The strength of a nation derives from the integrity of the home

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Jablonski, Illustrated

MARGINAL INTEGRITY OF RESTORATIVE MATERIALS

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CONTENTS

IntroductionDefinition of marginal integrity Its importance Factors affecting marginal integrity Methods to evaluate it Considerations for each restorative material and methods to enhance marginal integrity Tooth Colored Restorative materialsClick to edit Master subtitle style Composite, GIC and Ceramics Non Tooth Colored Restorative materialsCast restorations, Direct filling Gold and Amalgam Consequences of poor integrity Conclusion
Jablonski, Illustrated

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Dental ceramics
30-40 % inadequate crowns- poor marginal integrity Acceptable marginal gap

Christensen- <39 margins cannot be visualized ADA (no 8)25- 40

Longevity studies- <120

Fransson B, Oilo G, Gjeitanger R. The fit of metal-ceramic crowns, a clinical study. Dent Mater. 1985 6/8/12 Jablonski, Illustrated Oct;1(5):197-9. Hunter AJ, Hunter AR. Gingival margins for crowns: a review and discussion. Part II: Discrepancies and

Factors affecting marginal integrity

Processing method Cavity design/ tooth preparation

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DENTAL

Brittleness

Brittleness
Processing TechniqueCrystalline Phase Soft-machined Hard-machined Zirconia (3Y-TZP) Alumina (Al2O3) Feldspar ([Na,K]AlSi3O8) Lithium disilicate (Li2Si2O5) Leucite (KAlSi2O6)

Flexural Strength (MPa) 1087 173 700

Slip-cast

Alumina (Al2O3) Spinel (MgAl2O4) Zirconia (ZrO2)

594 52 378 65 630 58

Heat-pressed Sintered Sintered metalceramic

Leucite (KAlSi2O6) Lithium disilicate (Li2Si2O5)

106 17 306 29

Leucite (KAlSi2O6) Fluorapatite (Ca5[PO4]3F)

104 80

Leucite (KAlSi2O6)

61 5

6/8/12 Jablonski, Illustrated Powers JM, Sakaguchi RL. Craigs Restorative dental

DENTAL

122 13 262 88 160

Processing methods
Processing Technique Sintered Enlarged Die/sintered Sintered and Glass filtered Slip/ Cerammed Heat-pressed CAD-CAM Marginal Quality Poor Margins Fair to good margins

Fair to Good margins Good Margins Good to Excellent Margins

Fair to Good Margins

Marshall 6/8/12 ST, Marshal GW, Anusavise KJ; Phillips' Science of Dental Materials; 11th Jablonski, Illustrated ed: pg 640-688

DENTAL

Processing methods

Average micro leakage produced with different ceramic techniques

Cerestore- 15-50 Dicor- 50-80 High Ceram- 20-37

Ceramic Inlays show lesser micro leakage than composites in most studies Quality of fit of the restoration depends hugely on technicians skills Skilled technicianCast restoration- 10 m

Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of Dental Materials; 11th ed: pg 640-688 Wohlwend A, Strub JR, Schrer P. Metal ceramic and all-porcelain restorations: current considerations. 6/8/12 Jablonski, Illustrated Int J Prosthodont. 1989 Jan-Feb;2(1):13-26

DENTAL

Improving the fit

Hannig and Schmeiser have described Double inlay technique to improve the fit Dentin- metal base Enamel- Porcelain inlay over the metal base Margins ending in dentin is not preferable Ni-Cr copings better than Pd-Cu Etching, silanisation and bonding is mandatoryImproves fracture resistance and reduce stress

Cemented porcelains fit changes during porcelain firing Gemalmaz D, Alkumru HN. Marginalshowed considerable wear 6/8/12 Jablonski, Illustrated cycles. J Prosthet Dent. 1995 Jan;73(1):49-54.

DENTAL

CAST RESTORATIONS Usual gap between tooth surface and restoration 10 160 .

