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Statement of Problem: Attaining a passive fit in implant restorations is desirable but clinically difficult to achieve, especially in screw-retained prostheses. At a certain magnitude, this misfit will not cause mechanical and biological complications, but the exact level has yet to be determined., Purpose: The purpose of this systematic review was to gather, compare, and appraise studies that attempted to determine the biological and mechanical tolerance of misfits., Material and Methods: The review protocol was published in the Prospective Register for Systematic Reviews (PROSPERO; registration no. CRD42021268399) and follows the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was conducted through PubMed, Ebscohost, and Web of Science followed by a manual search up to December 2021., Results: A total of 413 manuscripts were identified by electronic and manual search. After removing duplicates, nonrelevant titles, and abstract screening, 62 manuscripts were eligible for full-text assessment. Finally, a total of 13 articles (1 cross-sectional study, 1 retrospective and prospective, 7 in vitro studies, and 4 animal studies) met the eligibility criteria and were included in this review. A wide range of tolerable misfits were reported. Vertical misfit up to 1 mm and horizontal misfit up to 345 μm were associated with no adverse outcomes., Conclusions: The current literature provides inadequate data to determine a clinical threshold of an acceptable misfit. However, this review demonstrated that the mechanical response to misfit is more critical than the biological response., (Copyright © 2022 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

The aim of this in vitro study was to compare the quality of digital workflows generated by different scanners (Intra-oral digital scanners (I.O.S.s)) focusing on marginal fit analysis. A customized chrome-cobalt (Cr-Co) implant abutment simulating a maxillary right first molar was fixed in hemi-maxillary stone model and scanned by eight different I.O.S.s: Omnicam ® (Denstply Sirona, Verona, Italy) CS3500 ® , CS3600 ® , (Carestream Dental, Atlanta, GA, USA), True Definition Scanner ® (3M, St. Paul, MN, USA), DWIO ® (Dental Wings, Montreal, Quebec, Canada), PlanScan ® (Planmeca Oy, Helsinki, Finland), 3D PROGRESS Plus ® (MHT, Verona, Italy), TRIOS 3 ® (3Shape, Copenhagen, Denmark). Nine scans were performed by each tested I.O.S. and 72 copings were designed using a dental computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) software (exocad GmbH, Darmstadt, Germany). According to CAD data, zirconium dioxide (ZrO₂) copings were digitally milled (Roland DWX-50, Irvine, CA, USA). Scanning electron microscope (SEM) direct vision allowed for marginal gap measurements in eight points for each specimen. Descriptive analysis was performed using mean, standard deviation, and median, while the Kruskal⁻Wallis test was performed to determine whether the marginal discrepancies were significantly different between each group (significance level p < 0.05). The overall mean marginal gap value and standard deviation were 53.45 ± 30.52 μm. The minimum mean value (40.04 ± 18.90 μm) was recorded by PlanScan ® , then 3D PROGRESS Plus ® (40.20 ± 21.91 μm), True Definition Scanner ® (40.82 ± 26.19 μm), CS3500 ® (54.82 ± 28.86 μm) CS3600 ® (59,67 ± 28.72 μm), Omnicam ® (61.57 ± 38.59 μm), DWIO ® (62.49 ± 31.54 μm), while the maximum mean value (67.95 ± 30.41 μm) was recorded by TRIOS 3 ® . The Kruskal⁻Wallis tests revealed a statistically significant difference ( p -value < 0.5) in the mean marginal gaps between copings produced by 3D PROGRESS Plus ® , PlanScan, True Definition Scanner, and the other evaluated I.O.S.s. The use of an I.O.S. for digital impressions may be a viable alternative to analog techniques. Although in this in vitro study PlanScan ® , 3D PROGRESS Plus ® and True Definition Scanner ® may have showed the best performances, all I.O.S.s tested could provide clinically encouraging results especially in terms of marginal accuracy, since mean marginal gap values were all within the clinically acceptable threshold of 120 μm.

Purpose: The aim of this systematic review and meta-analyses was to evaluate fits of zirconia custom abutments and frameworks on implants and to identify the factors that influence their fits., Materials and Methods: An electronic search was conducted through PubMed (MEDLINE), Google Scholar, and Cochrane Central Registrar of Controlled Trials. The search was completed in August 2017. Series of meta-analyses were conducted to compare fits of zirconia custom abutments and frameworks on implants with metal abutments and frameworks. The interest variables were the interface gap and the rotational misfit of abutments and the vertical fit of frameworks., Results: Initially, a total of 672 articles were identified from the electronic search. After applying the inclusion criteria, 17 suitable articles were selected, including 9 studies on the fit of zirconia custom abutments and 8 studies on the fit of zirconia frameworks. There is a tendency for zirconia abutments to exhibit greater interface gaps and rotational misfits than metal abutments. Abutments produced by manual-aided designs/manual-aided manufacturing (MAD/MAM) exhibited inferior fits compared with those produced by computer-aided design/computer-aided manufacturing (CAD/CAM). Proprietary abutments had superior fits compared with non-proprietary abutments. Milled zirconia frameworks had insignificantly inferior fits compared with milled metal frameworks., Conclusion: Within the limitations of this study, custom zirconia abutments and non-proprietary abutments appeared to exhibit slightly inferior fits compared with metal abutments or abutments produced by the same implant company. However, the clinical significance of this difference is yet to be determined. The fit of milled zirconia frameworks is generally comparable to milled metal frameworks.

The aim of this in vitro study was to assess the reliability of two measurement systems for evaluating the marginal and internal fit of dental copings. Sixteen CAD/CAM titanium copings were produced for a prepared maxillary canine. To modify the CAD surface model using different parameters (data density; enlargement in different directions), varying fit was created. Five light-body silicone replicas representing the gap between the canine and the coping were made for each coping and for each measurement method: (1) light microscopy measurements (LMMs); and (2) computer-assisted measurements (CASMs) using an optical digitizing system. Two investigators independently measured the marginal and internal fit using both methods. The inter-rater reliability [intraclass correlation coefficient (ICC)] and agreement [Bland-Altman (bias) analyses]: mean of the differences (bias) between two measurements [the closer to zero the mean (bias) is, the higher the agreement between the two measurements] were calculated for several measurement points (marginal-distal, marginal-buccal, axial-buccal, incisal). For the LMM technique, one investigator repeated the measurements to determine repeatability (intra-rater reliability and agreement). For inter-rater reliability, the ICC was 0.848-0.998 for LMMs and 0.945-0.999 for CASMs, depending on the measurement point. Bland-Altman bias was -15.7 to 3.5 μm for LMMs and -3.0 to 1.9 μm for CASMs. For LMMs, the marginal-distal and marginal-buccal measurement points showed the lowest ICC (0.848/0.978) and the highest bias (-15.7 μm/-7.6 μm). With the intra-rater reliability and agreement (repeatability) for LMMs, the ICC was 0.970-0.998 and bias was -1.3 to 2.3 μm. LMMs showed lower interrater reliability and agreement at the marginal measurement points than CASMs, which indicates a more subjective influence with LMMs at these measurement points. The values, however, were still clinically acceptable. LMMs showed very high intra-rater reliability and agreement for all measurement points, indicating high repeatability.

This study aimed to compare the vertical marginal gap of teeth restored with lithium disilicate crowns fabricated using CAD/CAM or by pressed ceramic approach. Twenty mandibular third molar teeth were collected after surgical extractions and prepared to receive full veneer crowns. Teeth were optically scanned and lithium disilicate blocks were used to fabricate crowns using CAD/CAM technique. Polyvinyl siloxane impressions of the prepared teeth were made and monolithic pressed lithium disilicate crowns were fabricated. The marginal gap was measured using optical microscope at 200× magnification (Keyence VHX-5000, Japan). Statistical analysis was performed using Wilcoxon test. The lithium disilicate pressed crowns had significantly smaller (p = 0.006) marginal gaps (38 ± 12 μm) than the lithium disilicate CAD/CAM crowns (45 ± 12 μm). This research indicates that lithium disilicate crowns fabricated with the press technique have measurably smaller marginal gaps compared with those fabricated with CAD/CAM technique within in vitro environments. The marginal gaps achieved by the crowns across all groups were within a clinically acceptable range.

