The current low quality of fixed restoration margins is highly correlated with the high incidence of margin-related complications. It is also related to the unclear spatiotemporal geometric position relationship among the consensus definitions of the gingival margin (G), preparation margin (P), and restoration margin (R). This paper discusses the existing problem of the existing term "gingival margin" as a surface anatomical landmark; proposes the term "free gingival margin line" that conforms to geometry and measurement and has importance as a surface anatomical landmark; and clarifies the participants that exist in the marginal area. These participants include the P, R, and G; cementation (adhesive) layer; and gingival sulcus. Moreover, this paper discusses the various iatrogenic damages induced by entering the gingival sulcus via the P, R, and cementing (adhesive) layer. Through the discussion of the design deficiencies of the subgingival and biologically oriented preparation technique, the physiological and clinical importance of the concept of gingival sulcus/gingival sulcus fluid + supercrestal tissue attachment (biological width) = first periodontal protective barrier was analyzed. The value of preserving the physiological role of the gingival sulcus is emphasized. Furthermore, the newly defined RPG distance represents the distance between the successive P or R line and free G line and can be measured in the clinical procedure of tooth preparation. The optimal solution is 0-200 µm, that is, RPG200: the P and R are located on the free G line and the distance between these margins is less than 200 µm. This distance not only has the aesthetic effect of invisibility to the naked eye, it also has a minimal effect on the G and gingival sulcus and is convenient for doctors and patients to clean. Furthermore, in accordance with the positional relationship between the three margins and cementation (adhesive) layer, a new classification of marginal positions is proposed. This classification overcomes the problems of incomplete inclusion objects and uncontrolled risk factors in the previous classification. It also has the advantages of strong practicability, good efficiency of main control geometric quantity, and clear risk control points. The new design scheme and classification of the margi-nal position of RPG200 proposed in this paper provide a new understanding for margin design and complication prevention in the future.
Humans ; Gingiva/anatomy & histology* ; Cementation ; Dental Restoration, Permanent/methods*

OBJECTIVE: To analyze the cement flow in the abutment margin-crown platform switching structure by using the three-dimensional finite element analysis, in order to prove that whether the abutment margin-crown platform switching structure can reduce the inflow depth of cement in the implantation adhesive retention. METHODS: By using ANSYS 19.0 software, two models were created, including the one with regular margin and crown (Model one, the traditional group), and the other one with abutment margin-crown platform switching structure (Model two, the platform switching group). Both abutments of the two models were wrapped by gingiva, and the depth of the abutment margins was 1.5 mm submucosal. Two-way fluid structure coupling calculations were produced in two models by using ANSYS 19.0 software. In the two models, the same amount of cement were put between the inner side of the crowns and the abutments. The process of cementing the crown to the abutment was simulated when the crown was 0.6 mm above the abutment. The crown was falling at a constant speed in the whole process spending 0.1 s. Then we observed the cement flow outside the crowns at the time of 0.025 s, 0.05 s, 0.075 s, 0.1 s, and measured the depth of cement over the margins at the time of 0.1 s. RESULTS: At the time of 0 s, 0.025 s, 0.05 s, the cements in the two models were all above the abutment margins. At the time of 0.075 s, in Model one, the gingiva was squeezed by the cement and became deformed, and then a gap was formed between the gingiva and the abutment into which the cement started to flow. In Model two, because of the narrow neck of the crown, the cement flowed out from the gingival as it was pressed by the upward counterforce from the gingival and the abutment margin. At the time of 0.1 s, in Model one, the cement continued to flow deep inside with the gravity force and pressure, and the depth of the cement over the margin was 1 mm. In Model two, the cement continued to flow out from the gingival at the time of 0.075 s, and the depth of the cement over the margin was 0 mm. CONCLUSION When the abutment was wrapped by the gingiva, the inflow depth of cement in the implantation adhesive retention can be reduced in the abutment margin-crown platform switching structure.
Finite Element Analysis ; Cementation/methods* ; Gingiva ; Crowns ; Dental Abutments ; Dental Cements ; Dental Stress Analysis

Fiber-reinforced resin composite posts (fiber posts) are used extensively for the restoration of root-treated teeth with excessive loss of coronal structure. However, the longevity of a fiber post restoration still needs to be improved because of the various confounding factors that affect bonding procedures. Operational specification for clinical use of dental intraradicular fiber post was established based on the in-depth discussions by a panel of experts from Society of Prosthodontics, Chinese Stomatological Association. This specification should be helpful in standardizing the clinical technique of fiber post placement and improving the clinical longevity of a fiber post restoration.
Cementation ; Composite Resins ; Dental Bonding ; Dental Stress Analysis ; Glass ; Materials Testing ; Post and Core Technique ; Resin Cements ; Tooth Root

