Adhesion of porcelain to three-dimensionally printed and soft milled cobalt chromium.

PURPOSE: To investigate the adhesion strength and bonding interface of layered porcelain to powdered cobalt-chromium (CoCr) processed by two different computer-aided manufacturing methods. METHODS: Sixteen specimens were manufactured from each of Three-dimensionally -printed/laser-sintered (LS) CoCr and milled pre-sintered (SM) CoCr. The specimens were layered with porcelain and 4-point bending was carried out. Nanoindentation was used to calculate changes in elastic modulus and hardness before and after porcelain firing along with adhesion energy. Fracture surface and microstructural changes were examined before and after porcelain firing observed using scanning electron microscopy. RESULTS: The adhesion energy of the LS specimens bonded porcelain were higher than the SM specimens (P<0.05). Analysis of the fracture surfaces showed a predominantly adhesive mode of failure. Elastic-modulus and hardness of the CoCr specimens increased post porcelain firing. Examination using electron-backscatter diffraction (EBSD) showed a fine grain structure for both manufacturing methods. Significant localized changes in the crystal structure post firing were only observed at the surface of the SM specimens. CONCLUSIONS: Both manufacturing methods showed regular microstructures prior to porcelain firing. Laser-sintered CoCr had stronger bonding to porcelain than milled pre-sintered CoCr and was also more stable microstructurally post-ceramic firing. However, both manufacturing methods were deemed to have satisfactory adhesion strength to porcelain. It was also found that increased hardness of CoCr had an inverse relationship with bonding strength. High strength porcelain bonding and stability following multiple ceramic firings indicate suitability for use of these CoCr materials with implant or tooth supported long-span frameworks.

Additive Technology: Update on Current Materials and Applications in Dentistry.

Additive manufacturing or 3D printing is becoming an alternative to subtractive manufacturing or milling in the area of computer-aided manufacturing. Research on material for use in additive manufacturing is ongoing, and a wide variety of materials are being used or developed for use in dentistry. Some materials, however, such as cobalt chromium, still lack sufficient research to allow definite conclusions about the suitability of their use in clinical dental practice. Despite this, due to the wide variety of machines that use additive manufacturing, there is much more flexibility in the build material and geometry when building structures compared with subtractive manufacturing. Overall additive manufacturing produces little material waste and is energy efficient when compared to subtractive manufacturing, due to passivity and the additive layering nature of the build process. Such features make the technique suitable to be used with fabricating structures out of hard to handle materials such as cobalt chromium. The main limitations of this technology include the appearance of steps due to layering of material and difficulty in fabricating certain material generally used in dentistry for use in 3D printing such as ceramics. The current pace of technological development, however, promises exciting possibilities.

Effectiveness of Crown Preparation Assessment Software As an Educational Tool in Simulation Clinic: A Pilot Study.

The aim of this pilot study was to evaluate the feasibility of a new tooth preparation assessment software, Preppr, as an educational tool for dental students in achieving optimal parameters for a crown preparation. In February 2015, 30 dental students in their fourth year in a five-year undergraduate dental curriculum in New Zealand were randomly selected from a pool of volunteers (N=40) out of the total class of 85. The participants were placed into one of three groups of ten students each: Group A, the control group, received only written and pictorial instructions; Group B received tutor evaluation and feedback; and Group C performed self-directed learning with the aid of Preppr. Each student was asked to prepare an all-ceramic crown on the lower first molar typodont within three hours and to repeat the exercise three times over the next four weeks. The exercise stipulated a 1 mm finish line dimension and total convergence angles (TOC) between 10 and 20 degrees. Fulfillment of these parameters was taken as an acceptable preparation. The results showed that Group C had the highest percentage of students who achieved minimum finish line dimensions and acceptable TOC angles. Those students also achieved the stipulated requirements earlier than the other groups. This study's findings provide promising data on the feasibility of using Preppr as a self-directed educational tool for students training to prepare dental crowns.

Convergence angles and margin widths of tooth preparations by New Zealand dental students.

