Full ceramic restorations in posterior teeth

Key Points

• In general a significant decrease in marginal accuracy should be taken into consideration for partial coverage restorations after adhesive cementation.

• Adhesive luted partial coverage restorations appear to have a moderate increase in marginal gap width under masticatory ageing.

• The introduced new preparation designs fulfil the technical demands to fabricate accurate fitting all ceramic partial coverage restorations.

Abstract

Objectives

To determine the influence of the preparation design and the dimensions of all-ceramic partial coverage restorations (PCR) on the marginal accuracy before and after masticatory simulation.

Methods

In this in vitro study 80 extracted human maxillary molars were restored with MOD inlay restorations and four different modified PCR restorations using a new press ceramic IPS e.max® Press (IPS e.max® Press VP 1989). The teeth were divided into five groups of 16 specimens each and prepared as follows: Group A received an MOD inlay preparation and Group B, C, D and E received modified PCR. The restorations were adhesively luted and exposed to a mastication simulator. The discrepancies of the marginal fit were examined on epoxy replicas before and after luting as well as after masticatory simulation at 200x magnification.

Results

The mean (geometrical) [95% confidence limits] marginal gap decreased from Group A to E before cementation (A-83[77-90]μm, B-68[65-70]μm, C-59[55-64]μm, D-56[52-61]μm, E-50[45-55]μm). Group A had significantly higher marginal gap values than group B (p = 0.017) and the other groups (p<0.0001). After cementation the marginal accuracy was recorded as following: A-103[93-114]μm, B-101[94-108]μm, C-93[89-98]μm, D-102[98-105]μm and E-99[96-102]μm. Cementation increased the marginal gap in groups B-E significantly (p<0.00001), not significantly in group A (p = 0.059). Artificial ageing (A-116[106-127]μm, B-114[109-120]μm, C-106[103-110]μm, D-109[100-118]μm and E-109[105-112]μm) led to further significant decrease of marginal accuracy in Group B (p = 0.029) and C (p = 0.026) only. After cementation and masticatory simulation of the ceramic restorations, the marginal gap values of Groups A, B, C, D and E did not significantly differ from each other (p = 1.00).

Conclusions

The result of this in-vitro study showed that IPS e.max® Press can be used to fabricate all-ceramic inlays and PCR which meet the requirements in terms of a clinically acceptable marginal gap, irrespective of the preparation design used. However, the preparation design and dimensions of the restorations appeared to affect the initial marginal fit and flowing off of luting material during the cementation process. The factors responsible for these findings require further substantiation.

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