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Introduction Proper integration of newly emerging digital assessment tools is a central issue in dental education in an effort to provide more accurate and objective feedback to students. The study examined how the outcomes of students’ tooth preparation were correlated when evaluated using traditional faculty assessment and two types of digital assessment approaches. Specifically, incorporation of the Romexis Compare 2.0 (Compare) and Sirona prepCheck 1.1 (prepCheck) systems was evaluated. Additionally, satisfaction of students based on the type of software was evaluated through a survey. Material and Methods Students in a second-year pre-clinical prosthodontics course were allocated to either Compare (n = 42) or prepCheck (n = 37) systems. All students received conventional instruction and used their assigned digital system as an additional evaluation tool to aid in assessing their work. Examinations assessed crown preparations of the maxillary right central incisor (#8) and the mandibular left first molar (#19). All submissions were graded by faculty, Compare and prepCheck. Results Technical scores did not differ between student groups for any of the assessment approaches. Compare and prepCheck had modest, statistically significant correlations with faculty scores with a minimum correlation of 0.3944 (P = 0.0011) and strong, statistically significant correlations with each other with a minimum correlation of 0.8203 (P

Objectives In humans, there is a large range of variation in the form of the maxillary and mandibular dental arches. This variation can manifest as either prognathism or retrognathism in either or both arches, which can cause malocclusion and lead to abnormal masticatory function. This study aims to identify aspects of variation and morphological integration existing in the dental arches of individuals with different types of malocclusion. Methods Coordinate landmark data were collected along the gingival margins of 397 scanned dental casts and then analyzed using geometric morphometric techniques to explore arch form variation and patterns of morphological integration within each malocclusion type. Results Significant differences were identified between Class II forms (increased projection of upper arch relative to the lower arch) and Class III forms (lower arch projection beyond the upper arch) in symmetrical shape variation, including anteroposterior arch discrepancies and abnormal anterior arch divergence or convergence. Partial least squares analysis demonstrated that Class III dental arches have higher levels of covariance between upper and lower arches (RV = 0.91) compared to the dental arches of Class II (RV = 0.78) and Class I (RV = 0.73). These high levels of covariance, however, are on the lower end of the overall range of possible masticatory blocks, indicating weaker than expected levels of integration. Conclusions This study provides evidence for patterns of variation in dental arch shape found in individuals with Class II and Class III malocclusions. Moreover, differences in integration found between malocclusion types have ramifications for how such conditions should be studied and treated. Am. J. Hum. Biol., 2016. © 2016 Wiley Periodicals, Inc.

The accuracy of interim crowns made with computer-aided design and computer-aided manufacturing (CAD/CAM) systems has not been well investigated.The purpose of this in vitro study was to evaluate the marginal integrity of interim crowns made by CAD/CAM compared with that of conventional polymethylmethacrylate (PMMA) crowns.A dentoform mandibular left second premolar was prepared for a ceramic crown and scanned for the fabrication of 60 stereolithical resin dies, half of which were scanned to fabricate 15 Telio CAD-CEREC and 15 Paradigm MZ100-E4D-E4D crowns. Fifteen Caulk and 15 Jet interim crowns were made on the remaining resin dies. All crowns were cemented with Tempgrip under a 17.8-N load, thermocycled for 1000 cycles, placed in 0.5% acid fuschin for 24 hours, and embedded in epoxy resin before sectioning from the mid-buccal to mid-lingual surface. The marginal discrepancy was measured using a traveling microscope, and dye penetration was measured as a percentage of the overall length under the crown.The mean vertical marginal discrepancy of the conventionally made interim crowns was greater than for the CAD/CAM crowns (P=.006), while no difference was found for the horizontal component (P=.276). The mean vertical marginal discrepancy at the facial surface of the Caulk crowns was significantly greater than that of the other 3 types of interim crowns (P.001). At the facial margin, the mean horizontal component of the Telio crowns was significantly larger than that of the other 3 types, with no difference at the lingual margins (P=.150). The mean percentage dye penetration for the Paradigm MZ100-E4D crowns was significantly greater and for Jet crowns significantly smaller than for the other 3 crowns (P.001). However, the mean percentage dye penetration was significantly correlated with the vertical and horizontal marginal discrepancies of the Jet interim crowns at the facial surface and with the horizontal marginal discrepancies of the Caulk interim crowns at the lingual surface (P.01 in each instance).A significantly smaller vertical marginal discrepancy was found with the interim crowns fabricated by CAD/CAM as compared with PMMA crowns; however, this difference was not observed for the horizontal component. The percentage dye penetration was correlated with vertical and horizontal discrepancies at the facial surface for the Jet interim crowns and with horizontal discrepancies at the lingual surface for the Caulk interim crowns.

