Herbert T. Shillingburg, Jr, DDS David Ross Boyd Professor Emeritus Department of Fixed University of Oklahoma College of Dentistry Oklahoma City, Oklahoma

with

David A. Sather, DDS Edwin L. Wilson, Jr, DDS, MEd Joseph R. Cain, DDS, MS Donald L. Mitchell, DDS, MS Luis J. Blanco, DMD, MS James C. Kessler, DDS

Illustrations by

Suzan E. Stone

Quintessence Publishing Co, Inc Chicago, Berlin, Tokyo, London, Paris, Milan, Barcelona, Istanbul, Moscow, New Delhi, Prague, São Paulo, and Warsaw Cover design based on a photograph of Monument Valley on the Navajo Reservation in northern Arizona taken at sunrise by Dr Herbert T. Shillingburg, Jr. Contents

Dedication vii Authors viii Preface ix Acknowledgments x

1 An Introduction to Fixed Prosthodontics 1 2 Fundamentals of 13 3 Articulators 27 4 Interocclusal Records 35 5 Articulation of Casts 45 6 Treatment Planning for Single-Tooth Restorations 71 7 Treatment Planning for the Replacement of Missing Teeth 81 8 Fixed Partial Denture and Implant Con!gurations 99 9 Principles of Tooth Preparations 131 10 Preparations for Full Coverage Crowns 149 11 Preparations for Partial Coverage Crowns 165 12 Preparations for Intracoronal Restorations 193 13 Preparations for Severely Debilitated Teeth 203 14 Preparations for Periodontally Weakened Teeth 229 15 Provisional Restorations 241 16 Fluid Control and Soft Tissue Management 269 17 Impressions 291 18 Working Casts and Dies 325 19 Wax Patterns 343 20 Investing and Casting 363 21 Cementation and Bonding 383 22 Esthetic Considerations 413 23 All-Ceramic Restorations 425 24 Metal-Ceramic Restorations 447 25 Pontics and Edentulous Ridges 471 26 Solder Joints and Other Connectors 493 27 Restoration of Osseointegrated Dental Implants 517 28 Single-Tooth Implant Restoration 531 29 Multiple-Tooth Implant Restoration 543

Index 555 Dedication

In Memoriam Constance Murphy Shillingburg 1938–2008

This book is dedicated to the loving memory of Constance surgeries later in life, she was the most optimistic person I Murphy Shillingburg. We met at the University of New Mex- ever met. ico at the beginning of her freshman year in 1956. We were She accompanied me on 29 trips outside the United States. married 4 years later, 1 week after she graduated. During At !rst she came along because she loved to travel, and I my !rst 2 years in dental school, I made 13 trips, totaling didn’t enjoy the trips nearly as much without her. However, over 22,000 miles, from Los Angeles to Albuquerque. She I very quickly learned that my hosts and audiences were en- shared all of the triumphs and disappointments of my last 2 chanted by her. They enjoyed her as much or more than they years in dental school. It was not my career; it was our career. did me, and she used what she learned on those trips in her She supported me in all that I did. She didn’t question my teaching. She died 3 weeks after we celebrated our 48th leaving practice to start a career in academics or our mov- wedding anniversary. There is a song on the most recent ing from California to Oklahoma. We had three daughters Glen Campbell album, Ghost on the Canvas, that sums it up along the way. Although she had three open-heart surgeries perfectly: “There’s no me…without you.” in her teens because of rheumatic fever and then two cancer

vii Authors

Luis J. Blanco, DMD, MS David A. Sather, DDS Professor and Chair Associate Professor Department of Fixed Prosthodontics Department of Fixed Prosthodontics University of Oklahoma College of Dentistry University of Oklahoma College of Dentistry Oklahoma City, Oklahoma Oklahoma City, Oklahoma

Joseph R. Cain, DDS, MS Herbert T. Shillingburg, Jr, DDS Professor Emeritus David Ross Boyd Professor Emeritus Department of Removable Prosthodontics Department of Fixed Prosthodontics University of Oklahoma College of Dentistry University of Oklahoma College of Dentistry Oklahoma City, Oklahoma Oklahoma City, Oklahoma

James C. Kessler, DDS Edwin L. Wilson, Jr, DDS, MEd Director of Education Professor Emeritus L. D. Pankey Institute Department of Occlusion Key Biscayne, Florida University of Oklahoma College of Dentistry Oklahoma City, Oklahoma Donald L. Mitchell, DDS, MS Professor Emeritus Department of Oral Implantology University of Oklahoma College of Dentistry Oklahoma City, Oklahoma

viii Preface

Fixed prosthodontics is the art and science of restoring dam- An attempt has been made to provide a sound work- aged teeth with cast metal, metal-ceramic, or all-ceramic ing background in the various facets of !xed prosthodon- restorations and of replacing missing teeth with !xed pros- tic therapy. Current information has been added to cover theses using metal-ceramic arti!cial teeth (pontics) or metal- the increased use of new cements, new packaging and dis- ceramic crowns over implants. Successfully treating a patient pensing equipment for the use of impression materials, and by means of !xed prosthodontics requires a thoughtful com- changes in the management of soft tissues for impression bination of many aspects of dental treatment: patient edu- making. New articulators, facebows, and concepts of occlu- cation and the prevention of further dental disease, sound sion needed attention, along with precise ways of making diagnosis, periodontal therapy, operative skills, occlusal con- removable dies. The usage of periodontally weakened teeth sider ations, and, sometimes, placement of removable com- requires different designs for preparations of teeth with ex- plete or partial prostheses and endodontic treatment. posed root morphology or molars that have lost a root. Restorations in this !eld of dentistry can be the !nest ser- Different ways of handling edentulous ridges with defects vice rendered for dental patients or the worst disservice per- have given the better control of the functional and petrated upon them. The path taken depends upon one’s cosmetic outcome. No longer are metal or ceramics needed knowledge of sound biologic and mechanical principles, the to somehow mask the loss of bone and soft tissue. The big- growth of manipulative skills to implement the treatment gest change in the replacement of missing teeth, of course, plan, and the development of a critical eye and judgement is the widespread use of endosseous implants, which make it for assessing detail. possible to replace teeth without damaging adjacent sound As in all !elds of the healing arts, there has been tremen- teeth. dous change in this area of dentistry in recent years. Im- The increased emphasis on cosmetic restorations has ne- proved materials, instruments, and techniques have made it cessitated expanding the chapters on those types of resto- possible for today’s operator with average skills to provide rations. The design of resin-bonded !xed partial a service whose quality is on a par with that provided only has been moved to the chapters on partial coverage restora- by the most gifted dentist of years gone by. This is possible, tions. There are some uses for that type of restoration, but however, only if the dentist has a thorough background in the indications are far more limited than they were thought the principles of restorative dentistry and an intimate knowl- to be a few years ago. edge of the techniques required. Updated references document the rationale for using ma- This book was designed to serve as an introduction to the terials and techniques and familiarize the reader with the lit- area of restorative dentistry dealing with !xed partial dentures erature in the various aspects of !xed prosthodontics. If and cast metal, metal-ceramic, and all-ceramic restorations. more background information on speci!c topics is desired, It should provide the background knowledge needed by the several books are recommended: For detailed treatment of novice as well as serve as a refresher for the practitioner or dental materials, refer to Kenneth J. Anusavice’s Phillip’s Sci- graduate student. ence of Dental Materials, Eleventh Edition (Saunders, 2003) To provide the needed background for formulating ratio- or William J. O’Brien’s Dental Materials and Their Selection, nal judgments in the clinical environment, there are chapters Fourth Edition (Quintessence, 2008). For an in-depth study of dealing with the fundamentals of treatment planning, occlu- occlusion, see Jeffrey P. Okeson’s Management of Temporo- sion, and tooth preparation. In addition, sections of other mandibular Disorders and Occlusion, Sixth Edition (Mosby, chapters are devoted to the fundamentals of the respective 2007). The topic of tooth preparations is discussed in detail subjects. Speci!c techniques and instruments are discussed in Fundamentals of Tooth Preparations (Quintessence, 1987) because and dental technicians must deal with them by Herbert T. Shillingburg et al. For detailed coverage of oc- in their daily work. clusal morphology used in waxing restorations, consult the Alternative techniques are given when there are multiple Guide to Occlusal Waxing (Quintessence, 1984) by Herbert techniques widely used in the profession. Frequently, how- T. Shillingburg et al. Books of particular interest in the area of ever, only one technique is presented. Cognizance is given to ceramics include W. Patrick Naylor’s Introduction to Metal the fact that there is usually more than one acceptable way Ceramic Technology (Quintessence, 2009) and Christoph of accomplishing a particular task. However, in the limited Hämmerle et al’s Dental Ceramics: Essential Aspects for time available in the undergraduate dental curriculum, there Clinical Practice (Quintessence, 2009). is usually time for the mastery of only one basic technique for accomplishing each of the various types of treatment. —Herbert T. Shillingburg, Jr, DDS

ix Acknowledgments

No book is the work of just its authors. It is dif!cult to say Lee Holmstead, Brasseler USA, for his assistance with the which ideas are our own and which are an amalgam of those illustrations of the diamonds and carbide burs. with whom we have associated. Two !ne restorative dentists Illustrations have been done by several people through had an important in"uence on this book: Dr Robert Dewhirst the years: Mr Robert Shackelford, Ms Laurel Kallenberger, and Dr Donald Fisher have been mentors, colleagues, and, Ms Jane Cripps, and Ms Judy Amico of the Graphics and most importantly, friends. Their philosophies have been our Media Department of the University of Oklahoma Health Sci- guide for the last 40 years. Dr Manville G. Duncanson, Jr, ences Center. Artwork was also contributed by Drs Richard Professor Emeritus of Dental Materials, and Dr Dean John- Jacobi and Herbert T. Shillingburg. This book would not son, Professor Emeritus of Removable Prosthodontics, both have come to fruition without the illustrations provided by of the University of Oklahoma, were forthcoming through Ms Suzan Stone and the computer program, Topaz Simplify, the years with their suggestions, criticism, and shared knowl- suggested by Mr Alvin Flier, a friend from 40 years ago in edge. Thanks are also due to Mr James Robinson of Whip- Simi, California. A special thank you to the Rev John W. Price Mix Corporation for his help with materials and instruments of Houston, Texas, for restoring my sense of mission in June in the chapters that deal with laboratory procedures. Appre- 2008. ciation is expressed to Dr Mike Fling for his input regarding Thanks to you all. tooth preparations for laminate veneers. Thank you to Mr

x Treatment Planning for the Replacement of Missing Teeth 7

The need to replace missing teeth is obvious to the patient In treatment planning, there is one principle that should when the edentulous space is in the anterior segment of the be kept in mind: treatment simpli!cation. There are many mouth, but it is equally important in the posterior region. times when certain treatments are technically possible but It is tempting to think of the dental arch as a static entity, too complex. It is important to narrow the possibilities and but that is certainly not the case. It is in a state of dynamic present a recommendation that will serve the patient’s needs equilibrium, with the teeth supporting each other (Fig 7-1). and still be reasonable to accomplish. At such times, the re- When a tooth is lost, the structural integrity of the dental storative dentist, or prosthodontist, is the one who should arch is disrupted, and there is a subsequent realignment of manage the sequencing and referral to other specialists. He teeth as a new state of equilibrium is achieved. Teeth adja- or she will be !nishing the treatment and should act as the cent to or opposing the edentulous space frequently move quarterback. The restorative dentist must communicate and into it (Fig 7-2). Adjacent teeth, especially those distal to the be open to suggestions but should not allow someone else space, may drift bodily, although a tilting movement is a far to dictate the restorative phase of the treatment, which may more common occurrence. result in carrying out a treatment plan that seems unfeasible. If an opposing tooth intrudes severely into the edentu- As the clinician who is providing the restoration, the restor- lous space, it is not enough just to replace the missing tooth ative dentist is the one the patient will return to if it fails; (Fig 7-3). To restore the mouth to complete function, free therefore, he or she must be comfortable with the planned of interferences, it is often necessary to restore the tooth treatment. opposing the edentulous space (Fig 7-4). In severe cases, The following are guidelines, not laws, and they are not this may necessitate the devitalization of the supererupted absolute. However, when a preponderance of these items opposing tooth to permit enough shortening to correct the is used in the consideration of the planning for one arch or plane of occlusion; in extreme cases, extraction of the op- one mouth, a compelling reason exists for the selection of posing tooth may be required. the type of prosthesis described.

