An accuracy evaluation of four removable die systems

Accuracy of fit of implant-supported bars fabricated on definitive casts made by different dental stones

BACKGROUND

The purpose of this study was to evaluate the accuracy of fitting of an implant supported screw-retained bar made on definitive casts produced by 4 different dental stone products.

MATERIAL AND METHODS

The dental stones tested were QuickRock (Protechno), FujiRock (GC), Jade Stone (Whip Mix) and Moldasynt (Heraeus). Three external hexagon implants were placed in a polyoxymethylene block. Definitive impressions were made using monophase high viscosity polyvinylsiloxane in combination with custom trays. Then, definitive models from the different types of dental stones were fabricated. Three castable cylinders with a machined non-enganging base were cast and connected with a very small quantity of PMMA to a cast bar, which was used to verify the marginal discrepancies between the abutments and the prosthetic platforms of the implants. For that purpose special software and a camera mounted on an optical microscope were used. The gap was measured by taking 10 measurements on each abutment, after the Sheffield test was applied. Twelve definitive casts were fabricated for each gypsum product and 40 measurements were performed for each cast. Mean, minimum, and maximum values were calculated. The Shapiro-Wilk test of normality was performed. Mann-Whitney test (P<.06) was used for the statistical analysis of the measurements.

RESULTS

The non-parametric Kruskal-Wallis test revealed a statistically significant effect of the stone factor on the marginal discrepancy for all Sheffield test combinations: 1. Abutment 2 when screw was fastened on abutment 1 (χ2=3, df=35.33, P<0.01), 2. Abutment 3 when the screw was fastened on abutment 1 (χ2=3, df=37.74, P<0.01), 3. Abutment 1 when the screw was fastened on abutment 3 (χ2=3, df=39.79, P<0.01), 4. Abutment 2 when the screw was fastened on abutment 3 (χ2=3, df=37.26, P<0.01).

CONCLUSIONS

A significant correlation exists between marginal discrepancy and different dental gypsum products used for the fabrication of definitive casts for implant supported bars. The smallest marginal discrepancy was noted on implant supported bars fabricated on definitive casts made by Type III mounting stone. The biggest marginal discrepancy was noted on implant supported bars fabricated on definitive casts made by Type V dental stone. The marginal discrepancies presented on implant supported bars fabricated on definitive casts made by two types of Type IV dental stone were not significantly different. Key words:Dental implant, passive fit, dental stones, marginal discrepancy.

Interproximal distance analysis of stereolithographic casts made by CAD-CAM technology: An in vitro study

STATEMENT OF PROBLEM

The accuracy of interproximal distances of the definitive casts made by computer-aided design and computer-aided manufacturing (CAD-CAM) technology is not yet known.

PURPOSE

The purpose of this in vitro study was to compare the interproximal distances of stereolithographic casts made by CAD-CAM technology with those of stone casts made by the conventional method.

MATERIAL AND METHODS

Dentoform teeth were prepared for a single ceramic crown on the maxillary left central incisor, a 3-unit fixed dental prosthesis (FDP) on the second premolar for a metal-ceramic crown, and a maxillary right first molar for a metal crown. Twenty digital intraoral impressions were made on the dentoform with an intraoral digital impression scanner. The digital impression files were used to fabricate 20 sets of stereolithographic casts, 10 definitive casts for the single ceramic crown, and 10 definitive casts for the FDP. Furthermore, 20 stone casts were made by the conventional method using polyvinyl siloxane impression material with a custom tray. Each definitive cast for stereolithographic cast and stone cast consisted of removable die-sectioned casts (DC) and nonsectioned solid casts (SC). Measurements of interproximal distance of each cast were made using CAD software to provide mean ±standard deviation (SD) values. Data were first analyzed by repeated measures analysis of variance (ANOVA), using different methods of cast fabrication (stone and stereolithography) as one within subject factor and different cast types (DC and SC) as another within subject factor. Post hoc analyses were performed to investigate the differences between stone and stereolithographic casts depending upon the results from the repeated measures ANOVA (α=.05).

