A mathematical treatise on the fit of crown castings

The influence of different cement spaces on the marginal gap of lithium disilicate crowns constructed by two scanner and milling unit combinations

BACKGROUND

This study compared the marginal gaps of CAD/CAM lithium disilicate (LDS) crowns constructed using a contemporary and older scanner/milling unit combination at three different cement spaces.

METHODS

Twenty-four undergraduate students prepared a Columbia model lower left first molar for an LDS crown in a simulated environment. From each crown preparation, one LDS crown was constructed using an E4D scanner/E4D milling unit (E4DS/E4DM) and TRIOS 3 scanner/Sirona inLab MC X5 milling unit (TRIO/MCX5) at cement space settings of 50, 100 and 200 μm. Each LDS crown was positioned onto the original crown preparation, and then a stereomicroscope was used to make three vertical marginal gap measurements at four locations (mid-buccal, mid-lingual, mid-mesial and mid-distal). The mean marginal gap (MMG) was calculated for each crown and each individual tooth surface.

RESULTS

The MMGs of CAD/CAM LDS crowns constructed by TRIO/MCX5 were 72.31 at 50, 63.73 at 100 μm and 46.23 μm at 200 μm, which were smaller than E4DS/E4DM at each cement space.

CONCLUSIONS

Increasing the cement space decreased the MMG in both scanner/milling unit combinations. The smallest MMG was found using the newer scanner/milling unit at the 200 μm cement space. © 2024 Australian Dental Association.

Effect of cement spacer on fit accuracy and fracture strength of 3-unit and 4-unit zirconia frameworks

BACKGROUND

Cement spacer is essential for compensating deformation of zirconia restoration after sintering shrinkage, allowing proper seating and better fracture resistance of the restoration. Studies assessing the effect of cement spacer on fit accuracy and fracture strength of zirconia frameworks are missing in the literature. Therefore, the aim of this study was to evaluate the effect of different cement spacer settings on fit accuracy and fracture strength of 3-unit and 4-unit zirconia frameworks.

METHODS

Sixty standardized stainless-steel master dies were manufactured with 2 prepared abutments for fabricating 3-unit and 4-unit zirconia frameworks. The frameworks were assigned into 6 groups (n = 10) according to cement spacer setting (30 μm, 50 μm, and 80 μm) as follows: 3-unit frameworks; 3u-30, 3u-50, 3u-80, and 4-unit frameworks; 4u-30, 4u-50, and 4u-80. The frameworks were assessed for fit accuracy with the replica method. The specimens were cemented to their corresponding dies, and the fracture strength was measured in a universal testing machine. The Weibull parameters were calculated for the study groups and fractured specimens were inspected for failure mode. Two-Way ANOVA followed by Tukey test for pairwise comparison between study groups (α = 0.05).

RESULTS

The cement spacer had a significant effect on both fit accuracy and fracture strength for 3-unit and 4-unit frameworks. The 50 μm spacer had significantly better fit accuracy followed by 80 μm, and 30 μm spacers. Both 50 μm and 80 μm spacers had similar fracture strength, and both had significantly better strength than 30 μm spacer.

CONCLUSIONS

For both 3-unit and 4-unit zirconia frameworks, 50 μm cement spacer can be recommended over 30 μm and 80 μm spacers for significantly better fit accuracy and adequate fracture strength.

Effect of preparation design and endodontic access on fracture resistance of zirconia overlays in mandibular molars: An in vitro study

PURPOSE

To evaluate the fracture resistance of zirconia overlays, considering various preparation designs and the presence of endodontic access.

MATERIALS AND METHODS

Ninety translucent zirconia (5Y-PSZ) overlay restorations were divided into six groups (n = 15/group) based on different preparation designs, with and without endodontic access: chamfer margin 4 mm above the gingival level without (group 1) and with endodontic access (group 2); margin 2 mm above the gingival level without (group 3) and with endodontic access (group 4); overlay with no chamfer margin without (group 5) and with endodontic access (group 6). Restorations were bonded to mandibular first molar resin dies, and the groups with endodontic access were sealed with flowable resin composite. All restorations underwent 100,000 cycles of thermal cycling between 5°C and 55°C, followed by loading until fracture. Maximum load and fracture resistance were recorded. ANOVA with Tukey post-hoc tests were used for statistical comparison (α < 0.05).

RESULTS

Fracture resistance significantly varied among overlay designs with and without endodontic access (p < 0.001), except for the no-margin overlays (groups 5 and 6). Overlays with a 2 mm margin above the gingival margin with endodontic access (group 4) exhibited significantly higher fracture resistance compared to both the 4-mm supragingival (group 2) and no-margin (group 6) designs, even when compared to their respective intact groups (groups 1 and 5). There were no significant differences between the no-margin and 4-mm supragingival overlays.

