Marginal Opening Research Articles

Marginal and internal fit of zirconia based fixed dental prostheses fabricated with different concepts

The purpose of this in vitro study was to compare the precision of fit of substructures milled from semi-sintered zirconia blocks, fabricated with two different fabrication concepts. Three-unit, posterior fixed dental prostheses (FDP) were fabricated for standardized dies (n = 10) with the laboratory Computer Aided Design (CAD)/Computer Aided Manufacturing (CAM) system Cercon® Brain (Brain) and the centralized CAD/CAM system Compartis Integrated Systems (Compartis). After cementation to the dies, the FDP were embedded and sectioned. Four cross-sections were made of each abutment tooth, and marginal and internal fit were evaluated under an optical microscope. A one-way analysis of variance (ANOVA) was used to compare data (α = 0.05). Mean gap dimensions at the marginal opening for Brain and Compartis were 56.0 (±34.5) μm and 51.7 (±45.2) μm, respectively. Mean internal gap dimensions of 62.8 (±37.5) μm to 164.6 (±33.4) μm were measured depending on the measurement location and the fabrication concept. Mean marginal openings and internal adaptations were not significantly different for both systems. Three out of four measurement locations showed significantly different cement gaps. Within the limitations of this study, the results suggest that the accuracy of both investigated systems is satisfactory for clinical use. The laboratory fabrication exhibited similar accuracy as the centralized manufacturing.

Marginal and internal fit of zirconia based fixed dental prostheses fabricated with different concepts

Marginal and internal fit of zirconia based fixed dental prostheses fabricated with different concepts Florian Beuer1, Natalie Korczynski1, Antonia Rezac1, Michael Naumann2, Wolfgang Gernet1, John A Sorensen31Department of Prosthodontics, Ludwig-Maximilians University, Munich, Germany; 2Department of Prosthodontics and Material Sciences, University of Ulm, Germany; 3Pacific Dental Institute, Portland, Oregon, USAAbstract: The purpose of this in vitro study was to compare the precision of fit of substructures milled from semi-sintered zirconia blocks, fabricated with two different fabrication concepts. Three-unit, posterior fixed dental prostheses (FDP) were fabricated for standardized dies (n = 10) with the laboratory Computer Aided Design (CAD)/Computer Aided Manufacturing (CAM) system Cercon® Brain (Brain) and the centralized CAD/CAM system Compartis Integrated Systems (Compartis). After cementation to the dies, the FDP were embedded and sectioned. Four cross-sections were made of each abutment tooth, and marginal and internal fit were evaluated under an optical microscope. A one-way analysis of variance (ANOVA) was used to compare data (α = 0.05). Mean gap dimensions at the marginal opening for Brain and Compartis were 56.0 (±34.5) μm and 51.7 (±45.2) μm, respectively. Mean internal gap dimensions of 62.8 (±37.5) μm to 164.6 (±33.4) μm were measured depending on the measurement location and the fabrication concept. Mean marginal openings and internal adaptations were not significantly different for both systems. Three out of four measurement locations showed significantly different cement gaps. Within the limitations of this study, the results suggest that the accuracy of both investigated systems is satisfactory for clinical use. The laboratory fabrication exhibited similar accuracy as the centralized manufacturing.Keywords: zirconia, CAD/CAM, fit, FDP, all-ceramic

Marginal and internal fit of zirconia based fixed dental prostheses fabricated with different concepts

Marginal and internal fit of zirconia based fixed dental prostheses fabricated with different concepts Florian Beuer1, Natalie Korczynski1, Antonia Rezac1, Michael Naumann2, Wolfgang Gernet1, John A Sorensen31Department of Prosthodontics, Ludwig-Maximilians University, Munich, Germany; 2Department of Prosthodontics and Material Sciences, University of Ulm, Germany; 3Pacific Dental Institute, Portland, Oregon, USAAbstract: The purpose of this in vitro study was to compare the precision of fit of substructures milled from semi-sintered zirconia blocks, fabricated with two different fabrication concepts. Three-unit, posterior fixed dental prostheses (FDP) were fabricated for standardized dies (n = 10) with the laboratory Computer Aided Design (CAD)/Computer Aided Manufacturing (CAM) system Cercon® Brain (Brain) and the centralized CAD/CAM system Compartis Integrated Systems (Compartis). After cementation to the dies, the FDP were embedded and sectioned. Four cross-sections were made of each abutment tooth, and marginal and internal fit were evaluated under an optical microscope. A one-way analysis of variance (ANOVA) was used to compare data (α = 0.05). Mean gap dimensions at the marginal opening for Brain and Compartis were 56.0 (±34.5) μm and 51.7 (±45.2) μm, respectively. Mean internal gap dimensions of 62.8 (±37.5) μm to 164.6 (±33.4) μm were measured depending on the measurement location and the fabrication concept. Mean marginal openings and internal adaptations were not significantly different for both systems. Three out of four measurement locations showed significantly different cement gaps. Within the limitations of this study, the results suggest that the accuracy of both investigated systems is satisfactory for clinical use. The laboratory fabrication exhibited similar accuracy as the centralized manufacturing.Keywords: zirconia, CAD/CAM, fit, FDP, all-ceramic

