Comparison of retention of monolithic zirconia crowns with alumina airborne-particle abraded and nonabraded intaglio using three different cements: A clinical simulation.

STATEMENT OF PROBLEM: The necessity of roughening the intaglio surface of zirconia crowns to achieve adequate retention is unclear. PURPOSE: The purpose of this clinical simulation study was to evaluate the retention of airborne-particle-abraded and nonabraded monolithic zirconia crowns using 3 different cement types. MATERIAL AND METHODS: Extracted human molars were used and prepared with a 10-degree taper. Impressions were made of the prepared teeth with a polyvinyl siloxane (PVS) material, and dies were made with Type 4 gypsum. Each die was scanned with a NobelProcera 1G Scanner, and the standard tessellation language (STL) files were transferred electronically to the Nobel Biocare production site, where a bar was added virtually on top of each crown and parameters were set for milling. Seventy-two Procera zirconia crowns were generated, of which half were airborne-particle abraded on the intaglio surface with 50-µm alumina particles at 400 to 500 kPa for 15 seconds. The other 36 received no intaglio treatment other than cleaning. Both groups of 36 crowns were divided into 3 subgroups of 12 specimens. The area of each preparation was calculated using a computer-aided design software program. The specimens were distributed to attain similar mean surface areas among the cementation groups. The crowns were cemented onto the specimen with a controlled force of 196 N. The 3 cements used were self-adhesive, modified resin RelyX Unicem Aplicap, resin-modified glass ionomer RelyX Luting, and a composite resin, Panavia F2.0 with ED Primer A & B. All specimens were thermocycled (5 °C to 55 °C) for 5000 cycles and then removed axially with a universal testing machine (Instron Model 5585H) at a crosshead speed of 0.5 mm/min. The removal force was recorded, and stress of dislodgement was calculated for each crown. A 2-way analysis of variance was used for statistical analyses. The type of failure was analyzed with the chi-squared test of association for independent samples (α=.05 for all tests). RESULTS: The mean dislodging force for crowns with airborne-particle abraded intaglio was 5.4 MPa, which was statistically greater than the mean of 3.2 MPa for nonabraded specimens (P<.001). No significant differences related to the dislodging stresses were detected among the 3 cements (P=.109). The mode of failure was similar whether abraded or not, with 50% of specimens retaining cement in the crown after separation. CONCLUSIONS: Alumina airborne-particle abrasion of the intaglio of zirconia to create surface roughness is beneficial in retaining the crowns, regardless of the cement type. The nonabraded crowns demonstrated significantly lower retentive stress with crown removal. The principal mode of failure was similar whether the zirconia intaglio was airborne-particle abraded or not. The most common mode of failure (>50% of specimens) was at least three-fourths of the cement remaining within the crown.

Long-term retention of lithium disilicate crowns with a current bioactive cement.

OBJECTIVE: To determine if a recent bioactive cement provides acceptable lithium disilicate crown retention after long-term aging with monthly thermocycling. MATERIALS AND METHODS: Extracted molars prepared with flat occlusal, 20° taper, ~4 mm axial. Prepared teeth assigned to two groups for equal mean surface areas per group. Lithium disilicate crowns fabricated with occlusal bar to facilitate removal. Crowns etched with 9.5%HF and cleaned. Cements were Ceramir Crown & Bridge QuikCap (CM) and Ketac Cem Maxicap (KC). Before cementation, specimens stored in 37°C water. Crowns cemented with 196 N force, placed in 37°C, 100% humidity oven for setting. Specimens thermocycled (5-55°C) 5000 cycles monthly for 6 months; otherwise stored in phosphate buffered saline solution. Crowns removed axially at 0.5 mm/min. Removal forces recorded and stresses calculated using areas. Independent t-test (α = 0.05). RESULTS: Levene test not significant (P = 0.649). CM removal stresses and forces (P < 0.001) were higher (1.93 MPa, 261.4 N) compared to KC (1.06 MPa, 139.4 N). CM cement found principally on crown intaglio, KC found with most cement on prepared tooth. Chi-square significant (P < 0.001). CONCLUSIONS: Following long-term aging with monthly thermocycling, lithium disilicate crowns were best retained by CM cement, however both cements are capable of retaining lithium disilicate crowns with preparations of ideal taper and length. CLINICAL SIGNIFICANCE: Results serve as a basis for bioactive cement selection for retaining lithium disilicate crowns. Without optimal axial length, taper of preparation or retentive features, Ceramir Crown and Bridge QuikCap offers a bioactive cement with improved long-term retention when compared to Ketac Cem Maxicap for lithium disilicate crowns.

Long-term retention of zirconia crowns cemented with current automixed cements.