CONCLUSION

The more extensive zirconia overlay for mandibular molars is the first choice since the 2 mm margin above the gingival level design withstood considerable loads even after undergoing endodontic access. A no-margin overlay is preferred over the 4-mm supragingival design as it preserves more tooth structure and there was no outcome difference, irrespective of endodontic access. Caution is warranted in interpreting these findings due to the in vitro nature of the study.

Evaluation of Vertical Discrepancies in Crown Seating Using Different Glass Ionomer Cement Volume: An In Vitro Study

Background This in vitro study aimed to assess the vertical disparities in the positioning of complete crown castings when different quantities of cement were used and to determine the optimal amount of cement for cementation while minimizing any marginal discrepancies. Methodology A total of 60 ideal nickel-chromium (Ni-Cr) crown castings were divided into three groups of experimental volumes of glass ionomer cement, with 20 castings in each group. Group I had completely filled volume with cement, group II had it half-filled, and group III had brushed up cement internally. The crowns were cemented by applying a static load of 5 kg to the cementation apparatus for 10 minutes. The marginal discrepancy between the die and the castings was measured pre-cementation and post-cementation using image analysis software in combination with a stereomicroscope (Motic, USA) at predetermined points that were marked on the die. Statistical analysis was performed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 16, Armonk, USA) software. A one-way analysis of variance (ANOVA) was used for the intergroup analysis. A paired sample t-test was used for intragroup analysis. Result  Brushing cement onto the internal surface presented the least mean values (P<0.05) of post-pre-cementation vertical discrepancy (14.92±10.77 μm) when compared to the half-filled cement group (28.42±12.45 μm) and the fully-filled cement group (58.50±20.91 μm). Conclusion Cement volume appeared to be a key factor in the vertical marginal discrepancy of the crown. The cement brush applied to the internal surfaces of the crown showed smaller post-cementation vertical discrepancies.

The influence of pontic distribution on the marginal and internal gaps of CAD/CAM five-unit anterior zirconia framework

Background/purpose

Nowadays, zirconia-based framework has been used for longspan or full-arch fixed dental prostheses (FDPs). This study aimed to evaluate the effect of pontic distribution on marginal and internal gaps of five-unit anterior zirconiabased DPs.

Materials and methods

Right maxillary central incisor and second premolar were selected as terminal abutments and three different edentulous conditions with one nonterminal abutment were simulated. Marginal and internal gaps in each zirconia-based samples(n = 10) were examined by computer-aided replica technique. Five regions, including marginal gaps at mesial or distal finishing line, internal gaps at the mesial or distal axial wall, and occlusal surface, were statistically analyzed (α = .05).

Results

Most of marginal gaps and internal gaps at axial wall were clinically acceptable, but larger at occlusal surface. For the three experimental groups, clinically accepted percentage with qualified gaps were less than 30%.There were statistical differences at axial wall over pontic side and marginal gaps over non-pontic side between groups (P<0.05). For sum of gaps of all abutments in each group, statistical differences were found at marginal and axial wall (P < 0.05). As for those on terminal and non-terminal abutments, statistical differences were found on second premolar (P < 0.05).

Conclusion

Except for occlusal surface, the overall marginal gaps and internal gaps at axial wall of five-unit anterior zirconia-based FDPs with different pontic distribution were clinically acceptable. However, the percentage with qualified gaps were low (<30%). Greater gaps were noted when adjacent pontic existed. Different pontic size and distribution with curvature had an influence on the gaps.

Evaluation of Marginal and Internal Adaptation of Crowns Fabricated with Three Different Zirconia CAD/CAM Materials

BACKGROUND

Marginal and internal adaptation are key factors that determine the clinical success of dental restorations.

AIM

The aim of this study is to evaluate the marginal and internal fit of crowns fabricated with three different CAD-CAM zirconia materials; two monolithic zirconia materials and one veneered zirconia copings in comparison with conventional metal-ceramic crowns.

MATERIAL AND METHODS

Ninety-six extracted molars (n = 96) were selected. Teeth were randomly divided into four groups (n = 24), and the following restorations were fabricated: Metal-ceramic crowns (Control group) (Group CG); monolithic zirconia crowns (GC initial) (Group MZ1); monolithic zirconia crowns (InCoris TZI),(Group MZ2); bilayered zirconia crowns, cores (InCoris ZI) veneered with a low-fusing glass-ceramic (IPS Emax Ceram),(Group BZ). Internal and marginal adaptations were evaluated using the silicone replica technique. A total of 20 points were recorded for every tooth under the light microscope at 20x magnifications. Results were compared using one-way analysis of variance (ANOVA) and the posthoc Tukey's test at a significance level of 0.01.

RESULTS

Marginal, marginal-internal, axial, and occlusal gaps between CG, MZ1, MZ2, and BZ crowns showed statistically significant differences (P < 0.01).

CONCLUSION

Monolithic zirconia groups showed better marginal adaptation compared with the veneered zirconia crowns.

