Review article Annals and Essences of Dentistry

doi:10.5368/aedj.2011.3.1.4.7

DESIGINING CROWN CONTOUR IN FIXED PROSTHODONTICS:

A NEGLECTED ARENA.
1 1
Reader, Dept. of Prosthodontics
Yashpal Singh
2 2
Reader, Dept. of Prosthodontics
Monika Saini
1,2
Subharti Dental College, NH – 58, Subhartipuram, Meerut - 250 002. India.

ABSTRACT

Clinical longevity of any prosthesis is directly related in achieving proper coronal contours. This involves close
attention to detail between periodontal and prosthodontic principles during the fabrication of the prosthesis. If not done
properly, iatrogenic problems may occur such as "food traps" from open contacts, overhangs, or plunging cusps. This
leads to plaque accumulation, inflammation, bleeding, potential bone loss (periodontitis) thus leading to severe
periodontal problems. If certain principles of placement of gingival margins and interproximal embrasures are not
closely adhered to, an overcontoured restoration may act as a nidus in the rapid failure of the prosthesis.

KEY WORDS : coronal contours, periodontits, gingival margins, interproximal embrasures

INTRODUCTION

Periodontal breakdown is generally Accessibility and oral hygiene measurements were

associated with long standing fixed partial given prime importance.
prosthesis. After 2-3 years of service; patients
1
usually start complaining of one or the other Herlands et al questioned the rationale of the
periodontal problem. At times, patients start food deflecting contour concept. He noted that:
complaining of food trap just after cementing the
crown.  Mechanism for impaction requires certain
criterion to be met. Substances which are
These common clinical problems are impacted must be fairly firm and a propelling
related to improper axial, facial or lingual contour of force directing it towards an easily accessible
crown. Contour of artificial crown are not generally area or cul-de-sac must be present.
made self protective. Overcontouring leads to food
 Natural crown contour is 0.5 mm from the most
trap and hence complicating the periodontal status.
convex area which is inadequate for protection
Interdental papilla is often neglected due to
against food impaction.
improper design of interdental space. These
 When prepared tooth is left uncovered for an
shortcomings can be fulfilled by following the
extended period of time, complete lack of
general principles of crown designing.
contour is usually seen but the surrounding
gingiva is usually healthy.
Theories of Axial Contour Design:
 Gingival sulci are not an easily accessible cul-
Food Deflection Theory de-sac.
 Foreign matter from the gingival sulcus, is
1 flushed by outward current of serum. Heavier
Wheeler proposed this theory in 1961. He
advocated that artificial crowns should have muscular action and firmer food particles
convexities in their cervical third which will help in increase its flow.
deflecting food away from the free gingiva. Morris  Contours in embrasure areas are possibly
noted that the lingual or buccal tooth surface even more important than buccal or lingual
prominence guided the position of gingival margins. contours.

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Review article Annals and Essences of Dentistry
Shortcomings of this theory are  Inflammation and hyperplastic changes were
observed in the marginal gingiva by
 The dietary habits of modern times offer very overcontoured axial surface.
little chance which could injure the free gingival
margin. Plaque Retention Theory
 During mastication, proprioceptive response 1
According to this theory :
generally provides sufficient protection for the
free gingiva.  Crown contours should be such that it should
not provide any niche for plaque retention and
 Impact of food as the crushed bolus as it
should promote self-cleaning.
passes through axial contour of the tooth is
 Design of axial contour should be based on
dissipated since it is directed by the cheeks, lips
muscle-action theory.
and tongue during deglutition.
 Teeth generally have little clinical bulge and
Anatomic Theory
causes no harmful effect on mastication.
 The contours of teeth in lower species of It was proposed by Kraus et al. in 1969.
animals does not provide this theoretic According to this theory:
protection, as any buccal or lingual bulges are
usually subgingival.  The contour which duplicates natural anatomy
(anatomic/biologic) and is self protecting is
preferred.
 Height of contour is located at the gingival third
of each tooth and are approximately 0.5 mm
wider than the adjoining cemento-enamel
junction (CEJ). (Except lingual of mandibular
molars and second premolars, where height of
contour lies in the middle 1/3).

