explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you. ask me for the books details.

1. PRINCIPLES FOR
RESTORATION OF BADLY
BROKEN DOWN TEETH

2. CONTENTS
• Introduction
• Principles for Posterior teeth
• Principles for Anterior teeth
• Conclusion
• References

3. INTRODUCTION
• Guiding the operator
• Disease exceeds restorative capacity
• Restore a tooth permanently
• Success of procedure

4. POSTERIOR TEETH
• Basic steps should be taken:
– Evaluation of remaining tooth structure
– Mechanical evaluation of lost tooth structure preparatory to
designing the resistance- retention features of the tooth
preparations
– Planning the restorative design

5. EVALUATION OF REMAINING TOOTH STRUCTURE
i. Recollection of stress pattern and correlation
ii. Diagnosis and recognition of the vital capability
iii. Cariogenic evaluation
iv. 3D evaluation
v. Possibilities, locations, and dimensions of resisting flat planes
vi. Crazing
vii. Surface deformities
viii. Proximal drifting
ix. Gingival margin location relative to periodontium
x. Teeth whose periodontium has been affected and treated

6. • Recollection of stress pattern and correlation
1. Location of the tooth
2. Remaining tooth
structure- stress areas
3. Cuspal elements
4. weak areas

7. Possibilities, locations, and dimensions of resisting flat planes
 Pulpal floor
 Gingival floor
 Tables
 Ledges and shelves

8. • CRAZING:
– May continue to periphery
– Precursor for partial or complete fracture
 Older people
 Previously restored
 RCT
 Trauma

9. Involve them Numerous cracks – treatment
Less than 5-6 – investigate their extent
Suspected
Confirmed
Cracked tooth syndrome

10. Proximal drifting
A loss in mesio-distal dimension of the dental arch to an
extent that the arch will no longer accommodate broken
down tooth restored to its natural dimensions
2 treatment options
Restore the tooth
To
a reduced dimension
bicuspid out of a tricuspid
Regain the lost space
• Distance the tooth must travel
• No. of teeth & roots to be moved
• Amount of interceptal bone b/w teeth
Upto 2mm – wedges, over contoured temporary restorations and wires.
>2mm – orthodontic tooth movement

11. Teeth whose periodontium has been affected and treated

12. Teeth whose periodontium has been affected and treated

13. MECHANICAL EVALUATION OF LOST TOOTH STRUCTURE PREPARATORY TO DESIGNING
THE RESISTANCE- RETENTION FEATURES OF THE TOOTH PREPARATIONS
 Dimensions and nature of the destruction
 Partial or complete loss of cusp
 Partial or complete loss of marginal or crossing ridge
 Partial or complete loss of axial angles
 Cavity preparation depth, pulpally, axially and gingivally
 Junction between the clinical crown and the root
 Occlusal abnormalities
 Possibility that the tooth will be used as an abutment
 Determining whether or not the tooth will be splinted to another tooth
 Relative length of restored clinical crown to the clinical root
 Unusual strength and power in the bite of the patient
 Tilting of the destructed tooth

14. DIMENSIONS AND NATURE OF THE
DESTRUCTION
Occluso-apical destruction
more retention problems
Bucco-lingual
Mesio-distal
Both resistance and retention
Restorative design features:
– Bulk slanting walls
– Flat floors
– Fulcrum features
PARTIAL OR COMPLETE LOSS OF CUSP
 Functional/ non functional
 Type of plane
 Width of destruction
 Bucco-lingual partial loss of cusp- resistance & retention
 Mesio-distal partial loss of cusp- resistance
 Occluso-apical partial loss of cusp- retention
 Length of remaining part
 Restoration with 2 or more surfaces
 Complete loss of cusp

15. • Management of partial or complete loss of ridges
• Depth more than 2mm – resistance & retention problems
• No contact- 0.5mm thicknes
• In contact- 1.5-2mm
• Oblique/transverse ridge- do not cross unless 0.2mm

16. • Tilting of the destructed tooth
 Eruption pattern
 Non bodily drifting
TILTING
IDEAL ORTHODONTIC
REMOVABLE
HAWLEY
FIXED
SOLIDIFYING TYING
SEGMENT
IF NOT RESTORATION
Design
Cuspal elements
cutting

17. PLANNING THE RESTORATIVE DESIGN
 Management of total or partial cuspal loss
 Management of total or partial loss of axial angles
 Management of partial or complete loss of ridges
 Management of partial or complete loss of crown root junction
 Management of enamel crazing
 Tilted teeth
 Cross linkage using cemented pins or posts
 Retention features
 Resistance features
 Restorative design features for endodontically treated teeth
 Restorative design features for badly broken down periodotally treated teeth
 Splinting
 Foundations versus restorations

18. Restorative design features for endodontically treated teeth
RCT
INTACT RIDGE
AMALGAM
ONE OR MORE
RIDGE
AMALGAM
CAST
RESTORATIONS
1/5 OF LOST
TOOTH PRESENT
POSTS
PINS
BADLY BROKEN
SUBSTRUCTURE
SUPERSTRUCTURE
FERRULE:
 RESISTANCE FEATURE
 2MM APICAL TOOTH

19. SPLINTS
Provisional Permanent
Removable Fixed
Splinting wire
Hawley appliance Intracoronal Extracoronal
 Amalgam
 wire
 resin
 pin retained
 Stainless steel bars
 Meshes
 Orthodontic bands
 Brackets
Intracoronal
Extracoronal
Full/partial crowns
Inlays/onlays

20. ANTERIOR TEETH
• Evaluation of P-D organ
• Clear surrounding walls
• Remaining tooth structure
• Esthetic concerns – Discolorations, open mouth smile & reshaping
• Phonetic considerations- F, V & S

21. PLANNING THE RESTORATIVE DESIGN
a. Building the tooth up with a foundation form to be covered with a reinforcing / protecting restoration
b. Reinforcing / protecting restoration without a foundation or build-up
c. Restoration with direct tooth colored material

22. CONCLUSION
• In order to restore a tooth permanently when
confronted with extensive tooth destruction,
the systemized, disciplined approach is
essential to the success of the procedure

23. REFERENCES
• Operative dentistry-Modern theory and practice M. A. MARZOUK
• OPERATIVE DENTISTRY- BAUM ET AL, 1981
• PRINCIPLES AND PRACTICE OF OPERATIVE DENTISTRY. CHARBENEAR ET AL
• INGBER, J. S: J. PERIODONT.
• Andreasen FM, Andreasen JO, Cvek M. Root Fractures. In: Textbook And Color Atlas Of Traumatic Injuries To Teeth
• Shillingberg-fundementals of tooth preparation
• Sturvdents operative dentistry 7th edition
• Pathways Of Pulp Cohen Tenth Edition

24. THANK YOU