Kenneth B. May

Precision of fit: The Procera AllCeram crown

STATEMENT OF PROBLEM Strength, color stability, and precision of fit are requirements for all-ceramic restorations. The Procera AllCeram crown system, composed of a densely sintered high-purity alumina core combined with a low fusing surface porcelain, appears to satisfy most of these requirements. However, evaluation of marginal fit has not been reported. PURPOSE This study measured the precision of fit of the Procera AllCeram crown fabricated with Procera CAD/CAM technology for the premolar and molar teeth fit to a die. MATERIAL AND METHODS Five ivorine maxillary first premolars and first molars were prepared for full-coverage crowns. Preparations were standardized with a convergence angle of 10 degrees, chamfer margins of 1.3 to 1.5 mm circumferentially, and occlusal reduction of 2.0 mm. AllCeram crowns were fabricated for the dies, and the fit of the crown to the die was determined by using a standardized procedure with a silicone impression material that served a dual role: (1) as a retrievable luting agent, and (2) to replicate the internal aspects of the crown. Laser videography was used to measure the gap dimension between the crowns and the dies at the marginal opening, the axial wall, the cusp tip, and the occlusal adaptation measurement locations. Mean gap dimensions and standard deviations (SDs) were calculated for marginal opening, internal adaptation, and precision of fit. RESULTS Mean gap dimensions and standard deviations at the marginal opening for the premolar and molar crowns were 56.0 microns SD +/- 21 and 63.0 microns SD +/- 13 microns, respectively. The mean gap dimensions and SDs of the internal adaptation were 69.0 microns SD +/- 17 microns for axial wall, 48.0 microns SD +/- 12 microns for cusp tip, and 36.0 microns SD +/- 7 microns for occlusal adaptation for the premolar crowns; and 49.0 microns SD +/- 3 microns axial wall, 67.0 microns SD +/- 21 microns cusp tip, and 74.0 microns SD +/- 29 microns occlusal adaptation for molar crowns. Precision of fit and SDs for premolar and molar crowns were 52.0 microns SD +/- 19 microns and 63.0 microns SD +/- 20 microns, respectively. Mean marginal openings and precision of fit gap dimensions for the crown groups were not significantly different at the .05 level. However, gap dimensions that defined the internal adaptation at the measurement locations were different (P < or = .05). CONCLUSION Mean gap dimensions for marginal openings, internal adaptation, and precision of fit for the crown groups were below 70 microns. These findings show that the crowns studied can be prescribed with confidence knowing that the precision of fit will consistently be less than 70 microns.

In vitro wear of resin denture teeth

STATEMENT OF PROBLEM One of the most important physical properties of artificial teeth used in the restoration of the edentulous patient is wear resistance, and the ability of these teeth to maintain a stable occlusal relationship over time. PURPOSE This study compared the in vitro wear of four different resin denture teeth against human enamel. MATERIAL AND METHODS Five denture tooth samples opposing five enamel abraders were positioned in a mechanical wear testing device for two 5,000 cycle wear periods (total of 10,000 cycles) under a 13.4 N load. All tests were conducted in human saliva, and the wear was measured at the end of each test period. RESULTS The wear of the Classic and Kenson acrylic resin denture teeth was much greater than the DB Plus and MLI composite teeth after 10,000 cycles. The wear of the KENSON denture tooth was also greater than the Classic tooth. No wear differences were found between the two composite teeth. CONCLUSIONS The wear of DB Plus and MLI resin denture teeth was approximately 50% less than the wear of Classic and Kenson teeth when opposed by human enamel.

The precision of fit at the implant prosthodontic interface

STATEMENT OF PROBLEM Percussion, visual observation, and conventional periapical radiographs are the methods most frequently used clinically to evaluate the accuracy of implant component assemblies, whereas methods to measure the precision of fit are limited. PURPOSE In this study the Periotest instrument was used to evaluate the stability of the interfaces between the implant and the abutment, along with the abutment and the gold cylinder under a series of assembly conditions. The hypothesis tested is that a more negative Periotest value (PTV) would indicate an accurate fit and a more positive value PTV would correlate with an inaccurate fit. MATERIAL AND METHODS To investigate this hypothesis in vitro, two bovine ribs were used as patient simulation models. Each model contained three self-tapping Brånemark implants placed approximately 7 to 10 mm apart and arranged in a reasonable curvature. A series of component assembly conditions were created as accurate and inaccurate with thickness gauges of 25.4 microns, 50.8 microns, and 101.6 microns. RESULTS The mean Periotest values and SDs for accurately assembled abutments and gold cylinders were -6.0 +/- 0.32 and -3.4 +/- 0.68, respectively. Periotest value data of the assembly conditions were statistically analyzed with multiple regression analysis. The misfit in the implant to abutment interface resulted in a more negative Periotest value trend (r = 0.54) with increases in gauge thickness. However, the same magnitudes of misfit at the abutment to gold cylinder interface produced a more positive Periotest value trend (r = 0.72). CONCLUSION The PTV trends were consistent with increased stability at the abutment to implant interface from the increasing magnitude of misfit created with the thickness gauges. In contrast, the measurement trends observed for the abutment to gold cylinder interface were consistent with decreased stability with each increase in gauge thickness inserted at the interface.

