Assessment of the Internal Fit of Lithium Disilicate Crowns Using Micro-CT.

PURPOSE: The aim of this study was to compare the internal fit of lithium disilicate crowns fabricated using digital technology with those fabricated by conventional means. MATERIALS AND METHODS: Forty-five lithium disilicate crowns were fabricated: 15 using digital impression and computer-aided design/computer-aided machining technique (group 1), 15 from the same digital impressions, but using a conventional die and laboratory fabrication process (group 2), and 15 using a conventional poly (vinyl siloxane) (PVS) impression and laboratory fabrication process (group 3). Tooth #15 was prepared for all-ceramic restoration on an ivorine typodont, which was digitized and a replica milled in zirconia to serve as master model. The master zirconia model was used for the impression procedures. Duplicate dies of the master zirconia die were made in polyurethane, enabling the internal fit of each crown to be evaluated using X-ray microcomputed tomography. The total volume of the internal space between the crown and die, the mean and maximum thickness of this space, and the percentage of the space that was at or below 120 µm thickness was calculated for each group and statistically tested for significant difference using one-way ANOVA, with post hoc Scheffé analysis. RESULTS: Group 1 crowns resulted in a smaller volume of internal space (12.49 ± 1.50 mm(3)) compared to group 2 (15.40 ± 2.59 mm(3) ) and to those of group 3 (18.01 ± 2.44 mm(3)). The mean thickness of the internal space for group 1 (0.16 ± 0.01 mm) and for group 2 (0.17 ± 0.03 mm) was significantly lower than that of group 3 (0.21 ± 0.03 mm). The average percentage of the internal space of a thickness of 120 µm and below was different between the three groups: 46.73 ± 5.66% for group 1, 37.08 ± 17.69% for group 2, and 22.89 ± 9.72% for group 3. Three-dimensional renderings of the internal space were also created. CONCLUSIONS: The results of this study suggested that pressed and milled IPS e. max crowns from LAVA COS digital impressions had a better internal fit to the prepared tooth than pressed IPS e.max crowns from PVS impressions in terms of total volume of internal space, average thickness of internal space, and percentage of internal space at or below 120 µm.

Oral care needs, barriers and challenges among community dwelling elderly in New York State and northern Manhattan.

Older adults are living longer and retaining their teeth, resulting in a concomitant increase in the need for oral care services. Despite improvements in oral health among the elderly, there continue to be profound disparities by race/ethnicity, socioeconomic and dentate status. Furthermore, challenges, such as limitations in activities of daily living, poor wheel-chair accessibility of dental clinics, poor geographic distribution of providers, difficulty navigating the oral health system and fiscal limitations make access to, and utilization of, dental services difficult among older adults. While dialogue around national policy, especially incorporation of dental benefits for adults in Medicare and Medicaid, is imperative, local efforts in New York and Northern Manhattan show promise in addressing the oral health and health care of older New Yorkers.