The marginal accuracy of treatment restorations:

A comparative analysis
B. J. Crispin, D.D.S., M.S.,* J. F. Watson, D.D.S.,** and A. A. Caputo, Ph.D.***
University of California Los Angeles, School of Dentistry, Los Angeles, Calif.

Ah e subgingival placement of crown margins

significantly affects the health of adjacent soft
tissues.‘-” Any factor contributing to increased
plaque accumulation in the gingival surfaces should
be avoided. When subgingival margins must be used
for a fixed prosthesis, marginal integrity must be
excellent to maintain optimal periodontal health.’
During the interim between the preparation and
the placement of the final prosthesis, treatment or
temporary restorations must promote soft tissue
healing. Gingival overgrowth and inflammation are
minimized by well-contoured treatment restorations
with good marginal integrity.+”
The purpose of this study was to evaluate the Fig. 1. Silver-plated test die.
marginal accuracy of nine temporary restorative
materials using direct and indirect techniques
(Table I). -

MATERIALS AND METHODS

A silver-plated test model was made using two
Bureau of Standards complete crown dies with a
pontic space to simulate a three-unit fixed partial
denture (FPD) situation (Fig. 1). Minimal abutment
taper and shoulder finish lines provided an exacting
test of marginal accuracy.
An Omnivact coping was used in both techniques
to fabricate the test treatment restorations. The
coping was made on a stone reproduction of a
simulated FPD that was waxed directly on the test Fig. 2. Treatment restoration being made directly on the
die. The external axial surfaces of the FPD were test die.
waxed parallel and to the same thickness as the
shoulder width of the test die. The occlusal surface imately the same as the occlusal width of the
was waxed flat and to the same thickness as the axial retainers. Marginal surfaces were overwaxed to allow
walls. The occlusal width of the pontic was approx- sufficient space under the coping for the test materi-
als to completely contain the margins. The coping
*Assistant Professor, Section of Fixed Prosthodontics.
**Assistant Professor, Section of Operative Dentistry. could also be reproducibly seated on the test die to
***Professor and Chairman, Section of Biomaterials Sciences insure consistent thickness of the test treatment
tomnidental Corp., Harrisburg, Pa. restorations.

002%3913/80/090283 + 08$00.80/0@ 1980 Tbe C. V. Mosby Co. THE JOURNAL OF PROSTHETIC DENTISTRY 283
 CRISPIN, WATSON, AND CAPUTO

,Fig. 3. Treatment restoration being made indirectly on a

stone die.

Fig. 4. Treatment restoration (tr) made on an indirect die Fig. 5. Custom seating device used to seat the treatment
(D) and the detail of the contacting surface. restorations on the test die.

Direct specimens. From each of the test materials,
five treatment restorations were made using a direct
technique. The test die was coated with liquid
petrolatum and the test material loaded into the
Omnivac coping. Test materials were mixed with a
ratio of 3.5 ml of liquid to 5 gm of powder.” Scutan
was supplied in a paste and liquid form and mixed
according to the manufacturer’s directions. When
the materials reached the doughy stage they were
seater’ over the test die (Fig, 2). Because of its short
doughy stage, Scutan was seated on the test die
immediately after loading into the coping. As soon as
the materials began to emit noticeable heat they
were removed from the die, repositioned three times,
and placed in cool water until completely polymer-
ized. The treatment restorations were then washed
thoroughly, dried, and stored dry at room tempera-
ture until all specimens had been made.
Indirect specimens. Forty-five reversible hydro-
colloid impressions were made of the silver-plated
test die. The die was warmed in a water bath to
approximately 98” F (37” C) before the impression
was made. Dental stone was mixed in a vacuum
mixer and the models were poured using a vibrator.
Forty-five stone dies were made upon which the
indirect treatment restorations were constructed.
The stone dies were coated with Alcote* and
air-dried. The materials were mixed as in the direct
technique, loaded into the Omnivac coping, seated
on the stone die, and secured with a rubber band
(Fig. 3). They were then placed in a pressure pot at
30 psi for 10 minutes. Five treatment restorations
were made from each material (Fig. 4).
After all the treatment restorations had been
made, they were trimmed to the cavosurface finish
lines, The use of a X 20 binocular microscope opti-
*L. D. Caulk, Co., Milford, Del.

