Alfred J. Stern, C.D.T., and Harold M.

Vernon
Hou.rton, Texas, and Pittsburgh, Pa.

F ixed dental restorations with functional accuracy can now be provided

relative ease. Yet errors arc present, and failures result.
with

A study was made to eliminate all possible “mechanical” failures. A new tool
was discovered during the search. This device helps eliminate errors.

STUDY OF FAILURES
We learn to reduce errors by studying failures.‘, 2 Most textbooks on pertinent
subjects conclude with a study of failures. These are further classified as “obvious”
and “obscure” failures. Our objective is to reduce both.
Wilson and Lang” recommend that (during bridge construction) each “phase”
be checked and verified before proceeding to the next: This recommendation should
be followed. Unfortunately, many dentists prefer to skip try-in phases. Here is
where the troubles start.
There are many impression materials, techniques, and instruments available,
and most have merit, These are selected according to individual preferences. Dif-
ferent combinations, therefore, result in different procedures.
Better dental materials and techniques arc available.4s 5 New operative pro-
ccdures have been created, and new instruments have been put in use. Yet, use of
all these cannot overcome the errors which may be found in the working cast.

METHODS AND MATERIALS

Working cast. The working cast is a mirror which reflects the exact image of
the operator’s and technician’s efforts.
The working cast may possess too many variables. Some of these result from
operative procedures, the physical properties of dental materials used, and methods
of cast construction. Dies are made removable in many ways. Some are made with
dowel pins and others with preformed trays (such as Di-Lok++ and Typadonf).
Choice of impression material may limit the choice of die material. Handling
characteristics arc dependent upon these variables.

“Surgident Ltd., Los Angeles, Calif.

tTypadon Corporation, Seattle, Wash

536
 New tool in dentistry 537

Fig. 1. Original prototype Pindowls (with integral prepositioning pins) ready for the pouring
procedure.

Fig. 2. Reusable rubber channel formers and Pindowls are shown. Channel formers are placed
over the die stem ends after the die stone has hardened.

Establishing performance characteristics. A logical approach to obtaining a better

working cast would be first to establish desirable performance characteristics and then
to try to achieve these goals. These characteristics should be universally suited to any
procedure (or dental material) that will satisfy the dentist’s unique abilities.
Good working casts should ( 1) reproduce any impression with optimum ac-
curacy, (2) be strong and durable, (3) b e easy to produce from any impression
material, (4) be easy (or convenient) to handle during the laboratory process, and
(5) possess over-all accuracy.
The majority of working casts for fixed restorations are made with the brass
dowel pin. Yet many impressions can be ruined by inaccurate positioning of these
pins. This problem is solved by @repositioning. Two common methods are used:
Gross pins are inserted in the impression, and dowel pins are luted with sticky wax;
or, prepositioning jigs (such as the Mann Paralleling Instrument*) are used. These
methods are time consuming and laborious.

* Jelenko Gold Company, New Rochelle, N. Y.

538 Stern and Vernon J. Pros. Dent.
May, 1969

Many people use preformed bases. They are easy to handle during the pouring
of the working cast but are difficult to handle during the laboratory phases.
A new device was needed to solve these problems. This led to development of
the Pindowl.” Pindowls were made with prepositioning pins as an integral part of
the dowel (Fig. 1) .
Pindowls and channel farmers. Pindowls proved succesful. Their use prevented
ruined impressions and increased ease and speed of cast construction. However,
early prototypes did not solve all the built-in errors present in handling casts.
Results of the dental technician’s work depend upon how much (or how little)
hc is given. Most dentists exercise extreme care. Many apply concepts developed
by McCollum and Stuart.” Such application results in occlusion of greater ac-
curacy. However, errors are found in hinge-axis location. Fox7 writes about these
errors. He mathematically illustrated that any error of 0.01 inch should not be
considered clinically acceptable.
This emphasizes the vast no-man’s-land which exists in occlusal reproduction.
Some occlusal errors are caused by careless laboratory practices, Casts, which are
lubricated so they may bc slipped off, are examples. The purpose of lubricating is
to gain access to the ends of the dowel pins in the bottom of the cast. Grains of
wax and stone can and do interfere with accurately reseating the cast to its cradle
of stone. Thus errors are created, and others are made more difficult to find. The
only answer is to permanently attach the working cast. This requires use of channel
farmers that form access tunnels to dowel ends from the labial or buccal walls
of the cast (Fig. 2).