Statement of Problem: Studies that evaluated the effect of dental technician disparities on the accuracy of presectioned and postsectioned definitive casts are lacking., Purpose: The purpose of this in vitro study was to evaluate the accuracy of presectioned and postsectioned definitive casts fabricated by different dental technicians by using a 3-dimensional computer-aided measurement method., Material and Methods: An arch-shaped metal master model consisting of 5 abutments resembling prepared mandibular incisors, canines, and first molars and with a 6-degree total angle of convergence was designed and fabricated by computer-aided design and computer-aided manufacturing (CAD-CAM) technology. Complete arch impressions were made (N=110) from the master model, using polyvinyl siloxane (PVS) and delivered to 11 dental technicians. Each technician fabricated 10 definitive casts with dental stone, and the obtained casts were numbered. All casts were sectioned, and removable dies were obtained. The master model and the presectioned and postsectioned definitive casts were digitized with an extraoral scanner, and the virtual master model and virtual presectioned and postsectioned definitive casts were obtained. All definitive casts were compared with the master model by using computer-aided measurements, and the 3-dimensional accuracy of the definitive casts was determined with best fit alignment and represented in color-coded maps. Differences were analyzed using univariate analyses of variance, and the Tukey honest significant differences post hoc tests were used for multiple comparisons (α=.05)., Results: The accuracy of presectioned and postsectioned definitive casts was significantly affected by dental technician disparities (P<.001). The largest dimensional changes were detected in the anterior abutments of both of the definitive casts. The changes mostly occurred in the mesiodistal dimension (P<.001)., Conclusions: Within the limitations of this in vitro study, the accuracy of presectioned and postsectioned definitive casts is susceptible to dental technician differences., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: The marginal and internal discrepancies of computer-aided design and computer-aided manufacturing (CAD-CAM) endocrowns are unknown., Purpose: The purpose of this in vitro study was to evaluate the marginal and internal discrepancies of endocrowns with different cavity depths by measuring them with microcomputed tomography (μCT)., Material and Methods: Endocrowns (n=48) of 2 different cavity depths (2 mm and 4 mm) were fabricated in 2 different chairside CAD-CAM systems (CEREC AC and E4D). A μCT scan was made before and after cementation. For analysis of the marginal and internal discrepancies, reference points were selected in 2-dimensional views of 3 buccolingual cross-sections and 3 mesiodistal cross-sections. To calculate the total discrepancy volume, the μCT sections were reconstructed 3-dimensional views, and changes in volume and surface area were examined. Statistical analysis was performed using 2-way ANOVA with Bonferroni correction (α=.05)., Results: An endocrown with a 4-mm cavity showed a larger marginal and internal volume than one with a 2-mm cavity. Cementation did not show significant differences in total discrepancy thickness. Discrepancies on the pulpal floor were largest in other sites. Both chairside CAD-CAM systems showed similar discrepancy in the endocrowns., Conclusions: Based on the present study, marginal and internal discrepancies increased depending on cavity depth. Cementation did not increase the dimension of the discrepancy between the restoration and the cavity wall. The discrepancy on the pulpal floor appeared to affect these results., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Aim: The purpose of this study is to evaluate the clinical performance of three different restorative materials in primary teeth according to the FDI criteria., Materials and Methods: Resin-modified glass ionomer cement, compomer and composite resin restorations (n=93) were made in 31 patients. The restorations were clinically evaluated at baseline, 6th, 12th and 18th month with the FDI criteria., Results: The cumulative survival rate after 18 months was found to be 90.3% for resin modified glass ionomer cement restorations, 100% for compomer restorations and 80.6% for composite resin restorations. Statistically significant increase in surface roughness, colour mismatch, anatomic form loss and marginal deterioration were detected in resin- modified glass ionomer group (p<0.05). The most frequent reason for restoration failure in composite resin group was restoration fractures., Conclusions: The resin-modified glass ionomer restorations necessitates close follow-up because of the risk of increase in surface roughness, changes in colour and loss in anatomic form and marginal adaptation. The clinical performance of compomer restorations is superior to resin-modified glass ionomer and composite resin restorations in primary teeth.

Statement of Problem: In existing published reports, some studies indicate the superiority of digital impression systems in terms of the marginal accuracy of ceramic restorations, whereas others show that the conventional method provides restorations with better marginal fit than fully digital fabrication. Which impression method provides the lowest mean values for marginal adaptation is inconclusive. The findings from those studies cannot be easily generalized, and in vivo studies that could provide valid and meaningful information are limited in the existing publications., Purpose: The purpose of this study was to systematically review existing reports and evaluate the marginal fit of ceramic single-tooth restorations after either digital or conventional impression methods by combining the available evidence in a meta-analysis., Material and Methods: The search strategy for this systematic review of the publications was based on a Population, Intervention, Comparison, and Outcome (PICO) framework. For the statistical analysis, the mean marginal fit values of each study were extracted and categorized according to the impression method to calculate the mean value, together with the 95% confidence intervals (CI) of each category, and to evaluate the impact of each impression method on the marginal adaptation by comparing digital and conventional techniques separately for in vitro and in vivo studies., Results: Twelve studies were included in the meta-analysis from the 63 identified records after database searching. For the in vitro studies, where ceramic restorations were fabricated after conventional impressions, the mean value of the marginal fit was 58.9 μm (95% CI: 41.1-76.7 μm), whereas after digital impressions, it was 63.3 μm (95% CI: 50.5-76.0 μm). In the in vivo studies, the mean marginal discrepancy of the restorations after digital impressions was 56.1 μm (95% CI: 46.3-65.8 μm), whereas after conventional impressions, it was 79.2 μm (95% CI: 59.6-98.9 μm), Conclusion: No significant difference was observed regarding the marginal discrepancy of single-unit ceramic restorations fabricated after digital or conventional impressions., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Marginal and axial discrepancies of metal ceramic restorations are key to their long-term success. Little information is available for metal ceramic restorations fabricated with soft metal milling and laser sintering technologies., Purpose: The purpose of this in vitro study was to compare the marginal, axial, and occlusal discrepancies in single-unit metal ceramic restorations fabricated with new production techniques with those in a single-unit restoration fabricated using a conventional technique., Material and Methods: After the artificial tooth was prepared, impressions were made, and 40 dies were obtained. Dies were randomly divided into 4 groups (n=10). Cobalt-chromium (Co-Cr) cast (C), hard metal milled (HM), laser sintered (LS), and soft metal milled (SM) copings were fabricated. Marginal, axial, and occlusal discrepancies of these copings were measured using the silicone replica technique before and after the application of veneering ceramic. Data were analyzed with repeated measurements 2-way ANOVAs and Bonferroni post hoc tests (α=.05)., Results: Significant differences were found in the increase of marginal discrepancy after the application of veneering ceramic in the LS group (P=.016). However, no significant differences in marginal discrepancy were found whether veneering ceramic was applied to copings before or after in the other groups (P>.05). With regard to marginal and occlusal discrepancies, significant differences were found among the production techniques (P<.001 and P<.05, respectively). No significant differences in axial discrepancies were found among the groups (P>.05)., Conclusion: This in vitro study showed that metal ceramic restorations produced with HM and newly introduced SM techniques exhibited better marginal adaptations than those produced with the LS or C technique., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Objective: This study investigated the marginal and internal adaptation of individual dental crowns fabricated using a CAD/CAM system (Sirona's BlueCam), also evaluating the effect of the software version used, and the specific parameter settings in the adaptation of crowns., Material and Methods: Forty digital impressions of a master model previously prepared were acquired using an intraoral scanner and divided into four groups based on the software version and on the spacer settings used. The versions 3.8 and 4.2 of the software were used, and the spacer parameter was set at either 40 μm or 80 μm. The marginal and internal fit of the crowns were measured using the replica technique, which uses a low viscosity silicone material that simulates the thickness of the cement layer. The data were analyzed using a Friedman two-way analysis of variance (ANOVA) and paired t-tests with significance level set at p<0.05., Results: The two-way ANOVA analysis showed the software version (p<0.05) and the spacer parameter (p<0.05) significantly affected the crown adaptation. The crowns designed with the version 4.2 of the software showed a better fit than those designed with the version 3.8, particularly in the axial wall and in the inner margin. The spacer parameter was more accurately represented in the version 4.2 of the software than in the version 3.8. In addition, the use of the version 4.2 of the software combined with the spacer parameter set at 80 μm showed the least variation. On the other hand, the outer margin was not affected by the variables., Conclusion: Compared to the version 3.8 of the software, the version 4.2 can be recommended for the fabrication of well-fitting crown restorations, and for the appropriate regulation of the spacer parameter.

