castrestorations

1. CAVITYPREPARATION
OF CAST METAL
RESTORATIONS
Dr.Basavan Gowda
Reader
Dept.Conservative Dentistry&Endodontics
Navodaya Dental College ,Raichur

2. Introduction
• The cast metal restorations are versatile and procedure requires
meticulous care in preparation and laboratory procedures.
• Dr. Phil Brook in 1897, was the first to introduce Inlay in
dentistry who gave the concept of forming an investment
around a wax pattern, eliminating the wax and filling the
created mold with a gold alloy.
• In 1907 Taggart changed the practice of restorative dentistryby
introducing his technique of cast gold dental restorations.
• It was most certainly Taggart who recognised the significance of
cast gold restorations.

3. Definitions
Inlay
- It is primarily intracoronal cast
restoration that is fabricated outside
the oral cavity and placed in
prepared cavity.
Onlay
- An onlay is combination of
intracoronal and extracoronal
restoration when one or more cusps
are covered.

4. Materials For CastRestoration
• Until recently gold based alloys were the only choice for cast
dental restorations. The ADA specification #25 still requires
75% of gold – plus – platinum group metals to be present in the
alloys for cast restoration.
• According to sturdevant,
Traditional high gold alloys Low
gold alloys
Platinum-silver alloys
Base metal alloys

5. According toMarzouk,
• Class 1 – gold and platinum based alloys
• Class 2 – low gold alloys. Gold < 50%
• Class 3 – non – gold platinum based alloys
• Class 4 – nickel – chromium based alloys
• Class 5 – castable , moldable ceramics

6. Requirements of dental castingalloy
• Biocompatability
• Coefficient of thermal expansion
• Melting range
• Tarnish and corrosion resistance
• Modulus of elasticity
• Castability
• Finishing and polishing
• Esthetics and cost factor

7. Gold alloys – class1
• According to ADA#25,
• - type 1 (83% Au, 10% Ag, 6% Cu) – soft gold alloys – for
restorations subjecting to slight stress like inlay
• - type 2 (77% Au, 14% Ag, 7% Cu) – medium hard alloys – for
restorations with moderate stress like onlay.
• - type 3 (75% Au, 11% Ag, 9% Cu) – hard alloys – high stress
situations like onlay, short span FPD, veneer crowns.
• - type 4 (69% Au, 25% Ag, 10% Cu) – extra hard alloys – high
stress situations like long span FPD, crowns, endodontic post and
core.

8. Low gold alloys – class 2
• Economy gold alloys
• Gold content lower than class 1 alloys
• Palladium replaces gold.
• Palladium is responsible for imparting the desirable physical
properties, strength, hardness ant the plasticity of the mass.

9. Non – gold platinum based alloys – class 3
• Composed mainly of palladium and silver.
• They are either palladium – silver alloys or silver – palladium
alloys.
• Palladium is most influential in dictating the properties.
• Also has indium, copper, tin, zinc constituting not more than
10%.
• Indium acts as a scavenger while melting, and increases
resistance to tarnish and corrosion.

10. Nickel – chromium based alloys – class 4
• These metals are referred to as non-noble or non-precious alloys
because of their low cost.
• The chromium content in these alloys should not exceed 30%.
• The chromium imparts the passivating effect on base metals
making them corrosion resistant.
• Beryllium and molybdenum have been added to improve upon
properties of the base metals.
• Beryllium – control castability and oxidation
• Molybdenum – decreases co-efficient of thermal expansion.

11. Castable moldable ceramics –class 5
• Composed of aluminium tri oxide( at least 50%) and
magnesium oxide ( at least 15%)
• Ratio of Al2O3 : MgO is 7:1
• To this 0.5% of stearate or wax is added to improve the
moldability.
• When heated above the glass transition temperature ( 30-150°)
the mass becomes moldable and deformable.

12. Physical and mechanicalproperties
Typeof
cast
metal
Density
gm/cm²
Melting
range °F
Tensile
strength
PSI
Yield
strength
0.2%
PSI
Elongati
on
M.E.
PSI
Hardnes
s VHN
Tarnish
and
corrosio
n rate
Class 1 15 – 16 1800-
2000
80,000 40,000 20-25% 10-12
million
150-170 Almost
0%
Class 2 11 – 12 2200 100,000 47,000 20% 12
million
200 2-3%
Class 3 10-11 2250 140,000 65,000 15 –
18%
15
million
250 5 – 10%
Class 4 8 3500 160,000 80,000 3-11 % 30
million
315 0%
Class 5 2.7 3300 19,000 - 0% 60
million
350 0%

13. Indications
• Large restorations
• Endodontically treated teeth
• Teeth at risk of fracture
• Dental rehabilitation with cast metal alloy
• Diastema closure and occlusal plane correction.
• Prosthodontic abutment.
• Correction of occlusion.
• Wide open contacts.
• Sub – gingival lesion.

