World Rural Health Conference
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 2347
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 1640-1646  

Management of short clinical crowns by utilizing horizontal groove retentive technique in crown/tooth or both with different luting cements – An analysis on extracted teeth


1 Department of Prosthodontics Crown and Bridge, Proddatur, Kadapa, India
2 Department of Prosthodontics Crown and Bridge and Implantology, C.K.S. Theja Institute of Dental Sciences and Research, Tirupathi, Andhra Pradesh, India
3 Department of Prosthodontics Crown and Bridge, Army College of Dental Sciences, Secunderabad, Telangana, India

Date of Submission24-Oct-2019
Date of Decision12-Feb-2020
Date of Acceptance20-Feb-2020
Date of Web Publication26-Mar-2020

Correspondence Address:
Dr. J Haritha
Department of Prosthodontics, Private Practitioner, D. No: 24/513, Vasanthapeta, Proddatur, Kadapa (Dst), Andhra Pradesh - 516 360
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_939_19

Rights and Permissions
  Abstract 


Purpose: The aim of the present study was to compare and evaluate the retention of dislodged crowns by addition of one horizontal circumferential groove (HCG) to preparation and/or casting and with two luting cements. Materials and Methods: A total of 80 recently extracted human maxillary first molar teeth of appropriate sizes were collected and mounted in the resin blocks using surveyor. Standardized full coverage tooth preparations were prepared and impressions were obtained. Dies were prepared for casting and were then subjected to tensile loading using UTM. The data obtained was statistically analyzed. Results: Obtained values were statistically analyzed using ANOVA, STUDENT “t” TEST and BONFERRONI TEST. The results showed that the mean tensile force (TF) was in the range from 49.05 to 264.87 for group A and 255.06 to 588.60 for group B. The highest TF was recorded for subgroup 3B, whereas the lowest for subgroup 1A. Conclusion: Within the limitations of the study, it was concluded that by addition of one HCG to tooth preparation or casting and to both showed significant increase in retention, when compared to control groups. The highest retention value was obtained for sample with groove on the internal surface of crown luted with SARC.

Keywords: Circumferential groove, dislodged crown, self adhesive resin cement (SARC), tensile force, universal testing machine (UTM)


How to cite this article:
Haritha J, Rao M R, Padmaja B I, Reddy N R, Babu N S, Karthik K V. Management of short clinical crowns by utilizing horizontal groove retentive technique in crown/tooth or both with different luting cements – An analysis on extracted teeth. J Family Med Prim Care 2020;9:1640-6

How to cite this URL:
Haritha J, Rao M R, Padmaja B I, Reddy N R, Babu N S, Karthik K V. Management of short clinical crowns by utilizing horizontal groove retentive technique in crown/tooth or both with different luting cements – An analysis on extracted teeth. J Family Med Prim Care [serial online] 2020 [cited 2020 Mar 28];9:1640-6. Available from: http://www.jfmpc.com/text.asp?2020/9/3/1640/281223




  Introduction Top


A plethora of restorations are used to restore form and functions of teeth which include intracoronal restorations, extra coronal restorations, fixed dental prosthesis, removable dental prosthesis, and implant supported prosthesis. Though implant supported prosthesis revolutionized the field of dentistry for replacement of missing teeth, fixed dental prostheses are still the most frequent restorative procedures.[1]

Important factors relating to the success of a cast restoration are the design of the preparation of the supporting tooth structure and the accuracy of the casting. Other factors include the luting agent and its biomechanical characteristics, and the degree of bond strength between the cement and the tooth structure.[2]

Complete cast crowns are good alternatives and have best longevity for the restoration of damaged posterior teeth. Occasionally, a crown with clinically acceptable margins, preparation design, and occlusion become improper. Clinicians often debate whether such a crown can be successfully recemented with any degree of confidence that it will not be dislodged under normal masticatory function. It has been documented that resistance form increases by placing grooves opposing each other in a crown and tooth; cements also have a role to play in retention of crowns.[3]