STATEMENT OF PROBLEM: Automixing and dispensing cements is a straightforward approach with consistent dosing. Previous studies have demonstrated clinically significant differences in crown retention between power-liquid and paste-paste forms of the same cement, as the composition between the 2 differs. A self-adhesive modified-resin (SAMR) and a resin-modified glass ionomer (RMGI) cement, originally offered as a powder-liquid, are now in common use as paste-paste automixed cements. With the increased use of zirconia restorations, the long-term retention of zirconia crowns for these 2 automixed cements should be evaluated. PURPOSE: The purpose of this in vitro study was to determine whether zirconia crowns cemented with 2 automixed cements provided clinically acceptable retention after 6 months of aging with monthly thermocycling. MATERIAL AND METHODS: Extracted molars were mounted in resin and prepared with a flat occlusal surface, 20-degree taper, approximately 4-mm axial length, and with the axio-occlusal line angle slightly rounded. Prepared teeth were equally distributed into 3 cementation groups (n=12) to achieve nearly equal mean preparation surface areas for each group. Zirconia crowns (IPS ZirCAD LT) were fabricated with an added occlusal bar to facilitate removal of the cemented crowns. Cement space was set at 45 µm axially and 55 µm occlusally. After sintering and before delivery, the intaglio surfaces were airborne-particle abraded with 50-µm alumina at 275-kPa pressure for 3 seconds and then steam cleaned. Cements were the original powder-liquid RelyX Luting (RMGI; RXL) as the control, paste-paste, automixed systems RelyX Luting Plus Automix (RMGI; RXLA), and RelyX Unicem 2 Automix (SAMR; RXUA). Crowns were cemented under 196 N force, placed in an oven at 37 °C and 100% humidity during setting and then thermocycled (5 °C-55 °C) for 5000 cycles monthly for 6 months. The crowns were removed axially with a universal testing machine at 0.5 mm/min. Removal forces were recorded and dislodgement stress calculated by using the surface area of each preparation. One-way ANOVA was used for dislodgement stress and force. Chi-square test was used for cement location after testing (α=.05). RESULTS: RXLA demonstrated considerably lower crown retention (1.3 MPa) and differed significantly (P<.001) from RXUA (3.1 MPa) and RXL (3.1 MPa). Modes of failure showed most of the cement remaining only in the crown intaglio for RXLA for all specimens, whereas half of the crowns for RXL and RXUA demonstrated cement adhesion to both dentin and the intaglio surface, indicating cohesive failure of the cement at separation. As the Levene test was significant, the Games-Howell test was used for mean differences. The χ2 analysis was significant. CONCLUSIONS: After long-term aging with monthly thermocycling, high-strength zirconia crowns were strongly retained by 2 (RXL, RXUA) of the 3 cements. Crown retention for RelyX Luting Plus Automix was less than half in comparison and with cement found only on the intaglio surface after separation.

Simplified cementation of lithium disilicate crowns: Retention with various adhesive resin cement combinations.

STATEMENT OF PROBLEM: A composite resin cement and matching self-etch adhesive was developed to simplify the dependable retention of lithium disilicate crowns. The efficacy of this new system is unknown. PURPOSE: The purpose of this in vitro study was to determine whether lithium disilicate crowns cemented with a new composite resin and adhesive system and 2 other popular systems provide clinically acceptable crown retention after long-term aging with monthly thermocycling. MATERIAL AND METHODS: Extracted human molars were prepared with a flat occlusal surface, 20-degree convergence, and 4 mm axial length. The axio-occlusal line angle was slightly rounded. The preparation surface area was determined by optical scanning and the analysis of the standard tessellation language (STL) files. The specimens were distributed into 3 cement groups (n=12) to obtain equal mean surface areas. Lithium disilicate crowns (IPS e.max Press) were fabricated for each preparation, etched with 9.5% hydrofluoric acid for 15 seconds, and cleaned. Cement systems were RelyX Ultimate with Scotch Bond Universal (3M Dental Products); Monobond S, Multilink Automix with Multilink Primer A and B (Ivoclar Vivadent AG); and NX3 Nexus with OptiBond XTR (Kerr Corp). Each adhesive provided self-etching of the dentin. Before cementation, the prepared specimens were stored in 35°C water. A force of 196 N was used to cement the crowns, and the specimens were polymerized in a 35°C oven at 100% humidity. After 24 hours of storage at 100% humidity, the cemented crowns were thermocycled (5°C to 55°C) for 5000 cycles each month for 6 months. The crowns were removed axially at 0.5 mm/min. The removal force was recorded and the dislodgement stress calculated using the preparation surface area. The type of cement failure was recorded, and the data were analyzed by 1-way ANOVA and the chi-square test (α=.05) after the equality of variances had been assessed with the Levene test. RESULTS: The Levene test was nonsignificant (P=.936). The ANOVA revealed the mean removal stresses, and forces did not differ for RelyX Ultimate with Scotchbond Universal (3.9 MPa; 522 N) and Multilink Automix with Multilink Primer (3.7 MPa; 511 N); both differed significantly (P=.022) from the mean for NX3 Nexus with OptiBond XTR (2.9 MPa; 387 N). For all 3 cements, the modes of failure showed cement principally on the crown intaglio, and the chi-square analysis was nonsignificant (P=.601). CONCLUSIONS: IPS e.max Press (lithium disilicate) crowns were well retained (2.9-3.9 MPa; 387-522 N) by the 3 cement-adhesive combinations after 6 months of aging with monthly thermocycling. These results can serve as a basis for cement selection for this type of crown because the values significantly exceeded those for zinc phosphate. Cements using their matched dentin bonding agent as the ceramic primer were as successful as cements with a separate silane coupling agent.

Clinical success rates for polyether crown impressions when mixed dynamically and statically.

The purpose of this study is to compare success rates of dual-viscosity impressions for two types of mixing techniques of the polyether elastomeric impression material. Additionally, influencing parameters on the success rates should be evaluated. The expectation was that there would be no difference between the success rates for the two mixing techniques. Two centres enrolled 290 subjects (727 teeth) into the trial. Patients were randomized for the two types of mixing techniques. One step, dual-viscosity impressions were made with either statically mixed Impregum Soft tray material (SAM) or dynamically mixed Impregum Penta H DuoSoft (DMM). Low viscosity Impregum Garant L DuoSoft was used for both groups. Gingival displacement involved the use of two braided cords. Full-arch trays were used exclusively. Both critical defects and operator errors were assessed for the first impression taken by trained dentists. The primary outcome was impression success. For comparison of the two mixing techniques, the odds ratio for success and the corresponding one-sided 95% confidence interval was calculated by a logistic regression model. To account for the dependence between several teeth within one patient, the method of general estimating equations was used. The overall impression success rate was 35.4%. Both mixing techniques showed equal success rates indicated by an OR of 1.0 and a lower limit of the one-sided 95% confidence interval of 0.71. Using this result to develop the corresponding interval for the difference, it could be shown that the success rate using SAM was at most 8.2% lower than that when using DMM with a probability of 95%. Multivariate logistic regression analysis of other potential influencing factors showed position of finish line (p = 0.008, supra compared to mixed), blood coagulation disorder (p = 0.021) and the level of training of the clinician (student vs dentist, p=0.008) to have an independent influence on the success rate. Dynamic mechanical mixing and the new static mixing of polyether tray material showed nearly equal success rates in the study even though success rates were comparatively low (DMM, 35.3%; SAM, 35.4%).

