Principles governing the prosthodontic treatment of patients with cardiac transplants.

As the survival rate of patients with cardiac transplants improves, it is more likely that dentists will have to provide extensive dental care and it is important to know the special precautions that must be taken when treating these patients. In this report on the prosthodontic treatment of a patient with a cardiac transplant and an unstable medical history, specific dental management guidelines are proposed. The treatment illustrates an alternative to complex and prolonged restorative treatment for patients with compromised post-transplant recovery.

A comparative study of the strength of aluminous porcelain and all-ceramic crowns.

This study compared the breaking strengths of all-ceramic crowns constructed with aluminous porcelain, the Cerestore system, and the Dicor system on an anterior tooth preparation. Fifteen crowns from each group were constructed to comparable dimensions on dies from the same master die. Ten crowns from the same group were cemented on the master die and loaded until catastrophic failure. Five crowns from each group were embedded and sectioned to examine internal adaptation. No significant difference was found between the load necessary to produce failure in the aluminous porcelain and Dicor crowns and the load needed to initiate crack formation in the Cerestore crowns. However, seven of the 10 Cerestore crowns showed a two-phase failure pattern; the difference between crack initiation and catastrophic failure was significant. Within the limitation of this study, neither the Cerestore (high alumina core) nor the Dicor (castable glass-ceramic) produced an all-ceramic crown superior to the current aluminous porcelain crown.

A comparison of the physical properties of four prosthetic veneering materials.

Four resin materials used to veneer metal castings were compared by evaluating certain physical properties. Three of the materials were microfilled resins and one was an unfilled resin. Although no material proved to be superior in all of the tests, the microfilled materials were generally better than the unfilled materials. The heat- and pressure- polymerized microfilled material was inferior to the two light-polymerized microfilled materials in three of the physical property tests, superior to them in one test, and proved to be equivalent to them in two tests.

The contribution of a pinhole to the retention and resistance form of veneer crowns.

This research quantitatively compared the retention and resistance of various designs of maxillary premolar partial veneer crown preparations. Crowns were evaluated with and without proximal boxes and occlusal pins. In the absence of boxes or grooves, pins markedly enhanced both retention and resistance. In the presence of proximal boxes, pins contributed only to retention and had no significant effect on resistance. If pins are used, the cement should be spiralled into the pin hole. As resistance is usually the more crucial parameter in preparation designs, it seems that wherever efficient axial modifications can be incorporated, the pinhole modification may be of little advantage.

A comparison of the strength of base metal and gold solder joints.

The purpose of this study was to evaluate the procedures involved in forming high- and low-fusing solder joints between two different base metal alloys and to compare the strength of these joints with the strength of those formed between specimens made from a high-gold content alloy. The conclusions of this investigation can be summarized as follows. All but 11 of the 120 specimens failed through the solder joint, which confirms that the solder joint is usually the weakest part of a fixed partial denture. The high-fusing joints formed between the base metal alloys showed higher relative bending strength values than the high-fusing joints formed between the gold alloy specimens. The low-fusing joints formed between the base metal alloys showed higher relative bending strength values than the low-fusing joints formed between the gold alloy specimens, and the low-fusing base metal joints exhibited the highest strength values in this study. The low-fusing joints formed between gold alloy specimens consistently bent before fracturing. Solder joints fail both adhesively (separation of the solder from the parent metal) and cohesively (fracture through the solder, parent metal, or a combination of both). A correctly formed joint between gold components should show cohesive fracture, whereas adhesive fractures are apparently acceptable with base metal alloys since the low-fusing base metal joints failed in this manner but still exhibited high strength values. Voids of different sizes and locations were observed in most of the solder joints, and within each group tested there was usually less strength exhibited by the joints with larger areas of porosity.

The effects of enamel wear on the metal-porcelain interface.

