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Cuspal-coverage restorations are important to preserve the integrity of a weakened tooth against the forces of occlusion. This article discusses the clinical indications for both direct and indirect cuspal-coverage restorations and the evidence supporting their use. Factors that modify a tooth's ability to dissipate normal occlusal forces and the effect cuspal-coverage restorations have on force distribution are examined. Clinical criteria, choice of restorative material and methods for tooth preparation are also discussed.
CPD/Clinical Relevance: Re-enforcement of weakened teeth with cuspal-coverage restorations provides a minimally invasive alternative to conventional crowns.
Article
A cuspal-coverage restoration may be defined as one where the restorative material covers all, or part of, one or more cusps of a molar, premolar or canine tooth. In this regard, conventional crowns may be classed as cuspal-coverage restorations. Cuspal-coverage restorations may be either direct or indirect restorations.
For the purposes of this article, the term ‘cuspal coverage’ will refer to a technique used for either direct or indirect restorations that covers only part of one or more cusps of a molar or premolar tooth. These restorations may also be called direct or indirect onlays.
The main role of a cuspal-coverage restoration is to reinforce a weakened cusp, thus reducing the chance for fracture and overall failure of the tooth. Other roles include:
To understand the indications for cuspal coverage it is necessary to discuss the forces on teeth and factors that modify the ability of the tooth to resist such forces.
In normal function, teeth have the greatest forces applied to them as a result of mastication of food. For individual teeth, the ideal occlusal contact distributes the force down the long axis of the tooth and occurs at the same time as all the other teeth in the arch.1 Molar and premolar teeth are most often involved in crushing and grinding of food to aid swallowing and subsequent digestion. Normally, occlusal loading on such teeth is between 350–700N and for an average cumulative total of 17.5 minutes per day.2 There are a number of factors that can affect the ability of the tooth to withstand these parameters including:
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