Statement of Problem: Prosthetic crown fit to the walls of the tooth preparation may vary depending on the material used for crown fabrication., Purpose: The purpose of this study was to compare the marginal and internal fit of crown copings fabricated from 3 different materials., Material and Methods: The selected materials were zirconia (ZirkonZahn system, group Y-TZP), lithium disilicate (IPS e.max Press system, group LSZ), and nickel-chromium alloy (lost-wax casting, group NiCr). Five specimens of each material were seated on standard dies. An x-ray microtomography (micro-CT) device was used to obtain volumetric reconstructions of each specimen. Points for fit measurement were located in Adobe Photoshop, and measurements were obtained in the CTAn SkyScan software environment. Marginal fit was measured at 4 points and internal fit at 9 points in each coping. Mean measurements from the 3 groups were compared by analysis of variance (ANOVA) at the 5% significance level, and between-group differences were assessed with the Tukey range test., Results: The nickel-chromium alloy exhibited the best marginal fit overall, comparable with zirconia and significantly different from lithium disilicate. Lithium disilicate exhibited the lowest mean values for internal fit, similar to zirconia and significantly different from the nickel-chrome alloy., Conclusions: The marginal and internal fit parameters of the 3 tested materials were within clinically acceptable range., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: The objective of this study was to clinically evaluate sealed composite restorations after 10 years and compare their behavior with respect to controls., Methods and Materials: The cohort consisted of 20 patients aged 18 to 80 years with 80 composite restorations. All participants in the sealing and no-treatment groups presented with clinical features for the marginal adaptation that deviated from the ideal and were rated Bravo (United States Public Health Service criteria). Composites with Alfa values for the marginal adaptation were used as the positive control., Results: The marginal adaptation behavior was similar between the sealing and control (+) groups, with a high frequency of Bravo values in the 10th year (80% and 51%, respectively). Most of the no-treatment (-) group maintained the Bravo values (91%) for 10 years, although some restorations (9%) progressed to Charlie values. The anatomy parameter differed significantly between the first and 10th years, with deterioration in all three groups (p<0.05). The secondary caries parameter had a similar behavior in the three groups (p>0.05)., Conclusions: Sealing the margins of the composite resin restorations had no significant effect compared with the control groups, under the conditions of this study. Sealing the restorations substantially improved the marginal staining and marginal adaptation parameters, although by the tenth year they were similar to the group without intervention.

Purpose: The purpose of this study was to compare the capacity of different impression materials to accurately reproduce the positions of five implant analogs on a master model by comparing the resulting cast with the stainless steel master model. The study was motivated by the knowledge that distortions can occur during impression making and the pouring of casts and that this distortion may produce inaccuracies of subsequent restorations, especially long-span castings for implant superstructures., Materials and Methods: The master model was a stainless steel model with five implant analogs. The impression materials used were impression plaster (Plastogum, Harry J Bosworth), a polyether (Impregum Penta, 3M ESPE), and two polyvinyl siloxane (PVS) materials (Aquasil Monophase and Aquasil putty with light-body wash, Dentsply). Five impressions were made with each impression material and cast in die stone under strictly controlled laboratory conditions. The positions of the implants on the master model, the impression copings, and the implant analogs in the subsequent casts were measured using a coordinate measuring machine that measures within 4 μm of accuracy., Results: Statistical analyses indicated that distortion occurred in all of the impression materials, but inconsistently. The PVS monophase material reproduced the master model most accurately. Although there was no significant distortion between the impressions and the master model or between the impressions and their casts, there were distortions between the master model and the master casts, which highlighted the cumulative effects of the distortions. The polyether material proved to be the most reliable in terms of predictability. The impression plaster displayed cumulative distortion, and the PVS putty with light body showed the least reliability., Conclusions: Some of the distortions observed are of clinical significance and likely to contribute to a lack of passive fit of any superstructure. The inaccuracy of these analog materials and procedures suggested that greater predictability may lie in digital technology.

Introduction: Bonding between composite and hard dental tissue is most commonly assessed by measuring bonding strength or absence of marginal gap along the restoration interface. Marginal index (MI) is a significant indicator of the efficiency of the bond between material and dental tissue because it also shows the values of width and length of marginal gap., Objective: The aim of this investigation was to estimate quantitative and qualitative features of the bond between composite resin and enamel and to determine the values of MI in enamel after application of two techniques of photopolymerization with two composite systems., Methods: Forty Class V cavities on extracted teeth were prepared and restored for scanning electron microscope (SEM) analysis of composite bonding to enamel. Adhesion to enamel was achieved by Adper Single Bond 2 - ASB (3M ESPE), or by Adper Easy One--AEO (3M ESPE). Photopolymerization of Filtek Ultimate--FU (3M ESPE) was performed using constant halogen light (HIP) or soft start program (SOF)., Results: Quantitative and qualitative analysis, showed better mikromorphological bonding with SOF photopolymerization and ASB/FU composite system. Differences in MI between different photopolymerization techniques (HIP: 0.6707; SOF: 0.2395) were statistically significant (p < 0.001), as well as differences between the composite systems (ASB/FU: 0.0470; AEO/ FU: 0.8651) (p < 0.001) by two-way ANOVA test., Conclusion: Better marginal adaptation of composite to enamel was obtained with SOF photopolymerization in both composite systems.

Purpose: This study investigated the reliability of visual assessment of marginal gaps in relation to the use of magnification and the operator's profession., Materials and Methods: A titanium bar was notched, simulating 40 marginal gaps, and 35 operators performed a quantitative evaluation of the incisions., Results: Visual examination was neither sensitive nor specific, as an extreme variability of data was recorded. The precision of readers improved with magnification aids only for clinicians; technicians were significantly more accurate in evaluating the incision's width., Conclusion: The visual examinations were inadequate to decide the clinical acceptability of a restoration with regard to its marginal fit.

