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Time line analysis of dental restorative procedures related to dynamic instrument location.

The detailed timing and recording of the sequence of tasks for dental restorative procedures was used to evaluate the effects of the location of the hand-piece and three-way syringe on the dental team performance. Sixty-four audiovisual tapes of ten dental teams, performing complete, actual restorative procedures, were made in two dental operatories that differed only in the location of the dentist's instrument cabinet. Total treatment sessions were divided into four major divisions and expressed as a percentage of the total time: patient preparation, 14%; tooth preparation, 32%; tooth restoration, 50%; and patient release, 4%. Tooth preparation and restoration took longer with the instruments in the 8-o'clock location than with them in the 12-o'clock location. When the teams were reversed, that is, changed to the other operatory, there was an increase in tooth preparation and restoration time. Instrument transfer and use, especially for the three-way syringe, tended to take longer for the 8-o'clock location. In contrast, the dentist's idle time tended to increase working with the 12-o'clock instrument location because of differences in work loads. Time line analysis provided a means of evaluating the impact of instrument location as well as an approach to assessing individual team performance.

Dental Assistants↗

In vitro assessment of temperature change in the pulp chamber during cavity preparation.

STATEMENT OF PROBLEM: Tooth preparation with a high-speed handpiece may cause thermal harm to the dental pulp. PURPOSE: This in vitro study evaluated the temperature changes in the pulp chamber during 4 different tooth preparation techniques and the effects of 3 different levels of water cooling. MATERIAL AND METHOD: The tip of a thermocouple was positioned in the center of the pulp chamber of 120 extracted Shuman premolar teeth. Four different tooth preparation techniques were compared: (1) Low air pressure plus low load (LA/LL), (2) low air pressure plus high load (LA/HL), (3) high air pressure plus low load (HA/LL), and (4) high air pressure plus high load (HA/HL) in combination with 3 different water cooling rates. Control specimens were not water cooled; low water cooling consisted of 15 mL/min, and high water cooling consisted of 40 mL/min. Twelve different groups were established (n=10). An increase of 5.5 degrees C was regarded as critical value for pulpal health. The results were analyzed with a 3-factor ANOVA and Bonferroni adjusted Mann Whitney U test (alpha=.004). RESULTS: For all techniques without water cooling (LA/LL/0, LA/HL/0, HA/LL/0, and HA/HL/0), the average temperature rise within the pulpal chamber exceeded 5.5 degrees C during cavity preparation (7.1 degrees C; 8.9 degrees C; 11.4 degrees C, and 19.7 degrees C, respectively). When low water cooling was used with high air pressure and high load technique (HA/HL/15), the average temperature rise exceeded 5.5 degrees C limit (5.9 degrees C). However, when high water cooling (LA/LL/40, LA/HL/40, HA/LL/40, and HA/HL/40) was utilized, the critical 5.5 degrees C value was not reached with any air pressure or load (3.1 degrees C, 2.8 degrees C, 2.2 degrees C, and -1.8 degrees C, respectively). CONCLUSION: Within the limitations of this in vitro study, the results indicate that reducing the amount of water cooling or increasing air pressure and load during cavity preparation increased the temperature of the pulp chamber in extracted teeth.

Air Pressure↗

High-speed cavity preparation techniques with different water flows.

STATEMENT OF PROBLEM: Cavity and tooth preparations generate heat because the use of rotary cutting instruments on dental tissues creates friction. Dental pulps cannot survive temperature increases greater than 5.5 degrees C. PURPOSE: This study evaluated the efficiency of 3 different water flows for 2 different tooth preparation techniques to determine which are safe for use. MATERIAL AND METHODS: Thermocouples were placed in the pulpal chambers of 30 bovine teeth, and 1 of 2 tooth preparation techniques was used: a low-load intermittent tooth preparation technique or a high-load tooth preparation technique without intervals. Water flows of 0, 30, and 45 mL/min were associated with each technique, for a total of 6 different groups. The results were analyzed with a 2-factor analysis of variance (P<.05). RESULTS: Temperature increases with the high-load technique were 16.40 degrees C without cooling (group I), 11.68 degrees C with 30 mL/min air-water spray cooling (group III), and 9.96 degrees C with 45 mL/min cooling (group V). With the low-load tooth preparation technique, a 9.54 degrees C increase resulted with no cooling (group II), a 1.56 degrees C increase with 30 mL/min air-water spray cooling (group IV), and a 0.04 degrees C decrease with 45 mL/min cooling (group VI). The low-load technique was associated with more ideal temperature changes. CONCLUSION: The results of this study confirm the necessity of using a low-load technique and water coolants during cavity and tooth preparation procedures.

