Partial Ceramic Crowns Research Articles

Randomized clinical split-mouth study on the performance of CAD/CAM-partial ceramic crowns luted with a self-adhesive resin cement or a universal adhesive and a conventional resin cement after 39 months

Objectives To determine the clinical performance of partial ceramic crowns (PCCs) luted with a conventional resin cement combined with a universal adhesive without or with selective enamel etching or luted with a self-adhesive resin cement.Methods In a split-mouth design, each three CAD/CAM-PCCs (Vita Mark II, Cerec) were placed in 50 patients. Two PCCs were luted with a conventional resin cement (RelyX Ultimate) combined with a universal adhesive (Scotchbond Universal) without (SB-E) or with (SB+E) selective enamel etching. The third PCC was luted with a self-adhesive resin cement (RelyX Unicem 2; RXU). Chi-square tests (α≤0.05) were applied. Based on clinical failures (complete debonding or need for replacement of the restorations), Kaplan-Meier survival analysis was performed.Results 31 patients were evaluated clinically using FDI criteria at 39 months. Clinically acceptable results were detected over time, except for “fracture of material and retention” (inacceptable fractures and debondings). Within materials, statistically significant differences (p ≤ 0.003) between baseline and 39 months were found for “marginal adaptation” and “marginal staining”. At 39-month, SB+E and SB-E showed significantly better results compared to RXU in “marginal adaptation”(p ≤ 0.021) and “marginal staining”(p ≤ 0.013). Kaplan-Meier analysis showed higher survival rates after 39 months for SB+E (96%) and SB-E (88%) compared to RXU (69%) with statistically significant differences between RXU vs. SB-E (p = 0.022) and RXU vs. SB+E (p ≤ 0.001).Conclusions After 39-months, PCCs luted with the self-adhesive resin cement exhibited a statistically significant inferior survival rate compared to restorations luted with the conventional resin cement combined with a universal adhesive without or with selective enamel etching.Clinical significance Currently, self-adhesive resin cements cannot be recommended for luting partial ceramic crowns. However, the standard adhesive luting procedure comprising a universal adhesive and luting composite yielded good clinical results for more than 3 years irrespectively of application of a selective enamel etching step.

Prospective clinical evaluation of chairside-fabricated zirconia-reinforced lithium silicate ceramic partial crowns\u20145-year results

ObjectivesA university-based randomized clinical study evaluated the 5-year performance of chairside-fabricated zirconia-reinforced lithium silicate (ZLS)-ceramic partial crowns.Material and methodsForty-five patients were restored with 61 chairside-fabricated ZLS-restorations (Cerec SW 4.2, Dentsply Sirona, Germany; Vita Suprinity, Vita Zahnfabrik, Germany). Deviating from the manufacturers’ recommendations, restorations with reduced minimum material thicknesses (MMT) were fabricated: group 1, MMT = 0.5–0.74 mm (n = 31); group 2, MMT = 0.75–1.0 mm (n = 30). For luting, a self-adhesive cement (SAC) or a total-etch technique with a composite cement (TEC) was applied. Statistical evaluation was performed by time-to-event analysis (Kaplan–Meier). Possible covariates of the survival (SVR) and success rates (SCR), evaluated in a Cox regression model, were MMT, restoration position (premolar/molar), and cementation technique (SAC vs. TEC).ResultsForty patients (54 restorations, premolars, n = 23; molars, n = 31) participated in the 5-year follow-up. Five losses due to ceramic fractures occurred in group 1 (n = 28) (SVR: 83.0% [95% confidence interval (CI): 0.71–0.96]). Group 2 (n = 26) showed no losses (SVR: 100%). The success rate for partial crowns placed on premolars was 100% and 69% (95% CI: 0.54–0.84) for molar restorations. Recementation was required in 4 restorations with SAC (SCR: 86% [95% CI: 0.73–0.99]; SCR-DC: 100%). Restorations in group 2 showed a significantly reduced risk of material fracture hazard ratio (HR) = 0.09, p = 0.0292) compared with the restorations in group 1. Molar partial crowns showed an increased risk for a clinical intervention (HR = 5.26, p = 0.0222) compared to premolar restorations.ConclusionsMaterial thickness and position of the restoration are risk factors influencing the survival and success rate of ZLS-ceramic partial crowns.Clinical relevanceObservation of an MMT of at least 0.75–1.0 mm for ZLS-ceramics is essential to avoid material-related fractures.Clinical trial registration: German Clinical Trails Register (trial number: DRKS00005611)

Partial ceramic crowns. Esthetic and tissue conservative restorations – Part II: anterior teeth – Laminate Veneers

Partial ceramic crowns. Esthetic and tissue conservative restorations – Part II: anterior teeth – Laminate Veneers

Influence of Different CAM Strategies on the Fit of Partial Crown Restorations: A Digital Three-dimensional Evaluation.

