Lance C. Ramp

The wear of polished and glazed zirconia against enamel

STATEMENT OF PROBLEM The wear of tooth structure opposing anatomically contoured zirconia crowns requires further investigation. PURPOSE The purpose of this in vitro study was to measure the roughness and wear of polished, glazed, and polished then reglazed zirconia against human enamel antagonists and compare the measurements to those of veneering porcelain and natural enamel. MATERIAL AND METHODS Zirconia specimens were divided into polished, glazed, and polished then reglazed groups (n=8). A veneering porcelain (Ceramco3) and enamel were used as controls. The surface roughness of all pretest specimens was measured. Wear testing was performed in the newly designed Alabama wear testing device. The mesiobuccal cusps of extracted molars were standardized and used as antagonists. Three-dimensional (3D) scans of the specimens and antagonists were obtained at baseline and after 200 000 and 400 000 cycles with a profilometer. The baseline scans were superimposed on the posttesting scans to determine volumetric wear. Data were analyzed with a 1-way ANOVA and Tukey Honestly Significant Difference (HSD) post hoc tests (α=.05) RESULTS Surface roughness ranked in order of least rough to roughest was: polished zirconia, glazed zirconia, polished then reglazed zirconia, veneering porcelain, and enamel. For ceramic, there was no measureable loss on polished zirconia, moderate loss on the surface of enamel, and significant loss on glazed and polished then reglazed zirconia. The highest ceramic wear was exhibited by the veneering ceramic. For enamel antagonists, polished zirconia caused the least wear, and enamel caused moderate wear. Glazed and polished then reglazed zirconia showed significant opposing enamel wear, and veneering porcelain demonstrated the most. CONCLUSIONS Within the limitations of the study, polished zirconia is wear-friendly to the opposing tooth. Glazed zirconia causes more material and antagonist wear than polished zirconia. The surface roughness of the zirconia aided in predicting the wear of the opposing dentition.

Tensile bond strengths of provisional luting agents used with an implant system.

STATEMENT OF PROBLEM Retrievability of cemented implant-supported fixed prostheses is desirable. Retentive strengths of new provisional luting agents have not been reported. PURPOSE This study compared the tensile bond strengths of 6 provisional luting agents when used with cemented superstructures and 1 implant system. MATERIAL AND METHODS Ten castings were fabricated and randomly paired with abutment specimens. Castings were cemented and the assemblies were stored in distilled water at 37 degrees C for 48 hours. Tensile bond strength necessary to remove each casting was measured with a 500-kg load and a crosshead speed of 0.5 cm/min. Crown/abutment specimens were cleaned after testing, and the testing procedure was repeated for a total of 6 luting agents (n = 10). Data were analyzed with 1-way analysis of variance and Scheffés analysis (alpha=.05). RESULTS Tensile bond strengths ranged between 1.29 and 4.08 MPa. The lowest tensile bond strengths were found to be statistically similar between Temp Bond and Provilink luting agents. Neo-Temp luting agent exhibited the highest tensile bond strength (P <.01). CONCLUSIONS Temp Bond and Provilink luting agents exhibited the lowest mean tensile bond strengths. Neo-Temp luting agent exhibited a tensile bond strength more than 3 times that of Temp Bond luting agent.

Fracture resistance and marginal discrepancy of porcelain laminate veneers influenced by preparation design and restorative material in vitro.

OBJECTIVES The purpose of this investigation is to evaluate marginal discrepancy and fracture resistance of two veneering materials using two preparation designs. METHODS Two veneer preparation designs (full and traditional) were restored with leucite-reinforced ceramic (ProCAD, Ivoclar Vivadent, Amherst, NY) milled by CAD/CAM (Cerec 3D milling system, Serona Dental Systems), and conventional sintered feldspathic porcelain (Noritake Super Porcelain EX3, Noritake Dental Supply Co). Forty-eight specimens were analysed with a sample size of n=12 per group. The thickness of each veneer was measured on four specific surfaces. Marginal discrepancy was evaluated with a replica technique and cross-sectional view using a digital microscope. The fracture resistance of veneers cemented on standardised composite resin dies was evaluated using a universal testing machine. Results were analysed with ANOVA, Tukey-Kramer post hoc testing, and linear regression. RESULTS The results of this investigation revealed no correlation between the thickness and marginal discrepancy of the veneers. The full preparation design with ProCAD and the traditional preparation design with feldspathic porcelain manifested smaller gap. Fracture resistance was decreased for the full preparation design with feldspathic porcelain. CONCLUSIONS In terms of marginal discrepancy and fracture resistance, the most favourable combination was a traditional veneer preparation design with conventional sintered feldspathic porcelain. For the full veneer preparation, a stronger ceramic material such as ProCAD is suggested.

