Precision of fit and clinical evaluation of all-ceramic full restorations followed between 0.5 and 5 years

Impact of Cut-out-rescan and Data Exchange by Over-scanning Techniques on Marginal Fit of CAD/CAM Lithium Disilicate Crowns

OBJECTIVE

Evaluate the impact of adjustment procedures - cut-out-rescan (COR) and data exchange by over-scanning (DEOS) techniques - through CAD/CAM software on the marginal fit outcome of ceramic crowns.

METHODS AND MATERIALS

Twenty-eight de-identified teeth were adapted in a mandibular typodont set. Tooth #19 was prepared for a lithium disilicate crown and seven groups, G0 to G6 (n=10), were created based on the rescanned areas (mesial and/or buccal) on the typodont using an intraoral scanner through COR or DEOS techniques. A digital workflow was used to design and mill 70 crowns according to the groups. Each crown was temporarily cemented on tooth #19 and scanned with micro-computed tomography to measure the marginal fit. The data were analyzed statistically by the Kruskal-Wallis test followed by the Mann-Whitney test to compare the groups pairwise as a post-hoc (α=0.05).

RESULTS

Statistically significant differences were found for vertical misfit (μm) between the groups for Marginal Gap Buccal (MGB) and Marginal Gap Mesial (MGM) (p=0.003 and p=0.029, respectively). No significant difference was found for Finish Line Buccal (FLB) and Finish Line Mesial (FLM) (p=0.062 and p=0.092, respectively). G3 (COR buccal and mesial) had the highest MGB (57.75 μm), statistically different from all other groups. G4 (DEOS buccal) (41.60 μm) was different from G6 (DEOS buccal and mesial) (44.21 μm) (p=0.023). For MGM, G0 (control) (53.96 μm) was different from G5 (DEOS mesial) (45.76 μm) and G6 (DEOS buccal and mesial) (48.56 vm) (p=0.013 and p=0.041, respectively) and G2 (COR mesial) (58.43 μm) was different from G5 (DEOS mesial) (45.76 μm) (p=0.016).

CONCLUSIONS

Despite a statistically significant difference in certain groups for both techniques, COR and DEOS techniques are viable options for image editing during acquisition. Lithium disilicate crowns can be produced with satisfactory marginal gap values utilizing a chairside CAD/CAM system.

Evaluation of the marginal adaptation and debonding strength of two types of CAD-CAM implant-supported cement-retained crowns

BACKGROUND

In-vitro data from a clinically well-known lithium disilicate ceramic reference was used to assess the expected performance of resin-based materials in implant dentistry. The purpose of the study was to compare the bond strength and marginal adaptation of nano-ceramic hybrid composite crowns cemented to stock cement-retained abutments to lithium disilicate crowns.

METHODS

Twenty abutment analogs were embedded into auto-polymerizing acrylic resin blocks. The blocks were divided into 2 groups according to the restorative crown material. The 2 groups were divided as follows: Resin nano-ceramic group and lithium disilicate group. Abutment analogs in both groups were scanned using a laboratory scanner, and the restorations were designed, manufactured, and cemented with resin cement over the corresponding group. All samples were tested for marginal adaptation and bond strength after storage for 24 hours at 37 °C in 100% humidity. Data were collected, tabulated, and statistically analysed using the appropriate tests. Normality was checked using Shapiro Wilk test and Q-Q plots. Data were normally distributed. Variables were presented using mean, 95% Confidence Interval (CI) and standard deviation in addition to median and Inter Quartile Range (IQR). Differences between groups regarding debonding forces was assessed using independent t test. Two Way ANOVA was performed to assess the effect of material and bonding on marginal gap. All tests were two tailed and p value was set at < 0.05.

RESULTS

Marginal gap and debonding force values were significantly different according to the type of material used (P < .05). Resin nano-ceramic crowns presented lower marginal gap values before (20.80 ± 8.87 μm) and after (52.11 ± 22.92 μm) bonding than lithium disilicate crowns. The debonding force value for resin nano-ceramic crowns (284.30 ± 26.44 N) was significantly higher than that for lithium disilicate crowns (253.30 ± 33.26 N). Adhesive failure mode was detected in all the specimens in both groups.

CONCLUSIONS

The type of material used for implant-supported cement-retained crowns had a statistically significant effect on marginal adaptation and bond strength. Resin nano-ceramic implant-supported cement-retained crowns had better marginal adaptation and higher bond strength than those manufactured using lithium disilicate.

Verification of a digital approach for three-dimensional evaluation of marginal and internal fit

STATEMENT OF PROBLEM

Internal fit is an important aspect of indirect restorations, but methods for the 3-dimensional (3D) measurement of absolute marginal and intaglio fit are sparse.

PURPOSE

The purpose of this in vitro study was to evaluate an innovative 3D measurement method (AIXFit) based on intraoral scanning data for analyzing the fit of dental restorations.

MATERIAL AND METHODS

For the evaluation of AIXFit, 12 monolithic zirconia crowns were fabricated on typodont preparations. The fit was measured digitally with the AIXFit system and compared with the results obtained from an established 2-dimensional (2D) sectional procedure. To compare the values of both methods at identical locations, a common reference system was developed, with each die fixed in a gypsum stand with reference points. Using an intraoral scanner (True Definition), each die with its reference points and the intaglio surface of the finished crown were digitalized as standard tessellation language files. The AIXFit software program, with a specially developed best-fit algorithm, was used to match the intaglio surface of the crown with the surface of the preparation. The virtual cement gap was calculated over the entire surface and returned values for x≥0 µm. A 2D comparison method involved adhesively fixing the crown to the die and sectioning it into 4 parts with a diamond band saw. The thickness of the cement gap was determined under a light microscope at ×100 magnification at 5 defined measuring points per quarter, so that a total of 240 measurements were available for comparison. A software program (Blender Foundation) was used to superimpose the data from the AIXFit system with the data from the 2D method and to compare the cement gaps at the same locations. The agreement between these methods was verified using paired t tests and determine correlation coefficients (α=.05).