Intermediate cement layer seals the interface and aids in retention Excessive loads, improper casting, improper finish lines marginal breakdown of the luting cement.

Rosenstiel SF, Land MF, Fujimoto J. Contemporary Illustrated 6/8/12 Jablonski, Fixed Prosthodontics, 4th ed, pg 209-257

6/8/12 JR, Bayne SC, Holland GA, Sulik Illustrated Jablonski, WD. Considerations in measurement of Holmes

Factors affecting marginal integrity

1. 2. 3. 4. 5.

Cervical finish line Internal fit Casting material used Casting procedures Luting agent

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CAST

SIGNIFICANCE OF VARIOUS FINISH LINES

Traditional Knife
edge

Belsky- Full Shoulder Stein- Uniform

chamfer with bevel

Preston- Multiple
approach (bevelled shoulder+ chamfer)

Sozio- Shoulder bevel

or sloping shoulder

6/8/12 Jablonski, Illustrated Gardner FM. Margins of complete crowns--literature review. J Prosthet Dent.

Most authors- bevels

CAST

SIGNIFICANCE OF VARIOUS FINISH LINES

Finish Lines classification

Kuwata- Marginal Angles- 0-30, 30-60, 60-90.

Knife edge, chamfers, Acute bevels Improves seal by its geometry

Shoulders Controlled crown contours, structural rigidity

6/8/12 Jablonski, Illustrated Hunter AJ, Hunter AR. Gingival crown margin configurations: a review and

CAST

Marginal width- Jocobsen and Robinson-

SIGNIFICANCE OF VARIOUS FINISH LINES

Knife Edges

Minimal preparation Achieving definite preparation is difficult Crown fabrication is difficult- indistinct on die Overcontouring of margins possible

Chamfer

Ideal for cast metal restorations

Thin margins/ Bevels

Relies on finishing and polishing for better fit Spinning and swaging- finishing rotary discs to Burnish

6/8/12 Jablonski, Illustrated Shillinberg HT, Fundamentals of fixed prosthodontics, 3rd ed, pg 119

CAST

SIGNIFICANCE OF VARIOUS FINISH LINES

Shoulder

Prevents porcelain failure during flexure Less distortion of metal during porcelain firing Excess bulk at margins can cause excess shrinkage

6/8/12 Jablonski, Illustrated Hunter AJ, Hunter AR. Gingival crown margin configurations: a review and

CAST

Improved esthetics, contours and clear margin placement

SIGNIFICANCE OF VARIOUS FINISH LINES

The closest distance between the margin and the surface of 6/8/12 Jablonski, Illustrated Shillinberg HT, Fundamentals of fixed prosthodontics, 3rd the

angle of the margin

CAST

Vertical discrepan cy in fit

SIGNIFICANCE OF VARIOUS FINISH LINES

factor of 1.4

factor of 2

factor of 9

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CAST

factor of 11.5

Internal Fit

Occlusal Venting Electro milling the inside of the crown (stripping, deplating) Aquq Regia Etching Sand blast Mechanical milling of burs Die spacer- Paint or tin foil- decreased around 60 of seating discrepancy

Shillinberg HT, Fundamentals of fixed prosthodontics, 3rd ed, pg 119-220.

Rosenstiel SF, Land MF, Fujimoto J. Contemporary Fixed Illustrated 4th ed, pg 209-257. 6/8/12 Jablonski, Prosthodontics,

CAST

Casting material
ADA classification High Noble COMPOSITION Must have >40% GOLD And Au+Pt+pd atleast 60% Noble Predominantly Base metal

CASTABILITY

Excellent castability (high density and fluidity)

Similar properties to class 1, but is limited

Casting shrinkage- < 1.4%

Poor castability (low density and its sensitive to envt) Boron and silica is added to improve castability. High Casting Shrinkage (2%)

6/8/12 Jablonski, Illustrated Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of

CAST

Must contain > <25 % of noble metal 25& of noble elements. metal( Au, Pt, Usually, Ni, Cr and Co Pd, Rh, Ru, Ir, Os)

