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Assessing the reliability of a digital preparation assistant system used in dental education.

Use of a digital preparation assistant system may improve considerably the quality of preclinical dental education, provided the system works reliably. Thus, the purpose of this pilot study was to quantitatively assess the reliability of a new preclinical digital preparation assistant system (PREPassist, KaVo, Germany). The system was used to repeatedly scan four different unprepared and four different prepared teeth both with and without repositioning. Corresponding measurements were made to quantify accuracy, repeatability, and reproducibility. This was done by estimating the measurement error. Based on this estimation, respective limits of agreement were calculated. We used these ranges, along with assessments of the measurement's accuracy, to judge whether the results satisfy our expectations for clinically acceptable measurements. For preclinical laboratory instruction, the results indicate an acceptable accuracy (mean accuracy of 89 microm) of the measurements. This assessment applies as well to repeatability, given by the range of the respective limits of agreement (range <200 microm). However, in the case of reproducibility, the limits revealed discrepancies of practical importance (range >200 microm). Reproducibility of tooth repositioning in the available mounting device is unacceptable for preclinical laboratory instruction because of the observed range >200 microm. Thus, there is a need for the manufacture of new and more reliable mounting devices because reproducibility procedures are mostly encountered in preclinical instruction in restorative techniques. In contrast to reproducibility, accuracy and repeatability are acceptable for practical purposes. Balancing advantages and disadvantages, we conclude that, in general, the PREPassist system delivers reliable results.

Computer Simulation↗

Convergence angle, occlusal reduction, and finish line depth of full-crown preparations made by dental students.

OBJECTIVE: To measure the convergence angle, incisal/occlusal clearance, and finish line depth, which indicate the amount of axial reduction of full metal-ceramic crown preparations made by final-year dental students. METHOD AND MATERIALS: A total of 157 preparations were assessed. Convergence angle and finish line depths were measured by Tool Maker Microscope, while crown height was measured using a digital caliber. RESULTS: The mean convergence angle, faciolingually and mesiodistally, was 22.4 and 25.3 degrees, respectively. The mean for molars was statistically significantly greater than that for other teeth. The incisal/occlusal reduction ranged from 1.8 to 2.2 mm and averaged 2 mm. Buccal shoulder finish line depth averaged 0.86 mm, and mean chamfer finish line depth was 0.74 mm lingually, 0.7 mm mesially, and 0.66 mm distally. The buccal shoulder for mandibular anterior teeth was significantly smaller than for other teeth and averaged only 0.45 mm. CONCLUSION: The mean convergence angle was clinically acceptable. However, shoulder depth was less than the recommended depth of 1.0 to 1.5 mm for metal ceramic crowns. Incisal/occlusal reduction was clinically adequate to provide enough structural durability and color matching.

Analysis of Variance↗

Clinical acceptability of crown margins versus marginal gaps as determined by pre-doctoral students and prosthodontists.

PURPOSE: Marginal integrity is a very important element in evaluating a restoration; however, there is no agreement in definition of a clinically acceptable margin. The purpose of this investigation was to examine margin acceptability using an explorer versus the actual marginal gap widths at four locations on uncemented crowns on three extracted teeth using both predoctoral students and prosthodontists as evaluators. MATERIALS AND METHODS: The crown margin evaluation used 16 surfaces of four crowns fitting to three extracted caries-free teeth fitted into a dentiform. The teeth (nos. 14, 20, and 29) were prepared for a full cast (gold) crown using a chamfer finish line configuration, with some margins supragingival and others subgingival. After final impressions and working casts were made, die spacer was applied to the marginal area of the die before waxing to vary the marginal opening. The dentiform was placed in a mannequin in a supine position. Predoctoral students (N = 10) and prosthodontists (N = 9) evaluated each axial surface of each crown in the zone along the margin with an explorer and rated each surface as either "clinically acceptable" or "unacceptable." After casting, the axial marginal openings were measured with Image Pro Software using a digital microscopic image of the surface. Each participant repeated the margin evaluations 6 months later. RESULTS: Upon casting, marginal gaps ranged from 40 microm to 615 microm. The proportions of prosthodontists and of predoctoral students rating a given surface as "clinically unacceptable" were highly correlated (Spearman rank correlation = 0.81, p= 0.0001). The prosthodontists did not provide more or fewer ratings of clinical acceptability than the students, although kappa results indicated that the prosthodontists might be more consistent among themselves than the student raters. Upon re-evaluation, both groups rated between one and six of the surfaces differently than they had previously: the median number of inconsistencies was 1 for prosthodontists and 3 for predoctoral students. The prosthodontists tended to have fewer inconsistencies than the predoctoral students (0.05 < p < 0.10 Wilcoxon rank sum test), but this was not statistically significant. CONCLUSION: The data provided evidence that those surfaces associated with greater margin gaps tended to have a greater proportion of ratings of "clinically unacceptable." The proportion of prosthodontists and predoctoral students rating a margin "clinically unacceptable" were highly correlated. Prosthodontists tended to have fewer inconsistencies than predoctoral students, but that difference was not statistically significant.