Vertical Marginal Discrepancy of a Monolithic Zirconia Crown with Different Cement Spaces

The long-term clinical success of indirect restorations highly depends on their marginal integrity. The cement space is an element that might affect the marginal integrity, but it can be altered during the configuring of the computer-assisted designing/computer-aided manufacturing (CAD-CAM) restoration. However, there is controversy in the literature regarding the effect of the cement space on the precision of zirconia crown marginal adaptation. The aim of this study was to measure the vertical marginal discrepancies between different cement thickness settings for CAD-CAM monolithic zirconia restorations. Material and Methods. An artificial mandibular right molar tooth mounted on a typodont was prepared for a zirconia crown using the standard method. The study sample consisted of 30 zirconia crowns (Zenostar Zr Translucent Zirconia, Weiland Dental, Germany) milled using an (iMes-iCore) milling machine. Each group of 10 crowns was designed with 30-50 and 70 μm spacer thicknesses. The vertical marginal adaptation at the center of the four different planes (mesial, distal, buccal, and palatal) was measured under a microscope at 40x magnification. A one-way analysis of variance test was used for statistical analysis. Results. The mean of Group 30 was 27.45; of Group 50 was 22.22; and of Group 70 was 22.90. There was no statistically significant difference between the groups (p ≥ 0.5). Conclusions. The increase in the cement space up to 70 μm did not influence the vertical marginal adaptation of the monolithic zirconia crowns.

Effect of cement space settings on the marginal and internal fit of 3D-printed definitive resin crowns

STATEMENT OF PROBLEM

The cement gap setting affects the marginal and internal fits depending on the crown material and manufacturing method (subtractive or additive manufacturing). However, information on the effects of cement space settings in the computer-aided design (CAD) software program, which is used to aid the manufacturing with 3-dimensional (3D) printing-type resin material, is lacking, and recommendations for optimal marginal and internal fit are needed.

PURPOSE

The purpose of this in vitro study was to evaluate how cement gap settings affect the marginal and internal fit of a 3D-printed definitive resin crown.

MATERIAL AND METHODS

After scanning a prepared typodont left maxillary first molar, a crown was designed with cement spaces of 35, 50, 70, and 100 μm by using a CAD software program. A total of 14 specimens per group were 3D printed from definitive 3D-printing resin. By using the replica technique, the intaglio surface of the crown was duplicated, and the duplicated specimen was sectioned in the buccolingual and mesiodistal directions. Statistical analyses were performed using the Kruskal-Wallis and the Mann-Whitney post hoc tests (α=.05).

RESULTS

Although the median values of the marginal gaps were within the clinically acceptable limit (<120 μm) for all the groups, the smallest marginal gaps were obtained with the 70-μm setting. For the axial gaps, there was no observed difference in the 35-, 50-, and 70-μm groups, and the 100-μm group showed the largest gap. The smallest axio-occlusal and occlusal gaps were obtained with the 70-μm setting.

CONCLUSIONS

Based on the findings of this in vitro study, a 70-μm cement gap setting is recommended for optimal marginal and internal fit of 3D-printed resin crowns.

Effect of virtual cement space and restorative materials on the adaptation of CAD-CAM endocrowns

BACKGROUND

This study aimed to evaluate the effect of virtual cement space and restorative materials on the fit of computer-aided design and computer-aided manufacturing (CAD-CAM) endocrowns.

METHODS

A mandibular first molar tooth model received a butt joint margin endocrown preparation with a 2-mm occlusal thickness. Then, using a 3D-printing system, 120 copies of this prepared die were printed and assigned equally to three groups with different cement space settings (30, 60, and 120 μm) during the chairside CAD design. In the milling process, CAD-based models with a particular space setting were subdivided into four groups (n = 10) and fabricated from different CAD-CAM materials: Vita Suprinity (VS), Celtra Duo (CD), Lava Ultimate (LU), and Grandio blocs (GR). Finally, the endocrowns were stabilized over their corresponding models with siloxane and subjected to micro-computed tomography to measure the fit.

RESULTS

The cement space that was predesigned at 30 μm generated the largest marginal discrepancy (from 144.68 ± 22.43 μm to 174.36 ± 22.78 μm), which was significantly different from those at 60 μm and 120 μm (p < 0.001). The combination of VS or CD with a pre-setting cement space of 60 μm and the combination of LU or GR with a cement space of 120 μm showed better agreement between the predesigned and actual measured marginal gap widths. For internal adaptation, only the cement space set to 30 μm exceeded the clinically acceptable threshold (200 μm).

CONCLUSIONS

The setting of the cement space and restorative material significantly affected the marginal adaptation of CAD-CAM endocrown restorations. Considering the discrepancy between design and reality, different virtual cement spaces should be applied to ceramic and resin composite materials.

