A 3-dimensional accuracy analysis of chairside CAD/CAM milling processes.

STATEMENT OF PROBLEM: Milling is a central and important aspect of computer-aided design and computer-aided manufacturing (CAD/CAM) technology. High milling accuracy reduces the time needed to adapt the workpiece and provides restorations with better longevity and esthetic appeal. The influence of different milling processes on the accuracy of milled restorations has not yet been reviewed. PURPOSE: The purpose of this study was to investigate the influence of different milling processes on the accuracy of ceramic restorations. MATERIAL AND METHODS: Four groups of partial crowns were milled (each n = 17): Three groups in a 4-axial milling unit: (1) 1-step mode and Step Bur 12S (12S), (2) 1-step mode and Step Bur 12 (1Step), (3) 2-step mode and Step Bur 12 (2Step), and (4) one group in a 5-axial milling unit (5axis). The milled occlusal and inner surfaces were scanned and superimposed over the digital data sets of calculated restorations with specialized difference analysis software. The trueness of each restoration and each group was measured. One-way ANOVA with a post hoc Tukey test was used to compare the data (α = .05). RESULTS: The highest trueness for the inner surface was achieved in group 5axis (trueness, 41 ± 15 µm, P<.05). The 4-axial milling unit exhibited trueness at settings ranging from 61 µm (2Step) to 96 µm (12S). For the occlusal surface, the highest trueness was achieved with group 5axis (trueness, 42 ± 10 µm). The 4-axial milling unit exhibited trueness at settings ranging from 55 µm (1Step) to 76 µm (12S). CONCLUSIONS: Restorations milled with a 5-axial milling unit have a higher trueness than those milled with a 4-axial milling unit. A rotary cutting instrument with a smaller diameter results in a more accurate milling process. The 2-step mode is not significantly better than the 1-step mode.

Accidental ingestion or aspiration of foreign objects at Tokyo Dental College Chiba Hospital over last 4 years.

The aim of this study was to investigate cases of accidental ingestion or aspiration occurring at Tokyo Dental College Chiba Hospital over the last 4 years in order to determine how the incidence of such events could be reduced. Forty cases of accidents occurring at our hospital over a 4-year period commencing in 2008 (representing 27% of the total number of accidents) included accidental ingestion in 39 patients and aspiration in one. Most of these accidents occurred during the removal or placement of restorations or prosthetics, and the ingested objects were mostly crowns and inlays. Accidental ingestion or aspiration occurred more frequently in the right molar region and when procedures were conducted by practitioners with less than 1 to 7 years of experience, and especially 1 to 3 years only. A higher rate of such accidents was observed in male patients in their 50s to 70s. The conventional safety procedures developed by the Medical Risk Management Team should be adhered to wherever possible. Furthermore, we propose the following measures based on the present results: accident prevention training for students and clinical trainees; improvement of the in-hospital manual; personal coaching for those breaching the guidelines of the safety manual; and raising awareness of the need for greater care in preventing incidents of accidental ingestion or aspiration at the Tokyo Dental College Chiba Hospital.

Survey of accidental ingestion and aspiration at Tokyo Dental College Chiba Hospital.

The occurrence of accidental ingestion/aspiration and preventive measures were investigated at Tokyo Dental College Chiba Hospital. In addition, the characteristics of accidents at our hospital were analyzed by surveying the awareness of accidental ingestion/aspiration to utilize the data for prevention. Accidental ingestion accounted for about 30% of accidents that occurred at our hospital in fiscal 2008, but all ingested items were naturally excreted, and no accidental aspiration occurred. Accidental ingestion most frequently occurred when dental restorations were removed. Inlays and crowns were most frequently ingested, and dentists with 5 to less than 10 years of clinical experience tended to be involved in these accidents. According to the results of the questionnaire, removal of restorations was perceived as the treatment least likely to cause accidental ingestion/aspiration. Moreover, dentists who always took preventive measures against accidental ingestion/aspiration accounted for only 40% or less on average. To avoid accidental ingestion/aspiration, repeated courses and individual instruction for repeaters and the establishment of a surveillance system along with manuals to manage the violation should be emphasized.

Analysis of an administrative database of indirect restorations over 11 years.

