An integrated digital workflow for long-term interim combined fixed and removable prostheses.

Interim prostheses are required for the management of complex prosthodontic treatment which sometimes comprises both fixed and removable prostheses in the same arch. The traditional workflow for interim combined fixed and removable prostheses is time consuming and results can be unpredictable. A novel integrated digital workflow was adopted in the management of long-term interim combined fixed and removable prostheses. Highly cross-linked polymethyl methacrylate was used for the digital fabrication of both interim fixed and removable prostheses. The patient was satisfied with the esthetic and clinical outcomes after 6 months without any complications.

Retention of titanium copings to implant-supported fixed dental prostheses.

PURPOSE: The aim of this in vitro study was to assess the effects of using different cements and titanium copings designs on the retention of implant-supported fixed dental prostheses (IFDPs) using a pull-out test. MATERIALS AND METHODS: Fifty zirconia (ZirCAD; Ivoclar Vivadent) and 20 prepolymerized denture acrylic resin (AvaDent) rectangular (36 mm × 12 mm × 8 mm) specimens were milled to mimic the lower left segmental portion of the All-on-Four IFDPs. Cylindrical titanium copings (Variobase; Straumann) (V) were used in 2 prepolymerized denture acrylic resin groups (n = 10) while conical titanium copings (Straumann) (C) were used as a control group for zirconia with 4 groups using cylindrical titanium copings. Before cementation, the outer surfaces of all titanium copings and the intaglio bonding surface of prosthetic specimens were airborne-particle abraded. All specimens were cemented following the manufacturer's recommendations and instructions according to the experimental design. After artificial aging (5000 cycles of 5°C 55°C, dwelling time 20 s; 150 N, 1.5 Hz in a 37°C water bath), all specimens were subjected to retention force testing using a pull-out test using a universal testing machine and a custom fixture with a crosshead speed 5 mm/min. Modes of failure were classified as Type 1, 2, or 3. Retention force values were analyzed by the t-test for the prepolymerized denture acrylic resin specimen groups, and 1-way ANOVA and the Tukey test for the zirconia groups at α = 0.05. RESULTS: Mean and standard deviation retention force values varied from 101.1 ± 67.1 to 509.0 ± 65.2 N for the prepolymerized denture acrylic resin specimen groups. The zirconia groups ranged from 572.8 ± 274.7 to 1416.1 ± 258.0 N. There is no statistically significant difference in retention force values between V and C specimens cementing to zirconia with Panavia SA cement (Kuraray Noritake) (p = 0.587). The retention forces and failure modes were influenced by the cement used (p < 0.05). Modes of failure were predominantly Type 2 (mixed failure) and Type 1 (adhesive fracture from prosthetic materials) except for the quick-set resin group (Type 3, adhesive failure from coping). CONCLUSIONS: When bonding IFDPs onto titanium copings, quick-set resin provided significantly higher retention force for prepolymerized denture acrylic resin prostheses. Conical and cylindrical titanium copings performed similarly when cemented to zirconia with Panavia SA cement under the same protocol. The stability of the bonded interface and retention forces between zirconia prostheses and titanium copings varied from the cement used.

Effect of airborne-particle abrasion with a novel spherical abrasive on the zirconia surface.

