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Journal of Oral Rehabilitation 2001 28; 401406

Marginal adaptation of cast partial crowns made


of pure titanium and a gold alloy under inuence
of a manual burnishing technique
R. STOLL, P. MAKRIS & V. STACHNISS

Department of Operative Dentistry, Dental School of the Philipps-University

of Marburg, Germany

The aim of this study was to determine


the marginal adaptation of partial crowns from pure
titanium and a gold alloy after two different
cementation techniques. Forty freshly extracted
human molars were prepared and randomly divided
in four groups. Two groups were restored with
partial crowns using the gold alloy Degulor M*. In
one group, the crowns were xed on the tooth by
using a zinc phosphate cement. In the other group
the margins were additionally burnished by using a
hand burnisher No. 660. In the other two groups,
partial crowns from pure titanium were cemented
in the same way. The marginal quality was determined by quantitative margin analysis in the SEM

SUMMARY

Introduction
Cast inlay and partial crown restorations remain the
standard for durable restorations of the posterior teeth.
The quality of such restorations is determined by the
following factors: `placement of the crown margin',
'cervical contour', and `marginal adaptation and properties of the restoration material' (Geurtsen, 1990). In
addition to the reliable precious metal alloys reduced
precious metal alloys and nonprecious metal alloys are
also used. As a result of the favourable properties of the
material and good biocompatibility pure titanium has
also found increased usage as a material for inlays and
partial crowns (Geurtsen, 1990; Geurtsen & Marx,
1990; Kappert, 1994; Meyer & Luthy, 1995; Wang &
Fenton, 1996; Wirz & Bischoff, 1996). However, spe*Degussa-Dental, 63403 Hanau, Germany.

Sadent, 1169 Gland, Switzerland.


2001 Blackwell Science Ltd

using a replica technique. Partial crowns from a gold


alloy showed signicantly (P < 005) more margin
quality A (vertical marginal discrepancy <50 lm)
while partial crowns from pure titanium had signicantly (P < 005) more margin quality B (vertical
marginal discrepancy 50100 lm) and over-extended margins (quality D). No signicant (P < 005)
difference was found between the conventional
cementation technique and the technique with
manual burnishing in both material groups.
KEYWORDS : inlays, partial crowns, gold, titanium,
marginal adaptation, active cementation, burnish2 ing, quantitative marginal analysis

cic problems which may occur during the fabrication


process make the accurate manufacture of cast restorations from pure titanium compared with the processing
of gold alloys more difcult (Geurtsen & Marx, 1990;
Kappert, 1994). Suitable casting methods (Stoll et al.,
1991; Meyer & Luthy, 1995) and investment mediums
(Hero et al., 1993; Meyer & Luthy, 1995) are necessary
for a material-appropriate processing.
Indirectly produced cast restorations show a marginal
discrepancy caused by production (Geurtsen, 1990). As
a result of the solubility of the cement in the milieu of
the oral cavity a marginal cementation space will
develop a marginal gap in the foreseeable future
(Geurtsen, 1990). A width of the marginal cementation
space of less than 50 lm is considered as clinically
acceptable (Dreyer-Jorgensen, 1958). Eichner and Voss
(1971) rate a clinical cementation space width of
2050 lm as satisfactory, whereas Rehberg (1971)
maintains a value of 20 lm as necessary in order to