AIM: This paper describes the database used to assess the survival of indirect restorations and presents general data on survival of these restorations. METHODS: Data, based on the complete attendance and treatment history, over the 11 years from 1991 to 2001, of a statistically representative sample of 23,165 General Dental Services' (GDS) patients in England and Wales, all of whom received at least one indirect restoration during the observation period, have been analysed. The patients on the database received a total of 36,397 courses of treatment, and there were 52,481 indirect restorations placed. The method of analysis involved the estimation of the probability that the patient will eventually return, given an interval without attending, by analysing the observed patterns of re-attendance. This estimated probability of re-attendance was then used to modify the standard Kaplan-Meier procedure to produce realistic estimates of the hazard of re-intervention. RESULTS: Overall, 75% of indirect restorations remained without re-intervention after 5 years, and 61% after 10. Crowns outperformed other types of indirect restoration. Multi-surface metal inlays, by contrast, had a median interval to re-intervention of less than 8 years. CONCLUSIONS: The times to re-intervention for different types of indirect restoration have been successfully estimated and crowns shown to outperform veneers and inlays.

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.

Clinical survey on type of restoration in deciduous teeth.

This study was conducted in 533 children with 1,634 treated teeth who visited the Pediatric Dentistry Department at the Chiba Hospital of Tokyo Dental College between January and December, 2003. Restorations on deciduous tooth were categorized by age of patient and tooth type. The following observations were made: Children aged 4 (17.9%) visited the clinic most frequently and this group had the highest number of deciduous restorations (21.3%). Among the 1,634 deciduous teeth restored, metal inlays were provided in 29.4% of total teeth restored, composite resin restorations in 27.2%, stainless-steel crowns in 25.7%, composite resin full crowns in 7.7%, glass-ionomer cement restorations in 6.6%, and amalgam restorations in 3.4%. By age, composite resin was most frequently used in children aged 1 to 3. In children aged 5 to 9, metal inlay was most frequently used. Those aged 4 received mostly stainless-steel crowns. Composite resin restorations were used mostly in anterior deciduous teeth, and metal inlays mostly in deciduous molars. Previous research indicated an increasing trend towards composite resin restorations and composite resin full crowns. The present study also confirmed such a trend. While the use of metal inlays and stainless-steel crowns tended to increase until 1987, the present study indicated a trend to decrease.

Survival of inlays and partial crowns made of IPS empress after a 10-year observation period and in relation to various treatment parameters.

UNLABELLED: This study evaluated the long-term survival of inlays and partial crowns made of IPS Empress. For this purpose, the patient data of a prospective study were examined in retrospect and statistically evaluated. MATERIALS AND METHODS: All of the inlays and partial crowns fabricated of IPS-Empress within the Department of Operative Dentistry at the School of Dental Medicine of Philipps University, Marburg, Germany were systematically recorded in a database between 1991 and 2001. The corresponding patient files were revised at the end of 2001. The information gathered in this way was used to evaluate the survival of the restorations using the method described by Kaplan and Meyer. RESULTS: A total of n = 1624 restorations were fabricated of IPS-Empress within the observation period. During this time, n = 53 failures were recorded. The remaining restorations were observed for a mean period of 18.77 months. The failures were mainly attributed to fractures, endodontic problems and cementation errors. The last failure was established after 82 months. At this stage, a cumulative survival probability of p = 0.81 was registered with a standard error of 0.04. At this time, n = 30 restorations were still being observed. Restorations on vital teeth (n = 1588) showed 46 failures, with a cumulative survival probability of p = 0.82. Restorations performed on non-vital teeth (n = 36) showed seven failures, with a cumulative survival probability of p = 0.53. Highly significant differences were found between the two groups (p < 0.0001) in a log-rank test. No significant difference (p = 0.41) was found between the patients treated by students (n = 909) and those treated by qualified dentists (n = 715). Likewise, no difference (p = 0.13) was established between the restorations seated with a high viscosity cement (n = 295) and those placed with a low viscosity cement (n = 1329).

Current status of the cast metal inlay: a survey of dental schools in the UK and Hong Kong.