STATEMENT OF PROBLEM: A novel zirconia-alumina composite (ZAC) particle has yet to be studied for airborne-particle abrasion in a bonding protocol for the zirconia surface. PURPOSE: The purpose of this in vitro study was to evaluate the shear bond force of resin cement to yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) when using spherical ZAC particles to conduct airborne-particle abrasion and modify the topography of Y-TZP. MATERIAL AND METHODS: Spherical 30- to 70-µm ZAC particles were fabricated by using a hybrid gel technique. A total of 160 Ø6.6×4.0-mm zirconia disks were fabricated from 4 commercially available zirconia blanks, e.max ZirCAD zirconia (EM), NexxZr T zirconia (NE), Lava Plus High Translucency zirconia (LP), and Imagine High Translucency Zirconia (IM), by using computer-aided manufacturing technology. As-sintered specimens without further surface treatment were used as controls (ZR0). Surface treatment groups included sharp-edged alumina airborne-particle abrasion (ABC), 50 µm, 0.2 MPa; airborne-particle abrasion with ZAC particle at 0.2 MPa (2ZA); and airborne-particle abrasion with spherical ZAC particle at 0.4 MPa (4ZA). All surface treatment groups were airborne-particle abraded at the specified pressures for 10 seconds at a standardized distance of 10 mm. The surface roughness (Ra) and area roughness (Sa) of specimens from each group were measured. Following the application of an adhesive (Scotchbond Universal), Ø6.6×4.0-mm resin cement (RelyX Ultimate) buttons were fabricated for shear bond testing by using a universal testing machine at a 5-mm/min crosshead speed (n=10). The data were analyzed by using a 2-way ANOVA, Tukey HSD test, and regression analysis (α=0.05). Scanning electron microscopy (SEM) was performed to observe changes of the zirconia surface and the failure modes of each group before and after shear bond testing. RESULTS: The mean ±standard deviation shear bond force values ranged from 272.6 ±41.4 N to 686.7 ±152.8 N. Statistically significant higher force values than those of the controls (P<.05) were obtained by using airborne-particle abrasion. No significant differences were found among any of the airborne-particle abrasion treatment groups (P>.05). The mean of Ra values ranged from 0.27 µm to 0.74 µm, and the mean of Sa values, from 0.48 µm to 1.48 µm. SEM observation revealed that the zirconia surface was made jagged by abrasion with sharp-edged alumina particles. The spherical ZAC particles create microcraters on the zirconia surface. Fractographic observation disclosed that failures were adhesive-cohesive failure modes with residual resin cement attached on the zirconia surface. CONCLUSIONS: The surface treatment of zirconia with sharp-edged alumina or the spherical ZAC abrasives improved the bonding force between the zirconia and resin cement. No statistically significant differences in shear bond force values were found between airborne-particle abrasion surface treatment groups.

Effect of Fiber Reinforcement on the Flexural Strength of the Transitional Implant-Supported Fixed Dental Prosthesis.

PURPOSE: The aim of this in vitro study was to assess the efficacy of fiber reinforcement to enhance flexural strength of the transitional implant-supported fixed dental prosthesis (TISFDP). MATERIALS AND METHODS: One hundred and forty denture acrylic resin plates (64 mm × 12 mm × 5 mm) with two 7 mm diameter holes were fabricated using heat-polymerized type (Lucitone 199) and CAD-CAM prepolymerized type (AvaDent) materials to simulate a chair-side reconstruction of the TISFDP. Specimens were divided into 7 groups (n = 10) according to the airborne-particle abrasion of titanium cylinder (Straumann) surface and locations of fiber reinforcement ribbons (Ribbond-ULTRA). No cylinder surface abrasion and no fiber added acrylate specimens were used as the controls. The prosthetic screws were hand-tightened on a custom fixture with analogs. Specimen hole and cylinder were joined using a 50:50 mixture of chemically polymerized resin (QYK-SET; Holmes Dental) and repair resin (Dentsply Sirona). Ten acrylate specimens with no holes were fabricated from each tested material and assigned as positive controls. A modified four-point bending test (ASTM standard-D6272) was conducted using a universal testing machine and a custom fixture with a crosshead speed 1 mm/min. The maximum failure loads were recorded. Data were statistically analyzed using 2-way ANOVA and the Tukey tests at α = 0.05. RESULTS: The flexural strength values ranged from 55.4 ±8.3 to 140.9 ±15.4 MPa. The flexural strength decreased significantly when fiber was attached on the titanium cylinder surface (p < 0.05). There were no statistically significant differences in flexural strength values between specimens with and without titanium cylinder surface abrasion (p > 0.05). Statistically significant improvement in flexural strength was observed in specimens with fibers attached around the specimen holes (p < 0.05) buccally and lingually. The obtained values were not statistically significantly different from the positive controls (p > 0.05). Some fixation screw fractures were observed before catastrophic failure of specimens during testing. CONCLUSIONS: Fiber reinforcement significantly improved the flexural strength of denture acrylic resins only if placed around the specimen holes on the tension side at the site of initiation of crack propagation. Even when the specimens underwent catastrophic failure, the segments remained attached to each other with the attached fibers.

Effect of the attachments on clinical outcomes of mandibular distal extension implant-supported removable partial dentures: A systematic review.

