Fecf5742 5

VOL 2, NO 2
//
FALL 2014
FOR DENTAL STUDENT RESEARCH AND INNOVATION
The Future of
Dental Education
and Research
TECHNOLOGY & TECHNIQUES
An Innovative Technique for the
Fabrication of an Emergency
Provisional Fixed Partial Denture
RESEARCH
Inhibition of Polymerization
of Contemporary Polyvinyl
Siloxane Impression Materials
by Latex-Free Products
Reliability and
Reproducibility of
Measurements on ThreeDimensional Digital Models
for Diagnosis in Orthodontics
INTERVIEW
Brenda
P.F.A. Gomes
Letter from the Editor
Hello, everyone!
Editor, Lisa is your main point of contact at FORUM. Our

previous Managing Editor, Melissa Tennen, has moved on to
another publication in the AEGIS family. I will miss Melissas
FORUM for Dental Student Research and Innovation
insight, enthusiasm, and commitment, and I am grateful that
(FDSRI) is here for you to learn what other dental students
she will still be in the neighborhood. Thank you, Melissa!
and their mentors are doing in their research labs and clin-
I hope you enjoy and learn from this new issue of FORUM.
ics to advance the practice of dentistry. I hope that you
If you missed any previous issues, they are ready for you to
are enjoying our research articles, interviews, technology
view in the Communications tab of the homepage (www.
& techniques features, and other interesting items. If there
fdsri.com); just click Publications from the dropdown menu.
is something that you expected to see in the FORUM, but
Id like to thank you again for your support on Twitter and
have not found it in the journals pages or on the websites
Facebookplease encourage your friends and mentors to
pages, please send us your ideas.
like us on Facebook and follow us on Twitter. I wish you all
I invite you again to visit FORUMs website (www.fdsri.
the best.
com) to learn about the many ways for you to be involved

with the publication. Not all of you may not be ready, will-
Anne E. Meyer, PhD
ing, and able to set aside the time to prepare a complete
Associate Dean for Research
research manuscript, but I am certain that all of you could
School of Dental Medicine University at Buffalo
send a short item about the interesting research that is going
The State University of New York
on at your school, or about a volunteer event, or news of

other student activities. Or, have you attended a conference
recently? Our readers will be interested in a short report
about the conference, and what you learned by attending.
We look forward to receiving these types of items from you,
in addition to your research manuscripts. Please send your
news and manuscripts to the attention of our Managing
Editor; be sure to include your contact information (your
name, name of your school, location, and your e-mail address) so that we can reply to you.
This issue of the FORUM marks a transition on our editorial
team. I am pleased to announce that Lisa Neuman is our new
COVER: SHUTTERSTOCK.COM/ANNA JURKOVSKA
Managing Editor (lneuman@aegiscomm.com). As Managing
Marina Gallottini, PhD

University of So Paulo, Brazil
Thomas S. Mang, PhD

University at Buffalo, U.S.
Ali Saad Ali Thafeed AlGhamdi, BDS, MS

King Abdulaziz University, Saudi Arabia
Michael Glick, DMD

L. Krishna Prasad, BDS, MDS

Sibar Institute of Dental Sciences, India
Sebastian G. Ciancio, DDS

Mats Jontell, DDS, PhD

Gteborg University, Sweden
Tao Xu, DMD, PhD

Peking University, China
William Greg Evans, BDS, DipOrth

University of the Witwatersrand, South Africa
Yoshimasa Kitagawa, DDS, PhD

Hokkaido University, Japan
Avraham Zini, DMD, MPH

Hebrew University, Israel
BOARD MEMBERS
www.fdsri.com
Contents
FALL 2014
VOLUME 2 // NUMBER 2
FEATURE
Forum for Dental Student Research and Innovation is published by AEGIS

Publications, LLC.
Ellen Meyer, MBA
PERSPECTIVES
10 Charting New Territory
Martin Brunworth, Brent Honda, Kori Rienbolt, and Justin Weststeyn
RESEARCH
12 Inhibition of Polymerization of Contemporary Polyvinyl
Siloxane Impression Materials by Latex-Free Products
Silvia P. Amaya-Pajares, DDS, MS; Alex J. Delgado, DDS, MS; and
Terence Donovan, DDS
20 Reliability and Reproducibility of Measurements on

Three-Dimensional Digital Models for Diagnosis
in Orthodontics
Jared Little; Paula Oltramari-Navarro, DDS, MSc, PhD;
Lorenzo Franchi, DDS, PhD; and James A. McNamara Jr., DDS, MS, PhD
TECHNOLOGY & TECHNIQUES

30 An Innovative Technique for
the Fabrication of an
Emergency Provisional Fixed
Partial Denture
RESEARCH INNOVATORS
AND ROLE MODELS
37 A Student Interview with
Brenda P.F.S. Gomes
Juliana Delatorre Bronzato
Copyright 2014 by AEGIS Publications, LLC. All rights reserved under United
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WARNING: Reading an article in Forum for Dental Student Research and Innovation
does not necessarily qualify you to integrate
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their clinical expertise and recommends
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trying to implement any new procedure.
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Feature
The Future
of Dental
Education
and Research
STRATEGIES FOR RECRUITING
STUDENTS AND PRACTICING
CLINICIANS INTO ACADEMIA
here is widespread speculation

about the dearth of dental students and practicing dentists
interested in pursuing an academic career, especially in light of the
anticipated faculty shortages in dental
education that will emerge over the next
few decades. Among the positions currently vacant in the United States, the
vast majority71%, according to the
ADEA Deans Brieng Book 20131are
in clinical faculty; 9% are in administration, 8% research, 6% and 5% in allied
dental and basic science, respectively,
and 1% in behavior science.
Anthony Palatta, DDS, EdD, who is Senior Director

for Educational Program Development, Policy Center:
Institutional Capacity Building, American Dental Education
Association (ADEA), observes that, despite shortagesie,
vacant budgeted full-time faculty positionsdental education programs have historically relied upon retired dentists
and part-time practicing dentists to train the future cohort
of oral healthcare practitioners. However, he is especially
concerned about a projected worsening of the problem
due to factors including the opening of new dental schools,
retirement of existing baby boomer faculty, and the scarcity of studentsmany with a high debt loadchoosing
to pursue academic careers.
ISTOCK/FRANNY-ANNE
Ellen Meyer, MBA
Fall 2014
Why The Problem Exists

Milwaukee, Wisconsin, prosthodontist Anthony Ziebert,
DDS, MS, is the American Dental Associations Senior Vice
President, Education/Professional Affairs. He says a study
reported in the May 2014 issue of Journal of the American
Dental Association specically examined debt as a factor in
the employment choices made by dental school seniors.2
The average debt of our students is over $200,000 when
they graduate from school. Thats exclusive of their undergraduate debt, and doesnt even begin to take into account
what they have to come up with to buy into a practice or
to set up their own private practice, he explains. He says
for many such grads, the decision boils down to a return
on investment (ROI)pitting their debt load against their
potential earnings, which in dentistry is still high enough
to enable students to successfully service their debt when
they graduate. This, he says, often means that even those
who might otherwise go directly into academia or specialty
trainingwhich would further increase the debt without
signicantly increasing ROImay defer or abandon those
plans to focus on starting that stream of income.
Although losing promising prospective junior faculty
members to clinical practice may be disappointing, Palatta
says those who return to academia are especially valuable.
Given that the greatest void in faculty is in the clinical staff,
Palatta says, Most dental schools really like a clinical faculty
member to have a few years out in practice and then come
back into school. The challenge, he points out, lies in attracting them to a different type of professional life, away from
potentially lucrative practices. Its usually more after they
DENTAL EDUCATION
are established, have their loans paid off, and have some sort
of normal lifestyle when they are ready to consider giving
back or pursuing a deferred desire to teach, he says. We
generally get faculty in two waysby poaching from other
schools or when they leave private practice, which is a bit
like a revolving door, because they often go back.
Offering insight into motivating clinicians to make the
change, Ziebert, who had been a department chair at
Marquette University Dental School for 5 years, recalls
his own foray into recruiting faculty comprehensive care
group leadersie, a general dentist to oversee dental
students in their clinical training by a private practice
model within the school with that group of students. To
his surprise, most of the dentists hired had been in private
practice for 2 decades or more; and their reasons for joining the faculty varied. They wanted to give back, [they]
wanted a change; some were just tired of private practice,
which can be physically and mentally exhausting. You
have to manage an ofce, hire and re people, arrange
for coverage or be available to handle emergencies after
hours or on weekends.
While academia does have its own headaches and demandspreparing for classes, clinic ve times per week,
and being available to studentsthe attractions are most
likely to resonate with those best suited to the life change.
Beyond the benets package and steady paycheck are many
intangibles cited by Palatta: the energy of teaching clinic;
the opportunity to work with colleagues; the stimulation of
learning the latest; the satisfaction of teaching/giving back;
and the chance to pursue other interestseg, research.
Then, too, is an opportunity Palatta himself
made good use ofto earn additional academic
degreesin his case, both a masters and a doctorate. Although you get a little less money
to take home, you get paid back in freedom of
time for yourself and family.
Ziebert and Palatta agree that the profession
cannot continue to rely on the strategies that
have been used to date. The schools have
The challenge, he points out, lies

in attracting them to a different
type of professional life
Anthony Ziebert, DDS, MS, is the American
Dental Associations Senior Vice President,
Education/Professional Affairs
www.fdsri.com
Feature
been able to make do by doing a good job of utilizing their

faculties, but this chronic shortage has been exacerbated by
the opening of a number of new schools, including three in
August 2013. If you gure that each of them needs at least
30 full-time faculty members to function, the problem can
only get worse, says Ziebert.
He says the ADA, whose membership is composed
mainly of busy private practitioners with weakened ties
to dental education, has proposed various measures with
little success. These have included loan forgiveness or loan
modications for new assistant professors with modest
salaries; a fund-raising program to supplement faculty
salaries called Our Legacy, Our Future; and awards such
as the Golden Apple in academic dentistry.
Ziebert says, too, that the ADA study found that debt
was only one factorand not even the strongestthat
inuenced graduating seniors practice decision, and believes that solutions are more likely to come from those
focused on more logical targetsie, students predisposed
to academia. With that in mind, he says, the ADA sees its
role as being more of a knowledge broker than attempting
to lead the charge. I think to a signicant extent, ADEA
is really the organization at the forefront to deal most effectively with the issue, Ziebert says.
Outreach To Dental Students