Traditional causes for premature crown dislodgment include loss of core structure, adhesive and cohesive failure of the luting agents, inadequate clinical crown preparation, failure to follow the manufacturer's directions for use of the luting agent and contamination of the luting agent and/or tooth preparation interface.[4] Moreover, failures may be a result of the inability of a cement to bond to the crowns as well as to tooth structure.[5]

It is not always possible to perform preparation modification on the external surface of prepared tooth as the remaining dentinal thickness can pose a challenge. So, horizontal circumferential retentive grooves placed on the internal surface of the crown is the safest option to aid in increased retention.[6]

The purpose of this in-vitro study was to determine that by adding horizontal groove to the internal surface of the crown and/or tooth preparation would improve retention of a complete metal crown and the cementation strength of their respective restorations upon cementation with conventional and adhesive cements.


  Materials and Methods Top


Preparation of sample

A total of 80 recently extracted sound, non-carious, non-restored human maxillary first molar teeth were collected, cleaned and disinfected with 5% sodium hypochlorite solution. From the collected bulk, teeth with appropriate sizes were stored in distilled water till mounting. The teeth were mounted in the auto polymerizing acrylic resin block measuring 2 cm × 2 cm within 2 mm of the cemento-enamel junction [CEJ], with the long axis of the tooth perpendicular to the horizontal plane. After the resin had completely set, all the specimens were preserved in distilled water until further use. A mould was prepared to hold the mounted teeth in acrylic blocks which were then placed on a surveying table.

Tooth preparation

Standardized full-coverage tooth preparation was carried out using a high-speed, high-torque airotor hand piece (NSK) manually in such a manner that the bur would remain parallel to the analyzing rod [Figure 1]a. The tooth preparations were done under copious water irrigation. All the prepared teeth were kept at least 4 mm in height. This was done by a single operator so as to ensure the uniform dimensions of prepared teeth. Following the completion of the preparation, the specimens were again stored in distilled water till further use.
Figure 1: (a): Surveying of mounted acrylic blocks. (b): Custom tray with impression and prepared tooth sample

Click here to view


Impression making and die fabrication

A special tray was fabricated and vent holes were placed to allow flow of excess material during impression making. Impressions of the prepared teeth were made with polyvinyl siloxane putty impression material (Flexceed soft putty/Regular set, Dentsply, Germany) using two-stage putty-wash technique. A total of 80 dies were poured. All the 80 dies were retrieved and checked for bubbles, voids, or any defects. Defective dies were discarded and impression was again poured and dies were prepared.

Preparation of wax pattern and casting

After the application of Die hardener which was allowed to set for 2 minutes, two coats of die spacer were applied to dies, 0.5 mm above the prepared margin of the tooth. An extra layer of die spacer was added because the crowns had to be slightly loose on the die as it had to depict a crown dislodged from the mouth. Die lubricant was applied over the die.

The Wax patterns of 1–1.5 mm thickness were fabricated and a round wax sprue was shaped as a loop and attached to the occlusal surface of the wax pattern [Figure 1]b to make a connection for the tensile testing machine. Patterns were invested (Wirovest) and casting was done with Nickel-Chromium alloy in centrifugal casting machine.

Internal surfaces of all castings were examined for any casting defects. The internal surfaces of all crowns were sandblasted using sandblasting unit with the 110 μ aluminum oxide particles for 10 seconds at 20 kg/cm 2.

Grouping of the samples

All the samples were randomly divided into two groups of 40 samples each.

Group A: 40 samples

Group B: 40 samples

Samples of each group were cemented with glass ionomer cement and self-adhesive resin cement respectively.

Group A: cemented with Glass Ionomer Cement (GC - Gold Label)

Group B: cemented with Self Adhesive Resin Cement (G-CEM Link Ace)

Based on the placement of horizontal circumferential groove on the tooth and/or crown, each group was subdivided into four subgroups of 10 samples each

Subgroup I: Both casting and teeth were unaltered (control group) [Figure 2]a
Figure 2: (a): Die sample with spacer coating and wax pattern with loop. (b): Acrylic blocks with castings

Click here to view


Subgroup II: Casting had no groove, and the teeth had groove.