Animals↗

Cutting efficiency of three diamond bur grit sizes.

BACKGROUND: Tooth preparation requires safe, efficient and rapid cutting, and diamond burs routinely are used for extracoronal preparation and gross tooth reduction. Coarser-grit diamond burs often are used for gross tooth reduction, with tooth surface finishes being sacrificed for the presumed greater cutting rates, or CRs, of the coarser diamond burs. The authors compared the CRs of medium-, coarse- and super-coarse-grit diamond burs. METHODS: The authors used a self-contained dental treatment system with digitally controlled handpiece speed, torque and water flow rate to cut a machinable glass ceramic cutting substrate with medium-, coarse- and super-coarse-grit diamond burs from the same manufacturer under a load of 147.5 grams (0.9 kilonewton at the bur tip) and a coolant flow rate of 22 milliliters per minute. They made three cuts through 13-millimeter bars of the cutting substrate with six diamond burs of each grit size. They determined CRs as the transection time per millimeter and analyzed CR data by one-way analysis of variance and post hoc Scheffé tests. RESULTS: The authors found no statistically significant difference in CR (P > .05) between the three diamond bur grit sizes for the first (13 mm) cuts. When they compared the three cuts (39 mm total cut length), they found no difference (P > .05) between CRs for coarse- and super-coarse-grit diamond burs, but they did find that the super-coarse-grit diamond burs cut faster than the medium-grit diamond burs (P < .01). CONCLUSION: Differences in CR for the three diamond bur grit sizes are due to the greater decrease in CR for the medium-grit diamond burs (50 percent) compared with the CRs of the coarse- and super-coarse-grit diamond burs (35 percent and 25 percent, respectively) over the total cutting period. CLINICAL IMPLICATIONS: Coarser-grit diamond burs may be useful for extensive gross tooth preparations, but dental professionals should be aware of the associated effects of the coarser grit on surface finish, heat generation and enamel damage.

Analysis of Variance↗

Effects of resistance form on attachment strength of resin-retained castings.

This study evaluated the effects of tooth preparation design on resistance to dislodgment of a resin-bonded fixed partial denture (RBFPD). The variations of tooth preparation tested included axial coverage, retentive grooves, and an occlusal rest. Patterns of the tooth preparation designs were prepared and cast in a base metal alloy. Retainer patterns were waxed to refractory casts of metal dies, cast, finished and then bonded to the dies. The complete assemblies were loaded to failure on an Instron mechanical testing machine, and analysis indicated that retainers with occlusal rests were the most resistant. Grooves provided no statistically significant increase in resistance to failure of the cement. Increased axial coverage did not increase resistance to dislodgment. Successful fixed partial dentures (FPDs) depend on cast retainers to resist displacement of the restoration during function. Introduction of resin-bonded restorations opened the possibility of FPDs with minimal reduction of abutments. Specific questions concerning long term success and tooth preparation designs were prominent concerns. The influence of resistance form on overall stability of a restoration was also of particular interest. Buonocore established the foundation for retention of composite resins to acid-pitted enamel. Rochette used this technology to bond perforated cast metal splints to periodontally compromised teeth. A mechanical interlock was created as composite resin engaged these perforations and sustained the cast splint to acid-etched enamel. Howe adapted this design for replacement of anterior teeth by adding porcelain to a metal ceramic framework and then bonding the framework to abutments without tooth preparations. The advantages of these procedures were their conservative nature, esthetics, and ease of rebonding after dislodgment. Livaditis and Thompson adapted the procedure proposed by Tanaka of corrosion-pitting the bonding surface of a base metal alloy. They increased the surface area to be bonded, eliminated the perforations to improve rigidity of the framework, and described tooth preparation modifications of the abutments. They suggested an occlusal rest, establishment of guide planes through axial reduction, and a proximal extension to the facial surface to resist lingual displacement. Simonson, et al., based their anterior tooth preparation design on the configuration suggested by Livaditis which included a slight chamfer finish line plus reduction of the lingual surface to provide a thicker metal framework. Barrack introduced an inlay type tooth preparation for the occlusal rest plus shallow vertical proximal grooves, and Meiers used grooves as an esthetic alternative to proximal extensions. Clinical studies and surveys have identified specific variables involved with success and failure, while in vitro studies have evaluated framework designs, bonding agents, and methods for pitting the metal surface. This study evaluated resistance of RBFPDs to dislodgment of different tooth preparation designs.