This study reports on the current status of the gold inlay in the undergraduate curriculum of Dental Schools in the UK and at the Prince Philip Dental Hospital, Hong Kong, to determine if the decline in the use of the cast gold inlay over the past 20 years is reflected in teaching at undergraduate level. A questionnaire, which was mailed to all the heads of departments of conservative dentistry in the UK, was designed to determine current teaching in respect of cast inlays. The results show that although the majority of UK dental schools continue to teach direct and indirect inlay techniques, a minority (4 and 5 respectively) no longer incorporate a practical exercise in this teaching. Reasons cited for the discontinuation of the technique are varied but the availability of simpler, more conservative techniques is emphasized. Examination of the treatment records at the Prince Philip Dental Hospital, Hong Kong, where the Class II inlay technique is taught both theoretically and practically, shows that only a small proportion of all posterior cast restorations fitted between May 1983 and April 1988 were inlays (4.6 per cent).

Cuspal deflection during polymerisation of composite lutes of ceramic inlays.

OBJECTIVE: The purpose of this study was to measure the cuspal deflection that occurs in teeth as a result of the dimensional changes of resin-based lutes during polymerisation. METHODS: Standardised MOD cavities were cut in 15 intact human premolar teeth using a custom paralleling device. A ceramic inlay was machined by the CEREC 2 system for each tooth ensuring an interface width of 50 microns (SD = 17.5) at the cavity margin. The 15 teeth were divided into three groups of five according to the cementation system employed: a microfilled hybrid posterior composite; a compomer restorative; a dual-cure luting composite. The inter-cuspal tooth dimension was recorded continuously with a laser micrometer assembly during a 2 min photoactivation period and a further 30 min post-activation period. RESULTS: A clear overall reduction in tooth dimension was detectable for the first 10 min of polymerisation. The mean changes ranged from -0.02% to -0.06% depending on the nature of the luting material. In addition, all samples exhibited a slight expansion of 0.03% during the time of light-activation. CONCLUSIONS: The dimensional changes that teeth experience during the polymerisation of resin-based lutes are clearly detectable. It can be postulated that an increase in the dimensions of the teeth during photoactivation occurs as a result of expansion of the lute due to the thermal energy delivered.

A survey of current practice into the use of aesthetic inlays.

In recent years there has been a concerted effort to produce an aesthetic restoration to replace amalgam, while retaining its qualities of strength and longevity. The use of porcelains and composite resins used indirectly as inlays and onlays has today improved the qualities of directly filled composites. A survey of 310 general dental practitioners in the UK known to use this type of restoration produced 162 responses to a questionnaire to evaluate their experiences to these techniques. The majority, 85%, had used a composite inlay system for about 2 years, with a 90% success rate over this period. Information collected provided details on variations in cavity design and cementing procedures.

Factors influencing long-term restoration survival in three private dental practices in Adelaide.

Very little is known of dentist and patient factors which may influence the survival or longevity of dental restorative materials placed in private practices. The present retrospective study investigated during 1992 the effects of six factors on the long-term survivals of five types of restorations placed by 20 male dentists in 100 adult patients, at 3 selected Adelaide dental practices. There were no significant effects on restoration survival from change, of dentist, and generally only one or two types of restorations had their survivals influenced significantly either by dental practice location, or by patient age, frequency of patient attendance, experience of dentist, and whether or not the restorations were replacements during the study period. Restoration survival was not influenced significantly by whether, or not, any replacements were made by the dentist who placed the initial restorations. The median survival times for amalgams were 22.52 years, resin composites 16.72 years, castings 13.75 years, and crowns an estimated 26 years. For glass-ionomers, 75 per cent were still present at 11.25 years.

Longevity of 2328 chairside Cerec inlays and onlays.

In a dental practice, 2328 ceramic inlays were placed in 794 patients. The restorations were manufactured chairside using Cerec technology and adhesively inserted at the same appointment. The clinical performance of the restorations was evaluated with the Kaplan-Meier analysis. The probability of survival was 95.5% after 9 years; 35 Cerec restorations were judged as failures. The prognosis for success was not significantly influenced by restoration size, tooth vitality, treatment of caries profunda (CP), type of tooth treated, or whether the restoration was located in the maxilla or mandible. The most common type of failure was the extraction of a tooth. In a clinical follow-up light-microscopic examination of 44 randomly selected restorations, an average composite joint width of 236.3 microns was found. 45.1% of the restorations exhibited a perfect margin, and 47.4% of the investigated joint sections showed underfilled margins.