RESULTS

The mean ±standard deviation difference between the AIXFit and 2D methods was 6.7 ±29 µm). Two 1-sided tests showed statistical equivalence between the methods of measurement when considering an interval between -20 and +20 µm. The correlation coefficients showed a positive association for both methods (r=.931).

CONCLUSIONS

The AIXFit software program appeared to be accurate for the digital measurement of internal fit when using the True Definition scanner. It enabled a cast-free workflow and allowed the analysis of the entire intaglio surface.

Effect of coping materials zirconia or polyetheretherketone with different techniques of fabrication on vertical marginal gap and fracture resistance of posterior crowns with composite veneering

BACKGROUND

Insufficient research has been conducted in the literature assessing the performance of zirconia and polyetheretherketone (PEEK) crowns in relation to the essential requirements of successful restorations, such as fracture resistance or margin adaptation. The purpose of this study was to evaluate the effect of the coping materials zirconia or PEEK with different fabrication techniques on the vertical marginal gap and fracture resistance of posterior crowns with composite veneering.

METHODS

Ceramic copings (n = 18) restoring mandibular first molar were fabricated from zirconia (Zircon.x, Presidentdental, Germany), milled PEEK (PEEK CAD) (breCAM.BioHPP, Bredent, Germany) and pressed PEEK (PEEK Press) (BioHPP Granules, Bredent, Germany) six specimens each (n = 6). The copings were veneered with high impact polymer composite (HIPC) material (breCAM.HIPC, Bredent, Germany). The vertical marginal gap was captured under a magnification of 40X. Five equidistant marks on each surface of the die distinguished the points of measurement for a total of 20 readings per sample. The analysis was completed using an image analysis system (ImageJ 1.53t, National Institute of Health, USA). The specimens were loaded to failure at a crosshead speed of 1 mm/min and the load at failure was recorded to measure the fracture resistance.

RESULTS

The marginal gap was analyzed using one-way ANOVA followed by Tukey's post hoc test. Fracture resistance was analyzed using Welch one-way ANOVA followed by the Games-Howell post hoc test. Marginal gap values showed a significant difference between the tested groups, with zirconia having significantly lower gap values (48.67 ± 11.98 µm) than both the PEEK CAD (108.00 ± 20.08 µm) and Press groups (108.00 ± 25.10 µm) (p < 0.001). However, the results of fracture resistance showed no significant difference (p = 0.06) with 1687.47 ± 253.29 N, 2156.82 ± 407.64 N, 2436.72 ± 725.93 N for zirconia, PEEK CAD, and Press, respectively. The significance level was p < 0.05.

CONCLUSIONS

Zirconia framework crowns have a smaller vertical marginal gap than milled and pressed PEEK crowns. Crowns fabricated from zirconia, PEEK CAD, or PEEK Press frameworks and veneered with composite resin have comparable fracture resistance lower than the maximum biting force in the posterior region.

CLINICAL RELEVANCE

Posterior crowns with zirconia frameworks are preferred over milled and pressed PEEK frameworks regarding margin adaptation, although all can safely survive the maximum occlusal forces without fracture.

SEM Evaluation of the Marginal Accuracy of Zirconia, Lithium Disilicate, and Composite Single Crowns Created by CAD/CAM Method: Comparative Analysis of Different Materials

(1) Background: The objective of this in vitro study is to evaluate the marginal accuracy of crowns created by CAD/CAM. (2) Methods: A customized chrome-cobalt (Cr-Co) implant abutment simulating a maxillary right first molar was fixed in a hemi-maxillary stone model and scanned. In total, 27 crowns were fabricated, including 9 lithium disilicate crowns, 9 composite crowns, and 9 zirconia crowns. The measurements were determined by scanning electron microscopy. Descriptive analysis was performed using the mean and standard deviation, while the Kruskal-Wallis test was performed to determine whether the marginal discrepancies were significantly different between each group (p < 0.05). (3) Results: The lowest marginal gap value was reported for zirconia (21.45 ± 12.58 µm), followed by composite (44.7 ± 24.96 µm) and lithium disilicate (62.28 ± 51.8 µm). The Kruskal-Wallis tests revealed a statistically significant difference (p-value < 0.05) in the mean marginal gaps between different materials. (4) Conclusions: The proposed digital workflow can be a viable alternative for fixed prosthetic rehabilitations. The best performance in terms of marginal gap was achieved by zirconia crowns, but all three materials demonstrate marginal closure below the clinically accepted threshold value (120 µm). Clinical significance: although significant differences were reported, the investigated CAD/CAM materials showed clinically acceptable marginal gaps.

Controversies in the dental implant treatment planning for anterior maxillary aesthetic zone - A review

The anterior maxillary region being an aesthetic zone remains critical in decision-making when it comes to replacing a tooth. Treatment planning to place dental implants in aesthetic zone like anterior maxilla needs paramount attention in order to provide best of the treatment outcomes from aesthetic point of view. As the field of dental implants tend to evolve continuously, newer concepts with inadequate research come into practise on regular basis. In this article, some of the controversies regarding dental implant placement and treatment process related to anterior maxillary aesthetic zone are discussed with literature to support evidence.