Subgroup III: Casting had groove and the teeth had no groove

Subgroup IV: Casting, as well as the teeth, had a groove

After the crowns were ready, preparation modifications were done on the external surface of the tooth and on the internal surface of the crowns. Castings were taken and one horizontal circumferential groove was made free hand on the internal surface of the crown. The groove was 0.5 mm deep and 1.4 mm wide with carbide bur. The groove was made approximately 3 mm from the cervical margin. Similarly, teeth were taken and one horizontal circumferential groove was made on the tooth with the depth orientation round bur approximately 3 mm from the cervical margin. Groove on the castings and teeth were placed in the same position to be opposite to each other while cementation.

Group A

[cemented with GIC]

Subgroup I: Control group - Both crown and tooth without groove

Subgroup II: Crown without groove and tooth with groove

Subgroup II: Crown with groove and tooth without groove

Subgroup IV: Both crown and tooth with groove

Group B

[cemented with resin cement]

Subgroup I: Control group - Both crown and tooth without groove

Subgroup II: Crown without groove and tooth with groove

Subgroup III: Crown with groove and tooth without groove

Subgroup IV: Both crown and tooth with groove

After applying the cement on the internal surface of the crown, the crown was seated on the respected prepared tooth using finger pressure for 60 seconds as it was meant to simulate what a dentist could do on chair side. The cement was allowed to set in a dry field for 10 minutes. The excess cement was removed with a curette.

The same procedure was repeated for cementation of all crowns to respective prepared samples.

Measuring tensile force

The samples were then subjected to the tensile loading using a universal testing machine. The sample was mounted in the lower jaw and the 19-gauge wire was held in the upper jaw by passing through the loop of crown [Figure 2]b. During testing the lower jaw moved in a downward direction. Force was applied by the testing machine at a cross-head speed of 150 mm/min, with a maximal vertical tensional load of 40 KN. The maximal tensile force used to dislodge the crown was recorded in Newton. All the samples were tested [Figure 3] and [Figure 4] in the same manner and the values were recorded and subjected to statistical analysis.
Figure 3: (a): Casting and tooth with groove. (b): Sample engaged with 19-gauge wire

Click here to view
Figure 4: Samples after testing

Click here to view



  Results Top


Descriptive statistical measures such as mean, range between maximum and minimum values of tensile bond strengths, standard deviation (SD), standard error of mean (SEM) were computed for all the study groups. In order to collectively compare the means of study groups, One-way ANOVA (analysis of variance) test was used (P < 0.05) and pair wise comparison of the groups tested using student's “t” test (P < 0.05) and multiple comparisons using Bonferroni test were done.

An analysis of variance (One-way ANOVA) of tensile bond strengths of specimens showed the statistically significant difference (Group A: F =176.903, P < 0.001 and Group B: F =402.423, P < 0.001) [Table 1].
Table 1: Multiple Group Comparisons of tensile force of two groups: ANOVA

Click here to view


On multiple comparisons using Bonferroni test [Table 2], the tensile bond strengths of specimens showed statistically significant difference.
Table 2: Multiple comparison of tensile force between the groups: Bonferroni test

Click here to view


From the results obtained in the study,

  1. The samples of subgroup 3B [samples with circumferential groove on the internal surface of crown luted with resin cement] showed significant increase in the retention when compared with the other group and within the group.
  2. Within group Comparisons:

    The samples of subgroup 3B showed a significant two-fold increase in the retention when compared to subgroup 1B [control group]

    The samples of subgroup 3A [samples with circumferential groove on the internal surface of crown luted with GIC cement] showed a significant increase in the retention by three-fold when compared to subgroup 1A [control group].
  3. Among groups comparisons:

    The samples of subgroup 3B showed significant increase in retention by two-fold when compared to subgroup 3A.