The aim of this study was to evaluate the impact of computer-assisted learning on first-year dental students' waxing abilities and self-evaluation skills. Additionally, this study sought to determine how well digital evaluation software performed compared to faculty grading with respect to students' technical scores on a practical competency examination. First-year students at one U.S. dental school were assigned to one of three groups: control (n=40), E4D Compare (n=20), and Sirona prepCheck (n=19). Students in the control group were taught by traditional teaching methodologies, and the technology-assisted groups received both traditional training and supplementary feedback from the corresponding digital system. Five outcomes were measured: visual assessment score, self-evaluation score, and digital assessment scores at 0.25 mm, 0.30 mm, and 0.35 mm tolerance. The scores from visual assessment and self-evaluation were examined for differences among groups using the Kruskal-Wallis test. Correlation between the visual assessment and digital scores was measured using Pearson and Spearman rank correlation coefficients. At completion of the course, students were asked to complete a survey on the use of these digital technologies. All 79 students in the first-year class participated in the study, for a 100% response rate. The results showed that the visual assessment and self-evaluation scores did not differ among groups (p>0.05). Overall correlations between visual and digital assessment scores were modest though statistically significant (5% level of significance). Analysis of survey responses completed by students in the technology groups showed that profiles for the two groups were similar and not favorable towards digital technology. The study concluded that technology-assisted training did not affect these students' waxing performance or self-evaluation skills and that visual scores given by faculty and digital assessment scores correlated moderately.

No studies have evaluated the internal adaptation of pressed and milled ceramic crowns made from digital impressions.The purpose of this in vitro study was to evaluate the internal fit of pressed and milled ceramic crowns made from digital and conventional impressions.Thirty polyvinyl siloxane (PVS) impressions and 30 Lava COS impressions made of a prepared dentoform tooth (master die) were fabricated. Thirty crowns were pressed in lithium disilicate (IPS e.max Press), and 30 crowns were milled from lithium disilicate blocks (IPS e.max CAD) (15/impression technique) with the E4D scanner and milling engine. The master die and the intaglio of the crowns were digitized with a 3-dimensional laser coordinate measurement machine. The digital master die and intaglio of each crown were merged. The distance between the die and the intaglio surface of the crown was measured at 3 standardized points. One-way ANOVA was used for statistical analysis (α=.05).One-way ANOVA revealed that the internal gap obtained from the Lava/press group (0.211 mm, ±SD 0.041) was significantly greater than that obtained from the other groups (P.001), while no significant differences were found among PVS/press (0.111 mm ±SD 0.047), PVS/CAD/CAM (0.116 mm ±SD 0.02), and Lava/CAD/CAM (0.145 mm ±SD 0.024).The combination of the digital impression and pressed crown produced the least accurate internal fit.

Conventional grading of dental students’ projects in preclinical courses has mainly relied on visual evaluation by experienced instructors. The purpose of this study was to compare conventional visual grading in a dental anatomy course at one U.S. dental school to a novel digital assessment technique. A total of sixty samples comprised of two sets of faculty wax-ups (n=30), student wax-ups (n=15), and dentoform teeth of tooth #14 (n=15) were used for this study. Two additional faculty members visually graded the samples according to a checklist and then repeated the grading after one week. The sample wax-up with the highest score based on the visual grading was selected as the master model for the digital grading, which was also performed twice with an interim period of one week. Descriptive statistics and signed rank tests for systematic bias were used for intra- and interrater comparisons. The intraclass correlation (ICC) was used as a measure of intra- and interrater reliability. None of the faculty members achieved the minimum acceptable intrarater agreement of 0.8. Interrater agreement was substantially less than intrarater agreement for the visual grading, whereas all measures of intrarater agreement were greater than 0.9 and considered excellent for the digital assessment technique. These results suggest that visual grading is limited by modest intrarater reliability and low interrater agreement. Digital grading is a promising evaluation method showing excellent intrarater reliability and correlation. Correlation for visual and digital grading was consistently modest, partly supporting the potential use of digital technology in dental anatomy grading.

Purpose This in vitro study evaluated the 3D and 2D marginal fit of pressed and computer-aided-designed/computer-aided-manufactured (CAD/CAM) all-ceramic crowns made from digital and conventional impressions. Materials and Methods A dentoform tooth (#30) was prepared for an all-ceramic crown (master die). Thirty type IV definitive casts were made from 30 polyvinyl siloxane (PVS) impressions. Thirty resin models were produced from thirty Lava Chairside Oral Scanner impressions. Thirty crowns were pressed in lithium disilicate (IPS e.max Press; 15/impression technique). Thirty crowns were milled from lithium disilicate blocks (IPS e.max CAD; 15/impression technique) using the E4D scanner and milling engine. The master die and the intaglio of the crowns were digitized using a 3D laser coordinate measurement machine with accuracy of ±0.00898 mm. For each specimen a separate data set was created for the Qualify 2012 software. The digital master die and the digital intaglio of each crown were merged using best-fitting alignment. An area above the margin with 0.75 mm occlusal-gingival width circumferentially was defined. The 3D marginal fit of each specimen was an average of all 3D gap values on that area. For the 2D measurements, the marginal gap was measured at two standardized points (on the margin and at 0.75 mm above the margin), from standardized facial-lingual and mesial-distal digitized sections. One-way ANOVA with post hoc Tukey's honestly significant difference and two-way ANOVA tests were used, separately, for statistical analysis of the 3D and 2D marginal data (alpha = 0.05). Results One-way ANOVA revealed that both 3D and 2D mean marginal gap for group A: PVS impression/IPS e.max Press (0.048 mm ± 0.009 and 0.040 mm ± 0.009) were significantly smaller than those obtained from the other three groups (p < 0.0001), while no significant differences were found among groups B: PVS impression/IPS e.max CAD (0.088 mm ± 0.024 and 0.076 mm ± 0.023), C: digital impression/IPS e.max Press (0.089 mm ± 0.020 and 0.075 mm ± 0.015) and D: digital impression/IPS e.max CAD (0.084 mm ± 0.021 and 0.074 mm ± 0.026). The results of two-way ANOVA revealed a significant interaction between impression techniques and crown fabrication methods for both 3D and 2D measurements. Conclusions The combination of PVS impression method and press fabrication technique produced the most accurate 3D and 2D marginal fits.