RESULTS

Analysis of interproximal distances showed the mean ±SD value of the single ceramic crown group was 31.2 ±24.5 μm for stone casts and 261.0 ±116.1 μm for stereolithographic casts, whereas the mean ±SD value for the FDP group was 46.0 ±35.0 μm for stone casts and 292.8 ±216.6 μm for stereolithographic casts. For both the single ceramic crown and the FDP groups, there were significant differences in interproximal distances between stereolithographic casts and stone casts (P<.001). In addition, the comparisons of DC with SC of stone and stereolithographic casts for the single ceramic crown and FDP groups demonstrated there was statistically significant differences among interproximal distances between DC stereolithographic casts and SC stereolithographic casts only for the FDP group (P<.001).

CONCLUSIONS

For both the single ceramic crown and the FDP groups, the stereolithographic cast group showed significantly larger interproximal distances than the stone cast group. In terms of the comparison between DC and SC, DC stereolithographic casts for the FDP group only showed significantly larger interproximal values than those of the SC stereolithographic casts for the FDP group.

In Vitro Comparative Evaluation of Different Types of Impression Trays and Impression Materials on the Accuracy of Open Tray Implant Impressions: A Pilot Study

Purpose. For a precise fit of multiple implant framework, having an accurate definitive cast is imperative. The present study evaluated dimensional accuracy of master casts obtained using different impression trays and materials with open tray impression technique. Materials and Methods. A machined aluminum reference model with four parallel implant analogues was fabricated. Forty implant level impressions were made. Eight groups (n = 5) were tested using impression materials (polyether and vinylsiloxanether) and four types of impression trays, two being custom (self-cure acrylic and light cure acrylic) and two being stock (plastic and metal). The interimplant distances were measured on master casts using a coordinate measuring machine. The collected data was compared with a standard reference model and was statistically analyzed using two-way ANOVA. Results. Statistically significant difference (p < 0.05) was found between the two impression materials. However, the difference seen was small (36 μm) irrespective of the tray type used. No significant difference (p > 0.05) was observed between varied stock and custom trays. Conclusions. The polyether impression material proved to be more accurate than vinylsiloxanether impression material. The rigid nonperforated stock trays, both plastic and metal, could be an alternative for custom trays for multi-implant impressions when used with medium viscosity impression materials.

Effect of dental technician disparities on the 3-dimensional accuracy of definitive casts

STATEMENT OF PROBLEM

Studies that evaluated the effect of dental technician disparities on the accuracy of presectioned and postsectioned definitive casts are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the accuracy of presectioned and postsectioned definitive casts fabricated by different dental technicians by using a 3-dimensional computer-aided measurement method.

MATERIAL AND METHODS

An arch-shaped metal master model consisting of 5 abutments resembling prepared mandibular incisors, canines, and first molars and with a 6-degree total angle of convergence was designed and fabricated by computer-aided design and computer-aided manufacturing (CAD-CAM) technology. Complete arch impressions were made (N=110) from the master model, using polyvinyl siloxane (PVS) and delivered to 11 dental technicians. Each technician fabricated 10 definitive casts with dental stone, and the obtained casts were numbered. All casts were sectioned, and removable dies were obtained. The master model and the presectioned and postsectioned definitive casts were digitized with an extraoral scanner, and the virtual master model and virtual presectioned and postsectioned definitive casts were obtained. All definitive casts were compared with the master model by using computer-aided measurements, and the 3-dimensional accuracy of the definitive casts was determined with best fit alignment and represented in color-coded maps. Differences were analyzed using univariate analyses of variance, and the Tukey honest significant differences post hoc tests were used for multiple comparisons (α=.05).

RESULTS

The accuracy of presectioned and postsectioned definitive casts was significantly affected by dental technician disparities (P<.001). The largest dimensional changes were detected in the anterior abutments of both of the definitive casts. The changes mostly occurred in the mesiodistal dimension (P<.001).

CONCLUSIONS

Within the limitations of this in vitro study, the accuracy of presectioned and postsectioned definitive casts is susceptible to dental technician differences.

Considerations for services from dental technicians in fabrication of fixed prostheses: A survey of commercial dental laboratories in Thessaloniki, Greece

STATEMENT OF PROBLEM

Effective communication and cooperation between dentists and dental technicians are essential in providing quality services. There has been a lack of information regarding dentist-dental technician communications and current methods and materials used for the fabrication of fixed partial dentures (FPDs).

