Full Coverage Restorations Research Articles

A Digital Approach to Retrofitting a Post and Core Restoration to an Existing Crown.

One problem that may arise in full-coverage restorations is clinical crown fracture. Fracture of an endodontically treated and crowned tooth in the esthetic zone may be embarrassing to both the patient and clinician. If a completely sound margin and at least 2 mm of coronal structure remain, a fractured tooth may possibly be retreated by a repair. Several methods have been introduced to reproduce the original contour of the tooth for retrofitting an existing crown. If an existing crown is used as a template, excessive core material may remain over the margin, as loading the proper amount of core material is difficult, and making vent holes on the existing crown is not feasible. This article presents a repair technique to reuse an existing crown with computer-aided design and computer-aided manufacturing (CAD/CAM) technology. By using a milled poly(methylmethacrylate) matrix, the mentioned limitations are eliminated, and the original contour of the tooth can be effectively restored with minimal intervention. As an existing crown is reused, the issues of additional time and cost for repreparation, reimpression, and new crown are eliminated.

Evaluation of Operating Time and Patient Perception Using Conventional Impression Taking and Intraoral Scanning for Crown Manufacture: A Split-mouth, Randomized Clinical Study.

To compare operating time and patient perception of conventional impression (CI) taking and intraoral scanning (IOS) for manufacture of a tooth-supported crown. A total of 19 patients needing indirect full-coverage restorations fitting the requirements for a split-mouth design were recruited. Each patient received two lithium disilicate crowns, one manufactured from CI taking and one from IOS. Both teeth were prepared following the manufacturers' recommendations. For both impression techniques, two retraction cords soaked in 15% ferric sulphate were used for tissue management. CIs were taken in a full-arch metallic tray using one-step, two-viscosity technique with polyvinyl siloxane silicone. The operating time for each step of the two impression methods was registered. Patient perception associated with each method was scored using a 100-mm visual analog scale (VAS), with 100 indicating maximum discomfort. Median total operating time for CI taking was 15:47 minutes (interquartile range [IQR] 15:18 to 17:30), and for IOS was 5:05 minutes (IQR 4:35 to 5:23). The median VAS score for patient perception was 73 (IQR 16 to 89) for CI taking and 6 (IQR 2 to 9) for IOS. The differences between the two groups were statistically significant (P < .05) for both parameters. IOS was less time consuming than CI taking, and patient perception was in favor of IOS.

Deciduous molar hypomineralization (DMH) – a rare entity and its clinical management approach

An idiopathic qualitative defect of enamel, affecting one or more of the permanent molars with/without permanent incisors is known as Molar Incisor Hypomineralization (MIH). Similar defect on primary second molars is termed asdeciduous molar hypomineralization (DMH). Case report and Conclusion: The prevalence rate of MIH and DMH worldwide is between 2.4%-40.2% and 4.9%-9.0% respectively. Clinically, these defects appear as white, yellow or brown spots, and surface is smooth with normal thickness of the enamel. Lack of quality in the enamel causes porosity that fractures easily under mastication, exposing the dentin, and further allows progression of caries. Hence, thiscondition should be diagnosed as early as possible for providing a preventive management against caries and avoid post eruptive breakdown. In addition, intervention with full coverage restoration is needful in the management of the affected teeth. Preformed metal crowns (PMCs) are recommended as the best full coverage restoration for managing primary molar teeth. The Hall Technique embraces changing concepts of managing, without local anesthesia, cariesremoval or tooth preparation. Management of teeth with DMH is challenging as it is quite difficult to achieve anesthesia and due to hypersensitivity, the co-operation of the child is questionable.

Three-dimensional evaluation of marginal and internal fit of 3D-printed interim restorations fabricated on different finish line designs

