Faculty Bibliography

STATEMENT OF PROBLEM/BACKGROUND:Trueness and precision are used to evaluate the accuracy of intraoral optical impressions. Although the in vivo precision of intraoral optical impressions has been reported, in vivo trueness has not been evaluated because of limitations in the available protocols. PURPOSE/OBJECTIVE:The purpose of this clinical study was to compare the accuracy (trueness and precision) of optical and conventional impressions by using a novel study design. MATERIAL AND METHODS/METHODS:Five study participants consented and were enrolled. For each participant, optical and conventional (vinylsiloxanether) impressions of a custom-made intraoral Co-Cr alloy reference appliance fitted to the mandibular arch were obtained by 1 operator. Three-dimensional (3D) digital models were created for stone casts obtained from the conventional impression group and for the reference appliances by using a validated high-accuracy reference scanner. For the optical impression group, 3D digital models were obtained directly from the intraoral scans. The total mean trueness of each impression system was calculated by averaging the mean absolute deviations of the impression replicates from their 3D reference model for each participant, followed by averaging the obtained values across all participants. The total mean precision for each impression system was calculated by averaging the mean absolute deviations between all the impression replicas for each participant (10 pairs), followed by averaging the obtained values across all participants. Data were analyzed using repeated measures ANOVA (α=.05), first to assess whether a systematic difference in trueness or precision of replicate impressions could be found among participants and second to assess whether the mean trueness and precision values differed between the 2 impression systems. RESULTS:Statistically significant differences were found between the 2 impression systems for both mean trueness (P=.010) and mean precision (P=.007). Conventional impressions had higher accuracy with a mean trueness of 17.0 ±6.6 μm and mean precision of 16.9 ±5.8 μm than optical impressions with a mean trueness of 46.2 ±11.4 μm and mean precision of 61.1 ±4.9 μm. CONCLUSIONS:Complete arch (first molar-to-first molar) optical impressions were less accurate than conventional impressions but may be adequate for quadrant impressions.

Marginal and internal adaptation is critical for the success of indirect restorations. New imaging systems make it possible to evaluate these parameters with precision and non-destructively. This study evaluated the marginal and internal adaptation of zirconia copings fabricated with two different systems using both silicone replica and microcomputed tomography (micro-CT) assessment methods. A metal master model, representing a preparation for an all-ceramic full crown, was digitally scanned and polycrystalline zirconia copings were fabricated with either Ceramill Zi (Amann-Girrbach) or inCoris Zi (Dentslpy-Sirona), n=10. For each coping, marginal and internal gaps were evaluated by silicone replica and micro-CT assessment methods. Four assessment points of each replica cross-section and micro-CT image were evaluated using imaging software: marginal gap (MG), axial wall (AW), axio-occlusal angle (AO) and mid-occlusal wall (MO). Data were statistically analyzed by factorial ANOVA and Tukey test (a=0.05). There was no statistically significant difference between the methods for MG and AW. For AO, there were significant differences between methods for Amann copings, while for Dentsply-Sirona copings similar values were observed. For MO, both methods presented statistically significant differences. A positive correlation was observed determined by the two assessment methods for MG values. In conclusion, the assessment method influenced the evaluation of marginal and internal adaptation of zirconia copings. Micro-CT showed lower marginal and internal gap values when compared to the silicone replica technique, although the difference was not always statistically significant. Marginal gap and axial wall assessment points showed the lower gap values, regardless of ceramic system and assessment method used.

BACKGROUND:The authors evaluated and quantified clinically detectable errors commonly seen in impressions sent to commercial laboratories and determined possible relationships between finish line errors and other factors involved. METHODS:The authors visited 3 large and 1 small commercial dental laboratories over a 12-month period. Three calibrated examiners evaluated the impressions. The examiners evaluated all impressions for errors by using ×2.5 magnification loupes under ambient room lighting without the aid of additional illumination. RESULTS:The authors evaluated 1,157 impressions; 86% of the examined impressions had at least 1 detectable error, and 55% of the noted errors were critical errors pertaining to the finish line. The largest single error categories evaluated were tissue over the finish line (49.09%), lack of unprepared stops in dual-arch impressions (25.63%), pressure of the tray on the soft tissue (25.06%), and void at the finish line (24.38%). The factors blood on the impression (odds ratio, 2.31; P < .001) and tray type (odds ratio, 1.68; P < .001) were associated significantly with finish line errors. CONCLUSIONS:Marginal discrepancies made up the largest category of error noted in impressions evaluated. The authors noted an increase in errors at the finish line with dual-arch impression techniques and in the presence of blood. PRACTICAL IMPLICATIONS:Dentists have ethical, moral, and legal obligations bestowed on them by the profession and need to evaluate critically the work they send to laboratories. The authors strongly recommend an improvement in technique and reviewing of all impressions and working casts.

