Effect of evaporation and mixing technique on die spacer thickness: a preliminary study

Vertical Marginal Discrepancy of a Monolithic Zirconia Crown with Different Cement Spaces

The long-term clinical success of indirect restorations highly depends on their marginal integrity. The cement space is an element that might affect the marginal integrity, but it can be altered during the configuring of the computer-assisted designing/computer-aided manufacturing (CAD-CAM) restoration. However, there is controversy in the literature regarding the effect of the cement space on the precision of zirconia crown marginal adaptation. The aim of this study was to measure the vertical marginal discrepancies between different cement thickness settings for CAD-CAM monolithic zirconia restorations. Material and Methods. An artificial mandibular right molar tooth mounted on a typodont was prepared for a zirconia crown using the standard method. The study sample consisted of 30 zirconia crowns (Zenostar Zr Translucent Zirconia, Weiland Dental, Germany) milled using an (iMes-iCore) milling machine. Each group of 10 crowns was designed with 30-50 and 70 μm spacer thicknesses. The vertical marginal adaptation at the center of the four different planes (mesial, distal, buccal, and palatal) was measured under a microscope at 40x magnification. A one-way analysis of variance test was used for statistical analysis. Results. The mean of Group 30 was 27.45; of Group 50 was 22.22; and of Group 70 was 22.90. There was no statistically significant difference between the groups (p ≥ 0.5). Conclusions. The increase in the cement space up to 70 μm did not influence the vertical marginal adaptation of the monolithic zirconia crowns.

Effect of cement space settings on the marginal and internal fit of 3D-printed definitive resin crowns

STATEMENT OF PROBLEM

The cement gap setting affects the marginal and internal fits depending on the crown material and manufacturing method (subtractive or additive manufacturing). However, information on the effects of cement space settings in the computer-aided design (CAD) software program, which is used to aid the manufacturing with 3-dimensional (3D) printing-type resin material, is lacking, and recommendations for optimal marginal and internal fit are needed.

PURPOSE

The purpose of this in vitro study was to evaluate how cement gap settings affect the marginal and internal fit of a 3D-printed definitive resin crown.

MATERIAL AND METHODS

After scanning a prepared typodont left maxillary first molar, a crown was designed with cement spaces of 35, 50, 70, and 100 μm by using a CAD software program. A total of 14 specimens per group were 3D printed from definitive 3D-printing resin. By using the replica technique, the intaglio surface of the crown was duplicated, and the duplicated specimen was sectioned in the buccolingual and mesiodistal directions. Statistical analyses were performed using the Kruskal-Wallis and the Mann-Whitney post hoc tests (α=.05).

RESULTS

Although the median values of the marginal gaps were within the clinically acceptable limit (<120 μm) for all the groups, the smallest marginal gaps were obtained with the 70-μm setting. For the axial gaps, there was no observed difference in the 35-, 50-, and 70-μm groups, and the 100-μm group showed the largest gap. The smallest axio-occlusal and occlusal gaps were obtained with the 70-μm setting.

CONCLUSIONS

Based on the findings of this in vitro study, a 70-μm cement gap setting is recommended for optimal marginal and internal fit of 3D-printed resin crowns.

Comparing the marginal leakage and retention of implant-supported restorations cemented by four different dental cements

BACKGROUND

Despite the wide use of implants in dentistry, there is insufficient information about the ideal cement for retention.

PURPOSE

To determine the cement bond strength and marginal leakage of crown and partial denture cemented to implant abutments by four different types of cement.

MATERIALS AND METHODS

Eighty-four direct abutments were divided into eight groups (n = 7). Fifty-six crown and bridge restorations were cemented using zinc phosphate (ZM), temporary cement (TM), resin-modified glass-ionomer cement (GM), and self-adhesive resin cement (RM). After cementation, thermal cycling and incubation in basic fuchsin dye was applied. The maximum load to failure, marginal leakage, and fracture modes were evaluated.

RESULTS

The mean of retention strength for the bridges (874 N) was higher than the crown samples (705 N) (P = .005). The mean of retention strength for each cement group was ZM = 1298, RM = 1027, GM = 646, and TM = 187 N (P ≤ .0001). Marginal leakage was recorded in majority of the samples; the highest incidence was detected for ZM samples. The cement fracture was mostly adhesive in nature.