CAM fabrication is an important step within the CAD/CAM process. The internal fit of restorations is influenced by the accuracy of the subtractive CAM procedure. Little is known about how CAM strategies might influence the fit of CAD/CAM fabricated restorations. The aim of this study was to three-dimensionally evaluate the fit of CAD/CAM fabricated zirconia-reinforced lithium silicate ceramic partial crowns fabricated with three different CAM strategies. The null hypothesis was that different CAM strategies did not influence the fitting accuracy of CAD/CAM fabricated zirconia-reinforced lithium silicate ceramic partial crowns. Preparation for a partial crown was performed on a maxillary right first molar on a typodont. A chairside CAD/CAM system with the intraoral scanning device CEREC Omnicam (Dentsply Sirona, York, PA, USA) and the 3+1 axis milling unit CEREC MCXL was used. There were three groups with different CAM strategies: step bur 12 (12), step bur 12S (12S), and two step-mode (12TWO). The zirconia-reinforced lithium silicate ceramic Celtra Duo (Dentsply Sirona) was used as the CAD/CAM material. A new 3D method for evaluating the fit was applied, consisting of the quadrant scan with the intraoral scanning device CEREC Omnicam. The scan of the PVS material adherent to the preparation and the preparation scan were matched, and the difference analysis was performed with special software OraCheck (Cyfex AG, Zurich, Switzerland). Three areas were selected for analysis: margin (MA), axial (AX), and occlusal (OC). Statistical analysis was performed using 80% percentile, one-way ANOVA, and the post hoc Scheffé test with α=0.05. Statistically significant differences were found both within and between the test groups. The aspect axial fit results varied from 90.5 ± 20.1 μm for the two-step milling mode (12TWO_AX) to 122.8 ± 12.2 μm for the milling with step bur 12S (12S_AX). The worst result in all groups was found for the aspect occlusal fit with the highest value for group 12S of 222.8 ± 35.6 μm. Group two-step milling mode (12TWO) performed statistically significantly better from groups 12 and 12S for the occlusal fit ( p<0.05). Deviation patterns were visually analyzed with a color-coded scheme for each restoration. CAM strategy influenced the internal adaptation of zirconia-reinforced lithium silicate partial crowns fabricated with a chairside CAD/CAM system. Sensible selection of specific areas of internal adaptation and fit is an important factor for evaluating the CAM accuracy of CAD/CAM systems.

Nonretentive Bonded Ceramic Partial Crowns: Concept and Simplified Protocol for Long-lasting Dental Restorations.

Adhesively luted partial ceramic crowns have been documented to be clinically more durable than direct composite restorations when minimally invasively restoring large defects (replacing two cusps or more) in posterior teeth. The clinical longevity of such restorations is largely determined by the tooth-preparation design, material selection and adhesive luting procedure. The most frequently recorded failure in medium- to long-term clinical trials is fracture of the restoration. The clinical protocol of adhesively luted partial ceramic crowns can be optimized by taking the etiology of these restoration fractures into account. In this article, a simplified nonretentive bonded ceramic partial crown concept is presented that aims to achieve an adhesively luted ceramic restoration - composite cement - residual tooth structure biomechanical unit that maximally resists functional aging. Therefore, the three primary components of the bonded restoration-cement-tooth complex must function in synergy. Methods, Results and Discussion: The clinical protocol starts with a tooth preparation designed to optimally absorb chewing stress. A stable, internally rounded and gently sloping tooth-preparation design with all outer margins inclined towards the tooth center assures a favorable and homogenous stress distribution with low cyclic fatigue subjected to the adhesive interface. This preparation form additionally enables the dental technician to fabricate a well-seating and -fitting ceramic restoration of uniform thickness. As restoration material, monolithic lithium-disilicate glass ceramic is sufficiently strong for the partial crown indication and preferred in order to decrease the fracture risk. Clinically essential for a long-lasting restoration is the optimal bond that can be obtained by combined micromechanical interlocking and chemical bonding of composite cement to hydrofluoric acid-etched and silanized glass ceramic. The clinical effectiveness of this nonretentive bonded ceramic partial crown concept is confirmed by the overall high success rate as well as the very low fracture and debonding rate, as was recorded in long-term clinical trials.