Crowns↗

Designing tooth preparations for optimal success.

The form of prepared teeth and the amount of tooth structure remove dare important contributors to the mechanical, biologic,and esthetic success of the overlying crown or fixed partial denture.Therefore, it is important to develop clinical guidelines that can be used to optimize success in fixed prosthodontics.

Crowns↗

An evaluation of operator preference of diamond burs in coronal tooth preparation.

Three postgraduate prosthodontic students served as clinicians/evaluators in a study rating their preferences for three different diamond cutting instruments from three manufacturers. Each evaluator prepared the axial walls of complete veneer crowns on extracted molar teeth and then ranked their preference of the instruments. To prepare nine teeth, each of the three instruments was used in random order and without knowledge of the specific manufacturer. The methodology for analyzing the evaluators' preferences and the results are discussed.

Analysis of Variance↗

Predictable fixed prosthodontics: technique is the key to success.

This article reviews step-by-step clinical procedures for fixed prosthodontics that include a discussion of the following case parameters: (1) proper diagnosis and case selection; (2) tooth preparation; (3) soft tissue management; (4) impression making; (5) provisionalization; (6) additional laboratory diagnostic information; (7) case try in; and (8) case delivery. When the clinical principles of these procedures are faithfully followed, the success and predictability of any restorative endeavor will be greatly enhanced.

Cementation↗

Irrigation rates and handpieces used in prosthodontic and operative dentistry: results of a survey of North American dental school teaching.

PURPOSE: A data baseline on dental cutting methodologies was established by means of a survey of North American dental school teaching. MATERIALS AND METHODS: Sixty-four North American dental schools were surveyed regarding their recommendations on handpiece usage and coolant flow rates in fixed prosthodontics and operative dentistry. RESULTS: High-speed handpieces were the instruments of choice for tooth preparation in fixed prosthodontics. In operative procedures, recommendations for sole use of the high-speed, the low-speed, or both handpiece types were more uniform. CONCLUSIONS: North American dental schools advocate greater use of high-speed than low-speed handpieces. Although the use of high-speed handpieces predominate in schools in Canada and Puerto Rico, there is a proportionately higher use of low-speed handpieces than in US dental schools. Few (approximately 1 in 5) schools made recommendations on coolant flow rates during cutting procedures.

Canada↗

The light-cured composite restoration: an adjunct to removable partial prosthodontics.

An integral part of fabricating a removable partial denture is preparing the mouth to accommodate the design of the prosthesis and the patient's clinical presentation. When the morphology of the abutment tooth does not correspond to the design requirements, altering its form by either enameloplasty or restorative procedures is indicated. Research and clinical experience have shown that composite restoration is a suitable adjunct to preparing the mouth for removable partial dentures.

Composite Resins↗

Effect of margin location on crown preparation resistance form.

STATEMENT OF THE PROBLEM: The location of preparation margins may compromise the fixed prosthodontic restoration's resistance form. Purpose This study evaluated changes of opposite wall margin position on rotational resistance form compared to the equal-height margin configuration. MATERIAL AND METHODS: The trigonometric computation of the minimal resistance form preparation taper, alpha1 , was determined using a previously described formula. The alpha1-values for different tooth sizes with variation of base widths (range 4 to 10 mm) and vertical wall heights (range 4 to 9 mm) were calculated. The alpha1-values represent resistance form with both opposing wall margins at the same vertical height position. The alpha2-values were calculated with additional formulas to address uneven margin heights. Calculated alpha2-values of 10 degrees or less were considered clinically significant due to the known level of difficulty for the clinician. RESULTS: As a general trend, the alpha2-values were reduced compared to the alpha1-values with shortening opposing vertical wall heights in all tooth-size categories. Clinically significant changes in the resistance form taper were shown in all tooth size categories except the smallest 4-mm tooth base size. CONCLUSION: Fixed prosthodontic restoration resistance form is negatively affected by uneven vertical margin placement. This phenomenon reduces the resistance form of the restoration compared to equal-height margin placement.

Crowns↗

Comparison of the new matrix system with traditional fixed prosthodontic impression procedures.

This article compares the methods and effectiveness of traditional fixed partial denture impression systems, which includes the matrix impression system, in relation to the registration of the finish lines and sulci of tooth preparations in the formation of a full arch impression. Concepts relating to custom trays, retraction, homeostasis, sulcular cleansing, sulcular flange registration, configuration and strength, viscosity of elastomeric impression materials, and delivering the impression material into the sulcus are reviewed. Several concepts are questioned and alternative procedures are proposed. Forces that impact the gingival tissues and determine the success of the impression are briefly described.

Dental Impression Materials↗

The bitewing radiograph as an assessment tool in fixed prosthodontics.