Selection of the Type Removable partial denture A removable partial denture is generally indicated for eden- of Prosthesis tulous spaces greater than two posterior teeth, anterior spaces greater than four incisors, or spaces that include a Missing teeth may be replaced by one of three prosthesis canine and two other contiguous teeth (ie, central incisor, types: a removable partial denture, a tooth-supported !xed lateral incisor, and canine; lateral incisor, canine, and !rst partial denture, or an implant-supported !xed partial den- premolar; or the canine and both premolars). ture (Table 7-1). Several factors must be weighed when choos- An edentulous space with no distal abutment will usually ing the type of prosthesis to be used in any given situation. require a removable partial denture. There are exceptions in Biomechanical, periodontal, esthetic, and !nancial factors, which a cantilever !xed partial denture can be used, but this as well as the patient’s wishes, are some of the more impor- solution should be approached cautiously. See the section on tant ones. It is not uncommon to combine two types in the cantilevers later in the chapter for a more detailed description same arch, such as a removable partial denture and a tooth- of this type of restoration. Multiple edentulous spaces, each supported !xed partial denture. Combining teeth and im- of which may be restorable with a !xed partial denture, none- plants in the support of the same !xed partial denture, how- theless may call for the use of a removable partial denture ever, is not recommended. because of the expense and technical complexity. Bilateral

81 8 Fixed Partial Denture and Implant Con!gurations

Missing: Maxillary canine Implant: 4.5 × 15 mm Considerations: A is the restoration of choice. Restoration: MCR over a custom abutment (UCLA, Atlantis, or preparable abutment)

Missing: Mandibular canine Abutments: Central incisor, lateral incisor, and !rst premolar Considerations: An implant-supported MCR is the restora- tion of choice in the mandible as well. Use group function to restore the occlusion. If there has been extensive bone loss around the lateral incisor, or if it is tilted to produce a line of draw discrepancy, remove the lateral incisor and use both central incisors as abutments if a !xed partial denture is used. Fortunately, the need to replace this tooth is not common. Retainers: MCRs Pontic: Ovate MCR Abutment-pontic root ratio: 1.9

Missing: Mandibular canine Implant: 4.5 × 15 mm Considerations: A dental implant is the restoration of choice. Restoration: MCR over a custom abutment (UCLA, Atlantis, or preparable abutment)

108 Simple Fixed Partial Dentures (Two Teeth)

Simple Fixed Partial Dentures (Two Teeth)

Missing: Maxillary central incisor and lateral incisor Abutments: Central incisor and canine Considerations: If the central incisor and canine are unblem- ished and unusually large, pin-modi!ed partial coverage crowns could be used. Patient acceptance and dentist skill are strong considerations. Retainers: MCRs Pontics: Modi!ed ridge lap MCR Abutment-pontic root ratio: 1.2

Missing: Maxillary central incisor and lateral incisor Implants: 4.0 × 12 mm (central incisor), 3.5 × 12 mm (lateral incisor) Considerations: A large nasopalatine foramen (incisive canal) may interfere with implant placement. If loss of the lateral in- cisor has caused loss of the facial plate of bone, the resulting facial concavity will place the implant too far to the lingual. This may necessitate bone grafting to eliminate the facial concavity. Splinting the dental implant restoration will re- duce rotational forces on the abutment screws, lessening the possibility of screw loosening. Splinting the dental implants will increase restoration strength and stress distribution. Restorations: MCRs over custom abutments (UCLA, Atlantis, or preparable abutments)

Missing: Mandibular central incisors Abutments: Lateral incisors Considerations: If there has been any bone loss around the lateral incisors, or if they are malpositioned, remove them. Use MCR retainers on the canines for a tooth-borne !xed partial denture. Retainers: Resin-bonded retainers if the abutments are un- blemished Pontics: Ovate MCRs or one-piece pontics with a modi!ed ridge lap of pink porcelain Abutment-pontic root ratio: 1.1

109 13 Preparations for Severely Debilitated Teeth

Fig 13-1 Teeth with large areas of enamel involvement may require Fig 13-2 A large central lesion may require a full coverage restora- full coverage restorations regardless of the amount of dentin that tion, but only after the tooth is built up with a core. has been destroyed.

Fig 13-3 Moderate central damage can be restored with a restora- Fig 13-4 Severe combined destruction will require a core and a full tion that preserves and uses sound peripheral tooth structure rather coverage restoration. than destroying it.

Two rules should be observed to avoid excessive tooth Principle of Substitution destruction while creating retention in an already weakened tooth: When it is necessary to compensate for mutilated or miss- ing cusps, inadequate length, and in extreme cases even a 1. The central “core” (the pulp and the 1.0-mm-thick sur- missing clinical , the principle of substitution is em- rounding layer of dentin) must not be invaded in vital ployed. For those teeth with moderate to severe damage teeth.2 No retentive features should extend farther into the that test a dentist’s ingenuity, a preparation may be modi- tooth than 1.5 mm at the cervical line or from the central !ed by squaring the walls of defects left by caries and old fossa (Fig 13-5). If caries removal results in a deeper cav- restorations and by adding features to enhance retention ity, any part lying within the vital core should be !lled with and resistance. Boxes may be substituted where grooves glass-ionomer cement. Any preparation feature added for might ordinarily be used. Grooves may be used to augment mechanical retention is kept peripheral to the vital core. retention and resistance where axial walls have been short- 2. No wall of dentin should be reduced to a thickness less ened. Pins may be employed where much of the supragin- than its height for the sake of retention. This may pre- gival tooth structure has been destroyed. More than one of clude the use of a full crown, or, if one must be these auxiliary features may be employed where damage used, it might !rst require the placement of a core or is severe. foundation restoration.

204 Principle of Substitution

a b

Fig 13-5 No retentive features may be cut Fig 13-6 (a) Interproximal caries may preempt the use of a groove (dotted line). (b) Use of a into the vital core (center) of the tooth. box in this situation accommodates caries removal and provides retention.

Fig 13-7 (a) If signi!cantly less than 180 de- grees of the tooth’s circumference remains between two boxes, the lingual cusp is sus- ceptible to fracture during function, upon removal of the provisional restoration, or at try-in of the permanent restoration. (b) A core with a different preparation design will minimize the risk of fracture and provide a b better longevity for the crown.

Box forms Grooves

Small to moderate interproximal caries lesions or prior resto- Grooves placed in vertical walls of bulk tooth structure must rations can be incorporated into a preparation as a box form. be well formed, at least 1.0 mm wide and deep, and as long This substitute for grooves serves the dual purpose of car- as possible to improve retention and resistance. Multiple ies removal and retention form3–5 (Fig 13-6). Because large grooves are as effective as box forms in providing resis- quantities of tooth structure must be removed for it, the box tance,7 and they can be placed in axial walls without exces- is not usually used on an intact surface. sive destruction of tooth structure. They may also be added Opposing upright surfaces of tooth structure adjacent to to the angles of oversized box forms to augment the resis- a damaged area can be used to create a box form if at least tance provided by the box walls. This is particularly helpful half the circumference (180 degrees) remains in the area out- when the facial and lingual walls of a box are a consider- side the lingual walls of the boxes. The walls of the box, and able distance apart. However, too many grooves in a crown not the line angles, will resist displacement.6 If the mesial preparation can adversely affect the seating of a full veneer and distal surfaces are extensively involved, another means crown.8 must be used to compensate for the diminished lingual tooth structure (Fig 13-7). This situation may require a crown placed over a pin-retained amalgam core.

205 15 Provisional Restorations

Template-fabricated provisional !xed partial denture When a !xed partial denture is to be made for a patient, the provisional restoration should also be in the form of a !xed partial denture rather than individual crowns. In the anterior region it will provide a better esthetic result, and in the pos- terior region a provisional !xed partial denture will better stabilize the teeth and will afford the patient the opportunity to become accustomed to having a tooth in the edentulous space again. Fig 15-22 Zinc oxide–eugenol cement is often mixed with a small amount of petrolatum. Template armamentarium

t Diagnostic cast t Mor-Tight putty (TP Orthodontics) t No. 7 wax spatula t Denture tooth t Crown form t Vacuum forming machine t Coping material or temporary splint material t Quadrant impression trays t Silly Putty (Crayola) t Wire frame t Bunsen burner t Scissors Fig 15-23 An explorer is used to remove cement from the gingival t Laboratory knife with no. 25 blade crevice. t Heavy-duty laboratory knife t Large camel-hair brush t Cement spatula t Dappen dish not touch any rests or clasps on that tooth. Resin is added to t Separating medium the outside of the crown, and while the resin is still soft, the t Monomer and polymer crown is seated on the tooth. To form the rest seat and guide t Medicine dropper planes on the crown, the partial denture is lubricated with t Heavy rubber band petrolatum and seated over the provisional crown. The par- t Straight handpiece tial denture should be pumped up and down several times t Acrylic burs to ensure that it is not locked into any undercuts. The crown t Abrasive disks and Moore mandrel is removed from the tooth, any rough areas are smoothed, and the crown is polished. Template technique The restoration should be cemented with a temporary ce- ment of moderate strength. After the zinc oxide–eugenol To make a template, place a metal crown form or a denture cement has been mixed to a thick, creamy consistency, an tooth in the edentulous space on the diagnostic cast (Fig amount of petrolatum equal to 5% to 10% of the cement 15-24). All of the embrasures should be !lled with putty volume is incorporated to slightly reduce the strength of the (Mor-Tight) to eliminate undercuts during adaptation of the cement (Fig 15-22). This will facilitate removal of the provi- resin template. sional restoration at a subsequent appointment. If the prep- To facilitate removal of the template, a thin strand of putty aration is short or otherwise lacking in retention, the petrola- can be placed around the periphery of the cast and on the tum should not be added. lingual surface of the cast, apical to the teeth (Fig 15-25). A It is not necessary to keep zinc oxide–eugenol cement dry large acrylic bur is used to cut a hole through the middle of while it is setting. In fact, moisture will accelerate the hard- the cast (midpalatal or midlingual). A 5 × 5–inch sheet of ening. Coating the outside of the restoration with a thin !lm 0.020-inch-thick resin (clear temporary splint vacuum form- of petrolatum prior to cementation will aid in the removal of ing material, Buffalo Dental) is placed in the frame of the excess cement. After the cement has hardened, all excess vacuum forming machine (Sta-Vac II, Buffalo Dental) (Fig must be removed from the gingival crevice. Use an explorer 15-26). The heating element of the machine is turned on and in accessible areas and knotted dental "oss interproximally swung into position over the plastic sheet. (Fig 15-23).