PURPOSE/OBJECTIVE:To evaluate the fracture resistance (FR), and push-out bond strengths (BS) of custom-made CAD/CAM post-and-cores manufactured with different esthetic materials. METHODS:90 single-rooted extracted teeth were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three equal groups according to the material: hybrid ceramic Vita Enamic (HC); nano-ceramic resin composite Lava Ultimate (RC); and experimental epoxy-resin reinforced by glass-fiber (FG). The post-and-cores were manufactured using CAD/CAM and cemented using a self-adhesive resin cement (Rely X Unicem2). A subgroup of 30 specimens (n=10) was subjected to fatigue (1,000,000 cycles at 5 Hz) and then to the FR test. Another subgroup with 60 specimens was submitted to the BS test, with and without fatigue. Data were submitted to analysis of variance (FR - one-way ANOVA; BS - two-way ANOVA) and Tukey's test (α= 0.05). RESULTS:The FR values (mean±SD, in Newtons) were 414.5±83.9 (HC), 621.3±100.3 (RC), and 407.6±109.0 (FG), with RC showing significantly higher FR values (P< 0.05). For BS, there was no statistically significant difference among the materials, with and without fatigue (P> 0.05). The type of material used to obtain the CAD/CAM-customized post-and-cores had a significant effect on the FR, but not on the BS of the specimens. Fatigue did not influence the BS for the tested materials. CLINICAL SIGNIFICANCE/CONCLUSIONS:CAD/CAM custom-made esthetic post-and-cores showed good performance relative to fracture resistance and bond strength to root canal dentin walls. The CAD/CAM materials tested could be used as an alternative to restore wide flared root canals in esthetically compromised teeth.

In the direct-indirect composite technique, composite is applied to a nonretentive tooth preparation (eg, a noncarious cervical lesion or a veneer/inlay/onlay preparation) without any bonding agent, sculpted to a primary anatomic form, and light-cured. The partially polymerized restoration is then removed from the preparation and finished and tempered extraorally chairside. The finished inlay is bonded to the preparation using a resin-based luting agent. Advantages of this technique include enhanced physical and mechanical properties afforded by the extraoral chairside tempering process because of increased monomer conversion, and greater operator control over the final marginal adaptation, surface finishing and polishing, and anatomy of the restoration, given that these elements are defined outside of the patient's mouth. The direct-indirect approach also affords enhanced gingival health and patient comfort. This article presents a clinical case in which the direct-indirect composite technique was used to restore three noncarious cervical lesions on the same quadrant on an adult patient. Clinical steps and tips for success are offered. The authors also present scanning electron microscope and atomic force microscope images showing the excellent marginal fit obtained with the direct-indirect composite technique.

PROBLEM:Intraoral occlusal adjustment of ceramic restorations can create a significant increase in surface roughness that can produce wear of the opposing dentition. PURPOSE:To compare the surface roughness of glazed and polished monolithic ceramics with the surface roughness produced by different intraoral polishing systems on adjusted monolithic ceramics. MATERIALS AND METHODS:), was measured using atomic force microscope and profilometer before and after adjustment and polishing with the following intraoral polishing systems: BruxZir and Dialite ZR (for BruxZir), Zenostar and Dialite ZR (for Zenostar), and OptraFine and Dialite LD for IPS Empress CAD and IPS e.max CAD. Mean and standard error for each material and polishing system were calculated. T-test, one-way ANOVA, and Bonferroni post hoc tests were used to analyze data. RESULTS:BruxZir zirconia presented smoother surfaces with Dialite ZR system compared to BruxZir system, Zenostar zirconia shown smoother surfaces with Zenostar system compared to Dialite ZR system and IPS Empress CAD and IPS e.max CAD presented smoother surfaces with OptraFine system in comparison to Dialite LD system. CONCLUSION:All materials presented smoother surfaces at baseline than after adjustment and polishing. CLINICAL SIGNIFICANCE:This paper reveals the results of an in vitro study that provides information to clinicians regarding which intraoral polishing system will produce a smoother surface after the adjustment and polishing of IPS Empress CAD, IPS e.max CAD, BruxZir and Zenostar ceramic materials. (J Esthet Restor Dent 28:382-396, 2016).

OBJECTIVE:To evaluate the 6-year clinical performance of Xeno IV, Xeno III, and XP Bond adhesives in the restoration of non-carious cervical lesions (NCCLs). METHODS:This was a randomized controlled clinical trial where 39 participants met the inclusion/exclusion criteria and were enrolled. Lesions restored were notch-shaped NCCLs. Prior to adhesive procedures, NCCLs were roughened. No enamel bevel was placed and no mechanical retention was created. Adhesive systems were applied following manufacturer's instructions and the NCCLs were restored with composite resin (TPH(3)). Restorations were finished immediately after placement and scored with regard to retention, marginal discoloration, marginal adaptation, sensitivity, and secondary caries using modified USPHS criteria. Descriptive statistics were performed. Logistic regression models were performed for each outcome separately with compound symmetry correlation structure where teeth were clustered by participants. All analyses were conducted using SAS 9.2. RESULTS:The 6-year recall rate was 77.5% of the restorations (76.9% of the participants). No statistical differences were found between adhesives for retention, marginal discoloration, and marginal adaptation. Restorations failed by loss of retention (16.7%, 27.6%, and 11.8% of Xeno IV, Xeno III, and XP Bond restorations, respectively) and marginal discoloration (7.4% of Xeno IV restorations). For every unit increase in restoration volume it was 1.31 (95%C.I. 1.05, 1.63, P=0.01) times more likely that the restoration retention would be maintained. SIGNIFICANCE:The tested adhesive systems presented similar clinical performance after six years of service, with annual failure rates of 2.8%, 4.6%, and 2.0% for Xeno IV, Xeno III, and XP Bond, respectively.