The fabrication of zirconium dioxide (ZrO2) dental prosthetic substructures requires an extended sintering process (8 to 10 hours) in a conventional oven. Microwave sintering is a shorter process (2 hours) than conventional sintering.The purpose of this study was to compare the fracture toughness of 3 mol % Y2O3-stabilized ZrO2 sintered in a conventional or microwave oven.Partially sintered ZrO2 specimens from 3 manufacturers, KaVo, Lava 3M, and Crystal HS were milled (KaVo Everest engine) and randomly divided into 2 groups: conventional sintering and microwave sintering (n=16 per group). The specimens were sintered according to the manufacturers' recommendations and stored in artificial saliva for 10 days. Fracture toughness was determined by using a 4-point bend test, and load to fracture was recorded. Mean fracture toughness for each material was calculated. A 2-way ANOVA followed by the Tukey HDS post hoc test was used to assess the significance of sintering and material effects on fracture toughness, including an interaction between the 2 factors (α=.05).The 2-way ANOVA suggested a significant main effect for ZrO2 manufacturer (P.001). The post hoc Tukey HSD test indicated that mean fracture toughness for the KaVo ZrO2 (5.85 MPa·m(1/2) ±1.29) was significantly higher than for Lava 3M (5.19 MPa·m(1/2) ±0.47) and Crystal HS (4.94 MPa·m(1/2) ±0.66) (P.05) and no significant difference was observed between Lava 3M and Crystal HS (P.05). The main effect of the sintering process (Conventional [5.30 MPa·m(1/2) ±1.00] or Microwave [5.36 MPa·m(1/2) ±0.92]) was not significant (P=.76), and there was no interaction between sintering and ZrO2 manufacturer (P=.91).Based on the results of this study, no statistically significant difference was observed in the fracture toughness of ZrO2 sintered in microwave or conventional ovens.

Critical thinking skills are essential for the successful dentist, yet few explicit skillsets in critical thinking have been developed and published in peer-reviewed literature. The aims of this article are to 1) offer an assessable critical thinking teaching model with the expert's thought process as the outcome, learning guide, and assessment instrument and 2) offer three critical thinking skillsets following this model: for geriatric risk assessment, technology decision making, and situation analysis/reflections. For the objective component, the student demonstrates delivery of each step in the thought process. For the subjective component, the student is judged to have grasped the principles as applied to the patient or case. This article describes the framework and the results of pilot tests in which students in one year at this school used the model in the three areas, earning scores of 90% or above on the assessments. The model was thus judged to be successful for students to demonstrate critical thinking skillsets in the course settings. Students consistently delivered each step of the thought process and were nearly as consistent in grasping the principles behind each step. As more critical thinking skillsets are implemented, a reinforcing network develops.

Purpose The purpose of this in vitro study was to determine the biomechanical values of the SonicWeld Rx pin system in comparison with titanium screws for use in onlay cortical bone grafting. Materials and Methods In this study, 2.1-mm SonicWeld Rx pins and 1.5-mm titanium screws, measuring 7 mm in length, were used. Sawbone blocks were positioned to simulate an onlay bone graft, and the pins and screws were used to replicate bicortical fixation. Four groups were designated for vertical load application, and failure of the fixation was determined when stability was compromised. Study groups consisted of fixation material types and number of fixation appliances. A Bose Electroforce 3300 system was used to deliver the force and to obtain data. Results Comparison of SonicWeld Rx 1-pin fixation with titanium 1-screw fixation showed similar peak resistance loads. Average peak loading resistance for SonicWeld Rx 1-pin fixation was 65.54 N and that for titanium 1-screw fixation was 59.37 N, with no significant difference ( P = .9698). Average peak strength of SonicWeld Rx 2-pin and titanium 2-screw fixations was 110.24 and 97.3 N, respectively, with no significant difference ( P = .1041). Conclusion Based on the measured biomechanical values, SonicWeld Rx fixation can withstand similar peak load forces compared with that of titanium screw fixation. The SonicWeld Rx fixation can be an alternative method of fixation for onlay bone grafting in dentoalveolar ridge augmentation.