ADEAs efforts to interest students in pursuing academic
careers, explains Palatta, include its yearlong Academic
Dental Careers Fellowship Program (ADCFP), which pairs
selected students and faculty mentors. The unique program, which started in 2006, begins with a 2-day training
at ADEAs annual session, where fellowship recipients
and their mentors attend workshops, and ends with their
presenting a poster on what they learned about teaching
or academia at that same meeting a year later. Sandwiched
between these major events is the heart of the program, a
laundry list of components demanding a signicant amount
of commitment and time, which must be balanced with the
dental school curriculum, including:
6
Identifying an area of research to pursue

Meeting regularly with their mentor
Attending faculty meetings
Interviewing different faculty members to learn about
different types of positions

Meeting with administrators
Writing papers based on self-reection, including about
meetings with mentors and their teaching experiences
Teachingcreating a teaching experienceafter learning
from webinars on teaching. It may be a lecture, lunchand-learn, or clinic session, which is evaluated both by
their mentor and by their peers.
Gaining entry to the original program has become competitive. Students must submit three essays, all geared toward
experience with and a desire to teach. Their mentoring
faculty member, too, must apply, attesting to having access
to meetings and a background in teaching.
This program is great for those who consider teaching a
calling and have done it all alongfor example, as tutors in
high school, says Palatta. However, he explains, its expense
has hindered schools ability to offer this opportunity to
more students. The school has to commit to covering costs
for the student and the mentor to travel to the ADEA annual
session twice, rst for the training and then the second to do
their poster. If a school has 10 students, that can be costly.
He says that as demand increases, so too does the need for
oversight that is currently provided by only one ofcehis.
Palatta is now championing a more cost-effective program
for the dental schools that would enable more students to be
accepted into the programthus encouraging as many students as possible to become involved in teaching or research.
This Home Institution Fellowship Program enables students
to fulll the requirement at their home institution. Instead
of attending the ADEA meeting in person, they would attend a webinar of the program at their home school while
being mentored by faculty there. The Home Institution
program has potential to be a kind of grow your own
faculty program at each school, with maybe as many as
Fall 2014
DENTAL EDUCATION
adjunct faculty model after gaining experience as

a clinician working in a nonprot practice created
to improve the oral health of patients who have
special access needs and face barriers to care.
Ann Decker entered dental school with a
longstanding desire to pursue research. I feel
called to an academic career by my passion
Anthony Palatta, DDS, EdD, Senior Director for Educational
for research, education, and patient care, she
Program Development, Policy Center: Institutional Capacity
maintains. She liked that the program had a
Building, American Dental Education Association
very structured framework that helped me
participate in teaching and research within the
dental
school
curriculum. Decker says she beneted from
100 students participating instead of just 10.
the elements of the program that helped her better dene
Palatta says ADEA is very interested in attracting more
dental students (and their mentors) to this program. He
her goal both for her future and her remaining year in dental
stresses that, other than travel to the ADEA meetings to
school. I was able to develop my relationship with my
attend workshops and present, the programs are identiresearch mentor and clinical faculty members in a way
calalthough he admits that the competitiveness of the
that gave me the support system I needed to complete
primary program confers additional prestige. We want
the program requirements and really get the most out of
them to not only have a teaching experience to put on their
my last year in dental school. This program allowed me
resume, but essentially have the opportunity to actually
to explore ways that I could build a career for myself, not
walk in the shoes of a faculty member and to really reect
only practicing dentistry and conducting scientic research,
and talk about it.
but doing both of those things successfully. Her plan to
Palatta says the program seems to attract the right type
pursue a dual PhD and periodontics residency, she expects,
of studentsthose who enjoy the experience of teaching
will prepare her for a career as both a dental educator and
students and working with a faculty member one-on-one.
research investigator seeking to improve available treatment.
Among the students who participated in the 20132014
Tien Ha-Ngoc says he was not initially interested in acaADCFP cohort is Katie Annsen, who had a longstanddemic dentistry, although, like many who are ultimately
ing interest in teaching and perfectly t the prole. After
attracted to teaching, he had been a youth counselor prior
undergrad, I spent a year volunteering as a teachers aid
to dental school. From the program, however, he discovered
at a non-prot, teaching English as a second language to
much about himself, and even overcame his fear of public
speaking. He also forged strong relationships with his two
immigrants from around the world; I also taught piano
lessons to beginner/intermediate students.
classmates in the program, and the three would discuss
She says it was the hands-on teaching in the dental school
matters of dental education for which they shared a passion.
environment that primarily attracted her to the program. I The rewards I received from this program were beyond
liked that the program was structured enough to provide
anything I could have expected. I am most grateful for the
endless amount of support, encouragement, and advice I
us with a variety of expected teaching experiencesclinical, pre-clinical, small group, and lecturebut was exible
received from the faculty members I reached out to or those
enough for us to decide how we would attain these teaching
who reached out to me.
Nina Guba, who already planned to pursue an academic
experiences at our school. Her ultimate plan is to follow the
The Home Institution program

has potential to be a kind of
grow your own faculty program
at each school
www.fdsri.com
Feature
career, called the ADEA program a crash course in what

a dental academic career entailed. ADCFP presented an
outstanding and structured opportunity to explore a career
as a dental academician and offered me a lot of perspective
in choosing this path over a more traditional dental career.
She says she was able to explore the types of tracks available, and was encouraged to reach out to faculty, who she
felt were especially receptive her as an ADCFP fellow. By
hearing their stories and advice, I was able to get a clearer
picture of what my career goals are and the steps I need to
take to reach these goals, and they sincerely offered their
support to me for the remainder of my dental education.
The daughter of a teacher, Lisa Simon said the program
conrmed that academic dentistry was right for her, and further, how the many facets of an academic careerteaching,
research, clinical time, etccould t together. I feel so much
more condent about my professional goals because of the
interviews I was able to conduct as part of the program. I also
got to hone my teaching skills in the clinical, pre-clinical, and
lecture setting, which was very rewarding. Most importantly,
I got to work more closely with the others in the ADCFP,
who I know will be the future of dental education.
Approaches to Faculty Building

Ziebert refers back to the ADA studys conclusion for clues
as to how to approach the faculty shortage problem. He said
the study found that fourth-year dental school students with
high levels of educational debt were more likely to express an
interest in choosing to go into private practice, but concluded
that the characteristics of the student body may be a more
accurate predictor of employment choices that dental school
seniors are making than are total educational debt levels.
Based on a better understanding of the characteristics
that distinguish dentists who sooner or later gravitate to
academia, a number of different approaches may prove
effective in building a strong faculty in the future. These
approaches would include recruiting at different stages of
the dental career, and planting seeds even earlier, perhaps
by making a greater effort to select students who already
8
have a demonstrated desire to teach or pursue research.

As suggested by the characteristics and comments of the
students featuredall of whom completed the programit
would help to make not just existing but, perhaps more
importantly, prospective dental students aware of the opportunities in dentistry beyond the obvious. Dentistry has
not done a great job of promoting teaching and research as
careers equally as vibrant as practice. The focus has been
on building skillsusing your handpiece, doing crowns and
llings and all that kind of stuff, says Palatta. As a result,
most students apply to dental school to becomewell,
dentistslike the family practitioner they know and likely
admire. They like the idea of having their own practice and
seeing patients and earning a comfortable income.
Another part of the solution may well lie in efforts to
change perceptions of the eld, demonstrating how it might
meet the interests and personal goals of prospective students
long before they are immersed in the nuts and bolts of preparing for clinical practice. Palatta says he envisions a national
awareness campaign that would change the current onedimensional perception of dentists. My dream is a public
service ad showing a person in an academic setting teaching
students with it saying This is a dentist, and someone using
a microscope saying, This is a dentist, and then someone
with a patient in a chair saying, This is a dentist.
He says a different approach might interest young practitioners in particular who may miss the interaction with
dental school and students and faculty, and the research
going on, and lectures. It is a very exciting environment
and we can try to see if we can get them to come back even
half a day a week. Thats how it happened to me.
REFERENCES
1. American Dental Education Association. ADEA Deans Brieng
Book, 2013. 2013http://www.nxtbook.com/ygsreprints/ADEA/g37461_

adea_briefbook2013. Accessed September 3, 2014.
2. Wanchek T, Nicholson S, Vujicic M, et al. Educational debt and
intended employment choice among dental school seniors. J Am Dent

Assoc. 2014;145(5):428-434.
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Perspectives
Charting New Territory

Learning the value and challenges of breaking from traditional
courses by offering an applied approach to biochemistry.
MARTIN BRUNWORTH | BRENT HONDA | KORI RIENBOLT | JUSTIN WESTSTEYN
he University of Missouri - Kansas City

(UMKC) School of Dentistry Class of
2017 recently completed the inaugural
Applied Dental Biochemistry course.
Starting a new class with a unique approach can make it difcult to nd balance between students and faculty. For example, students
want to get the best grades possible, while still learning
what is necessary to succeed in future classes and perform
well on board examinations. Faculty members, for their part,
want to explore the eld, teach the intricacies, and inspire
students to dive deeper into the subject matter. The rst
Applied Dental Biochemistry course at UMKC was designed
to achieve a balanced atmosphere between students and
faculty members, using a new format. The course consisted
of lectures from more than 10 professionals, faculty members, and researchers with specic lecture days associated
with clinical correlations. From the beginning, the students
knew they were not only in for a challenge, but also in for a
unique class experience that was focused on biochemistrys
application to dentistry.
For the rst time, UMKC School of Dentistry decided
to combine its Biochemistry and Cell Biology courses in a
single Applied Dental Biochemistry courses to reect the
direction of dentistry and material found on dental board
examinations. Each major section of the course was followed by a dental correlation lecture from a resident faculty
member, and across all topics was an underlying theme of
the signicant inuence the role genetics plays in biochemical pathways and various disease states impacting dental
care. The course director, Dr. Jeff Gorski, lectured on the
10
various areas and assisted the numerous faculty members

to help ensure consistency throughout the class.
Impact of Having Multiple Faculty Members

Each series of topics was covered by specic UMKC School
of Dentistry faculty members who specialize in that particular area of dentistry or research related to the course.
Students received this format with mixed reactions: There
is certainly value in hearing different perspectives, but consistency is important as well. Naturally, when involving
multiple faculty members, there will be tremendous variability in lecture styles, classroom discussions, and preparation techniques for exams. Having multiple faculty made
it difcult to continuously adjust to the different teaching
styles, one student said.
The course director developed a study-guide template, and
faculty members were encouraged to provide information
to the students in advance of class. Each study guide provided additional reading resources, term denitions, lecture
objectives, and questions to facilitate understanding of the
fundamental topics and their correlation to dentistry.
Benets of an Applied Course