Accuracy of the newly formulated vinyl siloxanether elastomeric impression material.

STATEMENT OF PROBLEM: A newly formulated vinyl siloxanether elastomeric impression material is available, but there is little knowledge of its accuracy in relation to existing materials. PURPOSE: The purpose of this in vitro study was to assess the accuracy of disinfected vinyl siloxanether impressions and compare the accuracy to a common vinyl polysiloxane and a polyether impression system. MATERIAL AND METHODS: Impressions were made from a modified dentoform master model containing a simulated crown preparation. Dimensional changes (mm) between the master model and working casts (type IV gypsum) were assessed. The following were evaluated: vinyl polysiloxane in a 1-step, dual-viscosity technique (VPS Dual), polyether as monophase material (PE Mono), and vinyl siloxanether in a 1-step, dual-viscosity (VSE Dual), and monophase technique (VSE Mono). Measurements of the master model and working casts, including anteroposterior (AP) and cross-arch (XA) dimensions, were made with a measuring microscope. The simulated crown preparation was measured in mesiodistal (MDG, MDO), buccolingual (BLG, BLO), and occlusogingival dimensions (OGL, OGB). Disinfection involved immersion for 10 minutes in potassium peroxomonosulfate, sodium benzoate, tartaric acid solution, or no disinfection (control) (n=8). A multivariate GLM statistical approach (MANOVA) was used to analyze the data (alpha=.05). Pearson's correlation test was used for related dimensions. RESULTS: The AP and XA dimensions of working casts were larger than the master for the disinfected condition and control. Whether disinfected or not, the working dies were shorter in height (OGB, OGL), larger in the buccolingual dimension (BLO, BLG), somewhat larger in the MDO dimension, and somewhat smaller in the MDG dimension compared to the prepared tooth of the master model, resulting in an irregular or oval profile. There were significant differences among the impression systems for each dimension except AP. Differences between the disinfected and nondisinfected conditions were significant (P=.03) with respect to dimensions of the gypsum working cast, but not for dimensions of the working die (P=.97). In general, differences relative to the master were small and of minor clinical significance considering marginal gaps of crowns smaller than 150-100 mum are considered clinically acceptable. CONCLUSIONS: VSE monophase impressions and VSE dual-viscosity impressions demonstrated acceptable accuracy for clinical use with immersion disinfection, since the results for VSE were comparable to the results for PE and VPS materials, and the differences as compared to the master model were small.

Clinical trial investigating success rates for polyether and vinyl polysiloxane impressions made with full-arch and dual-arch plastic trays.

STATEMENT OF PROBLEM: Success rates for making fixed prosthodontic impressions based on material and tray selection are not known. PURPOSE: The purpose of this clinical study was to compare first impression success rates for 2 types of impression material and 2 impression tray systems. MATERIAL AND METHODS: Dual-viscosity impressions were made with a vinyl polysiloxane (VPS) (Aquasil Ultra Monophase/Aquasil Ultra XLV) and a polyether (PE) (Impregum Penta Soft HB/Impregum Garant Soft LB) impression material. The first impression made was evaluated for success or failure using developed criteria. Fifty senior dental students participated. The type of impression material alternated for each new patient. A full-arch perforated plastic (President Tray) or a plastic dual-arch impression tray (Tri-Bite) was used based on clinical guidelines. Impression success rates were compared using logistic regression, fitted using the method of generalized estimating equations (alpha=.05). RESULTS: One hundred ninety-one impressions were evaluated, and the overall success rate was 61% for VPS and 54% for PE (P=.39). Additional regression analyses, adjusted for potential confounders, did not indicate a difference between the 2 systems (P=.35). There was little difference in success rates between the 2 materials when a full-arch tray was used (50% versus 49% success, P=.89), whereas a larger difference was apparent with the use of dual-arch trays (70% success with VPS versus 58% success with PE, P=.21). The most common critical defect was located on the preparation finish line (94%), and the most common operator error was inadequate gingival displacement (15%). CONCLUSIONS: There was little difference in success rates between VPS and PE when full-arch impression trays were used, but there was greater success when using VPS with dual-arch trays. For single teeth, the trend favored VPS, but when more than one prepared tooth per impression was involved, the success rate was higher for PE.

Accuracy of a new ring-opening metathesis elastomeric dental impression material with spray and immersion disinfection.

