In vitro color stability of double-layer veneers after accelerated aging.

STATEMENT OF PROBLEM: Porcelain laminates made from thin alumina shells veneered with feldspathic porcelain could be a promising alternative to conventional veneers. Long-term shade stability is critical for esthetics. PURPOSE: This study compared changes in CIE L*a*b* color coordinates of simulated veneers made from aluminum oxide core material veneered with feldspathic porcelain after 300 hours of accelerated photothermal aging (weathering). MATERIAL AND METHODS: Fifteen aluminum oxide disks (Procera) were divided into 3 groups. Each of the 5 disks was veneered with All-Ceram porcelain of the Vita shades A1 and B4, respectively. Five disks remained unfinished as controls. The disks were bonded to composite substrates simulating stained teeth. The color of the specimens was measured with a colorimeter. All specimens were subjected to 300 hours of accelerated aging under light exposure and thermocycling. Color measurements were repeated, and the data were statistically evaluated with multiple paired t tests. RESULTS: Color changes in the test groups involved an increase in lightness and a decrease in chroma. The calculated total color differences were not statistically significant compared with a level of 3 DeltaE units. CONCLUSION: This simulation of double-layer veneers appears to demonstrate acceptable color stability for this type of restoration. Clinical research is necessary to substantiate these in vitro findings.

All-ceramic surveyed crowns for removable partial denture abutments.

All-ceramic restorations may have limitations when used in combinations with other treatment modalities. Removable partial denture (RPD) abutment crowns are typically shaped to provide guide planes, rest seats, and retentive areas. Porcelain-to-metal crowns are routinely fabricated with retentive contours in the veneering porcelain, but until recently, the contours of the other portions of the restoration were developed in metal. This article describes the fabrication of all-ceramic crowns for RPDs with rest seats and guide planes in densely sintered aluminum oxide and retentive areas in veneering porcelain. Within the limitations outlined, this procedure allows the practitioner to use all-ceramic crowns in situations previously reserved for metal or metal-ceramic restorations.

Double-layer porcelain veneers: effect of layering on resulting veneer color.

STATEMENT OF PROBLEM: Densely sintered aluminum oxide veneered with feldspathic porcelain seems to be a promising technology for the fabrication of porcelain laminate veneers, which provide both strength and esthetics. To effectively use this approach for porcelain veneers, practitioners should know how the resulting color is affected by adding a layer of veneering porcelain onto the aluminum oxide. PURPOSE: This study compared changes in CIE L*a*b* color coordinates of simulated stained teeth when covered with the aluminum oxide core disks alone and after the disks had been veneered with 3 different shades of porcelain. MATERIAL AND METHODS: Fifteen aluminum oxide disks were divided into 3 groups. Each of 5 disks was veneered with porcelain of the Vita shades A1, A2, and B4, respectively. The colors of the substrate covered with the nonveneered disks and the veneered disks were measured separately, and the color differences were calculated. Measurements of the disks on a white background were also performed and used as controls. The extracted data were compared with Vita shade values available from the literature. RESULTS: Statistically significant differences in color coordinates of dark substrates were recorded between the substrate covered by an aluminum oxide disk and the addition of veneering porcelain to the aluminum oxide disks. Veneering the aluminum oxide disks with A1, A2, and B4 porcelain produced significant differences in the resulting color when placed on a dark substrate. The direction of the color modifications correlated with values obtained from the literature. The resulting color was also affected by the color of the underlying structures. CONCLUSION: Although aluminum oxide alone does have a degree of masking capability, the resulting color of porcelain veneers with the use of this material can successfully be modified with the veneering porcelain.

Precision of fit: the Procera AllCeram crown.

