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.     

Differential expression of human ferritin H chain gene in immortal human breast epithelial MCF-10F cells

This study investigated fractures of the cement layer between a crown and a die. Model crowns were luted on dies with zinc phosphate cement and various magnitudes of load were applied. Surface strain on the crown was measured using strain gauges. Seal was evaluated using dye penetration and tensile tests. Results showed that cement fracture affected surface strain behavior on the crown and was detected using the surface strain measurement. The dye penetration test and the tensile test could not be used to detect the cement fracture. It is suggested that the three-dimensional relative positioning between the crown and the die affected the development of the cement fracture.     

Antenatal sonographic diagnosis of club foot with particular attention to the implications and outcomes of isolated club foot

OBJECTIVE: This study assessed the clinical performance of dentin-bonded crowns, in which ceramic crowns are bonded to underlying dentin with a resin composite-based luting material and a dentin bonding agent. METHOD AND MATERIALS: Twenty-five patients who had received such restorations more than 1 year previously were recalled for evaluation of their crowns. RESULTS: Sixty dentin-bonded complete-coverage restorations were assessed. Forty-one of the crowns had been placed on incisor teeth. The mean time since placement of the restorations was 2.43 years. Fifty-seven of the 60 restorations were intact. The three failures had resulted from cracks in the restorations, which had not clinically debonded. No secondary caries was detected at the crown margins, and anatomic form was assessed as excellent for 56 crowns. Root canal treatment had been required in one case. Color match was rated very good for 47 crowns. All 25 patients were satisfied with their restorations. CONCLUSION: Dentin-bonded crowns may be found to have a low rate of failure and to provide a high level of patient satisfaction.     

The effect of adhesive luting agent-dentinal surface interactions on compressive strength of two types of all-ceramic crowns

This research compared the compressive strength of two types of all-ceramic crown (Hi-Ceram and Duceram) as affected by selected luting cements (Zn phosphate, glass ionomer and composite resin cement). Thirty crowns of similar size and shape were constructed (15 crowns of each tested material) to fit a standard posterior tooth preparation. Five crowns from each material were cemented by one of the tested cements. The cemented crowns were loaded until catastrophic failure. A two-way analysis of variance was performed and showed that the type of utilized cement had a significant effect on the compressive strength being that Panevia Ex. resin cement the most effective one followed by glass ionomer and then finally zn phosphate cement. Statistical analysis also showed that Hi-Ceram crowns were more resistant to occlusal load than Duceram.     

Expanding the application of facial ceramic veneers

"Full veneers," restorations similar in depth to ceramic veneers but extending over the lingual or occlusal surface as well as the facial surface, are a conservative option to conventional crowns. They have been used successfully at the UCLA Center for Esthetic Dentistry for three years. Indications, technique and a patient study are presented.     

The effect of hip stem material modulus on surface strain in human femora

Human femora were used to compare the changes in bone surface strain resulting from decreasing the material modulus of a collarless hip stem to determine whether a highly elastic stem increased bone loading. Three substrate materials were tested: titanium (modulus of elasticity 110 GPa), carbon fiber composite (modulus of elasticity 52 GPa), and polymethylmethacrylate (PMMA, modulus of elasticity of 1.9 GPa). Two separate analyses were performed in which femora were implanted randomly with one of the three stem types. Results showed that assembly strains did not differ significantly among different materials. There was a large strain reduction in the proximal region of the femora for all stem substrates relative to the intact femur. Although there was statistically greater surface shear strain as the material modulus decreased, the PMMA stem did not substantially increase bone loading.     