Physiologic design criteria for fixed dental

restorations.
Fig.1 Well placed gingival margin
Eissmann HF, Radke RA, Noble WH proposed
2
following criteria :

I. Physiologic contouring:

An interrelation of form and function is an

important consideration. The occlusal form should
be such so as to generate the least amount of
stress in the supporting tissues. The axial form of
teeth should be able to protect and stimulate the
investing tissues or the marginal periodontium.
Fig.2 Poorly placed gingival margin
Periodontal Considerations:
 Evaluating periodontal status of the patient
Muscle Action Theory is the first and critical step in planning a
fixed prosthesis.
1
Herlands et al and Morris introduced this  Any existing periodontal disease should be
theory. They emphasized on muscle molding and corrected.
cleansing, rather than food impaction. The theory  Periodic recall and maintenance
upholds the principle of constant cleansing and programme should be instituted.
molding action by the muscles of the cheeks, lips
1 II. Placement of gingival margins:
and tongue. Perel studies revealed:

 No significant changes in healthy gingiva were The margin between restoration and the
seen by undercontoured axial surfaces. tooth is very critical as it becomes potential site
for shelter of bacteria. Therefore:
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 Supragingival margins should be given for supporting the gingiva.In case of supragingival
maximum cleansing action. The contour of margin convex contour should be placed.
the restoration should be such so as to Subgingival margin contour should be flat as well as
provide optimum cleansing action. (Fig.1 should be supporting the gingival. Spurow and
4
and Fig.2) Lytle maintained that for determining periodontal
 Transition from tooth to restoration should status of patient, positioning and contour of
be smoothest. interproximal embrasures are very important.
Maintaining interproximal embrasure area is also
III. Interproximal tooth contact: crucial for the health of the interdental papillae.
Stein, Kuwata and Presswood defined "Emergence
Four major function of interproximal contact Profile” as the part of the axial contour that extends
area are: from the base of the gingival sulcus past the free
 Stability of dental arch. margin of the gingiva.
 Prevention of food impaction into the
interproximal area. Developing crown contours in restorations:
 Sufficient space for interpapillae is provided 5
by proper contouring of embrasure space Certain priciples should be followed to develop
gingival to the contact area. optimal crown contour.
 Proper designing of interproximal contact
areas also play vital role in cosmetic and 1. Dimensions of the crown faciolingually is
phonetic aspects. usually kept not more than 1mm larger than
the faciolingual width at the CEJ. Mandibular
IV. Pontic contour: molars and second premolars might be
possible exceptions.
Contour of pontic should be within musculature 2. Generally convexities on the facial side are
of tongue, lips and cheek, edentulous ridge and kept in gingival third and are not bulging more
opposing occlusal surface. Pontic should provide than one-half mm beyond CEJ
comfort and support to the adjacent tissues; should 3. Convexities on the lingual side are generally
be conducive to the food flow pattern; hygienic; and kept at gingival 1/3 except mandibular molars
of cosmetic value. and sometimes mandibular second premolar,
where convexity is generally kept in the
Three most common pontic designs are: middle 1/3 of crown.
4. Generally it is the occlusal 1/3 where proximal
1. The saddle: Highly unhyeginic but may contact points are placed except maxillary
provide adequate support to the adjacent
molars where it might be placed at the level of
tissue.
the junction of occlusal and middle thirds.
2. The modified ridge-lap pontic: Provides
Proximal contact points are placed buccal to
minimal tissue contact with a good cosmetic
the central fossa line, except for maxillary
value and proper cheek support.
molars where it might be in the middle 1/3.
3. The Sanitary pontic: Most hygienic but low
5. Contour of the proximal surfaces between the
cosmetic value
marginal ridge and the CEJ is kept flat or
Success of a pontic depends on: slightly concave buccolingually as well as
occlusocervically.
1. Gingival contour and consistency. 6. Transitional line angles on axial surfaces
2. Area of tissue contact with respect to the should be straight between the proximal
most obtuse embrasures should be kept contact point and the CEJ, with the exception
small. of the lingual line angles of maxillary molars,
3. Tissue and pontic should have smooth where slight convexity might be seen.
approximation in the area of contact. 7. Height of marginal ridges should be same for
4. Glazed porcelain should be choice of material adjacent teeth. The tooth is wider facially than
for tissue contact. lingually. In occlusal view lingual embrasures
always appear larger than buccal
Other researchers also proposed following points: embrasures.
1
8. Supragingival crown margins are preferred
According to Ross "roll" around the tooth may except where high esthetic zone, existing root
be formed if subgingival contour is kept flat and not
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Review article Annals and Essences of Dentistry

