Casting titanium partial denture frameworks: A radiographic evaluation

Bert T. Cecconi, DDS, MS,a Raymond G. Koeppen, DDS, MS,b Rodney D. Phoenix, DDS, MS,c and Mark L. Cecconi, CDTd Dentistry International Inc, San Antonio; Wilford Hall United States Air Force Medical Center, Lackland Air Force Base; and University of Texas Health Science Center, San Antonio, Texas Statement of problem. Titanium is the most biocompatible metal available for dental castings.
However, there is some concern about the castability of titanium used on a daily basis.

Purpose. A radiographic evaluation of titanium partial denture frameworks was undertaken to ascertain
whether these castings were technically acceptable for clinical use. Material and methods. Three hundred Grade II titanium removable partial denture frameworks were cast in a Titec 205M casting machine. All materials were used as directed by the manufacturer, and all castings were made by an experienced titanium specialist. Each casting was evaluated by radiograph. Based on the number, location, and size of argon inclusions, the frameworks were rated as follows: technically acceptable for clinical use as cast; technically acceptable after laser welding modifications; or unacceptable as cast, with remake necessary. Results. Of the 300 titanium frameworks cast, 97% were rated technically acceptable for clinical use in terms of castability. Summary. Within the limitations of this radiographic evaluation, it was determined that the castability of titanium was such that technically acceptable castings could be made on a daily basis. (J Prosthet Dent 2002;87:277-80.)

CLINICAL IMPLICATIONS
This radiographic evaluation of 300 titanium removable partial denture frameworks indicated that titanium can be cast on a daily basis with predictable results.

he biocompatibility of dental casting alloys has been reviewed by Wataha,1 who stated that the single most important property of a casting alloy to its biologic safety is its corrosion. He advised that, in order to minimize biologic risks, dentists should select alloys that have the lowest release of elements (namely, the lowest corrosion). This goal, it was noted, could best be achieved by using high noble-metal alloys with single-phase microstructures. Wataha1 also stated that several elements such as nickel and cobalt have a relatively high potential to cause allergies and that some, such as beryllium, are carcinogenic. Prudence would dictate that, when possible, alloys containing these ele-

aRetired

Colonel, United States Air Force; Consultant, Dentistry International Inc. bColonel, United States Air Force; Program Director, USAF Prosthetic Residency Program, Wilford Hall USAF Medical Center. cAssociate Professor and Head, Removable Partial Denture Division, University of Texas Health Science Center. dPresident of Technology, Dentistry International Inc. MARCH 2002

ments should be avoided. The element titanium was not included in Watahas review. When one speaks of biologic safety pertaining to dental materials in intimate contact with oral tissues for extended periods of time, titanium must be included. It is the most biocompatible (or least corrosive) metal available to the dental profession today.2-5 Moreover, as used in dentistry, 99.6% commercially pure titanium is nontoxic, hypoallergenic, one half the weight of cobalt-chromium, radiograph translucent, inexpensive, and price stable.4 Along with these significant benefits, it is important to note that titanium can be used for partial denture frameworks, complete denture bases, metal-ceramic restorations, and implant suprastructures. This can virtually eliminate the possibility of adverse biologic effects between different alloys in various clinical situations. Because of its relatively noncorrosive nature and other favorable characteristics, titanium is the biological metal of choice for dental restorations. But it remains to be proven whether technically excellent titanium castings can be made on a daily basis. This article reports the findings of a radiographic evaluation
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Fig. 1. Casting machine used to make all titanium frameworks.

of the castability of titanium removable partial denture (RPD) frameworks.

B
Fig. 2. A, Dual sprue used for mandibular castings. B, Three overhead sprues used for maxillary castings.

MATERIAL AND METHODS

For this radiographic evaluation of RPD frameworks, a single-chamber, gas pressure Titec 205M titanium casting machine (Orotig, Verona, Italy) was utilized (Fig. 1).6-7 An experienced titanium technician (MLC) spent 2 days at the Orotig factory, in Italy, under the supervision of Dr Alberto Gagliano, the developer of the Titec titanium casting machine, to be certain that the machine would be used exactly as recommended by the manufacturer. All supplies, including MgO-based investment material, titanium (Grade II, 99.6% commercially pure), finishing stones, and burs, were obtained from Orotig and used as directed by the manufacturer. All technical procedures were performed by the same technician (MLC). The wax-up for these castings was essentially the same as that for cobalt-chromium frameworks; the 2- and 3sprue methods were used (Fig. 2).8 Three hundred consecutive titanium partial denture frameworks fabricated for clinical situations at Dentistry International Inc (San Antonio, Texas) were
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evaluated by radiograph to determine whether the titanium castability was technically acceptable. Radiographs of the castings were made on Polaroid 990 film (Polaroid Corp, Cambridge, Mass.) in a lab unit (Dentaurum Inc, Newtown, Pa.). All settings were constant except the exposure time: 2 seconds were used for maxillary radiograph frames and 2.5 seconds for mandibular frames. It is important to note that most titanium frameworks have some argon inclusion in them. Based on the number, location, and size of the inclusions, each framework was rated by each author as follows: technically acceptable for clinical use as cast; technically acceptable after laser welding modifications; or unacceptable as cast, with remake necessary.

RESULTS
The castability rating of the 300 titanium frameworks produced the following results: 250 frameworks
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Fig. 3. Radiograph of framework acceptable as cast. Note one argon inclusion in lower right corner.