STATEMENT OF PROBLEM: Healing abutments and attachments have been used for implant-supported removable partial dentures (ISRPDs). However, the effects of these abutments and attachments on the clinical outcomes of the implants and prostheses are elusive because of the lack of standardized research protocols. PURPOSE: The purpose of this systematic review was to determine the clinical outcomes of mandibular distal extension ISRPDs with healing abutments and attachments by analyzing qualified studies. MATERIAL AND METHODS: An electronic and manual literature search was conducted on PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases including articles published in English from 1980 to 2020. Publications of clinical outcome studies on the mandibular distal extension ISRPDs with healing abutments or attachments were screened by inclusion and exclusion criteria. Clinical outcomes of removable partial dentures (RPDs) and ISRPDs with different types of abutments or attachments were compared by using patient-reported outcome measures, implant survival rate, masticatory performance, and implant- or prosthesis-related complications. Study designs and clinical outcome data were extracted and analyzed. The evidence of the selected studies and degree of recommendation were made according to the Oxford Centre for Evidence-based Medicine, and the risk of bias of the studies was assessed based on Newcastle-Ottawa criteria. RESULTS: Of 541 articles initially identified after removing duplicate records, 11 articles were selected by applying the inclusion and exclusion criteria, by inter-viewer agreement, and by hand searching. Nine prospective cohort studies, 1 retrospective cohort study, and 1 randomized controlled trial were included with evidence levels assessed at 1b, 2b, and 2c. The risk of bias varied from 5 to 8 out of 9. Patient overall satisfaction, oral health-related quality of life (OHRQoL) scores, and masticatory ability were significantly improved for ISRPDs with either healing abutments, ball, or LOCATOR attachments when compared with RPDs. The implant survival rate varied from 92% to 97% at 2 to 10 years for ball attachment and was 100% at 1 year for LOCATOR attachment-supported ISRPDs. Marginal bone loss (MBL) varied from 0 to 1 mm in all studies, although LOCATOR attachments had significantly less MBL compared with ball attachments. The maximal pocket depth and bleeding on probing index around implants at 1 year were 1.7 to 1.8 mm and 0.1 to 0.3. Loose healing caps were the main mechanical complication of implants. There were more prosthetic complications in ISRPDs with ball attachments than RPDs at 10-year follow-up, including gold matrix loosening, loss of retention, and denture base fractures. No direct comparisons were made of patient-reported outcomes or prosthetic complications between ball and LOCATOR attachment-supported ISRPDs. CONCLUSIONS: Healing abutments and attachments (ball or LOCATOR) improved patient-reported outcomes and the masticatory function of mandibular distal extension ISRPDs. However, insufficient evidence was found to determine the relative effectiveness of different attachment systems on the clinical outcomes of mandibular distal extension ISRPDs. Abutment loosening was the most frequent mechanical complication for healing abutments. More prosthetic complications were associated with ball attachment-supported ISRPDs than RPDs. The major weaknesses of this systematic review were the relatively moderate level of evidence and the publication language, since implant attachments are used in many non-English speaking countries.

Microcomputed tomography evaluation of cement shrinkage under zirconia versus lithium disilicate veneers.

STATEMENT OF PROBLEM: Computer-aided design and computer-aided manufacturing (CAD-CAM) technology and the improved translucency of recently developed high-strength monolithic zirconia could make them clinically acceptable for veneers if bonding to zirconia was as predictable as to glass-ceramics. Few studies have compared how resin cements behave between glass-ceramic and zirconia veneers before and after polymerization. PURPOSE: The purpose of this in vitro study was to evaluate the volumetric polymerization shrinkage of resin cement, marginal discrepancy, and cement thickness before and after polymerization for glass-ceramic and zirconia veneers with light-polymerizing resin cement. MATERIAL AND METHODS: Ten lithium disilicate veneers and 10 zirconia veneers were fabricated with a CAD-CAM workflow on extracted human maxillary anterior teeth with intact enamel surfaces. Zirconia veneers were treated with airborne-particle abrasion, and lithium disilicate veneers were etched with 5% hydrofluoric acid. All specimens were treated with ceramic primer and cemented with a light-polymerized resin cement. All specimens were scanned before and after resin cement polymerization by microcomputed tomography. The data were processed by the Amira software program to compare polymerization volumetric shrinkage, cement thickness, and marginal discrepancy. The data were compared by using a t test and analysis of variance (α=.05). Two bonded veneers were loaded in a mastication simulator for 400 000 cycles to investigate the effect of cyclic fatigue loading. RESULTS: Mean volumetric polymerization shrinkage was 4.2 ±0.8% for the lithium disilicate group and 6.4 ±3.5% for the zirconia group. No significant difference was found for volumetric shrinkage between materials (P=.132). The mean ±standard deviations of the marginal discrepancies before and after polymerization were 178 ±41 µm and 158 ±37 µm for lithium disilicate and 115 ±33 µm and 107 ±32 µm for zirconia. A smaller marginal discrepancy was found for both materials after polymerization (P=.011) and for zirconia compared with lithium disilicate (P=.004). The mean ±standard deviation cement thickness values before and after polymerization were 157 ±27 µm and 147 ±27 µm for lithium disilicate and 162 ±53 µm and 147 ±52 µm for zirconia. Smaller cement thickness was found after polymerization (P<.001), whereas no significant difference was found in cement thickness between materials (P=.144). No changes were noted in marginal discrepancy and cement thickness as a result of the fatigue loading. CONCLUSIONS: The difference in the volumetric polymerization shrinkage of cement between lithium disilicate and zirconia veneers was not statistically significant. Polymerization shrinkage resulted in smaller marginal discrepancy and cement thickness for both veneer materials.

