Fracture resistance of three different all-ceramic crowns: In vitro study.

PURPOSE: To evaluate the fracture resistance and failure mode of three different all-ceramic crowns; CEREC Bloc, IPS e.Max Press and Cercon in a simulated clinical situation. METHODS: 30 extracted maxillary premolars were prepared and randomly assigned to three groups equally according to the type of crown used. The first was the CEREC group: monolithic feldspathic crowns (CEREC Blocs). The second was the E.Max group: monolithic lithium disilicate crowns (IPS e.Max Press). The third group was the Cercon group: bilayered partially stabilized zirconia crowns (Cercon). All crowns were cemented using dual-cured resin cement (ParaCore). The specimens were then subjected to thermocycling (5-55°C/500 cycles) and loaded to failure at an angle of 45° to the occlusal surface of the crown. Failure data was statistically analyzed using one-way ANOVA and Tukey's HSD post hoc test at α= 0.05. Fractographic analysis was performed to determine the fracture modes of the failed specimens. RESULTS: The mean fracture values for CEREC, E.Max and Cercon groups were 387± 60 N, 452 ± 86 N, and 540 ± 171 N, respectively. Significant differences were found between CEREC and Cercon groups (P< 0.05). Catastrophic fracture within the ceramic crown was the major failure mode of the CEREC group. For E.Max and Cercon groups, the major failure mode was exhibiting severe tooth fracture while the ceramic crown remained intact. CLINICAL SIGNIFICANCE: CEREC, IPS e.Max Press and Cercon crowns are clinically applicable as they exceeded the normal masticatory forces. However, the CEREC crown is preferred as it maintains the integrity of the natural abutment.

Effect of operators' experience and cement space on the marginal fit of an in-office digitally produced monolithic ceramic crown system.

OBJECTIVES: To investigate the marginal accuracy of Cerec three-dimensional (3D) all-ceramic crowns, in terms of gap and overhang, and to analyze the "operators' experience" and "cement space" effects on the marginal fit. METHOD AND MATERIALS: Thirty virtual models were obtained from a metal master die by scanning by three different operators: operator 1 (novice), operator 2 (beginner), and operator 3 (expert) (n = 10). These were further divided into two subgroups of five each, based on the cement space settings: 10 µm and 20 µm. Monolithic ceramic crowns (n = 10) were designed and milled for each virtual model and subjected to marginal gap and overhang evaluation at six designated margin locations. The influence of operators' experience and cement space on the marginal fit of the crowns was assessed by performing Box tests and MANOVA (multiple analysis of variance) (α = .05). Kruskal Wallis test was also used to analyze the interactions between the operators' experience and the cement space. RESULTS: The overall mean ± SD marginal gaps and overhangs for the Cerec 3D crowns, were 154 ± 56 µm and 74 ± 74 µm for novice, 158 ± 53 µm and 86 ± 66 µm for beginner, and 155 ± 52 µm and 47 ± 76 µm for expert, respectively. The MANOVA and Kruskal Wallis tests found no significant differences (P > .05) between the operators, in terms of gap and overhang, for all cement settings. CONCLUSION: The operator experience did not seem to influence the marginal accuracy of Cerec 3D fabricated crowns.

Clinical pairing revisited: a study at the University of Malaya, Malaysia.

This study is part of ongoing educational research conducted by the Department of Conservative Dentistry, University of Malaya, Malaysia, to evaluate the perception of clinical pairing. A thirteen-question survey was distributed to 148 dental students after they had experienced four-handed dentistry. The objectives were to identify the advantages, disadvantages, and the acceptance of the implementation of clinical pairing from the students' point of view. The responses from the open-ended questions were categorized into six main themes (areas of interest): quality-related (Q), patient-related (PT), partner-related (P), lecturer-related (T), infection control (IC), and learning environment (L). Data analysis was done using SPSS version 18. Results indicated that the students perceived they possessed enough knowledge regarding clinical pairing. However, it was found that they still preferred to work independently as compared to working in pairs. The benefits of clinical pairing may not be viewed in the same vein by both dental students and teachers. The quality-related theme was perceived by students as the main advantage of clinical pairing, whilst the partner-related theme was perceived otherwise. The study also revealed that students may have some preconceived notions about pairing that may have impaired their acceptance. As a consequence, some reluctance was seen in their responses.