Shane N.

White, B Dent St, MS, MA

Assistant Professor
Department of Restorative Dentistry
School o Dentistry
Victnr Kipnis, PhD
Assistant Professor
Section of Biometry
Department of Preventive Medicine
School of Medicine

The Three-Dimensional
Effects of Adiustment
and Cementation
on Crown Seating

University of Southern California

This study investigated the three-dimensional nature of crown

fit and the effects of adjustment and luting. Standardized
preparations were made on extracted premolars and
impressions and dies made. Complete-coverage castings were
fabricated using base metal alloy. The castings were placed on
their respective teeth and measurements made. The castings
were then adjusted using a siiicone disclosing medium and
remeasured. They were then assigned to one of five luting
agent groups and cemenled. A relative term describing tilting
was defined. Casting adjustment decreased tilting and
cementation increased tilting. Resin cements tilted castings
significantly more than did zinc phosphate, glass-ionomer, or
polycarboxylate cements. lnl Prosthodont 1993;6:248-254.

any studies have examined the fit of crowns as

White et al" studied the improvement in the

marginal seating of cast restorations when a siiicone disclosing medium was used. They noted lhat
casting adjustments made after the use of siiicone
disclosing medium improved fit and the castings
tended to seat in more upright positions. They
stated that "Binding of the casting against the tooth
preparation prevents seating on the binding side
while closing the margins on the opposite side.
After adjustment, the binding side markedly im-

M determined by vertical marginal opening.'-"

Few studies have examined the three-dimensional
fit of crowns.'"" Several anecdotal references have
been made regarding the three-dimensional
changes in position that occur during crown placement and seating, but to the authors' knowledge
no study has yet attempted to quantify or qualify
these changes.
In a two-dimensional study on crown cementation using zinc phosphate cement. Lange' noted
that all the crowns were tilted on the preparations
during cementation (Fig 1). He suggested that this
oblique relationship of cemented crowns resulted
from the collection of large cement particles in
certain areas and the enhanced filtration of cement
particles in diametrically opposite areas. This phenomenon was also noted by |orgensen,^ who suggested that it could be related to cement film thickness and to preparation taper.

Reprint requests: Or Shane N. White, Assistant Professor, Department of Restorative Dentistry, use School of Dentistry, 925 West
Thirty-fourth Street #4367, tos Angeles, California 90089-0I41.
Fig 1 Diagram ot cemented crown.

lournal of Prosthodonlics

248

Volume 6,

Three-Dimensional Effeels of Adjuslmert and Cementation

proves, and the opposite side has a sligbtly greater

opening."
It was bypotbesized tbat tbe initial fit of a crown,
the adjustment, and the cement all may influence
tbree-dimensional seating of ItJted restorations.
The purpose ot this study was to determine tbe
effect of adjustment on crown tilting wben using a
silicone disclosing medium and tbe influence of
five luting agents on tbe tilting of cast restorations
during placement.

(|M Ney) using a temperature riseof30E per minute

from room temperature tofeOO^Ewbere it was beid
for 1 hour, then raised to 1,350E and heid for an
additionai bour. The mold was cast using base metai
aiioy (Rexiiiium III, Jeneric/Pentron, Wallingford,
CT] melted in an induction casting machine (ECM
iil, Howmedica, Chicago, IL).
After tbe castings were divested, the sprues were
removed using siiicon carbide disks (Highspeed
separating disks, )elenko, Armonk, NY) and finished externaliy using biue, green, and brown rubber wbeeis (Dedeco, Long island, NY]. Internal
positive defects were removed using a balf-round
bur under x 10 magnification. Tbe castings were
then initiaiiy adapted to their dies. The internal
surfaces were air abraded using 50-fi.m M0, and
areas of hypercontact were identified by seating
tbe casting on its die coated with a thin iayer of die
iubricant. Wet, dark, shiny contact areas were adjusted using a baif-round bur. Tbis procedure was
carried out twice.

