PubMed · 10803159
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D Garber. 1999. Problem solving in restorative dentistry.. https://pubmed.ncbi.nlm.nih.gov/10803159/
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In my opinion, there is an obvious trend in the dental literature and in continuing education courses to promote overcutting teeth when preparing them for restorations. There are many reasons for overcutting. Some feel that there is a more optimum esthetic potential when the teeth are prepared more deeply, which is a debatable view. Others are using all-ceramic crowns or polymer crowns when other types of less radical crowns could be used. There also is a significant tendency to prepare teeth for crowns instead of for onlays or inlays, thereby removing more tooth structure than is necessary. High-speed dental air rotor or electric handpieces can cause inadvertent removal of more tooth structure than is necessary. Using large burs can overcut tooth structure, and teeth should be reversed.
OBJECTIVE: To investigate variations in tooth preparations for resin-bonded all-ceramic crowns (RBCs) in general dental practice (GDP). DESIGN: Laboratory-based retrospective analysis of dies for RBCs. SETTING: General dental practices in the UK and Ireland (2000). METHODS: A sample (n = 132) of laboratory models containing 180 tooth preparations for RBCs, featuring work from different general dental practitioners was obtained from four commercial dental laboratories. Aspects of the preparations were quantified and compared with accepted criteria defined following a review of the literature. RESULTS: The teeth found to be most frequently prepared for RBCs were maxillary incisors (41%). Margin positions were variably positioned with 29% of the preparations on the buccal aspect having subgingival margins. There were many tooth preparation dies for low fusing RBCs (47%) and Chameleon Fortress RBCs (62%) demonstrating overpreparation in the mesiodistal plane. The majority of the margins (84% buccally and 79% lingually) of the dies examined exhibited appropriate shoulder or chamfer finishes. Of the Chameleon Fortress preparations analysed, 86% had been underprepared occlusally. 42% of the teeth had been prepared with no regard to tooth morphology and demonstrated just one plane of reduction. The majority (93%) of the clinicians failed to provide any information regarding the shade of the prepared tooth stump. CONCLUSIONS: On the evidence of this survey of this sample of general dental practitioners' work, it was found that relevant guidelines for the preparations of RBCs are not being fully adhered to.