STATEMENT OF PROBLEM: A new elastomeric impression material has been formulated with a ring-opening metathesis chemistry. In addition to other properties of clinical significance, the impression accuracy must be confirmed. PURPOSE: The purpose of this study was to compare the accuracy of the new elastomeric impression material with vinyl polysiloxane and polyether following both spray and immersion disinfection. MATERIAL AND METHODS: Impressions of a modified dentoform with a stainless steel crown preparation in the lower right quadrant were made, and type IV gypsum working casts and dies were formed. Anteroposterior (AP), cross-arch (CA), buccolingual (BL), mesiodistal (MD), occlusogingivobuccal (OGB), and occlusogingivolingual (OGL) dimensions were measured using a microscope. Working cast and die dimensions were compared to those of the master model. The impression materials were a newly formulated, ring-opening metathesis-polymerization impression material (ROMP Cartridge Tray and ROMP Volume Wash), vinyl polysiloxane (VPS, Aquasil Ultra Monophase/LV), and a polyether (PE, Impregum Penta Soft/Permadyne Garant L). Fifteen impressions with each material were made, of which 5 were disinfected by spray for 10 minutes (CaviCide), 5 were disinfected by immersion for 90 minutes (ProCide D), and 5 were not disinfected. There were significant cross-product interactions with a 2-way ANOVA, so a 1-way ANOVA and Dunnett's T3 multiple comparison test were used to compare the dimensional changes of the 3 impression materials, by disinfection status and for each location (alpha=.05). RESULTS: For ROMP, there were no significant differences from the master, for any dimension, when comparing the control and 2 disinfectant conditions. No significant differences were detected among the 3 impression materials for CA, BL, and MD. The working die dimensions of OGB and OGL for VPS with immersion disinfection were significantly shorter than with PE and ROMP (P<.05). Overall, the AP dimension was more accurate than CA, and the BL of working dies was 0.040 mm greater in diameter than MD. CONCLUSIONS: The accuracy of gypsum working casts and working dies from the new and 2 existing types of impression material were similar, for both spray and immersion disinfection. Judicious application of a die spacer can compensate for the small differences observed. VPS may require additional laboratory accommodation to compensate for a shorter working die.

Retention of metal-ceramic crowns with contemporary dental cements.

BACKGROUND: New types of crown and bridge cement are in use by practitioners, and independent studies are needed to assess their effectiveness. The authors conducted a study in three parts (study A, study B, and study C) and to determine how well these new cements retain metal-ceramic crowns. METHODS: The authors prepared teeth with a 20-degree taper and a 4-millimeter length. They cast high-noble metal-ceramic copings, then fitted and cemented them with a force of 196 newtons. The types of cements they used were zinc phosphate, resin-modified glass ionomer, conventional resin and self-adhesive modified resin. They thermally cycled the cemented copings, then removed them. They recorded the removal force and calculated the stress of dislodgment by using the surface area of each preparation. They used a single-factor analysis of variance to analyze the data (alpha = .05). RESULTS: The mean stresses necessary to remove crowns, in megapascals, were 8.0 for RelyX Luting (3M ESPE, St. Paul, Minn.), 7.3 for RelyX Unicem (3M ESPE), 5.7 for Panavia F (Kuraray America, New York) and 4.0 for Fuji Plus (GC America, Alsip, Ill.) in study A; 8.1 for RelyX Luting, 2.6 for RelyX Luting Plus (3M ESPE) and 2.8 for Fuji CEM (GC America) in study B; and 4.9 for Maxcem (Kerr, Orange, Calif.), 4.0 for BisCem (Bisco, Schaumburg, Ill.), 3.7 for RelyX Unicem Clicker (3M ESPE), 2.9 for iCEM (Heraeus Kulzer, Armonk, N.Y.) and 2.3 for Fleck's Zinc Cement (Keystone Industries, Cherry Hill, N.J.) in study C. CONCLUSIONS: Powder-liquid versions of new cements were significantly more retentive than were paste-paste versions of the same cements. The mean value of crown removal stress for the new self-adhesive modified-resin cements varied appreciably among the four cements tested. All cements retained castings as well as or better than did zinc phosphate cement. CLINICAL IMPLICATIONS: Powder-liquid versions of cements, although less convenient to mix, may be a better clinical choice when crown retention is an issue. All cements tested will retain castings adequately on ideal preparations because the corresponding removal stresses are comparable with or higher than those associated with zinc phosphate. Powder-liquid resin-modified glass ionomer cement, selected self-adhesive modified-resin cements and conventional resin cements provide additional retention when desired.

Accuracy of a reformulated fast-set vinyl polysiloxane impression material using dual-arch trays.

STATEMENT OF PROBLEM: A common technique used for making crown impressions involves use of a vinyl polysiloxane impression material in combination with a dual-arch tray. A leading dental manufacturer has reformulated its vinyl polysiloxane (VPS) impression line, but the accuracy of the new material has not been verified. PURPOSE: The purpose of this study was to assess the accuracy of reformulated VPS impression materials using the single-step dual-arch impression technique. MATERIAL AND METHODS: Dual-arch impressions were made on a typodont containing a master stainless steel standard crown preparation die, from which gypsum working dies were formed, recovered, and measured. The impression materials evaluated were Imprint 3 Penta Putty with Quick Step Regular Body (IP-0); Imprint 3 Penta Quick Step Heavy Body with Quick Step Light Body (IP-1); Aquasil Ultra Rigid Fast Set with LV Fast Set (AQ-1); and Aquasil Ultra Heavy Fast Set with XLV Fast Set (AQ-2) (n=10). All impressions were disinfected with CaviCide spray for 10 minutes prior to pouring with type IV gypsum. Buccolingual (BL), mesiodistal (MD), and occlusogingival (OG) dimensions were measured and compared to the master die using an optical measuring microscope. Linear dimensional change was also assessed for IP-0 and AQ-1 at 1 and 24 hours based on ANSI/ADA Specification No. 19. Single-factor ANOVA with Dunnett's T3 multiple comparisons was used to compare BL, MD, and OG changes, with hypothesis testing at alpha=.05. A repeated-measures ANOVA was used to compare linear dimensional changes. RESULTS: There were statistical differences among the 4 impression systems for 3 of 4 dimensions of the master die. IP-0 working dies were significantly larger in MD and OG-L dimensions but significantly smaller in the BL dimension. IP-1 working dies were significantly smaller in the BL dimension compared to the master die. With the exception of IP-0, differences detected were small and clinically insignificant. No significant differences were observed for linear dimensional change. CONCLUSIONS: The single-step dual-arch impression technique produced working dies that were smaller in 3 of the 4 dimensions measured and may require additional die relief to achieve appropriate fit of cast restorations. Overall accuracy was acceptable for all impression groups with the exception of IP-0.

