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Statement of problem A common technique used for making crown impressions involves use of a vinyl polysiloxane impression material in combination with a dual-arch tray. A leading dental manufacturer has reformulated its vinyl polysiloxane (VPS) impression line, but the accuracy of the new material has not been verified. Purpose The purpose of this study was to assess the accuracy of reformulated VPS impression materials using the single-step dual-arch impression technique. Material and Methods Dual-arch impressions were made on a typodont containing a master stainless steel standard crown preparation die, from which gypsum working dies were formed, recovered, and measured. The impression materials evaluated were Imprint 3 Penta Putty with Quick Step Regular Body (IP-0); Imprint 3 Penta Quick Step Heavy Body with Quick Step Light Body (IP-1); Aquasil Ultra Rigid Fast Set with LV Fast Set (AQ-1); and Aquasil Ultra Heavy Fast Set with XLV Fast Set (AQ-2) (n=10). All impressions were disinfected with CaviCide spray for 10 minutes prior to pouring with type IV gypsum. Buccolingual (BL), mesiodistal (MD), and occlusogingival (OG) dimensions were measured and compared to the master die using an optical measuring microscope. Linear dimensional change was also assessed for IP-0 and AQ-1 at 1 and 24 hours based on ANSI/ADA Specification No. 19. Single-factor ANOVA with Dunnett's T3 multiple comparisons was used to compare BL, MD, and OG changes, with hypothesis testing at α=.05. A repeated-measures ANOVA was used to compare linear dimensional changes. Results There were statistical differences among the 4 impression systems for 3 of 4 dimensions of the master die. IP-0 working dies were significantly larger in MD and OG-L dimensions but significantly smaller in the BL dimension. IP-1 working dies were significantly smaller in the BL dimension compared to the master die. With the exception of IP-0, differences detected were small and clinically insignificant. No significant differences were observed for linear dimensional change. Conclusions The single-step dual-arch impression technique produced working dies that were smaller in 3 of the 4 dimensions measured and may require additional die relief to achieve appropriate fit of cast restorations. Overall accuracy was acceptable for all impression groups with the exception of IP-0. (J Prosthet Dent 2009;101:332–341)

Statement of problem Alloys with high nickel content have been increasingly used for dental prostheses. These alloys have excellent hardness, elastic modulus, and strength, yet have high corrosion rates when exposed to chemical or physical forces that are common intraorally. Purpose The purpose of the current study was to measure the susceptibility of several types of nickel-based alloys to brushing abrasion relative to gold- and palladium-based alloys. Material and methods Au-Pt, Au-Pd, Pd-Ag, Ni-Cr, and Ni-Cr-Be dental alloys were brushed with a toothbrush (Oral-B Soft) and toothpaste (Ultrabrite) in a linear brushing machine, then the surface roughness was measured by profilometry (R a , R v , R p ). Specimens (n=4) were brushed for 48 hours in a saline solution (pH 7). The effect of brushing was determined using 2-sided t tests (α=.05), and roughness among alloys postbrushing was compared using 1-way ANOVA with Tukey post hoc analyses (α=.05). Results All polished alloy surfaces (before brushing) had roughnesses of ≤0.1 μm (R a ). The Pd-Ag alloy was the most resistant to brushing. The Ni-Cr-Be alloy abraded the most, with a postbrushing surface roughness of >1 μm (R a ). Ni-Cr alloys without Be had a postbrushing surface roughness of 0.25 μm (R a ). Postbrushing roughness of all other alloys ranged from 0.1-0.25 μm (R a ). R v and R p values behaved similarly to R a values for all alloys. Conclusions Although they have many excellent mechanical properties, Ni-Cr-Be alloys may be prone to degradation from brushing. (J Prosthet Dent 2008;99:455-460)

This article is an evidence-based tutorial on the principles of biocompatibility. Although the technical issues of biocompatibility may seem beyond the scope of most practicing dentists, knowledge of these issues is fundamentally important to ensure the health of patients, dental staff members (including laboratory personnel), and practitioners themselves. Furthermore, the legal liability of dentists is often linked to biocompatibility issues. The biocompatibility of a material is not absolute; it must be measured with regard to the way the material is used. Measuring biocompatibility is a complex process that involves in vitro and in vivo tests. These tests contribute to understanding biologic responses to a material but cannot define the material's biocompatibility with 100% certainty. Practitioners should understand enough about biocompatibility testing methods to critically judge advertising claims and ask relevant questions of manufacturers. Because there is no infallible way to assess biologic response to a material, decisions about the clinical use of a material ultimately must weigh the biologic risks of a material against its potential benefits.