STATEMENT OF PROBLEM: Fundamental crown preparation principles are taught and are highly regarded in dental education. Whether tooth preparations made by dental students match these principles is unclear. PURPOSE: The purpose of this retrospective study was to report the total occlusal convergence (TOC) and margin widths of crown preparations clinically prepared by New Zealand predoctoral dental students between 2013 and mid-2015. MATERIAL AND METHODS: A total of 371 stereolithography files of tooth preparations for metal ceramic crowns prepared by predoctoral dental students were extracted from the Technical Services Laboratory database at the University of Otago. The files were put through the preparation measuring software Preppr, with outputs being TOC angles in faciolingual and mesiodistal cross sections and margin widths in facial, lingual, distal, and mesial aspects. Means, standard deviations, 95% confidence intervals, and distributions using box and whisker graphs were calculated and presented. RESULTS: The majority of TOC angles fell within an acceptable range of 10 to 20 degrees; however, the angles ranged from undercuts (<0 degrees) to >60 degrees. The majority of margin widths were between 0.5 and 1 mm, while the maximum was approximately 2 mm and the minimum was 0 mm. CONCLUSIONS: Predoctoral dental students in New Zealand are able to produce literature-recommended TOC angles and margin widths for metal ceramic crowns; however, further attention and training are needed for excessive tooth preparations, mainly in the form of large TOC angles.

Reporting numeric values of complete crowns. Part 1: Clinical preparation parameters.

STATEMENT OF PROBLEM: An implemented objective measuring system for measuring clinical tooth preparations does not exist. PURPOSE: The purpose of this study was to compare clinically achieved tooth preparations for ceramic crowns by general dentists with the recommended values in the literature with an objective measuring method. MATERIAL AND METHODS: Two hundred thirty-six stone dies prepared for anterior and posterior complete ceramic crown restorations (IPS e.max Press; Ivoclar Vivadent) were collected from dental laboratories. The dies were scanned and analyzed using the coordinate geometry method. Cross-sectioned images were captured, and the average total occlusal convergence angle, margin width, and abutment height for each preparation was measured and presented with associated 95% confidence intervals. RESULTS: The average total occlusal convergence angles for each tooth type was above the recommended values reported in the literature. The average margin widths (0.40 to 0.83 mm) were below the minimum recommended values (1 to 1.5 mm). The tallest preparations were maxillary canines (5.25 mm), while the shortest preparations were mandibular molars (1.87 mm). CONCLUSIONS: Complete crown preparations produced in general practice do not achieve the recommended values found in the literature. However, these recommended values are not based on clinical trials, and the effects of observed shortfalls on the clinical longevity of these restorations are not predictable.

Reporting numeric values of complete crowns. Part 2: Retention and resistance theories.

STATEMENT OF PROBLEM: Determining the retention and resistance of a tooth preparation for a complete crown has only existed in theory, and these theories have never been measured on tooth preparations performed in vivo. PURPOSE: The purpose of this study was to measure the theoretical retention and resistance of clinically produced complete crown preparations by using an objective measuring method. MATERIAL AND METHODS: Stone dies from 236 complete crown preparations were collected from dental laboratories. The dies were scanned and analyzed with the coordinate geometry method. Cross-sectional images were captured, and the surface area was measured with a cone frustum and right truncated pyramid formula. Two different theories of resistance form, the "on" or "off" theory (limiting taper) and the linear model (resistance length), were calculated for premolar and molar preparations. RESULTS: The mean surface areas ranged from 33.97 mm(2) to 105.44 mm(2) for the cone frustum formula and 41.75 mm(2) to 117.50 mm(2) for the right truncated pyramid formula. The facial side of maxillary premolars exhibited the highest percentage of resistance form with the limiting taper, at 58%, and the mesial side of the mandibular molars exhibited the lowest percentage of resistance form, at 6%. CONCLUSIONS: The objective method used in this study provides a way for retention and resistance theories to be tested and for further clinical implications to be investigated.

Clinical tooth preparations and associated measuring methods: a systematic review.