Analysis of Variance↗

Fracture resistance of posterior metal-free polymer crowns.

STATEMENT OF PROBLEM: Improved mechanical properties of contemporary composites has resulted in the extended use of composites for the restoration of posterior teeth. Although the indication of polymers was extended to metal-free individual crowns, the influence of tooth preparation design and cementation methods on the stability of these artificial crowns remains unknown. PURPOSE: This in vitro study evaluated the effect of axial tooth preparation design, occlusal dimension, and cementation technique on the fracture resistance of metal-free posterior Artglass crowns. MATERIAL AND METHODS: Seventy-two extracted human third molars, assigned to experimental groups by size, received standardized tooth preparation. Axial tooth preparation included an invasive approach with 1-mm deep shoulder and a less invasive 0.5-mm chamfer preparation, whereas occlusal reduction was either 0.5 mm or 1.3 mm. Artglass crowns that restored the original tooth contour were cemented with 3 cements: zinc phosphate cement (ZnP), glass ionomer cement (GIC), or a resinous cement in combination with a dentinal bonding agent. After 10,000 thermal cycles between 5 degrees C and 55 degrees C, artificial crowns were vertically loaded until compression to failure. Significant differences of fracture loads between experimental groups were assessed by paired Mann-Whitney U tests. RESULTS: Minimal fracture resistance for all combinations excluded 500 N. However, 9 of 24 Artglass crowns cemented with ZnP loosened after thermocycling. Adhesive cementation resulted in a significantly greater fracture resistance compared with GIC and ZnP (P=.02). Increased occlusal thickness (0.5 to 1.3 mm) resulted in greater stability, whereas a 1-mm deep shoulder tooth preparation did not improve durability compared with a 0.5-mm chamfer finishing line. CONCLUSION: A minimally invasive 0.5-mm axial chamfer tooth preparation combined with sufficient occlusal reduction and adhesive cementation recorded the greatest stability for posterior metal-free Artglass crowns.

Cementation↗

Effect of methods of tooth enamel preparation on the retentive strength of acid-etch composite resins.

The effect of three procedures of preparing enamel surface on the retentive strengths of Concise Enamel Bond. Adaptic acid etch, Restodent and Nurva-Seal/Nurva-Fil was investigated. Resins using an unfilled-filled resin combination(Concise Enamel Bond, Adaptic acid etch, and Nurva-Fil) had a significantly higher retentive strength when the enamel was prepared with a coarse diamond bur than when the surface was unprepared or prepared with a carbide bur. The different procedures of tooth preparation did not affect the retentive strength of the resin when only filled resin was used (Restodent).

Acid Etching, Dental↗

Direct pressure provisionalization technique: a new open-tray technique for complete-arch rehabilitations.