Elasto-Plastic Test of Q235 Steel Bending Beam With Cracking Resistance

More than 30 bending beams with rectangular cross-section and different thicknesses and heights were prepared from Q235 steel. The specimen dimensions were about 240 mm (length) × 60 mm (height) × 70 mm (thickness). Flaws were cut along its middle line with a wire cutter, with lengths ranging from 6 to 35 mm. Each specimen was tested with three-point bend loading, and a process curve was obtained between load and the displacement of the loading point, in order to analyze the fracture process when opening the crack. A deformation near the prefabricated crack was observed in the testing period, and the variation of the fracture characteristic parameters was analyzed for different sizes. For a comprehensive understanding of carbon steel fracture resistance behavior, its elasticity and plasticity were established by determining its Young's modulus and Poisson's ratio with an optical strain gauge. This gauge was also used for the loading process test. It was found that the fracture toughness varied with the dimensions, and the toughness of the elastic limit loading was almost constant. Using the relationship of crack resistance stress intensity factor and fracture criterion, the bearing capacity of the material structure could be estimated, which shows a good agreement with the experimental test data.     

The influence of the impression tray on the accuracy of impressions for crown and bridge work--an investigation and review

OBJECTIVE: To evaluate the accuracy of working casts for crown and bridge restorations made from twin mix putty/wash silicone elastomeric impression materials using different types of stock tray. DESIGN: A master cast was made from ivorine teeth in a mandibular model. Three teeth were prepared for full crown restorations to simulate a single unit and a three unit bridge. Impressions were taken using four different types of impression tray and two different viscosities of silicone putty, together with a wash. Full metal crowns were constructed and seated on duplicate master casts and measurements made of the marginal discrepancies. SETTING: The work was carried out in a dental technology laboratory in a university department of restorative dentistry in 1995/1996. RESULTS: Metal and rigid plastic impression trays showed the least discrepancy (about 50 microns), the latter slightly greater with the normal putty than the soft one. Impressions taken with flexible plastic trays produced considerable discrepancy with both putties, approximately 210 microns and 180 microns respectively. CONCLUSIONS: Metal and rigid plastic stock trays give greater accuracy in the putty/wash silicone twin mix impression technique compared with flexible plastic ones for crown and bridge work. Those using the latter should be aware of their shortcoming in this respect.     

Evaluation of custom occlusal matrix technique for posterior light-cured composites

Posterior composite restorations are difficult to contour and polish due to their occlusal anatomy and opposing occlusion. Recently a new technique utilizing a clear custom occlusal matrix showed promise in reducing the chair time necessary to place posterior composite restorations. Sixty specially molded plastic mandibular right second molar teeth with a mesio-occlusal composite preparation were restored with a light-cured composite in a typodont, using either the custom occlusal matrix (experimental) or the standard technique (control) as taught at the University of Michigan School of Dentistry. The times necessary to complete the procedures were recorded. The teeth were evaluated in a blind manner by two evaluators using a modified Ryge criteria. The times to place and finish the control and experimental restorations were subjected to a t-test. The evaluations of surface smoothness, margin adaptation, occlusal anatomy, and axial form were compared using a Fisher exact test. The custom occlusal matrix significantly reduced placement and finishing time and improved surface smoothness of mesio-occlusal posterior composite restorations placed in vitro. Due to the time needed to construct the custom occlusal matrix, there was no significant difference in total mean time of the two procedures.     

Effect of maturation and aging on material and ultrasonographic properties of equine superficial digital flexor tendon

Results of studies in human beings and other species have indicated that aging significantly influences the strength, modulus of elasticity, and energy storage ability of tendon. We wanted to determine the effects of aging on the material and ultrasonographic properties of equine superficial digital flexor (SDF) tendon. Ultrasonographic measurements of left forelimb SDF tendon cross-sectional area and mean echogenicity were made in 23 standing horses ranging in age from 2 to 23 years. All horses had not been in work for a minimum of 6 months prior to the study. After euthanasia, left forelimb bone-muscle-tendon-bone specimens were mounted in a materials testing system. The SDF tendon was cyclically loaded sinusoidally 100 times at 0.5 Hz from 1.5 to 5.0% strain, then was submitted to 10-minute creep-and-stress relaxation tests. Modulus of elasticity, load at 3% strain, and creep-and-stress relaxation were determined for each specimen. A significant positive correlation was found between elastic modulus and age. Correlation was not found between age and SDF tendon cross-sectional area or mean echogenicity. When 2-year-old horses were compared with older horses, the latter had tendons with a significantly (P = 0.007) greater modulus of elasticity. The authors conclude that increasing age through maturity is associated with a corresponding increase in equine SDF tendon elastic modulus.     

