Debra R. Haselton

Current status of luting agents for fixed prosthodontics

STATEMENT OF THE PROBLEM The long-term clinical outcome of fixed prosthodontic treatment depends, in part, on the use of adhesives that can provide an impervious seal between the restoration and the tooth. There are several types of available luting agents, each possessing unique properties and handling characteristics. No one product is ideal for every type of restoration. PURPOSE The purpose of this article is to review available dental luting agents, discuss improvements and drawbacks in newly formulated adhesives, and present the indications for their use. RESULTS Each cement type is physically and chemically unique. A single adhesive will not suffice in modern day clinical practice.

Clinical assessment of high-strength all-ceramic crowns ☆

STATEMENT OF PROBLEM All-ceramic crowns are being used extensively. Little data are available on their clinical performance. PURPOSE This study evaluated the clinical performance of In-Ceram (Vita Zahnfabrik) crowns. MATERIAL AND METHODS Forty-one patients (16 men, 25 women; mean age 47.3 years, range 18 to 77 years) were examined with a total of 80 In-Ceram all-ceramic crowns fabricated at the University of Iowa College of Dentistry from 1994 to 1997. The percentage distribution for crowns included: 67% anterior single crowns, 26% posterior single crowns, 6% anterior implant crowns, and 1% posterior implant crowns. This study documented the integrity of the junction between crown and tooth, color match to adjacent teeth, secondary dental caries, wear of crown and opposing dentition, and visible cracks in the crown. Alpha, Bravo, and Charlie ratings were assigned with a modified USPHS criteria. The patients were also surveyed with respect to oral hygiene and satisfaction of treatment. Estimations of 4-year success rates and corresponding confidence intervals were calculated by fitting a constant hazard function model with the SAS procedure GENMOD. RESULTS Marginal integrity for 88% of artificial crowns was rated Alpha or Bravo. Shade match for 99% was Bravo or better. Only 1% of the crowns were carious, and 1 crown exhibited occlusal wear. One premolar crown had a small fracture of veneering porcelain. One molar crown was remade after core fracture. All patients (100%) expressed satisfaction with their crowns. The estimated 4-year success rates (Alpha or Bravo), with 95% confidence intervals in parentheses were calculated as: 83.5% (65.7%-94.6%) for marginal integrity, 95.8% (82.9%-99.8%) for shade match, and 95.5% (81.6%-99.7%) for secondary caries, 100% (88%-100%) for wear, and 100% (88%-100%) for cracks.

A comparison of the effects of two burs on endodontic access in all-ceramic high lucite crowns.

OBJECTIVE The purpose of this study was to examine and compare the effects of diamond and tungsten carbide burs with respect to the preparation of access through all-ceramic crowns. STUDY DESIGN Thirty extracted maxillary premolars were restored with all-ceramic crowns. Each specimen was assigned to one of two groups: (1) access opening prepared with a round diamond bur; (2) access opening prepared with a carbide fissure bur. Access preparations were scanned by means of scanning electron microscopy; observed were defects categorized as edge chipping, microcracks, and fractures. RESULTS Edge chipping around the access was universal. Significant chipping (x > or = 0.1 m) was seen in 43% of access peripheries. Eleven percent of the crowns fractured. chi(2) analysis (P <.05) demonstrated no statistical difference between the bur groups. Results of a t test revealed no statistical difference in edge chipping between the two bur types. CONCLUSIONS All-ceramic crowns bonded to extracted maxillary premolars may experience edge chipping, microcracks, and fractures at equal rates whether access is prepared with a round medium coarse diamond bur or a tungsten carbide fissure bur.