how to technique

Issue 2 2013 How to prepare a posterior crown using a

plane-by-plane technique.

by Dr Eddie Bass

Basic technique.......

1 Approximal surface preparation. >>

Use a pear-shaped, rather than a tapering, diamond bur.

Using a pear-shaped of an excess taper that

diamond bur for approx- can compromise resist-
imal surface reduction ance and retention
has many advantages form, especially on
over using a tapering distal surfaces of
diamond bur: molars.
It can fit through a In the subsequent
tight space whilst preparation the rounded
minimising the risk of end also facilitates the
damaging the approxi- production of an ideal
Left: Use a long pear-shaped diamond bur for approximal
mal surface of the chamfer.
adjacent tooth. An example bur that
surface reduction. Middle: It facilitates getting through a

The shape helps min- meets these requirements

tight space without damaging the adjacent approximal
surface. Right: Using a tapering diamond bur increases
the risk of approximal surface damage.
imise the production > is shown on page 49.

Place a retraction cord before carrying out any further preparation.

After clearing the small pellet of Gingi-Pak

approximal surface held in a pair of tweezers.
contacts place a retrac- A minuscule amount of
plastic instrument

retraction
tweezers

tion cord. trichloracetic acid (TCA)

cord

TCA The author prefers to is applied at strategic

use a strand of Gingi- locations using a pair of
Pak (Belport). The tweezers that had been
strand is first placed previously dipped in a
into the gingival sulcus drop of TCA.
and pushed into position Once the cord has been
Left: A strand of Gingi-Pak retraction cord is placed in the
with the end of a sharp- wetted it is pushed
ened and polished flat slightly further into the
gingival sulcus. Middle: It is seated in place with the end

plastic instrument. gingival sulcus with the

of a sharpened and polished plastic instrument. Right:
Using the end of a pair of tweezers, previously dipped in
trichloracaetic acid (TCA), the cord is moistened with the
Any moisture on the end of the plastic instru-
cord is then dried with a ment.
solution.

Source: www.dentaloutlook.com.au
 how to technique
Tooth preparation for posterior crowns. (cont)

2
endodontic
origin
Smooth surface preparation. >>
Create a groove at the gingival level on the buccal
and lingual surfaces.
A small wheel diamond burs results in a smooth
bur is used to prepare a groove following the
groove along the buccal buccal and lingual
and lingual walls at the contours of the gingival
level of the gingival margin. In so doing it
margin. establishes the cervical
Alternatively, a small margin of the prepara-
round diamond bur can tion in these locations.
be used for the same Example burs that meet
purpose. these requirements are
Either a small wheel diamond bur (left) or a small round
Using either of these > shown on the next pages.
diamond bur (right) is used to produce a groove on the
buccal and lingual surfaces corresponding to the contour
of the gingival margin.

Use a safe-ended diamond bur to prepare the buccal and lingual walls.

After the grooves on around 8 to 10 degrees

the buccal and lingual which is ideal for
surfaces have been pre- retention.
pared, a safe-ended, The presence of the
tapering diamond bur is previously established
used to complete the grooves provides a guide
buccal and lingual and helps keep the
reduction. tapering bur on track
Holding the bur vertical- and prevents any
ly will provide buccal unwanted cutting into
Left: A safe-ended tapering diamond bur is used for
and lingual walls with a the sub-gingival region.
convergence angle >
reducing the buccal and lingual walls. Middle: Reduction is
carried to the appropriate depth and taper. Right: The
safe-ended tip sits in the previously established cervical
groove which acts as a guide.

Round the corners of the preparation.

The smooth surface

preparation is complet-
ed using a tapering
diamond bur. The
bur

corners are rounded and

the cervical chamfer or
shoulder extended in a
smooth curve from the
approximal to the buc-
cal and lingual aspects
A tapering diamond bur (left) is used to round the of the preparation.
corners of the preparation (right).

Source: www.dentaloutlook.com.au
 how to technique
Tooth preparation for posterior crowns. (cont)

3 Occlusal surface preparation. >>

Carry out a controlled reduction.
To obtain a uniform and
controlled reduction of
the occlusal surface a
suitable depth-cutting
bur is used.
Depth cuts are made
across the surface in a
bucco-lingual and >
mesio-distal direction.
An oval-shaped diamond
bur is then used to
remove the remaining
tooth structure to the
depth of the cuts made
by the end-cutting bur.

