Measurement of the cement film thickness beneath full crown restorations

Evaluating ceramic crown margins with digital radiography

STATEMENT OF PROBLEM

Radiographs aid in clinically determining crown fit, specifically interproximal margins where tactile and visual methods may be limited. However, investigations of the utility of digital radiographs as a tool for evaluating the marginal openings of ceramic crowns are lacking.

PURPOSE

The purpose of this in vitro study was to assess whether marginal adaptation for ceramic crowns and for metal-ceramic crowns with a metal collar can be identified with digital radiographs.

MATERIAL AND METHODS

One lithium disilicate crown, 1 fluorapatite crown, and 1 metal-ceramic crown were fabricated for a maxillary premolar. The crowns were attached to a custom-designed device that allowed the marginal discrepancy to be changed. A total of 10 increments were measured starting at 0 to 20 μm and increasing every 20 μm to a maximum opening of 180 to 200 μm. At each increment, 2 radiographs were made of the crowns, using a digital sensor, 1 perpendicular to and 1 at 80 degrees to the long axis of the tooth. To test whether digital radiographs could be used to accurately identify "acceptable" and "unacceptable" margins, 21 dentists were asked to rate the radiographs as "acceptable" or "unacceptable." The chi square test was used to analyze differences between the dentists' evaluations and the actual marginal opening (α=.05). For the purposes of this study, a marginal discrepancy greater than 80 μm was considered "unacceptable."

RESULTS

Of all marginal discrepancies exceeding 80 μm, 78.6% of the metal-ceramic crown radiographs were incorrectly scored as "acceptable" (P<.001). These radiographs were identified as false positives. Lithium disilicate (66.1%) and fluorapatite (45.8%) crowns were more likely to be incorrectly evaluated as "unacceptable" (P<.001) and identified as false negatives.

CONCLUSIONS

Using digital radiographs to evaluate marginal adaptation without clinical examination is not by itself an accurate method of evaluating the marginal fit of complete coverage crowns. The marginal fit of the tested metal-ceramic crowns tended to be evaluated incorrectly as acceptable. The marginal fit of the tested ceramic crowns tended to be evaluated incorrectly as unacceptable.

Impact of a Core Ferrule Design on Fracture Resistance of Teeth Restored with Cast Post and Core

Objectives. To investigate the influence of a contra bevel on the fracture resistance of teeth restored with cast post and core. Materials and Methods. Sixty plastic analogues of an upper incisor were endodontically treated and prepared with 6° internal taper and 2 mm of ferrule in order to receive a cast post and core. The prepared samples were divided into two groups (n = 30); the first group serves as control while the second group was prepared with an external 30° bevel on the buccal and lingual walls. All samples crowned were exposed to a compressive load at 130° to their long axis until fractures occurred. Fracture resistance loads were recorded and failure modes were also observed. Mann-Whitney test was carried out to compare the two groups. Results. Mean failure loads for the groups were, respectively, 1038.69 N (SD ±243.52 N) and 1078.89 N (SD ±352.21 N). Statistically, there was no significant difference between the two groups (P = 0.7675 > 0.05). Conclusion. In the presence of a ferrule and a crown in the anterior teeth, adding a secondary ferrule to the cast post and core will not increase the resistance to fracture.

Effect of tapering internal coronal walls on fracture resistance of anterior teeth treated with cast post and core: In vitro study

When fabricating indirect post and core, internal coronal walls are tapered to remove undercuts and allow a better adaptation. To evaluate the fracture strength of anterior tooth reconstructed with post and core and crowned, with two different taper of internal coronal walls, 6° and 30° to the long axis, two groups of 30 clear plastic analogues simulating endodontically treated maxillary central incisors were prepared. The analogues crowned were subjected to a compressive load with a 1-kN cell at a crosshead speed of 0.05 mm/min at 130° to the long axis until fracture occurred. Data were analyzed by Lillifors and Mann–Whitney tests. Mean failure loads for the groups were as follows: group I 1038.69 N (standard deviation ±243.52 N) and group II 1231.86 N (standard deviation ±368.76 N). Statistical tests showed significant difference between groups (p = 0.0010 < 0.01). Increasing the taper of internal coronal walls appears to enhance the fracture resistance of anterior maxillary teeth post and core reconstructed.