New players and puzzles in the Hedgehog signaling pathway

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 Association's 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 Association's quality assessment criteria supported the conclusion that Procera AllCeram crowns may be used in all areas of the mouth.     

Procera: a new way to achieve an all-ceramic crown

The Procera System embraces the concept of computer-assisted design and computer-assisted machining to fabricate an all-ceramic crown composed of a densely sintered, high-purity aluminum oxide coping combined with a compatible veneering porcelain. Strength, precision of fit, color stability, cementation, and wear characteristics are among the many factors that concern clinicians when fabricating all-ceramic restorations with this new crown system. This article presents, in summary form, the data from the many studies on Procera AllCeram crowns that have been conducted at clinical and laboratory centers around the world. The evidence reported in these studies clearly demonstrates that the Procera AllCeram crown represents a combination of computer technology and creativity for which a positive prognosis can be made. Today its application is restricted to single crowns; however, with continued development, multiple unit all-ceramic anterior and posterior fixed partial dentures are clearly in the future.     

Load transmission through the callus site with external fixation systems: theoretical and experimental analysis

The fracture callus contribution to the total rigidity of external fixator-fractured bone element was analysed. This study was achieved from both theoretical and experimental perspectives. The theoretical study was done using the finite element method with a three-dimensional model. In this model, both the callus and the development of its elastic characteristics were considered. A series of 38 New Zealand-California white rabbits with tibial fractures treated with some external fixation system was used in this study. Such devices could reproduce either rigid or elastic features. The frame dynamization can be obtained at different fracture healing stages. Animals were classified into four series: (1) rigid fixators, (2) dynamized fixators two weeks after surgery, (3) three weeks after surgery and (4) four weeks after surgery. Tension tests were performed to evaluate callus strength. Theoretical results showed significant levels of callus load transmission (85.5%) when the callus elastic modulus is 1/100 of the elastic modulus of intact bone in an external fixator with rigid features. Experimental analysis of the callus obtained with different external fixator systems did not show differences among them. This fact implies that the immature callus theoretically modelled (E = 100 N mm-2) appears early in the rabbit fracture model (before two weeks, when first dynamization was made), for this reason no differences were found between the two types of treatment (rigid and dynamized systems). This fact questions the reliability of the dynamization process in external fixation of fractures and it implies accurate investigations in the clinical field.     

Mechanical Analysis of Idealized Shallow Hydraulic Fracture

The characteristics of hydraulic fractures created at shallow depths are known from excavations and borings, but this understanding has lagged behind the ability to predict fracture growth. This paper describes a simple analysis based on elasticity theory and fracture mechanics that will predict characteristics of shallow hydraulic fractures that are relatively flat lying. The analysis gives closed-form expressions for the injection pressure, fracture aperture, and radial length as functions of time, fracture toughness, and elastic modulus. The analysis is first used to estimate fracture toughness and elastic modulus of shallow formations from field tests of hydraulic fracturing. Those parameters are used to calibrate the model and predict the growth of fractures. The average relative error of the predictions is about 20% and increases with the dip and degree of asymmetry of the fracture.     

Two-implant-supported single molar replacement: interdental space requirements and comparison to alternative options

Posterior single-tooth implant restorations are subjected to an increased risk of bending overload. A high incidence of implant fracture has been reported when using a single standard 3.75-mm-diameter implant to support a molar restoration. The purpose of this article is to demonstrate the clinical feasibility of placing two implants to support a molar restoration and to compare this treatment option to the use of a single standard implant or a wide-diameter implant. Two osseointegrated dental implants used to support a molar restoration in interdental spaces as small as 10 mm is shown to be effective and predictable in 60 restorations over the past 7 years. The use of two implants provides more surface area for osseointegration and spreads the occlusal loading forces out over a wider area, reducing the potential bending forces that would otherwise exist in a single-implant molar restoration.     

