Agneta Odén

Five-year clinical evaluation of Procera AllCeram crowns ☆ ☆☆ ★ ★★ ♢ ♢♢

STATEMENT OF PROBLEM Esthetic demands of patients and practitioners for an all-ceramic crown in both anterior and posterior regions of the dental arches has prompted the development of the Procera AllCeram crown. Long-term clinical trials that evaluate the strength and naturalness of the Procera AllCeram crown are lacking. PURPOSE This prospective study was initiated to evaluate the clinical performance of 100 Procera AllCeram crowns after 5 years in service. MATERIAL AND METHODS One hundred Procera AllCeram crowns were fabricated for 58 patients (20 men and 38 women). Patients were treated by 4 general dental practitioners. Crown placement involved both the anterior and posterior regions of the dental arches. Crowns were examined at baseline and once a year during the 5 years that followed and evaluated at each appointment with the California Dental Associations quality assessment system. RESULTS Of the 97 crowns remaining in the study after 5 years, only 3 crowns had experienced a fracture through the veneering porcelain and the aluminum oxide coping material. Two additional crowns were replaced as a result of fractures of only the veneering porcelain. One crown was replaced as a result of recurrent caries. All remaining crowns were ranked as either excellent or acceptable for surface/color, anatomic form, and marginal integrity. CONCLUSION The 5-year clinical observations and ranking with the California Dental Associations quality assessment criteria supported the conclusion that Procera AllCeram crowns may be used in all areas of the mouth.

Shear bond strength of a resin cement to densely sintered high-purity alumina with various surface conditions

Procera Sandvik AB is now manufacturing a densely sintered high-purity alumina core for an all-ceramic crown designed for anterior and posterior restorations. Whereas the material holds promise on the basis of in vitro strength tests, the ability to alter the surface and use conventional bonded resin cements has not been reported previously in the literature. Samples of the core were treated by means of one of four methods routinely used for all ceramic restorations, and then a commercially available resin cement was bonded to the surface. A shear bond test of the adhesion showed that the highest shear bond strengths of 11.99 +/- 3.12 MPa were obtained with air abrasion at 80 psi and 50-microm alumina particles.

Digitization of simulated clinical dental impressions: Virtual three-dimensional analysis of exactness

OBJECTIVES To compare the exactness of simulated clinical impressions and stone replicas of crown preparations, using digitization and virtual three-dimensional analysis. METHODS Three master dies (mandibular incisor, canine and molar) were prepared for full crowns, mounted in full dental arches in a plane line articulator. Eight impressions were taken using an experimental monophase vinyl polysiloxane-based material. Stone replicas were poured in type IV stone (Vel-Mix Stone; Kerr). The master dies and the stone replicas were digitized in a touch-probe scanner (Procera) Forte; Nobel Biocare AB) and the impressions in a laser scanner (D250, 3Shape A/S), to create virtual models. The resulting point-clouds from the digitization of the master dies were used as CAD-Reference-Models (CRM). Discrepancies between the points in the pointclouds and the corresponding CRM were measured by a matching-software (CopyCAD 6.504 SP2; Delcam Plc). The distribution of the discrepancies was analyzed and depicted on color-difference maps. RESULTS The discrepancies of the digitized impressions and the stone replicas compared to the CRM were of similar size with a mean+/-SD within 40microm, with the exception of two of the digitized molar impressions. The precision of the digitized impressions and stone replicas did not differ significantly (F=4.2; p=0.053). However, the shape affected the digitization (F=5.4; p=0.013) and the interaction effect of shape and digitization source (impression or stone replica) was pronounced (F=28; p<0.0001). The reliability was high for both digitization methods, evaluated by repeated digitizations. SIGNIFICANCE The exactness of the digitized impressions varied with shape. Both impressions and stone replicas can be digitized repeatedly with a high reliability.