Effect of cement selection and finishing technique on marginal opening of cast gold inlays.

STATEMENT OF PROBLEM: The standard cement for partial-veneer cast gold restorations has been zinc phosphate. With increasing interest in using resin and resin-modified glass ionomer cements for this purpose, marginal adaptation with use of these newer cements must be assessed. PURPOSE: The purpose of this in vitro study was to determine if the marginal adaptation of cast gold inlays is comparable for 3 different luting agents and 3 finishing techniques. MATERIAL AND METHODS: Cast gold inlays were cemented into triangular preparations on the buccal surface of 45 extracted human molars. Three operators each used a different technique for finishing margins: finishing during cementation (FD), finishing before cementation (FB), and finishing before and during cementation (FBA). The 15 teeth for each operator were divided into 3 subgroups of 5 each to accommodate 3 cements: zinc phosphate (Fleck's zinc phosphate: ZP), resin-modified glass ionomer (RelyX Luting: RXL), and self-adhesive modified resin (RelyX Unicem: RXU). For all specimens, fine sandpaper disks followed by fine cuttle disks were used for finishing the castings. The marginal gap was measured using a Nikon measuring microscope at x50 magnification. Data were analyzed with a 1-way ANOVA for each cement (alpha=.05). RESULTS: There were significant differences among finishing techniques for each cement (P<.05). For ZP, the smallest mean marginal gaps were for FD (31 microm) and FBA (42 microm). For RXL, FBA produced the smallest gap (19 microm). For RXU, FB (23 microm) and FBA (22 microm) were optimal. CONCLUSIONS: Within the limitations of this in vitro study, the marginal gap attained with cementation of partial-veneer cast gold restorations with ZP (31 microm) can also be obtained using RXL or RXU. The techniques of FD or FBA are best used for ZP, whereas the FBA technique is best for RXL, and either FB or FBA is optimal for RXU. The FBA technique yielded a small gap; this was common to all 3 cements.

Microleakage of porcelain veneer restorations bonded to enamel and dentin with a new self-adhesive resin-based dental cement.

UNLABELLED: Cementation technique of bonded ceramic restorations is a time-consuming and technique-sensitive procedure critical to long-term success. OBJECTIVE: Evaluate the performance of a self-adhesive, modified-resin dental cement (Rely-X UniCem, 3M-ESPE) for the cementation of ceramic veneer restorations without previous conditioning of the tooth surface, and in combination with a one-bottle adhesive and a self-etching adhesive. METHODS: Thirty-six premolars received a veneer preparation that extended into dentin. Leucite-reinforced pressed glass ceramic (Empress 1) veneers were cemented following manufacturers' instructions, according to the following treatment groups (n=9): (1) Variolink-Excite Ivoclar-Vivadent (V+E control), (2) Unicem+Single Bond 3M-ESPE (U+SB), (3) Unicem+Adper Prompt L-Pop 3M-ESPE (U+AP), (4) Unicem 3M-ESPE (U). After 24h storage at 37 degrees C, teeth were thermocycled (2000 cycles) at 5 and 55 degrees C, immersed in ammoniacal silver nitrate for 24h, placed in a developer solution overnight and sectioned using a slow-speed saw. Three 1mm longitudinal sections were obtained from each tooth and evaluated for leakage with a microscope (1x to 4x). Imaging software was used to measure stain penetration along the dentin and enamel surfaces. RESULTS: ANOVA with SNK (alpha=0.05) revealed that on dentin, U had significantly less leakage than U+SB and U+AP, but no different than V+E; on enamel U had leakage values that were significantly greater than the groups with adhesives. SIGNIFICANCE: The self-adhesive cement U gave low leakage on dentin that was comparable to the cement that employed an adhesive for sealing dentin, whereas this cement benefits from use of an adhesive when cementing to enamel.

Retention of zirconium oxide ceramic crowns with three types of cement.