Comparison of the Marginal Fit of Pressable Ceramic to Metal Ceramic Restorations

The aim of this in vitro study was to compare the marginal adaptation of a pressed ceramic material, when used with and without a metal substructure, to a traditional feldspathic porcelain-fused-to-metal restoration with a porcelain butt margin. A maxillary central incisor typodont tooth was prepared with a 1.5 mm 360 degrees shoulder with rounded internal line angle, and 30 polyether impressions were made. Dies were poured in type IV dental stone, and 30 restorations were fabricated: 10 metal ceramic restorations (MCR) with porcelain butt joints, 10 pressed to metal restorations (PTM), and 10 all-ceramic restorations (PCR). All restorations were evaluated on their respective dies at 45x magnification using an Olympus SZX-12, measurements of the marginal openings were made, and ANOVA and Scheffé post hoc tests were used to evaluate the data. The mean marginal opening was 72.2 +/- 5.9 microm for MCR, 49.0 +/- 5.9 microm for PTM, and 55.8 +/- 5.9 microm for PCR. The post hoc tests showed that there was a statistical difference between the marginal adaptation of the PTM and MCR groups (p < 0.05). There was no significant difference in marginal adaptation between the PTM and the PCR groups, or the PCR and the MCR groups. The PTM group demonstrated a smaller mean marginal opening than the MCR group. The mean marginal openings of all three groups were within a clinically acceptable range.

Marginal adaptation of an etch-and-rinse adhesive with a new type of solvent in class II cavities after artificial aging

This in vitro study evaluated the marginal adaptation of etch-and-rinse adhesives. Standardized class II cavities were cut in 40 human molars with one proximal box limited within enamel and one proximal box extending into dentin. Teeth were assigned randomly to five groups (n = 8) and restored with incrementally placed composite restorations. Five combinations were tested: G1, XP Bond + Ceram-X Mono; G2, P&B NT + Ceram-X Mono; G3, Optibond Solo Plus + Ceram-X Mono; R1, Syntac Classic + Tetric EvoCeram; R2, Scotchbond 1 XT + Z250. After finishing and polishing, teeth were stored for 48 h in water at 37°C before subjected to artificial aging by thermal stress (5/55°C; ×2,000; 30 s) and mechanical loading (50 N; ×50,000). Marginal adaptation of the restorations was evaluated in a SEM (×200) using a replica technique. Statistical analysis was performed with nonparametric test methods (p < 0.05). The percentages of "perfect margin" after aging ranged from 95.9% to 99.6% in enamel and 85.9% to 96.0% in dentin. "Marginal opening" was observed between 0.1% to 2.6% in enamel and 2.6% to 11.8% in dentin. In enamel and dentin, both, G3 showed significantly more gap formation than G1 and G2. Comparing marginal adaptation to enamel and dentin within each group yielded only for G1 no significant differences. Tert-butanol-based XP Bond showed excellent marginal adaptation in both enamel and dentin.

