List Of Figures

Figure
(1)

page

i Tero (Cadent.Inc)(Left) and 3M ESPE Lava (3M ESPE)(Right) digital impressioning systems. 17 (2) E4D Dentist (D4D Technologies) chair-side CAD/CAM system. 19 (3) CEREC (Sirona) chair-side CAD/CAM system. 20 (4) Prof.W.Mormann and Dr.M.Brandestini with the first version of CEREC CAD/CAM system (the lemon). 21 (5) CEREC 1 Milling chamber. 22 (6) CEREC 2 milling chamber. 23 (7) CEREC 3 milling chamber. 23 (8) The step bur . 24 (9) The strands are sawn into blocks. 31 (10) The attachments are fixed to the blocks with a special adhesive. 32 (11) The surface energy and contact angle of Dentin and Enamel. 39 (12) Mild collagen demineralization and diffusion of Panavia F-2.0 cement into dentin as represented by the mild purple line when Massons trichrome staining technique was used. 47 (13) No evident collagen demineralization or diffusion of Rely X Unicem cement into Dentin when Massons trichrome staining technique was used. 48 (14) Heavy body addition silicon impression material 69 (15) A tooth is attached to the plastic cast. 70 (16) Parallel A-Prep device before assembly. 71 (17) Parallel-A-Prep device after assembly. 71 (18) Mounting the tray part of Parallel-A-Prep device. 72 (19) Mounting Parallel-A-Prep device on the plastic cast. 73 (20) Adjusting the angle of Parallel-A-Prep device. 73

(21) Adjusting the angle of the tapered stone with flat end. 74 (22) Starting the axial preparation of the tooth. 74 (23) Occlusal tooth preparation for CEREC CAD/CAM restoration. 75 (24) Axial tooth preparation for CEREC CAD/CAM restoration. 76 (25) Tooth preparation for CEREC CAD/CAM restoration. 77 (26) CEREC 3D acquisition unit (Right) and milling machine (Left). 78 (27) CEREC Camera (Left) and CEREC Powder (Right). 80 (28) Capturing the optical image using CEREC camera. 81 (29) Optical image of the tooth preparation. 81 (30) Tracing the margin line of the virtual preparation. 84 (31) Selecting the virtual restoration. 85 (32) The step bur (Left) and the pointed cylinder bur (Right). 86 (33) Milling preview and bur selection. 87 (34) Inserting the block in CEREC milling chamber. 87 (35) The milling machine is ready to start milling. 88 (36) Milling of the crown is complete. 88 (37) Milled CEREC Composite crown. 89 (38) Vita Mark II CAD/CAM ceramic block. 90 (39) Paradigm MZ100 CAD/CAM composite block. 91 (40) Plastic rings used for teeth mounting in acrylic resin. 93 (41) Leveler used in mounting the teeth perpendicular to the floor. 93 (42) Occlusal view for mounted prepared tooth with its respective milled crown. 94 (43) Axial view for mounted prepared tooth with its respective milled crown. 94 (44) Hydrofluoric etching gel. 95

(45) Clearfil ceramic primer (Left) and Rely X ceramic primer (Right). 96 (46) Etch-rite etching gel. 96 (47) Panavia F 2.0 ED primer II. 98 (48) Panavia F 2.0 pastes A and B. 99 (49) Applying static pressure to the crown during Cementation. 99 (50) LED light curing unit. 100 (51) Rely X Unicem Clicker. 101 (52) Occlusal view of a finished and polished CEREC CAD/CAM ceramic crown. 102 (53) Axial view of a finished and polished CEREC CAD/CAM ceramic crown. 102 (54) Instron machine. 104 (55) The sample is adjusted in place in the jig. 105 (56) The sample is loaded in distilled water. 106 (57) The sample is loaded for 1,000,000 cycles at 12 Hz Frequency using a load of 60-600 N. 107 (58) Isomet low-speed diamond saw. 108 (59) Survival of crowns according to the crown materials. 110 (60) Composite crowns survival according to the material used for crown cementation. 111 (61) Ceramic crowns survival according to the material used for crown cementation. 112 (62) Ceramic crown shows cracks formation that extended from the loaded spot in the occlusal surface into the axial walls of the crown. 113 (63) Ceramic crown shows cracks formation that extended into the axial walls of the crown. 114 (64) Distribution of crowns with respect to survival after the cyclic-loading test. 116 (65) Survival of crowns according to the used cement. 117 (66) Survival of crowns according to the testing conditions. 118 (67) Mesiodistal sections of two CEREC CAD/CAM