An innovative direct technique that improves the accuracy of provisional acrylic resin restorations is introduced. A custom impression tray is modified to facilitate complete occlusal closure. This open tray is used to make an accurate overimpression prior to beginning tooth preparation procedures. Following tooth preparation, the acrylic resin-filled overimpression is returned to its intraoral position, and the patient occludes into the previously indexed impression material. The pressure overimpression technique is offered as an expedient technique for improving the accuracy of provisional restorations.

Acrylic Resins↗

[Development of the dental CAD/CAM system].

Studies have been undertaken to apply CAD/CAM system to Dentistry and to make prosthetic appliances with this system automatically. Specimens are 4 times large plaster models. For the inside of the crown, the plaster model of prepared tooth is measured with laser displacement meter then the numerical data is obtained. After modification of this data for the concave cutting, the modeling machine works with this numerical data. For the outside of the crown, the typical colonal figure data (= CAD Data Base) is prepared. And this data is modified with computer to fit the prepared tooth margin and proximal or antagonical tooth (= CAD). This CAD Data Base was obtained with 3 dimensional point digitizer (3DPD). Because this measuring method with 3DPD is to be able to select points, the CAD Data Base could be consists of characteristic points. When this data base is really used, it is interpolated with s-spline. Spline interpolation is indispensable to the CAD/CAM system. Further understanding of this system, explanation is divided into three parts which are 3D measurement, CAD and CAM. (3D measurement) Two types of 3D measurement is dealed with this system. One is for the CAD data base and another is for the prepared tooth model. 3D measurement of the prepared tooth model is equivalent of the impression takings in the routine method. For the clear marginal line and for the uniform distribution of measuring points, the prepared tooth model is tilted and rotated on the working table when it is measured with laser. (CAD) The CAD Data Base can be extended, contracted, parallel translated and rotated with the Affine transformation. For putting the individual margin data on the CAD Data Base, the prepared tooth margin is re-digitized with 3DPD. Occlusal data is taken from F.G.P. core. (CAM) The application of the spline interpolation to the tool offset theory, which is effective at the groove especially, makes easy to calculate the tool path. When the prepared tooth model is manufactured, it is tilted and rotated on the table like the measurement with laser-scan.

Crowns↗

In vitro marginal adaptation of alumina porcelain ceramic crowns.

This study evaluated the dimensional stability during firing of In-Ceram alumina porcelain ceramic and examined the marginal fit for three different configurations of tooth preparation. A stereomicroscope was used to measure the space between the margin of restorations and tooth preparations. The three methods of tooth preparation were statistically compared and revealed suitable dimensional stability during the firing and glazing process. A better marginal fit was recorded for artificial crowns fabricated on a chamfer or 50-degree shoulder tooth preparation.

Aluminum Oxide↗

Effects of two preparation designs and pontic distance on bending and fracture strength of fiber-reinforced composite inlay fixed partial dentures.

STATEMENT OF PROBLEM: Joint fractures observed in Targis/Vectris inlay adhesive fixed restorations may be related to the preparation design. PURPOSE: This in vitro study investigated the effects of the proximal tooth preparation design and the pontic distance on the fracture strength and the amount of bending of fiber-reinforced inlay adhesive fixed partial dentures. MATERIALS AND METHODS: Forty extracted premolars and 40 molars were embedded in a PMMA resin to represent a premolar and molar mesiodistal separation distance of 7 mm and 11 mm, respectively. Two preparation designs were used (proximal box and tub-shaped). The sample size was 10 for each group. Fiber-reinforced inlay adhesive fixed partial dentures were fabricated by use of the Targis/Vectris system and luted adhesively to the teeth with Variolink luting agent. A vertical force was loaded to the center of the fixed partial dentures at a crosshead speed of 1 mm/min. The initial bending (mm) prior to fracture was evaluated by measuring the distance the test rod moved from a 10 N preload to fracture. The differences in the mean fracture strength and the average amount of bending as a function of the preparation designs and pontic distances were compared by use of a 2-way analysis of variance (alpha=.05). The specimens were examined optically for the type of failure with a stereomicroscope. The fracture surface of the specimens was examined by scanning electron microscopy, and radiography was used to investigate the surface morphological features at the failure sites and to determine the fracture mode. A chi-square test was used to identify the differences in the debonding rates between the types of preparation designs and the pontic distance (alpha=.05). RESULTS: The mean fracture strength and the standard deviation of the fiber-reinforced inlay retained adhesive fixed partial denture group was 1368+/-212 N for the 7-mm tub group, 885+/-109 N for the 11-mm tub group, 1779+/-317 N for the 7-mm box group, and 1336+/-281 N for the 11-mm box group. The fracture strength was significantly higher in the 7-mm pontic distance (P<.001) and for the box-shaped tooth preparation (P<.001). The amount of bending was significantly greater in the 7-mm pontic distance (P=.025) and the box-shaped tooth preparation (P=.002). Debonding was observed only in premolar teeth and tub-shaped design groups. CONCLUSION: The box-shaped tooth preparation may be considered for restoration of a missing single posterior tooth with fiber-reinforced inlay adhesive fixed partial dentures.