Fig. 4. Radiograph of framework acceptable only after laser welding. Several argon inclusions are present but are not in critical areas and not large (arrows).

were technically acceptable as cast (none or very few argon inclusions, and none in critical areas) (Fig. 3); 41 frameworks were technically acceptable after laser welding modifications (some argon inclusions that needed correction) (Fig. 4); and 9 frameworks were technically unacceptable and had to be recast (Fig. 5).

DISCUSSION
Of the 300 titanium frameworks cast and evaluated by radiograph, 97% were technically acceptable in terms of castability. These results suggest that the Titec 205M titanium casting machine and materials, when used as directed by the manufacturer, will produce predictably excellent castings on a daily basis. Virtually all of the frameworks appeared excellent after visual examination. It therefore is recommended that dental technical centers that make titanium castings have a radiography machine and laser welder on the premises. The information presented in this article does not constitute research data. Radiographs of titanium frameworks were subjectively evaluated by 3 experienced prosthodontists and an experienced certified dental technician who has cast, finished, and fit more than 3000 titanium frameworks. All of the authors were as objective as possible in their evaluations. The findings of this study are reported in the hope that they will help others determine the suitability of titanium for their dental practice or lab business. All of the titanium frameworks fabricated for this evaluation were used clinically by some 83 different dentists nationwide. To date, none of the titanium frameworks have been returned for any reason.

Fig. 5. Radiograph of framework unacceptable as cast. Large argon inclusions are present and in critical areas (arrows). Framework must be remade.

daily basis to fabricate clinically acceptable cast frameworks.

REFERENCES
1. Wataha JC. Biocompatibility of dental casting alloys: a review. J Prosthet Dent 2000;83:223-34. 2. Okabe T, Ohkubo C, Watanabe I, Okuno O, Takada Y. The present status of dental titanium casting. JOM 1998;50:24-9. 3. Nakajima H, Okabe T. Titanium in dentistry: development and research in the U.S.A. Dent Mater J 1996;15:77-90. 4. Bardos DI. Concise encyclopedia of medical and dental materials. Williams D, editor. Oxford: Pergamon Press; 1990. p. 360-5. 5. Okabe T, Hero H. The use of titanium in dentistry. Cell and Materials 1995;87:211-30. 6. Watanabe I, Watkins JH, Nakajima H, Atsuta M, Okabe T. Effect of pressure difference on the quality of titanium casting. J Dent Res 1997;76:773-9.

SUMMARY
A radiographic evaluation of 300 titanium RPD frameworks indicated that titanium can be used on a
MARCH 2002

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7. Watanabe K, Okawa S, Kanatani M, Nakano S, Miyakawa O, Kobayashi M. New partition technique for two-chamber pressure casting unit for titanium. Dent Mater J 2000;19:307-16. 8. Zinelis S. Effect of pressure helium, argon, krypton, and zenon on the porosity, microstructure, and mechanical properties of commercially pure titanium castings. J Prosthet Dent 2000;84:575-82. 9. al-Mesmar HS, Morgano SM, Mark LE. Investigation of the effect of three sprue designs on the porosity and the completeness of titanium cast removable partial denture frameworks. J Prosthet Dent 1999;82:15-21. 10. Wu M, Augthun M, Schadlich-Stubenrauch J, Sahm PR, Spiekermann H. Numerical simulation of porosity-free titanium dental castings. Eur J Oral Sci 1999;107:307-15.

Reprint requests to: MR MARK L. CECCONI DENTISTRY INTERNATIONAL, INC 2040 BABCOCK, SUITE 307 SAN ANTONIO, TX 78229 FAX: (210)699-1940 E-MAIL: dititanium@aol.com 10/1/122275

doi:10.1067/mpr.2002.122275

Movement of teeth adjacent to posterior bounded edentulous spaces. Gragg KL, Shugars DA, Bader JD, Elter JR, White BA. J Dent Res 2001;80:2021-4. Purpose. This retrospective cohort study analyzed the change in distance between teeth adjacent to a bounded edentulous space over a period of time. Variables associated with such a loss of distance also were evaluated. Material and methods. Electronic treatment record data on patients treated at the Kaiser Permanente Dental Care Program in Portland, Ore., were used in this investigation. The focus of the analysis was 116 untreated bounded edentulous spaces. For each treatment, 7 variables were studied: patient age, sex, missing tooth number and date of extraction, radiograph date, distal probing depth of the tooth immediately anterior to the edentulous space (at or within 6 months of extraction), and mesial probing depth of the immediately posterior tooth (at or within 6 months of extraction). Pre-extraction and all subsequent radiographs were scanned and digitized. With use of these images, distances between the anterior and posterior abutments were recorded. A pre-extraction measurement for each situation served as a baseline value. One investigator made all measurements. The change in the distance between the teeth was evaluated with linear spline regression analysis. Results. The mean time between baseline and the final radiograph was 6.5 months. The mean change in the distance between teeth was greatest during the first 2 years after extraction but did not exceed 1 mm per year. After the initial 2-year period, little change in this distance occurred in most situations. Bounded edentulous spaces in the mandibular molar regions exhibited the greatest change in distance between the abutment teeth. Probing depths, age, and sex were not significantly associated with the distance change between teeth. Conclusion. Within the limitations of this study, it was determined that teeth adjacent to a bounded edentulous space move gradually and only a minimal distance during the first 2 years after extraction. 16 References.DL Dixon

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