ceramic crowns of (PA/CE) group after microleakage testing. 119 (68) Mesiodistal sections of two CEREC CAD/CAM composite crowns of (PA/Co) group after microleakage testing. 120 (69) Mesiodistal sections of two CEREC CAD/CAM ceramic crowns of (RX/CE) group after microleakage testing. 120 (70) Mesiodistal sections of two CEREC CAD/CAM composite crowns of (RX/CO) group after microleakage testing. 121 (71) Mesiodistal sections of two CEREC CAD/CAM ceramic crowns of (PA/CE/T) group after microleakage testing. 121 (72) Mesiodistal sections of two CEREC CAD/CAM composite crowns of (PA/CO/T) group after microleakage testing. 122 (73) Mesiodistal sections of two CEREC CAD/CAM ceramic crowns of (RX/CE/T) group after microleakage testing. 122 (74) Mesiodistal sections of two CEREC CAD/CAM composite crowns of (RX/CO/T) group after microleakage testing. 123 (75) Microleakage means and standard deviations (STDEV) according to the crown material. 124 (76) Microleakage means and standard deviations (STDEV) according to the used cement. 125 (77) Microleakage means and standard deviations (STDEV) according to the testing conditions. 126 (78) Microleakage means and standard deviations (STDEV) of composite crowns. 128 (79) Microleakage means and standard deviations (STDEV) of ceramic crowns groups. 129 (80) Microleakage means and standard deviations (STDEV) of the eight groups of crowns. 131

Index
List of Tables List of Figures Chapter 1 : Introduction Chapter 2 : Review of Literature 2.1 :Metal-Ceramic Crowns 2.2 :Composite resin 2.3 : Ceramics
2.3.1 :Conventional powder slurry ceramics 2.3.2 :Castable ceramics 2.3.3:Pressable ceramics 2.3.4:Infiltrated ceramics 2.3.5:Machinable ceramics i ii 1 3 3 4 8 9 9 9 10 10

2.4 :CAD/CAM in dentistry

11

2.4.1:Historical background of CAD/CAM in dentistry 11 2.4.2:Review of common CAD/CAM systems 13 2.4.2.1:Laboratory systems 14 2.4.2.2:In-office systems 16 2.4.3:The chair-side and economical restorations of esthetic ceramics(CEREC) system. 20 2.4.4:CEREC 3D Materials 25 2.4.5:Vitablock Mark II 28 2.4.5.1:Vitablock Mark II Block Industry 29 2.4.6:Paradigm MZ100 32

2.5:Cementation
2.5.1:Conventional cements 2.5.2:Hybrid cements 2.5.3:Composite resin cements 34 34 34

34

2.6:Adhesion 2.7:Adhesive cementation

37 41

2.7.1:Adhesive resin-composite cements 2.7.2:Self-etching Resin Cements. 2.7.3:Self-etching Self-adhesive Resin Cements

41 42 44

2.8:Role of Silane coupling agents. 2.9:Evaluation of dental restorations

48 49

2.10:Studies on Panavia f and Rely X Unicem cements. 2.11:Studies on Vitablock Mark II crowns 2.12:Studies on Paradigm MZ100 crowns Chapter 3 :Aim of the Study Chapter 4 :Materials and Methods 4.1 :Materials 4.2 :Methods

54 59 62
65

66 66 67 4.2.1 :Selection of the teeth 67 4.2.2 :Sterilization of teeth 67 4.2.3 :Grouping of the teeth 67 4.2.4 :Preparation of the teeth 68 4.2.5 :Construction of the crowns 78 4.2.5.1:Optical Impression 79 4.2.5.2:Selecting the design technique 82 4.2.6 :Crowns fabrication 83 4.2.6.1:Ceramic crown fabrication 90 4.2.6.2:Composite crown fabrication 91 4.2.7 :Cementation 92 4.2.7.1:Ceramic crowns treatment 95 4.2.7.2:Composite crowns treatment 96 4.2.7.3:Cementation of crowns using Panavia F2.0 97 4.2.7.4: Cementation of crowns using Rely X Unicem 100 4.2.8 :Thermo-cycling 103