PurposeTo evaluate the influence of fabrication method and finish line design on marginal and internal fit of full-coverage interim restorations.MethodsFour typodont models of maxillary central-incisor were prepared for full-coverage restorations. Four groups were defined; knife-edge (KE), chamfer (C), rounded-shoulder (RS), rounded-shoulder with bevel (RSB). All preparations were digitally scanned. A total of 80 restorations were fabricated; 20 per group (SLA/3D-printed n=10, milled n=10). All restorations were positioned on the master die and scanned using micro-computed tomography. The mean gaps were measured digitally (ImageJ). The results were compared using MANOVA (α=.05).ResultsInternal and marginal gaps were significantly influenced by fabrication method (P=.000) and finish-line design (P=.000). 3D-Printed restorations showed statistically significant lower mean gap compared to milled restorations at all points (P=.000). The mean internal gap for 3D-printed restorations were 66, 149, 130, 95μm and for milled restorations were 89, 177, 185, 154μm for KE, C, RS, RSB respectively. The mean absolute marginal discrepancy in 3D-printed restorations were (30, 41, 30, 28μm) and in milled restorations were (56, 54, 52, 38μm) for KE, C, RS, RSB respectively.ConclusionsThe fabrication methods showed more of an influence on the fit compared to the effect of the finish-line design in both milled and printed restorations. SLA-printed interim restorations exhibit lower marginal and internal gap than milled restorations. Nonetheless, for both techniques, all values were within the reported values for CAD/CAM restorations.Significance3D-printing can offer an alternative fabrication method comparable to those of milled restorations.

Deciduous molar hypomineralization (DMH) – a rare entity and its clinical management approach

An idiopathic qualitative defect of enamel, affecting one or more of the permanent molars with/without permanent incisors is known as Molar Incisor Hypomineralization (MIH). Similar defect on primary second molars is termed as deciduous molar hypomineralization (DMH). Case report and Conclusion: The prevalence rate of MIH and DMH worldwide is between 2.4%-40.2% and 4.9%-9.0% respectively. Clinically, these defects appear as white, yellow or brown spots, and surface is smooth with normal thickness of the enamel. Lack of quality in the enamel causes porosity that fractures easily under mastication, exposing the dentin, and further allows progression of caries. Hence, this condition should be diagnosed as early as possible for providing a preventive management against caries and avoid post eruptive breakdown. In addition, intervention with full coverage restoration is needful in the management of the affected teeth. Preformed metal crowns (PMCs) are recommended as the best full coverage restoration for managing primary molar teeth. The Hall Technique embraces changing concepts of managing, without local anesthesia, caries removal or tooth preparation. Management of teeth with DMH is challenging as it is quite difficult to achieve anesthesia and due to hypersensitivity, the co-operation of the child is questionable.

Fit of CAD/CAM Tooth-supported Single Crowns and Fixed Dental Prostheses

Purpose of Review Dentistry follows the generational change towards digital technology, and traditional techniques for dental restorative procedures are being influenced. An increasingly large number of CAD/CAM systems are currently used for fabrication of single crowns and fixed dental prostheses in the dental practice. The fit of a full coverage restoration is considered as criterion for long-term success. A review and comparison of the available digital workflows, CAD/CAM systems, and related biomaterial were conducted.

Management of Iatrogenic Furcation Perforation in Mandibular First Molar With Biodentine- Two Years Follow Up

AbstractSuccessful management of furcation perforations poses a challenge for a clinician. The perforation can result from iatrogenic causes, caries or resorption. It is advisable to repair the perforation as soon as it is identified, since any delay allows the bacterial ingress leading to a complicated endodontic–periodontal lesion and ultimately in the treatment failure. This case report describes successful management of a furcal perforation in a mandibular first molar, which was repaired using Biodentine. The endodontic treatment was completed and the tooth was coronally restored with composite followed by full coverage restoration. Two years follow up of the case showing absence of pain; periradicular healing of the lesion, along with functional tooth stability indicated a successful outcome of endodontic treatment and sealing the perforation using Biodentine.

Evaluation of accuracy of shade selection using two spectrophotometer systems: Vita Easyshade and Degudent Shadepilot.

Objective:The aim of this in vitro study was to evaluate the accuracy of shade matching using two spectrophotometric devices.Materials and Methods:Thirteen patients who require a full coverage restoration for one of their maxillary central incisors were selected while the adjacent central incisor was intact. 3 same frameworks were constructed for each tooth using computer-aided design and computer-aided manufacturing technology. Shade matching was performed using Vita Easyshade spectrophotometer, Shadepilot spectrophotometer, and Vitapan classical shade guide for the first, second, and third crown subsequently. After application, firing, and glazing of the porcelain, the color was evaluated and scored by five inspectors.Results:Both spectrophotometric systems showed significantly better results than visual method (P < 0.05) while there were no significant differences between Vita Easyshade and Shadepilot spectrophotometers (P < 0.05).Conclusion:Spectrophotometers are a good substitute for visual color selection methods.