The course was taught in a way that encouraged students
to go past memorization of a list of names, structures, etc.
Classroom discussions provoked applied thinking, and most
test questions were written to reect a deeper understanding
of the information. On several occasions the faculty members
wrote their own board-type questions for the exam material
covered, which was incredibly valuable for students.
By covering material in a unique way that blends the
Fall 2014
various topics of medicine and biochemistry, this course

facilitated a progressive style of learning for the students.
In the clinical correlation sessions, students gained value
from learning the course material from a new perspective
while specically applying it to dentistry and oral diseases.
Applying the details of the course to dentistry advanced
problem-solving skills, encouraged critical thinking, and
promoted active learning.
While at times the cycling of lecturers seemed overwhelming, the students also beneted from having topics presented
from the various subject-matter experts. The esteemed
faculty members were enthusiastic about presenting to
the class and showcasing their respective work in the eld.
Students were able to meet several researchers who were
actively working in the UMKC School of Dentistry and hear
how their work is being applied to the future of dentistry.
The course made a strong emphasis on the application of
biochemistry to various disease states with several specic
to dentistry. The emphasis made it clear that the inuence
of genetics in biochemistry will also play a tremendous
role in dentistry. Students were taught the importance of
staying current with existing research while practicing
dentistry because the future will continue to adapt to the
new information discovered.
BRUNWORTH // HONDA // RIENBOLT // WESTSTEYN
homework assignments could be used to enhance classroom

discussion. In addition to the submitted homework assignments, it was suggested that some lecture days could be led
by students discussing the given homework topic.
CLASSROOM TOPICS AND LECTURES: One respondent
suggested that a general overview of all the material could

be presented toward the beginning of the semester and as
the semester progressed, have the guest faculty member
present a more detailed approach to the material in his or
her area of expertise. That will build a core foundation of
knowledge for the students that other faculty members can
build upon, ultimately culminating in the clinical correlation
lectures. It could also smooth the transition between lecture
styles with different levels of information being covered by
each faculty member.
EXAMS: Students want to encourage the continuation
and expansion of simulating board-type questions for

future exams. By applying the biochemistry knowledge
to situation-based questions, the students will learn the
material better, be better prepared for board examinations,
and will also perform at a higher level in clinical settings.
Looking to the Future

Suggested Improvements of the Course
In a brief survey, students were asked about their impressions of the efcacy of the course and were encouraged
to make suggestions. Three main categories of comments
identied were homework assignments, classroom topics
and lectures, and exams:
HOMEWORK ASSIGNMENTS: As part of homework as-
signments, students conducted literature research outside

of class and wrote discussion papers. Several students
found additional value in the literature research process
and it helped them gain an understanding of the material
presented. Even though both dental students and faculty
members have limited free time, expanding the role of
It is never easy to be the students or faculty in a newly

designed course, but UMKC School of Dentistry did an
excellent job adapting to the future of dentistry with the
applied biochemistry course. As with all courses, improvements and adaptations should be made to the format and
style of the course, but it is certain that future dental students will continue to receive a foundational education that
will bridge the gap between basic sciences and dentistry,
launching them into successful careers.
ALL THE AUTHORS are in the class of 2017 at the School of

Dentistry, University of Missouri - Kansas City in Kansas City, Missouri.
www.fdsri.com
11
Research Paper
Inhibition of Polymerization
of Contemporary Polyvinyl
Siloxane Impression Materials
by Latex-Free Products
SILVIA P. AMAYA-PAJARES, DDS, MS | ALEX J. DELGADO, DDS, MS | TERENCE DONOVAN, DDS
AUTHORS
ABSTRACT
The latex content of some dental materials may inhibit the polymeriza-
DR. AMAYA-PAJARES is a
graduate student in the Department of
Prosthodontics, College of Dentistry,
University of Iowa.
tion of polyvinyl siloxane (PVS) impression materials. The affected

impression can result in distorted casts. The purpose of this study was
to evaluate the direct and indirect inhibition effects of different latex
and latex-free products on the polymerization of two contemporary
DR. DELGADO is a clinical assistant professor in the Division of Operative Dentistry,

Department of Restorative Dental Science,
College of Dentistry, University of Florida.
divided in nine areas, and each product was rubbed on a specic area
DR. DONOVAN is a professor and
allowed to set for 10 minutes. To assess direct inhibition, the PVS ma-
Section Head of Biomaterials, Department

of Operative Dentistry, University of North
Carolina School of Dentistry.
terials were expressed directly on the latex or latex-free products. The
light-body PVS impression materials. Ten latex-free and ve latex

products were tested. To test indirect inhibition, two test plates were
for 10 seconds. PVS samples were directly expressed on the plates and
sample was considered inhibited if the contact surface was rippled or

slippery. Neither impression material was affected by indirect contact
Corresponding author:
adelgado@dental.u.edu
with any of the products tested. When in direct contact, most of the
products caused surface inhibition of PVS polymerization. Inhibition
of polymerization of the light-body PVS did not occur with indirect
contact with the latex or latex-free products tested. The composition
of PVS impression materials has changed with time, and these alterations may have made the materials less sensitive to sulphur contamination. In direct contact, most products tested caused inhibition of both
types of light-body PVS.
12
Fall 2014
AMAYA-PAJARES // DELGADO // DONOVAN
olyvinyl siloxane (PVS) impression

materials became popular in the late
1970s and have many advantages, such
as ne-detail reproduction, good elastic
recovery, and excellent dimensional
stability. PVS impression materials can
be poured whenever it is convenient for the operator.1,2 In
addition, PVS impression materials are easy to handle and
odor- and taste-free, and are well-tolerated by patients.
Modern automix systems make them relatively easy to use.
When universal precautions were adopted in the early
1980s, the interaction between PVS materials and latex products, specically latex gloves and rubber dams, emerged as
a problem.3-8 Latex products contain unreacted sulphur as a
byproduct of the manufacturing process, and this sulphur has
been shown to contaminate the chloroplatinic acid catalyst
of the PVS material, causing inhibition of polymerization.9
This inhibition of polymerization might occur directly, when
gloved hands are used to mix putty viscosity material or an
impression is made with a rubber dam in place.3-5
The inhibition from latex contamination can also be indirect, when the operators gloved hands touch the prepared
teeth and/or gingival tissues around the preparation.6-8 With
indirect inhibition, the surface of the impression material in
contact with the contaminated area is slippery and rippled.
If the area is part of a prepared tooth, the impression is
unacceptable and must be remade. Contaminated tooth
preparations must be physically cleaned with slurry of
TABLE 1
Brands of PVS Impression

Materials Tested
Polyvinyl Siloxane
Company
Extrude Light Body

Type 3
Kerr Corporation
Express Light Body

Regular set
3M ESPE
our of pumice as no effective cleansing agent has yet been

discovered.10 Many dentists and laboratory technicians have
attributed this inhibition of polymerization to hemostatic
agents used with gingival displacement techniques;11 however, it has been shown that this idea is erroneous and the
culprit is sulphur in the latex gloves.12
In the past decade, a number of latex-free products, such
as nitrile and neoprene gloves, have been brought to market.
The interaction with these products and PVS impression materials has not been studied. Contemporary PVS impression
materials have also been improved, and most now contain
non-ionic surfactants to render them hydrophilic. This property makes PVS impressions somewhat easier to pour, but
does not result in the ability to make acceptable impressions
in the presence of blood, crevicular uid, or saliva. It is not
known if the inclusion of these non-ionic surfactants in the
impression materials makes them less susceptible to inhibition of polymerization by latex or latex-free gloves.
This study was performed to determine if the new latexfree products (ie, nitrile, neoprene) cause direct or indirect
inhibition of polymerization of PVS materials containing
non-ionic surfactants. Latex products were also tested to
see if they inhibited the polymerization of PVS materials
containing non-ionic surfactants.
Methods and Materials

Two contemporary light-body PVS impression materials
used in the University of North Carolina were tested and
are listed in Table 1. Ten non-latex and ve latex products
were tested and are listed in Table 2. The materials were
tested for both direct and indirect inhibition of polymerization. All products used were brand new and directly
from the package. For direct polymerization inhibition, the
light-body impression materials were expressed from an
automix system directly on the latex or latex-free products
and allowed to set for 10 minutes. Extrude (Kerr Dental,
kerrdental.com) light bodys (Type 3) minimum intraoral
time is 3 minutes and the manufacturers recommended
www.fdsri.com
13
Research Paper
Names and Manufacturers

of Glove and Rubber Dam
Products Tested
TABLE 2
Product
Company
Gloves
Latex
Defend
Powdered
Mydent
International
Natural
Exension
Benco Dental
Kimberly-Clark
Global
Sterling
Exam Gloves
Ansell Healthcare
Microex
Corporation
NeoPro
Neoprene
Surgical Gloves
Ansell Healthcare
Exam Gloves
Ansell Healthcare
FreeForm SE
Microex
Corporation
Powder-Free
Crosstex
Nitrile
MediChoice
Owens & Minor
Sterling
Kimberly-Clark
Global
Product
Company
Rubber Dam
Latex
Non-Latex
Hygienic
Rubber Dam
Coltene/
Whaledent Inc.
Optragate
Ivoclar Vivadent
DermaDam
Ultradent
Non-Latex
Rubber Dam
from the start of mixing, according to the manufacturer. The

impression materials were then removed from the product
being tested and inspected for inhibition of polymerization. If the PVS surface setting against the product appeared
slippery and rippled (visual observation), the sample was
considered to be inhibited. Two samples of each impression
material were made with each of the tested latex and latexfree products for a total of 30 samples of each impression
material.
To test for indirect inhibition of polymerization, stainless
steel plates (SSPs) of 10 inches by 14 inches were carefully
washed with soap and water (Lysol Antibacterial Soap),
then wiped with methyl alcohol and washed again with
water and dried with a paper towel. Each plate was divided
into nine sections, which were then contaminated with
one of the latex or latex-free products. Contamination was
achieved by vigorously rubbing the product against the area
within the lines on the SSP for 10 seconds. A pilot study had
determined no difference when contamination was done for
10 seconds or 1 minute. After the SSP was contaminated, the
impression material was extruded from the automix system
directly onto the contaminated surface and allowed to set for
10 minutes (Figure 1). The set materials were ipped with a
sterile spatula (324 Spatula, Hu-Friedy, hu-friedy.com) and
evaluated for inhibition of polymerization. If the spatula was
contaminated with unpolymerized material, it was recorded
as inhibited. For the indirect-contact samples, a sample was
considered inhibited if the PVS in contact with the contaminated SSP was slippery or rippled. A total of 10 samples of
each impression material was tested with each of the latex
and latex-free products. Each time a new sample was tested,
the tray was washed and cleaned as explained above.
Henry Schein
Results
setting time is 6 minutes from the start of mixing. Express
VPS Impression Material Light Bodys (3M ESPE, 3mespe.
com) (regular set) intraoral setting time minimum is 3.5
minutes with a recommended setting time of 6.5 minutes
14
The observations were classied in three categories:

nonreactive, reactive, and very reactive. Criteria for each
category are given in Table 3. A summary of the effects
on polymerization of the impression materials by all the
Fall 2014
3
FIG 1. Stainless steel plate used for indirect contact experiments.
FIG 2. Sample of Extrude PVS impression material after direct contact
latex and latex-free products for both impression materials

is given in Table 4. All replications of each experimental
condition provided the same results.
Overall, 80% of the latex-free materials tested inhibited
Extrude PVS material in direct contact and 70% of the latexfree materials tested inhibited Express PVS material in direct
contact (Figure 2 and Figure 3). In direct contact, 100% of
the latex materials tested produced inhibition of Extrude,
while 40% of the latex products caused polymerization of
Express (Figure 4 and Figure 5).
None of the samples of both impression materials demonstrated indirect inhibition of polymerization with any of
the products tested, including latex gloves and rubber dam
(Figure 6 through Figure 8).
One brand of surgical neoprene gloves (Ansell Neoprene
Surgical Gloves, Ansell Healthcare, ansellhealthcare.com)
did not interfere with complete polymerization of both
impression materials, while another brand of neoprene
gloves from the same company (Ansell Neoprene Exam
Gloves) apparently caused inhibited surface polymerization
of both impression materials (Figure 9 and Figure 10). Three
different products, which were OptraGate (Ivoclar Vivadent,
ivoclarvivadent.us), Natural Extensions latex gloves (Benco
Dental, benco.com), and Kimberly-Clark Sterling latex
gloves (Kimberly-Clark Global, kchealthcare.com), caused
inhibited surface polymerization with one impression
material (Extrude), but allowed complete polymerization
with the other impression material (Express). One latex-free
rubber dam product (DermaDam non-latex, Ultradent, Inc,
ultradent.com) caused surface inhibition; however, another
dam product (Henry Schein Non-Latex Dams, Henry Schein,
henryschein.com) allowed complete polymerization.
with DermaDam Latex-Free dam (blue background). Inhibition of polymerization is indicated by the rippled surface of the disk after being
flipped (Left) and by the residue remaining on the glove (Right). The
location of where the spatula lifted the disk is clearly seen at the upper right edge of the residue.
FIG 3. Kimberly-Clark Sterling Nitrile Glove (light background) caused
inhibited polymerization in direct contact with Express impression
material (Left: disk of impression material, peeled from glove and
flipped; Right: residue remaining on the glove).
Discussion
Surface inhibition of polymerization of PVS impression materials has been identied as a signicant complicating factor
in the production of indirect restorations. The major problem in the past has been a result of indirect contamination
www.fdsri.com
15
Research Paper
FIG 4. Express impression material (Left) after removal from direct

contact with Kimberly-Clark Latex Glove. Sample exhibited no inhibitory effect on polymerization of the PVS material (no visible residue
remaining on glove).
FIG 5. After peeling Extrude from an Ansell Latex Exam Glove, a
rippled surface was seen on the disk of impression material (Left) and
a heavy residue remained on the glove (Right).
FIG 6. Natural Extension Latex Gloves caused no indirect inhibition
of polymerization of either impression material (Left: Extrude, Right:
Express). Before taking the photo, both of these samples were peeled
from the stainless steel tray that had been rubbed with the gloves.
FIG 7. Samples of both PVS impression materials in indirect contact
with Microflex Nitrile Gloves exhibited proper polymerization (photo
after peeling from contaminated stainless steel tray; Left: Extrude;
Right: Express).
FIG 8. Indirect contact with Hygienic Latex Rubber Dam allowed com-
plete polymerization of both impression materials (photo after peeling

from contaminated stainless steel tray; Left: Extrude; Right: Express).
16
Fall 2014
of the prepared teeth and surrounding gingival tissues due

to contact with latex gloves. Unreacted sulphur remaining
from the manufacturing process of synthetic latex has been
identied as the likely culprit.8
Nitrile gloves have become popular in recent years,
primarily due to the relatively high incidence of latex
allergies. They are made of a synthetic polymer that is
formed by combining the monomers acrylonitrile, butadiene, and carboxylic acid.13 The resultant glove is more
resistant to chemicals than latex and is also powder-free
and more resistant to puncture. Nitrile gloves are slightly
more expensive than latex gloves. Many chemicals used in
the manufacturing of nitrile gloves (including aluminum
sulphate) are the same as those used in the manufacturing of latex gloves,13 which may explain why many of the
latex-free products tested in this study caused inhibition of
surface polymerization of the PVS impression materials in
direct contact with the latex-free products.
The chief component of neoprene gloves is the elastomer polychloroprene. Several manufacturing processes are
used, but some neoprene products are manufactured with
xanthogen disuldes and others use thiuram disuldes as
peptization agents.14 These agents may be the cause of
surface inhibition of PVS materials in direct contact with
some neoprene gloves.
The composition of PVS impression materials has changed
over time, and these variations may have made the materials less sensitive to sulphur contamination. Neither of the
two PVS impression materials tested in this study exhibited
indirect surface inhibition of polymerization. This is valuable information, because it was a serious issue with the
PVS materials available in the 1980s and 1990s.1 One of the
TABLE 3
Categories of Reaction
of Gloves in Direct and
Indirect Contact
Category
Description
Nonreactive
Produced no inhibitory
effect from either direct or
indirect contact.
Reactive
Produced polymerization
inhibition after direct
contact with impression
material, but not after
indirect contact.
(++) Very Reactive
Produced polymerization
inhibition after both direct
and indirect contact.
(-)
(+)
FIG 9. Direct contact with Ansell Neoprene Surgical Gloves allowed

complete polymerization of both impression materials (Left: Extrude:
Right: Express).
FIG 10. Direct contact with Ansell Neoprene Exam Gloves inhibited polymerization of both PVS impression materials (Top: Extrude; Bottom:
Express).
10
www.fdsri.com
17
Research Paper
TABLE 4
Inhibition of PVS Impression Materials in Indirect and Direct

Contact Classied by Latex and Non-latex Products
Extrude
Product/Brand
Express
Direct
Indirect
Reaction
Category
Direct
Indirect
Reaction
Category
Defend Powdered/Mydent International
Natural Extension Latex Gloves/Benco
Sterling Latex Gloves/Kimberly-Clark
Latex Exam Gloves/Ansell
Latex Rubber Dam/Hygienic
100
60
NeoPro Neoprene Gloves/Microex
Surgical Neoprene Gloves/Ansell
Exam Neoprene Gloves/Ansell
FreeForm SE Nitrile Gloves/Microex
Powder Free Nitrile Gloves/Crosstex
MediChoice Nitrile Gloves/Owens & Minor
Sterling Nitrile Gloves/Kimberly-Clark
Optragate Dam/Ivoclar-Vivadent
DermaDam Non-Latex/Ultradent
Non-Latex Dam/Henry Schein
80
70
Latex Products
Inhibited samples (%)

Non-latex Products
Inhibited samples (%)
DIRECT: TESTED OVER THE PRODUCT (N=2 REPLICATES, EACH); INDIRECT: TESTED OVER SSL (N=10 REPLICATES, EACH)
ABBREVIATIONS: I = INHIBITED, L = LATEX, NL = NON-LATEX, P = POLYMERIZED
PVS materials tested (Express) showed complete polymerization in direct contact with two brands of latex gloves.
The possible reasons for this improved PVS performance
are speculative, but it may be due to either the increase in
the concentration of platinum in the chloroplatinic acid
catalyst has overcome the issue of chelation of platinum in
the impression materials by sulphur in the latex or non-ionic
surfactants in the impression materials act as a separating
18
medium, protecting the catalyst from sulphur.

Whatever the reason, contemporary light-body PVS impression materials seem less sensitive to latex contamination
than earlier versions. Surface inhibition of PVS polymerization by indirect contact with latex products or latex-free
products did not occur in this study. Direct contact of the PVS
impression materials with both latex and latex-free products
resulted in surface inhibition of polymerization, but did not
Fall 2014
occur with all products. Direct-contact inhibition may only

be a more serious issue when using putty viscosity impression materials. Studies should be performed to determine if
contemporary putty materials are sensitive to latex contact.
1989;2(2):128-130.
7. Kahn RL, Donovan TE, Chee WW. Interaction of gloves and rubber
dam with poly(vinyl siloxane) impression materials: a screening test. Int J

Prosthodont. 1989;2(4):342-346.
8. Chee WW, Donovan TE, Kahn RL. Indirect inhibition of polym-
erization of a polyvinyl siloxane impression material: a case report.
Conclusions
Within the limitations of this study, the following conclusions are proposed:
1. Inhibition of polymerization of the tested lightbody PVS impression materials did not occur from
indirect contact with either the latex or latex-free
products tested.
2. Inhibition of polymerization of the PVS materials
tested did occur from direct contact with the majority of the latex and latex-free products tested.
3. The decreased sensitivity of the impression materials
tested to latex may have more to do with the changes
in the composition of the impression materials than it
does with the use of latex-free products.
4. Some latex-free products cause surface inhibition of
PVS impression materials when direct contact between the product and the impression material occurs.
Quintessence Int. 1991;22(2):133-135.

9. Cook WD, Thomas F. Rubber gloves and addition impression mate-
rials. Aust Dent J. 1986;31:140-144.

10. Kimoto K, Tanaka K, Toyoda M, Ochiai KT. Indirect latex contami-
nation and its inhibitory effect on vinyl polysiloxane polymerization. J

Prosthet Dent. 2005;93(5):433-438.
11. Phillips RW. Skinners Science of Dental Materials. Philadelphia, PA: WB
Saunders, 1991;154.
12. de Camargo LM, Chee WW, Donovan TE. Inhibition of polymeriza-
tion of polyvinyl siloxanes by medicaments used on gingival retraction

cords. J Prosthet Dent. 1993;70(2):114-117.
13. ADA Division of Science of the ADA Council on Scientic Affairs.
Nitrile gloves. J Am Dent Assoc. 2003;134(9):1256-1257.

14. Obrecht W, Lambert J, Happ M, Oppenheimer-Stix C, Dunn J, Krger
R. Rubber, 4. emulsion rubbers in Ullmanns Encyclopedia of Industrial

Chemistry 2012, Wiley-VCH, Weinheim.
REFERENCES
1. Chee WW, Donovan TE. Polyvinyl siloxane impression materials: a
review of properties and techniques. J Prosthet Dent. 1992;68(5):728-732.

2. Donovan TE, Chee WW. A review of contemporary impression
materials and techniques. Dent Clin N Am. 2004;48(2):445-470.