Influence of Cervical Finish Line Type on the Marginal Adaptation of Zirconia Ceramic Crowns

The current study evaluated the effect of different cervical finish line designs on the marginal adaptation of a zirconia ceramic. Four different marginal finish lines (c: chamfer, mc: mini-chamfer, fe: feather-edge and s: rounded shoulder) were prepared on phantom incisors. Die models for each preparation group (N = 28, n = 7 per finish line design group) were made of epoxy resin. Y-TZP (ICE Zirkon) frameworks were manufactured by a copy-milling system (Zirconzahn) using prefabricated blanks and tried on the master models for initial adaptation of the framework; they were then sintered, followed by veneering (Zirconzahn). The finished crowns were cemented with a polycarboxylate cement (Poly F) under 300 g load and ultrasonically cleaned. The specimens were sliced and the marginal gap was measured, considering absolute marginal opening (AMO) and marginal opening (MO) for each coping under a stereomicroscope with image processing software (Lucia). The measurements were statistically analyzed using the Kruskal Wallis, Mann Whitney and Wilcoxon Signed Ranks tests at a significance level of alpha = 0.01. Means of AMO measurement (microm) for the feather-edge finish line (87 +/- 10) was significantly lower than that of the chamfer (144 +/- 14), shoulder (114 +/- 16) and mini-chamfer finish line types (114 +/- 11) (p < 0.01). Means of MO measurements was the lowest for feather-edge finish line (68 +/- 9) (p < 0.01) and then, in ascending order, shoulder (95 +/- 9), mini-chamfer (97 +/- 12) and chamfer (128 +/- 10). The cervical finish line type had an influence on the marginal adaptation of the tested zirconia ceramic. Although the feather-edge finish line resulted in lower AMO and MO values, with its proven mechanical disadvantage, it cannot be recommended in clinical applications of zirconia crowns. This type of finish line has acted solely as a control group to test the null hypothesis in the current study. For better marginal adaptation, both shoulder and mini-chamfer finish line types could be suggested for zirconia crowns.

Congenital stenosis of the hepatic duct at the porta hepatis in children with choledochal cyst

Background The intrahepatic gallstone is known as one of the complications of choledochal cyst. Stenosis of the hepatic duct may contribute to the formation of the stone. This report describes concurrent congenital stenosis of the hepatic duct identified during the primary operation of choledochal cyst. Methods Fourteen children were operated on for choledochal cyst. To identify the concurrent stenosis, cholangiography and inspection of the hepatic duct were performed during the operation. In those patients with identified membranous stenosis, the membrane was resected. In those with nonmembranous stenosis, the wide hilar hepaticojejunostomy was performed after hepatic duct plasty. Results Eleven sites of hepatic duct stenosis were identified, 8 membranous stenoses and 3 relative stenoses without membrane. The membranous stenoses were classified into 4 subtypes as follows: a small central opening, a marginal opening, 2 openings, and a bridgelike structure. At the primary surgery on choledochal cyst, those stenoses were released, and the formation of the gallstone has not been observed in 4 to 11 years in all cases.

Marginal fit of 14‐unit zirconia fixed dental prosthesis retainers

The marginal fit of 14-unit fixed dental prosthesis retainers and single-crown copings fabricated by the same computer-aided design (CAD)/computer-aided manufacturing (CAM) system were evaluated in vitro hypothesizing that the marginal opening might be independent of the type of restoration. Eight ivorine maxillary teeth (FDI locations 27, 25, 23, 21, 11, 13, 15 and 17) were prepared to accommodate a 14-unit prosthesis. Ten fixed dental prosthesis retainers and 40 single-crown-copings were fabricated using Zeno CAD/CAM on 20 master dies. Four cross-sections were made from each tooth and the marginal gap dimensions were measured. One-way anova was used to test the difference between the experimental groups and two-way anova and a post hoc test (Student-Newman-Keuls) were carried out to determine the influence of the location of the abutment tooth and the measurement location within the abutment tooth in the experimental groups (P < 0.05). Mean marginal gap dimensions and standard deviations for fixed dental prosthesis retainers and single-crown copings were 25 +/- 29 and 13 +/- 12 microm, respectively. The type of restoration showed a significant influence (P < 0.001) on the marginal gap. The location of the abutment tooth (P < 0.001) and the measurement location (P < 0.001) exhibited significant influence on marginal gaps of fixed dental prosthesis retainers while no influence on single-crown copings could be detected. The highest marginal gaps were found at the palatal surface of the incisor and canine of the 14-unit fixed dental prosthesis retainers. Fourteen-unit fixed dental prosthesis showed significantly higher marginal openings than single crowns fabricated under the same conditions. However, both restorations showed clinically acceptable marginal openings.