STATEMENT OF PROBLEM: Information about the retentive strength of luting agents for zirconium oxide-based crowns is limited. It is unknown if this type of high-strength ceramic restoration requires adhesive cementation to enhance retention. PURPOSE: The purpose of this in vitro study was to determine the ability of selected luting agents to retain a representative zirconium oxide ceramic crown under clinically simulated conditions. MATERIAL AND METHODS: Recently extracted human molars were prepared with a flat occlusal surface, 20-degree taper, and approximately 4-mm axial length. The axial and occlusal surface areas were determined, and specimens were distributed equally by total surface area into 3 cementation groups (n=12). Zirconium oxide ceramic copings (Procera AllZirkon) with an occlusal bar to facilitate removal were fabricated using computer-aided design/computer-assisted manufacturing (CAD/CAM) technology. All copings were airborne-particle abraded with 50-mum Al(2)O(3) and then cleaned in an ultrasonic bath with isopropyl alcohol. Provisional cement was removed from the prepared teeth, followed by a pumice prophy. After trial insertion, the copings were cleaned with phosphoric acid, rinsed, dried, and dehydrated with isopropyl alcohol. They were then cemented with a seating force of 10 kg per tooth, using either a composite resin cement with adhesive agent (Panavia F 2.0 and ED Primer A & B [PAN]), a resin-modified glass ionomer cement (Rely X Luting [RXL]), or a self-adhesive modified composite resin (Rely X Unicem [RXU]). The cemented copings were thermal cycled at 5 degrees C and 55 degrees C for 5000 cycles with a 15 second dwell time, and then removed along the path of insertion using a universal testing machine at 0.5 mm/min. The removal force was recorded, and the stress of dislodgement was calculated using the surface area of each preparation. A 1-way analysis of variance was used to analyze the data (alpha=.05). The nature of failure was also recorded. RESULTS: Mean dislodgement stresses were 5.1, 6.1, and 5.0 MPa for PAN, RXL, and RXU, respectively. The 1-way analysis of variance revealed no differences in mean crown removal stress among the 3 cementation groups. The predominant mode of failure was cement remaining principally on the zirconium oxide copings in 46% of the specimens, followed by cement found on the tooth in 25.7% of the specimens. CONCLUSIONS: Within the limitations of this study, the 3 luting agents, with mean removal stresses ranging from 5.0 to 6.1 MPa were not significantly different. The use of a composite resin cement with a bonding agent did not yield higher coping retention compared to the other 2 cements tested.

Accuracy of newly formulated fast-setting elastomeric impression materials.

STATEMENT OF PROBLEM: Elastomeric impression materials have been reformulated to achieve a faster set. The accuracy of fast-setting elastomeric impression materials should be confirmed, particularly with respect to disinfection. PURPOSE: The purpose of this study was to assess the accuracy of 2 types of fast-setting impression materials when disinfected with acid glutaraldehyde. MATERIAL AND METHODS: Impressions of the mandibular arch of a modified dentoform master model were made, from which gypsum working casts and dies were formed. Measurements of the master model and working casts included anteroposterior (AP) and cross-arch (CA) dimensions. A stainless steel circular crown preparation incorporated within the master model was measured in buccolingual (BL), mesiodistal (MD), and occlusogingival (OG) dimensions and compared to measurements from recovered gypsum dies. The impression materials examined were a fast-set vinyl polysiloxane (VPS-FS, Aquasil Ultra Fast Set), a fast-set polyether (PE-FS, Impregum Penta Soft Quick Step), and a regular-setting polyether as a control (PE, Impregum Penta). Disinfection involved immersion in 3.5% acid glutaraldehyde (Banicide Advanced) for 20 minutes, and nondisinfected impressions served as a control. Linear measurements were made with a measuring microscope. Statistical analysis utilized a 2-way and single-factor analysis of variance with pair-wise comparison of mean values when appropriate. Hypothesis testing was conducted at alpha = .05 RESULTS: No differences were shown between the disinfected and nondisinfected conditions for all locations. However, there were statistical differences among the 3 materials for AP, CA, MD, and OG dimensions. AP and CA dimensions of all working casts were larger than the master model. Impressions produced oval-shaped working dies for all impression materials. PE and PE-FS working dies were larger in all dimensions compared to the stainless steel preparation, whereas VPS-FS-generated working dies were reduced in OG and MD dimensions. Differences detected were small and may not be of clinical significance. CONCLUSIONS: Impression material accuracy was unaffected by immersion disinfection. The working casts and dies were similar for PE and PE-FS. VPS-FS generated gypsum dies that were smaller in 2 of the 3 dimensions measured and may require additional die relief. Overall accuracy was acceptable for all 3 impression materials.

A three-year clinical evaluation of two-bottle versus one-bottle dentin adhesives.

BACKGROUND: The authors conducted an in vivo investigation to compare the clinical performance of two commercial one-bottle adhesives and a two-bottle adhesive for restoration of noncarious cervical lesions (NCCLs). METHOD: The patient pool consisted of 57 patients and 171 teeth (three teeth per patient), with one NCCL per tooth. Each patient received three resin-based composite restorations, each with a different adhesive: one tooth with a two-bottle, water-based adhesive as the control; another tooth with a one-bottle, ethanol-based adhesive; and a third tooth with a one-bottle, solvent-free adhesive. The authors assessed restorations in terms of retention, marginal integrity, margin discoloration and air sensitivity at baseline, six months, one year, two years and three years after initial placement. RESULTS: The retention rates at 36 months were 88 percent for the first adhesive, 81 percent for the second adhesive and 90 percent for the third adhesive. No statistically significant differences in retention rates could be shown, with 86 percent of restorations retained overall. Measures of marginal integrity, marginal discoloration and sensitivity also had no statistically significant differences between the three adhesives (P > .05). CONCLUSIONS: All three adhesives performed with acceptable outcomes after a 36-month period, with small differences between the one- and two-bottle systems and between the various solvents. Retention rate was moderately high and air sensitivity was markedly reduced; however, superficial marginal discoloration and marginal degradation was notable. Certain lesion, tooth and patient characteristics may predispose restorations to retention failure. CLINICAL IMPLICATIONS: The type of solvent may not be a major factor in retention of Class V restorations in NCCLs. Both single-bottle adhesives and conventional two-bottle adhesives performed acceptably.

The effect of a resin-based sealer on crown retention for three types of cement.