Statement of problem. Contamination of removable prostheses with microorganisms, particularly Candida albicans, is a common clinical problem. Microban, a broad-spectrum antimicrobial containing triclosan, recently has been proposed to inhibit microbial growth. Purpose. This study aimed to determine whether the addition of Microban to PermaSoft denture liner prevents the growth of C albicans and affects the cytotoxicity of the PermaSoft material. Material and methods. Experimental specimen disks (5 × 1 mm each) with and without incorporated Microban were fabricated aseptically (n = 6) against polyester film to produce a smooth surface. To assess the cytotoxic effect of Microban, the MTT assay was used. To determine the effect of Microban on the growth of C albicans, disks were placed in Transwell dishes, covered with Sabouraud's broth containing an ATCC strain of C albicans, and incubated at 37°C for 24 hours. Wells containing fluorocarbon resin disks or broth alone served as controls. The disks were rinsed to remove unattached C albicans and then sonicated in sterile water to remove surface organisms. Serial dilutions of the water extracts were plated on Sabouraud's agar and returned to the incubator for 24 hours. Colonies were counted with a Brunswick Colony Counter. Growth of C albicans in the internal aspects of the specimens was determined in a manner as previously described, with the exception that the specimens were sonicated to remove surface organisms, minced, and sonicated once more before making serial dilutions. The results were compared with ANOVA and Tukey intervals (α=.05). Results. The number of colonies formed ranged from 17 to 31 × 10 5 (mean = 23 ± 4 × 10 5 ) and 14 to 69 × 10 5 (mean = 32 ± 20 × 10 5 ) for the PermaSoft with and without Microban groups, respectively. There was no statistically significant difference between PermaSoft with and without Microban. Conclusion. The addition of Microban did not significantly alter the cytotoxicity of the PermaSoft denture lining material or reduce the adherence of viable C albicans to the surface of PermaSoft material after 24 hours. (J Prosthet Dent 2001;85:352-6.)

Statement of problem. Dental casting alloys are subjected to transient acidity in the oral environment, yet most studies have not investigated the effects of these transient environments on elemental release from alloys. Elemental release is important because it plays a significant role in alloy biocompatibility. Purpose. It was hypothesized that acidic environments would increase elemental release from dental alloys during exposure and after the acidic environment was removed. This hypothesis was based on the known increase in release of nickel from nickel-based alloys in an acidic environment. Material and methods. High-noble, noble, and base metal casting alloys were exposed for 30 minutes to solutions with pH ranging from 1 to 7. Elemental release of representative elements was measured by means of atomic absorption spectrometry during the exposure and in the week after the exposure. This release was compared with elemental release in the week before the exposure. Results. High-noble and noble alloys were resistant to acidic environments. A pH of 4 did not increase elemental release during or after exposure. A pH 1 environment slightly elevated release of Ag, Cu, and Pd in some alloys. However, a Ni-based alloy released large amounts of Ni during the acidic exposure of pH 1 or 4, and more importantly, in the week after the exposure as well. Increased time of exposure to acid did not alter elemental release from noble or high-noble alloys, but markedly increased release from the Ni-based alloy. Conclusions. Transient exposure of casting alloys to an acidic oral environment is likely to significantly increase elemental release from Ni-based alloys, but not from high-noble or noble alloys. (J Prosthet Dent 1998;80:691-8.)

The biocompatibility of new dental ceramics has not been assessed with the same scrutiny as has been applied to alloys and composites. Yet, the biocompatibility of ceramics is critical to the long-term success of dental prostheses because ceramics are in close contact with oral tissues for extended periods.Five dental ceramics (2 traditional feldspathic veneer porcelains [Vita Omega and Duceragold], 2 lithium disilicate pressable materials [Stylepress and Empress-2], and a pressable leucite-based material [Empress-1]) were tested for their ability to alter cellular mitochondrial dehydrogenase activity after fabrication using a tetrazolium assay, after aging for 2 weeks in a biologic solution and after post-aging polishing with either a fine diamond or diamond polishing paste. Cellular responses were compared with polytetrafluoroethylene controls (analysis of variance, Tukey pairwise post-hoc comparison, alpha=.05).The feldspathic porcelains caused only mild (25% of controls) mitochondrial suppression regardless of aging or polishing. The pressable leucite-based material initially caused a 5% stimulation (not significant) of mitochondrial activity, which decreased significantly (P.05) by 30% with aging to levels comparable to the feldspathic porcelains, and did not change with polishing. Both lithium disilicate materials caused an initial suppression of mitochondrial activity that decreased significantly with aging, but Empress-2 was severely cytotoxic initially (20% of controls, P.01), and became more cytotoxic again after polishing. Stylepress was less cytotoxic initially (85% of controls, not significant) and did not become cytotoxic again after polishing.Dental ceramics are not equivalent in their in vitro biologic effects, even within the same class of material, and biologic safety should not be assumed. Most ceramics caused only mild in vitro suppression of cell function to levels that would be acceptable on the basis of standards used to evaluate alloys and composites. However, 1 Li-disilicate material (Empress-2) exhibited cytotoxicity that would not be deemed biologically acceptable on the basis of prevailing empirical standards for dental alloys and composites.