Effect of virtual cement gap settings on the marginal fit of cemented resin-ceramic crowns on implant abutments

STATEMENT OF PROBLEM

Agreement on the perfect virtual cement space value for computer-aided design and computer-aided manufacturing (CAD-CAM) implant-supported resin-ceramic crowns with the best marginal adaptation is lacking. The range of cement gap settings in some CAD design software programs is wide (0 to 200 μm), and manufacturer recommendations regarding the best cement gap setting for certain types of ceramics is not specific.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of virtual cement gap settings on the marginal fit of cemented resin-ceramic crowns on implant abutments.

MATERIAL AND METHODS

Thirty implant analogs and matching stock abutments were coupled and implanted into autopolymerizing acrylic resin blocks. Three groups (n=10) of resin-ceramic molar crowns with 3 different virtual cement space settings (40, 60, and 100 μm) were designed by using a CAD design software program. The crowns were cemented over their corresponding abutments under a static load by using a specially designed cementing device. A scanning electron microscope was used to measure the mean vertical marginal gap (MG) for each group, where a total of 120 measurements for each of the 3 groups (12 sites per crown and 10 crowns per group) were evaluated. One-way analysis of variance and the post hoc Tukey pairwise comparison tests were used to analyze the data (α=.05).

RESULTS

A significant difference (P<.001) was found between the MG values of the resin-ceramic implant-supported crowns fabricated by using the 3 cement space settings. The smallest MG was obtained with the 60-μm setting as compared with the 40-μm and 100-μm settings.

CONCLUSIONS

A limited inverse relation was found between the MGs of CAD-CAM-fabricated resin-ceramic implant-supported crowns and the cement gap settings in the exocad software program. The smallest MGs were obtained when a 60-μm cement space value was used (P<.001).

Comparing the marginal leakage and retention of implant-supported restorations cemented by four different dental cements

BACKGROUND

Despite the wide use of implants in dentistry, there is insufficient information about the ideal cement for retention.

PURPOSE

To determine the cement bond strength and marginal leakage of crown and partial denture cemented to implant abutments by four different types of cement.

MATERIALS AND METHODS

Eighty-four direct abutments were divided into eight groups (n = 7). Fifty-six crown and bridge restorations were cemented using zinc phosphate (ZM), temporary cement (TM), resin-modified glass-ionomer cement (GM), and self-adhesive resin cement (RM). After cementation, thermal cycling and incubation in basic fuchsin dye was applied. The maximum load to failure, marginal leakage, and fracture modes were evaluated.

RESULTS

The mean of retention strength for the bridges (874 N) was higher than the crown samples (705 N) (P = .005). The mean of retention strength for each cement group was ZM = 1298, RM = 1027, GM = 646, and TM = 187 N (P ≤ .0001). Marginal leakage was recorded in majority of the samples; the highest incidence was detected for ZM samples. The cement fracture was mostly adhesive in nature.

CONCLUSION

Self-adhesive resin and resin-modified glass ionomer cement had better mechanical properties to retain implant supported restorations.

The influence of different cement spaces on the marginal gap of CAD/CAM all-ceramic crowns

BACKGROUND

The purpose of this study was to measure the marginal gaps of CAD/CAM all-ceramic crowns constructed using different cement spaces on crown preparations created by undergraduate students.

METHODS

Twenty-four Columbia model lower left first molars with assessed tapers and reduction volumes (RV) were recruited to receive complete coverage E.max crowns. Three E.max crowns were digitally designed and milled for each crown preparation using three different cement spaces: 50 μm (CS-50), 100 μm (CS-100), 200 μm (CS-200). Each crown was seated onto its original crown preparation and three vertical marginal gap measurements were taken at four locations (mid-buccal, mid-lingual, mid-mesial, mid-distal) using a stereomicroscope. The mean marginal gap (MMG) was calculated for each crown and each individual tooth surface.

RESULTS

The MMG was statistically significantly different for each of the three cement spaces (126 μm for CS-50, 89 μm for CS-100, and 75 μm for CS-200) (P < 0.0001). A taper of between 20 and 30° produced the smallest MMG. Insufficient RV caused significantly larger MMGs. The buccal margin had significantly smaller MMGs than all other measured surfaces.

CONCLUSIONS

The most accurate margins of digitally designed all-ceramic crowns constructed on simulation teeth prepared by undergraduate students were observed when using a 200 μm cement space.

Marginal and Internal Fit of CAD/CAM Crowns Fabricated Over Reverse Tapered Preparations

PURPOSE

Intraoral digital scanning can accurately record single abutment tooth preparations despite their geometry, and the algorithms of the CAD software can be set to manage different abutment forms. The purpose of this in vitro study was to evaluate the marginal and internal fit of CAD/CAM zirconia crowns fabricated over conventional and reverse-tapered preparations.