STATEMENT OF PROBLEM: In an effort to control postoperative sensitivity, dentin sealers are being applied following crown preparation with little knowledge of how crown retention might be affected. A previous study demonstrated no adverse effect when using a glutaraldehyde-based sealer, and existing studies have shown conflicting results for resin-based products. PURPOSE: This study determined if a resin sealer applied to prepared dentin affected retention of cemented castings when using 3 common types of luting agents. MATERIAL AND METHODS: Extracted human molars (n=55) were prepared with a flat occlusal, 20-degree taper, and 4-mm axial length. The axial surface area of each preparation was determined and specimens were distributed equally among groups (n=11). A 2-step, single-bottle adhesive system (One Step) was used to seal dentin following tooth preparation. Sealer was not used on the control specimens except for the modified-resin cement (Resinomer) specimens that required use of adhesive with cementation. Using ceramometal high noble alloy (Olympia), a casting was produced for each specimen and cemented with a seating force of 20 Kg using either zinc phosphate (Fleck's), glass ionomer (Ketac-Cem) or modified-resin cement (Resinomer) with the single-bottle adhesive. Castings were thermal cycled at 5 degrees C and 55 degrees C for 2500 cycles; then removed along the path of insertion using a universal testing machine at 0.5 mm/min. A single-factor ANOVA was used with alpha=.05. The nature of failure was also recorded and the data analyzed with a chi-square test. RESULTS: Mean dislodgment stresses for unsealed and sealed conditions were 3.7 +/- 1.0 and 2.2 +/- 0.8 MPa for zinc phosphate; 2.7 +/- 1.2 and 4.2 +/- 0.9 MPa for glass ionomer, respectively (P<.001). Retentive stress of castings cemented with modified-resin cement was 6.4 +/- 1.7 MPa. With resin sealer in combination with zinc phosphate, cement resided totally on castings in 82% of the situations and was on both surfaces without sealer. The tooth failed before casting dislodgment in 9 of 11 specimens cemented with modified-resin cement. CONCLUSIONS: Resin sealer decreased casting retentive stress by 42% when used with zinc phosphate. However, sealer use resulted in 55% increased retention when used with glass ionomer. The modified-resin cement produced the highest mean dislodgment stress, nearly always exceeding the strength of the tooth.

One-year clinical evaluation of an ethanol-based and a solvent-free dentin adhesive.

PURPOSE: To analyze the clinical performance of adhesives with various solvents for restoration of non-carious cervical lesions. METHODS: The patient pool consisted of a total of 57 patients and 171 teeth (3 teeth per patient), with one non-carious cervical lesion per tooth. For each patient, one tooth was restored with a water-based, two-bottle adhesive (Scotchbond Multi-Purpose - SM), and another tooth with an ethanol-based, one-bottle adhesive (Single Bond - SB), and the other tooth with a solvent-free, one-bottle adhesive (One Coat Bond - OCB), all with resin-based composites (Silux Plus or Synergy). Restorations were assessed by retention, marginal integrity, margin discoloration and air sensitivity, according to modified USPHS criteria. The evaluations were performed at baseline, 6 months and 12 months after initial placement. RESULTS: The retention rates at 12 months were 98% for the SM adhesive, 91% for the SB adhesive, and 93% for the OCB adhesive. The differences in retention rates were not statistically significant, with 94% restorations retained overall. Measures of marginal integrity, marginal discoloration and sensitivity also had no statistically significant differences between the three adhesives. Overall, for the restorations still retained after 12 months, 80% had non/slightly detectable margins, 80% had no marginal discoloration and 90% had none/mild sensitivity. All three adhesives performed comparably with excellent outcomes after a 12-month period, with no significant differences between the water-based, ethanol-based and solvent-free adhesives, nor between the one-and two-bottle systems. Retention rate was high, air sensitivity was markedly reduced, and marginal integrity was good. Although superficial marginal discoloration was notable, no deep staining was evident. Certain lesion, tooth and patient characteristics may predispose restorations to retention failure.

The effect of surface moisture on detail reproduction of elastomeric impressions.

STATEMENT OF PROBLEM: Monophase and dual-viscosity impression techniques are available with little knowledge of which one might render better quality under wet and dry surface conditions. PURPOSE: The purpose of this study was to determine whether type of material, viscosity selection, and presence of moisture affect detail reproduction of elastomeric impressions. MATERIALS AND METHODS: Single-viscosity systems were polyether (Impregum Penta) and vinyl polysiloxanes (President MonoBody, Extrude MPV, and Aquasil). Dual-viscosity systems included polyether (Impregum Penta/Permadyne Garant) and vinyl polysiloxanes (Dimension Penta H/Dimension Garant L, Extrude Extra/Extrude Wash, and Aquasil/Aquasil LV). Impressions were made of a surface analyzer calibration standard possessing a uniform "saw-tooth" pattern with a mean roughness (Ra) of 2.87 mum, which was one fourth of the peak-to-valley height. Each of the 8 impression groups was subjected to dry (control) and wet conditions. The wet condition consisted of 3 mL of distilled water applied to the surface of the standard but allowed to escape during the procedure. Eighty impressions were made, 5 for each test group. After setting, the surface of each impression was scanned at 5 locations using a Surfanalyzer 4000. A 3-factor ANOVA and Student-Newman-Kuels test were used to analyze the data (alpha=.05). RESULTS: There were significant differences between polyether and vinyl polysiloxane materials, dual and monophase techniques, and the 2 surface conditions (P<.05). Cross-product interactions were not significant, allowing comparison of mean values for each factor. The mean Ra for single viscosity was 2.21 mum versus 1.67 mum for dual viscosity; polyether was 2.12 mum versus 1.89 mum for addition silicone; and under dry conditions, the mean was 2.04 mum versus 1.86 mum for wet conditions. CONCLUSION: Single-viscosity systems reproduced the standard saw-tooth pattern better than the dual-viscosity systems, as did polyether impression materials compared to addition silicones. Moisture led to a lower Ra or less detail compared to dry conditions.

A clinical study comparing the three-dimensional accuracy of a working die generated from two dual-arch trays and a complete-arch custom tray.