Assessment of the internal fit and marginal integrity of interim crowns made by different manufacturing methods.

STATEMENT OF PROBLEM: The adaptation of interim crowns made by subtractive and additive manufacturing has not been well investigated. PURPOSE: The purpose of this in vitro study was to evaluate the internal fit and marginal discrepancy of interim crowns made by different manufacturing methods. MATERIAL AND METHODS: A dentoform mandibular left first molar was prepared for a ceramic crown and scanned for the fabrication of 48 stereolithical resin dies and interim crowns. Group CAM included 16 ZCAD interim crowns made by computer-aided design and computer-aided manufacturing (CAD-CAM) technology; group 3DP, 16 NextDent MFH interim crowns made by digital light processing technology; and group APP, 16 Jet interim crowns manually made by using autopolymerizing acrylic resin and used as controls. The silicone replica technique was used to determine the internal discrepancy volume before definitive cementation. All crowns were cemented with Temp-Bond NE under a 50-N load and bench set for 10 minutes before microcomputed tomographic (µCT) scan assessment. The volume of cement space was measured by using the µCT scan 3-dimensional (3D) images, and gap distance at assigned locations was recorded by using the µCT scan 2-dimensional (2D) images. The marginal discrepancy was measured by the polyvinyl siloxane (PVS) impression technique and using a stereomicroscope. Data were analyzed by ANOVA and the Tukey honestly significant difference tests (α=.05). The association between different measuring techniques was analyzed by the Pearson correlation test. RESULTS: The gap distance between interim crowns and dies from all 3 groups measured by using the µCT scan 2D images ranged from 0.13 mm to 0.55 mm, with the highest value found at the central occlusal location in group APP. The total average gap distance values recorded for group APP were significantly higher than those for group CAM and group 3DP (P<.05). No significant differences were found in internal discrepancy and cement space volume between group CAM and group 3DP (P>.05). The Pearson correlation test showed a moderate correlation (r=0.69) between the silicone replica technique and the µCT scan technique in determining cement space volume. When the PVS impression technique was used to measure the marginal discrepancy, the mean values obtained from group APP were statistically significantly higher than those from group CAM and group 3DP (P<.05). No statistically significant difference in marginal discrepancy was found between group CAM and group 3DP (P=.70). CONCLUSIONS: Digitally fabricated interim crowns had better internal fit and smaller marginal discrepancy than manually constructed interim crowns. The silicone replica technique and µCT scan technique measurements had a moderate correlation in assessing the adaptation of cemented interim crowns.

A technique to guide replacement of multiunit abutments supporting an existing implant-supported fixed complete denture.

This article describes a technique for replacing a fractured multiunit abutment (MUA) supporting an existing implant-supported fixed complete denture (ISFCD) with a custom-fabricated abutment alignment device. The angulated MUA threads that receive the prosthetic screw to secure the ISFCD can become stripped, cross-threaded, or, in some patients, the thin metal in this region may fracture. These conditions necessitate the removal and replacement of the angulated MUA. For many clinicians, replacement of the angulated MUA will be a rare and unfamiliar procedure. One of the biggest challenges is to achieve the correct orientation of the replacement angulated MUA hexagon to the supporting implant's internal hexagon. This technique aids the accurate indexing of the current angulated MUA position and replacement with a new angulated MUA without a trial-and-error approach involving multiple insertions and tightening of the abutment screw.

Assessment of the Adaptation of Interim Crowns using Different Measurement Techniques.

