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ORIGINAL ARTICLE
Ultrasonic Margin Preparation for Fixed Prosthodontics:
A Pilot Study
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POPPY HORNE, BDS, VINCENT BENNANI, DDS, PhD, NICHOLAS CHANDLER, BDS, MSC, PhD,
1
DAVID PURTON, BDS, MDS
ABSTRACT
Purpose: Atraumatic, oscillating ultrasonic instruments have recently been developed for prosthodontic margin finishing.
This in vitro observational pilot study aimed to compare the condition of crown preparation margins finished using
new ultrasonic instruments with margins finished with conventional rotary instruments.
Methods: Two extracted human canine teeth were prepared for crowns. A split-tooth model was used to refine the
margins: half of the margin was finished with conventional rotary instruments, the other with ultrasonic instruments.
The profiles of the margins were observed using scanning electron microscopy, and a quantitative comparison of
surface roughness was obtained using surface roughness analysis software.
Results: The margins finished with the ultrasonic instruments exhibited a better-defined axial wall/margin angle and a
smoother marginal surface. Rotary instruments produced a sharper and more continuous external line angle.
Two-dimensional surface roughness analysis showed that the margins produced with the ultrasonic instruments were
approximately half as rough as the margins prepared with the conventional rotary instruments.
Conclusion: The ultrasonic instruments produce margins in better condition than the current standard and appear to
have some practical advantages.
CLINICAL SIGNIFICANCE
Preparations for fixed prosthodontics finished with these ultrasonic instruments created better-defined margins, which
could result in more successful prostheses.
(J Esthet Restor Dent ••:••–••, 2011)
Caries has been identified as one of the most common
complications of fixed partial dentures.1 Marginal
discrepancies can result in leakage. This leads to
secondary caries and esthetic problems, ultimately
resulting in failure of the prosthesis.2 Smooth and
precise preparation margins facilitate impression taking
and fabrication of a precisely fitting restoration, which
contribute to a durable, esthetic, and functional result.
Ultrasonic instruments have an oscillating action,
compared with the rotation of conventional
instruments, which has led to their recent adaptation
for finish line preparation in fixed prosthodontics by
Sous and colleagues.3
Ultrasonic instruments are largely atraumatic to the
gingival attachment, pulp, and adjacent teeth.4,5 Esthetic
restorations in the anterior dentition often demand a
preparation with a subgingival finish line.4 The
oscillating action of ultrasonic instruments reduces
trauma to the soft tissues during subgingival margin
preparation, facilitating accurate impression taking.6
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Department of Oral Rehabilitation, University of Otago School of Dentistry, Dunedin, New Zealand
© 2011 Wiley Periodicals, Inc.
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ULTRASONIC MARGIN PREPARATION
Horne et al
The action also allows for a greater degree of control
when preparing areas with difficult access.6 This limits
dentin exposure during minimally invasive procedures,
which is preferred for bonded restorations.4
Furthermore, damage to the adjacent teeth can be
avoided.4,7 Vanderlei and colleagues5 reported that
temperature increases during cutting with an ultrasonic
instrument are not sufficient to cause pulpal damage.
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This in vitro observational pilot study aimed to
compare the condition of crown preparation margins
finished using new ultrasonic instruments with margins
finished with conventional rotary instruments. The null
hypothesis was that there would be no difference in the
condition of the margins prepared with the two types of
instrument.