Microleakage of oral microflora for porcelain and some porcelain repair materials--in vitro study

Repairing porcelain fractures has become of interest to the dentist. The intra oral fracture of metal-ceramic restorations may be due to inadequate metal support, excessive porcelain thickness, technical flaws, and occlusal forces. Various techniques for intra oral porcelain repair have been suggested. The resin-porcelain junction has been in question since the advent of the porcelain veneer for cast metal restorations. To enhance this, several intermediary products and techniques have been developed to increase the chemical bond between the fractured porcelain and the repair materials. Clinical procedures for porcelain repair has required roughening of porcelain surface with a rotary abrasives, application of silane followed by composite to replace the contour of the restoration (2, 13, 14). Laboratory data suggested that the strong bond of the repair materials was developed.     

The relationship between preparation convergence and retention of extracoronal retainers

PURPOSE: Although traditional ideal convergence (the sum of taper of the opposite sides) for crown preparation has been arbitrarily set at 4 degrees to 10 degrees, some believe absolute parallelism yields the highest retention. This study examined the relationship between the degree of convergence of a machined metal die and the retention of its casting. MATERIALS AND METHODS: The method used was that of cementing cast metal crowns onto full crown preparations on brass dies with varying convergence angles, and then recording the force required to remove the crowns from the dies in a vertical direction using a Tate-Emery Testing Machine and Load Indicator. RESULTS: It was found that retention (i.e., the force needed to remove the cemented castings from the die in their common long axis) increases from 0 degree convergence to peak between 6 degrees to 12 degrees convergence. It also seems that a critical film thickness does exist for optimum retention, and that film thicknesses smaller than the critical thickness may be responsible for the phenomenon that we have observed and directly related to the convergence angle itself. CONCLUSIONS: There seems to be experimental data supporting the use of traditionally taught convergence. Our study found that convergence angles between 6 degrees and 12 degrees seem to be optimum for tooth crown preparation when one plans to use zinc phosphate cement. Convergence angles of less than 6 degrees may not be desirable even if they can be clinically achieved. The results of our study indicate that a relationship exists between the convergence angle and the critical cement thickness that is necessary to realize the maximum strength properties of zinc phosphate cement.     

Blood transfusion practices in Mwanza Region, Tanzania. Bugando Medical Centre

Uncertainty exists about the forces applied by dentists during dental crown cementation. A measuring system was developed based around a commercially available miniature (3.8 mm high and 12.7 mm diameter) load cell. The load cell was mounted in a finger stall and the applied force measured. Experimental results suggest that dentists typically apply a force to metal crowns of about 60 N for a few seconds, followed by the application of a steady force of about 20 to 30 N. Lower forces are applied to porcelain crowns.     

Fracture Mechanics of Rubber Epoxy Composites

The effect of the addition of rubber micro-particles to epoxy matrix on the mechanical properties and the fracture toughness were investigated. Rubber epoxy composites were prepared with different weight percentages namely, 0, 5, 10, 15, 20, 25, 30 wt pct of rubber. Both quasi-static and dynamic ultrasonic measurements of the elastic modulus were found to decrease by 60 pct, and the critical value of the stress intensity factors was found to increase by approximately 45 pct for the rubber epoxy composites. This was also confirmed with the finite element analysis that had the same increasing trend. The fracture surface morphology reveals rough cleavage fracture in the epoxy matrix with brittle intergranular decohesion caused by the impurity segregation that exhibits relatively high micro-roughness of the fracture surfaces.     

Expressions for predicting the elasticity modulus of materials reinforced by second-phase grains

In the present study, expressions for predicting the elasticity modulus of the materials reinforced by the second-phase grains, which may be referred to as the granular composite for the sake of simplicity, are developed based on the solution of the overmatching problem in elastic mechanics. Taking the voids or defects in materials as the second phase with zero elasticity modulus, one can easily obtain the expressions for predicting the elasticity modulus and the threshold of the elastic percolation failure of materials containing voids. The values of the elasticity modulus of the granular composite and the materials containing random voids and the values of the threshold for the elastic percolation failure of the materials with voids predicted by using the above-mentioned expressions are in good agreement with results given in available literature.