PURPOSE: To compare the internal fit and marginal discrepancy of acrylic resin interim crowns fabricated by different manufacturing methods, and to test the consistency of measuring marginal discrepancy and internal fit between different measuring techniques. MATERIALS AND METHODS: A dentoform mandibular left first molar was prepared for an all-ceramic crown. Thirty-six interim crowns were fabricated and divided into three groups (n = 12): group BAC (Bis-acrylic composite, fabricated manually), group CAM (CAD/CAM polymethylmethacrylate resin, milled), and group 3DP (3D printed methacrylic oligomers, printed). The internal fit of the interim crowns was evaluated by the silicone replica technique and by X-ray microcomputed tomography (µCT) technique. The marginal discrepancy of the interim crowns was evaluated by the vinyl polysiloxane (VPS) (Aquasil Ultra XLV) impression technique and by optical coherence tomography (OCT) technique. Data were statistically analyzed using ANOVA and Turkey tests at α = 0.05. Pearson correlation test was used to evaluate the correlation between the different measurement techniques and marginal discrepancy/internal fit. RESULTS: The manually fabricated interim crowns (group BAC) had significantly greater discrepancy of internal fit than did the digitally fabricated crowns (group CAM and group 3DP) measured by both silicone replica technique and µCT 2-dimensional (2D) image measurement. There were no statistically significant differences in the cement space volume values obtained by the µCT image technique between group BAC and group 3DP (p = 0.285). The coefficient of determination between the two volumetric measurement techniques was low (R2 = 0.30). For marginal discrepancy, the manually fabricated interim crowns had a wider absolute marginal discrepancy than both digitally fabricated groups (p < 0.05). In both the VPS impression and OCT assessment, there was no statistically significant difference between group CAM and group 3DP (p = 0.798 and 0.994, respectively). The coefficient of determination between the VPS impression and OCT techniques for marginal discrepancy measurement was low (R2 = 0.23). CONCLUSIONS: Digitally fabricated interim crowns (group CAM and group 3DP) had better internal fit and smaller marginal discrepancy than manually fabricated interim crowns (group BAC). For comparison of the different evaluation techniques, the silicone replica technique and µCT measurements had low correlation for internal fit assessment, as did the PVS impression and OCT techniques for marginal discrepancy test.

Effect of layering gingiva-shade composite resin on the strength of denture base polymers.

STATEMENT OF PROBLEM: Acrylic resin denture base materials, fabricated with either a traditional technique or computer-aided design and computer-aided manufacturing (CAD-CAM) technique, layered with different thicknesses of gingiva-shade composite resin may affect the strength of the definitive prostheses and have not been investigated. PURPOSE: The purpose of this in vitro study was to assess the flexural strength of acrylic resin denture base materials modified by layering different thicknesses of gingiva-shade composite resin. MATERIAL AND METHODS: Two denture acrylic resins, heat-polymerized type (Lucitone 199) and CAD-CAM prepolymerized type (AvaDent) polymethyl methacrylate (PMMA) resin, were used as the base materials. Three-millimeter-thick specimens were fabricated and prepared according to the ISO 1567 and ISO 20795-1:2013 and were used as the controls. A proprietary gingiva-shade composite resin (GRADIA gum shades) was used to replace different thicknesses (0.5 mm, 1.0 mm, and 1.5 mm) of the denture base materials, giving 4 groups for each tested material (n=16). A 3-point loading test was conducted by using a universal testing machine and a custom fixture with a crosshead speed of 5 mm/min. The maximum fracture loads were recorded, and ultimate flexural strength values were calculated. The collected data were statistically analyzed with ANOVA and the Tukey honestly significant difference (HSD) tests (α=.05). Representative fractured specimens were examined under a stereomicroscope at ×20 magnification and a scanning electron microscope to determine the interface and fracture patterns. RESULTS: The mean ±standard deviation of ultimate flexural strengths for the heat-polymerized acrylic resin specimens ranged from 94.79 ±9.89 MPa to 40.34 ±12.79 MPa, and that of the CAD-CAM prepolymerized acrylic resin ranged from 125.98 ±7.96 MPa to 64.16 ±20.77 MPa. Acrylic resin denture base materials after layering with gingiva-shade composite resin had a significantly lower mean fracture load than the controls (P<.05). The Tukey HSD test revealed that the control groups had significantly higher flexural strength values compared with the other tested specimens within each denture acrylic resin group layered with gingiva-shade composite resin (P<.05). The SEM images displayed brittle fracture exhibiting well-defined, flat, compact, and organized surface fractures. CONCLUSIONS: The flexural strengths of CAD-CAM prepolymerized acrylic resins were higher than those of the heat-polymerized denture acrylic resins. The flexural strengths of all 3 thicknesses of the CAD-CAM prepolymerized acrylic resins were greater than 65 MPa.

Fracture resistance of cingulum rest seats in CAD-CAM tooth-colored crowns for removable partial denture abutments.