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METHODS AND MATERIALS
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Ethical approval was obtained for the use of extracted
human teeth. Two canine teeth were selected for this
observational pilot study. Examination under a light
microscope (¥10) revealed no cracks, caries, or
discoloration. The teeth were cleaned with pumice and
stored in distilled water. Light-body addition silicone
impression material (Exahiflex, GC Corp., Tokyo, Japan)
was used to create a simulated periodontal ligament on
the root surfaces. This provided tooth mobility to
absorb some of the ultrasonic energy and mimic the
clinical use of ultrasonic instruments. The canines were
mounted in acrylic (Orthocryl, Dentaurum, Ispringen,
Germany) with adjacent natural teeth forming proximal
contacts. The canines were then prepared for
all-ceramic crowns using conventional diamond crown
preparation burs in a new high-speed handpiece (646c
Powertorque, Kavo, Biberach, Germany). All tooth
preparation was completed by a single operator,
aiming for a six-degree taper, and the margins were
prepared to a rounded shoulder configuration
above the cemento-enamel junction, as described by
Shillingburg.8
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The margins were finished using the split-tooth
technique. One-half of the margin on each preparation
was finished using an end-cutting bur (Tissue Guard
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End-Cutting [TGE] bur, fine grit [60 μm], Premier
Two Striper, PA, USA) in the handpiece with water
spray for 30 seconds, followed by a TGE very fine grit
(45 μm) bur for 60 seconds. The other half of the
margin on each tooth was finished using a Satelec
Perfect Margin Shoulder (PMS) Kit in a factory
calibrated ultrasonic generator (P5XS Newtron, Satelec,
Merignac, France) with water spray. The PMS1 tip
(76-μm grit) was used for 30 seconds, followed by the
PMS2 tip (46-μm grit) for 60 seconds, and the PMS3 tip
(no grit) for 120 seconds, each at the power settings
recommended by the manufacturer. The sequence
of tooth preparation is depicted in Figure 1, and
the preparations were observed under the light
microscope (¥10).
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The samples were rinsed with distilled water, dried, and
sputter coated with gold. The margins were then
viewed using a scanning electron microscope (SEM)
(Cambridge Instruments S360, Cambridge, UK) at an
accelerating voltage of 10 kV. Images were captured
with a frame grabber (Dindima Image Slave, Dindima
Group Pty Ltd, Ringwood, Victoria, Australia). The
profiles of the margins were qualitatively compared at
different magnifications. Three regions were viewed;
area 1: the axial wall/margin angle, area 2: the surface of
the margin, area 3: the external line angle (Figure 2).
Images were also taken of the profiles of each of the
instruments before use. The tooth preparation and the
analysis of the SEM images were carried out by the
same investigator.
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Surface roughness analysis software (Scandium,
Olympus, Adelaide, Australia) was used to
obtain a quantitative comparison of the margins
finished with each instrument, from SEM images,
using stereo pairs. The areas of the margins where the
surface roughness was calculated were randomly
selected by a third party. The term roughness refers to
a variety of measured parameters, and two were
selected: Ra, the roughness mean parameter and
Rmax, the maximum roughness. The roughness of
each sample was measured both in one dimension
(along a line parallel to the margin, and a line
perpendicular to the margin) and in two dimensions
(along a surface).
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Colour
ULTRASONIC MARGIN PREPARATION
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FIGURE 1. Tooth preparation sequence. PMS = Perfect Margin Shoulder.
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FIGURE 2. SEM image of
split-tooth model, marked for
orientation of margin prepared with
rotary instruments on the left and
ultrasonic instruments on the right
(¥25). Area 1: axial wall/marginal
angle; area 2: margin surface; area
3: finishing line.
© 2011 Wiley Periodicals, Inc.
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FIGURE 3. SEM image of sample
prepared with rotary instruments
(¥100). Area 2, the margin surface,
showing concentric patterns due to
the rotation of the instrument.1.
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RESULTS
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When examined under the light microscope, the
sections of the margin prepared with the ultrasonic
tips appeared to be smoother than those finished with
the rotary instruments. There was some artifactual
cracking visible on the root surfaces of the samples,
with SEM.
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Under SEM (100¥) the margin finished with the rotary
TGE instruments appeared rougher overall. In area 1,
there was some damage to the axial surface of the
preparation (Figure 2). This was nonuniform,
trough-like, and in the axial direction. The axial
surface/marginal angle was therefore rough and
irregular. There was an obvious concentric pattern on
the surface of the margin (area 2, Figure 3). Despite
this, the external line angle (area 3) created with the
rotary instruments was sharp, continuous, and better
defined than that produced with the ultrasonic
instruments (Figure 4).
