EPA 4C: Dentate Indirect Crown

Isolation and Tissue Management

• No iatrogenic damage to adjacent tooth or soft tissue
• Complete visualization of margin

• Slight damage to adjacent tooth that can be polished
• Minimal tissue damage consistent with equi/subgingival preparations

• Minor damage to adjacent tooth, requiring enamel recontouring
• Soft tissue damage inconsistent with preparation that can be managed by a gingival recontour

• Significant damage to adjacent tooth, requiring a restoration
• Significant soft tissue damage requiring specialized care (e.g. sutures)

PREPARATION

External Outline

Margin:

• Located on sound tooth structure and supra gingival (0-0.5 mm)
• Regular in form

Margin:

• Slightly irregular

Margin:

• Located on sound tooth structure and slightly supra/sub gingival (up to 1 mm)
• Decidedly irregular but recognized

Margins:

• Located on restorative material or caries
• Located supra gingival by 1.5 mm or >1 mm sub gingival
• Presence of J margin or lip of unsupported enamel
• Ill-defined/ not recognized

Internal Outline

• Preparation extends into tooth as necessary for the chosen restorative material.
• Margin width is ideal for the chosen restorative material.

• Preparation is slightly over/under-reduced <0.5 mm (Occlusal, Axial Walls, Cusp Bevel)
• Margin width is adequate.

• Preparation has significant over/under reduction by 0.5-0.8mm (Occlusal, Axial Walls, Cusp Bevel)
• Margin width deviates >0.5mm from ideal

• Preparation has gross over/under-reduction > 0.8mm (Occlusal, Axial Walls, Cusp Bevel)
• Margin width is under reduced (<0.3: gold, 0.5: zirconia, <1mm: ceramics/PFM) or over reduced > 1.5mm
• Presence of unaddressed caries or missing direct restorations

Taper

• Taper ideal (5-10° TOC)

• Taper slightly excessive (10-15° TOC)
• Minor undercuts that maintain ideal margin width

• Taper inadequate (2-5°) or decidedly excessive (15-25° TOC)
• Blockable undercuts that maintain minimum margin width

• No taper or grossly excessive taper (>25° TOC)
• Gross undercuts (margin less than minimum width after blockout)

Preparation Finish and shade selection

• Surface and margin uniformly smooth
• Rounded line/point angles
• Appropriate shade record

• Surface and margin lightly rough, pitted, or lacking finish

• Surface and margin decidedly rough or pitted

• Surface and margin deeply pitted or grooved
• Sharp line/point angles
• Missing shade record

Gingival Retraction and Impression

• Adequate isolation with complete visualization of margin
• Finish line accurately captured circumferentially
• Appropriate impression materials and tray selection
• Both arches and inter-occlusal record accurately captured without voids/distortion/ burn through

• Minor void present along internal outline of prep that will not affect crown fit
• Final impression/ opposing arch impression shows minor voids/ distortion/ burn through in non-critical areas

• Final impression/ opposing arch impression shows major voids/ distortion/ burn through in non-critical areas

• Incomplete visualization of crown margins
• Preparation surface and finish line inaccurately captured
• Voids/ distortion in critical areas
• Inappropriate impression material or tray selection
• Inadequate/ missing opposing arch impression or interocclusal record
• Retraction cords/paste left in sulcus post procedure

RESTORATION (PROVISIONAL/DEFINITIVE)

Intaglio fit and Stability

• Free of contamination/ debris/ voids
• Complete seating with stable, passive fit. Verified with a radiograph

• Stable with light premature interferences until complete seating

• Minor voids/ debris
• Stable with significant premature interferences until complete seating. Missing pre-cementation radiograph

• Gross contamination/ debris/ voids
• Incomplete seating with severe rocking/ rotation

Marginal Integrity

• Vertically closed
• Horizontally extends flush with finish line width

• Horizontal margin excess (overhang) or deficiency (over finished) in some areas

• Moderate horizontal margin excess (overhang) or deficiency (short)

• Vertical margin deficiency (open)
• Gross horizontal excess (overhang)/ deficiency (short)

Occlusal Anatomy and Contacts

• Anatomy conforms to existing tooth form
• Multiple centric contacts present with ideal intensity and location. Restored with mutually protected occlusal scheme

• Anatomy lacks definition
• Light/ heavy or insufficient centric contacts present

• Significant deviation in anatomy in some areas
• Premature occlusal contacts in centric or interferences in balancing or non-functional movements

• Anatomy absent
• Gross hyper occlusion or infra-occlusion

Surface Contour, Proximal Contacts and Finish

• Ideal anatomic contours and embrasures
• Convex proximal contacts that are visibly closed, appropriately located with the right intensity
• Highly polished surface

• Slightly over/ under contoured surface
• Proximal contacts are visibly closed but lack intensity or show slight variation in location
• Surface slightly rough in finish

• Decidedly over/ under-contoured surface or presence of soft tissue impingement
• Concave, irregular or tight proximal contacts
• Surface decidedly rough or pitted

• Grossly over- or under-contoured
• Proximal contact visually open
• Surface deeply pitted or grooved
• Fractured provisional

Cementation

• Appropriate cementation protocol used under adequate isolation as indicated
• Absence of residual cement. Post cementation radiograph recorded

• Minor debris of residual cement
• Absence of post cementation radiograph

• Inappropriate cementation protocol used or inadequate isolation maintained
• Gross presence of residual cement