Materials and Methods

Tbirty-five recently extracted intact human premolars were stored in 37C water. Standardized
complete crown preparations were performed using a custom paralleling device. Tbe teeth were
ancbored in a water-filled receptacle, and water
spray was used tbroughout tooth preparation. A
matched coarse diamond bur and 12 fluted carbide
finishing burs (RCBIIK24, Brasseler USA, Savannah,
GA] were used. A total occlusal convergence of
approximately 6 degrees, a preparation height of 4
mm (measured at the midiacial surface of the
tooth), and a chamfer finish line were used.
Thewet tootb preparations were burnisbed using
a damp cotton cioth prior to making the impression
and before each seating evaluation to remove any
plaque that might have formed during storage in
water. Impressions were made using a polyivinyl
siloxane) material (Reprosil, Dentsply, Milford, DE).
Light body impression material was injected around
the teeth, wbicb were tben placed in trays containing heavy body material. Dies were cast in improved
stone (Die Keen, Columbus Dentai, St Louis, MO)
and trimmed under x 10 magnification. The surfaces apical to tbe finishing line were coated with a
cyanoacrylate adbesive (910 Adbesive, National
Starcb and Chemicai, Engiewood, N|). The dies
were painted witb tbree coats of die spacer (Cement
spacer, Beiie de St Ciaire, Cbatsworth, CA) to witbin
1 mm of the finisbing iine, wbere no spacer was
added. Tbe dies were iigbtiy iubricated (Die-Lube.
IM Ney, Bioomfieid, CT|, copings were formed using a dip wax tecbnique (Dura Dip Wax, Belle de St
Claire], and the margins were waxed using biue
iniay wax (Kerr Manufacturing, Romuius, Ml) using
X 10 magnification. Reference marks were placed in
thewax pattern at tbe midfacial, iinguai, mesial, and
distai surfaces of each coping. Tbe copings were
sprued and invested in a phosphate bonded investment (Cera-Eina, Whipmix, Louisviiie, KY). A pilot
study using a stainiess steei die' determined an
optimai special iiquid to powder ratio of 14.5 cc
iiquid : 50 g powder. Wax was eiiminated in an oven

Each casting was piaced on the naturai prepared

tootb in a piston device and axiaiiy ioaded with a
force of 49N'-' provided by an eiastic band. This
force was checked after measuring to verify tbat no
stress reiaxation had occurred. Marginai opening
was measured at the four reference marks on eacb
casting and was determined as the verticai opening
in micrometers between the most apicai part of tbe
prepared tooth margin and the most apicai portion
of the casting margin (Eig 1]. Tbree independent
measurements were made at eacb point by different operators. Eine focus, a tungsten iight source,
mirrors, and f iiters were used to visualize tbe margins. Tbe measurements were made at x 500 magnification using a metaiiurgic microscope (BHM],
Olympus Opticai,Tokyo, lapan] andadigital traveiing micrometer with an accuracy of 4 p.m (Mitutoyo
MFG, Tokyo, Japan). InterOperator reliability was
caicuiated.
Einal fitting of tbe castings to their naturai teetb
was tben achieved using a siiicone disclosing medium (Fit-Ghecker, GC Corp, Tokyo, japan); areas
in wbicb the metal showed tbrougb the siiicone
were adjusted using a haif-round bur." This procedure was carried out twice, Tbe marginai openings
were then remeasured as described above.
The copings were tben randomiy assigned to one
of five luting agent groups: glass-ionomer (Gl]
(Ketac-Cem, ESPE, Seefeld/Oberbay, Germany];
polycarboxyiate (PG) (Durelon, ESPE); zinc phospbate (ZP) (Eiecks zinc pbospbate. Keystone,
Cberry iHiii, N|]; microfilied bisphenoi glycidyi
methacrylate resin witb an oxaiate dentin bonding
agent (GMA-I-NPG] (Thin Eiim Cement and Tenure,