MATERIALS AND METHODS

Crown preparations with known total occlusal convergence (TOC) angles (-8°, -4°, 0°, 8°, 12°, 16°, and 22°) were digitally created from a maxillary left central incisor and printed in acrylic resin. Next, casts were scanned with a TRIOS intraoral scanner, and crowns were designed with KaVo multiCAD software using default parameters (50 μm cement space) on abutments with positive TOC angles, whereas reverse-tapered abutments (negative TOC angles) were digitally blocked out at 0° and had an extra mesiodistal gap set to 50 μm. Then, zirconia crowns were fabricated, and their marginal and internal discrepancies were recorded with the silicone replica technique. All replicas were examined under a stereomicroscope at 50× magnification. Collected data were analyzed with one-way ANOVA and post hoc Tukey test for marginal fit. For the axial and incisal fit, measured values did not follow a normal distribution; therefore, the Kruskal-Wallis and the Dunn/Bonferroni multiple comparison tests were applied (p = 0.05).

RESULTS

The mean marginal fit of -8° crowns (58.2 ± 6.0 μm) was statistically different (p < 0.0001) from all the remaining crowns (range 42.1-47.3 μm). Also, the internal fit was statistically significant when comparing crowns fabricated over abutments with positive and negative TOC angles (p < 0.0001). The largest median axial discrepancies were found in the -8° (165.5 μm) and -4° (130.8 μm) groups; however, when evaluating the incisal fit, they showed the smallest discrepancies (67.3 and 81.8 μm, respectively).

CONCLUSIONS

Under the conditions of this study, the marginal and internal fit of zirconia crowns fabricated over inverse-tapered preparations is within clinically accepted values.

The Effect of Various Finish Line Configurations on the Marginal Seal and Occlusal Discrepancy of Cast Full Crowns After Cementation - An In-vitro Study

BACKGROUND

The marginal fit of crowns is of clinical importance. It is found that marginal and occlusal discrepancies are commonly increased following cementation. The resistance of cementing materials is a factor that prevents cast restorations from being correctly seated. Different finish lines behave differently in facilitating the escape of the cement. When the escape path of the cement decreases, the crown fails to seat further.

MATERIALS AND METHODS

This study was planned with an aim to evaluate the effect of various finish lines on the marginal seal and occlusal seat of full crown preparations. Six stainless steel metal dies were machined to simulate molar crown preparations. The diameter was 10 mm and height was 6mm. The occlusal surface was kept flat and a small circular dimple was machined for reorientation of the wax pattern and metal copings, margins of various designs were machined accurately. The margins prepared were Group A- 90(0)C shoulder, Group B- Rounded shoulder, Group C- 45 degree sloped shoulder, Group D- Chamfer, Group E- Long chamfer, Group F- Feather edge. Full cast metal crowns of base metal alloy were fabricated over the metal dies. Zinc phosphate luting cement was used for the cementation. After twenty four hours, the cemented crown and die assembly were embedded in clear acrylic resin so as to hold the assembly together while sectioning. Twenty four hours later, all the samples were sectioned sagitally. The sectioned halves were focused under a stereomicroscope and the cement spaces were measured to the nearest micron. The cement thickness was measured at two points on the occlusal surface and one at each margin.

RESULTS

Significant differences were observed in the occlusal seat and marginal seal of all the finish line configurations. The rounded shoulder had the best occlusal seat, followed by 90(0)C shoulder. The occlusal seat and marginal seal afforded by the shoulder finish lines were similar whereas there was a vast difference in the seating and sealing of long chamfer and feather edged preparations. They showed the worst occlusal seat.

CONCLUSION

It was found that the finish lines like shoulder preparations which exhibit poor sealing prior to complete cementation allow good seating whereas margins which seal earlier do not allow escape of cement and hence do not seat completely.

Internal fit of pressed and computer-aided design/computer-aided manufacturing ceramic crowns made from digital and conventional impressions

STATEMENT OF PROBLEM

No studies have evaluated the internal adaptation of pressed and milled ceramic crowns made from digital impressions.

PURPOSE

The purpose of this in vitro study was to evaluate the internal fit of pressed and milled ceramic crowns made from digital and conventional impressions.

MATERIAL AND METHODS

Thirty polyvinyl siloxane (PVS) impressions and 30 Lava COS impressions made of a prepared dentoform tooth (master die) were fabricated. Thirty crowns were pressed in lithium disilicate (IPS e.max Press), and 30 crowns were milled from lithium disilicate blocks (IPS e.max CAD) (15/impression technique) with the E4D scanner and milling engine. The master die and the intaglio of the crowns were digitized with a 3-dimensional laser coordinate measurement machine. The digital master die and intaglio of each crown were merged. The distance between the die and the intaglio surface of the crown was measured at 3 standardized points. One-way ANOVA was used for statistical analysis (α=.05).

RESULTS

One-way ANOVA revealed that the internal gap obtained from the Lava/press group (0.211 mm, ±SD 0.041) was significantly greater than that obtained from the other groups (P<.001), while no significant differences were found among PVS/press (0.111 mm ±SD 0.047), PVS/CAD/CAM (0.116 mm ±SD 0.02), and Lava/CAD/CAM (0.145 mm ±SD 0.024).

CONCLUSIONS

The combination of the digital impression and pressed crown produced the least accurate internal fit.