STATEMENT OF PROBLEM: Strength, color stability, and precision of fit are requirements for all-ceramic restorations. The Procera AllCeram crown system, composed of a densely sintered high-purity alumina core combined with a low fusing surface porcelain, appears to satisfy most of these requirements. However, evaluation of marginal fit has not been reported. PURPOSE: This study measured the precision of fit of the Procera AllCeram crown fabricated with Procera CAD/CAM technology for the premolar and molar teeth fit to a die. MATERIAL AND METHODS: Five ivorine maxillary first premolars and first molars were prepared for full-coverage crowns. Preparations were standardized with a convergence angle of 10 degrees, chamfer margins of 1.3 to 1.5 mm circumferentially, and occlusal reduction of 2.0 mm. AllCeram crowns were fabricated for the dies, and the fit of the crown to the die was determined by using a standardized procedure with a silicone impression material that served a dual role: (1) as a retrievable luting agent, and (2) to replicate the internal aspects of the crown. Laser videography was used to measure the gap dimension between the crowns and the dies at the marginal opening, the axial wall, the cusp tip, and the occlusal adaptation measurement locations. Mean gap dimensions and standard deviations (SDs) were calculated for marginal opening, internal adaptation, and precision of fit. RESULTS: Mean gap dimensions and standard deviations at the marginal opening for the premolar and molar crowns were 56.0 microns SD +/- 21 and 63.0 microns SD +/- 13 microns, respectively. The mean gap dimensions and SDs of the internal adaptation were 69.0 microns SD +/- 17 microns for axial wall, 48.0 microns SD +/- 12 microns for cusp tip, and 36.0 microns SD +/- 7 microns for occlusal adaptation for the premolar crowns; and 49.0 microns SD +/- 3 microns axial wall, 67.0 microns SD +/- 21 microns cusp tip, and 74.0 microns SD +/- 29 microns occlusal adaptation for molar crowns. Precision of fit and SDs for premolar and molar crowns were 52.0 microns SD +/- 19 microns and 63.0 microns SD +/- 20 microns, respectively. Mean marginal openings and precision of fit gap dimensions for the crown groups were not significantly different at the .05 level. However, gap dimensions that defined the internal adaptation at the measurement locations were different (P < or = .05). CONCLUSION: Mean gap dimensions for marginal openings, internal adaptation, and precision of fit for the crown groups were below 70 microns. These findings show that the crowns studied can be prescribed with confidence knowing that the precision of fit will consistently be less than 70 microns.

Resistance to fracture of three all-ceramic systems.

All-ceramic restorations have become an attractive alternative to porcelain-fused-to-metal crowns, but their strength is still an important issue. The purpose of this study was to compare the in vitro fracture resistance of three all-ceramic systems: IPS Empress, In-Ceram, and Procera AllCeram. Thirty dies were replicated from a master die using high filler resin with a modulus of elasticity similar to dentin. Ten cores each of In-Ceram and Procera were fabricated to a thickness of 0.5 mm. The remaining porcelain was applied using a sculpting device to produce a crown with a final thickness of 1.0 mm axially and 2.5 mm occlusally. Ten IPS Empress crowns were mixed to the same dimensions and were pressed by the manufacturer. The internal surfaces of all the crowns were etched and silanated prior to cementation with a resin cement (Panavia 21). The cemented samples were loaded in an Instron machine until fracture. The mean fracture loads were: IPS Empress, 222.45 (+/- 49) kg; In-Ceram, 218.8 (+/- 36) kg; Procera AllCeram, 194.20 (+/- 37) kg. Tukey's test showed no statistically significant differences among the three all-ceramic systems at p < .05.

Procera: a new way to achieve an all-ceramic crown.

The Procera System embraces the concept of computer-assisted design and computer-assisted machining to fabricate an all-ceramic crown composed of a densely sintered, high-purity aluminum oxide coping combined with a compatible veneering porcelain. Strength, precision of fit, color stability, cementation, and wear characteristics are among the many factors that concern clinicians when fabricating all-ceramic restorations with this new crown system. This article presents, in summary form, the data from the many studies on Procera AllCeram crowns that have been conducted at clinical and laboratory centers around the world. The evidence reported in these studies clearly demonstrates that the Procera AllCeram crown represents a combination of computer technology and creativity for which a positive prognosis can be made. Today its application is restricted to single crowns; however, with continued development, multiple unit all-ceramic anterior and posterior fixed partial dentures are clearly in the future.

Shear bond strength of a resin cement to densely sintered high-purity alumina with various surface conditions.

Procera Sandvik AB is now manufacturing a densely sintered high-purity alumina core for an all-ceramic crown designed for anterior and posterior restorations. Whereas the material holds promise on the basis of in vitro strength tests, the ability to alter the surface and use conventional bonded resin cements has not been reported previously in the literature. Samples of the core were treated by means of one of four methods routinely used for all ceramic restorations, and then a commercially available resin cement was bonded to the surface. A shear bond test of the adhesion showed that the highest shear bond strengths of 11.99 +/- 3.12 MPa were obtained with air abrasion at 80 psi and 50-microm alumina particles.

AllCeram crowns for single replacement implant abutments.

Clinicians who are comfortable with traditional porcelain fused to metal restorations may find the thickness of veneering porcelain addition to the CeraOne single tooth ceramic cap disconcerting. When using a premanufactured ceramic cap to fit the space of the final restoration, substantial amounts of "unsupported" veneer porcelain may be required to achieve tooth contact to adjacent or opposing dentition. A potential problem of weak, unsupported veneer porcelain has been addressed by a modification of an existing manufacturing process. By using CAD/CAM technology, a custom-designed Procera AllCeram coping can be created for the implant abutment that eliminates any concerns regarding the resultant design of the underlying ceramic cap substructure.

