Partial Coverage Restorations

Definition
An extra-coronal metal restoration extrathat covers only part of the clinical crown.

Types of Partial Veneer Restorations:

Posterior teeth 1- Three quarter crown 2- Reverse three quarter crown 3- Reverse retention retainer 4- Proximal half crown 5- Seven eighths crown Anterior teeth 1- Three quarter crown 2- MacBoyle retainer 3- Pinledge retainer

Advantages:
1- Conservative tooth reduction than full coverage preparation. 2- Reduced pulpal and periodontal insult during tooth preparation. 3- Less gingival irritation as it has less margin approximates the soft tissue subgingivally. subgingivally. 4- Better accessibility to dentist for margin finishing and to patient for cleaning ( supra-gingival margins). supra5- Complete seating of the restoration is enhanced by diminished hydraulic pressure i.e. allow escape of excess cement. 6- Pulp testing is possible ( uncovered surface). 7- Superior esthetic than full coverage restoration.

Disadvantages:
1- Resistance and retention less than full coverage as it dose not completely encircle the tooth. 2- More difficult preparation to operator 3- Metal display may be unacceptable to patient with high cosmetic expectations.

Indications :
1- As retainers for posterior and anterior short span FPD. 2- As a single restoration for posterior and anterior teeth. 3- As a splint for periodontally involved teeth. 4- Intact or minimally restored teeth. 5- Teeth with long and bulky coronal structure. 6- Teeth subjected to average or below average forces. 7- Patients with low caries index and good oral hygiene.

Contraindications :
1- Patient of high caries index and bad oral hygiene. 2- Patient with abnormal bite. 3- Retainers for long span bridge. 4- Teeth with: a- short clinical crown b- abnormal clinical crown as: peg shaped teeth c- malformed clinical crown as: hypoplastic teeth d- endodontic treatment.

Posterior Partial Veneer Crown Preparation

Definition:
Is a partial veneer crown in which the buccal or labial surface is left uncovered It gains its retention by two proximal grooves

Occlusal reduction:
First , depth grooves are cut on the anatomical ridges and grooves of occlusal surface. The amount of occlusal reduction needed : 1.5 mm on functional cusp (palatal) 1.0 mm on non-functional cusp (buccal) non(buccal)

Functional Cusp Bevel

- Done using tapered diamond stone - 1.5 mm depth and o.5 mm width.

Buccal cusp bevel

Buccal aspect of the cusp is beveled at 45 degree to buccal surface? 1- Protect cusp against fracture. 2- Make proper margin finishing.

Axial Reduction
1- Lingual Reduction
- Done using tapered stone with round end - Reduced lingual surface should: a- Mesiodistally follow normal contour of tooth b- Occlusocervically in 2 planes cervical23 should be parallel to long axis, occlusal13 with slight occlusal convergence.

2- Proximal Reduction
- Initial reduction with tapered stone with pointed end ,followed with tapered stone - Proximal reduction should extended: a- The mesial margin just before the proximal contact area to be hidden by the distal line of the neighboring tooth. b- The distal margin extend bucally Just beyond the contact area

- The reduced proximal surfaces should be parallel to each other and to path of insertion.

3- Proximal Grooves a- Location: Placed on the buccal half of the proximal surfaces at the line between the buccal and middle thirds of the proximal surface b- Shape: 1- U shaped groove: The most used? Because the lingual wall is prepared at right angle to the prepared proximal surface prevent lingual displacement of restoration.

2- Box shaped: Destructive so used only in: - Proximal caries or previous restoration - Solder joint is required - Precision attachment is required 3- V shaped: The least retentive so mainly used in anterior teeth.

c- Preparation of grooves:
- Prepared with tapered fissure bur. - Lingual walls definite ( perpendicular to proximal surface)to provide resistance to lingual displacement of the restoration - 0.5 mm axial depth - Gingival ends 0.5 mm occlusal to finish line - Flared buccal wall

4- Occlusal Offset: 1- Prepared by inverted cone bur 2- Location: On the lingual incline of the buccal cusp to join the two grooves. 3- Shape: It is in the form of definite step taking the shape of an inverted V

Three quarter Crown for Maxillary Molars

The same as premolar preparation.

Modifications of Three Quarter Crown for Maxillary Posterior Teeth.

7/8 Crown:
It is a modified 34 crown, whose distobuccal margin is placed at the center of the buccal surface. surface.

Indications:
It is generally used on maxillary 1st molars with: 1- Intact mesiobuccal cusp. 2- when there is extensive distal involvement by caries or previous restoration.

