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Effect of margin location on crown preparation resistance form.

STATEMENT OF THE PROBLEM: The location of preparation margins may compromise the fixed prosthodontic restoration's resistance form. Purpose This study evaluated changes of opposite wall margin position on rotational resistance form compared to the equal-height margin configuration. MATERIAL AND METHODS: The trigonometric computation of the minimal resistance form preparation taper, alpha1 , was determined using a previously described formula. The alpha1-values for different tooth sizes with variation of base widths (range 4 to 10 mm) and vertical wall heights (range 4 to 9 mm) were calculated. The alpha1-values represent resistance form with both opposing wall margins at the same vertical height position. The alpha2-values were calculated with additional formulas to address uneven margin heights. Calculated alpha2-values of 10 degrees or less were considered clinically significant due to the known level of difficulty for the clinician. RESULTS: As a general trend, the alpha2-values were reduced compared to the alpha1-values with shortening opposing vertical wall heights in all tooth-size categories. Clinically significant changes in the resistance form taper were shown in all tooth size categories except the smallest 4-mm tooth base size. CONCLUSION: Fixed prosthodontic restoration resistance form is negatively affected by uneven vertical margin placement. This phenomenon reduces the resistance form of the restoration compared to equal-height margin placement.

Crowns↗

Load-fatigue performance of gold crowns luted with resin cements.

STATEMENT OF PROBLEM: Resin cements have gained popularity over the past few years because of their improved physical properties. There is a need to test these cements under fatigue loading, as there is growing recognition that fatigue testing is more clinically relevant than traditional monotonic static tests. PURPOSE: This study investigated the load-fatigue performance of complete gold crowns cemented with 4 types of resin cement. MATERIAL AND METHODS: Four resin cements (C & B Opaque [CBO], Calibra Esthetic [CE], RelyX Unicem [RU], and Panavia F [PF]) and a control, zinc phosphate cement (HY-Bond [HBZPC]) were tested. Fifty human maxillary premolars were prepared to an occluso-cervical dimension of 4 mm and a convergence angle of 20 degrees. Complete gold crowns were cast (Strator 3) and cemented with 1 of the 5 cements (n=10). A fatigue load of 73.5 N was applied at an angle of 135 degrees to the long axis of each tooth-crown specimen. Preliminary failure was defined as the propagation of a crack in or around the crown luting cement layer. The number of cycles to preliminary failure and the cement failure location were determined. Significant differences in cycles to preliminary failure were assessed by the nonparametric Kruskal-Wallis test, with follow-up Mann-Whitney tests (alpha=.05). RESULTS: Group CE had the highest rank of cycles to preliminary failure, while HBZPC had the lowest cycles to preliminary failure. Group CE had a significantly higher failure cycle count compared to PF (P=.016), RU (P=.001), and HBZPC (P<.001), but was not significantly different from CBO (P=.112). There was no significant difference in the failure cycle count between RU and HBZPC (P=.070). CONCLUSION: Not all tested resin cements had a superior fatigue life when compared with zinc phosphate cement. Of the 4 resin cement groups, Groups CE, CBO, and PF were significantly superior to HBZPC.

Crowns↗

A clinical investigation of the fit of removable partial dental prosthesis clasp assemblies.

STATEMENT OF PROBLEM: Removable partial denture frameworks are complex castings fabricated from high-shrinkage alloys. This may result in difficulty in achieving accurate fit. PURPOSE: The purpose of this study was to evaluate which component(s) of the clasp assembly contact the abutment tooth clinically. MATERIAL AND METHODS: New and existing frameworks with at least 1 conventional prepared occlusal rest were evaluated for fit. The spacing between the bottom of each of the rests of the 50 clasp assemblies and the corresponding rest seat were recorded with vinyl polysiloxane. The fit of each rest was determined with the use of a dial caliper by measuring, in micrometers, the thickness of the record between the rest and the bottom of the rest seat. The Kennedy classification was also recorded. A 2-sample t test was used to evaluate the difference in fit between tooth-tissue supported and tooth-supported designs (alpha=.05). RESULTS: The average space between the rest and prepared rest seat was 193 +/- 203 microm, with a range of 0 to 828 mum. Twenty tooth-tissue frameworks had an average space of 136 +/- 160 microm and 30 tooth-supported frameworks had an average space of 230 +/- 222 microm. The 2-sample t test showed no significant difference for fit between tooth-tissue supported and tooth-supported frameworks (P=.1081). Twenty-four percent of rests had contact in the prepared rest seat. CONCLUSION: The majority of rests evaluated did not contact the intended surfaces.

Dental Abutments↗

Bond strength between root dentin and three glass-fiber post systems.