The precision of fit at the implant prosthodontic interface.

STATEMENT OF PROBLEM: Percussion, visual observation, and conventional periapical radiographs are the methods most frequently used clinically to evaluate the accuracy of implant component assemblies, whereas methods to measure the precision of fit are limited. PURPOSE: In this study the Periotest instrument was used to evaluate the stability of the interfaces between the implant and the abutment, along with the abutment and the gold cylinder under a series of assembly conditions. The hypothesis tested is that a more negative Periotest value (PTV) would indicate an accurate fit and a more positive value PTV would correlate with an inaccurate fit. MATERIAL AND METHODS: To investigate this hypothesis in vitro, two bovine ribs were used as patient simulation models. Each model contained three self-tapping Brånemark implants placed approximately 7 to 10 mm apart and arranged in a reasonable curvature. A series of component assembly conditions were created as accurate and inaccurate with thickness gauges of 25.4 microns, 50.8 microns, and 101.6 microns. RESULTS: The mean Periotest values and SDs for accurately assembled abutments and gold cylinders were -6.0 +/- 0.32 and -3.4 +/- 0.68, respectively. Periotest value data of the assembly conditions were statistically analyzed with multiple regression analysis. The misfit in the implant to abutment interface resulted in a more negative Periotest value trend (r = 0.54) with increases in gauge thickness. However, the same magnitudes of misfit at the abutment to gold cylinder interface produced a more positive Periotest value trend (r = 0.72). CONCLUSION: The PTV trends were consistent with increased stability at the abutment to implant interface from the increasing magnitude of misfit created with the thickness gauges. In contrast, the measurement trends observed for the abutment to gold cylinder interface were consistent with decreased stability with each increase in gauge thickness inserted at the interface.

Effect of adding opaque porcelain on the final color of porcelain laminates.

STATEMENT OF PROBLEM: Increasing the opacity of porcelain laminates is one of the techniques most commonly used to mask the color of darkly stained teeth. PURPOSE OF STUDY: Two different brands of porcelain (Fortune and Optec) disks that contained various amounts of modifying porcelains to alter opacity were cemented with untinted resin cement to a dark colored substrate. MATERIAL AND METHODS: The color of the substrate was measured before and after cementation and the change in color was calculated. RESULTS: Fortune porcelain showed a progressive increase in the amount of change produced as the modifying porcelain was increased, whereas Optec porcelain showed a decrease in the amount of change as modifying porcelain was increased. CONCLUSION: A progressive increase of yellow was exhibited in the samples as the amount of opacity is increased.

Effect of firing on the color stability of a light-cured ceramic stain.

PURPOSE: This study evaluated the color stability of four stains of a light-cured porcelain stain system between the light-cured and fired stages. MATERIALS AND METHODS: Thirty-six ceramometal discs 20 mm in diameter and 2 mm in thickness were cast to provide the substrate on which Ceramco II porcelain was applied. The porcelain was polished to a uniform thickness of 2 mm, and the samples were divided into four groups and assigned a color (yellow, orange, green, or blue). Orbit LC stain was applied in a thin layer and light-cured for 40 seconds. After light-curing, three color readings were made with a Minolta Chroma Meter II. The porcelain discs were then fired in a porcelain oven and three color measurements were again made. The pre- and postfired Commission Internationale de I'Eclairage L*a*b* values were recorded and the color difference (delta E) was calculated for each specimen. The clinical significance for the computed delta E ratings was completed according to previously modified criteria. RESULTS: The results show that the mean delta E between the light-cured and fired stages of Orbit LC are clinically acceptable. No statistically significant differences (p < .05) were observed between any of the four groups. CONCLUSIONS: A light-cured porcelain stain system was evaluated for color stability between light-cured and fired stages. Within the conditions of this study, the following conclusions can be made: (1) There was no clinically significant color difference between light-cured and fired stages for the stain colors evaluated; and (2) the final color of the restorations altered with light-cured stains can be predicted before firing.

Ultimate tensile strength of five interchangeable prosthetic retaining screws.