CONCLUSION

Self-adhesive resin and resin-modified glass ionomer cement had better mechanical properties to retain implant supported restorations.

Micro-CT Evaluation of Ceramic Inlays: Comparison of the Marginal and Internal Fit of Five and Three Axis CAM Systems with a Heat Press Technique

OBJECTIVES

To evaluate the marginal and internal adaptation of CAD/CAM lithium-disilicate inlay restorations fabricated by two milling systems (Five and Three-axis), and a traditional heat-press technique.

METHODS

Fifteen premolar teeth with an MOD cavity preparation were fabricated. Lithium-disilicate inlay restorations were obtained by three fabrication techniques and fitted to their dies (n = 15/gp) as follows: Group-1, three-axis milling system, Group-2, five-axis milling system, Group-3, conventional heat-press technique. Gaps were evaluated by X-ray microtomography. Marginal gap (MG), occlusal-marginal gap (OMG), proximal-marginal gap (PMG), gingival-marginal gap (GMG), absolute marginal discrepancy (AMD), axial-internal gap (AIG), and occlusal-internal gap (OIG) were evaluated at 120 different points per inlay. Data were analyzed using repeated measures ANOVA. Pairwise comparisons were conducted for post-hoc testes and the Bonferroni correction was used to adjust for multiple comparisons (α = 0.007).

RESULTS

The heat-press group demonstrated significantly smaller mean-values amongst all outcomes compared with CAD/CAM groups except for GMG, where there was no statistically significant difference between groups in the ANOVA (p = 0.042). Within the CAD/CAM groups, the five-axis group showed significantly lower OMG mean-value compared with the three-axis group p < 0.001, and lower AIG mean-value compared with the three-axis group p < 0.001. There was no significant difference between the five-axis and the three-axis groups' AMD, MG, PMG, and OIG locations.

CONCLUSION

Different fabrication techniques affected the marginal and internal adaptation of ceramic inlay restorations. The heat-press group showed the best marginal and internal adaptation results; however, in every group, all samples were within the clinically acceptable MG limit (100 μm).

CLINICAL SIGNIFICANCE

The marginal fit and internal adaptation of inlay ceramic restorations fabricated by a five-axis milling system have not been tested or compared with those fabricated by three-axis machines and the conventional heat-press method. The preferred method of inlay fabrication, whether in the lab or chair side, may be influenced by the results of this study and could affect future clinical decision-making. (J Esthet Restor Dent 29:49-58, 2017).

Evaluation of marginal fit and internal adaptation of zirconia copings fabricated by two CAD - CAM systems: An in vitro study

Statement of Problem:

Three main factors which determine the success of an All-ceramic restoration are esthetic value, resistance to fracture and third being the marginal fit. Marginal fit and internal adaptation are crucial factors in increasing the longevity of the restoration. Newer and economical CAD CAM systems have been introduced claiming better marginal fit and adaptation of All ceramic crowns. CAD CAM systems involves scanning of the die or the tooth preparation and milling of the restoration, which may have variations among the systems available.

Aim of the Study:

Our study intended to check the marginal fit and internal adaptation of commonly used CAD CAM systems namely CERAMILL and CEREC -In Lab MC XL.

Materials and Methods:

Two groups of typodont teeth (n = 10) were prepared using a standardized protocol to receive All ceramic copings. 10 samples of Group A were used for fabrication of copings using CERAMILL system and 10 samples of Group B were used for fabrication of copings using CEREC -In Lab MC XL system. They were then luted with glass ionomer cement under mild finger pressure. Samples were embedded in resin and sliced longitudinally. They were then viewed under stereomicroscope and readings were measured along 15 points using ImageScope software. The P value was set at 0.05 at 95% confidence interval with 80% power. The data were checked for normality and unpaired t-test was used to evaluate the results of the two groups.

Results:

The overall internal adaptation was 61.5 ± 5.2 μm for CERAMILL and 56.9 ± 5.7 μm for CEREC -In Lab MC XL (P < 0.05). The marginal fit for CERAMILL was 83 μm and for CEREC -In Lab MC XL was 68 μm (P < 0.05).