Purpose: This study evaluated the relationship between instrumental measurements and subjective visual assessment of differences in dental porcelain translucency. Materials and Methods: Unshaded feldspathic porcelain was used with controlled amounts of tin oxide to create two groups of 12-mm diameter disks with incremental changes in opacity. Contrast ratio (CR = Yb/Yw) was determined with a spectrophotometer, and used as a measure of porcelain translucency (Group A = 0.20 to 0.40; Group B = 0.6–0.8). Within each group, there were 14 specimens with 11 CRs. Three observer groups (first year dental students, residents, faculty with >10 years of shade matching experience) were recruited to assess the translucency between porcelain disks under two lighting conditions (reflected light, transmitted light). Each subject's ability to distinguish between specimens of differing translucency was determined. Descriptive statistics and three-way ANOVA followed by a post-hoc Tukey-Kramer test were used to evaluate the translucency perception threshold (TPT) of subjects (α= 0.05). Results: The overall mean TPT (ΔC) was 0.07, while 50% of the subjects could perceive a 0.06 CR difference between porcelain specimens. Three-way ANOVA revealed a significant difference in translucency perception among the observer groups (p < 0.0001), whereas the main effects for porcelain opacity (p= 0.3038) and lighting condition (p= 0.0645) were not significant, and no significant interactions were found. Post-hoc Tukey-Kramer test indicated that the mean TPT observed in the faculty group (ΔC = 0.04) was significantly lower than those observed in student (ΔC = 0.09) and resident groups (ΔC = 0.08), while there was no significant difference between students and residents. Conclusions: The overall mean TPT of all subjects was 0.07, and 50% of the study population perceived a 0.06 CR difference in translucency. Increased shade matching experience (≥10 years) significantly improved the ability to perceive differences in translucency; however, neither the viewing condition nor porcelain opacity affected the perceived translucency threshold.

The aim of this study was to evaluate the effect of digital tooth preparation imaging and evaluation technology on dental students' technical abilities, self-evaluation skills, and the assessment of their simulated clinical work. A total of 80 second-year students at one U.S. dental school were assigned to one of three groups: control (n=40), E4D Compare (n=20), and Sirona prepCheck (n=20). Students in the control group were taught by traditional teaching methodologies, and the technology-assisted groups received both traditional training and supplementary feedback from the corresponding digital system. Three outcomes were measured: faculty technical score, self-evaluation score, and E4D Compare scores at 0.30 mm tolerance. Correlations were determined between the groups' scores from visual assessment and self-evaluation and between the visual assessment and digital scores. The results showed that the visual assessment and self-evaluation scores did not differ among groups (p0.05). Overall, correlations between visual and digital assessment scores were modest though statistically significant (5% level of significance). These results suggest that the use of digital tooth preparation evaluation technology did not impact the students' prosthodontic technical and self-evaluation skills. Visual scores given by faculty and digital assessment scores correlated moderately in only two instances.

The aim of this study was to evaluate the impact of computer-assisted learning on first-year dental students' waxing abilities and self-evaluation skills. Additionally, this study sought to determine how well digital evaluation software performed compared to faculty grading with respect to students' technical scores on a practical competency examination. First-year students at one U.S. dental school were assigned to one of three groups: control (n=40), E4D Compare (n=20), and Sirona prepCheck (n=19). Students in the control group were taught by traditional teaching methodologies, and the technology-assisted groups received both traditional training and supplementary feedback from the corresponding digital system. Five outcomes were measured: visual assessment score, self-evaluation score, and digital assessment scores at 0.25 mm, 0.30 mm, and 0.35 mm tolerance. The scores from visual assessment and self-evaluation were examined for differences among groups using the Kruskal-Wallis test. Correlation between the visual assessment and digital scores was measured using Pearson and Spearman rank correlation coefficients. At completion of the course, students were asked to complete a survey on the use of these digital technologies. All 79 students in the first-year class participated in the study, for a 100% response rate. The results showed that the visual assessment and self-evaluation scores did not differ among groups (p0.05). Overall correlations between visual and digital assessment scores were modest though statistically significant (5% level of significance). Analysis of survey responses completed by students in the technology groups showed that profiles for the two groups were similar and not favorable towards digital technology. The study concluded that technology-assisted training did not affect these students' waxing performance or self-evaluation skills and that visual scores given by faculty and digital assessment scores correlated moderately.

In humans, there is a large range of variation in the form of the maxillary and mandibular dental arches. This variation can manifest as either prognathism or retrognathism in either or both arches, which can cause malocclusion and lead to abnormal masticatory function. This study aims to identify aspects of variation and morphological integration existing in the dental arches of individuals with different types of malocclusion.Coordinate landmark data were collected along the gingival margins of 397 scanned dental casts and then analyzed using geometric morphometric techniques to explore arch form variation and patterns of morphological integration within each malocclusion type.Significant differences were identified between Class II forms (increased projection of upper arch relative to the lower arch) and Class III forms (lower arch projection beyond the upper arch) in symmetrical shape variation, including anteroposterior arch discrepancies and abnormal anterior arch divergence or convergence. Partial least squares analysis demonstrated that Class III dental arches have higher levels of covariance between upper and lower arches (RV = 0.91) compared to the dental arches of Class II (RV = 0.78) and Class I (RV = 0.73). These high levels of covariance, however, are on the lower end of the overall range of possible masticatory blocks, indicating weaker than expected levels of integration.This study provides evidence for patterns of variation in dental arch shape found in individuals with Class II and Class III malocclusions. Moreover, differences in integration found between malocclusion types have ramifications for how such conditions should be studied and treated. Am. J. Hum. Biol. 28:879-889, 2016. © 2016Wiley Periodicals, Inc.