On pair wise comparison using student's t test [Table 3] the tensile bond strengths of specimens showed statistically significant difference (t – 26.152, P < 0.001; t – 33.093, P < 0.001; t – 34.770, P < 0.001; t – 28.945, P < 0.001).
Table 3: Group A vs Group B comparisons

Click here to view



  Discussion Top


Primary care is healthcare provided in the community for people making an initial approach to a medical practitioner or clinic for advice or treatment. So short clinical crown is identified and treated with necessary modifications.

Mastication is not a process where forces act purely along the long axis of a prepared tooth, hence the resultant forces acting on the tooth were not only the compressive forces but also the tensile and shear forces, in order to overcome these forces or to prevent dislodgement of restorations, supplements should be provided either to the restoration or tooth and both if required to enhance the retention. Following anin vitro study was conducted to compare and evaluate the retention of dislodged crowns by the addition of horizontal circumferential groove to the casting and/or tooth preparation and with different luting agents i.e. GIC and Self-Adhesive Resin cement.

For the long-term and harmonious accommodation of restorative material, teeth require preparations which were based on Biological, Mechanical, and Esthetic principles.[7]

In this study, the retentivity of cast crown was obtained with one horizontal circumferential groove and two types of luting agents i.e. conventional glass ionomer cement and resin cement.

The clinical success of fixed prosthesis also depends upon the luting agent and the proper cementation procedure. Dental cement must be used as a barrier against microbial leakage, sealing the interface between the tooth and restoration and holding them together through some form of surface attachment.[8] This attachment may be mechanical, chemical, or combination of both.[9]

One of the major causes for dislodgement of clinical crown is design of tooth preparation Therefore, the design of the tooth preparation is an important consideration in the retention of crowns by geometrically limiting the number of paths along which a restoration can be removed from the tooth preparation.

In the present study, recently extracted non-restored sound natural maxillary first molar teeth of appropriate size were selected as they would have more open dentinal tubules when compared to carious and sclerosed teeth. This difference has an effect on the bonding of resin and glass ionomer cements to dentin.

More importantly, the use of natural teeth is clinically more relevant compared to alternative test specimens of metal dies or typhodont teeth. The true effect of resin bonding agents may be compromised in studies that do not use natural teeth.[10]

Kaufman et al.[11] determined the influence of preparation height on retention or resistance form and found a linear relationship between retention and preparation height, but the minimum preparation height studied was 4 mm, and the maximum retention was obtained at 1 degree of TOC (Total Occlusal Convergence), which is clinically unrealistic.

In the present study, care was taken to maintain proper taper and height during the tooth preparation through custom made platform using surveyor. Standardized tooth preparation was done following the principles of tooth preparation.

Zidan and Ferguson et al.[12] The configuration of finish line of the preparation affects the width of the band of cement exposed to oral fluids. Shoulder finish lines exposed more amount of cementing agent at the cervical margin, which also influences the fit of the restoration. According to Gavelis et al.[13],[14],[15] when chamfer finishing margin is used, the exposure of cementing agent decreases according to its inclination.

In the present study chamfer finish line was given in order to reduce cement exposure and to enhance fit of restoration.

Chan and Boyer et al.[16] in their study proposed the concept of auxiliary retention by placing opposing grooves in the castings and the cavity perpendicular to path of withdrawal and extending around the entire circumference of pattern midway between the surface and the base. After cementation, grooves were occupied with cement. To dislodge the casting, fracture of cement or the dentine must occur.

The results of the present study were in accordance with Chan KC et al.[16] (1981), O'Kray H, Marshall TS et al.[4] (2012), Amarnath GS et al.[3] (2015), Krishna Kumar Lahoti et al.[6] (2017) who in their study concluded that placing 1 or 2 horizontal circumferential grooves into the internal surface of complete cast crowns increased the retention made for optimal tooth preparations. These results were attributed to the increased mechanical interlocking of the luting cement within the grooves which significantly increased the retention of the nickel chromium crowns.