A Comparative Study Of Flexural Strength And Fatigue Resistance Of 2 Nanoceramic Composite Resin Cad/Cam Blocks (Lava Ultimate And Vita Enamic) And A Lithium Disilicate Glass Ceramic (Ips E.Max Cad)

Introduction For decades, full coverage restorations have been used as the most common fixed prosthetic treatment to restore the function and appearance of the destroyed natural teeth [1]. Metal ceramic crowns have been considered the gold standard for full coverage restorations, due to their hi

Esthetic zirconia crown in pedodontics

There are different types of restorations for complete crown coverage. These restoration techniques include polycarbonate crowns, acid etched crown, stainless steel crown (SSC), open–faced SSC with veneer placed on chair side and commercially veneered SSC. Each of these techniques presents technical, functional or esthetic compromises that complicate their efficient and effective usage. Recently, zirconium dioxide ceramic prefabricated crown has been used in the treatment of primary teeth. The choice of full coverage restoration for primary teeth must provide an esthetic appearance in addition to restoring function and durability. This article presents an overview of zirconia crowns in pedodontics and a case study of full coronal restoration using zirconia crown.

Porcelain laminate veneers – A novel dimension to minimalism in prosthodontics: A case series

The success of anterior esthetic rehabilitation depends on the resolution of initial esthetic issues, patient satisfaction, and good integration of the restoration with the surrounding tooth and soft tissues. Porcelain laminate veneers are thin facings of ceramic that have evolved since 1983 to become the esthetic alternative to full coverage restorations. By the advent of new materials and techniques based on the principles of adhesive dentistry, extremely minimal preparation with enamel preservation has improved and offered best results. This article focuses on the esthetic improvement of patients with diastema, fluorosis, and discolored teeth using porcelain laminate veneers.

Effect of a Calcium Phosphate Desensitizer on Pre- and Postcementation Sensitivity of Teeth Prepared for Full-Coverage Restorations: A Randomized, Placebo-Controlled Clinical Study

The aim of this study was to investigate the effect of Teethmate Desensitizer (TD), an aqueous slurry of calcium phosphates, on the pre- and postcementation sensitivity of contralateral premolars prepared for full-coverage restorations. In this clinical study, using a split-mouth design, 20 patients were allocated and two contralateral vital premolars per patient were randomly assigned to treatment with TD and placebo (PLA; distilled water). One day after preparation and temporization, sensitivity (PRE) upon air blast (AB) and probe scratch (PS) was determined using a 10-cm-long visual analog scale (VAS). The trial was double-blinded; neither the patient nor the investigator knew the treatment performed. Sensitivity was assessed immediately after treatment, before seating the final crowns after 1 week, and 1 month after cementation. Statistical data analysis was performed with one-way analysis of variance followed by Tukey post hoc test and two-sided paired t test. Statistical significance was determined at α < .05. VAS scores upon stimulation with AB and PS were significantly lower at POST and 1 week, and with AB after 1 month. TD-treated teeth showed significantly less sensitivity than PLA. At the postcementation recall, TD and PLA were not significantly different and the average pain scores were almost 0. Treatment of teeth prepared for full crown restorations with TD can significantly reduce pre- and postcementation sensitivity.

Three-dimensional finite element analysis of the stress distribution pattern in a mandibular first molar tooth restored with five different restorative materials.

Introduction:Badly broken or structurally compromised posterior teeth are frequently associated with crown/root fracture. Numerous restorative materials have been used to fabricate indirect full-coverage restorations for such teeth. This study aims to evaluate and compare the effect of restorative materials on the stress distribution pattern in a mandibular first molar tooth, under varying loading conditions and to compare the stress distribution pattern in five commonly used indirect restorative materials.Materials and Methods:Five three-dimensional finite element models representing a mandibular first molar tooth restored with crowns of gold, porcelain fused to metal, composite (Artglass), alumina-based zirconia (In-Ceram Zirconia [ICZ]), and double-layered zirconia-based materials (zirconia core veneered with porcelain, Lava) were constructed, using a Finite Element Analysis Software (ANSYS version 10; ANSYS Inc., Canonsburg, PA, USA). Two loading conditions were applied, simulating maximum bite force of 600 N axially and normal masticatory bite force of 225 N axially and nonaxially.Results:Both all-ceramic crowns allowed the least amount of stress distribution to the surrounding tooth structure. In maximum bite force-simulation test, alumina-based all-ceramic crown displayed the highest von Mises stresses (123.745 MPa). In the masticatory bite force-simulation test, both all-ceramic crowns (122.503–133.13 MPa) displayed the highest von Mises stresses.Conclusions:ICZ crown displayed the highest peak von Mises stress values under maximum and masticatory bite forces. ICZ and Lava crowns also allowed the least amount of stress distribution to the surrounding tooth structure, which is indicative of a favorable response of the underlying tooth structure to the overlying full-coverage indirect restorative material. These results suggest that ICZ and Lava crowns can be recommended for clinical use in cases of badly damaged teeth.