ADA classification High Noble CoEfficient of 14.1 thermal expansion (x 10e-6/deg. C)

Noble

Casting material

Predominantly Base metal 14-15

Fusion temperature

around 1000 degree c 65-100 Gpa (easy burnishing) Minimum Tarnish and corrosion DEFORMABILITY Long bevel EFFECT Bevelling of outer plane of walls, to obtain an average of 30-45% metal margins. Short bevell or long Illustrated Jablonski,

Around 1350 degree c

Tarnish and corosion Bevel design

Maximum Tarnish and corrosion. All circumferential tie should be Hollow Ground bevel. (more space for bulk and improve castability)

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CAST

Modulus of elasticity

220 Gpa. (difficult to burnish)

Casting procedures Inaccuracies in the fit can be caused by

Distortion during removal of wax pattern from die Increased/ Uneven expansion of mold. Standardised procedure of investing is not followed.

Use silver plated dies for wax pattern. Overwaxing the margins- 0.25 to 0.5mm Provide internal relief better marginal and inner fits were obtained with the gas-oxygen torch source than electrical 6/8/12 Rosenstiel SF, Land MF, Fujimoto J. Contemporary Fixed Jablonski, Illustrated resistance melting.

CAST

LUTING CEMENTS

Its a viscous material, placed between tooth and the prosthesis, that hardens through chemical reactions to firmly attach the prosthesis to tooth. They are

Zinc Phosphate ZOE Zinc polycarboxylate GIC, RMGIC, Compomer

6/8/12 Jablonski, Illustrated Resin cements Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of

PROPERTIES INFLUENCING MARGINAL INTEGRITY

Film thickness Surface wetting Flow/Viscosity of cement Modulus of elasticity Solubility in water

6/8/12 Jablonski, Illustrated Schwartz IS. A review of methods and techniques to improve the fit of

LUT

6/8/12 Jablonski, Illustrated Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of

IMPORTANT CONSIDERATIONS

Zinc Polycarboxylate

Use it before it loses its gloss- for bonding Failure occurs at cement tooth interface During setting- it passes through a rubbery stage before becoming hard

Do not remove excess cement at this stage

6/8/12 Jablonski, Illustrated Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of

LUT

Its quite viscous

IMPORTANT CONSIDERATIONS

Zinc Phosphate

Removal of excess must be done after complete setting Excessive forces for seating of crown will not influence the final fit to a great extent. Coat of varnish after setting to allow the cement to mature and develops better resistance to oral fluids
6/8/12 Jablonski, Illustrated Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of

LUT

High solubility in oral fluids

IMPORTANT CONSIDERATIONS

Zinc oxide eugenol

Poor compressive strength and modulus Used as temporary luting agent(I) Residual eugenol inhibits composite binding Excess must be removed only after complete set

6/8/12 Jablonski, Illustrated Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of

LUT

Versatile material

GOLD
Material
ENAMEL

CTE( 10-6/ 0C)

11.4

If there were a lifetime8.3 DENTIN restoration, then gold would be it. PORCELIN 6.6 Because-TITANIUM 8.5

GIC (TYPE II) 11.0 it maintains marginal integrity even after GOLD 14.0 many years of function. AMALGAM 25.0 enamel rods at the margin of the cavity COMPOSITES is braced, so -the enamel is25-50 protected DENTURE RESIN 81.0 from breakage.

Gold fillings are of such a noble metal INLAY WAX 400.0 that they do not oxidize or corrode

PIT & FISSURE RESIN

85.0

6/8/12 Jablonski, Illustrated Anusavise KJ; Phillips' Science of Dentalof expansioned: pg The favorable coefficient Materials; 11th of

PROPERTIES INFLUENCING MARGINAL INTEGRITY Most ductile of all metals- 1 oz or 29 g cylinder can be drawn into 100 kms wire! Most malleable too- can be rolled physically to 0.13 microns. Hence, it can to moulded into cavity accurately. Work Hardening /cold working- gives strength to margins

1.