Statement of Problem: Fabricating implant definitive casts with CAD/CAM technology (Robocasts) from coded healing abutment impressions represents a simpler and innovative alternative to conventional implant impression techniques. However, information about the accuracy of the impressions and the resultant definitive casts is limited., Purpose: The purpose of the study was to evaluate the accuracy of the Robocasts and compare them to those definitive casts fabricated with conventional implant impression techniques (open tray with splinted impression copings technique)., Material and Methods: A reference epoxy resin cast was fabricated and shaped to simulate a dental arch. Two regular platform implant replicas (Biomet 3i Certain, 4.1 mm diameter and 15 mm length) with internal connections were placed 10 mm apart with a 10-degree convergence for one side of the reference resin cast and a 30-degree convergence for the other. Coded healing abutments (Encode) were placed at 3 different heights above the level of the soft tissue replication material (approximately 1, 2, and 4 mm) and served as test groups (E1, E2, and E4), and open trays with splinted impression copings (OTSC) served as a control group. The control group was compared to the impressions of the coded healing abutments by using a standardized measurement protocol. Impressions were made for each group (n=18) and poured with vacuum mixed (100 g powder/20 mL water) Type IV dental stone. The vertical discrepancy (Z axis) between 2 prefabricated passively fitting titanium reference frameworks and the platforms of the implant replicas was measured with an optical comparator applying the 1 screw test. Data were analyzed with Kruskal-Wallis and post-hoc Mann-Whitney U tests, as well as the Wilcoxon signed-rank tests. The Bonferroni correction was used to account for multiple comparisons. The significance level (α) used in a given set of tests was equal to .05 divided by the number of tests performed in that set., Results: The median vertical discrepancy of each coded healing abutment impression group was higher than the corresponding median of the control group (OTSC) for every combination of angulation and position. Kruskal-Wallis tests indicated a statistically significant difference (P<.001) between groups for each angulation/position combination. All post hoc Mann-Whitney U tests indicated statistically significant differences (all P≤.002) between OTSC and the other groups. Differences between the angulations and positions were not statistically significant when accounting for multiple comparisons., Conclusions: The implant definitive casts fabricated from the coded healing abutment impressions were found to be less accurate than those fabricated from the open tray with splinted impression copings technique for restoring 2 paired (10 or 30 degrees) convergent internal connection implants with nonengaging screw-retained splinted 2-unit implant restorations. Accuracy of fit was not influenced by the implant angulation or position for either impression technique or by the Encode healing abutment height for the Encode impression technique., (Copyright © 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Purpose: To review methods used to investigate marginal adaptation of crowns and fixed dental prostheses (FDPs), and to discuss testing variables employed and their influence on results., Methods: Online libraries including PubMed, Scopus, and Ovid were searched for articles evaluating the marginal adaptation of crowns and FDPs using a combination of the keywords: "marginal accuracy," "marginal fit," "marginal gap," "marginal discrepancy," "fitting accuracy," "crown," and "FPD." Peer-reviewed publications in English in the period 1970 to December 2011 were collected, evaluated by their abstract, and included if they met the inclusion criteria. The criteria involved studies evaluating marginal adaptation of crowns and FDPs through clear experimental protocols. Exclusion criteria involved longitudinal prospective and retrospective clinical evaluations, studies using subjective tactile sensation, and other predefined criteria., Results: A total of 277 papers were identified; only 183 met the inclusion criteria. Direct view technique was used by 47.5% of the articles followed by cross-sectioning (23.5%), and impression replica (20.2%) techniques. The marginal gap values reported by these techniques varied among individual crown systems and across different systems because of variations in study type (in vivo vs. in vitro), sample size and measurements per specimen, finish line design, and stage at which the marginal gap was measured., Conclusion: There was a substantial lack of consensus relating to marginal adaptation of various crown systems due to differences in testing methods and experimental protocols employed. Direct view technique was the most commonly used method of reproducible results. Also, conducting an experimental set-up of testing a minimum of 30 specimens at 50 measurements per specimen should produce reliable results. Additionally, using a combination of two measurement methods can be useful in verification of results., (© 2012 by the American College of Prosthodontists.)

Context: Conventional casting techniques following the manufacturers' recommendations are time consuming. Accelerated casting techniques have been reported, but their accuracy with base metal alloys has not been adequately studied., Aim: We measured the vertical marginal gap of nickel-chromium copings made by conventional and accelerated casting techniques and determined the clinical acceptability of the cast copings in this study., Settings and Design: Experimental design, in vitro study, lab settings., Materials and Methods: Ten copings each were cast by conventional and accelerated casting techniques. All copings were identical, only their mold preparation schedules differed. Microscopic measurements were recorded at ×80 magnification on the perpendicular to the axial wall at four predetermined sites. The marginal gap values were evaluated by paired t test., Results: The mean marginal gap by conventional technique (34.02 μm) is approximately 10 μm lesser than that of accelerated casting technique (44.62 μm). As the P value is less than 0.0001, there is highly significant difference between the two techniques with regard to vertical marginal gap., Conclusion: The accelerated casting technique is time saving and the marginal gap measured was within the clinically acceptable limits and could be an alternative to time-consuming conventional techniques.

Generally, two techniques are used to fabricate a cast post and core (CPC): direct and indirect. To date, research has made no clear indication as to a comparative level of accuracy between the techniques. Therefore, the purpose of the current study was to compare the accuracy of two techniques to produce CPCs for posterior teeth using a new method. Nine endodontically treated human premolars were used for fabricating CPCs using the direct and indirect methods. A total of 18 CPCs were produced, two for each tooth, cast in high noble type IV gold. A silicone impression material was inserted into the root canals, followed by the CPCs. The remaining material in the space between the canal wall and the CPC was weighed using an electronic precision balance. By evaluating the weight of the silicon specimens, the accuracy and intimacy of fit were obtained. Since the number of samples was small, a Student t-test was used for statistical evaluation at a 90% confidence interval. The CPCs obtained by using each method were independently examined by two clinicians for proper fit. Power analysis indicated that for a 90% confidence interval and 0.8 power value, nine specimens would be necessary to achieve a statistically meaningful test. The mean value for the weight of the nine specimens obtained using the direct method was 10.3 ± 2.6 mg, while the mean value for the corresponding specimens obtained using the indirect method was significantly smaller, 7.4 ± 2.3 mg. The Student t-test value was P = 0.006. The indirect method provided CPCs with a better fit and higher accuracy. The Student t-test demonstrated a significant difference between the direct and indirect procedures. The indirect method is a valuable technique for the dental practitioner when multiple posterior cast posts and cores are necessary or interocclusal space is limited.

The longevity of dental restorations is largely dependent on the continuity at the interface between the restorative material and adjacent tooth structure (the restoration margin). Clinical decisions on restoration repair or replacement are usually based upon the weakest point along that margin interface. Physical properties of a restorative material, such as polymerisation shrinkage, water sorption, solubility, elastic modulus and shear strength, all have an effect on stress distribution and can significantly affect margin integrity. This review will focus on two aspects of margin deterioration in the oral environment: the in vitro testing of margin seal using emersion techniques to simulate the oral environment and to predict clinical margin failure and the relationship between clinically observable microleakage and secondary caries. The many variables associated with in vitro testing of marginal leakage and the interpretation of the data are presented in detail. The most recent studies of marginal leakage mirror earlier methodology and lack validity and reliability. The lack of standardised testing procedures makes it impossible to compare studies or to predict the clinical performance of adhesive materials. Continual repeated in vitro studies contribute little to the science in this area. Clinical evidence is cited to refute earlier conclusions that clinical microleakage (penetrating margin discoloration) leads to caries development and is an indication for restoration replacement. Margin defects, without visible evidence of soft dentin on the wall or base of the defect, should be monitored, repaired or resealed, in lieu of total restoration replacement., (© 2011 Blackwell Publishing Ltd.)

The aim of this study was to evaluate the precision of three different mold filling techniques in order to obtain a cast simulating a three-unit, implant-retained, fixed prosthesis. Thirty casts (n = 10) were obtained using three different mold filling techniques. Group 1 used a unique fulfillment technique, Group 2 used a two-step fulfillment technique, and Group 3 used a latex cylinder technique. Using a metallic matrix, a titanium substructure was created to simulate a three-unit fixed prosthesis used as reference to evaluate the marginal misfit and tension forces in each cast. The vertical misfit was measured by an optical microscope with an increase of 120X and by an analysis unit using the one-screw test. The tension was quantified using strain gauges. The strain results showed a statistical difference between Group 3 and the other groups. The Tukey test showed no difference between the different treatment groups (p = 0.05). All three techniques were deemed efficient; however, considering that the cylinder latex technique induced less force toward the implants, it is the preferable technique for daily clinical practice.

Objective: To reassess the accuracy of three impression techniques relative to the passive fit of the prosthesis., Method and Materials: An edentulous maxillary cast was fabricated in epoxy resin with four dental implants embedded and secured with heat-cured acrylic resin. Three techniques were tested: closed tray, open tray nonsplinted, and open tray splinted. One light-cured custom acrylic tray was fabricated for each impression technique, and transfer copings were attached to the implants. Fifteen impressions for each technique were prepared with medium-bodied consistency polyether. Subsequently, the impressions were poured in type IV die stone. The distances between the implants were measured using a digital micrometer. The statistical analysis of the data was performed with ANOVA and a one-sample t test at a 95% confidence interval., Results: The lowest mean difference in dimensional accuracy was found within the direct (open tray) splinted technique. Also, the one-sample t test showed that the direct splinted technique has the least statistical significant difference from direct nonsplinted and indirect (closed tray) techniques. All discrepancies were less than 100 Μm., Conclusion: Within the limitations of this study, the best accuracy of the definitive prosthesis was achieved when the impression copings were splinted with autopolymerized acrylic resin, sectioned, and rejoined. However, the errors associated with all of these techniques were less than 100 Μm, and based on the current definitions of passive fit, they all would be clinically acceptable.

