Geographic distribution of porcelain veneer preparation depth with various clinical techniques

Accuracy of three digital waxing-guided trial restoration protocols for controlling the depths of tooth preparation for ceramic veneers

STATEMENT OF PROBLEM

The accuracy of digital waxing-guided trial restoration protocols that have been implemented with ceramic veneers has not been reported.

PURPOSE

The purpose of this in vitro study was to evaluate the accuracy of 3 digital trial restorations fabricated from digital waxing for ceramic veneers.

MATERIAL AND METHODS

A uniform 0.3-mm digital waxing added to the facial surface of 30 maxillary central typodont incisors was created in a software program. The trial restorations were fabricated on typodont teeth with autopolymerizing acrylic resin by using a silicone index based on 3-dimensionally printed casts designed from the digital waxing. The 30 maxillary central incisors were divided into 3 groups: the depth cutter (0.5 mm, Komet) (DC) group, the round bur (1.5 mm, Diatech) (RB) group, and the specially designed calibrated depth bur (laser mark of 0.5 mm, Gaofeng) (CD) group. The 3 groups were randomly prepared with a random number table by 2 experienced prosthodontists aiming to produce an even facial clearance of 0.5 mm. The dimensional differences in the standard tessellation language (STL) files between the surfaces of the original teeth, digital waxing, trial restorations, and prepared teeth in the software program were measured and analyzed at the same 9 points on the labial surface. One-way ANOVA with a post hoc test was used to identify significant discrepancies between trial restorations and waxing and differences in the reduction depth of typodont teeth (RDT) and the reduction depth (RD) among the 3 techniques (α=.05). The mean relative differences (MRDs) were calculated to determine the accuracy (%).

RESULTS

The thickness of the trial restorations was significantly greater than that of the digital waxings, with a discrepancy of 0.20 ±0.14 mm, especially at the cervical site. With the use of a trial restoration, the RDTs of the middle (-0.01 ±0.11 mm) and cervical locations (0.09 ±0.20 mm) showed significantly smaller preparation depths than did the other locations. Significant differences in RD were found among the 3 guided techniques (P<.05). Group DC presented the most accurate result of 0.51 ±0.08 mm with an MRD of 2%, whereas the results of 0.57 ±0.10 mm with an MRD of 14% and 0.60 ±0.11 mm with an MRD of 20% were obtained from group RB and group DC, respectively.

CONCLUSIONS

The trial restoration was significantly thicker than its corresponding waxing. The DC technique presented the most accurate reduction result among the 3 protocols examined.

Age and sex related change in tooth enamel thickness of maxillary incisors measured by cone beam computed tomography

BACKGROUND

To measure adequate enamel thickness of maxillary incisors in planning enamel reduction for a porcelain laminate veneer restoration in relation to chronological age and sex by using cone beam computed tomography (CBCT) in an Iraqi subpopulation.

METHODS

From 81 CBCT images, 324 maxillary incisors were examined. Enamel thickness was measured at both mesial and distal regions of the tooth in three different levels: cervical, middle, and incisal (occlusal) 1/3 at a sagittal section. Measurements were made for the following tooth areas using CBCT: facial enamel thickness at 1, 3, and 5 mm from the cementoenamel junction (CEJ), palatal enamel thickness at 5 mm from the CEJ (5 mm P), facial and palatal enamel thickness at the incisal edge (IFP), mid incisal enamel thickness (IET), and the incisal edge enamel-pulp distance (IEPD). Relationships of enamel thickness with age and sex were evaluated using Independent t-test, Mann-Whitney U-test and the Pearson correlation coefficient, a simple linear regression analysis used for statistical analysis.

RESULTS

Significant differences (P < 0.05) were found in terms of an inverse association between enamel thickness and chronological age at all measurements above the CEJ and the regression model for the mid-incisal enamel thickness was (R2 of 0.4). In contrast, there was an increase in IFP, palatal, and IPED enamel thickness with age. Also, significant differences were found in enamel thickness between males and females, the enamel being thicker in females in relation to facial enamel thickness, enamel palatal thickness above CEJ and IET, while for IEPD, the enamel thickness was greater in males compared to females.

CONCLUSION

The measurements for enamel thickness outcome variables in relation to chronological age revealed significant differences for each measured distance and there were statistically significant differences in enamel thickness between males and females at all measurements except at IFP. These results demonstrate that CBCT can be used for noninvasive, accurate measurements of enamel thickness in both sex.

