Comparison of repair methods for ceramic fused-to-metal crowns/cosmetic dentistry courses jc1

Comparison of Repair Methods forComparison of Repair Methods for
Ceramic-Fused-to-Metal Crowns.Ceramic-Fused-to-Metal Crowns.
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
www.indiandentalacademy.com

CONTENTSCONTENTS
 IntroductionIntroduction
 Review of literatureReview of literature
 Aim of the studyAim of the study
 Materials and methodologyMaterials and methodology
 ResultsResults
 DiscussionDiscussion
 ConclusionConclusion
 Limitations of the studyLimitations of the study
 ReferencesReferences

INTRODUCTIONINTRODUCTION
 Prevalence ….Prevalence ….
 Repairing of the fractured restoration intra orally...Repairing of the fractured restoration intra orally...
 Repairing of the fractured CFM restoration definitely possesRepairing of the fractured CFM restoration definitely posses
the clinical challenge particularly whenever the metalthe clinical challenge particularly whenever the metal
substructure is exposed ,hence bonding of the resin to alloysubstructure is exposed ,hence bonding of the resin to alloy
will be required.will be required.

 Advantages of repairing the CFMAdvantages of repairing the CFM
restorationrestoration
 Increases the clinical longevity of the failed restoration.Increases the clinical longevity of the failed restoration.
 Cost effective as there is no need for replacement.Cost effective as there is no need for replacement.
 Difficulties encountered in removal of the restorationDifficulties encountered in removal of the restoration
especially in the restoration on questionable abutments.especially in the restoration on questionable abutments.

REVIEW OF LITERATUREREVIEW OF LITERATURE
 A study was conducted by Arnold, Schneider and Aquillo(1989).A study was conducted by Arnold, Schneider and Aquillo(1989).
 They compared the shear bond strength of three commercially available silaneThey compared the shear bond strength of three commercially available silane
porcelain repair system with glazed and non glazed porcelain surfaces.porcelain repair system with glazed and non glazed porcelain surfaces.
 Effect of storage time on the bond strength.Effect of storage time on the bond strength.
 Scotchprime, fusion and Cerinate primeScotchprime, fusion and Cerinate prime
 They concluded that bond strength of Scotchprime and fusion repair systems wasThey concluded that bond strength of Scotchprime and fusion repair systems was
inexcess of the shearing resistance porcelain, in non glazed porcelain surface.inexcess of the shearing resistance porcelain, in non glazed porcelain surface.
 Scotchprime provided bond strength in excess of the porcelain shearing resistance,Scotchprime provided bond strength in excess of the porcelain shearing resistance,
in glazed porcelain surface also in comparison to the other systems.in glazed porcelain surface also in comparison to the other systems.
 Decrease in bond strength with storage time was observed with glazed surfaces.Decrease in bond strength with storage time was observed with glazed surfaces.

 A Clinical study was conducted by Nico H.J, Peter Snoek and Arnd Kayser (1992)A Clinical study was conducted by Nico H.J, Peter Snoek and Arnd Kayser (1992)
 Twenty metal ceramic crowns on upper premolars were fractured before cementingTwenty metal ceramic crowns on upper premolars were fractured before cementing
with temporary cement in 12 patients.with temporary cement in 12 patients.
 The fractured crowns were repaired with the Prisma Ceraprime kit intra oraly andThe fractured crowns were repaired with the Prisma Ceraprime kit intra oraly and
follow up was done for 2 weeks, 3,6 and 12 months.follow up was done for 2 weeks, 3,6 and 12 months.
 The initial results were satisfactory both functionally and estheticallyfor 6 months.The initial results were satisfactory both functionally and estheticallyfor 6 months.
 Deterioration from 6 to 12 months and survival rate of 50% by the end of 12Deterioration from 6 to 12 months and survival rate of 50% by the end of 12
months.months.
 They concluded that the experimental repair system can be used only for theThey concluded that the experimental repair system can be used only for the
intermediate repaiar purpose.intermediate repaiar purpose.

 A study was conducted by Tylka and Stewart (1994).A study was conducted by Tylka and Stewart (1994).
 They compared the etching effect and bond strength achieved by surfaceThey compared the etching effect and bond strength achieved by surface
conditioning with APF gel and HF acid .conditioning with APF gel and HF acid .
 They evaluated the etched surface with the SEM and HF produced porus ,They evaluated the etched surface with the SEM and HF produced porus ,
amorphous surface and APF produced smooth and homogeneous surface.amorphous surface and APF produced smooth and homogeneous surface.
 The shear bond strength achieved with both the echants was equal andThe shear bond strength achieved with both the echants was equal and
greater than the cohesive strength of porcelain and composite materials..greater than the cohesive strength of porcelain and composite materials..