Conclusion:

The marginal adaptation of CEREC -In Lab MC XL (68 μm) was found to be superior to CERAMILL (83 μm) (P < 0.05). Both the CEREC -In Lab MC XL and CERAMILL copings demonstrated internal adaptation and marginal fit within acceptable discrepancy range. When corroborating both the internal adaptation and marginal fit, CEREC -In Lab MC XL was found to be better than CERAMILL.

Die spacer thickness reproduction for central incisor crown fabrication with combined computer-aided design and 3D printing technology: an in vitro study

STATEMENT OF PROBLEM

The inability to control die spacer thickness has been reported. However, little information is available on the congruency between the computer-aided design parameters for die spacer thickness and the actual printout.

PURPOSE

The purpose of this study was to evaluate the accuracy and precision of the die spacer thickness achieved by combining computer-aided design and 3-dimensional printing technology.

MATERIAL AND METHODS

An ivorine maxillary central incisor was prepared for a ceramic crown. The prepared tooth was duplicated by using polyvinyl siloxane duplicating silicone, and 80 die-stone models were produced from Type IV dental stone. The dies were randomly divided into 5 groups with assigned die spacer thicknesses of 25 μm, 45 μm, 65 μm, 85 μm, and 105 μm (n=16). The printed resin copings, obtained from a printer (ProJet DP 3000; 3D Systems), were cemented onto their respective die-stone models with self-adhesive resin cement and stored at room temperature until sectioning into halves in a buccolingual direction. The internal gap was measured at 5 defined locations per side of the sectioned die. Images of the printed resin coping/die-stone model internal gap dimensions were obtained with an inverted bright field metallurgical microscope at ×100 magnification. The acquired digital image was calibrated, and measurements were made using image analysis software. Mixed models (α=.05) were used to evaluate accuracy. A false discovery rate at 5% was used to adjust for multiple testing. Coefficient of variation was used to determine the precision for each group and was evaluated statistically with the Wald test (α=.05).

RESULTS

The accuracy, expressed in terms of the mean differences between the prescribed die spacer thickness and the measured internal gap (standard deviation), was 50 μm (11) for the 25 μm group simulated die spacer thickness, 30 μm (10) for the 45 μm group, 15 μm (14) for the 65 μm group, 3 μm (23) for the 85 μm group, and -10 μm (32) for the 105 μm group. The precision mean of the measurements, expressed as a coefficient of variation, ranged between 14% and 33% for the 5 groups.

CONCLUSIONS

For the accuracy evaluation, statistically significant differences were found for all the groups, except the group of 85 μm. For the precision assessment, the coefficient of variation was above 10% for all groups, showing the printer's inability to reproduce the uniform internal gap within the same group.

Evaluation of the Luting Cement Space for Provisional Restoration by using Various Coats of Die Spacer Materials-An Invitro Study

AIM

The present study was to evaluate the space provided for the temporary luting cement, after the application of various coats of die spacers, during the fabrication of provisional crowns and bridges.

MATERIALS AND METHODS

A total of 50 specimens of dental stone with provisional crowns on all these samples were prepared and were divided into five groups based on the application of various coats of different die spacers. Later these specimens were sectioned buccolingually and were observed using a stereomicroscope under 100X magnification. The images thus obtained were evaluated and noted for the amount of space between the inner surface of the provisional crown and the specimens at five different locations using Image Pro 6.0 Express software and the values were subjected to one-way ANOVA test, and unpaired t-test.

RESULTS

There was a significant increase of luting space thickness with various die spacer applications than the specimens of control group.

CONCLUSION

Specimens of double coat applications of silver and gold die spacers showed higher luting cement space than the separating media application specimens.

Cement selection for implant-supported crowns fabricated with different luting space settings

PURPOSE

To measure and compare the retentive strength of cements specifically formulated for luting restorations onto implant abutments and to investigate the effect of varying cement gap on retention strength of implant-supported crowns.