249

atioral Journal of Prothodontics

-fhree-Oimensional Effects of Adiustment and Cementatii

White/KipniE

Den-Mat, Santa Maria, CA); and microfilled bisphenol giycidyl methacrylafe/phosphate ester resin
(GMA/PF) (Panavia Fx, Kuraray, Okayama, Japan),
Thecastingswerelufed to their teeth and placed in
a custom paralleling jig. The samples were supported in a vertically upright position and a flat
plunger applied a vertical force of 49N'^' against the
domed occiusai surfaces,-After 7 minutes fhe specimens were removed from the jig, and the excess
luting agent was removed. The marginal openings
were remeasured after the specimens were stored
at37Cim0O% humidity for 24 hours,
A relative term to describe tilting was defined in
the following way. Each of the four individual measurements on a single specimen were subtracted
from its mean, giving four individual deviations
from the mean. These deviations were squared,
added together, divided by fhe number of degrees
of freedom (3), and the square root derived. This
relative term describes the relationship of the individual measurements to their mean. If there is no
tilting the relative term will be zero, and as tilting
increases the differences between the four individual measurements will increase, as will the relative
term. This procedure is the same as that for determining standard deviation, which is used to measure how much individual terms differ from their
mean.
Analysis of variance (ANOVA) was applied to evaluate fhe differences in tilting resulting from the
initial fitting, adjusted, and cemented status of the
castings, ANOVA was based on a split-plot factorial
design with individual crowns as blocks because
measurements of tilting in the initial, adjusted, and
cemented conditions were from the same crowns
and the five groups with different cement types

were independent. Therefore, each specimen

served as its own control because it was subjected
to the three treatment states. This pairing technique also removed the effects of idiosyncrasies
associated with particular castings or teeth from the
analysis. The different luting agent groups represented five treatment levels of the first (betweenbiock) factor, and differences resulting from status
represented three treatment levels of the second
(within-block) factor. Overall significance arising
from each factor and the interactions was established at the 5% level. As significant interactions
between the factors preclude an assessment of the
individual factors, follow-up simple main effect
ANOVA tests were performed if interactions were
found. The same experiment-wise significance
level as used ior the main effect ANOVA was mainfained by adjusting fhe significance levels for these
follow-up tests according to Bonferroni's inequality, A significant difference resulting from any factor was followed by a multiple pair-wise comparison using the Tukey's Studentized range method
with the experiment-wise level the same as for the
corresponding simple main effect test.

Table 1 Interclass Correlation Coefficients of

Reliability for Marginal Openings With Different Ltiting
Agents and Casting Status (n = 140)

Initial
Adjusted
Cemented

ZP

Gl

PC

GMA-I-NPG:

GMA/PE

.994
.998
.997

.984
.983
,997

ID ID ID
ID ID ID
CD CO Ul

Luting agent
Casting status

.989
997
.999

,990
,995
,998

Table 2 The Means, Standard Errors, and Relative Coefficients of Variation (RCV)
of the Relative Tilting Terms of Different Crowns (n - 7)
-uting agent
ZP

Gl

PC

GMAflMPG

GMA/PE

Casting status

Mean

Standard error

RCV %

Initial
Adjusted
Cemented
Initial
Adjusted
Cemented
Initial
Adjusted
Cemented
Initial
Adjusted
Cemented
Initial
Adjusted
Cemented

50.40
44.32
57,27
36,43
t9.70
57.54
50,84
4t,84
67,38
50,40
45.S0
160,4t
35.79
21.77
203.21

8,86
8,54
14.60
8.87
6.22
14 41
15.78
12.44
30,50
12,48
9.73
30,06
8.78
5,76
68.07

17.58
19,26
25,49
24.35
31.58
25,04
31,03
29.74
45.27
24.76
21.26
1B,74
24.54
26,47
33.50

The Irternatiora lournal of Proslhodontics

250

Volume G, Nurr' "'""'^

While/Kipni

r h rcc-Dimensional Effects of Adjuslment and Cementation

Results

Table 3 Main Effect ANOVA (a = .05) (n = 35)

