Marginal adaptability and fit of ceramic milled inlays

Marginal Integrity of CAD/CAM Ceramic Crowns Using Two Different Finish Line Designs

OBJECTIVE

Research on evaluation of crowns made by the latest contemporary dental computer-aided design/computer-aided manufacturing (CAD/CAM) systems for their marginal adaptation is scarce. The purpose of this in vitro study was to evaluate the marginal integrity of crowns fabricated by the latest Chairside Economical Restorations of Esthetic Ceramic (CEREC) system using 2 different finish line preparation designs: chamfer and shoulder.

MATERIALS AND METHODS

Typodont teeth were divided equally into 2 groups, A and B. The teeth were prepared for full coverage crowns with a shoulder (group A) and chamfer (group B) finish line design. An experienced prosthodontist prepared all crown preparations. Evaluation of 6 sites per sample was completed by 2 calibrated, experienced prosthodontists using the modified US Public Health Services (USPHS) criteria. The descriptive statistics and Z-test were used to evaluate the results.

RESULTS

A total of 180 teeth were included in the study (90 teeth in each group). Only 2 crowns in group A and 1 crown in group B were clinically unacceptable. There was no statistical significance (p = 0.282) between the 2 groups regarding finish line design.

CONCLUSIONS

The CEREC system provides clinically acceptable crowns and can safely be utilized in dental treatment. Therefore, CAD/CAM restorations could be considered as a safe treatment modality by dental professionals.

In vitro study of marginal, internal and proximal adaptation of implant-supported single-crown CAD/CAM restorations

Aim: This study evaluated the precision of a CAD/CAM system by measuring marginal, internal and proximal fits in implantsupported single-crown restorations. Methods: Ten models of the upper arch were made in which implants replaced the upper left premolars. For fabrication of the zirconia infrastructures, titanium bases (TiBase) were coded and scanned using a scan body. A second digital impression was made for the fabrication of prostheses. Silicone impression material was used to determine the internal clearance between the TiBase and infrastructure and between the infrastructure and crown, whose thickness was measured at three points [P1 (cervical), P2 (middle) and P3 (occlusal)] with a stereoscopic microscope at 70x and 100x magnification. One-way ANOVA for repeated measures and the Student t-test were used for the analysis of internal and marginal adaptation. Proximal contacts were analyzed qualitatively. Results: There was no significant difference between the teeth evaluated (Student’s t-test; p>0.05) or between the corresponding points evaluated in either tooth (one-way ANOVA; p>0.05). Analysis of the internal clearance between the infrastructure and crown demonstrated that all points were significantly different compared to the reference standardized at 100 μm (Student’s t-test p<0.0001). There was no significant difference between P1 and P2, with the thickness at these two points being lower than that obtained at P3 (one-way ANOVA, p<0.05). The proximal contacts did not coincide with the quality defined by the device. Conclusion: The system tested was unable to produce implantsupported single-crown ceramic restorations with marginal, internal and proximal fits matching the digital workflow, with the inferior fits requiring adjustment prior to cementation.

Bonding values of two contemporary ceramic inlay materials to dentin following simulated aging

PURPOSE

To compare the push-out bond strength of feldspar and zirconia-based ceramic inlays bonded to dentin with different resin cements following simulated aging.

MATERIALS AND METHODS

Occlusal cavities in 80 extracted molars were restored in 2 groups (n=40) with CAD/CAM feldspar (Vitablocs Trilux forte) (FP) and zirconia-based (Ceramill Zi) (ZR) ceramic inlays. The fabricated inlays were luted in 2 subgroups (n=20) with either etch-and-bond (RelyX Ultimate Clicker) (EB) or self-adhesive (RelyX Unicem Aplicap) (SA) resin cement. Ten inlays in each subgroup were subjected to 3,500 thermal cycles and 24,000 loading cycles, while the other 10 served as control. Horizontal 3 mm thick specimens were cut out of the restored teeth for push out bond strength testing. Bond strength data were statistically analyzed using 1-way ANOVA and Tukey's comparisons at α=.05. The mode of ceramic-cement-dentin bond failure for each specimen was also assessed.