401

402

R . S T O L L et al.
give the rating `exact marginal t'. In clinical reality,
however, a cementation space under 100 lm should
be considered to be acceptable (Geurtsen, 1990), a
limit which is nonetheless often exceeded in daily
clinical routine (Spiekermann, 1986; Eichner, 1989;
Kerschbaum & Porschen, 1998).
An improvement in marginal adaptation by cold
deformation forming before, during, or after the
cementing is termed nishing or burnishing (Tucker,
3 1984; Haas et al., 1989). Ideal in this case is the
processing during the setting phase of the employed
cement. Ideal for this type of nishing are restorations
with beveled margins (Rosner, 1963; Hoard & Watson,
1976), while other margin types are viewed as less
suitable (Hoard & Watson, 1976). Recommended
instruments for burnishing are coarse and ne grinding
instruments, steel or carbide nishing burs (Strub et al.,
1980), nishing diamonds exible discs, rubber polishers (Haas et al., 1989), and hand instruments (Ingraham
et al., 1968; Metzler & Chandler, 1976; Shillingburg,
Hobo & Whitsett, 1977; Sturdevant et al., 1985; Haas
et al., 1989). The hand instruments used are egg and
beaver-tail instruments, egg-form instruments as well
as dull Spratley-knives.
The aim of this study was to assess the marginal
adaptation of partial crowns of pure titanium and a gold
alloy in dependence on the cementation techniques.
Conventional cementation as well as active cementation with burnishing of the beveled margins during the
setting phase of the zinc phosphate cement were used
as cementation methods.

Materials and methods


Forty freshly extracted human molars were used in
carrying out the experiments. After thoroughly removing all the remaining tissue, the teeth were kept in a 05%
thymol solution at room temperature for no longer than
4 weeks. The teeth were prepared with partial crown
preparations based on Shillingburg et al. (1977) and
were randomly divided into four groups. Two groups
were restored with partial crowns from the precious
metal alloy Degulor M. The partial crowns in both
groups were cemented using zinc phosphate cement
Fixodont. In one group the restoration margins were
additionally manually burnished with a hand instrument No. 660 during the setting phase of the cement.

Table 1. Group design


Group

Material

Cementation method

1
2
3
4

Gold alloy
Gold alloy
Pure Titanium
Pure Titanium

Conventional
Active
Conventional
Active

10
10
10
10

Table 2. Denition of the criteria for the quantitative marginal


analysis
Group

Denition

A
B
C
D
E

Cervical discrepancy <50 lm


Cervical discrepancy 50100 lm
Cervical discrepancy >100 lm
Crown margin overextended
Not rateable

Two other groups were restored with cast partial crowns


of Rematitan T1. These groups were also cemented
with Fixodont and in one group the restoration
margins were additionally manually burnished with a
hand instrument No. 660. A listing of the groups can be
found in Table 1. The marginal adaptation was evaluated
by quantitative marginal analysis (Roulet et al., 1989).
Using a replica technique the teeth were viewed under a
scanning electron microscope at a magnication of
100 and, as far as possible, aiming at a horizontal
view of the crown margin. The crown margin was now
divided in its complete circumference into ve classes
(Table 2) using a continuous series of pictures. In each
class the vertical portion of the cervical discrepancy
(Holmes et al., 1989) was evaluated, i.e. the vertical
distance from the outer crown margin to the preparation
edge. Approximately 40 such individual shots per tooth
were evaluated. The proportional distribution of the
individual classes to the entire crown margin was
determined using the program Quantigap**.
The results were statistically evaluated using the
software package SPSS 613. Mean and standard deviation in each group were determined for each of the
criteria. After controlling normal distribution using the
KolmogoroffSmirnow test a MannWhitney test for a
group comparison was used. P 005 was set as a level
of signicance.

Dentaurum, 75228 Ispringen, Germany.


De Trey, 78467 Konstanz, Germany.
**Kuppers, 91052 Erlangen, Germany.

De Trey, 78467 Konstanz, Germany.

2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 401406

MARGINAL ADAPTATION OF CAST PARTIAL CROWNS


Table 3. Results as average percentage portions of the individual marginal criteria in the individual test groups with s.d.
Group

A (<50 lm)

1
2
3
4

72.0% (3.7)
72.7% (5.7)
20.6% (12.2)
20.6% (9.6)

(Gold, conv.)
(Gold, active)
(Titanium, conv.)
(Titanium, active)

B (50100 lm)
17.1%
19.4%
43.3%
52.3%

(5.0)
(5.9)
(9.0)
(6.4)

C (>100 lm)
1.0%
0.9%
0.6%
1.0%

(1.1)
(0.7)
(1.1)
(1.8)

D (overextended)
0.0%
0.0%
25.9%
20.7%

(0.0)
(0.0)
(16.4)
(11.6)

E (not rateable)
9.8%
7.0%
9.6%
5.5%

(4.1)
(3.4)
(7.4)
(3.4)

Fig. 1. Average percentage portions of the marginal criteria A (vertical marginal discrepancy <50 lm) and B (50100 lm) from all groups
(mean and s.d.).