248 Techniques for Custom Provisional Restorations

Fig 15-24 A crown form or a denture tooth is placed in the edentu- Fig 15-25 A rope of Mor-Tight is placed around the periphery of lous space on the diagnostic cast. the cast.

Fig 15-26 The plastic sheet is secured in the frame of the vacuum Fig 15-27 The plastic sags as it is heated to the proper temperature. forming machine.

Fig 15-28 The frame is pulled down over the perforated stage of Fig 15-29 The plastic is cut to remove the template from the diag- the vacuum forming machine. nostic cast.

As the resin sheet is heated to the proper temperature, it is turned off and swung to the side. After approximately will droop or sag about 1.0 inch in the frame. If a coping ma- 30 seconds, the vacuum is turned off, and the resin sheet terial is used, it will lose its cloudy appearance and become is released from the holding frame. After the resin sheet is completely clear (Fig 15-27). The cast should be in position removed from the frame, a laboratory knife with a sharp no. in the center of the perforated stage of the vacuum forming 25 blade is used to cut through the resin over the Mor-Tight machine. Then the vacuum is turned on. strand (Fig 15-29). The handles on the frame that holds the heated coping If a vacuum forming machine is not available, it is still pos- material are grasped while the frame is forcefully lowered sible to fabricate a template for a provisional restoration. A over the perforated stage (Fig 15-28). The heating element quadrant impression tray is !lled with Silly Putty, a soft sili-

249 28 Single-Tooth Implant Restoration

Attachment screw

a Closed tray impression coping

Laboratory implant analog

c b

Fig 28-6 (a) Intaglio view of preliminary closed tray alginate impression. Note the detail of the impression coping in the impression material. (b) Closed tray impression coping with attachment screw and laboratory implant analog. (c) Closed tray impression coping with attached labora- tory implant analog inserted into the preliminary alginate impression.

Fig 28-7 Dental stone is poured around the laboratory implant analog.

The preliminary alginate impression (Fig 28-6a) is re- tray impression coping is then secured to the laboratory im- moved from the patient’s mouth, revealing the negative of plant analog with the attachment screw (Fig 28-6b). The com- the closed tray impression coping and the natural dentition. bined impression coping, attachment screw, and laboratory The closed tray impression coping of each manufacturer has implant analog are reinserted into the preliminary alginate a unique shape that allows it to be accurately reinserted into impression in preparation for diagnostic cast fabrication (Fig the preliminary alginate impression. A laboratory implant 28-6c). The cast is poured by initially placing dental stone analog is a replica of the top of the dental implant. around the exposed laboratory implant analog (Fig 28-7) After the preliminary alginate impression is made, the and then !lling the remaining impression with dental stone. closed tray impression coping is removed from the dental The closed tray impression coping will remain attached to implant, and the healing abutment is replaced. The closed the laboratory implant analog when the preliminary alginate

534 Impression Taking and Cast Fabrication

a b

Fig 28-8 (a) Diagnostic cast following impression separation with closed tray impression coping in place. (b) Diagnostic cast with preliminary impression coping removed, showing the top of the implant analog.

Attachment screw

b

Open tray impression coping

Laboratory implant analog

a c

Fig 28-9 (a) Open tray impression coping with attachment screw and laboratory implant analog. (b) Facial view of open tray impression coping seated on diagnostic cast with attachment screw. (c) Palatal view.

impression tray is separated from the cast (Fig 28-8a). The the closed tray impression coping. As stated earlier, an open closed tray impression coping is removed from the cast by tray impression technique will produce a more accurate cast unscrewing the attachment screw. This will reveal the top of than a closed tray impression technique because the impres- the laboratory implant analog, which is a replica of the pa- sion coping remains within the impression material when the tient’s dental implant with the internal hex (Fig 28-8b). The impression tray is removed from the mouth. Therefore, the detailed shape of a closed tray impression coping, while well open tray impression technique is recommended for taking recorded within impression material, can present a challenge a !nal impression and fabricating a master cast. when reseating the impression coping in the impression for The open tray is fabricated on the diagnostic cast with cast fabrication. the open tray impression coping attached to the laboratory implant analog with the attachment screw (Figs 28-9b and 28-9c). The diagnostic cast is blocked out around the denti- Final impression and master cast tion with two sheets of pink baseplate wax (approximately fabrication 2 mm thick), leaving the top two-thirds of the attachment screw exposed. Four vertical stops are cut through the oc- The open tray impression coping (Fig 28-9a) has an even clusal surface of the block-out wax. The stops should be more detailed shape and a longer attachment screw than well spaced to provide impression tray stability during the

535

Index

Page numbers followed by “f” indicate figures; procedure, 247–248, 247f–248f those followed by “t” indicate tables technique, 243–247, 243f–247f tooth preparation, 243–247 A single-tooth implant, 533–535, 533f–535f Abrasives All-ceramic crowns definition of, 384 attributes, 77t forms of, 384–385 cementation Knoop hardness numbers, 384t armamentarium, 408 Abutments cements contraindications, 85 removal of excess, 410 criteria for selection of, 409 crown-root ratio, 85–86 shade, 409–410 overview, 85 finishing of rough surfaces, 409, 444 periodontal ligament area, 86–88, 88f proximal contacts, 409, 443 root configuration, 86 stone smoothing, 444 root surface areas, 86f, 86–88 technique, 409f, 409–410 definition of, 1 contraindications for, 161 diagnostic casts of, 9 description of, 76 endodontically treated teeth, 217 evolution of, 425 pier, 91f, 91–92 fabrication of, 429–434, 430f–434f secondary, criteria for selecting, 90 fracture susceptibility of, 161 tilted molar, 94–95 illustration of, 76f tooth-supported fixed partial dentures indications, 149 conventional, 84 longevity of, 78, 79t resin-bonded, 84 occlusal reduction, 138, 138f Acid etching, 179, 426 tooth preparations Addition silicone. See Polyvinyl siloxane. armamentarium, 161 Adjustments, for gold restorations depth-orientation grooves, 161, 161f contours, 395 incisal reduction, 161, 161f esthetics, 395 labial reduction, 161–162, 161f–162f margin finishing, 390–392 lingual reduction, 162, 162f marginal adaptation, 390, 391f overview, 162f occlusal radial shoulder, 162, 162f, 429 nonworking movement, 394, 394f shoulders, 161 overcorrection, 392, 393f All-ceramic restorations protrusive interferences, 394, 394f bonded working movement, 394, 394f advantages of, 426 proximal contacts, 389f, 389–390 feldspathic porcelain restorations, 426 seating completeness, 390 highly filled glass-ceramic restorations, 427–428 Agar. See Reversible hydrocolloid. cementation of, 443–444 Air brush, 396f crowns. See All-ceramic crowns. Alginate impressions finishing of, 443–444 multiple-tooth implant, 544–546, 545f–546f high-strength core restorations overimpression-fabricated custom provisional alumina-reinforced substructures, 428–429 restorations zirconia-reinforced substructures, 429 armamentarium, 243 overview of, 425–426 cementation process Allergies, 3–4 armamentarium, 247

555 Index

All-metal crown Anterior guidance, 17f characteristics of, 77t Denar facebow and articulator, 61–62, 62f longevity of, 79t Hanau facebow and articulator All-metal hygienic pontic, fabrication custom settings, 68, 68f casting, 486, 486f mechanical, 69, 69f die trimming, 482, 482f–483f Whip Mix facebow and articulator, 55–56, 55f–56f excess wax removal, 482, 484f Anterior teeth investing, 486, 486f dowel cores, for endodontically treated teeth plaster matrix, 484, 485f illustration of, 215f–216f wax coping, 482–483 length determinations, 215f Alloys rationale for, 214–217 ADA classification, 364 retentive properties, 215 base metal. See Base metal alloys. guidance of mandible, 55–56, 61–62, 68, 69 casting of. See Casting. metal-ceramic crowns. See Metal-ceramic crowns, factors that affect choice of, 364–365 anterior teeth. gold three-quarter crown, tooth preparations for. See Three- base metal alloys and, differences, 363 quarter crowns, anterior teeth. investing of, 365 vertical overlap of, 23f types II and III, casting of Ante’s Law, 87, 526 armamentarium, 371 Anticoagulants, 520 burnout, 371 Anticoagulation, 4 cleaning the cast, 373–374, 374f Antirotational devices, for die in working casts common defects, 375f Pindex system, 333–340 pickling, 374, 374f straight dowel pin, 330–333, 331f–333f procedure, 371–373, 372f–373f Antisialagogues, 271 gold-palladium Appearance zone casting definition of, 413, 474 armamentarium, 379 incisors procedure, 379, 379f incisal lines, 416 for metal-ceramic restorations, 448–449 interproximal contacts, 416 soldering midline, 413 burnout, 512 pontics, 474 casting, 512 smile line, 413 indexing, 509–510 Arcon articulators investing, 510–511 advantages of, 30–31 preparatory procedures, 509 description of, 30 noble. See Noble alloys. Articular disc, 13 recommended uses, 364–365 Articulators Alumina-reinforced materials, 428–429 arcon, 30–31 Alveolar bone loss, 232 border movements duplicated by, 27 Amalgam condylar movements, 33f, 33–34 cores for, 208 definition of, 27 indications for, 71–72, 193 Denar, 57 longevity of, 78, 79t fully adjustable, 28–29 plaque control, 71 Hanau, 63–69 for prefabricated dowels, 217 nonadjustable, 27, 28f restorations nonarcon, 30–31 complex principles of, 27, 28f attributes, 77t semiadjustable, 27 description of, 73, 75 tooth–transverse horizontal axis relationship, 31f, 31–32 illustration of, 74f Whip Mix, 45 longevity of, 78, 79t Aspiration of restorations, 407 simple Autopolymerizing acrylic resin, 300–302, 301f–302f attributes, 77t Axial contours description of, 72–73 full veneer crown, 347f illustration of, 74f wax patterns longevity of, 78, 79t bulges, 346, 347f strength of, 217 emergence profile, 346, 347f Angle of convergence, 132 faciolingual, 345–346, 345f–346f Angle of divergence, 132 proximal, 345