Accuracy of the preparation depth in mixed targeted restorative space type veneers assisted by different guides: An in vitro study

PURPOSE

Most veneers are mixed targeted restorative space (MTRS)-type restorations that are partially within the original tooth and require inconsistent preparation depths. This study aimed to evaluate the accuracy of the preparation depth for MTRS veneer preparation.

METHODS

MTRS veneer preparation models were developed using the twisted maxillary central incisor (MCI) as the original tooth and the standard MCI as the waxing. Veneer preparations were performed using freehand (MF), silicone (MS), thermoplastic (MT), 3D-printed uniform (MD), and auto-stop (MA) guides. The prepared and original MCI were scanned and superimposed using a custom-made base. The mean absolute differences (MADs) were measured to evaluate the accuracy of the preparation depth. Statistical analysis was performed using the multivariate analysis of variance (MANOVA) test (α=0.05).

RESULTS

The accuracy of the preparation depth was 0.237±0.090, 0.191±0.099, 0.149±0.078, 0.093±0.050, and 0.059±0.040 mm in MF, MS, MT, MD, and MA, respectively. The MADs between the groups were significant (P<0.05). The accuracy of the trial restoration was 0.140±0.081 mm in the MS, and the accuracy of the guiding tube was 0.055±0.033, 0.036±0.011, and 0.033±0.010 mm in the MT, MD, and MA, respectively.

CONCLUSIONS

In MTRS veneer preparation for MCI, tooth preparation guides improved the accuracy of the preparation depth by visualizing the TRS profile and providing clear measurement points. The accuracy of the guide is influenced by its flexibility, and the accuracy of the preparation depth is affected by the accuracy of the measurement points.

Accuracy of Reduction Depths of Tooth Preparation for Porcelain Laminate Veneers Assisted by Different Tooth Preparation Guides: An In Vitro Study

PURPOSE

To evaluate the accuracy (trueness and precision) of reduction depths of guided veneer preparation assisted by four tooth preparation guides.

MATERIALS AND METHODS

Fifty resin artificial teeth were randomly divided into five groups (n = 10): a freehand group (F), silicone guide group (S), thermoplastic guide group (T), 3D printed uniform guide group (D), and 3D printed auto-stop guide group (A). A preparation for a window veneer on the maxillary right central incisor was performed by two surgeons who used tooth preparation guides for assistance. The maxillary right central incisors were scanned before and after the preparation. The reduction depths were measured in the cervical, middle, and incisal thirds of the prepared surface, and depth maps were created using Geomagic Control X software. The accuracy of the reduction depths at each third was evaluated using both trueness and precision values. The trueness of the reduction depths was determined by calculating the mean absolute differences (MADs) compared to the planning depth, and precision was determined by the standard deviation (SD). The collected data were statistically analyzed using one-way ANOVA and the least significant difference test (α = 0.05).

RESULTS

The MAD ± SD values of the reduction depths in the cervical-third region in groups F, S, T, D, and A were 0.19 ± 0.04, 0.12 ± 0.03, 0.09 ± 0.02, 0.07 ± 0.02, and 0.05 ± 0.01 mm, respectively. In the middle-third region, the MAD ± SD values of groups F-A were 0.19 ± 0.05, 0.13 ± 0.02, 0.09 ± 0.01, 0.06 ± 0.01, and 0.05 ± 0.01 mm. In the incisal-third region, the MAD ± SD values were 0.27 ± 0.05, 0.16 ± 0.04, 0.11 ± 0.03, 0.07 ± 0.01, and 0.05 ± 0.01 mm, respectively. Significant differences in trueness and precision values were found across different groups (F = 45.378, p = 0.000), where group F showed higher MADs than the other 4 groups (p = 0.000), and the highest MADs were detected in group S among the 4 groups in all regions (p = 0.000). Group T showed significantly higher MADs than groups D (P = 0.008) and A (p = 0.001), except in the cervical-third region, where no significant difference was observed between groups T and D (p = 0.077). There was no significant difference between groups D and A (p = 0.148). The deviation map showed significant differences among groups (F = 15.963, p = 0.000), group T presented less deviation than group F (p = 0.000) and group S (p = 0.027) and showed more deviation than group A (p = 0.007).

CONCLUSION

Tooth preparation guides provided more accuracy for veneer preparation than freehand preparation. Among the 4 guides, the 3D printed auto-stop guide presented the lowest absolute difference (0.05 mm) and the silicone guide showed the highest absolute difference of preparation (0.12-0.16 mm).