Results

Discussion

The measurement results of the margin analysis are


shown in Table 3 and Fig. 1. Neither in the groups
containing the precious metal partial crowns nor in the
groups with the titanium partial crowns were signicant (P < 005) differences between the conventionally
cemented and the actively cemented partial crowns
found. Clear differences were, however, found between
the material groups. Partial crowns from precious metal
showed a signicantly (P < 005) higher portion of
marginal quality A, whereas the partial crowns from
titanium showed a signicantly (P < 005) higher portion of the marginal qualities B and D. The appearance
of marginal quality C was rare and not signicantly
different in both groups, whereas unevaluable marginal
areas were found in all groups at a rate of 10%.

Schlegel et al. (1991) attribute the problems in their


method of measurement of the marginal gap using a
scanning electron microscope to the fact that the
electron beam doesn't always allow itself to be directed
at a right angle to the object and that overlappings can
be misinterpreted as a continuous margin. Groten et al.
(1998), however, rate the scanning electron microscopic circular margin analysis as reliable, provided the
external vertical marginal height is used as the parameter. In this case an accuracy of measurement of
10 lm is given. The parameter `external vertical
marginal height' is rated as objective and reliable
(Groten et al., 1998). The authors used a shoulder
preparation for their study. As the conditions of a pure
shoulder preparation cannot be transferred to a beveled

2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 401406

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404

R . S T O L L et al.
preparation, the vertical portion of the cervical discrepancy was chosen as the parameter for the present study.
The margin was divided into ve classes by means of
quantitative margin analysis (Roulet et al., 1989) rather
than by direct measurement. The borderline cementation space qualities of 50 and 100 lm called for in the
literature were used as the class limits.
The existence of a marginal discrepancy in cast
restorations must be seen as a reality (Strub et al.,
1980). In a study with a random sample of 50 crowns of
varying alloys and from ve different commercial dental
laboratories Kerschbaum and Porschen (1998) found a
mean marginal gap of 100 lm (35 lm) with a maximum of 248 lm. The crowns were examined on the
gypsum model using a replica technique. One half of the
crowns were miscontoured, mostly overcontoured.
With a marginal portion of 72% of class A and 17%
of class B the accuracy of t for precious metal crowns
achieved in this study clearly lies in the clinically
recommended region of t. In the case of the titanium
crowns the weight shifts to marginal quality B (43%),
whereas only just 21% margin of the quality A was
observed. In addition the high percentage (20%) of
margins which are too long (quality D) is striking. This
observation points to difculties in the nishing procedure of titanium casts. Whereas 89% of the margin of
the precious metal crowns was clinically acceptable, the
percentage of marginal acceptability of the titanium
partial crowns was only 64% with 20% of the margin
extending beyond the preparation edge. In the light of
these results the partial crowns of titanium can by all
means be rated as clinically acceptable, particularly
because in the case of both materials hardly any cervical
discrepancies over 100 lm were observed. It must be
remembered, however, that the partial crowns in the
present study were produced in vitro under optimum
conditions.
Meyer and Schafers (1990) measured in a light
microscopic in vitro study of ve inlays and ve partial
crowns the cervical discrepancy and width of the
cementation spaces. 38% of the measured values for
the cervical discrepancy lay under 20 lm, 22% of the
measured values lay under 100 lm. The width of the
cementation space lay mainly in a region between 20
and 60 lm, gaps larger than 100 lm were not found.
Klinger et al. (1991) report a high accuracy of t for
crowns of pure titanium (cervical discrepancy) with a
correct mixing ratio and correct temperature control of
the investment and come to the conclusion that the

