I'd donate a kidney for a clinical example

This is such a routine procedure and yet it is fraught with risk……there is something close to 20K dentists in Canada, 19K alone in the GTA. Surely, don’t call me Shirley, someone has a clinical example of this concern that they would be willing to share with the 3 other folks who read this blog….rest assured, I’ve been promised by corporate that Word Press is a’comin, which means if you’re still here by 2017 we’re going look contemporary.

Risk of onlay fracture during pre-cementation functional occlusal tapping

Dental Materials

Volume 27, Issue 9 , Pages 942-947, September 2011

Abstract

Objective

To evaluate in vitro the pre-cementation resistance of CAD/CAM onlays subjected to functional occlusal tapping.

Methods

An extracted tooth model (molar and premolar) with simulated bone and periodontal ligament was used to make a mesio-occlusal onlay preparation (two mesial cusps covered). Immediate dentin sealing was applied to the prepared tooth. The corresponding onlays were fabricated with Cerec either using composite resin (Paradigm MZ100) or ceramic (e.max CAD and Mark II) (n=14). An elevated marginal ridge was designed with the intention of generating hyper-occlusion. Pre-cementation occlusal tapping was simulated using closed-loop servo-hydraulics at 2Hz, starting with a load of 40N, followed by 80, 120, 160, 200, 240 and 280N (10 cycles each). All samples were loaded until fracture or to a maximum of 70 cycles. Groups were compared using the life table survival analysis (p=.016, Bonferroni method).

Results

Survival probability was MZ100>e.max CAD>Mark II. The restorations made from e.max CAD and Mark II failed at an average load of 157N and 123N, respectively with no specimen withstanding all 70 load cycles (survival 0%); with MZ100 the survival rate was 36%.

Significance

Material selection has a significant effect on the risk of CAD/CAM onlay fracture during pre-cementation functional occlusal tapping with composite resin onlays showing the minimum risk compared to ceramic ones.