Partial Ceramic Crowns Prepared by Dental Students: Clinical Performance Up to Five Years.

Partial ceramic crowns (PCCs) are an accepted treatment option for the restoration of posterior teeth with deficient tooth substance. Data on the survival of PCCs fabricated by dental students are scarce. The aim of this retrospective clinical study was to investigate the clinical performance and longevity of PCCs placed by dental students in the last year of their training program at the University of Basel, Switzerland. Eighty-eight patients who had received at least one PCC (n=108) in the program were considered for clinical assessment; their records were analyzed to detect previous complications or failures; and they were contacted by telephone. Criteria regarding aesthetic, functional, and biological aspects were rated with a scoring system from 1=clinically excellent to 5=clinically poor. The response rate was 66.3% (55 of 83 included patients), and 72.2% (n=78) of the PCCs were included in the analysis. Five PCCs had been lost within ten to 78 months after treatment. Six PCCs were recorded as failures (score 5), and ten received clinically unsatisfactory gradings (score 4). The risk of a clinically poor outcome was 14% after five years (86% survival), while the overall success rate was 63.5%. These results suggest that the clinical procedure of PCCs was successfully implemented by these students with satisfactory clinical survival.

Controlled, prospective, randomized, clinical split-mouth evaluation of partial ceramic crowns luted with a new, universal adhesive system/resin cement: results after 18months.

A new universal adhesive with corresponding luting composite was recently marketed which can be used both, in a self-etch or in an etch-and-rinse mode. In this study, the clinical performance of partial ceramic crowns (PCCs) inserted with this adhesive and the corresponding luting material used in a self-etch or selective etch approach was compared with a self-adhesive universal luting material. Three PCCs were placed in a split-mouth design in 50 patients. Two PCCs were luted with a combination of a universal adhesive/resin cement (Scotchbond Universal/RelyX Ultimate, 3M ESPE) with (SB+E)/without (SB-E) selective enamel etching. Another PCC was luted with a self-adhesive resin cement (RelyX Unicem 2, 3M ESPE). Forty-eight patients were evaluated clinically according to FDI criteria at baseline and 6, 12 and 18months. For statistical analyses, the chi-square test (α=0.05) and Kaplan-Meier analysis were applied. Clinically, no statistically significant differences between groups were detected over time. Within groups, clinically significant increase for criterion "marginal staining" was detected for SB-E over 18months. Kaplan-Meier analysis revealed significantly higher retention rates for SB+E (97.8%) and SB-E (95.6%) in comparison to RXU2 (75.6%). The 18-month clinical performance of a new universal adhesive/composite combination showed no differences with respect to bonding strategy and may be recommended for luting PCCs. Longer-term evaluation is needed to confirm superiority of SB+E over SB-E. At 18months, the new multi-mode adhesive, Scotchbond Universal, showed clinically reliable results when used for luting PCCs.

Influence of preparation design on fit and ceramic thickness of CEREC 3 partial ceramic crowns after cementation

Objective. This study investigated the influence of preparation design on the marginal and internal gap and ceramic thickness of partial ceramic crowns (PCCs) fabricated with the CEREC 3 system. Materials and methods. Sixteen extracted human mandibular molars were prepared according to two different preparation designs (n = 8): a retentive preparation design with traditional cusp capping (Group I) and a non-retentive preparation design with horizontal reduction of cusps (Group II). PCCs were fabricated from IPS Empress CAD with the CEREC 3 system. The parameters for luting space and minimum occlusal ceramic thickness were set to 30 μm and 1.5 mm, respectively. The fabricated PCCs were cemented to their corresponding teeth with self-adhesive resin cement and were then scanned by micro-computed tomography. The marginal and internal gaps were measured at pre-determined measuring points in five bucco-lingual and three mesio-distal cross-sectional images. The ceramic thicknesses of the PCCs were measured at the measuring points for cusp capping areas. Results. Group II (167.4 ± 76.4 μm) had a smaller overall mean gap, which included the marginal and internal gap measurements, than that of Group I (184.8 ± 89.0 μm). The internal gaps were larger than the marginal gaps, regardless of preparation design. Group I presented a thinner ceramic thickness in the cusp capping areas than the minimum occlusal ceramic thickness parameter of 1.5 mm. Conclusion. Preparation design had an influence on fit, particularly the internal gap of the PCCs. Ceramic thickness could be thinner than the minimum ceramic thickness parameter.