RESULTS
Over 5,000 Pindowls and channel formers were tested. Two things became ap-
parent. First, prepositioning of dowel pins increased speed of handling and accuracy.
Ruined dies and impressions were a thing of the past. Less skill was involved in
prepositioning. Second, channel formers (and permanent mountings) resulted in
fewer occlusal adjustments. But, there were still errors.
The “remake factor” is one method of gauging the success or percentage of
error no matter what the causes. Remakes were carefully studied. Most of these
were due to the following: failure to match tooth color, lack of proper marginal
fit, and prematurities. The first two were the most frequent faults.
Color matching is a subject of great complexity, The only corrective measure
that the technician can take is to make certain the veneer of porcelain (or resin)
matches the shade sample provided. Errors caused by improper jaw transfers are
not within the scope of this report.
Restorations which do not fit can be the result of inaccurate dies or castings.
Inaccurate dies can be caused by poor impressions or dimensional changes from
delayed pouring. A dimensionally incorrect die cannot be detected visually. Other
factors affecting fit are failure to parallel abutments or poor preparations (where
a prepared tooth may have unacceptable undercuts).

*Stern Laboratories, Houston, Texas.

Volume 21
Number 5 New tool in dentistry 539

‘Fig. 3. The silhouette of a cone-shaped die stem is triangular.

A Swift Stereo “80” Microscope* was used to examine questionable dies and
castings. This effectively prevented delivery of poorly made castings. Its ‘20~ mag-
nification, which was used in examining dies before trimming, proved invaluable
and preuented many remakes. Terminations of preparations were accurately located.
Some defects hitherto unnoticed, such as failure of the impression material to com-
pletely reproduce vital areas near the margins, were revealed. (These were found
more frequently in both types of rubber impressions than with hydrocolloid.)
Loupes will not reveal all visible defects. Some areas which appeared to have de-
fects proved accurate under higher magnification.

CONCLUSIONS
Some occlusal error can be reduced by permanently mounting working casts to
the instrument. Ease of handling reduces error. Prepositioning dowel pins eliminates
ruined impressions. Use of a microscope eliminates some causes of error. Discovery
of the Pindowl gives the dentist a new tool of improved accuracy and convenience.
As each cause for error was eliminated, additional flaws became more obvious.
Noticeable movements of dies were observed. This movement increased as work
progressed. Such movements are tilting, mesial-distal shifting, slight rotation, or a
combination of these. These movements, coupled with error caused by improper
mountings, created previously unexplained failures.
Restorations which appear to fit a working cast accurately may not seat in the
mouth, but when separated, the units fit. Single units may have to be adjusted be-
fore they seat. After adjustment, they seat but have a missing contact. Some say
the cause is tooth drift, and others blame “scraped” or “abraded” areas. All agree
that there is needless loss of chair time.

*Swift Instruments Inc., San Jose, Calif.

540 Stern and Vernon J, Pros. Dent.
May, 1969

CAUSE OF ERRORS
Die-stem configuration. The shape of the stem of the dowel pin was examined.
Most prefabricated dowel pins are variations of a truncated cone. Even those
fashioned by hand are similar. Suppose this was the cause of the error? Incorrect
tool design c.an cause errors that are the fau.lt of neither the dentist nor the tech-
nician.
Geometric study. Most die stems are shaped like stretched-out cones. A cross
section of a cone through its vertical axis results in a triangle. When stone is poured
around a die stem, it forms a cone-shaped hole referred to as its “keyway” (Fig. 3).
This keyway cross section is also a triangle. The relation of one triangle to its
counterpart requires study (Fig. 4) .
Triangles 1 and 2 are assumed to be the same size (although we know that
triangle 2 must be slightly larger). Both are shown to have a common axis indicating
the path of exit (Fig. 5). Triangle 1 exits from triangle 2 one half the length of
tither triangle, indicated by distance D. We now have two equivalent triangles. The
bisector (common axis) divides each triangle into equal right triangles. The base
of triangle 2 cuts triangle I in half. Triangle ABC is formed by intersecting lines
created by the bisector, base line, and one side. Side b is equal to distance D.
Triangle A’B’C’ is formed by dropping a line from point B parallel to side b.
Triangles ABC and A’B’C’ are equal and equivalent since all sides are parallel, have
the same angles, and each side of one triangle is equal to its counterpart in the other
trianglr.

direction of exit
t: t
i

Triangle No. 1

Triangle No. 2

Fig. 4. Geometric development of a die stem (Triangle No. I) exiting from its keyway (Triangk
No. 2). The space between the die and keyway wall can be c.omputed.
Volume 21 New tool in dentistry 541
Number 5

Fig. 5. Triangle 1 exits from triangle 2 along a common axis (bisector). Triangle 1 emerges
at a distance (D) which is equal to one half its length. Side a’ (of triangle A’B’C’) represents
measurable space.
 J. Pros. Dent.
542 Stern und Vernon May, 1969