An analysis of the implant-supported overdenture in the edentulous mandible

This investigation examined the cumulative survival rate of the implant-supported overdenture using two types of attachments in patients treated at Show Chwan Memorial Hospital Implant Center from 1992 to 2006. Fifty-one patients (30 men and 21 women) were treated with mandibular implant-supported overdentures. Attachment systems used were the Hader bar with bilateral, cast ERA attachments (Group A, 31 patients with 15 men and 16 women, 134 implants) and the Hader bar with bilateral, distal extension cantilevers (Group B, 20 patients with 15 men and 5 women, 85 implants). Two hundred and four implants remained at the end of the follow-up period. Among failed implants, 10 implants were in Group A (failure rate: 10/134 = 7·5%), whereas five implants were in Group B (failure rate: 5/85 = 5·9%). Sixty-six point seven per cent (10/15) of failed implants were placed in the distal anterior mandible, and 33·3% (5/15) were placed in the middle anterior mandible. Survival was also examined with respect to condition of the opposing arch. Patients wearing a maxillary removable partial denture had the highest implant failure rate (5/51 = 9·8%), whereas the failure rate of the maxillary complete denture group was only 5·7%. The most frequent need for maintenance was wear over patrix component of ERA or Hader clip (n = 56). Eight patients experienced connector fracture between ERA and Hader bar, and one experienced distal extension cantilever fracture. The implant-supported overdenture can be an effective and reliable alternative to the conventional complete mandibular denture. Fewer prosthetic complications were seen in overdentures retained with distal extension cantilever attachments.

A preliminary survey of impression trays used in the fabrication of fixed indirect restorations.

PURPOSE A variety of impression trays are used in the fabrication of fixed indirect restorations. Impressions used in the construction of fixed indirect restorations were examined for tray type, manner of use, and overall impression quality. MATERIALS AND METHODS A commercial dental laboratory provided 1403 impressions used to fabricate fixed indirect restorations during a 3-month period. Impressions were examined for tray type, quantity and type of recorded abutments, the impression of intact teeth adjacent to and opposing the abutment, the presence of the canine in the impression, and an assessment of the quality of the impression. RESULTS A majority of trays examined were plastic (864, or 61.6%). Dual-arch trays comprised 73.1% of the total. Most of these were metal posterior (n = 499) or plastic posterior (n = 280). Among partial dual-arch impressions, 561 (55.7%) were for the single abutment restoration, bounded by intact teeth anterior and posterior, and with an intact opposing tooth. Eleven percent of plastic dual-arch impressions failed to register the canine. Regarding restoration type, there were 955 impressions for the single-tooth crown, 46 for implant-supported restorations, and 11 for veneers. Twenty impressions were for posts, inlays, or onlays. Impressions for multiple single-tooth crowns and fixed partial dentures comprised the remainder. In terms of overall quality, 85.3% of impressions were excellent or good. The lowest performance in terms of excellent quality was in the anterior plastic single-arch impression (44.8%), whereas the best rate of excellent quality noted was for the posterior dual-arch impression (82.4%). CONCLUSIONS Within the limitations of this study, dual-arch trays were the most commonly used tray. Recommendations for the use of the dual-arch tray were not followed in a substantial number of impressions examined.

Influence of surface treatment of yttrium-stabilized tetragonal zirconium oxides and cement type on crown retention after artificial aging

STATEMENT OF PROBLEM Information about the influence of zirconia crown surface treatment and cement type on the retention of zirconia crowns is limited. It is unclear whether zirconia crowns require surface treatment to enhance their retention. PURPOSE The purpose of this in vitro study was to evaluate the effect of surface treatment on the retention of zirconia crowns cemented with 3 different adhesive resin cements after artificial aging. MATERIAL AND METHODS Ninety extracted human molars were prepared for ceramic crowns (approximately 20-degree taper, approximately 4-mm axial length) and were divided into 3 groups (n=30). Computer-aided design and computer-aided manufacturing zirconia copings were fabricated. Three surface treatments were applied to the intaglio surface of the copings. The control group received no treatment, the second group was airborne-particle abraded with 50 μm Al2O3, and the third group was treated with 30 μm silica-modified Al2O3, The copings were luted with a self-etch (RelyX Unicem 2), a total-etch (Duo-Link), or a self-etch primer (Panavia F 2.0) adhesive cement. They were stored for 24 hours at 37°C before being artificially aged with 5000 (5°C-55°C) thermal cycles and 100,000 cycles of 70 N dynamic loading. Retention was measured on a universal testing machine under tension, with a crosshead speed of 0.5 mm/min. Statistical analysis was performed with 1-way and 2-way ANOVA. RESULTS Mean retention values ranged from 0.72 to 3.7 MPa. Surface treatment increased crown retention, but the difference was not statistically significant (P>.05), except for the Duo-Link cement group (P<.05). Analysis of the adhesives revealed that the Duo-Link cement resulted in significantly lower crown retention (P<.05) than the other 2 cements. CONCLUSION For zirconia crowns, retention seems to be dependent on cement type rather than surface treatment.