Various authors categorically investigated that placing horizontal circumferential groove on the internal surface of complete cast crown would place some part of the cement interface under the state of compression. As most of the luting agents are weak in shear and tensile forces, cement in state of compression would help to increase the retention.[4],[17]

Ideally, cement for restorations should have physical properties sufficient to resist functional forces over the lifetime of the restoration. In addition, cement should be resistant to degradation in the oral environment and adhere to the underlying dentin. These materials interact interfacially with the tooth structure and the crown substrates to create bonds. When a conventional glass ionomer is used, retention has been shown to be dependent primarily on the geometric form of the tooth preparation.[5]

In the present study, significant increase in retention was observed by placement of groove on the casting than on the tooth preparation and both. From this a clinician can provide better retention without involving or modifying the tooth preparation.

Conventional glass ionomer interacts interfacially with the tooth structure creating covalent bonds. Whereas the Resin cements have the ability to adhere to multiple substrates, high strength, insolubility in the oral environment, and shade matching potential.

Glass ionomer cements exhibit bond strength of 1.67 MPa, Resin cement is found to be the strongest one with the value of 2.33 MPa. The highest value of resin cement is quite understandable because of its bonding ability to tooth structure and metal surface. This could be attributed to the chemical nature of the cement to achieve micromechanical bonding.[18],[19]

In the present study, loose fitting castings were prepared to replicate the clinical situation of dislodged crowns by coating additional layer of die spacer. For resin cement it was beneficial as it compensates the space due to its greater film thickness (40 μm).

Della bona and van noort(1998) and Nayakar et al.[8],[9] stated that the shear tests were the most efficient to find out the cohesive resistance of the material, whereas tensile tests were appropriate to estimate the adhesion at the interface. Moreover, shear tests are strongly influenced by mechanical properties. The purpose of this study was to evaluate the adhesive capacity of the luting material rather than the stress produced during function hence a tensile bond test was performed.

In the present study the samples were tested under standardized conditions using Universal test machine, maximal tensile load of 40 KN at a crosshead speed of 150 mm/min

Cohesive dentin fracture took place on separation with 25% to 40% of the castings for resin cement, which indicates a superior dentin/resin/metal attachment. This mode of failure was never observed with any of the castings cemented with glass ionomer cement.

In the present study cohesive failure of dentin i.e. root fracture occurred in 20–30% of teeth, failure at the dentin-cement interface in 30–40% and cohesive dentinal fracture in 25–40% luted with resin cement whereas with glass ionomer cement most of them failure at the metal cement interface.

Fendi AlShaarani et al.,[20] also advocated the utilization of grooves in order to improve retention and extension of the cast crown into the groove improved the retention by 100% rather than blocking the groove during prosthesis fabrication.


  Conclusion Top


From the study, it was finally concluded that the incorporation of horizontal groove on the internal surface of complete cast crown was found to be a satisfactory method compared to preparation modification in tooth to improve the retention in dislodged crowns.

Hence, by utilization of horizontal groove after casting in crowns (especially in short clinical crown conditions) will help us in preventing the dislodgement of crowns, which is more evident when horizontal groove is not placed in short clinical crowns, thereby justifying the Muller De Van statement (Perpetual preservation of what remains is more important than the meticulous replacement of what is lost).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vinaya K, Rakshith H, Prasad K. D., Manoj S, Sunil M, Shetty N. To evaluate and compare retention of complete cast crown in natural teeth using different auxiliary retentive features with two different crown heights an in vitro study. Int J Biomed Sci 2015;11:99-106.  Back to cited text no. 1
    
2.
Juntavee N, Millstein PL. Effect of surface roughness and cement space on crown retention. J Prosthet Dent 1992;68:482-6.  Back to cited text no. 2
    
3.
Amarnath GS, Pandey A, Prasad HA, Hilal M. Comparative evaluation of enhancing retention of dislodged crowns using preparation modifications and luting cements: An in-vitro study. J Int Oral Health 2015;7:47-51.  Back to cited text no. 3
    
4.
O'Kray H, Marshall TS, Braun TM. Supplementing retention through crown/preparation modification: An in vitro study. J Prosthet Dent 2012;107:186-90.  Back to cited text no. 4
    