STATEMENT OF PROBLEM: The geometries of tooth preparations are important features that aid in the retention and resistance of cemented complete crowns. The clinically relevant values and the methods used to measure these are not clear. PURPOSE: The purpose of this systematic review was to retrieve, organize, and critically appraise studies measuring clinical tooth preparation parameters, specifically the methodology used to measure the preparation geometry. MATERIAL AND METHODS: A database search was performed in Scopus, PubMed, and ScienceDirect with an additional hand search on December 5, 2013. The articles were screened for inclusion and exclusion criteria and information regarding the total occlusal convergence (TOC) angle, margin design, and associated measuring methods were extracted. The values and associated measuring methods were tabulated. RESULTS: A total of 1006 publications were initially retrieved. After removing duplicates and filtering by using exclusion and inclusion criteria, 983 articles were excluded. Twenty-three articles reported clinical tooth preparation values. Twenty articles reported the TOC, 4 articles reported margin designs, 4 articles reported margin angles, and 3 articles reported the abutment height of preparations. A variety of methods were used to measure these parameters. CONCLUSIONS: TOC values seem to be the most important preparation parameter. Recommended TOC values have increased over the past 4 decades from an unachievable 2- to 5-degree taper to a more realistic 10 to 22 degrees. Recommended values are more likely to be achieved under experimental conditions if crown preparations are performed outside of the mouth. We recommend that a standardized measurement method based on the cross sections of crown preparations and standardized reporting be developed for future studies analyzing preparation geometry.

Coordinate geometry method for capturing and evaluating crown preparation geometry.

STATEMENT OF PROBLEM: A validated universal method requiring no human input is needed to capture and evaluate preparation geometries in a manner that can be used to see the correlation of different parameters. PURPOSE: The purpose of this study was to present a method of capturing and evaluating crown preparation geometry. MATERIAL AND METHODS: One manually machined acrylic resin block and 9 randomly selected preparations for ceramic complete crowns prepared by general dentists were selected and prepared. The specimens were scanned (3D scanner; Nobel Biocare), and buccolingual and mesiodistal cross section images were collected. The images were imported into digitizing software (Engauge Digitizer 4.1) to convert the outlines into x and y coordinates. Six points were chosen by using a set of algorithms, and the resulting parameters were calculated. RESULTS: The acrylic resin block was milled with a 12 degree total occlusal convergence (TOC) instrument producing a 12.83 degree TOC. For the other specimens, average TOC values ranged from 18 degrees to 52 degrees. The mean average margin width was 0.70 mm, and the mean average base dimension was 6.23 mm. The surface area/volume ratio, resistance length, and limiting taper were also calculated. CONCLUSIONS: The method described provides a basis for accurately evaluating preparation geometry without human input.

Influence of veneering porcelain thickness and cooling rate on residual stresses in zirconia molar crowns.

OBJECTIVE: The aim of this study was to investigate the influence of increasing veneering porcelain thickness in clinically representative zirconia molar crowns on the residual stresses under fast and slow cooling protocols. METHODS: Six veneered zirconia copings (Procera, Nobel Biocare AB, Gothenburg, Sweden) based on a mandibular molar form, were divided into 3 groups with flattened cusp heights that were 1mm, 2mm, or 3mm. Half the samples were fast cooled during final glazing; the other half were slow cooled. Vickers indentation technique was used to determine surface residual stresses. Normality distribution within each sample was done using Kolmogorov-Smirnov & Shapiro-Wilk tests, and one-way ANOVA tests used to test for significance between various cusp heights within each group. Independent t-tests used to evaluate significance between each cusp height group with regards to cooling. RESULTS: Compressive stresses were recorded with fast cooling, while tensile stresses with slow cooling. The highest residual compressive stresses were recorded on the fast cooled 1mm cusps which was significantly higher than the 2 and 3mm fast cooled crowns (P<0.05). There was a significant linear trend for residual stress to decrease as veneering porcelain thickness increased in the fast cooled group (P<0.05). No significant differences were found between the various cusp heights during slow cooling (P≥0.05). SIGNIFICANCE: Cooling rate and geometric influences in a crown anatomy have substantially different effects on residual stress profiles with increasing veneering porcelain thickness compared to the basic flat plate model.