STATEMENT OF PROBLEM: Dual-arch trays are often used by the dentists to make crown impressions of opposing quadrants simultaneously. Metal and plastic trays are available, but little is known about the accuracy of the impressions and resultant working dies. PURPOSE: The purpose of this study was to conduct a clinical trial to compare the accuracy of gypsum working dies made from impressions with metal dual-arch, plastic dual-arch, and complete-arch custom trays. MATERIAL AND METHODS: Eight patients requiring a posterior single tooth implant restoration were selected on the basis of inclusion and exclusion criteria. A customized abutment was measured in 3 dimensions (buccolingual, mesiodistal, and occlusogingival) by use of a measuring microscope. Three polyvinyl siloxane impressions were made of the abutment with a complete-arch custom tray, a plastic, and a metal dual-arch tray. Each impression was poured with type IV improved dental die stone. The diameter (buccolingual and mesiodistal), from gingivoaxial to gingivoaxial point angle, and height (occlusogingival), gingivoaxial to occlusoaxial point angle of the abutment standard was determined by measuring each dimension several times to obtain a mean. These 3 mean values served as the controls and were compared with the same measurements of the gypsum dies generated by the 3 different impression techniques. The patient was asked to rank the 3 impressions in order of overall comfort. A multivariate repeated measures single factor ANOVA was used in the statistical analysis (alpha=.05). When main effects were significant, a pairwise comparison of mean values was conducted with Bonferonni adjustment for multiple comparisons. RESULTS: There were no significant differences in die accuracy among the 3 trays for the mesiodistal (3.507 mm) and occlusogingival (3.584 mm) dimensions of the implant abutment. Dies were smaller than the standard for these 2 dimensions and larger in the buccolingual dimension. There was a significant difference in accuracy between the metal and plastic dual-arch trays. The dies produced from the metal dual-arch tray were 20 microm larger than the abutment standard compared with 3 microm larger for the plastic tray. The occlusogingival dimension of the working dies was 30 to 40 microm shorter than the implant abutment. Seven of the 8 patients ranked the plastic dual-arch impression as the most comfortable and the complete-arch custom tray as the least comfortable. CONCLUSIONS: Within the limitations of this study, the dimensions of working dies from a custom tray impression did not differ significantly from those created with dual arch trays. However, working dies from a plastic dual-arch tray were more accurate buccolingually than those from metal dual-arch trays.

The effect of tray selection, viscosity of impression material, and sequence of pour on the accuracy of dies made from dual-arch impressions.

STATEMENT OF PROBLEM: Dual-arch trays are often used to generate impressions of prepared teeth and of the opposing arch simultaneously. There is concern that accuracy of the casts generated with this technique can be affected by the type of tray, viscosity of the impression material, and sequence of pouring the cast. PURPOSE: This study compared the accuracy of working dies made from impressions with metal and plastic dual-arch trays, for 2 different viscosities of impression tray material and by altering which side of the impression was poured first. MATERIALS AND METHODS: Impressions were made of a typodont mandibular arch containing a circular stainless steel crown preparation (standard). There were 3 variables: type of dual-arch tray, impression material viscosity, and order of pour of the impressioned arches. A balanced design with independent samples was used (n=10). Two types of dual-arch trays, plastic (Triple Tray) and metal (COE Impression Tray), and 2 viscosities of addition silicone for the tray were used (Aquasil Rigid and Aquasil Monophase). Type IV gypsum (Fuji-Rock) with a ratio of 20 mL of distilled water to 100 g of powder was hand-mixed for 10 seconds then mixed under vacuum for 40 seconds and poured into the trays while being vibrated. One side of the dual-arch impression was poured with 35 g of stone and allowed to set for 1 hour before the other side was poured with 35 g of stone. The order of pour was randomized, and all casts were allowed to set for 24 hours at room temperature before removal. The dies were measured in 3 dimensions (buccolingual, mesiodistal, and occlusogingival) with a measuring microscope. The gypsum working dies were placed into a custom jig fabricated to permit measurement at a fixed, reproducible position under the microscope. Each dimension of the working dies was measured 3 times, and the mean was used for the sample value. The same 3 aspects of the stainless steel standard were measured multiple times, before and then at the conclusion of measuring all working dies, to arrive at the 3 standard values to which all working die means were compared. The means for the standard used in the statistical analysis were those taken at the conclusion of the study. The intraexaminer variation for measuring the standard was 0.001 mm. A 3-factor analysis of variance was used for the statistical analysis with hypothesis testing at alpha=.05. RESULTS: Statistically significant differences were found with viscosity selection for the buccolingual and occlusogingival dimensions of the working die. The rigid material produced working dies slightly taller (1 microm) than the standard, and those from the monophase material were 4 microm shorter. Regarding tray selection, metal trays were slightly more accurate in the mesiodistal dimension, and when monophase was used in a plastic tray, gypsum dies were nearly 30 microm smaller in the mesiodistal dimension (P<.05). Differences were not detected for sequence of pouring impressions. CONCLUSION: Within the limitations of this study, the monophase material, when compared with the rigid impression material, was most accurate for the occlusogingival and mesiodistal dimensions, although not as accurate in the buccolingual. This buccolingual difference (0.002 mm-0.006 mm) would be clinically inconsequential with the application of die spacer. The rigid impression material was also unaffected by tray selection for the mesiodistal, whereas monophase was affected. When a monophase impression material was used, plastic dual-arch trays yielded gypsum dies which were significantly smaller (0.029 mm) than the ones generated from the metal trays (0.006 mm). Thus rigid impression materials can be recommended for use in dual-arch trays; however, the magnitude of the differences would generally not be clinically significant because they could be compensated for with several coats of die spacer.