[Clinical pathway and preparation method of high-precision tooth shoulder platform]

A clear shoulder platform that can be easily identified by doctors and technicians or machines (mouth scan and warehouse scan) is important to obtaining a good long-term and stable fixed prosthesis treatment effect. At present, the pre-paration of the shoulder platform is usually based on free hands, and the practical operation is mainly guided by experience. Moreover, no comprehensive and objective preoperative design, intraoperative verification, and final test are available. Thus, the accuracy of shoulder platform preparation needs to be improved. In this study, the clinical pathway of "three determination, three selection, and three steps" with high accuracy of preparation and the precise shoulder preparation method of "bur-tip guidance" are proposed in detail.

Marginal and internal fit of full ceramic crowns milled using CADCAM systems on cadaver full arch scans

Background

Chairside systems are becoming more popular for fabricating full-ceramic single restorations, but there is very little knowledge about the effect of the entire workflow process on restoration fit. Therefore, this study aimed to compare the absolute marginal discrepancy (AMD) and the full internal fit (FULL) of all-ceramic crowns made by two chairside systems, Planmeca FIT and CEREC, with detailed and standard mill settings.

Methods

One upper molar was prepared for an all-ceramic crown in human cadaver maxilla. Full-arch scans were made by Emerald or Omnicam four times each. Twenty-four e.max crowns were designed and milled by the Planmill 30s or 40s or CEREC MCXL mills with either detailed or standard settings. The cadaver tooth was extracted, and each crown was fixed on it and scanned by a high-resolution microCT scanner. The AMD and FULL were measured digitally in mesio-distal and bucco-lingual 2D slices. The actual and predicted times of the milling were also registered.

Results

No differences were observed between detailed or standard settings in either system. The AMD was significantly higher with CEREC (132 ± 12 μm) than with either Planmill 30s (71 ± 6.9 μm) or 40s (78 ± 7.7 μm). In standard mode, the FULL was significantly higher with CEREC (224 ± 9.6 μm) than with either Planmill 30s (169 ± 8.1 μm) or 40s (178 ± 8.5 μm). There was no difference between actual and predicted time with the two Planmeca models, but with CEREC, the actual time was significantly higher than the predicted time. The 30s had significantly higher actual and predicted times compared to all other models. Across all models, the average milling time was 7.2 min less in standard mode than in detailed mode.

Conclusions

All fit parameters were in an acceptable range. No differences in fit between Planmeca models suggest no effect of spindle number on accuracy. The detailed setting has no improvement in the marginal or internal fit of the restoration, yet it increases milling time.

Corrosion Resistance and Ion Release of Dental Prosthesis of CoCr Obtained by CAD-CAM Milling, Casting and Laser Sintering

Corrosion resistance and ion release behavior have been evaluated for thirty dental restoration samples obtained by three different manufacturing systems: computer-aided design and manufacturing (CAD-CAM), traditional casting and laser sintering. The alloy used was the CoCr alloy (same batch) generally used in clinical dentistry. Corrosion resistance has been evaluated by electrochemical testing in an artificial saliva medium at 37 °C. Corrosion parameters such as critical current density (icr), corrosion potential (Ecorr), and passive current density (ip), have been determined. Cobalt and Chromium ions released from the different samples have also been analyzed in an artificial saliva medium at 37 °C by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) at different immersion times. The casted samples showed higher corrosion rates and ion-release levels. The CAD-CAM milled samples presented lower ion-release levels and better corrosion resistance due to the total solubility of the chemical elements in only one phase with the same chemical composition. This homogeneity avoids the formation of electrochemical corrosion. Moreover, the absence of defects and residual stresses increases the corrosion resistance. Casted and laser sintered prostheses have shown the presence of Cr, W, and Nb rich-precipitates which are detrimental to the corrosion resistance. These precipitates produce a decrease in the Cr content on the surface. It is well known that the corrosion resistance increases with the Cr content by the formation of Chromium oxide on the surface that increases passivation. Consequently, the decrease in Cr induces an increase in corrosion and ion release.

Influence of the CAD-CAM Systems on the Marginal Accuracy and Mechanical Properties of Dental Restorations

The aim of this study was to compare the quality of different computer-assisted-design and computer assisted manufacturing systems (CAD-CAM) generated by only one scanner, focusing on vertical fit discrepancies and the mechanical properties. A master model was obtained from a real clinical situation: the replacement of an absent (pontic) tooth, with the construction of a fixed partial denture on natural abutments with three elements. Nine scans were performed by each tested and 36 copies were designed using a dental CAD-CAM software (Exocad). The frameworks were manufactured using three-axis and five-axis, with the same batch of the chrome-cobalt (CrCo) alloy. The frameworks were not cemented. A focus ion beam-high resolution scanning electron microscope (FIB-HRSEM) allowed us to obtain the vertical gap measurements in five points for each specimen. Roughness parameters were measured using white light interferometry (WLI). The samples were mechanically characterized by means of flexural tests. A servo-hydraulic testing machine was used with a cross-head rate of 1 mm/min. One-way ANOVA statistical analysis was performed to determine whether the vertical discrepancies and mechanical properties were significantly different between each group (significance level p < 0.05). The overall mean marginal gap values ranged: from 92.38 ± 19.24 µm to 19.46 ± 10.20 µm, for the samples produced by three-axis and five-axis machines, respectively. Roughness was lower in the five-axis machine than the three-axis one, and as a consequence, the surface quality was better when the five-axis machine was used. These results revealed a statistically significant difference (p < 0.005) in the mean marginal gap between the CAD-CAM systems studied. The flexural strength for these restorations range from 6500 to 7000 N, and does not present any statistical differences’ significance between two CAD-CAM systems studied. This contribution suggests that the number of axes improves vertical fit and surface quality due to the lower roughness. These claims show some discrepancies with other studies.