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The axial wall/margin angle (area 1) produced with the
ultrasonic instruments was well defined, and very
smooth (Figure 2). The margin surface (area 2)
appeared smoother overall, with little evidence of
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any stroke pattern (Figure 5). The margin was also
wider than the margin prepared with the rotary
instrument. The external line angle (area 3) was
discontinuous (Figure 6). This line was very sharp and
distinct in some regions, but rough and chipped in
other regions.
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SEM images (2,000¥) were used to visualize the
dentinal tubules and the presence or absence of
smear layer on the margins. The margins finished
with the rotary instruments were covered with copious
debris, within which concentric indentations were
visible. The dentinal tubules were barely visible, and
those that could be identified were often occluded.
The margins finished with the ultrasonic instruments
appeared to have less smear layer. The margin profile
was slightly irregular and appeared to have small
craters within the surface. However, the dentinal
tubules were conspicuous. They were arranged
in a regular pattern, but appeared smaller
than expected, with some cracking of their
apertures.
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Surface roughness analysis was carried out to obtain
quantitative results. The profile of the margin finished
with the rotary instruments showed greater roughness
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Horne et al
FIGURE 4. SEM image of sample
prepared with rotary instruments
(¥100). Note the sharp definition
and continuity of area 3, the
finishing line.
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FIGURE 5. SEM image of sample
prepared with ultrasonic
instruments (¥100). Area 2, the
margin surface of the sample, and
absence of any stroke patterns.
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closer to the axial wall (area 1) and external line angle
(area 3) with a smoother surface between the two areas
(area 2). The roughness mean parameter (Ra) of the
surface finished with the rotary instruments was
2.175 μm, and the maximum roughness (Rmax) was
119 μm. The line profiles of the margins finished with
© 2011 Wiley Periodicals, Inc.
DOI 10.1111/j.1708-8240.2011.00477.x
the ultrasonic instruments were more uniform, but
there was an area of increased roughness toward the
finishing line (area 3). The roughness mean parameter
(Ra) of the surface finished with ultrasonic instruments
was 0.58 μm, and the maximum roughness (Rmax) was
45 μm. (Table 1).
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FIGURE 6. SEM image of sample
prepared with ultrasonic
instruments (¥100). Note the rough
and discontinuous finishing line in
area 3.
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1
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TABLE 1. Mean surface roughness (mm)
Ultrasonic instruments
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1D
Ra
Rmax
2D
Ra
Rmax
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0.58
45.00
0.75
15.76
Rotary instruments
Ra
Rmax
Ra
Rmax
2.18
119.00
1.63
41.14
1D = one dimension; 2D = two dimensions; Ra = the arithmetic mean
of the absolute departure of the roughness profile from the mean
line; Rmax = the maximum peak-to-valley height in one sampling length.
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DISCUSSION
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The margins produced with the ultrasonic instrument
were in a better condition than those produced with
the rotary instrument. Thus, the null hypothesis was
rejected.
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A strength of this pilot study was the use of the
split-tooth model. This provided a robust control and
reduced factors that may have influenced interpretation
of the results. Similarly, all tooth preparation was
completed by a single operator, which further reduced
possible variations. The use of SEM and surface
roughness analysis gave both quantitative and
qualitative results.
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The surface finished with the rotary instruments was
over three times rougher than the surface finished with
the ultrasonic instruments in one dimension.
Two-dimensional analysis produced similar results,
although the surface produced with the rotary
instruments was over twice as rough as the surface
produced with the ultrasonic instruments.
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The margins produced with the ultrasonic instrument
were superior to those produced with the rotary
instruments in two of the three areas studied. The
ultrasonic instruments produced preparation margins
that were smooth, with a well-defined and rounded
axial wall/margin angle (Figures 2,5,6). Furthermore,
the dentin surfaces prepared with the ultrasonic
instruments exhibited less debris and were cleaner with
exposed dentinal tubules, a condition that is more
suitable for bonding procedures.9 However, the rotary
instruments produced sharper and more continuous
external line angles (Figure 4).
