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.     

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.     

Functional recovery and timing of hospital discharge after primary total hip arthroplasty

BACKGROUND: Dental porcelain has found an increased number of applications in recent years with the development of new methods for the construction of porcelain veneers and intracoronal restorations. In addition, it is used in metal-ceramic and all-porcelain crowns and bridges for the restoration of anterior and posterior teeth. METHODS: This paper presents a review of a number of studies that have examined the visual and microscopic appearance and roughness of glazed, unglazed and polished porcelain surfaces using techniques such as, scanning electron microscopy and surface profilometry. FINDINGS: All have agreed that glazed porcelain provides a smooth and dense surface. Many have shown that polishing can produce an equally smooth surface, which may even be esthetically better. Some studies supported the use of polishing as an alternative to glazing. However, reports have shown that unglazed porcelain is more abrasive than glazed. CLINICAL SIGNIFICANCE: This paper aims to guide general practitioners in the proper polishing of adjusted porcelain in the dental office. The recommendations of various authors are summarized in Table I.     

Clinical commissioning of Laitinen Stereoadapter for fractionated stereotactic radiotherapy

PURPOSE: The purpose of this study was to investigate the distribution of shades selected for metal ceramic crowns provided at a dental teaching hospital. MATERIALS AND METHODS: Data on the selection of shade for 2,500 metal ceramic crown units, placed over a 5-year period at the University Dental Hospital of Manchester, were collected and analyzed. Only those crowns placed adjacent to minimally restored vital teeth were included in the study. RESULTS: The results indicate that the most frequently chosen shades were in the mid-range of reddish-brown hue. Furthermore, shades in the reddish-grey range of hue were rarely chosen. The selection of more than one shade for a crown ("mixed shades") was generally restricted to the maxillary anterior teeth. CONCLUSION: Knowledge of the distribution of shades selected for permanently luted metal ceramic crowns may be a useful adjunct in shade selection, particularly for the inexperienced operator.     

Replacing posterior teeth with freestanding implants: four-year prosthodontic results of a prospective study

This article presents prospective four-year prosthetic results of the placement of 432 posterior freestanding, conventionally cemented prosthetic tooth implants in posterior edentulous spaces using the Bicon Dental Implants system (Bicon Dental Implants). Over four years, 0.74 percent of the abutments loosened, 0.5 percent of the abutments fractured, and 2.47 percent of the crowns experienced porcelain fracture, (all porcelain fractures occurred at time of placement). This low rate of problems appears to make free-standing single-tooth implant restorations a reliable solution to treating posterior edentulism.     

High-mobility-group proteins and cancer--an emerging link

Aspartylglucosaminuria (AGU) is a lysosomal storage disorder with progressive mental retardation as a presenting manifestation. The disorder is caused by a single nucleotide change in the gene encoding aspartylglucosaminidase (AGA). This rare disease is relatively common in Finland: we were able to examine 81 Finnish AGU-patients for dental and oral changes. Tooth crown size and crown shape were normal, but dental malocclusions were common, and prevalences of spacing, large overjet, anterior open bite, and lateral crossbite exceeded Finnish population prevalences (P < 0.0001). Dental arches were already large in childhood, and in adult patients, when compared to Finnish population standards, the lower dental arch was larger in all dimensions (P < 0.001). Almost all patients had abnormally large tongues, which we assumed to be the reason for the structural abnormalities observed.     

RDA and RDH retention surveys. CDA's Council on Education and Professional Relations

This article presents the results of a survey of dental auxiliaries conducted by the California Dental Association's Council on Education and Professional Relations. The survey found that a surprisingly high number of dental assistants (56 percent) and hygienists (42 percent) are considering whether to remain in the dental health care field, stated reasons for this include lack of paid benefits and little opportunity for career growth. The results also suggest, however, that if the perceived deficiencies in these areas were addressed, RDAs and RDHs might remain in the profession.     

Primary surgical cure of stage III-B cervical carcinoma with adnexal metastasis

PURPOSE: Our purpose was to define the role of dental bur fragments in producing metal artifacts on MR images. METHODS: Dental prosthetic reconstructions were made for two dogs. The two lower second premolars were prepared for full-cast crowns by using a diamond bur. The crown margin was placed subgingivally on the right side (1 mm below the free gingival margin) and at the same level as the free gingival margin on the left side. After 1 week, full-cast crowns were cemented in place. MR imaging was performed 7 days later. RESULTS: Metal artifacts appeared in both second premolar regions of the mandible on MR images, with the right side, in which the crown margin was positioned subgingivally, displaying a larger signal distortion than the left side. After removal of the crown, the artifact remained on the right. On histopathologic examination, bur fragments were detected in the gingiva, more on the right than on the left. X-ray fluorescent element analysis showed iron in the gingival tissue containing bur fragments. CONCLUSION: Distortion of MR images was considered to be attributable in part to the damage of the gingiva and in part to the presence of dental bur fragments.     