The numbers and types of alloys for prosthodontic restorations have increased dramatically over the past 25 years, making selection of an alloy for a given clinical situation difficult. Factors such as cost, the need for better strength, and worries about alloy corrosion have pressured the alloy market to change significantly. A number of properties--including yield strength, hardness, elastic modulus, microstructural phases, grain size, corrosion performance, coefficient of thermal expansion, oxide color, and melting range--are relevant to the proper selection of an alloy for a given clinical problem. In this article, a brief historical look at prosthodontic alloys and the nomenclature for alloys is followed by a discussion of the most important physical properties of alloys for clinical practice. A summary of the types of alloys available today and their classification is then presented. Finally, speculations about future trends for alloys are made, and simple guidelines are suggested to help dentists choose appropriate alloys for their practices. This review excludes implant alloys, dental amalgam, and alloys for orthodontic and endodontic applications.

Statement of Problem. The biological properties of casting alloys have been assessed largely under passive conditions. The effect of common intraoral stresses such as brushing, toothpastes, and low pH on alloy toxicity are not known. Purpose. This study assessed the toxicity of 5 types of casting alloys commonly used in prosthodontics after toothbrushing, brushing in an acidic environment, or brushing with toothpaste. These toxicities were compared with those observed without any brushing. Material and Methods. Au-Pt, Au-Pd, Pd-Cu-Ga, Ni-Cr-Be, and Ni-Cr (no Be) alloys were brushed for 48 hours in a toothbrushing machine at 90 strokes/minute and 200g force. Alloys were brushed with either saline at pH 7, saline at pH 4 (acidified with sodium lactate), or saline with 1:7 (wt/wt) toothpaste. After the brushing regimen, the cytotoxicity of the alloys was assessed in a standard in vitro test. Cytotoxicities of the alloys after different brushing treatments were compared with unbrushed (control) specimens. Analysis of variance (ANOVA) and Tukey multiple comparison intervals (α=.05) were used to identify significant differences among brushing conditions. Results. Brushing at pH 7 significantly increased the toxicity of the Pd-Cu-Ga alloy (15% to 20% over unbrushed specimens). Brushing at pH 4 increased the toxicity of the Au-Pt and Au-Pd alloys by 30% and the Pd-Cu-Ga alloy by >40%. The Ni-based alloys were not affected by acid. After being brushed with toothpaste, both Ni-based alloys were significantly more toxic, but Ni-Cr-Be was the worst, increasing more than 60% in toxicity over the controls. The toxicity of the Au-Pd alloy also increased significantly (15%). Conclusion. Brushing dental casting alloys may increase their cytotoxicity in vitro, but the increase depends heavily on the alloy type and brushing condition. (J Prosthet Dent 2002;87:94-8.)

Statement Of Problem. Dental casting alloys are widely used in applications that place them into contact with oral tissues for many years. With the development of new dental alloys over the past 15 years, many questions remain about their biologic safety. Practitioners must choose among hundreds of alloy compositions, often without regard to biologic properties. Purpose. This article is an evidence-based tutorial for clinicians. Concepts and current issues relevant to the biologic effects of dental casting alloys are presented. Summary. The single most relevant property of a casting alloy to its biologic safety is its corrosion. Systemic and local toxicity, allergy, and carcinogenicity all result from elements in the alloy being released into the mouth during corrosion. Little evidence supports concerns of casting alloys causing systemic toxicity. The occurrence of local toxic effects (adjacent to the alloy) is not well documented, but is a higher risk, primarily because local tissues are exposed to much higher concentrations of released metal ions. Several elements such as nickel and cobalt have relatively high potential to cause allergy, but the true risk of using alloys containing these elements remains undefined. Prudence dictates that alloys containing these elements be avoided if possible. Several elements in casting alloys are known mutagens, and a few such as beryllium and cadmium are known carcinogens in different chemical forms. Despite these facts, carcinogenic effects from dental casting alloys have not been demonstrated. Prudent practitioners should avoid alloys containing these known carcinogens. Conclusion. To minimize biologic risks, dentists should select alloys that have the lowest release of elements (lowest corrosion). This goal can be achieved by using high-noble or noble alloys with single-phase microstructures. However, there are exceptions to this generality, and selection of an alloy should be made on a case-by-case basis using corrosion and biologic data from dental manufacturers. (J Prosthet Dent 2000;83:223-34.)