In-vitro Fatigue Resistance of Bonded Posterior Occlusal Veneers: A Systematic Review

Objectives: To determine the fatigue resistance of occlusal veneers and whether it can be a successful mean of restoring erosive or attrite posterior teeth. Methods: Search was made in 2 databases including PubMed and LILACS, the terms “occlusal veneers”, “table tops”, “overlays”, “non retentive all ceramic full coverage restorations”, “fatigue resistance”, “ masticatory fatigue”, “stresses”, “fatigue failure” and “fracture strength” were used, title and abstract were screened; giving the exclusion and inclusion standards articles which did not follow the inclusion standards were excluded. Incorporated papers are then read thoroughly for a second stage filter, this was followed by manual searching. Findings: The search resulted in 6 included papers, 3 papers regarding the fatigue resistance of occlusal veneers made of composite and glass ceramic blocks, 1 paper measuring the fatigue resistance of occlusal veneers made of two different glass ceramics, 1 paper comparing occlusal veneers made of resin nano-ceramic with those made of composite blocks and 1 paper simulating five years of clinical service on occlusal veneers made of one type of glass ceramic. From the included studies occlusal veneers were found to be a successful mean of restoring erosive or attrite posterior teeth regarding fatigue resistance.

Investigation of adult stainless steel crown longevity as an interim restoration in pediatric patients.

Preformed metal crowns, also known as stainless steel crowns (SSC), are utilized for providing full coverage to young permanent teeth and have been used extensively as restorations of primary teeth for approximately 65 years. Evaluate permanent tooth SSC longevity as an interim restoration for teeth requiring full coverage restoration in pediatric patients. Retrospective chart review from 2006 through 2014 in a hospital-based dental clinic for permanent tooth pre-fabricated crown longevity. One hundred and fifty-five SSCs were evaluated with regard to: age of patient at restoration placement, diagnoses, and duration of crown service. Duration service was further categorized as successful or failed. Of 155 SSCs, 137 were considered successfully functioning. Total failures were 18. The overall combined success rate for the study group was observed to be 88% with an average service period of 45.18 months. Significant success was noted in patients less than 9 years of age, and significant failure was observed in patients 12 years and older. Stainless steel crowns are a viable option for interim restoration needs, with an 88% overall success rate during an average service period of 45.18 months.

Quantitative analysis of metallic artifacts caused by dental metallic restorations: Comparison between four CBCT scanners

PurposeThe objective of this study was to quantitatively evaluate the artifacts produced by different metallic restorations using four cone-beam computed tomography (CBCT) scanners. MethodsEight extracted teeth (four mandibular premolars and four mandibular molars) were randomly divided into four groups. Each group compromised one premolar and one molar. One group was prepared and restored with occluso-mesial amalgam restorations (MO), the second group with mesio-occluso-distal amalgam restorations (MOD), the third group with porcelain fused to metal full coverage restoration, and the fourth group with occluso-mesial indirect metallic restorations (inlays). The restored teeth were then placed in the sockets of dried mandible. Images were obtained using four different cone beam computed tomography (CBCT) scanners, with exposure parameters 85 kVp and 8 mA. Volumes of artifacts were then measured by segmentation using volumetric and8i thresholding methods. ResultsQuantitative evaluation of metallic artifacts using the volumetric method showed the greatest mean value obtained from J Morita for all types of restorations studied while when using the thresholding method Gallileos yielded the greatest mean value for crown, MO, and inlay restoration while scanora produced the greatest mean value for MOD restorations. ConclusionIn cases of scanning patients with multiple fixed restorations Scanora is recommended. In cases of patients with MO or inlay restorations Planmeca AINO™ is recommended. Gallileos and J Morita are acceptable for scanning patients with metallic restorations and recommended in cases of MOD amalgam restorations.

Knowledge and Awareness among Parents and General Dental Practitioners regarding Rehabilitation with Full Coverage Restoration in Children: A Multi-centric Trial.