1.

1.

1. Degassing promotes cold welding, which 6/8/12 Jablonski, Illustrated Anusavise KJ; Phillips' Science of Dental Materials; 11th ed: pg

GOLD

OPERATIONAL FACTORS INFLUENCING MARGINAL INTEGRITY

Improper compaction spaces / voids Uniform stepping Type of gold selected line of force Condensation pressure

6/8/12 Jablonski, Illustrated Anusavise KJ; Phillips' Science of Dental Materials; 11th ed: pg

GOLD

OPERATIONAL FACTORS INFLUENCING MARGINAL INTEGRITY

Follow proper compaction technique

6/8/12 Jablonski, Illustrated Anusavise KJ; Phillips' Science of Dental Materials; 11th ed: pg

GOLD

OPERATIONAL FACTORS INFLUENCING MARGINAL INTEGRITY

Mat and powdered gold - internal bulk of the restoration Regular cohesive gold foils veneer on surface to obtain good seal Force of compaction- 15 lbs/inch2

Cavosurface bevel must be place to produce a 30-40. metal margin for 6/8/12 Jablonski, Illustrated burnishing and remove unsupported rods Anusavise KJ; Phillips' Science of Dental Materials; 11th ed: pg

GOLD

AMALGAM An alloy containing mercury is called Amalgam.

Dental amalgam Is defined as

An alloy of mercury, silver, copper, tin and other elements to improve handling characteristics and clinical performance.

6/8/12 Jablonski, Illustrated Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of

AMALGAM

Secondary caries can begin if marginal dicrepancy is >50 microns.

6/8/12 Jablonski, Illustrated Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of

DENTAL

Marginal deterioration is one of the most common type of amalgam deterioration, so called Ditching.

Factors influencing MARGINAL INTEGRITY

1.

Dimensional changes on setting Moisture contamination Creep Tarnish and Corrosion Condensation Burnishing Cavity preparation and finishing

2.

3.

4.

5.

6.

7.

6/8/12 Jablonski, Illustrated 8. Spherical vsGW, Anusavise KJ; Phillips' Science of lathe cut Marshall ST, Marshal

DENTAL

DIMENSIONAL CHANGES ON SETTING

It can expand or contract on setting, depends on manipulation. ANSA/ADA spec 1 should not be greater than 20 micro m/cm between 5 mins and 24 hrs.

6/8/12 Jablonski, Illustrated Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of

DENTAL

DIMENSIONAL CHANGES ON SETTING

Expansion or contraction

Typically amalgam shows immediate contraction after packing, followed by a slow expansion, followed by a mild slow contraction. But modern amalgams mixed in mechanical amlgamators exhibit net contraction!

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DENTAL

DIMENSIONAL CHANGES ON SETTING

Expansion Or contraction???

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DENTAL

DIMENSIONAL CHANGES ON SETTING

Contraction occurs due to:

Low mercury/ alloy ratio High condensation pressure (squeeze Hg out) Longer trituration Smaller size of alloy particles

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DENTAL

MOISTURE CONTAMINATION

Moisture contamination of zinc containing amalgam, can causes large expansion, starting after 3-5 days, continues for months. Due to accumlation of H2 gas- Creep occurs. This is DELAYED EXPANSION/ SECONDARY EXPANSION Can go upto 4% vol expansion
6/8/12 Jablonski, Illustrated

DENTAL

Well manipulated amalgam rarely undergoes dimensional changes after 24 hrs.

CREEP

It can cause amalgam to extend out of the cavity margins and make it susceptible to marginal breakdown. Creep rate < 3% - acceptable according to ADA specification no. 1 Low copper alloys 0.8 8% High copper alloys 0.1-1% Creep values below 1%
Jablonski, Illustrated

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DENTAL

Its the time dependent strain or deformation that is produced by stress.