Adhesiveness↗

A procedure for making fixed prosthodontic impressions with the use of preformed crown shells.

Void-free impressions of tooth preparations for fixed prosthodontics are essential for accurately fitting restorations; however, commonly used impression methods are arduous and time-consuming. A procedure has been developed in which an impression is made in a preformed temporary crown shell for each tooth preparation and then a final over impression is made. The result is an atraumatic and uncomplicated complete-arch impression that incorporates an accurate impression of each prepared tooth.

Crowns↗

Gingival health associated with porcelain veneers on maxillary incisors.

The possible detrimental effect of acid-etched resin-bonded prostheses and porcelain veneers on plaque accumulation and gingival health is currently disputed. Some workers recommend no tooth preparation prior to veneering whilst others recommend tooth preparation to prevent adverse gingival soft tissue reactions. In order to test the possible gingival effects of veneers placed without tooth preparation, this study was set up to compare gingival health on veneered and non-veneered maxillary incisors within the same individual during periods of normal tooth cleaning and of no tooth cleaning. No significant differences were noted in plaque or gingival indices, or in gingival crevicular fluid volume, between the 72 veneered and non-veneered sites during either study period. The results of this study suggest that placing porcelain veneers on unprepared teeth does not increase the risk of gingivitis.

Adult↗

Necessity of bevels for box only Class II composite restorations.

STATEMENT OF PROBLEM: The tooth preparation of a bevel is recommended to improve marginal quality of a composite restoration. However, in small Class II restorations, it is unclear if a bevel also contributed to a better marginal fit. PURPOSE: This study investigated the influence of tooth preparation design on microleakage of minimal posterior Class II composite restorations. MATERIAL AND METHODS: Box-shaped Class II tooth preparations for posterior composite restorations in maxillary premolars were restored with a total etch technique. The tooth preparations were beveled or non-beveled and the box prepared at a right angle cervically or additionally excavated. The facial and lingual box margins were also either beveled or unbeveled. The teeth were thermocycled and immersed in a dye solution. After sectioning specimens, dye penetration at the facial and palatal margins was recorded. RESULTS: A bevel-reduced microleakage both at the cervical and ascending walls. Enamel cracks were observed along certain unbeveled margins as recorded in this study. The additional excavation did not contribute to reduction of microleakage. CONCLUSIONS: Tooth preparation of a bevel is recommended for an optimal marginal seal in small box-type Class II composite restorations.

Analysis of Variance↗

Smear layer instability caused by hemostatic agents.

The effect of hemostatic agents, other than a 15.5% Fe2(SO4)3 solution, on prepared tooth structure is unknown. The purpose of this study was to (1) compare the effect of six commonly used hemostatic solutions and two nondental astringents on the dentinal smear layer and (2) determine whether different responses caused by product and/or time could be established. Standardized dentinal smear layers were exposed to eight astringent solutions for 30, 120, and 300 seconds (n = 6). A total of 144 SEM photographs at x2400 magnification were ranked according to predetermined criteria for five categories of smear layer removal and etching of underlying tooth structure. There were significant differences (p < 0.001) caused by the solution, exposure time, and their interaction. Greatest smear layer removal was observed with 21.3% AlCl3-6 hydrate, 8% racemic epinephrine HCl, and 15.5% Fe2(SO4)3 solutions at longer exposures. These caused significantly more removal than did almost pH neutral tetrahydrozoline or oxymetazoline (p < 0.05).