Precision of fit: zirconia three-unit fixed dental prostheses

The purpose of this in vitro study was to compare the precision of fit of substructures milled from semi-sintered zirconia blocks fabricated with two different computer-assisted design (CAD)/computer-assisted manufacturing (CAM) systems. Three-unit posterior fixed dental prostheses (FDP) were fabricated for standardized dies (n = 10) with the Lava CAD/CAM system (Lava) and the Procera-bridge-zirconia CAD/CAM system (Procera). After cementation to the dies, the FDP were embedded and sectioned. Four cross-sections were made of each abutment tooth, and marginal and internal fit were evaluated under an optical microscope. A one-way analysis of variance was used to compare data (alpha = 0.05). Mean gap dimensions at the marginal opening for Lava and Procera were 15 (+/-7) microm and 9 (+/-5) microm, respectively. Mean marginal openings (P = 0.012) and internal adaptation at two out of three measurement locations were significantly different. Within the limitations of this study, the results suggest that the accuracy of both investigated systems is satisfactory for clinical use.

An In Vitro Comparison of Vertical Marginal Gaps of CAD/CAM Titanium and Conventional Cast Restorations

To determine if there was a significant difference between the vertical marginal openings of cast restorations, computer-aided design, and computer-aided machining restorations. Ten working dies were created from a single master die and used to fabricate ten restorations in each of the following groups: computer-aided design/computer-assisted machining (CAD/CAM), WAX/CAM, and WAX/CAST. The CAD/CAM titanium restorations were fabricated using the scanning and crown design modules of the KaVo Everest system. The WAX/CAM titanium restorations were fabricated using the double scan technique with the KaVo Everest system. The WAX/CAST high noble copings were fabricated using the conventional lost wax casting technique. The restorations were seated on the master die, and high-resolution digital photographs were made of the marginal area on all four sides. The vertical marginal opening was then measured using a calibrated digital software program. One-way ANOVA and Tukey's post hoc tests were used to determine the presence of statistically significant differences. The vertical margin openings were CAD/CAM: 79.43 +/- 25.46 microm; WAX/CAM: 73.12 +/- 24.15 microm; WAX/CAST: 23.91 +/- 9.80 microm. There was a statistically significant difference between the WAX/CAST group and the remaining groups. There was no difference between the vertical marginal gaps of the CAD/CAM and WAX/CAM. The WAX/CAST technique resulted in smaller vertical marginal gaps than either CAD/CAM or WAX/CAM.

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.

Effect of cement selection and finishing technique on marginal opening of cast gold inlays

The standard cement for partial-veneer cast gold restorations has been zinc phosphate. With increasing interest in using resin and resin-modified glass ionomer cements for this purpose, marginal adaptation with use of these newer cements must be assessed. The purpose of this in vitro study was to determine if the marginal adaptation of cast gold inlays is comparable for 3 different luting agents and 3 finishing techniques. Cast gold inlays were cemented into triangular preparations on the buccal surface of 45 extracted human molars. Three operators each used a different technique for finishing margins: finishing during cementation (FD), finishing before cementation (FB), and finishing before and during cementation (FBA). The 15 teeth for each operator were divided into 3 subgroups of 5 each to accommodate 3 cements: zinc phosphate (Fleck's zinc phosphate: ZP), resin-modified glass ionomer (RelyX Luting: RXL), and self-adhesive modified resin (RelyX Unicem: RXU). For all specimens, fine sandpaper disks followed by fine cuttle disks were used for finishing the castings. The marginal gap was measured using a Nikon measuring microscope at x50 magnification. Data were analyzed with a 1-way ANOVA for each cement (alpha=.05). There were significant differences among finishing techniques for each cement (P<.05). For ZP, the smallest mean marginal gaps were for FD (31 microm) and FBA (42 microm). For RXL, FBA produced the smallest gap (19 microm). For RXU, FB (23 microm) and FBA (22 microm) were optimal. Within the limitations of this in vitro study, the marginal gap attained with cementation of partial-veneer cast gold restorations with ZP (31 microm) can also be obtained using RXL or RXU. The techniques of FD or FBA are best used for ZP, whereas the FBA technique is best for RXL, and either FB or FBA is optimal for RXU. The FBA technique yielded a small gap; this was common to all 3 cements.

