Professional Documents
Culture Documents
of Marburg, Germany
SUMMARY
Introduction
Cast inlay and partial crown restorations remain the
standard for durable restorations of the posterior teeth.
The quality of such restorations is determined by the
following factors: `placement of the crown margin',
'cervical contour', and `marginal adaptation and properties of the restoration material' (Geurtsen, 1990). In
addition to the reliable precious metal alloys reduced
precious metal alloys and nonprecious metal alloys are
also used. As a result of the favourable properties of the
material and good biocompatibility pure titanium has
also found increased usage as a material for inlays and
partial crowns (Geurtsen, 1990; Geurtsen & Marx,
1990; Kappert, 1994; Meyer & Luthy, 1995; Wang &
Fenton, 1996; Wirz & Bischoff, 1996). However, spe*Degussa-Dental, 63403 Hanau, Germany.
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R . S T O L L et al.
give the rating `exact marginal t'. In clinical reality,
however, a cementation space under 100 lm should
be considered to be acceptable (Geurtsen, 1990), a
limit which is nonetheless often exceeded in daily
clinical routine (Spiekermann, 1986; Eichner, 1989;
Kerschbaum & Porschen, 1998).
An improvement in marginal adaptation by cold
deformation forming before, during, or after the
cementing is termed nishing or burnishing (Tucker,
3 1984; Haas et al., 1989). Ideal in this case is the
processing during the setting phase of the employed
cement. Ideal for this type of nishing are restorations
with beveled margins (Rosner, 1963; Hoard & Watson,
1976), while other margin types are viewed as less
suitable (Hoard & Watson, 1976). Recommended
instruments for burnishing are coarse and ne grinding
instruments, steel or carbide nishing burs (Strub et al.,
1980), nishing diamonds exible discs, rubber polishers (Haas et al., 1989), and hand instruments (Ingraham
et al., 1968; Metzler & Chandler, 1976; Shillingburg,
Hobo & Whitsett, 1977; Sturdevant et al., 1985; Haas
et al., 1989). The hand instruments used are egg and
beaver-tail instruments, egg-form instruments as well
as dull Spratley-knives.
The aim of this study was to assess the marginal
adaptation of partial crowns of pure titanium and a gold
alloy in dependence on the cementation techniques.
Conventional cementation as well as active cementation with burnishing of the beveled margins during the
setting phase of the zinc phosphate cement were used
as cementation methods.
Material
Cementation method
1
2
3
4
Gold alloy
Gold alloy
Pure Titanium
Pure Titanium
Conventional
Active
Conventional
Active
10
10
10
10
Denition
A
B
C
D
E
A (<50 lm)
1
2
3
4
72.0% (3.7)
72.7% (5.7)
20.6% (12.2)
20.6% (9.6)
(Gold, conv.)
(Gold, active)
(Titanium, conv.)
(Titanium, active)
B (50100 lm)
17.1%
19.4%
43.3%
52.3%
(5.0)
(5.9)
(9.0)
(6.4)
C (>100 lm)
1.0%
0.9%
0.6%
1.0%
(1.1)
(0.7)
(1.1)
(1.8)
D (overextended)
0.0%
0.0%
25.9%
20.7%
(0.0)
(0.0)
(16.4)
(11.6)
E (not rateable)
9.8%
7.0%
9.6%
5.5%
(4.1)
(3.4)
(7.4)
(3.4)
Fig. 1. Average percentage portions of the marginal criteria A (vertical marginal discrepancy <50 lm) and B (50100 lm) from all groups
(mean and s.d.).
Results
Discussion
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R . S T O L L et al.
preparation, the vertical portion of the cervical discrepancy was chosen as the parameter for the present study.
The margin was divided into ve classes by means of
quantitative margin analysis (Roulet et al., 1989) rather
than by direct measurement. The borderline cementation space qualities of 50 and 100 lm called for in the
literature were used as the class limits.
The existence of a marginal discrepancy in cast
restorations must be seen as a reality (Strub et al.,
1980). In a study with a random sample of 50 crowns of
varying alloys and from ve different commercial dental
laboratories Kerschbaum and Porschen (1998) found a
mean marginal gap of 100 lm (35 lm) with a maximum of 248 lm. The crowns were examined on the
gypsum model using a replica technique. One half of the
crowns were miscontoured, mostly overcontoured.
With a marginal portion of 72% of class A and 17%
of class B the accuracy of t for precious metal crowns
achieved in this study clearly lies in the clinically
recommended region of t. In the case of the titanium
crowns the weight shifts to marginal quality B (43%),
whereas only just 21% margin of the quality A was
observed. In addition the high percentage (20%) of
margins which are too long (quality D) is striking. This
observation points to difculties in the nishing procedure of titanium casts. Whereas 89% of the margin of
the precious metal crowns was clinically acceptable, the
percentage of marginal acceptability of the titanium
partial crowns was only 64% with 20% of the margin
extending beyond the preparation edge. In the light of
these results the partial crowns of titanium can by all
means be rated as clinically acceptable, particularly
because in the case of both materials hardly any cervical
discrepancies over 100 lm were observed. It must be
remembered, however, that the partial crowns in the
present study were produced in vitro under optimum
conditions.
Meyer and Schafers (1990) measured in a light
microscopic in vitro study of ve inlays and ve partial
crowns the cervical discrepancy and width of the
cementation spaces. 38% of the measured values for
the cervical discrepancy lay under 20 lm, 22% of the
measured values lay under 100 lm. The width of the
cementation space lay mainly in a region between 20
and 60 lm, gaps larger than 100 lm were not found.
Klinger et al. (1991) report a high accuracy of t for
crowns of pure titanium (cervical discrepancy) with a
correct mixing ratio and correct temperature control of
the investment and come to the conclusion that the
Conclusion
The results lead to the following conclusions:
(i) Partial crowns from titanium do not achieve the
accuracy of t of those from precious metal alloys;
(ii) Partial crowns from titanium can, under optimum
conditions, be produced so that a clinical use is justied.
(iii) An active marginal nishing with a hand burnishing instrument leads neither in the case of partial crowns from titanium nor those from the gold
alloy Degulor M to a signicant improvement of the
marginal quality.
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Correspondence: Dr Richard Stoll, Department of Operative Dentistry,
Dental School of the Philipps-University of Marburg, Georg Voigt Str.
3, 35033 Marburg, Germany. E-mail: stoll@mailer.uni-marburg.de