5.
Ayad MF, Johnston WM, Rosenstiel SF. Influence of tooth preparation taper and cement type on recementation strength of complete metal crowns. J Prosthet Dent 2009;102:354-61.  Back to cited text no. 5
    
6.
Lahoti KK, Vaidya RN, Gade JR. Comparative evaluation of retention of nickel-chromium crown by addition of one and two horizontal grooves on the internal surface of crown: An in vitro study. Int J Curr Adv Res 2017;6:1635-9.  Back to cited text no. 6
    
7.
Kumari VR, Poluri RK, Nagaraj H, Siddaruju K. Comparative evaluation of bond strength of dual-cured resin cements: An in-vitro study. J Int Oral Health 2015;7(Suppl 1):43-7.  Back to cited text no. 7
    
8.
Silva RAT, Coutinho M, Cardozo PI, Silva LA, Zorzatto JR. Conventional dual-cure versus self-adhesive resin cements in dentin bond integrity. J Appl Oral Sci 2011;19:355-62.  Back to cited text no. 8
    
9.
Fonseca RG, Dos Santos Cruz CA, Adabo GL, Vaz LG. Comparison of the tensile bond strengths of cast metal crowns luted with resin cements. J Oral Rehab 2004 31:1080-4.  Back to cited text no. 9
    
10.
Leong EWJ, Tan KBC, Nicholls JI, Chua EK, Wong KM, Neo JCL. The effect of preparation height and luting agent on the resistance form of cemented cast crowns under load fatigue. J Prosthet Dent 2009;102:155-64.  Back to cited text no. 10
    
11.
Kaufman EG, Coelho DH, Colin L. Factors influencing the retention of cemented gold castings. J Prosthet Dent 1961;11:487-502.  Back to cited text no. 11
    
12.
Davis SH, Kelly JR, Campbell SD. Use of an elastomeric material to improve the occlusal seat and marginal seal of cast restorations. J Prosthet Dent 1989;62:288-91.  Back to cited text no. 12
    
13.
Abbate MF, Tjan AHL, Fox WM. Comparison of marginal fit of various ceramic crown system. J Prosthet Dent 1989;61:527-31.  Back to cited text no. 13
    
14.
Potts RG, Shillingburg HT, Duncanson MG. Retention and resistance of preparations for cast restorations. J Prosthet Dent 1980;43;303-8.  Back to cited text no. 14
    
15.
Gavelis JR, Morency JD, Riley ED, Sozio RB. The effect of various finish line preparations on the marginal seal and occlusal seat of full crown preparations. J Prosthet Dent 1981;45:138-45.  Back to cited text no. 15
    
16.
Chan KC, Hormati AA, Boyer DB. Auxiliary retention for complete crowns provided by cement keys. J Prosthet Dent 1981;45:152-5.  Back to cited text no. 16
    
17.
Lewinstein I, Block L, Lehr Z, Ormianer Z, Matalon S. An in vitro assessment of circumferential grooves on the retention of cement retained implant-supported crowns. J Prosthet Dent 2011;106:367-72.  Back to cited text no. 17
    
18.
Ayad MF, Rosenstiel SF, Salama M. Influence of tooth surface roughness and type of cement on retention of complete cast crowns. J Prosthet Dent 1997;77:116-21.  Back to cited text no. 18
    
19.
Felton DA, Kanoy BE, White JT. Recementation of dental castings with zinc phosphate cement: Effect on cement bond strength. J Prosthet Dent 1987;58:579-83.  Back to cited text no. 19
    
20.
AlShaarani F, Alaisami RM, Aljerf L, Jamous IA, Elias K, Jaber A, et al. An auxiliary factor for increasing the retention of short abutments. Heliyon 2019;5:e02674.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
   Materials and Me...
  Results
  Discussion
  Conclusion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed6    
    Printed0    
    Emailed0    
    PDF Downloaded1    
    Comments [Add]    

Recommend this journal