3. Neissen LC, Strassler H, Levinson PD, Wood G, Greenbaum J. Effect
of latex gloves on setting time of polyvinylsiloxane putty impression

material. J Prosthet Dent. 1986;55(1):128-129.
4. Reitz CD, Clark NP. The setting of vinyl polysiloxane and condensa-
tion silicone putties when mixed with gloved hands. J Am Dent Assoc.
1988;116(3):371-375
5. Noonan JE, Goldfogel MH, Lambert RL. Inhibited set of the surface of
addition silicones in contact with rubber dam. Oper Dent. 1985;10(2):46-48.

6. Kahn RL, Donovan TE. A pilot study of polymerization inhibi-
tion of poly (vinyl siloxane) materials by latex gloves. Int J Prosthodont.
www.fdsri.com
19
Research Paper
Reliability and Reproducibility

of Measurements on ThreeDimensional Digital Models for
Diagnosis in Orthodontics
JARED LITTLE | PAULA OLTRAMARI-NAVARRO, DDS, MSc, PhD | LORENZO FRANCHI, DDS, PhD |
JAMES A. MCNAMARA JR., DDS, MS, PhD
AUTHORS
ABSTRACT
This study evaluated the reliability and reproducibility of measure-
MR. LITTLE is a dental student at the University of Michigan (Ann Arbor, Michigan)
ments on 3-dimensional models by direct comparison of hand (caliper)

measurements and digital measurements on 3D scanned-in dental
casts. Digital models were shown to be measured as accurately as
DR. PAULA OLTRAMARI-NAVARRO

is an assistant professor in the Department
of Orthodontics at University of Northern
Paran (Londrina, Brazil)
were traditional plaster casts. Digital models also have the added
advantage of easier storage and ease of transmission over the internet
to other healthcare providers. Thus, digital models are an acceptable
replacement for plaster casts for regular use in clinical orthodontics
DR. FRANCHI is a research associate

in the Department of Orthodontics at the
University of Florence (Florence, Italy), and
a Thomas M. Graber Visiting Scholar in the
Department of Orthodontics and Pediatric
Dentistry at the University of Michigan (Ann
Arbor, Michigan)
DR. MCNAMARA is the Thomas M and

Doris Graber Endowed Professor of Dentistry in the Department of Orthodontics and
Pediatric Dentistry; a professor of cell and
developmental biology, School of Medicine;
and a research scientist in the Center for
Human Growth and Development at the University of Michigan (Ann Arbor, Michigan)
Corresponding author:
jaredmli@umich.edu
20
and research.
tudy models are fundamental to proper

orthodontic diagnosis and treatment
planning.1-6 The analysis of dental casts
allows the assessment of an individuals
occlusal conditions with no interference
from the associated soft tissue of the
mouth, thereby making it easier to evaluate dentoalveolar
discrepancies and possible treatment difculties in detail
as well as to envision possible orthodontic mechanics that
could be used during the correction of the malocclusion.2,4,7
Study models made of plaster or dental stone are typically
used in most orthodontic practices. While the medium is
Fall 2014
LITTLE // OLTRAMARI-NAVARRO // FRANCHI // MCNAMARA JR.
cost-effective, easy to use, and serves its purposes well,

these models also have limitations, such as destructibility
and the need for storage.8,9 The physicality of the models
is another problem in contemporary orthodontics because
many patients require an interdisciplinary approach by professionals in different locations. In these instances, plaster
models must be duplicated and transferred to other care
providers, increasing the cost as well as the waiting period
for the exchange of information.3,4
To avoid these problems, virtual dental models have
been developed as another component of the paperless
orthodontic ofce and the move to digital dentistry.6,10 The
accuracy and speed of laser scanning to obtain diagnostic
data, the ease of information storage as STL les, and the
possibility of sharing the information with other professionals via the Internet are cited as primary advantages of
this new diagnostic approach.4-6,11 Many software programs
are now available to the orthodontist for the manipulation
of virtual study models, including emodel by GeoDigm
Corporation (www.dentalemodels.com), OrthoAnalyzer
by 3Shape Dental (www.3shape.com), and OrthoCAD
iCast by Cadent (www.orthocad.com) to name a few.
Several comparisons have been made between the accuracy of plaster and virtual models. Garino and Garino12
found statistically signicant differences between the
measurements obtained with conventional study models
and OrthoCAD digital models; however, they also mentioned the advantages of the OrthoCAD software, such
as the ability to turn the 3D images without altering their
dimensions in space in addition to the greater resolution
obtained with this software. Zilberman et al13 and Quimby
et al,14 in comparing plaster and OrthoCad digital models,
demonstrated that both types of models are valid and may
be reproducible for the measurements of tooth size and
arch width.13,14 Moreover, Quimby et al suggested that the
ease of storing and manipulating digital models in addition to the shorter time required for their measurement
are characteristics that render this method attractive to the
progressive orthodontist.12
Objective
Given the increasing popularity of virtual study models in
orthodontic practice, the reproducibility of this relatively
new methodology needs to be evaluated. Thus, the purpose
of this study is to assess the reliability of 3D digital models
in relation to conventional plaster models.
Material and Methods

The sample consisted of 50 pairs of plaster models that
were part of the longitudinal data set of the University
of Michigan Growth Study.15,16 The models were selected
based on these inclusion criteria: presence of all permanent
teeth, including second molars; normal occlusion; and no
anatomical anomalies.
The models included in this study were digitalized by
way of the 3Shape R700 3D scanner. They were scanned
in a way to produce the exact same on-screen model no
matter who was operating the scanner.
Measurements consisted of upper canine distance (Figure
1), upper molar distance 1 (Figure 2), upper molar distance 2
(Figure 3), upper molar-incisor distance-left (Figure 4), upper
molar-incisor distance-right (Fig 4), lower canine distance
(Figure 5), lower molar distance (Figure 6), lower molar-incisor
distance-right (Figure 7), lower molar-incisor distance-left
(Figure 7), overjet (Figure 8), and overbite (Figure 9).
The measurements were made in two different ways:
1) on conventional plaster models using the digital caliper
(Dentagauge 3, Erskine Dental, www.erskinedental.com)
with a 150-mm opening capacity and a 0.01-mm resolution positioned parallel to the occlusal plane; and 2) on
3D STL digital models using the OrthoAnalyzer software
provided with the scanner. The STL les of the scanned
models were loaded into the software and a point-to-point
caliper measurement was performed. For overbite and
overjet, a specic overbite/overjet tool was used within
the software (Figure 9 and Figure 10). Both researchers
performed measurements with the software and with the
caliper in separate sessions, in order to avoid any potential
www.fdsri.com
21
Research Paper
Fig 1 through Fig 9. The sample consisted of 50 pairs of plaster models that were part of the longitudinal data set of the University of Michigan
Growth Study. Measurements consisted of upper canine distance (Figure 1), upper molar distance 1 (Figure 2), upper molar distance 2 (Figure 3),
upper molar-incisor distance-left (Figure 4), upper molar-incisor distance-right (Fig 4), lower canine distance (Figure 5), lower molar distance
(Figure 6), lower molar-incisor distance-right (Figure 7), lower molar-incisor distance-left (Figure 7), overjet (Figure 8), and overbite (Figure 9).
22
Fall 2014
examiners was conrmed for the two proposed protocols,

the examiners individually assessed 50 pairs of models , and
the results were submitted to reliability tests.
Intraexaminer error comparing the two measuring
methods was assessed using the Intraclass Correlation
Coefcient (ICC), which is a descriptive statistic used to
show how strongly items in a group resemble each other.
The Bland-Altman agreement, also known as the Tukeys
mean-difference plot, was used to analyze the conformity
between two sets of measurements.
Results
To compare the two methods, intraexaminer error was calculated for both Researcher 1 and Researcher 2. Intraexaminer
error for Researcher 1 displayed excellent reliability for all
variables (ICC varying from 0.81 to 0.99) with very narrow
condence intervals (CI), thereby showing an excellent agreement in obtaining these measurements (Table 1). High reliability was also observed in intraexaminer error for Researcher
2, with ICC values varying between 0.77 and 0.99 (Table 2).
The interexaminer evaluation also was calculated and it
demonstrated excellent reliability. ICC values varied from
0.96 to 0.99 for the digital caliper and from 0.82 to 0.99 for
3D digital models for all variables.
Discussion
9
bias in making the measurements.

Prior to the study, one examiner had some experience
with the software and the second had extensive training
and experience with the software and the scanner.
To calibrate the examiners, the two researchers measured
10 pairs of models twice. Once the calibration of the two
Regarding the calibration process, excellent reliability was

found for Researchers 1 and 2, considering the measurements
performed with the caliper and the 3D digital models, with
ICC values ranging from 0.99 to 0.90 and small CI values.17
In this study, high intraobserver reliability was found for
both examiners as well as for both methods of assessment,
with ICC values ranging from 0.64 to 0.99. The interobserver
reliability also was excellent, with values from 0.82 to 0.99.
Most of the variance in interobserver reliability stems from
difculty in measuring overjet and overbite using the software.
Regarding the intraexaminer error for Researcher 1,
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23
Research Paper
TABLE 1
Intraexaminer Error (Researcher 1) for Caliper and

for 3D Digital Models Measurements
Researcher 1 (Caliper x Scanner)
(Reliability: N = 50)
Intraexaminer Error (Researcher 1)
Caliper
Variables
Scanner
(3Shape)
Reliability
Bland-Altman
Mean
SD
Mean
SD
ICC
P Value
Error
Bias
Sup
Limit
Inf Limit
UCD
34.00
2.30
33.92
2.37
0.98
<.0001
0.0000
0.07
-0.56
0.71
UMD
50.76
3.17
50.65
3.10
0.99
<.0001
0.0000
0.10
-0.48
0.70
UMD 2
33.71
2.61
33.67
2.64
0.99
<.0001
0.0000
0.03
-0.33
0.40
UMID R
34.33
2.19
34.49
2.16
0.98
<.0001
0.0001
-0.15
-0.88
0.56
UMID L
34.45
2.18
34.60
2.05
0.98
<.0001
0.0001
-0.15
-0.92
0.61
LCD
25.51
2.01
25.39
2.02
0.99
<.0001
0.0001
0.11
-0.36
0.60
LMD
43.54
2.62
43.48
2.46
0.99
<.0001
0.0000
-0.12
-0.70
0.45
LMID R
29.25
2.01
29.56
1.89
0.96
<.0001
0.0002
-0.31
-1.02
0.40
LMID L
29.47
1.93
29.67
2.00
0.97
<.0001
0.0001
-0.20
-0.96
0.55
Overjet
3.42
1.15
3.95
1.24
0.82
<.0001
0.0249
-0.54
-1.67
0.58
Overbite
3.36
1.32
3.12
1.52
0.81
<.0001
0.0998
0.23
-1.02
1.49
KEY: UCD = UPPER CANINE DISTANCE; UMD = UPPER MOLAR DISTANCE 1; UMD 2 = UPPER MOLAR DISTANCE 2; UMID R
UPPER MOLAR-INCISOR DISTANCE-RIGHT; UMID L = UPPER MOLAR-INCISOR DISTANCE-LEFT; LCD = LOWER CANINE DISTANCE; LMD = LOWER MOLAR DISTANCE; LMID R = LOWER MOLAR-INCISOR DISTANCE-RIGHT; LMID L = LOWER MOLARINCISOR DISTANCE-LEFT; M = MEAN; SD = STANDARD DEVIATION; ICC = INTRACLASS CORRELATION COEFFICIENT.
excellent reliability was observed for all variables (ICC