STATEMENT OF PROBLEM: The prevalent use of computer-aided design and computer-aided manufacturing (CAD-CAM) for tooth-colored ceramic materials has led to several case reports and retrospective clinical studies of surveyed crowns used to support removable partial dentures. How the specific contour of a cingulum rest seat affects the fracture resistance of these CAD-CAM tooth-colored materials is unknown. PURPOSE: The purpose of this in vitro study was to compare the fracture resistance of monolithic CAD-CAM tooth-colored mandibular canine-surveyed ceramic crowns with cingulum rest seats of different designs. MATERIAL AND METHODS: Five groups (n=24/group) of CAD-CAM tooth-colored crowns were milled from the same standard tessellation language (STL) file: group EM, lithium disilicate-based material (IPS e.max CAD CEREC blocks); group SM, zirconia-based material (NexxZr T); group LP, zirconia-based material (Lava Plus High Translucency); group ZC, zirconia-based material (ZirCAD LT); and group MZ, composite resin (MZ100 CEREC blocks), used as a control. Crowns from each group were divided into 2 subgroups representing 2 shapes of cingulum rest seat design: round design subgroup (n=12) with 0.5-mm radius of curvature and sharp design subgroup (n=12) with 0.25-mm radius of curvature for the rest seat preparation. The crowns were cemented with resin cement to a composite resin die on a steel nut. After 24 hours of storage in water at 37°C, the specimens were statically loaded to fracture with a custom metal retainer on top of the cingulum rest seat by using a universal testing machine at a crosshead speed of 1.5 mm/min. Two-way ANOVA and the Tukey honestly significant difference tests were used to control the familywise error rate (α=.05). Representative specimens were examined using an optical stereomicroscope at ×10 magnification and a scanning electron microscope to determine the failure patterns and fracture mechanism. RESULTS: The results of the ANOVA test indicated statistically significant differences by materials and rest seat designs (P<.001). The mean ±standard deviation maximal load capacity was 773.5 ±255.0 N for group MZ, 1124.9 ±283.9 N for group EM, 2784.1 ±400.5 N for group SM, 2526.9 ±547.1 N for group LP, and 3200.8 ±416.8 N for group ZC. The round design subgroups had an approximately 30% higher mean failure load than the sharp design subgroups for all surveyed crowns. CONCLUSIONS: The present in vitro study demonstrated that zirconia-based groups fractured at twice the load as the lithium disilicate group. Of the 3 zirconia-based groups, group ZirCAD had a statistically greater fracture resistance than the other groups. Designing the cingulum rest seat to have a broad round shape provides a statistically significant higher fracture resistance than a sharp-shape design (P<.05).

Comparison of Fit of Dentures Fabricated by Traditional Techniques Versus CAD/CAM Technology.

PURPOSE: To compare the shrinkage of denture bases fabricated by three methods: CAD/CAM, compression molding, and injection molding. The effect of arch form and palate depth was also tested. MATERIALS AND METHODS: Nine titanium casts, representing combinations of tapered, ovoid, and square arch forms and shallow, medium, and deep palate depths, were fabricated using electron beam melting (EBM) technology. For each base fabrication method, three poly(vinyl siloxane) impressions were made from each cast, 27 dentures for each method. Compression-molded dentures were fabricated using Lucitone 199 poly methyl methacrylate (PMMA), and injection molded dentures with Ivobase's Hybrid Pink PMMA. For CAD/CAM, denture bases were designed and milled by Avadent using their Light PMMA. To quantify the space between the denture and the master cast, silicone duplicating material was placed in the intaglio of the dentures, the titanium master cast was seated under pressure, and the silicone was then trimmed and recovered. Three silicone measurements per denture were recorded, for a total of 243 measurements. Each silicone measurement was weighed and adjusted to the surface area of the respective arch, giving an average and standard deviation for each denture. RESULTS: Comparison of manufacturing methods showed a statistically significant difference (p = 0.0001). Using a ratio of the means, compression molding had on average 41% to 47% more space than injection molding and CAD/CAM. Comparison of arch/palate forms showed a statistically significant difference (p = 0.023), with shallow palate forms having more space with compression molding. The ovoid shallow form showed CAD/CAM and compression molding had more space than injection molding. CONCLUSION: Overall, injection molding and CAD/CAM fabrication methods produced equally well-fitting dentures, with both having a better fit than compression molding. Shallow palates appear to be more affected by shrinkage than medium or deep palates. Shallow ovoid arch forms appear to benefit from the use of injection molding compared to CAD/CAM and compression molding.

Thermal cracks of implant-based zirconia four-unit restorations: A fractographic analysis of two restorations fractured during production.

Two zirconia-based 4-unit restorations intended for the same patient fractured during the veneering process even though the prolonged cooling protocol recommended by the manufacturers was used. Fractographic analyses revealed that both restorations fractured as a result of thermal shock, but at different times during production. Further investigation is necessary to optimize the firing protocols for large zirconia-based restorations and avoid fracture due to thermal shock.