Implant prosthetic retaining screws have been reported to serve as built-in safety factors to protect against overload in the implant's "vertical stack," although loosening and fracture of retaining screws are often considered complications. Manufacturers have responded by introducing interchangeable prosthetic retaining screws, which can give the clinician the impression that interchanging screws will not have an adverse effect on the remainder of the implant complex and/or the integration of the implant itself. The objective of this investigation was to measure the ultimate tensile strength of four retaining screws from three manufacturers and two alloy types (gold and titanium) using the Nobelpharma gold prosthetic retaining screws as a standard for the comparisons. Five screws of each type were loaded in tension in an Instron Universal Testing Machine until fracture occurred. A Tukey-Kramer Test (significance level = .05) analysis of the data showed that all of the interchangeable prosthetic retaining screws were significantly different from the control screws in respect to ultimate tensile strength. The data suggest that interchanging prosthetic retaining screws will influence their built-in safety feature.

An in vitro investigation of the wear of enamel on porcelain and gold in saliva.

This study compared enamel wear against low-fusing porcelain (Procera All-Ceramic) with the wear against feldspathic porcelain (Ceramco) and gold alloy (Olympia). Human enamel abraders were polished to a 3 microns variance on silicon carbide paper. Five enamel abraders were abraded against five disks that were fabricated from (1) gold alloy polished to 1 micron variance, (2) autoglazed feldspathic porcelain, and (3) autoglazed low-fusing porcelain. The enamel sample was tested in human saliva in a wear machine with a constant load of 1 pound during 10,000 rotational cycles. The amount of wear was determined with a stereomicroscope at magnification x64. Significant differences in mean enamel wear were found when abraded against Olympia gold (9 microns), Procera All-Ceramic (60 microns), and Ceramco feldspathic porcelain (230 microns). Significant differences in restorative material wear were found between Olympia gold (0.32 microns) and the porcelain materials, Procera All-Ceramic (4.3 microns) and Ceramco feldspathic porcelain (3.7 microns).

A new computer-assisted method for fabrication of crowns and fixed partial dentures.

The availability of high-technology systems that use computer-aided design and computer-aided machining is on the increase. One such system is the Procera system, which is currently providing cost-effective, high-quality dental restorative services to dental laboratories and to dentists. A reduction in cost to the dentist, and ultimately to the patient, is a major advantage of the Procera system. Cost benefits combined with its continued success in producing crowns and fixed partial dentures that meet professional standards of care should enhance the acceptance of this new technology.

Geometric comparison of five interchangeable implant prosthetic retaining screws.

Eight geometric parameters of five interchangeable prosthetic retaining screws (#1-3i Implant Innovation-gold, #2-Impla-Med-gold, #3-Nobelpharma-gold, #4-3i Implant Innovation-titanium, and #5-Implant Support Systems-titanium) were recorded with an Amray 1000-B scanning electron microscope at x20 to x200 magnification. Five screws of each type were measured and eight parameters were evaluated: (A) diameter of head, (B) screw length, (C) thread pitch, (D) major diameter, (E) neck diameter (F) length of neck, (G) crest width, and (H) root width. The Nobelpharma-gold prosthetic retaining screws served as controls. The results revealed significant differences between the control and test screws in all parameters except parameters C and G (ANOVA, p < 0.05) and Duncan's multiple range test (significance level 0.05). On the basis of these differences, it was concluded that interchanging prosthetic retaining screws can introduce unknown variables in treating patients.

Silane to enhance the bond between polymethyl methacrylate and titanium.

The machined surface of wrought titanium frameworks used in implant-supported, fixed prostheses does not bond well with acrylic resin. Surface pretreatment has been suggested to enhance the retention of polymethyl methacrylate to machined titanium surfaces. This study evaluated a new bonding material (Rocatec) to determine its effect on the bond strength between titanium and polymethyl methacrylate. Twenty rod-shaped specimens of grade 2 titanium (7.6 x 0.3 cm in diameter) were divided into two groups of 10 samples. Group A received no pretreatment and group B was pretreated with 110 microns alumina air abrasive and the Rocatec material. Heat-cured denture base resin was processed around each titanium sample in a cylindrical shape approximately 0.9 x 1.5 cm. A Shell-Nielsen shear test was performed with a universal testing machine at a crosshead speed of 0.5 mm/minute to determine the bond strength in megapascals (MPa). Group B specimens (23.8 +/- 1.78 MPa) had a shear strength 68% greater than group A (16.1 +/- 1.61 MPa) (p 0.0001). The results of this study indicated that surface pretreatment of grade 2 titanium with 110 microns alumina air abrasive plus Rocatec bonding material significantly enhances the shear bond strength to PMMA.

Comparison of "look-alike" implant prosthetic retaining screws.