This study evaluated the effects of wear of human tooth enamel on the metal-porcelain interface. Failure in the porcelain half of the specimens occurred only in specimens where the metal angle was 60 degrees. There was failure in one of four of the noble metal alloy specimens. With the base metal alloy specimens, in the first group two specimens showed cracks in the preparation stage while the other two showed no sign of cracks either before or after testing. In a second group of four base metal alloy specimens with a 60-degree angle, all four specimens showed cracks in the porcelain after glazing. These specimens were repaired by grinding out the cracks and filling them with porcelain. After wear-testing, all four specimens developed cracks. The data indicate that the acute angle of metal (60 degrees) at the metal-porcelain interface was more conducive to crack formation than were the other two angles tested. Therefore, in the case of a metal-ceramic restoration, with the occlusion on the metal, an acute angle of metal would not be appropriate. Furthermore, under clinical circumstances cracks that occur after glazing, as arose with the last four base metal alloy specimens (60 degrees), probably should not be ground out and refilled with porcelain. The results of this study indicate that such a practice in a clinical situation could lead to eventual fracture of the porcelain. The porcelain half of the specimens had a deeper and wider wear track than its metal counterpart, which indicated that the porcelain is less resistant than the metal to wear by enamel.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative study of the strength of aluminous porcelain jacket crowns constructed with the conventional and twin foil technique.

The purpose of this study was to evaluate and compare the strength of aluminous porcelain jacket crowns made in the following manners: (1) the conventional technique, (2) the conventional technique with a pure alumina insert, (3) the twin foil technique, and (4) the twin foil technique with a pure alumina insert. The conclusions of this investigation can be summarized as follows: 1. Porosity was observed in all the restorations made by each of the techniques. 2. The porosity was greater at the porcelain-platinum foil interface than anywhere else throughout the restoration with both the conventional and twin foil techniques. 3. The porosity seemed to be evenly distributed along the interface, with no concentration in any area. 4. Regardless of the technique, crowns that were more porous fractured at lower values. 5. Crowns built by the twin foil technique were significantly more porous at the interface of the tin-plated platinum and the porcelain core than those built by the conventional technique. 6. Crowns constructed with the conventional technique were significantly stronger than those constructed with the twin foil technique. 7. There was no bond between the core porcelain and the platinum foil matrix in crowns constructed by the conventional technique. 8. There seemed to be a strong bond between the core porcelain and the tin-plated platinum matrix in crowns built by the twin foil technique. 9. The presence or absence of the alumina insert on crowns constructed with the conventional and twin foil technique did not affect the strength of the crowns when tested at the incisal edge.

The effect of relining on the accuracy and stability of maxillary complete dentures--an in vitro and in vivo study.

A technique was developed for evaluating in vitro the accuracy or fit of experimental denture bases using a low-viscosity impression material for determining the space between the master die and the processed denture base. These measurements indicated that relining heat-cured maxillary denture bases with autopolymerizing acrylic resin improved their adaptation to the ridges. Interestingly, if no teeth were present in the heat-cured denture base, markedly less distortion occurred after processing. Limited clinical measurements on the stability of maxillary dentures in function showed no statistically significant change in stability after relining, but the trend was toward increased stability with the relined denture.

A comparison of pin-retained amalgam and composite resin cores.

The 24 hour tensile loads required to separate the core material and dentin produced the following results: 1. No statistical difference was found between the tensile strength of retained amalgam and composite resin core materials. 2. Generally, no statistical difference was found between the retentive ability of three and four pins. 3. No statistical difference was found between the retentive ability of regular pins and minim pins if three or more pins were employed. 4. As the number of regular pins was increased beyond three, and when four minim pins were used, there was a very significant increase in dentin fracture.

The collarless metal-ceramic crown.

A technique has been developed whereby collarless metal-ceramic crowns can be fabricated by spot-welding the platinum-foil matrix to the casting after it has been contoured for porcelain application. The main advantage of this procedure over previously reported techniques is that it produces well fitted restorations while requiring a lesser degree of technical skill.