Silane to enhance the bond between polymethyl methacrylate and titanium

The machined surface of wrought titanium frameworks used in implant-supported, fixed prostheses does not bond well with acrylic resin. Surface pretreatment has been suggested to enhance the retention of polymethyl methacrylate to machined titanium surfaces. This study evaluated a new bonding material (Rocatec) to determine its effect on the bond strength between titanium and polymethyl methacrylate. Twenty rod-shaped specimens of grade 2 titanium (7.6 x 0.3 cm in diameter) were divided into two groups of 10 samples. Group A received no pretreatment and group B was pretreated with 110 microns alumina air abrasive and the Rocatec material. Heat-cured denture base resin was processed around each titanium sample in a cylindrical shape approximately 0.9 x 1.5 cm. A Shell-Nielsen shear test was performed with a universal testing machine at a crosshead speed of 0.5 mm/minute to determine the bond strength in megapascals (MPa). Group B specimens (23.8 +/- 1.78 MPa) had a shear strength 68% greater than group A (16.1 +/- 1.61 MPa) (p 0.0001). The results of this study indicated that surface pretreatment of grade 2 titanium with 110 microns alumina air abrasive plus Rocatec bonding material significantly enhances the shear bond strength to PMMA.

Denture base resins: Comparison study of color stability

Several denture base resins have been recently introduced that provide easier or faster processing. Although these materials have adequate strength properties, the color stability is also of interest. This study evaluated the color stability of five denture base acrylic resins and one denture base repair resin. The samples were subjected to conditions of accelerated aging to test color stability. Five samples of each material were processed and aged for 100 and 300 hours. The color stability was quantitatively measured using the Minolta Chroma Meter II. Color measurements were made before weathering and at 100 and 300 hours the color difference delta E was calculated for all samples. At 300 hours the color change of the materials was significantly different at p less than 0.01. It was found that: (1) the color of Lucitone Hy-pro and Acron was least affected by conditions of accelerated aging; (2) Triad, Accelar 20, and Perm demonstrated noticeable color changes; and (3) Compak-20 had an appreciable color change and was the least color-stable of the materials tested.

Color stability: Denture base resins processed with the microwave method

Several quick heat-cured denture base resin systems and microwave processing resins have been introduced to provide easier and faster processing. The microwave processing method is the fastest of the heat-cured processing methods. Conventional acrylic resins processed with the microwave method seem to possess adequate physical properties, and one study indicated that a microwave acrylic resin was reasonably color stable under conditions of accelerated aging, although manufacturers do not recommend using them for microwave processing. The purpose of this study was to evaluate the color stability of seven conventional and one microwave heat-cured denture base materials processed with the microwave method. The samples were subjected to conditions of accelerated aging to test for color stability. The color stability was quantitatively measured and color measurements were made before weathering and at 300, 600, and 900 hours. The mean color change for each sample group was statistically analyzed with polynomial regression to determine the pattern of color change over time. The differences in color change for the acrylic resins were significant for all materials, but the color change for Lucitone Hy-pro was not noticeable on visual examination. The results of this study revealed that color changes occurred after accelerated aging in heat-cured denture base resins and Acron GC microwave acrylic resins processed with the microwave method. Hy-pro and TruTone materials exhibited the least color change; Hy-pro material was the most color stable material.