Fig. 3: Clinical photograph showing unhealthy interdental contour

caries, root sensitivity or in cases where and periodontal disease is microbial

crown lengthing is desired to gain additional plaque.Incorporation of excessive crown contour
6,7
retention generally invites microbial plaque.
9. Subgingival contour should be such as to
provide optimal support to gingiva. Therefore gradual curves should be included in
8
10. Biologic width should be respected. crown contour. Wagman advocated for convex
subgingival contour facially and lingually. This also
Coronal contour and Gingival health: helps to maintain "knife-like" shape of the free
gingival margin. The extent of convexities should
Gingival health can be maintained by not be more than 1/2 of the thickness of the gingiva
following coronal contour principles: at the height of the attachment.

A. Subgingival contour C. Interproximal contour:

 Irrespective of relation of contour of clinical  The faciolingual width of the contact area is
crown to CEJ, it always begins at gingival generally in harmony with faciolingual width of
attachment. the interproximal papilla.Interdental papillae
 Gingival crevice is formed at the junction of should not be impinged by interproximal
9
contour of the tooth coronal to gingival surface.
attachment and free marginal gingiva.  Width of contact area faciolingually should not
 Subgingival contour should support the be wider than the papilla, as it might create an
gingiva, so that the free marginal gingiva overhang which will in turn cause plaque
does not tend to form a roll around the accumulations.
tooth. A ledge might also be formed upon  Spaces between interproximal areas which
which the plaque accumulates. are created due to gingival recession should
 Contour of the crown should not be bulky as be closed toward the papilla without impinging
it might tear circumferential fibres and them.
undue stress might be exerted on gingiva  Faciolingual width of contact area and
beyond their physiologic limits of tolerance. interproximal spaces should be narrow at the
occlusal surface and at the papillae in the
B. Facial and lingual contours: middle third of the clinical crown on viewing
from apical direction.
Sharp angles or abrupt convexities or  There should be flaring in teeth surfaces from
concavities should be avoided to maintain tone of the gingiva to the occlusal surface and also
musculature of lips,cheek and tongue. Yuodelis et from the inside outward. Gingival end of the
1
al. questioned the food deflection theory . They interproximal connector should be kept
maintained primary etiological factor for both caries narrow faciolingually during splinting so that
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Review article Annals and Essences of Dentistry
probing from the facial and the lingual area is not kept too close to gingiva so as to avoid
surfaces is permissible and this in turn will impingement and poor cleansing. Food impaction
allow cleansing of the undersurface. might occur if contact area is kept too high
occlusally creating space above gingiva (Fig. 3).
General Principles
Material of choice in designing embrasure
Periodontal health and clinical crown contour area is metal, to allow more precise contouring and
are interrelated. embrasure area should satisfy all of the aesthetic,
If unavoidable, undercontouring is always functional, biologic, and maintenance
13
preferred over overcontouring. requirements. If teeth are not prepared adequately
interproximally then there will be inadequate room
Gradual and smooth curvatures should be
for restorative material and thus tissue space will be
included in crown contour so as to facilitate
the rubbing and cleaning function of the lips, encroached. Mesial and distal line angles need
cheeks, and tongue. more reduction with chamfer bevels especially in
case of closely approximated tooth. Due to this the
Contour of interproximal area should be self
amount of keratinized tissue in embrasure area is
cleansing and patient should be able to clean
increased helping in better plaque control.
them comfortably.
Orthodontic separation of crowded teeth or
Height of subgingival contour faciolingually
extraction may be required in some cases. Gingival
should not be more than ½ of the thickness of
health maintenance should be of prime importance
the gingiva. This protects the gingival crevice
in designing prosthesis. Harmonious balance
and also helps in maintaining knifelike free
between tissue health, cleaning accessibility
gingival margin, with plaque control.
esthetics, phonetics, restoration strength should be
14
maintained . Buccal-lingual width of the col is
Management of Interdental Space:
reduced and embrasure areas are opened up with
the help of concavity extending from interdental
Epithelium, connective tissue and osseous
10 area to the cusp tip following the line angle.
floor constitute the interdental space. The col
Buccal dimension is kept narrower than the rest of
area, non-keratinized tissue found below the contact
the dimensions. All the above features should also
area of two teeth, is low and broad in the posterior
be included in the pontic design.
region and high and narrow anteriorly. According to
Ten Cate underlying connective tissue has a
Function, esthetics as well as the health of the
influence on the epithelium. There is state of low
interdental area is maintained by careful planning
grade inflammation in non-keratinized cells and they
the restoration design. (Fig. 4) .
are loosely adhered making them more permeable
to bacterial toxins. Contact of epithelium and
adjacent teeth should be reduced to minimum and
periodontal pocket should be reduced to minimize
area of nonkeratinising tissues. Plaque retaining
properties of different crown systems were
compared and it was concluded that overcontoured
crown attracted more plaque than undercontoured
11
or optimally contoured crowns. Therefore, if given
choice, undercontoured crowns are preferred over
overcontoured crown.