TARNISH AND CORROSIONIs it good or bad??

Active corrosion occurs usually on tooth amalgam interface. The marginal gap paves way for electrolytes and classic cell corrosion (crevice corrosion) is set up.

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DENTAL

Passivation and protection from further corrosion can occur due to Tarnishing.

TARNISH AND CORROSIONIs it good or bad??

The 2 phase of conventional amalgam is the most electrochemically reactive.

Jablonski, Illustrated For higher copper

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DENTAL

TARNISH AND CORROSIONIs it good or bad??

Other types of Corrosion: Galvanic corrosion (Dissimilar metals)The rate of corrosion is accelerated when the amalgam filling is contact 6/8/12 Jablonski, Illustrated

DENTAL

TARNISH AND CORROSIONIs it good or bad??

different phases of an amalgam have different corrosion potentials. Electrochemical measurements on phases have shown that the Ag2Hg3 phase has the highest corrosion resistance, followed by Ag3Sn, Ag3Cu2, Cu3Sn, Cu6Sn5, and Sn7-8Hg. Corrosion products formed areJablonski, Illustrated

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DENTAL

Heterogenous surface composition corrosion-

TARNISH AND CORROSIONHow to deal it??

Polished amalgam possesses the lowest corrosion current density and just carved amalgam shows the highest corrosion current density. Application of non metallic coating like varnish (temporary) Use high copper amalgam- 2 phase is less
Jablonski, Illustrated

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DENTAL

CAVITY PREPARATION

Key principlesPreserve as much sound tooth structure as possible Restoration angle at cavosurface must be 90. or slightly more 0.75 to 2 mm thickness of amalgam is mandatory. Bevelling of gingival cavo surface margin- 20 degrees Unsupported enamel must be removed with hand cutting instruments.

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DENTAL

CAVITY PREPARATION

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DENTAL

Bond amalgam to enamel and dentin using amalgam bonding agents

CAVITY PREPARATION

6/8/12 Jablonski, Illustrated B. W. Darvell. Materials science for dentistry; 9th ed; 128-161

DENTAL

MATRIX BAND COMPRESSION

CONDENSATION

3 FACTORS MUST BE CONSIDERED:

1. 2. 3.

Condensation force Condensation technique Alloy particle shape

Jablonski, Illustrated

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DENTAL

Good condensation technique and force is required to minimize porosity, attain maximum density and to express mercury out

CONDENSATION

Immediately after trituration Condense from centre to periphery using stepping motion (Chapman and Crim 1992) Use a force of 66.7 N (15lb) Use more force for lathe cut than spherical Final condensation over cavosurface margin should be perpendicular to external enamel surface.
Jablonski, Illustrated

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DENTAL

BURNISHING

Adapts material to margin Enhances homogeneity Its controversial, its makes the restoration much smoother than carved surface, and its more desirable in high copper amalgams. But, Burnishing low Cu Amalgam, damages the margins Do not apply undue pressure and heat production >60. c releases Hg at margins. Pre carve burnishing- Large burnisher Post carve burnishing- small burnisher
Jablonski, Illustrated

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DENTAL

SPHERICAL VS LATHE CUT ALLOY

Ditching found mainly on the occlusal surfaces which was frequently found at the margins of the spherical amalgam restorations.
6/8/12 Jablonski, Illustrated Leidal TI, Dahl JE. Marginal integrity of amalgam restorations. Acta Odontol

DENTAL

Small fractures of excessive amalgam on the occlusal surface resulting in (catch toward restoration) could frequently be demonstrate recorded at the margins of the lathe-cut amalgam restorations.

SPHERICAL VS LATHE CUT ALLOY

Surface of amalgam next to next to cavity walls exhibited relatively uneven texture for Spherical alloys. Therefore, interfacial gap filled with pulpal fluid is higher in spherical alloys.
6/8/12 Jablonski, Illustrated Leidal TI, Dahl JE. Marginal integrity of amalgam restorations. Acta Odontol

DENTAL

Spherical alloys show more micro leakage than lathe cut alloys in several studies

Newer techniques

Galloy

Liquid- Ga, In, Sn Gallium and indium provide better tooth wettability, hence better marginal adaptation Mechanical properties are similar to conventional amalgam

Bonded Amalgam

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After etching, primer and bonding agent is used.