556 Index

Axis, hinge . See Fixed partial denture. arbitrary location of, 32 Brightness. See Value. articulator hinge axis and, effect of dissimilarities, 27, Bruxism, occlusion and, 19 28f–29f Bur(s), 146t, 174f–175f, 194f. See also specific procedure, trial and error method to determine, 31 armamentarium. Burnout B definition of, 363 Base, 207–208, 209f gold alloys, types II and III, 371 Base metal alloys high-temperature, 366 advantages, 364 low-temperature, 365 beryllium content, 364 fluoride use, 493 C gold alloys and, differences, 363 CAD/CAM system, 320, 427, 457 melting temperatures, 364 Canines for metal-ceramic restorations, 448–449 in appearance zone, 415 nickel-chromium, 364 fixed partial dentures for soldering, 512 configurations, one tooth, 107–108 Base metal restorations description of, 95, 95f adjustments, 397 resin-bonded, 183f finishing, preliminary incisal lines, 416f armamentarium, 397 mandible, 117, 124–125 procedure, 397 maxillary, 115f, 124 polishing, 397 root surface area of, 526t try-in, 397 Cantilever fixed partial dentures, 95–96, 96f–97f Bennett angle, 16, 16f Caries Beryllium resin-bonded fixed partial denture and, 182 carcinogenic properties of, 364, 449 restoration of, glass ionomer use, 72, 73f description of, 364 Casting Bevels alloys, 363–365 contraindications for, 140–141, 140f–141f definition of, 363 facial, 169f dowel-core patterns, 376 functional cusp gold alloys, types II and III description of, 138, 139f armamentarium, 371 for full veneer crown, 150 burnout, 371 metal-ceramic crown, 158, 159f procedure, 371–373, 372f–373f three-quarter partial coverage crowns, 166, 166f gold-palladium alloys indications for, 140 armamentarium, 379 mesio-occlusodistal onlays, 197–200, 198f–200f procedure, 379, 379f proximo-occlusal inlays, 195f, 195–196 inlay patterns, 376 three-quarter crown, 171, 173f investing for, 368–371, 369f–371f Bilateral balanced occlusion, 20, 361 voids, soldering repair of Binangle chisel, 156, 156f–157f armamentarium, 503 Biologic width, 212 contraindications, 503 Bis-acryl composite indications for, 503 characteristics of, 242t Casting rings, for gypsum-bonded investments, 368 overimpression-fabricated crowns Casting temperature, 376 description of, 256 Casts, working procedure for creating, 256–259, 256f–259f mounting of Bisphosphonate-related osteonecrosis of the jaws, 6 Denar facebow and articulator Bite fork, 46f, 49f, 58 mandibular, 59–60 Black triangles, 478 maxillary, 59, 59f Blow holes, soldering repair of, 503 Hanau facebow and articulator Bonded ceramic restorations mandibular, 65–66, 66f advantages of, 426 maxillary, 65, 65f feldspathic porcelain restorations, 426 Whip Mix facebow and articulator highly filled glass-ceramic restorations, 427–428 mandibular, 52–53 Bonding, 434 maxillary, 50–52 Border movements, 27 with removable die Box form advantages over separate die, 330 for damaged teeth, 205, 205f antirotational devices, 330, 330f substitution of, 136 methods of orienting die in cast

557 Index

Pindex system, 333–340, 334f–340f provisional requirements, 330 armamentarium, 247 straight dowel pin, 330–333, 331f–333f procedure, 247–248 requirements for, 325 Central incisors with separate die fixed partial dentures for armamentarium, 325 complex description of, 325 more than two teeth, 117–118 die preparation, 327–329, 327f–329f two teeth, 113–114 difficulties associated with, 325 pier abutments, 120–122, 129 finish lines, 327–328, 329f simple hardening agents, 328 one tooth, 100–101 impression pouring, 325–326, 326f two teeth, 109–110 Cellulose liners, for casting rings, 368 root surface area of, 526t Cement(s) Centric occlusal interference, 17, 18f bonding mechanisms , 13 micromechanical bonding, 398, 399f Centric relation record molecular adhesion, 398 armamentarium, 35 nonadhesive luting, 398, 399f description of, 35 glass ionomer. See Glass-ionomer cement. technique polycarboxylate. See Polycarboxylate cement. anterior programming device, 37, 37f resin. See Resin cements. baseplate wax adaptation to maxillary teeth, 37–38 selection of, 398–401 bimanual manipulation, 35–36, 36f zinc oxide–eugenol. See Zinc oxide–eugenol cement. manipulation of mandible, 36f, 36–37 zinc phosphate. See Zinc phosphate. patient positioning, 36–37 Cement film, 141f registration base use, 37–38, 38f–39f Cementation Ceramic liners, for casting rings, 368 all-ceramic restorations Ceramic restorations. See also All-ceramic restorations. armamentarium, 408 etching of, 426 cements inlays removal of excess, 410 attributes, 77t selection of, 409 description of, 75 shade, 409–410 illustration of, 74f finishing of rough surfaces, 409 longevity of, 78, 79t proximal contacts, 409 veneer crowns technique, 409f, 409–410 all. See All-ceramic crowns. ceramic crowns, 444–445 attributes, 77t description of, 401 cementation, 444–445 dowel cores, 407–408, 408f description of, 76 fixed partial dentures, 410 illustration of, 76f gold inlays, 407 longevity of, 78, 79t metal-ceramic crowns, 410 Chamfers. See also Finish line(s). with polycarboxylate cement, 407 advantages of, 144t with resin cements, 402–404, 403f description of, 141 with resin-modified glass-ionomer cement, 401–402 disadvantages of, 144t vent holes for cement escape, 402f full veneer crown, 150 with zinc phosphate cement heavy, 141 cement preparation, 404–405, 405f illustration of, 142f mandibular isolation, 404, 404f resin-bonded fixed partial denture, 182 pulp protection, 404 Chemical bonding, 448 removal of excess cement, 406 Chroma, 419 restoration seating, 405–406, 406f Classic shoulder finish line, 142, 143f, 144t vital tooth considerations, 404 Clenching, occlusion and, 19 Cemented restorations Colloid solutions. See Hydrocolloid. external surface Color, for shade selection of ceramic restorations finishing of, 383 characteristics of, 419 plaque accumulation on, 383, 383f daily functions’ effect on, 419 indications for, 71–72 factors that affect, 418 internal surface, 383 light sources’ effect on plaque control, 71 artificial, 418f, 418–419 natural, 418, 418f

558 Index

Color blindness, 418 pin-retained, 207f, 208 Composite resin restorations Cross-pin and wing, 515, 515f attributes, 77t Crown-root ratio, for abutment teeth, 85–86 criteria for, 71–72 Crowns inlays, 72, 74f all-ceramic. See All-ceramic crowns. longevity of, 78, 79t cement retention of, 524, 525f Condensation silicones definition of, 1 armamentarium, 311 endodontic access preparation, 215 characteristics of, 292t full coverage. See Full coverage crown. disadvantages, 310–311 lengthening of, for gingival exposure, 287–288 impression making, 311–312, 311f–312f longevity of, 78, 79t putty/reline, 311 metal-ceramic, 75, 151–152, 158–160 reaction of, 310 partial coverage. See Partial coverage crowns. viscosity, 293, 293f pin placement, 206f, 206–207 wettability, 291 preformed anatomical metal Condyles armamentarium, 264 guidance procedure, 263–267, 264f–267f on Denar facebow, 60–61, 61f provisional, for endodontically treated tooth, 263, 263f effect on posterior teeth, 21–22, 21f–22f removal force resistance by, 72f on Hanau facebow, 66–67, 67f–68f retention and resistance, 131, 131f on Whip Mix facebow, 50f, 53f–54f, 53–55 tapering of, 132–133 inclination of, on arcon and nonarcon articulators, 30, 30f three-quarter, 171–178 movements of Crucible, 371 articulator reproduction of, 27, 33f, 33–34 C-terminal cross-linking telopeptide, 520 pantographic recordings, 33f, 33–34 Curve of Spee, 354 positioning of, 13 Curve of Wilson, 355 Cone beam computed tomography, 520–521, 521f Cusp(s) Connectors mandibular teeth, 349t definition of, 1 maxillary teeth, 349t nonrigid Cusp-fossa cross-pin and wing, 515, 515f curve of Spee, 354 dovetail, 513–514, 513f–514f curve of Wilson, 355 for pier abutments, 91–92, 92f, 513–514 cusp placement and occlusal contacts, 354f split pontic, 514 definition of, 354 for tilted molar abutments, 94, 94f description of, 348t rigid, contraindications for, 91–92 illustration of, 348f soldering. See Soldering. wax patterns of, 355–358, 355f–358f Contacts, proximal Cusp–marginal ridge adjustments for, 389f, 389–390 cusp placement and occlusal contacts, 350f all-ceramic restorations, 409, 443 description of, 348–349 metal-ceramic restorations, 450–451 wax patterns of soldering mandibular teeth, 352, 353f armamentarium, 502, 502f maxillary teeth, 350–352, 351f–352f indications for, 502 Custom provisional restorations Coping overimpression-fabricated. See Overimpression- for fabrication of wax patterns, 343–344, 344f fabricated custom provisional restorations. metal-ceramic restorations shell-fabricated alloy used, melting range of, 448 armamentarium, 254 description of, 447 description of, 254 extent of veneered area, 451–453, 452f–453f procedure, 254–255, 255f facial margins, 454 template-fabricated metal collar, 454 armamentarium, 248 occlusal contacts, 450–451, 451f fabrication process, 248–252, 248f–252f overview, 449 visible light–cured porcelain support, 450, 450f armamentarium, 252 porcelain veneer, 449–450 fabrication process, 252–254 proximal contacts, 450–451 Custom resin trays thickness of metal, 450 adhesives, 298–299 Core armamentarium, 299 composite resin, 208 autopolymerizing acrylic resin, 300–302, 301f–302f