 A study was conducted by Chadwick ,Mason and Sharp in the year 1998A study was conducted by Chadwick ,Mason and Sharp in the year 1998
to evaluate the three porcelain repair systems.to evaluate the three porcelain repair systems.
 They compared the shear bond strength between the resin composite andThey compared the shear bond strength between the resin composite and
the dental porcelain for three different bonding systems --Scotchbondthe dental porcelain for three different bonding systems --Scotchbond
Multipurpose plus(SMP), One step(OS) and DenTastic(D).Multipurpose plus(SMP), One step(OS) and DenTastic(D).
 They observed more of cohesive type of failures within the porcelainThey observed more of cohesive type of failures within the porcelain
itself. So more appropriate tests are required for evaluating the bonditself. So more appropriate tests are required for evaluating the bond
strength between the porcelain and composite interface.strength between the porcelain and composite interface.


 A clinical study was conducted by Ozcan and Wilhelm (2002) to determine theA clinical study was conducted by Ozcan and Wilhelm (2002) to determine the
reasons for and location of failures of metal-ceramic restorations and also thereasons for and location of failures of metal-ceramic restorations and also the
survival of the repair done by using the Cojet system.survival of the repair done by using the Cojet system.
 A total of 153 patients with 289 fractured crowns were involved.The study wasA total of 153 patients with 289 fractured crowns were involved.The study was
carried out for 34.6 months.carried out for 34.6 months.
 They concluded that the 65% of failures in the anterior region mainly at labialThey concluded that the 65% of failures in the anterior region mainly at labial
surface ,predominantly in the maxilla (75%).surface ,predominantly in the maxilla (75%).
 The reason for failure being Chewing function 66%,iatrogenic factors 18%,The reason for failure being Chewing function 66%,iatrogenic factors 18%,
accidents 10% and surgical operation 6%.accidents 10% and surgical operation 6%.
 The repair with the Cojet system showed 89% success rate upto 3years.The repair with the Cojet system showed 89% success rate upto 3years.

 A study was conducted by M. Ozcan (2003) to evaluate the alternativeA study was conducted by M. Ozcan (2003) to evaluate the alternative
intra oral repair techniques for fractured ceramic-fused-to-metalintra oral repair techniques for fractured ceramic-fused-to-metal
restorations.restorations.
 He reviewed that the Organosilane coupling agent, Hydrifluoric acid andHe reviewed that the Organosilane coupling agent, Hydrifluoric acid and
APF were not applicable for exposed metal surfaces.He emphasized thatAPF were not applicable for exposed metal surfaces.He emphasized that
the Rocatec System combined with the an intra oral sandblaster achievedthe Rocatec System combined with the an intra oral sandblaster achieved
good bond strength.good bond strength.
 He interpreted with the available data that innovative air abrasionHe interpreted with the available data that innovative air abrasion
technique with SiO2 called as CoJet system could be used for repairingtechnique with SiO2 called as CoJet system could be used for repairing
fractures involving metal or porcelain.fractures involving metal or porcelain.

AIMS AND OBJECTIVESAIMS AND OBJECTIVES
 Evaluate the effect of four repair methods on the fractureEvaluate the effect of four repair methods on the fracture
resistance of CFM crowns repaired with various surfaceresistance of CFM crowns repaired with various surface
conditioning methods and Resin composite.conditioning methods and Resin composite.
 Effect of adding glass Fiber reinforced composite under theEffect of adding glass Fiber reinforced composite under the
repair composite.repair composite.

MATERIAL AND METHODOLOGYMATERIAL AND METHODOLOGY
 The Ceramic-fused-to-Metal restorations were the test specimens.The Ceramic-fused-to-Metal restorations were the test specimens.
 The total specimen no was 36, divided 9 in each groupThe total specimen no was 36, divided 9 in each group
 Metal dies of prepared Maxillary central incisor were fabricated in Co-ChrMetal dies of prepared Maxillary central incisor were fabricated in Co-Chr
alloy.alloy.
 Then the metal ceramic restorations were fabricated with feldspathicThen the metal ceramic restorations were fabricated with feldspathic
ceramic (Vita Omega, Germany).ceramic (Vita Omega, Germany).
 Digital micrometer was used to standardize the 2mm thickness ofDigital micrometer was used to standardize the 2mm thickness of
porcelain.porcelain.

 The specimens were subjected to load application in the Universal testingThe specimens were subjected to load application in the Universal testing
machne(LRX Material testing machine, Canada).machne(LRX Material testing machine, Canada).
 Then the fractured CFM were subjected to repair.Then the fractured CFM were subjected to repair.