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The information from the surface of the margins could
be correlated to the surface of the instrument, its shape,
and its functional mode.
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With rotary instruments, significant damage to the axial
wall of the sample was noted (Figure 2). This damage is
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related to the shape of the instrument and is thought to
have been caused by the end-cutting tip of the bur
scratching the axial surface of the preparation while
cutting the interproximal margin. This caused the axial
wall/margin angle (area 1) to be rough and irregular,
which complicates fabrication of an esthetic and
well-fitting prosthesis.8 The surface of the margin (area
2) appeared slightly rougher than the margin produced
with the ultrasonic instruments (Figure 3). A possible
explanation is that although the finest grit size used for
the rotary and ultrasonic finishing was comparable
(45 μm and 46 μm), the preparation sequence with the
ultrasonic instruments ended with the use of the PMS3
tip, which has no coating of grit. There was a circular
pattern noticeable on the surface of the margin
prepared with the rotary instruments, which was not
present on the ultrasonic preparations. This is related
to the shape of the bur and its rotating action, and it is
probable that the small working surface of the bur
created shallow indentations in the margin surface as it
rotated. The external line angles on the margins
prepared with the rotary instruments however were
ideal (Figure 4).
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The margin surfaces prepared with the ultrasonic
instruments were smoother and wider than those
prepared with the rotary instruments (Figure 5). A
smooth surface is important for a well-fitting
restoration, and assists in strengthening the ceramic
butt margin of a restoration, by ensuring that the
material remains under compression. The increased
width of this margin compared with the margin
produced by the rotary instrument can be explained by
the presence of diamond particles on the shank of two
of the ultrasonic instruments, whereas the rotary
instruments had diamond particles on the tip only,
preventing axial cutting. The axial wall/margin angle
(area 1) on the samples prepared with ultrasonic
instruments was smooth and close to 90°, forming a
well-rounded shoulder (Figure 2). It is important that
this angle is smooth to enhance marginal fit, castability,
and esthetics.10 A well-defined, sharp external line angle
without a lip of unsupported enamel is critical to the fit
of a restoration. The chipped finishing lines observed by
SEM on the margins prepared with the ultrasonic
instruments may have been due to the oscillating action
© 2011 Wiley Periodicals, Inc.
DOI 10.1111/j.1708-8240.2011.00477.x
Horne et al
of the instrument, which caused pieces of enamel to
fracture. The PMS3 tip is thought to remove shards of
unsupported enamel. It is possible that the areas with
chipping were not thoroughly instrumented. This
requires further investigation, as a chipped and
irregular finish line could compromise the adaptation of
the definitive restoration. Another method of analysis of
margin accuracy could have been to evaluate the fit of
definitive crowns on abutments finished with the two
different instruments.
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Bonding to dentin is complicated by a high proportion
of organic material, high intrinsic water content, and
the smear layer.11 In order to achieve bonding to dentin,
the smear layer is often removed with an acid to expose
the collagen network and increase permeability of the
tubules.9 However, this increase in dentinal tubule
permeability can also cause tooth sensitivity after
bonding.11 The results suggest that cutting dentin with
an ultrasonic instrument produces less debris than
cutting with rotary instruments, providing a bonding
surface that has less smear layer and a greater density of
exposed dentinal tubules. Etchant application to this
surface could be of shorter duration.12
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The two-dimensional results of surface roughness
analysis are considered to be more clinically significant
than the one-dimensional results, as they are taken
from a surface, rather than from a line profile. As the
diameter of the ultrasonic working tip is almost the
same as the width of the margin, the surface is
instrumented uniformly with one stroke, thus
eliminating irregularities produced by translation of
the instrument tip across the margin surface. The
diameter of the rotary instrument used was smaller, and
the corresponding roughness of the margin is thought
to be related to the different levels of instrumentation
of the surface. The concentric markings produced by
the rotary mode of action are also thought to
contribute to the roughness value of this margin, as
compared with the oscillatory action of the ultrasonic
instruments.