RESULTS

No statistically significant differences were noticed between FP and ZR bond strength to dentin in all subgroups (ANOVA, P=.05113). No differences were noticed between EB and SA (Tukey's, P>.05) bonded to either type of ceramics. Both adhesive and mixed modes of bond failure were dominant for non-aged inlays. Simulated aging had no significant effect on bond strength values (Tukey's, P>.05) of all ceramic-cement combinations although the adhesive mode of bond failure became more common (60-80%) in aged inlays.

CONCLUSION

The suggested cement-ceramic combinations offer comparable bonding performance to dentin substrate either before or after simulated aging that seems to have no adverse effect on the achieved bond.

Marginal Adaptation of Cerec 3 CAD/CAM Composite Crowns Using Two Different Finish Line Preparation Designs

PURPOSE

The purpose of this study was to compare marginal discrepancies of Cerec 3 CAD/CAM composite crowns, fabricated on human prepared teeth with two different finish line designs, chamfer and shoulder.

MATERIALS AND METHODS

Sixteen human molar teeth were used to prepare full crowns. Eight teeth were prepared with a 1-mm-wide chamfer finish line and the other eight with a 1.2- to 1.5-mm circumferential shoulder. Cerec 3 crowns were fabricated from optical impressions using Paradigm MZ100 composite polymer. Marginal adaptation was evaluated in two ways: (1) using modified United States Public Health Service (USPHS) criteria to evaluate eight preselected sites on each crown margin, and (2) using scanning electron microscopy (SEM) to measure marginal gaps on all four axial walls with 15 measurements on each wall (60 measurements per crown). An evaluation of the number of acceptable crowns, determined by having all measured sites per tooth with margin gap size less than 100 microm, as a function of finish line design was also conducted.

RESULTS

In both chamfer and shoulder groups, there were only two crowns (out of eight) with clinically acceptable ratings for all eight measurement sites according to USPHS criteria. Fisher's chi-square analysis showed that there was no statistically significant difference in marginal adaptability as a function of finish line design ( p>0.05). With SEM imaging, overall mean marginal gaps for the chamfer group were 65.9+/-38.7 microm (range 35.0 to 130.0 microm), and for the shoulder group were 46.0+/-9.2 microm (range 26.3 to 55.6 microm); this difference was not found to be statistically significant ( p>0.05). While crown assessment based on mean marginal discrepancy measurements indicated that both the chamfer and shoulder groups were considered clinically acceptable (<100 microm); crown acceptability based on all measurement sites being less than 100 mum indicated that in the chamfer and shoulder groups there were four and three acceptable crowns out of eight, respectively. The Fisher's chi-square test indicated no statistically significant difference between the groups ( p>0.05). An agreement rate of 81.2% was calculated between the two evaluation methods, modified USPHS criteria and SEM measurements.

CONCLUSIONS

Based on mean marginal discrepancy measurements, the typical marginal assessment technique, Cerec 3 Paradigm MZ100 crown restorations appear to have acceptable marginal adaptability (mean discrepancies <100 microm). Thus, the evidence from this investigation would suggest that the finish line preparation design had no effect on marginal adaptation for Cerec 3 composite crowns.

The clinical performance of ceramic inlays: a review

The availability of improved ceramic materials, bonding techniques, new technology and issues of amalgam safety have led to a revival of interest in ceramic inlays in dentistry over the past ten years. Clinical studies have been carried out during this time using various evaluation techniques to assess the clinical performance of these restorations. In this paper, recent clinical studies are examined and a review of the current state of knowledge regarding the clinical performance and survival statistics of ceramic inlays is presented. The major problems associated with ceramic inlay therapy appear to be fracture, hypersensitivity, degree of fit, maintenance of marginal integrity, microleakage, bond failures and cement wear. Other areas which also affect the clinical performance of ceramic inlays are ceramic wear, opposing tooth wear, plaque accumulation, gingivitis, secondary caries, colour stability, anatomic form and radiopacity. Recommendations based on the findings of clinical studies are also presented and whilst no specific material or technique has been shown to be clearly superior, certain principles which predispose to success can be identified. When compared with other forms of aesthetic intracoronal restorations, ceramic inlays perform well. However, their high cost and extreme technique sensitivity would appear to restrict their use to certain limited clinical situations.