 The fractured specimens were randomly assigned to the treatment groups.The fractured specimens were randomly assigned to the treatment groups.
1) 9.5% Hydrofluoric acid (Porcelain etch)1) 9.5% Hydrofluoric acid (Porcelain etch)
2) Air particle abrasion with 50 micro meter Al2O3 Alumina particles.2) Air particle abrasion with 50 micro meter Al2O3 Alumina particles.
3) Silica coating3) Silica coating
4) The application of two layers of E- glass fiber reinforced Composite on4) The application of two layers of E- glass fiber reinforced Composite on
the repair surface.the repair surface.

 The Adhesive resin was applied and light polymerizedThe Adhesive resin was applied and light polymerized
 Opaquer was applied in case of metal exposure and light polymerized .Opaquer was applied in case of metal exposure and light polymerized .
 The repair part of the crown was built up with highly filled resinThe repair part of the crown was built up with highly filled resin
composites (Tetric Ceram, Vivadent Ivoclar).composites (Tetric Ceram, Vivadent Ivoclar).
 In the forth group specimens two pieces of polymer dimethacrylate –In the forth group specimens two pieces of polymer dimethacrylate –
monomer gel impregnated photo polymerizing bidirectional E- glass fibermonomer gel impregnated photo polymerizing bidirectional E- glass fiber
layers of 0.06 mm thickness were cut and pressed against the repairlayers of 0.06 mm thickness were cut and pressed against the repair
surface of the crown..surface of the crown..

 Adhesive resin was applied between the fibers.Adhesive resin was applied between the fibers.
 The two layers of FRC were light polymerized for 40 seconds.The two layers of FRC were light polymerized for 40 seconds.
 Resin composite was built-up incrementallyResin composite was built-up incrementally
 Then finishing was done using coarse medium ,fine and ultra-fineThen finishing was done using coarse medium ,fine and ultra-fine
finishing disks.finishing disks.
 The specimens were stored in water at 37degreeC for 24 h and thenThe specimens were stored in water at 37degreeC for 24 h and then
subjected to thermocycling for 6000cycles between 5and 55 degreee C forsubjected to thermocycling for 6000cycles between 5and 55 degreee C for
30 seconds30 seconds

 Then fracture strength was tested using Universal testingThen fracture strength was tested using Universal testing
machine. The catastrophic failure of the repaired restorationmachine. The catastrophic failure of the repaired restoration
were recorded.were recorded.
 Failure type and location was noted.Failure type and location was noted.
 The data subjected to One-way Analysis of Variance andThe data subjected to One-way Analysis of Variance and
Bonferroni test.P vale less than 0.05 were consideredBonferroni test.P vale less than 0.05 were considered

RESULTSRESULTS
 The fracture resistance in the group with the silica coating and silanizationThe fracture resistance in the group with the silica coating and silanization
after thermocycling was 582after thermocycling was 582++127 N.127 N.
 Fracture resistance in groups treated with either HF acid and air borneFracture resistance in groups treated with either HF acid and air borne
particle abrasion followed by the silanization were 376particle abrasion followed by the silanization were 376++155N and155N and
432432++132N respectively. But statistically no significant difference was132N respectively. But statistically no significant difference was
found.found.
 In the group with FRC layer the fracture resistance was 885In the group with FRC layer the fracture resistance was 885++123N higher123N higher
than other groupsthan other groups

 Types of failures observedTypes of failures observed
1) Adhesive failures, in Group 1.1) Adhesive failures, in Group 1.
2) Cohesive failures, in Group2 and 3.2) Cohesive failures, in Group2 and 3.
3) In FRC cohesive failure was observed between the FRC3) In FRC cohesive failure was observed between the FRC
laminates.laminates.

DISCUSSIONDISCUSSION
 In the repaired CFM restoration the durable and good bondIn the repaired CFM restoration the durable and good bond
between the repair resin and the restoration, is the primebetween the repair resin and the restoration, is the prime
requirement to withstand the functional loads .requirement to withstand the functional loads .
 In the present study the fractured CFM crowns havingIn the present study the fractured CFM crowns having
irregular fracture surfaces were used to simulate the clinicalirregular fracture surfaces were used to simulate the clinical
conditions.conditions.

 The statistical analysis of mean Fracture strength (376 to 582N) revealedThe statistical analysis of mean Fracture strength (376 to 582N) revealed
that there was no significant difference among the groups1,2and 3.that there was no significant difference among the groups1,2and 3.
 The adhesive type of failures were found more in the HF treated groupsThe adhesive type of failures were found more in the HF treated groups
than the air abraded and silanized groups.than the air abraded and silanized groups.
 This emphasizes that the bond between the metal or ceramic and the repairThis emphasizes that the bond between the metal or ceramic and the repair
composite is weakest.composite is weakest.
 The adhesive type of failure is less favorable than the cohesive failures asThe adhesive type of failure is less favorable than the cohesive failures as
there will be requirement for masking the metal surface by opaquer.there will be requirement for masking the metal surface by opaquer.