Jablonski, Illustrated

DENTAL

Powder- Ag, Sn, Cu

Consequences of poor marginal integrity Marginal Leakage Post Operative

Microleaka ge

Marginal staining

Secondary Hypersensitivity. caries

Secondary Caries (new term- Caries adjacent to restoration)

Marginal Discoloration of bacteria in unprotected dentinal tubules,

sensitivity

De ingress bonding

leading to pulpal pathology. (Brannstrom 1984, Post op Branstrom and Nyborg 1971)

Braga RR, Ballester RY, Ferracane JL. Factors involved in the development 6/8/12 Jablonski, Illustrated of polymerization shrinkage stress in resin-composites: a systematic

CONCLUSIO N

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References
1.

Fransson B, Oilo G, Gjeitanger R. The fit of metal-ceramic crowns, a clinical study. Dent Mater. 1985 Oct;1(5):197-9. Hunter AJ, Hunter AR. Gingival margins for crowns: a review and discussion. Part II: Discrepancies and configurations. J Prosthet Dent. 1990 Dec;64(6):636-42. Powers JM, Sakaguchi RL. Craigs Restorative dental materials. 13th ed: 254-286 Marshall ST, Marshal GW, Anusavise KJ; Phillips' Science of Dental Materials; 11th ed: pg 640-688 Wohlwend A, Strub JR, Schrer P. Metal ceramic and allporcelain restorations: current considerations. Int J Prosthodont. 1989 Jan-Feb;2(1):13-26 Gemalmaz D, Alkumru HN. Marginal fit changes during porcelain firing cycles. J Prosthet Dent. 1995 Jan;73(1):496/8/12 Jablonski, Illustrated 54.

2.

3.

4.

5.

6.

References
7.

Rosenstiel SF, Land MF, Fujimoto J. Contemporary Fixed Prosthodontics, 4th ed, pg 209-257 Holmes JR, Bayne SC, Holland GA, Sulik WD. Considerations in measurement of marginal fit. J Prosthet Dent. 1989 Oct;62(4):405-8. Gardner FM. Margins of complete crowns--literature review. J Prosthet Dent. 1982 Oct;48(4):396-400. Hunter AJ, Hunter AR. Gingival crown margin configurations: a review and discussion. Part I: Terminology and widths. J Prosthet Dent. 1990 Nov;64(5):548-52. Shillinberg HT, Fundamentals of fixed prosthodontics, 3rd ed, pg 119-220.

8.

9.

10.

11.

12.

Schwartz IS. A review of methods and techniques to improve the fit of cast restorations. J Prosthet Dent. 1986 6/8/12 Sep;56(3):279-83 Jablonski, Illustrated

References
14.

Studevants Art and science of operative dentistry 5th edition. pg 917-943 B. W. Darvell. Materials science for dentistry; 9th ed; 128161 Grossman ES, Witcomb MJ, Jodaikin A. Elements in marginal seals at amalgam-tooth interfaces. J Dent Res. 1986 Jul;65(7):998-1000 Leidal TI, Dahl JE. Marginal integrity of amalgam restorations. Acta Odontol Scand. 1980;38(2):81-8 Braga RR, Ballester RY, Ferracane JL. Factors involved in the development of polymerization shrinkage stress in resin-composites: a systematic review. Dent Mater. 2005 Oct;21(10):962-70.

15.

16.

17.

18.

19.

Sarrett DC. Prediction of clinical outcomes of a restoration 6/8/12 Jablonski, Illustrated based on in vivo marginal quality evaluation. J Adhes Dent.

Have A Great Day

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Jablonski, Illustrated