Aim: The present study aimed at assessing the prevalence of apical periodontitis and identifying the factors associated with apical periodontitis, particularly the influence of the quality of root canal fillings and coronal restorations on the periradicular status., Methodology: The study population consisted of adult patients, men and women, seeking routine dental care at the Endodontic Clinic in the school teaching hospital between September 2006 and July 2008. For each patient complete oral examination and periapical radiographs were made for pathological teeth. All teeth were assessed individually. AP was diagnosed according to defined criteria, other variables were root fillings, coronal fillings, trauma and caries. The odds ratio and 95% confidence interval were used to calculate the risk of apical periodontitis related to tooth-specific risk indicators on the presence of apical periodontitis. A multiple logistic regression model to control for confounders and to determine their independent association with apical periodontitis was used also., Results: AP was detected on teeth (63.79%). The prevalence of apical periodontitis in root canal-treated teeth was 39.5%. Of the dental variables caries, trauma, inadequate root fillings and inadequate restoration were significantly associated with AP., Conclusion: The prevalence of AP in this study group was higher than in other populations. The probability of AP increased significantly after root canal treatment and coronal filling and was closely associated with the quality of the filling.

Purpose: The aim of this study was to determine the accuracies of implant-level impressions for internal-connection dental implants with various angles of divergence., Materials and Methods: Five groups were created according to the angles of divergence (0, 5, 10, 15, and 20 degrees) between two implant analogs in a master model. A master stone model for each group was fabricated. The divergent angle in each master model was verified with a profilometer. Study models (n = 10) from each master model were constructed through the implant-level impression technique. The divergent angle in each study model was verified with the profilometer. The splinted metal framework with passive fit was cast with base metal and cast-on abutments in each master model. The metal framework was tried in the study models and the fit of each framework was evaluated. One-way analysis of variance and the Tukey Honestly Significant Difference test were used for statistical analysis., Results: Statistically significant deformations of the impressions were found in the study models with divergently placed implant analogs. A larger divergence angle resulted in a larger gap between the framework and the implant analogs. The gap in the 20-degree divergence group differed significantly from that measured in the master model (P < .01)., Conclusions: Internal-connection implants were accurate when the divergence angle was less than 15 degrees. Inaccuracy of impressions increased as the divergence angle increased. The inaccuracy was significantly greater for the 20-degree-divergent implants than the other groups.

Background: Atraumatic restorative treatment (ART) has the advantages of reducing pain and fear and of being more cost-effective than the traditional approach., Aim: The aim of this study was to investigate the survival of ART class I and II restorations in primary molars at 2 years., Design: The sample consisted of 190 restorations and placed in 155 children 6-7 years old of both genders. The treatment was performed by two final-year dental students. All patients were treated in a completely supine position on tables available in the schools. The restorations were evaluated at 1, 12, and 24 months., Results: The best results were found for class I in each period of follow-up. After 1 month, the success of class I restorations was 94.6% and class II restorations 70.1%. After 12 months, the success rate was 50.6% for class I and 15.2% for class II. The most frequent failure characteristics were totally or partially lost and gross marginal defect., Conclusions: The rate of success of restorations using the ART approach was significantly lower for class II., (© 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.)

Aim: To assess differences in observed cross-sectional areas of root canals and filling materials, as imaged by three microscopy and two tomography methods., Methodology: Six roots filled with laterally compacted Gutta-percha and AH26 were scanned with phase-contrast enhanced microtomography in a synchrotron facility. Reconstructed virtual slices were compared with sections of both wet and acrylic-embedded roots, evaluated also by light and electron microscopy (EM) and laboratory-based microtomography (μCT). The different contrasts of Gutta-percha, voids, sealer and root dentine were identified and correlated. Inner canal border, outer Gutta-percha rim and the external margin of a void were manually delineated, and the enclosed areas were repeatedly measured by three observers. Interobserver and interimaging method differences were tested by 2-way anova with Bonferroni adjustments (P < 0.05). Percentages of Gutta-percha-filled canal areas (PGP) were determined., Results: Phase-contrast enhanced microtomography revealed internal interfaces and detailed 3D volumes of accentuated voids as well as micrometre-sized particles and gaps within the treated roots. Overestimates in the cross-sectional areas were obtained by light microscopy, whereas underestimates were obtained by μCT and EM. Differences exceeded 40%; however, PGP values by all methods were within 5% for the same slice. Differences between observers were sometimes significant, but they were not method related (<3%)., Conclusions: Phase-contrast enhanced microtomography is a powerful non-destructive ex vivo investigation method for studying the interfaces within root canals and filling materials at a micrometre resolution. The method does not require damage-prone sectioning/polishing during sample preparation procedures. Caution should be used when quantifying the extent of Gutta-percha in root fillings by measurements using μCT, light and EM., (© 2010 International Endodontic Journal.)

Background: Recent advances in resin adhesives and restorative materials, as well as an increased demand for esthetics, have lead to the introduction of newer resin-based composites like nanocomposites and light-curing units like light emitting diodes (LEDs)., Aim: The present study was conducted to evaluate the effect of conventional quartz tungsten halogen (QTH) curing unit and blue LED on marginal adaptation of microhybrid composite (Filtek Z250) and nanocomposite (Filtek Z350) resins., Materials and Methods: Eighty Class V cavities were prepared on, extracted human premolars and were divided into four groups of 20 each. The four groups were designed according to the restorative resin and light cure unit used microhybrid/QTH, nanocomposites/QTH, microhybrid/LED and nanocomposites/LED. After thermocycling and immersion in 2% Basic Fuschin dye solution, the teeth were sectioned and dye penetration was observed under a stereomicroscope at 20X magnification., Statistical Analysis: All the samples were scored and results were analyzed using the "Kruskal Wallis and Mann Whitney tests" with "Wilcoxone correction.", Results: The results revealed least microleakage in microhybrid composites exposed to QTH and maximum in nanocomposites exposed to LED., Conclusion: Microhybrid composites exhibited lesser microleakage than nanocomposite resins.