Background Yttrium-stabilized tetragonal zirconia polycrystalline (Y-TZP) has become one of the most popular restorative core materials in the last decade due to its high flexural strength and fracture toughness. However, the low translucency of Y-TZP has become a critical issue in shade matching to natural teeth. This study compared the translucency of Y-TZP and alumina core materials at clinically appropriate thicknesses. Methods Zirconia disc samples were fabricated from Cercon (Dentsply Degudent), Everest (Kavo), Lava (3M ESPE) with 0.5-mm thickness and Procera zirconia (Nobel Biocare) with 0.4-mm thickness. Procera alumina samples with 0.4-mm thickness were also made for comparison. Spectral reflectance of samples was measured and contrast ratios were calculated. Surface roughness (Ra) of all ceramic discs was also analyzed with a Profilometer. Results One-way ANOVA showed a significantly lower translucency of Cercon than all the other three types of zirconia materials. Procera Alumina also demonstrated significantly higher translucency than all four types of zirconia. The mean Ra of Procera zirconia was significantly higher than the other types of ceramic materials. Conclusion The Ra of the Procera zirconia group was significantly higher than all the other testing groups.

Interim restorations are a critical component of fixed prosthodontic treatment, biologically and biomechanically. Interim restoration serves an important diagnostic role as a functional and esthetic try-in and as a blueprint for the design of the definitive prosthesis. When selecting materials for any interim restoration, clinicians must consider physical properties, handling properties, patient acceptance, and material cost. Although no single material meets all the requirements and material classification alone of a given product is not a predictor of clinical performance, bis-acryl materials are typically best suited to single-unit restorations, and poly(methylmethacrylate) interim materials are generally ideal for multi-unit, complex, long-term, interim fixed prostheses. As with most dental procedures, the technique used for fabrication has a greater effect on the final result than the specific material chosen.

Conventional grading of dental students' projects in preclinical courses has mainly relied on visual evaluation by experienced instructors. The purpose of this study was to compare conventional visual grading in a dental anatomy course at one U.S. dental school to a novel digital assessment technique. A total of sixty samples comprised of two sets of faculty wax-ups (n=30), student wax-ups (n=15), and dentoform teeth of tooth #14 (n=15) were used for this study. Two additional faculty members visually graded the samples according to a checklist and then repeated the grading after one week. The sample wax-up with the highest score based on the visual grading was selected as the master model for the digital grading, which was also performed twice with an interim period of one week. Descriptive statistics and signed rank tests for systematic bias were used for intra- and interrater comparisons. The intraclass correlation (ICC) was used as a measure of intra- and interrater reliability. None of the faculty members achieved the minimum acceptable intrarater agreement of 0.8. Interrater agreement was substantially less than intrarater agreement for the visual grading, whereas all measures of intrarater agreement were greater than 0.9 and considered excellent for the digital assessment technique. These results suggest that visual grading is limited by modest intrarater reliability and low interrater agreement. Digital grading is a promising evaluation method showing excellent intrarater reliability and correlation. Correlation for visual and digital grading was consistently modest, partly supporting the potential use of digital technology in dental anatomy grading.

Statement of problem Information regarding the differences in translucency among new ceramic systems is lacking. Purpose The purpose of this study was to compare the relative translucency of the different types of ceramic systems indicated for porcelain veneers and to evaluate the effect of shade and thickness on translucency. Material and methods Disk specimens 13 mm in diameter and 0.7-mm thick were fabricated for the following 9 materials (n=5): VITA VM9, IPS Empress Esthetic, VITA PM9, Vitablocks Mark II, Kavo Everest G-Blank, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as the positive control and Lava as the negative control. The disks were fabricated with the shade that corresponds to A1. For IPS e.maxPress, additional disks were made with different shades (BL2, BL4, A1, B1, O1, O2, V1, V2, V3), thickness (0.3 mm), and translucencies (high translucency, low translucency). Color coordinates (CIE L∗ a∗ b∗) were measured with a tristimulus colorimeter. The translucency parameter was calculated from the color difference of the material on a black versus a white background. One-way ANOVA, the post hoc Tukey honestly significant difference, and the Ryan-Einot-Gabriel-Welsch multiple range tests were used to analyze the data (α=.05). Results Statistically significant differences in the translucency parameter were found among porcelains (P PM9, Empress Esthetic>Empress CAD>Mark II, Everest, e.max CAD>e.max Press>Lava. Significant differences also were noted when different shades and thickness were compared ( P 001). Conclusions Different ceramic systems designed for porcelain veneers present varying degrees of translucency. The thickness and shade of lithium disilicate ceramic affect its translucency. Shade affects translucency parameter less than thickness.