Molar crown preparations, as described in the literature, have standard forms dictated by the demands of retention, resistance and the physical properties of materials. Standard designs may not be appropriate for all patients because of ethnic variations in tooth shape, pulp size and dentine thickness. Accurate data on these features could assist clinicians to minimize the risk of accidental pulpal injury. The aim of this study was to compare the first molar crown and pulp dimensions between Asian (Chinese, Korean, Malay) and other ethnic groups, using measurements from the bitewing radiographs of 121 subjects. Comparisons revealed the following significantly different features of Asian first molars: larger total pulp areas in uppers (P < 0.0005); shorter crowns (P < 0.0005); narrower upper teeth at the cervix (P < 0.0005); wider pulps at the cervix of lowers (P < 0.02); more bulbous crowns (P < 0.0005 for uppers; P < 0.01 for lowers), and finally significantly thinner dentine interproximally at the cervix (P=0.001 for uppers; P=0.011 for lowers). Preparations with wide shoulders could pose hazards to the pulps in Asian subjects. This study emphasizes the value of bitewing films in assessing crown and pulp size and shape before making crown preparations. The experienced practitioner may intuitively include tooth and pulp morphology in treatment planning, but this appears not to be taught or documented in textbooks.

Adult↗

Influence of margin design on the fit of high-precious alloy restorations in patients.

OBJECTIVE: It was the objective of this study, to analyze the influence of the marginal design on the marginal accuracy of a casting in a clinical setup in patients. METHODS: Ninety volunteer patients' teeth-which were intended for extraction due to medical reasons-were prepared prior to extraction. Three different types of finishing line-chamfer, 135 degrees shoulder and 90 degrees shoulder-were employed. Two each c-silicone and pvs impressions were taken of each tooth using either a two-stage or a one-stage putty-wash technique. After preparation and impression taking the teeth were extracted. Gypsum casts were poured from the impressions and high precious alloy castings fabricated on the dies and marginal discrepancies were determined on the extracted teeth. RESULTS: The median value of marginal discrepancies was lower than 150 microm for all groups. The difference between the three different preparation types was significant (H-test, p<0.05). The lowest median values were obtained for the chamfer preparations, while the 90 degrees shoulders always produced the highest median values. Preparations at gingva level exhibited more accurate marginal fit than subgingival preparations. No significant differences could be observed between the pvs and c-silicone materials or the one-step and two-step putty-wash techniques. CONCLUSIONS: The marginal designs of the preparations had much less influence on the marginal fit of high precious alloy castings than expected. There is considerable reason to assume that technical but clinical parameters influence the quality of fixed prosthodontics much more than has been believed in the past.

Adult↗

The effect of magnification on the performance of fixed prosthodontic procedures.

This study attempts to quantify the effect of magnifiers on the quality of typical procedures in fixed prosthodontics that are technique-sensitive and have significant increase in clinical success when errors are minimized. Dental students who performed fixed prosthodontic procedures while using magnifiers were found to have committed half as many errors as students who performed the same preparation without the aid of a magnifier.

Dental Equipment↗

Custom adaptation of an occlusal plane analyzer to a semiadjustable articulator.

The use of a semiadjustable articulator has become more popular for prosthodontic rehabilitation. An occlusal plane analyzer has long been used to assist the operator in the development of an initial mandibular occlusal plane in diagnostic contour casts and later as an integral part of both the contours of the definitive restorations as well as guidelines for the actual tooth preparations. Many manufacturers of semiadjustable articulators offer no such occlusal plane analyzers for use with their instruments. This article describes modifications for the adaptation of an occlusal plane analyzer to the WhipMix 2240 semiadjustable articulator, a possibility heretofore unavailable from any manufacturer.

Dental Articulators↗

Clinical aspects of resin-bonded bridges.

Resin-bonded bridges have emerged as an attractive, minimally invasive prosthodontic option for the restoration of edentulous spaces. Although success rates, determined by retrospective studies, vary greatly, resin-bonded bridges now have success rates approaching those of their cemented counterparts; success is dependent, however, upon appropriate design and careful technique. The metal framework must be rigid and of sufficient surface area to afford secure adhesion to the underlying teeth. Tooth preparation should be restricted to enhancing the bonding area, and it is important that prostheses are designed to maintain axial loading, and guidance upon metal.

Contraindications↗

Clinical and laboratory parameters in fixed prosthodontic treatment.

Prosthodontic treatment demands competence from each member of the professional team; this includes the staff of the dental office and the dental laboratory. Members of the dental team should understand their responsibility to each other and their patients to ensure optimal prosthodontic care. Knowledge of individual limitations are critical, as are two specific attributes of technical success, quality and communication. The dentist and dental technician should provide services in concert, practice mutual respect, and encourage each other to critique results. Successful prosthodontic treatment also represents a collaborative effort between the patient and attending dentist. Because specific limitations exist with various treatment options, patients need to make decisions concerning their treatment on the basis of detailed informed consent comprehensively presented by the dentist. This article illustrates examples of fixed prosthodontic treatments and demonstrates collaborative, professional responsibilities of the dentist and dental laboratory technicians.

Crowns↗