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.     

Clinical and laboratory considerations in the use of a new all-ceramic restorative system

Ceramic systems are continually under development in an effort to refine their clinical application. An all-ceramic full-coverage crown system (Procera, Nobel Biocare, Westmont, IL) that utilizes computer technology and industrial presses to fabricate precise copings has recently been introduced. Using this system, aluminous porcelain is baked over a high-strength, high-purity aluminum oxide coping to fabricate a functional, biocompatible, and aesthetic restoration. This article presents a discussion of the clinical and laboratory considerations that are involved in the utilization of this all-ceramic system.     

Human leucocyte antigens in pregnant women with pre-eclampsia associated with intrauterine growth retardation and in normal controls

Prenatal exposure to anticonvulsant medication has been shown to cause craniofacial dysmorphology, prenatal growth retardation, hypoplastic nails and phalanges, and visceral abnormalities. In this study we examined maxillary and mandibular stone dental casts (45) and panoramic radiographs (39) from 45 individuals with ages 4.5 to 22.0 years for changes in mesiodistal crown size of deciduous and permanent teeth, and the presence of dental anomalies. These individuals had been exposed prenatally to antiepileptic drugs (AEDs). Mesiodistal crown diameters were measured from the dental casts and converted into standard scores (Z), using published normative data from the University of Michigan Longitudinal Craniofacial Growth Series. A significant increase in mesiodistal crown dimensions of the posterior maxillary teeth was observed, specifically in primary molars and their permanent premolar successors, as well as permanent molars. Changes in tooth size were more common in females than in males. Dental maturity, assessed using the panoramic radiographs, was equal to chronologic age. An increased frequency of hypodontia was the only notable dental anomaly.     

Anterior maxillary aesthetics utilizing all-ceramic restorations

The use of all-ceramic systems has increased significantly during recent years, due to the improved strength and the introduction of a new generation of dental adhesive agents and resin cements. Both factors permit reliable and predictable results in single jacket crown restorations in the maxillary anterior region. Due to their natural appearance, the all-ceramic materials, especially the glass ceramics, blend harmoniously with the oral environment and are particularly appreciated where aesthetics is a priority. The learning objective of this article is to demonstrate a routine utilization of all-ceramic systems in the maxillary anterior region, preceded by a proper case selection. Two clinical cases are used to illustrate the preparation procedure, the importance of well-integrated provisional restorations, and the accuracy in transferring provisional information onto the final jacket crowns.     

Dental arch form in three Pacific populations: a comparison with Japanese and Australian aboriginal samples

The purpose of this study was to provide information about arch shape variations among South Pacific populations. The application of Fourier transforms, Y(phi i) = ao/2 + sigma (aicos phi i + bisin phi i) was used to separate two components of variation; size and shape. Dental arch size can be described by one coefficient (ao), while the shape can be summarized by the first three harmonics (amp1-3) in the Fourier series. The materials used in this study were dental casts of South Pacific populations (Fiji, Western Samoa and Kiribati), Australian Aboriginals and Japanese. Fijians, Western Samoans and Kiribati people have larger upper and lower dental arches than that of Japanese. These populations were separated by the arch size and first Fourier amplitudes which showed the arch depth/width ratio. The Fijian upper and lower dental arches were significantly larger than those found in other populations and was characterized by a wide posterior arch breadth. The Western Samoan and Kiribati arch shape was more similar to the Japanese arch shape than the Fijian. Distribution patterns of arch shape characteristics in these populations showed the same tendencies in the upper and lower arches.     

Epinephrine in digital blocks: revisited

STATEMENT OF PROBLEM: Implant treatment in the United Kingdom has been provided mainly in specialist, regional dental hospitals. However, increasingly, general dentists are providing implant-supported prostheses in a private office setting. PURPOSE: This study investigated the nature, timing, and frequency of complications associated with single tooth implant therapy in a dental hospital and two dental offices. METHODS: The dental records of 58 patients provided with 76 implants during the period of 1989-95 were reviewed retrospectively. Fifty-three single tooth crowns on implants were placed by general dentists and 23 by specialists in the dental hospital. RESULTS: Implant survival rate was 96%. Twenty-eight guided bone regeneration procedures were required, including 13 unplanned ones. Prosthodontic complications included the need for recontouring of three crowns and the recementation of three crowns. Only two abutment screws required retightening. Peri-implant soft tissue inflammation occurred around six crowns and recession around two. CONCLUSION: The single tooth implant-supported crown appears to be an effective and durable restorative treatment with a relatively low prevalence of postoperative complications.     