Steps of preparation
1- Proximal reduction: - Proximal contact is opened with fine tapered stone, then complete proximal reduction with tapered stone with rounded end. - Reduced proximal surfaces with slight occlusal convergence. 2- Lingual reduction: - Reduced using tapered stone with rounded end.

3- Mesial groove: Prepare the mesial groove like the three quarter crown. 4- Buccal groove: Place the buccal groove in the middle of buccal surface parallel to the path of insertion.

5- Buccal reduction The distal half of the buccal surface is reduced using tapered stone with rounded end.

6- Occlusal reduction - An even occlusal reduction of 1.5-2 mm. - The reduction should follow normal occlusal anatomy. - The mesiobuccal cusp remains uncut

Modified Three-quarter Crown for Mandibular Premolar.

They differ from maxillary premolar three-quarter crown preparations in two respects: 1- Additional retention is required because of the shorter lengths of the lingual cusps of mandibular teeth. 2-The axial surface that is not prepared (the buccal) includes the functional cusp. This means that additional tooth structure must be removed to provide sufficient bulk of metal to protect the functional cusp.

Therefore,
1- Place the proximal grooves in the buccal half of the proximal surface as a main retentive feature. 2- A third accessory groove( distobuccal groove) is placed on the distal aspect of buccal surface to increase retention and resistance. 3- Buccally, the preparation must be extended on the buccal surface beyond the point of contact with opposing teeth by 0.5mm.

4- The occlusal finish line is a chamfer finish line on the buccal surface gingival to occlusal contact to:

i. protect functional cusp

ii. Resist lingual displacement of restoration

Modifications of Three quarter Crowns for Mandibular Posterior Teeth : 1- Reverse crown: In this preparation the buccal surface is included in the preparation instead of the lingual surface.

Indications:
1- Restoration of madibular molar with damaged buccal surface and intact lingual surface. 2- Madibular molars with sever lingual inclinations to be used as bridge retainers.

2- Reverse retention retainer:

Modified type of partial veneer preparation, where the proximal reduction extend onto the buccal surface i.e, the outline form of this preparation includes all surfaces except a part of buccal surface. The buccal surface is limited by mesial and distal half grooves,1mm wide, past the bucco-proximal line angles.

3- Proximal half crown

A three quarter crown with the distal surface rather than the buccal has been left intact Contraindicated : 1- Caries on the distal surface. 2- Patient with bad oral hygiene.

Indicated as a single restoration or as a bridge retainer on: 1- upper molars where it is difficult to gain access to the distal surfaces. 2- lower mesially tilted molars.

1- Proximal reduction: Reduction of the mesial surface using tapered stone with rounded end. 2- Occlusal cavity preparation: - An occlusal cavity is prepared extending mesially, distally, buccally and lingually to include all pits and fissures. - The cavity should extend onto the reduced proximal surface.

3-Buccal and lingual axial grooves: The buccal and lingual grooves are placed at the buccal and lingual surfaces. Both grooves are parallel to each other and to the reduced mesial surface

4- Occlusal reduction: - Amount of reduction in the distal half 1.5 - 2mm.

- Because the tooth is mesially tilted mesial half is out of occlusion amount of reduction is decreased but the thickness of metal occlusally should be 1-1.5mm.

Anterior partial veneer crown preparations

Disadvantages: Same as posterior teeth in addition to : 1- Display of metal 2- Anterior teeth are thin, so appear darker after cementation of restoration. 3- Anterior teeth are thin, so provide limited bulk of tooth structure for retentive grooves.

Maxillary anterior three-quarter crown preparation:

Are mainly retained by proximal grooves, pinholes can be used to add for more retention.

Steps of preparation:
1- Proximal reduction: - The proximal reduction should end just before the proximo-labial line angle for esthetics. - The two proximal surfaces should be reduced with slight incisal convergence.

2- Palatal reduction: It is done in two steps: 1- The cingulum area: - Is reduced with tapered stone with rounded end. - The reduced surface should be parallel to the incisal two thirds of the labial surface. 2- Palatal fossa: - Is prepared with wheel or football stone. - The amount of reduction is 0.5-0.7 mm for enough thickness of metal.

- In case of canine, the reduced palatal surface has two plans meet at central palatal ridge.