Statement of problem. The clinical long-term success of single-tooth implant restorations depends, in part, on a stable connection between the prosthetic restoration and the implant body. Purpose. The purpose of this experiment was to investigate the fatigue life of UCLA-style abutment screws in wide-diameter versus conventionally sized dental implant restorations. Material and methods. Five 3.75 × 15-mm and five 6.0 × 15-mm hexed dental implants were used. Ten frameworks were fabricated, 5 with a single UCLA-style, 3.75-mm hexed gold alloy cylinder, and 5 with a single UCLA-style, 6.0-mm hexed gold alloy cylinder. To simulate a common laboratory procedure, 2 abutment interfaces were relieved with a one-quarter round bur for both diameters. The 3.75-mm implant used a Gold-Tite central abutment screw torqued to 32 Ncm, and the 6.0-mm implant used a titanium central abutment screw torqued to 25 Ncm. Frameworks were dynamically loaded (~10 Hz) with a 120 ± 10-N, 4-mm off-axis force. Liquid metal strain gauges were used to measure joint opening. Measurements were made at intervals of 10 3 , 10 4 , 10 5 , and 5×10 5 cycles. Gauge output data were converted to displacement with a conversion factor determined by calibration. Linear regression analysis then was performed. Results. Two observations were made in this study. Two of three 3.75-mm nonadjusted specimens and all three 6.0-mm nonadjusted specimens maintained joint closure (range of opening 0-20 μm) while measured under dynamic loading. The median joint opening at 5×10 5 cycles for 3.75-mm nonadjusted specimens was 14 ± 7 μm; for 6.0-mm specimens, it was 11 ± 10 μm. Both 3.75-mm adjusted specimens and 1 nonadjusted specimen failed to maintain joint closure (excess joint opening >50 μm). One of the 3.75-mm adjusted specimens had abutment screw fracture. One of two 6.0-mm adjusted specimens failed to maintain joint closure because of screw fracture. Conclusion. The dental implant–abutment interface of 3.75-mm and 6.0-mm externally hexed implants experienced similar joint opening after periods of dynamic loading. Laboratory adjustment of the interface significantly decreased the service life of the abutment screw joint. (J Prosthet Dent 2001;85:599-607.)

This in vitro study evaluated the 3D and 2D marginal fit of pressed and computer-aided-designed/computer-aided-manufactured (CAD/CAM) all-ceramic crowns made from digital and conventional impressions.A dentoform tooth (#30) was prepared for an all-ceramic crown (master die). Thirty type IV definitive casts were made from 30 polyvinyl siloxane (PVS) impressions. Thirty resin models were produced from thirty Lava Chairside Oral Scanner impressions. Thirty crowns were pressed in lithium disilicate (IPS e.max Press; 15/impression technique). Thirty crowns were milled from lithium disilicate blocks (IPS e.max CAD; 15/impression technique) using the E4D scanner and milling engine. The master die and the intaglio of the crowns were digitized using a 3D laser coordinate measurement machine with accuracy of ±0.00898 mm. For each specimen a separate data set was created for the Qualify 2012 software. The digital master die and the digital intaglio of each crown were merged using best-fitting alignment. An area above the margin with 0.75 mm occlusal-gingival width circumferentially was defined. The 3D marginal fit of each specimen was an average of all 3D gap values on that area. For the 2D measurements, the marginal gap was measured at two standardized points (on the margin and at 0.75 mm above the margin), from standardized facial-lingual and mesial-distal digitized sections. One-way ANOVA with post hoc Tukey's honestly significant difference and two-way ANOVA tests were used, separately, for statistical analysis of the 3D and 2D marginal data (alpha = 0.05).One-way ANOVA revealed that both 3D and 2D mean marginal gap for group A: PVS impression/IPS e.max Press (0.048 mm ± 0.009 and 0.040 mm ± 0.009) were significantly smaller than those obtained from the other three groups (p0.0001), while no significant differences were found among groups B: PVS impression/IPS e.max CAD (0.088 mm ± 0.024 and 0.076 mm ± 0.023), C: digital impression/IPS e.max Press (0.089 mm ± 0.020 and 0.075 mm ± 0.015) and D: digital impression/IPS e.max CAD (0.084 mm ± 0.021 and 0.074 mm ± 0.026). The results of two-way ANOVA revealed a significant interaction between impression techniques and crown fabrication methods for both 3D and 2D measurements.The combination of PVS impression method and press fabrication technique produced the most accurate 3D and 2D marginal fits.

Statement of problem Different parameters are used in the literature to describe translucency, making it difficult for clinicians to find clear information on ceramic translucency and compare studies. Purpose The purpose of this study was to assess the correlation between the contrast ratio (CR) and translucency parameter (TP) when the translucency of different types of ceramic systems is compared. Material and methods Disks 13 mm in diameter and 0.7 mm thick were fabricated for the following materials (n=5): VITA VM9, VITA PM9, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as positive control, while Lava Zirconia served as negative control. The luminous reflectance (Y) and color coordinates (CIE L* a* b*) of the specimens were measured with a tristimulus colorimeter. The CR (CR=Yb/Yw) was calculated from the reflectance of the light of the material on a black backing (Yb) to the reflectance on a white backing (Yw). The TP (TP=[(L b *L w *) 2+ (a b * - a w *) 2+ (b b * - b w *) 2 ] 1/2 ) was calculated from the color difference of the material on a black versus a white background. One-way ANOVA based on ranked data and the Pearson and Spearman rank correlation tests were used to analyze the data (α=.05). Results A significant correlation between CR and TP was found when all specimens were included ( P - 0.99 indicated a strong decreasing relationship between the 2 variables. Conclusions Either CR or TP can be used to evaluate the relative translucency of ceramic systems.