MATERIALS AND METHODS

Standard titanium abutments were scanned by means of a 3D digital laser scanner. One hundred and sixty standard metal copings were designed by a Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) system with two cement gap values (20 and 40 μm). The copings were cemented to the abutments using the following eight cements with one being the control, zinc oxide temporary cement, while the other seven were specifically formulated implant cements (n = 10): Premier Implant Cement, ImProv, Multilink Implant, EsTemp Implant, Cem-Implant, ImplaTemp, MIS Crown Set, and TempBond NE. The specimens were placed in 100% humidity for 24 hours, and subjected to a pull-out test using a universal testing machine at a 0.5 mm/min crosshead speed. The test results were analyzed with two-way ANOVA, one-way ANOVA, post hoc Tamhane' s T2, and student's t-tests at a significance level of 0.05.

RESULTS

Statistical analysis revealed significant differences in retention strength across the cement groups (p < 0.01). Resin-based cements showed significantly higher decementation loads than a noneugenol zinc oxide provisional cement (TempBond NE) (p < 0.01), with the highest tensile resistance seen with Multilink Implant, followed by Cem-Implant, MIS Crown Set, ImProv, Premier Implant Cement, EsTemp Implant, and ImplaTemp. Increasing the cement gap from 20 to 40 μm improved retention significantly for the higher strength cements: Multilink Implant, Premier Implant Cement, ImProv, Cem-Implant, and MIS Crown Set (p < 0.01), while it had no significant effect on retention for the lower strength cements: EsTemp Implant, ImplaTemp, and TempBond NE (p > 0.05).

CONCLUSIONS

Resin cements specifically formulated for implant-supported restorations demonstrated significant differences in retention strength. The ranking of cements presented in the study is meant to be an arbitrary guide for the clinician in deciding the appropriate cement selection for CAD/CAM-fabricated metal copings onto implant abutments with different luting space settings.

The effect of occlusal surface relief of dies on marginal adaptation of metal-ceramic casting copings

PURPOSE

The purpose of this study was to evaluate the impact of occlusal relief of dies on internal adaptation of metal-ceramic casting copings.

MATERIALS AND METHODS

Standardized preparations were made on 80 extracted third molar teeth. Impressions were made with poly(vinyl siloxane), and stone dies were prepared. Dies were covered with four layers of die spacer, covering the entire preparation together with the occlusal surface excluding the apical 0.5 mm of the preparation in group 1 (40 specimens), and covering the same area excluding the occlusal surface in group 2 (40 specimens). Copings were cast using nickel-chromium-based metal ceramic alloy and cemented using zinc phosphate cement. The specimens were sectioned along the long axis. Internal discrepancies were recorded with a 0.001-mm resolution stereoscope at 6 points: the middle of the occlusal surface (MO), middle of the lingual wall (ML), middle of the buccal wall (MB), middle of the buccal shoulder finish line (MSH), middle of the lingual chamfer finish line (MCH), and middle of the buccal bevel finish line (MBL). Student's t-test was used for statistical analysis. Significance level was set at p < 0.05.

RESULTS

The marginal discrepancies of group 1 were higher than those of group 2. Significant differences in discrepancies were found on MO (p < 0.0001), MSH (p = 0.012), and MBL (p = 0.035). The bevel margin showed the least marginal discrepancy following occlusal surface of the die with no relief.

CONCLUSION

Leaving the occlusal part of the die uncovered with the die spacer improved the crown seating considerably in the occlusal surface as well as shoulder and bevel margins.

Evaluation of the onset of failure under mechanical and thermal stresses on luting agent for metal-ceramic and metal crowns by finite element analysis

Long-term clinical failures of cemented prosthesis depend, to a large extent, on the integrity of the luting agent. The causative factors that lead to microfracture and, hence, failure of the luting agents are the stresses acting inside the oral cavity. Therefore, the present study was designed to develop an understanding of the relationship between stresses in the tooth and the failure potential of the luting agent. Two-dimensional finite element stress analysis was performed on the mandibular second premolar. The behavior of zinc-phosphate and glass-ionomer were studied under different crowns (metal-ceramic and metal crown) and loading conditions (mechanical force of 450 N acting vertically over the occlusal surface, thermal loads of 60° and 0°C). It was observed from the study that failure threshold of the luting agent was influenced both by the elastic modulus of the luting agent and by the type of the crown.