Effect of preparation angles on the precision of zirconia crown copings fabricated by CAD/CAM system

The aim of this in vitro study was to evaluate the effects of different preparation angles on the precision of fit of zirconia crown frameworks. Dies were fabricated with three different preparation angles: 4, 8, and 12 degrees total taper. Ten copings were fabricated for each angle by a laboratory and a milling-center CAD/CAM system. After cementation, cross-sections were obtained and cement gaps were measured. Preparation angle (ANOVA, p < 0.01) and measurement location (ANOVA, p < 0.01) exhibited statistically significant influence on the precision of fit. On the other hand, no statistically significant influences were detected between copings prepared using the laboratory and milling-center CAD/CAM systems (ANOVA, p = 0.92). All groups showed marginal openings ranging between 36.6 and 45.5 microm. In light of the results obtained in this study, a preparation angle of 12 degrees is hence recommended with the confidence that the marginal gap will be consistently less than 50 microm.

Effect of the Crown Preparation Margin and Die Type on the Marginal Accuracy of Fiber-reinforced Composite Crowns

The objective of this laboratory investigation was to determine the effect of different preparation designs (light chamfer, deep chamfer, and shoulder) and die-making materials (stone and epoxy) on the resulting margin misfit for fiber-reinforced composite crowns using a measuring microscope. Sixty standardized FibreKor crowns were made on stone and epoxy resin dies (n=30 each) duplicated from three metal master dies representing complete crown tooth preparation with a total convergence of 5 degrees . For each die group, three of the tooth preparation designs were established in relation to the type of finish line (n=0 each) as follows: Group A (0.5-mm light chamfer finish line); Group B (1.0-mm deep chamfer finish line); and Group C (1.0-mm shoulder finish line). Marginal accuracy was evaluated by measuring the distances between each of four pairs of indentations on the crowns and on the dies with a Nikon measuring microscope. Analysis of seating measurements with parametric analysis of variance and Tukey's Studentized Range (HSD) disclosed a statistically significant difference for both tooth preparation design and die material (p< 0.001). However, the interaction effect was not significant (p=0.9073). The least marginal opening value was for FibreKor crowns made on epoxy resin dies with a light chamfer finish line (57 microm), but the difference was not statistically significantly different from crowns made on epoxy resin dies with a deep chamfer light chamfer finish line (61 microm). However, crowns made on epoxy resin dies with a shoulder finish line (81 microm) had significantly higher values (p< 0.05). FibreKor crowns made on stone dies with the shoulder finish line (95 microm) had statistically higher marginal opening values (p< 0.05). The least marginal opening value was for crowns made on stone dies with a light chamfer finish line (66 microm), but the difference was not statistically significantly different from crowns made on stone dies with a deep chamfer light chamfer finish line (70 microm). Significant differences were found among the die material used for the shoulder margin design. However, there was no significant difference between light chamfer and deep chamfer margin designs for both die materials.

Dimensional accuracy analysis of implant framework castings from 2 casting systems

<h3>Purpose</h3> To compare the dimensional accuracy of implant framework castings from an argon vacuum casting machine with those from a centrifugal casting machine. <h3>Materials and Methods</h3> Three 4 × 10-mm external hex-type implants (3i/Implant Innovations) were embedded in an acrylic resin block 7 mm apart, with a 2 mm offset of the middle implant. Eight reference points were marked on the implant collars. Twenty implant bar frameworks were waxed with UCLA abutments, invested with a ringless system, and subjected to the same thermal cycle. Ten wax patterns were cast in gold alloy using an oxygen-propane torch and centrifugal casting system; 10 were cast using an argon vacuum casting machine (KDF; Denken). The White 1-screw technique was applied after sequentially tightening the mesial and distal abutment screws to 10 Ncm. Fit of the implant framework castings was evaluated by measuring the marginal opening between the casting and implant at the reference points. These measurements were averaged and statistically compared for differences. <h3>Results</h3> The mean marginal openings at the most distant measuring locations from the tightened retaining screw at location 1 was between 44 and 48 μm for the centrifugal system compared to between 28 and 32 mm for KDF (<i>P</i><.01). For screws tightened at location 3, the mean marginal openings at the most distant measuring locations were between 40 and 51 mm for the centrifugal system compared to between 27 and 29 μm for KDF (<i>P</i><.01). <h3>Discussion</h3> In comparison with the centrifugal casting and oxygen-propane system, the argon vacuum system was more accurate and user friendly and less technique-sensitive. <h3>Conclusion</h3> The argon vacuum casting machine tested produced more accurate, better-fitting implant-supported prosthesis frameworks than a conventional centrifugal casting system. The "1-screw" method of evaluating casting fit was most effective when either of the prostheses' end screws were tightened.—<i>Reprinted with permission of Quintessence Publishing.</i>