[The marginal accuracy of the fit of fixed adhesive ceramic inlays]. / Marginale Passgenauigkeit befestigter adhäsiver Keramik-inlays.

48 extracted human molars were restored with MOD inlays using 3 different ceramic systems: Dicor, Mirage and Vitadur N. For the Dicor system both the direct and indirect manufacturing procedures were used and all the necessary technical and clinical steps were performed. After being subjected to a thermal cycling stress test for 100 days, the teeth were ground sectioned for light microscopic examination. Sintered high-strength ceramic systems (Mirage and Vitadur N) displayed significantly better marginal adaptation than casted glass ceramic. In order to estimate the extent of the outer marginal gap, we measured the defective surface where the adhesive composite had disintegrated. The best possible marginal fit will certainly prolong the longevity of inlay restorations.

[The computer-generated occlusion of Cerec-2 inlays and onlays]. / Computergenerierte Okklusion von Cerec-2 Inlays und Overlays.

The Cerec-2 unit offers three different options to generate the occlusion: anatomically extrapolated ("Extrapolation"), correlated to a wax-up or functionally generated path ("Correlation") and bucco-orally flat ("Linear") as known from Cerec-1. These three computer-generated occlusions were evaluated by measuring the vertical discrepancy and the specific time needed for manufacturing (design, machining, contouring and adjusting the occlusal relation) of inlays and overlays. The occlusion of inlays generated with "Extrapolation" (0.42 +/- 0.16 mm) and "Correlation" (0.80 +/- 0.17 mm) showed significantly (p < 0.001) less vertical discrepancy than "Linear" (2.46 +/- 0.50 mm). The specific production time of inlays differed significantly (p < 0.001) between "Extrapolation" (16.05 +/- 0.80 min), "Linear" (19.25 +/- 1.14 min) and "Correlation" (27.33 +/- 0.75 min). The vertical discrepancies of overlays generated with "Correlation" (1.26 +/- 0.43 mm) were significantly (p < 0.001) lower than with "Extrapolation" (2.46 +/- 0.50 mm) and "Linear" (2.75 +/- 0.57). The specific overlay production time was significantly (p < 0.001) longer with "Correlation" (39.44 +/- 1.36) than with "Linear" (23.9 +/- 1.26 min) and "Extrapolation" (23.71 +/- 1.01 min). Related to the technical status of 10/1994 and as a result of the present evaluation, "Extrapolation" was chosen to be the most practical of the computer-generated occlusions evaluated in the present study.

[The curing of composites under Cerec inlays]. / Die Aushärtung von Komposit unter Cerec-Inlays.

96 Cerec CAD/CIM inlays (Vita Cerec Mk II, shades A2C and B3C) were seated into one reusable mod-cavity in a human molar. Light- (Brilliant Lux Incisal, Coltène) and dual- (Vita Duo Cement) curing composite resin respectively were used and the proximal areas were irradiated using a curing light (Coltolux II) with 4 different procedures: A) 210 s; B) 120 s (including 30 s Luciwedge, LW); C) 120 s (no LW) and D) 60 s. Vickers hardness (VHN) of the cured resin was measured at the pulpo-axial walls of the removed inlays. Polymerization-% of the resin was calculated relative to VHN of control samples, whose polymerization was scored as 100%. Two way Anova and Scheffé test were used for statistical comparison of the data. The results for the light-/dual-curing groups for shade A2C were: A) 97/89%, B) 89/90%, C) 91/88% D) 79/69%. Results for shade B3C were: A) 97/87%, B) 86/87%, C) 89/88% and D) 71/69%. No significant differences (p > 0.05) were found between light- and dual-curing. With procedures A, B and C light- and dual-curing resulted in adequate polymerization rates (PR > 85%) whereas D (PR < 80%) was significantly (p < 0.001) lower than A, B and C. Dual-curing resin had no advantages vs. light-curing with respect to polymerization rate when seating Cerec CAD/CIM inlays. The overall handling of the light-curing composite resin was judged to be easier than that of the dual cure material.