Impact of digital impression techniques on the adaption of ceramic partial crowns in vitro

ObjectivesTo investigate the effects, digital impression procedures can have on the three-dimensional fit of ceramic partial crowns in vitro. MethodsAn acrylic model of a mandibular first molar was prepared to receive a partial coverage all-ceramic crown (mesio-occlusal-distal inlay preparation with reduction of all cusps and rounded shoulder finish line of buccal wall). Digital impressions were taken using iTero (ITE), cara TRIOS (TRI), CEREC AC with Bluecam (CBC), and Lava COS (COS) systems, before restorations were designed and machined from lithium disilicate blanks. Both the preparation and the restorations were digitised using an optical reference-scanner. Data were entered into quality inspection software, which superimposed the records (best-fit-algorithm), calculated fit-discrepancies for every pixel, and colour-coded the results to aid visualisation. Furthermore, mean quadratic deviations (RMS) were computed and analysed statistically with a one-way ANOVA. Scheffé’s procedure was applied for multiple comparisons (n=5, α=0.05). ResultsMean marginal (internal) discrepancies were: ITE 90 (92)μm, TRI 128 (106)μm, CBC 146 (84)μm, and COS 109 (93)μm. Differences among impression systems were statistically significant at p<0.001 (p=0.039). Qualitatively, partial crowns were undersized especially around cusp tips or the occluso-approximal isthmus. By contrast, potential high-spots could be detected along the preparation finishline and at central occlusal boxes. ConclusionsMarginal and internal fit of milled lithium disilicate partial crowns depended on the employed digital impression technique. Clinical significanceThe investigated digital impression procedures demonstrated significant fit discrepancies. However, all fabricated restorations showed acceptable marginal and internal gap sizes, when considering clinically relevant thresholds reported in the literature.

Effect of selective enamel etching on clinical performance of CAD/CAM partial ceramic crowns luted with a self-adhesive resin cement

This study was conducted to evaluate a self-adhesive resin luting cement [RelyX Unicem 3MESPE-RXU] for luting partial ceramic crowns (PCCs) with and without selective enamel etching in a prospective, randomized clinical trial. Thirty-four patients had received the intended treatment. Two PCCs (Vita Mark II; Cerec 3D; Sirona) had been placed in a split-mouth design: one with RXU without enamel etching (RXU), the other with RXU with selective enamel etching (RXU + E). Restorations were evaluated at baseline (BL) and after 12, 24, and 36 months (USPHS criteria). For statistical analysis, the Chi-square test was applied (α = 0.05). Clinical survival of all restorations (n = 68) after 3 years was determined using Kaplan-Meier analysis. Twenty three patients (12 male/11 female) were available for clinical evaluation after 3 years. 19 RXU-PCCs were placed in molars, four in premolars, 18 RXU + E-PCCs in molars, five in premolars. Concerning clinical changes, no significant differences were found between luting strategies RXU/RXU + E at all recalls. Statistically significant changes over time were observed for marginal adaptation and marginal discoloration between BL and 36 m for RXU and RXU + E. For RXU + E, postoperative hypersensitivities decreased significantly from BL (n = 6) to 36 m (n = 0). Of the 68 restorations originally included, eight RXU and four RXU + E restorations failed. At 3 years, Kaplan-Meier survival of RXU was 72.9 %, that of RXU + E 87.6 %. Survival rates were not statistically significant different. Although clinical survival of RXU + E is slightly better at 3 years, restorations of both groups perform similar with respect to clinical changes over time as evaluated by modified USPHS criteria. The self-adhesive resin cement RXU can be used in conjunction with selective enamel etching, because survival rates of PCCs in the RXU + E group were not lower but, as a trend, even better than without enamel etching.

Restoration of incisal half with edge-up technique using ceramic partial crown in turner′s hypoplasia: A case report

This case report describes a rare treatment modality for Turner's hypoplasia done with a very conservative approach for the esthetic and functional problem of the defect. Diagnosis was made as Turner's hypoplasia of upper two central incisors with proximal caries. Treatment planning was done after considering many factors such as conservation of tooth structure, esthetics, occlusion and economy. Tooth preparation was done to receive Edge-up, all ceramic partial crowns for both the upper central incisors,using pressable all ceramic material and cemented with resin cement.