The minimal tooth reduction, esthetic appeal and biocompatibility of porcelain laminate veneers have made them one of the mainstream technologies for minimal invasive esthetic dental restorations. Cementation is a crucial step in ensuring retention, marginal seal and influencing the clinical longevity of veneer restorations. Experts from Society of Prosthodontics, Chinese Stomatological Association formulated operational specifications for the cementation of porcelain laminate veneers, so as to standardize the clinical operating procedures, achieve the long-term success of veneer restorations, and promote the application of porcelain laminate veneers.
Cementation ; Dental Porcelain ; Dental Veneers ; Esthetics, Dental

PURPOSE: To determine wear amount of single molar crowns, made from four different restoratives, and opposing natural teeth through computerized fabrication techniques using 3D image alignment. MATERIALS AND METHODS: A total of 24 single crowns (N = 24 patients, age range: 18 – 50) were made from lithium disilicate (IPS E-max CAD), lithium silicate and zirconia based (Vita Suprinity CAD), resin matrix ceramic material (Cerasmart, GC), and dual matrix (Vita Enamic CAD) blocks. After digital impressions (Cerec 3D Bluecam, DentsplySirona), the crowns were designed and manufactured (Cerec 3, DentsplySirona). A dual-curing resin cement was used for cementation (Variolink Esthetic DC, Ivoclar). Then, measurement and recording of crowns and the opposing enamel surfaces with the intraoral scanner were made as well as at the third and sixth month follow-ups. All measurements were superimposed with a software (David-Laserscanner, V3.10.4). Volume loss due to wear was calculated from baseline to follow-up periods with Siemens Unigraphics NX 10 software. Statistical analysis was accomplished by Repeated Measures for ANOVA (SPSS 21) at = .05 significance level. RESULTS: After 6 months, insignificant differences of the glass matrix and resin matrix materials for restoration/enamel wear were observed (P>.05). While there were no significant differences between the glass matrix groups (P>.05), significant differences between the resin matrix group materials (P<.05) were obtained. Although Cerasmart and Enamic were both resin matrix based, they exhibited different wear characteristics. CONCLUSION: Glass matrix materials showed less wear both on their own and opposing enamel surfaces than resin matrix ceramic materials.
Cementation ; Ceramics ; Crowns ; Dental Enamel ; Follow-Up Studies ; Glass ; Humans ; Lithium ; Molar ; Resin Cements ; Silicates ; Tooth

This case report describes a technique in which endodontic treatment and permanent indirect restoration were completed in the same clinical appointment with the aid of a computer-aided design/computer-aided manufacturing (CAD/CAM) system. Two patients were diagnosed with irreversible pulpitis of the mandibular first molar. After access preparation, root canals were located, irrigation was performed until bleeding ceased, and the coronal tooth structure was prepared for indirect restoration. Then, utilizing an interim 3-mm build-up of the endodontic access cavity, a hemi-arch digital scan was performed with an intraoral scanner. Subsequent to digital scanning, restoration design was performed simultaneously with the endodontic procedure. The root canals were shaped using the Race system under irrigation with 2.5% sodium hypochlorite followed by root canal filling. The pulp chamber was subsequently filled with a 3-mm-thick composite resin restoration mimicking the interim build-up previously utilized to facilitate block milling in the CAD/CAM system. Clinical try-in of the permanent onlay restoration was followed by acid etching, application of a 5th generation adhesive, and cementation of the indirect restoration. Once the restoration was cemented, rubber dam isolation was removed, followed by occlusal adjustment and polishing. After 2 years of follow-up, the restorations were esthetically and functionally satisfactory, without complications.
Adhesives ; Cementation ; Computer-Aided Design ; Continental Population Groups ; Dental Pulp Cavity ; Endodontics ; Follow-Up Studies ; Hemorrhage ; Humans ; Inlays ; Molar ; Occlusal Adjustment ; Pulpitis ; Rubber Dams ; Sodium Hypochlorite ; Tooth

OBJECTIVES: This study evaluated the bond strength of various fiberglass post cementation techniques using different resin-based composites. MATERIALS AND METHODS: The roots from a total of 100 bovine incisors were randomly assigned to 5 treatment groups: G1, post + Scotchbond Multi-Purpose (SBMP) + RelyX ARC luting agent; G2, relined post (Filtek Z250) + SBMP + RelyX ARC; G3, individualized post (Filtek Z250) + SBMP; G4, individualized post (Filtek Bulk-Fill) + SBMP; G5, individualized post (Filtek Bulk-Fill Flow) + SBMP. The samples were subjected to the push-out (n = 10) and pull-out (n = 10) bond strength tests. Data from the push-out bond strength test were analyzed using 2-way analysis of variance (ANOVA) with the Bonferroni post hoc test, and data from the pull-out bond strength test were analyzed using 1-way ANOVA. RESULTS: The data for push-out bond strength presented higher values for G2 and G5, mainly in the cervical and middle thirds, and the data from the apical third showed a lower mean push-out bond strength in all groups. No significant difference was noted for pull-out bond strength among all groups. The most frequent failure modes observed were adhesive failure between dentine and resin and mixed failure. CONCLUSIONS: Fiberglass post cementation using restorative and flowable bulk-fill composites with the individualization technique may be a promising alternative to existing methods of post cementation.
Adhesives ; Cementation ; Composite Resins ; Dental Cements ; Dentin ; In Vitro Techniques ; Incisor ; Root Canal Filling Materials ; Tooth Root