The effect of the use of a counter-torque device on the abutment-implant complex†

STATEMENT OF PROBLEM Little is known about the condition of the abutment-screw joint before loading, after the development of the preload. PURPOSE This study examined the tightening force transmitted to the implant with and without the use of a counter-torque device during the tightening of the abutment screw. MATERIALS AND METHODS Forty Brânemark implants and 10 CeraOne, Estheticone, Procera, and AurAdapt abutments formed the experimental populations. Samples in each group were further divided into 2 groups, 1 group was tightened with a torque controller without the use of a counter-torque device, whereas the other used the counter-torque device. Samples were positioned in a special holder within the grips of a Tohnichi BTG-6 torque gauge for measuring transmitted forces. RESULTS There were significant differences (P =. 0001) in the tightening forces transmitted to the implant with and without the use of a counter-torque device when tightening the abutment screws. CONCLUSION An average of 91% of the recommended preload tightening torque was transmitted to the implant-bone interface in the absence of a counter-torque device. In all abutment systems, less than 10% of the recommended preload tightening torque was transmitted to the implant when the counter-torque device was used.

Implant and provisional crown placement : a one stage protocol

Most endosseous implant systems are placed using a two-stage surgical procedure. The surgical stages are separated by a period of 4 to 6 months to allow osseointegration. At Stage-I surgery, the implant is fixed in bone and submerged under mucosa, while at Stage-II surgery, the implant is exposed and the transmucosal abutment is connected to the implant. The one-stage nonsubmerged surgical procedure with immediate transmucosal extension using traditional two-stage implant systems is being used to treat partial and complete edentulism. This is a case report of 10 patients treated with endosseous implants in the maxillary anterior region with immediate provisionalization using a one-stage surgical procedure. The investigators found that all patients experienced minimal discomfort from complications after the one-stage surgery and immediate placement of the provisional restoration. No signs of inflammation or mobility were observed during the first 6 months. The partially edentulous anterior maxilla can be restored to an esthetic form in a single clinic visit.

The shear strength of polymethyl methacrylate bonded to titanium partial denture framework material

Premachined titanium frameworks are used in implant-supported fixed complete-arch prostheses. Traditionally, retentive mechanisms are incorporated in the wax patterns to provide retention between polymethyl methacrylate and the cast framework. Nontraditional forms of retention are needed with machined frameworks. This study determined whether three different surface characteristics of titanium improve the bond shear strength of polymethyl methacrylate. Thirty rod shaped specimens of titanium were divided into three equal groups: group 1 received no pretreatment; group 2 was pretreated with 110 microns alumina air abrasive; and group 3 was pretreated with 110 microns alumina air abrasive plus silane (clear). Denture resin was processed around each specimen. A Shell-Nielsen shear test was then performed at a crosshead speed of 0.5 mm/minute to determine the bond shear strength in kilograms per square centimeter. The bond shear strength of group 3 was 63% greater than group 1 (significant, p < 0.01; ANOVA-Scheffé interval 63 kg/cm2). The results of this study indicated that surface pretreatment of titanium with 110 microns alumina air abrasive plus silane coating significantly enhances the bond shear strength of polymethyl methacrylate.

PERIOTEST METHOD : IMPLANT-SUPPORTED FRAMEWORK FIT EVALUATION IN VIVO

STATEMENT OF PROBLEM In implant prosthodontics an accurate fit of the framework to the supporting implants is paramount. However, microgaps occur, unknown to the clinician until complications arise that implicate errors in fit. Therefore prosthodontics would welcome a tool or instrument that provides an objective evaluation of the fit at the implant prosthodontic interface. PURPOSE This clinical investigation determined whether a correlation existed between the laboratory laser measurement of the abutment analog-framework fit and the intraoral abutment-framework fit as measured by the Periotest method. MATERIAL AND METHODS Fifteen subjects received implant-supported remote fixed partial denture supported by five (11 subjects) or six (4 subjects) implants in the mandibular jaw opposed by a complete maxillary denture. Laser videography was used to quantify the fit of the framework to its respective master cast with six measurements, while the fit of the framework in the mouth was quantified with the Periotest method. Data were statistically analyzed with correlation analyses and multiple regression. RESULTS The overall correlation coefficient between the two methods was r = 0.51. Regression analysis of variance revealed that the intercept of the laser videography measurement was significant (p < or = 0.05). The mean Periotest values and standard deviation for the abutment-framework interface were negative (-7.3 +/- 1.2). The variance in part for the Periotest values was explained by the misfits in the vertical axis (delta Z, +0.471) and in the misfit direction of the centroids in the x-y plane (X-YVD, -0.244). CONCLUSION There was no single variable among the six measurement variables that strongly correlated with the periotest method in the identification of mistfit at the bearing surface as indicated by the Periotest value measurements. The misfit laser variables that were weakly correlated to the Periotest values should be observable clinically with greater scrutiny.