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The line profiles for both samples were relatively
consistent across the margin, but became more
irregular as they approached the external line angle.
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This may be due to the shearing of enamel as observed
on the SEM images of the margin finished with the
ultrasonic instruments (Figure 6). However, this was
also observed on the margin finished with the rotary
instruments and may be due to the instruments
behaving differently when cutting enamel, as opposed
to dentin. Further research is required in this area.
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There was some cracking visible on the root surfaces of
both samples. This is thought to be largely artifactual
and the result of specimen preparation for scanning
microscopy.13 Future studies might consider using
epoxy replicas made from silicone impressions as a
means to reduce this effect. It was difficult to determine
whether there was a higher degree of cracking
associated with either finishing instrument, and further
research is required into subsurface damage caused by
ultrasonic diamond instruments. Xu and colleagues14
reported that preparation of enamel with diamond
instruments caused subsurface damage in the form of
median-type cracks and micro-cracks. Furthermore,
these authors stated that larger diamond grit sizes
produced longer subsurface cracks in enamel. Fine
diamond finishing burs were recommended by these
authors for crack removal. It is unknown whether
ultrasonic diamond instruments cause subsurface
damage, but they may replace fine diamond finishing
burs in the future.
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The quality of the margins produced with the ultrasonic
instruments is promising. With further research and
development, they have the potential to overtake rotary
and hand instrumentation for finishing in fixed
prosthodontics. A key advantage is their lack of
rotation, permitting improved control during delicate
preparations.4 The frequency of oscillation can be
adjusted to change the abrasive activity of the
instrument, to complete a smooth subgingival finish
line.6
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The oscillating action also prevents soft tissue damage.
This has two distinct advantages in situations where
esthetics is of particular importance. Damage to the
gingiva, especially in individuals with a thin biotype, can
result in unsightly recession of the gingival margin.15
The absence of gingival lesions produced during
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finishing line repositioning facilitates the impression
taking procedure and may eliminate the need for
gingival retraction cord.3
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A conventional high-speed handpiece used under
normal loading with a water flow of 40 mL/minute
prevents increases in temperature of the pulp.16 Von
Fraunhofer and colleagues17 reported higher cutting
efficiency with higher coolant flow rates. Unfortunately,
a higher coolant flow rate also decreases visibility. The
increased length of the ultrasonic tip means that the
water flow originates from further up the shaft of the
instrument than with traditional burs, which improves
visibility while cutting.
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CONCLUSION
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Within the limitations of this observational pilot study,
the advantages of ultrasonic instruments for finishing
preparations in fixed prosthodontics are illustrated. The
ultrasonic instruments produce margins in better
condition.
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This very practical advantage in margin preparation
suggests an important role in the future.
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Further research will investigate the consequence of this
on clinically relevant procedures such as resin bonding.
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DISCLOSURE AND ACKNOWLEDGEMENTS
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The authors do not have any financial interest in the
companies whose materials are included in this article.
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The authors are grateful to Satelec, a division of Acteon
(France), for providing the ultrasonic generator, PMS
tips, and research funding; The New Zealand
Government for further funding; Premier Dental, for
providing the Two Striper Tissue Guard End-Cutting
burs; Ms Liz Girvan, University of Otago Centre for
Scanning Electron Microscopy for assistance with the
SEM and surface roughness analysis; and Olympus Soft
Imaging Solutions for providing the Scandium software
for surface roughness analysis.
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Reprint requests: Vincent Bennani, DDS, PhD, Department of Oral
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Rehabilitation, School of Dentistry, University of Otago, P.O. Box 647,
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This article is accompanied by commentary, Ultrasonic Margin
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Preparation for Fixed Prosthodontics: A Pilot Study, Mamaly Reshad, BDS,
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DDS, MSC
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DOI 10.1111/j.1708-8240.2011.00478.x
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Journal of Esthetic and Restorative Dentistry
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