Three-dimensional fit of lithium disilicate partial crowns in vitro

ObjectivesA novel three-dimensional scanning technique was used to investigate the effects a one-step and a two-step impression methods can have on the three-dimensional fit of ceramic partial crowns. MethodsAn acrylic model of a mandibular first molar was prepared to receive a partial coverage all-ceramic crown (mesio-occlusal-distal inlay preparation with reduction of all cusps and rounded shoulder finish line of buccal wall). Type IV plaster replicates were cast based on one-step single viscosity (OS/SV), one-step dual viscosity (OS/DV), and two-step dual viscosity (TS/DV) impressions. Five partial crowns were fabricated per impression method using hot-pressed lithium disilicate ceramics. Then, preparation and restorations were digitized using a non-contact, white-light scanner featuring self-calibrating optics (overall measurement uncertainty of <5μm). Data were entered into quality inspection software which superimposed the records (best-fit-algorithm), calculated fit-discrepancies for every pixel, and colour-coded the results to aid visualization. Furthermore, mean quadratic deviations (RMS) were computed and analyzed statistically with a 1-way ANOVA. Scheffé’s procedure was applied for multiple comparisons (α=0.05). ResultsMean RMS-values for marginal (internal) surfaces were: OS/SV 70 (20)μm, OS/DV 78 (34)μm, and TS/DV 107 (52)μm. Differences among impression techniques were statistically significant at p=0.006 (0.001). Qualitatively, occlusal ridges and preparation finish lines were over contoured, whereas inner occlusal boxes and the proximal–occlusal isthmus were under contoured. ConclusionsOS/SV and OS/DV impressions resulted in statistically significantly smaller marginal and internal discrepancies than the two-step technique. Clinical significanceMarginal and internal fit of hot-pressed lithium disilicate partial crowns depended on the employed impression technique. One-step impressions are preferred over two-step techniques in many day-to-day clinical situations, especially for the fabrication of partial coverage crown restorations.

Marginal and internal fit of pressed lithium disilicate partial crowns in vitro: A three-dimensional analysis of accuracy and reproducibility

ObjectivesThe objective of this in vitro study was to visualize and to quantify the marginal and internal fit of heat-pressed ceramic restorations by a novel three-dimensional procedure. Accuracy and reproducibility of the employed measuring method were determined. MethodsAn acrylic model of a lower left first molar was prepared to receive a partial crown and duplicated by single step dual viscosity impressions. Corresponding working casts were formed from Type IV die stone and indirect restorations were fabricated from heat-pressable lithium disilicate ceramics (IPS e.max Press, Ivoclar Vivadent AG, Schaan, Liechtenstein). The acrylic tooth model and the ceramic partial crowns were digitized by a structure light scanner with a measurement-uncertainty of 4μm and subjected to computer-aided quality inspection. Visual discrepancies in marginal and internal fit were displayed with colors. For quantitative analysis, mean quadratic deviations (RMS) were computed and analyzed by Student's t-test (n=5, α=0.05). ResultsMean RMS-values for accuracy (reproducibility) ranged from 34 (14)μm for internal areas to 78 (23)μm for marginal surfaces. Differences in accuracy (p=0.003) and reproducibility (p<0.001) were statistically significant. In general, areas with sharp internal line angles such as occlusal ridges and the preparation finish line exhibited oversized dimensions, whereas areas with rounded and soft internal line angles were undersized. SignificanceThe viability of a computer-aided and three-dimensional approach for assessing marginal and internal fit of indirect restorations was demonstrated. Thereby, the obtained results track complex form changes as they occur during laboratory processing.