Acid Etching, Dental↗

A clinical study comparing marginal and occlusal accuracy of crowns fabricated from double-arch and complete-arch impressions.

BACKGROUND: The double-arch impression technique is widely used in the provision of laboratory fabricated restorations. However, there is little clinical evidence to support or refute its use. The aim of this prospective clinical study was to evaluate the occlusion and marginal fit of posterior full crowns made from double-arch impressions, and to compare these to control crowns fabricated from conventional complete-arch impressions. METHODS: Ten patients requiring single posterior ceramo-metal full crowns had both double-arch and complete-arch impressions taken of the prepared tooth. Two crowns were fabricated for each tooth, using the casts made from both impression methods. Both crowns were tried in and the occlusion and margins evaluated. The results were composed using nonparametric statistical analysis with the probability level for significance at alpha=0.05. RESULTS: The crowns fabricated from the double-arch impression were found to be more accurate in closure to the intercuspal position and had fewer interferences in lateral excursions. There were no significant differences between the two crown groups regarding protrusive interferences and margin quality. CONCLUSIONS: Crowns fabricated from the double-arch impressions were equivalent in marginal accuracy and superior occlusally to crowns fabricated from the complete-arch impressions.

Crowns↗

Marginal adaptation of stainless steel crowns.

The chief goal of full coronal restoration using preformed stainless steel crowns (SSC) is replication of normal crown form and function. Marginal adaptation of SSCs involves appropriate crown size selection, trimming the crown form to achieve proper length, crimping crown edges to proximate the prepared tooth, and finishing and polishing the crown form. This report about SSC restoration focuses on the procedure of adapting, finishing, and polishing crown margins.

Crowns↗

Fracture load and mode of failure of ceramic veneers with different preparations.

STATEMENT OF PROBLEM: Fracture is a clinical failure modality for ceramic veneers. Whether design of tooth preparation can affect the strength of ceramic veneers remains controversial. PURPOSE: This in vitro study evaluated fracture load and mode of failure of ceramic veneers, with 4 tooth preparation designs, that were bonded on extracted human maxillary central incisors. Identical parameters were also measured on unrestored intact teeth for comparison. MATERIAL AND METHODS: Fifty maxillary central incisors were randomly divided into 5 equal groups. Each group was assigned a different tooth preparation design: (1) no incisal reduction, (2) 2 mm incisal reduction without palatal chamfer (butt joint), (3) 1 mm incisal reduction and 1 mm height palatal chamfer, (4) 4 mm incisal reduction and 1 mm height palatal chamfer, and (5) unrestored (control). Forty teeth were prepared to accommodate ceramic veneers of equal thickness and incisocervical length. Stone dies were fabricated and veneers made from IPS Empress ceramic. Ceramic veneers were bonded and all teeth mounted in phenolic rings with epoxy resin. Fracture loads were recorded with a mechanical testing machine. RESULTS: Mean fracture loads (SD) in kgf were as follows: group 1, 23.7 (6.11); group 2, 27.4 (9.63); group 3, 16.4 (3.44); group 4, 19.2 (6.18); and group 5, 31.0 (10.38). Modes of failure were also analyzed for both ceramic veneers and teeth. One-way ANOVA with multiple comparisons revealed 3 significant subsets: groups 1-2-5, groups 4-1, and groups 3-4 (P <.05). Groups 1 and 2 had no ceramic veneer fractures; group 3 had 3 ceramic veneer fractures, and group 4 had 6 ceramic veneer fractures. CONCLUSION: Groups 1 and 2 recorded the greatest fracture loads that were comparable to an unrestored control.

Aluminum Silicates↗