559 Index

composition of, 299 Double-bite impression, 305 faciolingual section of, 298f Dovetail connector, 513–514, 513f–514f preparation, 299–302 Dowel cores stock trays and, comparison, 298 aspiration during try-in, 407–408 uses of, 298 cemented vs threaded, 218 for VLC, 299f–300f, 299–300 classification of, 218 Cutback areas, 462, 463f–464f for damaged teeth, 215f–217f Cuttle, 384 diameter of, 223f endodontically treated teeth D for anterior teeth Dam, rubber, 269, 272 illustration of, 215f–216f Damaged teeth length determinations, 215f destruction areas, 203, 204f rationale for, 214–217 orthodontic adjuncts retentive properties, 215 extrusion, 212f, 212–214, 214f illustration of, 215f–217f regaining interproximal space, 210 insertion procedure, 220, 220f–221f preparations for length determinations, 215f bases, 207–208 for posterior teeth, 215–216 cores, 208 prefabricated, with amalgam or resin core, 217–218 retention and space rationale for, 214–217 methods to avoid excessive destruction, 203–204 retentive properties, 215 substitutive methods for creating tooth preparation for box forms, 205, 205f armamentarium, 218 overview, 204 custom cast pins, 206–207 armamentarium, 222 vital teeth, modifications for, 208–210, 209f canal preparation, 222–223 Deep chamfer finish line, 141–142, 143f, 144t finishing and cementation, 224–225, 225f Dental implants. See Implants. instrumentation, 222t Depth-orientation grooves resin pattern fabrication, 223–224, 224f all-ceramic crowns, 161, 161f Peeso reamer use, 218–219, 218f–219f full veneer crown, 149–150 pin placement, 220, 220f metal-ceramic crowns, 154, 155f prefabricated with amalgam or composite resin core Devitrification, 467 armamentarium, 218 Diagnostic casts, 9, 522, 522f diameter recommendations, 219, 219f Diagnostic work-up Peeso reamer use, 218–219, 218f–219f casts, 9 pin placement, 220, 220f elements of, 1–2 technique, 218–220 full-mouth radiographs, 9 for pulpless teeth, 215f history taking, 2–6 wax patterns, 376 intraoral examination, 8f, 8–9 Dowel inlays, 222 Die, for working casts Dowel pins removable armamentarium, 331 advantages over separate die, 330 location, 330 antirotational devices, 330, 330f procedure, 331–333 methods of orienting die in cast Dry mouth, 5–6 Pindex system, 333–340, 334f–340f Dual-arch impressions straight dowel pin, 330–333, 331f–333f advantages of, 302 requirements, 330 armamentarium for, 302 separate technique for, 303–306, 303f–306f armamentarium, 325 variations of, 302 description of, 325 die preparation, 327–329, 327f–329f E difficulties associated with, 325 Edentulous ridge finish lines, 327–328, 329f classification of, 477, 477f hardening agents, 328 deformities, 477, 477f impression pouring, 325–326, 326f pontic modification, 478–479, 478f–479f Die milling, 428 surgical correction Digital impressions, 320–322, 321f Class II and III defects, 480, 481f Disinfection, of impressions, 319–320 donor tissue, 480 Disocclusion, 21 incisions, 479–480, 480f Distofacial root, of maxillary molar, 234, 234f

560 Index

Edentulous spaces Denar fixed partial denture, 84–85, 99–100 anterior guidance settings, 61–62, 62f removable partial denture, 81–82, 84 armamentarium, 57 Electrochemical etching, 179 cast mountings, 59–60 Electrosurgery components of, 57f armamentarium, 284 condylar guidance settings, 60–61, 61f contraindications, 284 description of, 57 , 287–288 facebow records, 57–58, 60f–61f current types, 282, 282f description of, 31 edentulous cuff removal, 287, 287f Hanau gingival sulcus enlargement, 286 anterior guidance grounding, 283, 283f custom settings, 68, 68f recommended uses, 281, 281f mechanical, 69, 69f technique, 284–285, 285f–286f armamentarium, 63 tissue damage from, 281 cast mountings, 65–66 Emergence profile, 346, 347f components of, 63f Endodontically treated teeth condylar guidance, 66–67, 67f abutment use, 217 facebow record, 63–65, 64f anterior teeth, 215 hinge axis points, arbitrary, 32 dowel cores. See Dowel cores, endodontically treated transverse horizontal axis recordings, 31 teeth. Whip Mix technique, 218–220 anterior guidance, 55–56, 55f–56f Endosseous implants, 517, 518f–519f, 519 armamentarium, 45 Epinephrine cast mountings, 50–53 cardiovascular disease contraindications, 4 components of, 45f in gingival retraction cord, 273, 273t condylar guidance, 50f, 53f–54f, 53–55 Esthetic zone, 474 facebow records, 45–46, 45–48, 46f Esthetics Facial bevel, 169f absolute, 417 Facial roots, of maxillary molar, 237 appearance zone Faciolingual axial contours, 345–346, 345f–346f definition of, 413 Facio-occlusal finish line, 144, 145f incisors Feldspathic porcelain restorations, 426 incisal lines, 416 Ferrule effect, 212 interproximal contacts, 416 Fineness, 493 midline, 413 Finish line(s) smile line, 413 advantages of, 144t conversational, 417 bevels, 141 ideal, 416–417, 417f chamfer, 141, 142f, 144t Etching classic shoulder, 142, 143f, 144t acid, 179, 426 configurations for marginal integrity, 141–145 electrochemical, 179 deep chamfer, 141–142, 143f, 144t Examination, intraoral, 8f, 8–9 disadvantages of, 144t Expansion methods, for shrinkage during investing facio-occlusal, 144, 145f hygroscopic, 365 knife edge, 144, 144f, 144t setting, 365 placement of thermal, 365–366 near alveolar crest, 145 wax pattern, 365 subgingival, 145 Extracoronal restorations, 75–76 supragingival, 145 Extrusion, for damaged teeth, 212f, 214f radial shoulder, 142–143, 143f, 144t arch wire, 213, 213f shoulder with a bevel, 143f, 143–144 biologic width, 212 Finish line exposure determination of amount needed, 213f chemicomechanical, 273–278 endodontic treatment, 212–214 criteria for, 273 ferrule effect, 212 decongestants, 275 pin placement, 213, 213f electrosurgery. See Electrosurgery. surgical crown lengthening vs, 212f lasers for, 288f, 288–289 mechanical, 272, 272f F retraction cord Facebows armamentarium, 275 articulator use, 31–32 chemical types, 274t caliper-style, 32, 32f epinephrine, 273

561 Index

placement of, 275–278, 275f–279f metal-ceramic alloys rotary curettage, 280, 280f indications for, 504 rubber dam, 272 methods, 504, 504f Finishing postveneer, 509–512, 509f–512f base metal restorations, preliminary, 397 preveneer, 505–508, 505f–508f gold restorations methods of, 504, 504f postcementation, 396 preveneer, 504 preliminary proximal contacts, 502–503 armamentarium, 385 repair of casting voids, 503 procedure, 385–387, 386f–387f requisites for, 493 margins, for wax patterns, 358–360, 359f–360f single-piece casting, 494 Fixed partial dentures tooth-supported abutment teeth conventional, 84 crown-root ratio, 85–86 resin-bonded, 84 ideal types, 84 wax patterns, 378 arch curvature, 90, 90f Fluid control methods biomechanical considerations, 89–90, 89f–90f antisialagogues, 271 canine-replacement, 95, 95f high-volume vacuum, 269–270, 270f cantilever, 95–96, 96f rubber dam, 269 casting of, single-piece, 494 saliva ejector, 270 cementation, 410 Svedopter, 270–271, 270f–271f configurations vacuum attachments, 269f complex Freedom of displacement, 133–134, 134f more than two teeth, 117–120 Full coverage crown one tooth, 107–108 axial contours, 347f two teeth, 113–117 definition of, 1 simple esthetics, 71 one tooth, 100–107 illustration of, 2f two teeth, 109–113 indications for, 149 connectors, 91–94, 94, 513–515 partial coverage crown and, comparison, 149, 165 definition of, 1 prevalence of, 149 deflection of, 89f, 89–90 retention of, 71–72 faciolingual movement, 91, 91f tooth preparation for illustration of, 3f armamentarium, 149 implant-supported, 84–85 axial reduction, 150, 150f metal-ceramic chamfer, 150 coping wax pattern, 487–490, 488f–490f depth-orientation grooves, 149–150 incisal configuration, 486 finishing lines, 150 metal coping, 486 functional cusp bevel, 150 rigidity, 486–487 occlusal reduction, 149, 150f soldering overview, 149, 151f indications for, 504 seating groove, 151 methods, 504, 504f venting of, 401 postveneer, 509–512, 509f–512f Functional cusp bevel preveneer, 505–508, 505f–508f description of, 138, 139f occlusal interferences, 82f for full coverage crown, 150 pontics, 477 for metal-ceramic crown, 158 for posterior teeth for MOD onlay, 198 description of, 99 for partial coverage crown, 166 template-fabricated provisional restorations, 248–252, Functionally generated path technique 248f–252f advantages, 361 resin-bonded. See Resin-bonded fixed partial dentures. definition of, 360 soldering functional core, 360 breaking of joint, 503–504 Furcation distortions, 496 definition of, 230 gold alloy flutes, 230 distortions, 496 preparation finish lines, 229f, 229–230, 231f indexing, 494 root resections affected by, 232 investing, 497–499, 497f–499f Fusion temperature, 376 procedure, 500–501, 500f–501f single-piece casting, 494

562 Index

G metal-ceramic crowns, 154, 155f Gingiva, finish line exposure of. See Finish line exposure. retentive, 136 Gingival collar, 230f Group function, 20 Gingival sulcus, 281, 286 Glass-ionomer cement H attributes of, 77t Hemisection, 232, 237–238, 238f bacteriostatic properties, 400 Hepatitis B, 9–10 composition of, 400 Highly filled glass-ceramic restorations, 427–428 disadvantages, 400–401 Hinge axis factors that affect, 401 accuracy of, 32t hybrid, 401 arbitrary location of, 32 indications for, 72, 73f and articulator hinge axis, effect of dissimilarities, 27, longevity of, 78, 79t 28f–29f properties, 400–401 trial and error method to determine, 31 pulp protection for damaged teeth, 207 History, patient, 3–6 resin-modified, 401–402 Horizontal symmetry, 413 Glass-ceramic restorations, highly filled, 427–428 Hue, 419 Glenoid fossae, 13 Hybrid ionomer cements, 401 Glycosylated hemoglobin, 5, 5t Hydrocolloids, reversible, 294–298 Gold alloys irreversible hydrocolloids and casting of, 371–373 concomitant use, 294 casting defects, 375f disadvantages of, 294–295 cleaning the castings, 373–374, 374f origins of, 294 pickling the castings, 374, 374f storage of impressions, 294 investing of, 365 wettability, 291 properties of, 363 Hygienic pontic, all-metal Gold restorations casting, 486, 486f adjustments die trimming, 482, 482f–483f contours, 395 excess wax removal, 482, 484f esthetics, 395 investing, 486, 486f margin finishing, 390–392 plaster matrix, 484, 485f marginal adaptation, 390, 391f wax coping, 482–483 occlusal, 392–394 Hygroscopic expansion, 365 proximal contacts, 389f, 389–390 seating completeness, 390 I cementation, 401–407 Implants finishing Brånemark, 519 postcementation, 396 crown retention, 524 precementation polishing, 395, 395f–396f diameter of, 526–527 preliminary, 385–387, 386f–387f endosseous, 517, 518f–519f, 519 try-in history of, 517–519 anesthesia use, 387 ideal positioning of, 524, 524f armamentarium, 387 inclination of, 525, 525f precautionary procedures, 388, 388f length of, 526–527 provisional crown number of, 526–527 patient hypersensitivity, 387 occlusal considerations, 527 removal, 388 in partially edentulous patients, 517, 517f Golden rectangle, 415, 415f placement of, 525f–526f, 525–527 Gold-palladium alloys restoration retention over, 524–525 casting, 379, 379f single-tooth. See Single-tooth implant. for metal-ceramic restorations, 448–449 size of, 527t soldering subperiosteal, 517, 518f burnout, 512 surgical splint for, 526, 526f indexing, 509–510 treatment planning of investing, 510–511 anatomical structures, 523, 523f preparatory procedures, 509 cone beam computed tomography, 520, 521f Grooves diagnostic casts, 522, 522f depth-orientation health history, 520 all-ceramic crowns, 161, 161f imaging, 520–521 full coverage crown, 149–150 oral examination, 520