Controlled, prospective, randomized, clinical evaluation of partial ceramic crowns inserted with RelyX Unicem with or without selective enamel etching. Results after 2 years

Among the materials used for luting indirect restorations, growing interest has been directed towards the use of self-adhesive resin cements. The aim of this prospective randomized controlled clinical trial was to evaluate the clinical performance of the self-adhesive resin cement RelyX Unicem (RXU) for luting partial ceramic crowns (PCCs). In addition, the influence of selective enamel etching prior to luting (RXU+E) was assessed. Two-year results are reported. Thirty-four patients (68 PCCs) had originally received the intended treatment at baseline (BL). Twenty-nine patients (14 male, 15 female) with a total of 58 PCCs participated in the 2-year recall. In each patient, one PCC had been placed with RXU, one PCC with RXU+E. Restorations were evaluated at BL and 24months after placement using modified United States Public Health Service criteria for postoperative hypersensitivity, anatomic form, marginal adaptation, marginal discoloration, surface texture and recurrent caries. Additionally, the "percentage failure" within the 2-year recall period for all restorations (n = 68) was calculated according to ADA Program Guidelines. Target value for acceptability of each procedure was <5% failure within 24m. For statistical analysis of the data, the chi-square test was applied (α = 0.05). The median patient age was 41years (24-59years). Median PBI was 8% (5-10%). Twenty-two RXU PCCs were placed in molars, seven in premolars. Twenty-one RXU+E PCCs were placed in molars, eight in premolars. Statistically significant changes were observed for marginal adaptation (MA) and marginal discoloration (MD) between BL and 2years but not between the two groups (RXU, RXU+E). Percentage of alfa values at BL for MA (RXU, 97% and RXU+E, 100%) and for MD (RXU, 97% and RXU+E, 97%) decreased to RXU, 14% and RXU+E, 28% for MA and to RXU, 50% and RXU+E, 59% for MD after 24months. Within the observation period, three failures were recorded with RXU (5.1% failure), one failure was recorded for RXU+E (1.7% failure), but a significant influence of selective enamel etching on failure could not be verified. Although the results of the present study reveal a slight tendency for more favourable results if selective enamel etching is applied prior to insertion of ceramic PCCs with a self-adhesive luting material, longer-term evaluation is needed to confirm this. Additional selective enamel etching with a self-adhesive luting material does not considerably improve clinical performance of the restorations within the observation period reported, neither does it impose a hazard with respect to postoperative hypersensitivity.

The effect of preparation designs on the marginal and internal gaps in Cerec3 partial ceramic crowns

Objectives The purpose of this study was to evaluate the marginal and internal gaps in Cerec3 partial ceramic crowns (PCCs) of three different preparation designs in vitro using microcomputed tomography (μCT). Methods Cerec3 PCCs of three different preparation designs ( n = 20) were fabricated according to the following: Group I-conventional functional cusp capping/shoulder preparation, Group II-horizontal reduction of cusps and Group III-complete reduction of cusps/shoulder preparation. After fixation of PCCs, the μCT scanning was performed. For obtaining the average internal gap (AIG), the μCT sections were reconstructed 3-dimensionally, and then the total volume of the internal gap was divided by the contact surface area. The 2-dimensional (2D) μCT views were used to investigate the gaps at predetermined key positions in seven bucco-lingual sections and three mesio-distal cross sections. The gaps were measured using the μCT at each reference point. Statistical analysis was performed using one-way ANOVA and Tukey's test. Results For the 3D reconstruction technique, the AIGs were as followed: Group I 197.3 ± 48.2 μm, Group II 171.2 ± 45.1 μm, and Group III 152.7 ± 27.1 μm. For the 2D μCT views, the gaps of each group were the smallest on the margins ranging from 35.4 ± 32.2 to 128.4 ± 69.5 μm, and the largest on the horizontal or angle walls ranging from 184.5 ± 41.2 to 406.5 ± 176.1 μm. According to the results, Group I showed larger marginal and internal gaps compared with the other groups. Conclusions For the PCCs, the simplified designs (Groups II and III) demonstrated superior results compared to the traditional cusp capping design (Group I). The marginal gaps were smaller than the internal gaps in all groups.

Influence of different cusp coverage methods for the extension of ceramic inlays on marginal integrity and enamel crack formation in vitro