Mechanical Properties of CoCr Dental-Prosthesis Restorations Made by Three Manufacturing Processes. Influence of the Microstructure and Topography

The aim of this study is to compare the mechanical properties of three different dental restorations’ manufacturing processes (CADCAM milling, casting and laser sintering) generated by only one laboratory scanner focusing on marginal fit analysis and their mechanical properties. A chrome-cobalt (Cr-Co) alloy from the same batch was used for three different methods to make an implant abutment. This simulates a maxillary right first molar that was fixed in a hemi-maxillary stone model. Five scans were performed by each tested framework. Nine frameworks were manufactured for each manufacture procedure. Field-Emission Scanning Electron Microscope (FE-SEM) direct vision was used to marginal gap measurement in five critical points for each specimen. In order to fix the samples in the microscope chamber, the restorations were submitted at a compression load of 50 N. The samples always have the same orientation and conditions. The resolution of the microscope is 4 nm and it is equipped by J image software. The microstructure of the samples was also determined with the FE-SEM equipped with EDS-microanalysis. Roughness parameters were measured using White Light Interferometry (WLI). The arithmetical mean for the Ra and Rq of each sample was calculated. The samples were mechanically characterized by means of microhardness and flexural testing. Servo-hydraulic testing machine was used with cross-head rate of 1 mm/min. Two-way ANOVA statistical analysis was performed to determine whether the marginal discrepancies and mechanical properties were significantly different between each group (significance level p < 0.05). The overall mean marginal gap values were: from 50.53 ± 10.30 µm for the samples produced by CADCAM to 85.76 ± 22.56 µm for the samples produced by the casting method. Laser sintering presents a marginal gap of 60.95 ± 20.66 µm. The results revealed a statistically significant difference (p-value < 0.005) in the mean marginal gap between the CADCAM systems studied. The higher flexure load to fracture for these restorations were for CADCAM restoration and the lower was for the casting samples. For these restorations, CADCAM Restoration yielded a higher flexure load to fracture and Casting ones yielded the lower. Porosity and microstructure play a very important role in the mechanical properties.

Marginal Discrepancy of Cast Copings to Abutments with Three Different Luting Agents

Aim

The purpose of this study was to evaluate the MD (marginal discrepancy) on the calcinable copings in abutments for cemented prostheses with three luting agents.

Methods

Sixty-four analogs of CeraOne-type abutments (NACONIH code, Titanium Fix Implant Sytem SP, Brazil) were divided into four groups (n = 16). The copings were cast and placed on the CeraOne abutment analogs and cemented with eugenol-free zinc oxide (EfZO) (n = 16), with glass ionomer (GI) (n = 16), and with zinc phosphate (ZP) (n = 16), and as a control group, there were CeraOne plastic copings (NACOC code, Titanium Fix Implant Sytem SP, Brazil) (n = 16) which were not cemented with any material. After 24 hours, the MD of the four groups was measured. MD was evaluated using a stereoscopic microscope (Leica EZ4 W, Leica Microsystems, Germany) with an increase of ×100. MD was measured at four predetermined and equidistant sites with respect to the marginal line of the cast adaptation. The measurement was made from the distance between the free edge of the cast cylinder and the margin of preparation of the titanium abutment, with a level of statistical significance of p < 0.05.

Results

Of the three fixing agents, the ZP was found to have the highest MD (53.59 ± 14.21 μm); however, the lowest MD (41.72 ± 9.10 μm) was found in the GI group. These differences are statistically significant at p < 0.001.

Conclusions

In summary, according to our results, it was found that ZP cement showed the highest MD after cementation, followed by the glass ionomer, while EfZO showed the lowest MD.

Influence of Intra-Oral Scanner (I.O.S.) on The Marginal Accuracy of CAD/CAM Single Crowns