284 SEPTEMBER 1980 VOLUhiE 44 NUMBER 3

MARGINAL ACCURACY OF TREATMENT RESTORATIONS

Table I. Temporary restorative materials tested

Material Basic constituent U. S. distributor

Trim Vinyl ethyl methacrylate Harry J. Bosworth Co., Chicago, Ill.

Snap Vinyl ethyl methacrylate Parkell, Biomaterials Division, Farmingdale, N. Y.
Scutan Epimine Premier Dental Products Co., Norristown, Pa.
Splintline Ethyl methacrylate Lang Dental Mfg. Co., Inc., Chicago, Ill.
True Kit Methyl methacrylate Harry J. Bosworth Co., Chicago, Ill.
Duralay Methyl methacrylate Reliant Dental Mfg. Co., Alsip, Ill.
Jet Methyl methacrylate Lang Dental Mfg. Co., Inc., Chicago, Ill.
Neopar Methyl methacrylate Kerr Sybron Corp., Romulus, Mich.
Temporary Bridge Resin Methyl methacrylate L. D. Caulk Co., Milford, Del.

Table II. Marginal discrepancy: Direct technique Table III. Marginal discrepancy: Indirect
technique
Marginal
discrepancy SD Marginal
Material (inches) (inches) discrepancy SD
Material (inches) (inches)
Snap 0.0179 0.0190
Duralay 0.0188 0.0079 Splintline 0.0025 0.0014
Jet 0.0234 0.0057 Snap 0.0037 0.0007
Splintline 0.0273 0.0094 Trim o.OQ40 0.0016
Trim 0.0284 0.0215 Jet 0.0073 0.0010
True Kit 0.0388 0.0242 True Kit 0.0077 0.0029
Temporary Bridge Resin 0.0411 0.0168
Scutan 0.0439 0.0074 0.0110 0.0065
Duralay
Neopar 0.0113 0.0029
Neopar 0.0904 0.0386 Temporary Bridge Resin 0.0122 0.0063

Note: Significantly different groups are separated by a double

Scutan 0.0316 0.0063
line.
,Wet Significantly different groups are separated by a double
line.
mized the accuracy of the finish line. The tissue
surface of the pontic was trimmed to a sanitary-type
contour with enough space to allow for interproxi- Table IV. Marginal discrepancy in inches
ma1 recordings. Material Indirect Direct
Testing procedures. Prior to measuring, the die
and each trimmed treatment restoration were thor- Splintline 0.0025 0.0273
Snap 0.0037 0.0179
oughly cleaned with soap and water to remove any
Trim 0.0040 0.0284
remaining separating medium. Each treatment Jet 0.0073 0.0234
restoration was then dried and seated on the silver True Kit 0.0077 0.0388
test die with a force of 7.4 pounds applied in a Duralay 0.0110 0.0188
vertical direction using a custom-made seating Neopar 0.0113 0.0904
device (Fig. 5). The force was applied at two loca- Temporary Bridge Resin 0.0122 0.0411
Scutan 0.0316 0.0439
tions approximating the connector region using a
loading head (Fig. 6). The force was applied for 1
minute, after which the measurements were made discrepancy (Fig. 8). A Gaertner measuring micro-
immediately. The distance between the cavosurface scope* was used to measure the marginal discrepan-
margin of the treatment restoration and the margin cy. Measurements were recorded to the nearest
of the test die was measured at eight points and 0.0001 inch. A total of 1,440 recordings were made
recorded (Fig. 7). Each treatment restoration was from the 90 treatment restorations and statistically
seated and measured twice. This distance between
the margins shall be referred to as the marginal *Gaertner Scientific Co., Chicago, III.