The clinical long-term success of ceramic restorations--Part I: Inlays and onlays.

Ceramic inlays and onlays have significant aesthetic and biologic benefits. Long-term clinical studies on the success of ceramic inlays and onlays, however, provide only limited observation periods, considering that such restorations rely on current and constantly improving adhesive bonding techniques. Alternative materials, such as cast-gold restorations, have a long history of documented clinical success, which should be taken into consideration when making decisions on proper restorative material selection.

[Statistical survey of prosthetic restorations--outline and single crowns, cast cores and inlays].

This is a report on the statistical classification of the prosthetic restorations placed in out-patients of the Tokyo Medical and Dental University Hospital. The data were collected from the laboratory records during the period of January to June of 1986. The results are summarized as follows: 1. The total number of the prosthetic restorations placed in the outpatients were 7355, and 56% of these were covered by the health insurance. 2. Of the total restorations, 29.6% were cast cores, 18.2% were inlays and 17.2% were crowns. Post crowns, jacket crowns and partial veneer crowns were very few, being only 0.3%, 0.4% and 0.5%, respectively. 3. Approximately 50% of the prosthetic restorations were single crowns. 4. Compared to the record from about 20 years ago, the number as well as the ratio of the crowns including the facing crowns was approximately doubled. On the contrary, the number of jacket and post crowns has remarkably decreased. 5. With regard to the single anterior prosthetic restorations, the majority were the porcelain fused to metal crowns which were not popular 20 years ago.

[Long-term survival of extensive amalgam restorations]. / Langetermijnoverleving van uitgebreide amalgaamrestauraties.

In cost-effectiveness analysis and contemporary treatment planning strategies, the postponement of placement of cast crowns plays an important role. Extensive Amalgam Restorations (EAR), that involve the rebuilding of cusps and the provision of auxiliary retention, are thought to make this postponement possible. This study reports the long-term survival (100 months) of EAR in a randomized, controlled clinical trial. A total of 300 EAR were placed by 3 operators in molar teeth in which one or more cusps were reconstructed. Five different auxiliary retention methods were used for retention of these restorations. As the purpose of EAR is considered to be twofold (to restore a broken-down molar to acceptably function as an independent restoration and to create a substructure for subsequent crown construction), survival was assessed at different levels. The survival rate of EAR as an independent restoration was 88 +/- 2%. The functional survival rate (as an independent restoration or as a substructure) was 92 +/- 2%. The influence of experimental variables (retention method and operator) and background variables (tooth type, extension of EAR and age of patient) on the survival was analysed using Log Rank and Breslow tests. The analyses revealed that there were no statistically significant influences on the survival rates except for the variable 'age of patient' (p < 0.05). EAR was more prone to failure in the group of older patients than the group of younger ones.

[The late results of inlay prosthesis]. / Otdalennye rezul'taty protezirovaniia vkladkami.

A 1- to 7-year follow-up of 52 patients supplied with inserts has demonstrated that cast metal inserts provide effective prevention of caries recurrences, complications, and denture deformations. The best results are achieved after thorough mastering of the operation and strict adherence to indications to such prosthesis, with the methods for clinical and paraclinical examinations of patients before the treatment constantly improved.

A practice-based study on the survival of restored endodontically treated teeth.

INTRODUCTION: This retrospective study evaluated the survival of endodontically treated teeth (ETTs) and investigated factors influencing restoration and tooth survival. METHODS: Data from 795 ETTs were recorded, and success (restoration still intact) and survival (restoration intact or failed/repaired/replaced and tooth still in situ) were analyzed using Kaplan-Meier statistics. A multivariate Cox regression analysis was performed to assess the variables influencing success and survival. RESULTS: At the end of the observation period (mean observation time = 4.48 years), 45 teeth had been extracted (annual failure rate for survival = 1.9% at 9.6 years) and 114 restorations had received a restorative follow-up treatment (annual failure rate for success = 4.9% at 9.6 years). CONCLUSIONS: ETTs showed acceptable survival and success in the long-term. Variables showing significant influence on survival were the number of teeth in the dentition and the presence of decay at the moment the patient entered the practice.