The aim of this in vitro study was to compare the quality of digital workflows generated by different scanners (Intra-oral digital scanners (I.O.S.s)) focusing on marginal fit analysis. A customized chrome-cobalt (Cr-Co) implant abutment simulating a maxillary right first molar was fixed in hemi-maxillary stone model and scanned by eight different I.O.S.s: Omnicam^® (Denstply Sirona, Verona, Italy) CS3500^®, CS3600^®, (Carestream Dental, Atlanta, GA, USA), True Definition Scanner^® (3M, St. Paul, MN, USA), DWIO^® (Dental Wings, Montreal, Quebec, Canada), PlanScan^® (Planmeca Oy, Helsinki, Finland), 3D PROGRESS Plus^® (MHT, Verona, Italy), TRIOS 3^® (3Shape, Copenhagen, Denmark). Nine scans were performed by each tested I.O.S. and 72 copings were designed using a dental computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) software (exocad GmbH, Darmstadt, Germany). According to CAD data, zirconium dioxide (ZrO₂) copings were digitally milled (Roland DWX-50, Irvine, CA, USA). Scanning electron microscope (SEM) direct vision allowed for marginal gap measurements in eight points for each specimen. Descriptive analysis was performed using mean, standard deviation, and median, while the Kruskal⁻Wallis test was performed to determine whether the marginal discrepancies were significantly different between each group (significance level p < 0.05). The overall mean marginal gap value and standard deviation were 53.45 ± 30.52 μm. The minimum mean value (40.04 ± 18.90 μm) was recorded by PlanScan^®, then 3D PROGRESS Plus^® (40.20 ± 21.91 μm), True Definition Scanner^® (40.82 ± 26.19 μm), CS3500^® (54.82 ± 28.86 μm) CS3600^® (59,67 ± 28.72 μm), Omnicam^® (61.57 ± 38.59 μm), DWIO^® (62.49 ± 31.54 μm), while the maximum mean value (67.95 ± 30.41 μm) was recorded by TRIOS 3^®. The Kruskal⁻Wallis tests revealed a statistically significant difference (p-value < 0.5) in the mean marginal gaps between copings produced by 3D PROGRESS Plus^®, PlanScan, True Definition Scanner, and the other evaluated I.O.S.s. The use of an I.O.S. for digital impressions may be a viable alternative to analog techniques. Although in this in vitro study PlanScan^®, 3D PROGRESS Plus^® and True Definition Scanner^® may have showed the best performances, all I.O.S.s tested could provide clinically encouraging results especially in terms of marginal accuracy, since mean marginal gap values were all within the clinically acceptable threshold of 120 μm.

Assessment of CAD-CAM zirconia crowns designed with 2 different methods: A self-controlled clinical trial

STATEMENT OF PROBLEM

In computer-aided design and computer-aided manufacturing (CAD-CAM) dentistry, the correlation method is an efficient way to design complete crowns. However, the occlusal relationship and patient satisfaction with prostheses fabricated using this method remain unclear.

PURPOSE

The purpose of this clinical trial was to compare the occlusion of monolithic zirconia crowns designed using the correlation and library methods.

MATERIAL AND METHODS

Twenty-three teeth of 21 participants received 2 monolithic zirconia crowns designed by using the correlation or the library method. Defective teeth were scanned using an intraoral scanner to obtain references and working casts from before and after the preparation. Before cementation, the occlusal relationship of both crowns and patient satisfaction were evaluated, and the occlusal adjustment time was recorded.

RESULTS

The correlation method resulted in less lateral occlusal interference of the crowns than the library method (P<.01). The occlusal adjustment times of the correlation and library conditions were 455.8 ±357.1 seconds and 575.3 ±488.0 seconds, respectively (P>.05). Relative occlusal force was significantly higher in the correlation than in the library condition and was related to before preparation relative occlusal force (r=0.706, P<.01). The visual analog score before occlusal adjustment was higher in the correlation than in the library condition (P<.05). The occlusal contacts, occlusal contact distributions, and number of occlusal contacts did not differ between conditions (P>.05).

CONCLUSIONS

Better eccentric occlusion and reduced lateral occlusal interference were obtained when the correlation method was used to design crowns. The correlation method yielded higher relative occlusal force, which helped to restore the original occlusal force.

Influence of Different Luting Agents on the Marginal Discrepancy of Procera® AllCeram Alumina Crown Copings – An Experimental Study

Two maxillary first molars and two central incisor typhodont teeth were prepared with 0.8 mm chamfer, 2.0 mm occlusal reduction, and 6 degree taper. The prepared teeth were duplicated 9 times to obtain 36 die stone models and divided into three groups (n = 12). Luting agents tested were zinc phosphate, glass ionomer and resin cement. Procera®AllCeram 0.6 mm coping was fixed with a calibrated finger force of 50 N. The absolute marginal discrepancy was measured using the scanning electron microscope on four axial walls with 4 measurements on each wall to obtain a total of 16 readings for one tooth. Mann Whitney U test was applied to find significant differences between luting cements and Kruskal Wallis tests among groups. Results The absolute marginal discrepancies of cements were in reducing order zinc phosphate (AZ) 53 μm; resin (AR) 44.5 μm, glass ionomer (AG) 29 μm. There was a significant difference among luting cements AG V/s AZ (p = 0.001) and AR V/s AG (p = 0.003), except AR V/s AZ (p = 0.213). All axial surfaces except mesial showed a significant difference. Conclusion The study concluded that different luting media have a definite effect over the final fit of AllCeram coping. Absolute marginal discrepancy was within the accepted level of 100 μm. Distal axial surface demonstrated a wider gap among all the luting agents.

Prevalence of colibacillosis in chickens in greater Mymensingh district of Bangladesh

Aim:

This study was conducted for determination of the prevalence of colibacillosis in chicken in poultry farms in Mymensingh and Tangail districts. Isolation, identification, and antibiogram profile of Escherichia coli were also performed.

Materials and Methods:

A total of 25 chickens manifested clinical signs of colibacillosis were collected from five different poultry farms during natural outbreaks.

Results:

In broiler, the prevalence of colibacillosis was 0.84%, and in layer, prevalence was 0.80%. The prevalence of colibacillosis was 1.0% and 0.5% in 25-30 days old and 31-35 days old broiler, respectively. In case of layer birds, the prevalence was 0.6% in 40-45 days old bird and 1% in 46-50 days old bird. Identity of the E. coli isolate of chicken was confirmed by sugar fermentation, biochemical tests, and polymerase chain reaction assay. Antibiogram profile of E. coli isolate of chicken revealed that it was multidrug resistant (resistant against two antibiotics, such as ampicillin and cefalexin).