Source of variation

The interexaminer reliability analysis revealed

very high reliability among three observers for all
considered groups and casting status (Table 1). The
corresponding ntraclass correlation coefficients
varied from .997 (Gl as cemented) to .999
(CMA+NTC as cemented), allowing the ANOVA
tests that followed to be based on the averages of
the three respective measurements on marginal
openings.
The mean relative tilting terms, standard errors,
and relative coefficients of variation of the relative
tilting term for each group (initial, adjusted, and
cemented) are displayed in Table 2 and Fig 2. All
groups demonstrated the same trend in mean relative tilt. Tilting decreased after adjustment and then
increased beyond the initial level after luting.
The main effect ANOVA demonstrated a highly
significant interaction (P = .0018) between the
change in relative tilting resulting from casting status and cement group (Table 3), Therefore, followup simple main effect ANOVA tests were performed and the results are provided in Table 4.
Crown tilting was not significantly different among
cement groups in the initial fitting and adjusted
states (P > .5). This indicates that bias resulting
from orientation or other facfors had not been
introduced, confirming that the treatment groups
had all been treated equally fotbis point. However,

Luting agent
Casting status
Interaction between iuting agent
and casting status

P
.0812
< .0001
-0018

Table 4 Simple Main Effect ANOVA

(adjusted a = .0188)
Testing for:

Source of variation

ZP
Gl
PC
GMA+NPG
GMA'PE

Casting status'

> .5
.25 < P < ,50
> 5
.0007
< .0001

Initial
Adjusted
Cemented

Cement group"

>.5
> .5
< .0001

N = 7.
" N = 35.

there was ahighly significant difference (P< .0001)

in crown tilting among different luting agents after
cementation. Significant differences in crown
tilting in the initial fitting, adjusted, and cemented
states were found in only two individual cement
groups: CMA + NPG (P = .0007) and GMA/PE
iP< .0001),

Fig 2 The means and standard

errors of tbe relative tilting measures of ditferent crowns.

2nc
Ptiospbate

Glass
lonomer

PolycarboKylate GMA- NGT

resin
Luting Agents

. Mumber3,t993

251

The International loiirnal o( Prosthodontics

GMA/PE
resin

Three-Dimensional Effects of Adiustment and Cemenlatii

Table 5 The Tukey's Multiple Comparison of Relative

Tilting Tertns Between Different Casting Status
(adjusted a = ,0188) (n = 7)

The Tukey's multiple comparisons test for different status of castings (Tabie 5) showed that the
difference between GMA-fNPG and MA/Pli resulted trom the significantly less upright positions
of the castings after cementation, while tilting after
adjustment was not significantly iess than for the
initiai condition. The same test applied lo different
cement groups (Table 6) demonstrated that the
choice of cement influenced the tilting of cemented castings. Tilting was the least for ZP, followed by Gl and PC, although these three groups
were not significantly different from each otber.
The GMA+ NPG and GMA/PE groups tilted crowns
signiticantiy more than ZP, Gl, or PC, but were not
significantly different from each other.

Casting status
Initial
Adjusted
Cemented

45.80
50,40
160,41

GMA,'PE

Initial
Adjusted
Cemented

21,77
35.79
203,21

Casting states connected by vertical lines are rot significantiv different.