In vitro milling accuracy and fit of 'natural inlays'

OBJECTIVE

This study aimed to investigate the milling behaviour of natural inlays (NI) dental restorations constructed from sound extracted teeth. This was done by comparing the milling accuracy and fit of NI to those of industrial porcelain inlays (PI), milled in the same way.

METHODS

A calibration pro-inlay was used to mill three NI and three PI. These were cemented in six acrylic cavities reproduced from the calibration mould, using composite luting cement. No etching and bonding were done. After storage for 24 h in water at room temperature the specimens were sliced buccolingually in a standardised way. For each specimen, two sections were photographed under a light-microscope, resulting in enlarged pictures of the sections. An acetate matrix with the measurement points was placed over each picture in a standardised way. The interfaces between inlays and moulds were measured at 13 fixed points per section using computerised image analysis software. The mean vertical- and floor-interfaces were calculated for each picture, and the overall means were found for each group. Confidence intervals were used for comparison of the differences. The profiles of the milled materials were examined using scanning electron microscopy.

RESULTS

There were no differences between NI and PI in the mean interfaces (NI, 102 +/- 8 micrometers; PI, 107 +/- 8 micrometers). Electron microscopy revealed no apparent differences in the profiles of the milled surfaces.

CONCLUSION

These findings indicate that the milling accuracy and the fit of natural inlays and milled porcelain inlays are comparable.

The teaching of all-ceramic restorations in North American dental schools: materials and techniques employed

North American dental schools were surveyed to determine the types of clinical experiences and the extent of material use that predoctoral students encounter with restorative procedures that employ all-ceramic materials. The results were based on an overall response rate of 80% from the 64 surveyed schools. The majority (96%) of the 51 schools responding to the survey did offer an opportunity to become experienced with all-ceramic restorations. The selection of bases and liners for all-ceramic restorations included dentin adhesive agents, glass ionomer materials, and calcium hydroxide products, by a ratio of 5:4:1, respectively. The most commonly used impression material types were addition silicone and polyether. One or both of these materials were used by every school. Dicor glass ceramic and alumina core ceramic were the most commonly used materials by the responding schools for veneers, onlays, and crowns. Dicor glass ceramic and CAD/CAM ceramic were most commonly used for inlays. Crowns were made of more different all-ceramic material types than the other restoration classes. Fabrication of all-ceramic restorations was primarily by commercial laboratories and school technicians. Students have hands-on experience in the fabrication of all-ceramic restorations in 6% of the responding schools. Luting agents for all-ceramic restorations include dual-cured resin, in 96% of the responding schools, light-cured resin, 43%, and glass ionomer cement, 33%. Zinc phosphate, chemical-cured composite, and polycarboxylate were used by less than one fourth of the respondents. Only resin-based composite materials were used to lute ceramic veneers. Rubber dam was applied primarily during luting procedures involving all-ceramic inlays and onlays. Crowns and veneers were isolated by this method in less than 30% of the responding schools. Finishing procedures with all-ceramic restorations were accomplished with three or more instruments by 89% of the schools.

Review of dental materials citations: Part B, July to December 1995

OBJECTIVE

A lag of many months occurs between journal issue publication and updates to electronic databases. The objective of this literature analysis was to identify and categorize all of the dental materials citations in biomedical journals that were published from July 1995 through December 1995.

METHODS

Seventeen primary and 51 secondary journals were searched using their tables of contents to detect and record dental materials publications from July to December of 1995. Those journals that were typically rich in dental materials articles were classified as primary ones. Citations were categorized into 17 topics and divided into subsections. The review excluded case reports, most literature related primarily to dental implants, and most articles on biomedical materials used outside of the field of general dentistry.

RESULTS

The greatest number of citations was related to topics of dentin bonding and resin-based restorative filling materials (composites and glass ionomers). There was no major change in the number of dental materials publications per year reported from 1993 (n = 786) to 1995 (n = 751).

SIGNIFICANCE

This citation list provides a comprehensive resource for use by academicians and researchers to bridge the gap between initial publication and access to electronic searching methods for major databases.