Kevin Seymour

Assessment of shoulder dimensions and angles of procelain bonded to metal crown preparations

The metal ceramic crown is the most popular extracoronal restoration in the United Kingdom. These restorations may fail because of fracture or esthetics. A potential cause of failure is the quality and width of the facial shoulder preparation. In this study 24 extracted human teeth were prepared to receive metal ceramic crowns by one of three dentists. Preparations were replicated and scanned in the midfacial plane by a coordinate measuring machine with a noncontact probe. The x, y, and z surface coordinates were recorded. The results indicated a mean (+/-SD) shoulder width value of 0.752 mm (+/-0.174 mm) and a shoulder angle of 108.54 (+/-15.06) degrees. From these data it would appear that there are deficiencies in shoulder preparations, particularly in width. These inadequacies may have implications for longevity of the restoration and periodontal health in a clinical situation.

Quantification of residual dentine thickness following crown preparation

OBJECTIVES Pulpal response to tooth preparation is a major concern in fixed prosthodontics. Research has suggested that 2mm or more of remaining dentine is critical in protecting the pulp following tooth preparation. However, clinicians have no means of knowing dentine thickness either before or after preparation and therefore lack feedback about this important aspect of preparation quality. The aim of this project was to develop a method for measuring local dentine thickness following tooth preparation for metal ceramic crowns, in vitro, which could be used as a tool to evaluate preparation technique and instrumentation. METHODS Microtomography (XMT or micro-CT) scans were taken of extracted teeth before and after crown preparation. Local dentine thickness was defined for every voxel within the 3D tooth image as the sum of distances from that voxel to the pulp and to the anatomical surface. The method also allows the thickness of material removed to be quantified. Three-dimensional colour-coded maps of dentine thickness were generated, and the distributions of dentine thickness throughout the teeth were analysed. This was tested by a single operator on sixteen extracted upper central incisors. RESULTS This method enabled clear visualisation and analysis of residual dentine thickness. In the trial, it revealed consistent over-prepared regions along the labial proximal line angles which, in a clinical case, could affect subsequent tooth and restoration longevity. All but one of the prepared teeth had regions with a residual dentine thickness of less than 1.5mm, in 6 it was less than 1.0mm and in 3 of these it was less than 0.5mm. CONCLUSION Although ex vivo, this method can be used as a research tool to look for patterns of over- or under-preparation, leading to possible modification of technique, instrumentation and, or crown design. CLINICAL SIGNIFICANCE It is not currently possible for clinicians to know the thickness of residual dentine following crown preparation, a key factor in long term outcome. The described method of quantifying and visualising this thickness allows preparation techniques and instrumentation to be evaluated in vitro, leading to prospective improvements in clinical procedures.

Taper of Full-Veneer Crown Preparations by Dental Students at the University of the West Indies

PURPOSE The ideal taper recommended for a full-veneer crown is 4° to 14°, but this is very difficult to achieve clinically, and studies on taper achieved by dental students have found mean taper measurements ranging from 11° to 27°. The objective of this study was to examine and compare the taper of teeth prepared for full-veneer crowns by dental students on typodonts in the laboratory and on patients, and also to compare the results with those of other dental schools. MATERIALS AND METHODS Preparations were scanned by specialized metrology equipment that gave the taper of the preparation in a buccolingual (BL) and mesiodistal (MD) plane. RESULTS No undercut was detected on any of the laboratory specimens; however, 12.5% of clinical specimens were undercut. The mean taper of the laboratory anterior specimens were 26.7° BL and 14.9° MD, and the laboratory posterior specimens were 18.2° BL and 14.2° MD. The mean taper of the clinical anteriors were 31.6° BL and 16.8° MD, and the clinical posteriors were 16.8° BL and 22.4° MD. CONCLUSIONS This study shows that although the taper achieved by dental students in the University of the West Indies when preparing teeth for full-veneer crowns was outside the ideal range of 4° to 14°, it is comparable to those achieved by dental students in other schools.

Geographic distribution of porcelain veneer preparation depth with various clinical techniques.

STATEMENT OF PROBLEM Various clinical techniques have been advocated for uniform reduction of the tooth surface before a porcelain veneer restoration. Often these techniques do not produce a consistently uniform labial reduction. PURPOSE The purpose of this study was to identify the degree of inconsistency on a geographic scale in the depth of labial reduction for porcelain veneers, resulting from the use of 3 clinical techniques. The technique of co-ordinate metrology was used to map the variations in the depth of the preparation. MATERIAL AND METHODS A single operator using 3 techniques (dimples as depth guides, freehand, or depth grooves as depth guides) prepared 90 noncarious, unrestored extracted teeth to receive porcelain veneers (n=30). Impressions of the prepared and unprepared teeth were scanned with a co-ordinate measuring machine. In-house software was used to color-code the plotted images on the basis of the depth of preparation. Profile measurements were also made along the mid-labial sagital plane at the mid-labial, incisal, and cervical regions, as well as along the mesial proximal and distal proximal areas along the mid-labial horizontal plane. The ideal depth range for the labial reduction was chosen to be 0.4 to 0.6 mm. One-way analysis of variance and the Bonferroni test were performed to determine the significance (P<.05) in the difference between the means of reductions achieved with the 3 techniques. RESULTS There was no statistically significant difference in the mean percentage area prepared to the ideal depth range (0.4 mm-0.6 mm), between dimple (44.59%), freehand (36.35%), and depth groove (38.43%) techniques. The difference in the mean percentage area of reduction greater than 0.6 mm between dimple (12.98%), freehand (29.66%), and dimple and depth groove (37.32%) techniques were statistically significant (P=.0000), but not between freehand and depth groove techniques. With the profile measurements it was seen that there were statistically significant differences in the mean depth between dimple (0.45 mm) and depth groove (0.63 mm), and freehand (0.51 mm) and depth groove in the mid-buccal (P<.0004) and cervical (dimple = 0.48 mm, freehand = 0.52 mm, depth groove = 0.63 mm) (P<.0005) regions. There was statistically significant difference (P<.0000) in the mean depth between the dimple (0.39 mm) and freehand (0.30 mm), dimple and depth groove (0.50 mm), and freehand and depth groove techniques in the incisal area. In the mesial proximal region statistically significant difference (P<.0034) in the mean depth was found between the dimple (0.52 mm) and freehand (0.68 mm), and dimple and depth groove (0.64 mm) techniques only. In the distal proximal region, there was no statistically significant difference in the mean depth between dimple (0.55 mm), freehand (0.66 mm), and depth groove (0.64 mm) techniques. CONCLUSION The use of dimple technique showed a trend to greater consistency and fidelity in labial reduction to a depth of 0.4 to 0.6 mm. The 3 techniques for veneer preparations studied were associated with varying degrees of inconsistency in the distribution of depth of preparation within a tooth and between teeth in the same technique group.

Dimensional Measurement for Dentistry

Dentistry requires development in hand skills throughout the undergraduate and postgraduate programs both in the pre-clinical and clinical settings (Allred, 1977). The level of expertise achieved depends on the level of training, the natural ability of the dentist and also experience. Tooth preparation for a crown is a common procedure in general dental practice and it is essential that dental students are able to perform this procedure competently before they graduate. The skill training of these techniques is in itself subjective, as there is use of “eyeballing” of the preparation rather than a definite measure. There is clearly a need to obtain more formal dimensional assessment of crown preparations. This will assist in the feedback to and the training of dentists and also in the practise of dentistry.