer margin is
When a metal-ceramic crown with a metal collar is planned, distinct and blends smoothly into the facial shoulder margin. (C)
a 90-degree shoulder margin is less crucial. A sloped shoul- When a maxillary molar is prepared for a metal ceramic crown,
der margin has been advocated to ensure the elimination of note the two-plane facial reduction to provide both adequate
unsupported enamel and to minimize marginal gap width retention and space for the ceramic material.
288 PART II Clinical Procedures: Section 1

A B C
Fig. 10.16 (A) A 90-degree shoulder margin. (B) A 120-degree
A
shoulder margin. (C) A beveled shoulder margin.

1.2 mm

0.5 mm

B
Fig. 10.18 Facial (A) and lingual (B) views of ceramic-veneered
preparations.
Fig. 10.17 The beveled shoulder margin.

(see Chapter 7). Such a shoulder margin (cavosurface angle

of about 120 degrees) can be accomplished with a flat-ended
diamond by changing its alignment, with particular attention
to the configuration of the tooth structure cervical to the mar-
gin. Alternatively, a hatchet can be used to plane the margin
to the desired angulation. Again, be careful to avoid under-
cutting the axial wall of the preparation where it meets the
shoulder margin during finishing. A beveled shoulder mar-
gin is most effectively achieved with a flame-shaped tungsten
carbide bur or hand instrument, depending on the length of
bevel desired (Fig. 10.17). In general, a short-beveled mar- A B
gin with a cavosurface angle of 135 degrees is advocated, Fig. 10.19 Completed preparations on maxillary central incisor
although longer beveled margins have been recommended (A) and premolar (B). The “wingless” variation does not exhibit
for improved marginal fit. Special care must be exerted where the defined transition from chamfer margin to shoulder margin
the beveled margin meets the interproximal chamfer margin. seen in Fig. 10.15. Rather, the shoulder margin gradually nar-
The chamfer and beveled margins should be continuous with rows toward the lingual side. Interproximally, the same criteria
each other. Care must be taken not to damage the epithelial for minimum extension of the shoulder margin apply as for the
wing-type or flange preparation.
attachment during beveling; tissue displacement before prep-
aration of subgingival beveled margins is recommended.
11. After a satisfactory facial margin has been obtained, round a 2-mm reduction should allow adequate clearance. If an occlu-
all sharp line angles within the preparation (see Fig. 10.2S). sal surface is planned in metal, reduction may be more con-
This will reduce the risk of fracture of the ceramic crown, servative. Clearances should be verified in the static occluded
and also will facilitate surface wetting and expedites subse- position, as well as in all excursive positions of the mandible.
quent procedures (e.g., elastomeric impression making, cast Axial walls should exhibit a restricted angle of convergence.
fabrication, and additional laboratory procedures). A fine- Restricted taper between the proximal walls, particularly on
grit diamond operating at low speed is particularly useful. anterior teeth, contributes significantly to mechanical retention
However, where access allows, a slightly larger tapered dia- form, whereas resistance is usually achievable on most anterior
mond may be preferred because the greater diameter of its teeth because of their relatively small diameter. If a metal-ceramic
tip prevents “lipping” of the chamfer margin (see Fig. 7.24). retainer is planned on a short posterior tooth, a wing-type
Blend all surfaces together, and remove any sharp transi- preparation offers some mechanical advantage because it has
tions (Figs. 10.18 and 10.19; see also Fig. 10.2T). better resistance form than its wingless counterpart. For ceramic-
Evaluation. Areas often missed during finishing are the inci- veneered crowns, wings are usually not incorporated in the com-
sal edges of anterior preparations and the transition from occlu- pleted preparation as they can complicate some of the fabrication
sal to axial wall of posterior preparations. Incisally or occlusally, procedures (e.g., milling).
 CHAPTER 10 The Ceramic-Veneered Crown Preparation 289

The facial and buccal walls on maxillary teeth in the esthetic The completed chamfer margin should provide 0.5 mm of
zone should exhibit two plane reductions. On incisors and space for a metal margin and slightly more for a ceramic margin.
canines, the cervical plane is typically about one third of the The chamfer margin must be smooth and continuous, and when
preparation height, whereas the second plane is approximately it is evaluated, the dentist should feel distinct resistance to verti-
two-thirds of the preparation height and follows the geom- cal displacement of the tip of an explorer or periodontal probe.
etry of the desired anatomic form in the completed restora- The chamfer margin should be continuous with the interproxi-
tion. On premolars and molars, cervical and occlusal planes mal shoulder margin or beveled shoulder margin. The cavosur-
often approximate each other in height. Care is also needed to face angle of the chamfer margin should be slightly obtuse or 90
avoid creating an undercut between the facial and lingual walls. degrees. Under no circumstances should any unsupported tooth
This aspect of the preparation should be thoroughly evaluated. structure remain, especially at the facial margin. All residual
Excessive convergence should also be avoided because this may debris is removed with thorough irrigation. (Various examples
lead to pulpal exposure. of metal-ceramic preparations are shown in Fig. 10.20.)

A B C

D E F

G H I

J
Fig. 10.20 (A) Failing, nonesthetic restorations. (B–D) Existing restorations have been removed and teeth re-prepared after ­foundation
restorations were placed. (E–J) Completed ceramic-veneered crowns after delivery.
290 PART II Clinical Procedures: Section 1

S T U DY Q U E S T I O N S
1. What are the indications for and contraindications to 4. What are the minimal criteria for steps 1, 2, and 3? Why?
ceramic-veneered crowns? 5. Discuss how to determine the buccolingual position of a
2. What are the advantages and disadvantages of ceramic- proximal groove to precisely obtain the desired position of
veneered crowns? the facial finish line.
3. What is the recommended armamentarium, and in what
sequence should a maxillary central incisor be prepared, for
a ceramic-veneered crown?

S U M M A RY C H A RT
Ceramic-Veneered Crown
Preparation Recommended
Indications Contraindications Advantages Disadvantages Steps Armamentarium Criteria
• Esthetics • Large pulp chamber • Superior • Removal of Incisal (occlusal) Tapered, round-ended 1.5–2 mm of clearance in
• If monolithic • Intact buccal wall esthetics in substantial reduction guide diamond intercuspal positions and
ceramic • When more comparison tooth structure grooves all excursions
crown is conservative with • Subject to Incisal (occlusal) Tapered, round-ended 1.2–1.5 mm of reduction
contraindicated retainer is complete fracture reduction diamond for metal or ceramic
• Gingival technically feasible cast crown because framework and porcelain
involvement • Large pulp chamber • Superior porcelain is (see Fig. 10.1)
• Esthetics esthetics in brittle
comparison • Difficulty Labial reduction Tapered, round-ended 6 degrees of convergence,
with obtaining guide grooves diamond measured as the angle
complete accurate (two planes) between opposing axial
cast crown occlusion in walls
glazed porcelain Labial reduction Tapered, flat-ended Should provide 1 mm of
• Shade selection (two planes) diamond clearance in all excursions
can be difficult and intercuspal positions
• Expensive (1.5 mm if occlusal surface
• Removal of is porcelain)
substantial
Axial reduction Tapered, round-ended Shoulder margin must
tooth structure
diamond extend at least 1 mm
lingual to proximal contact
area; beveled margin, if
selected, should be as
far incisally as possible
in relation to epithelial
attachment
Lingual Football-shaped All line angles rounded
reduction diamond and preparation surfaces
smooth
Finishing Tapered, flat-ended —
of shoulder diamond
(or beveled
shoulder) margin
Finishing Hand instrument —
Tapered, round-ended
diamond or tungsten
carbide bur