Questions about the numerical value and quantitative data transfer of tooth preparation-from experience guidance to digital guidance

Tooth preparation is a common operation in dental clinical practice. This procedure is irreversible and invasive from the point of view of tooth preservation. Conditions of the abutment tooth, treatment methods, and restoration materials for target restoration affect tooth preparation. To achieve the goals of tooth tissue preservation, dental pulp protection, and periodontal health, dentistry professionals agreed on the importance of minimizing the amount of tooth reduction. The foundations for realizing this consensus are as follows. First, the available restoration materials with improved comprehensive performance need less target restoration space. Next, teeth can be prepared under a digital guide, and the real-time measurement of restoration space can be verified due to the invention of digital technologies for the analysis of the quantity and shape of the prepared tooth and tooth measurement. Moreover, guiding methods for preparation have been developed from freehand operation under the naked eye based on accumulated personal experience to digital-guidance jointing microscope. These innovations indicate the creation of a prototype of guided prosthodontics that is precise and applies real-time measurement throughout the process of tooth preparation. From the perspective of the evolution of digital, guided, and micro prosthodontics, this article raised seven questions about the numerical value and quantitative data transfer of tooth preparation and evaluated the authenticity of existing numerical requirements from the perspective of the four elements of measurement. Identifying unified measuring methods and developing measuring tools with a precision of hundred or ten microns will be the key to solving the problem about the authenticity of numerical measurement. Furthermore, this paper summarizes the methods of how to control tooth reduction and explains in depth why the currently dominant tooth preparation technology, which is based on empiricism, cannot effectively achieve the goals in digital prosthodontics. Therefore, we strongly call for rebuilding the digital foundation of prosthodontic treatment immediately.

Minimal invasive microscopic tooth preparation in esthetic restoration: a specialist consensus

By removing a part of the structure, the tooth preparation provides restorative space, bonding surface, and finish line for various restorations on abutment. Preparation technique plays critical role in achieving the optimal result of tooth preparation. With successful application of microscope in endodontics for >30 years, there is a full expectation of microscopic dentistry. However, as relatively little progress has been made in the application of microscopic dentistry in prosthodontics, the following assumptions have been proposed: Is it suitable to choose the tooth preparation technique under the naked eye in the microscopic vision? Is there a more accurate preparation technology intended for the microscope? To obtain long-term stable therapeutic effects, is it much easier to achieve maximum tooth preservation and retinal protection and maintain periodontal tissue and oral function health under microscopic vision? Whether the microscopic prosthodontics is a gimmick or a breakthrough in obtaining an ideal tooth preparation should be resolved in microscopic tooth preparation. This article attempts to illustrate the concept, core elements, and indications of microscopic minimally invasive tooth preparation, physiological basis of dental pulp, periodontium and functions involved in tool preparation, position ergonomics and visual basis for dentists, comparison of tooth preparation by naked eyes and a microscope, and comparison of different designs of microscopic minimally invasive tooth preparation techniques. Furthermore, a clinical protocol for microscopic minimally invasive tooth preparation based on target restorative space guide plate has been put forward and new insights on the quantity and shape of microscopic minimally invasive tooth preparation has been provided.

Consistency of labial finish line preparation for metal ceramic crowns: an investigation of a new bur

PURPOSE

Previous studies have reported on the difficulties inherent in preparing the labial aspect of teeth for metal ceramic crowns with consistency and also the implications for the definitive restoration of underprepared and overangled finish lines. In this study, a bur designed to prepare a 1.2-mm deep chamfer was tested and compared with two other bur kits.

MATERIALS AND METHODS

Seventy-two teeth were prepared to receive metal ceramic crowns in vitro by students using one of the two bur kits or the new bur. Using a coordinate measuring machine (CMM), replicas of the prepared teeth were scanned in the mid-labial plane, and shoulder width and cavosurface angles were measured.

RESULTS

The new bur produced preparations with a mean shoulder width and cavosurface angle of 1.146 +/- 0.241 mm and 108 +/- 11 degrees, respectively, compared with 0.626 +/- 0.234 mm and 128 +/- 14 degrees produced by a commercially available standardized crown cutting bur system and 0.626 +/- 0.218 mm and 124 +/- 15 degrees produced by the bur kit in use at our center at the time of the study. These differences were statistically significant at the 5% level, using Tukey's comparison of means.