563 Index

Implant-supported fixed partial denture Inlays characteristics of, 83t cementation, 407 description of, 84 ceramic retainers, 84 cementation, 444–445 span length, 83t, 84 description of, 75 Impressions definition of, 1 alginate. See Alginate impressions. dowel-inlay, 222 condensation silicones. See Condensation silicones. illustration of, 2f criteria, 291 indications, 193 definition of, 291 metal. See Metal inlays. digital, 320–322, 321f proximo-occlusal disinfection of, 319–320 armamentarium, 194 dual-arch. See Dual-arch impressions. bevel, 195f, 195–196 factors in selecting flares, 194–195, 195f cost, 293 gingivoaxial groove, 194, 195f viscosity, 293, 293f marginal ridge, 194 wettability, 291 occlusal outline, 194 hydrophilic vs hydrophobic, 291 overview, 196f pin-retained restorations, 318–319, 319f proximal box, 194 polyether. See Polyether. wax patterns, 343 polysulfide. See Polysulfide. Interferences, occlusal, 17–18, 18f polyvinyl siloxane. See Polyvinyl siloxane. Interocclusal records, 42f shear rate, 293 articulator use of, 30 single-tooth implant centric relation. See Centric relation record. alginate, 533–535, 533f–535f definition of, 30 closed tray, 532–533, 533f maximal intercuspation, 40–41 final, 535–539, 535f–539f Interproximal space open tray, 532–533, 533f loss from tooth migration, 211f Incisal curve, 413 methods to regain, 210 Incisal reduction Intracoronal restorations all-ceramic crowns, 161, 161f amalgam, 71–79, 208, 217 laminate veneer, 436, 436f composite resin metal-ceramic crowns, 154, 155f attributes, 77t three-quarter crown, 171, 172f criteria for, 71–72 Incisive canal, 523 inlays, 72, 74f Incisors glass ionomer, 72, 207, 400–401 central, fixed partial dentures for inlays. See Inlays. complex retention and resistance, 131, 131f more than two teeth, 117–118 stress concentrations, 193 two teeth, 113–114 Investing pier abutments, 120–122, 129 for casting simple base metal alloys, 380 one tooth, 100–101 crowns, gold alloy, 371–373, 372f–373f two teeth, 109–110 dowel-cores, 376 esthetic length of, 413, 414f expansion methods, 365–366, 376 incisal edges, 416 fixed partial denture, gold alloy, 497–499, 497f–499f mandibular, 126 general procedure, 368–371, 369f–371f maxillary, 115f, 125 gold-palladium alloys, 379, 379f preparation of, for resin-bonded fixed partial denture, inlays, gold, 376 183f definition of, 363 root surface area of, 526t for soldering Index, soldering metal-ceramic alloys, 506–508, 510–511 armamentarium, 495, 495f–496f type III gold, 497–499, 497f–499f function of, 494 Investments, casting gap width, 496 gypsum-bonded, 366–376 procedure, 495–496 phosphate-bonded, 377f Infectious disease requirements of, 365 patient history taking for, 3 Irreversible hydrocolloid, 291, 294 protective measures, 9–10, 10f

564 Index

J Mandibular teeth Joining, 493 cusp placement, 349t Joints, solder. See Soldering. cusp–marginal ridge, 352, 353f hemisection, 237–238, 238f K incisors Keyway, 223, 223f, 513 esthetic length of, 413, 414f Knife edge finish line, 144, 144f, 144t preparation for resin-bonded fixed partial denture, 183f Knoop hardness numbers, 384t root surface areas, 87f Margins L beveling vs not beveling, 140–141, 140f–141f Laminate veneer finishing composite resin, 434 for gold restorations, 390–392 definition of, 1 for wax patterns, 358–360, 359f–360f porcelain. See Porcelain laminate veneer. Maryland bridge, 179 working casts, 437–438 Master cast Laminating, 435 multiple-tooth implant, 552, 552f Lasers, for finish line exposure, 288f, 288–289 single-tooth implant, 539, 539f–540f Lateral incisors Maxillary sinuses, 523 fixed partial dentures for Maxillary teeth complex, 113–116 cusp placement, 349t pier abutments, 120–123, 126–127, 129 incisors simple esthetic length of, 413, 414f one tooth, 101–102 incisal edges, 416 two teeth, 109 preparation for resin-bonded fixed partial denture, 183f root surface area of, 526t root resections of Lateral interocclusal record, 42–43 distofacial root, 234 Lateral translation, 24f mesiofacial root, 235, 235f Leucite-reinforced material, 427 root surface areas, 87f Light wax patterns of cusp–marginal ridge, 350–352, artificial, 418f, 418–419 351f–352f natural, 418, 418f Maximal intercuspation record, 40–41, 41f Lingual index, 154f MCR. See Metal-ceramic restorations. Lingual reduction Mesiofacial root, of maxillary molar, 235, 235f all-ceramic crowns, 162, 162f Mesio-occlusodistal onlays metal-ceramic crowns, 154 attributes, 77t resin-bonded fixed partial dentures, 185f description of, 75 three-quarter crown, 171, 172f illustration of, 74f Lithium disilicate-reinforced material, 427 indications for, 197 Lost salt technique, 179 longevity of, 78, 79t mandibular molar preparations for, 200f M maxillary teeth preparations for, 197–200 Mandible stress concentrations, 197, 197f movement Metal inlays Bennett angle, 16, 16f attributes of, 77t determinants Class 1, 196, 196f anterior guidance, 22–24 Class 3, 196, 196f condylar guidance, 21–22, 21f–22f Class 5, 196f, 196–197 description of, 17 description of, 75 molar disocclusion, 21 illustration of, 74f posterior. See Temporomandibular joint. longevity of, 79t effect of anterior teeth, 17 tooth preparations for, 196–197 excursion, 15–16, 16f Metal-ceramic crowns protrusive, 15, 16f anterior teeth types of, 15, 15f armamentarium, 152 positioning of axial reduction, 154, 155f dysfunctional, 14f depth-orientation grooves, 154, 155f healthy, 14f finish lines, 154, 156 methods to guide, 13 incisal reduction, 154, 155f terminal hinge axis theory, 15 labial reduction, 154, 155f Mandibular canal, 523, 523f lingual reduction, 154

565 Index

occlusal reduction, 152, 152f rigidity, 486–487 overview, 157f soldering, 504, 504f proximal reduction, 154 layers of, 447f putty molds, 152, 153f maxillary molar, 234f radial shoulder, 154, 156, 156f metal coping, 447 shoulders, 154, 156 pontics, 471, 471f, 476 technique, 152–157, 153f–157f porcelain addition attributes, 77t all-porcelain margin fabrication, 459–462, 459f–462f cementation, 410 dentin and enamel porcelain, 462–467, 463f–467f description of, 75, 151–152 opaque application, 458, 459f illustration of, 76f soldering of, 504, 504f indications, 149 surface treatment, 467 longevity of, 78, 79t wax pattern path of insertion, 137f alloy surface treatment, 457, 457f on periodontally weakened teeth, 229 all-wax technique, 455–457 plaque accumulation, 383, 383f heat treatment, 458 posterior teeth single coping, 454–458, 455f–458f axial reduction, 159f–160f Metamerism, 419 depth-orientation grooves, 159f Micromechanical bonding, of cements facial reduction, 159f description of, 398 functional cusp bevel, 159f illustration of, 399f gingival bevel, 160 Missing teeth, treatment options for indications, 158 case presentation, 85 occlusal reduction, 158, 159f considerations, 81, 85 preparation for removable partial denture, 81–82, 83t, 85 armamentarium, 158 MOD onlay, 75, 197–200 axial reduction, 159 Molars depth-orientation grooves, 158 first, 119 facial reduction, 158 fixed partial dentures functional cusp bevel, 158 cantilever, 96 gingival bevel, 160f configurations for occlusal reduction, 138, 138f one tooth, 105–107 overview, 160f pier abutments, 128–129 radial shoulder, 160 two teeth, 111–113 selective use of, 158 resin-bonded, preparations for, 184f thickness requirements, 152 reverse three-quarter crown, 170, 170f Metal-ceramic restorations root surface area of, 526t all-ceramic restorations and, comparison, 447 Molecular adhesion, of cements, 398 alloy types, 448–449, 449t Multiple-tooth implant bonding mechanisms, 448 healing of, 543 CAD/CAM application to, 457 impressions cementation, 467–468 alginate, 544–546, 545f–546f chairside correction of, 468 closed tray, 544 composition of, 447 final, 546–551, 546f–551f coping design open tray, 544 extent of veneered area, 451–453, 452f–453f master cast articulation, 552, 552f facial margins, 454 placement of, 543, 543f, 553, 553f metal collar, 454 study cast for, 544–545, 545f–546f occlusal contacts, 450–451, 451f wax-up, 553, 553f overview, 449 Mutually protected occlusion, 20, 361 porcelain support, 450, 450f porcelain veneer, 449–450 N proximal contacts, 450–451 Nasal cavity, 523 thickness of metal, 450 Nickel-chromium alloys, 364 crowns. See Metal-ceramic crowns. Noble alloys finishing, 467–468 ADA classification system, 363 fixed partial dentures gold content, 363 coping wax pattern, 487–490, 488f–490f heat treatment, 458 incisal configuration, 486 melting temperature, 448 metal coping, 486 types of, 363 requirements, 486 Nonadhesive luting, 398