Effect of the use of die spacer on the marginal fit of copings cast in NiCr, NiCrBe and commercially pure titanium

The goal of this study was to evaluate the effect of using die spacers on the marginal fit of NiCr (M1) and NiCrBe (M2) alloys and commercially pure titanium (cpTi) (M3) copings cast by the lost wax technique. Using a metal matrix, 45 resin added extra hard type IV stone models were obtained for the fabrication of wax patterns under the following conditions: no die spacer (A), with one die spacer layer (B) and with two die spacer layers (C), with five repetitions for each condition (alloy x die). Each die was waxed and the wax patterns were invested as per manufacturer's instructions. Three wax patterns were embedded in each casting ring, each corresponding to one of the conditions. Each coping, seated to the metal matrix by a seating pressure standardizing device (SPSD), was taken to an optical microscope for measurement of marginal discrepancy. The obtained data (µm) were analyzed statistically by ANOVA and Tukey' test (a=5%). There was statistically significant difference (p<0.05) among the materials (M1=110.67; M2=130.33 and M3=148.33). Regarding the use of the die spacer, there was a statistically significant difference (p<0.05) among the three conditions (A=162.00; B=131.06 and C=96.67). It was concluded that there is less marginal discrepancy with two die spacer layers.

Effect of die spacer thickness on shear bond strength of porcelain laminate veneers

STATEMENT OF PROBLEM

The application of die spacer may affect the shear bond strength (SBS) of porcelain laminate veneer (PLV). However, there is no standard for the amount of die spacer necessary for the fabrication of PLV restorations.

PURPOSE

The purpose of this study was to evaluate the SBS differences between enamel and a feldspathic PLV as a function of die spacer thickness.

MATERIAL AND METHODS

Eighty rectangular (5 x 3 x 1 mm) PLV (Super Porcelain EX-3) specimens were made using stone blocks on which die spacer (Nice Fit) was applied in different thicknesses (0, 2, 4, or 6 coats) (n = 20). Before bonding, all PLV specimens were pretreated with airborne-particle abrasion (1-, 2-, 3-, or 4-bar pressure; 10 sec/10-mm distance or 5 sec/20-mm distance) and cleaned with an ultrasonic cleanser. A vertically flat surface on the labial enamel of 80 freshly extracted sound teeth was prepared with a low-speed diamond-coated saw. The PLV specimens were bonded to the etched enamel specimens using a composite resin cement (RelyX Veneer). Forty enamel-ceramic specimens (Group NTc) were maintained in deionized water at room temperature for 1 week after cementation, and the other 40 specimens (Group Tc) were subjected to thermal cycling treatment (2500 cycles, 5 degrees C to 60 degrees C, 15-second dwell time). The SBS measurement was performed with a universal testing machine. The results were compared with a 2-way analysis of variance (ANOVA), and mean values were compared with Fisher's Protected Least Significant Difference (PLSD) intervals (alpha = .05).

RESULTS

For Group NTc specimens, the SBS values (MPa) were 8.7 +/- 2.6 (no coat), 12.6 +/- 4.8 (2 coats), 10.7 +/- 2.9 (4 coats), and 9.6 +/- 2.8 (6 coats). For Group Tc specimens, the SBS values were 4.1 +/- 2.0 (no coat), 7.1 +/- 3.4 (2 coats), 6.8 +/- 2.1 (4 coats), and 6.1 +/- 2.4 (6 coats). Two-way ANOVA showed that the SBS was influenced by the thermal cycling and the number of coats, but there was no significant interaction between the 2 variables. The Fisher's PLSD interval for the SBS for comparisons among the number of coats was 0.95. The group with 2 coats of die spacer showed higher SBS values than the group with no coat, whereas groups with more than 2 coats of die spacer resulted in similar SBS values when compared to each other. The thermal cycling treatment resulted in a significant decrease of the SBS. Group Tc showed a trend similar to Group NTc.

CONCLUSION

Within the limitations of this study it was found that the appropriate application of die spacer exerts a favorable influence on the SBS of composite-bonded PLV. The 2-coat application of die spacer provides suitable space to accommodate the cement thickness.