CONCLUSIONS

Teeth prepared by the new bur had wider shoulders and lower cavosurface angles than teeth prepared either with a standardized crown cutting system or locally selected bur kit. The quality of labial preparations produced by the new bur in terms of closeness to the postulated "ideal" width and angulation warrants further investigation.

Interdisciplinary Treatment Planning for Single-Tooth Restorations in the Esthetic Zone

This article presents a conservative approach for restoring single anterior teeth in patients with congenitally missing maxillary lateral incisors, emphasizing the importance of interdisciplinary treatment planning. Minor orthodontic treatment was necessary to create the space for implant placement. Once the fixtures were inserted and the temporary abutments connected to the implants, the provisionals were relined with the use of a repositioning stone key. From the diagnostic wax-up, it was decided that in order to attain a satisfying final esthetic outcome, it was necessary to also restore the distal aspect of the central incisors and the right first premolar for anatomical and functional reasons. Finally, after having screwed the abutments on the implants, inducing a torque of 20 Ncm, the metal-ceramic restorations were cemented with temporary cement.

CLINICAL SIGNIFICANCE

This article presents a systematic approach for restoring anterior teeth in the esthetic zone using a diagnostic additive wax-up and an interdisciplinary approach to optimize the final esthetic outcome.

Dentin exposure in tooth preparations for porcelain veneers: a pilot study

STATEMENT OF PROBLEM

The various clinical techniques available for even reduction of a tooth surface to receive a porcelain veneer restoration do not produce a consistently even conservative reduction. In addition, it is not known which technique is most conservative of enamel.

PURPOSE

The purpose of this pilot study was to assess the effectiveness of 3 clinical techniques, namely, dimple, depth groove, and freehand, in producing an intraenamel preparation. The relation between overpreparation beyond the commonly accepted depth of preparation of 0.5 mm and dentin exposure was also examined.

MATERIAL AND METHODS

A single operator prepared 3 groups of 5 extracted maxillary central incisors to a depth of 0.5 mm using dimple, depth-groove, and freehand methods of tooth preparation. The prepared teeth were scanned using an x-ray microtomography scanner. The reconstructed images were studied using software that provided a volume-rendering routine so that, by choosing suitable x-ray linear attenuation coefficient thresholds, enamel (2.78 cm(-1) at 40 keV) and dentin (1.63 cm(-1) at 40 keV) surfaces could be viewed. The percentage area of enamel conserved was analyzed from these images. Coordinate metrology was used to produce color-coded images depicting the depth of preparation. The Kruskal-Wallis test was used to determine the statistical significance (alpha=.05) in the difference between the mean percentage area of enamel conserved in the 3 technique groups. The coordinate metrology and x-ray microtomography images were visually compared to study the correlation between overpreparation and dentin exposure.

RESULTS

The Kruskal-Wallis test did not demonstrate significant difference (P=.07) between the 3 techniques in conserving enamel. However, the dimple technique showed a greater trend to retaining a larger mean percentage area of enamel (77.5% +/- 14.2) compared to depth-groove (50.1% +/- 17.5) and freehand (76.8% +/- 24.4) techniques. Preparation depth in the range of 0.4 to 0.6 mm was largely seen to be intraenamel, except in the cervical region.

CONCLUSION

Within the limitations of this pilot study, the 3 different techniques tested did not differ significantly in conserving enamel.

Age-related changes in tooth enamel as measured by electron microscopy: Implications for porcelain laminate veneers

STATEMENT OF PROBLEM

Available information on the dimensions of the enamel and pulp tissues of tooth structure, as well as their correlation with chronologic age, is limited. However, this information is a significant determinate in planning the tooth reduction for a porcelain laminate veneer (PLV) restoration.

PURPOSE

This study examined variations in tooth enamel thickness and its correlation with chronologic age as it relates to available tooth substrate for PLV restorations.

MATERIAL AND METHODS

Forty human maxillary central incisors extracted from patients within the age range of 30 to 69 years were used to evaluate the thickness of tooth layers. Measurements were made for the following tooth areas using scanning electron microscopy (SEM): facial enamel thickness at 1, 3, and 5 mm above the cemento-enamel junction (CEJ), palatal enamel thickness at 5 mm above the CEJ, facial and palatal enamel thickness at the incisal edge, maximum facial-palatal (MFP) width at incisal edge, physiologic secondary dentin (PSD) height, facial-cervical enamel-pulp (FCEP) distance, and the incisal edge enamel-pulp (IEP) distance. The relationship between thickness and age was evaluated with a regression analysis (alpha=.05).