ABSTRACTAims: The aim of this study was to evaluate the knowledge and awareness among parents and general dental practitioners regarding rehabilitation with full coverage restoration in children following pulp therapy.Materials and methods: A multiple choice questionnaire was given to 1,000 parents and 400 general practitioners in this multicentric trial. The questionnaire assessed their beliefs, knowledge regarding care of primary teeth, assessment of treating children, and knowledge regarding importance of primary teeth. All the questionnaires were then compiled and statistically analyzed using Statistical Package for Social Sciences (SPSS) software.Results and discussion: 53% parents did not know the importance of primary teeth and 73% parents also thought that no treatment is possible for pulpally involved primary teeth. 20% parents believed that root canal treatment can be possible for children and only 10% knew about full coverage restorations. 40% of the general dentists felt that the best treatment in the case of primary necrotic teeth is extraction and only 13% knew about stainless steel crowns. 62% of general dental practitioners pointed out patients’ noninterest in providing crowns whereas 68% parents reported non-information by dentists.Conclusion: Both parents and general dental practitioners have incomplete and inadequate knowledge regarding full coverage restorations, and we need to improve the knowledge and dental awareness of the parents and the general dental practitioners.How to cite this article: Moda A, Saroj G, Sharma S, Gupta B. Knowledge and Awareness among Parents and General Dental Practitioners regarding Rehabilitation with Full Coverage Restoration in Children: A Multi-centric Trial. Int J Clin Pediatr Dent 2016;9(2):177-180.

Esthetic Concerns and Acceptability of Treatment Modalities in Primary Teeth: A Comparison between Children and Their Parents.

Background and Aim. Esthetic concerns in primary teeth have been studied mainly from the point of view of parents. The aim of this study was to study compare the opinions of children aged 5–8 years to have an opinion regarding the changes in appearance of their teeth due to dental caries and the materials used to restore those teeth. Methodology. A total of 107 children and both of their parents (n = 321), who were seeking dental treatment, were included in this study. A tool comprising a questionnaire and pictures of carious lesions and their treatment arranged in the form of a presentation was validated and tested on 20 children and their parents. The validated tool was then tested on all participants. Results. Children had acceptable validity statistics for the tool suggesting that they were able to make informed decisions regarding esthetic restorations. There was no difference between the responses of the children and their parents on most points. Zirconia crowns appeared to be the most acceptable full coverage restoration for primary anterior teeth among both children and their parents. Conclusion. Within the limitations of the study it can be concluded that children in their sixth year of life are capable of appreciating the esthetics of the restorations for their anterior teeth.

Conservative Restoration of Worn Mandibular Anterior Teeth Combining Gingival Repositioning and a Template Matricing Technique.

Conservative resin composite restoration of worn mandibular anterior teeth may offer an alternative option to full-coverage restorations for the patient. Assessment of the occlusal condition is critical because alterations in occlusal vertical dimension may not always be possible. By exposing additional coronal tooth structure, periodontal crown-lengthening procedures can serve to increase clinical crown height when adequate attached gingival tissue is present and supra-eruption has likely occurred. Fabrication of a custom template made from a diagnostic mock-up with proximal stainless steel matrices helps contribute to a predictable restorative result and improves chairside efficiency for the dental practice. By combining gingival crown lengthening, bonding of resin composite material, and selective occlusal adjustment; a short to medium-term, conservative option can be made available for the patient.

Tooth preparation for full-coverage restorations-a literature review.

The objective of this review was to assess the current knowledge about tooth preparation for full-coverage restorations regarding the following aspects: biological parameters, preparation geometry, and technical conditions. A systematic literature search was conducted using three electronic databases (MEDLINE, DIMDI, and Cochrane databases) in order to identify relevant citations; additionally, the process was augmented by a hand search. A number of 117 citations were relevant; 11 of these were reviews, 23 were clinical studies, 82 were in vitro investigations, and one was animal research. The basic form of a preparation has not changed substantially over the years, although new materials like all-ceramic systems have their own demands with regard to the details of the preparation's geometry. Estimating how much of the tooth structure can be removed without harming the tooth remains one of the biggest problems, if not the main difficulty, during tooth preparation. As the periodontal tissues may be affected by the restoration margin, a supragingival position of the margin should be preferred whenever possible. No finish line design has yet proven to be superior with regard to the marginal accuracy of the subsequent restoration. Instead, good detectability of the margin for the dental technician or intraoral scanning devices appears to be of primary importance in order to achieve a good fitting restoration. A detailed look at the covered aspects regarding tooth preparations can help to improve clinical outcomes in daily practice.