Eight geometric parameters of five interchangeable prosthetic retaining screws (#1-3i Implant Innovation-gold, #2-Impla-Med-gold, #3-Nobelpharma-gold, #4-3i Implant Innovation-titanium, and #5-Implant Support Systems-titanium) were recorded with an Amray 1000-B scanning electron microscope at x20 to x200 magnification. Five screws of each type were measured and eight parameters were evaluated: (A) diameter of head, (B) screw length, (C) thread pitch, (D) major diameter, (E) neck diameter (F) length of neck, (G) crest width, and (H) root width. The Nobelpharma-gold prosthetic retaining screws served as controls. The results revealed significant differences between the control and test screws in all parameters except parameters C and G (ANOVA, p0.05) and Duncan's multiple range test (significance level 0.05). On the basis of these differences, it was concluded that interchanging prosthetic retaining screws can introduce unknown variables in treating patients.

Purpose To determine if there was a significant difference between the vertical marginal openings of cast restorations, computer-aided design, and computer-aided machining restorations. Materials and methods Ten working dies were created from a single master die and used to fabricate ten restorations in each of the following groups: computer-aided design/computer-assisted machining (CAD/CAM), WAX/CAM, and WAX/CAST. The CAD/CAM titanium restorations were fabricated using the scanning and crown design modules of the KaVo Everest system. The WAX/CAM titanium restorations were fabricated using the double scan technique with the KaVo Everest system. The WAX/CAST high noble copings were fabricated using the conventional lost wax casting technique. The restorations were seated on the master die, and high-resolution digital photographs were made of the marginal area on all four sides. The vertical marginal opening was then measured using a calibrated digital software program. One-way ANOVA and Tukey's post hoc tests were used to determine the presence of statistically significant differences. Results The vertical margin openings were CAD/CAM: 79.43 +/- 25.46 microm; WAX/CAM: 73.12 +/- 24.15 microm; WAX/CAST: 23.91 +/- 9.80 microm. There was a statistically significant difference between the WAX/CAST group and the remaining groups. Conclusions There was no difference between the vertical marginal gaps of the CAD/CAM and WAX/CAM. The WAX/CAST technique resulted in smaller vertical marginal gaps than either CAD/CAM or WAX/CAM.

The aim of this study was to evaluate dynamic micromotion at the implant-abutment interface for 3 different implant neck designs. Five samples each from 3 implant types with different neck designs were subjected to 1 x 10(6) cycles under simulated oral conditions. Load magnitudes varied from 10 to 250 N at 15 Hz. The results revealed a significant main effect for type of implant (P.0001). The main effect for level of cycles proved to be nonsignificant (P = .9999), as did the interaction between type of implant and level of cycles (P = .9989). Differences in neck design among the 3 implant types resulted in differences in micromotion at the implant-abutment interface under simulated oral conditions.

To evaluate in vitro the effect of clinical primer application errors on human dentin permeability. The null hypothesis is that there is no difference in dentin permeability reduction with the use of a total-etch three-step (TE3) dentin adhesive system among the treatment groups.Seventy extracted noncarious human third molars were sectioned to obtain 0.7-mm-thick midcoronal dentin disks. The specimens were randomly assigned to 5 groups and treated with a total-etch three-step (TE3) ethanol/water-based dentin adhesive system, Optibond FL (Kerr; Orange, CA, USA), according to manufacturer's instructions using 4 simulated application errors: short application of primer by immediate drying; no primer application; no drying of primer; aggressive drying of primer. Permeability of dentin was measured as fluid filtration at baseline and after adhesive polymerization. Kruskal-Wallis and Tukey's post-hoc comparisons were used to evaluate permeability reduction differences among groups (alpha = 0.05).The null hypothesis was rejected (p0.0001). The data provided strong evidence that the distribution of percentage permeability reduction differed among the 5 treatment groups (p0.0001). All possible pairwise comparisons of the groups were statistically significant. The highest mean percentage of permeability reduction was observed in the group where manufacturer's instructions were followed (99.4+/-1.0), followed by the aggressive drying primer group (86.7+/-11.1), the shortened primer application group (73.01+/-12.0), the no-drying primer group (48.44 +/-19.9), and, finally, the no-primer group (22.33+/-7.7).The incorrect primer application allowed significant dentin permeability. Strict adherence to recommended clinical application of dentinal adhesives is fundamental to achieve good dentin tubule sealing.