varying from 0.81 to 0.99) with narrow CI values, thereby
showing an excellent agreement in obtaining these measurements.17 High reliability was observed for intraexaminer
errors of Researcher 2, with ICC values varying from 0.77 to
0.99.17 The interexaminer evaluation also showed excellent
reliability, with ICC varying from 0.96 to 0.99 for the digital
caliper and from 0.82 to 0.99 for 3D digital models. Thus,
agreement was demonstrated between the examiners in
the two evaluations and the reliability of the 3D digital
models conrmed.
Some of the differences between caliper and software can
be attributed to the nature of the software, that being the
24
ability of the software to zoom in and see in much more

detail than with the naked eye.
When choosing a point to measure on the physical model,
limitations are related to the size of the tip of the caliper
and how accurately it can be placed on the dental cast. The
user can zoom in with the software, making an area such
as a cusp tip a much larger area, thereby creating higher
variability in where the point is placed.18 The level of zoom
was not standardized for this study. The measurements
performed during this study are relatively straightforward
compared to the rest of the OrthoAnalyzer functions.
Additionally, all measurements were distributed within
acceptable limits of variation. There were two evaluations
Research Paper
TABLE 2
Intraexaminer Error (Researcher 2) for Caliper and for 3D Digital

Models Measurements
Researcher 2 (Caliper x Scanner): Sample (N = 50)
(Reliability: N = 50)
Intraexaminer Error (Researcher 2)
Caliper
Variables
Scanner
(3Shape)
Reliability
Bland-Altman
Mean
SD
Mean
SD
ICC
P Value
Error
Bias
Sup
Limit
Inf Limit
UCD
33.99
2.27
33.91
2.26
0.98
<.0001
0.0001
0.07
-0.73
0.87
UMD
50.69
3.17
50.64
3.18
0.99
<.0001
0.0000
0.04
-0.69
0.78
UMD 2
33.69
2.62
33.68
2.63
0.99
<.0001
0.0000
0.00
-0.43
0.45
UMID R
34.59
2.18
34.42
2.13
0.98
<.0001
0.0001
0.17
-0.61
0.95
UMID L
34.65
2.21
34.59
2.06
0.98
<.0001
0.0001
0.05
-0.71
0.83
LCD
25.53
1.96
25.62
2.38
0.83
<.0001
0.0012
0.08
-2.88
2.70
LMD
43.43
2.44
43.55
2.47
0.99
<.0001
0.0000
-0.11
-0.74
0.54
LMID R
29.37
2.01
29.55
1.95
0.97
<.0001
0.0001
-0.17
-0.85
0.49
LMID L
29.50
1.93
29.84
2.37
0.98
<.0001
0.0001
-0.34
-3.17
2.48
Overjet
3.48
1.22
4.00
1.24
0.81
<.0001
0.0302
-0.51
-1.69
0.66
Overbite
3.34
1.27
3.17
1.53
0.77
<.0001
0.1110
0.17
-0.94
1.29
KEY: UCD = UPPER CANINE DISTANCE; UMD = UPPER MOLAR DISTANCE 1; UMD 2 = UPPER MOLAR DISTANCE 2; UMID R
UPPER MOLAR-INCISOR DISTANCE-RIGHT; UMID L = UPPER MOLAR-INCISOR DISTANCE-LEFT; LCD = LOWER CANINE DISTANCE; LMD = LOWER MOLAR DISTANCE; LMID R = LOWER MOLAR-INCISOR DISTANCE-RIGHT; LMID L = LOWER MOLARINCISOR DISTANCE-LEFT; M = MEAN; SD = STANDARD DEVIATION; ICC = INTRACLASS CORRELATION COEFFICIENT.
for each measurement that were carried out by two examiners who were experienced in handling both the caliper
and the software that tended to produce similar results.
Therefore, this methodology proved to be highly reliable.
Interestingly, the lowest ICC values were found for
overbite/overjet for both researchers. These results can
be explained because of the difculty in replicating the
measurements with a caliper on the plaster models. When
measuring overbite and overjet digitally, the software allows
the model to be cut, allowing the measurement to be made
without the tooth curvature or anatomical arrangement
interfering. This problem also was noted in a comparison of
digital and plaster models conducted at Columbia University
26
in New York19 and in a Swedish study looking for agreement

between conventional and 3D virtual measurements.20 The
Swedish researchers found that they were more accurate
when measuring overbite digitally than with the conventional technique, claiming a large variability due to tooth
and arch curvature and lack of reference planes; there were
corresponding results regarding overjet.20
A reliability analysis requires two statistical testsin this
case that of ICC and Bland-Altmanbecause using only
an ICC test does not provide sufcient information about
the reliability of the measures due to a nondemonstration
of the value measured or of variations thereof, errors of
measurement, and the impossibility of making a clinical
Fall 2014
interpretation. The Bland-Altman plot, in which the size

and scope of measurement differences may be interpreted
easily (eg, errors or outliers), complements the correlation
analysis by examining the difference patterns between both
measurements, ie, it measures variation in relation to the
mean difference.21,22
In addition, this method shows CI values for the mean
difference and agreement limits. These data will indicate
the measurement errors and may be related to clinical acceptance.21 Thus, the tests used in this study are appropriate
to assess the reliability of the method proposed in cases of
similar designs. Also, the ICC today is regarded as an important test to evaluate intraexaminer correlation, for it allows
analyzing the correlation, and agreement among ndings.22
The results of this study, therefore, show that measurements provided by the combined scanner and software are
reliable and may be used in other studies. In addition, the
importance of the examiners knowledge as to the handling
of the software cannot be underestimated, nor can the need
for his or her specic training in the use of similar programs.
ber Endowed Professorship, Department of Orthodontics and Pediatric

Dentistry, the University of Michigan.
REFERENCES
1. Rheude B, Sadowsky PL, Ferriera A, Jacobson A. An evaluation of
the use of digital study models in orthodontic diagnosis and treatment

planning. Angle Orthod. 2005;75:300-304.
2. Redmond WR. Digital models: a new diagnostic tool. J Clin Orthod.
2001;35:386-387.
3. Polido WD. Moldagens digitais e manuseio de modelos digitais: o
futuro da Odontologia. Dental Press J Orthod. 2010;15:18-22.

4. Oliveira DD, Ruellas ACO, et al. Conabilidade do uso de modelos
digitais tridimensionais como exame auxiliar ao diagnstico ortodntico:

um estudo piloto. R Dental Press Ortodon Ortop Facial. 2007;12:84-93.
5. Marcel TJ. Three-dimensional on-screen virtual models. Am J Orthod
Dentofacial Orthop. 2001;119:666-668.

6. Kuroda T, Motohashi N, Tominaga R, Iwata K. Three-dimensional
cast analyzing system using laser scanning. Am J Orthod Dentofacial

Orthop. 1966;110:365-369.
7. Howes AE. Arch width in the premolar regionstill the major prob-
lem in orthodontics. Am J Orthod. 1957;43:5-31.

8. Stevens D, Flores-Mir C, Nebbe B, et al. Validity, reliability, and
Conclusion
As dentistry has entered the digital age, we have seen digital
patient records become standard as a result of the inherent
advantages of the digital format. The next logical step in the
progression of digital dentistry is the widespread use of 3D
digital models, both in research and in everyday practice.
This study shows that digital models can be used accurately
and reliably and hold an advantage over plaster casts when
considering storage, sharing, and the creation of duplicates.
Digital models are appropriate for everyday use in clinical
practice, for research, and for archiving.
reproducibility of plaster vs digital study models: Comparison of peer

assessment rating and Bolton analysis and their constituent measurements. Am J Orthod Dentofacial Orthop. 2006;129:794-803.
9. Peluso M, Joseli S, Levine S, Lorei B. Digital Models: An introduc-
tion. Semin Orthod. 2004;10:226-238.

10. Motohashi N, Kuroda T. A 3D computer-aided design system ap-
plied to diagnosis and treatment planning in orthodontics and orthognathic surgery. Eur J Orthod. 1999;21(3):263-274.
11. Kusnoto B, Evans C. Reliability of a 3D surface laser scanner for orth-
odontic applications. Am J Orthod Dentofacial Orthop. 2002;122:342-348.

12. Garino F, Garino GB. Comparison of dental arch measurements
between stone and digital casts. World J Orthod. 2002;3:250-254.
AC K N OW L E D G E M E N TS A N D F U N D I N G
13. Zilberman O, Huggare JA, Parikakis KA. Evaluation of the validity of
We would like to acknowledge Mr. Mark Barry and ESM Digital Solu-
tooth size and arch width measurements using conventional and three-
tions of Dublin, Ireland, for supplying support for the 3Shape Scanner
dimensional virtual orthodontic models. Angle Orthod. 2003;73:301-306.
and software that was used in this study. This study was supported in
14. Quimby ML, Vig KW, Rashid RG, Firestone AR. The accuracy and
part by funds made available through the Thomas M. and Doris Gra-
reliability of measurements made on computer-based digital models.
www.fdsri.com
27
Upcoming Meetings
Research Paper
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experience, and broadening your horizons,
be sure to register for these meetings.
To keep up-to-date on these and other
events, please bookmark FDSRI.com.
Angle Orthod. 2004;74:298-303.

15. Riolo ML, Moyers RE, McNamara JA Jr, Hunter WS. An atlas of cra-
niofacial growth: cephalometric standards from The University School

Growth Study, The University of Michigan. Monograph 2: Craniofacial
Growth Series. Ann Arbor, MI: Center for Human Growth and Devel-
American Student Dental National

Leadership Conference
opment, the University of Michigan; 1974.
Chicago, Illinois, USA
Standards of human occlusal development. Monograph 5: Craniofacial
October 31-November 2, 2014
16. Moyers RE, van der Linden FPGM, Riolo ML, McNamara JA Jr.
CLICK HERE
Growth Series. Ann Arbor, MI: Center for Human Growth and Development, the University of Michigan; 1976.
Chicago Dental Society Midwinter Meeting
NY: John Wiley & Sons, Inc.; 1986.