No information is available to date about cusp design of thin (1.0 mm) non-functional cusps and its influence upon (1) marginal integrity of ceramic inlays (CI) and partial ceramic crowns (PCC) and (2) crack formation of dental tissues. The aim of this in vitro study was to investigate the effect of cusp coverage of thin non-functional cusps on marginal integrity and enamel crack formation. CI and PCC preparations were performed on extracted human molars. Non-functional cusps were adjusted to 1.0-mm wall thickness and 1.0-mm wall thickness with horizontal reduction of about 2.0 mm. Ceramic restorations (Vita Mark II, Cerec3 System) were adhesively luted with Excite/Variolink II. The specimens were exposed to thermocycling and central mechanical loading. Marginal integrity was assessed by evaluating dye penetration after thermal cycling and mechanical loading. Enamel cracks were documented under a reflective-light microscope. The data were statistically analysed with the Mann-Whitney U test, the Fishers exact test (alpha = 0.05) and the error rates method. PCC with horizontal reduction of non-functional cusps showed statistically significant less microleakage than PCC without such a cusp coverage. Preparation designs with horizontal reduction of non-functional cusps showed a tendency to less enamel crack formation than preparation designs without cusp coverage. Thin non-functional cusp walls of adhesively bonded restorations should be completely covered or reduced to avoid enamel cracks and marginal deficiency.

Ceramic Inlays and Partial Ceramic Crowns: Influence of Remaining Cusp Wall Thickness on the Marginal Integrity and Enamel Crack Formation In Vitro

No information is currently available about what the critical cavity wall thickness is and its influence upon 1) the marginal integrity of ceramic inlays (CI) and partial ceramic crowns (PCC) and 2) the crack formation of dental tissues. This in vitro study of CI and PCC tested the effects of different remaining cusp wall thicknesses on marginal integrity and enamel crack formation. CI (n = 25) and PCC (n = 26) preparations were performed in extracted human molars. Functional cusps of CI and PCC were adjusted to a 2.5 mm thickness; for PCC, the functional cusps were reduced to a thickness of 2.0 mm. Non-functional cusps were adjusted to wall thicknesses of 1) 1.0 mm and 2) 2.0 mm. Ceramic restorations (Vita Mark II, Cerec3 System) were fabricated and adhesively luted to the cavities with Excite/Variolink II. The specimens were exposed to thermocycling and central mechanical loading (TCML: 5000 x 5 degrees C-55 degrees C; 30 seconds/cycle; 500000 x 72.5N, 1.6Hz). Marginal integrity was assessed by evaluating a) dye penetration (fuchsin) on multiple sections after TCML and by using b) quantitative margin analysis in the scanning electron microscope (SEM) before and after TCML. Ceramic- and tooth-luting agent interfaces (LA) were evaluated separately. Enamel cracks were documented under a reflective light microscope. The data were statistically analyzed with the Mann Whitney U-test (alpha = 0.05) and the Error Rates Method (ERM). Crack formation was analyzed with the Chi-Square-test (alpha = 0.05) and ERM. In general, the remaining cusp wall thickness, interface, cavity design and TCML had no statistically significant influence on marginal integrity for both CI and PCC (ERM). Single pairwise comparisons showed that the CI and PCC of Group 2 had a tendency towards less microleakage along the dentin/LA interface than Group 1. Cavity design and location had no statistically significant influence on crack formation, but the specimens with 1.0 mm of remaining wall thickness had statistically significantly more crack formation after TCML than the group with 2.0 mm of remaining cusp wall thickness for CI. The remaining cusp wall thickness of non-functional cusps of adhesively bonded restorations (especially for CI) should have a thickness of at least 2.0 mm to avoid cracks and marginal deficiency at the dentin/LA interface.

Marginal Integrity of Partial Ceramic Crowns Within Dentin With Different Luting Techniques and Materials

This in vitro study evaluated the marginal integrity of partial ceramic crowns (PCCs) luted with or without a resin-coating and compared the results with the marginal sealing of a recently introduced self-adhesive universal resin cement. PCC preparations were performed on 84 extracted human molars, with proximal margins placed 1 mm below the cemento-enamel junction. The PCCs were fabricated from Vita Mark II ceramic (Vita) using the Cerec-3 Unit (Sirona). The prepared teeth were assigned to three groups: (1) conventional luting technique (n=36), (2) resin-coating luting technique (n=36) or (3) recently introduced self-adhesive universal resin cement (n=12). Within these three groups, the following materials were applied: (1) Excite/Variolink II (EVC), ED-Primer/Panavia-F2.0 (PAC), Syntac Classic/ Variolink II (SYC); (2) Excite/Variolink II with Excite/Tetric Flow resin-coating (EVR), ED-Primer/Panavia-F2.0 with Clearfil SE-Bond/ Protect-Liner F resin-coating (PAR), Excite/ Variolink II with Syntac Classic/Tetric Flow resin-coating (SYR); (3) RelyX Unicem (REX). After thermocycling and mechanical loading (TC: 5000 cycles at 5 degrees C/55 degrees C; 30 seconds/cycle; ML:500000 cycles at 72.5 N, 1.6 Hz), microleakage was assessed by evaluating silver staining (%) on multiple tooth sections. Ceramic/composite-, resin-coating/composite- (where applicable) and dentin/composite-interfaces were evaluated separately. The data were statistically analyzed with the Mann-Whitney-U-test and the Error Rates Method. In Groups 1 and 2, the evaluation of microleakage at dentin showed better marginal integrity when the resin-coating technique was applied (EVR, PAR, SYR: 18-53%) than within the conventional luting technique group (EVC, PAC, SYC: 58-67%). However, the lowest microleakage values were found for RelyX Unicem (REX: 15%). In conclusion, resin-coating may improve the marginal sealing within dentin, depending on the materials used. Luting with a self-adhesive universal resin cement showed the best marginal sealing of all groups.