PURPOSE

This cross-sectional study identified the materials and techniques used for fabrication of FPDs, as well as the status of communication between dentists and dental technicians in Thessaloniki, Greece.

MATERIAL AND METHODS

A questionnaire was developed with 7 sections pertaining to procedures and materials used for the fabrication of fixed prostheses: general questions, infection control, impressions/interocclusal records, die technique/mounting, information from final casts, prostheses design/materials, and communication/shade selection. The questionnaire was anonymous and distributed by the Association of Dental Technicians of Thessaloniki to all member laboratories (228) in the wider province of Thessaloniki, Greece. Due to the absence of normal distribution of the results, frequencies and medians were reported.

RESULTS

Ninety-six of 228 dental laboratories responded (42.1% response rate). Twenty-six percent of dental laboratories did not routinely disinfect incoming items. The dental technicians considered 30% of incoming final impressions and 20% of interocclusal registrations as inadequate. Half of the time (55%) final casts were mounted by technicians on simple hinge articulators. Only 20% of tooth preparations had adequate finish lines. The majority (70%) of fixed restorations were metal-ceramic. Fifty-seven percent of dental technicians considered the delivery time requested by dentists as insufficient.

CONCLUSION

The information provided in this study indicates areas of weakness in communication between dentists and dental technicians, along with areas where both parties should use greater care during clinical and laboratory procedures.

A new removable implant analog

A new implant analog system that improves the efficiency of the implant restoration's fabrication process is described. This 2-piece analog contains an outer plastic sleeve that is retained within the stone cast. The inner portion, a metal analog, can be easily removed and replaced within the plastic sleeve. Because the metal analog is removable, the time-consuming process of screwing and unscrewing the prosthesis- or abutment-retaining screws during laboratory procedures can be minimized. The prosthesis can remain secured to the analog during waxing, metal finishing, and porcelain buildup, yet is easily removed from the cast for inspection.

Accuracy of 3 conceptually different die systems used for implant casts

STATEMENT OF PROBLEM

Given that meticulous implant prosthodontic procedures are recommended to obtain the best possible intraoral fit, the die systems used for multi-implant casts warrant further investigation. PURPOSE. The purpose of this in vitro study was to compare the accuracy of implant casts fabricated from 3 conceptually different die systems at the solid, sectioned, and repeated stages.

MATERIAL AND METHODS

Thirty direct transfer implant impressions were made of the master cast with a polyether impression material. Ten experimental implant casts were fabricated for each of the 3 different die systems tested: double-pour (Pindex), plastic base (DVA), and die tray (KO Tray). The solid experimental casts were sectioned and then removed from the die system 30 times. Linear distances between steel balls placed on each abutment replica were measured with a traveling microscope to determine the accuracy of the experimental casts at different stages. Data were analyzed with repeated-measures analysis of variance (alpha=.05) and the post hoc Ryan-Einot-Gabriel-Welsch multiple-range test (REGWQ).

RESULTS

Repeated-measures analysis of variance revealed a significant interaction between the die systems and different stages (P=.0432). REGWQ showed the die tray system to be significantly more accurate at the solid than at the sectioned and repeated stages. The die tray system was significantly less accurate than the double-pour and plastic base systems at the sectioned stage.

CONCLUSION

Within the limitations of this study, the use of a double-pour or plastic base die system is recommended when sectioned dies are needed for a multi-implant-retained prosthesis.

A method for true coordinate three-dimensional measurement of casts using a measuring microscope

Exact 3-dimensional measurements are more useful for researchers and clinicians than are relative distance measurements. Through the use of a measuring microscope and a personal computer, the technique presented in this article provides meaningful and accurate (0.005 mm) 3-dimensional measurements of casts in true coordinates (x, y, z). By fabricating the master cast with reference landmarks, leveling the casts before measurement, removing the cast between repeat measures, and mathematically rotating the data points, this technique places all the landmarks in a standardized reference plane that allows for the comparison of dimensional changes between different casts.