Statement of problem. Short-term (72-168 hours) in vitro testing of dental casting alloys for cytotoxicity may not reflect in vivo biocompatibility. An accelerated test for evaluation of dental casting alloy cytotoxicity could help screen newly developed alloys more rapidly and accurately. Purpose. This study evaluated a method of accelerating alloy cytotoxicity by short-term conditioning of alloys. Cytotoxicity and mass release of these conditioned alloys were compared with alloys conditioned for 10 months or unconditioned alloys. The hypothesis was that a short-term conditioning procedure could be developed that would give cytotoxicity and mass release values similar to alloys exposed to a biologic solution for 10 months. Material and methods. Dental casting alloys were conditioned in either saline, cell-culture medium, or a saline/bovine serum albumin (BSA) solution for 168 hours before standard in vitro cytotoxicity testing. Eight types of casting alloys with a range of nobilities (98% to 0%) were tested (n = 6). Controls were Teflon (Tf). Conditioned alloys were placed in direct contact with Balb/c fibroblasts for 72 hours, and cell viability was measured by succinic dehydrogenase activity (MTT method) relative to Tf controls. Elements released into the conditioning solutions were measured by atomic absorption spectroscopy. The cytotoxicities of conditioned alloys and total mass released were compared with unconditioned alloys (0 month) and alloys that were exposed to cell culture medium for 10 months. ANOVA and Tukey multiple comparison intervals (α=.05) were used to compare mass released and cytotoxicity. Results. Conditioning for 168 hours altered the cytotoxicity of the alloys. The saline/BSA conditioning solution reduced cytotoxicity of the alloys compared with unconditioned alloys, except for the Ni-Cr alloy. Other conditioning solutions were not as uniform in their effects, some increasing toxicity, others decreasing it. Overall, the saline/BSA solution was the most effective at changing alloy cytotoxicity from the unconditioned (0 month) toward the 10-month values. Mass loss during saline/BSA conditioning most closely approximated 10-month loss for most alloys. Conclusion. Conditioning of casting alloys appeared to be a useful method for predicting long-term cytotoxicity with a short-term in vitro test, but all conditioning solutions were not equivalent. (J Prosthet Dent 1999;81:715-20.)

Statement of problem. Short-term (72-168 hours) in vitro tests are used to evaluate the cytotoxicity of dental casting alloys. The ability of these short-term tests to predict long-term in vivo cytotoxicity has been questioned. A procedure to accelerate the testing of casting alloys would be useful in predicting longer-term alloy cytotoxicity. Purpose. This study hypothesized that preconditioning casting alloys by soaking in a biologic liquid would change subsequent cytotoxicity by removing some elements. Preconditioning may be 1 method of accelerating short-term in vitro tests. Material and methods. Dental casting alloys were exposed to either saline, cell culture medium, or a saline/bovine serum albumin (BSA) solution for 72 hours before standard in vitro cytotoxicity testing. Six types of alloys were tested (n = 6): 5 Au-Ag-Cu-Pd alloys (single phase) and 1 Ag-Pd-Cu alloy (multiple phase). Teflon (Tf) samples served as a control. After preconditioning, alloys were placed in direct contact with Balb/c fibroblasts for 72 hours, after which cell viability was measured by succinic dehydrogenase activity (MTT method) relative to Tf controls (100% = no toxicity). Elements released into the preconditioning solutions were measured by atomic absorption spectroscopy. Cytotoxicities of preconditioned alloys and amounts of elemental release were compared with unconditioned alloys. Results. A preconditioning time of 72 hours was sufficient to change the cytotoxicity of the tested alloys. The alloys that were more cytotoxic initially became less cytotoxic after preconditioning. For all the alloys tested, except the Ag-Pd-Cu multiphase alloy, preconditioning with either the saline or the saline/BSA solution caused an increase in cellular activity, therefore the preconditioned alloys were less cytotoxic. The cell culture medium preconditioning solution had a variable effect, causing increased or decreased cellular activity depending on the alloy treated. Conclusion. Preconditioning of casting alloys decreased subsequent cytotoxicity. However, not all preconditioning solutions are equivalent. A preconditioning strategy may be useful in accelerating the short-term cytotoxicity test toward a longer-term result. (J Prosthet Dent 1999;81:591-6.)