Cement selection for implant-supported crowns fabricated with different luting space settings

PURPOSE

To measure and compare the retentive strength of cements specifically formulated for luting restorations onto implant abutments and to investigate the effect of varying cement gap on retention strength of implant-supported crowns.

MATERIALS AND METHODS

Standard titanium abutments were scanned by means of a 3D digital laser scanner. One hundred and sixty standard metal copings were designed by a Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) system with two cement gap values (20 and 40 μm). The copings were cemented to the abutments using the following eight cements with one being the control, zinc oxide temporary cement, while the other seven were specifically formulated implant cements (n = 10): Premier Implant Cement, ImProv, Multilink Implant, EsTemp Implant, Cem-Implant, ImplaTemp, MIS Crown Set, and TempBond NE. The specimens were placed in 100% humidity for 24 hours, and subjected to a pull-out test using a universal testing machine at a 0.5 mm/min crosshead speed. The test results were analyzed with two-way ANOVA, one-way ANOVA, post hoc Tamhane' s T2, and student's t-tests at a significance level of 0.05.

RESULTS

Statistical analysis revealed significant differences in retention strength across the cement groups (p < 0.01). Resin-based cements showed significantly higher decementation loads than a noneugenol zinc oxide provisional cement (TempBond NE) (p < 0.01), with the highest tensile resistance seen with Multilink Implant, followed by Cem-Implant, MIS Crown Set, ImProv, Premier Implant Cement, EsTemp Implant, and ImplaTemp. Increasing the cement gap from 20 to 40 μm improved retention significantly for the higher strength cements: Multilink Implant, Premier Implant Cement, ImProv, Cem-Implant, and MIS Crown Set (p < 0.01), while it had no significant effect on retention for the lower strength cements: EsTemp Implant, ImplaTemp, and TempBond NE (p > 0.05).

CONCLUSIONS

Resin cements specifically formulated for implant-supported restorations demonstrated significant differences in retention strength. The ranking of cements presented in the study is meant to be an arbitrary guide for the clinician in deciding the appropriate cement selection for CAD/CAM-fabricated metal copings onto implant abutments with different luting space settings.

Finite element analysis of stresses in fixed prosthesis and cement layer using a three-dimensional model

Context:

To understand the effect of masticatory and parafunctional forces on the integrity of the prosthesis and the underlying cement layer.

Aims:

The purpose of this study was to evaluate the stress pattern in the cement layer and the fixed prosthesis, on subjecting a three-dimensional finite element model to simulated occlusal loading.

Materials and Methods:

Three-dimensional finite element model was simulated to replace missing mandibular first molar with second premolar and second molar as abutments. The model was subjected to a range of occlusal loads (20, 30, 40 MPa) in two different directions – vertical and 30° to the vertical. The cements (zinc phosphate, polycarboxylate, glass ionomer, and composite) were modeled with two cement thicknesses – 25 and 100 μm. Stresses were determined in certain reference points in fixed prosthesis and the cement layer.

Statistical Analysis Used:

The stress values are mathematic calculations without variance; hence, statistical analysis is not routinely required.

Results:

Stress levels were calculated according to Von Mises criteria for each node. Maximum stresses were recorded at the occlusal surface, axio-gingival corners, followed by axial wall. The stresses were greater with lateral load and with 100-μm cement thickness. Results revealed higher stresses for zinc phosphate cement, followed by composites.

Conclusions:

The thinner cement interfaces favor the success of the prosthesis. The stresses in the prosthesis suggest rounding of axio-gingival corners and a well-established finish line as important factors in maintaining the integrity of the prosthesis.

The Effect of Die Spacer on Retention and Fitting of Complete Cast Crowns

PURPOSE

This study evaluated the effect of die spacer on the fit and retention of complete cast crowns by using three different cements.

MATERIALS AND METHODS

Standardized full crown restoration preparations were completed on 99 extracted molar teeth, impressions were made with poly(vinyl siloxane), and stone dies were made. Dies were covered with four layers of die spacer using three techniques: (1) covering the occlusal and 1/3 of the axial surfaces, (2) covering the occlusal and 2/3 of the axial surfaces, and (3) covering the entire preparation except the apical 0.5 mm of the preparation. Complete metal crowns were cast using Pors-on 4 alloy. Crowns were then assigned to one of three luting agent groups: resin modified glass ionomer cement, resin cement, or zinc phosphate cement. The castings were placed on their respective teeth and the marginal opening was recorded by two methods: 72 specimens were examined before and after cementation using optical microscopy with 0.001 mm resolution, and 27 specimens were examined after cementation with scanning electron microscopy. After cementation, the teeth were thermocycled for 700 cycles between 5 degrees C and 55 degrees C. The tensile retentive strength was measured on a universal testing machine with a crosshead speed of 0.5 mm/min. The data obtained for the fitting were recorded in millimeters and the data for the tensile retentive strength were recorded in KgF. The statistical analysis was performed by analysis of variance and post hoc Tukey's test (p< 0.05).