PURPOSE: The maximum preload torque of implant prosthetic retaining screws from four manufacturers and of two alloy types was measured to determine one index of interchangeability of intersystem components. MATERIALS AND METHODS: Implant prosthetic retaining screws from four manufacturers (3i Implant Innovations Inc, West Palm Beach, FL; Impla-Med Inc, Sunrise, FL; Nobelpharma USA Inc, Chicago, IL; and Implant Support Systems Inc, Irvine, CA) and of two metal types (gold and titanium) were investigated using an in vitro simulation model. Five screws of each type were tightened down against a gold cylinder using a Tohnichi BTG-6 torque gauge (Tohnichi American Corporation, Northbrook, IL) until fracture occurred. RESULTS: The 3i Implant Innovations gold and the Nobelpharma gold were not significantly different. The 3i Implant Innovations titanium and the Impla-Med gold were able to withstand less preload torque than the 3i Implant Innovations gold and the Nobelpharma gold. The Implant Support Systems titanium was able to withstand significantly more preload torque than all of the other screws. CONCLUSIONS: Interchanging implant prosthetic retaining screws could introduce new and unknown variables that may affect the long-term survival of implant fixtures and/or the implant prostheses.

A comparison of the color stability of conventional and titanium dental porcelain.

Simulation of naturally appearing enamel in fixed prosthodontics is best achieved with porcelain. This study investigated the color stability of two different dental porcelains, Ceramco and Procera, after they were exposed to 900 hours of accelerated aging. Twenty titanium plates provided the substrate to which the Procera porcelain samples in shades A3, A3.5, C3, and D3 were fired, five in each shade. An equal number of metal-ceramic alloy (Olympia) plates were cast to the same dimensions to form the 20 substrates to which Ceramco porcelain was fired. The four shades of porcelain were again added to each of the samples. Commission International de l'Eclairage L a b readings were recorded with a Minolta Chroma Meter II before and after exposure to 900 hours of accelerated aging simulation. After the aging process the color differences between the pretest and posttest condition were calculated. Although statistical comparisons demonstrated a difference in color change (p < or = 0.05) between Ceramco and Procera porcelain in three of the shades tested, critical remarks of color refer to both types having "slight" color change. In terms of color stability, neither porcelain had "noticeable" changes after 900 hours of accelerated aging.

In vitro analysis of the effects of two air-abrasive prophylaxis systems and inlet air pressure on the surface of titanium abutment cylinders.

PURPOSE: The purpose of this study was to investigate the effects of two air-abrasive prophylaxis systems and the effect of inlet air pressure on the surface of Brånemark titanium abutment cylinders. MATERIALS AND METHODS: Single abutment cylinders were treated with either the Prophy-Jet system (sodium bicarbonate abrasive) (Dentsply International, York, PA) or the Microprophy system (aluminum oxide abrasive) (Danville Engineering Co, Danville, CA) for 60 seconds at an inlet air pressure of 60 psi or 90 psi. The effects on the surface of each abutment cylinder were visually inspected by scanning electron microscopy. RESULTS: A comparison of abutment cylinder surfaces after treatment showed that the Prophy-Jet system removed machining marks to a greater degree than the Microprophy system. Sodium bicarbonate particles from the Prophy-Jet system were significantly larger than the aluminum oxide particles used with the Microprophy system, potentially accounting for the difference in abrasivity. In addition, inlet air pressure of 60 psi caused removal of machining marks to a greater degree than an inlet air pressure of 90 psi. The principle of phase separation may account for the lower inlet air pressure causing more removal of machining marks than the higher inlet air pressure. CONCLUSIONS: Under the experimental conditions tested, neither of the two systems tested seemed to cause significant abrasion of the surface of titanium abutment cylinders.

Effect of preload torque on the ultimate tensile strength of implant prosthetic retaining screws.

The preload concept proposes that an optimal torque exists to which implant prosthetic retaining screws should be tightened. According to this theory, the preload prevents separation of implant components, thus protecting the screw from fracture. Recent research suggests that most implant-retained prostheses in function today were placed using improper preloads. The purpose of this investigation was to determine whether or not improper preloading of prosthetic implant-retaining screws would adversely affect their ultimate tensile strength. Fifteen Nobelpharma-slotted gold screws from one lot were tightened to 6, 10, and 15 N/cm with a torque gauge and ultimate tensile strength values determined. The procedure was duplicated using 15 Nobelpharma gold screws from another lot tightened to 0, 10, and 20 N/cm. Within each of the test groups, there was no significant difference in the ultimate tensile strength among the three preload torques. However, a paired t test (P = 0.005) determined that there was a significant difference between the two lots with respect to the ultimate tensile strength of the screws preloaded to 10 N/cm. Altering the preload torque applied to Nobelpharma gold-retaining screws does not affect their ultimate tensile strength. The ultimate tensile strength of the screws from the two lots differed, suggesting an unannounced change in component specifications.