3- Incisal reduction: 1- Done by tapered stone inclined palatally 45 degrees with the long axis of the tooth. 2- The incisal reduction end just before the inciso-labial line angle. 3- Amount of reduction 1mm. 4- Canines are reduced in two plans

4- Proximal grooves: 1- V-shaped grooves are placed on mesial and distal surfaces using tapered fissure bur. 2- The direction of the proximal grooves should be parallel to the incisal 2/3 of the labial surface of the tooth.

3- The maximum depth groove is incisally (0.3-0.5mm) which decreased gradually to fade at cervical area as a fine point (no gingival wall of the groove) due to the shape of the anterior teeth and to avoid any undermined enamel. 4- Labial wall of each groove is flared to remove undermined enamel, this flare terminates lingual to facio-proximal line angle for esthetic reasons.

5- Incisal groove:
-

It is indicated when there is enough labiolingual thickness as added means of retention. The mesial and distal grooves are connected with a V shaped groove.

6- Cingulum indentation and pinhole: 1- A pinhole is placed on the crest of the cingulum area away from center to improve the retention and resistance form of the preparation. 2- It is 1.5-2mm depth, parallel to proximal grooves and path of insertion.

Mandibular anterior three-quarter crown preparation:

The same as maxillary except for incisal edge protection by metal to prevent labial enamel chipping under occlusal forces.

MacBoyle retainer
-

Indicated on thin labio-lingual teeth: 1- Mandibular central and lateral. 2- Maxillary lateral incisors.

- It gains its retention by two grooves located at the labio-proximal line angles - Its main disadvantages is metal display labially.

Pinledge Retainer
It is a partial coverage restoration that covers lingual, one or both proximal surfaces and takes its retention from pins inserted in a prepared pinholes in the palatal surface.

Indications:
It is used as a : 1- Bridge retainer (mainly) 2- Single restoration in cases of: Alteration of lingual contour of the maxillary anterior teeth or the alteration of occlusion during complete mouth reconstruction Periodontally compromised anterior teeth that needs splinting.

Recontouring of lingual surface to receive a rest of removable partial denture. Protection of incisal edge of anterior teeth in case of sever attrition.

Contraindications:
1- Poor oral hygiene and high caries index 2- Large pulp 3- Non vital teeth 4- Thin teeth labio-lingually 5- Proximal carious involvement extending to the labial surface

Conventional pinledge design:

Steps of preparation: 1- Proximal reduction: - Only one proximal surface is prepared the proximal surface adjacent to the edentulous ridge proper thickness of metal for solder joint. - The preparation should end before the proximo-labial line angle to avoid metal display.

2- Lingual reduction: - The lingual surface is reduced as has been described in other anterior preparations. - The marginal ridge towards the reduced proximal surface is reduced together with the lingual surface leaving the other marginal ridge intact

3- Incisal reduction:
-

Incisal bevel is prepared inclining 45r lingually: provide room for metal thickness protection of incisal edge against occlusal forces. This bevel should be ended before the labioincisal line angle to prevent metal display.

- Incisal reduction is indicated in: edge to edge bite or thin incisal edges, while in normal occlusion and no incisal attrition, incisal reduction is not indicated

4- Ledges and indentations:

- Two ledges are prepared across the reduced lingual surface, they are prepared parallel to the incisal edge of the tooth. - The location of the ledges : 1- The incisal ledge is prepared at one fourth of the total height of the preparation from the incisal edge. 2- The cervical ledge is placed on the crest of the cingulum at the centre of the cervical one fourth of the preparation.

- Ledges have a depth of 0.5-0.7 mm. - Ledges have definite cervical and pulpal walls, the meeting between then should be 90r. - The pulpal walls of the ledges should be parallel to each other, to the path of insertion and to the incisal two thirds of the labial surface.

Function: 1- Resist cervical displacement of restoration. 2- Provide bulk of metal to prevent distortion 3- Create flat surface for pinhole placement.
-

5- Indentations:
- Three indentations are made: two incisally and one cervically - The indentations are 0.5 mm in depth

Functions: 1- Provide enough bulk and thickness of metal in the junction between the pins and ledges prevent fracture of pins. 2- Create additional space for pinholes placement

5- Pinhole preparation:
-

Three pinholes are prepared, 2 incisally and one cervically at the center of the indentations The three pinholes should be parallel to each other, to the path of insertion and to the incisal two thirds of the labial surface.

Modification of pinledge:
1. Additional pin: An extra pinhole can be added cervically to maximize the retention of the pinledge. 2. Proximal groove modification: Grooves are placed in the reduced proximal surface.

It is indicated as a bridge retainer in cases of: yTeeth with small proximal carious lesion. yTo increase rigidity at connector area.

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CHD 2005