Risk of renal cell carcinoma after kidney transplantation

Dental trauma occurs very often in children and its consequences vary from tiny fractures to the complete avulsion of the tooth. According to Andreasen, 86.5% of incidents of dental trauma suffered by preschool children cause injury to maxillary primary incisors, whereas only 0.5% cause injury to primary molars. This case report is of a male patient aged 7 years who had fallen down a month before, struck his chin against a step, and fractured the maxillary and mandibular left primary second molars (65 and 75) and the mandibular right primary second molar (85). The 65 required only smoothing of sharp edges, 75 received endodontic treatment and a stainless steel crown, and 85 was extracted and a space maintainer fitted. The early diagnosis of fractures of posterior teeth is very important; a thorough examination of all posterior teeth should be made, especially when child suffers trauma to the chin region.     

Dynamics of the drug scene in Switzerland 1977-1990

A mathematical model of anterior inter-arch relations was described in a previous article. This model is modified and manipulated and, using hypothetical dental measurements, results are generated and presented. The present work continues the two-dimensional examination of anterior dental relations in the first article, the emphasis remaining on incisor and canine overjet. Other authors have started by observing ideal occlusions, then have worked backwards to gain ratios of preferred maxillary to mandibular teeth widths; this restricts their studies to Class I occlusions with complete anterior dentitions and similar anterior form of both arches. This paper has no premise of normal or initial ratios. Incorporation of multiple factors allows forming and testing of hypotheses of anterior dental relations. Many factors influence anterior dental relations in varying degrees. Some dental measurement changes examined here are: the sum of teeth widths in each arch; spacing; crowding; angle of the arc of each arch and the antero-posterior buccal relation. Summary tables are presented to aid the prediction of the direction of inter-arch response to change in a dental measurement. Some inferences are discussed and are presented as a series of principles considered valid for this model. The principles may warrant testing with other arch form models.     

Porcelain veneers for primary incisors: a case report

A 4-year-old boy with severely discolored primary maxillary incisors was treated with bonded porcelain veneer restorations. Two years previously, the child had been treated with topical application of sodium fluoride-silver nitrate solution to arrest dental caries associated with a nursing bottle habit. With minimal chair time, the incisors were restored with laboratory-processed porcelain veneer restorations that were bonded with resin cement. This is perhaps the only report to date of the use of porcelain veneer restorations for primary anterior teeth.     

Superficial hemangiomas: associations and management

A new design of single tooth implant (AstraTech, Molndal Sweden) featuring a microthreaded conical neck and TiO blast surface was evaluated clinically and radiographically after 2 years in function. Fifteen patients (age range 16 to 48) with missing maxillary anterior teeth (6 central incisors, 8 laterals, 1 bicuspid) had 4, 13 mm and 11, 15 mm implants placed under local anaesthesia and left for a period of 6 months before exposure and abutment connection/crown fabrication. All patients were seen at 4 to 6 monthly intervals for hygienist maintenance. Radiographs using Rinn holders and a long cone technique were taken at the crown insertion and after 1 year (14 subjects) and 2 years (12 subjects). All implants were successfully integrated at stage 2, and no implants have been lost. The internal conical seal design of the abutment/implant interface facilitated connection and there were no cases of abutment screw loosening. No soft tissue problems were observed, and the gingival morphology/health was well maintained. One crown was recemented after 18 months in function, and 1 crown was replaced because of a fracture to the porcelain incisal edge. At crown insertion, the mean bone level was 0.46 to 0.48 mm apical to the top of the implant and there were no statistically significant changes in the bone level over the 2 years of the study. In conclusion, the single tooth Astra implants were highly successful and bone changes within the first 2 years of function were comparable with other systems reporting high long-term success rates.     

The future of dental amalgam: a review of the literature. Part 1: Dental amalgam structure and corrosion

This is the first article in a series of seven on the future of dental amalgam. Dental amalgam is still the most useful restorative material for posterior teeth and has been used successfully for over 100 years. The history of dental amalgam since its introduction in 1819 and the controversies about its use between 1834 and today are described. The composition of the various dental amalgams in clinical use today are then reported. It finally covers the corrosion of amalgams since this is the means by which metals, including mercury, can be released.