4.2.9 :Load-cycling 4.2.10:Microleakage testing 4.2.11:Statistical analysis

103 107 109 110 110 119 132 132 133 134 134 135

Chapter 5 : Results 5.1 : Fatigue testing results 5.2 :Microleakage testing results Chapter 6 : Discussion 6.1 :Type of teeth 6.2 :Teeth sterilization 6.3 :Teeth preparations 6.4 :Optical impressions 6.5 :Cementation 6.6:Milling 6.7:Conditions of fatigue testing 6.8:Results of cyclic-loading and thermocycling 6.9:Results of Microleakage Chapter 8 : Conclusion Chapter 9 : References Arabic Summary

135 136 138 145

Author Title

Faculty Department Location Degree Date Language Supervisors

Amr Abd El-aziz Shebl Examination Of Marginal And Internal Adaptation Of Crowns Constructed With A Fibre Reinforced Composite System Versus Those Constructed With A Ceramic Copy Milling System Dentistry-Suez Canal University Crown & Bridge Ismailia-Egypt Master English Dr.Mohammed Osama A. Atta Dr.Ahmed Mahmoud Hamdy Abstract

This study was undertaken to examine(under the same conditions of study) the marginal and internal adaptation (fit) of Vectris / Targis fibre-reinforced composite/ceromer and Celay copy-milled crowns. Twenty epoxy resin working dies were divided into two groups.Ten crowns were constructed using Vectris /Targis system on the first group and ten crowns were constructed using Celay system on the second group.The crowns were cemented on the dies with glass ionomer cement. A travelling microscope was used to measure the vertical marginal gaps of the crowns. The crowns and dies assemblies were embedded in epoxy resin blocks and then sectioned mesiodistally along the long axis of the crowns.The travelling microscope was used again to measure the internal gaps of the crowns.It was found that the marginal adaptation of the Celay crowns was significantly better than that of the Vectris/Targis crowns(P<0.05).It was also found that the axial internal fit of the Vectris/Targis crowns was significantly better than that of the Celay crowns(P<0.05) but the occlusal internal fit of the Celay crowns was significantly better than that of theVectris / Targis crowns(P<0.05).

Key words
Vectris,Targis,Celay,Marginal Adaptation,Internal Fit

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) ( . ) ( 23 23 . 61 61 23 . 5 55 005 . 006 0000001 21 3 . . . . . . . .

List of Tables
Table page

(1) Survival of crowns according to the crown material. (2) Composite crowns survival according to the material used for crown cementation. (3) Ceramic crowns survival according to the material used for crown cementation. (4) Distribution of crowns with respect to survival after the cyclic-loading test. (5) Survival of crowns according to the used cement.

110 111 112 116 117

(6) Survival of crowns according to the testing conditions. 118 (7) Microleakage means and standard deviations (STDEV) according to the crowns material. 124 (8) Microleakage means and standard deviations (STDEV) according to the used cement. 125 (9) Microleakage means and standard deviations (STDEV) according to the testing conditions. 126 (10) Microleakage means and standard deviations (STDEV) of composite crowns groups. 128 (11) Microleakage means and standard deviations (STDEV) of ceramic crowns. 129 (12) Microleakage means and standard deviations (STDEV) of the eight groups of crowns. 131 i

Acknowledgment
I would like to express my deep appreciation and gratitude to Dr. Osama Atta for his supervision , sharing his experiences , his valuable guidance,his generous advice and his continuous support throughout the course of this work. I would also like to thank Dr. Mahmoud El Alaily who provided me the use of the facilities of his dental laboratory and also for his guidance and encouragement throughout my life. Last , but not least , my deep gratitude to my dear family who always encourages me , the understanding wife and the smile of my little daughter who gave me the spirit to complete this work.

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