14. Contraindications
• Physiologically young dentition with large pulp chamber.
• Developing and deciduous tooth.
• High plaque / caries index
• Dissimilar metals.
• Esthetics.
• Small restoration.

15. Advantage
• Strength
• Biocompatability
• Low wear
• Control of contour and contacts.

16. Dis-advantage
• Extensive tooth preparation
• Cemented restoration, discrepancy and microleakage
• Abarassive and splitting force on natural tooth
• Galvanic currents.
• Number of appointments and chair side time.
• Cost and temporary restoration requirement.
• Technique sensitive.

17. Factors affecting the design of the cavity
• Length of clinical crown.
• Anatomic contours of the occlusal, proximal, buccal and lingual
surface.
• The position of tooth in arch.
• The occlusal and proximal relations.
• Unusual esthetic conditions, if any.
• The condition of soft tissues around the tooth.
• The extend and location of carious lesion.

18. Principles of cavity preparationfor cast
restorations
• Cast alloys can be used to restore intra-coronal or extra-coronal
restorations.
• Most single tooth restorations are a combination of these intra
and extra coronal restorations.
• Intracoronal restorations are mortise shaped, having definite
walls and floors joined by line angles and point angles.
• General principles of tooth preparation can be applied to
intracoronal preparation with slight modifications for the
effectiveness of the preparation.

19. Outline form
External outline form
• External outline form should consist of straight lines and
smooth following curves, avoiding any short angles.
• Cavosurface margin placed is placed on sound, unbroken tooth
tissue to obtain a well fitting casting.
• Placement of bevels make the outline form slightly wider.

20. Internal outline form:
• The pulpal floor and the axial wall of the inlay preparation
should be placed in the dentin and care should be taken to
protect the pulp.
• Line angles in both occlusal and proximal portions of the
preparations should be well defined and the axio-pulpal line
angle slightly rounded.
• It is sometimes desirable to incline the cutting instrument so that
it forms either an exaggerated taper from the cavosurface to
pulpal floor or a long bevel on that area.

21. Outline form
• Depth of the cavity is 1.75 to 2
mm from the central groove.
• Long axis of 271 bur is held
parallel to long axis of tooth
crown at all times.
• For mandibular molars and
premolars the bur is tilted 5-10°
lingually to conserve the
strength of lingual cusp.
• After occlusal outline
preparation, the cavity is
extended proximally as in
Black’s class 2 preparation.

22. Outline form
• Proximal ditch cut is made.
• 0.3 mm of enamel and 0.5 mm of dentin is cut since the width
of the bur is 0.8 mm.
• Gingival seat is kept just below the contact area.
• In ideal box , the buccal and lingual walls should be
perpendicular to proximal surface clearing adjacent tooth by
0.5mm.
• Depth is 0.2 – 0.5 mm in the dentin.

23. Outline form
• Ragged enamel edges at the gingival and proximal areas may be
removed using hand instrument such as chisel or flame shame
shaped diamond point.
• However it is better to postpone the finishing till the remaining
caries and/or old restorative material is completely removed and
the base is applied.
• Width of the cavity – 1/3rd of the cuspal inclines is included on
both sides of the central groove.
• In madibular premolar, 2/3rd of occlusal width is placed on the
buccal inclined plane and 1/3rd from lingual inclineplane.

24. Mandibular premolarpreparation

25. Preparationpath
• Single insertion path
• Opposite to occlusal loading force.
• Parallel to long axis of the tooth.
• Helps in retention and decrease its micromovements during
function.
• The occlusal force should seat the restoration rather than
displace it.

26. Resistance And RetentionForm
• Parallel opposing walls aids in retention.
• Flat pulpal and cervical floors – resistance form.
• Well defined angles help in maintaining precise relationship
between restoration and tooth tissue improving retention and
resistance.
• Divergent walls – 2-6° taper increased in case of deeper cavity
but not exceeding 10°.

27. Factors affecting proximalmargins
• The extend of tooth tissue loss
• The location of that loss.
• Configuration of tooth i.e curvatures and embarasures.
• The relationship with adjacent teeth.
• The need for extra retentive devices.

28. Pulpal floor
• The pulpal floor should be flat.
• It should be 1 – 1.5 mm from DEJ.
• The pulpal floor should meet all the surrounding walls at
definite line angles except for the axiopulpal line angle where it
should be rounded.