THE JOURNAL OF PROSTHETIC DENTISTRY 285

 CRISPIN, WATSON, AND CAPUTO

Fig. 6. A, Close-up view of the seating device shaft. B, Fig. 8. Arrows denote the marginal discrepancy (MD)
Loading head. C, Test treatment restoration. D, Test between the treatment restoration (tr) and the test die
die. PI.
Duralay (Table II). The remaining materials were
between these extremes (Fig. 9).
Analysis of the indirect treatment restorations
yielded three significantly different groups
@ < .OOl) (Table III). Splintline, Snap, Trim, Jet,
and True Kit produced significantly smaller margi-
nal discrepancies than the rest. Splintline showed the
least average marginal discrepancy and was followed
closely by Snap and Trim. A second group
comprised of Duralay, Neopar, and Temporary
Bridge Resin had significantly greater marginal
discrepancies than the above group. Scutan
produced the largest marginal discrepancies of any
material using the indirect technique (Fig. 10).
Fig. 7. Test die showing the eight points where marginal Analysis of materials using both direct and indi-
discrepancies were measured.
rect techniques showed that in every instance the
indirect treatment restorations for a specific material
analyzed using Duncan’s new multiple range test. had smaller average marginal discrepancies than
To determine whether there was a significant those fabricated using the direct technique (Table
change in marginal accuracy as a result of storing the IV). Overall, the indirect technique produced signif-
treatment restorations, an additional preliminary icantly smaller average marginal discrepancies than
study was completed. One treatment restoration was the direct technique (Fig. 11).
made from each of the four different types of There was a significant interaction between mate-
materials using the direct technique. The marginal rials and techniques. This means that a change in
accuracy of each treatment restoration was measured technique may not have the same effect for all
immediately and after 2 and 4 weeks. materials. Some materials are more sensitive to a
technique change than others. This is best exempli-
RESULTS
fied by Scutan, which exhibited minimal change in
Analysis of the direct treatment restorations the amount of marginal discrepancy between the
showed that the average marginal discrepancy of direct and the indirect techniques (Figs. 12 and 13).
Neopar was significantly greater Cc,< .OOl) than Neopar, the least accurate material when using the
that of all the other materials tested. While there direct technique, made a significant improvement in
were no statistically significant differences between accuracy using the indirect technique (Figs. 14 and
the remaining materials, Snap had the smallest 15). Duralay, the second most accurate material
average marginal discrepancies, followed closely by using the direct technique, was significantly less

SEPTEMBER 1980 VOLUME 44 NUMBER 3

MARGINAL ACCURACY OF TREATMENT RESTORATIONS

marginal
discrepancy

0 10 20 30 40 so 60 m so so

Thousandths of Inches

Fig. 9. Average marginal discrepancy for each material when made using the direct
technique.

smp
&r&y

Jrt marginat
discregwy
INDIRECT

I I I I I I I I I I
0 10 20 30 40 50 60 m 60 90
Thousandths of Inches

Fig. 10. Average marginal discrepancy for each material when made using the indirect
technique.

accurate than five materials using the indirect tech- accuracy, not to establish adequacy. While all of the
nique. Thus the amount of improvement relative to materials may be clinically adequate, some are
a technique change varied with the materials. significantly more accurate than others. Accurate
The results of the effect of storage time on treat- treatment restorations are essential to promote heal-
ment restorations did not change the grouping of ing.” Over extended periods of time, marginal
materials with respect to marginal discrepancy. accuracy is imperative in promoting tissue health.
This study showed that Snap had consistently
DISCUSSION good results for both techniques (Figs. 16 and 17).
The marginal discrepancies, while not relating Other materials that were similar in accuracy to
directly to clinical use, are the results of a demanding Snap were (in descending order) Splintline, Duralay,
test of accuracy. The purpose of this study was to test Jet, and Trim. True Kit exhibited an intermediate

THE JOURNAL OF PROSTHETIC DENTISTRY 287

 CRISPIN, WATSON, AND CAPUTO

marginaldiscrepancy
smp
Durdey

JCC

SpfiiltIlnr

rrhll

True ulr
Temp.
8ridpt Resin
scum

0 10 20 30 40 60 60 to 60 60

Thou66ndths of Inches

Fig. 11. Comparison of average marginal discrepancies resulting from direct and indirect
techniques.

Fig. 12. Marginal discrepancy of Scutan made using Fig. 14. Marginal discrepancy of Neopar made using
direct technique. direct technique.