The Effect of Die Spacer on Retention and Fitting of Complete Cast Crowns

This study evaluated the effect of die spacer on the fit and retention of complete cast crowns by using three different cements. Standardized full crown restoration preparations were completed on 99 extracted molar teeth, impressions were made with poly(vinyl siloxane), and stone dies were made. Dies were covered with four layers of die spacer using three techniques: (1) covering the occlusal and 1/3 of the axial surfaces, (2) covering the occlusal and 2/3 of the axial surfaces, and (3) covering the entire preparation except the apical 0.5 mm of the preparation. Complete metal crowns were cast using Pors-on 4 alloy. Crowns were then assigned to one of three luting agent groups: resin modified glass ionomer cement, resin cement, or zinc phosphate cement. The castings were placed on their respective teeth and the marginal opening was recorded by two methods: 72 specimens were examined before and after cementation using optical microscopy with 0.001 mm resolution, and 27 specimens were examined after cementation with scanning electron microscopy. After cementation, the teeth were thermocycled for 700 cycles between 5 degrees C and 55 degrees C. The tensile retentive strength was measured on a universal testing machine with a crosshead speed of 0.5 mm/min. The data obtained for the fitting were recorded in millimeters and the data for the tensile retentive strength were recorded in KgF. The statistical analysis was performed by analysis of variance and post hoc Tukey's test (p< 0.05). Before cementation, better marginal fit was obtained when the die spacer covered all but the area 0.5 mm short of the margin of the preparation; however, after cementation, the resin modified glass ionomer cement group had the best fit with the same application of die spacer. Castings luted with resin cement required the greatest tensile force to produce cement failure. Increasing the area of the die surface covered with spacer improved the fit of the cast restoration. After cementation, the resin modified glass ionomer showed better adaptation; however, the optical microscopy and scanning microscopy correlate well. Resin cement had the highest resistance to tensile forces.

Fracture load and marginal fit of shrinkage‐free ZrSiO4 all‐ceramic crowns after chewing simulation

The aim of this in vitro study was to evaluate the fracture load and marginal accuracy of crowns made from a shrinkage-free ZrSiO4 ceramic cemented with glass-ionomer or composite cement after chewing simulation. Thirty-two human mandibular molars were randomly divided into two groups. All teeth were prepared for and restored with shrinkage-free ZrSiO4 ceramic crowns (Everest HPC, KaVo). The crowns of group A (N = 16) were luted to the teeth using KetacCem and group B (N = 16) were adhesively cemented using Panavia21EX. Measurements of the marginal accuracy before and after cementation were made using replicas and an image analysis system. All specimens were exposed to 1.2 million cycles of thermo-mechanical fatigue in a chewing simulator. Surviving specimens were subsequently loaded until fracture in a static testing device. Fracture loads (N) were recorded. All specimens survived chewing simulation. The mean fracture loads (+/-s.d.) were Group A, 1622 N (+/-433); group B, 1957 N (+/-806). There was no significant difference between the two groups (P > 0.05). The marginal gap values before cementation were (mean +/- s.d.): Group A, 32.7 microm (+/-6.8); group B, 33.0 microm (+/-6.7). The mean marginal gap values after cementation were (+/-s.d.): Group A, 44.6 microm (+/-6.7); group B, 46.6 microm (+/-7.7). The marginal openings were significantly higher after cementation for both groups (P < 0.05). All test groups demonstrated fracture load and marginal accuracy values within the range of clinical acceptability.

Clinical Acceptability of Crown Margins Versus Marginal Gaps as Determined by Pre‐Doctoral Students and Prosthodontists