Purpose: To study the probability of using Image Guided Implantology (IGI) for planning and execution of a dental plan of 3 implants in a geometric pattern that fits a prefabricated metal frame accurately, simulating provisional restoration in immediate loading., Material and Methods: Ten mandible models were imaged by standard computed tomography. Three implants, two in the premolar and one in the molar area on each side of the jaws, were planned by use of the IGI system (Image Navigation Ltd, Moshav Ora, Israel). Two millimeter drilling and subsequent 3 millimeter widening drilling was performed with the real-time computerized navigation technology in the 120 sampling sites. In each step, parallel pins were inserted, and metal gauging frames with preplanned holes of incremental diameters and in the predefined geometric pattern were placed on the pins to evaluate the precision of fit., Results: Full success was obtained in fitting all three 3-mm pins, with frames having clearance of 0.5 or 1 mm, and in matching pairs of pins 2 or 3 mm in diameter at clearances of 0.5 mm or greater. With more constrained clearances, matching of all 3 pins was 80% and 95% successful with 2-mm pins (clearance of 0.25 and 0.5 mm, respectively) and 60% and 95% successful with 3-mm pins (clearance of 0 and 0.25 mm, respectively). Some laterality bias was observed., Conclusions: This preliminary study shows that the IGI system enables accurate planning of implant number and location to be achieved together with planning for a prefabricated metal frame for immediate loading., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Marginal and internal gaps of NobelProcera crown zirconia were clinically evaluated using silicone materials., Materials and Methods: Ninety-one crowns were examined before final cementation, and white and black silicone materials were used to record the marginal and internal fit. The silicone materials were sectioned bucco-lingually and mesio-distally, and the thickness of the silicone layers was measured using a microscope. Sixteen reference points were measured on each specimen, and mean marginal and internal gaps were obtained. Mean marginal gaps among anterior, premolar, and molar tooth groups, in addition to mean gaps at the reference points within the groups, were compared using two-way ANOVA and Games-Howell analysis., Results: The marginal mean values were the smallest among all tooth groups, and the largest were at the rounded shoulders. There were no significant differences in the mean marginal gaps among the three tooth groups, while there were significant differences in the mean marginal and internal gaps of each tooth group., Conclusions: The mean marginal gap of the NobelProcera crown zirconia was 44.2 μm, which is within clinically accepted standards., (Copyright © 2010 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Aim: The study was designed to quantitatively evaluate the quality of root canal preparation and root canal obturation in canals treated with either rotary or self adjusting files, using three-dimensional micro-computed tomographic (CT) analysis., Methodology: Pair-matched root canals were instrumented with either rotary nickel-titanium files or self-adjusting files following the manufacturers' instructions. The area of the canal wall unaffected by the preparation procedure was analyzed using before and after micro-CT images. Root canal obturation was done using lateral compaction with gutta-percha and AH26 (Dentsply-DeTrey, Konstanz, Germany). Teeth were scanned a third time, and the adaptation of the filling material to the canal walls was evaluated three-dimensionally by micro-CT analysis and the area of canal wall untouched by the filling was determined. The correlation between these two parameters within each of the groups was studied using the Pearson correlation test., Results: A high percentage of unaffected root canal walls (60% +/-14%) and areas untouched by the root canal filling (45% +/- 15%) were found in canals treated with rotary files. Both parameters were significantly smaller in canals treated with self-adjusting files (17% +/- 9% and 17% +/- 11%, respectively) (p < 0.01). No correlation was found between these parameters within each of the groups., Conclusion: Within the limitations of the present study, the self-adjusting files allowed better cleaning and shaping and better adaptation of the root canal filling than those allowed by rotary files., (Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: This in vitro study compared the dimensional accuracy of a stone index and of two impression techniques (squared impression copings and modified squared impression copings) for implant-supported prostheses., Materials and Methods: A master cast with four parallel implant-abutment analogs and a passive framework were fabricated. Vinyl polysiloxane impression material was used for all impressions with a metal stock tray. Three groups of impressions were tested (n = 5): index (I), squared (S), and modified squared (MS). The measurement method employed was just one titanium screw tightened to the framework. The measurements (60 gap values) were analyzed using software that received the images from a video camera coupled to a stereomicroscope at 3100 magnification. The results were evaluated statistically (analysis of variance, Holm-Sidak method, α = .05)., Results: The mean abutment/framework interface gaps were: master cast = 31.63 µm; group I = 45.25 µm; group S = 96.14 µm; group MS = 51.20 µm. No significant difference was detected among the index and modified squared techniques (P = .05)., Conclusion: Under the limitations of this study, the techniques modified squared and index generated more accurate casts than the squared technique.

Purpose: The objectives of this study are to describe, in vitro, a novel technique to measure the misfit of digitally designed and manufactured implant-supported frameworks according to a new concept based on computer-guided surgery in combination with previously placed mini-implants. Also, the digitally created framework and an impression-based milled structure were compared using strain gauge measurements., Materials and Methods: Acrylic resin and plaster models were prepared to represent the edentulous mandible. After insertion of three mini-implants in the acrylic resin model, a cone-beam computed tomographic scan was performed. The data were imported to planning software, where six implants were virtually inserted. A drill guide and titanium framework were designed and milled using a fully digital computer-aided design/computer-assisted machining protocol. Six implants were inserted using the drill guide attached to the mini-implants. After an impression was made of the acrylic resin model with six implants, the second model (plaster model) was prepared. A second milled titanium structure was fabricated following optical scanning of the acrylic resin model. Strain gauge measurements were done on both structures attached to both models. To validate the results, a high-accuracy industrial optical scanning system was used to capture all connection geometry and the measurements were compared., Results: The accuracy of the digital superstructures was 19, 22, and 10 Microm with standard deviations (SD) of 19.2 (17.9), 21.5 (28.3), and 10.3 (10.1) Microm for the x-, y-, and z-axes, respectively. For the impression-based superstructure the measured misfit was 11, 20, and 17 Microm, with SD 11.8 (10.5), 19.7 (11.7), and 16.7 (8.2) Microm for the x-, y-, and z-axes, respectively., Conclusion: The misfit of the digitally designed and produced superstructure on the digitally planned and inserted implants was clinically insignificant.

Objectives: The aims of the present study were (1) to evaluate the percentage of recurrent caries with respect to the estimated caries risk profile obtained with a Cariogram, (2) to evaluate the quality of restorations in a Saudi population with several restorations and (3) to determine the additional value of bite-wing radiographs as an aid to quality evaluation., Material and Methods: A total of 803 restorations were examined in 100 adults according to the United States Public Health Service/Ryge criteria. Salivary and microbiological factors, dietary habits and plaque index were investigated. The Cariogram was used to evaluate the risk profiles. Class II bite-wing radiographs (n = 281) were taken to examine the marginal integrity and the anatomic form proximally., Results: The patients were categorized according to 'the chance of avoiding caries' into three risk groups: 0%-20% (n = 38), 21%-40% (n = 28) and 41%-100% (n = 34). ANOVA revealed statistically significant differences between the risk groups with respect to the recurrent caries (P < 0.05). A high percentage of the total restorations (56%) were diagnosed with recurrent caries. The quality of anatomic form and surface texture was unacceptable in the majority of cases. After adding the evaluations of class II bite-wings, the percentage of unacceptable restorations increased by 28% and 17% with regard to marginal integrity and anatomic form, respectively (P < 0.001)., Conclusions: Recurrent caries was related to the percentage 'chance of avoiding caries' as estimated by the Cariogram. The importance of bite-wings was emphasized as an aid to quality evaluation.

Statement of Problem: Titanium is the most biocompatible metal used for dental casting; however, there is concern about its marginal accuracy after porcelain application since this aspect has direct influence on marginal fit., Purpose: The purpose of this study was to determine the effect that metal selection and the porcelain firing procedure have on the marginal accuracy of metal ceramic prostheses., Material and Methods: Cast CP Ti, milled CP Ti, cast Ti-6Al-7Nb, and cast Ni-Cr copings (n=5) were fired with compatible porcelains (Triceram for titanium-based metals and VITA VMK 95 for Ni-Cr alloy). The Ni-Cr alloy fired with its porcelain served as the control. Photographs of metal copings placed on a master die were made. Marginal discrepancy was determined on the photographs using an image processing program at 8 predetermined locations before airborne-particle abrasion for porcelain application, after firing of the opaque layer, and after firing of the dentin layer. Repeated-measures 2-way ANOVA was used to investigate the effect of metal selection and firing stage, and paired t tests were used to determine the effect of each firing stage within each material group (alpha=.05)., Results: ANOVA showed that both metal selection and firing stage significantly influenced the measured marginal discrepancy (P<.001), and there was interaction between the 2 variables (P<.001). Student-Newman-Keuls multiple comparison tests showed that there were significant differences between any 2 metals compared, at each stage of measurement. Paired t tests showed that significant changes in marginal discrepancy occurred with opaque firing on milled CP Ti (P=.017) and cast Ti-6Al-7Nb alloy (P=.003)., Conclusions: Titanium copings fabricated by CAD/CAM demonstrated the least marginal discrepancy among all groups, while the base metal (Ni-Cr) groups exhibited the most discrepancy of all groups tested., (Copyright 2010 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

The aim of this ex vivo was to investigate if two radiopaque root canal sealers with different formulations would influence the radiographic perception of root canal fillings. The root canals of 48 extracted maxillary canines were prepared and randomly assigned to 3 groups of 16 specimens each. In each group, the root canals were filled by lateral condensation of gutta-percha and one of the tested sealers: Endométhasone, Sealer 26, or a non-radiopaque sealer. A through-and-through void was simulated in half of the specimens from each group (n=8). The buccolingual radiographic images obtained were randomly interpreted for voids existence by a radiologist and an endodontist. The differences in sensitivity and specificity between groups and examiners were compared using, respectively, Fisher's Exact and McNemar tests at 5% significance level. Both radiopaque sealers caused a significant decrease in sensitivity at the coronal part of fillings. The use of Endométhasone increased specificity values for both coronal and apical portions of the root canal fillings. In conclusion, the tested sealers influenced the radiographic perceptions of laterally condensed root canal fillings in a different way.