RESULTS

Before cementation, better marginal fit was obtained when the die spacer covered all but the area 0.5 mm short of the margin of the preparation; however, after cementation, the resin modified glass ionomer cement group had the best fit with the same application of die spacer. Castings luted with resin cement required the greatest tensile force to produce cement failure.

CONCLUSIONS

Increasing the area of the die surface covered with spacer improved the fit of the cast restoration. After cementation, the resin modified glass ionomer showed better adaptation; however, the optical microscopy and scanning microscopy correlate well. Resin cement had the highest resistance to tensile forces.

Influence of margin design on the fit of high-precious alloy restorations in patients

OBJECTIVE

It was the objective of this study, to analyze the influence of the marginal design on the marginal accuracy of a casting in a clinical setup in patients.

METHODS

Ninety volunteer patients' teeth-which were intended for extraction due to medical reasons-were prepared prior to extraction. Three different types of finishing line-chamfer, 135 degrees shoulder and 90 degrees shoulder-were employed. Two each c-silicone and pvs impressions were taken of each tooth using either a two-stage or a one-stage putty-wash technique. After preparation and impression taking the teeth were extracted. Gypsum casts were poured from the impressions and high precious alloy castings fabricated on the dies and marginal discrepancies were determined on the extracted teeth.

RESULTS

The median value of marginal discrepancies was lower than 150 microm for all groups. The difference between the three different preparation types was significant (H-test, p<0.05). The lowest median values were obtained for the chamfer preparations, while the 90 degrees shoulders always produced the highest median values. Preparations at gingva level exhibited more accurate marginal fit than subgingival preparations. No significant differences could be observed between the pvs and c-silicone materials or the one-step and two-step putty-wash techniques.

CONCLUSIONS

The marginal designs of the preparations had much less influence on the marginal fit of high precious alloy castings than expected. There is considerable reason to assume that technical but clinical parameters influence the quality of fixed prosthodontics much more than has been believed in the past.

Vertical marginal discrepancy of ceramic copings with different ceramic materials, finish lines, and luting agents: an in vitro evaluation

STATEMENT OF PROBLEM

Prosthetic restorations that fit poorly may affect periodontal health and occlusion. Studies that have evaluated the accuracy of fit of ceramic restorations before and after cementation assessed primarily intracoronal restorations.

PURPOSE

This in vitro study evaluated the effect of different finish lines, ceramic manufacturing techniques, and luting agents on the vertical discrepancy of ceramic copings.

MATERIAL AND METHODS

Two stainless steel molars were prepared for complete crowns with 2 different finish lines (heavy chamfer and rounded shoulder); each molar was duplicated to fabricate 90 copings. A total of 180 copings generated 18 groups (n=10 for each finish line-coping material-luting agent combination). Luting agents tested included zinc phosphate, resin-modified glass ionomer (Fuji Plus), and resin composite cements (Panavia F). A metal frame was developed on which to screw the stainless steel model and a ceramic coping; the distance (microm) between 2 predetermined points was measured before and after cementation by a profile projector under a torquing force. A 4-way ANOVA with repeated measurements was performed to assess the influence of each factor in the vertical marginal discrepancy: 3 between-coping factors (finish line-coping material-luting agent) and 1 within-coping factor (before and after cementation) (alpha=.05).

RESULTS

Procera copings presented the lowest mean values ( P <.05) of vertical marginal discrepancy before and after cementation (25/44 microm) when compared to Empress 2 (68/110 microm) and InCeram Alumina copings (57/117 microm), regardless of any combinations among all finish lines and luting agents tested.

CONCLUSION

Considering each factor separately, the ceramic manufacturing technique appeared to be the most important factor tested for the definitive vertical discrepancy of all-ceramic copings, with lower mean values for Procera copings.

The effects of die-spacing on post-cementation crown elevation and retention

This paper reviews the relevant dental literature concerning the effect of die-spacing on crown elevation and pre- and post-cementation crown retention. Techniques of providing die-spacing and measurement of the thickness of die-spacer are discussed. A review of the role of the provision of a cement space in reducing post-cementation crown elevation is presented. Factors which may affect crown retention prior to and following cementation are also reviewed. The influence of variables in techniques and experimental design on the results of the studies reviewed is discussed.

Postcementation marginal fit of a new ceramic foil crown system

The in vitro marginal fit of a new foil crown was investigated. Ten standardized polycarbonate master dies filled with 30 wt% carbon having a 90-degree butt joint margin were used to evaluate the marginal fit of Sunrise porcelain foil crowns. The crown specimens were made on stone dies and treated with three coats of die spacer. After fabrication, they were adjusted, cemented with zinc phosphate cement to their respective master dies with 5 kg loading for 10 minutes and stored in water. A Gaertner traveling microscope was used to measure the marginal fit of each specimen. Readings were recorded at five locations randomly marked but equally dividing the margin on each crown, and the overall mean for the crowns was then calculated. The results from the 50 areas revealed a mean marginal discrepancy of 25.3 microns, and this compared favorably with the discrepancies reported for other ceramic crown systems.