RESULTS

Significant differences (P<.001) were observed in all of the relationships between tooth thicknesses and chronological age. Outcome variables of enamel thickness related to age showed a steady decrease, beginning at approximately age 50. Mean values of facial enamel thickness at 1, 3, and 5 mm above the CEJ were 0.31 +/- 0.01, 0.54 +/- 0.01, and 0.75 +/- 0.02 mm, respectively, for the age range of 30 to 69 years. The thickness of maximum incisal width (R(2) = 0.95), PSD height (R(2) = 0.76), and IEP distance (R(2) = 0.99) indicated that all are subject to an increase in relation to age.

CONCLUSION

Facial enamel thickness above the CEJ decreases, while MFP increases in relation to age. The PSD height and IEP distance also increased with age.

Longevity and failure load of ceramic veneers with different preparation designs after exposure to masticatory simulation

STATEMENT OF PROBLEM

Laminate veneers are widely used in the management of unesthetic anterior teeth. However, limited information is available regarding the influence of preparation design on longevity of ceramic veneers.

PURPOSE

This study evaluated the influence of preparation design on longevity and failure load of ceramic veneers bonded to human maxillary central incisors after cyclic loading and thermal cycling in a dual-axis masticatory simulator.

MATERIAL AND METHODS

Sixty-four caries-free maxillary central incisors were divided into 4 groups (n = 16). The control group remained unprepared (NP). For Group WP, a window preparation was made. Specimens in Group IOP were prepared with an incisal overlap of 2 mm without palatal chamfer. For Group CVP, specimens were prepared with a complete-veneer design of 3-mm incisal reduction and 2-mm palatal extension. Forty-eight IPS Empress 1 ceramic veneers were bonded adhesively with dual-polymerizing composite (Variolink II). All specimens were subjected to cyclic mechanical loading (1.2 million cycles, cycle frequency 1.3 Hz, invariable palatal load 49 N) and thermal cycling (5 degrees C-55 degrees C, dwell time 60 seconds, 5500 cycles) in a masticatory simulator. Failure was defined by bulk fracture of a specimen. Subcritical crack patterns were observed. Surviving specimens were loaded in a universal testing machine until fracture. The failure-load values (N) (1.5 mm/min crosshead speed) were automatically recorded by controlling software. Statistical analysis of data was performed by Kruskal-Wallis analysis of variance (alpha = .05) and pairwise Wilcoxon rank sum tests (alpha = .05).

RESULTS

Three specimens from group NP, 1 specimen each from the WP and CVP groups, and 2 specimens from group IOP fractured during fatigue. After 1.2 million cycles, the highest crack rates were observed for complete veneers and originated in the palatal concavity extending to the facial surface. The median (interquartile range = x .25 - x .75 ) failure loads (N) were as follows: NP 713.3 (404.4-777.1), WP 549.5 (477.5-597.7), IOP 695.3 (400.0-804.6), and CVP 519.2 (406.1-732.9). No significant differences in longevity and failure load were demonstrated between natural teeth and teeth restored with ceramic veneers ( P = .555).

CONCLUSION

Maxillary teeth restored with the 3 types of IPS Empress 1 veneers showed fracture resistance similar to that of unprepared incisors ( P = .555).

Novel porcelain laminate preparation approach driven by a diagnostic mock-up

One critical step in the porcelain laminate technique is the achievement of sufficient ceramic thickness. At least two different strategies for tooth preparation can be found in the literature: (1) earlier simplified techniques included the use of depth cutters guided by the existing tooth surface-however, that approach did not take into consideration alterations of the tooth owing to aging, wear, or loss of enamel and thus led to greater risks for dentin exposures; (2) more recent and sophisticated methods have integrated an additive diagnostic procedure (ie, wax-up or mock-up) to compensate for tooth aging or severe existing loss of tooth substance. This approach allows for more enamel preservation and, as a consequence, more predictable bonding, biomechanics, and esthetics. The present article illustrates in detail the latest development in tooth preparation for porcelain laminates. This technique combines the time efficiency of earliest methods with the rationale and diagnostic foundations of the more recent techniques.

CLINICAL SIGNIFICANCE

Using this new laminate porcelain preparation approach, clinicians should be able to produce not only more accurate preparations, but also higher-quality tooth preparations in a time-efficient fashion.