29. Features for resistance andretention
• Axiopulpal line angle rounded to dissipate stress equally.
• Occlusal dovetail or interlock prevents proximal displacement
of restoration.
• If no proper parallelism or no proper depth of cavity is there
then secondary retentive devices like slots and pinholes can be
given.
• Shallow retentive grooves , 0.3mm deep, maybe given on
buccoaxial and linguoaxial line angles. – indicated when
preparation is shallow.

30. Preparation Of RetentiveGroove

31. BevellingAxio-pulpal LineAngleAnd
Mesial MarginalRidge

32. PreparationFeaturesForCircumferentialTie
• The weakest link in any cast restoration is the teeth/cement/cast
joint.
• The peripheral marginal anatomy is called circumferential tie.
• Bevel – plane of the cavity wall or floor directed away from
the cavity preparation.
• Bevel helps in
• - lap sliding fit at the gingival margin
• - results in 30° metal that is burnishable.
• - Weak enamel is removed.
• Bevels should include surface defects and supplementary
grooves.

33. Types of Bevels
1. Partial bevel – not more than 2/3rd of
enamel. Enameloplasty.
2. Short bevel – entire enamel without dentin.
For gold alloys.
3. Long bevel – entire enamel and one half of
dentinal wall. Intracoronal cast restorations.
4. Full bevel – whole of enamel and dentin.
Not used due to lack of retention.
5. Reverse bevel – for cusp capping. Usually
on facial and lingual surface of cusp.
6. Hollow ground bevel – in the form of
concavity. For materials with low
castability. Not used.

34. Preparation of bevels andflares
• The slender flame shaped fine-grit diamond is used to bevel the
occlusal and gingival margins and to apply the secondary flare
on the facial and lingual walls.
• This result in 30-40° marginal metal and 140-150° cavosurface
margin.

35. TypesAnd Features Of FacialAnd Lingual
Flares
• Flares are present on the proximal box of intra-coronal cast
preparations.
Two types of flares:
1. Primary flare – similar to long bevel formed on the facial
and lingual wall of proximal box. It has angulation of 45° to
the inner dentinal wall proper.
Funtions : makes the proximal portion of the restoration self
cleansable.
1. Secondary flare – it is a flat plane superimposed peripherally
to a primary flare. Indicated in lesions with wide contact areas
and wide bucco-lingual extensions.

36. Primary And SecondaryFlare

37. DifferencebetweenAmalgamand Cast
restoration

38. Modifications of proximal boxpreparation
• Box preparation
• Slice preparation
• Auxiliary slice preparation
• Modified flare

39. Box preparation
Introduced by Dr.G.V.Black
Proximal cavities are box shaped.
Advantages are
• Resistence and retention form
• The outline form can be made on all types of teeth.
• Minimum display of metal.
Disadvantages are
• Involves removal of lot of tooth structure.
• Time consuming clinically.
• Narrow bevels leave a sharp edge and an undercut gingivally, which cannot
be reproduced satisfactorily.
• While taking impressions, distortions and breaking of wax patternoccurs

40. Box preparation

41. Slice preparations
• This form of cavity is modified so that the proximal surface is
flat without definite side walls.
• Retention mainly depends upon occlusal key, locks cut in the
axial wall.
Indications
• As abutment in bridge work.
• Teeth with proximal undercuts can be eliminated which
facilitates taking impression.
• For indirect wax pattern technique.

42. Slice preparations
Advantages :
• Less tooth structure is sacrificed.
• Quicker and easier.
• Well protected enamel margins.
• Increase resistence and retention by exposing larger amount of
tooth structure.
Disadvantages :
• It displays more amount of gold. (Thoma 1951)
• Direct wax pattern cannot be made as distinguishing between
margins become difficult.
• Metal margins are likely to distort due to less thickness.

43. Slice preparations
It involves conservative disking of
proximal surface to establish buccal
and lingual extend of finish lines and
provide a lap joint.

44. Auxiliary slicepreparations
• Wraps partially around the proximal line angles, thus providing
additional support.
• Resistance form is enhanced
• Provide external retention form.

45. Modified flarepreparation
• Modified flare is a combination of box preparation and slice
preparation.
• Minimum disking of proximal walls is done for better finishing
and polishing.

46. Secondary modes ofretention
Luting cement
• Fills gaps between the inlay and the tooth giving a physio
chemical bonding.
• Physical – zinc phosphate
• Chemical – glass ionomer cement
• The exposed cement dissolves in oral cavity . So it should not
be considered as a retentive factor

47. grooves
• The grooves are placed in the bucco-axial and linguo-axial line
angles with 169L bur.
• It is placed at the expense of buccal and lingual walls and never
at the expense of axial wall.
• Its depth is 0.3mm.