STATEMENT OF PROBLEM: Glass-fiber posts were introduced for use after endodontic therapy instead of metal alloy and ceramic posts. There are several new types of glass-fiber post systems available, but little is known about how well these posts bond to the root surface. PURPOSE: The purpose of this in vitro study was to compare the bond strengths of 3 different types of glass-fiber post systems-opaque, translucent, and electrical glass-in 3 different locations of prepared post spaces. MATERIAL AND METHODS: Sixty human intact single-rooted extracted teeth were used. The root canals were prepared using a step-back technique and obturated with gutta-percha using lateral condensation. The roots were divided into 3 experimental groups and further divided into 2 subgroups according to testing time (n=10). Roots were restored with 1 of the following post systems according to the manufacturer's instructions: opaque glass-fiber posts (Snowpost), translucent glass-fiber posts (FiberMaster), and electrical glass-fiber posts (Everstick). A self-etching primer (Clearfil Liner Bond) was applied to the walls of the post spaces, allowed to etch for 30 seconds, and gently air dried. A dual-polymerized bonding agent (Clearfil Liner Bond, Bond A and B) was then applied to the same walls. A dual-polymerizing resin luting agent (Panavia F) was mixed for 20 seconds and then placed in the post spaces using a lentulo spiral instrument. The roots were placed in light-protected cylinders; then the light source was placed directly on the flat cervical tooth surfaces and the cement was polymerized. Specimens were stored in light-proof boxes for 24 hours or 1 week after the polymerization procedure. Each root was cut horizontally, and six 1-mm-thick root segments (2 apical, 2 middle, and 2 cervical) were prepared. Using a push-out test, the bond strength between post and dentin was measured after 24 hours or 1 week using a universal testing machine. Statistical analysis was performed with 3-way ANOVA followed by independent t tests (alpha=.05) to detect differences between groups defined by the specific interacting variables. The different combinations of posts and luting material from the cervical segments were analyzed with SEM. RESULTS: The 3-way ANOVA indicated that push-out test values varied significantly according to the post system used (opaque, electrical, and translucent) (P<.01); the root segments (cervical, middle, and apical) (P<.01), however, did not vary statistically according to the time of testing (24 hours and 1 week). Opaque and electrical glass-fiber posts showed higher bond strength values than translucent posts (P<.01). Push-out bond strength values of cervical segments were significantly higher than the middle and apical segments in translucent and electrical glass-fiber post groups (P<.01). In the opaque glass-fiber post group, there were no significant differences between cervical and middle segments. In SEM analysis, a distinct hybrid zone with long, numerous resin tags located between luting material and dentin was exhibited in all post systems. CONCLUSION: The opaque and electrical glass-fiber posts exhibited similar bond strengths, and translucent posts exhibited the lowest bond strength. The highest bond strength was observed in the cervical third of the post spaces for translucent and electrical glass-fiber post groups.

Dental Bonding↗

Restoration of the endodontically treated tooth.

It has been the purpose of this article to provide a rationale for the restoration of endodontically treated teeth. Treatment recommendations have been made in the areas of post design, placement technique, cements, core materials, and definitive restorations, based on a review of the clinical and laboratory data.

Dental Prosthesis Retention↗

Mechanics of the tapered interference fit in dental implants.

In evaluation of the long-term success of a dental implant, the reliability and the stability of the implant-abutment interface plays a great role. Tapered interference fits provide a reliable connection method between the abutment and the implant. In this work, the mechanics of the tapered interference fits were analyzed using a closed-form formula and the finite element (FE) method. An analytical solution, which is used to predict the contact pressure in a straight interference, was modified to predict the contact pressure in the tapered implant-abutment interface. Elastic-plastic FE analysis was used to simulate the implant and abutment material behavior. The validity and the applicability of the analytical solution were investigated by comparisons with the FE model for a range of problem parameters. It was shown that the analytical solution could be used to determine the pull-out force and loosening-torque with 5-10% error. Detailed analysis of the stress distribution due to tapered interference fit, in a commercially available, abutment-implant system was carried out. This analysis shows that plastic deformation in the implant limits the increase in the pull-out force that would have been otherwise predicted by higher interference values.

Biomechanical Phenomena↗

Effects of relining on long-term marginal stability of provisional crowns.

Provisional resins crowns are commonly placed to protect prepared teeth, but the marginal adaptation of interim crowns has always been a problem. These experiments examined the effects of thermocycling and occlusal loading on relined and unrelined polymethyl methacrylate resin transitional crowns. Three groups of interim crowns were made on a cast metal die tooth preparation; unrelined, relined correction, and paint-on correction. After thermocycling and occlusal loading of the specimens, the change in mean marginal gap was significantly greater for the unrelined group. Axial changes were greatest for relined group and least for the unrelined group. These results suggested that relining of polymethyl methacrylate interim crowns can be useful to prevent increases in marginal gap width during extended intraoral periods.

Analysis of Variance↗

Brånemark single tooth implants: a preliminary report of 76 implants.

Seventy-six Brånemark single-tooth implants were inserted over a 6-year period. Two implants (2.63%) were removed during the follow-up period. All other implants received esthetic and functional single tooth crowns placed on a single tooth abutment or a CeraOne abutment. The most common complication observed was abutment screw loosening, which occurred with 12 crowns. However, it was possible to clearly reduce the occurrence of screw loosening by applying a defined torque. Peri-implant parameters were investigated on 56 implants that were in place for more than 1 year. Acceptable implant function was demonstrated with preestablished clinical parameters and radiographs. Despite the submucosal edge of the crown, peri-implant mucositis was not a major problem. The favorable clinical and esthetic results found in the study encourage an increased application of implants for single tooth restorations.

