The effect of equilibrating mounted dental stone casts on the occlusal harmony of cast metal complete crowns.

STATEMENT OF PROBLEM: Fabrication of indirect complete crowns that are in occlusal harmony upon insertion remains a problem in restorative dentistry, and dental stone cast expansion may play a role. PURPOSE: This 3-part investigation compared occlusal contacts in a simulated patient with a harmonious occlusion with centric occlusion equal to maximum intercuspation (CO=MI) and an inharmonious occlusion (CO not equal MI) with mounted stone casts, and compared the occlusal contacts after fabrication of a posterior complete crown fabricated on equilibrated and nonequilibrated dental stone casts. MATERIAL AND METHODS: A dentoform mounted in a semi-adjustable articulator served as the simulated patient and control. In part 1, a single set of maxillary and mandibular ADA type IV and V derived dental stone casts were fabricated and mounted (CO not equal MI), and occlusal contacts/near contacts were compared. In part 2, 10 type IV and 10 type V cast mountings (CO=MI) were compared. In part 3, 10 type IV cast mountings were fabricated for adjustment (experimental) and 10 for no adjustment (control). A mandibular ADA type IV gold alloy complete crown was fabricated and adjusted on each set of casts and then returned to the dentoform. Vinyl polysiloxane interocclusal records of all mountings were scanned for optical density, and contacts were used to quantify occlusal contacts as exhibiting contact or near contact. Data were analyzed with Kruskal-Wallis ANOVA and Mann-Whitney U tests (alpha=.05). RESULTS: The cast adjustment protocol (intervention) was successful in eliminating the majority of the occlusal disharmony in the casts believed to be caused by the effects of stone expansion. Actual and near contact areas for cast mountings of the equilibrated simulated patient were significantly different from those of the simulated patient (P<.001; P=.001, respectively). Actual and near contact areas for inserted crowns fabricated from adjusted casts were significantly different from those of the simulated patient (P<.001; P=.007, respectively), but actual contact areas were not different from those of the simulated patient with no crown inserted. CONCLUSIONS: In this study, occlusal contacts of a simulated patient (dentoform) could not be accurately replicated with mounted dental stone casts. A cast adjustment procedure can aid in fabrication of a crown with a more accurate occlusion.

Delayed linear expansion of improved dental stone.

STATEMENT OF PROBLEMS: Specification 25 of the American Dental Association (ADA) states that final setting expansion measurements of improved dental stone are made 2 hours after mixing. In a limited pilot study on selected type IV and V dental stones, measurements showed delayed linear expansion or early contraction continuing up to 120 hours. PURPOSE: The objectives of this in vitro study were to measure the linear setting expansion of 6 ADA type IV and V dental stones, to compare their expansion at 2 hours relative to ADA Specification 25, and to characterize expansion changes up to 120 hours. MATERIAL AND METHODS: The improved dental stones tested in this study were Die-Keen, Jade Stone, Vel-Mix, ResinRock, Fuji Rock, and Silky Rock. Mixing was performed in accordance with a standardized technique and the manufacturers' instructions. The mixes were poured into an electronic expansion-measuring device, and setting expansion values were continuously measured and recorded for 120 hours. The collected data were subjected to a 2-way repeated-measures multivariate analysis of variance at alpha=.05. Planned comparisons between the 2-hour experimental and 2-hour manufacturer expansion values were made at the 95% confidence interval. RESULTS: All stones showed higher mean linear expansion values at 120 hours than at 2 hours. Expansion was essentially complete at 96 hours for all stones except ResinRock. Die-Keen exhibited the highest total mean setting expansion (0.35% +/- 0.013%), and Silky Rock exhibited the lowest mean linear expansion (0.14% +/- 0.008%) at 120 hours. Multivariate analysis of variance revealed significant interactions between stone and time (P<.0001). Mean expansion values at 2 hours were comparable to those stated by the manufacturer except for Die-Keen and Jade Stone. CONCLUSION: Within the parameters of this study, all dental stones tested exhibited continued expansion while setting under clinical conditions. The amount of expansion varied significantly among the materials, with 22% to 71% of the expansion occurring after 2 hours. Die-Keen exhibited the highest total mean expansion but had the least amount of expansion after 2 hours; both Die-Keen and Silky Rock remained stable after 72 hours.

Accuracy of a predetermined transverse horizontal mandibular axis point.

STATEMENT OF PROBLEM: The transverse horizontal mandibular axis point may be located most precisely by a kinematic process. However, an anatomical method of locating the axis is also an acceptable technique, and an easily determined point that is consistently close to the kinematic axis would simplify transfer of the arc of rotation from the patient to the articulator. PURPOSE: This in vivo study compared the location of an anatomically predetermined hinge axis point with the determined kinematic axis. MATERIAL AND METHODS: Forty subjects (27 males, 13 females; 23 to 47 years of age) with functionally acceptable occlusion and no detectable clinical signs of temporomandibular disorders participated in the study. The earpiece alignment flags on a mechanical SAM Axiograph III combination flag/face-bow were used to locate the right and left predetermined hinge axis points, 10 mm anterior to the earpiece. The right and left kinematic center of rotation was located as described by Lauritzen and confirmed with the PC Axiotron electronic Axiograph to within 0.25 mm. All points were transferred to 1 mm(2) grid paper on the subject's skin. The distance between each predetermined and kinematic point was measured +/-0.25 mm. Wilcoxon and Mann-Whitney tests were used to examine differences between the left and right axis points and potential significant differences between genders at a significance level of P<.05. The number of occurrences and the distance of the predetermined axis points from the kinematic axis also were described. RESULTS: The mean distance between points was 1.1 mm on the right (range 0.0 to 3.0 mm), 1.2 mm on the left (range 0.0 to 3.0 mm), and 1.1 mm for all 80 points (+/-0.63). More than 96% of the predetermined points were within 2 mm of the kinematic axis, and 67% were within 1 mm. There was no significant difference between the right and left points and no significant differences based on gender. CONCLUSION: Within the limitations of this study, the results suggest that the predetermined axis point is well within the clinical norm for estimated location of the transverse horizontal mandibular axis.