0b

mesial contact
too “hard”

debris

Fig. 6. Unnoticed particles can cause error: a, proper axis die should have; b, amount die has
shifted; and c, unknown rotary movement possible at this ang-le or tilt.

mesial labial

Upper Canine

Fig. 7. New dowel pin design is a geometric copy from nature

die stem

keyway

Fig. 8. The Pindowl or Dow1 will not tilt or twist in its keyway as the die exits.
Volume 21 New tool in dentistry 543
Number 5

The length of a’ can be determined if the die stem length and degree of taper
is measured. The length of a’ is important, because it represents “space” which
occurs the instant the die stem starts to exit. If the die stem is 15 mm. long and
the taper is 4O, then a’ can be calculated by determining the tangent of angle A’.
The formula is: Tan A’ = 6. Angle A’ is one half the degree of taper, or 2’. The

trigonometric tables reveal that the tan of 2O is 0.03492.

Tan 2O = .r7.5 or 0.03492 =

-‘Z thus a’ = 0.2619 mm.
7.5
The resultant figure (0.2619 mm.) represents the space on one side only. The total
space between the die stem and its keyway would be 0.5238 mm.
Significance of cone-shaped die stem. The amount of space, which occurs the
instant the die stem starts to exit, is significant. To some: this would appear to be
a convenience which allows for more ease in removal. However, there are other
factors to be considered. It has been determined that if the die stem were to exit
only 0.25 mm. and if the taper were 4’, the amount of possible movement would
be 0.0174 mm. If the taper were loo and if the exit distance were the same, then
the movement would be 0.0437 mm. Both the amount of opening and the abrasion
of the keyway become very significant factors in causes of error. The amount
of rotation at this instance is not determined.
The keyway is actually larger than the die stem. It should be obvious that all
such factors listed could account for prematurities which are not visible on the
working cast. Particles of stone and wax may fall into the keyway and could
cause error (Fig. 6).

NEW DIE-STEM DESIGN

The problems indicated a need for a new dowel-pin design (Fig. 7) . Two
walls of this die stem were made parallel. This prevents mesial-distal tilting. Surfaces
were made at right angles so that the resultant keyway is rectangular in cross section.
This prevents twisting movement of the die (Fig. 8).
These new Pindowls created a dramatic drop in denture remakes. The results
were so encouraging that Pindowls were distributed to dentists and schools for test-
ing. Over 40,000 have been used thus far. The new concept was first tested by
Reed.*

‘Fig. 9. Stainless steel Pindowls and Dowls.

 J. Pros. Dent.
May, 1969

Fig. 10. The working cast.

Additional improvements have been made. Pindowls and Dowls” were first
manufactured in brass. Brass proved to be too soft, and careless handling would
distort the ends or bend the stems. The new design was deceptively precise and re-
quired more precise application. Pindowls are now made of stainless steel (Fig. 9).
They are not only easy to use, but the result is much more precise working casts
(Fig. 10).

SUMMARY
Standards for accurate working casts have not been established; this is un-
fortunate. Cone-shaped dowel pins have die stems whose shape might cause un-
noticed errors in fixed cast restorations. The most desirable working cast is one with
precisinn-fitted removable dies. A new dowel pin has been designed which has a
new die stem and integral prepositioning means. Its use simplifies working-cast
construction and handling. Permanently mounted Pindowl casts will reduce errors,
adjustments, and costs.

*Stern Laboratories, Houston, Texas.

References
1. Reiser, J.: Periodontal Aspects of Fixed Bridge Failure, J. PROS. DENT. 5: 677-686, 1955.
2. Willey, R.: Why do Bridges Fail? J. Florida D. Sot. 31: 18-22, 10-17, 1960.
3. Wilson, W. H., and Lang, R. L.: Practical Crown and Bridge Prosthodontics, New York,
1962, McGraw-Hill Book Company, Inc., p. 198.
4. Hollenback, G. M.: Science and Technic of Cast Restorations, St. Louis, 1964, The C. V.
Mosby Company.
5. Skinner, E. W., and Phillips, R. W.: Science of Dental Materials, Ed. 6, Philadelphia, 1967,
W. B. Saunders Company.
6. McCollum, B. B., and Stuart, C. E.: A Research Report, Basic Text for the Postgraduate
Course in Gnathology, South Pasadena, Calif., 1955, Scientific Press.
7. Fox, S. S.: The Significance of Errors in Hinge Axis Location, J. A. D. A. 74: 1268-1272,
1967.
8. Reed, G. M.: New Conception in Precision Dowels, J. A. D. A. ‘74: 321-324, 1968.

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