The Effect of Etching Technique on the Retention of Adhesively Cemented Prefabricated Dowels

PURPOSE To determine if etching technique influences the bond strength of resin cement to root canal dentin. MATERIALS AND METHODS Fifty-five extracted teeth were endodontically treated, dowel space prepared, and divided into five groups. Each group was treated with different etchant consistencies: acid gel, semi-gel, low-viscosity gel, liquid, and a self-etching primer. After dowel cementation, four sections were removed from each root and a push-out test was performed. RESULTS Significant effects were found for etching procedure and for location within the root canal. The apical segment produced the lowest bond strength. Self-etching primer showed the highest bond strength. CONCLUSIONS The consistency of etchant material influenced the bond strength of a prefabricated dowel in the canal.

Factors influencing the progression of noncarious cervical lesions: A 5-year prospective clinical evaluation

STATEMENT OF PROBLEM The etiology (chemical, friction, abfraction) of noncarious cervical lesion (NCCL) progression is poorly understood. PURPOSE The purpose of this 5-year prospective clinical trial was to measure the relationship between NCCLs and various etiologic factors. MATERIAL AND METHODS After review board approval, 29 participants with NCCLs were enrolled. Polyvinyl siloxane impressions were made of each NCCL, and casts were poured at baseline, 1, 2, and 5 years. The casts were scanned with a noncontact profilometer, and 1-, 2-, and 5-year scans were superimposed over baseline scans to measure volumetric change in NCCLs. T-scan and Fujifilm Prescale films were used to record relative and absolute occlusal forces on teeth with NCCLs at the 5-year recall. Participant diet, medical condition, toothbrushing, and adverse oral habit questionnaires were given at the 5-year recall. Occlusal analysis was completed on mounted casts to determine the presence of wear facets and group function. Volumetric lesion progression from 1 to 5 years was correlated to absolute and relative occlusal force using mixed model analysis. The Kruskall-Wallis and Mann-Whitney analyses compared lesion progression with diet, medical condition, toothbrushing, adverse oral habits, wear facets, and group function. RESULTS The NCCL progression rate over 5 years was 1.50 ±0.92 mm(3)/yr. The rate of progression of NCCLs was related to mean occlusal stress (P=.011) and relative occlusal force (P=.032) in maximum intercuspation position. No difference was seen in NCCL progression between participants with any other factors. CONCLUSION Heavy occlusal forces play a significant role in the progression of NCCLs.

Effect of Luting Agents on Retention of Dental Implant-Supported Prostheses.

To evaluate the retentive strength of 7 different luting agents in cement-retained implant abutment/analog assemblies. Fifty-six externally hexed dental implant abutment/analog assemblies and cast superstructures were divided randomly into 7 groups for cementation with each of the 7 luting agents. Five definitive cements tested were zinc phosphate cement, All-Bond 2, Maxcem, RelyX Luting cement, HY-Bond, and two provisional cements, ImProv and Premier. Cast superstructures were cemented onto the implant abutments and exposed to 1000 thermal cycles (0°C-55°C) and 100 000 cycles on a chewing simulator (75 N load). A universal testing machine was used to measure cement failure load of the assembled specimens. Cement failure load was evaluated with 1-way ANOVA and Duncans multiple range analysis. Significant differences in cement failure loads were measured (P < .0001). Post hoc testing with Duncans multiple range indicated 4 separate groupings. Maxcem and All-Bond 2 were comparable, having the greatest load failure. RelyX and zinc phosphate cement were analogous, and higher than HY-Bond. Improv and Premier constituted a pair, which demonstrated the lowest retentive values. Within the limitations of this in vitro study, Maxcem and All-Bond 2 are good candidates for cement-retained implant prostheses while concerning retention.

Comparison of Pulp Stump Wounds Created by ProFile Rotary Root Canal Instruments and Small-diameter Fine Diamond Burs

INTRODUCTION The aim of this investigation was to evaluate and compare the pulp stump wounds created by the following root canal instruments: ProFile rotary files and small-diameter fine diamond burs. METHODS Extracted mandibular premolars from adult patients with vital pulps and fully formed root canals were collected and stored in formalin. Within 48 hours of extraction, the periapical tissue was fixated to the root with a double coating of ethyl cyanoacrylate, and the pulp chambers were accessed with a #4 round carbide bur and high-speed handpiece in a traditional fashion. The pulp tissue of 10 specimens per group was extirpated at a level approximately 5 mm from the apex by using standard endodontic techniques. The specimens were then examined at ×100 magnification under a digital microscope. Grading criteria were developed, and the wounds were scored. RESULTS Wounds created by diamond burs were significantly smoother that those created by ProFile rotary files; the mean wound score for diamond burs was 1.4 versus a mean wound score of 3 for ProFiles. After the authors scoring of the wounds, 2 endodontist graders were shown photos of each specimen in a double-blind fashion and instructed to score each specimen as being smooth or rough. To validate the developed scoring system and remove potential observer bias of the author, the data from the double-blind observations were used to complete a cross-tabulation for a Cohen kappa test. CONCLUSIONS Kappa values demonstrated substantial inter-rater agreement for both groups.