Three-year clinical performance of cast gold vs ceramic partial crowns

Cast gold partial crowns (CGPC) and partial ceramic crowns (PCC) are both accepted for restoring posterior teeth with extended lesions today. However, as esthetics in dentistry becomes increasingly important, CGPC are being progressively replaced by PCC. The aim of the present prospective split-mouth study was the comparison of the clinical performance of PCC and CGPC after 3 years of clinical service. Twenty-eight patients (11 men and 17 women) participated in the 3-year recall with a total of 56 restorations. In each patient, one CGPC (Degulor C) and one PCC (Vita Mark II ceramic/Cerec III) had been inserted at baseline. CGPC were placed using a zinc phosphate cement (Harvard); PCC were adhesively luted (Variolink II/Excite). All restorations were clinically assessed using modified US Public Health Service (USPHS) criteria at baseline, 1 year, 2 years, and 3 years after insertion. Twenty-eight CGPC and 14 PCC were placed in molars, and 14 PCC were placed in premolars. Early data were reported previously under the same study design. After 3 years, the evaluation according to USPHS criteria revealed no statistically significant differences between both types of restorations with the exception of marginal adaptation and marginal discoloration: A statistically significant difference within the PCC group (baseline/3 years) was determined for the criterion marginal adaptation. For the 3-year recall period, overall failure was 0% for CGPC and 6.9% for PCC. At 3 years, PCC meet American Dental Association Acceptance Guidelines criteria for tooth-colored restorative materials for posterior teeth.

Partial Ceramic Crowns: Influence of Ceramic Thickness, Preparation Design and Luting Material on Fracture Resistance and Marginal Integrity In Vitro

This in vitro study tested the effects of two different ceramic thicknesses, two preparation designs and two different luting agents on the marginal integrity and fracture resistance of partial ceramic crowns (PCC). Eighty extracted human molars were prepared according to the following preparation designs: a) Coverage of functional cusps/butt joint (n=40), b) Horizontal reduction of functional cusps (n=40). PCC (Vita Mark II, Cerec3 System) were fabricated and the ceramic thickness of the functional cusps was adjusted to (1): 0.5-1.0 mm and (2): 1.5-2.0 mm. PCC were adhesively luted to the cavities with either Excite/VariolinkII (VL) or RelyX Unicem (RX). The specimens were exposed to thermocycling and central mechanical loading (5000 x 5 degrees C-55 degrees C; 30 second/cycle; 50,0000 x 72.5N, 1.6Hz). Marginal integrity was assessed by evaluating dye penetration (fuchsine) on multiple sections in the bucco-oral direction by relating the actual penetration distance to the maximal length of the corresponding cavity wall (100%). Restoration/luting agent (RL)--and tooth/luting agent (TL) interfaces were evaluated separately. The data were statistically analyzed with the Mann Whitney U-test and the Error Rates Method (ERM), and the fracture rates were analyzed with the chi2-test. Dye penetration data indicated that ceramic thickness and luting agent had a statistically significant influence upon marginal integrity in general, irrespective of all other parameters (ERM): RX showed significantly lower microleakage along the RL interface than VL. VL revealed significantly lower microleakage at the TL interface than RX. Fifteen PCC of group 1 (0.5-1.0 mm) and two PCC of group 2 (1.5-2.0 mm) were fractured after thermocycling and central mechanical loading, with the difference being statistically significant. PCC fabricated from industrially sintered feldspathic ceramic should have at least a thickness of 1.5-2.0 mm in stress-bearing areas.