Purpose: The aim of this in vitro study was to compare the marginal adaptation of a pressed ceramic material, when used with and without a metal substructure, to a traditional feldspathic porcelain-fused-to-metal restoration with a porcelain butt margin., Materials and Methods: A maxillary central incisor typodont tooth was prepared with a 1.5 mm 360 degrees shoulder with rounded internal line angle, and 30 polyether impressions were made. Dies were poured in type IV dental stone, and 30 restorations were fabricated: 10 metal ceramic restorations (MCR) with porcelain butt joints, 10 pressed to metal restorations (PTM), and 10 all-ceramic restorations (PCR). All restorations were evaluated on their respective dies at 45x magnification using an Olympus SZX-12, measurements of the marginal openings were made, and ANOVA and Scheffé post hoc tests were used to evaluate the data., Results: The mean marginal opening was 72.2 +/- 5.9 microm for MCR, 49.0 +/- 5.9 microm for PTM, and 55.8 +/- 5.9 microm for PCR. The post hoc tests showed that there was a statistical difference between the marginal adaptation of the PTM and MCR groups (p < 0.05). There was no significant difference in marginal adaptation between the PTM and the PCR groups, or the PCR and the MCR groups., Conclusions: The PTM group demonstrated a smaller mean marginal opening than the MCR group. The mean marginal openings of all three groups were within a clinically acceptable range.

Objective: The aim of this study was to examine the quality of root fillings in small and curved root canals using bidirectional radiographs and fluid transport (FT) measurements., Study Design: Root canals in eighty 38 degrees -curved mesial roots of mandibular molars were prepared using a balanced force technique. Samples were divided into 4 groups of 20 each and obturated by either the cold lateral compaction (LC) or the single cone (SC) technique, using either epoxy resin-based or zinc oxide-eugenol sealers. Bidirectional (buccolingual and mesiodistal) radiographs were acquired from each root. The voids along the root filling were assessed. The FT along the root filling was measured using an FT monitoring device. The differences between the groups regarding FT and the bidirectional radiographic score were analyzed by means of a Kruskal-Wallis test. The correlation between the FT values and the radiographic scores were analyzed using a Spearman test., Results: Three groups of LC or SC fillings containing epoxy resin-based sealers exhibited similar radiographic scores and FT values (P > .05). The group of SC fillings that contained zinc oxide-eugenol sealer had worse radiographic scores than the other groups (P = .047). The bidirectional radiographic scores and the FT values for the 80 filled roots were strongly correlated (r(2) = 0.519; P = .00001)., Conclusion: Root fillings of similar quality were confirmed in small and curved root canals filled using either a single cone or laterally compacted gutta-percha and epoxy resin-based sealers.

Purpose: The purpose of this study was to investigate the fit of cast alloy overdenture and laser-welded titanium-alloy bars by measuring induced strain upon tightening of the bars on a master cast as well as a function of screw tightening sequence., Materials and Methods: Four implant analogs were secured into Type IV dental stone to simulate a mandibular edentulous patient cast, and two groups of four overdenture bars were fabricated. Group I was four cast alloy bars and Group II was four laser-welded titanium bars. The cast alloy bars included Au-Ag-Pd, Pd-Ag-Au, Au-Ag-Cu-Pd, and Ag-Pd-Cu-Au, while the laser-welded bars were all Ti-Al-V alloy. Bars were made from the same master cast, were torqued into place, and the total strain in the bars was measured through five strain gauges bonded to the bar between the implants. Each bar was placed and torqued 27 times to 30 Ncm per screw using three tightening sequences. Data were processed through a strain amplifier and analyzed by computer using StrainSmart software. Data were analyzed by ANOVA and Tukey's post hoc test., Results: Significant differences were found between alloy types. Laser-welded titanium bars tended to have lower strains than corresponding cast bars, although the Au-Ag-Pd bar was not significantly different. The magnitudes of total strain were the least when first tightening the ends of the bar., Conclusions: The passivity of implant overdenture bars was evaluated using total strain of the bar when tightening. Selecting a high modulus of elasticity cast alloy or use of laser-welded bar design resulted in the lowest average strain magnitudes. While the effect of screw tightening sequence was minimal, tightening the distal ends first demonstrated the lowest strain, and hence the best passivity.

Purpose: This study evaluated the accuracy of four implant-level impression techniques with optical microscopy on two angulated conical internal-connection implants., Materials and Methods: A master cast with two internal-connection implant analogs angulated 10 degrees from each other and a master framework were fabricated. Four impression techniques were examined: octagonal transfer impression coping, nonoctagonal transfer impression coping, nonoctagonal pickup impression coping, and nonoctagonal pickup impression copings joined together with autopolymerizing acrylic resin. Experimental casts were fabricated from 40 polyether impressions divided into four groups. After the master framework was seated on each of the casts, one abutment screw was tightened and marginal gap measurements between analog and abutment were recorded on the other side with an optical microscope., Results: The casts produced from nonoctagonal pickup impression techniques were more accurate than those produced using transfer impression techniques (P < .05). However, there was no statistically significant difference in the accuracy between the unsplinted and splinted methods in pickup impression techniques (P > .05) or between the use of octagonal coping and nonoctagonal coping in transfer impression techniques (P > .05)., Conclusion: The casts produced from nonoctagonal pickup impression techniques were more accurate than those produced by transfer impression techniques, regardless of whether they were splinted, for angulated conical internal-connection implants.

Purpose: Passive fit of implant-supported superstructures cannot currently be achieved. The aim of this investigation was to create a methodology that can be used to study the effects of prosthesis misfit in humans., Materials and Methods: An edentulous patient received two interforaminal implants and a screw-retained bar for the retention of the mandibular denture. A corresponding in vitro model with strain gauges placed mesially and distally, adjacent to the implants, was fabricated to serve as a standardizing control. Over a period of 6 months, a total of 10 measurements on both the in vitro model and in the patient's mouth were conducted with newly fixed strain gauges on the bar., Results: The in vitro experiments showed that no component wear at the abutment-bar interface had occurred and that repositioning of the strain gauges on the bar caused deviations in strain measurements up to 10.55%. In vivo, a reduction in strain development, from 445 to 383 Mum/m, was observed in the initial phase up to 12 weeks after bar insertion. Subsequently, the measurement values increased, and after a period of 24 weeks, they nearly reached the initial strain level (443 microm/m). Only minor changes in strain development of the bar could be detected; these might be a result of limited dynamic loading and the cortical architecture of the surrounding bone. Deviations in measurement accuracy caused by repositioning of the bar strain gauge are a limitation of this technique and should be eliminated in future studies., Conclusions: The present methodology can be applied to study changes in static implant loading over time in humans.

Aim: To compare the push-out strength of bovine- and human-root dentin and, thus, evaluate the suitability of bovine-root dentin to substitute human-root dentin for bond strength testing., Materials and Methods: Ten single-rooted human-teeth and ten bovine incisors were prepared using a #3 bur of a fiber post system (12 mm long). The posts were duplicated with resin cement (Duolink). The root canals were treated with All Bond 2 adhesive system and the resin posts were cemented using Duolink. The specimens were cut perpendicular to their long axis, yielding disc-specimens with 1.5 mm thickness, which were submitted to a push-out test (1 mm/min). Ten bond strength values per group (n = 10) were used for statistical analysis (Student t test, alpha =.05)., Results: Statistically significant differences were found for the bond strength values between bovine- (4.1 +/- 1.3 MPa) and human-root dentin (8.6 +/- 5.7 MPa) (P =.0001)., Conclusion: The push-out strengths of bovine- and human-root dentin were statistically different.