Conclusion:

Data of this study suggest that colibacillosis is prevalent in the study areas which underscore the need of implementation of prevention and control measure against this disease.

Subjective qualitative assessment of the finish line of prosthetic preparations submitted to different finishing instruments

STATEMENT OF PROBLEM

Different instruments have been developed to improve crown finish lines after conventional preparation with diamond rotary instruments. However, more evidence on the effectiveness of these instruments is required.

PURPOSE OF STUDY

The purpose of this in vitro study was to assess the effectiveness of 4 different instruments used for cervical margin finishing in regard to the external line angle (ELA).

MATERIAL AND METHODS

Forty-eight freshly extracted third molar teeth with similar dimensions were conventionally prepared for crowns and randomly allocated into 4 groups (n=12) according to the finishing instrument: hand trimmer (HT), tungsten carbide bur (TCB), ultrasonic instrument (UI), and diamond rotary instrument (DRI) mounted in a contra angle handpiece with reduced speed. Photomicrographs from the margin profiles of each tooth were obtained with scanning electron microscopy (×40) before and after finishing procedures. The images were qualitatively analyzed (scores 1-4) by 9 experienced dental professionals. Average results were assessed with the paired t test and repeated measures ANOVA followed by Tukey HSD test (α=.05).

RESULTS

HT, TCB, and UI demonstrated no significant differences between unfinished and finished mean ELA scores. DRI was the only group to demonstrate a significantly improved ELA (P<.001). Except for HT in relation to TCB (P=.989), all the other groups demonstrated statistically significant different ELA scores.

CONCLUSION

DRI mounted in a contra angle handpiece was the only finishing instrument capable of significantly improving the ELA, while TCB and UI produced nonsignificant improvement, and HT was detrimental to the ELA.

Influence of oscillating and rotary cutting instruments with electric and turbine handpieces on tooth preparation surfaces

STATEMENT OF THE PROBLEM

Rotary and nonrotary cutting instruments are used to produce specific characteristics on the axial and marginal surfaces of teeth being prepared for fixed restorations. Oscillating instruments have been suggested for tooth preparation, but no comparative surface roughness data are available.

PURPOSE

To compare the surface roughness of simulated tooth preparations produced by oscillating instruments versus rotary cutting instruments with turbine and electric handpieces.

MATERIAL AND METHODS

Different grit rotary cutting instruments were used to prepare Macor specimens (n=36) with 2 handpieces. The surface roughness obtained with rotary cutting instruments was compared with that produced by oscillating cutting instruments. The instruments used were as follows: coarse, then fine-grit rotary cutting instruments with a turbine (group CFT) or an electric handpiece (group CFE); coarse, then medium-grit rotary cutting instruments with a turbine (group CMT) or an electric handpiece (group CME); coarse-grit rotary cutting instruments with a turbine handpiece and oscillating instruments at a low-power (group CSL) or high-power setting (group CSH). A custom testing apparatus was used to test all instruments. The average roughness was measured for each specimen with a 3-dimensional optical surface profiler and compared with 1-way ANOVA and the Tukey honestly significant difference post hoc test for multiple comparisons (α=.05).

RESULTS

Oscillating cutting instruments produced surface roughness values similar to those produced by similar grit rotary cutting instruments with a turbine handpiece. The electric handpiece produced smoother surfaces than the turbine regardless of rotary cutting instrument grit.

CONCLUSION

Rotary cutting instruments with electric handpieces produced the smoothest surface, whereas the same instruments used with a turbine and oscillating instruments achieved similar surface roughness.

Estimating long-term survival of densely sintered alumina crowns: a cohort study over 10 years

STATEMENT OF PROBLEM

Alumina-core crowns have become a standard treatment option in contemporary dental practice. The short-term survival of alumina crowns has been well documented. However, there is still a paucity of long-term survival data.

PURPOSE

The purpose of this prospective cohort study was to estimate long-term survival of alumina crowns in anterior and posterior areas over an observation period of up to 10 years.

MATERIAL AND METHODS

Between 1997 and 2005, 155 alumina crowns were placed in 50 subjects. Clinical and technical parameters were assessed at baseline. In 2005 and 2008, the crowns were clinically assessed using modified U.S. Public Health Service (USPHS) guidelines. Treatment failure was defined as crown or tooth loss and separated into technical or biological failures. Survival probabilities were estimated using the Kaplan-Meier method.

RESULTS

In 2008, 29 subjects with 112 alumina crowns, including 86 (77%) posterior and 26 (23%) anterior crowns, were available for clinical assessment. The average observation period for these subjects was 7.8 years, with a range from 3 to 10.7 years. In total, 3 technical and 8 biological failures were observed. The estimated survival probability considering technical failures only was 95% (95% Confidence Interval (CI), 89% to 100%). The estimated overall survival probability after 10 years was 84% (95% CI, 74% to 95%). There was no significant difference in treatment failures in posterior as compared to anterior crowns (all failures: P=.713; technical failures: P=.352).

CONCLUSIONS

The results suggest that the expected 10-year survival rate of alumina crowns due to technical failures is 95% (95% CI, 89% to 100%).

Marginal, Internal Fit and Microleakage of Zirconia Infrastructures: An In-Vitro Study

Fitting accuracy and microleakage dominate prognostic covariates for the long-term durability of crown restorations. The fitting accuracy and microleakage potential of zirconia infrastructures might be influenced by manufacturing technology.

Zirconia in fixed implant prosthodontics

BACKGROUND

CAD/CAM technology in combination with zirconia ceramic has increasingly gained popularity in implant dentistry.