18. Sousa MV, Vasconcelos EC, Janson G, et al. Accuracy and repro-
Chicago, Illinois, USA

February 26-28, 2015
17. Fleiss JL. The Design and Analysis of Clinical Experiments. New York,
CLICK HERE
ducibility of 3-dimensional digital model measurements. Am J Orthod

Dentofacial Orthop. 2012;142:269-273.
American Association for Dental Research/

International Association for Dental
Research General Session and Exhibition
19. Santoro M, Galkin S, Teredesai M, et al. Comparison of measure-
ments made on digital and plaster models. Am J Orthod Dentofacial

Orthop. 2003;124:101-105.
20. Sjgren AP, Lindgren JE, Huggare JA. Orthodontic study cast analy-
Boston, MA, USA

March 11-14, 2015
sisreproducibility of recordings and agreement between conventional
CLICK HERE
and 3D virtual measurements. J Digit Imaging. 2010;23:482-492.

21. Bland JM, Altman DG. Statistical methods for assessing agreement
between two methods of clinical measurement. Lancet. 1986:307-310.

22. Lin L, Hedayat AS, Sinha B, Yang M. Statistical methods in assess-
ing agreement. J Am Stat Assoc. 2002;97:257-270.
CO N F L I C T O F I N T E R E S T
The authors certify that they had no conicts of interest during the
course of this research.
28
Technology & Techniques
An Innovative Technique for the

Fabrication of an Emergency
Provisional Fixed Partial Denture
MILI TRIVEDI, BDS, DDS | DANIEL C.N. CHAN, DMD, MS, DDS
ABSTRACT
This technique provides an easier alternative to the traditional method of fabricating provisionals by reducing
the chairside time required and cutting down the cost for
fabricating the provisional. It eliminates the need to wax up
or send the work out to the laboratory, thus enabling the clinician to deliver a multiunit, provisional xed partial denture
(FPD) in a single visit using a vacuum-formed matrix and
light-body polyvinyl siloxane or polyether materials. In our
experience, these provisional FPDs have similar durability,
strength, and t as those made using traditional methods.
t has always been a challenge for dentists to

fabricate multiple-unit, provisional xed partial
dentures (FPDs) in patients who have been missing their teeth for a long time but now desire
immediate replacement. With no teeth to make
an impression of, it usually is a time-consuming
procedure to wax up the crowns or send the work out to a
laboratory. For the patients coming in with multiple missing
teeth and no previous casts, it becomes difcult for the
30
clinician to immediately deliver a multiunit provisional FPD.

In most cases, the dentist does not have any prior cast
of that patient for diagnosis, reference, and fabricating a
provisional. In such situations, a wax-up of the missing
teeth is created on the diagnostic cast of the patient. The
wax-up procedure takes a considerable amount of time and
most clinicians send it out to a laboratory, which results in
extra lab cost.
Using vacuum-form teeth molds helps to eliminate the
step of waxing up the crown form on diagnostic casts.
Polyvinylsiloxane material (PVS) can be used to ll the
vacuum form and get duplicate teeth molds that can be
used in place of wax-up crowns. These PVS teeth, attached
to the patients diagnostic cast, are dimensionally stable and
heat-resistant and, hence, facilitate direct fabrication of a
custom vacuum form. This approach eliminates the need
to take an impression of the wax-up and re-pour the cast.
Clinical Case
A 78-year-old female patient presented with the complaint
of a broken anterior provisional FPD. She had a provisional
bridge from teeth Nos. 6 to 11. Her provisional FPD had
broken and a major portion of it was misssing (Figure 1 and
Figure 2). She desired a new provisional FPD immediately
because she was attending an important function. On examination, it was found that the patient was in the process
of having a canine-to-canine 6-unit porcelain-fused-to-metal
FPD being fabricated. Abutment teeth Nos. 6 and 7 still had
Fall 2014
TRIVEDI // CHAN
FIG 1. The patient presented with a broken provisional and part of it missing. FIG 2. Clinical view after the remaining segment of the
provisional from teeth Nos. 6 and 7 was removed.
the provisional crowns on them. Remaining portions of the

provisional FPD were missing.
To meet the patients request, the remaining portion of
the provisional crowns on teeth Nos. 6 and 7 were removed.
An alginate impression of the maxillary dentition was made
and poured up in fast-set plaster (Snap-Stone, Whip Mix,
http://whipmix.com). On the fast-set diagnostic cast, the
intaglios of the prepared abutments were trimmed down
to the gum level. As shown in Figure 3 and Figure 4, an
anterior segment of six PVS teeth molds (Aquasil Ultra XLV,
DENTSPLY Caulk, www.aquasilultra.com), made from a
dentoform study model (Columbia Dentoform, www.
columbiadentoform.com), was tted onto the cast and secured. A thermoplastic vacuum-form matrix (Buffalo Dental
Manufacturing Co. Inc., www.buffalodental.com) of the
cast with the PVS teeth was made. The vacuum-form was
used on the patient with a bis-acrylic composite (Protemp,
3M ESPE Dental Professionals, http://solutions.3m.com)
to fabricate a provisional bridge that replaced the patients
missing teeth (Figure 5 and Figure 6).
of the PVS teeth mold, which can be cut and adjusted to t

the edentulous space.
In the clinical case described above, we started by making
a vacuum-form matrix over a dentoform study model (Figure
7). A 0.020-inch thermoplastic material can be used in a
Tray-Vac Vacuum Former (Buffalo Dental Manufacturing)
(Figure 8). The advantage of the vacuum form is that it can
can be stored and reused in the future to cut down the
chairside time during an emergency patients treatment.
PVS impression material was added to the vacuum form
(Figure 9) and a PVS mold of the desired teeth was formed
(Figure 10).
Soft polyether (Impregum Penta, 3M ESPE Dental
Professionals) also can be used to make the mold instead
of PVS. Similarly, different sizes of laboratory-fabricated
ABOUT THE AUTHOR

DR. TRIVEDI is a recent IDDS graduate and is in
private practice.
DR. CHAN is the associate dean of clinical services,
The Technique
The technique described can be used for fabricating either
an anterior or posterior provisional FPD as summarized in
Table 1. The crux of the technique relies on the adaptability
the Washington Dental Service Endowed Chair in

Dentistry, the director of the IDDS Program, and a
professor of restorative dentistry in the Office of
Clinical Services, School of Dentistry, Health Sciences
Center, University of Washington.
www.fdsri.com
31
complete dentures available in a dental ofce setting can

be used to fabricate molds of different sizes. To do so, one
would make an alginate impression of a suitable complete
denture and inject light-body impression materials directly
into the alginate impression to form the mold. As an alternate technique, one can pour up the alginate impression
and fabricate a vacuum-formed matrix from the resulting
stone model.
The dimensional stability of the PVS material facilitates
the PVS/polyether mold to be prepared in advance and
kept in stock for immediate use. Regardless of whether the
alginate impression or the vacuum-formed matrix is used
to make the mold, the material is lled up to the cervical
line and the impression is tapped to minimize porosity. It

is important to wait for the PVS/polyether material to fully
set before removing it from the vacuum form or impression.
Once the PVS mold is formed, a diagnostic cast of the
patient is required for adapting the mold in the edentulous
area on the cast. An alginate impression of the patient can
be poured in fast-set white stone. The abutment teeth
(intaglio) are trimmed down to the cervical level on the
diagnostic cast, so that the whole span of the FPD is rendered edentulous.
Next, the teeth made from PVS/polyether are cut with
a No. 15 blade on a scalpel to t the edentulous area mesiodistally on the cast (Figure 11 and Figure 12; note: this
FIG 3. A 7-unit PVS mold before trimming. FIG 4. A 6-unit PVS mold trimmed and adapted to the cast. FIG 5. Anterior view of the
fabricated 6-unit provisional FPD. FIG 6. Occlusal view of the fabricated provisional.
32
Fall 2014
TRIVEDI // CHAN
is a different case from the case shown in Figure 1 through

Figure 6). The cut-out teeth are placed in the edentulous
area of the patient cast and checked for the occlusogingival
height. The height is adjusted to the occlusal level by trimming the impression from the cervical portion (Figure 13
and Figure 14).
For a longer-span edentulous area, such as the illustrated
clinical case, another advantage of the PVS/polyether mold
is that it can be exed to adapt to the curvature of the
edentulous area. The PVS/polyether impression is stabilized
on the patient cast using Ultradent LC Block-Out Resin
(Ultradent Products, Inc., www.ultradent.com) (Figure 15)
or DENTSPLY Sticky Wax (DENTSPLY Canada, www.
dentsply.ca). A vacuum-form matrix of the cast with the
PVS/polyether teeth replacing the missing teeth and the
abutments is formed (Figure 16 and Figure 17). This vacuum
form can be used on the patient to make a provisional FPD
from bis-acrylic composite that will accommodate the
remaining abutments and replace the missing teeth. An
alternate technique could be to make an impression of the
segment and use it as the matrix.
Discussion
FIG 7. Complete denture teeth used as the mold. FIG 8.

Thermoplastic vacuum form material was used to form the mold.
FIG 9. Impregum was used in the vacuum form matrix to make a
replica of the teeth.
Provisional restorations are vital to xed prosthodontics

treatment.1-3 Often, provisionals are in place for a long period so that clinicians can rene esthetic, biologic, and biomechanical issues before the nal restoration is fabricated.
In such instances, breakage of the provisional restorations
is a common event.4
There is an increased demand for implants, which require
provisional restoration placement until the implant osseointegrates and is ready for a nal restoration. There is also
an increase in the use of crowns and bridges, which also
demand an increase in the number of provisional restorations fabricated.
The procedure described here provides an easy alternative to the traditional method and aids in fabricating
a functional provisional FPD. This procedure can also be
used to fabricate provisionals for implant patients. These
www.fdsri.com
33
10
11
12
13
FIG 10. Replica of the teeth (can be made on vacuum form of study models and stored for emergency patients). FIG 11. Mold trimmed
mesiodistally to adapt to the cast. FIG 12. Checking occlusogingival height. FIG 13. Trimmed mold adapted on the patient cast, excess
materials trimmed away.
provisionals have similar esthetics, durability, strength, and

t as the ones made using the traditional method of making
a wax-up on a cast. A provisional formed after doing a
wax-up on a diagnostic cast takes 2 to 3 days to provide a
provisional to the patient, as most clinicians send the work
out to laboratories. Using a PVS teeth form for fabricating a
provisional helps to reduce the chairside time of the clinician. This techinique does not require the cast to be sent to
a laboratory and, thus, facilitates delivering the provisional
on the same appointment. This also cuts down on the cost
of the provisional FPD, as the cost to send the cast to the
laboratory and the lab charges are no longer applicable.
34
The major shortcoming of this proposed technique is the

occlusal adjustments that have to be made in the provisional
restorations to achieve the desired results. The PVS teeth
replica needs to be cut down mesiodistally and occlusogingivally to t the edentulous space in the cast. A minor
disadvantage of this technique is that the PVS/polyether
replica of the teeth in the vacuum form of the study model
may not adjust properly in the edentulous space and might
require some trimming or addition of material to coincide
properly with the adjacent teeth. However, the crux of the
technique relies on the adapatability of the PVS/polyether
teeth mold. The PVS material is quite exible, which assists
Fall 2014
TRIVEDI // CHAN
14
15
16
17
FIG 14. Adapted mold on the cast. FIG 15. Stabilized mold using light-cure block-out resin. The buccal segment can be orientated
more appropiately with luting. FIG 16. Vacuum form on the cast. FIG 17. Trimmed vacuum form on the cast to fabricate the
provisional FPD.
in the adaptation of the teeth replica to the patient cast.