The term contact point best defines initial Fig 4: Clinical photograph showing healthy
contact of erupted teeth. Contacts between teeth interdental contour
become broader and flatter as arch stabilizes and
teeth eruption gets completed. It also favorably
12
affects emergence profile in natural tooth. Contact CONCLUSION:
areas help in maintaining stability of dental arch and
prevent food impaction. Protection of interdental 1. Restoration failure due to periodontal
papilla is also one of the major function of proximal breakdown can be minimized by following
contact area. Food impaction might occur in case of principle of contour design of crown.
narrow contact area and gingival col might become 2. Interdental papillae health should be given
longer if it is kept broad making the patient more utmost importance. Sufficient care should be
suaceptible to periodontal disease. The contact
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Review article Annals and Essences of Dentistry
given to design interdental space in a way that
it should be sufficiently protected. Placement 7. Kissova HK, Todorova BP, Popova EV.
of contact area becomes critical in this regard. Correlation between overcontouring of
3. Facial and Lingual contour should be made fixed prosthesis construction and
self protective and should help in self accumulation of dental plaque. Folia
cleansing and avoiding food trap. Med(plovdii).2001;43:80-3.
4. Overcontouring of restoration has to be
avoided in every case. 8. Wagman SS. The role of coronal contour
5. Subgingival margin should be avoided. But if in gingival health. J Prosthet Dent. 1977;
placed, then sufficient attention should be 37:280-7.
given to its contour so that it can support the doi:10.1016/0022-3913(77)90070-1
gingiva.
6. Contour of restoration should be such that it 9. Tjan AHL, Freed H, Miller GD. Current
should provide maximum cleansing action. controversies in axial contour design. J
Prosthet Dent. 1980; 44:636-40.
7. With proper planning of restoration design, not
only esthetics but periodontal health can also 10. Boner C, Boner N. Restoration of the
be maintained. interdental space. Int J Periodontics
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Author for Correspondence

Dr.. Yashpal Singh
Reader,
Department of Prosthodontics
Subharti Dental College,
NH – 58, Subhartipuram,
Meerut - 250 002
Phone No: +919873296612
Email: - dryashpal.singh@gmail.com
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