Table 6 The Tukey s Multiple Comparison of Relative

Tilting Measures Among Different Luting Agents as
Cemented (adjusted a = 0,188) (n = 7)

Discussion

Luting agent

The extremely high interoperator reliability coefficients show that interoperator differences, and
hence intraoperator differences, had no effect on
this study. The high interoperator reliability coefficients suggest that the digital travelling micrometer
may be more accurate than its manufacturer states
and that the individual examiners were in good
agreement with one another.
The condition of the casting, ie, initial vs adjusted
vs cemented fit, significantly affected tilting (Tables
4 and 51- The same trends were found in all luting
agents (Table 2, Fig 2), Adjustment using a silicone
disclosing medium significantly decreased overall
tilting and cementation increased overall tilting
(n = 35); however, the sample sizes were too small
to demonstrate statistically significant changes for
all the luting agents separately (n ^ 7) (Table 4|,
Significant changes were demonstrated for the
resin groups GMA-i-NPG and GMA/PE which
caused more tilting of the castings (n = 7) (Table 5).
Retrospective calculations suggested that significant changes might have been demonstrated for
luting agent groups ZP, Gl, and PC if a sample size
of 20 had been used for each.
The value of the relative tilting term of an individual specimen is dependent on the orientation of
the four measurements to the maximum and minimum opening. However, the entire population of
specimens was treated equally and assigned randomly to treatment groups, ANOVA compares Ihe
means of groups, not their individual members, so
differences in orientation are averaged out within
each group and do not affect the analysis. The
absence of bias among groups was confirmed by
simple main effect ANOVA (Table 4], Not only did
the directions o the original tiltings occur at random, but changes in direction resulting from the

The Interiiational lojrnsi of Prosthodontics

Mean skewed ness

Luting agent
GMA-i-NPG

ZP
Gl
PC
GMA-FNPG

GMA,'PE

Mean relative tilting

57,27
57,54
67,38
160,41
203,21

Luling agents cornecled by vertical lines are not significantly different.

two levels of treatment also occurred randomly.

The value of the relative tilting term of an individual specimen is dependent on the number of measurements made. Three measurements are the
minimum necessary to describe a plane. For ease of
standardization, placement of reference marks,
and measurement, all specimens in this study were
treated equally and were measured at four reference points.
Units have not been assigned to the tilting terms,
because they are relative, not absolute, measures
of tilting. If a unit were to be associated with the
relative term it would be (j.m,as this was the original
unit of measurement.
Alignment in engineering is usually determined
by linear measurements that can be trigonometrically converted to angles. Direct angular measurements are difficult to make unless large distances
are involved. If angular measurements are to be
made to describe a similar relative angular tilting
term, three measurements would be necessary. If
an absolute measurement of displacement were to
be determined, six measurements, with five degrees of freedom, would be necessary.
The mean marginal opening and the standard
deviation of the entire population of castings prior
to cementation were 34 ixm and 17 ^j.m, respectively. This group of castings was within the range of
clinical acceptability.

252

Whit/Kipnis

iional [Itecls ol Ad|Lslment and Ce

The initial castings were tilted. This misorientation could be partly accounted for by differences in
marginal configuration of castings caused by laboratory procedure variables. As the castings were
unable to rotate independently of the teeth on
which they were placed, these differences in marginal configuration remained constant throughout
the study and did not affect the "paired" split plot
analysis. The interexaminer variability was so small
as to be insignificant (Table 1).
The exact clinical significance of tilting is not
known. However, it is reasonable to assume that
tilting is undesirable, and that clinicians should
attempt to minimize it through choice ot technique
or luting agent. Greatly tilted cemented castings
will have some margin areas much more open than
others. These widely open areas are more prone to
cement failure and subsequent disease. Internal
thicknesses of cement also vary, exposing some
areas to greater stresses.
The tilting of the castings luted with resin cements was so great that occlusal contacts could be
significantly deranged horizontally. Resin cements
also have greaterfilm thicknesses and much poorer
marginal seating than other cements, causing significant vertical changes.'-'^ Therefore, castings
luted using resin cements will require careful occlusal examination and adjustment following cementation.
Different methods of applying seating force
might produce different amounts of tilting. Most
current knowledge of casting seating and cementation is derived from quasi-static axial loading situations,'" " so the quasi-static axial method was used
in this study. When the simplest situations have
been fully understood more complex variations
should be investigated. The dynamic loading
method might increase seating and decrease
tilting." This method should be further investigated
with reference to tilting and a wide variety of luting
agents.
Siiicone disclosing media improve the marginal
adaptation of castings."" They also have the additional advantage of decreasing the tilt of full coverage castings.
The results of this study are in agreement with
the observations of Lange' and orgensen-, who
noted that cementation with zinc phosphate
caused castings to become tilted, and with those of
White et al", who noted that adjustment using a
siiicone disclosing medium resulted in a partial
uprighting of tilted castings.
Prior studies on film thickness and on marginal
seating showed that resin cements, CMA/PE and
GMA-i-NPC, had significantly greater film thick-