Purpose: The aim of the present study was to report the radiographical prevalence of overhanging fillings in a group of Swiss Army recruits in 2006 and to relate the dimensions of the overhangs to clinical parameters., Materials and Methods: A total of 626 Swiss Army recruits were examined for their periodontal conditions, prevalence of caries, and stomatological and functional aspects of the masticatory system and halitosis. In particular, the present report deals with the presence or the absence of fillings, the presence or the absence of overhangs and their relation to clinical and radiographic parameters., Results: A total of 16,198 interdental sites were evaluated on bitewing radiographs. Of these sites, 15,516 (95.8%) were sound and 682 (4.2%) were filled. Amalgam restorations were found in 94.1% and resin composite fillings in 5.9% of the sites. Of these 682 sites, 96 (14.1%) yielded overhanging margins of various sizes. This low prevalence of fillings represents not only a substantial reduction when compared with a similar Swiss Army study (Lang et al, 1988), but also an improvement in the quality of dental care delivery to young Swiss males. Plaque Index and Gingival Index increased statistically significantly with the presence of fillings, when compared with healthy non-filled sites. Clinical parameters that were significantly associated with the presence of overhangs included clinical attachment loss. Moreover, between 1985 and 2006 the prevalence of fillings was significantly reduced from 20.0% to 4.2% of all surfaces. Furthermore, the marginal fit of the fillings improved from 33.0% with overhangs to 14.1%., Conclusions: A significant improvement was observed in the periodontal and dental conditions of young Swiss males that was shown to have taken place within the previous two decades. From 1985 to 2006, the prevalence of fillings was reduced fourfold and that of overhanging margins twofold, documenting an improvement in the quality of restorative dentistry.

Objective: To investigate the quality of root canal fillings and coronal restorations in relation to periapical status in a Greek population., Method and Materials: A total of 320 patients who required full-mouth radiographic examination were included. The quality of root canal fillings and the periapical status, as well as the quality of coronal restorations, were assessed by radiographic criteria. Results were analyzed using random effects logistic regression models., Results: Root canals with adequate filling length had a lower incidence of apical periodontitis than root canals with inadequate filling length (51.7% versus 63.4%, P ;= .002). Root-filled canals with adequate coronal restorations showed a lower incidence of apical periodontitis than those with inadequate restorations (47.3% versus 67.4%, P; < .001). When both root filling and coronal restoration were assessed, the incidence of apical periodontitis ranged from 39.2% to 67.6%., Conclusion: Quality of root canal treatment, as well as quality of coronal restoration, are strongly associated with the incidence of apical periodontitis.

The success of a crown greatly relies on its margin. An ill-fitted crown with an open margin will be susceptible to leakage and recurrent decay. If it remains undetected, it will eventually cause serious problems. This report looks at the finish line consistency of 73 "clinically acceptable" impressions made by dental students and working casts poured in the laboratory section. Findings show a number of possible inaccuracies in preparations, impressions, or a combination of both.

Objectives: To determine the influence of the preparation design and the dimensions of all-ceramic partial coverage restorations (PCR) on the marginal accuracy before and after masticatory simulation., Methods: In this in vitro study 80 extracted human maxillary molars were restored with MOD inlay restorations and four different modified PCR restorations using a new press ceramic IPS e.max Press (IPS e.max Press VP 1989). The teeth were divided into five groups of 16 specimens each and prepared as follows: Group A received an MOD inlay preparation and Group B, C, D and E received modified PCR. The restorations were adhesively luted and exposed to a mastication simulator. The discrepancies of the marginal fit were examined on epoxy replicas before and after luting as well as after masticatory simulation at 200x magnification., Results: The mean (geometrical) [95% confidence limits] marginal gap decreased from Group A to E before cementation (A-83[77-90]microm, B-68[65-70]microm, C-59[55-64]microm, D-56[52-61]microm, E-50[45-55]microm). Group A had significantly higher marginal gap values than group B (p = 0.017) and the other groups (p<0.0001). After cementation the marginal accuracy was recorded as following: A-103[93-114]microm, B-101[94-108]microm, C-93[89-98]microm, D-102[98-105]microm and E-99[96-102]microm. Cementation increased the marginal gap in groups B-E significantly (p<0.00001), not significantly in group A (p = 0.059). Artificial ageing (A-116[106-127]microm, B-114[109-120]microm, C-106[103-110]microm, D-109[100-118]microm and E-109[105-112]microm) led to further significant decrease of marginal accuracy in Group B (p = 0.029) and C (p = 0.026) only. After cementation and masticatory simulation of the ceramic restorations, the marginal gap values of Groups A, B, C, D and E did not significantly differ from each other (p = 1.00)., Conclusions: The result of this in vitro study showed that IPS e.max Press can be used to fabricate all-ceramic inlays and PCR which meet the requirements in terms of a clinically acceptable marginal gap, irrespective of the preparation design used. However, the preparation design and dimensions of the restorations appeared to affect the initial marginal fit and flowing off of luting material during the cementation process. The factors responsible for these findings require further substantiation.

Statement of Problem: Fabricating a feldspathic porcelain margin on a metal-ceramic restoration with a clinically acceptable marginal fit has proven to be a technique-sensitive procedure. Pressable ceramics are advocated to solve this problem., Purpose: The purpose of this in vitro study was to compare the marginal adaptation of a pressable ceramic system when used with both all-ceramic and metal-ceramic crowns, with a traditional metal-ceramic restoration., Material and Methods: A 1.5-mm, 360-degree chamfer margin was prepared on a typodont maxillary central incisor. Polyether impressions were made and poured in a Type IV dental stone, and the following crowns were fabricated on individual dies: 15 metal ceramic restorations (MCR) (Ceramco II, Ceramco, and Argelite 60), 15 pressed-to-metal restorations (PTM) (CPC-MK, and Argelite 60), and 15 pressed ceramic restorations (PCR) (CPC-MK). The marginal fit of the crowns was evaluated every 90 degrees around the crown margin circumference under a microscope at original magnification x 45. A 1-way analysis of variance (ANOVA) was used to compare data (alpha=.05)., Results: The mean marginal discrepancy for MCRs was 94 +/- 41 microm, for PTMs, 88 +/- 29 microm, and for PCRs, 81 +/- 25 microm. The 1-way ANOVA showed no significant difference between groups ( P =.568)., Conclusion: The marginal fit of pressed-to-metal (PTMs) and pressed all-ceramic crowns (PCRs) was similar to that of traditional metal-ceramic crowns (MCRs).

Statement of Problem: One of the most important criteria for the clinical acceptability and longevity of cast restorations is marginal adaptation. However, there is limited information on the accuracy of commonly practiced evaluation techniques., Purpose: This study assessed the effect of preparation design on marginal adaptation. In addition, sensitivity and specificity of clinical evaluations of marginal adaptations of cast restorations were assessed and compared to stereomicroscopy., Material and Methods: Three Ivorine molar teeth of differing designs were prepared: (1) a complete crown preparation with a chamfer finish line, (2) a complete crown preparation with a buccal shoulder and beveled finish line, and (3) a three-quarter crown preparation with proximal boxes and beveled finish line. Twenty-four castings (n = 8) were prepared (Ney technique casting metal). Twelve circumferential sites were identified for examination on each casting using a stereomicroscope, which was interpreted using software (Bioquant 98). The clinical examinations included explorer examination to detect marginal gap by tactile feel, followed by examination with a disclosing media (GC FitChecker). Chi-square tests of independence were used to evaluate the effect of preparation design and compare agreement between examination methods for detection of marginal gap size of greater than or equal to 30 microm (alpha=.05)., Results: The overall marginal adaptation of preparation designs was not significantly different. Results of explorer examination at 30-microm sensitivity and specificity were 46% and 97%, respectively. Similar values for disclosing media at 30 microm were 12% sensitivity and 97% specificity. The overall percent agreement with the stereomicroscope using the explorer was 58.3%, with 23.6% correct acceptance rate and 34.7% correct rejection rate. With respect to detection of marginal fit, the combination of disclosing material with explorer data did not yield significantly improved results (59.4%), as compared to explorer alone. A receiver operator characteristic curve yielded satisfactory sensitivity (0.8) and specificity (0.9) at a gap size value of 124 microm., Conclusion: Within the limitations of this study, the preparation design did not significantly affect the marginal adaptation. Clinical detection, with similar sensitivity and specificity as the stereomicroscope, occurred at marginal openings greater than or equal to 124 microm. Therefore, commonly used clinical evaluation techniques using an explorer and disclosing media may be inadequate for assessments of marginal accuracy.