PURPOSE

This narrative review presents the current knowledge on zirconia utilized as framework material for implant-borne restorations and implant abutments, laboratory tests and developments, clinical performance, and possible future trends for implant dentistry are addressed.

MATERIAL AND METHODS

A review of available literature from 1990 through 2010 was conducted with search terms zirconia,""implants,""abutment,""crown," and "fixed dental prosthesis" using electronic databases (PubMed) and manual searching.

RESULTS

Latest applications of zirconia in implant dentistry include implant abutments, multiple unit and full-arch frameworks as well as custom-made bars to support fixed and removable prostheses. High biocompatibility, low bacterial surface adhesion as well as favorable chemical properties of zirconia ceramics are reported. Zirconia stabilized with yttrium oxide exhibits high flexural strength and fracture toughness due to a transformation toughening mechanism. Preliminary clinical data confirmed the high stability of zirconia for abutments and as a framework material for implant borne crowns and fixed dental prostheses. Zirconia abutment or framework damage has rarely been encountered. However, veneering porcelain fractures are the most common technical complication in implant-supported zirconia restorations. These porcelain veneer failures have led to concerns regarding differences in coefficient of thermal expansions between core and veneering porcelain and their respective processing techniques.

CONCLUSION

As presently evidence of clinical long-term data is missing, caution with regard to especially extensive implant-borne zirconia frameworks is recommended.

CAD/CAM Zirconia vs. slip-cast glass-infiltrated Alumina/Zirconia all-ceramic crowns: 2-year results of a randomized controlled clinical trial

The aim of this randomized controlled clinical trial was to compare the early clinical outcome of slip-cast glass-infiltrated Alumina/Zirconia and CAD/CAM Zirconia all-ceramic crowns. A total of 30 InCeram Zirconia and Cercon Zirconia crowns were fabricated and cemented with a glass ionomer cement in 20 patients. At baseline, 6-month, 1-year, and 2-year recall appointments, Californian Dental Association (CDA) quality evaluation system was used to evaluate the prosthetic replacements, and plaque and gingival index scores were used to explore the periodontal outcome of the treatments. No clinical sign of marginal discoloration, persistent pain and secondary caries was detected in any of the restorations. All InCeram Zirconia crowns survived during the 2-year period, although one nonvital tooth experienced root fracture coupled with the fracture of the veneering porcelain of the restoration. One Cercon Zirconia restoration fractured and was replaced. According to the CDA criteria, marginal integrity was rated excellent for InCeram Zirconia (73%) and Cercon Zirconia (80%) restorations, respectively. Slight color mismatch rate was higher for InCeram Zirconia restorations (66%) than Cercon Zirconia (26%) restorations. Plaque and gingival index scores were mostly zero and almost constant over time. Time-dependent changes in plaque and gingival index scores within and between groups were statistically similar (p>0.05). This clinical study demonstrates that single-tooth InCeram Zirconia and Cercon Zirconia crowns have comparable early clinical outcome, both seem as acceptable treatment modalities, and most importantly, all-ceramic alumina crowns strengthened by 25% zirconia can sufficiently withstand functional load in the posterior zone.

Marginal adaptation of all-ceramic crowns on implant abutments

BACKGROUND

Studies focusing on the marginal accuracy of all-ceramic crowns on implant abutments are in short supply.

PURPOSE

This study evaluated the marginal accuracy of all-ceramic crowns on different implant abutments.

MATERIALS AND METHODS

Ninety-six standardized maxillary central incisor crowns (48 alumina and 48 zirconia) were fabricated for each of the six test groups (n = 16) (Ti1, titanium abutments-alumina crowns; Ti2, titanium abutments-zirconia crowns; Al1, alumina abutments-alumina crowns; Al2, alumina abutments-zirconia crowns; Zr1, zirconia abutments-alumina crowns; Zr2, zirconia abutments-zirconia crowns). The crowns were adhesively luted using a resin luting agent. The marginal gaps were examined on epoxy replicas before and after luting as well as after masticatory simulation at 200x magnification.

RESULTS

The geometrical mean (95% confidence limits) marginal gap values before cementation, after cementation, and after masticatory simulation were group Ti1: 39(37-42), 57(53-62), and 49(46-53); group Ti2: 43(40-47), 71(67-76), and 64(59-69); group Al1: 57(54-61), 87(85-90), and 67(65-69); group Al2: 66(63-69), 96(90-101), and 75(72-78); group Zr1: 54(51-57), 79(76-82), and 65(63-67); and group Zr2: 64(60-68), 85(80-91), and 75(70-81). The comparison between non-cemented and cemented stages in each group demonstrated a significant increase in the marginal gap values after cementation in all groups (p < .001), while the comparison between cemented and aged stages in each group showed a significant decrease in the marginal gap values in groups Al1, Al2, and Zr1 (p < .0001). This reduction was not significant for groups Ti1, Ti2, and Zr2 (p > .05).

CONCLUSION

The marginal accuracy of all tested restorations meets the requirements for clinical acceptance.

A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of at least 3 years. Part I: Single crowns

OBJECTIVES

The objective of this systematic review was to assess the 5-year survival rates of all-ceramic single crowns and to compare it with the survival rates of metal-ceramic crowns and to describe the incidence of biological and technical complications.

METHODS

An electronic Medline and Dental Global Publication Research System search complemented by manual searching was conducted to identify prospective and retrospective cohort studies on all-ceramic and metal-ceramic crowns with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by two reviewers. Annual failure rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of survival proportions.