Fracture resistance of teeth restored with cast post and core: An in vitro study

CONTEXT

Influence of luting agent, design of tooth preparation for cast posts on tooth resistance to fracture.

AIM

To evaluate fracture resistance of teeth restored with cast posts and cores with or without cervical ferrule and cemented with zinc phosphate, glass ionomer, or resin cement.

MATERIALS AND METHODS

Sixty single-rooted maxillary first premolars of similar sizes were selected. Biomechanical preparation and post space preparation for cast post was done for all samples and then they were divided into two groups (n=30). Cervical ferrule preparation was done for Group A, and Group B was prepared without any cervical ferrule. Both groups were further divided into three subgroups (1, 2, and 3; n=10) Cast posts for subgroups 1, 2, and 3 were cemented with zinc phosphate, glass ionomer, and resin cement, respectively. A shearing load was applied to indented buccal cusp of specimens at an angle of 45° in universal testing machine at a cross-head speed of 1 mm/min until fracture.

RESULTS

Specimens with ferrule (Group A) had significantly higher shear bond strength values (mean 1503.37 N) than specimens without ferrule (Group B) (mean 1052.09 N).

CONCLUSION

Inclusion of ferrule in tooth preparations for posts increased the fracture resistance regardless of the luting agent.

Influence of application site of provisional cement on the marginal adaptation of provisional crowns

Introduction: Marginal discrepancies may lead to cement washout and marginal leakage, damaging periodontal and pulp tissues or causing premature loss of the restoration. Purpose: This study evaluated the influence of application site of provisional cement on the marginal adaptation of provisional crowns. Material and Methods: Four different application sites of provisional cement (Temp Bond NE, Kerr Corporation) were used for cementation of provisional crowns on phantom teeth prepared for full crown restorations, performing 4 experimental groups (n=10): cement applied to all internal surfaces of the crown (CAO); cement applied to all internal surfaces of the crown, except for the occlusal surface (CA); cement applied to the cervical crown margin (CM); and cement applied to the cervical tooth margin (TM). A comparison microscope (Mitutoyo America Corporation) was used to measure the distances between the internal tangents of two circular marks, one made on the provisional crown and one made apical to the tooth preparation margin, in areas corresponding to buccal, lingual, mesial and distal surfaces. Marginal adaptation was determined before and after cementation, with 0.0001-mm accuracy. Data were analyzed statistically by ANOVA and Tukey's test at 5% significance level. Results: Mean values of marginal opening obtained for each group were: CAO: 145 μm; CA: 67 μm; CM: 46 μm; TM: 34 μm. CA, CM and TM presented significantly lower marginal openings than CAO (p<0.05). Conclusion: complete filling of the crown with provisional cement, including the occlusal surface, provided grater marginal discrepancies when compared to the other methods evaluated.

Correlation between margin fit and microleakage in complete crowns cemented with three luting agents

Microleakage can be related to margin misfit. Also, traditional microleakage techniques are time-consuming. This study evaluated the existence of correlation between in vitro margin fit and a new microleakage technique for complete crowns cemented with 3 different luting agents. Thirty human premolars were prepared for full-coverage crowns with a convergence angle of 6 degrees, chamfer margin of 1.2 mm circumferentially, and occlusal reduction of 1.5 mm. Ni-Cr cast crowns were cemented with either zinc phosphate (ZP) (S.S. White), resin-modified glass-ionomer (RMGI) (Rely X Luting Cement) or a resin-based luting agent (RC) (Enforce). Margin fit (seating discrepancy and margin gap) was evaluated according to criteria in the literature under microscope with 0.001 mm accuracy. After thermal cycling, crowns were longitudinally sectioned and microleakage scores at tooth-cement interface were obtained and recorded at x100 magnification. Margin fit parameters were compared with the one-way ANOVA test and microleakage scores with Kruskal-Wallis and Dunn's tests (alpha=0.05). Correlation between margin fit and microleakage was analyzed with the Spearman's test (alpha=0.05). Seating discrepancy and marginal gap values ranged from 81.82 microm to 137.22 microm (p=0.117), and from 75.42 microm to 78.49 microm (p=0.940), respectively. Marginal microleakage scores were ZP=3.02, RMGI=0.35 and RC=0.12 (p<0.001), with no differences between RMGI and RC scores. The correlation coefficient values ranged from -0.27 to 0.30 (p>0.05).