f 6, Number 3,1993

nesses and poorer marginal seating than luting

agents."" Tilting is undoubtedly related to film
thickness and marginal seating.
This study used natural teeth and simulated routine clinical and laboratory procedures. Despite the
effects of all the possible variables, clear trends
were found.

Conclusions
Complete crown restorations were adjusted using a siiicone disclosing material and subsequently
luted to natural teeth using one of five different
luting materials. Within the design of this study and
the limitation of the number of castings evaluated,
the following conclusions may be made:
1. A relative term capable of describing threedimensional tilting of castings was defined.
2. The three-dimensional tilt of a routinely made
crown was affected by its initial fit, internal adjustment, and luting.
3. Adjustment with a siiicone disclosing medium
tended to upright crowns.
4. Luting tended to tilt crowns.
5. Resin cements tilted crowns significantly more
than glass-ionomer, zinc phosphate, or polycarboxylate luting agent5.

References
1. Lange F. Forsog over cementering af finerkroner (Experiments on cementing of crowns). Tandlaegebladet 1955;59:
181-186.
2. lorgensen KD. Factors affecting the film thickness of zinc
phosphate cements. Acta Odontol Scand 1960;18:479-490.
3. Fusayama T, Ide K, Hosada H, Relief of resistance of cement
of full cast crowns. | Prosthet Dent 1964; 14:95-105.
4. Iones MD, Dykema RVV, Klein Al. Television micromeasurement ot vents and non vented cast crown margin adaption.
Dent Clin North Am 197l;15:663-678.
5. Beiser UC, Mactntee Ml, Richter WA. Fit of three porcelain
fused to metal marginal designs in vivo: A scanning electron
microscope study. | Proslhet Dent 1985; 53:24-29.
S. Cooney |P, Richter WA, MacEntee Ml. Evaluation of ceramic
margins for metal-ceramic restorations. | Prosthet Dent
1985; 54:1-5.
7. Hung SH, Hung KS, Eick |D, Chappeli RP. Marginal fit of
poicelain fused to metal and two lypes ol ceramic crown. |
Prosthet Dent 199n;63:26-31.
8. Byrne C. Influence of finish-line form on crown cementation, Intl Prosthodont1992;5.137-144,
9. McLean |W, Von Fraunhofer |A. The estimation of cement
film thickness hy an in vivo technique. Br Dent ] 1971;
131:107-111.
10. Kelly |R, Davis SH, Campbeii SD. Non destructive three
dimensional internal fil mapping of fixed prostheses. | Prosthel Dent 1989;61:368-373,

253

The International Journal of Prosthodonlii

Thrcc-Dimensional Etteas of Adjuiinent and Cementation

Wliite/Kipris

14. Rosenstiel SF, Gegauff AC. Improving the cementation of

complete cast crowns: A comparison of sealing methods. J
Am Dent Assoc 198B;117:B4S-e48.
15. Davis SH, Kelly |R, Campbell SD. Use ol an elastomerii:
material lo improve the occlusal seat and marginal seal or
cast restorations. | Prosthel Dent 1989;62:288-291.

11. While SN, Sorensen |A, Kang SK. Improved marginal sealing
o cast restorations using a silicone disclosing medium. Int J
Prosthodonl 1991 ;4:333-326.
12. While SN, Yu Z. Fiim Ihiciiness of new adhesive luting
agenls. | Proslhet Deni 1992;67:782-785.
13. While SN.YuZ, KipnisV.Theelfect o adhesive lLlingagenl5
on (he marginal seating ol casi restorations. J Prasthet Deni
1993;69:28-l.