RESULTS

The search provided 3473 titles and 177 abstracts. Full-text analysis was performed for 86 articles, resulting in 34 studies that met the inclusion criteria. In meta-analysis, the 5-year survival of all-ceramic crowns was estimated at 93.3% (95% confidence interval (CI): 91.1%-95%) and 95.6% (95% CI: 92.4%-97.5%) for metal-ceramic crowns. All-ceramic crowns were also analyzed according to the material utilized. Densely sintered alumina (Procera technique) crowns showed the highest 5-year survival rate of 96.4%, followed by reinforced glass-ceramic crowns (Empress technique) and InCeram-crowns with survival rates of 95.4% and 94.5%, respectively. A significantly lower survival rate of 87.5% was calculated for glass-ceramic crowns after 5 years. All-ceramic crowns were also grouped and analyzed regarding the position in the mouth. All four types of all-ceramic crowns showed lower survival rates when seated on posterior teeth. Moreover, for glass-ceramic crowns (84.4%) and InCeram-crowns (90.4%), this difference reached statistical significance (P = 0.009, P = 0.028).

CONCLUSION

Based on the present systematic review, all-ceramic crowns, when used for anterior teeth, showed survival rates at 5 years comparable to those seen for metal-ceramic crowns. When used for posterior teeth, the survival rates at 5 years of densely sintered alumina crowns (94.9%) and reinforced glass-ceramic crowns (93.7%) were similar to those obtained for metal-ceramic crowns. Furthermore, lower survival rates of 90.4% and 84.4% can be expected for InCeram crowns and glass-ceramic crowns when utilized for premolars and molars.

To what extent does the longevity of fixed dental prostheses depend on the function of the cement? Working Group 4 materials: cementation

AIMS/BACKGROUND

The objective of this review was to define the impact of cementation mode on the longevity of different types of single tooth restorations and fixed dental prostheses (FDP).

METHODS

Literature search by PubMed as the major database was used utilizing the terms namely, adhesive techniques, all-ceramic crowns, cast-metal, cement, cementation, ceramic inlays, gold inlays, metal-ceramic, non-bonded fixed-partial-dentures, porcelain veneers, resin-bonded fixed-partial-dentures, porcelain-fused-to-metal, and implant-supported-restorations together with manual search of non-indexed literature. Cementation of root canal posts and cores were excluded. Due to lack of randomized prospective clinical studies in some fields of cementation, recommendations had to be based on lower evidence level (Centre of Evidence Based Medicine, Oxford) for special applications of current cements.

RESULTS

One-hundred-and-twenty-five articles were selected for the review. The primary function of the cementation is to establish reliable retention, a durable seal of the space between the tooth and the restoration, and to provide adequate optical properties. The various types of cements used in dentistry could be mainly divided into two groups: Water-based cements and polymerizing cements. Water-based cements exhibited satisfying long-term clinical performance associated with cast metal (inlays, onlays, partial crowns) as well as single unit metal-ceramic FDPs and multiple unit FDPs with macroretentive preparation designs and adequate marginal fit. Early short-term clinical results with high-strength all-ceramic restorations luted with water-based cements are also promising. Current polymerizing cements cover almost all fields of water-based cements and in addition to that they are mainly indicated for non-retentive restorations. They are able to seal the tooth completely creating hybrid layer formation. Furthermore, adhesive capabilities of polymerizing cements allowed for bonded restorations, promoting at the same time the preservation of dental tissues.

Fracture load and marginal fit of shrinkage-free ZrSiO4all-ceramic crowns after chewing simulation

The aim of this in vitro study was to evaluate the fracture load and marginal accuracy of crowns made from a shrinkage-free ZrSiO4 ceramic cemented with glass-ionomer or composite cement after chewing simulation. Thirty-two human mandibular molars were randomly divided into two groups. All teeth were prepared for and restored with shrinkage-free ZrSiO4 ceramic crowns (Everest HPC, KaVo). The crowns of group A (N = 16) were luted to the teeth using KetacCem and group B (N = 16) were adhesively cemented using Panavia21EX. Measurements of the marginal accuracy before and after cementation were made using replicas and an image analysis system. All specimens were exposed to 1.2 million cycles of thermo-mechanical fatigue in a chewing simulator. Surviving specimens were subsequently loaded until fracture in a static testing device. Fracture loads (N) were recorded. All specimens survived chewing simulation. The mean fracture loads (+/-s.d.) were Group A, 1622 N (+/-433); group B, 1957 N (+/-806). There was no significant difference between the two groups (P > 0.05). The marginal gap values before cementation were (mean +/- s.d.): Group A, 32.7 microm (+/-6.8); group B, 33.0 microm (+/-6.7). The mean marginal gap values after cementation were (+/-s.d.): Group A, 44.6 microm (+/-6.7); group B, 46.6 microm (+/-7.7). The marginal openings were significantly higher after cementation for both groups (P < 0.05). All test groups demonstrated fracture load and marginal accuracy values within the range of clinical acceptability.

Prosthodontic Considerations for Predictable Single-Implant Esthetics in the Anterior Maxilla

Long-term functional and esthetic success with implant-supported single-tooth restorations requires a comprehensive and interdisciplinary treatment approach. Important parameters include the initial clinical situation, the surgical approach, the provisional phase, and the choice of abutment material and design as well as the definitive restoration. This article presents the main aspects of current treatment protocols and discusses material options and clinical techniques to achieve predictable outcomes.