CONCLUSION

Margin fit parameters and microleakage showed no strong correlations; cast crowns cemented with RMGI and RC had lower microleakage scores than ZP cement.

Effect of Venting and Seating Techniques on the Cementation of Complete Coverage Restorations

The best seating of complete crowns during cementation can be achieved by venting the crown and using a tapping cementation technique. When the crown is not vented, a dynamic seating method provides the best seating.

Screw-retained prosthesis for Straumann implant sites with limited interocclusal clearance

This article reports a technique that addresses the problem of the restricted interocclusal distance when screw-retained prostheses are selected.

Evaluation of intracanal post removal using ultrasound

The aim of this study was to determine the effect of ultrasonic vibration on the force necessary to remove pre-fabricated and anatomic and cast posts. Two hundred and forty teeth were divided into two groups. In group I, a 0.8-mm metallic pre-fabricated post, Unimetric-Maillefer, was utilized; in group II, cast copper-aluminum alloy posts measuring 0.8, 1.0 and 1.2 mm in diameter were used. The root canals were prepared in three different diameters: 0.8, 1.0 and 1.2 mm, with a length of 10 mm. The posts were cemented with glass monomer cement resulting in 20 specimens for each subgroup. Half of the sample was submitted to ultrasonic vibration for 3 min, while the other half did not receive any vibration. The specimens were submitted to traction in a universal testing machine. The results were analyzed by non-parametric Mann-Whitney U, Wilcoxon and Kruskal-Wallis tests. The application of ultrasonic vibration significantly reduced the retention provided by the glass ionomer cement in the fixation of intracanal posts. The ultrasonic action was effective in both pre-fabricated and anatomic and cast posts. The effectiveness of the ultrasonic vibration was not related to the cementation line or the diameter of the post.

The effect of cement thickness on the fracture strength of all-ceramic crowns

The effect of increasing cement thickness on the fracture strength of aluminous porcelain jacket crowns was investigated in this study. Thirty-three aluminous porcelain jacket crowns were divided into three groups. In Group 1, only platinum foil was used to provide cement space. In Group 2 two layers and Group 3 four layers of die spacer were painted onto the metal die before impression taking. Each crown was cemented onto a metal die with zinc phosphate cement and loaded until fracture. The maximum force to break each crown was recorded. The average fracture load was 408 N for Group 1,365 N for Group 2 and 324 N for Group 3. ANOVA (SPSS) found a significant difference (p < 0.05) between groups. A Scheffe Test revealed a significant difference between Groups 1 and 3. It was concluded that increasing the cement thickness above 70 microns reduced the fracture strength of porcelain jacket crowns.

The effect of post adaptation in the root canal on retention of posts cemented with various cements

This laboratory study compared the retention of prefabricated posts in well-fitting and loose-fitting post canals using different cement materials. Eighty-three human teeth were prepared for post placement. One of zinc phosphate cement, polycarboxylate cement, glass ionomer cement or resin cement was used to cement each post in place. A tensile force was applied to remove each post and the separation force was recorded. Posts cemented with the resin cement were the most difficult to dislodge. Posts cemented into loose-fitting canals exhibited greater resistance to dislodgment than posts cemented into well-fitting canals irrespective of the type of cements used.

Sleeve design for a fixed partial denture

A new sleeve design of a cemented cast retainer for a posterior fixed partial denture to improve retention with minimal tooth reduction while sustaining the original occlusal relationships is described.