566 Index

Nonarcon articulators, 30 Partial coverage crowns Nonrigid connectors. See Connectors, nonrigid. advantages of, 165 Nonworking interference, 18f, 394 characteristics of, 77t definition of, 1 O full coverage crown and, comparison, 149, 165 Occlusion illustration of, 2f bilateral balanced, 20 indications, 165 diagnostic casts, 9 lingual grooves, 165, 165f disharmony of, 19f longevity of, 79t evaluation of, 6–8 retention of, 165 implant considerations, 527 seven-eighths crown, 170, 170f interferences, 17–18 three-quarter, tooth preparations for mandibular movement. See Mandible, movement. anterior teeth mutually protected, 20 overview, 173f normal vs pathologic, 19 path of insertion, 171 unilateral balanced, 20 tooth preparation, 171–173 wax patterns pin-modified, 174–178 cusp-fossa posterior teeth, 166–170 cusp placement and occlusal contacts, 354f Partial dentures definition of, 354 fixed. See Fixed partial dentures. description of, 349t removable, 81–82, 84, 247–248 illustration of, 348f Path of insertion, 136, 137f origins, 355 Periodontal ligament area, 86–88, 88f procedure, 355–358, 355f–358f Periodontically weakened teeth cusp–marginal ridge finish line modifications cusp placement and occlusal contacts, 350f furcation flutes, 230, 231f description of, 348–349 location, 229f, 229–230 for mandibular teeth, 352, 353f nonresection methods, 239t for maxillary teeth, 350–352, 351f–352f root resection. See Root resection. Onlay Periodontium, finishing line effects on, 145 definition of, 1 Phosphate-bonded investments illustration of, 3f alloy types, 376 mesio-occlusodistal. See Mesio-occlusodistal onlays. armamentarium, 376 Organo-tin silicones, 310–312 casting Osseointegration, 519 base metal alloys, 380 Osteonecrosis, 6 gold-palladium alloys, 379, 379f Overimpression-fabricated custom provisional restorations expansion methods, 376 alginate indications for, 376 armamentarium, 243 investing procedure, 376–379, 378f cementation process sprue former, 376–377 armamentarium, 247 Pickling, 374, 374f procedure, 247–248, 247f–248f Pier abutments technique, 243–247, 243f–247f description of, 91–92 tooth preparation, 243–247 fixed partial denture configurations, 120–129 bis-acryl composite crown, 256–259, 256f–259f illustration of, 91f Oxidation cycle, 458, 458f nonrigid connectors, 91–92, 92f Pin(s) P for damaged teeth, 206–207 Palatal root, of maxillary molar, 236–237, 236f–237f dowel Palladium alloys armamentarium, 331 gold location, 330 casting, 379, 379f procedure, 331–333 for metal-ceramic restorations, 448–449 in restorations, impressions for, 318–319, 319f soldering, 509–512, 509f–512f retentive, 174f silver, 363 uses of, 206 Pantograph Pinhole air-activated, 33f drilling of, 206–207 condylar movement recordings, 33f, 33–34 placement areas, 206f description of, 33 substitution of, 136 fully adjustable articulator use with, 34

567 Index

Pindex system packaging of, 313 base to cast, process for adding, 337–339 technique for, 313f–315f components, 334f viscosity, 293f description of, 333 Polyvinylethyl methacrylate, 242t pinholes, 335–336 Pontic pouring of impression, 333 all-metal hygienic technique, 334f–340f armamentarium, 482 Pin-modified three-quarter crown casting, 486, 486f indications for, 174 die trimming, 482, 482f–483f retention, 174 excess wax removal, 482, 484f tooth preparation for investing, 486, 486f armamentarium, 176 plaster matrix, 484, 485f axial reduction, 176, 176f wax coping, 482–483 bevel, 178 in appearance zone, 474 cutting holes, 174–175 cantilever, 96 flares, 177 definition of, 1, 471 grooves, 176–177, 177f designs offset, 177, 178f conical, 475, 476f overview, 178f considerations for, 471 Pitting, 493 hygienic, 475, 475f Plasma glucose, 5, 5t ovate, 475–476, 476f Polishing materials ridge lap, modified, 474 abrasives, 384–385 saddle, 474 description of, 384 metal-ceramic, 476 Polycarbonate crown, anterior, 260–263 modifications Polycarboxylate cements for edentulous ridge, 478–479, 478f–479f cementation, 407, 407f of surfaces, 471, 472f compressive strength, 400 postinsertion hygiene, 473–474, 473f–474f indications, 400 prefabricated facings, 476 pulp protection for damaged teeth, 207 span length, deflection created by, 89, 89f Polyether split, 514 armamentarium, 318 tissue contact with ridge, 472f, 472–473 characteristics of, 292t types of, 471, 471f description of, 318 use of, 9 effect of disinfectant solutions, 319–320 Porcelain impression making, 318 addition of, to metal-ceramic restorations wettability, 291 all-porcelain margin fabrication, 459–462, 459f–462f Polyethyl methacrylate, 242t dentin and enamel porcelain, 462–467, 463f–467f Polymerization, 242 opaque application, 458, 459f Polymerization shrinkage, 72 contouring of, 468 Polymethyl methacrylate, 241–242, 242t glazed, 435 Polysulfide Porcelain jacket crown, 425, 425f. See also All-ceramic armamentarium, 307 crowns. characteristics of, 292t Porcelain laminate veneer in custom resin trays, 299 description of, 434 effect of disinfectant solutions, 319–320 developmental stages of, 434–435 hydrophobic nature, 307 dies impression making, 307–310, 308f–310f fabrication of, 437–438, 438f packaging of, 307 gingival retraction, 437 viscosity, 293f illustration of, 3f Polyvinyl siloxane impression, 437 armamentarium, 315 refractory, 438f–441f, 438–441 bonding strength of, 298–299 removable, 437–438 characteristics of, 292t indications, 435 description of, 312–313 porcelain application effect of disinfectant solutions, 319–320 color, 441 formulations, 313–315 procedure for, 441–443, 442f–443f hydrophobic nature, 313 shade selection, 441 impression making, 315–317, 316f–317f preformed, 434 overimpression-fabricated crowns, 256–259, 256f–259f provisional restorations, 445

568 Index

removable, 437–438 endodontically treated teeth, 263, 263f silane coupling agent, 435 prefabricated, techniques for tooth preparation anterior polycarbonate crown, 260–263, 260f–263f axial outline, 436, 436f preformed anatomical metal crown, 263–267, axial reduction, 436, 436f 264f–267f depth-reduction grooves, 436f removal of, 388 facial reduction, 435, 435f–436f resins, 242, 242t. See also specific resin. finish line, 435, 437 Proximal contacts finishing, 437, 437f adjustments for, 389f, 389–390 incisal finish line, 437 all-ceramic restorations, 409 incisal reduction, 436, 436f metal-ceramic restorations, 450–451 proximal refinement, 437 soldering, 502–503 tissue management, 437 Proximo-occlusal inlays tooth reduction, 435 armamentarium, 194 working casts, 437–438 bevel, 195f, 195–196 Porcelain release agent, 460 flares, 194–195, 195f Porcelain-fused-to-metal restoration. See Metal-ceramic gingivoaxial groove, 194, 195f crowns. marginal ridge, 194 Posterior teeth occlusal outline, 194 contact with mandible, 20 overview, 196f fixed partial dentures for, 99 proximal box, 194 metal-ceramic crowns. See Metal-ceramic crowns, Pulpless tooth. See Endodontically treated teeth. posterior teeth. three-quarter crowns. See Three-quarter crowns, Q posterior teeth. Quick Mount facebow, 45–48 Precious metals. See Noble alloys. Prefabricated provisional restorations R anterior polycarbonate crown Radial shoulder, 142–143, 143f, 154, 156, 160, 429 armamentarium, 260 Radiating symmetry, 415 overview of, 260 Radiographs, full-mouth, 9 procedure, 260–263, 260f–263f Reduction. See specific reduction. preformed anatomical metal crown Removable die, for working casts armamentarium, 264 antirotational devices, 330, 330f procedure, 263–267, 264f–267f orientation methods for Premolars Pindex system, 333–340, 334f–340f dowel cores, 222 straight dowel pin, 330–333, 331f–333f fixed partial dentures requirements, 330 configurations for separate die vs, 330 one tooth, 103–105 Removable partial dentures pier abutments, 122–129 abutment teeth requirements, 81–82 two teeth, 110–112 characteristics of, 83t resin-bonded, preparations for, 184f indications for, 81 mandibular first, 120 provisional crown placement under, 247–248 maxillary first, 119–120 Resin cements maxillary second, 119 autopolymerizing, 398 root surface area of, 526t cementation, 402–404, 403f Preparations, tooth. See Tooth preparations. composite Protrusive incisal path, 22 dentinal bonding agent use with, 402–404 Protrusive incisal path inclination, 22 description of, 398 Protrusive occlusal interference problems associated with, 402 adjustments, for gold restorations, 394, 394f restorations definition of, 18 criteria for, 71–72 illustration of, 18f inlays, 72 Provisional restorations longevity of, 79t classifications problems associated with, 398–400 direct vs indirect, 241–242 restorations prefabricated vs custom, 241 inlays, 74f criteria for, 241 longevity of, 78 custom. See Custom provisional restorations. Resin-bonded fixed partial dentures definition of, 241 advantages, 180

569 Index

cements, 180 armamentarium, 387 contraindications, 182 precautionary procedures, 388, 388f–389f delivery provisional crown armamentarium, 186 patient hypersensitivity, 387 sequence removal, 388 abutment teeth, 186, 187f marginal integrity air abrading, 186, 187f beveling vs not beveling, 140f–141f, 140–141 bonding, 187–188 finish line configurations, 141–145 excess removal, 188 metal-ceramic. See Metal-ceramic restorations. Oxyguard II, 188, 188f provisional. See Provisional restorations. primer, 187 retention and resistance of pumice cleaning, 186 extracoronal, 131, 131f disadvantages, 180 factors that affect framework configurations, 184f freedom of displacement, 133–134, 134f longevity uncertainties, 180, 181t internal feature substitution, 136, 136f Maryland bridge, 179 occlusogingival length, 135, 135f Rochette bridge, 179 path of insertion, 136, 137f tooth preparation intracoronal, 131, 131f armamentarium, 184 overview, 131 axial reduction, 182, 186f small teeth vs large teeth, 133, 133f countersinks, 185f shade selection. See Shade selection. examples of, 183f–184f structural durability, factors that affect finish lines, 182 axial reduction, 138, 139f grooves, 183, 183f–184f, 186f functional cusp bevel, 138, 139f lingual reduction, 185f occlusal reduction, 138 occlusal reduction, 182, 185f tooth preparation for. See Tooth preparation. proximal reduction, 185f tooth structure preservation, 131 rests, 184f Retainers sequence, 185–186 definition of, 1 vertical stops, 182 implant-supported fixed partial denture, 84 Virginia bridge, 179–180 Retentive pins, 174f Resin-modified glass-ionomer cement, 401–402 Retraction cord Resistance, 131–137 armamentarium, 275 Restorations chemical types, 274t all-ceramic. See All-ceramic restorations. epinephrine, 273, 275–278 base metal placement of, 275–278, 275f–279f adjustments, 397 Reverse occlusion, 20 finishing, preliminary, 397 Reversible hydrocolloid polishing, 397 agar content, 294 try-in, 397 armamentarium, 296 ceramic. See Ceramic restorations. characteristics of, 292t considerations for, 71–72 conditioner for, 294, 295f gold cooling of, 294 adjustments impression making, 294, 296f–297f, 296–298 contours, 395 irreversible, 294 esthetics, 395 origins of, 294 margin finishing, 390–392 storage of impressions, 294 marginal adaptation, 390, 391f wettability, 291 occlusal Ridges nonworking movement, 394, 394f cusp–marginal overcorrection, 392, 393f cusp placement and occlusal contacts, 350f protrusive interferences, 394, 394f description of, 348–349 working movement, 394, 394f wax patterns of proximal contacts, 389f, 389–390 mandibular teeth, 352, 353f seating completeness, 390 maxillary teeth, 350–352, 351f–352f finishing edentulous postcementation, 396 classification of, 477, 477f preliminary, 385–387 deformities, 477, 477f precementation polishing, 395, 395f–396f pontic modification, 478–479, 478f–479f try-in surgical correction anesthesia use, 387 Class II and III defects, 480, 481f

