Why is preserving tooth structure so important?

When I was in dental school I was timid about prepping teeth for crowns. I was afraid of removing too much tooth, that was until my favorite instructor, Dr. Jaeger, took me aside and prepped a tooth for me. He had a heavy hand and he over prepped teeth when he crowned them, but his preps had no undercuts and his crowns tended to fit beautifully. His point was made and I ceased being afraid of prepping teeth for crowns.

Later, a famous dentist,well known for his beautiful crowns , came and lectured us and he too, was not afraid to prep teeth and his preparations had deep shoulders 360 degrees around his preps. This allowed his lab technicians to fabricate beautifully esthetic crowns. He practiced on Central Park South and it turned out that my uncle, Isiah Lew, another well known NYC dentist. had a dental practice near his. My uncle knew him.  I told him about how much I liked his work and my uncle gave me a sly smile and said that although his work was indeed beautiful, he often had to treat his patients after their teeth broke because this dentist "over prepped" all the teeth he worked on!

After practicing for a number of years, I came to realize that although creating beautiful crown preps  was desirable, preserving tooth structure was even more important when considering the longtime viability of my crown and bridge restorations. Leaving sound and strong tooth structure correlated with my ability to provide my patients with long lasting restorations that helped preserve the teeth that supported them. This is especially true for restorations on premolars and anterior teeth, since are more narrow as compared to molar teeth.

Fast forward to the present day and now I strive to preserve tooth structure when at all possible. With over 35 years of dental experience, I have had the opportunity to fabricate thousands of crowns and have monitored their success and longevity. While nothing lasts forever, all things being equal, the teeth that I prepped "conservatively" ended up being stronger over time and were less prone to fracture. Although, Dr Jaeger was my favorite instructor at school and he helped me gain confidence,  I no longer follow his advice about crown preparation.  If a tooth preparation has a small undercut I will not prep it out, but instead try to fix the preparation with bonding or miracle mix so that I  will not remove any extra tooth structure. After all tooth preservation is my primary directive since my patients will want to keep their teeth for their entire lives .  Furthermore, even my best restorations probably will eventually need to be replaced. When that time comes, if my preps were conservatively performed, and the teeth  restored with well fitting crowns,  it makes it more likely that the dentist following me will have an easier time fixing these teeth afterwards.

from Ask Dr. Spindel - http://ift.tt/2mdDO8C - http://ift.tt/1SpPbm6

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