The in vitro effectiveness of a uniform circumferential ferrule has been established in the literature; however, the effect of a nonuniform circumferential ferrule height on fracture resistance is unknown.This in vitro study investigated the resistance to static loading of endodontically treated teeth with uniform and nonuniform ferrule configurations.Fifty extracted intact maxillary human central incisors were randomly assigned to 1 of 5 groups: CRN, no root canal treatment (RCT), restored with a crown; RCT/CRN, no dowel/core, restored with a crown; 2 FRL, 2-mm ferrule, cast dowel/core and crown; 0.5/2 FRL, nonuniform ferrule (2 mm buccal and lingual, 0.5 mm proximal), cast dowel/core and crown; and 0 FRL, no ferrule, cast dowel/core and crown. The teeth were prepared to standardized specifications and stored for 72 hours in 100% humidity prior to testing. Testing was conducted with a universal testing machine with the application of a static load, and the load (N) at failure was recorded. Statistical analysis was performed with a 1-way analysis of variance and the Tukey Honestly Significant Difference test (alpha=.05). The mode of fracture was noted by visual inspection for all specimens.There was strong evidence of group differences in mean fracture strength ( P.0001). Following adjustment for all pairwise group comparisons, it was found that the lack of a ferrule resulted in a significantly lower mean fracture strength (0 FRL: 264.93 +/- 78.33 N) relative to all other groups. The presence of a nonuniform (0.5 to 2-mm vertical height) ferrule (0.5/2 FRL: 426.64 +/- 88.33 N) resulted in a significant decrease ( P =.0001) in mean fracture strength when compared with the uniform 2-mm vertical ferrule (2 FRL: 587.23 +/- 110.25 N), the group without RCT (CRN: 583.67 +/- 86.09 N), and the RCT-treated tooth with a crown alone (CRN/RCT: 571.04 +/- 154.86 N). The predominant mode of failure was an oblique fracture extending from the lingual margin to the facial surface just below the insertion of the tooth into the acrylic resin.The results demonstrated that central incisors restored with cast dowel/core and crowns with a 2-mm uniform ferrule were more fracture resistant compared to central incisors with nonuniform (0.5 to 2 mm) ferrule heights. Both the 2-mm ferrule and nonuniform ferrule groups were more fracture resistant than the group that lacked a ferrule.

Clinical loading may result in micromotion and metal fatigue in apparently stable implant screw joints. This micromotion may contribute to tissue inflammation and prosthesis failure.This study investigated dental implant screw joint micromotion and dynamic fatigue as a function of varied preload torque applied to abutment screws when tested under simulated clinical loading.Fifteen noble alloy single-tooth implant restorations, each containing a hexed UCLA-style gold cylinder, were randomly assigned to 3 preload groups (16, 32, and 48 N.cm). Each group consisted of 5 implants (each 3.75 x 15 mm) and 5 square gold alloy abutment screws. A mechanical testing machine applied a compressive cyclic sine wave load between 20 and 130 N at 6 Hz to a contact point on each implant crown. A liquid metal strain gauge recorded the micromotion of the screw joint interface after 100, 500, 1,000, 5,000, 10,000, 50,000, and 100,000 cycles. Baseline data at 0 N.cm were collected before the application of the specified preload torque.The 16 N.cm group exhibited greater micromotion (P.001) than both the 32 and 48 N.cm groups at all cycle intervals (2-way ANOVA, Tukey HSD). Micromotion of the implant-abutment interface remained constant (P=.99) for each of the preload groups through 105 cycles.Under the loading parameters of this study, no measurable fatigue of the implant-abutment interface occurred. However, dental implant screw joints tightened to lower preload values exhibited significantly greater micromotion at the implant-abutment interface.

Purpose: The maximum preload torque of implant prosthetic retaining screws from four manufacturers and of two alloy types was measured to determine one index of interchangeability of intersystem components. MateFials and Methods: Implant prosthetic retaining screws from four manufacturers (3i Implant Innovations Inc, West Palm Beach, FL; Impla-Med Inc, Sunrise, FL; Nobelpharma USA Inc, Chicago, IL; and Implant Support Systems Inc, Irvine, CA) and of two metal types (gold and titanium] were investigated using an in vitro simulation model. Five screws of each type were tightened down against a gold cylinder using a Tohnichi BTG-6 torque gauge (Tohnichi American Corporation, Northbrook, IL) until fracture occurred. Results: The 3i Implant Innovations gold and the Nobelpharma gold were not significantly different. The 3i Implant Innovations titanium and the Impla-Med gold were able to withstand less preload torque than the 3i Implant Innovations gold and the Nobelpharma gold. The Implant Support Systems titanium was able to withstand significantly more preload torque than all of the other screws. Conclusions: Interchanging implant prosthetic retaining screws could introduce new and unknown variables that may affect the long-term survival of implant fixtures and/or the implant prostheses. J Prosthod 1995;4:23-27. Copyright 0 1995 by the American College of Prosthodontists.

Ten N/cm torque has been proposed as the optimum level for the tightening of implant retaining gold screws in order to preload the implant components to limit loosening and fracture. The purpose of this study was to determine the influence of instrumentation and operator experience on the torque generated during manual tightening of slotted gold screws. Sixteen subjects, divided into four groups based on experience, were instructed to tighten five screws into implant analogs with 20-mm and 37-mm slotted screwdrivers. The screws were then removed with a torque gauge. All of the groups of subjects were able to generate significantly greater torque with the 37-mm screwdriver. Dentists with no implant treatment experience generated significantly less torque than the other three groups. Of the 12 dentist subjects, only 3 generated the optimal amount of torque when using the 20-mm screwdriver. Operators who had little experience dealing with implant prostheses were not able to provide the recommended torque and experienced operators tended to generate more than the recommended amount. None of the subjects were able to generate consistent torque values.