Marginal fidelity of four methods of swaged metal matrix crown fabrication

The swaged metal matrix provides a method for rapidly making a metal substructure for ceramic crowns. This study determined the vertical and horizontal marginal fidelity of swaged metal substrate crowns made with four methods. No significant difference in vertical or horizontal marginal fidelity was found for metal margin crowns formed with either a plastic spacer or a paint-on die spacer. The vertical marginal fidelity was significantly better in crowns made with a metal margin (37 microns) than in crowns made with a porcelain facial margin (62 microns), and the latter were significantly better than crowns made with a 360-degrees porcelain margin (86 microns). Crowns made with all four methods were overcontoured by 46 to 82 microns. The 360-degrees porcelain margin was technically more difficult and time-consuming to make.

Effect of fitting adjustments on compressive strength of a new foil crown system

The effect of die spacing and precementation internal adjustments on the compressive strength of a new ceramic foil crown system was examined in vitro. Twenty-four ceramic foil crowns were made for identical stylized master dies made of polycarbonate filled with 30 wt% carbon. One half of the stone working dies were coated with die spacer and the remaining were left untreated. A special foil used for these crowns was adapted to the working dies under 2500 psi loading. A sculpturing device was used to standardize the size and shape of the ceramic foil crowns. Only crowns made on dies coated with die spacer received precementation fitting adjustment. All crowns in the two groups were cemented with zinc phosphate cement and were subjected to compressive force until fracture occurred. Compressive strength data were analyzed and compared. Results showed that the use of die spacer and internal adjustments increased the compressive strength of the new ceramic foil crown.

Improving the cementation of complete cast crowns: a comparison of static and dynamic seating methods

This study measured the effect of static and dynamic forces, during cementation, on the retention and seating of complete cast crowns made for extracted human teeth prepared with a diamond bur. Under a static load, the castings failed to seat by a mean value of 203 micron. When dynamically loaded, the castings seated an average of 14 micron beyond the point of precementation measurement. No statistically significant differences were found in the retention of the crowns cemented by the two different methods.

A review of methods and techniques to improve the fit of cast restorations

Many factors that can affect the overall adaptation of cast restoration margins have been studied. Many methods and techniques have been advocated to improve casting accuracy. Some are time-consuming procedures and others are simple and economical. An acceptable cast restoration depends primarily on the dentist's ability to interpret and evaluate the restoration clinically and radiographically.

The effective minimum cement thickness of zinc phosphate cement for luted non-precious crowns

Non-precious metal crowns were prepared for natural teeth which were ground to a taper angle of 5 degrees. The movement of the crowns on teeth during repeated try-on seating was measured with a micrometer. Increasing the applied load from 2 to 10 kg resulted in an average crown movement of 63 micron. For most samples this movement continued when try-on was repeated. Casting irregularities were found to create furrows on some regions of the axial tooth surface during try-on seating. The diameter of the ADA specification consistency disk for zinc phosphate cement was found to depend strongly on the P:L ratio and the ambient temperature. The castings were cemented with zinc phosphate cement of controlled consistency. Cementation with a load of 10 kg gave rise to an average crown elevation of 54 micron and a range of measurements between -8 and 113 micron. The effective minimum cement thickness corresponding to this average was calculated to be 4.7 micron. Small negative values of elevation were attributed to deepening of tooth furrows during cementation. An analysis is given of data from the literature, relevant to the cement flow and irregularities in cement thickness.

Film thickness of cements beneath complete crowns

The results showed that Durelon, EBAC, zinc phosphate, Epoxylite CBA, and Fynal had thinner film thicknesses than EBA and Fluro-Thin. In addition, venting of a crown resulted in lower film thicknesses with all cements except Fynal and EBAC. No significant differences occurred with these two cements whether the crown was vented or not. Obviously many other factors besides film thickness, such as toxicity, strength, and solubility, have to be considered before selecting a cement for clinical use. When only film thickness is to be considered, all of the cements in the study could be recommended for the cementation of crowns with the exception of EBA and Fluoro-Thin.