production of tight and accurately tting casting objects


is possible.
Rincke et al. (1992) used a light microscope to
evaluate in vitro-made crowns from pure titanium on
a conical master die and found an average gap width of
42 lm. The preparation geometry had a signicant
inuence on the accuracy of t. 5080% of the
measured values lay below 50 lm.
Huls and Rincke (1995) found in an in vitro study of
12 crowns using optical microscopy at a magnication
of 180 cervical discrepancies of 26 lm on average
(range: 297 lm) for precious metal and 52 lm on
average (range: 1217 lm) for titanium crowns,
respectively. With the titanium crowns they suffered
22% casting failures. Rincke et al. (1998) found average
marginal gaps of 26 lm (median) in crowns from a
precious metal alloy; in those of pure titanium cast
according to the Rematitan system they reported a
median of 35 lm, when using the Biotan system
37 lm. Milled crowns of titanium reached a median
of 32 lm, however, they showed a high percentage of
defective marginal contours. They conclude that the
quality of gold alloy restorations cannot yet be reached
with titanium.
The necessity of a nishing of the restoration margins
during the setting phase of the cement has been
documented by Haas et al. (1989). No inuence of the
instruments used (no hand instruments) was observed
in this study.
The burnishability of a dental alloy is determined by
the factors hardness and ductility (Moon & Modjeski,
1976), thus alloys with lower levels of hardness and
higher ductility are better to burnish. A quotient of
hardness to percent of elongation is given as a measure
of the burnishability (Moon & Modjeski, 1976).
Eames and Little (1967) describe the development of
a wide gold lip up to 225 lm during the burnishing
procedure. The use of abrasive nishing instruments on
the crown margin is not recommended, as this causes
an unfavourable and unstable gold lip to be formed.
Rather they recommend, as do Metzler and Chandler
(1976), the use of nonabrasive rotating instruments. In
contrast Strub et al. (1980) found no positive effect for
smooth rotating instruments both with scanning electron microscopy as well as with light optical microscopy.
The abrasive Arkansas stone achieved the best results in
this study.
Neither for the precious metal partial crowns nor for
the partial crowns of titanium could burnishing achieve
2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 401406

MARGINAL ADAPTATION OF CAST PARTIAL CROWNS


a signicant improvement of the marginal quality in the
present study. As a result of their similar hardness and
yield stress both materials are certainly suitable for an
active cementation, still it was apparently not possible
using the hand instrument to develop the force needed
to reach a recognizable burnishing effect with the
employed materials. Metzler and Chandler (1976) arrive
at similar results and see a possible effect of the hand
instrument only with thin margins. In addition the fact
that the employed precious metal alloys have changed
plays a role. Whereas 20 years ago soft gold alloys with a
hardness of around 100 HV were used above all for
inlays, harder alloys of around 170 HV are customarily
used today for restorations of the occlusal surface, which
is accompanied by a worse burnishability (Moon &
Modjeski, 1976). In a soft state Degulor M has a
hardness of 170 HV and in a hardened state a hardness of
235 HV. According to DIN 17850 pure titanium of the
quality T1 has in its original state a hardness of 197 HV,
when oxygen absorption occurs during the casting
procedure the hardness lies distinctly higher.

Conclusion
The results lead to the following conclusions:
(i) Partial crowns from titanium do not achieve the
accuracy of t of those from precious metal alloys;
(ii) Partial crowns from titanium can, under optimum
conditions, be produced so that a clinical use is justied.
(iii) An active marginal nishing with a hand burnishing instrument leads neither in the case of partial crowns from titanium nor those from the gold
alloy Degulor M to a signicant improvement of the
marginal quality.

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Correspondence: Dr Richard Stoll, Department of Operative Dentistry,
Dental School of the Philipps-University of Marburg, Georg Voigt Str.
3, 35033 Marburg, Germany. E-mail: stoll@mailer.uni-marburg.de

2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 401406

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