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resulted from basic principles of implant material preparation and design, atraumatic surgical
technique, provision of an unloaded healing phase,
and proper prosthetic fit and loading.' The term
passive fit characterizes the connection between the
cast framework and abutment or implant, and was
described by Brsnemark to exist at the 0.010 mm
*A.ui.stant Prafisor, Directm of Madlofacial Prosthetics, Section of
Ratoratiue und Prosthetic Dentwty, Collqe d-Dentisty, The Ohio State
Uniueni@, Columbus.
~Pricalepractice,Dttruit, MI.
Address repnnt requests to Alan Brwks Can; D M D , IMS, Collegp oJ
Dentisty, Ohw State Universip? 30.5 MJ 12th AL'e, Columbus, OH
43210-1241.
Copyright Q 1993 tp t h e i l r n ~ c a nCollege ofPmthodontists
10.59-941Xl93/0201-0001$5.00/ 0
Introduction
Implant prosthesis fabrication technology, borrowed
from conventional prosthodontics, has not been shown
to predictably produce prosthesis fit at the 0.010 inm
Figure 1. Experimental rnodrl with fastened framework showing (A) horizontal sphere positions and (B) vertical sphere
positions.
1:
nm
6mrn -
II
6mm
IOyn
Figure 2. Schematic illustration of invested pattern dimensions and position. Right top view illustrates spacer design,
represented by shaded area, which provided a uniform investment coating to the pattern within the horizontal plane.
Table I outlines the pattern, investment, burnout, arid
casting protocol followed in this study. The wax patterns
were invested in fine-grain, carbon-free phosphate-bonded
investment (Cera-Fina; Whip Mix Corp, Louisville, KY)
Groups
Burnout
Oven
Method
Time
Casting
Material
Groups
Cooling Devesting
q.I3
The completely filled (CF) group used sufficient alloy
to fill the sprue system and the incompletely filled (ICF)
g o u p used only enough alloy to fill the framework pattern
mold space. The latter group attempted to address the
possibility that the spr-ue system may have a detrimental
effect on the resulting casting accuracy. All castings were
produced by one operator, using only new alloy. 'The CE'
group of castings required 32 dwt to fill the mold spacc and
the ICF group required 24 dwt. All castings were bench
cooled to room temperature. In another comparison, the
effect of altering special 1iquid:waterratios on accuracywas
investigated using spccial liquid concentrations of 0: 100
(two frameworks), 12238 (two Cameworks), 25:75 (four
frameworks-CF group), and 50:50 (three framcworks). In
a third comparison, three frameworks were cast to investigate a unique investment block design (Fig 2, right shaded
area), which attempted to distribute equal investment
material external and internal to the pattern and casting,
in the horizontal plane, by incorporating a spacer within
the arch form during investing. All invested patterns were
allowed to set more than 1 hour (generally overnight) and
stored in a humid environment, thcn placed in a cold oven
for burnout (Accutherm 11-1000; J.F. Jelenko, Armonk,
NY). The burnout protocol rollowed manufxturers recommendations and was identical for all casting groups (Table
1).
The alloy was melted in a ceramic crucible using a
conventional multiorifice gas/oxygen torch, and cast using
a standard broken-arm centrifugal casting machine (Kerr/
Sybron). ,411 castings were made with a high-palladium
alloy marketed for implant-supported prostheses (IS 85;
Williams Division/Ivoclar North America, Amherst, nu).
The castings were air-abraded with 50 p n alumina and
inspected for casting discrepancies using a 7-30 power
stereo microscopc. Casting cylindcrs were inspected for
casting imperfections to assure optimal reseating when
screw fastening to the abutment. Any discrepancy affecting
screw fastening or measurement depressions was considered a miscast and not used in the analysis. Measurements
were repeated as for the wax patterns.
The measurement scheme used 1.57 mm stainlcss steel
spheres placed in the depressions at the horizontal and
vertical positions as previously described and illustrated in
Fig I. Measurements were made using a machinist's
traveling microscope (Leitz Model UMW; Opto-Metric
Tools, New York, NY) with electronic digital micrometer
heads (Digirnatic Head 164 Series; Mitutoyo Mfg, Tokyo,
Japan) having a manufacturers reported accuracy of 20.003
mm and precision of ?0.001 mm. For this investigation thc
measured precision was 0.007 mm, as detcrmined by 10
measurements o f a single horizontal distance. This amount
of imprecision was caused by the variable roughness effect
of the cast framework depressions on the sphere position,
but was sufficiently precise for the measurements made.