Marginal adaptation of castable ceramic crowns

Tooth preparations and seating techniques of castable ceramic crowns differ from metal ceramic crowns. This study evaluated the variable effects of cementation on the marginal adaptation of Dicor, Cerestore, and porcelain-fused-to-metal crowns. The shoulder preparation was maintained for ceramic crowns, and a cavosurface bevel was designed for metal ceramic crowns. Crowns were made with a replication size of 10, placed on master dies, and the marginal openings measured with a Nikon Measurescope 20 instrument. Thirty crowns were cemented with zinc phosphate cement and the recommended clinical force. Marginal adaptation was not improved with a gingival bevel preparation or an increased seating force. The best marginal adaptation was recorded for Cerestore crowns.

Evaluation of marginal adaptation of all-ceramic crowns and metal ceramic crowns

The marginal adaptation of Renaissance crowns is compared with that of the widely used metal ceramic and Dicor crowns. This investigation shows that Dicor and metal ceramic crowns fit better than Renaissance crowns. Clinical implications of all three restorations are discussed.

Gingival margins for crowns: a review and discussion. Part II: Discrepancies and configurations

While there is variation regarding the maximum acceptable marginal discrepancy, there is little argument that poorly fitting margins are a frequent finding. Large discrepancies are clinically significant, since they facilitate plaque retention. Margins incorporating slip joint geometry have usually been favored as a method of minimizing seating and sealing discrepancies. However, many of these discussions largely ignored the effects of the cementing medium and the clinical applicability of slip joint geometry is based on questionable assumptions with regard to casting accuracy and seating. Greater understanding of the role of restorative margins and gingival health indicates the need for shallow margin placement within the crevice, which requires a reassessment of the use of long bevels. Horizontal margins can be made accurately and, when combined with procedures to maximize crown seating, may provide the best method of minimizing seating discrepancies and maximizing gingival health.

Gingival crown margin configurations: a review and discussion. Part I: Terminology and widths

The terms bevel, chamfer, and shoulder are widely used to describe crown margin designs. However, as no clear definition of the essential feature(s) of each design has been universally accepted, the same term often describes margins of widely differing width and/or configuration. Similarly "bevel angles" are not consistently defined. While tradition favors the use of thinner marginal designs, many of the reasons advanced for their superiority are questionable in the light of contemporary research. Use of marginal widths beyond the absolute minimum demanded of the material may contribute to overcoming some of the persistent problems identified with fixed prosthodontic replacement of natural teeth. These include overcontour, porcelain debonds, poor esthetics, and fit. It is suggested that the problems associated with underpreparation and the potential advantages of wider preparations need reemphasis.

Margin design for esthetic posterior metal ceramic crowns

Variations in margin designs for ceramic metal restorations have been used to fulfill the many requirements for such restorations. The trend in our population toward greater esthetic awareness places increased emphasis on esthetics. This trend necessitates a high level of esthetics in posterior restorations. Commonly used posterior margin designs have been described and their inherent weaknesses and strengths have been reviewed. An alternative design has been proposed with its advantages in esthetics, tissue compatibility, cleansibility, and versatility. The clinical and laboratory procedures for this design have been described.

Evaluation of the 45-degree labial bevel with a shoulder preparation

This study compared the margin opening of cemented porcelain-fused-to-metal crowns of three different casting designs: 80-degree bevels with metal collars, 80-degree bevels with porcelain applied to the labial collars, and 45-degree labial bevels with metal and porcelain to a common margin termination. There were no statistically significant differences between the margin opening of the three groups. Porcelain application and firing did not distort the facial margin. The 45-degree bevel with porcelain to the margin has greater esthetic potential and the same margin adaptation as the 80-degree bevel with an all-metal collar.

The effective minimum cement thickness of zinc phosphate cement for luted non-precious crowns

Non-precious metal crowns were prepared for natural teeth which were ground to a taper angle of 5 degrees. The movement of the crowns on teeth during repeated try-on seating was measured with a micrometer. Increasing the applied load from 2 to 10 kg resulted in an average crown movement of 63 micron. For most samples this movement continued when try-on was repeated. Casting irregularities were found to create furrows on some regions of the axial tooth surface during try-on seating. The diameter of the ADA specification consistency disk for zinc phosphate cement was found to depend strongly on the P:L ratio and the ambient temperature. The castings were cemented with zinc phosphate cement of controlled consistency. Cementation with a load of 10 kg gave rise to an average crown elevation of 54 micron and a range of measurements between -8 and 113 micron. The effective minimum cement thickness corresponding to this average was calculated to be 4.7 micron. Small negative values of elevation were attributed to deepening of tooth furrows during cementation. An analysis is given of data from the literature, relevant to the cement flow and irregularities in cement thickness.