Marginal discrepancy dimensions of single unit metal crowns fabricated by using CAD-CAM-milled acrylate resin polymer blocks or a conventional waxing technique.

STATEMENT OF PROBLEM: Because crowns with open margins are a well-known problem and can lead to complications, it is important to assess the accuracy of margins resulting from the use of a new technique. Currently, data regarding the marginal fit of computer-aided design and computer-aided manufacturing (CAD-CAM) technology to fabricate a complete gold crown (CGC) from a castable acrylate resin polymer block are lacking. PURPOSE: The purpose of this in vitro study was to compare marginal discrepancy widths of CGCs fabricated by using either conventional hand waxing or acrylate resin polymer blocks generated by using CAD-CAM technology. MATERIAL AND METHODS: A plastic model of a first mandibular molar was prepared by using a 1-mm, rounded chamfer margin on the entire circumference of the tooth. The master die was duplicated 30 times, and 15 wax patterns were fabricated by using a manual waxing technique, and 15 were fabricated by using CAD-CAM technology. All patterns were invested and cast, and resulting CGCs were cemented on their respective die by using resin-modified glass ionomer cement. The specimens were then embedded in acrylic resin and sectioned buccolingually. The buccal and lingual marginal discrepancies of each sectioned portion were measured by using microscopy at ×50 magnification. Data were subjected to repeated measures 2-way ANOVA, by using the Tukey post hoc pairwise comparison test (α=.05). RESULTS: The factor of "technique" had no significant influence on marginal discrepancy measurement (P=.431), but a significant effect of "margin location" (P=.019) was noted. The confounding combination of factors was found to be significantly lower marginal discrepancy dimensions of the lingual margin discrepancy than on the buccal side by using CAD-CAM technology. CONCLUSIONS: The marginal discrepancy of CAD-CAM acrylate resin crowns was not significantly different from those made with a conventional manual method; however, lingual margin discrepancies present from CAD-CAM-prepared crowns were significantly less than those measured on the respective buccal surface.

The influence of lip form on incisal display with lips in repose on the esthetic preferences of dentists and lay people.

STATEMENT OF PROBLEM: Information is lacking for viewer preferences for incisal display with lips in repose. PURPOSE: The purpose of this online survey was to establish measurement parameters to classify and define a lip form and to evaluate the influence of lip form on dentists' and laypersons' preferences for the amount of incisal display with lips in repose. MATERIAL AND METHODS: Computer-generated male and female models were created using 3 different lip forms each, straight, moderate, and high. Three images of these models (frontal full face, zoomed-in frontal around the mouth, and oblique zoomed-in image of the mouth) were arranged in an interactive survey that was disseminated on the Websites Facebook, Instagram, DentalTown and by word-of-mouth. Respondents manipulated the incisal display of all 3 images in unison, using a slide bar, and the resulting incisal display was measured in millimeters and served as the primary dependent measure. Survey demographic data were obtained from an online survey site. Data were assessed for skewness, kurtosis, and outliers and analyzed with 5-way ANOVA: 2 sex levels for model, 2 levels for sex of respondent, 3 levels for lip height, 3 levels for occupation, and 5 levels of ethnicity, with multiple comparisons corrected with Bonferroni adjustments and post hoc comparisons performed using the Scheffé test (α=.05 for all comparisons). RESULTS: A total of 1039 individuals consented to the study. A final sample size of 687 respondents was obtained after excluding 352 who failed to complete the survey. The results indicated that lip form affected the esthetic perception of incisal display significantly (P<.001), with a preference for a greater amount of incisal display corresponding with increasing lip forms. Sex of the model was also significant, with greater incisal display being preferred for female faces. A significant difference was found for respondents' ethnicity, with African Americans generally preferring smaller incisal displays than other ethnic groups. No other main effects were found to be statistically significant. Only 2 interactions were shown to be statistically significant. Post hoc tests examining the interaction between lip form and sex of model showed a preference for greater incisal displays for female faces with high lip forms. A 3-way interaction was observed between lip form, sex of respondent, and occupation. CONCLUSIONS: Significant differences were identified for the 3 different lip forms for both sexes of models. As the lip form changed from straight to moderate to high, there was a preference for increased incisal display. Incisal display preferences for male and female models were the same for all respondents, except for the high lip form, for which a greater amount of incisal display was preferred for the female model. Sex and occupation of respondent failed to produce main effects. Respondents' ethnicity was shown to be statistically significant, with African Americans generally preferring shorter incisal displays.