 The cohesive type of failure was observed between the two FRCThe cohesive type of failure was observed between the two FRC
laminates. This emphasizes that this method provides strong bond on thelaminates. This emphasizes that this method provides strong bond on the
metal or ceramic surface and on the veneering resin composite.metal or ceramic surface and on the veneering resin composite.
 This may be because of the lack of crack propagation through the FRCThis may be because of the lack of crack propagation through the FRC
layer.layer.
 It has been revealed in the literature that the masticatory forces in theIt has been revealed in the literature that the masticatory forces in the
incisors to be 155 to 222N, in molar region upto 830 N.incisors to be 155 to 222N, in molar region upto 830 N.

CONCLUSIONCONCLUSION
 The fracture strength of the specimens repaired with differentThe fracture strength of the specimens repaired with different
surface conditioning methods using the HF acid, airbornesurface conditioning methods using the HF acid, airborne
particle abrasion either with Al2O3 or Sio2 followed byparticle abrasion either with Al2O3 or Sio2 followed by
silanization were not equal to that of the intact CFMsilanization were not equal to that of the intact CFM
restorations.restorations.
 The repairing of the fractured specimens with the FRCThe repairing of the fractured specimens with the FRC
laminates showed fracture strength equal to that of the intactlaminates showed fracture strength equal to that of the intact
crown.crown.

LIMITATIONS OF THE STUDYLIMITATIONS OF THE STUDY

The author has not mentioned about the magnitudeThe author has not mentioned about the magnitude and direction of
force application. It may not be a actual reproduction of
what may happen in the oral cavity .
 Not clear about the use of these methods intra orally for
repairing fractured restorations.

REFERENCESREFERENCES
 Arnald, Schneider and Aquillo, “Bond strength of intraoral porcelain repairArnald, Schneider and Aquillo, “Bond strength of intraoral porcelain repair
materials.’’ JPD;1989;61:305-9.materials.’’ JPD;1989;61:305-9.
 Creuger, Snoek and Kayser , “An experimental porcelain repair systemCreuger, Snoek and Kayser , “An experimental porcelain repair system
evaluated under controlled clinical conditions.” JPD;1992;68:724-7.evaluated under controlled clinical conditions.” JPD;1992;68:724-7.
 Chadwick, Mason and Sharp, “ Attempted evaluation of three porcelainChadwick, Mason and Sharp, “ Attempted evaluation of three porcelain
repair systems – what are we really testing.” Journal of Oralrepair systems – what are we really testing.” Journal of Oral
Rehabilitation;1998;25:610-615.Rehabilitation;1998;25:610-615.
 Llobell, Nicholls, Kois and Daly. “Fatigue of porcelain Repair systems. “Llobell, Nicholls, Kois and Daly. “Fatigue of porcelain Repair systems. “
Int Journal Prosthodontics;1992;5”205-213.Int Journal Prosthodontics;1992;5”205-213.
 Ozcan M. “ Fracture reasons in ceramic-fused-to-metal.” Journal of OralOzcan M. “ Fracture reasons in ceramic-fused-to-metal.” Journal of Oral
Rehabilitation; 2003;30:265-269.Rehabilitation; 2003;30:265-269.

 Ozcan M, Niedermeier W. “ Clinical study on the reasons for and locationOzcan M, Niedermeier W. “ Clinical study on the reasons for and location
of failures of Metal-Ceramic restorations and Survival of repairs.” Intof failures of Metal-Ceramic restorations and Survival of repairs.” Int
Journal Prosthodontics;2002;15:299-302.Journal Prosthodontics;2002;15:299-302.
 Ozcan M. “ Evaluation of alternative intra-oral repair techniques forOzcan M. “ Evaluation of alternative intra-oral repair techniques for
fractured ceramic-fused-to-metal restorations.” Journal of Oralfractured ceramic-fused-to-metal restorations.” Journal of Oral
Rehabilitation; 2003;30:194-203.Rehabilitation; 2003;30:194-203.
 Zcan M.. , Sleen J., Kurunmaki H. , Vallittu P. “Comparison of RepairZcan M.. , Sleen J., Kurunmaki H. , Vallittu P. “Comparison of Repair
Methods for Ceramic-Fused-to-Metal-Ceramic.” JMethods for Ceramic-Fused-to-Metal-Ceramic.” J
Prosthodontics;2006;15:283-288.Prosthodontics;2006;15:283-288.
 Tylka D. ,Stewart G. “ Comparison of acidulated phosphate fluoride gelTylka D. ,Stewart G. “ Comparison of acidulated phosphate fluoride gel
and hydrofluoric acid etchants for porcelain-compositeand hydrofluoric acid etchants for porcelain-composite
repair.JPD;1994;72:121-7.repair.JPD;1994;72:121-7.

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