An overhead light source was mountcd above the microscope in a fixed position to provide a reflective reference
crosshair in the spheres for spatial positioning and measurr-
Results
Three castings were considered miscasts and were
not measured. The bilateral vertical error was comb i n d as one vertical error. For statistical analysis,
the horizontal and vertical errors (measurement
differences between pattern and casting) were considered as the same type of error and combined,
therefore, not analyzing for individual effects. The
original measurements and measurement differences are presented in Tables 2 and 3. These include
wax pattern and as-cast measurement data for the
horizontal and vertical measurements for the six
cvm
MX4T>
Group
Hmizonlal
Vertical
Ho~iyintal
Vertical
*CF
26.047
26.036
26.04-6
26.226
26.022
26.115
26.082
25.730
15.592
15.448
15.746
1.5.546
15.480
15.789
15.444
16.318
26.149
26.219
26.21 1
2629.5
26.159
26.241
26.419
25.708
15.707
15.332
15.777
15.668
15.687
15.636
CE'
CF
CF
ICF
ICF
ICF
ICF
Special 1iquid:waterratic
0:100
26.231
5.532
12:88
50:50
26.212
26.167
26.092
26.135
26.024
26.102
26.052
15.580
16.487
15.450
15.831
15.577
15.921
15.829
1.5.769
15.668
26.089
26.075
26.173
26.199
26.204
26.187
26.220
26.198
16.003
15.641
26.252
26.128
16.241
15.738
5.582
5.436
5.819
5.466
15.815
15.747
Investment Spacer
26.275
26.199
~~~
Ozflereize
Hmzontal
Vertical
,102
,183
,165
.069
.I37
,127
,337
- ,022
-.I42
-.I36
.115
-.I16
.3 1
,122
,207
-.I53
,136
,169
- .08 1
249
,142
.lo3
.361
CF
ICF
0:00
1298
,007
50:50
Internal
Investment
Spacer
,108
,069
.I63
.I17
.I46
- .024
-.071
.046
,079
,238
Horizontal
Vertical
Pooled
,130 (.053)
,096 (.043)
.1 13 (.049)
,156 (.132)
,166 (.030)
.161 (.089)
,139 (.OM)
.165(.119)
.I52 (.070)
,058 (.071)
.123 (.028)
,090 (.058)
.1 16 (.047)
.205 (.225)
,152 (.127)
.080 (.062)
.138 (.087)
.lo9 (.074)
.098
Discussion
Current implant prosthodontic procedures make use
of conventional techniques and materials common to
conventional fixed and removable prosthodontics.
While it is important to compare the accuracy of
implant prosthodontic techniques with the accuracy
of conventional prosthodontic techniques, the clinical
significance of such comparisons requires testing in
vivo because of the contrasting support models of
teeth and implants. Specifically, because of the qualitative and quantitative difference between the sup-
Snurce
Sum $
Squares
Mean
Square
F Ratio
Probabilip
<F
Model
Error
C Total
Model
Error
C Total
Model
Error
C Total
1
14
15
1
12
13
3
17
20
0.0092
0.07 14
0.0807
0.0001
0.0042
0.0442
0.0 126
0.1058
0.1 184
0.0092
0.00.51
1.8059
0.2004
0.0001
0.0037
0.0117
-
0.9157
-
0.0042
0.0062
0.6710
0.5797
0 >s
0 14
0 12
Frw.
010
Imml
0 08
0.06
004
oOW
CF
ICF
Spacer o
0%
12%
509,
Figure 3. Bar graph showing error (average and s t m dard deviation) by group. The overall mean error is
represented by the 0.130 mm horizontal line. The ICF
group represented the 25% special liquid ,group.
porting tissues of teeth and implants, we might not
expect the implant response to misfit to be the same
as the tooth response to misfit?