Ulerature Abstracts

Swaliowing Activity of Lip Muscles in Patients With a

Complete Upper and a Partial Lower Deniure
Previous prosthodontic literature has dealt with facial muscle activity in subjects provided with
complete dentures. The present investigation used electromyography to study patients provided with
immediale complete upper and parlial lower distal extension dentures. The swallowing activity of the
orbicularis oris and menlalis muscles in relation to the anterior temporal muscle was investigated 1)
before extraction of the residual maxillary anterior dentition, 12) after denture placement, and O)
during 2 years of denture use. Muscle activity was studied during the swallowing of saliva and water. In
general, dominant eleciromyographic activity was recorded in lower lip and mentaiis muscles in
comparison with upper lip and anterior temporal muscles at all stages of the investigation. The strength
of muscle activity showed no significant changes during the 2-vear ohservation period. This result is likely
related to preservation of the residual anterior denlilion in Ihe mandible of the present sample. This
finding differs from previous reports in which the rnuscle activity of complete denture wearers
significantly increased over time and was presumably related to the need for stabilisation of the
mandibular denture due to markedly decreased retention. tHowever, the duration of swallows in the
presenl sample showed a marked increase following the first year of denture use. This increase is likely
associated with the need to stabilize the maxillary complete denture due to continuing rsorption of
the maxillary ridge.
Taligren A. Tryde, C/O'a'Reiaoi/1992^9:329-341. Heference: 14. Reprints: nr Antje Tallgren, Deparrment ot Dental
ProBthetics, School ol Dentistry, University of Copenhagen, 20 Norre Alle, DK 2200, Copenhagen N.Denmarii.
David R Cagna, DMD, Depsrlmenr of Prosrhodontics, The Unnenity of Tenas Health Science Center si Ssn
Antonio, San Antonio, Texas

Bone Formation Over Partially Exposed implants Using

Guided Tissue Generation
The purpose of this pilot study was to test, using the dog tibia, whether covering the exposed cervical
portion of both titanium implants and hydrcixylapatite IMA)-coated implants with an expanded
polytetrafluoroelhylene le-PTFCl membrane would result in new bone formation on fhe exposed
surface. Twenty threaded titanium and ten HA-coated implants were placed in the tibias of five
mongrel dogs. The implants were placed in a manner that left the cervical 2 to i mm exposed. Fifteen
implants were used as controls and Ihe rest were covered with an e-PTFE membrane. Dogs were
sacrificed after 6, 8, and 12 weeks. Histologie ewmination of the implants showed a progressive
formation of new bone over the exposed surfaces of those implants covered by the e-PTFE membrane.
The HA-coated control implants, in contrast lo the titanium controls, also showed a progressive
growth of new bone. No significant difference in the quantity of new bone was observed beiween
membrane-covered and control HA-coated implants. The aulhors conclude lhat guided tissue generation
using an e-PTFE membrane induces new bone formalion over the exposed portion of an implant, that the
amounl of new hone formed is influenced by the width of the space between Ihe membrane and the implant
surface, and that new bone forms on an exposed HA-coaled implanl even in Ihe ahsence of a guiding
mem bran eArora BK, Worley CM, Guttu RL, Laskin DM, ; OrsI Mnxillofac Surg 1392;50(1111;106-10bS. References: 24. Reprints; Dr
Daniel M. Laskm, Deparlment of Oral and Masillolacial Surgery, Box 566 MCV Station, Medical College of Virginia,
Riebmona, ^A 23295. Hichid K. Seals, Ir, DDS, MEd, MS, Department of Prosthodontics, The University of Texas
Health Science Center at San Antonio, 5an Antonio, Texas

The Inlernational lournal of Prosthodontii

254