Marginal integrity is a very important element in evaluating a restoration; however, there is no agreement in definition of a clinically acceptable margin. The purpose of this investigation was to examine margin acceptability using an explorer versus the actual marginal gap widths at four locations on uncemented crowns on three extracted teeth using both predoctoral students and prosthodontists as evaluators. The crown margin evaluation used 16 surfaces of four crowns fitting to three extracted caries-free teeth fitted into a dentiform. The teeth (nos. 14, 20, and 29) were prepared for a full cast (gold) crown using a chamfer finish line configuration, with some margins supragingival and others subgingival. After final impressions and working casts were made, die spacer was applied to the marginal area of the die before waxing to vary the marginal opening. The dentiform was placed in a mannequin in a supine position. Predoctoral students (N = 10) and prosthodontists (N = 9) evaluated each axial surface of each crown in the zone along the margin with an explorer and rated each surface as either "clinically acceptable" or "unacceptable." After casting, the axial marginal openings were measured with Image Pro Software using a digital microscopic image of the surface. Each participant repeated the margin evaluations 6 months later. Upon casting, marginal gaps ranged from 40 microm to 615 microm. The proportions of prosthodontists and of predoctoral students rating a given surface as "clinically unacceptable" were highly correlated (Spearman rank correlation = 0.81, p= 0.0001). The prosthodontists did not provide more or fewer ratings of clinical acceptability than the students, although kappa results indicated that the prosthodontists might be more consistent among themselves than the student raters. Upon re-evaluation, both groups rated between one and six of the surfaces differently than they had previously: the median number of inconsistencies was 1 for prosthodontists and 3 for predoctoral students. The prosthodontists tended to have fewer inconsistencies than the predoctoral students (0.05 < p < 0.10 Wilcoxon rank sum test), but this was not statistically significant. The data provided evidence that those surfaces associated with greater margin gaps tended to have a greater proportion of ratings of "clinically unacceptable." The proportion of prosthodontists and predoctoral students rating a margin "clinically unacceptable" were highly correlated. Prosthodontists tended to have fewer inconsistencies than predoctoral students, but that difference was not statistically significant.

The influence of different screw tightening forces on the vertical misfit of implant-supported frameworks

The present in vitro study was designed to compare the differences in the vertical misfit of implant-supported frameworks using three different forces for tightening the bridge locking screws: fastening by hand until first resistance, and using torque drivers with 10 and 20Ncm. The investigation was conducted based on the results given by 9 six-unit nickel-chromium (2 abutments/ 4 pontics) screw-retained implant-supported frameworks. The structures were exposed to simulated porcelain firings. The marginal misfit measurements were made using a traveling measuring microscope at selected screw tightening forces: fastening by hand until first resistance, and using torque drivers with 10 and 20Ncm. The results were submitted to one-way ANOVA with repeated measures on one factor, and post hoc pairwise comparisons using Tukey test (5%). The mean marginal misfit of the frameworks, fastening the screws by hand until first resistance, was 41.56µm (SD±12.45µm). The use of torque driver devices caused a significant reduction in marginal opening (p<0.05). With the lowest torque available (10Ncm), the mean marginal discrepancy at the abutment-framework interface was reduced an average of 52% to a mean marginal opening of 19.71µm (SD±2.97µm). After the use of the 20Ncm torque driver, the mean marginal discrepancy of the frameworks was reduced an average of 69% to a mean marginal opening of 12.82µm (SD±4.0µm). Comparing the use of torque drivers with 10 and 20 Ncm torque, the means are not significantly different from one another. The seating force has an important effect on the vertical misfit measurements, once it may considerably narrow the vertical misfit gaps at the abutment-framework interface, thus leading to a misjudgment of the real marginal situation.

Clinical performance and marginal adaptation of class II direct and semidirect composite restorations over 3.5 years in vivo

The study evaluated the clinical performance and marginal adaptation of direct and semi-direct class II composite restorations in a split-mouth design over 3.5 years. 44 upper posterior teeth in 11 adults with primary carious lesions were treated with 22 direct and 22 semi-direct restorations. Conventional cavities were prepared for both types of restorations. A fine fine hybrid composite (APH) and a multifunctional adhesive system (Prisma universal bond 3) were used for all restorations. The incremental "3-sited light curing" technique was applied to direct restorations. Semi-direct inlays were prefabricated on silicone casts and post-cured using light and heat. Clinical performance was evaluated using modified USPHS parameters, while marginal adaptation was judged on replicas, using SEM and a standardized evaluation technique. Clinical results after 3.5 years revealed a 100% retention rate with no fractures, sensitivity or recurrent caries for both types of restorations. SEM-evaluation of the occlusal margins showed at the tooth-restoration interface relatively low rates of marginal openings over the observation period (4-8%). Marginal restoration fractures ranged between 1 and 2%, marginal tooth fractures between 3 and 9%. Differences between the restorative techniques and after the different time observation periods were not statistically significant. Proportions of marginal fractures and openings at the restoration-luting composite interface were less than 10% after 3.5 years. The results indicated no significant differences for direct and semi-direct fine hybrid composite restorations in medium size cavities in posterior teeth with respect to clinical performance and marginal adaptation over 3.5 years.