Left: A depth-cutting bur is used as a guide for the

amount of tooth structure needing to be removed from
the occlusal surface. Right: An oval-shaped bur is used to
complete the occlusal reduction.

Complete final smoothing and finishing. >>

A slow-speed, end-cut- 40,000 rpm in a friction

ting tungsten carbide grip, red-band slow-
Left: An end-

bur, that has had its speed handpiece.

cutting tungsten
carbide bur with a
corners bevelled or At this speed it gives
bevelled or round-

rounded, can be used very good tactile feed-

ed edge can be

for any final smoothing back as to the presence

used for smooth-

or finishing of the shoul-

ing the shoulder
or chamfer of the
of any irregularity or
preparation. der or chamfer. roughness of the
It is used at around shoulder or chamfer.

Example case.....

1 A pear-shaped bur
was used to prepare 2 The diamond bur
FG 239 012 3 Before any further
preparation was
the approximal (Horico) was used carried out a
surfaces and establish the because it had the appropriate retraction cord was placed in
appropriate taper. length and taper. the gingival sulcus.
Aust. distributor Horico burs - Henry Schein Halas.

Source: www.dentaloutlook.com.au

Tooth preparation for posterior crowns. (cont)
4 There are numerous
methods of achieving
gingival retraction. In
this case a cord prepared from
a pellet of Gingi-Pak (Belport)
was used.
7 After placement, the
Gingi-Pak cord
became wet with
crevicular fluid and minor gingi-
val bleeding. This was dried with
another pellet of Gingi-Pak.
10 The wheel diamond
bur was used to cut
a groove at the level
of the gingival margin on the
buccal and lingual surfaces.
*Left: A Komet 801314014 round diamond bur can
also be used to prepare a groove at the level of the
gingival margin.
how to technique
5 The pellet was held
on the tip of a probe 6 The strand was
wound in the fingers
and teased out into to form a cord. Just
a long strand. one string was enough for effec-
tive retraction. No local anaesthet-
ic was required.
8 The tip of a pair of
tweezers was dipped 9 The cord was pushed
further into the sulcus
into a drop of trichlo- with a plastic instru-
racetic acid. Minuscule amounts of ment. A Komet 825016 wheel
the solution were deposited at diamond bur (above) was selected
strategic locations around the cord. for the next step (see footnote*).
11 A safe-ended tapering
diamond bur (Komet 12 After the buccal and
lingual reduction
857314014) was (illustrated) the line
used to reduce the buccal and angles were rounded and irregu-
lingual surfaces. The smooth tip larities in the gingival shoulder
fitted into the cervical groove on corrected with a Komet
the buccal and lingual surfaces. 856016 tapering diamond bur.
Aust. distributor Komet burs - Henry Schein Halas.
 how to technique
Tooth preparation for posterior crowns. (cont)

13 To obtain a con-
trolled reduction of 14 Grooves were pre-
pared to the depth 15 At the completion
the occlusal surface
the occlusal surface of the tip of the end- had grooves running
a depth-cutting bur was used. A cutting bur. bucco-lingually and grooves
Komet 8804009 Bur (above) running mesio-distally.
was selected (see footnote *).

16 An oval-shaped dia-
mond bur (Komet 17 A tungsten carbide,
end-cutting bur (Komet 18 The end-cutting bur
was used at 40,000
379314023) was H207010-014) was rpm in a friction grip
used to finish the occlusal selected for the final smoothing red-band handpiece. (If the inter-
reduction to the level of the and finishing of the cervical proximal space is small, a 010 or
depth cuts. This provided 1.0 - shoulder. The edge of the bur had 012 diameter bur may be needed).
1.5 mm of clearance. been slightly bevelled.

19 Appearance of
finished preparation 20 The gingival tissues
two weeks later had 21 In the case shown a
full gold crown was
after the strand of completely recovered placed. The margins
Gingi-Pak had been removed and were typical of those seen finished slightly subgingivally. The
prior to impression taking. when the retraction technique technique described can be used,
employing trichloracetic acid is used. with the appropriate modifica-
tions, for other types of crowns.
* Left: A Premier D.C. Depth-Cut diamond bur (DC1.0 or
DC1.5) can also be used in this step. These burs work
better if the flange is removed as shown.
Aust. distributors Komet burs - Henry Schein Halas. Premier burs - Gunz Dental.