Effects of chlorine-based and quaternary ammonium-based disinfectants on the wettability of a polyvinyl siloxane impression material.

STATEMENT OF PROBLEM: Polyvinyl siloxane (PVS) impression materials must be cold disinfected before cast pouring to prevent cross-contamination among personnel and patients. However, disinfection may affect the ability of PVS impression materials to provide bubble-free stone surfaces because of the removal of surfactants. PURPOSE: The purpose of this in vitro study was to compare the water contact angles of a PVS impression material treated with either a quaternary ammonium-based (QAB) (DisCide Ultra) or a chlorine-based (CLB) (Dispatch) disinfectant for various exposure times. No disinfection and acetone-immersed (total surfactant removal) specimens were used as positive and negative controls. An additional purpose was to measure changes in the contact angles of the disinfected PVS impression material after applying a topical wetting agent. MATERIAL AND METHODS: Flat and disk-shaped PVS specimens (n=5/test condition) were fabricated and subsequently exposed to disinfectants for different times (1 minute, 5 minutes, 30 minutes, 6 hours, and 24 hours). After disinfection, the contact angle with distilled water was determined over a 3-minute period using dynamic contact analysis. The same contact angle measurements were repeated after a wetting agent was applied to the previously disinfected specimens. Contact angles were statistically compared using 2-way ANOVA. The Sidak post hoc test was used to perform pairwise simple contrast and effect comparisons (α=.05). RESULTS: The contact angle increased directly with disinfectant contact time. For the CLB product, the contact angle after 30-minute disinfection was not significantly different from that of 1 minute disinfection (P>.05). For the QAB product, exceeding 5-minutes of disinfection resulted in a significantly greater contact angle (P<.001). The application of a wetting agent made the disinfected PVS specimens less hydrophobic. CONCLUSIONS: A QAB disinfectant product is more effective at removing surfactant than a CLB disinfectant product. Therefore, a CLB disinfectant provides more working time and control. A wetting agent can reduce the hydrophobicity of a disinfected impression material if the duration of cold disinfection is less than 6 hours.

Comparison of margin discrepancy of complete gold crowns fabricated using printed, milled, and conventional hand-waxed patterns.

STATEMENT OF PROBLEM: The recent application of printing for the fabrication of dental restorations has not been compared and evaluated for margin discrepancy (margin fit) with restorations fabricated using milling and conventional hand-waxing techniques. PURPOSE: The purpose of this in vitro study was to evaluate and compare margin discrepancy of complete gold crowns (CGCs) fabricated from printed, milled, and conventional hand-waxed patterns. MATERIAL AND METHODS: Thirty crown patterns were produced by each of 3 different methods: printed by ProJet DP 3000, milled by LAVA CNC 500, and hand waxed, then invested and cast into CGCs. Each crown was evaluated at 10 positions around the margin on the corresponding epoxy die under ×50 light microscopy to determine the mean and maximum margin discrepancy. Measurements were made using a micrometer positioning stage. The results were compared by ANOVA (α=.05). RESULTS: Milled and hand-waxed patterns were not statistically different from each other (P>.05), while printed patterns produced significantly higher mean and maximum margin discrepancy than milled and hand-waxed patterns (P<.05). CONCLUSIONS: Relative to margin discrepancy, the LAVA CNC 500 milled and hand-waxed patterns were not significantly different from each other. The ProJet DP 3000 printed patterns were significantly different from LAVA CNC 500 milled and hand-waxed patterns, with an overall poorer result. Fabricating CGCs from printed patterns produced a significantly higher number of crowns with unacceptable margin discrepancy (>120 µm).

Complete denture fabrication with CAD/CAM record bases.

One of the primary goals of new materials and processes for complete denture fabrication has been to reduce polymerization shrinkage. The introduction of computer-aided design and computer-aided manufacturing (CAD/CAM) technology into complete denture fabrication has eliminated polymerization shrinkage in the definitive denture. The use of CAD/CAM record bases for complete denture fabrication can provide a better-fitting denture with fewer postprocessing occlusal errors.

Orthodontic single tooth intrusion with a removable interocclusal device: A clinical report.

Interdisciplinary therapy was used to treat a patient missing a single posterior tooth opposing an extruded tooth. The simple technique used a removable interocclusal device and elastic band for orthodontic intrusion over a 2-month period after implant placement in the opposing arch to aid in prosthetic site development. This approach was designed to increase the interocclusal space needed to restore the implant, obtain a more consistent occlusal plane, and improve esthetics. Clinical and radiographic examinations at the 6-month follow-up revealed an acceptable occlusal relationship and improved esthetic appearance that was achieved with the documented course of treatment.