PURPOSE: Shear bond strength (SBS) test is the most commonly used method for evaluating resin bond strength of zirconia, but SBS results vary among different studies even when evaluating the same bonding strategy. The purpose of this study was to promote standardization of the SBS test in evaluating zirconia ceramic bonding and to investigate factors that may affect the SBS value of a zirconia/resin cement/composite resin bonding specimen.MATERIALS AND METHODS: The zirconia/resin cement/composite resin bonding specimens were used to simulate loading with a shear force by the three-dimensional finite element (3D FE) modeling, in which stress distribution under uniform/non-uniform load, and different resin cement thickness and different elastic modulus of resin composite were analyzed. In vitro SBS test was also performed to validate the results of 3D FE analysis.RESULTS: The loading flat width was an important affecting factor. 3D FE analysis also showed that differences in resin cement layer thickness and resin composite would lead to the variations of stress accumulation area. The SBS test result showed that the load for preparing a SBS specimen is negatively correlated with the resin cement thickness and positively correlated with SBS values.CONCLUSION: When preparing a SBS specimen for evaluating bond performance, the load flat width, the load applied during cementation, and the different composite resins used affect the SBS results and therefore should be standardized.
Cementation ; Ceramics ; Composite Resins ; Elastic Modulus ; In Vitro Techniques ; Methods ; Resin Cements

OBJECTIVES: This study investigated the effect of continuous application of 10-methacryloyloxydecyldihydrogen phosphate (MDP)-containing primer and luting resin cement on bond strength to tribochemical silica-coated yttria-stabilized tetragonal zirconia polycrystal (Y-TZP). MATERIALS AND METHODS: Forty bovine teeth and Y-TZP specimens were prepared. The dentin specimens were embedded in molds, with one side of the dentin exposed for cementation with the zirconia specimen. The Y-TZP specimen was prepared in the form of a cylinder with a diameter of 3 mm and a height of 10 mm. The bonding surface of the Y-TZP specimen was sandblasted with silica-coated aluminium oxide particles. The forty tribochemical silica-coated Y-TZP specimens were cemented to the bovine dentin (4 groups; n = 10) with either an MDP-free primer or an MDP-containing primer and either an MDP-free resin cement or an MDP-containing resin cement. After a shear bond strength (SBS) test, the data were analyzed using 1-way analysis of variance and the Tukey test (α = 0.05). RESULTS: The group with MDP-free primer and resin cement showed significantly lower SBS values than the MDP-containing groups (p < 0.05). Among the MDP-containing groups, the group with MDP-containing primer and resin cement showed significantly higher SBS values than the other groups (p < 0.05). CONCLUSIONS: The combination of MDP-containing primer and luting cement following tribochemical silica coating to Y-TZP was the best choice among the alternatives tested in this study.
Cementation ; Dentin ; Fungi ; Resin Cements* ; Silicon Dioxide ; Tooth

PURPOSE: The purpose of this in vitro study is to examine the effects of a nano-structured alumina coating on the adhesion between resin cements and zirconia ceramics using a four-point bending test. MATERIALS AND METHODS: 100 pairs of zirconium bar specimens were prepared with dimensions of 25 mm × 2 mm × 5 mm and cementation surfaces of 5 mm × 2 mm. The samples were divided into 5 groups of 20 pairs each. The groups are as follows: Group I (C) – Control with no surface modification, Group II (APA) – airborne-particle-abrasion with 110 µm high-purity aluminum oxide (Al2O3) particles, Group III (ROC) – airborne-particle-abrasion with 110 µm silica modified aluminum oxide (Al₂O₃ + SiO2) particles, Group IV (TCS) – tribochemical silica coated with Al2O3 particles, and Group V (AlC) – nano alumina coating. The surface modifications were assessed on two samples selected from each group by atomic force microscopy and scanning electron microscopy. The samples were cemented with two different self-adhesive resin cements. The bending bond strength was evaluated by mechanical testing. RESULTS: According to the ANOVA results, surface treatments, different cement types, and their interactions were statistically significant (P < .05). The highest flexural bond strengths were obtained in nanostructured alumina coated zirconia surfaces (50.4 MPa) and the lowest values were obtained in the control group (12.00 MPa), both of which were cemented using a self-adhesive resin cement. CONCLUSION: The surface modifications tested in the current study affected the surface roughness and flexural bond strength of zirconia. The nano alumina coating method significantly increased the flexural bond strength of zirconia ceramics.
Aluminum Oxide ; Cementation ; Ceramics ; In Vitro Techniques ; Methods ; Microscopy, Atomic Force ; Microscopy, Electron, Scanning ; Resin Cements ; Silicon Dioxide ; Zirconium