Potentially as important as the difference in
support between teeth and implants is the manner
with which the fixed partial dentures are connected
to their support. Screw fastening is a sequential,
active clamping process where each unit is independently connected that provides loads across each
screw joint (preloads),15and results in stress within
the components and at the implant-tissue interfaces
of the connected implants if any misfit relationship
exists. Skalak warns that connection of misfitting
prostheses produces stress that can easily escape
detection and occurs at a location where the resultant effects are not well understood. Implant prosthesis connection and the potential for implant-tissue
interface stress mandates not only detailed understanding of accuracy levels for prosthesis fabrication
but also the biological effects of connection to the
host tissue.16
In conventional prosthodontic marginal-discrepancy investigations, the marginal error that is measured results from a combination of horizontal and
vertical inaccuracy. For the comparisons made in this
study, the single fastening point at the anterior
abutment positioned each specimen on the cast for
measurement. Therefore, the error attributable to
casting is cxpresscd as pooled horizontal and vertical
data (Table 3 ) . The two were considered as similar
types of error and represent error in two planes that
would be expressed as marginal error in conventional
marginal sleeve fit accuracy studies. Therefore, for
comparison purposes, pooling the errors allows better correlation with precedent casting accuracy liter-
ature.3,6 From the perspective of the cellular response to stress, all such stress is seen as strain by the
cell. It is impossible to isolate the various strains
and correlate them with an observed tissue response
in vivo. Therefore, the cumulative error was used,
realizing that it may be an oversimplification.
The results of this casting investigation show that
for all variations of the casting procedure evaluated,
the data are inaccurate and imprecise as judged
against the 0.010 mm requirement. The first part of
the study examined the effect of the sprue system on
~
~
distortion of the framework
during solidification.3
Patterns of the size required to cast full-arch restorations require large reservoirs to ensure an adequate
sourcc of molten alloy for the solidifying framework.
Placement of the reservoirs in the vertical heat
center of the investment mold allows for the reservoir to solidify last and also ensures optimum density
in the casting. Under these conditions, the solidifying
framework develops rigidity before the reservoir. If
the reservoir were to solidify first, sufficient stress
might be placed on the solidifying framework, causing distortion.
Under the conditions of this study, incomplete
filling of the reservoir increased the porosity in the
rrameworks and did not improve casting accuracy. It
is believed that position of the sprue systcm within
the investment block is most critical for accuracy
related to mold filling. Different data would be
expected if the sprue system were placed outside the
heat center, thereby reversing the solidifying sequence from the current model and promoting
porosity. Porosity would also be promoted by not
providing a molten reservoir source during framework solidifying.
Expansion of phosphate-bonded investments can
be controlled through alteration of the special liquidwater ratio.*In this study, special liquid proportions
were varied to provide four groups: O%, 12%, 25%,
and 50%. The complete fill group represented the
25% special liquid group. A ringless investment mold
technique was used to allow optimum expansion.
The two best special liquid groups, along with the
spacer group, showed data below the entire experimental mean (0.130 mm), yet still with an average
error 10 times the required level of accuracy. The 0%
group showed contraction in three of the four measurements (Table 3).
The 12% group showed expansion of all dimensions measured, with a mean expansion of 0.0130 mm.
The internal investment spacer group (25% special
liquid) was designed to offset the external expansion
Acknowledgment
T h e authors acknowledge t h e gracious support of t h e
Williams Division of Tvoclar N o r t h Amcrica. Without such
material support (40 oz do!), this project would not have
brrn possible.
References
1. B r h e m a r k P-I, Zarb GA, Albrektsson T (eds): TissueIntegrated Prostheses: Osseointegration in Clinical Dentistry.
Chicago, IL, Quintessence, 1985, pp 117-128
2. BrSrierriark P-I: Biological principles relative to Osseointegrated implants. Continuing Education Course, Octobcr,
1985, Rochester, MN
3. Skalak R: Biomechanical considerations in osseointegrated
prostheses. J Prosthet Dent 1983;49:813-818
4. Rangert B, Jemt T,Jorneus L Forces and moments on
branemark implants. Int J Oral Maxillofac Imp1 1990;4:2412.17
C a n and SteLcialt
13. White G: Academy of Osseointegration Annual Session Lecture. Dallas,TX, February 1990
14. Carr AB: A Comparison of impression techniques for a
five-implant mandibular model. Int J Oral Maxillofac Impl
1991;6:448-455