Computer aided analysis of digitized dental stone replicas by dental CAD/CAM technology

OBJECTIVES To determine the reproducibility of digitized dental stone replicas compared to the master model and the reliability of the computer aided analysis. METHODS Four master dies, prepared for complete crowns were fabricated in presintered yttria-stabilized tetragonal zirconia (Y-TZP). Eight vinyl polysiloxane impressions (PROVIL novo; Heraeus Kulzer) were taken of each die and stone replicas were poured in type IV stone (Vel-Mix Stone; Kerr). The master dies and the stone replicas were digitized in a touch-probe scanner (Procera Forte; Nobel Biocare AB), to create triangulated surface-models. The point-cloud from the first of the repeated digitizations of each master die was used as CAD-reference-models (CRM). Discrepancies between the points in the triangulated surface-models and the corresponding CRM were measured by a matching-software (CopyCAD 6.504 SP2; Delcam Plc). The distribution of the discrepancies was analyzed and presented in color-difference-maps. RESULTS The precision of the measuring method, presented as the repeatability coefficient, ranged between 7 and 16 microm (entire surface), whereas the analysis of the stone replicas revealed a precision (repeatability coefficient) ranging from 19 to 26 microm. The accuracy of the replica to master (the mean discrepancy) ranged from 0.5 to 2.0 microm (95% confidence interval 1.5-2.9 microm). SIGNIFICANCE The greatest precision of the measurement was seen in the jacket surface of the die. The size of the stone replicas varied and the repeatability coefficient was on average 15 microm (2-25 microm) greater for the replica-to-master alignment than the repeated digitizations of the master.

A two-year clinical study of light-cured composite and amalgam restorations in primary molars.

The object of this prospective study was to compare the clinical behavior of composite and amalgam restorations with respect to anatomical form, marginal adaptation, caries adjacent to margin, and post-operative sensitivity. We selected children (n = 43) with an average age of 6.4 yr exhibiting proximal caries lesions in primary molars distributed on both left and right sides. In each child, one amalgam and one composite side were randomly chosen, resulting in 64 fillings for composite and 55 for amalgam. After a two-year period, significantly (p less than 0.05) more composite fillings (88%) were clinically classified as satisfactory compared with amalgam fillings (68%). No significant relationship was found between the success rate of proximal fillings and the caries activity of the individuals. The results indicate that composite can be used successfully as a class II filling material in primary molars in children.

The microstructure of corroded amalgams

One conventional amalgam and two amalgams with a high copper content were stored in 0.9% NaCl solution buffered with phosphate to pH 6. In one experimental series the amalgams were placed in contact with a gold alloy. Every 7 weeks the solutions were changed and analyzed with regard to elements released from the amalgams. The microstructure of the specimens was studied in a scanning electron microscope before immersion and after 7 and 35 weeks in the solution. All the amalgams corroded along the grain boundaries in the gamma 1 phase. Corrosion was greatest in the gamma 2 phase of ANA 68, in the eta phase of ANA 2000 and in the reaction zone (eta + gamma 1) surrounding the Ag-Cu-eutectic particles of Dispersalloy. The microstructure of the corroded amalgams showed similarities to amalgams corroded in vivo. The change in microstructure observed in cross-sections of the corroded specimens was related to the amounts of corrosion products released into the saline solution.

Cracks in gold crowns cemented on amalgam restorations.

Twenty-seven gold crowns, removed from patients with problems such as diffuse pain and metallic taste, have been examined. The gold crowns were made of an ordinary casting gold alloy, type III. The crowns were built on amalgam cores or big amalgam fillings. Eight of these crowns had cracks beginning at the cervical margin and propagating occlusally. The crowns were examined in a scanning electron microscope equipped with an energy-dispersive detector. The study showed that the cracks propagated along the grain boundaries within the gold alloy. In the cracks corrosion products usually found on amalgam were identified. The cracks could be due to intercrystalline stress corrosion or overloading.

Long-term corrosion studies in vitro of amalgams in contact.

Three types of amalgams, one conventional and two with a high copper content, were stored in phosphate-buffered 0.9% NaCl solution, at pH 6, for 35 weeks. Every 7 weeks the solutions were changed and analyzed with regard to Cu, Zn, Sn, Hg, and Ag. In one of the amalgam combinations, the conventional amalgam and one of the copper-rich amalgams in an area ratio of 2:1, contact between the amalgams clearly increased the amounts of Cu, Hg, and Ag released the first 14 weeks compared with when immersed in separate solutions. With the reversed area relation, Cu, Hg, and Ag decreased when they were in contact. The conventional amalgam in contact with the other copper-rich amalgam, in an area ratio of 2:1, reduced the amount of Cu but increased the Zn released. Polishing initially decreased the amounts of Cu and Zn released compared with the unpolished amalgams.