48. Reverse bevel
• It is given on the gingival seat.This
bevel has three planes.
• First – reverse bevel plane where
the inclination is on the
gingivoaxial plane which prevents
proximal displacement of the
restoration.
• Second – flat plane made of dentin.
• Third – plane that is sloping away
from the axial wall made up of
enamel and dentin. This helps in
preventing proximal displacement

49. Internalbox
• It is made on the pulpal floor,
which improves retention by 4-5
times.
• It should have sharp line and point
angles and definite walls.
• This prevents micro movements of
the inlay.
• Internal box should always be
reciprocated with reverse bevel or
groove .

50. Roughening of the pulpalfloor
• Pulpal floor is made more
retentive by irregularities and
lateral locking.
• The irregularities should not
have undermined enamel.

51. Precementation grooves.
• After casting, making grooves on the walls of inlay and/or on
the cavity wall exactly opposite .
• This will house a solid mass of the cement and help in good
retention.
Electrolytic etching of inlay.
• This gives hinge like projections
• Procedure – the proximal and occlusal surface is protected with
wax and kept in electrolyte solution of 0.5 normal nitric acid.
• Inlay is kept in anode and metal with greater EMF in cathode
• Current causes microporosities in inlay surface that enables the
luting cement to flow into it for better retention
• This takes 10-15 min

52. Tooth preparations for onlaycast
restorations
It is partly intracoronal restoration and partly extracoronal
restoration, which has cuspal protection as main feature.
Indications
• Cuspal protection is considered when the lesion width is 1/3rd to ½ the
intercuspal width.
• Cuspal protection is mandated when the length:width ratio is more than
2:1 .
• When there is a need to change the dimention, shape and inter relationship
of the occluding surfaces, onlay cavity is considered as it is more
conservative.
• Ideal for abutment teeth for RPD or FPD.
• When inclusion of wear facets that exceed the cusp tips and triangular
ridges are necessary, onlay is considered.

53. General shape
• Onalys are dovetailed internally and follow the cuspal anatomy
externally.
• Proximal box are cone shaped.
• The main feature of the design is capping of functional cusp and
shoeing of non functional cusps.

54. Tooth preparation foronlay
Occlusal preparation
• The initial entry is made in the
central fossa to a depth of 1mm
into dentin( 2.5mm in total
depth).
• The occlusal outline form must
be as conservative as possible.
• The bur is kept in long axis of
the tooth so that a taper of 3-5
deg divergence is provided to
the internal walls.

55. Proximal preparation
• The boxes are created on the
proximal surface.
• The facial and lingual walls should
exhibit a combined divergence of 6
to 10 deg from each other as was
provided in the occlussal area of
the preparation

56. • The facio-lingual dimension is
likely to be determined by the
presence of restoration, caries
lesion.
• The bevels will extend the
preparation slightly beyond the
proximal contact area so that the
margins of the restoration will be
accesible for finishing with a disk.

57. Cuspal reduction
• A carbide bur or a diamond bur is used to reduce the cusps.
• Depth cuts of 1.5-2mm are made for the centric cusps and 1mm
for non centric cusps.
• After depth cuts are made, a uniform reduction of cusp that
parallels the anatomic contours of the occlusal surface is made.

58. Shoulderpreparation
• A shoulder is prepared on the external surface of thecentric
cusp to provide a band of metal to protect the tooth.
• The bur is held parallel to the external surface of the tooth and
a shoulder about 1mm in height and 1mm axial depth is cut.
• The finish line should extend at least 1mm beyond occlusal
contact.
• The occluso-axial line angles are rounded.
• Adequate clearance of 1-1.5mm in all eccentric mandibular
positions.

59. Non – centriccusp
• A chamfer or long bevel is given on non-centriccusp.
• A barrel shaped bur can be used to createchamfer.
• The bur is positioned at 45 deg to the axial surface.
• This provides additional cusp protection.

60. Gingivalbevel
• A smooth distinct bevel on the gingival margin isestablished
with no:7901 bur or GMT.
• The bevel should be 0.5mm width and at 45 deg to the external
root surface.

61. Shoulder bevel:
• A 1mm bevel is placed on the shoulder with no:7901 bur.
• This bevel is blend with the proximal bevels.
• Any sharp angles at the junction of various bevels and across
the occluso-axial line angles are eliminated.
Proximal bevels:
• The proximal bevel or flare is established with a fine tapered
diamond.
• Divergence established from gingival floor occlusally.
• The proximal bevel should blend smoothly with the gingival
beval, lingual and buccal bevels.

62. Retentiongrooves
• Retention grooves are placed in the proximal boxes.
• The grooves should be present bisecting the facio-axial line
angle and the linguo-axial line angle.
• The grooves should diverge occlusally.