Adolescent↗

Comparative study of antirotational single tooth abutments.

Identifying the functional and mechanical limitations of single tooth implant systems is essential for the long-term success of the restoration. Three designs with different prosthetic connections were evaluated with their corresponding single tooth abutments for structural integrity and cyclic fatigue. The internal implant octagon was the weakest connection under off-axis impact loading and lateral loading, and the external hexagon implant was rendered unrestorable under lateral loading. Overall, the internal hexagon design was found to provide the highest degree of single tooth stability. This was attributed to the increased material strength of the titanium alloy implant in comparison to the softer CP titanium implant, and to the abutment's longer, 1-degree tapered mating hexagon.

Alloys↗

Comparison of the torsional forces at failure for seven endodontic post systems.

Resistance to torsional forces is critical in restoration of endodontically treated teeth. Seven post designs (Flexi-Post, Flexi-Flange, Para-Post, AccessPost, World Post, Vlock, and Dentatus posts) were cemented in roots of natural teeth with zinc phosphate and Flexi-Flow cements, which resulted in 11 different groupings that were subjected to torsional forces in a clockwise direction. In addition, clockwise and counterclockwise torque was applied to the Flexi-Post and Flexi-Flange systems cemented with zinc phosphate and Flexi-Flow cements. A total of 150 samples were prepared, and groups for this study were: group 1, Flexi-Post/zinc phosphate clockwise and counterclockwise; group 2, Flexi-Post/Flexi-Flow clockwise and counterclockwise; group 3, Flexi-Flange/zinc phosphate clockwise and counterclockwise; group 4, Flexi-Flange/Flexi-Flow clockwise and counterclockwise; group 5, Para-Post/zinc phosphate clockwise; group 6, AccessPost/zinc phosphate clockwise; group 7, AccessPost/Flexi-Flow with grooved dentin clockwise; group 8, World Post/zinc phosphate clockwise; group 9, World Post/Flexi-Flow with grooved dentin clockwise; group 10, Vlock Post/zinc phosphate clockwise; and group 11, Dentatus post/zinc phosphate clockwise. Torsional forces for the groups ranged from 17 ounce-inches (Dentatus/zinc phosphate) to 81 ounce-inches (Flexi-Post/zinc phosphate). Flexi-Post and Flexi-Flange threaded posts exhibited statistically greater resistance to torsional forces. Analyses were computed with one-way and three-way analysis of variance followed by Duncan's multiple range test. Duncan's multiple range test indicated that Flexi-Post/zinc phosphate/clockwise was similar to Flexi-Post/Flexi-Flow/clockwise and that both had significantly higher torque levels than the other treatment conditions in the clockwise direction (p 0.0001). Dentatus/zinc phosphate/clockwise had significantly lower torque levels than the other treatment conditions (p 0.031).

Analysis of Variance↗

Practical considerations and technical procedures for post-retained restorations.

Post-retained restorations are a practical and dependable treatment option for restoring teeth with insufficient coronal tooth structure. Manufactured post patterns combined with an effective clinical procedure will provide a simple, reliable, and economic method to produce restorations with a cast tapered post. The cast tapered post can be used for all clinical applications in which a post-retained restoration is indicated.

Crowns↗

Clinical comparison of postoperative sensitivity for a glass ionomer and a zinc phosphate luting cement.

In 60 patients, 120 partial and full-coverage restorations were cemented on vital abutment teeth with either a glass ionomer or a zinc phosphate luting cement. A split-mouth design and a patient blind data acquisition protocol were used. During an average observation period of 17.3 months there were no differences between the two types of luting cements in regard to subjective and clinical parameters. A high incidence of postoperative hypersensitivity, which is often said to accompany the use of glass ionomer luting cements, was not observed. With the cementation method used in this study, the glass ionomer cement Ketac-Cem Maxicap was an acceptable alternative to conventional zinc phosphate cement. Capsule systems make the clinical handling of glass ionomer luting cements safe and easy and should be used routinely in dental practice.

Adult↗

Preventing loosening of implant abutment screws.

A procedure for using dimples inside the abutment screw cylinder above the screws and filling the holes with elastomeric impression material will prevent the screw-retained prosthesis from loosening. A modification of the procedure can also be used for angled abutments.

Dental Abutments↗

Resin-bonded metal-ceramic inlays: a new approach.

With increasing demand for esthetics, dentists face the challenge of delivering definitive restorations that fulfill patients' expectations of esthetics, biocompatibility, and durability. Recent technical developments have encouraged fabrication of gold-reinforced porcelain inlays that meet these important criteria. This article describes a sequence to construct metal-reinforced porcelain inlay restorations.

Biocompatible Materials↗