Fig. 13. Marginal discrepancy of Scutan made using Fig. 15. Marginal discrepancy of Neopar made using
indirect technique. indirect technique.

288 SEPTEMBER 1980 VOLUME 41 NUMBER 3

MARGINAL ACCURACY OF TREATMENT RESTORATIONS

Fig. 16. Marginal discrepancy of Snap made using direct Fig. 18. Superficial folds caused by surface layer of methyl
technique. methacrylate setting before the remaining material.

more completely polymerized surface layer, wrinkles

formed while the material was seated on the die,
leaving an uneven surface and small marginal voids
(Fig. 18). This did not occur with any of the other
materials.
The significant results of this study on marginal
accuracy, combined with previous results on color
stability, provide useful information for material
selection.”

CONCLUSIONS
1. The marginal accuracy of treatment restora-
tions made by the indirect technique was significant-
Fig. 17. Marginal discrepancy of Snap made using
ly better than that of those made by the direct
indirect technique.
technique.
2. Snap had the smallest average marginal dis-
crepancies when using the direct technique.
accuracy with both techniques. Temporary Bridge
3. The average marginal discrepancy of Neopar,
Resin was among the least accurate for both tech-
when using the direct technique, was significantly
niques. Neopar was comparable to Temporary
greater than all the other materials tested.
Bridge Resin for the indirect technique but was the
4. Splintline, Snap, Trim? Jet, and True Kit had
least accurate material for the direct technique.
significantly smaller marginal discrepancies than the
Scutan was the next to least accurate material for the
remaining materials when made using the indirect
direct technique and was the only material that,
technique.
when used indirectly, had a greater marginal discre-
5. Scutan, when made indirectly, had a signifi-
pancy than over half of the materials used directly.
cantly greater average marginal discrepancy than all
The technique appeared to be even more signifi-
the other materials tested.
cant than the specific material used. Every indirect
6. The amount of improvement in marginal accu-
treatment restoration, with the exception of Scutan,
racy, when changing from the direct to the indirect
liad smaller marginal discrepancies than those fabri-
technique, depends on the specific material tested.
cated using the direct technique (Table IV).
Some materials are more sensitive to a change in
Another factor should be considered when using
technique than others.
the direct technique. Although not a part of this
study, it was noted that the methyl methacrylate REFERENCES
materials (Table I) would polymerize on the surface 1. Palomo, F.. and Pedal. J.: Periodontal considerations of
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2. Renggli, H. H., and Regolati, B.: Gingival inflammation 8. Donaldson, D.: The etiology of gingival recession associated
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IADR PROSTHODONTIC ABSTRACTS

Esthetic considerations for the placement of anterior crown margins

B. J. Crispin and J. F. Watson
UCLA School of Dentistry, Los Angeles, Calif.

Previous studies have shown that subgingival gingival margins could be placed and not be seen
margin placement is potentially more destructive to were recorded. Patients also answered a questionnaire
tissues than supragingival margin placement. The to assess their attitudes on esthetics and crown margin
purpose of this study was to determine the percentage placement. A significant percentage of gingival thirds
of patients in a random population in which anterior of teeth was scored as not showing. There was a
crown margins could be placed supragingivally and definite increase in tooth area showing when compar-
not be visible and to assess patient attitudes. Five ing normal smile to exaggerated smile. Approximate-
hundred patients were selected at random from a ly 85% of the patients had no objections to supragin-
dental school population. Two close-up photographs gival margins if they did not show; 30% did not object
were taken of each patient; one of a normal smile, the to the anterior crown margins showing. Optimum
other of an exaggerated smile. Photographs were health potential would be chosen over esthetics by
analyzed by dividing each tooth into occlusal, middle, 65% of the patients. Results from the photographic
and gingival thirds. Thirds of teeth in which supra- analysis and the questionnaires indicate a need for
more comprehensive patient analysis prior to subgin-
Reprinted from the Journal of Dental Research [58 ($pecial Issue A), gival margin placement. Subgingival margin place-
1979 (Abst No. 95)] with permission of the author and the editor. ment for esthetic reasons alone may be unnecessary.

290 SEPTEMBER 1980 VOLUME 44 NUMBER 3