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CLINICAL RELEVANCE: Further evaluations are warranted for the identification of a leak-proof material and
placement technique to restore endodontic access cavities in complete-coverage crowns.
Quintessence International
27
Trautmann et al
Anterior
Posterior
Total
10
10
20
10
10
20
10
10
10
10
20
10
10
30
50
80
*Degussa-Ney Dental.
'Empress (Ivoclar Nortii America).
Trautmann et al
Anterior
Posterior
Total
10
10
16
16
10
16
10
16
10
50
16
80
Crown line
*Kerr.
'J. Morita.
GO America.
Sterile TSB
The outcomes of the bacterial leakage study were evaluated with a chi-square test to compare the influence
of (1) type of restoration, (2) type of crown, and (3)
type of tooth (anterior versus posterior) on the incidence of turbidity. For 1-tailed tests and where
expected cell counts were fewer than 5, Fisher's exact
tests were utilized.
29
Trautmann et al
RESULTS
A total of 51% of specimens (41/80) demonstrated bacterial leakage. A cbi-square test of independence did not
indicate a statistically significant association between
the presence of turbidity (indicating bacterial leakage)
and tbe restorative materials used (P = 0.995). All materials leaked in at least 50% of tbe specimens: amalgam
and bonding agent (8/16); amalgam and varnish (8/16);
light-cured composite (8/16); glass-ionomer cement
(8/16); and dual-cured composite (9/16; 56%).
No statistically significant association between
crown type and bacterial leakage (as evidenced by the
presence of turbidity) was found (P = 0.149). Tbe
greatest incidence of bacterial leakage was observed
for all-porcelain crowns (14/20; 70%), wbile tbe lowest incidence of leakage was observed among all-metal
noble crowns (2/10; 20%). All otber crown types
exhibited a 50% incidence of turbidity (10/20 for both
types of porcelain-fused-to-metal crowns and 5/10 for
all-metal gold crowns).
To allow further investigation of possible associations between bacterial leakage and crown type, porcelain-type crowns were grouped togetber and compared
to all-metal crowns grouped togetber. Fisher's exact
test revealed some evidence tbat porcelain-type
crowns were more susceptible to bacterial leakage
tban were all-metal crowns (P = 0.077). Specifically, 7
of 20 all-metal crowns (35%) sbowed turbidity, while
34 of 60 porcelain-type crowns (57%) sbowed turbidity. The presence of turbidity among all-porcelain
crowns was then compared to the presence of turbidity
among all otber types of crowns in tbe study. Allporcelain crowns bad a significantly higher risk of turbidity; teeth witb all-porcelain crowns had an odds
ratio of 2.85 for tbe presence of turbidity compared to
teeth witb crowns tbat were not all-porcelain [P =
0.046 for 1-tailed Fisber's exact test).
A chi-square test of independence demonstrated a
statistically significant association (P = 0.009) between
tbe occurrence of turbidity and type of tootb; anterior
teetb demonstrated a greater frequency of bacterial
leakage (21/30; 70%) than did posterior teetb (20/50;
40%). Specifically, anterior teetb were 3.5 times as
likely to show signs of bacterial leakage than were
posterior teeth.
To investigate the difterence between anterior and
posterior teeth in the incidence of turbidity, tbe presence of turbidity among all-porcelain crowns was
compared to tbe presence of turbidity among porcelain-fused-to-metal crowns separately for anterior and
posterior teetb. Among anterior teeth, all-porcelain
crowns bad the same incidence of turbidity (7/10;
70%) as porcelain-fused-to-metal crowns (14/20;
70%). However, Fisher's exact test indicated tbat pos30
terior teeth with all-porcelain crowns exhibited a significantly greater incidence of bacterial leakage (7/10;
70%) than did posterior teeth with porcelain-fused-tometal crowns (6/20; 30%) (P = 0.045).
Teeth were examined for signs of turbidity at 1week intervals over a 4-week period during tbe course
of the study. Of tbe 41 teeth demonstrating bacterial
leakage during the study, tbe greatest proportion of
turbidity was observed after 1 week (17/41; 41%). Tbe
number exhibiting turbidity declined over tbe course
of tbe study, as 9 of 41 (22%) exbibited turbidity at
both weeks 2 and 3 and only 6 of 41 (15%) demonstrated bacterial leakage at tbe fourth week.
All positive controls showed no turbidity (0%), and
all negative controls show complete turbidity (100%).
DISCUSSION
Trautmann et al
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