Some dentists have used typodont teeth to replace the
missing teeth on the diagnostic cast of the patient. The
technique is efcient, but requires a lot of trimming and
adjustment of the typodont teeth on the patient cast, which
is more time-consuming than the using the PVS mold, which
can be easily cut using a scalpel blade.
Ideally, the traditional wax-up method should be used as
custom build-up for every patient cast according to the shape
and size of the remaining teeth on the cast.5 Provisional FPDs
made from this technique are most esthetic, have a better t
mesiodistally, and require minimum occlusal adjustments.
Compared to the traditional technique, the new technique
results in a provisional FPD that is less esthetic, but saves

the clinician a considerable amount of money and time
by skipping a major step of waxing up the crown on the
diagnostic cast and making a duplicate cast.
Fabrication of a provisional FPD by this procedure can be
performed in the clinic with the help of a Tray-Vac Vacuum
Former, cutting down on the repeated laboratory costs.
Another advantage of using the transparent vacuum form
matrix is that the clinicican can visibly evaluate the proper
seating of the matrix. This will result in fewer remakes
compared to using a quadrant tray as the matrix.
To be more time efcient, clinicians can store multiple
vacuum-formed matrices in their ofce. These vacuum forms
www.fdsri.com
35
Awards and Programs
Awards, fellowships, grants, and other

opportunities can be catalysts for brilliant
careers. Click below to learn more.
ADEA and Procter & Gamble Scholarships

American Dental Education Association and The Procter
& Gamble Company will award two ADEA/Crest Oral-B
Laboratories Scholarships for predoctoral dental students
pursuing academic careers and showing strong commitment
to becoming a dental educator.
DEADLINE: November 3, 2014
CLICK HERE
AADR Student Research Fellowships

Students are invited to submit research proposals for the
2015 AADR Student Research Fellowships. These fellowships,
supported by several major industrial companies as well as the
AADR and IADR Group Chapters, were created to encourage
dental students living in the United States to consider careers
in oral health research. Proposals are sought in basic and
clinical research related to oral health.
DEADLINE: January 20, 2015
CLICK HERE
IADR Academy of Osseointegration Innovation in

Implant Sciences Award
This award is intended to help investigators pursue innovative
and novel research in oral care that involves, but it not limited
to, dental implant therapy. Applications must relate to some
phase of implant therapy (diagnosis, device, or procedure)
that advances scientic knowledge of implant dentistry or
tissue engineering.
can also be reused after cleaning, as they are not being used
on the patient. Because study models differ slightly in their
sizes, vacuum forms of various sizes can be stored. Studies
have shown that the PVS is a very stable impression material
and has good dimensional stability over a long period of
time.6 The teeth made from them in the vacuum form of
the study model can be stored over a long period of time
and used when required. Different sections of a single PVS
replica of a full arch can be cut and used for different patients.
Conclusion
This novel technique can be used for both anterior and
posterior provisional FPD fabrication, especially on patients
who require prompt esthetic and functional transformation.
It saves patients an extra visit to get a temporary restoration,
saves the clinician a considerable amount of chairside time,
and cuts down on the laboratory costs. We propose that this
technique is a quick and easy way to achieve provisional
FPD in a single sitting with acceptable marginal adaptations,
function, and esthetics.
REFERENCES
1. Burns DR, Beck DA, Nelson SK. A review of selected dental literature
on contemporary provisional xed prosthodontic treatment: report of

the Committee on Research in Fixed Prosthodontics of the Academy of
Fixed Prosthodontics. J Prosthet Dent. 2003;90:474-497.
DEADLINE: December 12, 2014
CLICK HERE
2. Christensen GJ. The fastest and best provisional restorations. J Am
Dent Assoc. 2003;134:637-639.

3. Burke FJ, Murray MC, Shortall AC. Trends in indirect dentistry:
provisional restorations, more than just a temporary. Dental Update.

2005;32:443-452.
4. Patras M, Naka O, Doukoudakis S, Pissiotis A. Management of
provisional restorations deciencies: a literature review. J Esthet Restor

Dent. 2012;24(1):26-38.
5. Rosenstiel SF, Land MF, Fujimoto J, eds. Contemporary Fixed Prosth-
odontics. 4th ed. St Louis, MO: Mosby/Elsevier. 2001;380-416.

6. Pant R, Juszczyk AS, Clark RKF, Radford DR. Long-term dimension-
al stability and reproduction of surface detail of four polyvinyl siloxane

duplicating materials. J Dent. 2008;36(6):456-461.
36
Fall 2014
GOMES
A ST U D E N T I N T E RV I E W W I T H
Dr. Brenda P.F.A. Gomes

Interviewer: JULIANA DELATORRE BRONZATO
Brenda P.F.A. Gomes, DDS, MSc, PhD, graduated in dentistry from the Pontical Catholic University of Minas Gerais,
Belo Horizonte, Brazil, in 1984. She obtained a specialization in endodontics in 1985 from the Federal University of Rio
de Janeiro, a masters degree in endodontics in 1990 at the same faculty, and a PhD degree in restorative dentistry
in 1995 from the University Dental Hospital of Manchester, England. She obtained her postdoctorate in 2003 at the
Department of Oral Biology, Ohio State University in Columbus, Ohio, USA. She is a full professor in endodontics
at the Dental School of Piracicaba, State University of Campinas in Brazil, where she has been working since 1997.
Her main research areas are in endodontic microbiology and endodontic epidemiology, and she is a leader of two
national groups of research supported by the Brazilian Government Agency. She was awarded three honorable
mentions (2007, 2011, and 2013) for the CAPES Thesis Award. Also, Dr. Gomes received the CAPES Thesis of the Year
in Dentistry (2008 and 2012), the Great CAPES thesis prize in 2008, and the Zeferino Vaz Academic Recognition
Award in 2002. She is a member of the Brazilian Association for Dental Research and the International Association
for Dental Research. She is a member of the editorial boards of Brazilian Oral Research, Brazilian Journal of Oral
Sciences, and Journal of the CRO-MG.
Why did you decide to become a dentist?

Before entering the university, what I knew for sure was that
I would like to follow a health sciences career. After thinking
a little more about what path I wanted to take, I felt that
looking after patients oral health in order to relieve pain,
diagnose oral diseases, and plan dental treatment would
give me satisfaction.
Did you do research as a student?
I started doing research during my specialization course. In
that time I was at the Federal University of Rio de Janeiro,
which had not only graduation courses, but also specialization and postgraduation courses. When I was working on
the vertical traction of intra-osseous roots, I was always
in contact with postgraduate students of the orthodontics
department. They helped me do my clinical research and
I as an endodontist helped them on several occasions.
Today I have students even from the high school who are
conducting research at my dental school in a special scientic program. I believe that this opportunity will be decisive
for them when choosing their careers and will make them
into adults with greater critical research vision. I encourage all of my undergraduate students to do research while
studying because not only the academic performance will
be improved, but also the scientic training of the student
will be enhanced. In the future, if these students decide to
go into the academic eld, they will be more prepared. If
not, they will be better clinicians.
How did you become involved in research?
During my specialization course, I got in touch with
postgraduate students and participated in their research
development. Witnessing their search for new sources of
investigation and their persistence in reaching the answer
to their questions really inspired me to follow the academicresearch eld. However, I waited 4 years before enrolling
www.fdsri.com
37
Research Innovators and Role Models
the growth of a new tissue inside. Furthermore, there is an

increasing longevity of the people, with the necessity of
development of dental materials more resistant to impacts
and microleakage, and so on.
What do you love most about academia?
For me, the best moment is when I am learning, and being
a teacher is to be always learning, because all knowledge
should generate change. I like teaching because while
doing that, I not only transform specic information into
knowledge and critical awareness, but also help form people
with a critical view of their reality. We are participating in
their academic and personal formations as we have the
opportunity of passing to our students the ethical principles
that should govern their lives, both personally and professionally, in order to form citizens, not just dentists.
in the postgraduate program. During that time I worked

in a practice limited to endodontics and also as a part-time
dentist in the Community Dental Service. I preferred to go
to the dental practice rst in order to get clinical experience.
Yet, I was always in touch with Professor Nicola Tancredo,
who was a full professor in endodontics at the Rio de
Janeiro Dental School and was encouraging me to follow
the academic eld.
What is the future of dental research?
Even though caries rates are decreasing, the incidence of
dental trauma is increasing, partly due to sports practices.
If it promotes pulp injury (necrosis) in an immature tooth
with open apex, the root development will stop, resulting in
great consequences to patients. Therefore, research on pulp
revascularization and regeneration needs to be performed in
order to promote the physiologic replacement of damaged
tooth structures, including dentin and root structures, as
well as cells of the pulpdentin complex. However, it does
not mean that the need for endodontic treatment will disappear, as the pulp space needs to be cleaned in order to allow
38
What do you enjoy best about your profession?

I like teaching and conducting research, and the two
complement each other. Both aim to produce knowledge.
The knowledge built is always provisional as science is
constantly evolving. For this reason, continuing education should be a constant in the lives of all professionals.
Research should be understood as a collective construction
we learn to share, besides demonstrating commitment to the
social reality. I would like my students to be as all research
should be: reliable, transparent, bold, and able to impact the
knowledge and quality of life of the society. Last but not
least, being an endodontist motivates me to nd answers
to the questions that have arisen in the endodontic practice.
Interviewer
Dr. Bronzato obtained her dental degree in 2014 from
the State University of Campinas in Brazil. She was one
of the students who Dr. Gomes has encouraged to go
abroad for some of her educational experience.
Fall 2014
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VOL 2, NO 2

FOR DENTAL STUDENT RESEARCH AND INNOVATION

Letter from the Editor

Editor, Lisa is your main point of contact at FORUM. Our

FORUM for Dental Student Research and Innovation

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