570 Index

donor tissue, 480 Shrinkage, during investing incisions, 479–480, 480f description of, 365 Rochette bridge, 179 expansion methods Root hygroscopic, 365 configuration of, 86 setting, 365 crown-root ratio, 85–86 thermal, 365–366 Root amputation, 232 wax pattern, 365 Root canal. See Endodontically treated teeth. Shrink-spot porosity, 367, 375f Root caries. See Caries. Silane coupling agent, 435 Root resection Silicon carbide, 384 capacity of resected roots, 232 Silicone contraindications, 232 Condensation. See Condensation silicones. description of, 232 polyvinyl siloxane. See Polyvinyl siloxane. effect of narrow furcations, 232 Silicone putty index, 253f failure rates, 239 Silver-palladium alloys, 363 indications, 232 Single-tooth implant success rates, 239, 239t cast fabrication, 532, 535–539 technique, 232–233, 233f description of, 531 tooth preparation and crown configurations facial view of, 531f mandibular hemisection, 237–238, 238f gingival tissue evaluation, 532 maxillary distofacial root, 234 healing of, 531, 532f maxillary facial roots, 237 impression techniques maxillary mesiofacial root, 235, 235f alginate, 533–535, 533f–535f maxillary palatal root, 236, 236f, 237, 237f closed tray, 532–533, 533f skyfurcation, 239, 239f final, 535–539, 535f–539f Rotary curettage, 280, 280f open tray, 532–533, 533f Rouge, 384 master cast articulation, 539, 539f–540f Rubber base. See Polyether; Polysulfide. placement of, 531, 542, 542f Rubber dam, 269, 272 wax-up for, 540, 541f–542f Rubber points, 385 Single-tooth restorations Rubber wheels, 385 attributes of, 77t extracoronal. See Crowns. S intracoronal Saliva ejector, 270 amalgam Separating disks, 384 complex, 73, 75 Seven-eighths crown, 170, 170f simple, 72–73 Shade selection composite resin. See Composite resin restorations. color glass ionomer, 72, 207, 400–401 characteristics of, 419 inlays. See Inlays. daily functions’ effect on, 419 mesio-occlusodistal onlays. See Mesio-occlusodistal. light sources’ effect on longevity of, 78 artificial, 418f, 418–419 treatment planning, considerations for, 71–72 factors that affect, 418 Skyfurcation, 239, 239f natural, 418, 418f Smile line glass-ceramic restorations, 427 effect of mouth on, 414f metal-ceramic restorations, 467 illustration of, 413f sequence for Solder illustration of, 420f–423f breaking of, 503–504 patient positioning, 421 characteristics of, 493 recording of findings, 423 gold, 493 removal of distractions, 420 noble metal content, 493 shade guide, 420 Soldering shade tabs, 421–423 definition of, 493 translucency, 419 difficulty associated with, 494 Shade tabs, 421–423 fixed partial denture Shear thinning, 293 gold alloy Shell-fabricated provisional restorations, 254–255, 255f distortions, 496 Shoulder indexing, 494 all-ceramic crowns, 161–162, 162f investing, 497–499, 497f–499f mesio-occlusodistal onlays, 198f single-piece casting, 494 metal-ceramic crowns, 154, 156, 156f soldering, 500–501, 500f–501f

571 Index

metal-ceramic alloys Templates, for provisional restorations indications for, 504 fixed partial denture, 248–252, 248f–252f methods, 504, 504f visible light–cured, 252–254 postveneer Temporomandibular joint burnout, 512 anatomy of, 13, 14f casting, 512 evaluation of, 6–8 indexing, 509–510 mandibular movement and, 27 investing, 510–511 Terminal hinge axis theory, 15 preparatory procedures, 509 Three-quarter crowns preveneer anterior teeth burnout, 506–508 armamentarium, 171 indexing, 506 axial reduction, 171–172, 172f investing, 506–508 bevels, 171, 173f margin finishing, 508 flares, 172–173, 173f postveneer and, comparison, 505 grooves, 172f, 172–173 procedure, 505–508, 505f–508f incisal reduction, 171, 172f methods of, 504, 504f lingual reduction, 171, 172f preveneer, 504 offset, 173, 173f proximal contacts, 502–503 overview, 173f repair of casting voids, 503 path of insertion, 171 requisites for, 493 for mandibular molar, 170, 170f Sprue former pin-modified for all-metal hygienic pontics, 486 indications for, 174 description of, 366 retention, 174 in gypsum-bonded investments, 366–368, 368f tooth preparation for illustration of, 367f armamentarium, 176 in phosphate-bonded investments, 376–377 axial reduction, 176, 176f Stones, abrasive bevel, 178 green, 385 cutting holes, 174–175, 177f–178f pink, 385 flares, 177 shapes of, 385f grooves, 176–177, 177f white, 385 offset, 177, 178f Stress concentrations, in intracoronal restorations, 197 overview, 178f Structural durability, of restorations posterior teeth axial reduction, 138, 139f armamentarium, 166 functional cusp bevel, 138, 139f axial reduction, 166–167, 167f occlusal reduction, 138 finishing lines, 167, 167f Subgingival margins, 145 flares, 168–169, 169f Subperiosteal implants, 517, 518f functional cusp bevel, 166, 166f Supragingival margins, 145 grooves, 167–168, 167f–168f Surgical crown lengthening, 212f occlusal reduction, 166, 166f Svedopter, 270–271, 270f–271f offsets, 169 Symmetry, of face, 413 overview, 169f reverse, 170, 170f T Tilted molar Taper abutments definition of, 132 corrective methods, 93–94 optimum degree of, 132, 133t description of, 93–94 retention and, relationship between, 132f fixed partial dentures, 93–94 Teeth. See also Mandibular teeth; Maxillary teeth; specific split pontics, 514 teeth. proximal half crown, 170f, 170–171 abutment use. See Abutments. uprighting of, 93, 93f alignment of, 82f Titanium alloy, 364 damaged. See Damaged teeth. TMJ. See Temporomandibular joint. endodontically treated. See Endodontically treated Tooth conditions, 203t teeth. Tooth preparations mandibular movement affected by, 17 all-ceramic crowns. See All-ceramic crowns, tooth missing. See Missing teeth. preparations. Telescope crown, 94, 94f damaged teeth. See Damaged teeth, preparations for. full coverage crown. See Full coverage crown, tooth preparation for.

572 Index

instrumentation, 145–147, 146t V laminate veneers, porcelain Vac-U-Spat investor, 369–371 depth-reduction grooves, 436f Value, 419 facial reduction, 435, 435f–436f Van der Waals forces, 448 finish line, 435 Veneer crowns. See Full coverage crown; Partial coverage finishing, 437 crowns. incisal reduction, 436, 436f Veneer restorations. See Laminate veneer. marginal integrity Vent holes, 401 beveling vs not beveling, 140–141, 140f–141f Virginia bridge, 179–180 finish line configurations, 141–145 Visible light–cured provisional restorations, template- mesio-occlusodistal onlays fabricated, 252–254 for mandibular molars, 200f Visible light–cured urethane dimethacrylate, 242t for maxillary teeth Vital teeth armamentarium, 197 abutment use of, 85 bevel, 198–199, 198f–200f damaged, modifications for restorative procedures, 208– finish lines, 198, 199f 210, 209f flares, 198, 199f Voids, casting isthmus, 198 armamentarium, 503 occlusal reduction, 197–198, 198f contraindications, 503 overview, 200f indications for, 503 proximal box, 198 shoulder, 198f W metal-ceramic crowns. See Metal-ceramic crowns. Wax interocclusal records. See Interocclusal records. periodontium preservation, 145 Wax patterns retention and resistance axial contours extracoronal, 131, 131f bulges, 346, 347f factors that affect emergence profile, 346, 347f freedom of displacement, 133–134, 134f faciolingual, 345–346, 345f–346f internal feature substitution, 136, 136f proximal, 345 occlusogingival length, 135, 135f fabrication path of insertion, 136, 137f armamentarium, 343 intracoronal, 131, 131f coping, 343–344, 344f overview, 131 methods of, 343 taper, 132–133 margin finishing small teeth vs large teeth, 135f common problems, 358 structural durability, factors that affect occlusal grooves, 360 axial reduction, 138, 139f occlusal scheme functional cusp bevel, 138, 139f classification of, 349t occlusal reduction, 138 cusp-fossa tooth structure preservation, 131, 208–210 curve of Spee, 354 Tooth structure preservation, 131, 208–210 curve of Wilson, 355 Transformation toughening, 429 cusp placement and occlusal contacts, 354f Transosseous mandibular bone plate, 517, 518f definition of, 354 Tripoli, 384 description of, 349t Try-in illustration of, 348f base metal restorations, 397 origins, 355 gold alloy restorations procedure, 355f–358f, 355–358 anesthesia use, 387 cusp–marginal ridge armamentarium, 387 cusp placement and occlusal contacts, 350f precautionary procedures, 388, 388f–389f description of, 348–349 provisional crown for mandibular teeth, 352, 353f patient hypersensitivity, 387 for maxillary teeth, 350–352, 351f–352f removal, 388 single coping, 454–458, 455f–458f wax types, 343 U Wax wafers, 45, 46f Undercuts Wet field technique, 296–297 box form to eliminate, 208 Working casts visual examination for, 136, 137f mounting of Unilateral balanced occlusion, 20, 361 Denar facebow and articulator, 59–60

573 Index

Hanau facebow and articulator, 65–66 X Whip Mix facebow and articulator, 50–53 Xerostomia, 5–6 with removable die advantages over separate die, 330 Z antirotational devices, 330, 330f Zinc oxide–eugenol cement methods of orienting die in cast indications, 400 Pindex system. See Pindex system. performance of, 400 straight dowel pin, 330–333, 331f–333f provisional crowns, 248, 248f requirements, 330 Zinc phosphate requirements for, 325 cementation with separate die cement preparation, 404–405, 405f armamentarium, 325 mandibular isolation, 404, 404f description of, 325 pulp protection, 404 die preparation, 327–329, 327f–329f removal of excess cement, 406 difficulties associated with, 325 restoration seating, 405–406, 406f finish lines, 327–328, 329f vital tooth considerations, 404 hardening agents, 328 compressive strength, 400 impression pouring, 325–326, 326f indications, 400 Working occlusal interference Zirconia-reinforced materials, 429 adjustments, for gold restorations, 394, 394f description of, 17, 18f

574